Play Therapy and the Therapeutic Use of Story
Roxanne Carlson
Nancy Arthur
University of Calgary
Abstract
Children who develop behavioural problems are often living with severe emotional pain. Chil-dren can achieve personal growth, healing and alleviation of their emotional pain through treatment that allows the processing of traumatic events and experiences in a medium that is both natural and comfortable f °r them. Play therapy and the therapeutic use of stories allow
children to distance themselves from painful themes and deal with them symbolically. This article explores the healing process of a 6-year-old boy whose chaotic family lifestyle and struc-tured school environment presented more anxiety than he could cope with effectively.
Résumé
Les enfants chez lesquels se développent des problèmes de comportement, vivent souvent avec une douleur é m o t i o n n e l l e intense. Les enfants peuvent parvenir à une croissance personnelle et à un atténuement et une guérison de leur douleur grâce à des traitements qui permettent de traiter les é v é n e m e n t s et les e xpé ri ences traumatiques dans un milieu qui leur est à la fois naturel et confortable. La thérapie par le jeu et l'usage thérapeutique d'histoires permettent aux enfants de s'éloigner des thèmes douloureux et de les considérer symboliquement. Cet article explore les processus de guérison d'un jeune garçon de 6 ans dont la vie de famille chaotique et l'environnement scolaire structuré lui causaient plus d'anxiété qu'il ne pouvait endurer.
O n e perspective o n children's mental health proposes that every c h i l d is continually striving to become a well-adjusted h u m a n being. F o r example, A x l i n e (1969) suggests that adjusted c h i l d r e n appear to be those who have not e n c o u n t e r e d too many obstacles to their natural development. Alternatively, the c h i l d who ". . . is d e n i e d the right to achieve this with-out a struggle" (p. 20) often develops problematic behaviours a n d is fre-quently referred to counselling by c o n c e r n e d adults. A x l i n e also suggests that well-adjusted behaviour i n c h i l d r e n results w h e n they are self-aware a n d self-confident e n o u g h to consciously a n d purposefully behave i n a m a n n e r that is c o n g r u e n t with the process o f self-actualization. In contrast, c h i l d r e n display t r o u b l i n g behaviours w h e n they are not self-confident o r self-aware e n o u g h to behave i n ways that contribute posi-tively to the self-actualization process. It is c o m m o n for parents, teachers, a n d peers to negatively label these t r o u b l i n g behaviours, creating a self-image for the c h i l d that is not consistent with an originally positive sense of self. T h e resulting inconsistency i n self-knowledge further inhibits the child's difficulties o f adjustment.
A t the centre o f approaches to play therapy theory is the humanistic assumption that every c h i l d is a whole a n d u n i q u e person, worthy o f respect. A c c o r d i n g to Rogers (1980) ". . . individuals have within
them-selves vast resources for understanding a n d for altering their self-concepts, basic attitudes, a n d self-directed behavior" (p. 115). These are personal resources that can be drawn u p o n i n the child-centred a n d thera-peutic e n v i r o n m e n t o f play therapy. T h e c h i l d ' s uniqueness is appreci-ated a n d valued by the counsellor who communicates that value to the c h i l d by empathetically validating deeply felt emotions. Play therapists believe that the i n n e r strength a n d intuitive wisdom c h i l d r e n possess make t h e m i n c r e d i b l y resilient a n d capable o f positive self-direction. L a n d r e t h (1991) translates this p h i l o s o p h y i n t o action i n the p l a y r o o m where ". . . c h i l d r e n are n o t i c e d , listened to, heard, r e s p o n d e d to, a n d allowed to chart their own lives. T h i s freeing process for c h i l d r e n allows t h e m to draw o n their i n n e r resources for growth a n d self-direction"
(p. 51).
T h i s paper provides an overview o f the therapeutic principles involved i n play therapy. It was developed to address two questions c o m m o n l y asked by counsellors-in-training, "What distinguishes play therapy from play?" and, "What are the therapeutic processes that make play therapy effective?" A second goal o f the paper is to elaborate u p o n the use o f story as a meaningful i n t e r v e n t i o n for w o r k i n g with c h i l d r e n . F o l l o w i n g a discussion o f approaches to play therapy, a case study is described. T h e case study outlines the process o f play therapy supported by the thera-peutic use o f story with a six year o l d boy who was d e m o n s t r a t i n g behavioural problems i n b o t h h o m e a n d school settings. Examples o f the books read a n d stories developed to target the issues faced by the client are provided.
P R O C E S S O F PLAY T H E R A P Y
A c c o r d i n g to L a n d r e t h (1991), ". . . an inherent tendency exists within children to move i n subtle directedness toward adjustment, mental health, developmental growth, i n d e p e n d e n c e , autonomy o f p e r s o n h o o d a n d what can be generally described as self-actualization" (p. 60). Each child's view o f self is directly i n f l u e n c e d by his or her personal experiences a n d also determines the development o f general behavioural tendencies i n order to function i n the w o r l d . In play therapy the focus is o n the c h i l d ' s efforts to effectively cope with conflict a n d problems b o t h i n the present a n d i n the future.
