Inform The Play Therapy Relationship

As children grow, they develop a variety of skill set to optimize their development and aid them in managing the toxic effects of stress. The means through which they are able to develop the requisite skills is through play. Yogman et al. (2018) states that the definition of play as it pertains to children is very elusive. However, there is growing consensus that argues that play is an activity that internally directed, it involves dynamic engagement and its end product is joyful discovery (Henderson and Atencio 2007). It is through play that children learn a variety of skills and at the same time play helps in building up a prosocial brain that can interact effectively with others (Yogman et al. 2018). Play therapy is the use of children’s play as a basis of therapeutic interaction (Homeyer & Morrison 2008). It is within play which is the natural form of communication for a child that the dynamic therapy will. Children’s play is usually a symbolic expression of their world (Homeyer & Morrison 2008). A child’s early relationships affect play therapy and that will be the basis of this essay. When a child is born, the brain is premature and malleable. The brain is shaped by the caregiving that it receives and the interaction that the child has with their behavior. It is through these interactions that the caregiver stimulates the brain of the infant which releases chemicals, proteins, enzymes and other elements that will determine the shape, structure, and capacity of the brain (Levine & Kline, 2007). It is interesting to note that caregiving determines which genes will be turned on or off depending on the early caregiving experiences; caregiving determines epigenetic expressions (Blaze and Roth, 2013). When the child is born the most developed part of their brain is the lower brain (Blaze and Roth, 2013). Due to that the attachment relationship between the child and the caregiver works on the lower brain, and it usually works through sensory experiences. At that time the child will feel safe through their senses. 90% of brain growth will take part in the first 3 years of life; thus any experiences that the child will have in

those first three years will influence how they play and that will affect the play therapy that starts from 5-years of age. Cozolino (2002) notes that the presence of neuronal stimulation during that critical growth stage is important since it influences the development of each region of the brain which will, in turn, affect the wiring of the brain. If during this sensitive period the child is deprived of ample sensory experiences, there will be abnormal neuronal activation which has detrimental effects for the child. Affect attunement in the early years of the child is very critical. Therefore, a child’s early relationships and experiences will definitely inform the play therapy relationship.

Before getting into play therapy it is important to understand the value of play in children. Ginsburg (2007) notes that play is important for children since it contributes to the cognitive, physical, social, and emotional well-being of children. Moreover, play is important because it presents a superlative occasion for parents to fully engage with their children. At the same time, play therapy is very important for young children. According to Kool and Lawver (2010), play therapy is unique because it is not only tailored for young children, but it translates into a language that can be used and comprehended by young children. Within the first decade of an individual’s life children had neither the ability to form any meaningful expressions nor to understand complex issues and feelings (Piaget, 1962). Change occurs during the preoperational period since there is an expansion of cognitive horizons in the child’s life. During that period the child is in a position to understand complex interactions that include moral judgment and various rules. Axline (1947) noted that meaningful expressions exist in the process of play and that language is very important for bridging symbol and thought. Play therapy seeks to balance out the symbolism in play and language expression based on the age of the child. Batton et al. (2005) observed that the efficacy of play therapy lies in its adaptability. While adults express themselves through words children express themselves through play. Therefore, play therapy is a mode of communication between the child and the therapist. It is assumed that children will use the materials to directly or to symbolically express what they are feeling and to express experiences that they do not have the appropriate words to express (Batton et al. 2005). Play therapy is thus, a bridge between words, experiences, and understanding.

