1 Come Watch the Children: Promoting Mental Health in Young Children Through Play and Journaling It is a fact that from their earliest years children live with disrupting emotions, that fear and anxiety are part of their every day lives, that they continually cope with frustration as best they can. And it is through fantasy that children achieve catharsis. Maurice Sendak Nicky runs out onto the playground with his classmates. The children disperse to various parts of the playground. Nicky immediately goes to the second swing and spends the entire recess swinging on the swing. Nicky speaks to one girl who comes to swing on an adjacent swing for a few minutes. The remainder of the time he is quiet. He watches a few boys play dodge ball near him. He laughs when they laugh. When the bell rings, Nicky is one of the first children in line to go inside. Nicky says he has one friend at school the little girl who came briefly to swing on the swing with him. Nicky says he does not play with anyone except his sister when at home. Nicky says he does not like to play with other children. Nicky is six years old and in the first grade. He likes to play video games and read books. He lives with his father, an older sister (seven years old), and the father s younger brother in a small apartment. The school asked Nicky s father to contact our mental health agency, because Nicky was having difficulty controlling his impulses, not attending to tasks or completing tasks, and spending most of his time alone. Father brought Nicky to our agency and I developed a comprehensive treatment plan which included therapeutic play and journaling. In this paper I want to explain the rationale for families, schools, mental health agencies, and other community institutions to incorporate play and journaling in their interactions with young children. The theoretical framework will be explained first. Second the benefits of using therapeutic play will be outlined. General principles for conducting therapeutic play will follow. The paper will end with a general outline for play and journaling sessions with examples from sessions with Nicky and his family. Theoretical Foundations Bronfenbrenner (1979) reminded us to look at the child in his/her social milieu. The child does not stand in isolation. We must see how the family, the school, the community and the culture impact upon the child. Rogoff (2003) expands upon the ecological systems approach by incorporating the notion of the dynamic nature of the child and the various systems within the ecology of the child. The child and the systems around the child are not static but changing
2 (expanding or contracting). The child we interact with today is not the child we will be interacting with next week. It is important to note the role of experience in the child s life. Dewey (1938), Piaget (1926), and Vygotsky (1978) discussed the importance of children being involved in meaningful experiences in order to develop. Thus play is a perfect venue for interacting with the child. Nel Noddings (2003) discusses the concept of the ethic of care in relation to education. The ethic of care should inform all of our work with children not just educational pursuits. The ethic of care describes the relationship-building nature of interactions adults have with children. The child looks into the eyes of the adult and sees a reflection of him/herself as the adult sees the child. It is the concept of the partner as mirror. When the teacher looks at the child, does the teacher see a disruptive, troublemaker or does the teacher see a child who needs help. The way the teacher sees the child will be reflected in his/her eyes and the child will see what is in those eyes. In the schools in the USA today, there is a heavy emphasis on emergent literacy and numeracy. These are important. However, I say they are not enough. They are not even the foundation of learning. The foundation of learning is what I call emergent personhood. We need to see the child for who s/he is. We need to start where the child is and help that child develop into the best person that child can be. This is a continual process. A child is not going to having lasting success in literacy if her/his basic needs are not being met or the child does not feel valued by the people around her/him. Cindy Dell Clark (2006) talks about imaginal coping. This is the ability of the child to deal with a stressful situation such as asthma by pretending to administer medical procedures to a favorite teddy bear. A child learns to cope with stressful situations by imagining the situations in bite-size pieces and on her/his own terms. Each of these theoretical concepts have informed my approach to therapeutic play and journaling with young children. Benefits Derived from Therapeutic Play and Journaling The benefits of play have been enumerated in many places (Goncu & Gaskins, 2006; Johnson, Christie, & Wardle, 2005; Zigler, Singer, & Bishop-Josef, 2004) and need not be discussed here. However, I wish to list the benefits I expect to gain from therapeutic play and journaling with young children. The first benefit of the play is its ability to allow rapport to be established between the adult and the child. A child is more likely to interact with a playful, fun-loving adult in a play environment than an adult who is sitting in a chair in an office. Second, communication with the young child is enhanced in a play setting. A young child is often intimidated by the questions, comments or even the presence of an adult. However, if the child interacts with the adult in a play environment, the child is likely to open up and talk to the adult about a variety of topics. Also, the child can naturally express conscious and unconscious thoughts and feelings better through play than using words alone. The play environment allows the child to put down his/her guard and reveal his/her inner self. Next, play is an ideal mode for teaching. A child is much more likely to attend and learn a concept better if it is revealed or experienced in the medium of play. The child can explore, practice, and become accustomed to a new way of thinking/feeling during play. The last benefit is abreaction. In a play environment, a child can relive past stressful events and release the associated negative emotions in a safe place. The adult in the play situation must allow the child to vent thoughts and feelings that may be frowned upon by adults in other