L a n d r e t h (1991) states that the spirit o f c h i l d r e n is c o n t a i n e d i n their play. Play therapy allows c h i l d r e n to create a representation o f their i n -ner worlds a n d facilitates a wide range o f e m o t i o n a l expression. W h a t troubled c h i l d r e n n e e d most is for someone to recognize, acknowledge, a n d validate their e m o t i o n a l distress—not to solve their problems. C h i l -d r e n i n therapy often feel out o f c o n t r o l a n -d they nee-d a place o f safety to w h i c h they can escape. T h e play therapist applies sufficient limits so
that they can b r i n g themselves u n d e r c o n t r o l . T h e result is the establish-m e n t o f a therapeutic relationship where c h i l d r e n feel safe e n o u g h to play a n d to be i n c o n t r o l o f that part o f their life. T h a t sense o f c o n t r o l then transfers to other areas i n their lives.
A c c o r d i n g to G u e r n e y ( 1983), the most valuable tool that play thera-pists use is their ability to reflect the behaviour, thoughts, a n d affect that a c h i l d experiences t h r o u g h play. T h e abundant use o f empathie re-sponses demonstrates that the therapist understands what the c h i l d is experiencing. In play, when the therapist allows the c h i l d to feel the wide range o f his or her feelings, a n d where the therapist accepts a n d accu-rately reflects these feelings, that c h i l d ' s n e e d for acting out t r o u b l i n g behaviours can often "he e l i m i n a t e d .
A P S Y C H O D Y N A M I C A P P R O A C H T O PLAY T H E R A P Y
Play therapy was originally developed from a psychodynamic perspective as a vehicle by w h i c h c h i l d r e n c o u l d comfortably a n d therapeutically c o m m u n i c a t e a n d process their i n n e r thoughts a n d struggles. A c c o r d -i n g to E s m a n (1983), the major funct-ion o f play therapy -is to resolve any of the c h i l d ' s conflicts that interfere with the ability to function effec-tively within the environment. Play therapy encourages the development o f a therapeutic relationship allowing for the c h i l d ' s play to become a source o f i n f o r m a t i o n , w h i c h the therapist observes i n o r d e r to gain i n -sight into the i n n e r w o r l d o f the c h i l d . By c o m m u n i c a t i n g interpreta-tions a n d insight within the metaphor o f play to the c h i l d , the therapist helps the c h i l d to develop increased self-awareness. Support to develop more positive self-esteem assists the c h i l d to function more effectively within the environment.
A c c o r d i n g to Esman (1983), therapists have f o u n d that the best way to engage children i n the therapeutic process is to meet them at a place where they can easily a n d effectively communicate. C h i l d r e n are naturally and universally attracted to toys a n d play. They provide an effective way for the c h i l d a n d therapist to relate, thereby overcoming the child's natural resis-tance to dealing with painful life experiences. T h e result is the swift depar-ture o f the tension a n d fear that is often characterized as resistance i n clients. T h e rapid development of a therapeutic alliance between the thera-pist a n d the client allows for the child's imagination to become evident through play. T h e expression o f the child's behaviours, struggles, conflict-ridden issues a n d emotions lead to an overall reduction o f anxiety i n the c h i l d a n d eventually to p r o b l e m resolution. Play is a ". . . natural way for children to communicate a n d to act out sensitive material related to fright-e n i n g situations. T h r o u g h play, c h i l d r fright-e n gain thfright-e sfright-ecurity a n d sfright-elf-confi- self-confi-dence necessary to express underlying emotions a n d to try out new ways of t h i n k i n g a n d behaving" (Gumaer, 1984, p. 58).
Play therapy encourages t r o u b l e d c h i l d r e n to project difficult emo-tions such as fear, anxiety a n d guilt onto toys, allowing t h e m to distance themselves from the traumatic events a n d experiences that they find too painful to deal with directly ( L a n d r e t h , 1993). E n c o u r a g i n g the c h i l d to process difficult issues i n fantasy, the c h i l d remains feeling safe a n d i n c o n t r o l . T h e c h i l d is not r e q u i r e d to live t h r o u g h the trauma again. In-stead, the difficult issues are dealt with t h r o u g h the characters i n the story. By symbolically ". . . acting out t h r o u g h play a frightening or trau-matic experience, a n d perhaps c h a n g i n g o r reversing the outcome i n the play activity, c h i l d r e n move toward an i n n e r resolution, a n d then they are better able to cope with o r adjust to problems" (p. 17). T h e counsellor accepts a n d responds to the c h i l d ' s behaviour i n play by re-flecting a n d clarifying the feelings, thoughts a n d behaviours expressed
(Gumaer, 1984). T h e role o f the play therapist is to identify a n d label particular emotions that are relevant i n the c h i l d ' s play, thereby h e l p i n g that c h i l d l e a r n to recognize a n d actively express a wide range o f h u m a n e m o t i o n .
It is suggested by experts i n the field that play therapy is most effective with c h i l d r e n between the ages o f three a n d eight. However, with the use of b o a r d games, it can be adapted for o l d e r c h i l d r e n a n d y o u n g teens. Some psychologists even use play therapy with adults with dissociative disorders o r with adults whose development a n d opportunity to play was d e n i e d or stifled as a c h i l d .
