22 Play therapy – Melanie Klein’s approach

M. Priya

Introduction

Many research studies have identified current trends in child counselling treatment approaches. Most counselling approaches currently used in child counselling such as behaviour therapy and cognitive approaches, these are adaptations of strategies used with adults. Play therapy represents one of the few approaches developed specifically for child counselling. This provides an overview of the use of play therapy. It can be used to treat a wide range of childhood problems but appears to work best with neurotic children.

Play therapy also superior to nontreatment and promoted general adaptation and intellectual skills. The major schools of play therapy are currently in use. The first is the psychoanalytic school developed by Anna Freud and further refined by Melanie Klein. These psychologists incorporated the major principles of psychoanalysis in their approach. Eg: strengthening the ego to minimize endopsychic conflicts and utilizing the transference relationship to help children overcome traumatic experiences.

Objectives

• To outlay the history of play therapy
• To know the definition and basic goals of play therapy
• To understand theoretical bases of play therapy
• To understand the guidelines for play therapy
• To be aware of early thoughts on child analysis
• To know Kleins approach to play therapy

A HISTORY OF PLAY THERAPY

Play therapy was first coined by the child psychotherapist. Anna Freud (1928, 1964, 1965), Margaret Lowenfeld (1935, 1970) and Melanie Klein (1961, 1987) posted the theoretical premise for the use of play, for example, Klein (1961, 1987) stated that every child’s spontaneous play was like a substitute for the free association used within adult psychoanalysis.

For each child psychotherapy theories and practice play different roles. But, each tradition is connected by the central proposition that play transmits and communicates the child’s unconscious experiences, desires, thoughts, and emotions.

Play therapy has appeared from the elements of Child Psychotherapy with the specific theoretical foundations derived from the Humanistic Psychology tradition and Attachment theory.

In the 1940’s, Carl Rogers (1951, 1955) initiated a new model of psychotherapy, that is called client centred therapy (later termed person centred therapy). However, this new tradition was born as a protest against the diagnostic, prescriptive perspectives of that time. More emphasis was placed upon the relationship between therapist and client based upon their genuineness, trust and acceptance. As such, the person centred approach predicated a new and original theoretical perspective of personality structure, acquisition of psychological difficulty, psychological health and the change process within therapy.

With this approach, Axline (1969, 1971) has developed a new approach to work with children and that is called as non-directive play therapy. Utilising the person centred theoretical foundations, Axline devised a clear and succinct Play Therapy theory and method. Her account of how she worked with a young boy called Dibs is well known (Dibs: In Search of Self, 1964). Axline described in great detail how she worked with Dibs and how he was able to heal himself over a period of time. She said “No-body ever knows as much about a human being’s inner world as the individual himself in emotions. Responsible freedom grows and develops from inside the person”. Her eight principles of the therapeutic relationship inform the work of many Play Therapists.

Clark Moustakas describes his work concerned with the kind of relationship needed to make therapy a growth experience. His stages start with the child’s feelings are being usually negative and as they are expressed, they become less intense and the end results tend to be the emergence of more positive feelings and more balanced relationships with people.

For over past 50 years, Play Therapy was generally practiced and researched within America. This has been led by many Play Therapists, including Moustakas (1953, 1966, 1973, 1981, 1992), Schaefer (1976, 1986, 1993) and Landreth (1991,2002) who have progressed Axline’s original formulations and devised differing models integrating elements of systemic family therapy, narrative therapy, solution focused therapy and cognitive behavioural therapy. In Britain, Play Therapy was started to create a new and different tradition during 1980’s.

In parallel, two Drama therapists started using these Play Therapy methods to notify their Drama therapy exercise with children. Sue Jennings (1994) and Ann Cattanach (1993, 1994, 1998) integrated elements of non-directive Play Therapy to formulate a British Play Therapy movement. In 1990, the Institute of Drama therapy started to offer a Certificate and Diploma in Play Therapy.

In 1992, the British Association of Play Therapists (BAPT) was initially started with a group of people who are professionals in Drama therapy. Since then, BAPT has developed the British Play Therapy movement and now it offers many different types of training courses in the UK. But in India such types of courses unavailable.

Play therapy:

“Play Therapy is the vigorous process between child and Play Therapist, where the child explores at his or her own pace and with his or her own experience. These experiences may be of past and present, conscious and unconscious, which are troubling the child in present situations. The child’s inner feelings are enabled by the therapeutic process to bring changes in growth and development. Play Therapy is always a child-centred, in which play is the primary medium and speech is the source of secondary medium.”

Goals of Play therapy:

The primary goal of play therapy includes helping a child in minimising his troubles or negative feelings (resolving grief, depression, anxiety, stress etc) and to overcome trauma, to adjust in new life events such as loss of parents, coping with illness, divorce, phobias, work in school, home works, managing anger and temperament, to be able to attend better and to adjust with learning difficulties or physical disability.

