Bożena Muchacka Pedagogical University of Cracow
Play as a form of therapy for children (historical and pedagogical aspects of problem)
Play is a spontaneous activity which arises from the mental, physical, and perhaps also social requirements of children. It is a “natural” activity of the child and it may be employed, as well as drawing (Wallon, Cambier, Engelhart 1993; Fleck-Bangert 2004; Oster, Gould 2005; Czaja-Chudyba 2006; Muchacki, Stolińska 2004), during a therapy with children (aged from three to twelve years) because of its diagnostic value. Play provides a possibility for children to express their emotions and feelings through a natural and self-healing process. Friedrich Fröbel (1782–1852), a German educator, writes that play “[…] is the highest [form of] development in childhood, for it alone is the free expression of [it] what is in the child’s soul […]” (1903: 22). Moritz Lazarus (1824–1903), a German philosopher and psychologist, and a famous professor of Preussische Kriegsakademie [Prussian Military Academy] in Berlin (1868–1872) and next of the University in Berlin (from 1873), presented the therapeutic aspects of play in his important theory of play-recreation and play-relaxation (1883/1907, in: Kalmar 1987: 671–690; Klein 2004). The first (known and documented) case of the therapeutic use of play by “great” Sigmund Freud (1856–1939) was noted in Wien in 1909 (Freud 1921: 287–305). In the 1930s, psychologists and therapists working with children developed the theory of play therapy as well as the practical use of play in therapy with children. In 1934, Frederick Allen presented a new approach to the problem of play therapy (1934: 193–202) and David Levy (1938: 387–389) in the 1930s developed a new technique of play therapy (called “release therapy”) to deal with children with specific Bożena Muchacka 12 trauma. He showed that each child who had experienced a specific stressful trauma-situation would re-enact her/his trauma in “free” play (Levy 1938: 387–38). In 1932, Melanie Klein (1882–1960), the famous (Austrian-born) British psychoanalyst, incorporated play into her therapeutic sessions with children as the iure into therapy. In the 1940s, she devised a therapeutic technique for children that had an impact on the development of child psychology and contemporary psychoanalysis (Klein 1955: 223–237; see also: Ead. 1955: 122–140; Ead. 1955: 3–22; Grosskurth 1986; Kristeva 2004). After observing troubled children play (with toys [dolls], animals, etc.), Klein attempted to interpret the specific meaning [contents and forms] of child’s play (1959: 291–303). She explained the therapeutic function of play and also stressed that play therapy may provide a possibility to solve the child’s emotional problems. Donald W. Winnicott and John Bowly were her co-workers in that area and they continued her work. In the 1930s, Joseph C. Soloman developed a technique of “active play” which was used in therapeutic work with impulsive children, and Frederick Allen used Otto Rank’s theory of “birth trauma” in his practical work with children in play therapy and in his theory of relationship therapy. In the 1940s, psychologists and psychiatrists stressed that play may be used as a form of children’s psychotherapy, in which children reveal their problems as a “fantastic spectacle” to their toys or sometimes to their animals. During playtime, the therapists and children enter into a relationship which is designed to enable (the child) to experience basic trust and to trigger fantasies that represent the child’s conscious and unconscious thoughts. Children may learn to re-model the types of their emotional behaviour that have impaired their development. The play-setting (toys, creative tools and materials) and also the “freedom” of play activity (to do and to say whatever the child wishes) encourages the troubled child to realize a sense of child’s identification, transform her/his attitudes from passivity into activity, and separate fantasy and reality. Leo Kanner (1894–1981), an Austrian-born American psychiatrist and physician, devised a new diagnostic method for children. He offered children an opportunity to express themselves by speaking on behalf of dolls representing their parents and siblings, teachers or themselves. Kanner’s method gives the possibility to observe playing children (1943: 217–250). Play as a form of therapy for children... 