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PLAY THERAPY
Volume 2
December 2006
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BRITISH JOURNAL
OF
PLAY THERAPY
Editor
ANNE BARNES
Notre Dame Centre, Glasgow, Scotland
Editorial Board
ANN CATTANACH
Department of Social Policy and Social Work,
University of York, York, England
VIRGINIA RYAN
Department of Social Policy and Social
Work,University of York, York, England
CHRIS DANIEL-McKEIGUE
Postgraduate Studies, Liverpool Hope University,
Liverpool, England
JANET BARR
Notre Dame Centre, Glasgow, Scotland
SUE JENNINGS
Glastonbury, England
Advisory Board
MERKEL SENDER (Educational Psychology)
Summerfield Centre, London, England
MARY CARDEN (Child Protection)
Harpenden, Hertforshire, England
Correspondence to the Editor, Editorial Board and Advisory Board should be sent to the
Administrator, BAPT, 1 Beacon Mews, South Road, Weybridge, Surrey KT13 9DZ
info@bapt.uk.com
VOLUME 2
DECEMBER
EDITORIAL
Anne Barnes
PAPERS
Diana Jansen
David L Myrow
14
Chris Daniel-McKeigue
24
37
Angie Naylor
46
John Casson
55
Book Reviews
63
65
Table of Contents
66
Editorial
Abstract
In this paper I have given a brief description of Sandplay as it was first conceived by the Swiss psychotherapist,
Dora Kalff. Sandplay is used with wonderful results with both adults and children. I attempt to convey how the
unconscious can, without interference from the conscious mind, lead towards what Jung referred to as the self
healing of the psyche within a sandplay process. This process is enabled within the therapeutic relationship and
what Kalff referred to as the free and protected space of the sand tray itself. I have tried to illustrate this process
by describing the therapy of a three-and-a-half year old boy who created fourteen sandtrays. Through his play
in the sand he was able to mourn for the father he had lost and to re-connect with his own internal father. The
process led from a state of fragmentation to one of integration, and this coincided with a leap in his development
in his outer life.
Introduction
One of the most powerful ways I know of working
therapeutically, whether with adults or with
children, is with sandplay as the Swiss psychotherapist, Dora Kalff, conceived it. I would like in this
article to give a brief description of her way of
working with sand, which differs in some essential
ways from the work of Margaret Lowenfeld. I would
then like to give an example from my work with
children to demonstrate how it can activate a
powerful psychic process, which enables healing.
Sand trays are an essential part of every play
therapists play equipment. There is nothing either
new or original about playing in the sand. A single
sand tray can reveal much about a childs situation
in both their internal and external world. It can
enable a child to convey what, as yet, there are no
words to describe. It can act as an alternative way to
act out and express aspects of trauma in the same
way that other play materials can enable this
process. This was how Lowenfeld conceived the
sand tray work she pioneered in her work with
children
What is Sandplay?
The use of sand for creative purposes is as old as
time. It was used by the medicine men of Mali who
drew patterns in the sand to divine the future. The
Navaho Indians hold sand painting ceremonies,
creating images of world order in order to bring
about universal harmony. Monks in Tibet create
beautiful mandalas in the sand as an aid to
meditation (Cunningham, 1997). Building in the
sand or playing at the seaside, all aspects of sand
have a fascination, for children especially. Some
Practical Considerations
example, the therapist becomes cast as the allpowerful mother one can, as therapist, find oneself
caught in a no-win situation. The sand tray provides
a third dimension in which the problem can be
looked at and reflected upon by patient and
therapist together instead of the therapist being seen
as the problem.
I have two sand trays, one with wet and the other
with dry sand and I keep a watering can beside the
wet tray for extra wetness. Each of the trays sits on
a stand and the stands have casters so they can be
moved to any position in the room. The dimensions
of the trays are important. They are exactly the size
that can be taken in visually without the need to
move ones head. They measure 22.5 x 28.5 inches
(57 x 72 cm) and are three inches deep. The trays
are half filled with fine silver sand and the base is
painted blue to give the impression of water when
the sand is cleared from it (Ammann, 1991). On the
shelves beside the trays are the miniature figures.
Every category of figure is represented to include:
buildings
all modes of travel
stones
shells
nests
feathers
driftwood
leaves
1 Until now nothing has been published in relation to a sandplay process with severely damaged children. Agnes Bailey worked for many
years in the North East of England, with wonderful results, with this client group. Her work is now carried on by Mike Falcus. Anyone
interested in pursuing this further can contact him on his email: michael@falcus.wanadoo.co.uk or telephone: 0794 1650 788.
marbles
glass drops
beads
jewels
coins
Figure 1
Bens First Sandtray: The Deluge
2 A very young child is so close to the unconscious, as consciousness and self-consciousness (in other words, a sense of a self that is separate
from mother), is only just beginning. A severe trauma, like the death of a parent, can throw the child back into a more infantile and
unconscious state.
