Applying puppets in therapeutic work with children was introduced by Woltmann in the 1940s. According to Woltmann, puppets are useful because they are easy to handle and maneuver, allow the child to be spontaneous, and lend themselves naturally to a process of self-expression. Puppet play creates an atmosphere of free expression that captivates the child. The child tends to identify with the characters involved in the puppet play and projects their feelings and interpersonal conflicts into the play. In this way, children can communicate their distress without having to directly claim traumatic experiences and painful emotions as their own. The therapist, in turn, can use puppets to model, explain and provide corrective emotional experiences in response to the child’s play.
Puppet play is a popular play technique that helps children express feelings, reenact anxious events, try out new, more adaptive behaviors, and overcome inhibitions. Puppets take all forms, shapes, sizes and colors. They allow children to be very creative by expressing an interaction and acting in a puppet show/mini-play.
Thoughts, feelings and the relationship issues of children find a safe environment for expression using puppets. Children experience a sense of control and mastery with puppets that aids them in the recognizing or communicating feelings and thoughts, that could eventually become the basis of maladaptive behaviors.
Finally, since many children enjoy working with puppets and creating puppet shows, puppets are very effective tools in the treatment of children.
Behavior Cognitive Therapy
The Cognitive Therapy (CT) and child development
CT is a structured and directed approach to help individuals change their dysfunctional thoughts and behaviors. It is based on the cognitive model of emotional disorders, whereby maladaptive or disturbed behavior is considered an expression of irrational thinking. CT focuses on the cognitions and modification, in particular of irrational, maladaptive or illogical thinking.
This model, developed for adults, is applicable to children too, but young children do not have sufficient cognitive skills and flexibility to benefit from CT. CT requires the ability to follow a logical and rational sequence and the ability to distinguish between rational and irrational / logical and illogical thinking, skills that have not yet developed.
In the preoperational stage of the child’s development, thinking is self-centered, concrete and irrational by nature, and action may precede thinking due to cognitive immaturity or impulsiveness.
Which Group is Play Therapy often free to treat?
These characteristics make the use of CT problematic, thus, it is necessary to adapt it to practice with children and adolescents, in order to guarantee a more adequate approach to their development.
Knell and her colleagues have demonstrated that cognitive behavioral therapy can be communicated to children through play (Knell, 1993a, 1994, 1997, 1998, 1999; Knell & Moore, 1990; Knell & Ruma, 1996, 2003; Knell & Dasari, 2006).
Adapting CT for use with children
– Play Therapy for 3/5 year old
CT adaptations to younger populations involves a modification of its methodologies but not of its theoretical foundation. One of the biggest challenges in the development of CBPT has been to find a way to adapt CT to child development without relying on sophisticated language.
According to Knell (1993a, 1993b, 1994, 1997, 1998), CT could be applied to children if presented in a way accessible to them. Puppets, stuffed animals, books and other toys can be used to model children’s cognitive strategies, verbalizing the ability to solve problems or find possible solutions to a problem similar to the child’s.
CBPT, as conceptualized by Knell (1993a, 1993b, 1994, 1997, 1998, 1999, 2000; Knell & Moore, 1990; Knell & Ruma, 1996, 2003; Knell & Beck, 2000, Knell & Dasari, 2006) was developed for use with children between 2½ and 8 years and is based on cognitive, behavioral and traditionally therapies. CBPT is sensitive to developmental issues and emphasizes the empirical validation of effectiveness of interventions.
Puppets and CBPT
Puppets are tools that can be used both as a psychological assessment technique and as an intervention technique for young children, and is developmentally appropriate and well documented (for example Irwin, 2000).
ASSESSMENT WITH PUPPETS
The integration of puppets into psychological assessments provide a more sensitive approach to development, which can lead to more reliable clinical information. Several interviews that can be used to gather information for the assessment are described below:
Puppet Sentence Completion Task (Knell, 1992)
Most children under the age of 6-7 years have difficulty understanding task expectations and therefore are unable to respond consistently. A lot of material can be collected through the Sentence Completion Task (Knell 1992, 1993). The goal is to present a developmentally sensitive task for younger children, so that they can understand and respond appropriately according to age.