3 settings but need expression for the child to make sense of her/his world. The unconditional regard of the adult needs to be felt by the child so the child can express her/his true feelings. With the child s open expression in words and/or play, the child and the adult can come to understand and deal with the stressful event. General Principles for Therapeutic Play and Journaling For play to be therapeutic by design, there are basic principles that must be addressed. First, there needs to be a prepared environment. The adult has considered the circumstances of the child and has arranged the environment in such a way as to encourage play to address the child s needs. The second principle was mentioned above that is unconditional regard for the child. The child must know that s/he says or does in the session will not be held against her/him at a later time. To follow the lead of the child is the third principle. The adult cannot understand and help the child until the adult knows what the child is thinking and feeling. The adult can discover this by observing and following the lead of the child. The fourth principle is closely related to the previous principle. It is the willingness of the adult to take on a variety of roles as dictated by the child. The child will often have the adult take on the role of the bad guy in order for the child to work out her/his various perceptions of a stressful event or situation. The adult needs to comment on or narrate the action that is occurring in the therapeutic play session. This narration or commentary helps the child and the adult put words to the actions. The child can correct or expand upon the narration to ensure the proper interpretation of the play session. This narration or commentary is the fifth principle. The next principle is family involvement in therapeutic play sessions or journaling activities when appropriate. Again, the child is part of a family system. The family needs to adjust to the changes in the child just as much as the child needs to adjust to the changes in the family. A non-threatening way to achieve this is through sessions where the family is involved in joint play and/or journaling activities. Remembering to involve all the relevant systems in the treatment planning and implementation is the final principle. The child and family will be more successful when all systems impacting their world are aware of, engaged in, and supportive of treatment goals. Outline of Therapeutic Play and Journaling The play sessions can occur at home, school, playground, or a playroom. The therapist selects materials for each session. For example in the first session at Nicky s home, I brought these materials to the session: 1) the book Guess How Much I Love You, 2) family figures, 3) play-doh, 4) journal, and 5) a variety of drawing and writing utensils. Allow the child to choose the theme of the play and follow the child s lead. In the first session, Nicky chose to play with the play-doh first. He made balls, snakes and faces (frowns and smiles). He pounded the play-doh and began to throw the play-doh. After cleaning up the play-doh, Nicky began to play with the family figures. He named them and then he began to throw the adult figures on the floor and kick them. In successive sessions, the therapist should add new objects and suggest new themes. These interventions will help the child come up with alternative views from her/his previous negative and/or unproductive views. For Nicky, I brought a box which I designated as a hospital. Nicky would throw his figures and place them in the hospital to get well.
4 As mentioned above, the therapist should narrate or comment on the proceedings of the play session. While playing with Nicky, I often spoke about the anger of the boy figure and the pain of the adults who were being kicked. At the end of each session the therapist has the child make an entry in her/his journal. The entry may be a drawing or writing or both. The child is to depict a segment of the material covered during the day s session. Nicky frequently depicted a boy with bared, angry teeth. Play is an effective modality for a child to express and explore various social and emotional situations and experiences. In the process of therapeutic play and journaling, the child can learn to make sense of her/his world and to find healthy ways to interact with that world. References/Bibliography Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press. Clark. C. (2006). Therapeutic advantages of play. In A. Goncu & S. Gaskins (Eds.), Play and development: Evolutionary, sociocultural, and functional perspectives. (Pp ), Mahwah, NJ: Lawrence Erlbaum. Dewey, J. (1938). Democracy and education. New York: Macmillan. Goncu, A. & Gaskins, S. (Eds.) (2006). Play and development: Evolutionary, sociocultural, and functional perspectives. Mahwah, NJ: Lawrence Erlbaum. Hobday, A. & Ollier, K. (2005). Creative therapy with children and adolescents. Atascaderos, CA: Impact Publishers. Johnson, J.E., Christie, J., & Wardle, F. (2005). Play, development and early education. Boston, MA: Allyn and Bacon. Koplow, L. (2002). Creating schools that heal. New York: Teachers College Press. LeBlanc, M. & Ritchie, M. (2001). A meta-analysis of play therapy outcomes. Counseling Psychology Quarterly, 14, Noddings, N. (2003). Caring: A feminine approach to ethics and moral education, 2e. Berkeley: University of California Press. Piaget, J. (1926). The language and thought of the child. New York: Harcourt, Brace. Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001). The effectiveness of play therapy:
5 Responding to the critics. International journal of Play Therapy, 10, Reddy, L.A., Files-Hall, T.M., & Schaefer, C.E. (2005). Empirically-based play interventions for children. Washington, DC: American Psychological Association. Rogoff, B. (2003). The cultural nature of human development. New York: Oxford University Press. Schaefer, C.E. & Kaduson, H.G. (2006). Contemporary play therapy: Theory, research, and practice. New York: Guilford Press. Vygotsky, L.S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press. Zigler, E.F., Singer, D.G., & Bishop-Josef, S.J. (Eds.) (2004). Children s play: The roots of reading. Washington,DC: Zero to Three Press.
