PLAY IN CHILD DEVELOPMENT AND PSYCHOTHERAPY Toward Empirically Supported Practice SANDRA W. R USS Play in Child Development and Psychotherapy Toward Empirically Supported Practice Irving B. Weiner, Advisory Editor Play in Child Development and Psychotherapy Toward Empirically Supported Practice Sandra W. Russ Case Western Reserve University LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS 2004 Mahwah, New Jersey London Copyright © 2004 by Lawrence Erlbaum Associates, Inc. All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means, without prior written permission of the publisher. Lawrence Erlbaum Associates, Inc., Publishers 10 Industrial Avenue Mahwah, New Jersey 07430 Cover design by Kathryn Houghtaling Lacey Library of Congress Cataloging-in-Publication Data Russ, Sandra Walker. Play in child development and psychotherapy : toward empirically supported practice / Sandra W. Russ. p. cm. Includes bibliographical references and index. ISBN 0-8058-3065-0 (cloth : alk. paper) 1. Play therapy. 2. Play—Psychological aspects. I. Title. RC505.P6 R876 2003 618.92’891653—dc21 2002035397 CIP Books published by Lawrence Erlbaum Associates are printed on acid- free paper, and their bindings are chosen for strength and durability. Printed in the United States of America 10987654321 In memory of my parents, Edith and Wilson Walker, who provided me the opportunity to play Contents Preface ix 1 Fundamental Play Processes 1 2 The Role of Play in the Development of Adaptive 8 Abilities 3 The Role of Play in Therapy: The Theories 34 4 The Role of Play in Therapy: The Research 66 5 The Affect in Play Scale 79 6 Current Trends in the Therapeutic Uses of Play 115 7 Teaching Children to Play 125 8 Future Directions in Research and Practice 133 Appendix: Affect in Play Scale 145 References 156 Author Index 173 Subject Index 179 vii Preface Children’s pretend play is a complex phenomenon. Pretend play in- volves a myriad of processes and behaviors that change from moment to moment. Does pretend play have important functions in child develop- ment, or is it simply something children engage in to pass the time—al- beit while having fun? This is a central question in the field of child psychology today. It is an especially important question for child thera- pists. Practitioners of a variety of theoretical persuasions use play in working with children. As of 1992, play in some form was used in child therapy by a majority of clinicians, according to Koocher and D’Angelo (1992), who stated that “play-oriented therapy remains the dominant and most enduring approach to child treatment ... practiced by clinicians (p. 458). Many therapists use play because it is a natural activity and form of communication of young children. Also, different theoretical schools stress the importance of pretend play in the therapy process. Psychoana- lytic, psychodynamic, client-centered (nondirective) approaches, and cognitive-behavioral approaches as well, have proposed that change oc- curs in the child through the process of play. What is the evidence for this proposition? The movement toward em- pirically supported treatments is gaining increasing momentum. It is cru- cial for the development of scientific principles of behavior change. Also, the managed care system will be looking to research for guidance about its policies. If play is to continue to be used as a major treatment modality, its effectiveness must be empirically demonstrated. The main thesis of this book is that play has an important role in child development and is a major vehicle for change in child psychotherapy. Two extensive bodies of research literature address the functions of play, one focusing on pretend play and child development, one on the use of play in psychotherapy. These two literatures need to be integrated. Play is involved in the development of many cognitive, affective, and personality processes that are important for adaptive functioning in children. Often, those who discuss the effectiveness of play in therapy ignore the accumu- lating knowledge base in developmental psychology. We have not drawn ix x PREFACE on this knowledge base in developing play intervention and play preven- tion programs that can be evaluated empirically. On the other hand, insights from the theory and research of child ther- apists are not usually reflected in laboratory research on the role of play in child development. Only more effective two-way communication be- tween clinicians and developmental researchers can enable the evolution of more refined developmentally based play interventions and the for- mulation of clear guidelines about the next logical steps for play research programs. Finally, the implications for the practice of play therapy of the research that has been done thus far need to be spelled out. This book will attempt to accomplish these three