3 The transference includes aspects of the patients relationships from the past, especially parental relationships, which he projects onto the
therapist. It can also represent aspects of the patient himself, which have not yet been realised. It has the possibility of disrupting the
therapeutic encounter, when the therapist represents destructive past relationships, but also contains the potential for healing. (Samuels,
Shorter & Plaut, 1987).
10
Figure 2
Bens Seventh Sandtray: Breakfast for Two.
is the house made for me by Dad and I helped him.
Could this be the inner house that is now
developing within Ben, which Dad has played a part
in building?
In his ninth and thirteenth trays Ben created the
interior of his own house and this took up the entire
tray. He is inside the house as a small baby and
within the house is everything he will need for his
security and nurture: furniture for cooking and
toileting, a big secure bed, and also five candles that
represent light (like the light house), and are later
associated with Dad.
What was being enacted in the sand tray in terms of
Ben creating his own individual house was also
being enacted at home with Mum. She told me he
had asked for the help of six strong men to move
the furniture in the way he needed it to be. In his
thirteenth tray Ben placed the entire dolls house in
the tray again and the house was filled with all the
objects that had formed a part of his healing
process. Bens house was placed in the centre, inside
the dolls house. Beside it to the left is Dianas
Figure 3
Bens Fifteenth Sandtray: Dads Birthday
left behind in my room in early sessions.
A warm relationship had developed between Ben
and me during these eighteen sessions in which he
had created fourteen sand pictures. Now he was
quite clear that it was enough and it was time for us
to end. I remembered that in our sixth session I had
asked him how many more times he felt he would
need to come. Without hesitation he said, eight
more. This turned out to be exactly right. Of course
a three-year-old child has no concept of the number
eight or of the time that represents. However, in a
psychic process, which does not involve what is
known consciously, there is a clear sense of what is
needed, if we can only connect with this.
11
12
References
Ammann, R. (1991). Healing and Transformation in
Sandplay. USA: Open Court Publishing Company.
Bradway, K. & McCord, B. (1997). Sandplay silent worship of the psyche. London/New York:
Routledge.
Chetwynd, T. (1982). A Dictionary of Symbols.
London: Paladin.
Cirlot, J.E. (1971). A Dictionary of Symbols.
London: Routledge.
13
14
: An Introduction
Theraplay
David L. Myrow, Ph.D.
Buffalo, New York, USA
www.theraplace.com
Abstract
This article introduces Theraplay1, a therapeutic model that is becoming increasingly known for its focus on
promoting parent-child attachment. First developed in America, Theraplay is currently being used in at least
eleven countries and in a wide variety of settings including schools, mental health clinics, private practice, speech
and language therapy agencies, and residential treatment facilities. Theraplay differs from Child Centred or Nondirective approaches in that it is therapist-directed, includes physical contact, involves parents in the process
whenever possible, and is intended to be fun. This brief overview reviews the history of Theraplay, the principles
that guide it, its theoretical foundation in Object Relations and Attachment Theory (now supported by recent
findings in neurobiology), and notes recent scientific research that strongly supports its efficacy. Illustrations are
given from clinical practice. Keywords: Theraplay, play therapy, attachment, research, depression in children,
attention deficit, selective mutism, oppositional defiance, autistic spectrum, divorce.
1 The appellation Theraplay is a registered service mark of the Theraplay Institute. Early in its history, this was done as a way to ensure
that practitioners using the method were actually professionally trained in this specific approach. The intention is to make sure that the
techniques are used ethically, appropriately, and correctly. The Institute maintains control of the service mark and its use.
THERAPLAY: AN INTRODUCTION
Initially the treatment was with individual children
in preschool classrooms. Eventually Jernberg started
to include the family crucible in her psychotherapy
work (Jernberg & Booth, 1999). To this she
applied an application of Object Relations Theory
(Winnicott, 1957) and Attachment Theory
(Bowlby, 1969) that was well ahead of her time.
Besides drawing on the work of Bowlby and his
followers, Jernberg drew from the strategic therapy
of Milton Erickson (as cited in Haley, 1973).2
Jernbergs focus was always on what worked, to
create intense moments of connection. As has been
advanced more recently in psychoanalytic thinking
(Tronick, 1998), change seems to happen most
when there is a profound sense of emotional
engagement a moment of meeting - with the
client (Lyons-Ruth, 1998). Recent discoveries by
neurobiologists (Siegel, 1999) reveal in detail the
effects of early infant interactions on infant
attachment and development. Perhaps most
importantly it has become clear that warm, physical
contact plays an essential role in beginning the
process of self-regulation, starting with regulation of
affect (Schore, 2001). Mkel (2003) has articulated
how recent advances in neuroscience are applied in
Theraplay. Forty years ago, Jernberg anticipated
these developments. Instead of looking for
pathology, Jernberg looked toward looked toward
health, and studied the interactions of typical
parents and their children in search of activities that
might promote better functioning in children who
were struggling. Her model makes a direct
connection between Attachment Theory and
practical parenting. This helps to formulate the
therapeutic interventions that are likely to help.
