Wednesday, March 03, 2010

Reflections: Play Therapy

A few months back I read the deeply moving book - Dibs In Search of Self; a true story of an emotionally withdrawn, socially maladjusted boy, who after being rejected and ruled off as mentally deficient, recovered himself with the help of Play Therapy. Play Therapy is the pioneering work of Dr. Virginia Axline, a developmental psychologist. Dibs' story was not geared towards an academic (or uber-curious) audience, and consequently, there was very little elaboration on the principles behind Play Therapy and the reasons for its purported success. It seemed miraculous that a young boy such as Dibs, who was already pained with so many emotional problems, could learn to accept and take responsibility of himself and his life through a seemingly "simple" string of therapeutic encounters, which enabled him to vent and express himself through his most convenient medium of expression - play. Hence I had earmarked to read Dr. Axline's seminal book on Play Therapy to understand its roots, and I'm glad I took the effort to read this book. It has convincingly answered my questions and has turned me over into a fervent believer of this therapeutic principle.

Dr. Axline has comprehensively explored the principles of Play Therapy, shedding ample light on its theoretical foundations. She also details the explicit roles and attitude that the therapist/teacher needs to take, provides recommendations on how to set up a playroom and the kinds and range of toys that would afford the suitable medium of play. Finally, she has included an array of case studies with annotated notes on important turning points, explanations and critiques on the therapists' responses and insights on the child's verbalization, all of which cohesively come together to offer a holistic understanding of the therapeutic principles and procedures. What impressed me is Dr. Axline's open-minded discussion. She doesn't thrust, tout or campaign for this therapy. She discuses limitations, addresses concerns and questions that the reader would have, in an unbiased manner. Her annotated notes on archived case studies were extremely helpful in distinguishing which aspects were poorly handled by the therapist and which responses were aptly handled and why. The book includes over 10 case studies, each of which focuses on a unique challenge with a child. The successful cases reinstate the import and potential of Play Therapy.

The Principle
Adults make sense of their world by writing, talking, communicating. We verbalize our thoughts to express ourselves. Children are not linguistically mature enough to do this. But their behavior is a transparent expression of themselves. And a natural medium such as playing, gives them a channel to express themselves. At its core, Play Therapy is based on the principle of Non-Directive Therapy. The therapist does not attempt to lead the child, the child leads the therapist. The therapist does not correct, encourage, persuade, discipline, probe, question, or instruct the child. She attempts to provide a neutral atmosphere, wherein the child is accepted as s/he is. This is the most crucial cornerstone of this therapy. However, this doesn't imply that the therapist plays a passive role. She plays a very active role and participates in the child's dialogue and play, but doesn't direct the child in any way. If the child exhibits aggressive behavior and thrashes a doll, yells, swears, rolls on the ground, splashes paint or water, the therapist does not try to reprimand or discipline. Neither should she compliment and encourage a child if s/he painted a wonderful picture. This seems absolutely contradictory to what we are used to. So what does the therapist do? She lets the child vent out his/her emotions without attempting to stop the flow. The therapist's most important role is to reflect each of these emotions back to the child. If the child says, "I want to kill my dad", the therapist reflects the emotion back to the child, "You are angry with your dad that you want to kill him". Beneath every surface-level aggressive and "inappropriate" behavior lies deeper problems. It's incredulous, but such honest reflection of the child's emotions and feelings, and an open acceptance of the child, go a long way in helping the child excavate deeper problems, such that s/he trusts the therapist enough to share/verbalize them. This same child, after venting his surface emotions, ventures to say, "I don't really mean to kill him. But he is just so mean to me. I wish he comes to see me sometime." I am not making this up. Case after case discussed in this book teems with such revelations.

