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Chapter 3 History and

Development of Play Therapy

Birds fly, fish swim, and children play . Garry Landreth

Play has long been recognized as occupying a significant place in the lives of children . As early as the 18th century, Rousseau (1762/1930) wrote about the importance of observing play to learn about children and to understand them . In Emile, he expressed his ideas on the training and education of children and observed that they are not tiny adults . An interesting point to note is that 250 years later we are still struggling against this concept of chil- dren . Although Rousseau’s comments on the play and games of children were more in accord with educative purposes than with the therapeutic uses of play, his writings reveal a sensitive under- standing of the world of children . “Hold childhood in reverence, and do not be in any hurry to judge it for good or ill… . Give nature time to work before you take over her business, lest you interfere with her dealings… . Childhood is the sleep of reason” (Rousseau, 1762/1930, p . 71) .

As early as 1903 Froebel emphasized the symbolic components of play . He proposed that play has a definite conscious and uncon- scious purpose regardless of the nature of the play, and therefore

Landreth, Garry L.. Play Therapy : The Art of the Relationship, Taylor & Francis Group, 2012. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/capella/detail.action?docID=958282. Created from capella on 2024-05-24 21:14:59.

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can be looked to for meaning . “Play is the highest development in childhood, for it alone is the free expression of what is in the child’s soul… . Children’s play is not mere sport . It is full of mean- ing and import” (Froebel, 1903, p . 22) .

The first published case describing the therapeutic use of play and a psychological approach to working with a child was Sigmund Freud’s report in 1909 of the classic case of “Little Hans,” a 5-year-old boy with a phobia . Freud (1909/1955) saw Hans only one time for a brief visit and conducted the treatment by advis- ing Hans’ father of ways to respond with suggestions based on the father’s notes about Hans’ play . “Little Hans” is the first case of record in which a child’s difficulty was attributed to emotional causes . Today, emotional factors are so readily accepted that it is perhaps difficult to appreciate the magnitude of what was then a new concept of psychological disturbance in children . Reisman (1966) pointed out that at the dawning of the 20th century, profes- sionals generally believed childhood disorders were the result of deficiencies in the child’s education and training .

Kanner (1957) concluded from his research that when the 20th century began, no procedure or approach was being used with children that could in any sense be regarded as child psychiatry . Play therapy developed from efforts to apply psychoanalytic therapy to children . Considering how little was known about children in the early 1900s, one may be a bit surprised to realize that the formal and often highly structured approach utilized in adult analysis to obtain material for interpretation, primarily through the process of recall and recollections of the client, was so quickly recognized as being inadequate and inappropriate for child analysis .

Psychoanalytic Play Therapy Following Freud’s work with Hans, Hermine Hug-Hellmuth (1921) in the early 1900s seems to have been one of the first thera- pists to emphasize play as essential in child analysis and to provide children in therapy with play materials to express themselves . Although her work predates that of Anna Freud and Melanie Klein, she did not formulate a specific therapeutic approach . She did, however, call attention to the difficulty of applying methods

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History and Development of Play Therapy 29

of adult therapy to children . It seems that the same problem we face now existed then—that of attempting to apply established methods with adults to children and discovering that child therapy is distinct and different from adult therapy . In these early days, analysts found that children were unable to describe their anxi- eties verbally as adults did . Also, unlike adults, children seemed not the least bit interested in exploring their past or discussing their developmental stages, and many times refused to attempt to free associate . Consequently, most therapists who worked with children in the early 1900s resorted to indirect therapy contact by collecting observations of children .

In 1919, Melanie Klein (1955) began to employ the technique of play as a means of analyzing children under 6 years of age . She assumed that a child’s play was as motivationally determined as the free association of adults . Analysis was carried out by substi- tuting play for verbalized free association . Thus, play therapy pro- vided direct access to the child’s unconscious . She reported that additional material was exhibited in the child’s play as a result of her interpretations . During this same period, Anna Freud (1946, 1965) began to use play as a way to encourage the child to form an alliance with her . Unlike Klein, Anna Freud emphasized the importance of developing the emotional relationship between the child and the therapist before interpreting the unconscious motivation behind the child’s drawings and play . Both Klein and Freud stressed the importance of uncovering the past and strengthening the ego . Both also believed play to be the medium through which children express themselves most freely .