13 Ernest Harms (1895–1976), a well-known American philosopher and psychiatrist, presented the diagnostic function of play in his paper in 1948 (1948: 233–246) and the play techniques in a handbook (1964). He allowed the psychologists to observe child’s spontaneous play-activity and he stressed that a serious attempt to create the systematic basis for the play-diagnosis must include understanding of the specific character and interrelationship of: [a] psychology of a child and psychology of play, [b] philosophy of play, [c] childhood mental illness. He also explained that child’s play is the response (or may be the reaction) to her/his unconscious motivation. Thus, the understanding of play seems to enhance the understanding of the child’s motivation and behaviour (1948: 233–246). Incidentally, it is worth recalling that Ernest Harms was an author (and co- -author) of papers (1944: 112–122) and monumental books on children’s psychiatry and psychology (Harms 1960, 1962; Id., Problems of Sleep and Dream in Children, New York 1964, 1967; Harms, Jenkins 1976). Virginia M. Axline (1911–1988) was one of the American pioneers in the use of play therapy in her therapeutic work with children. She studied child’s psychology and psychology of play (at the Ohio State University and Columbia University). She taught six years in two schools (the School of Medicine and the School of Education) at the New York University and next she taught seven years in the Teachers’ College at Columbia University. Axline is also the author of Play Therapy, a book which since its first publication in 1947 (in New York) has helped to make her name synonymous with the technique of play therapy for children (Ekslajn/Axline 2003). She also wrote Dibs in Search of Self: Personality Development in Play Therapy (first edition in the USA was in 1964), the story of Dibs, a little boy, in search of self through the process of psychotherapy. In the 1940s, Axline began to develop nondirective play therapy, the principles of which were based on Carl Rogers’ newly-emerging person-centred approach1. Current play therapy practice (in the contemporary USA and Western Europe) is still largely based on Virginia Axline’s therapeutic work with children2.
1 In her text Entering the Child’s World Via Play Experiences [“Progressive Education” Vol. 27: 1950, pp. 68–75], Axline summarized her concept of play therapy. 2 See: http://en.wikipedia.org/wiki/Virginia_Axline – [dated: 2 December 2011]. Bożena Muchacka 14 Virginia Axline established eight basic principles of nondirective play therapy with children. In her opinion, each play therapist: [1.] must develop a warm, friendly relationship with the child, in which good rapport [between them – B.M.] is established as soon as possible, [2.] accepts the child exactly as she/he is, [3.] establishes a feeling of permissiveness in the relationship (and the child feels free to express her/his feelings completely), [4.] is alert to recognize the feelings that the child is expressing and reflects those feelings back to the child in such a manner that s/he gains insight into the child’s behaviour, [5.] maintains deep respect for the child’s ability to resolve her/his own problems if given an opportunity to do so, [6.] does not attempt to direct the child’s actions or conversation in any manner, [7.] does not attempt to hurry the therapy along [because it is a gradual process], and [8.] establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of her/his responsibility in the relationship (Axline 1989). Virginia Axline also presented the view that the playing child express her/his attitudes and concepts about herself/himself in relation to others people (1951: 358–363). In the 1950s, the theory of play therapy (as well as the practical use of play in therapy with children) was studied by the play therapists. In 1951 both Isidor Bernstein and Eugene Evart-Chmielnicki wrote about the diagnostic application of children’s play (Bernstein 1951: 503–508; Evart- -Chmielnicki 1951: 18–34). In the 2nd half of the 20th century, play therapists as well as educationists and psychologists presented play as the medium in therapy with children. In their papers and books, they stressed that play in therapy may be used for children suffering from a wide range of problems: from different “reactive” situations (such as a recent death in the family or the divorce of parents) to chronic stress or illness. In the scientific views of modern researchers, the use of play in therapy sessions with children is appropriate in many circumstances (abuse [by parents or by siblings] of alcohol or drugs, violence in the child’s family, maltreatment in the child’s family or at school) and disorders (brain dysfunction, brain damage syndrome, depressive psychosis and depression, Play as a form of therapy for children... 