- Email: [email protected]
Low budget play therapy for very young children
0145-2134/79/0301-0199$02.00/O.
Child Abuse and Neglect, Vol. 3, pp. 199 - 204. 0 Pergamon Press Ltd., 1979. Printed inGreatBritain.
LOW BUDGET PLAY THERAPY FOR VERY YOUNG CHILDREN
Elizabeth Davoren 5080 Paradise Drive, Tiburon, California 94920 USA
There is growing agreement in the field that children who have been abused and neglected need direct therapy; but only a emall portion of those who need the treatment get it. Lack of money, lack of therapists, and parental resistance are among the deterrents to the needed therapyl. I inadvertantly discovered one way around these three obstacles when working as a consultant forthe Extended Family Center in San Francisco2. The Extended Family Center provided day care for infants, toddlers, and preschool children who had been severely abused or neglected, and treatment for their parents. Excessive Violence -- the Presenting Problem One day during consultation the day care staff were discussing problems caused by the excessive violence of the three to five year old preschoolers. Physical attacks directed toward the staff could be handled. However, the attacks the children directed toward each other could not always be anticipated and prevented. They hurt each other, which was bad enough in and of itself, but in addition the resulting bruises, bite marks and scratches enraged the parents of the injured. "How come," their parents wanted to know, "we have to answer for anything that you don't like about the way the kids look when we bring them in, but when we pick them up, they have marks on them that would put us in jail?" Although such statements were not accurate, there was an uncomfortable element of truth in them. It was embarrassing to try to answer parents under the circumstances. Doll House Play --
a
Trial Solution
We considered what could be done to diminish the children's hitting each other that had not already been tried. It was the staff assumption, based on considerable experience, that the children were bringing to day care an overflow of anxiety and rage from home. I suggested that doll house play might be used to alleviate the tension that resulted in aggressive interaction while allowing a child to share home bound worries in a non-threateningway. Since the staff did not know how to encourage or handle doll house play, we arranged to use some of my conaultation time for a demonstration of play techniques. The first demonstration took place in a corner of the preschool play room. The doll house, typical of those used in play therapy, consisted of heavy rectilinear boards with appropriately placed holes to represent windowe and doors. The boards could be fitted together in a number of ways, thus allowing for variable room sizes. The house was roofless and all play took place
looking down on the rooms. Indestructiblewooden furniture was arranged in the rooms. Flexible plastic dolls with felt clothes were placed at random throughout the house. The dolls represented mothers, fathers, sisters and brothers. The popular baby dolls had to be replaced frequently because some of the youngsters swallowed them. There were black dolls and white dolls, but none to represent the appearance of latinos and orientals who were an important part of the play school population.
'For details of obstacles experienced at the National Center for Prevention and Treatment of Child Abuse and Neglect in Denver, 888 Chapter 21, pp. 265-273 in Martin, Harold, The Abused Child, Ballinger Publishing, Cambridge, 1976. =a fuller description, see: Ten Broeck, Elea, The Extended Family Center, Children Today, Vol. 3, No. 2, 2 (1974). 199
We could have guessed that doll house play in an open setting would soon become the free-forall it did. The amount of staff attention focused on the activity caused the children to contest for attention rather than play in the house. The winner of the contest sat himself down on the house, covering the rooms and their contents, thereby ending the play and enraging the other children. After this brief introduction,which at least allowed all of the children to have a look at the doll house and dolls, we moved into a separate structure only a few steps away, The tiny cottage normally used for staff meetings contained little that could damage or be damaged. There were no windows. The skylight was too high to be reached by objects hurled in its direction, and what furniture there was could be jumped on and otherwise abused without causing concern. On the minus side, the room was exceptionally unattractive and there was no heat. Since broken toys and other objects were stored in the room, it was important to remember to remove them before play sessions began. From Play Demonstrations to Play Therapy After a few weeks I felt that being in the role of demonstrator affected my relationship with the children, making the sesaions less productive than they should be. Also the staff who were used to being spontaneous with the children tended to interrupt the flow of their play by asking questions and making suggestions. I asked to see the children for a while without staff to give me a chance to refine techniques. The time spent with the children was so intriguing that what started out as brief demonstration8 of doll house play for the staff evolved into 18 months of play therapy sessions for the children. I had only two hours each week to be divided among the 10 to 15 children in the preschool group. There were always more requests for play sessions than could be mat. Frustrated by having to tell children too young to understand that I would see them next week, I tried in one session 'qencouraging"each one to leave after about 10 minutes. The week following 1 had the play room and the time to myself. The children had felt pushed out and unwanted, and did not want to return. With the free time I went shopping at a nearby sweet shop for candy bribes. An assortment of small candies was selected, from which the children could choose any three that appealed to them at the completion of their play. The bribea were intentionally small. That way no child would find it too much of a drawing card if he/she didn't want to come for a play period nor would any child find it too much of a disappointment if time, therefore the candy treat, were not available. Agatha At first the candies were given only to thoee who came for a play session, but an experience with four year old Agatha soon changed that. Agatha walked on tip toe all the time. She was one of the moat disturbed and frightened children at the Center. Her mother had