Clin Soc Work J (2007) 35:125–134
DOI 10.1007/s10615-006-0068-y
ORIGINAL PAPER
Posttraumatic Play: Towards Acceptance and Resolution
Valerie L. Dripchak
Received: 3 January 2006 / Accepted: 9 November 2006 / Published online: 15 December 2006
Ó Springer Science+Business Media, LLC 2006
Abstract Many children who experience trauma
demonstrate it through posttraumatic play (PTP). This
type of play is seen by professionals as a repetitive
reenactment of the traumatic event within the child’s
play. Reliving the event in this way may serve to
retraumatize the child and lead to other psychiatric or
behavioral problems. This article examines the issues
surrounding childhood trauma and PTP. It uses a case
study to illustrate the phases of a play therapy
approach that incorporates Ericksonian principles, in
order for the child to achieve resolution and accep-
tance. The countertransference issues that a clinician
may encounter also are discussed.
Keywords Trauma in children
Posttraumatic play

Retraumatize
Play therapy
While traumatic experiences impact individuals in
different ways, their consequences may be more
challenging to observe in children than in adults.
According to Pynoos and Fairbank (2003), more than
25% of American children experience a traumatic
event by the age of 16, and many of these children
endure repeated traumas. More of these traumatized
individuals are presenting themselves for treatment;
but unless social workers are able to recognize the
Editor’s Note: This article is the recipient of the Judith Mishne
Memorial Award for Excellence in Clinical Social Work Theory
and Practice.
V. L. Dripchak (&)
Department of Social Work, Southern Connecticut State
University, 501 Crescent St., New Haven, CT 06515, USA
e-mail: dripchakv1@southernct.edu
issues surrounding trauma in children, we may risk
retraumatizing them. The purpose of this article is to
explore the experience of trauma in children and to
discuss aspects of posttraumatic play (PTP). This paper
also uses a case study to describe an intervention
process that incorporates Ericksonian principles in play
therapy. Attention is given to the countertransference
issues that confront clinical social workers in their
practice with traumatized children.
Understanding the Experience of Trauma in Children
Generally speaking, trauma is a sudden and extraor-
dinary event that overpowers a child’s ability to cope
and to manage the reactions that are aroused by the
event. Rosenbloom and Williams (1999) discussed two
conditions that make an event traumatic. The first
condition is that the event involves actual or feared
death or serious physical and/or emotional injury. The
second condition is that there is some specific meaning
for the child that is associated with the event.
Terr (1991) further explained that trauma is classified
into two types: Type I and Type II. Type I trauma
involves a single event that is unanticipated and stress-
ful, such as transportation accidents, floods, or fires. A
Type II trauma results from exposure to chronic and
distressing acts that are viewed with fearful anticipation.
Some examples of Type II trauma include living in a
violent neighborhood, repeated acts of physical and
sexual abuse upon a victim, or growing up in a war zone.
Children’s responses to trauma are both subjective
and multidimensional. When a trauma occurs, the child
needs to find some way to understand it. Young
children are not able to use reason to find meaning in
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these life events as adults are able to do. Instead they
use magical thinking and believe that they are the
cause for the event(s) (Timberlake & Cutler, 2001).
The child’s developmental stage also influences how
the child perceives and responds to a trauma. Young
children have not reached the developmental level in
which they can express their inner responses in words
to alert us to their discomfort (Winnicott, 1971).
Instead, they develop disturbing symptoms. For exam-
ple, Steele (2004) observed the following. In preschool
children (0–5 years old), generalized fears, cognitive
confusion, sleep disturbances, anxious attachment,
regressive behaviors and attributing fantasies were
noted as responses to trauma. School-aged children (6–
10 years old) experienced preoccupation with their
own reactions during the events, as well as specific
fears, sleep disturbances, safety concerns, an inability
to focus in school, close monitoring of parents’
responses, a fear of ghosts, and fears about personal
harm or abandonment. As children mature, they were
better able to verbalize their reactions. However, older
children (12 through adolescence) also experienced
detachment, shame, guilt, acting out behaviors, abrupt
shifts in relationships, and vengeful ideations. Jacobs
(1999) further suggested that trauma includes grief
reactions. In grief reactions, anger is aggressive and
assaultive within the child’s fantasy and needs to be
allowed to be released in therapeutic play. These grief
reactions may be immediate or delayed.
There are a variety of factors that influence a
child’s response to a trauma. Ronen (2002) described
some of these factors to include whether the trauma
stemmed from environmental stressors or intrafamilial
factors, the duration of the event, proximity to the
situation, and the degree of personal injury to the
child. Marvasti and Dripchak (2002) discussed other
variables that impact the effects of trauma such as the
closeness in the relationship between the child and
the person(s) involved in the trauma and the way the
child perceived the event. Monahan (1993) included
the child’s temperament, coping style, intelligence,
and sense of mastery in the world as important
considerations in determining the traumatic results on
a child.