Melanie Klein (1955) used play as a way to encourage children to express fantasies, anxieties, and defenses, which she then inter- preted . A major difference between Melanie Klein and Anna Freud was Klein’s heavy reliance on interpretation of preconscious and unconscious meanings of children’s play . She saw symbolic mean- ing, especially sexual, in almost every play activity . She believed exploration of the unconscious was the main task of therapy and that this could best be achieved through analysis of the child’s transference relationship with the therapist . Klein stressed tak- ing the desires and anxieties in the therapist–child relationship back to where they originated—to infancy—and in relation to the

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first love objects—the parents, especially the mother . She believed that reexperiencing early emotions and fantasies and understand- ing them, gaining insight through the therapist’s interpretations, diminished the child’s anxieties .

Klein (1955) explained the significance of interpretation by describing a play therapy episode with a child who surrounded a few toy figures with bricks:

I would conclude and interpret that the child shows a room and that the figures symbolize people . Such an interpretation affects a first contact with the child’s unconscious . For through the inter- pretation he comes to realize that the toys stand in his mind for people and therefore that the feelings he expresses toward the toys relate to people; also that preceding the interpretation he had not been aware of this . He is beginning to gain insight into the fact that one part of his mind is unknown to him, in other words, that the unconscious exists . Moreover, it becomes clearer to him what the analyst is doing with him . (p . 225)

The toys and materials Klein used were primarily simple, small, unstructured, and nonmechanical: little wooden men and women, animals, cars, houses, balls, marbles, paper, scissors, clay, paints, glue, and pencils . She kept each child’s playthings locked in a drawer, which represented the private and intimate relation- ship between child and therapist . Klein did not allow physical attacks on herself, but she provided opportunities for children to act out aggressive fantasies in other ways, including verbal attacks on her . She stated that she was usually able to interpret children’s deeper motives in time to keep the situation under control .

Anna Freud (1946, 1965) used children’s play primarily as a means for facilitating children’s positive emotional attachment to the therapist, as a way to gain access to the child’s inner life . A major objective was to influence the child to like her . Direct interpretation of play was minimal, and she cautioned against viewing everything in the play situation as symbolic . She believed some play had little emotional value, because it was merely con- scious repetitions of recent experiences . Freud believed that chil- dren do not form a transference neurosis . She delayed offering direct interpretations to children concerning the real meaning

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of their play until she had gained extensive knowledge from play observations and interviews with parents .

Because free association as developed by Sigmund Freud was cognitive in nature, Anna Freud modified the structure by involv- ing the child in a feeling-level experience . She encouraged the child to verbalize daydreams or fantasies, and when the child had difficulty discussing feelings and attitudes, she encouraged the child to sit quietly and “see pictures .” By using this technique, the child learned to verbalize his innermost thoughts and, using the interpretations of the analyst, to discover the meaning of these thoughts . Thus the child gained insight into his unconscious . As the relationship with the therapist developed, the emphasis of the sessions was shifted from play to more verbal interactions .

Klein (1955) visited the United States in 1929 and later reported that play, as a part of the therapeutic procedure with children, was little used here . The works of Hermine Hug-Hellmuth, Anna Freud, and Melanie Klein were revolutionary in changing atti- tudes about children and their problems .

Release Play Therapy The second major development in formulating play therapy occurred in the 1930s with the work of David Levy (1938) in devel- oping release therapy, a structured play therapy approach for chil- dren who had experienced a specific stressful/anxiety-provoking situation . Levy felt there was no need for interpretation and based his approach primarily on a belief in the abreactive effect of play . In this approach, the major role of the therapist is to be a shifter of scenes, to recreate through selected toys the experience that precipitated the child’s anxiety reaction . The child is permitted to engage in free play to gain familiarity with the room and the therapist, and then the therapist uses play materials to introduce the stress-producing situation when he feels it is appropriate . The reenactment of the traumatic event allows the child to release the pain and tension it caused . At other times, the child may be allowed to select her own free play . In this process of “ playing out” or reenacting the experience, the child is in control of the play and thus moves out of the passive role of having been “done to”

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and into an active role of being the “doer .” As the child plays, the therapist reflects the verbal and nonverbal feelings expressed .

