Play Therapy — September 2013
Change Language:
Playing With Words

When you close your eyes and think of the words Play Therapy, what comes to mind?<br /> <br /> Typically, those words conjure up images of rooms full of carefully selected toys, games, and playthings; of children and therapists using those objects to communicate, process and resolve; of a freedom afforded children where they are not constrained by adult verbal language and expectations. In contrast, a therapy session of talk only, of an interaction that revolves around verbal communication, is usually deemed adult therapy. Is that divide absolute and rigid? Or is it possible to have a session where, from outside appearance, child and therapist are just talking, but in actuality, the process is very much guided by Play Therapy principles? A related question worth pondering is: What is it about the toys in the playroom that transforms them into such powerful agents? Is it possible to extract that element and transplant it into another medium without destroying its efficacy?<br /> <br /> Play Therapy is an effective approach to working with children for numerous reasons (Bratton, Ray, Rhine, & Jones, 2004). From a developmental perspective, children lack a rich enough repertoire of language to express their thoughts and feelings (Kail, 2001).<br /> <br /> Psychologically, play is a less intimidating, indirect and more comfortable form of selfexpression when compared to direct verbal communication. Toys can serve as a metaphoric symbolization of a child’s world (Bellinson,2000) – a container for difficult emotions or “exteriorized conflict” (Bromfield, 1995, p. 435). For these, and many other, reasons, children usually respond well when therapists work from the premise that “toys are like words and play is their language” (Landreth, 2012, p. 435). But when children refuse to play with toys, can play therapists still help?<br /> <br /> Jordana (pseudonym), a pre-teen with a long history of academic, behavioral, family, and social issues, had been in psychotherapy, with four different therapists, since age eight. Current stressors included illness in her family, inconsistent living arrangements, and difficulties in school. Jordana arrived to her first session with blazing eyes, a swag in her step, and an attitude far bigger than her slim body. She said not a word, but there was no mistaking what her body language was screaming: “I do not want to be here, I will not participate, and I plan to be a pain until I am excused from this never-ending cycle of therapists!” <br /> <br /> I invited Jordana into the playroom and let her know that this was a special place where she could do almost anything. She walked to the center of the room, placed her hands on her hips, looked me squarely in the eye, and said (quotes are paraphrased to protect confidentiality), “For your information, I do not play. Or do art. Or sandtrays. Or tell stories. I do not do any of this stupid therapy stuff. I will stay in here because I have too much dignity to fight it. But let me remind you that I’ve been doing this therapy thing for a long time and I know that your games and stuff are just a clever cover-up to get us to talk about our problems. And that’s not going to work with me.” <br /> <br /> Ever optimistic, and perhaps a tad naïve and inexperienced too, I told Jordana that this was her time to use however she wanted. She stood there with her arms crossed, impatiently tapping her feet, for that entire session—and for the next five sessions as well. She stared me down with an occasional reminder that “I don’t play and none of your stupid therapy tricks or games will work on me. I will not let you know anything about me and I will not touch anything in here that you can therapize and use to figure me out.” <br /> <br /> Children with a history of maternal deprivation often experience play disruption (Price, 1994). Though stable and consistent nurturing was sketchy in Jordana’s life, she seemed capable of play; now, it appeared, she was purposely refusing to play because she did not want to engage or allow me to get to know her. From a Play Therapy perspective, her actions made perfect sense: if toys are words and play is language, then the way to avoid conversation is simply not to play.<br /> <br /> Interestingly, in every other setting, Jordana was very articulate, quite willing to talk about anything but herself. If in doubt about where a conversation may be headed, she clammed up and cut off all interaction. The terror of allowing anyone into her inner world was one reason why Jordana was in treatment and, perhaps, why she had gone through so many therapists. I believed firmly that Play Therapy could be a nonthreatening way to help her heal, but where might I begin when she appeared terrified of the thought of touching a game or toy?<br /> <br /> Jordana herself led me toward the solution. During her sixth session I commented, “Looks like you figured out that the best way for you to deal with me is to assume I’m guilty until proven innocent and make sure I stay the hell outa your life.” She startled; then came her first non-hostile sentence: “Well, duh! It’s like, if someone is in a house and they don’t know who is outside, it takes so much energy to figure out who is there and what they want and if it is okay and what they might do and how that will end up...The easiest way to take care of the whole thing is shut the door, triple lock— done. No more problem!” Bingo! That one sentence brought a flash of lightning illuminating a different way I might be able to play with Jordana.<br /> <br /> Without any direct self-disclosure or touching any toys, Jordana clearly communicated a little piece of her emotional view of the world and that felt okay to her. Perhaps, I thought, we could continue this communication by blurring the boundaries between talk-therapy and Play Therapy. Jordana felt okay talking about anything that did not include herself or her emotions. So maybe she and I could engage in a process where we just talked, but not typical talktherapy conversation of dealing with issues directly. On some level, Jordana grasped the concept of symbolism and metaphor because she had just communicated to me like that. I wondered what would happen if we would continue to talk about the symbols and metaphors instead of using toys to represent the symbolism; would that make the communication more palatable to Jordana?<br /> <br /> My goal for therapeutic change was communication, particularly “implicit communication” (Schore, 2010, p. 184). True healing occurs when we communicate emotionally and access the right brain’s emotional connection, opposed to staying stuck in left-brain logic and verbiage. Adults use direct verbal self-disclosure and children typically use play to achieve this implicit communication. Jordana’s one sentence suggested that she might be capable of reaching the “communicating cure” (Schore, 2012, p. 182) albeit in a unique way.