History of Play Therapy at CACS

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Balance:

Directive and

Non-Directive

Play Therapy in

Jamaica: A

Case Study.

Avril Z Daley PhD & Carole D Mitchell PhD Contemporary Assessment & Counselling Services (CACS) (2015)

Play-Therapy for Enhancing Learning & Promoting Wellness in Children & Adolescents

History of Play Therapy at

CACS

–

In the beginning:

–

Traditional –Non-directive –Axiline model

–

Children having difficulty playing with the material in the

therapeutic sense

–

More play like “recess” at school – Romping

–

Reflective language stilted and not culturally sensitive

–

Limited description of emotions or feelings

Dr. AZ Daley & Dr C Mitchell,(2015) CACS@cwjamaica.com

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Dec 3-4, 2015

Clients seen for Play

Therapy at CACS

–

Children with Emotional/Behavioural Disorders

–

ADHD

–

ODD

–

Anxiety

–

Depression

–

Children with self-esteem or self-confidence issues

–

Children exposed to TRAUMA/ABUSE/VIOLENCE

–

Children with developmental disabilities (lower cognitive

functioning)

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Why the need to Balance?

–

Time limits

–

Cost of therapy

–

Some clients do not have the cognitive or emotional

maturity to repair trauma or change behaviour without

direct assistance

–

Some issues have to be raised directly as the child may not

bring these to the fore

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Dec 3-4, 2015

Why Blended Play?

Evidence based efficacy

–

Ray, Schottelkorb, & Tsai, 2007 – ADHD and Anxiety

–

Ray, Blanco, Sullivan, & Holliman, 2009- Behaviour disorder

–

Flahive & Ray, 2007 – Both internalizing and externalizing

symptoms

–

Blanco & Ray, 2011 – Academic Achievement

–

Fall, Balvanz, Johnson, & Nelson, 1999 - self efficacy

–

Post, 1999 -

self-esteem

and

internal locus

of control

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Dec 3-4, 2015

Different Theoretical Models

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Directive, Nondirective, or a combination of both

–

Psychoanalytic play therapy -uses a Freudian

approach,

–

Jungian Play Therapy – uses the Jungian approach

–

Child-Centered play therapy (CCPT) – uses Rogerian

(Axiline)

–

Object relations/thematic play therapy (OR/TPT)

(Schaefer, 2003) –uses object relations theory.

–

Solution-focus brief play therapy (SFBPT) -uses

cognitive behavioural approach.

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Directive Play Therapy

–

Directive = Therapist leads or guides

session

–

Creative activities are used to guide

therapy sessions in order to gauge the

thoughts, feelings, and behaviors of the

client

–

Goal oriented

–

Allows for specific evidence of change and

growth in the child

Dr. AZ Daley & Dr C Mitchell,(2015) CACS@cwjamaica.com Dec 3-4, 2015

Nondirective Play Therapy

–

Nondirective play therapy is child-centred and directed. In this

approach the therapist places confidence in the child’s ability to

direct his or her own process. Through freedom to express

themselves in the way they are most comfortable.

–

Unconditional acceptance and positive regard for the child is

crucial in this approach.

–

Noting a child’s play sequences and themes, the therapist is

able to understand and is able to enter the internal world of the

child.

–

The creation of a secure and protected space allows the child

needed opportunity to work through and process negative life

experiences and associated feelings thoughts and behaviours.

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Dec 3-4, 2015

Blended Play

Therapy at CACS

The Approach

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The Approach

–

A melding of Non-Directive and Directive solution focus

–

Eclectic approach allows the therapist to use the type of

play therapy that best fits the client and his or her

situation.

–

Provide a structure to create the play situation to lead the

child client in directions that are seen as beneficial in

therapy.

–

Choose activities that are developmentally appropriate to

the child, address the child's issues, and focus on the goals

of therapy.

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Dec 3-4, 2015

The Approach (Cont’d)

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Provide nondirective time to also see what the

child may bring to the session.

–

Develop parenting skills as well as coping with

issues with the child client.

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Dec 3-4, 2015

The Approach (cont’d)

A structured 6-15 sessions lasting 12 -39 weeks

approach based on three phases of treatment

Phase ONE;

6 sessions (bi-weekly)

• Relationship building;

skills learning;

learning to play

Phase TWO;

6 sessions (tri weekly)

• Practice skills and

processing

Phase THREE;

3 sessions tri weekly

• Resolution,

maintenance &

termination

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–

A specific beginning and ending in the Directive

portion includes child’s reporting on feelings and

skills, working on issues, then and review of the

session and homework.

–

Non-directive portion includes child’s directing

the activities and therapist following lead and

offering reflections (in Jamaican language).