smothered one baby before Agatha was born, and, although Agatha had never been physically harmed or neglected, she had been locked in a closet for aa much as five hours at a time. Unlike the others, she took weeks to get used to me. I chatted with her every week, or tried to. Slowly she responded, and after six weeks she even managed to tiptoe into the play room and ask if she could have some candies. I invited her in to play. She refused. I explained that candies came at the end of a play session. Agatha looked indignant and betrayed. She had worked up courage to come into a strange room for nothing. The next week I took her aside and told her the rule on candy was changed, so any time she wanted to come in and just ask for candies, that would be all right. She didn't come right away, but when she did she decided she would stay and play. Developing the Play Sessions The time spent in the play room by each child varied from a few minutes to thirty minutes. I learned to gauge how much time each child needed by taking into account: 1) the general appearance and affect of the child, 2) the importance of the subject matter tackled and the intensity of the play. In the beginning I very gently tried to focus the children's attention on the house and doll play. It became apparent that it was better to let each child choose what to do. The limited toy supply did some of the focusing for ~8. Any control which was tried experimentally in order tc streamline the use of the limited time available wa8 soon relinquished. AS it developed our brief play period became a time in which the children had almost complete control over their activities, as well aa undivided, non-critical adult attention. The sort of non-directive
Play Therapy
for Very Young
Children
201
play therapy3 that was being used was a unique experience for these children who were accustomed to exceptional demands, control, and criticism from their parents. Even the day care staff, who were pro-child, warm, and supportive, had to set limits continuously to avoid chaos. The children showed strength and insight in their play one would never believe possible. However, their play was so different from the non-Center children I had known in several states and settings that I asked staff who had preschool children if they would bring them in for a brief play session. The staff were of the same ethnic mix and lived in the same neighborhoods as the Center families. Their children's play did prove to be different from that of the Center children, and comparable to the other non-Center children I had known. Characteristicsof Play As others have found with abused and neglected children, the language skills of the Center's They used less fantasy in their play5. There was an abunchildren were notably deficient 4' dance of anticipated violence. Some of it was played out with the dolls. The parent dolls continuously threatened the child dolls, and beat them to reinforce threats. Mass violence -all the dolls beating and killing each other -- was common. Interestingly enough, with the exception of one 4-year old boy, no one used any television themes even though all of them had seen a great deal of television. The play house furniture was thrown around and stomped on many times. It was rarely placed in anything near an orderly fashion. If a child found the furniture arranged he/she would ask who put it that way, and, without waiting for an answer, would mess it up and stack it. Dolls, too, were often piled on top of one another. As most children do, they took off the dolls' clothes to look for genitals. However, their knowledge of sexual behavior exhibited in doll play was far more extensive than that of most children of comparable ages. Most non-violent play started with the dolls being put down to sleep. For many of the children putting the dolls to sleep was their major activity. An unusual amount of attention was paid to the refrigerator, but it was more likely to be used as a place to sleep than a source of food. I was surprised that food or eating was not more of a theme because of the enormous amount of time each child at the Center normally devoted to eating. The TV was probably the most commented on and used piece of furniture in the play house. The dolls were put about a room to watch TV -- that's all. The toilet was also used fairly frequently. Going "pee" or "ca-can seemed to be regarded with much more embarrassmentor sense of doing the forbidden than any of the sexual activity that was played out with the dolls. The bathtub was used for sleeping, as was every other piece of furniture in the house. Beds were used occasionally for sex, as well as sleeping. Agatha -- Reprise Although there were many similarities in their play, each child had his or her own agenda -played out from week to week, until reaching what appeared to be a resolution. For instance, Agatha, the child who had been so reluctant to try the play room, stayed for only brief periods at first. She was somewhat threatened by the locked door, which was necessary to keep the other children out. Her first day was spent picking up dolls and pieces of furniture naming each in a tentative sort of way, then quickly putting them down. "I want my candy now", she said. She snatched three pieces of candy and left as quickly as her tiptoeing would allow. Over a period of four months she progressed through four stages: 1) picking up, identifying by name and quickly putting down each piece of furniture and each doll (almost as if they were hot coals), 2) holding on to each object longer and naming each with increasing assurance, 3) piling dolls and furniture randomly about the rooms of the house, 4) making specific placement of the furniture and the dolls. Stage 3, the piling, went on the longest time, and stage 4, the specific placement, was epitomized in her last play session when she organized the furniture and sat the dolls, each in a place of its own. "ThereI" she said, looking quite satisfied. She had already increased her time of deliberation over the candy selection, but this time she was the most careful she had ever been. In her play room behavior, Agatha seemed to be taking 3 The form of therapy used with the children did not differ markedly from that described by Ballantine Books, New York, 1969 and Dibs in Search of Self, Virginia Axline inPla Thera allantine Books, New WL York9 & As noted p. 85 of: Martin, Harold, The Abused Child, Ballinger Publishing, Cambridge, 1976. 5 Compared, for instance, to the play of a normal four year old child as cited in Erikson, Erik, Toys and Reasons, Norton Publishers, New York, 1977.