Three forms of activities of release therapy occur in the playroom:

1 . Release of aggressive behavior in throwing objects or bursting balloons or release of infantile pleasures in suck- ing a nursing bottle

2 . Release of feelings in standardized situations such as stim- ulating feelings of sibling rivalry by presenting a baby doll at a mother’s breast

3 . Release of feelings by recreating in play a particular stress- ful experience in a child’s life

The following case described by Levy (1939) presents the essence of the release therapy approach:

A girl, aged two years, was referred because of night terrors, onset two days before referral . She awoke frightened and screamed that there was a fish in her bed… . The night terror was related to a visit to a fish market on that very day . The fish merchant…lifted her up to see the fish .

A second complaint was stammering, which had its onset five months before referral, although speech had developed normally up to that time… . There were ten play sessions . A fish made of clay was introduced in the second session . To the question, why was the doll afraid of the fish, the answer was that the fish would bite, and the fish would go “in here,” pointing to her eye, her ears, and her vagina . A few days before the night terror the patient had inquired about sex differences after seeing the father naked . Other than the introduction of the fish in various parts of the play sessions, the method was chiefly to facilitate her own type of play… . For example, she saw finger paint and wanted to play with it . I showed her how, but she wouldn’t touch it, nor let me put a dot of paint on her hand… . By playing with it myself and getting her to handle it gradually, she got to prefer it… .

Following her first appointment there was no change in behavior… . Fear of the fish left after the third or fourth session and the stammering showed improvement after the sixth, dis- appearing two weeks before the last session . A follow-up was made seven months later . Improvement was maintained . (p . 220)

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Gove Hambidge (1955) extended the work of Levy under the title “Structured Play Therapy” and was more direct in introducing events . Following the establishment of a therapeutic relationship, the format consisted of directly recreating the anxiety-producing situation, playing out the situation, and then allowing the child free play to recover from the intrusive procedure .

Relationship Play Therapy The emergence of the work of Jesse Taft (1933) and Frederick Allen (1934), referred to as relationship therapy, constituted the third significant development in play therapy . The philosophical basis for relationship play therapy evolved from the work of Otto Rank (1936), who deemphasized the importance of past history and the unconscious and stressed the development of the therapist–client relationship as crucial, with a consistent focus on the present, the here and now .

In relationship play therapy, the primary emphasis is placed on the curative power of the emotional relationship between the therapist and the child . As Allen (1934) stated,

I am interested in creating a natural relation in which the patient can acquire a more adequate acceptance of himself, a clear con- ception of what he can do and feel in relation to the world in which he continues to live… . I am not afraid to let the patient feel that I am interested in him as a person . (p . 198)

No effort is made to explain or interpret past experiences . Present feelings and reactions are the primary focus of attention, and this approach reportedly led to considerable reduction in the length of the therapy . Allen and Taft stressed regarding chil- dren as persons of inner strength with the capacity to alter their behaviors constructively . Therefore, children were given freedom to choose to play or not to play and to direct their own activ- ity . The hypothesis was that children gradually come to realize that they are separate persons with their own strivings and that they can exist in a relationship with other persons with their own qualities . In this approach, the child has to assume responsibility

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in the growth process, and the therapist concentrates on those difficulties that concern the child, rather than on those concern- ing the therapist .

Nondirective/Child-Centered Play Therapy The work of the relationship therapists was studied and expanded by Carl Rogers (1942), who extended these concepts and devel- oped nondirective therapy, later referred to as client-centered therapy (Rogers, 1951) and today as person-centered therapy .

