Counseling Today, Features

Remembering play

Stacy Notaras Murphy February 14, 2010

Sometimes, cohesion is an open therapy group’s biggest challenge. Although the open-door approach provides ongoing support as people find themselves in need, building connection may feel nearly impossible as members trickle in and out each week.

“Our open groups never close. I may have 13 women one week and three more the next. Our purpose really is to provide insight about what’s happening then and there,” explains Chris Johnson, an American Counseling Association member and licensed professional counselor intern who works with battered women and their children at Sistercare Inc. in Columbia, S.C.

Faced with the challenge of leading a group that is in an almost constant state of flux, Johnson uses balloons to help build bridges. “The balloons always get a reaction,” she says. “It’s one of the most successful ways I’ve found to build cohesion. I bring in different colors. They get to choose, blow them up and tie them up.” She then directs the women to balance their balloons in the air without letting them touch the ground.

“Then they pair off, and the two of them have to work as a team, which is something they’ve not been allowed to do (in their abusive relationships) have meaningful relationships and partnerships with other women,” Johnson says. “About 10 seconds in, you start to hear them laugh. They’re not as intent as they were before. Some laugh so hard they cry. Some have not laughed in so long they don’t remember what it’s like. Later I ask, ’What did you see?’ And I say, ’I saw a room of happy women.’ We talk about the last time they were a part of that kind of thing, and you hear stories about how they weren’t allowed to laugh at home. That’s when the support group becomes therapeutic for them.”

While the balloons in this instance serve as a simple ice-breaking exercise to accelerate the bonding process, they also demonstrate how play therapy techniques can enhance counseling work with adult clients. “Every program I’ve worked in has been about empowering the client to move forward with her own agenda,” Johnson says. “I’m very person-centered and eclectic and found myself asking, ’What can work in short order?’ If I have someone who has not been able to communicate a woman, a child, an adolescent boy how do I get them to a point of building rapport quickly and building trust? That’s where I came to play (techniques).”

Fun (and therapeutic) for all ages

“Although play therapy is frequently conceptualized as a treatment approach for children, there is growing support for the use of play therapy across the life span,” says Sueann Kenney-Noziska, president of Play Therapy Corner in La Mesa, N.M. “Play therapy provides some of the same benefits to adults. If incorporated into a solid, clinically grounded treatment approach, play therapy can provide an adult with an appropriate avenue to safely examine their thoughts, feelings and issues.”

Kenney-Noziska notes the Association for Play Therapy, a professional organization for play therapists headquartered in Clovis, Calif., recommends that university programs address the application of play therapy with adults and the elderly. The 2009 APT conference featured a workshop titled “Play Therapy Across the Life Span.” Counselors who want to incorporate these techniques into their work should pursue educational opportunities to develop this expertise. “Since play therapy is an area of specialization, training is imperative. Without adequate and appropriate training, a therapist should not utilize play therapy with adults,” Kenney-Noziska says.

Play therapy techniques may be appropriate for treatment of grief and loss, mood disorders, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder and attention-deficit/hyperactivity disorder. Some say play techniques that involve metaphor and other imagination-based approaches are not recommended for those suffering from delusions or hallucinations.

Distancing, mastery and projection are examples of the benefits adults may derive from play therapy, according to Kenney-Noziska. “Play therapy approaches often create a sense of safety from which some adults may be more comfortable approaching threatening issues or topics,” she says.

Johnson describes a drawing exercise called “The House That Is Me” that helps domestic violence survivors in her groups pinpoint their feelings at an exact moment in time. “I ask them to draw what the world would see if they each were a house what color it would be, are there trees in the yard, what is happening on the inside. Many of the houses have a plain outside look. Many of my women have dealt with isolation, power and control. They don’t have their own things, (so) they draw boring, plain-looking little houses. But when you open the doors, there is more to the story. One woman who is not very verbal in the group drew a bunch of little black circles inside her house. She said that she feels empty and has nothing inside. This was a breakthrough for her.”

Creative play techniques often cut through the more “adult” characteristics of guardedness and rationalization, helping the counselor understand the client’s issues at a deeper level. “Play therapy allows the adult to return to a slower, unrushed pace that is more conducive to the opening of the psyche to a greater arena of options for the client,” notes Pamela Coleman, an ACA member in Yuma, Ariz. “People talk when they are relaxed, and I pose that their subconscious self may ’peek out’ in play … allowing for a better knowing of one’s self and, thus, having a greater range from which to draw in meeting their treatment goals.”