Posttraumatic Play
Children, like adults, reexperience significantly dis-
tressing events in their lives through intrusive thoughts,
flashbacks and nightmares. While adults are able to
talk about these symptoms, young children are not able
to abstract the information and put them into words.
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Instead, they will use ‘‘traumatic play,’’ which is the
compulsive repetition of the trauma or trauma-related
themes in play (Terr, 1990). This type of play has been
observed in children following both Types I and II
traumas.
There are differences between the usual play in
which a child engages, and PTP. In ordinary play, the
play is free flowing and the play changes over time. In
PTP, the play is ritualistically repeating the traumatic
theme, arriving at the same ending and using specific
play materials. Such play serves to repeat parts of the
trauma.
Sadock and Sadock (2003) stated that traumatic play
is different from an enactment. In an enactment, part
of the traumatic event is unconsciously incorporated
into the child’s daily life. For example, the child may
fantasize about acts of revenge and begin to display
risky behaviors. In an enactment, the child may be the
victim, the perpetrator, or a bystander of the trauma.
Older children tend to use an enactment more than
younger children.
Marvasti (1994) discussed the term PTP as a
particular kind of repetitive play that the child dem-
onstrates during the therapeutic process. Two types of
PTP are defined: the positive type and the negative
type. In the positive type of PTP, the child reenacts the
trauma but is able to modify the negative components
of the trauma with the guidance of the therapist. In the
process of positive PTP, the child is able to gain
mastery over the experience. In the negative type of
PTP, the repetitive play is unsuccessful in relieving
anxiety and fails to help the child attain resolution or
acceptance.
Further distinctions may be made between positive
and negative PTP. In positive PTP, children feel happy
and in control of their fantasy world. This type of play
helps children to learn and express feelings. In the
negative type of PTP, children usually look anxious
and restricted in their play. They are not in control of
their fantasies and their repetitive play does not
alleviate their internal conflicts. This type of play
depicts a perceived danger and the child is ‘‘stuck’’ in
these traumatic reactions. The risk of the negative type
of PTP is that it may actually worsen the traumatic
effects and cause developmental regression. The child
needs help to move on.
The significance in understanding PTP for social
workers who work with children in a therapeutic
setting is to have them identify PTP and then intervene
with a process that allows the child to begin to heal. As
the child plays out the theme(s) of the trauma and
begins to demonstrate the negative type of PTP, the
therapist strategically guides the child in play with
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specific techniques that moves towards a more empow-
ered resolution of the traumatic experience or positive
type of PTP.
Therapies with Traumatized Children
There are a number of therapy approaches that are used
with traumatized individuals. One approach is eye
movement desensitization and reprocessing (EMDR),
which is a form of therapy that utilizes eye movements
to connect to the brain’s processing system (Shapiro &
Forrest, 1997). EMDR has achieved some degree of
success with adults and older children (12 years old and
older), but some clients may continue to require
additional treatment (Ayalon, 2004). Another approach
used with trauma patients is cognitive behavioral
therapy (CBT), which incorporates the components of
exposure, cognitive processing, reframing and stress
management (Cohen et al., 2000). Again, the use of
language as the primary means of communication
between the child and therapist makes CBT more
effective with older children rather than younger ones.
As explained above, younger children are very
different from adults in the ways that they are able to
verbalize their own traumatic experiences. Children
also require a different method of treatment. Conse-
quently, if the natural systems in children’s lives are
not sufficient for healing, play therapy is used to treat
children who range in ages from 3 to 11 years old.
Webb (1999) wrote that play therapy affords the child
the opportunity to experience acceptance, catharsis,
and a corrective emotional experience through which
children are able to divulge their inner thoughts,
feelings and concerns. When the child reaches the
latency stage, his or her verbal communication skills
have developed and there is less need to rely on
symbolic play (Sarnoff, 1987).
Gil (1991) indicated that the aim of play therapy
with children who have been traumatized is to have
them overcome the negative impact of the trauma.
Another aim is to empower children to release their
psychic energy, which was being used to suppress the
trauma, towards their own emotional growth. How-
ever, the emphasis is not on the play but on the
therapy; otherwise, there would be no difference
between what the clinician does in therapy and what
occurs on the playground.
