Partners in Play

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Partners in Play

• Promoting Health Through
• Filial Play Therapy
• Presented by Diane Kukulis, ACSW, LMSW, RPT-S
• To grow up to be healthy, very young children do
  not need to know how to read, but they do need to
  know how to play.
• 
  Fred
  Rogers

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WHY PLAY?
3
WHY PLAY?
4
WHY PLAY?

• WE LEARN 10 OF WHAT WE READ
• WE LEARN 20 OF WHAT WE HEAR
• WE LEARN 30 OF WHAT WE SEE
• WE LEARN 50 OF WHAT WE SEE AND HEAR
• WE LEARN 70 OF WHAT WE SAY
• WE LEARN 90 OF WHAT WE SAY AND DO
• 
  David Kolb

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The Case for Play (Experiential Learning)

• If We Learn 50 of what we SEE and HEAR
• and
• 90 of what we SAY and DO
• then (do the math ?)
• Consider the Learning Potential from what we
• See, Hear, Say and Do!!!
• THIS IS PLAY!

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WHAT IS PLAY?

• Play is a rite and a quality of mind in engaging
  with one's worldview. Play may consist of
  amusing, pretend or imaginary interpersonal and
  intrapersonal interactions or interplay. The
  rites of play are evident throughout nature and
  are perceived in people and animals, particularly
  in the cognitive development and socialization of
  children. Play often entertains props, animals,
  or toys in the context of learning and
  recreation. Some play has clearly defined goals
  and when structured with rules is entitled a
  game. Whereas, some play exhibits no such goals
  nor rules and is considered to be "unstructured"
  in the literature.
• 
  Wikipedia

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WHAT IS PLAY?

• It is a state of being that is intensely
  pleasurable. It energizes and enlivens us. It
  eases our burdens, renews a natural sense of
  optimism and opens us up to new possibilities.
  These wonderful, valuable qualities are just the
  beginning of what play is.
• Scientists - neuroscientists, developmental
  biologists, psychologists, scientists from every
  point on the scientific compass - have recently
  begun viewing play as a profound biological
  process.
• They are learning that play sculpts our brain it
  makes us smarter and more adaptable.  For many
  animal species it has evolved over eons with
  result that the most advanced animals play the
  most i.e., play is more central to their
  development. Humans are the biggest players of
  all, specially designed by nature to play
  throughout our long lives.
• Stuart Brown,
  MD National Institute for Play

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WHAT IS PLAY?

• Play brings mind, body and spirit together into
  one, unified whole. It is
• Intrinsically motivated - an end in itself done
  for the satisfaction of doing it.
• Freely chosen - there are no imposed rules no
  demands or requirements to engage in it.
• Pleasurable - it must enjoyed and not be a source
  of stress.
• Non-literal - it involves make-believe that
  accommodates the interest of the player.
• Active and engaging - dominated by the players
  players are not indifferent or passive.
• 
  Smith and Vollstedt, 1980

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Play Therapy Defined

• The Association for Play Therapy defines play
  therapy as
• "The systematic use of a theoretical model to
  establish an interpersonal process wherein
  trained play therapists use the therapeutic
  powers of play to help clients prevent or resolve
  psychosocial difficulties and achieve optimal
  growth and development."

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The Therapeutic Power of Play


Schaefer

• POWER FACTOR POSITIVE OUTCOME
• OVERCOMING RESISTANCE COOPERATION
• COMMUNICATION UNDERSTANDING
• COMPETENCE/MASTERY SELF-ESTEEM
• CREATIVE THINKING NEW SOLUTIONS TO
  OLD PROBLEMS
• CATHARSIS EMOTIONAL RELEASE
• ABREACTION ADJUSTMENT TO TRAUMA
• ROLE-PLAY ACQUIRE NEW BEHAVIORS
• FANTASY ENLARGES POSSIBILITIES
• METAPHORIC TEACHING INSIGHT
• ATTACHMENT FORMATION PLEASURE IN
  CONNECTEDNESS
• RELATIONSHIP ENHANCEMENT INTIMACY W/
  SELF OTHERS
• POSITIVE EMOTION EGO BOOST
• GAME PLAY POSITIVE SOCIAL
  RELATIONSHIPS
• DEVELOPMENTAL MASTERY COGNITIVE AND
  EMOTIONAL
• GROWTH IN ALL DOMAINS

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Play Therapy Defined

• In The Play Therapy Primer, Kevin OConnor
  defines play therapy as
• a cluster of treatment modalities that
  include a variety of highly developed theoretical
  orientations and technical strategies. all
  play therapy shares a common goal the
  reestablishment of the childs ability to engage
  in play behavior as it is classically defined.
• .Play therapists universally recognize that
  treatment has been successfully completed when
  the child demonstrates an ability to play with
  joyous abandon this is what makes play therapy
  unique.

