Treating Children of Divorce with Play Therapy

Introduction

There has been a growing interest in the different ways in which divorce impacts children (Landreth, Ray, & Bratton, 2009). Landreth et al. (2009) suggests that children of divorce are affected in many different ways including emotionally, socially, and even psychologically. This disruption in well-being is often shown not only in the home, but at school as well (Landreth et al., 2009). It has become of great importance to continue to emphasize the need to provide effective services for young children struggling with mental health issues at an early age (Meany-Walen, Bratton, & Kottman, 2014). Reports indicate that because children spend much of their time at school, institutions are an ideal location for children to receive these services (Meany-Walen et al., 2014). School counselors, teachers, administrators, and faculty spend a lot of time with students, and are sometimes the first to notice changes in behavior (Trice-Black, Bailey, & Riechel, 2013). With that being said, schools have an essential role of identifying those students who need mental health services (Trice-Black et al., 2013). The challenge often lies in implementing those services in an effective and developmentally appropriate manner (Trice-Black et al., 2013). Applying play therapy in educational settings has been long encouraged by researchers, given that young children's more complex verbal abilities emerge only as they progress in age (Trice-Black et al., 2013).

This research paper will cover relevant research related to children of divorce, how divorce adversely impacts children, and different aspects of play therapy that this population can benefit from. The first portion will discuss children of divorce and their common reactions as it relates to the separation process. The second portion will discuss the different ways in which children of divorce are impacted in the educational setting. The third portion will provide an overview of play therapy. It will discuss different forms of play therapy along some limitations that come along with this intervention. Finally, with discussing multicultural considerations, information related to why play therapy is a beneficial intervention for children of divorce will be discussed.

Children of Divorce

Increasing divorce rates have led to more research related to the impact of divorce on young children (Kelly & Berg,1978). As a result of divorce, millions of children and adolescents experience the dissolution of their families, and changes to single parent and or blended families (Connell, 2008). For some children, there are multiple changes as they realize that divorce is only the first step in a series of family transitions (Connell, 2008). Children may lose contact with one parent, and then be faced with the family to now include a stepparent and half or stepsiblings (Connell, 2008). All of these transitions can be stressful and impact children's psychological well-being (Connell, 2008).

Divorce is a time of great fear and emotional turmoil (Connell, 2008). For some young children, as new challenges and developmental tasks are confronted, problems may emerge or reemerge (Connell, 2008). Children who may seem to adjust well to the divorce may have difficulties arise later in the process (Connell, 2008). Divorce is an extremely unsettling experience for children and as a result, children must deal with feelings of insecurity and abandonment, which if not properly addressed, can lead to problematic post-divorce adjustment (Connell, 2008). Children view their families as support systems and the sources where they learn to develop trust and bonds (Connell, 2008). With that being said, loss occurs for some children of divorce on many levels (Connell, 2008). When the family unit breaks up, children lose the primary support system for their healthy development and growth (Connell, 2008). They might lose the support of the noncustodial parent, the sense of security the parental unit provided, their home, their original school, and even their neighborhood friends (Connell, 2008). Their lifestyle might even be affected as uprooted families sometimes experience socioeconomic decline (Connell, 2008). Although children's reactions to divorce vary based on developmental level, age, and several other factors, there are some common reactions (Connell, 2008). The feelings that seem to be common with children of divorce include anger, blame, anxiety, fear, depression, as well as feelings of rejection, abandonment, powerlessness, and hopelessness (Connell, 2008).

Children of divorce tend construct their own reality in response to their parents' separation and divorce (Mahony, Walsh, Lunn, & Petriwskyj, 2015). Because every child views divorce in a different way, not all children react the same. Each child's reaction depends on the meaning she or he attributes to the divorce, and factors that are personal and family related (Bojuwoye, Olaniyi, Akpan, & Orok, 2009). In terms of psychological adjustment, some children of divorce are at risk for reacting with both internalizing and externalizing behaviors (Ham, 2003). Externalizing behaviors include misbehavior, aggression toward others, non-compliance, acting-out, and delinquent behaviors (Ham, 2003). Internalizing behaviors include emotional distress, depression, anxiety, low self-esteem, withdrawal, and general unhappiness (Ham, 2003).