There are different types of play therapy approaches
that include: child-centered play therapy (Landreth
et al., 1996) which is a type of non-directive play
therapy that does not focus on problems or symptoms,
but on growth and maturity; Adlerian play therapy
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(Kottman, 1995) which is a form of play therapy that
addresses the social interests of the child; and Gestalt
play therapy (Oaklander, 1992) which is a directive
form of play therapy that helps children achieve an
‘‘authentic self’’ and move towards homeostasis.
According to anecdotal information and case studies,
all of these approaches are of value in working with
traumatized children; however, these approaches are
also used for a variety of presenting problems and
diagnoses. Traumatized children have unique needs
that require specialized interventions in regard to
PTP.
Ericksonian Play Therapy Approach
There is a therapeutic model that specifically targets
trauma work with children and PTP issues. It is a type
of play therapy that incorporates the principles of
Milton Erickson (1966). In this approach, the therapist
uses both non-directive and directive strategies and
techniques in the treatment of the trauma in children.
This type of play therapy requires neither insight nor
interpretation of the unconscious for change. Its focus
is on the present perceptions of the child and on future
acceptance and solutions. The method also utilizes the
child’s natural abilities, potentials and resources in the
child’s life.
In this type of play therapy, the child uses explor-
atory play to feel secure in the therapeutic environ-
ment. Allowing the child to set the pace during the
initial stage of therapy permits the traumatic theme(s)
to emerge in the play. After the therapist identifies the
traumatic theme(s), she uses directive strategies
through metaphors, fairy tales, and storytelling in the
play sessions to introduce new endings or solutions to
the traumatic experience.
Within these directive strategies, the clinician incor-
porates the Ericksonian model of indirect suggestions,
refractions (which is the process of the therapist
speaking through dolls or puppets, while the child
infers the meaning), reflective statements, interspersed
suggestions (which is emphasizing, through play, cer-
tain words or phrases to create a different direction or
emphasis), and direct suggestions. These techniques
are combined with the natural powers of a child’s
imagination so that the therapist is able to ‘‘rewrite’’
the outcome of the trauma with the child to achieve
resolution and acceptance (Marvasti, 1997). During the
implementation of these techniques, the therapist uses
a softer or lower timbre in her voice to add to the
child’s focus and imaginative powers. Consequently,
the child both guides and is guided in the play therapy
process. An important element in this approach is that
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this form of play therapy, when used appropriately, will
not retraumatize the child.
Marvasti (1994) defined three phases of treatment in
Ericksonian play therapy with each area having a
defined goal. In the first phase, the therapist establishes
the relationship with the child and assesses the theme
of the trauma as the child perceives it. The second
phase helps the child explore the emotional conflicts
related to the presenting symptoms and to offer a more
adaptive resolution to the trauma. In the third phase of
the therapeutic process, the clinician focuses upon
collateral therapies with other family members and the
termination process. The following case summary
illustrates these phases of treatment.
Case Illustration: Ashley
Background
Ashley was 5 years old when her parents took her on a
camping trip just before she began the first grade.
During the night prior to their returning home, their
gas stove exploded and a fire engulfed their trailer.
Ashley’s father rescued his wife and Ashley, who
suffered only minor injuries. However, when he
returned to the trailer to rescue Ashley’s pet, the
smoke overcame him and he died. Rescue workers
recovered his body after they put out the fire.
Initially, Ashley seemed to take these events in
stride without any significant changes in her level of
functioning. According to her mother, Ashley occa-
sionally cried whenever she asked how soon her father
would come home. The people around Ashley told her
that her father ‘‘went away to a better place.’’ Her
mother decided not to involve Ashley in the funeral
process, because ‘‘she did not understand what was
going on.’’ About 6 weeks after the accident, Ashley
began to refuse to attend school. She also began to cry
continuously when it was time for her mother to leave
for work. Whenever she was separated from her
mother, Ashley became hypervigilent, seeking her
mother’s return. Ashley also began to have nightmares
in which she awoke crying. After several weeks of
these behaviors, Ashley’s mother brought Ashley for a
psychotherapeutic assessment.
Phase 1
Ashley presented as a well groomed, polite, but shy
girl. During the first session, she did not want her
mother to leave the therapy play room. Ashley’s
mother and the therapist discussed this possibility at
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a previous meeting that included only Ashley’s mother
and the therapist. It was concluded that once Ashley
became involved in the play, her mother would find an
excuse to leave.
When Ashley and her mother entered the play room,
they were given a ‘‘tour’’ of the room and the materials.
Ashley appeared guardedly attentive. She showed a
great deal of interest in the paints and paper and asked
if she could paint a picture. As she began to open the
paints, her mother said that she needed to go to the car
to get her book. Ashley began to protest by saying that
her mother had to help with the painting. The therapist
took the opportunity to offer assistance until her
mother returned, and Ashley agreed. Ashley asked
what she should paint and the therapist suggested that
she might want to paint a picture of herself and her
family doing something. During the process of painting
the picture, she was very quiet and focused on her work.
