Play Therapy Theory and Practice

Comparing Theories and Techniques

Kevin J. O'Connor, Lisa D. Braverman

• Publisher: Wiley
• Year: 2009
• ISBN:
  9780470459393
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

The Bestselling Text on the Theory and Practice of Play Therapy—Completely Updated and Revised

Play Therapy Theory and Practice: Comparing Theories and Techniques, Second Edition provides a forum for the direct comparison of the major theoretical models of play therapy and their implications for treatment. Co-edited by Kevin O'Connor, one of the foremost authorities on play therapy, and Lisa Braverman, an experienced child psychologist, the new edition contains the most recent coverage of diagnostic approaches and treatment modalities in child psychology as they relate to integrating play therapy in practice. This edition also covers new topics such as bipolar and ADHD diagnosis and treatment.

Thorough, yet extraordinarily practical, the editors use two case studies throughout the text to demonstrate the application of each play therapy technique and treatment approach, allowing the reader to compare each major model of play therapy and assess its utility to their own particular client needs and practice orientation. After the cases are presented in the introduction, ten chapters follow, each written by a renowned expert(s) in play therapy introducing a major model of play therapy and applying it to the opening cases. This consistent format enables professionals to gain a practical, hands-on understanding of how current approaches to play therapy work, as well as the underlying principles upon which they are based.

Written for mental health professionals at all levels of training and experience, Play Therapy Theory and Practice: Comparing Theories and Techniques, Second Edition covers:

• Psychoanalytic Play Therapy
• Jungian Analytical Play Therapy
• Child-Centered Play Therapy
• Filial Therapy
• Cognitive Behavioral Play Therapy
• Adlerian Play Therapy
• Gestalt Play Therapy
• Theraplay
• Ecosystemic Play Therapy
• Prescriptive Play Therapy

Informative, thought provoking, and clinically useful, Play Therapy Theory and Practice: Comparing Theories and Techniques, Second Edition is a valuable resource for practitioners in the field of child psychotherapy, setting the standard for training and practice.

CHAPTER 1

Psychoanalytic Play Therapy

ANNA C. LEE

INTRODUCTION

Within the past 10 years, psychoanalytic play therapy has evolved significantly in several different directions, explicating further the nuances of therapeutic action and the underlying assumptions of the existing technique. Its scope has widened to include treatment of children with more severe ego deficits as well as neurotic compromises. The role of the therapist is emphasized as a full participant whose engagement with the child is an integral part of the play created, and it can fundamentally alter the very course of the therapy. Freud (1905) laid the foundations for psychoanalytic play therapy when he first wrote about infantile sexuality as manifested in the childhood of adult patients he came to analyze. Later on, his analyses of his own children and of Little Hans, through the intervention of the boy’s father, gave him further experience and insight into the emotional development of children. However, it was his daughter, Anna Freud, who broadened the scope of psychoanalysis to children and made lasting, profound contributions to the study of personality development of the child.

Over the years, with the need to obtain greater understanding of the effects of childhood trauma arising from knowledge gleaned from the analyses of adults, the direct observation of children in statu nascendi was deemed necessary and thus laid the foundation for child psychoanalysis. While several theories about child analysis have evolved, Anna Freud’s model (1965) is generally considered the most solid and integrated, positing the tenets and methodology by which to access and treat child psychopathology from years of clinical observation and research. The methods of child analysis depend on the developmental standing of each patient, whether children or adolescents. As one tool of child analysis, play therapy has emerged as a fundamental technique, allowing the child analyst to guide young patients in recognizing their internal pressures and to help them resolve conflicts to speed development on its way.

As we delve into the clinical cases of Jason L. and Cassie B., I will propose a postmodern (contemporary history post 1950 and 1960) and biosocial perspective of play therapy. This perspective integrates some advances in neuroscience and early neural development that have taken place within the last decade. It also highlights the ever-widening scope of the child analysis and play therapy to include trauma imposed by ongoing environmental influences affecting the development of the child.

