Play Therapy

Submitted by: Rita Mae L. Reyes

Lipa City Colleges Play therapy is an appropriate label for wide variety of activities developed for use with demented individuals by activity therapists, nurses, mental health professionals, other providers and staff, caregivers, friends, and family members. In nursing care facilities, adult family homes, and other residences in which these individuals reside, there is a clear need for play therapy opportunities and equipment for this population. According to leaders in the area of cognitive remediation, some of the most debilitating side effects of mental illness include cognitive decline in areas of memory, attention, problem-solving skills and motor speed. Mentally ill individuals also have difficulty with social interaction, which has been shown to be essential to overall well-being. Games are not only a fun way to engage patients, but when carefully selected they can add substantially to their functional abilities. As with any treatment plan, it is important to challenge the patient without adding to their level of frustration. Play Therapy for Adults By adulthood, most people have lost their ability to playfully explore themselves. Play therapists are trained to help a person relearn the valuable tool of play. Playful exploration has been proven to enhance both cognitive and physical behaviors and there is a vast amount of research from neurophysiology to molecular biology that supports Play Therapy as a valid therapeutic technique. For adults, play continues as an important vehicle because it fosters numerous adaptive behaviors including creativity, role rehearsal, and mind/body integration. Somewhere between childhood and adulthood, playful exploration becomes outdated. To achieve anything significant in life adults must work and forget the delights of play. However, as Dr. Stuart Brown, psychiatrist, leading expert in play research, and founder of The National Institute for Play explains, there is a large repository of research data from neurophysiology, developmental and cognitive psychology, to animal play behavior, and evolutionary and molecular biology containing evidence that supports the value of play in adult lives (from Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul, 2009).

Benefits of Play Therapy for Adults In addition to Play Therapy with children, adults benefit from playful exploration in a therapeutic environment. Play optimizes learning, enhances relationships, and improves health and well-being. Adults engaged in a therapeutic alliance with a focus on play have an opportunity to choose from a variety of modalities such as movement (body play), sand play, dream play, nature play, social play, pretend (fantasy) play, creative play, storytelling, and vocal play. Play offers both children and adults life experience, freedom, and greater creativity. The number of organizations and experts in the field dedicated to play research and advocacy grows, demonstrating the importance of play for people of all ages. Play can increase our self-esteem. It invites access to states of well-being and calm as well as silliness and joy. When relaxed in play, we often have an increased capacity for empathy and intimacy. Play is affirming. Diana Fosha (2000) describes joy and emotional pain among the affective markers of healing. Play becomes a natural and

gentle environment in which the inner landscape can safely be explored in any language. The results are easy to see. Stress release Mastery Play assessment Communication Insight

Principles of Play Therapy Keep the Bigger Picture In Mind Play therapy is one piece of a total picture. It is an important piece, but still, just one part of a larger process. There are other areas and people to be dealt with, either by the therapist or by colleagues. As work proceeds with the child, it is also important for someone to be involved with other people in the childs environment. We have seen a play therapy service in a school in the UK run by well trained, very experienced, well intentioned therapists founder because of a break down in communications with the teachers. Children of All Ages 0 - 100 Play therapy techniques can just as easily be adapted for adults and their inner children. We have , for example, observed the dramatic changes effected upon adults who have completed a sand tray. Positive results were obtained in a far shorter time than the use of talking therapy could have achieved. Obviously there are certain adaptations that have to be made for different age groups but, in general there are few limitations in tapping playful or creative impulses in the healing processes. Until now 3 years has been assumed to be the youngest age at which a child could benefit. However the exciting developments in filial play and the latest research into how young children learn and think suggests otherwise. Avoid Dogma Remember that the entire mental health field is brand new. It is hardly a century old and therapy with children is really so new that there is no excuse for getting locked into dogmatic beliefs about there being one wonderful model that works. Take everything you hear in the field with a grain of salt. There are mountains of theories and philosophies of working with children but relatively few facts. Models are based on theories. Unfortunately when much of a theory has been disproved, we are sometimes still left with the models. A critiquing mind is vital for a therapist. The Toolset The techniques and methods are the tools in the tool chest of a healer. The more skills or tools one has the better one can adapt to new situations., difficulties or problems. These tools are also resources. The more resources, inner and outer, that we have access to the less likely that we will burn out. However it is no use knowing the theory of a tool without the practical experience of using it, initially under safe conditions. Healing Comes From the Heart. Do not feel that you have to have all the right tools before beginning. You will never have all the resources you could hope to have but you will always have access to your own inner voice. Professionals in the most wonderfully equipped play therapy settings can still do a poor job. Toys do not make the therapy. A truly skilled therapist could work with only the air and emptiness.