When she finished, the therapist invited Ashley to
talk about her painting. Her picture showed many
details and used a full range of colors depicting Ashley
holding her cat and standing next to her parents. She
also painted a yellow sun and assorted flowers that
bordered the picture. There was a white vehicle in the
background. In later sessions, she referred to this
vehicle as the ‘‘camper.’’ Ashley pointed out herself
first and then her parents. Lastly, she identified her cat,
Tigger. Ashley further explained that her cat died in
the fire, but she said nothing more about the fire. When
the therapist encouraged Ashley to talk more about
the picture, Ashley did not reply. Instead, she took one
of the stuffed animals, a cat, from the shelf and asked if
she could hold it. Ashley then cradled and hugged it for
several minutes. She found a bell to tie around the cat’s
neck and began to play with it. Ashley then seemed to
become sad and stated, ‘‘This really isn’t Tigger, and
you can’t pretend it is. Tigger is in heaven and I won’t
see her for a long, long time!’’ When the therapist tried
to engage Ashley in more play, Ashley replied: ‘‘No.
You can’t pretend that someone is here when they are
really in heaven.’’ At that point, Ashley kicked the toy
cat and took a small blanket that was in the room. She
then sat on a chair and sucked her thumb, looking away
from the toy cat. She did not want to play with any
other materials in the room and waited until her
mother returned.
In the first phase of play therapy, it is important to
provide a safe and supportive environment for the
child to express her emotions. It also is essential to
evaluate the trauma from the child’s perspective and
to follow her lead. This is when the therapist uses a
non-directive strategy. During this session, Ashley
focused on the death of her cat as the traumatic event
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that was troubling her at this time. She was not ready to
disclose any information about the death of her father
or any details of the fire. Ashley exhibited a variety of
feelings towards Tigger’s death (demonstrating affec-
tion, sadness, and anger). According to James and
Gilliland (2005), reactions to traumatic death by a
young child may include feelings of sadness, anger,
guilt, separation anxiety, and crying spells. Ashley
seemed to experience all of these responses in varying
degrees as demonstrated in this first meeting and what
her mother reported to the therapist.
The therapist needs to be patient with the use of
non-directive strategies, in order to allow the child to
disclose her feelings at her own pace. This was the
reason that the therapist carefully backed off when
Ashley was not ready to proceed any further in play. A
therapeutic environment that offers trust and nurtur-
ance must first be established before the clinician is
able to successfully direct the theme in play.
When a child begins to identify conflicts through
objects of play, some temporary forms of regression
may occur. Ashley needed to use a blanket and sucked
her thumb for self-soothing. However, it is also
significant to note that Ashley’s picture of her family
was drawn reflecting age-appropriate abilities. Nader
(2004) stated that the child’s use of drawings and
paintings in play therapy may indicate the child’s
processing of traumatic elements. Drawings also allow
the therapist know about any developmental regres-
sion. On the other hand, it is essential not to make
judgments based on only one drawing but to wait and
observe if patterns develop (Gil, 1991).
During the next two sessions, Ashley explored many
of the toy materials in the room. However, she
returned to play with the toy cat that she used during
the initial session. Her mother read in the waiting room
during these meetings, while Ashley made several visits
to her to ‘‘let her mother know what she was doing.’’
Aside from playing with the toy cat and making several
visits to her mother, Ashley occasionally looked at her
painting from the previous session (which was hanging
on the easel), but made no comment about it. During
this initial stage, no negative type of PTP was observed,
although Ashley was beginning to reveal her emotions.
This exploratory play and relationship building stage
may last for several sessions.
Phase 2
At this stage of treatment the therapist works with the
child to explore more of the emotional conflicts related
to the symptoms and to achieve a more adaptive
resolution of the trauma. As the therapist was moving
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into this phase of treatment with Ashley, the therapist
encouraged Ashley’s mother to attend a support group
for bereaved individuals. This helped her mother to
better understand about her own reactions to the fire
and to her husband’s death.
It was during the fourth therapy session that Ashley
began to play with the doll house toys with more
specification. Taking the figures out of the doll house,
she identified a mother, father, and a baby and began
to play with them. Ashley then took a large toy tractor
trailer and said it was the ‘‘camper,’’ while pointing to
the picture that she painted during the first session. She
then wrapped the cat in the blanket and placed it on
the camper. She ‘‘drove’’ the camper to another part of
the room. After this, she began to play with the family
dolls. She had the mother and father figures shout at
each other. At the end of the argument, she had the
father figure leave, by placing the figure on the shelf.