The fourth major development in play therapy was the work of Virginia Axline (1947), a student and later colleague of Carl Rogers . She effectively operationalized the philosophy and princi- ples of Rogers’ nondirective/person-centered theory (i .e ., belief in the individual’s natural strivings for growth and the individual’s capacity for self-direction) for application in relationships with children in play therapy . Nondirective play therapy makes no effort to control or change the child and is based on the theory that the child’s behavior is at all times caused by the drive for complete self-realization . The objectives of nondirective play therapy are self-awareness and self-direction by the child . The therapist has a well-stocked playroom, and the child has the freedom to play as she chooses or to remain silent . The therapist actively reflects the child’s thoughts and feelings, believing that when a child’s feel- ings are expressed, identified, and accepted, the child can accept them and then is free to deal with these feelings .

In summarizing her concept of play therapy, Axline (1950) stated, “A play experience is therapeutic because it provides a secure relationship between the child and the adult, so that the child has the freedom and room to state himself in his own terms, exactly as he is at that moment in his own way and in his own time” (p . 68) . This approach was later referred to as client-centered play therapy and then as child-centered play therapy . Although there are several well-established theoretical approaches to play therapy, among those in current use, child-centered play therapy has the longest history of use, the strongest research support, and

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according to recent surveys of practicing play therapists, is most used by play therapy practitioners (Lambert et al ., 2007) .

Play Therapy in Elementary Schools The establishment of guidance and counseling programs in ele- mentary schools in the 1960s opened the door to the fifth major development in play therapy . Until the 1960s, play therapy was largely the domain of the private practitioner with a focus on treatment of maladjusted children, and the literature related to play therapy reflected this condition . However, with the addition of counselors to elementary schools, counselor educators such as Alexander (1964); Landreth (1972); Landreth, Allen, and Jacquot (1969); Muro (1968); Myrick and Holdin (1971); Nelson (1966); and Waterland (1970) were quick to describe their play therapy experi- ences in the literature . These authors encouraged the use of play therapy in school settings to meet a broad range of the develop- mental needs of all children, not just the maladjusted . This trend toward the preventive role of play therapy has continued .

Dimick and Huff (1970) suggested that until children reach a level of facility and sophistication with verbal communication that allows them to express themselves fully and effectively to others, the use of play media is mandatory if significant communication is to take place between child and counselor . They proposed that the main question is not whether the elementary school counselor, school psychologist, or social worker should use play therapy, but rather how play therapy should be used in elementary schools .

The ultimate objective of elementary schools is to assist the intellectual, emotional, physical, and social development of chil- dren by providing adequate learning opportunities . Therefore, a major objective of using play therapy with children in an elemen- tary school setting is to help children get ready to profit from the learning experiences offered . Children cannot be made to learn . Even the most effective teachers cannot teach children who are not yet ready to learn . Play therapy, then, is an adjunct to the learning

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environment, an experience that helps children maximize their opportunities to learn .

In recent years, growth in the number of elementary school coun- selors who utilize play therapy has been impressive and accounts for a large percentage of the total number of mental health professionals who use play therapy . Some university counselor education programs now require play therapy training in their school counseling tracks .

Association for Play Therapy The establishment of the Association for Play Therapy (APT) in 1982 constitutes the sixth major development in the progressive growth of the field of play therapy . The organization of APT was the brainchild of Charles Schaefer and Kevin O’Connor, who envisioned an international society dedicated to the advancement of play therapy . The APT is interdisciplinary and eclectic in ori- entation . The association publishes an excellent quarterly news- magazine, the International Journal of Play Therapy, and sponsors a conference each year in October in a different region of the United States . Membership in APT increased from a total of 450 in 1988 to over 5,670 in 2011 . This rapid increase graphically demonstrates how fast the field of play therapy is developing . APT encourages membership from mental health professionals interested in work- ing with children . For a membership application, write to the Association for Play Therapy, 2050 North Winery Avenue, Suite 101, Fresno, California, 93703, or go online to www .info@a4pt .org . Contact can also be made by consulting the Membership and Networking link on the Web site home page www .a4pt .org/ .

University Training An increasing number of universities are offering courses and supervised experience in play therapy in response to the height- ened interest in play therapy training by professionals in the field and preprofessionals in training . According to APT data, in 2011 at least 171 universities in the United States were offering play therapy training in the form of one or more full-semester courses . In 1989, only 33 universities offered a course in play therapy . The

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APT provides an online directory of universities offering play therapy training at Find University Play Therapy Directory on their Web site .