T H E R A P E U T I C U S E O F S T O R Y IN C O N J U N C T I O N W I T H PLAY T H E R A P Y
A n intervention that c o m p l i m e n t s play therapy very well is the use o f story. Similar to the theoretical tenets o f play therapy, stories can com-municate to the c h i l d an acceptance o f self, provide for the expression of relevant emotions a n d contribute to the development o f a therapeu-tic relationship. T h i s intervention can promote h e a l i n g a n d is often used with c h i l d r e n who have b e e n traumatized or w h o are e x p e r i e n c i n g behavioural a n d e m o t i o n a l difficulties. T h e use o f stories can help to solve interpersonal problems a n d p r o m o t e mental health i n c h i l d r e n lacking self-esteem, appropriate role models, expressive language a n d a vocabulary with w h i c h to express feelings. Davis (1989) points out that it is a particularly helpful f o r m o f therapy with c h i l d r e n because stories are already a ". . . n o r m a l a n d interesting part o f a c h i l d ' s life" (p. 18).
T h e process o f selecting appropriate therapeutic stories involves find-i n g those that reflect the c h find-i l d ' s find-identfind-ity a n d p r o b l e m sfind-ituatfind-ions accu-rately a n d w h i c h result i n positive a n d achievable p r o b l e m resolution. T h e therapeutic use o f story i n therapy allows c h i l d r e n to read o r hear about others who have overcome problems similar to their own, giving them the o p p o r t u n i t y to apply what they have learned from the stories to
their own real-life situations (Pardeck, 1990b). "By reading about others similar to themselves, troubled c h i l d r e n may not feel so alone o r differ-ent" (p. 1043). It is effective with c h i l d r e n because it allows t h e m to ". . . see solutions to problems without the b u r d e n o f in-depth verbalization, confrontation, a n d interpretation, strategies w h i c h are often critical to successful i n t e r v e n t i o n " (p. 1044), a n d avoids the problems that many c h i l d r e n have with traditional interview-based therapy.
T h e therapeutic use o f story is g r o u n d e d i n psychoanalytic theory whereby the c h i l d ' s natural resistance to change a n d n e e d for reason i n the conscious is bypassed, a n d the h e a l i n g resources o f the unconscious are stimulated i n o r d e r to give insight. N a n c y Davis (1989) emphasizes the view that ". . . the" conscious m i n d does not need to understand a therapeutic story for the unconscious m i n d to understand the h e a l i n g message it holds" (p. 22). Davis (1990) also points out that therapeutic stories tend to make presented ideas or themes m o r e memorable. Pub-lished stories with therapeutic messages can be used or therapists can create their own individualized stories.
Pardeck (1990a) theorizes that there are three components to the therapeutic process, the first o f w h i c h is the identification a n d projec-tion stage. A t this point, similarities between the c h i l d a n d the m a i n char-acter o f the b o o k are evident a n d the c h i l d identifies with the needs, wishes, a n d frustrations o f that character. T h e next stage is abreaction a n d catharsis where the c h i l d experiences an e m o t i o n a l release o f feel-ings that may be expressed either verbally or nonverbally. Because the c h i l d has identified a n d projected his or her own feelings onto the m a i n character(s) o f the story, when the character experiences the e m o t i o n a l release o f feelings about the story, the c h i l d ' s feelings are released as well. T h e final stage is insight a n d integration where the c h i l d recog-nizes h i m / h e r s e l f a n d significant others i n the characters o f the story a n d gains insight into the significance o f the similarities.
T h e therapeutic use o f story also " . . . draws o n theoretical constructs developed i n l e a r n i n g theory. A c c o r d i n g to l e a r n i n g theorists, humans l e a r n by i m i t a t i o n " (Pardeck, 1990a, p. 231). T h e fictional characters i n books are therapeutically offered as models o f positive, adaptive behaviour with w h i c h the c h i l d can identify. T h i s is especially i m p o r t a n t for chil-d r e n who lack positive family role mochil-dels as it allows them to reachil-d about others who have overcome problems similar to their own. T h i s provides c h i l d r e n with a corrective experience a n d gives t h e m the opportunity to apply what they have l e a r n e d from the stories to their own real-life situa-tions (Bauer & Balius, 1995).
D e t e r m i n i n g the successful use o f story i n a therapeutic setting can be observed when the c h i l d makes a c o n n e c t i o n with the story i n question. Davis (1990) says evidence that a c o n n e c t i o n has o c c u r r e d is when the c h i l d asks for a certain story repeatedly or responds to a particularly
helpful story with a c o m m e n t similar to, "I love that story." She points out that i f the story does not directly apply to the c h i l d or is not helpful for h i m or her, the c h i l d will appear uninterested a n d will not ask to hear the story again.
C A S E S T U D Y
Although there are several theoretical orientations that guide play therapy, a client-centred perspective (Rogers, 1980) f o r m e d the basis o f a treat-ment program with a six-year-old boy who was demonstrating behavioural problems i n the adjustment r e q u i r e d o f entering grade one. T h e pro-cess o f play therapy with the therapeutic use o f story demonstrates how a c h i l d can be h e l p e d to achieve a stronger a n d more positive sense o f self. Therapeutic goals, client assessment, a n d intervention strategies are dis-cussed.
