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Running head: AND ADLERIAN COMBINE 1

Logotherapy and Adlerian Combine:

An Integrative and Developmentally Appropriate Approach to Therapy

A Literature Review

Presented to

The Faculty of Adler Graduate

______

In Partial Fulfillment of the Requirements for

The Degree of Master of Arts in

Adlerian Counseling and

______

By

Sarah Bryna Nides

______

Chair: Louise Ferry, PhD, LP, LMFT

Reader: Amanda Ludtke, MA, LPCC

______

April, 2018

LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 2

Abstract

The following literature review focuses on scholarly articles that together illustrate ways in which Logotherapy can be implemented along with Adlerian play therapy in a developmentally appropriate way for children. The paper has two parts; The first includes reviews that illustrate and explain the therapeutic process proposed. The second part is a discussion in which therapeutic ideas are explained based on the information accumulated. The paper focuses on

Victor Frankl’s three ways of finding including, “through creating a work or doing a deed, encountering someone or experiencing something, and finding meaning in suffering”

(Frankl, 2006). The therapeutic process proposed also includes the four phases of Adlerian play therapy including, “building the relationship, investigating the , gaining , and providing reorientation/reeducation” (Meany-Walen, Kottman, Bullis & Taylor, 2015). The phases in the proposed form of therapy are similar to the typical Adlerian play therapy model with Logotherapy techniques incorporated into the process. The project also includes a review which demonstrates that children are able to find purpose and meaning in life events despite their developmental level (Banerjee & Bloom, 2015). However, children may help from an such as the therapist to learn how to find meaning within unfortunate life events which is why the gaining/insight and reorientation/reeducation phases are implemented (Meany-Walen et al.,

2015). The paper ultimately provides review-based knowledge to support the creation of an effective form of therapy that encourages positive growth and development in young children.

LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 3

Table of Contents Abstract ...... 2 Logotherapy and Adlerian Play Therapy Combine ...... 4 Development of Logotherapy ...... 5 Description of Logotherapy ...... 6 Techniques in Logotherapy...... 8 Research on the Importance of Finding Meaning Life ...... 9 Children Benefit from “Creating a Work or Doing a Deed” ...... 11 Children Benefit from “Encountering Someone or Experiencing Something” ...... 13 Children Benefit from “Finding Meaning in Suffering”...... 16 Description of Individual ...... 19 Description of Play Therapy ...... 20 and Play Therapy Combined to Create Adlerian Play Therapy ...... 21 Building the Relationship ...... 24 Investigating the Lifestyle ...... 25 Gaining Insight...... 25 Re-orientation/Re- ...... 26 Research on the Effectiveness of Adlerian Play Therapy ...... 26 Developmental Considerations in Child Therapy ...... 31 Building the Relationship Combines with Logotherapy ...... 33 Investigating the Lifestyle Combines with Logotherapy ...... 34 Gaining Insight Combines with Logotherapy ...... 36 Re-orientation/Re-education Combines with Logotherapy ...... 37 Conclusion ...... 39 References ...... 41

LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 4

Logotherapy and Adlerian Play Therapy Combine

Logotherapy and Individual Psychology are both relevant and effective forms of therapy in treating psychiatric disorders and individuals with mental symptoms. Logotherapy is a form of developed by the late Victor Frankl, that is based on Frankl’s in the concentration camps during (Tiwari, 2015). Frankl noted that the primary drive of beings is the “ to meaning.” Frankl believed that each individual has unique meanings that can be found through therapy to help the individual cope with life stressors and experiences (Ameli & Dattilio, 2013; Tiwari, 2015). In contrast, Individual Psychology was developed by and is based on “the ” (Ameli & Dattilio, 2013). Adler believed that the individual who is mentally ill lacks social connection, a sense of belonging, -enhancing beliefs, and therefore seeks power and superiority over others (Adler, 1988;

Taylor & Bratton, 2014). Individual psychology, unlike Logotherapy has been adapted for use with children in a therapeutic model called Adlerian Play Therapy which helps the child develop social connections, a sense of belonging, and reorients the child’s incorrect beliefs about self, the world, and others (Kottman, 2001 as cited in Even & Armstrong, 2011; Taylor & Bratton, 2014).

Research has shown that Adlerian Play therapy is effective when working with young children to eliminate unwanted , increase social skills, and establish positive (Akay

& Bratton, 2017; Meany-Walen, Kottman, Bullis & Taylor, 2015; Meany-Walen & Teeling,

2016).

While presenting a variety of similarities and differences Logotherapy and Adlerian Play

Therapy can be modified and merged to form an integrative approach to child therapy, but how can Logotherapy combined with Individual Psychology be effectively and developmentally appropriately applied to therapy with children? Research has shown the benefits of both forms LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 5 of therapy for children, but the two have yet to be merged to create a child friendly approach.

The following paper will examine and the background, development, and effectiveness of Individual Psychology and Logotherapy, to create an integrative and developmentally appropriate approach for children based on the Frankl’s three ways of finding meaning, within the four stage framework of the Adlerian Play Therapy Model (Taylor &

Bratton, 2014; Tiwari, 2015, p. 137).

Development of Logotherapy

In a book review on “A Man’s Search for Meaning,” Tiwari (2015) discussed and summarized the book written by Victor Frankl. Tiwari (2015) acknowledged that the book is a

“must read” which focuses on the desire to reach a destination (p. 137). The authors described

Frankl as a man who survived the brutal Nazi concentration camps and the pioneer of

Logotherapy (Tiwari, 2015). Tiwari (2015) explained that although Frankl lost all possessions and experienced horrific conditions in the camps, Frankl was able to find meaning in the suffering he experienced.

The review proceeds to summarize Frankl’s story, beginning with the first section of the book in which Frankl describes his in the camps (Tiwari, 2015). In the book, Frankl explained that he was imprisoned in Auschwitz. Frankl was taken from his including his parents, pregnant wife, and brother, and left with lack of food, loss of , trauma, and loss of . Due to the horrible trauma Frankl was forced to face, Frankl resulted to apathy toward all experiences including death (Tiwari, 2015). In the book, Frankl explained that a numbing sensation took over many of his fellow prisoners even after liberation. However, Frankl was still able to somehow find meaning in the of the people he loved which gave purpose to

Frankl’s terrible experiences (Tiwari, 2015). Tiwari (2015) explained that Frankl shared in the LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 6 book that the experiences he faced in the death camps taught him that although individuals are unable to avoid suffering, they can cope and find meaning in suffering to move forward with purpose (Tiwari, 2015). According to Frankl (1961) “Only to the extent that man has fulfilled the concrete meaning of his personal existence will he also have fulfilled himself” (p. 26).

Frankl believed that although human beings cannot always change the situations in their lives, they can choose their reactions and responses with renewed purpose (Tiwari, 2015). Frankl also believed that individuals have the ability to grow through (Frankl, 1980 as cited in Ameli

& Dattilio, 2013).

Description of Logotherapy

Logotherapy was created in the 1930’s by the Austrian and Neurologist,

Victor Frankl (Ameli & Dattilio, 2013). Logotherapy is a psychotherapeutic practice created by

Frankl and based on Frankl’s experiences in the Nazi concentration camps (Tiwari, 2015).

Frankl’s is not based on the “will to power” as in individual psychology or the “will to pleasure” as in . Instead, Logotherapy is based on the “will to meaning”

(Ameli & Dattilio, 2013).

