Positive Relationships: Play Therapy - Exploring feelings

I am a play therapist working in a primary school in a deprived area of Manchester. I work with children and families across all the key stages, including the foundation stage. An essential part of my work involves helping parents to develop their understanding of their child's behaviour.

Play therapy provides children with the opportunity to explore feelings, express themselves and make sense of their life experiences. Play is the natural way that children learn, communicate and explore their world, and working with a play therapist provides them with a safe and trusting environment in which to think about difficult experiences. Rather than having to explain what is troubling them, as adult therapy usually expects, children are able to use play, such as arts and crafts, puppets and dolls, or small-world play, to communicate at their own level and at their own pace, without feeling interrogated or threatened.

Conventional talking therapies may be inappropriate for children who have difficulty understanding their feelings and putting them into words. With play therapy children are less likely to internalise these feelings. This may result in increased self-esteem, helping the child to cope with these difficulties in the real world.

Play therapy is effective for children who have experienced a variety of difficulties, such as abuse, loss or trauma, or witnessed domestic violence. It is most often used with children aged from three to 12 years.

During weekly sessions, which tend to last around 30 to 45 minutes for between two and four terms, children receive emotional support and can understand more about their own feelings and thoughts and become more emotionally literate. Sometimes they re-enact or play out traumatic or difficult experiences to make sense of their past and cope better with their future. Children may also learn to manage relationships and conflicts in more appropriate ways.

The outcomes of play therapy may be general - for example, a reduction in anxiety and raised self-esteem - or more specific, such as a change in behaviour and improved relations with family and friends.

CASE STUDIES

Amelia, five years old

Amelia was referred by her teacher because she was struggling to separate from her mother in the morning and would cling to her leg, crying and begging her not to leave. She struggled to engage with activities and was quiet and withdrawn. Both the teacher and mother were concerned, especially as it seemed to be getting worse.

During an initial interview with the mother, she shared that she had severe postnatal depression when Amelia was born and felt she hadn't bonded with her. Amelia's behaviour deteriorated when her three-year-old brother was born and her mother was feeling overwhelmed by the anger Amelia displayed towards him. She had no postnatal depression with the brother and described him as a happy child who had settled well at nursery.

Amelia had 20 individual weekly play therapy sessions with me, followed by six parent and child sessions working together with me. Amelia was able to work through her feelings of anger towards her brother, experience the opportunity to be a baby again herself, and make sense of why she felt so anxious about leaving her mother.

I worked closely with the mother alongside Amelia's sessions, encouraging her to explore with me the first two years of Amelia's life and the impact on Amelia of her being emotionally unavailable. This work, which was often painful for her, enabled her to gain a deeper understanding of Amelia and her anxiety about being separated.

The sessions created a space for them to reconnect. I encouraged the mother to continue this with Amelia after the intervention. Amelia's behaviour changed dramatically and she became more confident at leaving and trusting that her mother would return. I supported them with weekly play dates for both siblings together to develop their relationship. At first these were challenging and ended in tears and fighting. However, as Amelia used her time in play therapy to work through her feelings of anger towards her brother, she no longer directed this at him and they became able to play together.

Amelia settled well in Year 1, separating easily from her mother. She is described as a confident and happy child by her teacher. The mother feels more confident in her ability to parent and is continuing with the weekly play dates with both children.

Ryan, four years old

Ryan's teacher was concerned about the aggressive behaviour he showed towards other children, especially his twin brother Joe. When he was reprimanded for this he would sob inconsolably.

When I met his mother, a single parent, she explained that he had always been difficult and referred to him as the 'bad twin' and his brother as the 'good twin'. Ryan's birth was very difficult and painful, whereas it had been easy with Joe, who was born first. Ryan struggled to feed, was difficult to settle and would be awake for hours at night, while Joe slept through. She found Ryan's behaviour so difficult to manage that he spent time at weekends with her sister, while Joe stayed with her.

Ryan had 18 individual sessions of play therapy and I also saw the mother on a weekly basis to support her, as at times Ryan's behaviour got worse as he worked through his feelings.

The sessions involved a lot of twin themes, such as 'the good and bad babies', two naughty dinosaurs who kept being sent away until they could be good. Ryan displayed lots of aggression towards the 'good baby', who eventually became bad and was sent away too. Over time, the sessions changed and involved two good babies who played together, were friends and had lots of adventures, always resulting in a happy ending.

This shift in Ryan's play therapy sessions mirrored changes at home, as my work with his mother enabled her to understand the impact of sending him away at the weekends. We explored how this reinforced Ryan's negative view of himself, as well as the difficulties for her of his birth and early childhood. This enabled her to develop a better understanding of his behaviour and to support him in making positive changes.

Ryan is now a popular member of the nursery, with a protective relationship towards his brother. His teacher describes him as kind and helpful. His mother is delighted with the changes in him and now refers to them proudly as 'my two good boys'.

Cath Hunter works as a freelance play therapist across primary schools in the north-west. She worked as a nursery nurse and childcare lecturer before qualifying as a play therapist in 2004

Further information

www.therapeuticfamilyinterventions.co.uk