As you saw in Chapter 4, projective techniques are commonly used to assess underlying emotional issues, which drive anxiety, depression, and other conditions. Play therapy is a projective technique in which your child's conflicts and desires are revealed through her play and her interaction with the therapist. Generally, play therapy is the mode of choice for children under the age of ten to age twelve, as they are less verbal and abstract than older children. As children mature, their ability to “think about thinking” and work with their emotions directly increases, and play techniques give way to more traditional talk therapies, which focus directly on emotional expression, problem solving, and behavioral change. It is important to note that play that occurs in a professional setting is different from play that occurs outside of the office. Unless your child's therapist guides you, it is generally unwise to attempt to make free play “therapeutic.”
The Symbolic Nature of Play
Play therapists work from the assumption that the symbols your child uses in his creative play are windows into the deeper recesses of his fears, desires, and motivations. When he expresses these through his play, they gradually become a part of his awareness; that is, he can learn about himself when guided by someone who is observant and responsive to his nonverbal messages. When your child feels fully understood, he is more likely to trust that he can manage his emotions and solve his problems.
Unfortunately, the highly subjective nature of play therapy does not lend itself well to research, though specific techniques such as sand tray therapy do have some support in the literature.
The Cathartic Nature of Play
When your child expresses her inner nature through her play, a natural emotional release, or catharsis, occurs. This emotional response can also uncover other, related emotions. For example, a girl who re-enacts a fight with her father in play therapy may feel relief, or might move from anger to sadness as her role in the conflict becomes clearer. Your child can then use her insights to change her self-talk and behavior about the situation, and make future adjustments. When an anxious child expresses fears or worries in therapy, they lose some of their power to torment her in her daily life.
Self-talk is a term coined from cognitive behavioral therapy. It refers to the things you say to yourself in your head about your experiences, like “She didn't say hello to me, so she must not like me.” These powerful thoughts influence your core beliefs and your emotions, which in turn influence your behavior. Learning to change self-talk is essential in managing anxiety.
Learning New Behavior Through Play
Play therapists are trained to gently comment on and intervene in play to help your child learn new behavior. For example, in the situation just described, a therapist might model a father and daughter having a talk together or making up, or suggest that a child come up with a different, more satisfactory scenario. In addition, though much of play therapy itself is unstructured, there are multiple opportunities to teach social skills such as developing confidence, taking turns, following the rules of a game, and negotiating. Play therapists incorporate all of these skills to help a child with anxiety develop confidence, decrease his need for control, and tolerate anxiety.
Tools of the Trade
A therapist who uses play therapy with children will usually have an array of items at hand to meet your child's particular needs and concerns. The experience of play therapy includes not only the play itself, but also the opportunity to build trust and cooperation, which sets the stage for change. The most common props used in play therapy are described in the following paragraphs.
A dollhouse is a common tool. It is used in therapy to help your child express thoughts, feelings, and experiences about her family and other people in her world such as pets or neighbors.
Games are used by many child therapists to help establish comfort and trust, to provide a window into a child's experiences, and to serve as a tool for skill building. There are many therapeutic games available to help children act spontaneously and express opinions and emotions in nonthreatening ways. Games may also be targeted toward specific objectives, such as making friends or expressing anger. Games provide a backdrop for children to express and work on issues of control and mastery, which are especially important for children with anxiety. In addition, playing games with children in therapy provides a perfect opportunity for therapists to help children improve their social skills.
The practice of “acting as if” can encourage a child with anxiety to try on new ways of thinking and acting, which may bring relief from fear, worry, or withdrawal and lead to new ways of acting outside the therapy office. Storytelling and role-playing are also techniques that draw on “make believe.”
PUPPETS, DOLLS, AND ANIMALS
Puppets can often convey feelings or thoughts a child is afraid to express because they let the child feel “once removed” from his direct experience. This emotional distance can allow a child to feel freer to fully express his needs and emotions. Dolls and animals serve a similar purpose, allowing your child to project his inner self without having to use more complicated means of expression. It is common for a child in therapy to choose a stuffed animal to “speak for him” or to say or do things he may feel he is unable to. Sometimes, therapeutic suggestions from “an older, wiser being” (like a well-worn teddy bear) are received on a deeper level than would be possible in simple “talk therapy.”
SAND PLAY / SAND TRAY
Sand play incorporates specially designed trays of sand in which children can form menageries of animals, people, houses, and other symbols that represent their internal world. Sand tray therapists are trained to interpret the scenes your child creates in the sand and to use these to help your child in therapy. The therapist may also use your child's creations to help her tell “stories,” to express strong needs and emotions in a nonthreatening way, and to point to recurring themes, which may indicate your child's concerns, strengths, or weaknesses.