Young children have big problems. In their own way they experience negative emotions that for adults ? parents, teachers, carers ? are incomprehensible. Even psychologists are not always able to recognise and deal with them. Play Therapy, not yet known in Poland, is considered to be one of the most effective methods of helping such children. What is this method and why is it so effective? We talk to Nina Ambroziak, a psychologist and one of the first Play Therapy therapists in Poland.
HEARD: What is play from a therapist's point of view?
NINA AMBROZIAK: Play is the language of the child. Toys, in turn, have the function of words. Depending on which toys a child chooses and how he or she behaves during this spontaneous activity of playing, it is possible to observe what the child feels and where the problems arise that cause parents or carers to seek help from a psychologist or psychotherapist. Simply put, play is the way through which you can best communicate with your child. A child of any age, by playing, in a way ? about their problems. All that is needed is to observe them carefully, to create the right conditions for this narration?
S.: Do children with specific problems choose a particular type of play?
N.A.: NThere is no research to support this. However, it is not only from my observations that every child has a specific repertoire of favourite games. That's why the Play Therapy office is full of toys - puppets, blocks, dolls, masks, cars, art materials and so on. Your child can play with whatever he or she wants. Choosing a toy is the first important step in therapy. Often during the whole period or until the climax, the child only uses one toy in play.
S.: How does playing in the therapist's office differ from playing at home?
N.A.: At home, parents expect the child to show positive emotions towards everything they encounter. The child's negative emotions usually arouse parental objections and a desire to change. In Play Therapy, the psychologist reflects the child's emotions (like a mirror), both positive and negative, through his or her reactions, facial expressions and gestures.
To explain this, I will tell the story of a four-year-old boy whose case was discussed at a training workshop. This child was a victim of psychological (verbal) abuse by his grandfather. Over the course of several sessions, this toddler spoke a maximum of 20 words. He chose pastry cream to play with in class, then started using plasticine and after the fifth session ? with paper pulp. This was the material with which he slowly began to discover his feelings. He created a family of snakes from it. This was no accident. In fact, by playing with the paper pulp, he was creating figures that were important in his life. The snake-dad was the longest because the father was the tallest in the family, the snake-grandmother had big eyes and was the thickest, the snake-mother had her mouth taped shut because the mother did not speak, but in her own way experienced her child's suffering. In the breakthrough session, the boy began to change the nature of play: he played more dynamically. At first he was just kneading, squeezing the material, then banging his fist on the table on which the plastic mass was laid. Eventually, the boy started throwing it on the ground, trampling it and shouting: "I hate you!". At that moment, the plastic material became something onto which he could transfer those feelings that he could not express in any way at home. One can imagine how big their deck must have been, since the boy at one point shouted: "I'm going to kill you!" and started banging the plastic mass hard against the wall. This was a crucial session for his therapy. The boy felt safe in the conditions created by the therapist and was thus able to confront his most hidden feelings. The therapist accepted and accepted all the child's feelings. During the next session the paper pulp was put away. The boy became interested in construction toys and building blocks. He started to play as a child his age usually plays.
S.: The boy shouted out these emotions and that was the end of his problem? A cleansing took place?
N.A.: You could say it was a moment of purification. Katharsis. In a key moment of therapy, he discovered the part of himself that he did not accept and was afraid of. Ambivalent feelings are very difficult for both children and adults. In children, they take the form of an inner monster. The toddler has to deal with it all the time if parents, caregivers do not give him the right to experience difficult feelings, such as anger. That is why, in Play Therapy, we try to create the conditions for the child to deal with difficult emotions and discover their inner monster. What is discovered is no longer fear-inducing. It is tamed.
S.: If this boy had played with the paper pulp in the same way at home, this play would not have been therapeutic for him?
N.A.: All children play. So parents, carers, teachers treat play as a natural form of leisure. They don't usually notice that the play is repetitive, organised, focused on a theme and finishes at a certain point. And even if the caregiver notices this, he or she will probably think that the toddler is bored and will immediately choose another toy. The Play Therapy therapist looks at this play differently. If the child builds the same scene over and over again out of paper pulp, pastry or sand, it means that he or she is facing a limit in play that he or she cannot cross. The therapist, through his presence, attitude, non-verbal messages, will try to create conditions for such a child to confront these difficult emotions. He or she may say, for example: ? "I see a family of hissing snakes. This snake
has big eyes. I think he is carefully watching everything that is going on around him? In this way the child gets information, a cue, through which he begins to confront his own emotions. During subsequent sessions, the therapist will observe whether the child feels safe enough to reach the crucial moment when the 'cleansing' takes place.
