This article will provide a brief history of child-centered play therapy and the key concepts of this clinical approach to the psychotherapeutic treatment of children. As well, this non-directive theoretical orientation will be used to propose the development of a child-centered play therapy group and the rationale for its implementation in my private practice, Toronto Psychological Services.
A Brief History of Child-Centered Play Therapy
By the early 20th century, play had been identified as an essential means of individual expression for children. With the exception of a few researcher-practitioners such as psychologists, Hermine Hug-Hellmuth, David Levy, Anna Freud, Melanie Klein (1955), and Carl Rogers most psychologists providing treatment to children in the first half of the last century, attempted to utilize therapeutic interventions developed exclusively for adults. The aforementioned innovatory psychologists recognized that play was an ideal medium to allow children’s expression of feelings and underlying emotionality because developmentally, few children had achieved the cognitive or language levels to express such feelings with the use of words. It was Virginia Axline (1947), author of Play Therapy and Dibs in Search of Self and doctoral student of Carl Rogers who “probably did more than anyone else to bring ‘play therapy’ to the attention of the general public interested in psychology” (Kirschebaum, 1979; pg 82).
Like Rogers, Axline emphasized the attitudes and personal characteristics of the therapist and the quality of the relationship between client and therapist as the essential factors in promoting change. Known as nondirective counselling or child-centered play therapy, Axline’s therapeutic model paralleled Roger’s theoretical orientation inasmuch as “a core theme in his theory (was) the necessity for nonjudgmental listening and acceptance if clients (were) to change” (Corey, 1991; pg. 204, my brackets). According to Axline, child-centered play therapy focused on the child, not on the child’s presenting problem. Like Rogers before her, she promoted a therapeutic relationship based on genuineness, authenticity, unconditional positive regard, acceptance and empathic understanding of the client in order to support psychological development and growth. While a quiet, private space with carefully chosen toys and art materials was provided to her young clients, no special techniques were implemented in the play therapy room and the therapist was cautioned not to probe, direct or make suggestions to the child. Axline wrote, “Non-directive counselling is really more than a technique. It is a basic philosophy of human capacities, which stresses the ability within the individual to be self-directive” (Axline, 1947; pg. 26).
Axline identified 8 basic principles to guide child centered therapists (1947; pg. 73-74, Axline’s italics).
- The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
- The therapist must accept the child exactly as he is.
- The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
- The therapist is alert to recognize the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behaviour.
- The therapist maintains a deep respect for the child’s ability to solve his own problems if given an opportunity to do so. The responsibility to make choices and to institute change is the child’s.
- The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.
- The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognized as such by the therapist.
- The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make to the child aware of his responsibility in the relationship.
In 1988, contemporary play therapist, psychologist, prolific researcher and professor, Garry Landreth, established the National Center for play Therapy at the University of North Texas. An ardent supporter of the child centered play therapy paradigm, Dr. Landreth wrote, “A therapeutic working relationship with children is best established through play, and the relationship is crucial to the activity we refer to as therapy. Play provides a means through which conflicts can be resolved and feelings can be communicated” (1991, pg. 11).
In his book, “Play Therapy: the art of the relationship”, Landreth conveys a deep and abiding respect for children and their innate potential for growth and change on their own terms. Through a unique relationship that genuinely prizes a child’s capacity to self-actualize, he refers to therapeutic objectives in general terms rather than setting specific goals in play therapy. According to Landreth (1991; pg. 80), “the objectives of child centered play therapy are to help the child:
- Develop a more positive self-concept.
- Assume greater self-responsibility.
- Become more self-directing.
- Become more self-accepting.
- Become more self-reliant.
- Engage in self-determined decision making.
- Experience a feeling of control.
- Become sensitive to the process of coping.
- Develop an internal source of evaluation and,
- Become more trusting of self.”
While child centered play therapy, like other child therapy modalities, has been used extensively by psychologists with individual clients it has been utilized far less often in a group therapy setting. The paucity of research and/or development of group therapy for children (through any theoretical orientation) suggested there was much scope for research in future.
Child Centered Group Therapy
In addition to more affordable fees and the advantage of treating more than one person at a time, group therapy demonstrates that client are not alone in their situation, “anchors the experience to the world of reality” (Landreth, 1991; pg. 315) and “provides a social microcosm” (Yalom, 1995; pg. 38) for individuals to display existing behaviours, practice new behaviours and learn the reactions of others to that behaviour. Thus, in the safety of the therapeutic group encounter, individuals can gain a deeper understanding of the meaning of their own behaviour and that of the other group members in a social setting. While most psychologists have restricted their group work to adolescent and adult populations, a number of therapists have recognized that group therapy could provide a valuable opportunity for children to learn about themselves and one other. Child focused group therapy has been used to develop group work with children of battered women (Peled. & Davis, 1995), abused children (Gil, 1991), sibling relationships (Landreth, 1991; Oe, as cited in Sweeney et. al., 1999), children with divorcing parents (Johnston & Roseby, 1997) as well as, grieving children (Le Vieux, as cited in Sweeney et. al., 1999).