15 aggressive conduct disorder, attention-deficit disorder, hyperkinesias, etc.) as well as in children impairments or disturbances (autism, enuresis, etc.) and also emotional or sensor-motor problems. Edna Salant (1980: 93–97) discusses the preventive use of play therapy in the treatment of the preschool child. She states that play provides a good opportunity to initiate therapeutic intervention when there are indications that a child needs it. Play may also be used by a child to communicate a family-, kindergarten- or school-conflict, fear, and other problems. In her/his play, the child may express emotions that indicate whether s/he is happy or sad. In the 1980s, experience with play therapy enabled American and Western-European psychiatrists (working with children) to apply an entire spectrum of modern treatment (in a socially appropriate way). Paul Fine (1982: 79–96) stresses that biological, behavioural, social and other forms of therapy can be anchored in a child’s play. Other psychiatrists (especially children neuropsychiatrists) discuss play as an effective therapeutic tool for the medical experts working with children with psychiatric disorders or physical handicaps (Guillemaut 1982: 415–422; Sikes, Kuhnley 1984: 272– 285; O’Connor 1986: 105–108; Conn 1989: 3–13; Baran 1998: 40–41). Valeria Sikes and John E. Kuhnley (1984) emphasize that play therapy may provide a corrective emotional experience in a schizophrenic child. Child’s play, in their opinion, is an instrumental tool (in the multimodal approach to treatment) in “producing” a re-integration of the child’s fragmented ego functions (Sikes 1984: 272–285). The contemporary play therapy used in schizophrenia is based on their therapeutic work experience with the schizophrenic child. Kevin O’Connor (1986) also shows play as a medium for testing a model of child’s depression. He claims that play enables to estimate the following agents: affective pain, anger at an object, introjections of an object and associated anger, and depressive symptoms (O’Connor 1986: 105–108; von Gontard, Lehmkuhl 2003: 35–48 and 88–97). Play therapy of children (aged 3–5 years) who were sexual abuse victims has also been studied by Redmond Reams and William Friedrich (1994)3 and next by Karyn Dailey Jones (2002: 377–389).
3 See: http://en.wikipedia.org/wiki/Play_therapy – [dated: 29 November 2011]. Bożena Muchacka 16 In the last two decades (from 1991 to 2010) it may have been noted that play therapy with children was used in kindergartens and elementary and secondary schools as an effective form of children’s problem solving (such as abuse [by parents or by siblings] of alcohol or drugs, violence in the child’s family, maltreatment in the child’s family or at school, etc.)4. In the last two decades, researchers have often studied the effectiveness of play therapy. Research examining that problem (related to children’s conduct disorders, aggression and oppositional behaviour of children) has been undertaken in the USA and in Western Europe. In the Internet encyclopaedic entry Play therapy we read: “[Dogra and Veeraraghavan (1994)] […] exhibited significant positive change in adjustment [of children (aged 8–12 years) who were exhibiting significant aggression – B.M.] while significantly decreasing aggressive behaviors [after sessions of nondirective play therapy – B.M.]. Schmidtchen, Hennies and Acke (1993) showed a decrease in behavioral disturbances and an increase in “person-centered competences” [of children aged 5–8 – B.M.] who exhibited behavioral disturbances and received […] sessions of nondirective play therapy”5. At the beginning of the 21st century, Dee Ray, Sue [C.] Bratton, Tammy Rhine and Leslie Jones (2001: 85–108) also examined the effectiveness of play therapy. Summarizing, play therapy is an effective form of counselling or psychotherapy that uses play to prevent or resolve psychological challenges of children. It may be used as a diagnostic tool that ought to determine the cause of the child’s disturbed behaviour. The different forms and patterns of play, as well as the different objects of play may be used to understand the rationale underlying the child’s behaviour, as children present in play their interior obfuscations and anxieties. In this context, I should like to stress that play therapy is in fact a self-help mechanism that effectively eliminates children’s interior obfuscations and anxieties, in the “natural” way.
