Hermine hug hellmuth play therapy

The Child Therapies: Application in Work

with Abused Children

Closer than the moon, even closer than the depths of the seas, the minds of children seem to most people not only mysterious, but impenetrable. -J, ALEXIS BURLAND & THEODORE B. COHEN

Child therapy is described by Sours (1980) as "a relationship between the child and the therapist, aimed primarily at symptom resolution and attaining adaptive stability" (p. 275). Child therapy, as a separate and distinct type of work, has been evolving since 1909, when Freud first attempted psychotherapy with the now historic patient Little Hans. The term child therapy is often used interchangeably with the term play therapy although play was not used directly in the therapy of children until 1920 when Hermine Hug-Hellmuth

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27 Applying the Child Therapies

began using play for the diagnosis and treatment of childhood emotional problems (Schaefer, 1980). Melanie Klein and Anna Freud formulated the theory and practice of psychoanalytic play therapy some 10 years later.

While most child therapists agree that play is the most effective medium for conducting therapy with children, others (Freiberg, 1965; Sandler, Kennedy, & Tyson, 1980) have raised questions as to whether play produces structural change, have pointed to the nebulous quality of play, and have dismissed it as consisting ofneither dream material nor free association. Schaeffer (1983) contends that "it is some­ what difficult for anyone interested in play and play therapy to gain a clear understanding of what is meant by the term play because no single, comprehensive definition of the term has been developed" (p. 2). However, the potential benefits of play are well documented. In his literature review Schaeffer found descriptions of play as "pleasurable," "intrinsically complete," "independent from external rewards or other people," "noninstrumental, with no goal," and "not occurring in novel or frightening situations." Schaeffer suggests that play is person- rather than object-dominated.

Schaeffer (1980) further asserts that "one of the most firmly established principles of psychology is that play is a process of development for a child" (p. 95). Play has been alternately depicted as a mechanism for developing "prob­ lem-solving and competence skills" (White, 1966); a process that allows children to "mentally digest" experiences and situations (Piaget, 1969); an "emotional laboratory" in which the child learns to cope with his/her environment (Erikson, 1963); a way that the child talks, with "toys as his words" (Ginott, 1961); and a way to deal with behaviors and concerns through "playing it out" (Erikson, 1963). Nickerson (1973) views play activities as the main therapeutic approach for children because it is a natural medium for self-expression, facilitates a child's communication, allows for a cathartic release of feelings, can be renewing and constructive, and allows the adult a window to observe the child's world. Nickerson points out that the child feels at home in a play setting, readily relates to toys, and will play out concerns

28 THE HEALING POWER OF PLAY

with them. Chethik (1989) makes an important point about the use of play as therapy: "Play in itself will not ordinarily produce changes...the therapist's interventions and utiliza­ tions of the play are critical" (p. 49). In addition, the clinician must serve as a participant-observer, rather than a playmate. I believe that play in therapy must be facilitated by an involved clinician in a meaningful way. Some of the most frequent errors made in child therapy are allowing a child to play randomly over an extended period of time, ignoring the child's play, and providing the kind of toys that do not promote self-expression.

As interest in child therapy has grown and as the num­ ber of child-specific referrals has increased, a variety of therapeutic techniques, games, and toys have also evolved. Play therapy has blossomed into a multifaceted and exciting field of study.

THE HISTORICAL DEVELOPMENT OF PLAY THERAPY

As mentioned earlier, Sigmund Freud in 1909 was the first to use play to uncover his client's unconscious fears and concerns. Hermine Hug-Hellmuth began using play as a part of her treatment of children in 1920 (Hug-Hellmuth, 1921) and 10 years later, Melanie Klein and Anna Freud formu­ lated the theory and practice of psychoanalytic play therapy. This type of play therapy continues to be one of the most respected forms of child therapy, usually conducted by analysts.

Psychoanalytic Play Therapy

Anna Freud and Melanie Klein wrote extensively about how they incorporated play into their psychoanalytic technique. Whereas the former advocated using play mainly to build a strong positive relationship between child and therapist, the latter proposed using it as a direct substitute for ver­

29 Applying the Child Therapies

balizations. The primary goal of their approach was "to help children work through difficulties or trauma by helping them gain insight" (Schaefer & O'Connor, 1983). Anna Freud has repeatedly pointed out that "the essential task [of therapy] is to remove the obstacles that impede [the child's] development and to allow his progressive develop­ mental forces and ego resources to complete the task of development" (Nagera, 1980, p. 22). Klein (1937) felt that an analysis of the child's transference relationship with the therapist was the main source of insight into the child's underlying conflict.

Freud and Klein took the basic concept of free associa­ tion, one of the basic precepts of adult analysis, and in its place substituted the child's natural tendency to play (Nagera, 1980). They proposed that play uncovered the child's unconscious conflicts and desires and that play was the child's way of free-associating. While Klein proposed that the child's play is "fully equivalent" to the adult's free associations and "equally available for interpretation," Freud's theory viewed play not as an equivalent to adult fre<) associations but as an ego-mediated mode of behavior "yield­ ing a substantial body of data" but requiring supplementa­ tion from a variety of sources, including parents (Esman, 1983). Psychoanalytic play therapy, predicated on the analysis of resistance and transference, emphasizes the use of interpretation, recognizing the child's ability to use play symbolically to manifest internal concerns. Nagera (1980) documents that even though significant differences existed in the theoretical tenets of Freud and Klein in the beginning, throughout the years there has been more of a convergence between the two theories. Fries (1937), a student of Anna Freud's, delineates the distinctions between the two theories, emphasizing Freud's preference to withhold inter­ pretation.