202
E. Davoren
increasing charge of the turmoil that she felt inside of herself, becoming lees afraid and She also could begin to make decisions about what she wanted more sure of her surroundings. for herself. April Unlike the reluctant Agatha, April was an enthusiastic and aggressive participant. She almost always managed to be the first play room participant of the day, no matter how severe the April was 3% years old at the time she started play therapy. She had been "in competition. charge" of a household and two younger brothers since whe was 3. Her mother was partially paralyzed and on occasion overtly psychotic. She stayed in bed a lot. Whatever was done while the father was at work had to be done by this child. April's main theme in play therapy was "Clean the house or go to jail" a policeman would roar to the assembled doll house cleaning. Everyone would refuse to clean the house and its piled up furniture. So they would family. be taken to jail. Elaborate, usually eucceesful, p lots to escape from jail took place, someThis sort of play went on for about a times ending with the policeman locked in his own jail. The concluding episode of the year -- not every week, but with a high degree of frequency. slowly evolving drama had the house being cleaned by all of its inhabitants, followed by the April seemed to be both the policeman and the houeepoliceman's moving in as a family member. holder -- at the same time she was the powerful person who would see to it that the house was in order and she was also one of those who would attempt to escape the responsibility. Her resolution of the dilemma was to spread the responsibility around, and change the role of the Toward the end of her play room visits she stopped fighting policeman from overseer to equal. At the time I thought she was less invested in play sessions, which ferociously to be first. may have been so, but it also seems likely that it was not as necessary for her to run things She could be one of the group -- which for her was an achievement. anymore. Mark April had run everybody else's life, but Mark was only responsible for his own. Mark was known in the neighborhood bars where he spent most of his time as the child who could take care By age three he was already a rough, tough street kid who had fallen out of a of himself. second story window onto the street below and survived with a scraped face and a broken arm. His mother had no investment in him and his stepfather was so passive he seemed not to exist. At the Center, Mark spent most of his time testing limits and his teacher's endurance. His He came first for the candy and ended up staying interest in play sessions developed slowly. As might be expected, his play was full of violence -- kicking off " the cop's weeto play. wee", and killing all the dolls over and over again -- but eventually rescuing one doll that There were many violent themes and much sex play. However, the seemed clearly to be himself. most relevant happening was not around the doll house play. At first the testing of limits which I had expected from Mark did not materialize. There are so few limits to teat, I thought, he can't be bothered, or possibly he is content here because As soon as Mark's intense I was wrong. there are so few limits -- he doesn't need to test. One day interest in play diminished, he found the limit to test -- the three candy limit. The rule was simply explained, but after picking three candies he announced he wanted more. Reflective techniques6 were used successfully for a couple of weeks he could not accept it. with such comments as: "you wish you had more candy", "you're mad because I don't let you have As soon as the candies were presented it". By the third week he was ready wrth a new tactic. I saw what was coming and closed the conhe dived for them -- prepared to take a fistful. "I promise I will just take three " he aaid and he did when the candy was again offered. tainer. "I don't have any candies But he quickly threw these candies away and showed his empty hands. "You can pick up those you threw if you like:' I Can I have my three candies?" he asked. now. Instead of candy, he picked up tricycle handlebars that had not been removed from the said. "Give me candy or I'll hit you", he said. 'You want to control room as they should have been. You have a hard time deciding to follow tha rule", I countered. the number of candies you pick. He was poised to strike for a few I prepared mentally to protect myself, but did not move. It was with relief that I watched him lower the handle bars to the floor. momemts. These vigorous attempts to get his way were tried with variation over a two-week period, and He looked then on the third week after a short play period, he aaid rrI'm ready for my candy."
6
Ae discussed p. 73 Axline, Virginia, Play Therapy, idem, and p. 16 Children in Play Therapy, Ballantine Books, New York, 1953.