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To Engage in Play (as it is classically
defined)With Joyous Abandon

• engaging with one's worldview
• energizes and enlivens
• opens up possibilities
• profound biological process
• sculpts our brain
• makes us smarter and more adaptable

• Intrinsically motivated
• Freely chosen
• Active and engaging
• Cathartic
• Enlarging possibilities
• Enhancing intimacy
• Ego boosting
• Developmental mastery

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Types of Play Therapy

• Child-Centered Play Therapy
• Filial Play Therapy
• Theraplay
• Short-Term Play Therapy
• Sandtray/Sandplay Therapy
• Gestalt Play Therapy

• Cognitive-Behavioral Play Therapy
• Prescriptive Play Therapy
• Adlerian Play Therapy
• Ecosystemic Play Therapy
• Group/Dyadic Play Therapy
• Developmental, Individual, Relationship Based
  Model

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Key Concepts of Child-CenteredPlay Therapy

• THE PRIMARY GOAL IS THE DEVELOPMENT OF
  SELF-AWARENESS AND CHOICE
• First, do no harm.
  -me
• Children are unique and worthy of respect
• Children are resilient
• Children have an inherent tendency toward
  growth and maturity
• Children are capable of positive self-direction
• Birds fly, fish swim, and children play.
  -Gary Landreth

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What Children Learn

• To respect themselves
• To identify their feelings and know their
  feelings are acceptable
• Self-control
• To assume responsibility for themselves
• To be creative and resourceful in confronting
  problems
• Self-direction
• To accept themselves
• To make choices and to be responsible for their
  choices

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Principles of Child-Centered Play Therapy



Axline, 1969

• 1. The therapist develops a warm, friendly
  relationship with the child with a focus on
  establishing rapport.
• 2. The therapist accepts the childs
  expressions, feelings and choices exactly as they
  are.
• 3. The therapist establishes a feeling of
  permissiveness in the relationship so that the
  child feels free to express his/her feelings
  completely.
• 4. The therapist is alert to the feelings and
  themes the child is expressing and reflects those
  back to the child so that s/he feels understood
  and can better learn about his/her emotions and
  behavior.

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Principles of Child-Centered Play Therapy



Axline, 1969

• 5. The therapist maintains a deep respect for
  the childs ability to solve his/her own
  problems, refraining from giving advice or doing
  for the child. The responsibility to make
  choices and to institute change is the childs.
• 6. The therapist does not direct the childs
  actions or conversation in any manner. The child
  leads the way.
• 7. The therapist does not hurry or rush the
  child. The process is gradual and the therapist
  is patient.
• 8. The therapist establishes only those
  limitations that are necessary to maintain safety
  and to make the child aware of his/her
  responsibility in the relationship.

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Following the Childs Lead

• Mirroring, Tracking, Reflection, and
  Interpretation focused on
• Person rather than Problem
• Present rather than Past
• Feelings rather than Thoughts or Acts
• Understanding rather than Explaining
• Accepting rather than Correcting
• Childs Direction rather than Therapists
  Instruction
• Childs Wisdom rather than Therapists Knowledge

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The Language of Reflection

• Thats where you wanted it.
• Thats how you.
• You know how to..
• You know what to do with that.
• Youre figuring out what that is.
• Thats your plan.
• You made it happen just like you said.
• Thats how you wanted it.
• Youre going to pick.
• You know how that works.

• You know what you like.
• Youre showing me how.
• You did it.
• You know all about it.
• Youre curious about that.
• You try and try and dont give up until you
  figure it out.
• That was hard but you did it.
• You can take care of yourself.
• You worked hard on that.
• You fixed it.

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What is Filial Play Therapy?

• The word Filial originates from Latin word
  meaning son. Greek word referred to love of
  a gentle nature.
• Developed in the late 50s/early 60s by Bernard
  and Louise Guerney.
• Grounded in child-centered play methods developed
  by Axline, Dorfman, and Moustakis.
• Child-centered play therapy skills are taught to
  parents (or paraprofessionals) so they may be
  translated to the home (or school) environment.

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Why Teach Parents to be Therapeutic Play Partners?

• Effective with a wide variety of behavioral and
  emotional issues the focus is not on the issue
  but on enhancing the interaction and
  strengthening the relationship between parent and
  child.
• Meta-analysis of filial research (22 studies)
  indicates that it is highly effective (ES1.15)
• Utilizes lower limit control (strategies that
  center on exploration and incorporation of new
  ideas) as opposed to upper limit control
  (strategies that center on the implementation of
  limits imposed by self or others).

