What do you see as the difference between Directive and Non-Directive Play Therapy? What experiences have you had in working with children and families? Offer some examples. Can you see a way that you can incorporate the intervention strategies previously discussed into your work with children and/or families?
Directive therapy is where the therapist leads the therapeutic process. An example would be, if the therapist was utilizing CBT, they are providing the client with directives to handle an issue, assisting them with utilizing certain techniques and providing them with worksheets to complete.
ReplyDeleteNon-directive therapy lets the client take the lead. The therapist sometimes reflects the information that client provides back to them, or searches for clarification, but it is the client who begins the content of the therapy session.
I have had experience working with children and adolescents in an inpatient psychiatric setting. I have lead and co-lead groups. I have found that the groups that allow them to be creative and artistic, have helped them to feel more comfortable and they have opened up and shared more with myself, as well as they rest of the group. At my current internship I am getting experience working with single mothers in recovery and many have psychiatric issues too. I have some mothers who are in the process of getting their children back and they are overly stressed on the things they have to do before reunification can happen. I have had them sit down and make a list of what they need to do and then after number the things by priority. This has made them feel better and not quite so overwhelmed, because it is out of there mind and on paper, so they do not have to worry so much about forgetting what they need to do.
I feel CBT would be useful in working with mothers to help change their outlook on life for the better and to give them ways to tackle the problems that cause anxiety or nervousness. In regards to families I would suggest solution based therapy, as families usually go into therapy with a presenting problem and only need short term therapy to work on that problem. Once that problem is solved, they no longer need session.
Christine McGovern
Hi Christine,
DeleteYour comments about the length of therapy is important to consider. I also think that using a psychoeducational approach can be really helpful in many of these situations. Whether this is CBT or SFT, I believe it depends on the client and their situation.
Christine
Christine,
DeleteThat is a very good point when thinking about psychoeducational approach for therapy, some clients can benefit in 45 minutes, where some clients who may have ADHD or schizophrenia and have difficulty sitting still for that length of time to engage in therapy, so yes it does depend on the client. In regards to situation, someone with a trauma history may only be able to withstand short intervals of treatment at first as they get to know and trust their therapist.
Christine McGovern
Christine
Christine very interesting when thinking about CBT when working with mothers in terms of changing their outlook. I also think for many children they are still learning so much from their mothers and having a mother who is depressed and unmotivated can absolutely change their development and negativity impact their ability to express themselves and learn.
DeleteDirective play therapy appears to have an active role for the therapist in which the therapist helps the client to engage in activities and perhaps even suggest activities to help solidify some of the skills the client may be working on or some of the aspects of life in which the client may be struggling. It may be useful to incorporate aspects of CBT along with directive play in order to help the client change unfavorable behaviors (ie: aggressively acting out, inability to appropriately express emotions). Non-directive therapy appears to have the therapist take a back seat and truly allows for the client to direct the flow of the session including which activities will be played and provide directions regarding how the therapist should act and engage in the session. It may be useful to incorporate solution focused practices in this type of therapy by encouraging the client and affirming that they completed a task well and looking forward to what specific goals they would like to incorporate in the future.
ReplyDeleteIn my past work with adolescents I have used sand tray therapy which appears to be productive and allows the client to talk about their story or the progression of their week in a way which does not seem as invasive. I had a variety of figurines that the clients would use to tell their stories (ie: old pill bottles or old empty bottles of nips, handcuffs, and people figures including family members and police). It appeared to help the client “paint a picture” and allowed me as a therapist to ask a lot of clarification and follow up questions. This was especially a good technique for clients who provided one word answers and truly did not want to attend treatment. It was interesting that I was also able to incorporate particular techniques or activities with the sand tray therapy (for example, dividing the sand and having the client create a functional analysis of substance using behavior, or perhaps even portray their family tree/genogram).
Hi Rebecca,
DeleteI can relate to your comments about using a sand tray when working with adolescents. This past week, I was working with a young lady who did much better during one on one sessions and family meetings if she was coloring mandala pictures. I am going to keep this in mind for future patients who may have difficulty talking with adults. I am hoping to learn more of these simple, yet important techniques as I continue my internship.
