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FamilyandPlayTherapy.pdf

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The Family and the Child: A Psychological View UMass Boston Prof. Peggy Vaughan Brief Overview of Therapy, Family Therapy, Play Therapy

+ Class Topics

n Review of a sample of and family therapy models and approaches.

n Video clips of a play therapy session

n Play therapy materials and a class activity.

n Discussion

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+ Multi-Theoretical Approach to Family Therapy

n Therapy should be n Developmentally Informed n Culturally Informed

n Focus of the therapy may address n Parent and Family Attachment n Trauma, Separation, and/or Loss n Family Stress and Conflict n Social and Behavioral Needs n Family Communication

n Therapy may incorporate theoretical perspectives such as n Psychoanalytic n Social Learning n Family System, Filial Perspectives n Cognitive–Behavioral n Humanistic n Mindfulness and anxiety reduction n Holistic techniques n Eye Movement Desensitization and Reprocessing (EMDR) n Medical models

Differences Between Individual and Systemic Therapy Models

Individual Therapist Systemic Therapist

Obtain accurate diagnosis from DSM V

Explore system for family processes and rules

Begin therapy right now Begin Invite in parents, siblings, children

Focus: causes, purposes, processes

Focus: family relationships; processes and communication

Concerned with individual experience and perspective

Concerned with inter- or trans- generational meanings, rules, themes

Intervene to help individual learn to cope, heal

Intervene to change context and/or functioning within family system

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+ Early Family Therapy Leaders

n Alfred Adler-Rudolf Driekurs: Open forum Child Guidance Clinics

n Murray Bowen-Multigenerational Model: Triangulation, Differentiation of Self

n Virginia Satir: Conjoint Family Therapy-Human Validation; Relational; Family Enhancement and validation of self-esteem

n Carl Whitaker: Experiential Symbolic Family Therapy; therapist as coach influences change

n Salvador Minuchin: Structural Family Therapy-create structural change

n Jay Haley: Strategic Family Therapy to solve problems now

n Cloe Madanes: Wife of Haley-Strategic Family Therapy

+ Beliefs of Family Therapists

n Individual’s affiliations, relationships, and interactions have more power in person’s life than a single therapist could ever hope to have.

n Working with child, family and/or community therapists allows one to see how a child or individual acts in their settings.

n Seeing individual as active in a set of systems assists in developing and implementing the types of interventions needed.

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+ Systemic Perspective

n Individual may carry a symptom for the entire family.

n Behavioral symptoms have a purpose.

n Individual’s behavioral functioning can be a manifestation of way family functions.

n Individual can have symptom existing independent of family structure.

n Symptoms always have ramifications for family members.

n Change the systems and individuals will change.

n Change dysfunctional patterns of relating and create functional ways of interacting and relating.

+ Family Therapy Ethical Standards: Nine Areas n Responsibility to Clients

n Confidentiality

n Professional competence and integrity

n Responsibility to students and supervisees

n Research and publication

n Technology-assisted professional services

n Professional evaluation

n Financial arrangements

n Advertising

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+ Studies of Trauma (Lieberman et al.,2005)

n Children and their parents traumatized by exposure to various forms of interpersonal violence, display a broad range of parental responses.

n These range from anger at the traumatized child to an exquisite attunement to the child’s suffering and determination to restore the child’s emotional health.

n A similar range of parental responses has been reported in nonclinical settings such as when traumatized children are brought to the attention of the authorities such as via law enforcement.

+ Angels in the Nursery: Parent-Child Therapy (Discussed in early weeks of class.)

n Lieberman and others worked with ethnically and socioeconomically diverse children ages birth to six and their parents. n Children/parents had witnessed or experienced trauma or

maltreatment n Families received child/caregiver therapy

n Their clinical studies with these children and parents identified parenting difficulties n Their work involved clinical interviews and the use of the Adult

Attachment Interview (Main, M., 1986; 1996).

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+ Lieberman (2005) Angels in the Nursery: Randomized Trial of Parent-Child Treatment Model

n Treatment children show greater improvements than comparison group children based on: n Traumatic stress symptomatology

n Diagnosis of Traumatic Stress Disorder n Behavior problems

n Treatment mothers show greater improvement based on: n Avoidant symptomatology

n Total PTSD symptomatology

n General symptomatology

(Lieberman, Van Horn, & Ghosh Ippen, 2005; Lieberman, Ghosh Ippen, & Van Horn, in press)

+ Treatment of Trauma

n Key ingredients in the treatment of trauma and trauma- related events n Supporting developmental progress

n Parent-child therapy/family therapy n Encouraging the (re-)discovery and practice of pleasurable

emotional investment in the self, others, and the world through the affective experience of interest, enthusiasm, joy, elation, self- confidence, reciprocity, intimacy, and love

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+ Trauma and Treatment: Outcomes

n Increased capacity to respond realistically to threat

n Differentiation between reliving and remembering

n Normalization of the traumatic response

n Placing the traumatic experience in perspective

+ Parent-child Therapy

n Parent-infant mental health

n Parent training to guide parent-child interactions

n Parent-toddler/preschooler intervention around developmental or behavioral needs (Greenspan & Weider, Floortime Model, and others.)