15
Structure
The parent builds a holding environment
(Winnicott, 1957), takes charge of defining physical
boundaries and setting limits. For a newborn this
involves schedules and routines for feeding,
sleeping, changing. Soon the parent teaches the
child about herself, These are your ears. A little
later the parent helps the child to differentiate,
These are your eyes, and these are my eyes.
Structuring takes different forms at the various
developmental stages. For the school age child, it
includes getting homework done and setting norms
of behaviour with peers. For the teenager, there
might be curfews and help organizing the search for
college or a job.
Engagement
The parent connects emotionally with the child.
There is a sense of immediacy and intimacy.
Accurate affective attunement is essential. In
interaction with the infant, this is seen in mirroring
behaviour that is in synchrony with affective
volume and tone. As the child develops, attending
to his emotional states and teaching the words for
them helps the child know himself and feel known.
For a child who avoids closeness (for example a
parentified, obsessive-compulsive child), sometimes
little surprises can help the child let go and have
fun. An anxious seven-year-old might be delighted
to find that he could jump further and further
distances from a tabletop into the arms of an
enthusiastic parent, who ends the game by
swinging the child around in a circle and then
gazing into his eyes.
Nurture
The parent protects and comforts the child, feeds
and clothes her. Warm, physical touch supports the
process of self-regulating. When the boy scrapes his
knee playing ball, Dad checks it out, gives it a kiss
2 In this approach, the therapist assumes increased responsibility for the therapeutic effort and may use unconventional techniques such as
paradoxical interventions. (For example, to a child who kicks off his shoe while entering the playroom, the therapist comments, Wow! You
have strong legs!)
16
THERAPLAY: AN INTRODUCTION
3 For a fascinating overview of the work and lives of Bowlby and the other Attachment Theorists, the reader is referred to Robert Karens
(1998) delightful volume.
THERAPLAY: AN INTRODUCTION
Theraplay as a Way to Reach Troubled
Children
In creating Theraplay, Jernberg hoped to reach back
to the innate capacity of the child in order to
encourage a more positive sense of herself to
develop. Jernberg hoped that hands-on, physical
experiences resembling those enjoyed by healthy,
typical parent-child dyads would provide a more
direct way for troubled children and their parents to
generate healthy interactions.
As Theraplay evolved, a number of characteristics
began to distinguish it from traditional methods:
The focus is on healthy parent-child
relationships rather than on the childs pathology or
internal processes.
The therapist is in charge of the session,
planning and organizing the experiences to meet the
childs needs.
The activities are designed to meet the childs
emotional stage of development rather than the
childs physical age. Therefore many games have a
regressive aspect. Nevertheless, these experiences are
designed to meet the childs unresolved early needs
while remaining ego-syntonic with the childs
current sense of herself.
The treatment includes physical, interactive,
emotionally attuned play. This helps with building
attachment as well as developing self-regulation.
The therapist (not a toy or symbolic item) is the
main playroom object. The therapist utilizes the
childs nonverbal behaviour to make physical and
emotional contact throughout the session.
Immediacy is central: the focus is on the
experience at the moment rather than on history,
pretend play, or interpretations.
Nurturing touch is a natural and integral aspect
of the interaction. In this Theraplay guided by the
wealth of research in the past few
decades
detailing the essential role that touch plays in
healthy physical and emotional development (Field,
1995; Mkel, 2003, 2005). Great care is taken to
ensure that touch is used respectfully and that it is
geared to the treatment plan.
17
18
THERAPLAY: AN INTRODUCTION
THERAPLAY: AN INTRODUCTION
19
Theraplay begins
Child-centred play therapy practitioners are usually
surprised to find that there are few toys visible in the
playroom. When using Theraplay, the therapist is
the primary object in the room, and the focus is
on how child and therapist interact.
In the waiting room Tony alternated between sitting
at a table working on a puzzle and coming over to
his Mums chair, asking her when the session would
begin. This behaviour resembled that of a two and a
half year old who plays independently, then
sporadically checks in with Mum for refuelling.
The therapist took Tonys hand and they headed to
the playroom. Once there, it was explained that
shoes were to be removed. Tony kicked off his
sneakers and lunged toward a beanbag chair.
However the therapist kept holding his hand and
carried Tony over to the beanbag chair. It was
explained that a video would be made for parents to
see later so that they could learn some of the games
that were to be played. The therapist stated the two
rules of the playroom: First, No one gets hurt
neither You (gently touching Tonys chest) nor I.
Second, Everybody has as much fun as possible!
Tony smiled, perhaps relieved that this wasnt going
to be all torture or a lecture session from an adult.
Then the therapist performed a check-in. The
therapist pointed to the boys very dark brown eyes,
even darker than mine! (a move, which caused
Tony to look at the therapists eyes for a moment).