Frankl noted that the name Logotherapy was developed based on the Greek word which translates in English to meaning. The name is meant to represent an that the primary drive in life is the search for meaning and purpose (Tiwari, 2015). Logotherapy is therefore, based on conscientiously choosing a positive way of life and choosing a meaningful response to suffering (Tiwari, 2015). In addition, Frankl noted that meaning can be discovered in three specific ways including “by creating a work or doing a deed, by experiencing something or encountering someone, and by the we take towards unavoidable suffering” (Tiwari,

2015, p. 137). In Frankl’s book A Man’s Search for Meaning, the importance of finding LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 7 meaning in suffering was illustrated when Frankl described made while in the camps. For example, the individuals who helped others appeared to endure the trauma better than individuals who only cared for themselves. Also, individuals who became overcome by the circumstances were likely to die (Tiwari, 2015).

In an article written by Frankl (1961), the background and implementation of

Logotherapy were described. Clients who struggle to find meaning in their lives often feel empty and hopeless, a condition in Logotherapy called the “existential vacuum” (Frankl, 1967).

When the “will to meaning” is hindered, the individual often feels hopeless and falls into an

“existential vacuum” which can cause psychological symptoms including but not limited to, apathy, and (Frankl, 1969). Frankl (1961) explained that an individual will only feel fulfilled again through understanding the meaning of existence. Frankl (1961) also noted that suffering does not by itself give a person meaning. Rather the individual must find meaning within the suffering experienced. Any person can endure suffering if that person can find the meaning within the unfortunate life event (Frankl, 1961). In fact, Logotherapeutic teachings say that every situation has a form of meaning and positive aspects can be found within every negative situation (Frankl, 1967). Additionally, Leider (2017) stated that purpose keeps human beings in the present moment, and research has shown that finding purpose helps individuals feel a part of something important instead of on and distress. People who search for meaning are also happier, healthier, and generally live longer lives (Leider,

2017).

However, meaning cannot be found intellectually or with rational . Meaning must be found within each unique individual’s and perspective (Frankl, 1961). Moreover, in Logotherapy, the therapist does not teach the client through his or her perspective. Instead, LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 8 the therapist helps the client to see the world through the client’s own perspective (Frankl, 1961).

Although the therapist cannot find meaning for the client, the therapist can and should encourage the client to find meaning (Frankl, 1967).

Frankl (1967) also emphasized the importance of the in

Logotherapy by stating, “We have long realized that what counts in therapy is not techniques, but rather the human relation between doctor and patient, or the personal and existential encounter” (p. 139). According to Frankl (1967), instead of the use of primarily techniques with clients, the importance of the therapeutic encounter should be emphasized. Additionally, the intervention in Logotherapy is somewhat non-directive, as it is important for the therapist to respect the individual’s search for a unique form of meaning (Tate, Williams & Harden, 2013).

It is also important for the therapist to empower the client to reach a certain level of awareness in learning about themselves and reactions in life (Tate et al., 2013). The therapist must not name the client as a victim, but should treat the client as a peer who is capable and able to carry challenging emotions such as (Frankl, 1967). When the therapist approaches the client as a human being rather than a problem to fix, the client will not feel manipulated (Frankl, 1967).

Techniques in Logotherapy

There have been a handful of approaches developed for the use of Logotherapy. One such approach is called which focuses on helping the individual find distance from the self through humor (Ameli & Dattilio, 2013). For instance, a client who is experiencing anxiety may be asked to tell themselves the worst case in a humorous way. The humor may counteract the anxiety by breaking an unfortunate cycle of intrusive (Ameli

& Dattilio, 2013). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 9

De-reflection is another technique often used during the implementation of Logotherapy which encourages the client to look beyond the self and focus on others and the outside world

(Frankl, 2006). The goal is to help the client find meaning in the outside world through redirection (Frankl, 2004). During the de-reflection phase of therapy, the therapist helps the client become aware of the unique meaningful hierarchy based on Frankl’s three ways to find meaning and then defining purposeful short and long term goals (Ameli & Dattilio, 2013).

Finally, attitude modification is when the client identifies personal values and personal meaning (Lukas, 1998 as cited in Ameli & Dattilio, 2013). The goal is to encourage the client to identify a different attitude and to begin the search for meaning in negative external factors.

(Lukas, 1998 as cited in Ameli & Dattilio, 2013)

Research on the Importance of Finding Meaning Life

Research studies have shown that increased meaning in life is associated with favorable psychotherapy outcomes. In a study examining the connections between clinical diagnosis, meaning in life, and psychotherapy outcome, Volkert, Schulz, Brutt, and Andreas (2013) explored the role of meaning in life among inpatients in psychotherapy outcome. Volkert et al.

(2013) hypothesized that patients with mental health diagnoses would show less meaning in life than individuals who did not have mental health diagnoses. In addition, Volkert et al. (2013) hypothesized that patients with depressive disorders would have less meaning in life compared to patients without depression. Additionally, Volkert et al. (2013) believed that lack of meaning in life would be connected to having depressive symptoms, and that meaning in life would increase with effective psychotherapy. Lastly, the study explored specific meaning areas of participants

(Volkert et al. 2013). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 10

The study included 214 females and males ages 18 and older (Volkert et al., 2013). The study was done in a nine-week inpatient therapeutic clinic that treated a variety of mental health diagnosis. The clinic administered individual and group therapy using alternative methods such as , art, and . Participants were assessed a total of three times throughout the process including prior to treatment, at discharge, and six months’ post treatment

(Volkert et al., 2013). The participants completed two assessments throughout the process of the study including the Schedule for Meaning in Life Evaluation (SMILE) with which participants were asked to write down three to seven forms of meaning in their lives and rate the importance of each. The Hamburg Modules for the Assessment of Psychosocial Health (HEALTH) was also given. The assessment measured various aspects of psychosocial health including anxiety and depressive symptoms, , and self- (Volkert et al., 2013). T-tests were performed as well to find differences of meaning in life score for patients and controls, and F- tests were performed to find changes in meaning in life prior to and post treatment. Pearson’s product moment correlation and Predictive Analysis Software were also used to evaluate data

(Volkert et al., 2013).

Results showed lower meaning in life scores in patients with mental health disorders compared with individuals without mental health disorders, and patients with depressive disorders had lower meaning in life than individuals without depressive disorders (Volkert et al.,

2013). Furthermore, work, family, and friends were the most common areas of meaning for both the treatment group and the control group. Lastly, the study showed that the results apply to individuals with a variety of mental health diagnoses. The study ultimately provides proof that there is a significant connection between meaning in life and mental health symptoms (Volkert et al., 2013). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 11

Children Benefit from “Creating a Work or Doing a Deed”

Frankl (2006) noted there are three ways to find meaning. The first way according to

Frankl (2006) is “creating a work or doing a deed.” Previous articles have explored the benefits of using , or in Frankl’s (2006) words “creating a work,” in therapy with children. In an article by Desmond, Kindsvatter, Stahl, and Smith (2015), the use of creativity in play therapy was explored. Expressive arts such as puppets, art, sand-tray, and writing are a developmentally appropriate way for children to process and understand past experiences (Desmond et al., 2015).

Children respond well to creative forms of therapy because of the hands on approach which fits a child’s developmental ability. Furthermore, children are able to understand and communicate through play which provides opportunities to externalize the child’s problems. Creative interventions often encourage the child to have a voice in the therapeutic process and feel empowered to heal and grow through therapeutic expression. Moreover, “creative methods can be integrated with the expressive arts for the purpose of engaging the child, generating a rich description of his or her experience, and facilitating the imaginative creation of new meanings”

(Desmond et al., 2015, p. 442).