Axline viewed non-directive group therapy a useful means of working with children whose problems concerned social and/or relational difficulties. According to Axline (1947; pg. 270), “The group experience brings out problems of adjustment that are not possible in an individual experience, while the individual experience focuses the treatment more sharply upon the individual and eliminates the possible stimulation for activity that he receives in the group situation”. The group experience often accelerates the therapeutic process because group members were more likely to experiment with behaviour that a peer had tried than they might have been if treated alone, particularly with the caring acceptance of a child centered therapist.
Contemporary editors, Sweeney and Homeyer (1999), have provided psychologists with the most comprehensive work related to group therapy for children to date. While the authors examined the primary theoretical approaches to play therapy group treatment for children, this article will consider group play therapy through a child centered framework. The basic tenets of the non-directive/child centered theory are maintained in child centered group therapy but the essential relationship between child therapist and client is broadened to include the relationship between therapist and each child in the group as well as the relationship between individual group members. Furthermore, the group therapist de-emphasizes the power disparity between child and adult and the image of expertise. The child centered psychologist understands that while they have a body of knowledge and specialized training, they don’t know how to live life any better than their clients. The therapist avoids techniques and structured games, which are considered antithetical to the non-directive process. “The group-centered therapist, like the person centered therapist with an individual client, views techniques and games as potential impediments to the group’s process and natural growth” (Sweeney et. al.,1999; pg. 45). Importantly, the therapist is interested in gaining an understanding of each group member’s inner world rather than addressing a particular referral problem. Questioning the children or attempting to get members of the therapeutic group to concretize their emotional experiences negates the fundamental principles of child centered group therapy. According to Sweeney and Homeyer (1999; pg. 47), “Questions tend to take the children out of their world of affectivity and into the world of cognition, which defeats the developmental rationale for using play therapy. Questions tend to structure the relationship in the direction of the therapist, placing the focus on the therapist rather than the child”.
While a sense of permissiveness is fostered in the child centered group relationship, it would be a mistake to assume that the relationships developed in the play therapy room impose no boundaries. However, limits when imposed are done so judiciously and not until there is cause to do so. According to Landreth and Sweeney (1997; pg.17-45), “Limits inherently need to be set on the following:
- behavior that is harmful or dangerous to any children in the group or the therapist.
- behavior that disrupts the therapeutic routine or process (continually leaving playroom, wanting to play after time is up.
- destruction of room or materials.
- taking toys from playroom.
- socially unacceptable behaviour.
- inappropriate displays of affection
Developing a Child Centered Group for Anxious Children
Children are routinely exposed to stressors at home, school and within their community. The sources of stress, worry and anxiety often change through developmental stages and could be related to level of academic achievement, changes in family dynamics, violence in the home, being bullied at school or their neighbourhood, abuse and/or, fears related to acceptance by others, to name just a few problems experienced by children. Thus, stress can be in any situation that involves unusual demands and/or simply exceeds the coping ability of a child. In addition to situational stress, a child’s biological predisposition, temperament, personality and, family environment will impact a child’s reaction to stressors.
Child centered group therapy would seem to be an ideal intervention for children suffering from anxiety because of the fundamental non-directive nature of the model. The leaders willingness to accept each group member as they are, give up adult control and trust the ability of the young group members to progress without direction is ideally suited to children who may have experienced few opportunities for choice or fear making independent choices. It is predicted that over time, children in such a group would be able to practice new behaviours, learn to take risks in a safe, supportive environment and discover inner resources to cope with change, stress and apprehension in the real world. What follows is a proposal for a time-limited therapeutic child centered group for anxious children.
Since the majority of children prefer to play in small groups of 2-4 children (Herron et. al., 1971), a group of 3-4 children would be optimal. The children will be selected carefully in order to optimize the success of the group. To this end, a parental interview and an individual play therapy session will take place with each child prior to their inclusion in the group. The group will consist of boys and girls, aged 4-5 years who are at a similar cognitive and psychosocial level of development so that they will be able to relate to one another with relative ease.
The group will be held at the Play Therapy room at Toronto Psychological Services. The room is approximately, 13’x14’ and contains toys “that allow for children’s self-directed activity and facilitate a wide range of feelings and play activity” (Sweeney et. al., 1999; pg. 55). Considering the young age of the children, it is anticipated that each therapeutic encounter will be no longer than 60-70 minutes and the sessions offered twice a week for 10-weeks. As has been well established at this point, the therapeutic relationship will be child focused rather than problem focused (Landreth, 1991; Sweeney et. al., 1999). The psychologist will endeavour to establish an atmosphere of warmth, empathy, acceptance, trust, inclusion and parity in the play therapy room by calling each member by name and acknowledging each child’s feelings as they are communicated. Limits will be set “objectively—with acceptance and without disapproval” (Sweeney et. al., 1999; pg. 61).
