Read an Excerpt
Foundations of Play Therapy
John Wiley & Sons
Copyright © 2003
Charles E. Schaefer
All right reserved.
PSYCHOANALYTIC PLAY THERAPY
Richard N. Bromfield
As he did for so many other forms of treatment, Sigmund Freud laid the foundation
for psychodynamic play therapy. His work with and thinking about his adult
patients inspired new insights into the emotional development and experiences of
children, particularly the profound relationship of children's psyches, bodies, and
sexuality (1905). Although he clinically focused on adults, his informal analyses
of his own children and treatment of Little Hans, a five-year-old boy with a horse
phobia (1909/1955), and his working backward toward the early experiences of
his adult patients, set the stage for the logical next step of treating children.
Hermine von Hug-Hellmuth, a teacher in Vienna, became the first to formally
treat children with talk and play. In 1920, she wrote that "[t]he analysis both of the
child and of the adult has the same end and object; namely, the restoration of the
psyche to health and equilibrium which have been endangered through influences
known and unknown" (p. 287). Initially treating her young patients in their own
homes, Hug-Hellmuth appreciated the influence of family and saw children's difficulties
much rooted in their parents' unresolved troubles.She also believed that
conscious insight was not a requisite to a child's finding relief and help in play.
The most cited beginnings of child therapy revolve around Anna Freud in Vienna
and Melanie Klein in Berlin. Both women held deep beliefs in the richness
and complexity of childhood and development, appreciated the suffering that
children know, and valued play therapy as a means for understanding and healing.
The two women, however, disagreed on much else.
Klein (1932/1975) saw the child's play in therapy as the equivalent of adult's
free associations and as the vehicle to making interpretations directly to even
very young children's unconscious. She especially focused on what she perceived
as the young child's experiences of abandonment, envy, and rage-concepts no
less relevant today.
Anna Freud's methods (1927/1974) were more measured, aimed at helping
children come to consciously understand why they thought, felt, and behaved as
they did, that insight inviting personal change. She respected the child's behavior
and defenses as the child's best attempts to cope with their anxieties, traumas,
life experiences, and growing up. Her lifetime of work not only recognized factors
such as the child's health, living conditions, cognitive ability, and such, but
she promoted parent guidance and school consultation as important functions of
the child therapist. If Sigmund Freud was the father of psychoanalysis, then Anna
Freud was child therapy's foremost mother.
BASIC CONSTRUCTS, GOALS, AND TECHNIQUES
The goals of psychoanalytic play therapy are many and include helping the child
to suffer less (e.g., quelling anxiety and related bodily symptoms, lifting depression,
and resolving complicated grief ); overcome trauma; adjust to life events,
such as divorce; cope with illness and comply with treatment; master phobias; be
better able to attend, learn, and work in school; manage personal anger and aggression;
and come to terms with a learning disability or physical handicap.
While these goals sound like those pursued by clinicians of other theoretical
persuasions, the goals of psychoanalytic play therapy sometimes are more ambitious,
aspiring to change not just a behavior or symptom but broader, deeper,
and more essential aspects of the child and her ways of dealing with life and its
ordeals. Psychoanalytic play therapy may be used to soften an overly harsh conscience
in a child who won't give himself a break. It can help a child integrate
various aspects of her personality or help her to master developmental tasks,
such as separating and growing up, or adapting to puberty and its changes.
Analytically-informed therapy can help detached or estranged children connect
more to themselves and to others. This type of therapy is extremely good at promoting
resiliency and adaptability, helping to reduce a child's vulnerability to
psychotic and borderline functioning, especially under stress. It can help an inhibited
child grow more spontaneous, active, and joyful; an impulsive child,
more contained, reflective, and responsible; and a narcissistic child, less susceptible
to wounded esteem and reactive rage.
Psychoanalytic play therapy intends to go beyond the immediate pain or difficulty
and clear the way so that healthy development can resume from where it has
been halted or detoured by external trauma or untenable internal conflict (neurosis).
It also is effective in helping children who have real and significant limitations
come to terms with who they are, helping them to develop more secure,
adaptable, compensating, and self-accepting ways and attitudes.