Appealing to the seven-year-old part of him, the
therapist counted Tonys fingers: Lets see, there
should be 10, right? 10-9-8-7-6 on this side and 1-
20
THERAPLAY: AN INTRODUCTION
THERAPLAY: AN INTRODUCTION
eating game would occur later in the session, but
that didnt satisfy him. He folded his arms and
pouted. After Hughes (1999), the therapist
interpreted (not usually a Theraplay move), I
wonder if youre angry that we cant do exactly what
you want right now. Maybe you think I dont like
you if I wont let you do it right now. This was
successful, and so it was possible to move on to the
next game, Tunnels.
For Tunnels, the three adults made parallel arches.
On the signal, Tony had to crawl through before the
count ended and the tunnels collapsed. On
succeeding crawls the number of counts was
reduced, so that Tonys parents eventually caught
him in warm hugs. Moving to a quieter game with
a large Nurturing component, Mum and Dad sat
facing each other, with Tony in Dads lap. Mum
played Guess the Goodies. This gave Tony a chance
to have a feeding experience with his Mum, to
renew and extend intimacy and nurturing from the
early years, and with Dad symbolically and literally
holding him.
This session concluded with a Blanket Swing. Tony
lay in a folded blanket, facing his parents while the
therapist took the opposite end and they slowly
rocked their seven-year-old, singing, Twinkle,
twinkle, little star. What a handsome boy you are!
Dark brown eyes and very smart. We love you with
all our heart! At first, Tony wiggled in the blanket,
even turned over to hide his eyes. By the third time,
he was looking into his parents eyes and seemed
quite relaxed.
21
Research on Efficacy
Clinicians who use Theraplay have reported success
with even the most challenging cases (cf. Munns,
2000; Mkel, 2005; Koller and Booth, 1997;
Lindaman and Haldeman, 1994, as well as
numerous articles in the Theraplay Institute
Newsletter). Mkel and Vierikko (2004) have
reported systematic assessment of Theraplay with
disadvantaged children and their families. Franke
and Wettig in Germany have done by far the most
comprehensive and robust assessment. In a
controlled, longitudinal study conducted between
1998 and 2005, sixty children diagnosed with both
speech-language and severe behaviour disorders
were given Theraplay treatment and compared to
thirty non-symptomatic children over time. A much
larger, multi-centre study looked at the results of
Theraplay treatment conducted in nine different
settings, including a centre for early intervention, a
kindergarten in a socially impoverished area, a
family therapy psychology practice, and practices
for speech-language pathologists. The children
ranged in age from two years and six months to six
years-11 months. Presenting problems included
attention deficit, oppositional defiance, shyness,
social anxiety, selective mutism, lack of social
mutuality and aggressiveness. Assessment included
tabulation of 53 symptoms seen as relevant to
Theraplay intervention. The findings (reported in
Wettig, Franke, and Fjordbak, 2006) showed
consistently strong effects. Problems seen as having
a more biological basis (e.g., attention deficit
22
THERAPLAY: AN INTRODUCTION
Correspondence
David L. Myrow, Ph.D.,
822 Center Road,
West Seneca,
New York 14224, USA
drdave@theraplace.com
References
Authors Note: In addition to the resources noted
below, the reader is encouraged to visit the web site
of the Theraplay Institute, www.theraplay.org, for
the latest information on Theraplay applications
and research, as well as about the Third
International Theraplay Conference, to be held in
Chicago in July 2007.
Bowlby, J. (1969). Attachment and Loss. Vol.1:
Attachment. New York: Basic Books.
Brody, V. A. (1993). The Dialogue of Touch:
THERAPLAY: AN INTRODUCTION
Lyons-Ruth, K. (1998). Implicit relational
knowing: its role in development and psychoanalytic treatment. Infant Mental Health Journal, 19
(3), pp 282-289.
Mahler, M.S., Pine, F., and Bergman, A. (1975).
The Psychological Birth of the Human Infant. New
York: Basic Books.
Mkel, J. (2003). What Makes Theraplay
Effective: Insights from Developmental Sciences. The
Theraplay Institute Newsletter, Fall/Winter 2003.
Mkel, J. (2005). The importance of touch in the
development of children. Finnish Medical Journal
60, pp 15439.
Mkel, J. and Vierikko, I. (2004). From heart to
heart: Interactive therapy for children in care: Report
on the Theraplay project in SOS Childrens Villages in
Finland 2001-2004. Billrothstr. 22A-1190 Vienna,
Austria: SOS-Kinderdorf International
Munns, E. (ed) (2000). Theraplay: Innovations in
Attachment-Enhancing Play Therapy. London: Jason
Aronson.
Myrow, D. L. (2000a). Applications for the
attachment-fostering aspects of Theraplay. In E.