Client Background
Jason is a six-year-old boy who attends grade one at his n e i g h b o r h o o d elementary school i n a lower to m i d d l e socio-economic area o f the city. Jason lives with his g r a n d m o t h e r who has legal custody, his eight-year-old sister, an uninvolved step grandfather a n d his m o t h e r who is unable to be emotionally available to her c h i l d r e n . H i s m o t h e r is diabetic (which is adversely affecting the health o f her heart), terminally i l l with ovarian cancer, smokes heavily, a n d is addicted to drugs. She leaves the family residence, often for days at a time, with no one knowing where she is o r when she will return. A t these times she admits that she escapes into a w o r l d o f d r u g use because the stresses o f her life become more than she can cope with. Jason a n d his m o t h e r lived alone together for the first four years o f his life at which time she was heavily using drugs a n d quite neglectful o f h i m . It appears that they have a mutually c a r i n g relation-ship but Jason's m o t h e r has said that she does not want her son to get too close to her because it will be harder o n h i m when she dies (which she expects to h a p p e n soon).
Jason's g r a n d m o t h e r appears to be a stable influence with for b o t h Jason a n d his sister; however, Jason was not yet securely attached with his g r a n d m o t h e r . T h e g r a n d m o t h e r ' s vocal disapproval o f his m o t h e r ' s behaviour a n d her reminders to the family that Jason was b o r n a prob-lematic "trouble-maker like his father" may be interfering with the pro-cess of attachment and may be h i n d e r i n g Jason's healthy self-actualization. Some family therapy has been attempted with Jason's mother a n d grand-mother but neither of them has engaged i n the therapeutic process. Treat-ment with Jason was initiated at the school's request i n order to help h i m deal with his problematic ways o f c o p i n g with conflict (i.e., temper tan-trums, r u n n i n g away, a n d hurtful behaviours towards his peers a n d
sis-ter) w h i c h have resulted i n h i m b e i n g labeled as a "bully" a n d b e c o m i n g socially isolated.
Goals of Play Therapy
T h e major goal o f play therapy is to p r o m o t e the development o f the c h i l d client by h e l p i n g that c h i l d to learn about a n d accept h i m / h e r s e l f . T h e play therapist provides the c h i l d with a positive growth experience i n o r d e r to discover his o r her i n t e r n a l strengths. M o r e specifically, a c h i l d - c e n t r e d play therapy p r o g r a m attempts to assist the c h i l d to ". . . develop a more positive self-concept, assume greater self-responsi-bility, become more seTf-directing, self-accepting a n d self-reliant, engage i n self-determined d e c i s i o n m a k i n g , e x p e r i e n c e feelings o f c o n t r o l , become sensitive to the c o p i n g process, develop an i n t e r n a l source o f evaluation, a n d become more self-trusting" ( L a n d r e t h , 1991, p. 80). W i t h i n this framework is a belief that c h i l d r e n are capable o f setting their own goals, acting them out i n their play, a n d developing the skills necessary to solve their problems i n their own way.
T h e overall purpose o f Jason's play therapy p r o g r a m was to provide h i m with an experience o f total acceptance, where he c o u l d feel free a n d safe to be himself. W i t h i n this e n v i r o n m e n t Jason was given the op-portunity to learn about a n d accept h i m s e l f as a worthwhile person. T h e first objective was to establish a therapeutic relationship with Jason thereby allowing h i m to develop a more positive concept, become more self-accepting, become aware o f the process o f c o p i n g , a n d to develop an i n t e r n a l source o f evaluation rather than l o o k i n g to others to determine his value. T h i s was achieved t h r o u g h the m e d i u m o f play a n d ad o p t i n g an accepting and respectful outlook towards whatever choices Jason made. A n o t h e r early specific goal was to encourage Jason to express o f a wide range o f emotions. By encouraging Jason to be i n c o n t r o l o f his thera-peutic process the goals o f b e c o m i n g responsible, directing, self-reliant a n d m o r e comfortable a n d confident m a k i n g decisions were allowed to be reached.
T h e stories that were shared with Jason throughout his treatment were chosen a n d created to reflect some o f the same issues with w h i c h he h a d been struggling, a n d to find positive experiences a n d solutions to those problems (i.e., e x p e r i e n c i n g a wide range o f emotions a n d expressing them i n acceptable ways, discovering a n d appreciating strengths; living i n a chaotic a n d fearful e n v i r o n m e n t while finding a way to experience peace a n d contentment within that environment, a n d d e a l i n g with the loneliness a n d frustration o f b e i n g socially isolated). T h e goal was to help Jason replace some o f his ineffective ways o f c o p i n g with more so-cially acceptable a n d appropriate behaviours similar to those used by c h i l d r e n i n the presented stories.
Intervention Strategies
Play therapy was d e t e r m i n e d to be the treatment o f choice with Jason because he was six years o l d a n d w o u l d be able to express h i m s e l f a n d grow emotionally more effectively through the m e d i u m o f play than with any other verbal-based i n t e r v e n t i o n . T h e r a p e u t i c stories were also used i n o r d e r to provide h i m with positive experiences i n relation to his trou-b l i n g issues w h i c h were different from those he lives with i n real life.