Mouetakae,
Clark,
Play Therapy
for Very Young
Children
203
over the offered mix for a long, long time, then slowly and deliberately picked out three, scrutinizing my face after each candy selection and building up considerable suspense. This It seemed as if this were the first time Mark knowbehavior was repeated for several weeks. ingly internalized someone else's rule and made it his own. "I will have three candies," he said on his last visit -- "not one, or two, or four, just three." Allen I was surprised when one of the staff members told me that Allen couldn't talk. I had passed him on the way through the Center to the play therapy room and he was saying a very underWe did not know it, at first, but Allen'8 use of langstandable "fuck you" into a toy phone. In the play room after weeks of playing out hitting uage reflected his whole state of being. and killing scenarios and abundant sex themes, (using a few words, when necessary), he turned his attention to the cassette recorder which was recording the sessions. Unlike the other children, who liked to speak briefly into it, rewind the tape and listen to themselves, Allen wanted only to talk. On guessing he wished to use the recorder, since he wasn't explicit about it, I put him on my lap and we put the recorder with its conddnser microphone in his lap. What followed was a bit He made noises as if talking, but there were no understandable words said. He of a shock. "talked" for half an hour without pause, saying nothing. When the tape clicked off, he left. Thirty minutes was a long time to spend with one child, but it was strange to spend it with a I played the tape at home one evening, and child making wordless noises into a tape recorder. was shocked again. After having been lulled almost to inattention I was startled to hear the word l'hospital'l said quite clearly. There was one more discernable word several minutes later, "hurt" . Allen spoke more often and more clearly during play sessions after that. As you have probably guessed he was physically abused and was in a hospital at one time. We had very little information about the hospitalization. Perhaps what Allen wanted to say had no words, or could not be said, except in the special way he used. I played the tape for the staff in a training meeting several months after Allen made it. They found the sounds that Allen uttered too painful to listen to, although they couldn't say why. Melissa I rarely talked with the staff about the content of sessions with the children. The exception was one session with Melissa. Melissa came from a very chaotic family. Melissa's mother had been severely abused as a child, physically by her mother and sexually by her father. Hot grease had been poured on her as a child -- and she poured hot grease on one of her children, causing him severe burns. Although Melissa had not been hurt, she was considered at risk and placed in the Center when she was five years old along with her younger siblings. I looked forward to her visits to the play room because, unlike the other children, her speech was easily understood and she played out stories of family life. One day she played out a story of murder. The girl doll (herself) and the mother doll were hiding from the father doll who was chasing them with a gun, having already killed the rest of the family. I had interviewed Melissa's parents sometime before this play episode and knew them to have murderous impulses as well as the guns to implement them. I was, therefore,very concerned that Melissa's play might be closer to reality than fantasy. The staff was alerted and devised a plan for closer support and supervision of the family. We had no way of knowing what would have happened withWith intervention the family relationships improved and no one was hurt. out intervention. It was unlikely that the staff made Melissa, however, did not play out family themes again. any overt reference to the play that stimulated the intervention, but the subsequent change in Melissa's behavior made me think she sensed that I had talked about her with others. Advantages
and Disadvantages
of Time Constraints
One of the advantages of low budget therapy turned out to be that there was relatively little time to share information about the content of play sessions with the staff. This meant that the confidences of my young patients were not violated, except for the described episode with Equally important, the staff did not fell deliberately left out of what went on Melissa. between the children and me. In addition to the minimal cost of providing 40 children with a play therapy experience there were other benefits. There were no subtle pressures on the children to attend or not attend play sessions as there can be when parents or others are involved in transporting a child at a set time to a waiting therapist. Since the decision was completely theirs to make on the spur of the moment, they controlled the first step of treatment; would they or would they not attend.
204
E. Dnvoren
As for the parents, they considered the time their children spent with me another preschool activity and no threat to their self-image. They did not feel that the need for play therapy implied they were inadequate or at fault fn their childrearing practices. The brief time I had with each child did not allow for much of a bond between "8, so that parents did not perceive my time with their children a challenge to their relationahip7. The time factor also could seemed to encourage autonomy, which supported the children in working out ways that ~ deal with their lives. The surprise waa that they were able to accomplish as much as they did. They had been so traumatized and they were 80 young. Their youth, however, waa an advantage. They had not built up many defenses, nor had they become aa fixed in their ways aa they would in a few years. The limited amount of play materials provided them with lees to pick from to express themselves, but fewer toys meant there was also leas to distract children who were highly distractable. Time limitations have disadvantages, too, of course. To name a few, there is lesa planning time, less recording time, and a good deal more wear and tear on the therapist. All told, however, most disadvantages changed into advantages as play therapy developed and moved beyond its original purpose of reducing physical conflict among the preschool children at the Extended Family Center through doll house play. Low budget play therapy became a useful tool for dealing with the overwhelming aggression and other problems as well of very young children who had been severely abused and neglected and were continuing to stay in their own homes while in day care.
7 For a significant elaboration of the psychology of the parent-child relationship see: Goldstein, Joseph; Freud, Anna; Solnit, Albert J., Beyond the Best Interests of the Child, Free Preaa, New York, 1973.