Munns (ed.), Theraplay: Innovations in Attachment
Enhancing Play Therapy (pp 55-77). Northvale, NJ:
Jason Aronson.
Myrow, D. L. (2000b). Theraplay: the early years.
In E. Munns (Ed.), Theraplay: Innovations in
Attachment-Enhancing Play Therapy (pp 3-8).
Northvale, NJ: Jason Aronson.
Rubin, P. & Tregay, J. (1989). Play with them Theraplay groups in the classroom. Springfield, Ill.:
Charles C. Thomas.
Schore, Allan N. (2001). The effects of a secure
attachment on right brain development, affect
regulation, and infant mental health. Infant Mental
Health Journal. 22 (1-2), pp 7-66.
23
24
Abstract
There is limited research available within the field of play therapy to draw upon when formulating a research
investigation. The author suggests that it is advisable to consult the development of research design within the
wider field of the arts therapies. It is acknowledged that quantitative methods have earned respect as credible
approaches to research within this genre. Alternatively it is recognised that a qualitative approach may be
efficacious for certain investigations within the creative arts therapies. The particular benefits of working within
a qualitative paradigm are explored: the affinity with the therapeutic medium; the utilisation of the therapists
skills; the opportunity to use a combination of approaches within the design; the concept of bricolage; the ability
to triangulate data and the more complex concept of crystallisation. The application of these principles are
applied to the authors own investigation which uses a heuristic framework to discover more about the nature of
change within play therapy. In the spirit of heuristic research the author invites readers to respond to the ideas
within this paper and would welcome correspondence via letter or Email. Keywords: arts therapies, heuristic,
methodology, play therapy, qualitative research, researcher-practitioner, art-based, arts-based.
25
26
27
1 Art-based research is a term adopted by therapy practitioners to describe the use of elements of the creative arts therapy experience
within an inquiry, see McNiff 1998.
2 Arts-based research describes inquiry that utilises a creative medium but is not necessarily related to therapy.
28
The practitioner-researcher
However some arts therapy practitioners suggest
that using therapy as inquiry has little relevance in
the research world (Payne 1993) and dismiss the
credibility of research by practitioners who rely
solely on their therapeutic skills, arguing that such
an approach is essentially flawed and does not
recognise that researching is a discipline in itself
(Barham, 2003 p.6). Presenting case studies is an
important impetus to research that should not be
undermined; however to undertake subsequent
investigation therapists may not be able to rely on
their existing skills. Proponents of qualitative
research within the health services, Dingwall,
Murphy, Watson, Greatbatch and Parker (1998,
p.167) use a metaphor from an unlikely text to
illustrate that it is not enough to be an experienced
health practitioner, researchers must develop
specialist research specific expertise:
A child does not catch a gold fish in water at
the first trial, however good his eyes may be,
and however clear the water: knowledge and
method are necessary to enable him to take
what is actually before his eyes and under his
hand. So it is with all who fish in a strange
element for the truth which is living and
moving there: the powers of observation must
be trained, and habits of method of arranging
the materials presented to the eye must be
acquired before the student possesses the
requisites for understanding what he
contemplates.
Martineau (1838)
How to Observe Morals and Manners
29
Noticing
In contrast Mason (2002) exhorts professionals to
research their own practice and whilst his primary
focus is on teachers he applies this definition widely
to include people who work in a caring or
supportive capacity (p.1). He strives to take some
of the mystique out of research and encourages
practitioners to utilise their current expertise. He
suggests that researchers can begin by being alert to
noticing and considers that this is a discipline that
is integral to research. Observation is one of the
strengths of arts therapy practice, which is also
inherently evaluative; therapists are trained to be
reflective practitioners and to use the process of
supervision.
For myself, entering the field of
research as a novice has been a challenging
experience; I recognise that I have required specialist
research advice and needed to develop particular
expertise. However, to discover that I had some
transferable skills from my therapy practice, such as
observation, listening, interview technique,
evaluation and self-reflection that could contribute
to the process of research has been a definite
advantage. It is possible that otherwise I may have
felt more deskilled by the process.
The therapist-researcher: advantage or oxymoron?
In the same way that it is possible for creative arts
therapists to employ their specialist media within an
investigation, it is also possible for them to utilise
some of their therapeutic skills, indeed this may
make the research process more accessible to them.
A balance must be established between taking
advantage of the familiar and taking a risk into the
unknown. So the arts therapist may endeavour to
embrace their skills as a practitioner and enhance
their investigation by accepting the challenge of
applying other methodologies.
However in
contrast to Mason, Rowan offers a caveat against the
therapist-researcher, implying that it may be an
oxymoron: the lot of the practitioner-researcher is
generally an unhappy oneit is almost impossible
to carry it out (1993, p ix).
So the arts therapist may endeavour to embrace
30
Bricolage
An amalgamative approach or research repertoire
(Grainger, 2001, p.9) is described by Denzin and
Lincoln (2005, p.4) as bricolage, an adaptive
approach to research design. A French word,
bricolage does not have a direct English equivalent.