O n e o f the most i m p o r t a n t aspects o f play therapy are the toys pro-vided for the client to create scenarios that will allow the c h i l d to play out his o r her issues. Play therapists w h o must transport their p l a y r o o m be-tween schools n e e d to be extremely selective a n d choose only toys that are particularly facilitative o f c o m m u n i c a t i o n a n d provide for the ex-pression o f a wide range o f emotions a n d symbolic representations. Fol-lowing is a sample o f the toys that were p r o v i d e d for Jason to play with a n d a description o f some o f the ways that he used t h e m therapeutically. Two telephones were available a n d Jason initially used t h e m to talk to a n d "get to know" the therapist. Later i n therapy he used the phones to rehearse telling his m o t h e r about the negative i n c i d e n t report he h a d received at school earlier that day.
Attacking a n d b e i n g attacked were frequent types o f play for Jason. H e staged many battles a n d used a g u n to shoot foam darts at imaginary characters, i n c l u d i n g monsters, knights, soldiers a n d an array vehicles with weapons. A t first Jason d i d not indicate that there was any reason for the fighting. T h e r e were n o g o o d o r b a d guys a n d everyone always d i e d i n the e n d . As therapy progressed, it became evident that there were g o o d guys a n d b a d guys w h o were fighting over l a n d , money, or revenge for h u r t i n g others. A dinosaur puppet with b i g teeth was often an i m p o r t a n t part o f Jason's play. It was frequently the bad dinosaur w h o attacked a n d hurt g o o d guys a n d Jason w o u l d lock it i n the suitcase for punishment. Rope that i n the first session was used to "tie" the therapist i n a chair was later used i n therapy to tie u p the dinosaur so he was no longer able to hurt g o o d guys.
N u r t u r i n g a n d healing were significant aspects o f Jason's therapy. T h i s usually o c c u r r e d near the e n d o f therapy sessions where intense conflict issues h a d been acted out i n his play. Jason often used plastic dishes, sparkling jewels, a n d playdough to prepare special "meals" for us. A r t materials were very i m p o r t a n t for Jason to express some o f the distress-i n g feeldistress-ings he e x p e r distress-i e n c e d about traumatdistress-ic events distress-i n hdistress-is ldistress-ife. F o r ex-ample, he used the playdough to make a teddy bear w h o got his ear cut off one week after his grandfather's d o g bit Jason's ear a n d he r e q u i r e d several stitches. T h e next week he drew a picture o f himself attempting to make friends with a d o g .
W h i l e J a s o n played out these scenarios the therapist reflected his behaviours, thoughts a n d feelings o n a regular basis i n the most
accept-i n g way possaccept-ible accept-i n o r d e r to c o m m u n accept-i c a t e to h accept-i m an understandaccept-ing o f what he was e x p e r i e n c i n g d u r i n g his play.
L i m i t setting was an issue that rarely caused problems i n Jason's thera-peutic process. In the first session the therapist told Jason he c o u l d play with the toys i n almost any way he wanted a n d she w o u l d let h i m know i f there was something he c o u l d not do. T h e only rules were that he was not allowed to hurt himself, the therapist, or purposely damage any equip-ment. In play therapy it is expected that clients will test the limits. Early in therapy, when Jason was throwing the b o p bag a r o u n d very aggres-sively a n d started to move towards the therapist with it, he was told "It looks like you're t h i n k i n g about h i t t i n g me with that b o p bag, but re-m e re-m b e r that you are hot allowed to hit re-me i n therapy." H e shrugged his shoulders a n d threw it i n the other d i r e c t i o n .
Assessment of Client Issues
In o r d e r to gain a better u n d e r s t a n d i n g o f their clients, many play thera-pists obtain important i n f o r m a t i o n about the c h i l d , the presenting prob-lems, a n d the family history. T h i s is also crucial i n order to select or create stories that address the issues that are the most troublesome for clients. Information about Jason, his presenting problems, a n d his fam-ily history was gathered at the b e g i n n i n g o f therapy through interviews with his teachers, his mother a n d grandmother, as well as the family's previous therapist.
Projective tests that were used to assess Jason's affect a n d significant issues were Draw A Person, H u m a n Figure Drawing Inquiry, H o u s e , Tree a n d Person Drawings, a n d a Sentence C o m p l e t i o n F o r m , administered both at the b e g i n n i n g a n d t e r m i n a t i o n o f Jason's treatment. T h e m e s evident i n the initial assessments were c o m p a r e d with those f o u n d i n the final assessment to determine growth a n d evidence o f healing.
Assessment i n play therapy can also be a c c o m p l i s h e d through infor-mal observation o f the c h i l d ' s play a n d viewing that play as a metaphor for what he or she is e x p e r i e n c i n g i n his o r her real life. It is necessary to observe themes that recur i n a c h i l d ' s play before it is possible to accu-rately hypothesize about the evident meanings. Observations o f Jason's b e h a v i o u r i n therapy revolved a r o u n d significant themes that were d e e m e d so because they were r e c u r r i n g .