Types of Play Therapy SOCIAL INTERACTION GAMES Social interaction games and activities incorporate important features of socialization, such as maintaining eye contact, give and take in dialogue, appropriate body distance, listening skills and appropriate salutations and departing remarks. Games that can be used to incorporate this include role-playing short scenarios, enacting short plays or stories, group charades where two or more people must interact with each other to act out an everyday scene or a title of a TV show or movie, or board games incorporating these themes. MEMORY AND ATTENTION GAMES Many board games and card games can be used to aid in developing memory and attention skills. The game Memory is a particularly good one, as is Go Fish. Uno incorporates memory and attention skills, and Eye-Spy requires attention. Playing the alphabet game using items in the room is a good way to reinforce how memory is benefited by repetition. This game requires a group of people to go in order with the first person finding something in the room that starts with the letter "A." The second person repeats the "A" word and adds a "B" word. The game continues around the circle, each person repeating the objects for every letter before adding an object corresponding to their current letter. It is important to pick objects in the room so that individuals can jog their memory by looking around. PROBLEM SOLVING GAMES AND ACTIVITIES Many computer games offer excellent ways to practice problem-solving skills. Unfortunately, some patient settings do not have access to computers or sufficient supervision for all patients to use the computer. Completing puzzles in a group setting is another way of improving both problem solving and motor skills. Other activities, such as going over recipes and discussing how to measure ingredients for a different number of guests, or the steps to planning a birthday party are helpful. A lot of problem-solving activities can be generated by the patients themselves. Group leaders should be sure to ask the members what daily activities they have trouble with, then solutions can be generated and practiced through role-playing. DRAMATIC ROLE PLAY A central assumption shared by most drama therapists is that performance, the act of taking on a role and telling a story in role, is inherently healing. One explanation is that the act of role-taking marks a separation from everyday reality, thereby creating a safe distance between actor and role. When a young girl takes on the demeanor and voice of her mother and assures her teddy bear at bedtime that there is nothing to be afraid of in the dark, she is using the distance provided by the role of mother to reassure herself. In drama therapy, this natural, unselfconscious process of healing is consciously applied to therapeutic treatment. When the play is applied to a therapeutic process, as it is in drama therapy, a conscious purpose arisesto offer a commentary on, or corrective of, everyday life, thereby gaining a greater sense of control. many adults in crisis are not ready to play, or, to be more precise, they are not able to play like children. In most instances, adults in need of therapy need to play like adults. This most often means, verbally and cognitively, sparring with language, telling stories, playing out alternative scenarios in thought, even meditating. But sometimes, when they are ready, after their stories have been told and witnessed, adults in drama therapy might be willing to take another step. By regressing and playing the roles of buildings and planes and fire hoses, even of children going for rides in their fathers cars, they may, like those in the previous examples, experience a sense of control and balance. After the play, it can be equally rewarding to resume the adult consciousness and to reflect on the play and recognize its capacity to contain contradiction.

Psychodrama is a method in which people explore their problems by enacting them in a role-playing fashion rather than by just talking. J. L. Moreno, MD (18891974), found that improvisationally dramatizing the actual scenes in the clients life allowed for the equivalent of play therapy with adults. People could replay situations and discover better ways of reacting.psychodrama may be thought of as a group of methods that can facilitate the processes of therapy as conceptualized by a wide variety of other schools of thought, such as psychodynamic, reality therapy, and transactional analysis. The classical verbal techniques are thus enhanced by the dynamism of physical action and direct encounter.Psychodrama theory suggests that promoting a clients creativity is an important element in overall treatment. THERAPEUTIC HUMOR Humor in psychotherapy is a curious conceptintegrating humor, generally a light, playful, and even distracting experience, with psychotherapy, which for many is a highly focused, serious process. Yet, from Freud to the present, clinicians have been intrigued by humor as a potential tool in the therapeutic process. The experience of a humorous event not only feels good, but also can help provide perspective on lifes challenges. Humor can serve as a vehicle through which to communicate and confront with a minimal amount of stress placed on the relationship. Humor has the distinctive ability to enhance interpersonal relationships. In addition, its capacity to reduce interpersonal tension and reestablish stretched relationships has resulted in its being labeled a social lubricant. While humor has many therapeutic benefits (including its ability to change emotional distress and cognitive distortions as well as enhance the therapeutic alliance), its use as part of the psychotherapeutic process is not well understood. In this chapter, you will learn about the therapeutic nature of humor and how humor can be integrated into the therapy process. The integration application of humor to psychotherapy can be particularly powerful because it has the potential to activate changes in all four of the core aspects of human experience (emotional, behavioral, cognitive, and physiological) that are targeted by the major theoretical approaches. Humorous interventions can be used as treatment (by helping to positively change emotions, behaviors, (cognitions, and physiology), for diagnosis, and for building the therapeutic relationship. Central to the effective use of humor by the therapist is tailoring interventions to the specific client. This takes both practice and planning. It is also crucial for the therapist to assess the clients potential receptivity to humorous interventions and to respond to the clients reactions to those interventions. The most effective use of humor occurs when, as with empathy, therapists are able to integrate humor into their own core being so that humor becomes an integral part of their interactions with clients. SANDPLAY/DOLL PLAY Sandplay therapy gives adult clients the opportunity to portray, rather than verbalize, feelings and experiences that are often difficult to express in words. Therapists and clients alike have found that Sandplay scenes, created with sand, water, and miniatures in a shallow box, serve as a window into the unconscious that contributes a surprising, new vantage point from which to nurture and experience healing and transformation. Using Sandplay with adults may offer them the opportunity to play creativelyand express themselves spontaneously, without words, for the first time since they were children. Through the free experience of play, the cognitive-logical mind is put aside, and the innocent, unsophisticated, and unconscious elements of the psyche, heretofore repressed, are allowed to emerge. Once these elements are made available, healing energies can be released to help the individual perceive and deal with life issues. Through this experience, unrealized aspects of the personality can be discovered, made conscious, and integrated, leading to a sense of greater balance and wholeness and an enriched, more satisfying life. The self-healing properties of the