When these goals of psychoanalytic play therapy are more aspiring and also determined to change not just to overcome behavioural/ emotional problems or symptoms but a broader, deeper and more crucial aspects of the child and her ways of dealing with life problems. Play therapy can be used to reduce the harsh integrity in a child who donot accept to give himself a break. It will help a child to integrate several aspects of his personality or help the child to directing his developmental tasks in each stages of life from infancy to till adolescence. This therapy can help the isolated or detached child to connect more to themselves, family, friends and others. Play therapy is enormously good at supporting self- resiliency and adaptableness which helps every child to reduce his susceptibility to psychological, emotional disorder or borderline disorder especially when the child is under stress, anxiety or depression. It will help the submissive child to grow more responsible, active, happy, comfortable, courageous and impulsive. It also proposes to go beyond the immediate discomfort, pain, internal conflict or trouble and clear the way which helps a child to grow in a healthy manner with appropriate developments in all the stages of his life. It is effective in helping a child in difficult conditions.

The psychoanalytic counsellor conceptualizes play in a manner similar to free association. From this perspective, play allows children to express themselves freely and spontaneously. The counsellor’s role in this process is passive and interpretive. For eg: if a child painted a picture with dark objects, the counsellor might ask “are you feeling sad or gloomy today?”.

This approach suggested that the counsellor conveys a warm and accepting attitude towards the child and encourages the child to explore the different play materials and ideas freely. As the child plays, counsellor attempt to convey empathetic understanding to reflecting what they sense the child experiencing.

Theoretical Basis of Play Therapy

Play Therapy emphasizes the client as trustworthy. Play Therapy is generally based upon three critical theoretical principles:

Actualisation – Humans are motivated by an innate tendency to develop constructive and healthy capacities. This disposition is to actualise each person’s inner potentials, including aspects of curiosity, creativity and the desire to become more effective and autonomous. The Need for Positive Regard – All people necessitate warmth, respect and acceptance from others, especially from ‘significant others’. As children grow old and develop the need for positive regard converts into a secondary, learned need for positive self-regard. Play is like as Communication – Children use play as their primary source of communication. Play is a set-up for transmitting children’s emotions, thoughts, values and perceptions. It is a medium of creativeness and socialization.

How it works?

Play therapy provides a difficult child in a place safe from physical, psychological harm where he can let his temper tantrums, troubles, and negative feelings to explore positive thoughts, feelings, and ideas for his life. This therapy considers along with child-centred approach in more reliable way and which helps the child to feel better and function normal. Play is the only way every child explores him in safe trustworthy environment and can easily convince when he found someone to self-explore. Psychotherapist empathetically and carefully listens and responds to a child deeply in play therapy which facilitates interventions to meet the client where he is emotionally neither falling flat nor irresistible. The atmosphere of therapy should create constant opportunities to communicate with child as well as explore to the core.

Guidelines for play therapy:

Play therapy could be conducted individually or in small groups of two or three children in certain cases if problems are alike or inter-related. The play therapy room should be approximately 15 by 15 feet. It should fit for two or three adults and at least three to four children, but small enough to encourage a sense of closeness between the counsellor and child. If the room is too big enough, the child may wander off. The counsellor should guarantee the privacy. No one should be permitted to come into the play therapy room while a session is in progress. Interruptions can be a major distraction from the counselling process. The counsellor should obtain different play materials such as puppets, dolls, molding clay, crayons, water colour materials, paper, pencils, story aids, musical instruments, drums etc.

The counsellor should establish limits with the child during the first session regarding time and behaviour. In terms of time, the session length can vary according to the time available but should not exceed one hour. The length of time should be determined before the first session and adhered to as much as possible. Regarding behaviour, the counsellor should restrain a child who acts in an aggressive, hostile manner. It may even be necessary to discontinue the play therapy session if the child persists in being hostile. When a child abuses a toy, the counsellor can use a logical consequence. Eg: the counsellor might say, “it looks like you are not ready to use the drum today. I will put it up for now. Some other time, you can carry to use it the way it is supposed to be used”.

In communicating, counsellor should use friendly, kind voice, especially if they sense a child feels insecure; not talk down to a child in terms of tone of voice; and use an appropriate vocabulary level so that the child will understand the words. While it may be necessary to be firm with a child, it is probably counterproductive to be stern. Counsellors should let themselves laugh and have fun with the child, and they should talk from a positive perspective, using encouragement whenever possible.

Early thoughts on child analysis:

The early emotional development of child was of considerable interest. However, it was not until after the First World War that the first children became subjects of analytic treatment in their own right. It is obvious that children could not be expected to manage their psychoanalytic setting without a counsellors help. Anna freud felt that children under the age of seven unable to help directly because in that age they are unable to co-operate with the adult technique.