S.: But what will that change? After all, a child whose problems are rooted in the behaviour of adults has to return to his or her family anyway?
N.A.: The child's therapy is the main focus of Play Therapy, but parents also play an important role in it. They meet with the therapist every few sessions. This does not mean that they are instructed or told how to deal with their child. In fact, this is impossible at the beginning, because the problem is not yet recognised. However, even when the therapist understands what it is, they do not say anything directly. This is the secret of the therapeutic process. During Play Therapy, he or she conducts a kind of dialogue with parents in review sessions, during which they discover a simple fact ? that the root of the child's problems is often their own. In the literature on Play Therapy, there are many descriptions of such cases. I recently read about a girl who could not acclimatise to kindergarten. This was the daughter of a mother of a mature age who did everything to keep the child with her for as long as possible - it was probably necessary for her to feel young. While playing in the sandpit, the girl would set up two elephants, a small one and a big one. When the little one played in the sandbox, the big one always stood outside. The little elephant would ask: "Can I go play with the horse?" and the big one answered: "Yes, but I will stand and watch you". This situation had a dozen variations. Sometimes there was still a horse and other animals with the small elephant. The big elephant would then enter the sandbox and say: "And now you will do what I want". These were not dialogues that the child could invent on her own. In play, the girl was simply repeating the words of her mother, who restricted her contact with her children and did not give her the right to separate. During the meeting, the therapist asked the mother a question to test her attitude towards the problem: "Can you imagine what your life will be like when your daughter becomes an adult, independent woman?". "It will still be many years before that happens," she replied. But in a moment she admitted: "I am not able to imagine it". This answer was the key to the child's problems. The woman who thought of herself as a perfect mother finally began to understand that the cause of her daughter's adaptation problems in kindergarten did not lie solely with her daughter. The child was showing the mother's difficulty.
S.: In Play Therapy, the assumption is that the child is capable of solving their own problems. Where does this assumption come from?
N.A.: From the stream of humanistic thinking, person-centred psychotherapy. It assumes that human beings are experts on their problems and are capable of solving them. As adults, we consider ourselves wise and experienced. We are convinced that we have knowledge about ourselves that a child cannot have. This is wrong thinking. Children are also well aware of what ails them, they are just not able to verbalise it. I remember an inconspicuous little girl whose parents brought her to me because she was having trouble in her relationships with her peers. I asked her a simple question: 'What would you like to have? "A gun. I would kill half the class and my father," she replied. Then the bag of family problems dissolved.
S.: Why does the presence of a therapist help children solve their problems?
N.A.: Because in the presence of the therapist the child feels: "This is an adult and my problems are very important. It must be so, since this adult is giving me one hundred per cent of his attention" Does either parent give the child one hundred per cent of his attention? The therapist can do so, because he has a whole session to do so : 45 minutes. Just by observing and accompanying the child in a non-intrusive way, this behaviour starts to change. The therapist actively responds to all the child's feelings. In this way, he learns about himself and the emotions he is experiencing. Unlike many carers, the therapist gives choices. It is the child himself who decides what to do. Some children, by the way, cannot find themselves in this situation. I remember a boy who couldn't relate to other children in the kindergarten. Three sessions he walked around the room as if he was not interested in playing. "I see you haven't played with a single toy for three sessions," I said to him at the next meeting. "But you were the one who always chose for me"-he replied. Since someone else was always making the decision for him, he felt he was powerless. He was convinced that he was not the perpetrator of what was happening to him. It is difficult for such a child to be active in play or to have good relationships with his peers, which are formed precisely by playing together. In order to awaken in him the natural desire to show his will, it was enough to create conditions in which he could make his own choices. Once the boy had learned to do this in the office, he began to behave differently in his natural environment as well. In the kindergarten, he first watched his peers play, then - as the teacher noticed - he started to suggest some additional elements to their play. After 6 months we finished the therapy, because the child started to say what he wanted, what he didn't want, he was even messing around in the kindergarten, leading his peers in games. He had clearly regained his sense of "I rule, I decide". And yet this was precisely the aim of his therapy.
S.: The number of problems in which Play Therapy proves helpful is overwhelming. Does it also work for childhood trauma?