As first conceptualized by Freud, psychoanalytic theory views personality development as a dynamic, multifaceted process based on the concept of infantile sexuality with its sequence of libidinal phases from whence derive instinctual drives and their energies. All behavior is thus motivated by the expression of these drives and their object cathexes. Throughout the life span, the cathexes of psychic energy is realized by experiences with important object relationships, shaping and molding the individual character as well as expressing the libidinal and aggressive drives, adaptive ego functions, and superego demands. In other words, the personality develops out of the need to fulfill the pleasure principle, all the while attempting to negotiate reality demands without incurring superego strictures. Nowhere is this process more critically developed and honed than within the formative years between birth until the onset of the post-oedipal, latency years. While the personality continues to change and adapt, the traumatic neuroses that can occur during the first six years, ending with the resolution of the Oedipus complex, create the regressions, fixations, and exaggerated defensive maneuvers that comprise the symptoms of the psychoanalytic treatment. Psychoanalytic understanding has evolved over the years, informed by perspectives from ethology, the study of the biology of behavior, and anthropology. Moreover, current psychoanalytic thinking is enriched with perspectives from ego psychology, object relations, and self-psychology (Klein, 1932; Hartmann, 1950; Winnicott, 1965; Kohut, 1971). As a technique, psychoanalysis continues to aim toward restructuring the personality as a whole, doing so by way of reconstruction of repressed memories, fantasies, wishes, and experiences.

This chapter focuses on the indications for and application of psychoanalytic play therapy to the case of Jason L. and Cassie B. It is this author’s premise that the psychoanalytic framework provides the most thorough and rigorous theory of personality development. As such, it encompasses well-developed techniques for working with the psychopathology of childhood toward the ultimate goal of removing the impediments to normal development.

The widely held view of psychoanalysis as a Eurocentric, often misogynistic, theory of personality development merits some discussion. Criticisms of the androcentric nature of psychoanalysis have been numerous, coming from women psychoanalysts (Horney, 1967; Thompson, 1943; Miller, 1973) as well as feminists of the 1960s and 1970s who viewed psychoanalysis as condoning the oppression of women. They cite Freud’s formulations about the differentiation between the sexes, penis envy, and female masochism, as well as his claim that women were passive, inferior beings. In contrast, Juliet Mitchell (1974) believes that Freud’s analysis of the psychology of women contributed greatly to the understanding of women in our patriarchal society. She asserts that Freud was describing his observations of women, not offering a prescription for the role they should have in society, and that much criticism of Freud is based either on unfamiliarity with or misunderstanding of his work (Solomon, 1976).

Psychoanalytic writing continues to address itself to the question Freud posed of “What do women want?” with a clear understanding, and hope, that the answer to this question will illuminate the psychology of all—men as well as women. As for child analysis, its major theoreticians have been women like Anna Freud, Melanie Klein, and Margaret Mahler, to name a few. Throughout their thinking and writing runs a strong sense of appreciation for the psychology of both genders, not one as superior to the other. What they bring to the analysis, whether intrapsychic or extrapsychic, is entirely grist for the mill.

Psychoanalysis has also been criticized for its seeming lack of relevance to culturally diverse populations. My answer to this lies in the fact that Freud and his theory were set in the context of his age and times, formulated without the benefit of our awareness of cultural diversity as it stands today. In attempts to widen the scope of psychoanalysis to different populations, today’s analysts do take into account the suitability of psychoanalysis for diverse groups and to increase our sensitivity to the cultural norms and issues they bring. Moncayo (1998) proposes a theory for articulating intrapsychic and extrapsychic dimensions of the theory, underscoring the need to redefine the psychoanalytic concept of insight to integrate the knowledge found in various cultures.