Child Abuse and Neglect, Vol. 3, pp. 199 - 204. 0 Pergamon Press Ltd., 1979. Printed inGreatBritain.
LOW BUDGET PLAY THERAPY FOR VERY YOUNG CHILDREN
Elizabeth Davoren 5080 Paradise Drive, Tiburon, California 94920 USA
There is growing agreement in the field that children who have been abused and neglected need direct therapy; but only a emall portion of those who need the treatment get it. Lack of money, lack of therapists, and parental resistance are among the deterrents to the needed therapyl. I inadvertantly discovered one way around these three obstacles when working as a consultant forthe Extended Family Center in San Francisco2. The Extended Family Center provided day care for infants, toddlers, and preschool children who had been severely abused or neglected, and treatment for their parents. Excessive Violence -- the Presenting Problem One day during consultation the day care staff were discussing problems caused by the excessive violence of the three to five year old preschoolers. Physical attacks directed toward the staff could be handled. However, the attacks the children directed toward each other could not always be anticipated and prevented. They hurt each other, which was bad enough in and of itself, but in addition the resulting bruises, bite marks and scratches enraged the parents of the injured. "How come," their parents wanted to know, "we have to answer for anything that you don't like about the way the kids look when we bring them in, but when we pick them up, they have marks on them that would put us in jail?" Although such statements were not accurate, there was an uncomfortable element of truth in them. It was embarrassing to try to answer parents under the circumstances. Doll House Play --
a
Trial Solution
We considered what could be done to diminish the children's hitting each other that had not already been tried. It was the staff assumption, based on considerable experience, that the children were bringing to day care an overflow of anxiety and rage from home. I suggested that doll house play might be used to alleviate the tension that resulted in aggressive interaction while allowing a child to share home bound worries in a non-threateningway. Since the staff did not know how to encourage or handle doll house play, we arranged to use some of my conaultation time for a demonstration of play techniques. The first demonstration took place in a corner of the preschool play room. The doll house, typical of those used in play therapy, consisted of heavy rectilinear boards with appropriately placed holes to represent windowe and doors. The boards could be fitted together in a number of ways, thus allowing for variable room sizes. The house was roofless and all play took place
looking down on the rooms. Indestructiblewooden furniture was arranged in the rooms. Flexible plastic dolls with felt clothes were placed at random throughout the house. The dolls represented mothers, fathers, sisters and brothers. The popular baby dolls had to be replaced frequently because some of the youngsters swallowed them. There were black dolls and white dolls, but none to represent the appearance of latinos and orientals who were an important part of the play school population.
'For details of obstacles experienced at the National Center for Prevention and Treatment of Child Abuse and Neglect in Denver, 888 Chapter 21, pp. 265-273 in Martin, Harold, The Abused Child, Ballinger Publishing, Cambridge, 1976. =a fuller description, see: Ten Broeck, Elea, The Extended Family Center, Children Today, Vol. 3, No. 2, 2 (1974). 199
We could have guessed that doll house play in an open setting would soon become the free-forall it did. The amount of staff attention focused on the activity caused the children to contest for attention rather than play in the house. The winner of the contest sat himself down on the house, covering the rooms and their contents, thereby ending the play and enraging the other children. After this brief introduction,which at least allowed all of the children to have a look at the doll house and dolls, we moved into a separate structure only a few steps away, The tiny cottage normally used for staff meetings contained little that could damage or be damaged. There were no windows. The skylight was too high to be reached by objects hurled in its direction, and what furniture there was could be jumped on and otherwise abused without causing concern. On the minus side, the room was exceptionally unattractive and there was no heat. Since broken toys and other objects were stored in the room, it was important to remember to remove them before play sessions began. From Play Demonstrations to Play Therapy After a few weeks I felt that being in the role of demonstrator affected my relationship with the children, making the sesaions less productive than they should be. Also the staff who were used to being spontaneous with the children tended to interrupt the flow of their play by asking questions and making suggestions. I asked to see the children for a while without staff to give me a chance to refine techniques. The time spent with the children was so intriguing that what started out as brief demonstration8 of doll house play for the staff evolved into 18 months of play therapy sessions for the children. I had only two hours each week to be divided among the 10 to 15 children in the preschool group. There were always more requests for play sessions than could be mat. Frustrated by having to tell children too young to understand that I would see them next week, I tried in one session 'qencouraging"each one to leave after about 10 minutes. The week following 1 had the play room and the time to myself. The children had felt pushed out and unwanted, and did not want to return. With the free time I went shopping at a nearby sweet shop for candy bribes. An assortment of small candies was selected, from which the children could choose any three that appealed to them at the completion of their play. The bribea were intentionally small. That way no child would find it too much of a drawing card if he/she didn't want to come for a play period nor would any child find it too much of a disappointment if time, therefore the candy treat, were not available. Agatha At first the candies were given only to thoee who came for a play session, but an experience with four year old Agatha soon changed that. Agatha walked on tip toe all the time. She was one of the moat disturbed and frightened children at the Center. Her mother had smothered one baby before Agatha was born, and, although