Creative mediums such as puppets can be used as a form of role-playing to help children process life events and experiences on an emotional and sensory level (Desmond et al., 2015).

Additionally, puppet play can help the therapist communicate with the child about uncomfortable and challenging topics without talking directly about the subject. The child is then able to share with the therapist comfortably in an objective manner. Puppets can be used through both passive and active probes with children. For instance, puppets can be used as passive probes when the child watches and observes the puppet show. In contrast, puppets can also be used as active probes when the child actively participates in puppet play together with the LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 12 therapist. Various approaches have been developed when using puppets as active probes such as the Alien Puppet Interview and the Berkeley Puppet Interview. In puppet interviews, the puppets ask the child specific interview questions for therapeutic purposes in an exciting and child friendly approach (Desmond et al., 2015).

Sand-tray and letter writing are also mediums which can be positive sources of creativity in play therapy with children (Desmond et al., 2015). Sand-tray allows the child to play in a tray of sand with miniature figurines and to process experiences and create concrete pictures through play in the sand. Additionally, letter writing enables the older child to tell his or her story through words. Letters can help the child express feelings and emotions and find solutions to create change. The therapist can also become involved in the process by helping the child develop insight to past experiences based on the child’s creation (Desmond et al., 2015).

Lastly, visual art gives children who have experienced trauma, the ability to express feelings through art (Desmond et al., 2015). Drawing, painting, and other mediums are often used in therapy with children combined with various techniques such as drawing the location of feelings on the body, making a picture of an event in the child’s life, or making separate masks of the outside world and private feelings. Art in play therapy can help clarify a problem for a child and allow the child to feel some understanding and control over the present situation

(Desmond et al., 2015).

In a book review of The Practitioner’s Guide to Child : Fostering Creativity and Relational Growth, Treadon (2013) explains the author’s belief that art is a positive source of therapy for children. According to Treadon (2013), using art therapy with children provides opportunities for increased awareness and the development of positive abilities.

Furthermore, success is often dependent on the relationship between the client and the therapist. LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 13

When early positive relational opportunities are missed, later relationships in life can suffer.

Lack of early secure attachment relationships can cause anxiety and a of helplessness.

Art therapy treatment can help the client learn to others, find voice, and develop positive and healthy relationships for the future (Treadon, 2013).

Children Benefit from “Encountering Someone or Experiencing Something”

Social connection through helping others is one way to find meaning in life (Klein,

2017). In a research study by Klein (2017), the relationship between social connection, helping others, and meaningfulness was explored. The study began with a sample of to find the relationship between a form of prosocial (volunteering) and meaning in life with The

Baylor Religion Survey Wave 2 (Baylor University, 2007 as cited in Klein, 2017). The participants were asked to reveal the amount of hours they volunteer and whether of purpose in life was present (Klein, 2017). The results for the first portion of the study showed that there is a relationship between and meaning in life, as participants who volunteered regularly perceived more purpose (Klein, 2017).

The second study examined the connection between giving money to others and purpose in life (Klein, 2017). The participants who were identified at a Midwestern University were assigned to either the self-interested group or the prosocial group. Participants in the prosocial group were asked to buy a gift for someone else, while participants in the self-interested group were asked to buy a gift for themselves. Next, the participants were asked to fill out a follow up survey including the Meaning in Life Questionnaire, and were then asked to report how well they followed the instructions given. Results showed that the prosocial group participants reported more meaning in life than self-interested participants (Klein, 2017). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 14

The third study explored whether buying gifts for others increases meaning in life through categories such social connection, self-worth, personal control, and values (Klein, 2017).

Participants were again asked to buy a gift either for themselves or for someone else. However, in study three the participants evaluated the specific categories of meaning for themselves and the study controlled for the individuals’ level of happiness after spending the money. The participants were also given a follow-up survey which asked how the money was spent. Results showed that participants in the prosocial group had displayed increased self-worth and increased social connection compared to participants in the self-interested group. However, participants in the prosocial group did not have increased values and had a lower sense of control. Overall, the results for all studies prove that prosocial behavior helps develop a sense of meaning in life, as spending money on others increased of meaning (Klein, 2017).

In a thirty-two-year , Olsson, McGee, Nada-Raja and Williams (2013) investigated the role of children’s social and academic experiences in terms of success in adulthood. Themes included sense of meaning in a person’s life, social experiences, prosocial values, and coping styles (Olsson et al., 2013).

The study by Olsson et al. (2013) involved 1,037 individuals born in New Zealand in

1972 or 1973. The participants were assessed a total of 12 times from the ages of three to 38 years old (Olsson et al., 2013). During the most recent phase 964 individuals remained participants of the study. The study began with parents of participants being asked to fill out an document and a questionnaire related to family life, health, development and behavior of their children. Parent questionnaires were administered through the child’s . In addition, the participant’s well-being in adults was assessed using the brief version of the SoC scale related to social coherence, social participation, positive coping styles, LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 15 and prosocial behavior in addition to subscales including manageability, comprehensibility, and meaningfulness. Adult social participation was determined based on involvement in a variety activities related to sports and hobbies, work, political, charity, and neighborhood and youth, church, and professional groups. Coping behaviors were also evaluated using the

Brief COPE inventory to identify negative coping responses, and prosocial behavior was evaluated using a 23 item questionnaire which assessed abilities such as kindness, trustworthiness, and (Olsson et al., 2013).

Childhood assessment included assessments of social connectedness using four-point parent ratings of childhood behavior, the Rutter Child Scale A for parents, and the Child Scale B for teachers (Olsson et al., 2013). was also evaluated using the Reynell

Receptive Language Scale and Expressive Language Scale, the Illinois of Psycholinguistic

Abilities, and the Burt Word Test (Olsson et al., 2013). Lastly, family environments in childhood were assessed by evaluating family mental health background, parent-child interactions, and socioeconomic status (Olsson et al., 2013).

Adolescent development indicators were composed of a variety of assessments as well.

Social connectedness in adolescence was identified through questions related to participation in groups, self-perceived strengths, social relationships, and life satisfaction (Olsson et al., 2013).

The Inventory of Parent and Peer Attachment was also administered to determine attachment relationships and a 22-item scale was administered to determine self-perceived strengths (Olsson et al., 2013). Adolescent academic skills were accumulated using the Burt Word Reading Test, the NZ Department of Education’s School Certificate exam, a mental health interview, and whether or not the participant finished three years of high school was noted (Olsson et al., 2013). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 16

Structural Equation Modelling (SEM) was then performed developed for the individual latent indicators utilized in the study, and organized into a developmental model which assessed the social, academic, and family life contributions to the individual’s well-being in adulthood

(Olsson et al., 2013).

There were various weak connections shown in the study such as the connection between adolescent academic success and adult well-being and childhood language and adolescent social success. Also, there was no connection between childhood social success and adolescent academic success. However, results for the study showed a significant connection between child social and language success and adolescent success, and adolescent social success and adult well-being (Olsson et al., 2013). Therefore, the study suggests that social success in childhood often results in adult-wellbeing (Olsson et al., 2013)

Children Benefit from “Finding Meaning in Suffering”

Frankl’s (2006) third way of finding meaning is to “find meaning in suffering,” but are children developmentally able to find meaning in suffering? In a study that investigated children’s perceptions of finding meaning in life events using teleological explanations such as teaching a lesson or sending a sign, Banerjee and Bloom (2015) investigated children’s preference for understanding events through meaningful explanations. Banerjee and Bloom

(2015) asked the question “Does the adult perception of purpose in significant life events have early roots in an experience-independent teleological in childhood?” The research question was explored by conducting three . The first included ninety-four participants ages five-seven years, eight-ten years, and adults for examination purposes. The child participants were located through Yale University and Connecticut children’s museum and tested in a in the museum while adult participants were tested online. The children LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 17 were shown cartoons of child friendly events. Next, the children were given different explanations told by two different fictional characters for why the events happened. The children were then asked to choose which fictional character was correct. In addition, parents of the child participants were asked to complete questionnaires which investigated parent religiosity in order to investigate whether religious exposure influenced the child’s perception of purpose in life events. The information accumulated was assessed with the Duke University Religion Index

(Banerjee & Bloom, 2015).

