Child and Adolescent Psychotherapy

Heather Christensen LCSW, RPT-S


Play therapy refers to a treatment modality used by specifically trained Master’s Level professionals with children who suffer from emotional, behavioral, or developmental difficulties. Play therapy utilizes the child’s innate impulses to play as a means of helping the child understand and cope with their fears, worries, and conflicts.

Play therapy helps children understand confusing feelings and upsetting events that they haven’t had the chance to sort out properly. Rather than having to explain what is troubling them, as adult therapy expects, children use play to communicate at their own level and at their own place without feeling interrogated or threatened. Since play is fun, it makes it easier for children to confront what is bothering them.

Once a child has used up their own problem-solving tools, they may begin to demonstrate behaviors (symptoms) that cause concern. When presented with a therapeutic environment containing toys that invite imagination, most children will immediately begin to play. The trained play therapist observes the play, sometimes interprets its possible meaning, and reflects the feelings expressed back to the child without judgment. This process allows the child to express the conflict and bring about resolution through the play. I find that the SPELL Model below is a simple way to conceptualize what occurs in the playroom.

STRUCTURE

Structure provides a safe environment in the form of routine weekly sessions, consistent playroom set-up, and consistent boundaries

POSITIVE APPROACH

Self-esteem and self-expression are established and reinforced in play therapy by building on natural strengths, interests, and abilities. The therapist communicates an unconditional acceptance of the child and a genuine enthusiasm for the child’s expression and exploration

EMPATHY

The play therapist meets and accepts the child where he or she is. By allowing the child to take the lead in the relationship, the therapist steps into the child’s world and gains understanding of what frightens, preoccupies, interests, and motivates the child

LOW AROUSAL

The playroom and sessions are organized to ensure that distractions and over-stimulation are minimized, thus reducing anxiety

LINKS

The play therapist maintains open communication with other professionals involved in the child’s life to ensure a holistic, cohesive treatment approach

Play therapy has a long and proud tradition stemming from Sigmund Freud (1856-1939), the father of Modern Psychotherapy, who was the first to apply analytic concepts to the treatment of a five year old child. A student of Freud, Helga Hug-Hellmuth (1871-1924) was known to be the first child therapist. She had a clinic in Vienna where she applied psychoanalytic technique to children.

Hellmuth strongly influenced Melanie Klein (1882-1960) who further developed the work by basing her interventions and interpretations on the way the child plays with the toys. Melanie Klein’s non-directive approach is the foundation of the Child-centered Play Therapy that is commonly practiced today.

Meanwhile, Anna Freud (1895-1982), youngest daughter of Sigmund, made profound contributions to our overall understanding of children, the stages of development, and defense mechanisms. Freud utilized a more directive approach to form a therapeutic relationship with children, and this model came to be known as Ego Psychology.

Since the work of Melanie Klein and Anna Freud, many other approaches to play therapy have been developed.

Here are just a few:

  • Adlerian Play Therapy

  • Child-centered Play Therapy

  • Cognitive Behavioral (CBT) Play Therapy

  • Ecosystemic Play Therapy

  • Jungian Play Therapy

  • Gestalt Play Therapy

  • Prescriptive Play Therapy

  • Filial Play Therapy

  • Trauma-focused Play Therapy

  • Expressive Therapies, i.e., sandtray, drama, puppets

  • Ericksonian Play Therapy

  • Floortime

The Association for Play Therapy (APT) was established in 1982. APT is a national professional society dedicated to the advancement of play therapy in order that clients in need may receive the best possible mental health services. Its members have unique and distinctive dedication to and preparation in the theories and techniques of play therapy.A Register Play Therapist RPT-S) credential ensures “a minimum of 2000 hours of supervised practice hours of counseling, 500 direct contact hours of play therapy under supervision, 150 clock hours of instruction in play therapy, and maintain 36 hours of professional training every three years, 18 hours specific to child therapy” (APT).

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