Play Therapy

The use of play therapy is based on a developmental understanding of children and can be traced back to the work of Anna Freud and Melanie Klein in their integration of toys and play into their work with children (Trice-Black et al., 2013). The use of play in counseling children was brought to the forefront as an effective and empirically supported intervention by the work of Virginia Axline, and built upon by the work of Landreth and numerous others who promoted the use of play therapy to meet the developmental needs of the children (Trice-Black et al., 2013). Play therapy has since gained prominence and awareness with the public at large (Trice-Black et al., 2013).

Counselors typically use: (a)real life toys like a house with furniture, or kitchen set with food (b) energy releasing and stress reducing materials like squishy balls, and (c) creative expression items like materials for making arts and crafts or costumes (Yih-Jiun & Sink, 2002). The use of play therapy is based on the developmental understanding of children and the agreement among early developmental leaders regarding the importance of play in a child's life (Landreth et al., 2009). According to Piaget, most children on the elementary-school level function at the two stages identified as preoperational, which is from two to seven years old, and concrete operational, which is from eight to eleven years old (Landreth et al., 2009). These stages are identified with chronological ages, but it is relatively understood that development is specific to the individual (Landreth et al., 2009). At the preoperational stage, a child is acquiring the skill of language where symbols are used to mentally represent objects (Landreth et al., 2009). Also in this stage, a child's thinking is rigid and limited to how things appear at the time (Landreth et al., 2009). This is the stage of magical thinking where children create unreasonable explanations for things that they do not understand (Landreth et al., 2009). Internally, the child has understanding and knowledge, but externally, the child still lacks the ability to communicate their thoughts to the world (Landreth et al., 2009). Play is the child's most natural way of communicating this internal awareness of self and others (Landreth et al., 2009). Symbolic play during this stage is encouraged, and allows children to freely assimilate their experiences without environmental restrictions (Landreth et al., 2009).

Because the child's world is a world of action and activity, play therapy provides the therapist with an opportunity to enter the child's world (Landreth et al., 2009). The toys are like the child's words, and play is the child's language (Landreth et al., 2009). The child is not restricted to discussing what happened, rather, the child lives it out in the moment through play that reveals themes related to past experiences and associated feelings (Landreth et al., 2009). If the reason the child is in play therapy is aggressive behavior, the medium of play gives the therapist an opportunity to experience the aggressive behavior firsthand as the child attempts to break toys, while also allowing the child opportunities to learn self-control by responding with appropriate therapeutic limit-setting procedures (Landreth et al., 2009). Without the presence of play materials, the therapist could only talk with the child about the aggressive behavior (Landreth et al., 2009).

Different Forms of Play Therapy

Some different approaches to play therapy include psychodynamic play therapy, cognitive behavioral play therapy, child centered, directive play therapy, Adlerian play therapy, family/systemic play therapy, and school based play therapy (Peabody, 2014). Psychodynamic play therapy has three forms, including insight oriented therapy, the structure building approach, and supportive psychotherapy. The purpose of insight oriented therapy is to help the child master developmental tasks and resolve internal conflicts (Peabody, 2014). This approach is useful with children who have experienced trauma. The structure building approach is used with children who have problems with the development of object relations. This approach emphasizes empathy over interpretation. Supportive psychotherapy is best used with children with externalizing problems (Peabody, 2014). The focus is on developing coping skills and problem solving. It is often used as a supplement to cognitive behavioral therapy, which uses cognitive and behavioral interventions within a play therapy context. It focuses on the child's thoughts and environment. The child is taught coping strategies and strategies for developing more adaptive thoughts and behaviors (Peabody, 2014). Empirical techniques such as modeling are used. It is structured and goal oriented. In child centered play therapy, the non-judgmental acceptance, empathy, and warmth between the child and counselor helps the child to play out their problems and move to more productive behaviors. The therapist believes in the child's ability to be self-directing, and it is the child's choice to play or not play (Peabody, 2014). The relationship with the child determines the success of this treatment. The child is the point of focus rather than the problem. The purpose of child centered therapy is for the child to have a positive experience with a supportive adult who helps the child to find their inner strengths. Directive play therapy involves the therapist structuring the session for assessment and diagnostic purposes, and taking an active role in the play (Peabody, 2014). The first session involves building rapport with the child. The therapist tries to structure the environment according to the specific problem the child needs to address. It is often used with older children, or for dealing with very specific issues. Adlerian play therapy consists of four phases: building an egalitarian relationship, exploring the child's lifestyle, helping the child gain insight into his or her lifestyle, and reorienting and reeducating the child (Peabody, 2014). The play therapist also works with the parents by helping them to gain insight into their own lifestyle, their child's lifestyle, and the way that both of these interact. Parents also learn new parenting skills and can work on any of their own personal problems. Family/systemic play therapy just combines family therapy and play therapy. The therapist does play therapy with the child while doing a family session (Peabody, 2014). Last but certainly not least, school based play therapy involves pulling from any of the previously mentioned approaches of play therapy and applying them in a preschool or elementary school setting. School based play therapy is often time limited, directive and guided, given that school counselors are not provided as much time with the students to conduct therapy as would a counselor providing treatment outside of a school setting (Peabody, 2014).