Results for experiment 1 showed that the younger children favored teleological to non- teleological accounts, as the younger child participants often chose both the teleological and material causes instead of the events that had only a material cause (Banerjee & Bloom, 2015).

The preference was stronger for younger versus older children. Adults preferred non- teleological accounts. However, there is the possibility the preference was due to younger children preferring more topical explanations of teleological accounts. In addition, the preference was not influenced by religious exposure (Banerjee & Bloom, 2015).

Experiment two focused on presenting teleological and non-teleological accounts independently to avoid using the forced- method and provide a clearer understanding of results in experiment one (Banerjee & Bloom, 2015). Experiment two continued with the remaining participants from the initial experiment. The 12 Cartoons from the initial experiment were shown again followed by two different explanations for why the event occurred given separately. The participants were then asked to choose how helpful each explanation was in helping the fictional character in the cartoon understand the why the event occurred using the one-four helpfulness scale. On the first trials the participants chose a teleological explanation and a non-teleological explanation for the events. In addition, control trials were implemented in LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 18 which the participants judged the helpfulness of one relevant teleological explanation and one incorrect and irrelevant non-teleological explanation. Adult participants were given the same tests online (Banerjee & Bloom, 2015).

Results of experiment two showed that young children preferred teleological and purposeful explanations for life events and younger and older children preferred teleological explanations even more than adults (Banerjee & Bloom, 2015). In sum, the experiment showed that children have a true preference of understanding life events through teleological explanations (Banerjee & Bloom, 2015).

Experiment three explored whether children favor all explanations that show purpose or if they favor a teleological account which is based on finding purpose (Banerjee & Bloom,

2015). The experiment used the original forced-choice methods, but clearly separated event outcomes from causes by mentioning a purpose for the events in the teleological and non- teleological accounts for the events. Participants again included remaining individuals from the first two experiments. The third experiment was conducted similarly to experiment one.

However, for experiment three the experimenter told the children that both event occurrences taught the fictional character an important lesson. Following the initial showing the fictional characters both agreed about learning lessons, but disagreed that the lesson was teleological (the reason for the event). The characters did not however, mention the material cause for the event.

Adult participants were given the same tests online (Banerjee & Bloom, 2015).

Results of experiment three showed that even when a lesson was learned from the event, children still chose the teleological explanation of the event, preferring the event that occurred to teach a lesson (Banerjee & Bloom, 2015). The experiment also shows that by eight years old children are able to separate relevant teleological explanations from irrelevant explanations. LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 19

Additionally, the experiments ultimately suggest that purpose-based explanations for life events are rooted early in childhood and preference of finding purpose in life events emerges early in life and is not only present in adults (Banerjee & Bloom, 2015).

Description of Individual Psychology

Alfred Adler, the creator of Individual Psychology believed that human beings are creative and unique individuals who long for a sense of belonging and social connection (Meany-

Walen et al., 2015). Adler created the term social interest, meaning the importance of social interaction and the ways in which the individual participates in the world with others (Meany-

Walen et al., 2015). Additionally, Adler believed people innately feel the need to connect with others and strive for significance (Taylor & Bratton, 2014). However, individuals who have experienced unfortunate early events may form discouraging mistaken beliefs about themselves, the world, and others (Taylor & Bratton, 2014).

Individual Psychology was developed through Adler’s search to understand the creative power of people which is apparent through the striving to compensate for perceived failures in one direction, and the striving for success in another direction (Adler, 2011). Alfred Adler believed that purposeful movement through the life tasks including work, , and community feeling, and the development of social interest, contribute to the natural course of the individual’s life (Ansbacher & Ansbacher, 1956). According to Adler (2011), each individual reaction to the life tasks is a part of the person’s attitudes in life. In addition, Adler (2011) explained that a person’s actions are teleological and taken for the purpose of striving for a specific goal.

Adler (1988) also explained Individual Psychology specifically for children. Adler

(2011) explained that mistaken beliefs and the fictional goal are developed early in childhood and contribute to the foundation for the matured personality. Adler (1988) stated that a child’s LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 20 emotions interact with the environment and outside sources which influence the child’s future character traits. The inner life of a child collects experiences and seeks to protect the life tasks

(Adler, 1988). If the child feels insecure, the child can develop feelings of anxiety and inferiority. Oftentimes, the child begins to feel inferior early in life, but struggles to accept inferiority (Adler, 2011). Therefore, the child who feels inferior often safeguards for fear of defeat, developing impulses and a fictional final goal to reach a level of superiority (Adler,

1988). The fictional goal developed by the child will cause the child to lack a and social interest. Furthermore, the goal may overcome the child and every action the child takes will become a movement toward the goal the child has created to help find safety in a world full of chaos (Adler, 1988). According to Adler (1988) children who develop inferiority feelings are often sick children, children who have had a difficult upbringing, and pampered children.

Description of Play Therapy

According to Mountain (2016) “play therapy can be seen as valuing the inner capacity of the child who seeks for understanding and wholeness” (p. 192). In addition, play therapy is a kind of spiritual connection linking the child to the therapist to help the child manage stressful life events (Mountain, 2016). Spirituality in this case is described as the inner life and motivating force within the individual and a desire for relational. Mountain (2016) also described play therapy as a form of therapy which provides the child toys to use for words, and play for language. Although there are a variety of forms of play therapy, all forms focus on the relational aspect as the initial goal. For instance, being with the child instead of doing for the child is emphasized. The importance of the child developing a secure attachment style is also LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 21 recognized in play therapy, as the therapeutic relationship is used to provide safety and for the child allowing the to learn and grow (Mountain, 2016).

Play therapy can be approached in a variety of ways (Mountain, 2016). For instance, play can be non-directive in which the therapist focuses on observing and narrating the child’s play and feelings. Non-directed play therapy allows the child to lead and the therapist to follow.

In contrast, directive play therapy allows the therapist to bring up new ideas during the therapy session as the child’s partner in play. In directive play therapy sessions, the counselor often lends his or her thoughts to the child by recognizing clues based on past experiences in the child’s play (Mountain, 2016). The therapist can also help the child find words for his or her feelings and normalize the environment through a safe and trusting relationship. Ultimately, in play therapy “the therapist walks gently, connected to the world of the child, listening, watching and considering the varied ways in which children express their issues and through play”

(Mountain, 2016, p. 199)

Individual Psychology and Play Therapy Combined to Create Adlerian Play Therapy

Adlerian play therapy, a specific form of play therapy pioneered by Terry Kottman merges aspects from Alfred Adler’s Individual Psychology with Play Therapy (Taylor &

Bratton, 2014). The theory focuses on how children interact with self, others, and the world based on past experiences (Even & Armstrong, 2011). Adlerian play therapy is an effective form of therapy for children because children are better able to communicate through play than through words (Kottman, 2001 as cited in Even & Armstrong, 2011). Play in therapy is seen as the child’s language and a form of communication between the child and the therapist (Taylor &

Bratton, 2014). In Adlerian Play Therapy in particular, toys are chosen for the child ahead of LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 22 time to encourage the child to explore views about self, the world, and others, as selection allows the child to embrace self-enhancing attitudes (Taylor & Bratton, 2014).