While it is impossible to predict the behaviour and feelings conveyed by children in the proposed group, it is hoped that each child will gently embark on a road of self-discovery and begin to realize that they have greater emotional resources and coping mechanisms than they once believed.
Rationale for the Child Centered Therapy at Toronto Psychological Services
Child therapists at Toronto Psychological Services, including this writer, deeply value the opportunity to work with vulnerable children. Through training and experience we are aware that change, should change be chosen by our young clients, must be made within a supportive environment with a therapist who is both sensitive and respectful. As therapists, we most often choose to use non-directive, child centred play therapy because we are well aware that positive change can never be forced or directed from outside of the client. We believe the therapeutic relationship to be central to change. The child centered theoretical orientation suits us best because we believe, like Sweeney and Homeyer (1999; pg. 45) that “the therapist does not take a person-centered approach as much as s/he lives a person-centered way of life in therapy”. Psychologists, psychological associates and child therapists at TPS embrace both the philosophy behind child centered play therapy and the belief that all people have the potential for growth and change within them.
- Axline, V. (1947). Play Therapy. New York: Ballantine Books.
- Corey, G. (1991). Theory and Practice of Counseling and Psychotherapy, 4th Edition. Pacific Grove, California. Brooks/Cole Publishing Company.
- Crooks, R. L. & Stein, J. (1991). Psychology: Science, Behavior, and Life-Second Edition. Fort Worth: Holt, Rinehard and Winston, Inc.
- DiLeo, J. H. (1983). Interpreting Children’s Drawings. New York: Brunner/Mazel Publishers.
- Foxman, P. (2004). The Worried Child: Recognizing Anxiety in Children and Helping Them Heal. Almeda, California: Hunter House Inc., Publishers.
- Freud, A. (1965). Normality and Pathology in Childhood. In P. L. Adams & I. Fras, Beginning Child Psychiatry. New York, New York: Brunner/Mazel, Inc.
- Frobel, F. (1903) The education of man. In G. L. Landreth, Play Therapy: The art of the relationship. Muncie, Indiana: Accelerated Development Inc., Publishers.
- Gil, E., (1991). The Healing Power of Play: Working with Abused Children. New York: The Guildford Press.
- Herron, R. E. & Sutton-Smith, B. (1971). Child’s Play. New York: John Wiley and Sons, Inc.
- Hug-Hellmuth, H. (1921). On the technique of child analysis. In G. L. Landreth, Play Therapy: The art of the relationship. Muncie, Indiana: Accelerated Development Inc., Publishers.
- Johnston, J. R. & Roseby, V. (1997). In the Name of the Child: A Developmental Approach to Understanding and Helping Children of Conflicted and Violent Divorce. New York: The Free Press.
- Kirschenbaum, H. (1979). On becoming Carl Rogers. New York: Delacorte Press.
- Klein, M. (1955). The psychoanalytic play technique. American Journal of Orthopsychiatry. 25, 223-237.
- Landreth, G. (1991). Play Therapy: The art of the relationship. Muncie, Indiana: Accelerated Development Inc., Publishers.
- Landreth, G. & Sweeney, D. (1997). In K. O’Connor & L. Braverman (Eds.), Play Therapy: Theory and Practice. New York: Wiley.
- Le Vieux, J. (1999). Group Play Therapy with Grieving Children. In D. S. Sweeney & L. E. Homeyer, The Handbook of Group Play Therapy: how to do it, how it works, whom it’s best for. San Francisco. Jossey-Bass Publishers.
- Levy, D. (1938). Release therapy in young children. In G. L. Landreth, Play Therapy: The art of the relationship. Muncie, Indiana: Accelerated Development Inc., Publishers.
- Oe, E. (1999). Sibling Group Therapy. In D. S. Sweeney & L. E. Homeyer, The Handbook of Group Play Therapy: how to do it, how it works, whom it’s best for. San Francisco. Jossey-Bass Publishers.
- Peled, E. & Davis, D. (1995). Groupwork with Children of Battered Women. London: Sage Publications.
- Rank, O. (1936). Will therapy. In G. L. Landreth, Play Therapy: The art of the relationship. Muncie, Indiana: Accelerated Development Inc., Publishers.
- Sweeney, D. S. & Homeyer, L. E. (Eds.) (1999). The Handbook of Group Play Therapy: how to do it, how it works, whom it’s best for. San Francisco. Jossey-Bass Publishers.
- Yalom, I. D. (1995). The Theory and Practice of Group Psychotherapy-Fourth Edition. New York, New York: Basic Books.
- Youngs, B. B. (1985). Stress in Children: How to Recognize, Avoid and Overcome it. New York: Arbor House.