This assessment requires the use of different puppets which should represent different categories (i.e. people versus animal puppets). According to the procedure, the child is asked to choose a puppet. Puppet A and B will be animated by the examiner and Puppet C by the child. There are two parts to the task.
In Part One, Puppet A states the sentence stem. Puppet B quickly respond. The examiner then turns to Puppet C (held by the child) for a response. If the child does not understand the task, the examiner should go back through the statements and have Puppet B prompt the child to help Puppet C give a response. This continues until the task is clearly understood by the child. In Part Two, Puppet A state the sentence stem. The sentence is stated directly to Puppet C who will respond. Examples of questions are: My favorite food is…; I like…; My favorite TV show is…; I like to pretend to be…etc.
Child structured interview (Irwin, 1985)
The interview is organized in four phases, described below:
- Step 1: Introduce 15-20 hand puppets to the child. The puppets should be easy to manipulate and represent a wide range of psychological and social characteristics (i.e. aggression education, shyness).
- Step 2: As a warm up, ask the child to introduce you to the selected puppet, saying its name, age and gender.
- Step 3: Ask the child to tell a make-believe story with the puppet(s) behind the puppet stage or an overturned table.
- Step 4: Once the show is over, the therapist interviews the puppets, and then the child, to get more information about the characters and why they did this.
Interview with puppet Barkeley (Measelle, Ablow, Cowan&Cowan, 1998)
This is a structured interview for young children (4-8 years) that evaluates the perception of the family environment, academic performance, relationships with peers and symptoms. The therapist conducts the interview using two puppets dogs who ask the child to indicate which of the two opposite statements is more similar to him/her. This assessment tool is particularly suitable for children that are non-verbal, shy or with selective mutism because the child can respond non-verbally by pointing, or speaking in the third person using a puppet to answer the interviewer’s questions.
PUPPETS AS INTERVENTION TOOLS
Adults in treatment work to achieve clarity and congruence between thoughts, feelings and behaviors. The process of achieving that clarity often involves discovering the feelings connected to events, beliefs or actions. Children have less access to their feelings since : (1) they have not yet developed the language to express them; (2) they are often in the operational stage of development; (3) they are oriented to the present moment.
The challenge for the therapist is to assist the child in acquiring an emotional vocabulary, to use concrete techniques developmentally appropriate for the child and to bring out problems to be addressed. Puppets can be used to confront these challenges. Children who are in pre-operative or operational stages of cognitive development have difficulty understanding and applying experience and meanings to present or future situations.
Children often relate more easily to toys, stuffed animals and cartoon characters. Through using puppets, the therapist supports the child to interact verbally while they relate through the animated puppet and with the therapist as the puppeteer. This is especially useful with children that are shy, ashamed and who have trouble talking directly to adults. Aggressive children can calm down by communicating with an object that interacts quietly.
Puppets are very useful combined with other compatible strategies for dealing with phobias, aggression, family problems, bullying, problems with peers, anxiety (including fear of the dark), reacting to insults and being made of fun of, and sibling rivalry. There are undoubtedly many other applications.
In most cases of CBPT, the puppets are used as a means for delivering specific cognitive and behavioral interventions, mainly through modeling and/or role-playing. Most of the techniques in CBPT are delivered by modeling; for example, using a puppet, doll, or stuffed animal to demonstrate the appropriate social skills to children. Several other examples of modeling with puppets can include shaping/positive reinforcement during the social skills group (Knell, 2009).
A recent CBPT development reveals that cognitive strategies can be used effectively with children if treatment is tailored to be developmentally appropriate and consistent with a child’s needs. While cognitive therapy methods can be communicated directly to adults, children may need to communicate them indirectly through play activities. In particular, puppets and stuffed animals can be very useful in modeling the use of cognitive strategies such as the contrast of irrational beliefs and the development of positive self-statements.
Puppet play is a powerful form of play that adapts to multiple combinations and possibilities. The child easily identifies with puppets of animals or people and their problems, therefore, he is able to make suggestions or think based on appropriate problem solving strategies. Puppets naturally lend themselves to storytelling, adapting to its infinite applications. The child can “act” through the puppets and vicariously experience different problems and problem solving strategies, and therefore, consider the possible consequences for themselves and others. In effect,the child can become a different person through the puppet or watch what happens to the puppet.