Coleman was trained in play therapy at Arizona’s Children Association and learned to use play during family sessions to help parents “join” with their children. Following a 12-week model for brief strategic family therapy, she found that most families benefited from play activities as part of the treatment plan. “In many cases, the counselor/therapist has the ability to model positive interaction skills for the adults with their children during play,” she adds. “All involved child, adolescent and parent seem to relax and are able to come further in therapy, as all become more open when having fun and learning about one another.”

At play in supervision

Just as play therapy techniques offer alternative paths to deeper meaning in counseling sessions, they also can be used to enhance counselor supervision experiences. Kenneth McCurdy, an ACA member and associate professor of community counseling at Gannon University in Erie, Pa., finds that play techniques such as drawing or puppets help his supervisees explore how their own styles of life are reflected in their counseling work.

For example, McCurdy has asked supervisees to re-create a client case using a sand tray. “The supervisee is asked to identify all of the contributing factors to the client’s case people, places, things, feelings, issues, etc. and re-create the whole conceptualization of the case in the sand. Next, the supervisee selects miniatures that best represent each of the contributing factors,” he says, noting that the first miniature placed in the sand is the client and the last is the supervisee. “We then process the whole sand world re-creation. I share observations about the creation, the miniatures and my feedback about the process of the supervisee selecting the miniatures and creating the sand world. This process often results in the supervisee seeing perspectives of the case and issues with the client that were previously unknown or not as easily identified.”

While using sand tray in his supervision of counseling students, McCurdy is also training supervisees to utilize the technique in their own counseling practices. “Not many other supervisory techniques can be applied as easily in both sides both in supervision and in clinical practice,” he says. Meanwhile, McCurdy is researching the actual impact of play techniques in clinical supervision. “I have found that some supervisors establish a stronger supervisory working alliance when they use the sand tray as compared to when the same supervisor uses traditional didactic supervision,” he says.

McCurdy admits the biggest challenge may be convincing supervisees to “buy into” the use of toys in supervision. “Often, I use the toys from the first supervisory session as we are getting to know each other,” he says. “I usually give them a toy during the first session to show my appreciation for their willingness to participate in supervision a Matchbox car, a figurine, a finger puppet, etc. Very often, that spurs them to explore using toys in their counseling practice if they do not already use them.”

Facing the resistance

Understandably, some adults may feel embarrassed if asked to use a puppet or play a game during a therapy session. Here, a strong counseling alliance built on trust can be the key to reaching that next level of therapeutic insight. “I try to just be open and honest when I’m doing these things with my (battered women’s) groups,” Johnson says. “I ask them to trust me. You are always going to have some resistant adults who are not going to want to participate but, hopefully, like any other play therapy session, the potential to enjoy themselves can draw the client in. Even participate yourself if that’s what gets them engaged.”

Coleman notes the counselor must consider the client’s personality and interests before applying a play technique. “I realize that play therapy does not lend itself well to adults who do not prefer a creative approach … due to their logical, dominant side of the brain,” she says.

McCurdy agrees: “I find that drawing and sand tray seem to be the two play media that adult clients readily respond to. I think it is because these two media do not initially come off as ’childish.’ Most of the adult clients I counsel have lost touch with their child side, and those who are most successful in counseling are the ones who come back in touch with the joyful/playful experience of childhood.”

Some adults who have experienced trauma may be numb to their feelings or block them out entirely. Reminding these clients of the childhood experience of joyful play can help make feelings safe again, allowing for deeper understanding between the client and counselor.

“I had the privilege of working with a grieving mother whose 4-year-old daughter was killed by a drunk driver. Mom struggled to directly discuss her thoughts and feelings related to her profound loss,” Kenney-Noziska recalls. “Using a cognitive behavioral framework, I began to incorporate play therapy interventions into our clinical work to create a less threatening and more indirect way for the mom to process her thoughts, feelings and issues. Once play therapy was incorporated into her treatment, the mom displayed an improved ability to share and process things on a very deep level. My clinical impression was that incorporating play therapy into the mom’s treatment tapped into mom’s ability to really explore her loss.”

As with any new method, counselors who add play therapy techniques to their work are advised to make room for case consultation and review. “Like any other treatment technique, counselors need to make sure that the play technique is a valid and reliable approach to use with the given client for the given treatment goal,” McCurdy advises. “It is imperative that the treatment goal is reliable and measurable. The counselor must be able to show how the objectives of the goal have been impacted in a verifiable way by the play technique.

“The most important thing is to treat play techniques like any other treatment modality empty chair, medication, etc. It must fit the client (and) the goal/objective, be assessed in relation to the intended outcome and be reliable and valid as supported in the professional literature.”

Stacy Notaras Murphy is a licensed professional counselor practicing in Washington, D.C. Contact her at snmurphy@verizon.net. Letters to the editor: ct@counseling.org.