psyche activated by Sandplay can deepen therapeutic work with adults, allowing them to communicate in a nonverbal way that opens up a whole new world. Dolls and toys have been used as a means of diagnosis and therapy with children for many years (Jennings, 1993) because it provides them with the opportunity to act out feelings and difficulties as they are experienced (McMahon, 1992; Synovitz, 1999). Through the manipulation of dolls and other everyday life items and toys, the child can show more adequately than through words how he or she feels about himself or herself and other persons and events in his or her life. It can also help in cases of sexual abuse, when the child can point on the puppet to the exact anatomic site of abuse (Eleanor, 1993; Martin, 1987). Using toys and other everyday items is needed because most children under the age of 9 or 10 have not yet developed the abstract reasoning skills and verbal abilities to sit in the therapists office and articulate their feelings. The therapist has to recognize the childs feelings in an indirect way by using a broad variety of materials, such as dolls, dollhouses, and toys, for better and open communication with children. Although research is sparse on the subject of doll therapy in adults, it appears that it can be an effective intervention for clients with dementia and seems to modify clients behavior in a positive way. Nurses who have participated in the use of doll therapy claim the dolls can be used to awaken pleasurable affective responses. Patients using dolls seem to generalize positive attachment to the staff, family, and other patients. This attitude facilitates treatment and, as a result, improves patients general condition and well-being. PLAY GROUPS/HYPNO-PLAY/CLIENT-CENTERED PLAY As members of the primate family, we humans embody two characteristics that enable us to engage in group play therapy, both in controlled and natural circumstances. First, we are a social species. We like to hang together in groups because it increases our survival as individuals. The benefit we derive from being together is greater than the cost of managing our social relationships. Second, we are lifelong learners. Playing has often been correlated with learning. Ultimately, the power of the group was the inherent power and beauty of play itselfplay can be a healing force. There is growth in joy and laughter, and change requires more than grief, sorrow, and painful introspection. Schaefer (1993) describes play as intrinsically motivating, requiring no pressure or rewards from external sources. He also characterized play as so involving and engrossing that the client may often lose awareness of time and surroundings. While he writes about children, the same can be said for adults, as, in fact, adult play is a boundless national market of sports equipment, electronic gadgets, art and craft supplies, creative board games, and so on. Brought into the therapeutic realm, the idea of using toys and play for adults may provide a shortcut to the injured child hidden deep within the adult person. The subtle magic of play, used in conjunction with more traditional interventions, may also provide inroads to healing that child. Recommended Games: Pictionary This well-known game requires players to draw and other players to guess what is being drawn. It includes a board, but I found that using the board is not always necessary, and the game can be played with equal satisfaction without the board. A white board or large easel of paper is helpful when playing with larger groups. Guesstures This game is similar to charades except its much faster and easier; the game includes cards with words that must be acted out by the players in only a few seconds. Team members attempt to guess what the player is acting out.

Guesstures was probably the favorite of all the games we played. The game of Charades can be played in a modified form if the boxed game of Guesstures cannot be found or is no longer available. Taboo This game requires players to communicate words while not saying other key words; for example, if the clue is picnic, the player must describe the word without using other words such as ants, park, July 4th, and so on. Taboo can be a bit more challenging than some of the others. Hypno-play therapy is the strategic use of play therapy with selected adults in a hypnotically induced ageregressed state. This method enables these adults to work on childhood issues and traumatic events in much the same way they would have if allowed the opportunity to have good psychotherapy as children. Most practitioners of hypnotherapy still follow Spiegel, Frischholz, Maruffi, and Spiegel (1981) in the definition of hypnosis as a method of disciplined concentration which can be used adjunctively with a primary treatment strategy. Some, such as Frischholz (1995), therefore, object to the term hypnotherapy, because they do not believe that hypnosis is a form of therapy or treatment in its own right. In general, that view is valid. As Frischholz continues, It is more important to focus on how hypnosis is used in conjunction with specific primary treatment strategies RESOURCES: www.livestrong.com http://www.goodtherapy.org Play Therapy with Adults by Charles E. Schaefer