Agatha had never been physically harmed or neglected, she had been locked in a closet for aa much as five hours at a time. Unlike the others, she took weeks to get used to me. I chatted with her every week, or tried to. Slowly she responded, and after six weeks she even managed to tiptoe into the play room and ask if she could have some candies. I invited her in to play. She refused. I explained that candies came at the end of a play session. Agatha looked indignant and betrayed. She had worked up courage to come into a strange room for nothing. The next week I took her aside and told her the rule on candy was changed, so any time she wanted to come in and just ask for candies, that would be all right. She didn't come right away, but when she did she decided she would stay and play. Developing the Play Sessions The time spent in the play room by each child varied from a few minutes to thirty minutes. I learned to gauge how much time each child needed by taking into account: 1) the general appearance and affect of the child, 2) the importance of the subject matter tackled and the intensity of the play. In the beginning I very gently tried to focus the children's attention on the house and doll play. It became apparent that it was better to let each child choose what to do. The limited toy supply did some of the focusing for ~8. Any control which was tried experimentally in order tc streamline the use of the limited time available wa8 soon relinquished. AS it developed our brief play period became a time in which the children had almost complete control over their activities, as well aa undivided, non-critical adult attention. The sort of non-directive
Play Therapy
for Very Young
Children
201
play therapy3 that was being used was a unique experience for these children who were accustomed to exceptional demands, control, and criticism from their parents. Even the day care staff, who were pro-child, warm, and supportive, had to set limits continuously to avoid chaos. The children showed strength and insight in their play one would never believe possible. However, their play was so different from the non-Center children I had known in several states and settings that I asked staff who had preschool children if they would bring them in for a brief play session. The staff were of the same ethnic mix and lived in the same neighborhoods as the Center families. Their children's play did prove to be different from that of the Center children, and comparable to the other non-Center children I had known. Characteristicsof Play As others have found with abused and neglected children, the language skills of the Center's They used less fantasy in their play5. There was an abunchildren were notably deficient 4' dance of anticipated violence. Some of it was played out with the dolls. The parent dolls continuously threatened the child dolls, and beat them to reinforce threats. Mass violence -all the dolls beating and killing each other -- was common. Interestingly enough, with the exception of one 4-year old boy, no one used any television themes even though all of them had seen a great deal of television. The play house furniture was thrown around and stomped on many times. It was rarely placed in anything near an orderly fashion. If a child found the furniture arranged he/she would ask who put it that way, and, without waiting for an answer, would mess it up and stack it. Dolls, too, were often piled on top of one another. As most children do, they took off the dolls' clothes to look for genitals. However, their knowledge of sexual behavior exhibited in doll play was far more extensive than that of most children of comparable ages. Most non-violent play started with the dolls being put down to sleep. For many of the children putting the dolls to sleep was their major activity. An unusual amount of attention was paid to the refrigerator, but it was more likely to be used as a place to sleep than a source of food. I was surprised that food or eating was not more of a theme because of the enormous amount of time each child at the Center normally devoted to eating. The TV was probably the most commented on and used piece of furniture in the play house. The dolls were put about a room to watch TV -- that's all. The toilet was also used fairly frequently. Going "pee" or "ca-can seemed to be regarded with much more embarrassmentor sense of doing the forbidden than any of the sexual activity that was played out with the dolls. The bathtub was used for sleeping, as was every other piece of furniture in the house. Beds were used occasionally for sex, as well as sleeping. Agatha -- Reprise Although there were many similarities in their play, each child had his or her own agenda -played out from week to week, until reaching what appeared to be a resolution. For instance, Agatha, the child who had been so reluctant to try the play room, stayed for only brief periods at first. She was somewhat threatened by the locked door, which was necessary to keep the other children out. Her first day was spent picking up dolls and pieces of furniture naming each in a tentative sort of way, then quickly putting them down. "I want my candy now", she said. She snatched three pieces of candy and left as quickly as her tiptoeing would allow. Over a period of four months she progressed through four stages: 1) picking up, identifying by name and quickly putting down each piece of furniture and each doll (almost as if they were hot coals), 2) holding on to each object longer and naming each with increasing assurance, 3) piling dolls and furniture randomly about the rooms of the house, 4) making specific placement of the furniture and the dolls. Stage 3, the piling, went on the longest time, and stage 4, the specific placement, was epitomized in her last play session when she organized the furniture and sat the dolls, each in a place of its own. "ThereI" she said, looking quite satisfied. She had already increased her time of deliberation over the candy selection, but this time she was the most careful she had ever been. In her play room behavior, Agatha seemed to be taking 3 The form of therapy used with the children did not differ markedly from that described by Ballantine Books, New York, 1969 and Dibs in Search of Self, Virginia Axline inPla Thera allantine Books, New WL York9 & As noted p. 85 of: Martin, Harold, The Abused Child, Ballinger Publishing, Cambridge, 1976. 5 Compared, for instance, to the play of a normal four year old child as cited in Erikson, Erik, Toys and Reasons, Norton Publishers, New York, 1977.