Evaluation of Therapeutic Gains
Play therapy is a slow process a n d the therapist must ". . . wait patiently for each c h i l d ' s self to emerge" ( L a n d r e t h , 1991, p. 322). T h e success o f play therapy can best be d e t e r m i n e d t h r o u g h observations o f qualitative differences i n the c h i l d ' s play. L a n d r e t h believes that the success o f a play therapy program s h o u l d be viewed globally rather than t h r o u g h the
attainment o f p r e d e t e r m i n e d specific objectives. However, he lists fif-teen specific changes that the therapist s h o u l d be watching for when d e t e r m i n i n g success a n d readiness for the c h i l d to leave therapy. T h e c h i l d becomes 1) less dependent, 2) less confused, 3) expresses needs openly, 4) able to focus o n self, 5) responsible for own actions a n d feelings, 6) able to l i m i t own behaviour appropriately, 7) m o r e inwardly d i -rected, 8) m o r e flexible, 9) m o r e tolerant o f happenings, 10) able to initiate activities with assurance, 11) cooperative but not c o n f o r m i n g , 12) able to express anger appropriately, 13) able to express happy a n d pleased affect, 14) more accepting o f self, a n d , 15) able to play out story sequences i n a direct way. Evidence that the therapeutic process is occur-r i n g can be obseoccur-rved w h e n the theoccur-rapist notices that behaviouoccur-rs aoccur-re oc-c u r r i n g for the first time i n play therapy. A n indioc-cation that the oc-c h i l d has e x p e r i e n c e d success i n play therapy is when previously r e c u r r i n g emo-tional experiences are n o longer observed i n the child's play.
Jason h a d twenty-three play therapy sessions a n d the most healing part of therapy appeared to be that these sessions provided h i m a place o f safety to escape his chaotic life. W i t h i n this e n v i r o n m e n t Jason was able to learn to b r i n g himself a n d his behaviours u n d e r control, first i n therapy a n d then m o r e slowly into the rest o f his life. By having his feelings, thoughts a n d behaviours i n play understood, accepted, a n d reflected accurately, his n e e d to act out those chaotic a n d t r o u b l i n g experiences i n other areas o f his life were d i m i n i s h e d .
Evidence that a therapeutic relationship was developing was observed i n Jason's physical reactions when his therapist p i c k e d h i m up weekly at his classroom. H e was very apprehensive about c o m i n g to his first five sessions a n d sometimes h a d to be c o n v i n c e d to come. H i s sixth session m a r k e d his first smile i n therapy a n d the first eye contact he h a d with the therapist. Before his tenth session he greeted his therapist at his class-r o o m d o o class-r with a big smile a n d immediately began asking questions about the u p c o m i n g session. Also, a tone o f relaxation, calm, a n d cheerfulness appear to have developed over the course of Jason's treatment that cer-tainly was not present i n the b e g i n n i n g . Initially Jason came i n t o the playroom very stiff, silent, a n d anxious l o o k i n g . N e a r the e n d o f therapy he came i n chattering cheerfully a n d smiling.
In the observations made o f Jason's play it was n o t i c e d that there was a gradual decrease i n his n e e d to express anger t h r o u g h physical aggres-sion. Early i n therapy Jason w o u l d hit the b o p bag continuously for 5 to 10 minutes with surprising force. H i s fellings were expressed with simi-lar intensity d u r i n g play with an aggressive l o o k i n g dinosaur or the army toys that he w o u l d sometimes shake. However, Jason d i d n o t hit the b o p bag once i n his last three sessions a n d b o t h the time spent a n d the inten-sity involved i n hitting a n d k i c k i n g it decreased considerably throughout therapy.
A significant indicator o f success i n Jason's treatment was apparent i n his use o f handcuffs to deal with his struggle with the issue o f c o n t r o l . D u r i n g the initial stages o f therapy Jason chose to handcuff the therapist to the coat-rack or chair when playing out conflict-ridden scenarios. Af-ter three months o f weekly sessions a dramatic shift was observed when for a few minutes he handcuffed h i m s e l f to the therapist a n d through-out the r e m a i n d e r o f his treatment he d i d not suggest once that the therapist be handcuffed. Slowly Jason began to involve the therapist i n his play about conflict situations a n d the handcuffs began to be used as a symbol o f heroism rather than c o n t r o l .
It was apparent that Jason made a significant c o n n e c t i o n with two sto-ries that were created for h i m a n d the stosto-ries appeared to have a pro-f o u n d epro-fpro-fect o n his h e a l i n g process. B o t h his teachers a n d therapist recognized that a major issue for Jason was his social isolation. Jason was labeled i n the school c o m m u n i t y as a "bully" because o f his sometimes aggressive a n d threatening behaviour i n the school a n d o n the play-g r o u n d . D u r i n play-g one therapy session Jason appeared to be i n a quiet a n d reflective frame o f m i n d a n d so the therapist d e c i d e d to tell h i m a story that m i g h t h e l p h i m deal with peer issues. T h e story was about a little boy who l i k e d to go to school a n d play, a n d who also wanted to have lots of friends. However, the little boy thought that the other kids at school were unfair a n d mean w h i c h caused h i m to get very angry. T h e opportu-nity for change o c c u r r e d when a new student arrived a n d they became "best friends." T h e story contained several ideas about what b e i n g a g o o d friend involves i n hopes that Jason w o u l d incorporate some o f the ideas into his own life. It i n t r o d u c e d conflict w h e n a friend pushed Jason down a n d he reacted by wanting to hurt h i m i n retaliation. But at the last minute Jason r e m e m b e r e d all o f the fun they h a d together a n d d e c i d e d to leave his f r i e n d alone to cool off. Later i n the day the friend apologized to Jason for p u s h i n g h i m d o w n , e x p l a i n e d his behaviour, a n d recognized the impact it h a d o n Jason a n d asked for forgiveness. T h e story e n d e d with Jason b e i n g able to see the situation from his friend's perspective, forgiving h i m , a n d then participating i n cooperative activities together.