One early childhood experience that may affect play therapy is trauma. Jamieson (2018) characterizes childhood trauma as Adverse Childhood Experiences (ACE). The researcher categorizes ACE into three categories: Abuse which can involve physical, emotional, and sexual abuse; neglect either physical or emotional; and household dysfunction as in the case of parents facing incarceration, separation, divorce, mental illness, domestic abuse, and substance abuse. ACE usually arises from socioeconomic hardships, divorces related issues, witnessing or being a victim of violence, living with individuals with mental illness or drug-related addictions and being separated from their family due to incarceration (Jamieson, 2018). The trauma that the child has experienced must be taken into account during play therapy. Play therapy will involve staying within the “window of tolerance.” The window of tolerance is the optimal arousal zone. Ogden, Minton, and Pain (2006) note that the optimal arousal zone is known as the Ventral Vagal “Social Engagement” Response and it is a state where emotions can be tolerated and information integrated. On one side of the spectrum is the hyperarousal zone which comprises the Sympathetic “Fight or Flight” Response. In this zone, there is an increase in sensations, flooded emotional reactivity, hypervigilance, intrusive imagery, flashbacks, and disorganized cognitive processing. On the other side of the spectrum is hypoarousal which is known as Dorsal Vagal “immobilization” response. In this zone there is a relative absence of sensation, numbing of emotions, disabled cognitive processing, and reduced physical movement. For the 5-year old who has been brought to therapy, it is important that the therapist strives to operate within the window of tolerance. If for any reason the therapist moves outside the window of tolerance there is a risk of re-traumatizing the child by causing them to re-live the traumatic events which he has experienced at home which may trigger the fight, flight or freeze responses (Ogden, Minton, and Pain, 2006).

There are a number of ways through which traumatic incidences can present themselves in the playroom. According to Copeland (2017), there are four ways through which trauma can present itself during play. The first is intense play in which the child’s play is enormously fixated and absorbed in a way that seems to hold deep meaning for the child; there is no joy or spontaneity in the play. The second is repetitive play in which the child’s play seems to hold a particular ritualistic quality since the child repeats exact themes, sequences and play behaviors without changing the manner through which they are enacted. Those particular themes and patterns seem to hold great meaning for the child. The third is play disruption, and it occurs when in the course of play that childhood experiences and emotion that is so intense that they disrupt the play as a way of dissociating from the intense emotion (Copeland, 2017). The fourth is avoidant play, and it occurs when the child avoids the therapist because they do not trust them and as a way through which they protect themselves. This may occur when the child has experienced traumatic incidences in their childhood in which the caregiver was abusive. Thus, they avoid the therapist as a form of self-protection. The fifth is the expression of negative affect. Negative affect refers to anxiety, anger, sadness, fear and other emotions. A child who has experienced traumatic incidences in their life is more likely to show a high degree of negative affect or a lack of affect. Therefore, a child who has experienced traumatic events in their life is going to present it in one of the above forms of play, or they may express it in more than one form of play.

For the child, the stress response system is conditioned through their interaction with their caregivers. The stresses which they are subjected to may expand or shrink their window of tolerance. As said above it is important for the therapist to operate within the window of tolerance for play therapy to be more efficacious. The size of the window of tolerance will depend on the degree of the traumatic events that the child has experienced. Say the five-year-old brought to therapy has been exposed to physical and verbal abuse every day since they were one and a half years old. The window of tolerance in the child is likely to be very small. In such a scenario the initial work of therapy will require the widening of this window through the regulation of lower stress regulatory parts of the brain. Widening of the window of tolerance must take place slowly since there is a risk of triggering a fight, flight or freeze response in the child. Therefore, while the therapist should work within the window of tolerance, they should find means through which the therapy can be widened through the regulation of the lower stress regulatory parts of the brain.

Affect attunement is another experience that would affect play therapy. According to Chasnoff (2011) is the means through which a parent is aware and responsive to their child. Many are the times that from an outsider’s perspective a child appears to be emotional for no apparent reason, but a parent is able to state that the child is emotional because they are angry, hungry, happy, sad and many other emotional states. The interesting thing about attunement is that it is predicated on non-verbal communication between the child and the parent. Before a child is able to grasp and understand the nuances of using spoken language, non-verbal communication is the means through which parents use to communicate with their children Chasnoff, 2011). The non-verbal communication may be in the form of facial gestures, the tone of voice, the movement of one’s hand or nodding and tipping one’s head. All those cues contribute to communication between the parent and child. Therefore, since affect attunement is essential in early childhood, it is expected that its presence or lack thereof will carry not only into play therapy but into other areas of the child’s life.