Klein’s approach

To overcome these challenges, Klein has developed a technique in which children could express themselves through toys and play. Klein wanted, as far as possible, to be able to analyze children in the same way that adults were analyzed, paying attention to the meaning of the play, the transference and the unconscious phantasies being expressed.

In this condition, the child instead being lie on the couch and bring verbal associations, the therapist could have a simple playroom containing a box or play materials such as papers, crayons, cups, string, sink with taps, small figures in which child can manipulate easily and would not be too illustrative or providing maximum opportunity for the child’s own imagination or creativeness to be expressed.

The child would then be left free to use the play materials, the room and the therapist himself as he wished, including the therapist being drawn in to play different roles – for example, being the naughty child while the child became the strict teacher.

In present practice, the basic setting and approach to child analysis is still largely as Melanie Klein described it.

It is fascinating to notice how available child analytic material is to non-child analysts, whereas the artificial characteristics of the setting are so different. However, once we see adult material as consisting of a constant process of action through words, that it is not so much that children are like little adults in their analyses, but rather that adults in analysis continue to be children, then it is not so secretive.

Child analysis and its impact on Klein’s theories

Using this technique of child analysis it was massive importance in Melanie Klein’s theories and especially on the experience of infants disturbance in later life.

In The Psychoanalytic Play Technique (1955, p122), Klein states that:

“….my work with both children and adults, and my contributions to psycho-analytic theory as a whole, derive ultimately from the play technique evolved with young children. I do not mean by this that my later work was a direct application of the play technique; but the insight that I gained into early development of child, into unconscious processes, and into the nature of the interpretations by which the unconscious can be approached, has been of far-reaching influence on the work I have done with older children and adults.”

Training in child analysis

Over the past years many psychoanalysts from The Institute of Psychoanalysis also trained as child analysts and indeed during the 1950s about half of the members were also child psychoanalysts and the majority of whom had trained in the Melanie Klein technique. This is a measure of how leading-edge child analysis was felt to be at that time. At present these findings of child analysis have progressed into the adult field and there are few child analysts though still a significant number and there is still a training at The Institute of Psychoanalysis which recently has become more popular again.

In the late 1940s Esther Bick, with the support of John Bowlby, founded the child psychotherapy training at the Tavistock Clinic. Bick wanted to see if child analytic work could be brought to the new National Heath Service and convinced Melanie Klein that it was possible to conduct authentic psychoanalytic therapy for children seen with less frequency than the five times weekly treatments. Melanie Klein found this quite convincing and so with her blessing the first training using her technique was started. The training has been led at different times by other internationally known child analysts and child psychotherapists Martha Harris, Donald Meltzer, Gianna Williams, Anne Alvarez and Margaret Rustin to name but a few. It has continued ever since and is now the largest child psychotherapy training in the UK.

Later the wish to spread child analytic work beyond London led first to Edinburgh with the training of the Scottish Institute of Human Relations and more recently the Northern School of Child and Adolescent Psychotherapy and the Birmingham Trust for Psychoanalytic Psychotherapy. There are also much training in psychoanalytic institutes and child psychotherapy organisations all over the world using Melanie Klein’s technique.

ROLE OF THE PARENTS

When parents bring their children to therapy because a school or agency pushed for it. The more we involve parents in the treatment the more faster it works. For every child, parents help, co-operation is very much essential to treat the child in trouble. There may be several other reasons also, we can include parents as a primary source of information, they help to tell their own perceptions of their child behaviour at home and with siblings. They can give a complete history of child development as well as they can explain the reasons for referral. While dealing with parents, therapist should listen carefully and patiently so that the parents also feel comfortable and trusting to speak candidly and fully. With this parents role also plays important in treating the child.

Conclusion:

Play therapy is a form of therapeutic renewal, guided by a therapist or a trained lay person. Therapeutic play has proven value across a wide range of childhood problems. As Brian Sutton-Smith has shown, play is a viable model of adaptive human functioning, in which adaptability is achieved by the limber use of symbols and narratives. By age three and sometimes earlier, children play out their troubles with impressive flexibility as they manipulate meanings symbolically. Play therapy, by formalizing a context for children’s self-guided play, highlights the importance of play to adaptive healing generally. Children’s intense involvements in particular play themes can be telling indicators of underlying unresolved issues, including for physically ill children. Given time to engage in pretense freely, children playfully confront difficult meanings on their own terms. Peggy Miller’s son Kurt, as early as age two, relistened and retold the story of Peter Rabbit repeatedly in a home setting, using intriguing authorial license in his retellings. His story renditions ran in parallel with his everyday emotional concerns about misbehaviour and its anxious implications. Play can poetically encode what is not resolved, in an approachable and confrontable framework. Play therapy in a clinical setting enables children to address even extreme disruptions, scaffolded by an empathic and supportive adult.

References:

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4. Stefflre, B.P., King and F.Leafgren (1962). Characteristics of counsellors judged by their peers, Journal of counselling psychology, 335-340.