PSYCHOANALYTIC PLAY THERAPY

1 1 Chapter 1 PSYCHOANALYTIC PLAY THER APYR ichard N. BromfieldAs he did for so many other forms of treatment, Sigmund Freud laid the founda-tion for psychodynamic play THERAPY . His work with and thinking about his adultpatients inspired new insights into the emotional development and experiences ofchildren, particularly the profound relationship of children s psyches, bodies, andsexuality (1905). Although he clinically focused on adults, his informal analysesof his own children and treatment of Little Hans, a five-year-old boy with a horsephobia (1909/1955), and his working backward toward the early experiences ofhis adult patients, set the stage for the logical next step of treating von Hug-Hellmuth, a teacher in Vienna, became the first to formallytreat children with talk and play.

2 In 1920, she wrote that [t]he analysis both of thechild and of the adult has the same end and object; namely, the restoration of thepsyche to health and equilibrium which have been endangered through influencesknown and unknown (p. 287). Initially treating her young patients in their ownhomes, Hug-Hellmuth appreciated the influence of family and saw children s dif-ficulties much rooted in their parents unresolved troubles. She also believed thatconscious insight was not a requisite to a child s finding relief and help in most cited beginnings of child THERAPY revolve around Anna Freud in Vi-enna and Melanie Klein in Berlin. Both women held deep beliefs in the richnessand complexity of childhood and development, appreciated the suffering thatchildren know, and valued play THERAPY as a means for understanding and two women, however, disagreed on much (1932/1975) saw the child s play in THERAPY as the equivalent of adult sfree associations and as the vehicle to making interpretations directly to evenvery young children s unconscious.

3 She especially focused on what she perceivedas the young child s experiences of abandonment, envy, and rage concepts noless relevant 6/4/03 2:46 PM Page 12 PSYCHOANALYTIC Play TherapyAnna Freud s methods (1927/1974) were more measured, aimed at helpingchildren come to consciously understand why they thought, felt, and behaved asthey did, that insight inviting personal change. She respected the child s behaviorand defenses as the child s best attempts to cope with their anxieties, traumas,life experiences, and growing up. Her lifetime of work not only recognized fac-tors such as the child s health, living conditions, cognitive ability, and such, butshe promoted parent guidance and school consultation as important functions ofthe child therapist.

4 If Sigmund Freud was the father of psychoanalysis, then AnnaFreud was child THERAPY s foremost CONSTRUCTS, GOALS, AND TECHNIQUESThe goals of PSYCHOANALYTIC play THERAPY are many and include helping the childto suffer less ( , quelling anxiety and related bodily symptoms, lifting depres-sion, and resolving complicated grief ); overcome trauma; adjust to life events,such as divorce; cope with illness and comply with treatment; master phobias; bebetter able to attend, learn, and work in school; manage personal anger and ag-gression; and come to terms with a learning disability or physical these goals sound like those pursued by clinicians of other theoreticalpersuasions, the goals of PSYCHOANALYTIC play THERAPY sometimes are more am-bitious, aspiring to change not just a behavior or symptom but broader, deeper,and more essential aspects of the child and her ways of dealing with life and itsordeals.

5 PSYCHOANALYTIC play THERAPY may be used to soften an overly harsh con-science in a child who won t give himself a break. It can help a child integratevarious aspects of her personality or help her to master developmental tasks,such as separating and growing up, or adapting to puberty and its THERAPY can help detached or estranged children connectmore to themselves and to others. This type of THERAPY is extremely good at pro-moting resiliency and adaptability, helping to reduce a child s vulnerability topsychotic and borderline functioning, especially under stress. It can help an in-hibited child grow more spontaneous, active, and joyful; an impulsive child,more contained, reflective, and responsible; and a narcissistic child, less sus-ceptible to wounded esteem and reactive play THERAPY intends to go beyond the immediate pain or diffi-culty and clear the way so that healthy development can resume from where it hasbeen halted or detoured by external trauma or untenable internal conf lict (neuro-sis).

6 It also is effective in helping children who have real and significant limita-tions come to terms with who they are, helping them to develop more secure,adaptable, compensating, and self-accepting ways and 6/4/03 2:46 PM Page 2 Basic Constructs, Goals, and Techniques3 How It WorksTherapy provides a troubled child a place safe from physical and psychologicalharm, where she can let her guard down sufficiently to explore her thoughts,feelings, and life. This type of THERAPY believes, along with the child-centeredapproach, that simply coming to know what she truly feels, thinks, and does canhelp a child to feel and function better, that is, to live in a more authentic looking in the mirror with the lights on is difficult.

7 By proving ourselvessafe and trustworthy over time, we steadily convince the child that she hasfound someone with whom she can pursue and share this establishing a safe and accepting atmosphere isn t enough. The psychoan-alytic play therapist strives to therapeutically hold the child (Winnicott,1945/1975). Parallel to the way that a mother holds her baby, the therapist holdsthe patient not physically, but psychologically. The therapist absorbs the excite-ment and distress that the child s mind and body cannot bear on its own. Momentby moment the therapist confirms the child s experience. This witnessing fostersthe child s trust in what she herself feels and perceives, leading to her evolving amore genuine self, a keystone of psychological health.

8 The therapist s noticingand admiring the child s steps forward renews enthusiasm and joy for her owngrowth and the risk-taking it of all, the therapist empathically listens and responds to the understood deeply, having your perspective heard, is itself one of themost powerfully moving experiences you can have and counters the painful, ifcommon, sense of being unheard and ignored. In addition to being reparative initself, the therapist s empathic stance facilitates clinical interventions thatacutely meet the patient just where she is emotionally, neither falling f lat noroverwhelming an empathic atmosphere also creates constant opportunities forthe therapist to make empathic failures (Kohut, 1971), moments when hedoesn t grasp some important communication from the patient, making the childfeel painfully dismissed, criticized, rejected, [fill in the blank].

9 By continually acknowledging our empathic missteps and allowing our patientsto react to and analyze them, we as therapists enable those children to grow stur-dier esteems under thicker the child is the one in charge of his own THERAPY , he can actively workon experiences in which he was originally helpless and impotent. In a fantastic re-versal of fortune, the abused child can be the big grizzly who torments his oncetormenter. The learning disabled child who finds every minute in school an assaulton his pride can be the one who, in play, asks his teachers and peers questions theycan t answer. Likewise, the bully can actively play out what really propels hissadistic behavior, his feeling little and powerless.

10 Their reenacting in play, 6/4/03 2:46 PM Page 34 PSYCHOANALYTIC Play Therapycasting themselves this time around as the heroes and rescuers, can help childrento master and grow beyond overwhelming situations and allows the child to put her conflict into a symbolic arena (Irwin, 1983). Achild who feels unable to confront her alcoholic mother can confront a doll stand-ing in for her mom. That girl can speak her mind and even take revenge withoutfearing reprisal. The child also can project intolerable feelings about herself,putting internal conf lict on the outside, making it a concrete reality she can wres-tle with more comfortably (Jacobson, 1954).