N.A.: Yes. I will use the example of my young client. He was a few-year-old boy who had survived a car accident. While playing, he was constantly smashing cars. His mother couldn't stand it because, she said, playing with it reminded her of the terrible accident. Indeed, at the beginning of the therapy, the child would recreate the scene of the accident ? a car was driving down the road, another car was coming out of a corner. A head-on collision! At this point, the little boy would stop playing and choose other toys. During the sessions that followed, he recreated further incidents. After the collision, the ambulance and the police would arrive, and people would turn up to try to help with the rescue operation. Finally, on the fifth session, the child reached the moment in his play when it was clear what had happened to the victims of the accident ? someone had been taken to hospital, someone had died. This was the end of the traumatic play. Later, the boy continued to play with the cars, but there was no longer a crash, no police, no ambulance. The car regained its function as a toy, not a machine for killing people. In therapy, the boy relived the event, but tried to take a bird's eye view of it - not as a participant but as an observer. Step by step, he sorted out his own feelings, trying to regain a sense of control over a situation over which, after all, he had no control. This is important, because in some types of therapy, patients are deliberately made to replay the details of traumatic events over and over again. However, research shows that this is not the way to go. Rather than reducing psychological trauma, reliving a traumatic event over and over again perpetuates negative feelings. In the case of Play Therapy, there is no such effect. As the child became more ready at each successive session, he went further in his own narration of the traumatic event, until it finally stopped triggering bad emotions in him.
S.: Is Play Therapy also helpful for deaf children?
N.A.: Yes, but after the age of three. With younger children in mind, the so-called Filial Therapy was created, which includes not only the children but also their mothers and fathers. For parents of children who are born with some kind of disability, the first three years are a critical period. Mothers and fathers then often experience the trauma of a disability diagnosis and do not know how to find their role as carers. Parents of a child who is born deaf often feel that there is no way to communicate with their toddler. Since the child can't hear (and doesn't speak), they are silent too. And yet it is possible to communicate without words! A crease of the eyebrows, a nod, gestures are enough to establish contact with the child. Such non-verbal communication, however, has yet to be learned by parents. This is why it is so important for mothers to take care of their children up to the age of three. This is the cut-off age for Play Therapy, which by definition focuses primarily on the child. Play Therapy for deaf children, however, is fundamentally different from therapy for children with other problems. With deaf children, the therapist is focused on the child, but the child is also focused on the therapist. The roles are therefore partly reversed: the deaf child is constantly observing the therapist and analysing the therapist's behaviour.
S.: Why is there such a role reversal?
N.A.: Deaf children play alone because neither peers nor caregivers are often able to relate to them. The result of this loneliness is frustration and withdrawal. So when such a child comes to therapy, he or she begins to look closely at the person who is doing the therapy. He is looking for information: who is he, what kind of person is he? Therefore, everything the therapist does, every movement, gesture, facial grimace he observes, is a message to the deaf child. If this message evokes positive feelings in the child ("He knows what I mean, I'm having fun with him"), a thread of communication will be established. This was the case, for example, with a deaf three-year-old who came to the session and played with toy cars the whole time. He somehow paid no attention to my presence. Nevertheless, I walked behind the child and tried to do the same as he was doing and, above all, in the same way. the little boy did not remain indifferent to this behaviour. During the third session he whined, imitating a car, and looked at me. It was a simple message: "I don't want to be alone, I want you to be with me, I want you to experience what I am experiencing". So when I also whined like his car, he smiled broadly and continued playing, already including my presence in it.
S.: Withdrawal is a common reaction of deaf people. What other problems do you encounter with hearing-impaired children during therapy?
N.A.: I remember a ten-year-old to whom I asked a simple question during an introductory interview: 'What is your problem?' I didn't actually expect an answer to it. Meanwhile, the boy answered: "I am stupid". And then he added: I don't actually know what's wrong with me. The boy's mother was shocked by this answer. "The son never talked about himself like that", she claimed. And this was certainly the case, as no one had probably also asked him such a simple yet difficult question before. In the presence of the psychotherapist, the boy was able to emerge as a person, so he said what was bothering him. This 10-year-old was communicating verbally, so it was relatively easy to contact him. A three- to four-year-old child who cannot communicate his feelings with words will, for example, bang his blocks on the floor or bite his balls. However, it is possible to establish contact with every toddler, to create a therapeutic relationship. You just have to know and choose the right tool to communicate with him. Only then is there a chance that his inner monster will stop tormenting him.
INTERVIEWED BY: JOLANTA CHYŁKIEWICZ
The article appeared in the monthly magazine "Słyszę" 05(139) 2014
PLAY THERAPY POLAND
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