Center for Play Therapy The national Center for Play Therapy established on the University of North Texas campus has been a significant development in the field of play therapy . The center serves as a clearinghouse for infor- mation regarding play therapy literature, training, and research as well as a site for ongoing play therapy training and research . The center has eight fully equipped play therapy rooms and three activ- ity therapy rooms, each with video equipment and one-way mirrors . The Center for Play Therapy in the Department of Counseling, Development, and Higher Education offers eight master’s- and doctoral-level courses in play therapy, including supervised practi- cum and internship experiences each semester; provides a 2-week Summer Play Therapy Institute in July; sponsors an Annual Play Therapy Conference in October; publishes results of surveys and research, including a Bibliography of Play Therapy Literature; has produced a video series of clinical play therapy sessions featuring distinguished contributors to play therapy; and provides scholar- ships for master’s degree and doctoral degree study . The Center for Play Therapy is recognized as the largest play therapy training pro- gram in the world, and scholars, researchers, and university profes- sors from numerous countries have studied in the center or used the facilities for their university research sabbatical . For informa- tion, write to the Center for Play Therapy, University of North Texas, 1155 Union Circle No . 310829, Denton, Texas, 76203-5017 or check out the Web site at www .coe .unt .edu/cpt .

Filial Therapy The nature of parent–child relationships is of primary importance to the present and future mental health of children . Therefore, clearly, if the mental health of future adult populations is to be sig- nificantly impacted in positive ways, greater effort must be made to substantially improve the mental health of all children . The

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skills of those in the mental health professions must be given away through training to parents, who are in the best position to pro- foundly impact the lives of future adults . Filial therapy, the train- ing of parents to be therapeutic agents with their children using basic child-centered play therapy skills, has been one of the most important developments in the field of play therapy . This innova- tive approach was developed in the 1960s by Bernard and Louise Guerney, a husband and wife team, and has gained widespread acceptance as a model for enhancement of the parent–child rela- tionship . The filial therapy model, as conceived by the Guerneys, trains parents in basic child-centered play therapy skills to become the therapeutic agent in their children’s lives by conduct- ing weekly special play times in their own homes .

Perhaps a more complete picture of filial therapy could be achieved by presenting a definition of filial therapy . In my work, filial therapy is defined as a unique approach used by professionals trained in play therapy to train parents to be therapeutic agents with their own children through a format of didactic instruction, demonstration play sessions, required at-home laboratory play sessions, and supervision in a supportive atmosphere. Parents are taught basic child-centered play therapy principles and skills, includ- ing reflective listening, recognizing and responding to children’s feelings, therapeutic limit setting, building children’s self-esteem, and structuring required weekly play sessions with their children using a special kit of selected toys. Parents learn how to create a nonjudgmental, understanding, and accepting environment that enhances the parent–child relationship, thus facilitating personal growth and change for both child and parent.

Building on the work of the Guerneys, I developed a more con- densed, 10-session parent training format (Landreth, 1991, 2002) based on my experience that time and financial constraints often hindered parents’ participation . Landreth and Bratton (2006) for- malized the 10-session format in a text, Child Parent Relationship Therapy (CPRT): A 10-Session Filial Therapy Model. The CPRT protocol has been manualized (Bratton, Landreth, Kellam, and Blackard, 2006) allowing for replication of the model . This manu- alized treatment approach is a first in the field of play therapy . Filial therapy is an encouraging development in the mental health

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field . Therapeutic skills should be shared with parents . If what the therapist does with children in the playroom is helpful to chil- dren, those same behaviors exhibited by parents can be helpful to children’s overall growth and development .

Trends in Play Therapy Adult Play Therapy A developing interest is occurring in the use of play therapy with adults in therapy settings . In these play sessions, the adult becomes absorbed in the activity of play itself and thus engages in a kind of awareness that is not possible through mere verbaliza- tion . Through play the adult has a conversation with self that is a very personal experience because direct involvement is called for . The dollhouse, sandbox, dart gun, paints, and Bobo and other typical play therapy toys can be facilitative materials for adults . Play therapy sessions with elderly residents in nursing homes are described in my book, Innovations in Play Therapy: Issues, Process, and Special Populations (2001), as being highly effective . Some therapists have reported exciting results allowing adults to choose toys freely in the playroom . Other therapists conduct group ther- apy sessions in the playroom and ask the adult members to choose objects that represent symbols for themselves . These objects then become the points of focus for sharing by the member and for feedback from other members .