6 Come Watch the Children Karen McChesney Johnson September 2007 Czech Republic
7 It is a fact that from their earliest years children live with disrupting emotions, that fear and anxiety are part of their everyday lives, that they continually cope with frustration as best they can. And it is through fantasy that children achieve catharsis. Maurice Sendak
8 Research LeBlanc & Ritchie, 1999 (meta-analysis of 42 experimental studies from , average age 7.9 years) Ray, Bratton, Rhine, & Jones, 2001 (metaanalysis of 94 experimental studies from , average age 7.1) Reddy, Files-Hall, & Schaefer, 2005 (clinical reference to evidenced-based play interventions)
9 Foundations Social Constructivist Systems Approach Nel Noddings: Ethic of Caring & Partner as Mirror Emergent Personhood Cindy Dell Clark: Imaginal Coping
10 Common Adult Reactions to Children s Play: Positive Encourage Facilitate Co-Player
11 Common Adult Reactions to Children s Play: Negative Ignore Interfere Discourage
12 Benefits to be Derived from the Play of Young Children Communication (children can naturally express conscious and unconscious thoughts/feelings better through play than words alone) Teaching ( children attend and learn better with play as a medium) Abreaction (children can relive past stressful events and release the associated negative emotions in a safe environment) Rapport-building (children are more likely to trust a playful, fun-loving adult)
13 Why should we care? Play is important to children. Play is a natural part of childhood. Play promotes development in many domains.
14 Play is important to children.
15 Play is a natural part of childhood.
16 Play promotes development in many domains.
17 Principles of Play Therapy Prepare environment Unconditional regard for child Follow child s lead Prepare to take on a variety of roles Comment/Narrate action to gain clarification of child s thoughts/feelings Journaling
18 Office Home Playground Setting
19 Play Materials - manipulatives (e.g., clay, crayons, painting supplies) - water and sand play containers - toy kitchen appliances, utensils, and pans - baby items (e.g., bottles, bibs, rattles, etc.) - dolls and figures of various sizes and ages - toy guns, rubber knives - toy cars, boats, soldiers, and animals - blocks, erector sets - stuffed animals - puppets
20 Play Therapy Session Allow child to choose materials from those that have been set out Allow child to choose theme of play Follow child s lead (Add new objects/themes in later sessions) to help child come up with alternate views Narrate/comment Have child make an entry in journal to summarize key points of session as a concluding activity
21 School Play Observation: Therapist Note themes, conversation, body language Who does child play with? Show child you are interested in her/his play If a harmful action occurs, get staff to intervene or intervene yourself Use information gleaned from observation to inform your play therapy sessions with the child
22 School Play Observation: Teacher Note child s theme, conversation, and body language Who are the child s play partners? Allow child to see your interest in his/her play Intervene if child is being hurt or is hurting another Use information gleaned from observation to inform your work with the child in the classroom
23 Example 1 Six year old male Primary Diagnosis: Oppositional Defiant
24 Five year old male Example 2 Primary Diagnosis: Attention Deficit Hyperactivity Disorder
25 Book Suggestions Contemporary Play Therapy Charles Schaefer (2006) Helping Abused and Traumatized Children Eliana Gil (2006) Empirically Based Play Interventions for Children Eds. Linda A. Reddy, et al (2005) In Sickness and in Play Cindy Dell Clark (2003)
26 The soul would have no rainbow if the eyes had no tears. Native American Proverb
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