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Why Teach Parents to be Therapeutic Play Partners?

• Enhances and optimizes resiliency provides one
  empathic other and supports/strengthens the
  development of the childs inner resources to
  resolve problems or distress.
• Research indicates long term changes in the
  quality of relationship between parent and child.
• Children love it! Play is a normal/preferred
  means of self-expression for children.
• Parents tell us it is helpful in developing a
  better understanding their children.

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Goals of Filial Play Therapy

• For the Child
• Better understand own and others feelings
• Learn to appropriately express feelings
• Reduce inappropriate behavior
• Increase trust in parents
• Test limits and problem-solving in a safe
  environment
• Increase self-confidence and self-esteem
• Promote mastery of skills

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Goals of Filial Play Therapy

• For the Parents
• Increase understanding of their childs
  development
• Increase understanding of their childs feelings
  and motivations
• Improve communication
• Increase feelings of warmth and trust in children
• Improve self-confidence
• Reduce parental frustration
• Learn skills to be used in everyday situations

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Goals of Filial Play Therapy

• For the Family
• Strengthen parent-child relationship
• Strengthen family ties and commitment
• Improve family communication skills
• Improve family coping capacities
• Increase positive family interactions
• Prevent/reduce future family problems
  (resiliency)
• The family that plays together stays together!

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Principles of Filial Play Therapy

• 1. The parent develops a warm, friendly
  relationship with the child with a focus on
  establishing rapport.
• 2. The parent accepts the childs expressions,
  feelings and choices exactly as they are.
• 3. The parent establishes a feeling of
  permissiveness in the relationship so that the
  child feels free to express his/her feelings
  completely.
• 4. The parent is alert to the feelings and
  themes the child is expressing and reflects those
  back to the child so that s/he feels understood
  and can better learn about his/her emotions and
  behavior.

• 5. The parent maintains respect for the childs
  ability to solve his/her own problems, refraining
  from giving advice or doing for the child. The
  responsibility to make choices and to institute
  change is the childs.
• 6. The parent does not direct the childs
  actions or conversation the child leads the way.
• 7. The parent does not hurry or rush the child.
  The process is gradual and the therapist is
  patient.
• 8. The parent establishes only those limitations
  that are necessary to maintain safety and to make
  the child aware of his/her responsibility in the
  relationship.

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Basic Structure to Filial Play Therapy

• Assessment/Treatment Planning 1-2 sessions
• Information gathering from parents
• Drawing or play assessment with child
• Rapport Building 3-4 sessions
• Non-directive play sessions to get to know
  child and assess their response to non-directive
  play
• Parent Training Sessions 2-3 sessions
• Didactic review of play skills and role-play
• Supervised Parent-Child Play Sessions 6-8
  sessions (can be more)
• 25-30 minutes of play and 25-30 minutes of
  processing with parent
• Home Play Sessions w/ Check-Ins Approximately
  monthly
• Address issues concerns re home sessions (but
  varies greatly) and explore strategies for
  expanding the use of the skills in day- to-day
  situations.

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A Word About Toys

• Toys should be
• safe
• cleanable
• without a prescribed structure/story (avoid too
  many popular action figures they will promote
  imitative play)
• interesting
• facilitate a range of creative and emotional
  expression
• allow exploration and expression without
  verbalization
• not so precious/noisy/messy that it pushes
  buttons or much time is spent setting limits
• Toys should be selected, not collected Gary
  Landreth

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Recommended Toys

• Family/Nurturing Toys
• Human/animal families
• Doll house w/furniture
• Baby doll w/ clothes/acces.
• Dress-up clothes
• Fake food/dishes
• Doctor kit w/bandaids
• Puppets

• Expressive Toys
• Playdoh or clay
• Sand/rice tray w/ miniatures
• Scarves and bandannas
• Chalk or dry erase board
• Mirror
• Magic wand
• Play telephone

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Recommended Toys

• Construction Toys
• Cardboard or wood blocks
• Blankets, sheets, pillows, etc.
• Paper, crayons, glue
• Paper plates, cardboard
• Cardboard/wooden blocks
• Aggression Related Toys
• Bop bag or
• Dart gun or dart board
• Soldiers
• Foam bat or pool noodle
• Rubber knife

• Miscellaneous Toys
• Cars, trucks, safety vehicles
• Ring-/beanbag-toss game
• Playing cards
• Play money
• Assorted cups, bowls, containers, spatulas, etc.
• Lined tablets w/pencils
• Crafting supplies - yarn, beads, foamboard,
  Sculpey, clothespins, cardboard boxes, etc.