goals: (a) to review and integrate what we have learned from research in the child development and play therapy areas, (b) to suggest directions for future studies, and (c) to present guidelines for practitioners based on current research findings. If we can construct a coherent picture of the current knowledge base, then we can understand more clearly what we should be doing as both re- searchers and practitioners. This book also identifies play processes and proposes that play interventions should target specific play processes rele- vant to the goals of the intervention program. Play is especially important in the processing of emotions. This specific approach to the use of play in psychotherapy and prevention programs is a new one. The book begins with an overview, “Fundamental Play Processes.” The processes that occur in play are presented, identified, and classified. Play and emotion are discussed, and a new paradigm for play intervention that targets specific play processes is suggested. Chapter 2, “The Role of Play in the Development of Adaptive Abilities,” reviews the research on child de- velopment in play and the areas of adaptive functioning of creativity, cop- ing, adjustment, and social behavior. Chapter 3, “The Role of Play in Therapy: The Theories,” reviews the major theories of the role of play in child psychotherapy and how change occurs. There is a focus on how the play processes with which therapists work “match up” with the play pro- cesses that emerge in the child development research. A model that bridges the two literatures is proposed. Several clinical cases are also pre- sented. Chapter 4, “The Role of Play in Therapy: The Research,” reviews studies of child psychotherapy and focused play intervention. One section discusses possible models for understanding the effectiveness of play in- terventions in reducing anxiety. Consistencies between the child development research and psychotherapy and play intervention research are highlighted. The next chapter, “The Affect in Play Scale,” presents the revised ver- sion of this standardized measure. There is a detailed review of the validity studies that I and my students have carried out. The revised version of the scale can be found in the Appendix. The clinical and scientific implications of its further development and use are discussed. Some other measures of PREFACE xi play are also discussed. Chapter 6 reviews “Current Trends in the Thera- peutic Uses of Play.”In chapter 7, “Teaching Children to Play,”studies that focus on facilitating play skills in children are presented, together with a pilot program that has developed play intervention scripts. The final chap- ter, “Future Directions in Research and Practice,” offers conclusions and suggestions for research and practice. I hope that the book will inspire cli- nicians and researchers to play with ideas and build the empirical founda- tion for play intervention programs. ACKNOWLEDGMENTS Special thanks go to Susan Milmoe, Senior Consulting Editor at Lawrence Erlbaum Associates, for her invaluable guidance in this process, and to Lawrence Erlbaum for his encouragement. I also want to thank Gail Gangidine for her word processing expertise. And, as always, a deep thank you to my husband, Tom Brugger, for his constant support of my work over the years. —Sandra W. Russ 1 Fundamental Play Processes I was sitting in the cafeteria at the San Diego airport, amidst the usual cha- otic airport scene, when I noticed a little boy, about 6 or 7 years old, sitting at the table next to mine. He was with an older brother or very young fa- ther, who was reading. The boy had laid out in front of him four figures: a cowboy, an Indian, a large monster, and a larger rubber dinosaur. He was totally engrossed in fantasy play with these creatures and was making up dialogue and action. I could not hear all of it, but I could hear, “Do this,” “No you won’t,” “Here’s this.” Some of the play was with an angry tone, some with a cooperative tone. There was a definite story line. His play went on for about 30 minutes. He was totally engaged and comfortable and was clearly having a good time. Finally,his older companion indicated it was time to leave. He helped the child carefully pack all of the creatures into his knapsack. The boy told one of them to “Have a good day.” He kept the dinosaur out and put it under his arm. The older companion was han- dling the situation very well: he was gentle, didn’t rush the boy, respected his little creatures, and did not intrude in the play.The boy was totally com- fortable playing in front of him. I don’t know what kind of family situation this boy comes from or what kind of stress he’s going on to, but I do know that he has a terrific resource—he can use play and he likes to play. He is a good player, and that will help him in a variety of ways (Russ, 1995, p.