How It Works
Therapy provides a troubled child a place safe from physical and psychological
harm, where she can let her guard down sufficiently to explore her thoughts,
feelings, and life. This type of therapy believes, along with the child-centered
approach, that simply coming to know what she truly feels, thinks, and does can
help a child to feel and function better, that is, to live in a more authentic way.
But looking in the mirror with the lights on is difficult. By proving ourselves
safe and trustworthy over time, we steadily convince the child that she has
found someone with whom she can pursue and share this self-exploration.
But establishing a safe and accepting atmosphere isn't enough. The psychoanalytic
play therapist strives to "therapeutically hold" the child (Winnicott,
1945/1975). Parallel to the way that a mother holds her baby, the therapist holds
the patient-not physically, but psychologically. The therapist absorbs the excitement
and distress that the child's mind and body cannot bear on its own. Moment
by moment the therapist confirms the child's experience. This witnessing fosters
the child's trust in what she herself feels and perceives, leading to her evolving a
more genuine self, a keystone of psychological health. The therapist's noticing
and admiring the child's steps forward renews enthusiasm and joy for her own
growth and the risk-taking it requires.
Most of all, the therapist empathically listens and responds to the child.
Being understood deeply, having your perspective heard, is itself one of the
most powerfully moving experiences you can have and counters the painful, if
common, sense of being unheard and ignored. In addition to being reparative in
itself, the therapist's empathic stance facilitates clinical interventions that
acutely meet the patient just where she is emotionally, neither falling flat nor
Maintaining an empathic atmosphere also creates constant opportunities for
the therapist to make "empathic failures" (Kohut, 1971), moments when he
doesn't grasp some important communication from the patient, making the child
feel painfully dismissed, criticized, rejected, humiliated ... [fill in the blank].
By continually acknowledging our empathic missteps and allowing our patients
to react to and analyze them, we as therapists enable those children to grow sturdier
esteems under thicker skins.
Because the child is the one in charge of his own therapy, he can actively work
on experiences in which he was originally helpless and impotent. In a fantastic reversal
of fortune, the abused child can be the big grizzly who torments his once
tormenter. The learning disabled child who finds every minute in school an assault
on his pride can be the one who, in play, asks his teachers and peers questions they
can't answer. Likewise, the bully can actively play out what really propels his
sadistic behavior, his feeling little and powerless. Their reenacting in play, their
casting themselves this time around as the heroes and rescuers, can help children
to master and grow beyond overwhelming situations and experiences.
Play allows the child to put her conflict into a symbolic arena (Irwin, 1983). A
child who feels unable to confront her alcoholic mother can confront a doll standing
in for her mom. That girl can speak her mind and even take revenge without
fearing reprisal. The child also can project intolerable feelings about herself,
putting internal conflict on the outside, making it a concrete reality she can wrestle
with more comfortably (Jacobson, 1954). Instead of being tormented by his
own conscience, a good boy who feels guilty over what he's thinking about can
stage a battle between the good guys and the bad. At its most basic, psychoanalytic
play-like most play-permits the child a forum in which she can face herself, her
conflicts, and the people in her life from a psychologically safer distance, hence,
more fully and openly.
Although a child is still very much in the midst of her childhood, her development,
and the context of her family, psychoanalytic play therapy recognizes her
wholeness as a person. The psychoanalytic therapist appreciates the role that
even a young child plays in her life. What, we wonder alongside the child, do you
contribute to your problems? What have been your ways of coping with an imperfect
home life or a difficult teacher? We sensitively move the child toward seeing
how she copes, defends against, and compensates for stresses-whether they
come from inside or outside-cherishing the child's inner world and reality as
much as that she experiences outside of herself. Rather than be cruel or victimizing,
crediting children, even in the worst of circumstances, with responsibility
over their own lives and the choices they make is ultimately more respectful,
freeing, empowering, and therapeutic. Neither the child who must do what is
asked of him nor the one who never can oblige is truly free. Psychoanalytic therapy
works to help children learn what it is they think is the right, good, or satisfying
thing to do.