The common translation of do it yourself does not
adequately summarise the nuances of this
expression; I draw upon the interpretation of
Brandon (2002), McLeod (2000), and Papert
(1994) to translate. Bricolage describes an approach
to construction that is in direct contrast to that of
engineering; it utilises a creative resourcefulness and
inventive spirit, to make the most of whatever
materials are to hand in response to the constantly
changing requirements of the job in hand. Such an
approach within the field of research would allow an
investigation to develop in an organic way and
respond to the process and the findings as they
emerge. Papert (1994) outlines that bricolage may
31
32
Conclusion
Consistent with a relatively youthful profession play
Acknowledgements
My thanks to Dr Juliet Goldbart, Manchester
Metropolitan University, for her helpful comments
on an earlier draft of this manuscript.
33
References
Atkins, D. & Lowenthal, D. (2004). The lived
experience of psychotherapists working with older
clients: An heuristic study. British Journal of
Guidance & Counselling, 3(4), 493-509.
Barham, M. (1999). The arts therapy profession:
Come to the edge. In A. Cattanach (Ed.), Process in
the arts therapies (pp. 198-214). London: Jessica
Kingsley Press.
Barham, M. (2003). Practitioner based research:
paradigm or paradox? Dramatherapy, 25(2), 4-7.
Brandon, E. P. (2002). Philosophy as Bricolage:
Paper presented at the Philosophy As conference,
London Nov 28-30, accessed on line 08.09.2005.
http://cavehill.uwi.edu/bnccde/epb/bricolage.html
Broomfield, R.N. (2003). Psychoanalytic play
therapy. In Schaeffer, C.E. (Ed.), Foundations of
play therapy (pp1-13). New York: John Wiley &
Sons.
34
35
36
37
Abstract
This presentation aims to provide a case example of how play therapy can provide an effective therapeutic
intervention for trauma experienced by child survivors of natural disasters. It illustrates how play therapy can
assist psychological recovery. It describes the authors work with a nine-year-old girl who experienced the tsunami
of 2004 and saw her sister swept away. Keywords: Non-directive play therapy, tsunami, trauma.
Introduction
I practise as a play therapist in Penang, Malaysia. I
work in an organisation that aims to provide
appropriate interventions for children with learning
difficulties and children with emotional and
behavioural difficulties. I also work one day a week
in a local hospital as outreach from my organisation.
My principle task is to provide play therapy services
to children aged between three and twelve years of
age who have experience of loss and grief, trauma,
abuse, family breakdown, and chronic illness. After
the tsunami in 2004 the mental health dept of the
local hospital called on those interested to form a
team to provide therapy to families who were
traumatised. I was one of the team members who
worked with the children. From there comes the
article.
Play therapy can help child survivors of a tsunami
by offering a space in which the feelings can be
expressed and contained. It helps children to make
sense of their experience in the tsunami and helps
them learn how to cope with anxiety and stress
related to their experience. Play therapy provides
children with a safe space to accept the loss and say
38
39
40
Self-protection
From the fourth session onwards
there was a change in Norlizas play
content and drawings. Norliza no
longer played out repeatedly the
Dying patients
41
42
Withdrawing Energy
from the Past and
Reinvesting in Other
Relationships
From the fourth
session
onwards,
Norlizas play showed
that she was no longer
pre-occupied
with
flash backs of the
tsunami. Her play
reflected
emerging
themes of hope in her
New houses and farms
current life. One of her drawings shows colourful houses in the housing areas with blue clouds and a yellow
shining sun. Another drawing shows a four-storey hotel with flowers, ocean, hillside and a swimming pool.
She said nobody lived in the hotel and nothing happened. This may be a sign of recovery, the rebuilding
phase after a disaster, awaiting occupation for life to go on (Herman, 1992).
Colourful houses
Four-storey hotel
43
During the time when Penang was alerted to Dengue Fever, in February 2005, Norliza pretended to be the
doctor treating the patients with Dengue fever. She also drew a poster to alert people to the importance of
keeping the environment clean in order to get rid of the dengue mosquitoes. This is parallel to the childs
pre-occupation with the thematic issue of protecting and guarding oneself against natural disaster, which
can
be
unpredictable
and dangerous.
The drawings
that
Norliza
made during
the sixth session
represents her
current family
re l a t i o n s h i p s
without
her
deceased sister.
This suggests
that
Norliza
was at the
fourth stage of
grief process,
able to reengage
with
people around
her
and
renegotiate her
c l o s e
Poster: Keep the Environment Clean
re l a t i o n s h i p s
Norliza has depicted herself in black although the
with her other sisters (Baker, Sedney & Gross,
sisters are colourful. Perhaps the lack of colour in
1992). In the drawing with her two older sisters
44
comparison to her
older sisters may
represent Norlizas
sense of loss of
her
special
companion, while
her sisters still
have each other.1
In the last session,
Norliza played
building houses
and nurturing the
girl. She also
made a drawing
of
the
zoo,
perhaps a fun
activity that she
had enjoyed in
the past and
expected to enjoy
again.