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+ Play Therapy Virginia Axline (1911-1988)

n Virginia Axline was influenced by the person-centered approach of Carl Rogers, a humanist. She continues to have an influence.

n Axline is recognized as the originator of Non-directive Play Therapy. n Her well-known book Dibs: In Search of Self written in 1964,

describes her work with Dibs and how he was able to heal himself over a period of time. Her book is an excellent introduction to the subject.

n Axline in turn influenced Violet Oaklander who added a gestalt therapy approach to play therapy, as described in her book Windows to Our Children (1988).

n Annie Rogers added psychoanalytic elements. n Bibliography of related authors will be posted

+ Guiding Principles of Play Therapy

n Focuses on developing a warm and friendly relationship with the child.

n Accepts the child as she or he is.

n Establishes a feeling of permission in the relationship so that the child feels free to express his or her feelings completely.

n Is alert to and recognize the feelings the child is expressing, and reflects these feelings back in such a manner that the child gains insight into his/her behavior.

n Maintains a deep respect for the child’s ability to solve his/her problems and gives the child the opportunity to do so.

n The responsibility to make choices and to institute change is the child’s.

n Does not attempt to direct the child’s actions or conversations in any manner.

n The child leads the way, the therapist follows.

n Does not hurry the therapy along.

n It is a gradual process and must be recognized as such by the therapist.

n Only establishes those limitations necessary to anchor the therapy to the world of reality and to make the child aware of his/her responsibility in the relationship. (Safety as well.)

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+ A Developmental Approach to Treatment

n Young children develop in relationships

n Young children depend on relationships with caregivers in order to: n Regulate physiological response

n Form internal working models of relationships n Provide secure base for exploration and learning

n Model accepted behaviors

+ Materials for Play Therapy

n What are some materials that children can use?

n What is appropriate based on child age and the conditions or situation?

n Your ideas?

n Example of activities and materials follow.

n Association for Play Therapy n http://www.a4pt.org/?page=ptmakesadifference

http://www.a4pt.org/?page=ptmakesadifference

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+ Clay

+ Music

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+ Paints and Paper

+ Mask Making

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+ Puppets

+ Sand Table

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+ Filial Play Therapy: Involving

Parents and Caregivers

n Filial play therapy is a relatively short-term child and family intervention with long-term results.

n The method was developed in the early 1960s by Drs. Bernard and Louise Guerney. It continues to be relied on for therapeutic treatment. This method has been researched over time.

n “Filial therapy is a psychoeducational family intervention in which the therapist trains and supervises parents as they hold special child-centered play sessions with their own children, thereby engaging parents as partners in the therapeutic process and empowering them to be the primary change agents for their own children." Source:apa.org

+ Trauma-Informed Approach

n A program, organization, or system that is trauma-informed: n Realizes the widespread impact of trauma and understands potential

paths for recovery; n Recognizes the signs and symptoms of trauma in clients, families, staff,

and others involved with the system; n Responds by fully integrating knowledge about trauma into policies,

procedures, and practices; and n Seeks to actively resist re-traumatization.

n A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma- specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitate healing.

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+ Six Key Principles of a Trauma-

Informed Approach

n A trauma-informed approach reflects adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific: n Safety

n Trustworthiness and Transparency n Peer support

n Collaboration and mutuality

n Empowerment, voice and choice

n Cultural, Historical, and Gender Issues

+ Trauma-Informed Interventions

n The dissemination of standardized, effective, trauma-informed clinical interventions is a central means by which the NCTSN seeks to advance the standard of care for traumatized children and to increase the nation’s capacity to meet the needs of these children.

n In recognition of the diverse needs of the child and adolescent populations served by NCTSN sites across the country, the interventions and treatments developed span a continuum of evidence-based and evidence-supported interventions ranging from rigorously evaluated interventions to promising and newly- emerging practices n See: https://www.nctsn.org/treatments-and-practices/trauma-

treatments. We will preview a few assessments and interventions in class.

https://www.nctsn.org/treatments-and-practices/trauma-treatments