DIRECTIVE PLAY THERAPY

Definition

Directive Play Therapy is an intervention that allows for relational experiences between the therapist and the child while using play as the principle means of communication. Play, unlike verbal therapy, is an activity of non-verbal symbols that constitutes the natural language of childhood and has an adaptive and organizational function during child development.

The origins of play in therapy: the main directional approaches

1. Psychoanalytic Play Therapy

Although Sigmund Freud (1909) worked mainly with adults, his analysis of “Little Hans” and his observations of the meaning of play for children, led the way to the development of child psychoanalysis. In fact, his observations about play reflected an intuitive understanding of its importance: “The most beloved and most engaging occupation of the child is the act of playing”. Every child’s play reproduces everything that in real life is meaningful to him and creates a world of which he is the master, organizing the things that belong in a new way that is more reassuring and more pleasant.

Play integration in the psychoanalytic setting

Melanie Klein (1932) and Anna Freud (1946) helped create the basis of play development in therapy, adapting traditional psychoanalysis to children. Both claimed that many childhood mental disorders were the result of unconscious conflicts, that would be resolved by strengthening the self-consciousness of the child and bringing the unconscious contents to awareness, through the interpretation and the understanding of the symbolic content of play and dreams. 

While for Anna Freud play was considered mainly an activity of involvement of the child and construction of the relationship with the therapist, with Melanie Klein, play became a means of communication and expression of the child’s thoughts and emotional states. In particular, Klein began to define a real technique of play, using a room as a therapeutic setting with various materials, representative figures and non-mechanical toys designed to stimulate and promote the child’s imaginative play.

Theirs was one of the first fundamental contributions to the development and understanding of working with children, which has led to the definition of methods that are still the basis of the therapeutic work. However, child psychoanalysis is a very long path that requires highly specialized training and self-analysis.

2. Object Relations Therapy

Donald Winnicott (1971), though trained as a Kleinian, developed a personal approach to working with children. He considered play as a central element of therapeutic experience and how this had a direct continuity with an “intermediate area”, where the child, using play as a means, is able to manage the transition between the inner world of the psyche and external reality.

Winnicott’s approach is directive, because the therapist can choose a certain type of play as a means of communication, and be interpreted as the therapist correlates the child’s manifesting behavior and hidden feelings, usually unconscious.

3. Cognitive behavioral approaches (CBT)

The cognitive behavioral approach (CBT) derives from the cognitive behavioral therapies that developed in the seventies and are based on the theory of learning. CBT sees behaviors as learned, and thoughts as a critical component of our behaviors and feelings. This intervention is based on the understanding of cognitive-behavioral mechanisms and its interventions, which are short-term and directive. In fact, the therapist, together with the patient, agrees on the objectives of the intervention and establishes a program of activities designed to positively reinforce desirable behaviors and extinguish unwanted ones. The cognitive component plays a fundamental role in learning more developmentally appropriate behaviors, and adaptive ways of thinking.

Susan Knell (1993), adapted the principles of adult CBT to children and integrated CBT approaches into play therapy by founding Cognitive Behavioral Play Therapy (CBPT). She combined play with adaptive thoughts and behaviors in order to help children develop effective coping strategies for dealing with problems.

4. Sand Play Therapy (The World Technique)

This approach was introduced by Margaret Lowenfeld in the 1920s and is also known as “Sand Play”. The purpose of this technique is to fill the limits of traditional psychoanalytic verbal therapy and allow the child to express thoughts and emotions that cannot be communicated through words. According to Lowenfeld, the need to give meaning to the experience is present since early childhood but is expressed by children through images.

Children are provided with sandboxes and miniature realistic object shelves. Subsequently, they are encouraged to make a three-dimensional image of their own world in the sand. Lowenfeld believed that the world created by each child reflected their problems, and that, commenting on the play, children could express their emotions and become aware of them (non-verbal thought) (Lowenfeld, 1950).

Although the technique is clearly based on psychoanalytic principles, some elements recall the non-directive approach, for example, the therapist’s comments are descriptive and not interpretative.

5. Narrative Play Therapy

The origins of Narrative Play Therapy can be identified in the writings of Ann Cattanach and has its roots in a play therapy model that has been influenced by dramatherapy and other arts therapies. There are three core constructs, that is the conceptualization of narrative as a function of the psychology of the self, the developmental research on narrative and play, and the use of story to co-contruct a shared meaning (Cattanach 1997, 1999).

The stories and narratives generated within the child’s play and co-constructed with the therapist remain the core elements of the therapeutic process, as well as the agent for change. The co-construction can help the child to place the story within a bigger story, thus allowing the child to gain a wider perspective, facilitated by the consideration of alternative endings, the clarification of confusions in the telling and the retelling of the story (McLeod 1997).

6. Structured Play Therapy

Structured Play Therapies evolved from the psychoanalytic current in the 1930s and 1940s. Compared to traditional psychoanalysis, the therapist takes  on a more active role, choosing the play’s material in order to guide and help the child to achieve therapeutic goals. The structured interventions are various and mainly differ according to the materials used and the verbal skills needed.