Afterwards
I think that she had formed a close relationship with all of her sisters and therefore derived a strong sense of
security from this support. It is common for older sisters to look after the younger ones in her culture and
1Although the lack of obvious hands in this picture may suggest helplessness, I feel that it probably signifies the long sleeves worn by
Moslem females to cover their arms.
Conclusion
The play therapy provided Norliza a space to
express and contain her traumatic experience, to
accept the loss and say goodbye to her beloved sister.
She showed repetitive play typical of trauma victims
during three of the sessions. She was given the
opportunity to acknowledge and express her pain,
explore her thoughts and feelings about death and
dying while finding meaning in life and living. It
seems likely that her experience of close family
relationships and community helped her to feel safe
enough to explore and resolve her trauma in a
relatively short time (although the normal grieving
process would clearly be expected to take its
course). Bratton, Ray, Rhine & Jones (2005)
suggest that a small number of sessions could be
effective for children in crisis situations. This may
apply where there is likely to be a pre-existing
baseline of security.
Correspondence
Min See Leong
Bureau on Learning Difficulties
Penang
Malaysia
minsee@gmail.com
boldpace@yahoo.com
45
46
Abstract
This paper brings together various theoretical standpoints to highlight the key issues in research with children
engaged in therapy and the complexities this can involve. Childrens rights, power dynamics and their impact on
the research process can be understood within discourses of childhood. Trust between the child and
therapist/researcher is a further dynamic as well as issues of informed consent, gatekeepers, confidentiality and
the possible impact on the intervention. Whilst research into the process of Non-directive Play Therapy is
important, this needs to be understood and acknowledged within a multi-faceted child-centred framework.
Keywords: Non-directive play therapy, ethics, children.
Introduction
There is a growing need for the ethics of researching
children in non-directive play therapy (NDPT) to
be further explored and debated. This paper draws
attention to the particular considerations that need
to be highlighted when conducting research that
involves children engaged in non-directive play
therapy. It seeks to encourage debate and further
consideration of these key issues.
Background
Ethical concerns are of paramount importance
when conducting research with children and even
more so when therapy is in process. Thus methodological concerns centre on the area of ethics and
practice when conducting research with children in
this setting. Ethical issues are a key consideration in
research with children and in particular in research
with abused or neglected children taking part in
47
48
49
Trust
The distinctive ethical dimension of NDPT
practice is the trust placed by child clients in
practitioners. This trust is not only essential to
achieving therapeutic goals for the client but also for
the practitioner to establish the quality of
50
Informed Consent
General discussions around research ethics are often
centred around two key preoccupations: informed
51
Gatekeepers
When considering the more practical aspects of
carrying out research with children in play therapy,
gatekeepers to the research data collection are
perhaps necessary for the childs protection but can
make access to research participants difficult for the
potential researcher. The NCB (2003) recognises
the need for children themselves to give consent to
52
Confidentiality
The codes of ethics and guidelines for good practice
provide a good starting point (Cree, Kay & Tisdall,
Impact on Intervention
The final ethical consideration is how to collect data
and conduct research into the therapeutic process
without influencing that process in some way.
Research into non-directive play therapy raises the
issue of the impact on the therapy itself of such an
intervention. As Daniel-McKeigue (2004) notes
one of the major issues that children explore in
therapy is self-esteem. The idea is that the therapist
should be engaged as a neutral facilitator of the
child (someone who is not involved in the childs
Summary
The numerous complexities and challenges in
involving children in research, particularly those
engaged in the sensitive process of non-directive
play therapy have been highlighted. As discussed the
therapeutic relationship is based on a foundation of
trust and the integrity of the therapeutic
relationship must be placed before any research.
Introducing a study may challenge the confidentiality boundary (usually only broken if the child is
deemed to be at risk). To what degree this would
influence the course of therapy and affect the childs
willingness to share their concerns or to participate
fully in the sessions may be difficult to predict.
Clearly though children should be involved in
research and have the right to have their voices
heard. It would be difficult to research the play
therapy process fully without including the child
clients experiences or views. There are major
challenges involved in this aim though. The various
ethical challenges such as gaining access to
appropriate populations and gatekeepers can form
challenges in themselves. However, it could be
agued that in terms of collecting valid and reliable
data within non-directive play therapy, the primary
concern of the researcher is the impact on the
process itself and hence the subsequent data
collection. It is therefore necessary to source of a
way of collecting data on the NDPT process with
the minimum disruption to the therapy itself. In
this way, the delicate process of NDPT may be one
step further towards being better understood.
53
References
Alderson, P. (1995). Listening to Children: Children,
Ethics and Social Research. London: Barnardos.