She then pretended to have a birthday party for the
baby with the mother figure there, along with some
‘‘visitors,’’ whom she identified as an aunt, uncle, and
grandparents. At this point, Ashley’s play became rigid
and repetitive; she continuously looked at the shelf
where she placed the father figure and shouted, ‘‘You
are bad!’’ Ashley shouted several times at the father
figure, ‘‘Don’t yell at mommy again!’’
When the therapist attempted to engage in the play
with her, Ashley stopped and began to cry. Ashley then
took the blanket and the toy cat and sat on the chair
next to the therapist, holding the therapist’s hand until
the end of the session. During this phase of the therapy
process, the therapeutic alliance with Ashley was
strong enough to allow Ashley to play out more of
her internal conflicts. It was also an opportunity for the
therapist not only to observe the trauma in Ashley’s
activities, but also to intervene and to respond to
Ashley’s need to be comforted.
Like many children, Ashley wanted to feel in control
of the events that occurred in the play. In fact,
Timberlake and Cutler (2001) described this age as
the ‘‘golden age’’ of play because children use their
fantasy world to play out their experiences in order to
make some sense of them. Ashley utilized the play
session to act out what she perceived to be the reason
that her dad was not there for her birthday. This play
showed her anger and sadness that her father was not
around.
In this phase of treatment as the therapist recognizes
that the traumatic theme is being played out, she needs
to intervene to guide the child away from retrauma-
tization (negative PTP). During this session with
Ashley, the therapist interrupted the action of play as
it became rigid and repetitive. At that point, Ashley
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did not want to continue with her play but required
some comforting. It seemed that she was tired from the
emotional disclosure. In subsequent sessions, the ther-
apist will need to become more directive to guide the
child towards a positive solution of her traumatic
experience.
Between sessions, the therapist had another tele-
phone conversation with Ashley’s mother to discuss
Ashley’s last session. Ashley’s mother said that she and
her husband did not argue during the evening of the
fire. They actually had a ‘‘loud discussion’’ (his voice
apparently became loud when he was excited) about a
week before the fire when he announced to his wife
that he was promoted at his job. They talked enthu-
siastically about the things that they could do with the
increase in his salary, including having her cut back on
her work hours. Ashley’s mother was so involved with
her own grief (while trying to get on with her life) to
know what impacted Ashley. She said that she wanted
to discuss her husband’s death with Ashley and
planned to do it before the next session. She also
agreed to join our next meeting. With this type of play
therapy, it is important to include the child’s care-
giver(s) whenever possible as a resource to assist in
finding solutions.
During the next session, Ashley played with the
same dolls as in the previous session. After she scolded
the dad figure again and placed him on the shelf, the
therapist took the lead by initiating some therapeutic
play. The therapist used the dad figure and toy cat to
play together, imitating some of the activities that
Ashley demonstrated in previous sessions. As Ashley
looked on, the therapist began to tell a story of a dad
and a cat being together in a special place. Ashley soon
joined in and engaged in the story through her play
with the therapist. Towards the end of the session,
Ashley said that ‘‘neither one of them (referring to her
dad and her cat) will be alone anymore.’’ This powerful
message was reinforced by Ashley’s mother who
followed her daughter’s lead and offered her loving
reassurances. With the guidance of the therapist,
Ashley began to engage in a ‘‘solution’’ about her
fears by focusing on a concrete place that her dad and
Tigger may be together. Her mother’s explanation to
Ashley about her father’s death prior to this session
was helpful in establishing a new theme (i.e., ‘‘they are
both in heaven.’’). However, in order to enter into the
child’s imagery of events, Ashley needed the play
strategies and concrete images (through toys) to
internalize the information and arrive at a more
adaptive ending to her trauma.
In subsequent sessions, the theme of this story was
replayed with Ashley adding various adaptations, in
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order to ensure that this experience was becoming an
acceptable resolution for Ashley. Her mastery over her
conflicts was evidenced through her play related to this
theme, which became flowing, interactive, and sponta-
neous. For example, she painted several ‘‘fun’’ pictures
of what heaven was like for them. These pictures
included images of some events that Ashley had shared
with her dad (e.g., when the family went to a theme
park and another showing a fishing trip). Eventually,
Ashley did not need to play this theme at all.
During these sessions, the therapist used refraction
through storytelling to bring about an empowered
process for Ashley. As Ashley allowed the therapist to
engage more in her play, reflective statements and
interspersed suggestions were used as techniques to
reinforce the new ‘‘ending.’’ These techniques can
change the type of learning for children from abstract
and theoretical concepts to vivid and imaginary modes
of thought. The child is guided by the therapist to
emphasize her strengths rather than weaknesses, pos-
sibilities rather than losses, hope rather than despair,
solutions rather than problems, and healing power
rather than pathology (Dripchak & Marvasti, 2004).