Rationale for School Based Play Therapy

Identifying early mental health interventions that are proven effective for young children and that can be delivered in highly accessible settings such as schools has been identified as a critical need (Landreth et al., 2009). Play therapy has gained widespread acceptance with clinicians as an empirically supported and developmentally responsive mental health treatment, but its use and acceptance in school settings has lagged behind (Landreth et al., 2009). Government reports on the dire status of children's mental health in the United States have brought national attention to the urgent need to identify effective early interventions, and the essential role of schools in delivery of mental health services (Meany-Walen et al., 2014). Schools are in a unique position to identify young children who are suffering from emotional and behavioral difficulties, and to provide accessible, early intervention that can prevent the onset of more severe problems (Meany-Walen et al., 2014).

Play therapy has been reported to be an appropriate counseling intervention for young children in school (Baggerly & Parker, 2005). When a young child is in need of mental health services, school counselors may consider play therapy as a developmentally responsive and empirically supported intervention (Peabody, 2014). The use of play therapy in the school setting can help students as they strive to overcome many challenges that may impede social and academic growth and success (Trice-Black et al., 2013). Play, as the natural universal language of children, allows them to express themselves in developmentally appropriate means that can override the limitations of verbal expression and cultural barriers (Trice-Black et al., 2013). It provides a culturally sensitive approach because students of diverse cultures, socio-economic status, and varying academic and language abilities can communicate through the vehicle of play (Trice-Black et al., 2013). Students' cultural and life experiences, which are often difficult to verbalize, can easily be expressed through play (Trice-Black et al., 2013).

Research has also noted that school based play therapy is beneficial in that it can help children academically by providing the opportunity to address and overcome emotional difficulties that can hinder academic growth (Trice-Black et al., 2013). Play therapy, therefore, is an adjunct to the learning environment, and an experience that helps children maximize opportunities to learn in the classroom (Trice-Black et al., 2013). School counselors, through play therapy, can restore the much-needed emotional support, provide children opportunities to release their stress, facilitate healing, strengthen their sense of being in charge, and lessen the chances for long-term emotional harm (Yih-Jiun & Sink, 2002). Due to space constraints however, many school counselors may struggle with setting up a play therapy environment (Trice-Black et al., 2013). Time constraints may be another concern in play therapy in the school environment. Sessions typically must be time friendly and structured around non-academic times during the school day (Trice-Black et al., 2013).

Rationale for Child Centered Play Therapy

Child centered play therapy is an extension of Rogerian client-centered therapy. The overarching concept of child centered play therapy is based on Rogers's belief that all individuals, including children, have the innate capacity to develop in a positive direction if a growth-promoting climate is provided to them (Davis & Pereira, 2014). The application of this idea in work with children implies that it is the therapist's responsibility to facilitate a space where the child can safely express and explore their feelings, thoughts, experiences, and behaviors (Davis & Pereira, 2014). Child centered play therapy stems from a nondirective theoretical orientation that focuses on the child's ability to work through their issues as compared with other more directive approaches. The primary techniques used by trained play therapists include tracking, reflective listening, and limit setting. Tracking is a skill that requires the therapist to monitor the play, show interest in the child's process, and begin to understand the underlying themes in the play (Davis & Pereira, 2014). Reflective listening is a process in which the therapist responds to the content and emotions connected to the child's work. This allows the therapist to provide support and insight, and helps the child move toward growth (Davis & Pereira, 2014). Limit setting allows the therapist to set and maintain specific boundaries for children to explore in a physically and emotionally safe and consistent environment.