I shall begin with an introduction of child psychoanalysis as a theory and technique, with specific emphasis on the role of play therapy. Although other theories and methods of child analysis and therapy exist (Klein, 1932; Axline, 1969; Winnicott, 1971), Anna Freud’s work is definitively associated with psychoanalytic play therapy. For that reason, this chapter limits itself to her views and those of the Freudian perspective. Specific application to the case of Jason L. with the pathogenic factors of the manifest symptoms will next be considered, followed by the indications for and techniques of psychoanalytic play therapy as applicable to a latency-age child such as Jason L. The effects of family dynamics, parental psychopathology, and their possible effect on Jason’s psychic development will be scrutinized. A discussion will follow of the prognosis for Jason L. and, to some extent, his family. The second case study of Cassie B. will also be addressed in this manner. Particular consideration of predominant familial factors which have contributed heavily to the psychic disturbances Jason manifests will merit special discussion and clinical attention. Finally, implications for future work with children and families with similar disturbances are addressed with an eye toward prevention of further psychopathology and encroachments upon the normal developmental progress.

PERSONALITY THEORY: FREUDIAN AND OBJECT RELATIONS PERSPECTIVES OF ATTACHMENT AND ATTUNEMENT

Freud first developed psychoanalytic theory out of clinical experience with patients suffering from symptoms caused by repression of childhood forbidden wishes, fantasies, and memories experienced in relation to important persons in their past. These were forbidden because of their sexual and aggressive content. From his observations came the basis of psychoanalytic theory, one that posits the personality develops out of the necessity of biologically based, instinctual urges that seek gratification. In the process of seeking drive gratification, conflict inevitably arises between the drives and the reality principle served by the ego, causing tension through the press of signal anxiety and depressive affect experienced in the “familiar calamities of childhood: object loss, loss of love, castration, and superego demands and prohibitions” (Brenner, 1982). Freud’s concept of the infantile neurosis was revolutionary for its day as it posited early childhood as the scene for libidinal urges that the child directed toward primary objects, particularly parental figures.

Freud viewed human development as an ontogeny in which all individuals progressed in predictable, albeit dynamic, phases he termed the psychosexual stages of libidinal development. These are specifically the oral, anal, phallic, and genital stages. He proposed five models of the functions of the mental apparatus, namely the structural (the agencies of id, ego, and superego), the economic (urge of instinctual energy to seek discharge and return to homeostasis), the dynamic (moving from unconscious to preconscious to conscious levels of awareness), the genetic (tracing back the origin of symptoms to the earliest years), and the hydraulic (psychic energy is considered a closed system, whereby it is either directed at an object or retracted, according to the needs of the system). While the personality is affected and modified by experiences throughout the life cycle, in classic psychoanalytic theory the major components of the personality are developed by the end of the oedipal phase. The stage of latency is thus a stage of quiescence of the instinctual urges following the generally tumultuous oedipal phase. It is a period for consolidating the gains achieved, during which time children normally direct their energies toward adaptive functioning in the world (i.e., school, peers, and social community).

As a clinical method, psychoanalysis strives to help its patients understand the nature and origins of their unconscious conflicts, whether they are warded-off drive derivatives, anxiety or depressive affect, defense maneuvers, or superego determinants. Through the use of free association and the analyst’s function of interpreting resistance and transference, analysis proceeds from defense and character analysis to that of repressed wishes, memories, and fantasies. Treatment strives toward increasing the patient’s self-awareness and capacity for problem solving, all of which eventually lead to a higher level of psychic organization (Ritvo, 1978).

Although it grew out of the reconstructions of adult psychoanalysis, child analysis differs significantly in many ways, chief among them the very nature of childhood, specifically the immature state of psychic structures such as the ego and superego. The child differs from the adult in four major ways: (1) basic egocentrism, (2) the immaturity of the infantile sexual apparatus, (3) the relative weakness of secondary process thinking, and (4) immature evaluation of time at various stages of development (A. Freud, 1965). Like biological pressures, psychic development also proceeds in a progression toward maturation, greater integration, and consolidation, with the gains acquired in an earlier stage serving as the basis for learning and mastery at the next level. As Anna Freud notes:

the urge to complete development is immeasurably stronger in the immature than it can ever be in later life. . . . The child’s unfinished personality is in a fluid state. Symptoms which serve as conflict solutions on one level of development prove useless on the next and are discarded. Libido and aggression are in constant motion and more ready than in adults to flow into the new channels which are opened up by analytic therapy. (1965, p. 28)