Adlerian play therapy also centers on collaboration, the life tasks, and social movement

(Kottman 2003 as cited in Even & Armstrong, 2011). The therapist views the child’s play themes as representative of the child’s lifestyle and works with the child in four phases including

“building the egalitarian relationship, investigating the lifestyle, gaining insight, and reorientation and/or re-education” (Taylor & Bratton, 2014, p. 208). However, the phases are not rigid and are interchangeable throughout the process if deemed necessary by the therapist

(Taylor & Bratton, 2014). The theory uses a team approach in which the therapist and child work together as a team to build a positive therapeutic relationship while sharing of the session (Meany-Walen et al., 2015). In addition, the therapist switches between a directive and non-directive role throughout the process (Taylor & Bratton, 2014).

Dreikurs and Soltz (1964), who were followers of Adler, believed children develop goals of misbehavior which contribute to the child’s discouragement and lack of social interest. In addition, children who seek therapy often feel inferior and are striving for superiority. When the child tries to eliminate inferiority feelings and is unsuccessful, courage is lost and mistaken beliefs are developed (Even & Armstrong, 2011). Adlerian play therapists believe once the child’s private logic is understood, the child’s viewpoint about self, others, and the world will be revealed to overcome mistaken beliefs (Even & Armstrong, 2011; Griffith & Powers, 2007).

Adlerian Play Therapy helps the child find conclusions about the mistaken beliefs and tailors interventions to helping the child gain insight and develop reorientation and positive behavioral patterns (Kottman, 2003 as cited in Even & Armstrong, 2011) The therapist might use creative techniques and approaches including sand trays, storytelling, role-playing, and drawing and LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 23 painting activities to help the client bring the child’s mistaken beliefs to the surface (Meany-

Walen et al., 2015). In addition, therapists may include metaphoric and didactic teachings to help the client practice positive social behaviors and explore thoughts and feelings during implementation of the final phase of therapy. In sum, the process of Adlerian play therapy helps the child unlock his or her private logic and mistaken beliefs and rehearse new and developed attitudes, perceptions, and behaviors in a safe and supportive therapeutic environment (Meany-

Walen et al., 2015).

An Adlerian technique often used in therapy is the gathering of lifestyle information such as early recollections to analyze the lifestyle through creativity in the play therapy session (Even

& Armstrong, 2011). The child’s lifestyle is the beliefs, themes, behavior, and meaning apparent in the individual’s lifelong movement towards a final goal (Dinkmeyer & Sperry, 2000 &

Kottman, 2003 as cited in Even & Armstrong, 2011). Early recollections can identify the child’s perception of self, others and the world (Even & Armstrong, 2011). However, children younger than 7 years of age may not yet have the developmental ability to process an interview approach of identifying early recollections, in which case play therapy methods such as sand-tray therapy might be appropriate (Even & Armstrong, 2011).

In an article by Even and Armstrong (2011), the use of sand-tray therapy as an early intervention is described. The intervention may begin with the therapist asking the client to create a in the sand or allowing the child to choose the activity and offering sand-tray as one of the choices (Even & Armstrong, 2011). The therapist may prompt the child to “make a scene in the sand of something you remember” (Even & Armstrong, 2011, p. 396). The child may then be asked to look at, touch, and describe the scene to the therapist (Even & Armstrong,

2011). Additionally, the processing phase may begin with a prompt such as “tell me about your LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 24 memory in the sand” (Even & Armstrong, 2011, p. 397). By allowing the child to process a memory in the sand, the therapist is able to gain insight to the child’s private logic and reorient through encouragement (Even & Armstrong, 2011). Certain objects in the scene may be especially important and hold deep meaning to the child (Even & Armstrong, 2011). “The client’s creativity to overcome challenges may be released by processing the emotional experience contained metaphorically in memory” (Even & Armstrong, 2011, p. 398). The client may be asked to explain feelings related to the memory in the scene and the figurines in the scene (Even & Armstrong, 2011). Based on the child’s explanation, the therapist is able to notice relationships, conflicts and behaviors in the scene (Even & Armstrong, 2011). In addition, through of the child’s current methods of striving, the therapist can reorient the child by encouraging the child to adopt more useful striving habits (Even & Armstrong, 2011). Once the child can recognize and process the feelings of the scene and reorientation from the therapist, the child is able to form new attitudes and behaviors (Even & Armstrong, 2011). Additionally, the child is able to accept present thoughts and feelings and creatively develop replacement lifestyle scripts (Even & Armstrong, 2011)

Building the Relationship

The first phase of Adlerian play therapy is building the relationship. During the relationship building phase of treatment the therapist works to create a warm, safe, encouraging and accepting environment for the client (Taylor & Bratton, 2014). In addition, the therapist begins by sharing power with the child in a non-directive manner. Allowing the child to find purpose in new tasks is important in the process as well (Taylor & Bratton, 2014).

The therapist may use skills during the relationship building phase which include answering questions the child has, feeling reflection, and playing with the client (Meany-Walen & Teeling, LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 25

2016). In addition, the therapist works towards identifying the client’s early attachment experiences and how the experiences contributed to child’s presenting behaviors (Taylor &

Bratton, 2014). The therapist also works with the child’s caregiver to address any concerns which may be present at home (Taylor & Bratton, 2014).

Investigating the Lifestyle

The second phase of Adlerian play therapy is investigating the lifestyle. During the investigating the lifestyle phase, understanding the lifestyle of the client is the ultimate goal

(Taylor & Bratton, 2014). The therapist takes a more directive role by searching for client information through play themes (Taylor & Bratton, 2014). The therapist may provide art, sand- tray, , and observe play activities to learn information about the client (Meany-Walen &

Teeling, 2016). The therapist also learns about the client by talking to teachers and parents and asking the child questions (Meany-Walen & Teeling, 2016). The therapist then develops a treatment plan that reflects the information accumulated including mistaken beliefs and goals

(Taylor & Bratton, 2014).

Gaining Insight

The third phase of Adlerian play therapy is gaining insight. During the gaining insight phase, the therapist helps the child process the lifestyle (Meany-Walen & Teeling, 2016). The therapist also shares power with the client in a both directive and non-directive approach (Taylor

& Bratton, 2014). In order to provide the child with insight in a developmentally appropriate way, the therapist provides the child with experiences within play and outside of the play therapy relationship to help the child develop a positive sense of self, others, and the world (Taylor &

Bratton, 2014). Strategies may include, dance, sand-tray, puppets, and mutual storytelling LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 26

(Meany-Walen & Teeling, 2016). In addition, the therapist works with the child’s caregiver to understand the meaning and purpose behind the client’s behaviors (Taylor & Bratton, 2014).

Re-orientation/Re-education

The final phase of Adlerian play therapy is re-orientation/re-education. During the re- orientation phase, the therapist teaches and encourages the client while showing the client new skills and views of self, the world, and others (Taylor & Bratton, 2014). Play in the re-education phase often becomes more collaborative in nature, helping the child to develop an increased level of social interest (Taylor & Bratton, 2014). The therapist teaches the child new behaviors through role playing and play activities in a safe and comfortable environment (Meany-Walen &

Teeling, 2016). In addition, results often begin to show at home as well, and the child starts to see positive traits of self and in the world (Taylor & Bratton, 2014). Role playing activities are often implemented during family play therapy with the child as well (Taylor & Bratton, 2014).

