By Dr Deborah Truneckova MAPS and Professor Linda L. Viney FAPS, Department of Health and Behavioural Sciences, School of Psychology, University of Wollongong

Helping troubled children in the school setting provides many challenges for the psychologist. When troubled children are identified by concerned parents and teachers, they are typically described as children exhibiting externalising behaviours which cause problems for others as well as the child. Usually by the time they are referred to the psychologist, these children come with a history of school detentions and suspensions, and discipline regimes at home and school that are usually reported to have had limited success. Many of the troublesome behaviours prevent the child from engaging in classroom learning.

This article presents a child-centred approach in a school setting based on developing the therapeutic relationship. The relationship is the tool to connect with the troubled child, and play activities are the medium to facilitate this engagement. Connection begins with the psychologist being credulous and open to the child’s ways of making sense of his or her life. It is an approach based in the present moment and one that invites the child to direct the process. As a strengths-based approach, it is also one where self-reflection is encouraged. The approach attempts to decrease behaviours that are impulsive, oppositional and hostile while developing the psychosocial skills necessary for the troubled child to begin to engage with classroom learning. 

Communicating hurt through challenging behaviours

When concerned adults try to find out from troubled children what might be upsetting them, children usually don’t know or become angry and close up. These concerned adults will usually try again but are faced with much the same response and begin to feel helpless and hurt. While research describes an association between stressful events and psychopathology in children (Tiet et al., 2001), the challenge for the psychologist is to understand the pervasive impact of the child’s life experiences on psychological growth and how the pain of ruptured relationships leads to a range of troublesome behaviours. These behaviours become the language the child uses to communicate pain. At any time, elaborating on feelings is not an easy thing for children to do when asked “What’s wrong?”. It is difficult for children to use everyday words to express the full impact of what they are experiencing. Troubled children have often been hurt excessively. They have stopped wanting to share their feelings and are defensive and hostile to concerned inquiries by adults and will either not reply, or angrily respond with “I don’t know” or “It’s not fair”, shutting the door on any further conversation. The challenge for the psychologist is to find the natural language of feeling for these children, and to unravel the nonverbal language of the child inherent in the internalised behaviours or states of being into the child’s words of pain.

Effectiveness of play therapy

Play has an important role in the cognitive and psychosocial development of children. In play, children attempt new tasks as they chase and challenge each other. They develop their minds as they play around with words and ideas. They learn social skills and moral rules as they play games and act out fantasies. Play is their world of imagination and it is essential for the developmental task of growing up. While differing philosophically and technically, the various play therapy treatments nevertheless all seek to achieve similar therapeutic and developmental outcomes. A recent meta-analytic review (Bratton, Ray, Rhine, & Jones, 2005) of 93 play therapy outcome studies, including 36 studies conducted in school settings, found that play therapy was an effective treatment for both internalising and externalising behaviour problems. The results also found the humanistic approaches, primarily those that are child-centred and non-directive, demonstrated a larger treatment effect compared to non-humanistic approaches.

The power of relationships in play therapy

The primacy of the therapeutic relationship, along with the basic theoretical beliefs about the formative and transformative power of relationships, plays a central role in our child-centred approach. It involves connecting with children in a way that helps them believe there is a willingness to understand them. The relationship is based on the eight basic principles proposed by Virginia Axline (1969), one of the pioneers of the use of play therapy. The psychologist sets out to develop a warm, caring relationship with the child by accepting the child and not wishing that he or she would be different in some way. The psychologist creates a feeling of safety and permissiveness in the relationship where the child feels free to be openly expressive. The psychologist is sensitive to the child’s feelings in a way that promotes self-understanding by the child. There is an implicit belief in the child’s capacity to act responsibly, which allows this to happen more readily. The psychologist trusts the child’s inner direction, allowing the child to lead in all areas of the relationship. This is a relationship where there is emotional closeness of two independent people, where their roles and selves are mutually respected.

Play becomes the child’s language

While the relationship is the tool the psychologist uses to connect with the troubled child, the play activities are the medium to facilitate the relationship-building. There is the assumption that the child will use the play activities to directly or symbolically act out feelings, thoughts and experiences that are not able to be meaningfully expressed through words (Axline, 1969). The activities and toys are like the child’s words and play becomes the child’s language (Landreth, 2009). Play activities provide troubled children with the tools to move beyond generalising everyday feeling words to a deeper portrayal of their experience. Making no assumptions about what the child means, the psychologist attempts to see the world through the eyes of the child. The psychologist communicates in a way that promotes hypothetical and provisional ways of thinking. The prevailing attitude of the psychologist is that asking questions or checking meanings is how we go about understanding each other. The troubled child is not being challenged or instructed, but rather invited to participate in a collaborative relationship with each trying to understand the other.