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Filial Play Therapy Skills

• CREATING THE
• THERAPEUTIC ENVIRONMENT
• The Four Skills
• Structuring Skill
• Sets the overall tone and format of the sessions.
• Empathic Listening Skill
• Shows sensitivity, acceptance and understanding.
• Imaginary Play Skill
• Promotes free expression and promotes elaboration
  of play themes.
• Limit Setting Skill
• Creates a safe, protected environment and
  promotes self-responsibility.

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Structuring Skill

• Establishes a framework within which the play
  sessions take place. Communicates to the child
  that this time is special and different from the
  rest of their lives and that the rules are
  different.
• Introductory Message (encourage memorization)
• ______, this is a very special play time (room).
  You can do almost anything you want to during
  this time. If there is something you may not do,
  I will let you know.
• It is time for our special playtime now.
• Bathroom Break
• Recommend that child use the bathroom prior to
  the play session. However, ONE bathroom break is
  allowed during the play session. After the child
  returns, the parent states You are back in our
  special playtime now.

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Structuring Skill

• Playroom Departure
• The parent gives a five minute warning (this can
  be varied, depending on the need of the child).
  ________, we have five more minutes of special
  playtime today. Then, a one minute warning is
  given ________, we have one minute left to
  play today. At the end of the playtime, parent
  pleasantly, but firmly states _______, our
  playtime is up today. We need to leave our
  playspace.
• If the child resists leaving, the parent reflects
  the childs feelings and then restates that the
  session is finished with a firm tone of voice.
  If the child continues to resist the parent
  firmly leads the child out of the space. It is
  very important that the session ends clearly and
  without delay this established boundaries for
  the play time and parental authority.

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What About the Clean-up?

• In filial play therapy sessions the child is not
  expected or asked to clean up.
• Resistance or a power struggle over clean-up can
  undermine parental authority and the therapeutic
  process. Enforcement focuses on ending the
  session as that is easier to enforce.
• Free expression of feelings may be inhibited if
  the child is thinking about the clean-up,
  especially in an anxious child.
• Some children will choose to clean-up at the
  five-minute or one minute warning. This is OK
  but it is still important to end the session when
  the time is up. Establishment of clear
  boundaries for the playtime is fundamental.

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Empathic Listening Skill

• Parents try to view the world from their childs
  point of view and put their own feelings and
  thoughts on hold.
• Undivided Attention and Interest
• Parents pay close attention to the childs
  expressions and feelings with genuine curiosity.
• Verbal Tracking
• Play by play commentary similar to what is done
  by sportscasters when describing a game in
  action. It is important to be attuned to the
  feelings observed and mirror them back to the
  child. Actions and the feelings associated can
  be tracked.

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Empathic Listening Skill

• Do not ask questions. Do not lead the child.
• Questions and directions can interrupt and shift
  the play away from where the child was going. It
  can also cloud the parents capacity to
  understand the themes played out.
• Do not assist the child any more than necessary
  to keep them engaged in their play process.
• This can be very difficult. It can be painful to
  watch a child struggle with a task and not step
  in to help. Verbal tracking in the form of
  You are working very hard on that, or You are
  figuring out how that works will promote a
  sense of mastery and competence. If the child
  becomes overwhelmed or demanding of help, the
  parent can partner with the child as part of
  the team or as a helper.

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Empathic Listening Skill

• If the child asks a question (Whats this for?
  or What do you want to do?)
• 1st) Reflect the question Youre trying to
  figure that out. or Youre thinking about what
  to do.
• 2nd) If child persists In our special playtime
  you can use that just about any way youd like.
  or This is special playtime and you get to
  choose what to do.
• 3rd) If child still persists, provide a simple
  answer but return the decision to the child
  Some people might use it as a wagon but you can
  use it just about any way youd like. or There
  are blocks or games to play with but this is
  special playtime and you can choose what to do.

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Empathic Listening Skill

• If the child states Stop copying me!
• Make sure you are varying your verbal tracking
  reponses.
• Explain that what they are doing is very
  important and you are trying to make sure that
  you understand him/her.
• Refrain from the play by play tracking and
  reflect feelings only.
• Stop reflecting aloud and show interest
  nonverbally for awhile.

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Imaginary Play Skill

• There will be times when parents are invited into
  their childs play. Parents should be responsive
  to the invitation and do their best to play out
  the role assigned to them. Some children will be
  more specific and demanding than others. There
  are some general guidelines that inform the
  imaginary play skill

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Imaginary Play Skill

• Be accepting and act out the role assigned to you
  within the limits of safety and appropriateness.
• The child is the director of the play and you are
  the actor.
• Once you have been assigned a role you no longer
  need to use empathic listening/verbal tracking
  you shift back when the child shifts out of
  imaginary role playing.
• It is OK to shift out of imaginary play to
  clarify what the child is wanting from you. Do
  you want me to fight back or give up?