There are eight basic principles of child centered play therapy outlined by Virginia Axline that help to distinguish it from other play therapy approaches. In child centered play therapy, the therapist approaches the relationship from a place of respect, where the development of a warm, genuine relationship is established as a primary goal (Davis & Pereira, 2014). Effort is made by the therapist to communicate that the child is fine as he or she is. This is done through reflection of empathy and genuine acceptance of the child's verbalizations and actions. It is the therapist's role to act as a partner on the child's journey of healing and to accept the child exactly as he or she is in each moment, not as the counselor would like the child to be (Davis & Pereira, 2014). The child is granted permission to do whatever they need within established limits. This feeling of permissiveness is established in the relationship so that the child feels free to express his or her feelings completely. Play is viewed as an expression of the child's world, and the therapist is responsible for working to understand that perspective, being alert to recognize the feelings the child is expressing, and reflecting those feelings back in such a manner that the child gains insight into their behaviors (Davis & Pereira, 2014). A key component of child centered play therapy is that the therapist maintains a deep respect for the child's ability to solve his or her own problems at all times throughout the relationship. The responsibility to make choices and change is the child's. The therapist remains nondirective throughout the therapeutic relationship, and does not attempt to direct the child's actions or conversation in any type of way (Davis & Pereira, 2014). The child leads the way and therapist follows. This means that the child is not rushed through the counseling process. It is a gradual process that is recognized and valued as such by the therapist. Following the child's lead in the therapeutic process also allows the therapist to maintain a respectful appreciation for the child's culture and beliefs rather than imposing their own cultural background on the process (Davis & Pereira, 2014). Finally, the therapist only establishes limits when they are necessary to ground the child to reality and to make the child aware of his or her responsibility.

By allowing children to express themselves in their own culturally accepted ways, for example, through the use of specific songs and dances, culturally appropriate pretend foods, cultural rituals, or the use of language and storytelling, counselors can add to their understanding and ultimately their effectiveness as professionals, resulting in a better ability to help others to possess their own identities (Davis & Pereira, 2014). This main strength to be considered with child centered play therapy is the potential multicultural impact it can have. This is especially the case when considering all societies differ in the upbringing of children, education, and influences such as parental expectations. Child centered play therapy is less limited by cultural differences and focuses on more culturally relevant concepts such as an emphasis on social and emotional environment, and acceptance of all culturally based aspects that the child chooses to bring into therapy (Davis & Pereira, 2014).

Multicultural Considerations

Mental health professionals are strongly encouraged to consistently engage in obtaining multicultural competence across the globe. Multicultural counseling refers to preparation and practice that integrates multicultural and culture specific awareness, knowledge, and skills into counseling interactions. Counselors must take into account current social, economic, and political realities, while responding to the developmental needs of children in rapidly changing multicultural societies (Davis & Pereira, 2014). Play therapy can serve as a beneficial intervention for integrating a culturally competent way of providing counseling services to children. More specifically, child-centered play therapy provides a creative, accepting, and safe environment for children to explore issues related to culture, development, and a variety of multicultural difficulties and issues in a creative and familiar way. Child centered play therapy is based in the humanistic orientation, believing that what ultimately makes human relatedness is the quality of the relationship as well as unconditional positive regard, genuineness, and presence when working with children (Davis & Pereira, 2014). With that being said, child centered play therapy provides a humanistic lens to view therapeutic work with children that addresses the constant need for multicultural competence in counseling, by allowing children to explore their worlds and issues from their idiosyncratic cultural perspectives without judgment. Child centered play therapy can be used in counseling settings with children to gain more understanding of the issues, culture, and developmental level of the child, as well as possible solutions across settings, age, gender, and race (Davis & Pereira, 2014). This understanding is important when considering the need to address multicultural issues for children as an ever-growing minority and underrepresented population in the mental health profession, with developmentally appropriate interventions such as child centered play therapy.