Play Therapy Techniques in Family Therapy Family therapists are beginning to recognize the value of bringing toys and art materials to their sessions to facilitate involvement and expressions of children and parents . Children below the age of 9 or 10 do not possess the verbal facility necessary to partici- pate effectively in family interviews . Without the inclusion of play media, many family therapy sessions consist primarily of verbal interactions between the participating adults, with the children either fulfilling the role of spectator or wandering aimlessly around the room in actuality or in their thoughts . Handing

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a child the family doll figures and asking him to show what happens at home is far more effective than asking the child to verbally describe or confirm what an interaction is like at home . At other times, involving the whole family in a play activity can be very facilitative and quite therapeutic for all involved . When parents are asked to participate with their children in planning play activities , they learn problem-solving methods that will be helpful to them in future family interactions . Family play therapy allows the therapist to assume a variety of roles in interacting with the family, including play facilitator, role model, participant, and teacher or educator .

group Play Therapy Although group play therapy has been used throughout most of the developmental history of play therapy, utilization has been very limited . Haim Ginott’s Group Psychotherapy with Children: The Theory and Practice of Play Therapy published in 1961 and republished in 1994 and Daniel Sweeney and Linda Homeyer’s Handbook of Group Play Therapy published in 1999 are the only texts published on the topic of group play therapy . Workshop training in group play therapy is an increasing point of focus at play therapy conferences . It is for these reasons that group play therapy is listed here under trends rather than in the section on significant developments .

As in group counseling for adolescents and adults, group play therapy is basically a psychological and social process in which children, in the natural course of interacting with one another in the playroom, learn not only about other children but also about themselves . In the process of interacting, children help one another assume responsibility in interpersonal relationships . Children are then able to naturally and immediately extend these interactions with peers outside the setting of group play therapy . Unlike most other approaches to group counseling, in group play therapy there are no group goals, and group cohesion is not an essential part of the developing process . By watching other children, a child gains the courage to attempt the things she wants to do .

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Play Therapy in Hospitals Hospitalization can be a frightening and stressful experience for the young child, because the child is in a strange environment where all sorts of invasive procedures are carried out . Because of these activities and new surroundings, children often experience anxiety and a feeling of loss of control . Golden (1983) believed that the play therapist’s toys are every bit as important as the surgeon’s knife in assisting children to leave the hospital healthier than when they arrived . If children do not have an opportunity to appropriately express and deal with their fears and apprehensions, emotional problems may emerge, and healthy adjustment will be altered .

The application of play therapy principles and procedures can be found in hospitals internationally . In the United States, Child Life Programs have been instrumental in incorporating play- rooms and play therapy procedures into what would otherwise be a sterile environment . Using hospital equipment, syringes, stetho- scopes, masks, and so forth, in combination with dolls or pup- pets, the therapist can acquaint children with medical procedures through directed play and thereby significantly reduce children’s hospital-related anxiety . Positive results also have been achieved by allowing children to choose materials and direct their own play . Children often will act out in their play procedures what they have just experienced . This could be viewed as the child’s way of trying to understand what has been experienced or as the child’s way of developing control .

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Consulting Psychology, 11, 61–69 . Bratton, S ., Landreth, G ., Kellam, T ., & Blackard, S . (2006) . Child parent rela-

tionship therapy (CPRT) treatment manual . New York: Routledge .

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Dimick, K ., & Huff, V . (1970) . Child counseling. Dubuque, IA: William C . Brown . Freud, A . (1946) . The psychoanalytic treatment of children. London: Imago . Freud, A . (1965) . The psycho-analytical treatment of children. New York: Inter-

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(2007) . Learning more about those who play in session: The national play therapy in counseling practices project (Phase I) . International Journal of Play Therapy, 14, 7–23 .

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