Children who are sent to therapy are not meant to be "fixed". The goal is not to change them, or discipline them. The goal is to comprehend what their inner turmoil is, and let the child face his problems and accept them. It might seem miraculous and impossible that a child can accept his problems just by confronting them through the therapists' reflections of his behavior. But it has been shown to work. And there are plenty of reasons why it works.
  1. Each of us have the urge for self-realization within us. There is a force within us trying to understand ourselves and the world around us better and struggles to adapt to it. It's the simple law of nature. Growing children have this spurt of curiosity and resilience to survive that is much vigorous in spirit. It wants to learn, to grow and adapt. Play therapy is one medium that gives the spirit free rein to be expressed, without being constrained by rules.
  2. Young children require very little out of life. They want love, warmth and acceptance. No fight is taken seriously, no word is uttered to intentionally hurt, and no thoughts harbor any ill towards anyone. They are at a stage where they are innocent and forgiving, if given a chance. When they are accepted completely for who they are, their defenses break and they truly confront their emotions. Once they deal with their emotions, the release helps them move on.
  3. Acceptance and approval are not the same. A child who says he wants to kill, is not approved or encouraged, but is merely accepted, despite the statement. There is an ocean of a difference between the two. A disturbed and traumatized child does not come to therapy to be disciplined and questioned. The therapist first needs to establish a bond with the child, without emotional attachment. When do we bond with friends? When we are accepted non-judgmentally. Whom are we willing to share our problems with? A person who listens and lets us express ourselves. When do we withdraw into our shells? When we are not given the respect and consideration to make our choices and are constantly told what to do. Don't these translate to children as well? They very well do.
  4. In the heat of an argument we utter many things and teeter on the verge of violence. But if those emotions and sentences are reflected to us and when the heat cools off, do we really mean those words? Our problems were deeper. But confronting our every own strong emotions, shocks us and it helps us introspect. Children are capable of this too. The time it takes and the means through which they understand about themselves is different. The fundamental problem is the adult's skepticism that children are capable of accepting and dealing with their problems. They do. The book shows numerous real-life examples. It is vital that we have faith in them.
Does this mean children should never be given any positive reinforcement and should never be disciplined? No. It only means that every once in a while, it pays to let the child explore himself without violations. It will help the parent/teacher learn more about the child, and the child will learn more about himself, if his emotions are deftly reflected to him. It is also unrealistic for a parent or anyone who is emotionally attached to the child to play the role of a therapist and bring in an unbiased exocentric view of the child's problems. A parent who hears her child's open confessions cannot deal with them objectively. It is also shown to lead to devastating consequences if the therapist emotionally bonds, supports and reassures the child. It is common for an emotionally deprived child to get emotionally dependent on the therapist. And it's quite natural and humane for a therapist to want to reciprocate. But the harsh truth is that when the child says, "Take me home with you, you said you love me", the therapist cannot fulfill the child's requests. In a sense she fails to live up to her promises to the child and the child is severely hurt yet again, and it opens a can of complications when it comes to severing this dependence. Such a therapy is futile. Children who are abandoned and who switch between foster homes have a bleak reality to face. The objective is to help them face, accept and adapt to their circumstances. The therapy teaches them to be independent and to be socially adaptive survivors. It instills responsibility in the child by providing confidence in his abilities and respect for him as an individual.

There are limitations to this therapy - the question of when to end therapy, and how to help children sustain their understanding of themselves, remain primary concerns. But there is no doubt that this technique holds immense potential to help children. The case studies are so heart-wrenching that I couldn't hold back my tears while reading. But each case history also carries with it immense hope for all the millions of unfortunate children the world over. It is a cry of hope for our future.

Dr. Axline's writing is empathetic, perceptive and beautiful, heightening the impact of this book. I know I haven't done justice in articulating my thoughts on this book and this therapeutic principle, but I can't emphasize enough how valuable this book is for parents and teachers.


Sanjini said...

This is a very very interesting post. I think you have done justice in conveying the idea of Play Therapy across in this post - as I am fascinated by this topic now.

Neeraja said...

SecondSight - Yay! Your comment has magically reappeared! ;) Hope you have started reading the book!

Sanjini - I'm glad that I have managed to convince one more person :)

SecondSight said...

Haha- I just noticed the reappearance too- Little blo-prizes ;)

Just started reading it a few days ago.. shall reserve comments for when I'm done :)