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Limit-setting Skill

• Provides for parent and child safety through the
  establishment of boundaries.
• Establishes parental authority.
• Promotes behavioral responsibility in child.
• There is a 3-Step sequence to the limit-setting
  process.

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Limit-setting Skill

• Limits should be kept minimal.
• Fosters the childs ability to remember/comply
• Safety should be a primary consideration in
  setting limits.
• Limits must be clear and consistent.
• Reduces/minimizes testing behavior
• Consequences are the same for all broken limits
• The child must leave the playspace and the
  session is ended.

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Limit-setting Skill

• Limits may include the following
• No throwing of toys or play items.
• Crayons/markers on appropriate surfaces only
  (paper, cardboard, etc.)
• No poking with sharp objects.
• No intentional destruction of toys.
• Personal parental limits as determined by parent
  in collaboration with therapist (no pointing guns
  at real persons, no abusive language, etc.)

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Limit-setting Sequence

• State the Limit
• Brief, clear, specific, firm.
• Use the childs name, reflect the childs desired
  behavior, state the limit, restructure/redirect
  the play.
• Stevie, youd like to hit me with the rubber
  bat. Remember I told you if there was something
  you could not do. You may not hit me with the
  rubber bat. You can do just about anything
  else.

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Limit-setting Sequence

• If Limit is broken
• Give a Warning
• Restate the limit, state what will happen if the
  limit is broken, restructure/redirect the childs
  play.
• Stevie, remember I told you that you may not hit
  me with the rubber bat? If you hit me with the
  bat again we will have to end our special
  playtime for today. You may do just about
  anything else.

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Limit-setting Sequence

• If the limit is again broken
• Enforce the Consequence
• Restate the limit, carry out the consequence in a
  firm but pleasant manner by leading the child
  away from the playspace.
• Stevie, I told you if you hit me with the rubber
  bat we would have to end our special play for
  today. Since you hit me again we have to end.
• This procedure helps the child learn that s/he is
  responsible for his/her choices and behavior and
  that the outcome is predictable and dependable.

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Common Play Themes

• Control
• Power
• Expression of feelings
• Problem-solving
• Trauma
• Rescue
• Family relationships
• Good vs. evil
• Developmental mastery
• Sacred vs. profane
• Winning and losing

• Wishes and dreams
• Friendship
• Dependency
• Loyalty binds
• Memories
• Competency vs. cheating
• Trust and betrayal
• Nurturance vs. neglect
• Aggression and violence
• Grief and loss
• Peer relationships

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Play Themes Indicators

• Repeated play with the same toys or storyline.
• Sudden/abrupt changes or shifts in play.
• Intense, lengthy or highly focused play.
• Secret/Silent play.
• Play is consistent or similar over sessions (may
  use different toys) or storyline picks up where
  previous session left off.
• Play from previous sessions is referred to by
  child.

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Play Themes

• A Special Word About Aggression and Violence
• Violence is uncontrolled and destructive
  aggression.
• Aggression is a natural part of human
  development it involves the release of energy
  and can be useful. Our task is to figure out how
  to express it without doing harm. Play is a
  natural way to practice aggressive behavior and
  determine what strategies are a best fit for
  various situations. Structuring and
  limit-setting skills provide safe boundaries for
  aggression to be expressed in a non-destructive
  manner.

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Processing Sessions with Parents

• How did it feel for you?
• How do you think your child was feeling?
• Was there anything that surprised you?
• Do you see any parallels in the play to your
  childs real life?
• How did the intense (aggressive, chaotic,
  fearful, etc.) play feel for you?
• What parts of the session were hardest for you?
  (Boring, scary, anxiety provoking, etc?)
• What parts of the session were most satisfying
  for you?
• Why do you think is was so hard (boring, scary,
  anxiety provoking/satisfying for you?

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Resources

• Filial Therapy Strengthening Parent-Child
  Relationships Through Play by Rise vanFleet.
• Play Therapy Theory and Practice A Comparative
  Presentation by Kevin OConnor and Lisa Mages
  Braverman.
• A Parent Handbook of Filial Play Therapy by Rise
  vanFleet.
• Mastering the Magic of Play A Training Manual
  for Parents in Filial Therapy by Mary Conley
  Ortwein, MS
• The Efficacy of Play Therapy A Meta-analytic
  Review of Treatment Outcomes by Bratton, Ray, Dee
  and Jones