The goals are for the child to become more capable and able to use self-expression throughout the therapeutic process, and for the child to develop positive social skills which will allow the child to feel a sense of belonging (Taylor & Bratton, 2014).

Research on the Effectiveness of Adlerian Play Therapy

Numerous studies have been conducted which prove Adlerian play therapy is effective.

Akay and Bratton (2017) explored the effects of Adlerian play therapy in helping children who experience maladaptive perfectionism in school. Children display maladaptive perfectionism in school through self-critical behaviors and anxiety and depression. Additionally, children who are perfectionists think they failed if they do not do well on a test or a school assignment and may avoid participating in classes for fear of failure and discouragement (Akay & Bratton,

2017). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 27

Adler explained that a healthy amount of perfectionism does have the ability to help individuals progress in life (Akay & Bratton, 2017). However, neurotic and maladaptive perfectionism and unrealistic and high standards toward personal achievement and rigidity often causes psychological problems. Government reports have encouraged early mental health intervention to prevent worsening of mental health symptoms in the future (Akay & Bratton,

2017).

Akay and Bratton (2017) hypothesized that Adlerian Play Therapy would decrease children’s maladaptive perfectionism and used a single-case A-B-A experimental research design to conduct the study. The study began as teachers and school counselors chose children who displayed perfectionist tendencies such as avoiding challenging assignments and activities and often feeling like failures. The children chosen received parental consent and participated in the study if they received clinical scores of perfectionism on the subscale CRS-R. Ultimately, only one of the five participants, a ten-year old male, qualified for the study (Akay & Bratton, 2017).

The participant was given 30-minute Adlerian play therapy sessions 2 times per week in a playroom in the school. The child attended 21 play sessions total (Akay & Bratton, 2017).

Furthermore, the child’s parents and caregiver attended regular consultation sessions every other week (Akay & Bratton, 2017). The Adlerian Play Therapy Skills Checklist and the Adlerian

Play Therapy Parent Consultation Skills Checklist were used to check treatment accuracy

(Kottman, 2009 as cited in Akay & Bratton, 2017). Additionally, the caregiver was given the

CPRS-R and the teacher was given the CTRS-R five times throughout the study (Akay &

Bratton, 2017). The CAPS and RCMAS-2 were also administered to the participant, and the therapist interviewed the participant’s caregiver. The data was assessed through a variety of processes included a visual analysis to assess behavioral responses, visual inspection of LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 28 performances throughout phases, and analysis of quantitative data accumulated from the caregiver and teacher. Additionally, least-squares regression lines were calculated and PEM was used to provide a visual of progress from the baseline phase to the intervention phase (Akay &

Bratton, 2017).

According to the self-report the client did not show improvement in maladaptive perfectionism throughout the study (Akay & Bratton, 2017). However, the caregiver and the teacher both reported significant improvement in maladaptive perfectionism and anxiety at home and at school, indicating that Adlerian Play Therapy likely did play a role in the client’s progress.

The therapist also observed the client improve negative behaviors and display heightened willingness to open up about life events and to face challenges. In addition, the therapist observed the client’s decreased anxiety throughout treatment. One explanation for the client’s self-report is the social desirability bias, as the client who is a perfectionist is likely unwilling to report imperfections about himself (Akay & Bratton, 2017).

Meany-Walen, Kottman, Bullis, and Taylor (2015) conducted another study which investigated the effectiveness of Adlerian Play Therapy. The study focused on children who showed disruptive behaviors in the classroom. The purpose of the study was to identify responsive services for children with disruptive behaviors and measure the helpful nature of

Adlerian play therapy on children’s off-task behaviors in a school setting. The research questions asked specifically were, “Is Adlerian play therapy effective in increasing students’ on- task behaviors? And Is Adlerian play therapy effective in decreasing problem behaviors?”

(Meany-Walen et al., 2015, p. 419).

The participants in the study included elementary students from a public school. The three children in the treatment group were each given fifteen to seventeen Adlerian play therapy LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 29 sessions twice weekly for a total of 30 minutes each (Meany-Walen et al., 2015). The sessions were run by a licensed counselor who was trained in school-based therapy and Adlerian play therapy. In addition, the study included a control group composed of two participants who received no treatment (Meany-Walen et al., 2015).

The participants were observed using the Direct Observation Form which included aspects such as sluggish cognitive tempo, opposition, withdrawn, problems, and attention deficit/hyperactivity problems (Meany-Walen et al., 2015). The form was completed by an observer who recorded the participant’s behaviors within ten-minute segments. In addition, visual analysis was used to decide whether change was due to the Adlerian play therapy interventions (Meany-Walen et al., 2015).

Results for the study showed that children in the treatment group displayed improvements in behavior both during and following the intervention (Meany-Walen et al., 2015). The results suggest that Adlerian play therapy is an effective form of therapy in reducing negative externalizing behaviors among elementary aged children (Meany-Walen et al., 2015).

In a final study examining Adlerian Play Therapy, a mixed treatment approach was implemented to determine whether individual and group Adlerian Play Therapy sessions would positively benefit elementary aged children who demonstrated off-task behaviors in the classroom (Meany-Walen & Teeling, 2016). A single-case experiment design (SCED) and a control group were used to assess participants progress in the study. Five elementary aged children from a public school located in the Midwest participated in the study. The first and second grade participants’ names were provided by teachers based on the children’s poor social skills and disruptive behaviors. A Master’s level research assistant initially observed the children using the DOF to determine whether each participant would be a part of the study. LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 30

Participants chosen were then assigned to either the treatment or the control group and were given parental consent to begin the study (Meany-Walen & Teeling, 2016).

The study continued for 16 weeks including baseline data collection, intervention period data collection, and post intervention data collection (Meany-Walen & Teeling, 2016).

Participants in the treatment group were given ten to 12 sessions by a level mental health counselor at the elementary school (Meany-Walen & Teeling, 2016). The treatment used followed guidelines from the Treatment Manual for Adlerian Play Therapy and included 30- minute individual sessions and 45-minute group sessions (Kottman, 2009 as cited in Meany-

Walen & Teeling, 2016).

The research assistant continued to collect data using the DOF based on assessments throughout the study (Meany-Walen & Teeling, 2016). In addition, visual analysis was utilized for the purpose of determining whether change resulted due to the treatment. Also, data was graphed to view change over time, and the PND statistic was analyzed (Meany-Walen &

Teeling, 2016).

Results of the study showed that Adlerian Play Therapy did improve negative behaviors of the participants in the treatment group following the intervention (Meany-Walen & Teeling,

2016). Furthermore, the results were consistent throughout participants and throughout time after the first two sessions. In contrast, participants in the control group who did not receive treatment did not show any improvement in behavior. The study ultimately showed strong evidence that Adlerian play therapy results in positive behavioral change among elementary aged children (Meany-Walen & Teeling, 2016).

LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 31

Developmental Considerations in Child Therapy

Neurological development is an important consideration when working with young children (Taylor & Bratton, 2014). The brain develops from the bottom part (the least ) to the top (the most complex). Brain plasticity allows the brain to respond to different environments. In addition, the structure of the brain can be changed based on experiences encountered and subjection to new stimuli. Children who are subjected to continuous adverse experiences without guidance and support are susceptible to becoming highly sensitive to and often lack self-regulation. However, the brain of a child exposed to early negative experiences can be altered through therapy which focuses on the relationship and provides opportunities for self-expression in play. Through play, children are able to learn about themselves and the world. Furthermore, young children demonstrate thinking that is egocentric, concrete, and influenced by perception. Therefore, in early development children are able to represent objects through the use of symbols, but are unable to express themselves entirely through words which explains why symbols through play is an appropriate form of communication for children (Taylor & Bratton, 2014).