Stern (1985) sates that attunement is very important since it goes hand in hand with attachment. Stern (1985) quotes the psychologist John Bowlby who states that the earliest bonds formed by children and their caregivers have carry-over effects that reflect throughout their life. Attunement and attachment are very related in the sense that caregivers who are highly attuned to their child’s needs and emotions and are responsive to them establish a strong sense of security in the child. A strong sense of security will have benefits since it will stimulate effective brain development in the child. Stern (19875) observes that the early attachments that are created in childhood lead to children with higher self-esteem, robust and fulfilling romantic relationships and they feel a higher degree of comfort when they share parts of themselves with other people. Moreover, Legerstee, Markova, and Fisher (2006) noted that improvement in dyadic communication and coordinated attention in the triadic period was highly dependent on maternal attunement. A high maternal attunement means that there was meaningful communication spearheaded by the mother which increased levels of interaction and led to overall improvement in communication during the dyadic and triadic periods. The communications in the dyadic and triadic period were thus found to lean heavily on maternal attunement. The researchers only concentrated on maternal attunement, but the conclusions of the study can be applied to all caregivers. The conclusions implied that the more highly attuned a caregiver was the better the effect they had on the child and their development. Therefore, affect attunement is important for the holistic development of the child.

Based on the importance of affect attunement as enumerated above one can surmise that the degree to which a child will experience attunement will affect play therapy. A child whose caregivers were highly attuned to them will be more responsive during play therapy. The child has learned to communicate what they feel, and they are used to people being able to pick up the cues. It will be easier for a therapist to deal with this child since in the course of play the patterns and themes that the child uses will have a high degree of correlation with whatever the child wants to communicate. Therefore, for a family in which caregivers are highly attuned to their child, then play therapy will be effective. Affect attunement becomes even more important in instances where the child has a developmental disability such as autism. Children with autism are not in a position to effectively communicate how they feel. As such during the development stage of the child, it is highly important that the parents be highly attuned to what the child is feeling. Say two families bring their children to play therapy. Caregivers of both children have been highly attuned but one child experiences typical development as far as cognitive development is concerned, and the other child has autism. Since both children come from caregivers who have highly attuned to their needs their interactions during play therapy will be more concrete and guided. While the therapist will still pay attention to the children, it will be easier in this instance since the children have formed strong attachments with their givers.

Additionally, the theory of mind comes into play in such situations. Theory of mind helps one predict other people’s behaviors and emotions, to be compassionate, to keep secrets to tell lies and to understand inferences in communication. The impairment of the Theory of Mind has links to autism, and it explains the social and communication deficits that are experienced. Theory of mind manifests in play therapy when the child uses one object as another, attributes properties to an object that it does not have, refers to absent objects as if they were present, and creates images from the imagination. A child’s theory of mind will be affected when the child has suffered severe and early neglect, when the parents of the child also have an impaired theory of mind as in the case of borderline personality disorder and in the case of severe anxiety and depression of the parent. A child’s theory of mind will depend on the degree of affect attunement that the child has experienced. In a case where the child has not experienced a high degree of attunement, it is up to the therapist to act as an “affect regulator.” Taipale (2016) notes that affect regulation is the ability to temper one’s emotional state in a manner that meets the adaptive demands of one’s environment. Due to the lack of affect attunement from the caregivers, the child will not be able to connect with their feelings nor will they be able to establish secure connections with other people. The therapist will act as an affect regulator in the sense that they will attune to what the child is trying to express and the more attuned they become, the better it will be for the child (Stern 1985). The therapist will follow the child’s lead as the play progresses and they will reflect back to the child in attunement with the child’s play. Therefore, affect attunement will have an effect on play therapy because the more attuned the therapist is to the child during play, the more receptive the child will be during play therapy. The therapist will mirror the actions of the child so that the mirror neurons in the brains of both are activate which will result in the therapist being attuned to the emotional state of the child (Cozolino, 2006). The therapist will experience emotional resonance with the child which has been found to be associated with the child being able to better regulate their own emotions and describe their inner experiences to other people (Robinson, 2011). It is through affect attunement that the therapist will be able to understand what the child is mirroring through play.