4 In Poland, Bożena Muchacka (1991: 179–186) and next Joanna Grochulska- -Stec (1993: 131–150) have presented the diagnostic aspect of children’s play in educational practice. 5 See: http://en.wikipedia.org/wiki/Play_therapy – [dated: 29 November 2011]. Play as a form of therapy for children... 17 In 1982, play therapists established the Association for Play Therapy (APT). In 2006, the APT had almost 5000 members in 26 countries6. Today, I hope that in the nearest future also Poland will have its representation in that Association. (Translation: M. Muchacki)
References
Allen F., 1934, Therapeutic work with children, “American Journal of Orthopsychiatry“, Vol. 4, Issue 2. Axline V.M., 1947, Nondirective therapy for poor readers, “Journal of Consulting Psychology”, Vol. 11. Axline V.M., 1950, Entering the child’s world via play experiences, “Progressive Education”, Vol. 27. Axline V.M., 1951, Observing children at play, “Techers College Record”, Vol. 52. Axline V.M., 1989, Play Therapy. London. Baran Z, 1998, Wieloaspektowość fenomenu zabawy dziecięcej, [in:] K. Duraj- -Nowakowa, B. Muchacka (Eds.), Funkcje zabaw w edukacji przedszkolnej i wczesnoszkolnej. Kraków. Bernstein I., 1951, Use of play in the treatment of children, “Journal of Pediatrics”, Vol. 39. Cangelosi D.M., 1997, Play Therapy for Children from Divorced and Separated Families, [in:] H.G. Kaduson, D.M. Cangelosi, C. Schaefer (Eds.), The Playing Cure: Individualized Play Therapy for Specific Childhood Problems. Northvale. Conn J.H., 1989, Play therapy: its history, theory and practice. A fifty year retrospective account, “Child Psychiatry and Human Development”, Vol. 20, Issue 1. Czaja-Chudyba I., 2006, Zabawy diagnostyczne w przedszkolu – możliwości zastosowania teorii inteligencji wielorakich w odkrywaniu zdolności dziecka, [in:] S. Włoch (Ed.), Edukacja przedszkolna w teorii i praktyce. Opole. Ekslajn W. [= V.M. Axline], 2003, Igrovaya terapiya v dejstvii. Moskva. Erikson E., 1950, Child and Society. New York. Evart-Chmielnicki E., 1951, Traitement du caractère par le jeu chez ľenfant, “Enfance”, Vol. 4. Fine P., 1982, Play and family therapy as core skills for child psychiatry: some implications of Piaget’s theory for integrations in training and practice, “Child Psychiatry and Human Development”, Vol. 2.
6 See: http://en.wikipedia.org/wiki/Play_therapy – [dated: 29 November 2011]. Bożena Muchacka 18 Fleck-Bangert R., 2001, O czym mówią rysunki dzieci. Kielce. Freud S., 1909, The Case of “Little Hans” and the “Rat Man”. London. Froebel [Fröbel] F., 1903, The Education of Man. New York. Gilroy A., 2009, Arteterapia – badania i praktyka. Łódź. Gontard von A., Lehmkuhl G., 2003a, Play therapy: psychotherapy with play as the medium, [in:] General introduction, psychoanalytic & client-centered approaches, “Praxis der Kinderpsychologie und Kinderpsychiatrie”, Vol. 52, Issue 1. Gontard von A., Lehmkuhl G., 2003b, Play therapy: Psychotherapy with play as the medium: II: New developments, “Praxis der Kinderpsychologie und Kinderpsychiatrie”, Vol. 52, Issue 2. Grochulska-Stec J., 1993, Psychoterapia w praktyce pedagogicznej, [in:] J. Włodek- -Chronowska (Ed.), Terapia pedagogiczna, wyd. II. Kraków. Guerney B., Guerney L., Andronico M., 1976, The Therapeutic Use of Children’s Play. New York. Guillemaut J., 1982, Jeux et traitements, “Neuropsychiatrie de l’Enfance et de l’Adolescence”, No. 7–8. Harms E., 1944, The development of religious experience in children, “American Journal of Sociology”, Vol. 50, Issue 2. Harms E., 1948, Play diagnosis: preliminary considerations for a sound approach, “Nervous Child”, Vol. 7. Harms E., 1964a, Handbook of Counseling Techniques. New York. Harms E., 1964b , Problems of Sleep and Dream in Children. New York. Harms E., 1967, Origins of Modern Psychiatry. Springfield. Hug-Hellmuth H., 1921, On the technique of