Play is incredibly important for child development as well, as make-believe play is one of the first ways young children create symbols (Crain, 2011). In addition, many studies have shown that children’s play helps develop cognitive abilities including creativity, , self-control, and the ability to see things from other’s perspectives (Crain, 2011).

According to Piaget (1962), play connects abstract thinking with concrete experiences through symbols. Play therapy allows the child to use sensory means and concrete objects to represent the child’s experiences. Play also allows the child to organize experiences while feeling in control and secure. According to (Froebel, 1903, p. 22 as cited in Landreth, 2012) “play is the LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 32 highest development in childhood, for it alone is the free expression of what is in the child’s … children’s play is not mere sport. It is full of meaning and import.” Therefore, play brings forth the child’s conscious and unconscious purpose to develop a sense of meaning (Landreth,

2012).

Discussion

Adlerian Play Therapy and Logotherapy have many similarities. For instance, both emphasize the therapeutic relationship and encouraging and empowering rather than doing for the client (Taylor & Bratton, 2014; Tate, Williams & Harden, 2013). Both allow for the client by using mostly non-directive approaches and find meaning within experiences to help the client grow and heal (Frankl, 1961; Tate, Williams & Harden, 2013; Taylor & Bratton,

2014;). Additionally, one of the most apparent similarities between the theories is the importance of creativity. While Logotherapy emphases creativity as a way of finding meaning,

Adlerian play therapy focuses on the creative power of the child and using creativity such as puppets and sandtray during therapy sessions (Meany-Walen et al.; Tiwari, 2015). Neither theory seeks to eliminate emotions and both theories allow the client to exhibit self-expression

(Frankl, 1967; Tate, Williams & Harden, 2013; Taylor & Bratton, 2014). In contrast, a primary difference between the theories is that Adlerian play therapy has been specifically formed with child development in while Logotherapy has not been adapted for use with children

(Kottman, 2001 as cited in Even & Armstrong, 2011). Due to the lack of literature on the use of

Logotherapy with children, certain considerations need to be made in order to implement

Frankl’s theory with children in combination with Adlerian Play Therapy (Taylor & Bratton,

2014). Such considerations include remaining aware of the young child’s concrete thought processes, as a child’s brain is not fully developed. In addition, the child’s sensitivity to adverse LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 33 experiences and the effect which experiences and relationships may have on the child’s long- term emotional state must be considered. Lastly, an understanding that children learn primarily through play must be taken into account (Taylor & Bratton, 2014).

Building the Relationship Combines with Logotherapy

The following will describe steps of the Adlerian Play Therapy model with

Logotherapeutic techniques included to enhance the therapeutic process for children. During the initial building the relationship phase combined with Logotherapy, the therapist works in a non- directive approach to help the client feel comfortable and safe in the therapeutic environment

(Taylor & Bratton, 2014). The relationship phase naturally combines Adlerian and

Logotherapeutic aspects. For instance, in Individual Psychology it is important to develop relationships to reach a healthy level of social interest and belonging. Therefore, the therapeutic relationship is incredibly important in developing a healthy environment for the child to share feelings and emotions (Taylor & Bratton, 2014; Meany-Walen et al., 2015). In addition, Frankl

(1967) said the therapeutic relationship is important in Logotherapy as well to create the

“existential encounter,” as research has shown that social connection has been linked to meaning in life (Klein, 2017). When the child feels connected to the therapist one of the ways of finding meaning, “encountering someone or experiencing something” will be achieved, (Klein, 2017;

Tiwari, 2015)

Another aspect of the proposed Adlerian and Logotherapuetic integrative approach combines Frankl’s belief that individuals can find meaning through helping others and Adler’s view that individuals need community feeling and a sense of belonging to heal through therapy

(Meany-Walen et al., 2015; Tiwari, 2015). Therefore, in the proposed form of therapy the relationship building phase will include encouraging the child to help out during the session LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 34

(Meany-Walen et al., 2015; Taylor & Bratton, 2014; Tiwari, 2015). For instance, the therapist may provide opportunities for the child to participate in helpful tasks such as helping the therapist pour sand in the sandtray before an early recollection activity or helping the therapist fill up a cup of water for a watercolor activity (Meany-Walen et al., 2015; Tiwari, 2015).

Furthermore, using phrases to provide teleological accounts such as, “Thanks for helping me put water in the cup, helping can make us feel good because we made someone else feel good too” can help the child understand why the activity was meaningful (Tiwari, 2015). The act of allowing the child to help during the session has the ability to provide the child with a feeling of belonging and meaning through helping others during the therapy session (Meany-Walen et al.,

2015; Tiwari, 2015).

The final approach which will be used in the proposed form of therapy will be implemented during consultation sessions with the child’s caregivers and family. During the therapy sessions the therapist will talk with the caregivers in order to develop the therapeutic relationship and identify concerns which are present at home as in Adlerian play therapy, but will also explain to the caregiver’s the importance of providing helping opportunities for the child at home, as in both Logotherapy to find meaning and in Adlerian play therapy to develop social interest and community feeling (Meany-Walen et al., 2015; Tiwari, 2015). In addition, the therapist will provide psycho-education on ideas for helpful opportunities and role playing activities for how to present the options in a developmentally appropriate and consistent way.

Investigating the Lifestyle Combines with Logotherapy

During the Investigating Lifestyle phase of therapy combined with Logotherapy, the therapist finds play themes during sessions and identifies the child’s goals and mistaken beliefs about self, the world, and others (Even & Armstrong, 2011; Taylor & Bratton, 2014). The LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 35 therapist identifies important life events and experiences that the child might be lacking meaning in and understanding of. The therapist also notices connections with behavioral patterns and lack of meaning, and mistaken beliefs (Frankl, 1967; Taylor & Bratton, 2014). In addition, the therapist provides opportunities for playing out stories through creativity such as sandtray to identify early recollections, art to process feelings, and puppets to process past experiences

(Even & Armstrong, 2011; Meany-Walen et al., 2015). The creative outlets have the ability to bring forth the child’s creative power as in individual psychology, and help the child find meaning in creativity as in Logotherapy (Tiwari, 2015; Griffith & Powers, 2007). During the lifestyle phase it is important for the therapist to continue using a non-directive approach to let the child find his or her unique meaning (Mountain, 2016; Tate, Williams & Harden, 2013).

Furthermore, the child should have the freedom to express play themes whether upsetting or not, to allow the child to feel empowered and not feel the need to avoid feelings. The flexible approach will allow increased opportunities for the child to find meaning through play (Frankl,

1967; Tate, Williams & Harden, 2013).