Phase 3
Although Ashley’s nightmares stopped and she was
going to school again without the previous protests; in
one of the later sessions, Ashley began to play that the
mother figure was crying and the baby couldn’t make
her happy. Another telephone call to Ashley’s mother
revealed that several anniversaries (first date, wedding
etc.) recently occurred that caused her to become
‘‘sentimental and emotional.’’ She agreed to attend
another session with Ashley and the therapist guided
her with suggestions about what to do during that
meeting.
During this session, the therapist encouraged
Ashley’s mother to take a more active role in the play
and the therapist took a secondary role. Her mother
was able to explain through play that her tears were
‘‘happy tears’’ and not sad ones. She added, in
storytelling fashion, how she and Ashley’s dad met
and had a beautiful baby together. Ashley listened with
attentiveness and asked questions as she seemed to use
her own imagination to make this story real for herself.
At the end of the session, Ashley and her mother made
plans ‘‘to celebrate’’ Ashley’s dad by planting his
favorite flowers in their garden.
The goals that were achieved at this level included
opening up a discussion about the previously unspoken
issues in Ashley’s family and facilitating a process that
not only empowered Ashley and her mother, but also
Clin Soc Work J (2007) 35:125–134
enabled them to support each other in new and
different ways. ‘‘Turning over’’ some of the process
from the therapeutic environment to normalize family
interactions is an important aspect towards termination.
Fornari (1999) stated that trauma work with chil-
dren may reach crisis states at some future time as
these children enter into different developmental
stages or with significant passage of time. The child’s
life may be divided into ‘‘before’’ and ‘‘after’’ the
experience illustrating the meaningful impact that
trauma has on its survivors. Consequently, it is
essential to have parents become aware of this issue
in order for them to answer questions, offer additional
support, etc. This important area was further discussed
in the final session with Ashley’s mom. Follow-up
telephone contacts after termination revealed that
both Ashley and her mother were doing better.
Discussion of Trauma, Play Therapy
and Countertransference
The case that was presented in this article related to
several Type I traumas. The Type I traumas that
Ashley experienced included not only Tigger’s death,
but what she perceived as her dad’s abandonment of
her. This resulted in an unhealthy attachment to her
mother. As with any good therapy process, the
clinician must conduct a thorough assessment before
beginning the process and have an understanding of
the dynamics that are involved. However, this pro-
cess also brings up countertransference issues that
the clinician must confront. As Mishne (1983) noted,
if the therapist is not in touch with her earlier
conflicts, therapeutic understanding and handling may
be compromised. Mishne also added that counter-
transference can be a means of increasing the social
worker’s understanding of the child and the child’s
play.
During the first phase of treatment, Ashley needed
to feel comfortable before she was able to disclose her
internal conflicts. A child will let the therapist know
when she is ready to do this, but the clinician must be
in tune to the child’s lead. If the therapist finds herself
moving too quickly, she may be experiencing a
countertransference need to focus on the problem area
more quickly than the child is ready to do. The
therapist must be willing to understand the child’s
reactions and retreat, if necessary. This is an important
element in trauma work, which Dalenberg (2000)
referred to as the ‘‘inadequacy of language,’’ that
may result in countertransference issues for the ther-
apist. This issue becomes even more challenging for the
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clinician who treats children and must be attentive to
the ‘‘language of play.’’ Dalenberg further explained
that countertransference issues occur when we ‘‘rush’’
to make interpretations in order to give meaning to
what we observe in the therapeutic encounter, before
the client is ready to ‘‘speak’’ about the trauma.
Another related countertransference issue is not to
define the trauma for the child. At times we may feel a
need to move into the next phase of treatment in order
to ‘‘rescue’’ the child from her worries, concerns or
anxieties. Some researchers (Shur, 1994; Wakeman,
1986) suggested that countertransference reactions are
stronger among therapists who work with children than
with adults in this regard.
In the second phases of the therapeutic process, it
was essential that Ashley not form the negative type of
PTP, related to the losses in her life. When the play
focused on the theme of her traumatic experiences,
Ashley’s play became rigid and anxiety producing, the
therapist strategically changed the therapeutic process
from non-directive (i.e., allowing the child to lead the
play) to directive work (i.e., the clinician leading the
play). Within this latter process, the therapist stopped
the direction of negative activities and used the
Ericksonian techniques to focus on a different ending.