Ethical Principles

An obligation of the play therapist is to act in the best interests of clients. This is extremely important considering the fact that play therapists' clients are generally dependent on caregivers. Ensuring that the client's best interests are met requires monitoring of practice and outcomes (Davis & Pereira, 2014). Play therapists establish relationships of trust with the children they work with. They honor and act in accordance with the trust placed in them. With that being said, play therapists are obligated to maintain confidentiality and restrict disclosures of confidential information to a standard appropriate to their workplace and legal requirements (Davis & Pereira, 2014). Play Therapists respect the dignity and worth of all people and the rights to privacy, confidentiality and autonomy. Play therapists who respect the autonomy of the children they work with ensure accuracy of advertising and delineation of service information. Play therapists seek freely the informed consent of those legally responsible for clients and, where possible, assent from clients, engage in clear and explicit contracts, including confidentiality requirements and inform those involved of any foreseeable conflicts of interest (Davis & Pereira, 2014). Play Therapists are aware that special safeguards may be necessary to protect the rights and welfare of clients who are non-autonomous and dependent on others.

Play Therapy Limitations Although play therapy has been accepted as an appropriate intervention for children, it has also been criticized for lacking adequate research that proves its effectiveness. Research often fails to validate this treatment because of inadequate definitions of what constitutes play therapy, research methods that often rely on case studies, small samples, uncontrolled studies, and last but not least, inadequate or non-measurable determinants of treatment outcome (Bratton, Ray, Rhine, & Jones, 2001). Research done on play therapy has had mixed results. Research that can be generalized beyond individual cases has not really been done. Most of the research being done is coming from practitioners who do play therapy, and therefore run the risk of being biased. These studies however, provide good argument for the benefits of play therapy and provide good descriptions of it (Bratton et al., 2001). Some studies on play therapy are well-designed and have a comparison group to increase internal validity and eliminate confounding factors. Play therapists treat many different types of problems with many different children, which makes it hard to generalize to larger populations (Bratton et al., 2001). Different groups of children will have differing responses to the treatment. Other limitations as it relates to determining the effectiveness of play therapy includes the fact that different children are often times not given the same treatment because different play therapists use different techniques, which makes it hard to make comparisons. Many aspects of play therapy are considered to be immeasurable. Research suggests that there are four underlying limitations to play therapy (Bratton et al., 2001). The first being an inconsistent definition of play therapy, the second being varied training of professionals who practice play therapy, the third being use of different materials and modes of play therapy, and the fourth being inadequate statistical designs. Most studies look at small samples and those that were large sometimes lack a control group, have poor statistical power, are highly subjective, or have low rater reliability (Bratton et al., 2001).

Personal Values and Interests

I personally find it important to take more of a person centered approach when it comes to conducting therapy. I am unauthoritative when interacting with patients because I find it to be very important to allow the patient to take the lead in the therapeutic process. I've found that often times, this allows the patient to slowly but surely identify their own solutions to the problems that they came in with. I believe gaining the ability to create their own solutions not only builds self-esteem within patients, but also builds their confidence as it relates to knowing that if they were able to identify their own solutions during the therapeutic process, then they will be more prepared and capable of doing it again on their own in the future. I value the idea of every individual having the capacity to positively grow if provided with the appropriate space to do so. I find that utilizing a person centered approach often times result in patients becoming advocates for themselves. Because I am personally interested in person centered therapy, my opinion is that child centered play therapy would be most beneficial for children of divorce. My personal rationale for choosing this intervention over the several other forms of play therapy include the fact that it allows the child to drive the therapeutic car with the therapist meeting them where they are. I think this is very important because what I've learned over time is that because of how we are developmentally programmed, it's much easier for an adult to meet a child where they are than to ask a child to meet an adult where they are. Another major rationale for choosing this approach includes its emphasis on being a beneficial multicultural approach. I am intrigued by the fact that it allows a child to bring their own culture, values, and interests into therapy without having any else's imposed on them to influence underlying themes behind their play.

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