Connecting with the troubled child

Connection is central to helping troubled children. Connection in therapy begins with the psychologist being credulous. While not blindly believing everything the child has to say, the psychologist however attempts to see things from the child’s perspective and to accept and trust the validity of that perspective. Credulous listening involves understanding the personal meaning of the child within his or her social context and facilitating the child’s articulation of thoughts and feelings through play. There is an emphasis on the personal meanings of the child, putting the child’s voice to interpretations of important life events. Through credulous listening the psychologist is helping the child to make experiences understandable and meaningful. This in turn facilitates the child’s capacity to consider views, feelings and concerns, something which there may not have been a preparedness to do before. The psychologist will draw on professional knowledge and learning to assist in organising the understanding of the child’s ideographical view of their world.

CONNECTING THROUGH PLAY THERAPY
Connection begins with the psychologist:
  • Being credulous
  • Accepting other ways of making sense of the child’s world
  • Being in the child’s immediate experience
  • Working alongside the child
  • Accentuating the strengths of the child
  • Developing the child’s capacity to reflect on actions, behaviours and feelings

 

As a verbal account of the troubled child’s problem is often not possible or enough, the common assumption of this therapy approach is that change is based on the lived experience. Within the child’s immediate experience, the psychologist resists attempts to hurry the process, allowing the child to lead with the psychologist working alongside.

Emphasising strengths and self-reflection

In the school setting, conceptualisation of the psychological problem will involve the psychologist hypothesising what the child needs to accomplish in therapy, to reduce troublesome behaviours and to grow in maturity and psychological capacity. This may include self-acceptance and respect, and assuming responsibility for the choices that are made. Conceptualisation also aims to accentuate the strengths of the child, and to engage the complexity, subtlety and resources of the whole child. The capacity of the child to take on the responsibility and to feel empowered to make decisions is facilitated and encouraged by the psychologist.

Encouraging the development of reflection is necessary for any therapeutic change to take place. This approach sets out to use the creative medium to develop a pre-reflective response to a reflective level of emotional processing (Upton, 2009). Developing the capacity to reflect on actions, behaviours or feelings can be difficult for troubled children. Play therapy facilitates the development of reflection as the child is able to see his or her world in miniature and from above. Rather than just a string of details, their problems can take on a wider perspective. The opportunity is also available for children to separate a part of themselves from the problems and to take on the perspectives of others. The psychologist sets out to link the child’s past with the present or future using comment that is simple enough for the child to understand.

Conclusion

This approach sets out to facilitate the engagement of troubled children in psychotherapy in the school setting through play. When the connection is made with the child, this approach can become the scaffolding within which other psychological interventions can be offered in the school setting. The ultimate goal is of enabling ordinary development to propel the child toward normalcy and psychosocial maturity.

The principal author can be contacted at dtruneck1@bigpond.com

References

Axline, V. (1969). Play Therapy. NY: Ballantine Books.

Bratton, S.C., Ray, D., Rhine, T., & Jones, L. (2005). The Efficacy of Play Therapy with Children: A Meta-Analytic Review of treatment Outcomes. Professional Psychology: Research and Practice, 36(4), 376-390. DOI:10.1037/0735-7028.36.4.376.

Landreth, G.L., Ray, D.C., & Bratton, S.C. (2009). Play Therapy in Elementary Schools. Psychology in the Schools, 46(3), 281-289. DOI:10.1002/pits.20374.

Tiet, Q.Q., Bird, H.R., Hoven, C.W., Moore, R., Wu, P., Wicks, J., & Cohen, P. (2001).
Relationship between Specific Life Events and Psychiatric Disorders. Abnormal Child Psychology, 29(2), 153-164. DOI:10.1023/A:10125288130494.

Upton, J. (2009). When Words are not Enough: Creative Therapeutic Approaches. In T. Cottis (Ed.), Intellectual Disability, trauma and Psychotherapy, pp. 29-44. NY: Routledge.

In Psych June 2012