In o r d e r to help Jason develop self-care skills a n d to access a calm i n n e r state, a story was created for h i m that h i g h l i g h t e d the integration o f a wise b e i n g into his concept o f self. Jason's h o m e life was chaotic a n d full o f conflict; therefore a situation i n the story was presented where the m a i n character was able to find peace, n u r t u r i n g , a n d comfort within a chaotic a n d fearful environment. In one o f his therapy sessions, Jason was playing i n a large box, w h i c h he was p r e t e n d i n g to be his cave. T h e therapist used this m o m e n t o f calm a n d peacefulness to tell a story about a little boy who lived a l l alone i n a cave. H e was afraid to leave the cave because o f the unpredictable nature o f the weather outside, but was req u i r e d to venture out occasionally i n search o f food when he was h u n
-gry. O n one such occasion, the little boy met a wise o l d m a n a n d they h a d a wonderful time p i c k i n g raspberries together. O n the way home the chaos o f a blizzard developed a n d the wise o l d m a n took the little boy's c o l d , shivering h a n d i n his strong, warm one and wrapped his large cape a r o u n d the little boy to keep h i m w a r m . T h e wise o l d m a n g u i d e d the little boy safely back to his cave a n d p l a n n e d to leave because he knew how m u c h the little boy l i k e d to be alone. However, the little boy had grown to love a n d care about the wise o l d m a n and invited h i m into the cave to share his meal o f raspberries that they had p i c k e d together. In the end, the little boy was not frightened to leave his cave anymore, because he know that the wise o l d m a n w o u l d always be there to help keep h i m safe. T h i s story was t o l d to Jason at the e n d o f his therapy session a n d as he left to return to the classroom, he said, "You remember that story exactly like that for next week a n d d o n ' t change any o f the words. O K ! "
Early i n therapy, Jason was not yet at a place where he c o u l d benefit from the h e a l i n g messages h e l d i n the books that were shared with h i m . However, i n his last session w h e n the therapist read the story, Oh, The
Places You'll Go (Suess, 1990), he appeared to be eagerly involved i n the
story a n d asked to have it read to h i m again. A list o f the books that were shared with Jason is c o n t a i n e d i n the A p p e n d i x .
F i n a l interviews with his teachers indicated that a dramatic shift i n Jason's ability to function i n the school setting had taken place. O t h e r teachers a n d support staff i n the school had been i n q u i r i n g about play therapy because they h a d seen such a noticeable difference i n Jason's behaviour since September. In December, Jason's h o m e r o o m teacher re p o r ted that Jason was p e r f o r m i n g significantly below grade level i n his reading a n d writing skills a n d it was likely that the school w o u l d be sug-gesting that he repeat grade one. However, i n the winter school term b o t h his reading and writing skills increased so dramatically that he was w o r k i n g above grade level. It seems that Jason's play therapy p r o g r a m allowed h i m to deal with his e m o t i o n a l anxiety, freeing u p his energy to absorb what was b e i n g taught to h i m i n the classroom. Jason had not h a d a temper tantrum or r u n away from school since early O c t o b e r and only occasionally gets involved i n schoolyard conflicts with other c h i l d r e n . H e has become m u c h less socially isolated a n d has even developed some tentative friendships with school peers. A final interview with Jason's g r a n d m o t h e r indicated that Jason's ability to deal with conflict effec-tively had i m p r o v e d at h o m e as well, a n d that he a n d his sister seemed to be getting a l o n g better.
Evidence collected from projective testing was used to investigate changes i n Jason's overall e m o t i o n a l well being. "Projective techniques are utilized because they tap the c hild' s unconscious. Since therapeutic stories are designed to talk to the unconscious o f the c h i l d , the
inter-pretation o f the drawings or the symbols the c h i l d uses.. .can serve as very powerful agents for change when used by the therapist" (Davis, 1990, p. 9). Validation o f the therapist's interpretation o f the projective tests a n d the i m p o r t a n t themes observed i n Jason's play o c c u r r e d through case consultations with two supervising therapists. Several themes were evi-dent at the initial administration o f the projective tests that demonstrate the "clients' perceptions o f their relationships to important others i n life such as family or friends a n d to their environments such as h o m e a n d s c h o o l " (Gumaer, 1984, p . 99). A view o f self as trouble-causing, injured, a n d fragile was apparent i n his drawings o f a broken-down house with cracked a n d jagged windows, a flower that was d r i p p i n g b l o o d , a n d a tree that was about to be destroyed. Isolation a n d rejection was heard i n his responses to his drawing inquiries a n d sentence c o m p l e t i o n when he wished that he w o u l d not cause his family members so m u c h trouble, a n d that he w o u l d not be so "bad". T h e desire to seek relief from adverse situations was evident i n his stated wishes to be an a n i m a l that c o u l d escape fearful situations.