This allowed Ashley to understand what occurred, and
with the guidance of the therapist and support of her
mother, to rewrite the resolution to her traumatic
experiences. This stage is pivotal in changing the
child’s responses to the trauma.
Although the therapist is more directive than in the
previous stage, the clinician needs to continue to be
attentive to the child’s responses to the intervention
strategies as well as to her own countertransference
issues. The child needs to set the pace for the
integration of new ‘‘views.’’ When the child achieves
mastery, her play around the event is no longer rigid
and repetitive, but spontaneous and free flowing.
Eventually, the trauma theme begins to appear less
often in play as the child moves on to other events.
During this phase of treatment, as the clinician is
facilitating a process of acceptance and change for the
child, the play therapist may discover her own coun-
tertransference issues regarding grief and loss. Rando
(1988) indicated that parts of grieving will remain with
us all of our lives and reactions may be triggered by
others going through the grieving process. At the same
time, the therapist who does trauma work must have
traits that include warmth, empathy, sensitivity, and
genuine concern (Cohen et al., 2006) which may leave
us vulnerable to reliving our own grief issues.
In the third phase, it is essential for the therapist to
turn over the process to the parent. Ashley’s mother
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was very receptive to this idea, but some parents may
need coaching and encouragement. The clinician may
want to spend more time with the parent(s) either by
telephone or in a therapy session (without the child),
until the parent(s) is able to achieve the intended goals.
When parents or other caregivers are unable, unwilling
or are considered not appropriate (e.g., in the case of a
parent who may be the perpetrator of physical or
sexual abuse) to take over this process, the therapist
may need to look to extended family members or other
significant people in the child’s life.
Dealing with the caregiver in this phase of treatment
may also bring up countertransference issues for the
clinician. Oftentimes, these issues relate to ‘‘judging’’
parenting skills. Metcalf (2003) explained that play
therapists are encouraged to develop a strength-based
approach in working with children that incorporates
working with parents. At the same time, there is also a
potential for viewing parental interactions with shades
of our own parental countertransference issues. It may
sometimes feel like a fine line between ‘‘advising,
educating and recommending’’ (and even accepting an
unfavorable response from the parent) and becoming a
‘‘parentified therapist’’ who tells the parent what to do.
In addition to a general discussion of countertrans-
ference issues, I would like to share some reflections of
my own affective responses in working with Ashley and
her mother. After nearly three decades of treating
children and their families, I continue to be confronted
with the realization that certain of my own counter-
transference issues are in connection to the therapeutic
relationship with the child’s parent(s), and I maintain
the use of peer supervision in this regard. Nonetheless,
Ashley and her mother evoked particularly strong
feelings in me and may be one of the reasons that I
chose to write about them in my illustration of this play
therapy approach. For example, during the initial
contacts with Ashley’s mother, I perceived her to be a
capable and devoted mother who was in emotional pain
as a result of the death of her husband (Ashley’s father).
However, this image was blurred by the projection of
my countertransference issues in the way that I
remember my mother’s reactions to the death of my
father. Although the traits of both women were quite
different, their profound states of sadness, but con-
trolled responses, were common features. My own
affective responses emerged almost immediately from
the assessment session when Ashley’s mother somberly
described the explosion in the camper, her husband’s
heroic actions and his death. Although there was an
awareness of these personal issues of countertransfer-
ence, there were times when these reactions became
stronger. For example, within the second phase of
123
Clin Soc Work J (2007) 35:125–134
treatment, I actually was surprised that Ashley’s mother
responded so readily to the idea of talking with Ashley
about her husband’s death (a reminder of a similar
discussion with my own mother). I recall wanting to
shield Ashley’s mother from additional emotional pain
that this conversation may incur for her, as I wanted to
lessen my mother’s pain during a similar exchange.
However, I also acknowledged that Ashley’s mother
needed to go through this event as part of her grieving
process (as did my mother), in order to help Ashley
through hers. During the last phase of treatment,
countertransference issues again resurfaced as I ques-
tioned whether termination was being considered
before the issues of the trauma were accepted and
resolved for Ashley. At that time I noted my own
discomfort in evaluating whether Ashley’s mother was
also ready to have this process end. However, a
colleague called my attention to how well Ashley and
her mother were doing, and that they both began to
move on. This was another reminder that moving on for
my mother took a different path, and it was time to
terminate with Ashley and her mother.