She has advocated ascertaining the normal versus the abnormal, as the child analyst sees progressive development as the most essential function of the immature. She has furthermore proposed the concept of developmental lines along which normality proceeds, taking into account the intertwining of drive and ego development. Examples of such developmental lines include (1) from dependency to emotional self-reliance and adult object relationships; (2) from lack of control toward body independence; (3) from egocentricity to companionship; and (4) from the body to the toy and from play to work. She noted that child’s play was the equivalent to the adult’s capacity to work, and that a “disturbance could manifest itself in an inability to play or in excessive imaginative play at the cost of constructive play” (Miller, 1996, p. 147). She later included additional developmental lines that involved secondary process functioning: distinguishing between the inner and outer world; discharging mental excitation via mental, as opposed to somatic pathways; impulse control; and the developmental of a time sense and insight (A. Freud, 1979).

She introduced the concept of developmental disharmonies, which encompassed early disturbances of the “basic fault,” a concept proposed by Michael Balint (1958) to describe early disturbances in the early mother- child relationship. Disharmonies were intrasystemic or intersystemic conflicts that could arise from several different determinants, including developments in drive expression, maturing ego functions, affect, object relations, and modes of attachment, as well as environmental influences. Miller states:

In order for the personality to be harmonious, growth on one developmental line needs to correspond with growth on another. Moderate disharmonies produce the many variations of normality. If the disharmonies are more severe pathology results. The analytic task is to trace the interaction between lines and to determine what components are causing the child’s difficulties. (1996, p.152)

Anna Freud summarized the normal developmental process as consisting of the interaction of three factors: endowment, environment, and rate of structuralization and maturation within the personality. Furthermore:

Provided that all three are within the expectable norm, the child will arrive in every crucial developmental phase with the right inner equipment and meet the right environmental response, i.e., have a chance or normal growth. If, however, any of the three deviates too far from the average, the developmental result will become distorted in one direction or another. (A. Freud, 1965, p. 90)

Psychoanalytic writers such as Winnicott (1953; 1965; 1971), Mahler (1968; 1979; 1980) and others have written more extensively on the theory of object relations, thereby deepening the theoretical understanding on the intrapsychic life of the infant and young child. Each emphasizes different facets of the child’s progress, first in symbiotic union with the mother and later toward differentiating the self from the other in establishing his or her own identity. Mahler, for example, introduced the theoretical concept of separation-individuation, a process by which the infant initially melds in identity with his mother in a symbiotic bond and, through a series of phases, emerges at the end of the third year as a separate entity. She writes that this achievement of the “psychological birth of the infant” is a gradual, unfolding process in the intrapsychic world of the infant and that actually all human life concerns an emotional bond with the mother, although the ties are lessened finally in adulthood.

Failure to negotiate successfully these subphases has ramifications for developmental deviance and pathology. For example, the toddler in the practicing subphase (approximate ages 10 to 18 months) experiences a “love affair with the world” because he is the center of his world as he narcissistically invests his own functions, his body, and the important objects of his world. In contrast, the toddler of the next phase, the period of rapprochement (ages 15 to 22 months), no longer feels the world to be his oyster. No longer does he believe in parental omnipotence or availability. He must woo back his mother’s attention, seeks to come back to her often for refueling, and demands that she be interested in whatever he requires of her. Mahler writes that

likewise, at the other end of the erstwhile dual unity, the mother must recognize a separate individual, her child, in his own autonomous right. Verbal communication has now become more and more necessary; gestural coercion on the part of the child will no longer suffice to attain the child’s goal of satisfaction. Similarly, the mother can no longer make the child subservient to her own predilections and wishes. (1980, p. 10)

The junior toddler must recognize that his love objects (his parents) are separate individuals with their own interests, and he must give up his delusion of his own grandeur, often through dramatic fights with his mother—less so with his father. This is a crossroad called the rapprochement crisis. If the mother remains emotionally available for the toddler during this period, if she shares his ex...