In the end, the experiences and relationships that a child experiences will affect play therapy. Some children experience great trauma. In such instances, the therapist must consider what their window of tolerance is. The window of tolerance is the optimal arousal zone in which the therapist must operate within. If the therapist moves beyond the window of tolerance, they may risk triggering a fight, flight or freeze response from the child and that may end up re-traumatizing the child. During play therapy, the therapist must find means through which they can increase the window of tolerance of their client since it will give more room to maneuver with the risk of retraumatizing the client. The other way through which childhood interactions affect play therapy is through affect attunement. Affect attunement bears weight since it determines to what degree the child will feel connected with their own feelings and to what degree they will form secure connections with other individuals. The more attune the caregiver to the child’s needs the better it will be for the child since that attachment will act as security. When parents are not attuned, that will affect the child’s theory of mind, and that will affect play therapy. In such instances, the therapist will act as an affect regulator where they will mirror the actions of the child so that the mirror neurons in the brains of both are activate which will result in the therapist being attuned to the emotional state of the child. In doing so, the therapist will understand what the child is expressing through play therapy.

Dig deeper into Influences And Societal Responses with our selection of articles.

References

• Axline V. (1947). Play Therapy. New York: Ballantine Books.
• Blaze, J. & Roth T, L. (2013). Exposure to caregiver maltreatment alters expression levels of epigenetic regulators in the medial prefrontal cortex. International Journal of Developmental Neuroscience, vol. 31(8), pp. 804-810.
• Bratton C, S., 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, vol. 36(4), pp. 376-390.
• Chasnoff J, I. (2011). The dance of attunement: Attunement between parent and child creates a balanced primary relationship. Psychology Today. Retrieved from
• Cozolino, L. (2002). The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain. New York: W.W. Norton & Company
• Cozolino, L. (2006). The Neuroscience of Human Relationships. New York: W.W.Norton. Ginsburg R, K. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. American Academy of Pediatrics, vol. 119(1). Henderson T, Z. & Atencio D, J., 2007. Integration of play, learning and experience: what museums afford young visitors. Early Child Education Journal, vol. 35(3), pp.245-251. Homeyer E, L. & Morrison O, M., 2008. Play
• Jamieson, K. (2018). How play therapy can help heal childhood trauma. Retrieved from
• Johnson, S. (2012). Therapist’s Guide to Pediatric Affect and Behavior Regulation. Cambridge, Massachusetts: Academic Press. Kool, R. & Lawver, T. (2010). Play therapy: Consideration and applications for the practitioner. Psychiatry (Edgmont), vol. 7(10), pp.19-24. Legerstee, M., Markova, G. & Fisher, T. (2006). The role of maternal affect attunement in dyadic and triadic communication. Infant Behavior and Development, vol. 30, pp. 296-306. Levine A, P. & Kline, M. (2007). Trauma through a child’s eyes: Awakening the ordinary miracle of healing. Berkel
• Ogden, P., Minton, K. & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: W.W. Norton. Piaget J. (1962). Play, Dreams, and Imitation in Childhood. Norton: New York Robinson, S. (2011) What play therapists do within the therapeutic relationship of humanistic/non-directive play therapy, Pastoral Care in Education, Vol.29 No.3 p.207-220 Stern D, N. (1985). The Interpersonal World of the Infant. A View from Psychoanalysis & Developmental Psychology. New York: Basic Books Taipale, J. (2016). Self-regulation and beyond: Affect regulation and the infant-caregiver dyad. Frontiers in Psychology, vol. 7, 889.
• Yogman, M., Garner, A., Hutchinson, J., Hirsh-Pasek, K. & Golinkoff M, R., 2018. The power of play: a pediatric role in enhancing development in young children. American Academy of Pediatrics, vol. 142(3), e20182058.