–

Parent training and guidance

Material

–

Material taken out into a less congested room for

either sections of the play :

–

Games (pick up sticks, connect 4),

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Deck of cards;

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Puppets (hand and finger),

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Dolls and household toys, weapons

–

Art supplies (crayon, paint, play dough)

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Dec 3-4, 2015

Puppets, dolls, household items

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Puppet Theatre and Puppets

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Dec 3-4, 2015

Animals

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Dec 3-4, 2015

Blocks

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Art Supplies

Goals of the Therapy

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Improve overall level of

emotional/behavioural functioning

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Teach social skills

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Build resilience

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Improve emotional intelligence

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Allow or self -expression

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Dec 3-4, 2015

The Introduction

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Safe play to express self

–

Limit setting

–

First Half of session- Therapist led

–

Second half of session- Child led

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Typical Session

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Directive: Two or three play-based techniques are used

both as therapeutic experiences as well as to inform an

assessment of the child’s overall functioning, his or her

perceptions of the environment and important

relationships, affective expression and communication

styles (including verbal and nonverbal methods).

–

more directive methods to direct children’s attention to

the reason for referral

–

Non-directive: chose own play material and also provides

the child an outlet if the directive session was too intense.

Provide warning of the approaching end of session.

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Dec 3-4, 2015

Play Based Techniques

used at CACS

–

Story telling Mutual/individualized- “Card Story game”

(Lowenstein, 1999).

–

Puppetry & Story telling (

Kaduson & Schaefer, (1997; Oaklander, (1998) )

–

Fantasy – The Rosebush (

Oaklander, 1998)

; 3 wishes; Safe room

–

Expressive Arts Techniques-Life Maps; Play art; play

sculpture; Colour my life, feelings wheel (

Kaduson & Schaefer, 1997)

–

Play Toys - The Magic Carpet technique; the Angry Tower

(Kaduson & Schaefer, 1997)

–

Relaxation techniques: children to learn how to self-calm

themselves.

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Dec 3-4, 2015

Products from Therapy

24 Directive Section

Non-directive

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End of Treatment

–

Termination sessions encourage the development of

optimism by providing children with opportunities to say

meaningful goodbyes and to view their lives in a more

balanced way (that is, a life that has included both positive

and negative events).

Outcomes for Blended Play

Therapy

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Develop positive relationships with others,

–

learn to use play materials and equipment,

–

learn to take turns,

–

learn how to verbalize their needs and wants,

–

learn to understand the role of others in their life, and

–

learn to master skills (Schriver, 2001).

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Dec 3-4, 2015

Findings

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Clients learn skills and see a change in behaviour and

resolution or reduction in symptoms

–

Reduction in symptoms as measured by the Vanderbilt

rating scales & BASC Monitor, anecdotal records.

–

Culturally more relevant to our population

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Parents can relate to the therapy as well.

–

Less relapse and crisis intervention

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CACS Case example

–

11 year old boy

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Bullied at school; low self-esteem and confidence; parental

separation

–

Phase One: building self confidence; learning coping skills;

expressing feelings

–

Phase Two: practicing assertiveness skills; continue to work

in self-confidence

–

Phase Three: Checking in and monitoring use of skills and

feeling- termination

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Dec 3-4, 2015

References

– Daley, A. Z. (2006). Raising Emotionally Smart Children: A training Manual. Kingston: Ministry of Health.

– Fall, M., Balvanz, J., Johnson, L., & Nelson, L. (1999). A play therapy intervention and its relationship to self-efficacy and learning behaviors. Professional School Counselling Vol 2 (1)194-204

– Gil, E. (1991). The healing power of play: Working with abused children. New York: Guilford

– Kaduson, H. & Schaefer, C. (1997) 101 favourite play therapy techniques. New Jersey: Jason Arsonson INC.

– Lowenstein, L. (1999). Creative interventions for troubled Children & Youth. Toronto: Champion Press

– Oaklander, V. (1998) Windows to Our Children: A Gestalt Therapy approach to children and Adolescents. New York: The Gestalt Journal Press

– Ray, D.C., Blanco, P. J., ( 2011). Play Therapy in Elementary Schools: A Best Practice for Improving Academic Achievement. Journal of Counselling & Development. Volume 89 (2), 235–245

– Ray, D.C., Blanco, P., Sullivan, J.M., & Holliman, R. P. (2009). An Exploratory Study of Child-Centered Play Therapy With Aggressive Children. International Journal of Play Therapy,; 18(3):162-175. DOI: 10.1037/a0014742

– Flahive, M. W., &Ray, D. (2007). Effects of group sandtray therapy with preadolescents. The Journal for Specialists in Group Work, 32 (4), 362-382

– Ray, D.C., Schottelkorb, A., Tsai, M. (2007). Play therapy with children exhibiting symptoms of attention deficit hyperactivity disorder. International Journal of Play Therapy, Vol 16(2), 2007, 95-111.

– Schriver, J.M. 2001. Human Behavior and the Social Environment: Shifting Paradigms in Essential Knowledge for Social Work Practice. Boston: Allyn and Bacon.

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Dec 3-4, 2015

The End, Thank You

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