Release Therapy

This type of play therapy was developed in America by David Levy in the 1930s. It is a “release” therapy of emotional tension aimed at helping children who have experienced a particular painful or traumatic event, to master the feelings associated with it. In fact, the aim is to use play as a means of recreating stressful situations, in order to free the child from the negative emotions connected to them. It is based on the psychoanalytic idea of compulsion to repetition: through re-interpretation and re-experimentation of a particular event, repressed or blocked feelings are released and finally processed (Levy, 1938).

Gove Hembridge (1955) expanded Levy’s work to apply his technique in the clinical setting to solve problems related to traumatic events. The role of the therapist becomes more directive and recreates conflict situations, then allows the child free play with these scenarios.

7. Adlerian Play Therapy

Adlerian play therapy is a therapeutic technique and methodology that combines both Individual Psychology and a Child-Centered focus.

According to Terry Kottman (2001), there are four fundamental moments that represent Adlerian-oriented play therapy: first, building cooperative, egalitarian and emotional relationships with the child; second, exploring the child’s “lifestyle” through play; third, promoting child’s insight; and fourth, providing orientation and re-education, offering the opportunity to explore new ways of interacting.

Play is considered as a preferential way for access to child exploration and intervention. Through play, the therapist has the possibility of projecting himself in a finalistic sense as to how the child is structured up to that moment, not only as a projection of the internal world interjected from previous experiences. Therefore, the goal of play is strictly linked to the possibility of exploring the “unknown” and developing an experiential-emotional and cognitive knowledge.

The therapist guides the child towards constructive goals, through encouragement, empowerment and building the relationship.

8. Prescriptive Play Therapy

The Prescriptive play therapy model was first described by Heidi Gerard Kaduson, Donna Cangelosi e Charles Schaefer (1997, 2019). They claim that strict adherence to one theory may be less effective for treating children and therefore recommend use of multiple constructs. The therapist, in fact, must be competent in more than one theoretical orientation and technique of both directive and non directive play therapy. Thus, they must be flexible and skillful in adapting a particular intervention to their own personal style.

Such integration reflects the fact that most psychological disorders are complex and multidimensional, caused by an interaction of biological, psychological, and social factors, and often in comorbidity among them.

With this in mind, prescriptive play therapists seek to acquire a deeper understanding of which therapeutic power of play, intended as a change agent, is more effective for specific disorders. Schaefer and his colleagues have identified 20 therapeutic powers of play that can produce therapeutic changes.

Among the basic principles that guide the practice of this approach are the application of empirically supported interventions, comprehensive assessment of symptoms and causes of the client’s problems and monitoring of their progress.

Bibliography

Cattanach, A. (1997). Children’s Stones in Plav Thera~y. London: Jessica Kingsley Press.Cattanach. A. (1999). Co-constmction in Play Therapy. In A. Cattanach (ed.) Process in the Arts Therwies. London: Jessica Kingsley Press.

Freud S (1909) Two case histories: “Little Hans” and the “Rat Man”. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Volume X. Published 1955. The Hogarth Press, London (Reprinted 2001, Vintage Publishers)

Freud, A. (1946). The psychoanalytic treatment of children. London: Imago.

Hambridge, G. (1955). Structured Play Therapy. American Journal of Orthopsychiatry, 25, 304-310.

Kaduson, H. G., Cangelosi, D., & Shaefer, C. E. (2019). Tailoring Interventions for Specific Childhood Problems. Guilford Publications.

Kaduson, H. G., Cangelosi, D., & Shaefer, C. E. (Eds). (1997). The playing cure: Individualized play therapy for specific childhood problems. Northvale, NJ: Jason Aronson.Klein, M. (1932). The psycho-analysis of children. London: Hogarth Press.

Knell, S. (1993). Cognitive-behavioral play therapy. Northvale, NH: Jason Aronson.

Knell S. (1998) Il gioco in psicoterapia : nuove applicazioni cliniche, Edizione italiana a cura di Francesca Pergolizzi McGraw-Hill Companies

Kottman, T. (2001), Adlerian Play Therapy, Int. J. Play Therapy, 10 (2)

Levy, D. (1938). Release therapy for young children. Psychiatry

Lowenfeld, M. (1950). The nature and use of the Lowenfeld World Technique in work with children and adults . The Journal of Psychology.

McLeod, John. (1997) Narrative and Psychotherapy, SAGE Publications

Shaefer, C. E. & Drewes, A. A. (2013). The therapeutic powers of play: 20. core agents of change (2nd ed.) Hoboken, NJ: Wiley.

Shaefer, C. E. (1993). The therapeutic powers of play. Northvale, NJ: Jason Aronson.

Taylor de Faoite, A. (2011). Narrative Play Therapy: Theory and Practice. Jessica Kingsley Publishers.

Winnicott D. W. (1971) Playing & Reality. Tavistock Publications

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