child-analysis, “International Journal of Psycho-Analysis”, Vol. 2. Hurlock E.B., 1960, Rozwój dziecka. Warszawa. Jenkins R.L., Harms E., 1976, Understanding Disturbed Children: Professional Insights into Their Psychiatric and Developmental Problems. Springfield. Jones K.D., 2002, Group play therapy with sexually abused pre-school children: group behaviors and interventions, “Journal for Specialists in Group Work”, Vol. 27, Issue 4. Kaduson H.G., 1997, Play Therapy for Children with Attention-Deficit Hyperactivity Disorder, [in:] H.G. Kaduson, D.M. Cangelosi, C. Schaefer (Eds.), The Playing Cure: Individualized Play Therapy for Specific Childhood Problems. Northvale. Kalmar I., 1987, The “Völkerpsychologie” of Lazarus and Steinthal and the Modern Concept of Culture, “Journal of the History of Ideas”, Vol. 48. Kanner L., 1943, Autistic disturbances of affective contact, “Nervous Child”, Vol. 2. Play as a form of therapy for children... 19 Kazdin A.E., 1991, Effectiveness of psychotherapy with children and adolescents, “Journal of Consulting and Clinical Psychology”, Vol. 59. Klein A., 2004, Simmel und Lazarus: Kulturwissenschaft und Völkerpsychologie in Ihren Beziehungen. Leipzig. Klein M., 1955a, The psychoanalytic play technique, “American Journal of Orthopsychiatry“, Vol. 25, Issue 2. Klein M., 1955b, The Psychoanalytic Play Technique: Its History and Significance, [in:] M. Klein, P. Heimann, R.E. Money-Kyrle (Eds.), New Directions in Psychoanalysis. New York. Klein M., 1957, The Psychoanalytic Play Technique: Its History and Significance, [in:] M. Klein (Ed.), Envy and Gratitude: A Study of Unconscious Forces. New York. Klein M., 1959, Our adult world and its roots in infancy, “Human Relations”, Vol. 12, Issue 4. Konieczna E., 2007, Arteterapia w teorii i praktyce. Kraków. Kristeva J., 2004, Melanie Klein. New York. Landreth G.L., 2002, Play Therapy: The Art of the Relationship, 2nd ed. New York. Lazarus M., 1883, Über die Reize des Spiels Völkerpsychologie. Berlin. Levy D., 1938, Release Therapy in Young Children, “Psychiatry”, Vol. 1. Lowenfeld V., Brittain W.L., 1977, Twórczość a rozwój umysłowy dziecka. Warszawa. Lowenfield M., 1939, The world pictures of children: a method of recording and studying them, “British Journal of Medical Psychology”, Vol. 18. Mazza N., 2003, Poetry Therapy: Theory and Practice. New York. McMahon L., 1992, The Handbook of Play Therapy and Therapeutic Play. London. Muchacka B., 1991, Diagnostyczna wartość zabaw badawczych, “Rocznik Naukowo- -Dydaktyczny Wyższej Szkoły Pedagogicznej w Krakowie”, «Prace Pedago- giczne», Vol. XII. Muchacki M., Stolińska A., 2004, Technologia informacyjna i Internet szansą na rozwój osób z dysfunkcją wzroku, [in:] J. Migdałek, B. Kędzierska (Eds.), Informatyczne Przygotowanie Nauczycieli. Kraków. O’Connor K., 1986, The interaction of hostile and depressive behaviors: a case study of a depressed boy, “Journal of Child and Adolescent Psychotherapy”, Vol. 3, Issue 2. Oster G.D., Gould P., 2005, Rysunek w psychoterapii. Gdańsk. Parker N., O’Brien P., 2011, Play Therapy – Reaching the child with autism, “International Journal of Special Education”, Vol. 26, Issue 1. Ray D., Bratton S., Rhine T., Jones L., 2001, The effectiveness of play therapy: responding to the critics, “International Journal of Play Therapy”, Vol. 10, Issue 1. Bożena Muchacka 20 Salant E., 1980, Case study: the collaborative use of art and play in the treatment of a preschool child, “American Journal of Art Therapy”, Vol. 4. Sikes V., Kuhnley J.E., 1984, Multimodal treatment of a child with schizophrenia, “American Journal of Psychotherapy”, Vol. 38, Issue 2. Wallon P., Cambier A., Engelhart D., 1993, Rysunek dziecka. Warszawa.
Websites http://en.wikipedia.org/wiki/Play_therapy [accessed: 29 November 2011]. http://en.wikipedia.org/wiki/Virginia_Axline [accessed: 2 December 2011].