202
E. Davoren
increasing charge of the turmoil that she felt inside of herself, becoming lees afraid and She also could begin to make decisions about what she wanted more sure of her surroundings. for herself. April Unlike the reluctant Agatha, April was an enthusiastic and aggressive participant. She almost always managed to be the first play room participant of the day, no matter how severe the April was 3% years old at the time she started play therapy. She had been "in competition. charge" of a household and two younger brothers since whe was 3. Her mother was partially paralyzed and on occasion overtly psychotic. She stayed in bed a lot. Whatever was done while the father was at work had to be done by this child. April's main theme in play therapy was "Clean the house or go to jail" a policeman would roar to the assembled doll house cleaning. Everyone would refuse to clean the house and its piled up furniture. So they would family. be taken to jail. Elaborate, usually eucceesful, p lots to escape from jail took place, someThis sort of play went on for about a times ending with the policeman locked in his own jail. The concluding episode of the year -- not every week, but with a high degree of frequency. slowly evolving drama had the house being cleaned by all of its inhabitants, followed by the April seemed to be both the policeman and the houeepoliceman's moving in as a family member. holder -- at the same time she was the powerful person who would see to it that the house was in order and she was also one of those who would attempt to escape the responsibility. Her resolution of the dilemma was to spread the responsibility around, and change the role of the Toward the end of her play room visits she stopped fighting policeman from overseer to equal. At the time I thought she was less invested in play sessions, which ferociously to be first. may have been so, but it also seems likely that it was not as necessary for her to run things She could be one of the group -- which for her was an achievement. anymore. Mark April had run everybody else's life, but Mark was only responsible for his own. Mark was known in the neighborhood bars where he spent most of his time as the child who could take care By age three he was already a rough, tough street kid who had fallen out of a of himself. second story window onto the street below and survived with a scraped face and a broken arm. His mother had no investment in him and his stepfather was so passive he seemed not to exist. At the Center, Mark spent most of his time testing limits and his teacher's endurance. His He came first for the candy and ended up staying interest in play sessions developed slowly. As might be expected, his play was full of violence -- kicking off " the cop's weeto play. wee", and killing all the dolls over and over again -- but eventually rescuing one doll that There were many violent themes and much sex play. However, the seemed clearly to be himself. most relevant happening was not around the doll house play. At first the testing of limits which I had expected from Mark did not materialize. There are so few limits to teat, I thought, he can't be bothered, or possibly he is content here because As soon as Mark's intense I was wrong. there are so few limits -- he doesn't need to test. One day interest in play diminished, he found the limit to test -- the three candy limit. The rule was simply explained, but after picking three candies he announced he wanted more. Reflective techniques6 were used successfully for a couple of weeks he could not accept it. with such comments as: "you wish you had more candy", "you're mad because I don't let you have As soon as the candies were presented it". By the third week he was ready wrth a new tactic. I saw what was coming and closed the conhe dived for them -- prepared to take a fistful. "I promise I will just take three " he aaid and he did when the candy was again offered. tainer. "I don't have any candies But he quickly threw these candies away and showed his empty hands. "You can pick up those you threw if you like:' I Can I have my three candies?" he asked. now. Instead of candy, he picked up tricycle handlebars that had not been removed from the said. "Give me candy or I'll hit you", he said. 'You want to control room as they should have been. You have a hard time deciding to follow tha rule", I countered. the number of candies you pick. He was poised to strike for a few I prepared mentally to protect myself, but did not move. It was with relief that I watched him lower the handle bars to the floor. momemts. These vigorous attempts to get his way were tried with variation over a two-week period, and He looked then on the third week after a short play period, he aaid rrI'm ready for my candy."
6
Ae discussed p. 73 Axline, Virginia, Play Therapy, idem, and p. 16 Children in Play Therapy, Ballantine Books, New York, 1953.