The Investigating the Lifestyle phase continues to provide consultation sessions with the caregivers (Meany-Walen & Teeling, 2016). For instance, during sessions with caregivers the therapist may explore the child’s past experiences and lifestyle by asking the caregivers specific questions about the child’s past experiences. The therapist may also ask the caregivers questions about perceptions of behaviors at home in relation to past experiences (Meany-Walen & Teeling,

2016). Toys will then be chosen for future sessions based on the child’s unique preferences for activities (activities the child appears to find meaning in) and the child’s unresolved past experiences (Tate, Williams & Harden, 2013; Taylor & Bratton, 2014). Finally, a treatment plan will be formed based on the child’s lifestyle goals (Taylor & Bratton, 2014). LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 36

Gaining Insight Combines with Logotherapy

During the gaining insight phase of therapy combined with Logotherapy the therapist works to find the meanings behind the child’s behaviors in a combination of a non-directive and directive approach to therapy (Frankl, 1967; Taylor & Bratton, 2014). The therapist continues to observe which creative activities the child feels most passionate about and finds meaning in by observing facial expressions, body language, and time frames in which the child remains engaged in certain activities (Tiwari, 2015). The therapist also encourages the child to put names to share feelings about play themes and conveys that bad feelings are okay to express (Frankl,

1967). Interactive puppet interviews and continued sandtray therapy is used to identify connections between lifestyle themes and behaviors, and the therapist investigates why the child might prefer certain activities as opposed to others, based on the child’s past experiences and mistaken beliefs (Desmond et al., 2015; Even & Armstrong, 2011; Taylor & Bratton, 2014).

Caregiver consultations are included by exploring the caregiver’s perception of the child’s understanding of past experiences (Taylor & Bratton, 2014). The caregivers will have the opportunity to provide insight and background based on observation and opinion (Taylor &

Bratton, 2014). The intervention will provide the therapist with information on how the child might have perceived certain life events, if lack of meaning and understanding are present, and possible meanings behind the child’s behaviors (Frankl, 1969; Taylor & Bratton, 2014). At the end of the gaining insight phase a concrete lifestyle, mistaken beliefs, and the child’s unique ways of finding meaning in creativity, helpful activities, relationships, and experiences are identified in order to prepare for the reorientation and re-education phase (Frankl, 1961; Taylor

& Bratton, 2014; Tiwari, 2015).

LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 37

Re-orientation/Re-education Combines with Logotherapy

During the re-orientation/re-education phase of therapy combined with Logotherapy, the therapist takes a more directive and collaborative approach while helping the client form new opinions of the self, the world, and others. The therapist also encourages the child to find unique creative outlets, and understand meaning in unfortunate experiences, unfortunate relationships, and helping others (Taylor & Bratton, 2014; Tiwari, 2015). The therapist will implement the reorientation phase primarily through narration of feelings and meanings (teleological accounts) in a concrete way and the use of puppet play and role playing activities (Banerjee & Bloom,

2015; Meany-Walen et al., 2015; Taylor & Bratton, 2014). In addition, the therapist will often use he/she learned” statements while also acknowledging negative feelings to help the child understand meanings of life events (Banerjee & Bloom, 2015). For example, during a puppet play activity involving a puppet named Henry with a child whose parents got divorced, the therapist might say “Henry felt sad that his mom and dad got divorced and feeling sad is a real feeling, but he learned that mom and dad did not argue so much and were happier when they were apart. Now mom and dad can focus more on helping Henry with his homework and playing with Henry during the day. Even though it’s too hard for mom and dad to be together now, they still love Henry just as much.” The statement presented may help the child have a positive view of self and others, see meaning in the relationship with the child’s parents, and find meaning in the unfortunate experience the child’s parents getting divorced (Banerjee & Bloom,

2015; Even & Armstrong, 2011; Tiwari, 2015). The therapist can also help the child find meaning in creative tasks by expressing narrations. For instance, the therapist can narrate for a child who has expressed a significant interest in art while the child is painting (Banerjee &

Bloom, 2015; Tiwari, 2015). The therapist might say, “I can see that you love painting. It looks LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 38 like you learned that painting can help you feel relaxed and calm. I think you realized what a creative and cool kid you are.” The statement presented may help the child develop a positive sense of self and identify a unique meaning forming activity (Banerjee & Bloom, 2015; Even &

Armstrong, 2011). The therapist will also provide opportunities for the child to acknowledge the child’s own feelings, understand the new meanings presented, and learn new behaviors to coincide with the established feelings such as new coping strategies (Meany-Walen & Teeling,

2016).

Lastly, narration for helping tasks, as mentioned in the building the relationship section should be continued in the re-orientation phase, as helping narrations may encourage the child to feel more control over the session, and find meaning in the relationship with the therapist and helpful behaviors or “doing a deed” (Banerjee & Bloom, 2015; Taylor & Bratton, 2014; Tiwari,

2015). A combination of statements such as those presented will not only help the child find meaning in current tasks and past experiences, but will also likely help the child develop a more positive view of self, the world, and others, as in Adlerian Play Therapy (Banerjee & Bloom,

2015; Even & Armstrong, 2011). Ultimately, through the successful combination of the phases of Adlerian play therapy and Logotherapy the child will gain social interest, community feeling, elimination of mistaken beliefs, identification of the child’s unique meaningful tasks, and understanding of meaning in past experiences (Ansbacher & Ansbacher, 1956; Banerjee &

Bloom, 2015; Tiwari, 2015).

Lastly, child appropriate forms of de-reflection, attitude modification, and paradoxical intention will also be used during the re-orientation phase (Ameli & Dattilio, 2013). Although paradoxical intention may not work with younger children, as young children may not have the developmental capacity to understand the humor in unfortunate events, humor can be used in LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 39 therapy to help provide a safe environment for the child, promote healthy coping strategies, and help the child process negative life events in a healthy way (Ameli & Dattilio, 2013; Taylor &

Bratton, 2014). Additionally, de-reflection can be used by helping the child see other’s perspectives with narration of family member’s possible feelings, narration of character’s feelings during puppet play, and role-playing activities (Banerjee & Bloom, 2015). Attitude modification can also be used in therapy with children to help the child see meaning in unfortunate relationships and events by providing narration of teleological accounts related to the negative relationships and events (Lukas, 1998 as cited in Ameli & Dattilio, 2013; Banerjee &

Bloom, 2015).

Caregivers should also be involved in the re-orientation portion of therapy.

Consultations with the child’s caregivers will continue, as the therapist provides psycho- education on the child’s unique meaningful activities during therapy, how to encourage the meaningful activities at home, how to continue providing helping tasks for the child, and ways to help the child continue to understand the meaning of unfortunate experiences at home through explanations from the caregivers (Banerjee & Bloom, 2015; Frankl, 1961). In addition, at the end of therapy the caregivers will be invited into sessions for with the child to practice learned skills through role-playing activities (Taylor & Bratton, 2014). During the development of the re-orientation phase and family therapy the child will begin to display more positive viewpoints, perceptions, and behavioral patterns during sessions and at home (Taylor &

Bratton, 2014).

Conclusion

In conclusion, Logotherapy promotes the use of forming meaning in life and Individual promotes the use of developing social interest in therapy. Research has shown that both LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 40

Individual Psychology and Logotherapy exhibit important guidelines, approaches, and techniques for implementation of effective therapy, as developing meaning and a sense of belonging and social interest help enhance individual well-being. Furthermore, Adlerian Play therapy, a child appropriate form of therapy based on Individual Psychology, enhanced with the use of logotherapeutic techniques presents well-rounded therapeutic process for child mental health. The use of concrete and simple teleological narration with relational goals, “he/she learned” statements, creative and, helping opportunities, lifestyle assessments through play, and involvement of family members can help the child learn and develop through play. Moreover, further research can be done on the implementation of both Logotherapy and Adlerian Play

Therapy to gain a clearer developmental understanding of the approaches combined and the creation of additional methods. In addition, research can be conducted with young children to determine whether use of the two theories combined is indeed effective in helping children with mental health diagnosis. However, despite direct research on the combined model presented, past research and articles have shown that Adlerian play in combination with Logotherapy does have the capacity to form a developmentally appropriate and effective form of therapy for children.

LOGOTHERAPY AND ADLERIAN PLAY THERAPY COMBINE 41

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