No less than adults who drink, abuse, or otherwise deny their problems, child
patients cannot make changes in their lives until they admit what is happening.
Our steady and empathic ears and eyes gradually invite the child to tell it like it
is, to confess that they do lie, steal, act mean, try to irritate their parents, and so
on. Once they can accept what they really do, and see the role it plays in their
troubles, children can make decisions as to what, if anything, they wish to do
about it. No one, not even a preschooler, will change until he has insight into his
difficulties, until he wishes to do something to make it better, and sees a reason
for doing so.
But acknowledging reality can be hard. Child-centered therapists, such as the
gifted play therapist and theorist Virginia Axline (1981) believe that with
enough unconditional love and acceptance, the child will, like a flower, increasingly
unfold until fully revealed and bloomed in all his or her rich potential.
Many children, like adults, often cannot broach the matters that most pain and
shame them, no matter how accepting we clinicians are. We as therapists often
have to confront our child patients, "interpreting" or pointing out what they are
not quite aware of or noting a discrepancy between what they say (and wish to believe)
and what is actually true. We sometimes need to spotlight important behaviors
and words, especially discrepancies between them, that left to the child
might go undetected and unanalyzed. "You cry about calling your mother a bitch,
but you're smiling all the while." After all, while we try to follow the lead and
pace of the child, we do wish to do as much as we therapeutically can as quickly
as possible. (There is no virtue in any child suffering or living in compromise any
longer than she has to.)
Everything the psychoanalytic play therapist does is in the service of the
child's self-discovery and his assuming more responsibility for his life. But just as
we promote his increasing sense of ownership (of therapy and his life) so do we attend
to other realities. Recognizing that children are in their parents' keep, we
work (see below) to guide, support, and awaken parents, always doing so with an
eye to the child's needs. While honoring our individual work with the child, we do
not hesitate to meet with parents or family members-sometimes with, sometimes
without the child herself-if it is clinically warranted. We keep abreast and involved
with the school and educational issues and enlist the consultation of psychiatrists
if we think that medication might offer benefits. Though we keep our
work with the child in the spotlight-cherished, insulated, and nurtured-we
never lose sight of the facts of the child's life and the bigger world in which he
spends most of his days and hours.
ROLE OF THE THERAPIST
In no mode of treatment is the role of the therapist more entwined with the basic
theory and constructs. In many ways, the therapist and her way of being is the
intervention. As with any relationship-based therapy, the therapist strives to
create an atmosphere of safety and acceptance, of genuine positive regard for
the child. Our empathic and inquisitive posture toward the child, her experience,
and her self-expression are essential. We show respect for the child's thoughts
and feelings, for no other reason than they are the child's own. If psychotherapy
is, to a great degree, a self-inquiry, then we aim to create the conditions in
which a child will be most willing to risk the pain and humiliation of looking in
Being human we will, of course, have opinions and feelings about the child's
behaviors and choices. Hearing, for instance, that a child we are seeing tortures
field mice will distress many of us. But reprimanding him will not likely do him
or the mice any more good than has the yelling of the parents and teachers in the
boy's life. We may share with him our sense that what he's doing is not good and
that it suggests to us that he is not as happy and content as he appears to be. But we
try to stay neutral, not to the boy, but to his conflict, so that he can openly explore
what need his sadism serves. The old ideal of the analytic therapist as aloof and
detached was a distortion of what was really needed. Children, even those within
psychodynamic treatment, need therapists who, while able to manage their own
psychic stuff, are emotionally genuine, available, and sincere.
The feelings that a child patient summons in us, sometimes called counter-transference,
is valuable information. Sometimes, it says more about us and our
own issues, issues that we need to clear up on our own time or at least keep out of
the child's way. At other moments, what we feel-wanting, maybe, to hurt the boy
who so hurts others, or conversely, wanting to buy a child special gifts-can help
us understand what is going on in the child and the treatment. Many more times
than not, we don't share the fantasies and feelings that a child evokes in us
(though sometimes we do).
Excerpted from Foundations of Play Therapy
Copyright © 2003 by Charles E. Schaefer.
Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.