Mouetakae,
Clark,
Play Therapy
for Very Young
Children
203
over the offered mix for a long, long time, then slowly and deliberately picked out three, scrutinizing my face after each candy selection and building up considerable suspense. This It seemed as if this were the first time Mark knowbehavior was repeated for several weeks. ingly internalized someone else's rule and made it his own. "I will have three candies," he said on his last visit -- "not one, or two, or four, just three." Allen I was surprised when one of the staff members told me that Allen couldn't talk. I had passed him on the way through the Center to the play therapy room and he was saying a very underWe did not know it, at first, but Allen'8 use of langstandable "fuck you" into a toy phone. In the play room after weeks of playing out hitting uage reflected his whole state of being. and killing scenarios and abundant sex themes, (using a few words, when necessary), he turned his attention to the cassette recorder which was recording the sessions. Unlike the other children, who liked to speak briefly into it, rewind the tape and listen to themselves, Allen wanted only to talk. On guessing he wished to use the recorder, since he wasn't explicit about it, I put him on my lap and we put the recorder with its conddnser microphone in his lap. What followed was a bit He made noises as if talking, but there were no understandable words said. He of a shock. "talked" for half an hour without pause, saying nothing. When the tape clicked off, he left. Thirty minutes was a long time to spend with one child, but it was strange to spend it with a I played the tape at home one evening, and child making wordless noises into a tape recorder. was shocked again. After having been lulled almost to inattention I was startled to hear the word l'hospital'l said quite clearly. There was one more discernable word several minutes later, "hurt" . Allen spoke more often and more clearly during play sessions after that. As you have probably guessed he was physically abused and was in a hospital at one time. We had very little information about the hospitalization. Perhaps what Allen wanted to say had no words, or could not be said, except in the special way he used. I played the tape for the staff in a training meeting several months after Allen made it. They found the sounds that Allen uttered too painful to listen to, although they couldn't say why. Melissa I rarely talked with the staff about the content of sessions with the children. The exception was one session with Melissa. Melissa came from a very chaotic family. Melissa's mother had been severely abused as a child, physically by her mother and sexually by her father. Hot grease had been poured on her as a child -- and she poured hot grease on one of her children, causing him severe burns. Although Melissa had not been hurt, she was considered at risk and placed in the Center when she was five years old along with her younger siblings. I looked forward to her visits to the play room because, unlike the other children, her speech was easily understood and she played out stories of family life. One day she played out a story of murder. The girl doll (herself) and the mother doll were hiding from the father doll who was chasing them with a gun, having already killed the rest of the family. I had interviewed Melissa's parents sometime before this play episode and knew them to have murderous impulses as well as the guns to implement them. I was, therefore,very concerned that Melissa's play might be closer to reality than fantasy. The staff was alerted and devised a plan for closer support and supervision of the family. We had no way of knowing what would have happened withWith intervention the family relationships improved and no one was hurt. out intervention. It was unlikely that the staff made Melissa, however, did not play out family themes again. any overt reference to the play that stimulated the intervention, but the subsequent change in Melissa's behavior made me think she sensed that I had talked about her with others. Advantages
and Disadvantages
of Time Constraints
One of the advantages of low budget therapy turned out to be that there was relatively little time to share information about the content of play sessions with the staff. This meant that the confidences of my young patients were not violated, except for the described episode with Equally important, the staff did not fell deliberately left out of what went on Melissa. between the children and me. In addition to the minimal cost of providing 40 children with a play therapy experience there were other benefits. There were no subtle pressures on the children to attend or not attend play sessions as there can be when parents or others are involved in transporting a child at a set time to a waiting therapist. Since the decision was completely theirs to make on the spur of the moment, they controlled the first step of treatment; would they or would they not attend.
204
E. Dnvoren
As for the parents, they considered the time their children spent with me another preschool activity and no threat to their self-image. They did not feel that the need for play therapy implied they were inadequate or at fault fn their childrearing practices. The brief time I had with each child did not allow for much of a bond between "8, so that parents did not perceive my time with their children a challenge to their relationahip7. The time factor also could seemed to encourage autonomy, which supported the children in working out ways that ~ deal with their lives. The surprise waa that they were able to accomplish as much as they did. They had been so traumatized and they were 80 young. Their youth, however, waa an advantage. They had not built up many defenses, nor had they become aa fixed in their ways aa they would in a few years. The limited amount of play materials provided them with lees to pick from to express themselves, but fewer toys meant there was also leas to distract children who were highly distractable. Time limitations have disadvantages, too, of course. To name a few, there is lesa planning time, less recording time, and a good deal more wear and tear on the therapist. All told, however, most disadvantages changed into advantages as play therapy developed and moved beyond its original purpose of reducing physical conflict among the preschool children at the Extended Family Center through doll house play. Low budget play therapy became a useful tool for dealing with the overwhelming aggression and other problems as well of very young children who had been severely abused and neglected and were continuing to stay in their own homes while in day care.
7 For a significant elaboration of the psychology of the parent-child relationship see: Goldstein, Joseph; Freud, Anna; Solnit, Albert J., Beyond the Best Interests of the Child, Free Preaa, New York, 1973.