ISSUES IN PLAY THERAPY

“Thinking through issues prior to beginning relationships with children can help the therapist to react with assurance so as not to confuse children by indecisiveness” (p. 303). Confidentiality

o Very young children not concerned about confidentialityo “In this special time, what you say or do is private. I will not

tell your parents or teacher or anyone unless it is necessary to keep you safe. If you want them to know what you do here, you can tell them. That will be fine. You can decide” (p. 304).

o Do not display artwork – personal like a therapy transcript of an adult session

o General impressions, not specific behaviors can be shared with parents

Confidentiality (cont.) Limits of confidentiality

o Suicidal threato Homicidal threato Threat against child by someone else

Confidentiality is a difficult issue to navigateo Parents want to know about therapy and how they can be

helpful to their childo Parents pay the bill and feel they have a right to know

what they are paying for and what is happening in sessionso A tension exists between the parents’ right to know and

the child’s privacyo Informing the child about confidentiality has the potential

for the child to feel that therapy is a secretive time and to feel guilty about keeping playroom experiences from parents

ISSUES IN PLAY THERAPY (CONT.)

Participation in child’s playo Child does not need a playmateo Child needs someone to understand and accept him or

hero When participating, therapist must

• Keep the child in the lead• Keep the child in view• Maintain an adult-therapeutic role• Maintain appropriate boundaries through limit setting

o Therapist should stop participating if negative feelings in therapist begin to develop

ISSUES IN PLAY THERAPY (CONT.)

Accepting gifts from children in play therapyo Consider the timing of gift giving

• Is it spontaneous?• Is it in response to limit-breaking in the previous session?• Or is it reparation?

o Consider the nature of the gift• Is it purchased?• Is it self-made?

o Consider the cost of the gift• Candy bar• Rolex watch

o The implications of accepting or not accepting the gift• Artwork is emotional giving• Emotional gifts are more satisfying than tangible gifts

Accepting gifts from children in play therapy

Do not display giftso Could foster competitiono Could encourage other children to bring gifts

Declining a gift: “I would like for you to take this and get something for yourself.”

Don’t give gifts: “What is held in the hand can be lost. What is held in the heart can never be lost.”

ISSUES IN PLAY THERAPY (CONT.)

Giving a child a reward at the end of sessions or a memento at terminationo Play experiences for children are intrinsically rewarding;

they do not need a reward for playingo What a child carries away in his or her heart is infinitely

more important than anything the child can hold in his or her hand

o Rewards for good behavior are part of the child’s life experiences; bringing the same into the playroom continues the same expectation of behavior

o Rewards inhibit children’s behaviors in the play therapy experience

ISSUES IN PLAY THERAPY (CONT.)

Asking the child to clean upo If toys are words, then the request to clean up is like telling the

child to clean up what has been expressedo If cleaning up is required, therapist conveys the message that

making a mess is not permissibleo Leave 15 minutes after session to clean up

Informing children of the reason they are in play therapyo Child-centered play therapy is not problem-focusedo Therefore, the reason for referral may not be knowno Informing children of the specific reason they are coming to the

playroom is not necessaryo “Your parents are concerned because sometimes things don’t

seem to go very well for you at home, and they thought you would like to have a special time in the playroom each Tuesday just for you”

ISSUES IN PLAY THERAPY (CONT.)

Bringing a friend to the playroomo Contraindicated for children who need therapist’s total

attention and acceptance (e.g., trauma)o Contraindicated for children who are sensitive to

comparisons with other childreno Contraindicated for children who have been sexually

abused or are overly aggressiveo Contraindicated early in treatment

Inviting parents or siblings to the playroomo Parents are generally not allowed in sessions

• Restricts therapeutic relationship• Violates confidentiality

o Overly anxious children can request parents if anxiety threatens to become debilitating

o What does the child have in mind with invitation?

CHILDREN IN PLAY THERAPY

Nancy – trichotillomaniao Fear of maternal separationo Competition with younger sistero Rebellion against overwhelming number of limits and

demands placed on hero Cautious, then messy, then free and acceptedo Regression was temporary, not self-reinforcingo Why did therapy stop at eight sessions?o Parent consultations

• Provide insight with respect to child’s feelings• Help parents develop communication skills• Help parents develop parenting skills

CHILDREN IN PLAY THERAPY (CONT.)

Nancy – trichotillomania (cont.)o Four stages of therapy

• Acclimation to playroom situation and therapist• Limit testing, expression of anger, and experience of

freedom• Experiencing independence/dependence relationship• Expression of positive feelings; decision-making about how

she will interact with her world

Cindy – borderline personality disorder? Oppositional defiant disorder?o Punitive conscience (superego)o Controlling

CHILDREN IN PLAY THERAPY (CONT.)

Amy – selective mutism and enuresiso Child-centered play therapy indicated because verbal

production is not necessaryo Introduction of sibling group therapy

• Help each other assume responsibility in interpersonal relationships

• Natural opportunity to generalize interactions outside play therapy setting

• Faster results• Immediate definition of issues• Work on the shift in communication patterns could begin in

sessions and at home immediately

• Diagnostic tool for the play therapist