Final evaluation assessments with Jason indicated that a shift i n pre-d o m i n a n t themes h a pre-d o c c u r r e pre-d a n pre-d at termination Jason was pre-displaying themes o f wanting to make connections with a n d to be heard by signifi-cant others i n his life. T h i s was apparent i n his drawing o f a d o g that he was trying to make friends with as well as drawing i n q u i r y a n d sentence c o m p l e t i o n responses stating his wishes to go c a m p i n g a n d s w i m m i n g with his mother, grandmother, a n d sister. Also evident was the expres-sion o f a variety o f feelings i n c l u d i n g both pleasant a n d happy ones as well as angry, confused, a n d fearful ones. Jason drew o n the c h a l k b o a r d a large tree with many circles inside it, each expressing a different feel-i n g feel-i n d feel-i c a t feel-i n g recognfeel-itfeel-ion that the same person c o u l d experfeel-ience many different feelings. A more secure a n d g r o u n d e d view o f self i n relation to his environment at the termination o f therapy was apparent i n his house a n d tree drawings. N o evidence o f an escaping theme c o u l d be detected in his final drawings.
C O N C L U S I O N
W h e n treating c h i l d r e n i n a therapeutic setting it is imperative to look at the w o r l d as the c h i l d sees it. C h i l d r e n are inherently active a n d their natural language is play. It is, therefore, necessary to allow c h i l d r e n to express themselves a n d to heal t h r o u g h the m e d i u m with which they are most comfortable. B o t h play a n d story can be used effectively by thera-pists to create an e n v i r o n m e n t for t r o u b l e d c h i l d r e n , which is conducive to self-awareness, growth, a n d healing. However, because the use o f thera-peutic stories is never used i n i s o l a t i o n , it is difficult to specify the behaviours that indicate their successful use. Consequently, Davis (1990)
advises the use o f projective tests with c h i l d r e n t h r o u g h o u t the thera-peutic process i n o r d e r to chart the child's general progress towards emotional health. Despite limitations i n drawing generalizations from one case a n d the possible c o n f o u n d i n g effects o f the authors' respective roles as therapist a n d practicum supervisor, we hope that this case illus-trates the healing relationship that can occur t h r o u g h play therapy a n d the therapeutic use o f story. W i t h i n the m e t a p h o r a n d symbolic w o r l d o f play a n d story c h i l d r e n are able to distance themselves from the trou-b l i n g issues with w h i c h they struggle, a n d yet are still atrou-ble to effectively process their traumatic experiences a n d events.
References
Axline, V. ( 1969). Play therapy. New York, NY: Ballentine.
Bauer, M. S., & Balius, F. A. (1995). Storytelling: Integrating therapy and curriculum for chil-dren with serious emotional disturbances. Teaching Exceptional Chilchil-dren, 27(2), 24-28. Davis, N. (1989). The use of therapeutic stories in the treatment of abused children. Journal of
Strategic and Systemic Therapies, 8(4), 18-23.
Davis, N. ( 1990). Therapeutic stories to heal abused children. Oxon Hill, MD: Psychological Associ-ates of Oxon Hill.
Esman, A. H . (1983). Psychoanalytic play therapy. In C. E. Schaefer & K . J . O'Connor (Eds.), Handbook of play therapy (pp. 11-20). Toronto, O N : John Wiley & Sons.
Guerney, L. F. (1983). Client-centered (nondirective) play therapy. In C. E. Schaefer & K . J . O'Connor (Eds.), Handbook of play therapy (pp. 21-64). Toronto, ON:John Wiley & Sons. Gumaer, J. ( 1984). Counseling and therapy for children. New York, NY: The Free Press.
Landreth, G. L . , (1991). Play therapy: The ari of the relationship. Bristol, PA: Accelerated Develop ment.
Landreth, G. ( 1993). Child-centered play therapy. Elementary School Guidance Ù? Counseling, 28, 17-29.
Pardeck, J. T. (1990a). Bibliotherapy with abused children. Families in Society: The Journal of Contemporary Human Services, 71(4), 229-235.
Pardeck, J . T. (1990b). Using bibliotherapy in clinical practice with children. Psychological Re-ports, 67,1043-1049.
Rogers, C. (1980). A way of being. Boston, MA: Houghton Mifflin. Seuss, Dr. (1990). Oh, the places you'll go. New York, NY: Random House.
Appendix
Stories Used in Conjunction With Jason's Play Therapy Program Carlson, N. (1988). Ilikeme. New York, NY: Puffin Books.
Garth, M. (1992). Moonbeam: A book of meditations for children. North Blackburn, Victoria, Austra-lia: Harper Collins.
Godwin, P. ( 1993). Ifeel orange today. Toronto, O N : Annick Press Ltd. Seuss, Dr. (1990). Oh, the places you 'II go. New York, NY: Random House.
Viorst, J. ( 1972). Alexander and the terrible, horrible, no good, very bad day. New York, NY: Aladdin Books.
About the Authors
Roxanne Carlson holds a M.Ed, degree in Counselling Psychology from the Department of Educational Psychology, University of Calgary. Her counselling practice with Calgary Family Services Bureau includes play therapy and the creative use of story in working with children. Nancy Arthur is an Associate Professor and counsellor educator in the Department of Educa-tional Psychology, University of Calgary. Her professional practice interests include multicultural counselling, career and cross-cultural transitions.
Address correspondence to: Nancy Arthur, Ph.D., Department of Educational Psychology, The University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4
