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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
In Play Therapy With a 6-Year-Old, Dr. Jane Annunziata demonstrates her approach to working with children. Play therapy is premised on the assumption that a child's problems come from unconscious conflicts and developmental deficits, both of which will be revealed in their play. This nondirective approach requires the therapist to follow the child's lead: Being receptive and open is necessary before a child feels comfortable enough to reveal his or her emotional life. In this session, Dr. Annunziata works with a young boy named Matthew who has been sad and withdrawn. Through the process of play therapy, Matthew expresses more of his emotions, and the therapeutic alliance becomes stronger. This video features a client portrayed by an actor on the basis of actual case material. Precipitating Events Since his father's death, Matthew has been intermittently sad and withdrawn. He has been behaving in an increasingly protective way with his mother, and he feels more responsible for her as he has gotten older. He frequently tries to "cheer her up" and make her happy. Matthew doesn't talk much about missing his dad, his dad's death, or his feelings in general. When asked about his feelings about his father's death, he minimizes the impact and tends to find a bright side to it, saying, for example, "I have such a nice mom, and I have lots of nice cousins and uncles." He presents for treatment because his mother often finds him waking with bad dreams, sobbing. She also reports periodic instances of sadness during the day and withdrawal from family and peers. His teacher reports that on occasion Matthew does not want to go out for recess, and he looks sad at those times. His teacher also notes that he is withdrawing from classmates more frequently and participates less actively than before in classroom activities. Matthew's mother has not dated since her husband's death 2 years ago. She appears somewhat sad and is frequently tearful, although she is not clinically depressed. She reports that she enjoys her work as a bank executive and that she has a strong network of friends and family. Questions
Initial Sessions Seven sessions preceded the videotaped session. These included one background and one child guidance session with the mother, two play evaluation sessions with Matthew, and three play therapy sessions with Matthew. Sessions 1 and 2: His mother also provided a detailed developmental history that included conception, pregnancy, feeding, sleeping, motor development, toilet training, play patterns, emotional and physical health history, school history, relationships, separations from parent(s), expressions of aggression, and style of parental discipline at home. During these initial sessions with the mother, Dr. Annunziata talked with her to get a detailed picture of the family: description and significance of the family's economic situation; their social, ethnic, and religious ties; the nature of interrelationships in the family; the quality of the marriage; and Matthew's mother's reaction and Matthew's reaction to her husband's death. Matthew's mother also described her past history (i.e., her significant life experiences) as well as her deceased husband's history. Sessions 3 and 4: Sessions 5 through 7:
Dr. Jane asks Matthew, "Do you know why you are here?" Matthew tells her that he thinks it is because his mom is worried because she thinks he is sad. Dr. Jane responds, "Yes, you're right. Your mom is concerned because you've seemed sad. We are going to meet here today, and once every week for 50 minutes, to play and talk about your sad feelings and anything else that is worrying you or bothering you." She continues by telling Matthew about confidentiality: "Everything we talk about is private and a 'one-way secret.' That means you can tell anybody anything you want to about our sessions, but I won't talk about them to anyone else. I will meet with your mom about one time each month to give her a general idea of what we're working on, but I will not tell her about the specific things that we talk about or do here. Also, if you ever tell about something that could be dangerous for you, like someone hitting you a lot or touching you inappropriately, I will tell your mom about that and get the right help for you so you can always be safe." In the next two sessions, Dr. Jane and Matthew play with various toys in the playroom. The therapist observes several patterns in Matthew's play that reflect his emotional concerns and issues. These themes include a strong need to please and not disappoint others (especially authority figures), fear of adult disapproval and anger, concerns about things changing very quickly and unexpectedly in life, a tendency to minimize and deny any affect perceived as "negative" (e.g., sadness, anger, disappointment), and a fear of losing people or objects that he is attached to. Given that it is very early in therapy, Dr. Jane primarily notes these themes for use in later sessions. She does begin to label some of the feelings, issues, and patterns she sees in these sessions, using the displacement that play affords. Examples of what she said to Matthew include "I can see the people in this dollhouse sometimes feel sad, but kind of run away from those sad feelings"; and "The mechanics in this garage get really worried about making a mistake and disappointing their customers"; and "This detective keeps trying to find the missing statue that someone stole, but no matter how hard he looks he just can't find it." These beginning interventions lay the groundwork for some of the themes that will continue to occur and further evolve in future sessions. Matthew seems (in these early sessions) to be developing an appropriate therapeutic alliance with Dr. Jane and appears glad to have the opportunity to come to therapy each week. He expresses relief to his mother about having a "feelings doctor" (as Dr. Jane described herself) to help him with his sadness, bad dreams, and other worries and feelings that bother him. On the basis of his response to the therapist and her interventions in these early sessions, his prognosis for improvement in play therapy is quite good. Session 8: To be viewed. Questions
Stimulus Questions About the Videotaped Session Early in the session, it becomes clear that Dr. Annunziata and Matthew will have many verbal exchanges as the play therapy proceeds. The amount of therapist talk may surprise many viewers, because play therapy is sometimes associated with nonverbal treatment.
About 10 minutes into the session, developmental themes in the therapy are introduced in play by Matthew and verbalized by Dr. Annunziata. These themes are elaborated later in the session as well.
At different points in the session, Dr. Annunziata offers comments and interpretations using displacement (e.g., through the play materials, through different characters Matthew mentions). She generalizes about how children might react or how a child (not necessarily Matthew) might feel in a given situation.
In the last third of the session, the intensity of therapist interpretations appears to increase.
Toward the latter part of the session, Dr. Annunziata brings up "Carmen San Diego," a plot that was used in a previous play therapy session with Matthew.
In the last segment of the session, Dr. Annunziata encourages Matthew to face "missing feelings" through a discussion of the missing giraffe. Matthew both verbally and nonverbally backs away from this interchange. Dr. Annunziata overtly recognizes his resistance to exploring the missing feelings and, in the end, she proposes that perhaps she did "talk too much about the missing feelings."
At the close of the session, Dr. Annunziata assures Matthew that she will be able to help him with his feelings as their work together continues. Matthew confirms the therapeutic alliance with a strong "okay" and also confirms his agreement with the therapeutic process (i.e., "you heard him this time").
General Questions
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