History of Play Therapy at CACS

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1 Striking the 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 2 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 3 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) 1

2 4 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 5 Why Blended Play? Evidence based efficacy Ray, Schottelkorb, & Tsai, 2007 ADHD and Anxiety Ray, Blanco, Sullivan, & Holliman, Behaviour disorder Flahive & Ray, 2007 Both internalizing and externalizing symptoms Blanco & Ray, 2011 Academic Achievement Fall, Balvanz, Johnson, & Nelson, self efficacy Post, self-esteem and internal locus of control 6 Different Theoretical Models 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. 2

3 7 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 8 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. Blended Play Therapy at CACS The Approach Dr. AZ Daley & Dr C Mitchell,(2015) 9 3

4 10 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. 11 The Approach (Cont d) 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. 12 The Approach (cont d) A structured 6-15 sessions lasting 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 4

5 13 The Approach cont d 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 14 Material Material taken out into a less congested room for either sections of the play : Games (pick up sticks, connect 4), Deck of cards; Puppets (hand and finger), Dolls and household toys, weapons Art supplies (crayon, paint, play dough) Puppets, 15 dolls, household items 5

6 16 Puppet Theatre and Puppets Animals 17 Animals 18 Blocks 6

7 Art 19 Supplies 20 Goals of the Therapy Improve overall level of emotional/behavioural functioning Teach social skills Build resilience Improve emotional intelligence Allow or self -expression 21 The Introduction Safe play to express self Limit setting First Half of session- Therapist led Second half of session-child led 7

8 22 Typical Session 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. 23 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. 24 Products from Therapy Directive Section Non-directive 8

9 25 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). 26 Outcomes for Blended Play Therapy 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). 27 Findings 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 Parents can relate to the therapy as well. Less relapse and crisis intervention 9

10 28 CACS Case example 11 year old boy 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 29 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) 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 ArsonsonINC. 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), 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): DOI: /a Flahive, M. W., &Ray, D. (2007). Effects of group sandtray therapy with preadolescents. The Journal for Specialists in Group Work, 32 (4), 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, Schriver, J.M Human Behavior and the Social Environment: Shifting Paradigms in Essential Knowledge for Social Work Practice. Boston: Allyn and Bacon. 30 The End, Thank You 10

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