<br /> <br /> Beginning with the next session, while still conceptualizing my approach based on Play Therapy principles, I changed the tools. Instead of using physical toys to provide psychological distance from the fear of direct communication, we used Jordana’s house metaphor. Touching toys and talking about herself or something in the room were the most terrifying situations for her. A discussion about hypothetical houses involved neither of those elements and became a safe and comfortable point of connection. The silent sessions were over; we now used words to play with hypothetical houses in our minds.<br /> <br /> We agreed on a non-negotiable foundation that “owners know their houses best” and no one has a right to break down a door or smash a window to enter. Owners have explicit permission to keep visitors outside, because they know best. If owners decided visitors were not welcome, I believe they had a good reason for doing so.<br /> <br /> But maybe, I said, without my knowing any details about this house, could we have a phone conversation, from an untraceable phone number if necessary, to discuss why it would be such a terrible idea for anyone to get near the house? Would it damage the house? Would delicate china get smashed if someone barged in? Is the arrangement of the house such that outsiders might unintentionally disturb vital aspects of its setup? Are there things inside the house that other people should not see? Would visitors be scared, injured, or even killed? Would the owner of the house be ashamed or embarrassed? Might a visitor steal something from the house or plant a bomb there?<br /> <br /> We never mentioned the words “trust” and “past experiences,” but in getting Jordana to describe her metaphorical house I learned how very important it was to her that no one enter the front door at all. Was that because, once people came into the front hall, they suddenly felt free to poke into the bedroom, dining room, living room, attic, and basement? Were some rooms, or sections of rooms, more acceptable for visitors to see than others were? Could certain items be locked in closets so that visitors may possibly view the remainder of the room? How did visitors know which rooms were open or off limits on that particular day? Had previous visitors failed to respect such limits? How did the people inside know which visitors could be trusted to respect limits?<br /> <br /> We never talked about Jordana’s feelings, coping skills, or supports, but we did talk about what it may be like for someone to live in a house all alone. Did it get lonely? Was it a sheltered and quiet cocoon? Was it difficult to take care of the whole house alone? Was it safe and predictable because she was in charge and not relying on anyone else? What did the people do all day? What type of outside contact, if any, was okay? Letters? E-mail? Phone calls? Internet chatting?<br /> <br /> Was it okay for people to send things into her house, even if they could not come in themselves? If we could find a comfortable way to get it in, was there anything from the outside that could make living in this house easier?<br /> <br /> The house has remained central to every session developing and evolving, adding dimension and depth. Jordana talked for the homeowners, expressing their opinions, desires, fears, and view of the world. We examined the potential problems of the people who live there and explored strategies to solve their challenges. Jordana felt comfortable having these discussions, as she did not experience it as talking about herself. We were just talking about a hypothetical person in a hypothetical house. Though it cannot be touched or seen, as the edifice grew in detail and strength, it provided a safe space for Jordana to project and grapple with her thoughts and feelings in a way that felt comfortable for her. This experiment is a work in progress, but the early returns seem positive: her difficult behaviors in school and at home are easing and her belligerent combative interactions with peers and authority figures have drastically reduced. Jordana’s attitude toward therapy has completely transformed: she happily comes and fully engages in each session.<br /> <br /> The unique qualities of Play Therapy are so powerful that Eller (2011) promoted using toys and objects in Play Therapy when working with a variety of populations. Play Therapy taps into language of metaphors and symbols to produce therapeutic change, with toys or concrete objects normally serving as the media used to symbolize experiences metaphorically. The playthings and indirect communication serve as an emotional anesthesia of sorts to make processing difficult situations and emotions less painful. Jordana’s case study shows that it is possible to blur the boundaries between talk-therapy and Play Therapy and transplant the power of play into something other than toys; in fact, it is possible to tap into the power of play without ever touching a toy! Our work has opened up a line of communication, though it is currently as slim as a phone line, between the inside of Jordana’s world and someone outside it—and communication is where healing begins (Schore, 2010). Play Therapy can perform its magic whether we are playing with dolls, puppets, miniatures, games, or words.<br /> <br /> References <br /> <br /> Bellinson, J. (2000). Shut up and move: The uses of board games in child psychotherapy.Journal of Infant, Child and Adolescent Psychotherapy, 1(2), 23-41. Doi: 10. 1080/15289168.2000.10486343 <br /> <br /> Bratton, S., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of Play Therapy with children: A meta-analytic review of the outcome research.Professional Psychology: Research and Practice, 36(4), 375-390. Doi: 10.1037/0735-7028.36.4.376 <br /> <br /> Bromfield, R. (1995). The uses of puppets in play therapy. Child and Adolescent Social Work Journal, 12(6), 435-444. Doi:<br /> 10. 1007/BF01875812 <br /> <br /> Eller, S. M. (2011) Play Therapy with adults. Play Therapy, 6(2), 16-19.<br /> <br /> Kail, R. V. (2001).Children and their development (2nd ed.). Upper Saddle River, NJ: Prentice Hall.<br /> <br /> Landreth, G. L. (2012). Play Therapy: The art of the relationship (3rd ed.). New York, NY: Routeledge.<br /> <br /> Price, A. (1994). Effects of maternal deprivation on the capacity to play: A Winnicottian perspective on work with inner-city children. Psychoanalytic Psychology, 11(3), 341-355. Doi:<br /> 10. 1037/h0079556 <br /> <br /> Schore, A. N. (2010). The right brain implicit self: A central mechanism of the psychotherapy change process. In J. Petrucelli (Ed.), Knowing, not-knowing and sort-of-knowing: Psychoanalysis and the experience of uncertainty (pp.177-202). London, UK: Karnac Books.