As Lieberman and Van Horn (2004) suggested,
traumatic losses need to be viewed along a continuum,
with the more severe experiences depending on the
child’s relationship with the deceased, the circum-
stances of death, and the child’s developmental age. In
this case, Ashley was fixated on the idea that her father
went away and she was dealing with her feelings of
being abandoned, particularly on her birthday. Ashley
first needed to reveal her perception of what occurred
before she was able to deal with her father’s death. The
case is also a reminder that words can create confusion
for children, who may be perplexed about the trau-
matic situations around them. Young children are
concrete thinkers and do not begin to abstract infor-
mation until they are older. Another important aspect
of this case is that children do not have the capacity to
grieve until the traumatic anxiety and fears are
alleviated (Alexander, 1999).
The outcome for Ashley, as well as for other
children who experienced trauma, was positive.
Although no scientific research or data are available
to prove (or disprove) this approach, case histories and
anecdotal evidence, particularly with those traumas
involving sudden deaths, losses or accidents (Type I
traumas) as well as sexual and physical abuse cases
(Type II traumas), demonstrate its benefits (Dripchak
& Marvasti, 2004; Marvasti, 1994, 1997). As Ayalon
(2004) indicated, the research on the effectiveness of
therapies on individuals who have been traumatized
falls short of definitive data, which may in part be due
to the many variables that are involved in a child’s life.
Clin Soc Work J (2007) 35:125–134
Each child is different and the reactions must be
assessed individually along with other variables that
are occurring in the child’s life. Continued research is
essential to study what works and what does not work
for each child. Straker et al. (2002) viewed a trauma as
a ‘‘radical disconnection’’ at various levels of function-
ing for the victim. In other words, it is the child’s
unique experience, of the trauma in a variety of areas
(i.e., cognitive, emotional, behavioral etc.), which
needs to be the focus of intervention and not the event
itself.
Conclusions
A significant number of children are being traumatized
each year. When a trauma occurs, children show us
both their resiliency and their vulnerability. PTP is the
child’s way of showing us when she needs help with the
struggles that are within her internal world. Therefore,
it is important for the child therapist to be able to
identify the differences between positive and negative
PTP within the therapeutic setting. This distinction
helps the therapist recognize when the child is dem-
onstrating solution play (positive type of PTP) or play
that may lead to retraumatization (negative type of
PTP). It further alerts the therapist when to effectively
intervene and change from non-directive strategies to
directive strategies.
The case that was summarized in this article was
used to illustrate the application of Ericksonian play
therapy. Using this approach, the child gains a new
ending and an adaptive understanding of the traumatic
event. This is accomplished by the clinician’s effective
use of direct and indirect suggestions, storytelling and
other Ericksonian play therapy techniques. This form
of play therapy also utilizes the natural resources that
are available to the child. Consequently, the therapist
incorporates the child’s caregiver(s) in partnership with
the therapeutic process. The therapist guides the child
towards ‘‘solutions,’’ so that the child becomes empow-
ered. This will allow for continued developmental
growth.
No single therapy approach, however, is a panacea to
use with every child. While this method has been
relatively successful in alleviating traumatic impact on
young children, individuals present with a multitude of
issues that may lead a therapist to use another approach
as described in this article (e.g., Adlerian form of play
therapy may be better suited for a child who presents
with issues of shyness as the primary focus of treatment
instead of a trauma). Consequently, the child therapist
must be skilled in different approaches to determine
133
what may work best with different children. As clinical
social workers, we must follow up with discharged
clients to ascertain if therapeutic gains are maintained
or if other issues arise.
Another important issue in working with children
who have been traumatized is the clinician’s counter-
transference. It is essential that we become aware of
our ‘‘triggers’’ for countertransference and be able to
manage our reactions. Some of the hazards about,
which Metcalf (2003) cautions us include adopting a
critical parent role, over-identification with the child or
other family members, or a form of sibling rivalry with
other professionals who are involved in the case.
Countertransference may also be influenced by signif-
icant events in the therapist’s life, such as the death of
parents or other losses, such as divorce. It is strongly
recommended that consultation or supervision become
an integral component of this work.
Lastly, we need to continue to share our case
findings with other clinicians, so that we may be aware
of what works in this complex area of social work
practice. This will give children the opportunities to
continue to achieve mastery over their conflicts.
Trauma interventions through play therapy can pro-
vide a hopeful future for the child.
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Biography
Valerie L. Dripchak, PhD/LCSW is an associate professor at
Southern Ct. State University (SCSU) in New Haven, Ct. She is
licensed in clinical social work practice and has been in private
practice for the past 25-Ãyears, working with children and fa-
milies. Dr. Dripchak has published journal articles and has
contributed to book chapters on trauma in children and adults.
She recently developed a Post MasterGúøs Certificate Program
at SCSU about working with children who have been trauma-
tized or terrorized. Professor Dripchak has been a lecturer at a
number of workshops and is a consultant to private and public
agencies.
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