British Association of Play Therapists (2nd edition,
August 2006). An Ethical Basis for Good Practice in
Play Therapy. BAPT
British Medical Association (2001). Consent, Rights
and Choices in Health Care for Children and Young
People. London: BMJ Books.
Carroll, J. (2002). Play therapy: the childrens views.
Child and Family Social Work, 2002, 7, 177-187.
Colton, M., Sanders, R. & Williams, M. (2001).
An Introduction to Working with Children. A Guide
for Social Workers. London: Palgrave.
Cree, V.E., Kay, H. & Tisdall, K. (2002). Research
with Children: sharing the dilemmas. Child and
Family Social Work, 7, 47-56.
54
117-82.
United Nations (1989). Convention on the Rights
of the Child. UNICEF, URL (consulted on 28
October 2004): http://www.unicef.org
Wilson, K. and Ryan, V. (2002) Play therapy with
emotionally damaged adolescents. Emotional and
Behavioural Difficulties, 7(3), 178-192.
55
Abstract
This paper introduces the concept of the Communicube and the Communiwell, two structures that have been
developed as communication tools for the 21st century. It presents a therapeutic method of using these tools, the
Five Story Self Structure. Information is provided on the origin, design and theory. In order to demonstrate the
flexibility of the tool brief examples of practice with adults are given followed by more detailed accounts of work
conducted by dramatherapists with school age children in Britain and France. Keywords: Communication, play,
levels, self, structure, miniature, patterns, story, container, assessment, therapy, education, distance, fun.
Introduction
The Communicube
55
56
57
58
Further developments
The Communiwell is a circular version, which
instead of the grid of squares has three concentric
circles. Some people prefer this version: it offers
clients and therapists a choice. The Communicube
and Communiwell are being further developed as
tools in therapeutic work with couples, groups,
families, supervision, team building and in
education.
1The rules of the game are in the Communicube users manual, Casson, 2005.
59
59
60
effective?
61
62
Conclusion
This new tool offers clients a metaphoric container
and an opportunity to play, explore, strengthen the
observer ego and integrate split off aspects of the self
into a greater whole. We live in a diverse and
complex world: the Communicube enables players
to model this complexity. We all need structure in
our lives. When people are struggling with the chaos
of trauma, complex feelings and conflicted
interpersonal relations, the Communicube and the
Communiwell can provide a containing structure to
achieve some order and discover meaning. The Five
Story Self Structure, as a therapeutic method,
promotes communication in a way that can be both
powerful and fun.
References
Bannister, A. (2003). Creative Therapies with
Traumatised Children. London: Jessica Kingsley
Publishers Ltd.
Casson, J. (1998). Right/Left Brain and
Dramatherapy. Journal of the British Association for
Dramatherapists. 20 (1).
Casson, J. (2004). Sculpting. Prompt: the newsletter
of the British Association of Dramatherapists,
Summer.
Casson, J. (2005). An Instruction Manual for the
Therapeutic method of the Five Story Self Structure,
concerning theory and practice. Failsworth:
Communicube Ltd.
Christensen, J. (2004). Im Telling: The Use of the
Five Story Self Structure with Adolescents in a School
Setting. Unpublished M.A. research essay:
University of Plymouth.
Hemmings, P. (2001). Button Sculpting:
Counselling Bereaved Children. Bereavement Care,
20 (2).
Jung, C. G. (1972). Man and his Symbols. London:
Aldus Books Limited.
BOOK REVIEWS
PLAY THERAPY
A Non-directive Approach
for Children and Adolescents
Second Edition
Authors: Kate Wilson & Virginia Ryan
Date Published: 2005
Publisher: Baillire Tindall
ISBN: 0 7020 2771 5
Price: 17.99 (amazon.co.uk)
63
64
issues is as yet undeveloped, and there may be
external pressures to solve the most distressing cases.
Wilson & Ryan provide very sound explanations in
this regard that, if adhered to, will help to ensure a
responsible approach. Always characteristic clarity
of thought and sound rationale is delivered that
supports the highest regard for childrens well being.
I wholeheartedly recommend this volume to all who
wish to practice in play therapy or to understand the
underlying processes. It will also help other
professionals, parents and carers who wish to gain
greater insight into central themes in childrens play
and behaviour. The fundamental principles and
guiding light underpinning this books aims are
firmly rooted in childrens needs at any stage of
development. This informs all, from moment to
moment practice of skills in the playroom, interpretation of childrens communications to others,
working with parents and carers, to advocacy in the
wider arena of society.
Anne Barnes
MA/Diploma in Play Therapy
Notre Dame Centre
Glasgow
Volume 3:
65
VOLUME 4
DECEMBER
EDITORIAL
Anne Barnes
PAPERS
The use of sandplay with children
Diana Jansen
Theraplay: An Introduction
David L Myrow
14
24
37
46
55
Book Reviews
63
ISSN 17441145
02
Laser Proof
9 771744 114001