Christine
Sand play therapy sounds very interesting- I imagine it is also relaxing and a sensory experience! I think different approaches like these, put people at ease and allow for more expression. I also think when a person sees their therapist taking risks they are more likely to feel comfortable.
DeleteDirective play therapy interventions include cognitive-behavioral techniques, metaphors, art therapy, role plays, games, letter writing, and other guided activities.
ReplyDeleteNon-directive approach to play therapy is client-centered.
Common non-directive play therapy approaches allow the child to direct the path of his or her own treatment by choosing his or her own play objects and themes.
As a former teacher for emotionally and behavioral challenged children in an alternative school I commonly used techniques and tools from the play therapy model to help my students with their emotions and behaviors. While most of the time students were thinking we were just playing a fun game or completing an activity, we were actually learning about how their emotions and feelings affect their behaviors and the choices they make.
www.youtube.com has great examples of both techniques. Rebecca and I also shared many other resources in our file exchange...
Hi Jennifer,
DeleteYour skill and experience working with children were very clear during your role play video this week. I hope to learn more tools and techniques to help create a safe, fun and supportive environment for kids and adolescents to talk and process thoughts, feelings and events.
Christine
Jen,
DeleteWhile using these models with the students would you say you used one more than the other? Would you sometime start with one and then switch to the other based on the child's words or body language? Did you find this therapy to always be an effective tool?
Christine McGovern
Hi Jennifer,
DeleteI t sounds like you pulled one over on the little ones. ;-)
It actually sounds like you've gotten a lot of really great experience at play therapy (and it showed in the role play!). It sounds like by teaching them these things through play, you made difficult to understand or to handle topics much more accessible.
Have you found that learning about these other techniques in class has added tools to your Play Therapy toolbox?
Thanks Alice! I no longer teach, but I have been able to use some of the same techniques when meeting with children in crisis.
DeleteHi Jennifer -
ReplyDeleteThanks for sharing additional resources. I think this type of therapy is great for children not only to hold their attention and help them verbalize their feelings, but perhaps make therapy feel less invasive and sterile for them. This module has held me to realize that I have used play therapy in the past perhaps without even realizing it (ie: mentoring a small child with anger issues when we were just playing Barbie but she was acting out some of her impulsive behaviors and I was able to direct how Barbie might feel if someone hit her). It has also struck my interest in this type of therapy with children and learning more about the appropriate uses of this technique.
Rebecca
Hi Rebecca,
DeletePlay is a wonderful venue for building relationship and can also be a place (or space) where people become uninhibited and may be more willing to explore and try things out.
I have often wondered why there isn't a Play Intervention for adults...there are such possibilities.
Gail
Adventure therapy probably comes closest to this.You could absolutely adapt many of the play therapy techniques to work with adults. Expressive therapy is another modality - using art to help people express their thoughts & feelings, useful for both adults & children.
DeleteHi Lee,
DeleteI was an inpatient at the Dartmouth Mental Health Center years ago when it was located in Hanover. Outward Bound had an outpost in Hanover at the time and they did one day Outward Bound initiative for some of us inpatients. I had been hospitalized for severe depression. The two weeks with Outward Bound changed my life and taught me more than I thought possible. I still carry the skills I learned. Plus, it was awesome- ropes courses to rock climbing to rappelling. I do like Adventure Therapy and had I started earlier in my life I would have opted for the UNH dual degree MSW/Adventure.
My thought, though, is really about play. How many people play? How many people think playing is for kids? For those who do play, they know the direct impact playing has on their daily lives and overall health and well-being. I am not talking about play therapy for adults, but play itself as a venue for elf-knowledge, finding meaning in life, resilience, and emotional health.
Play as Basic Pathway to Self by Thomas Henricks is closer to what I am talking about:
http://files.eric.ed.gov/fulltext/EJ1070402.pdf
Gail
I guess elf knowledge may work for some. But, of course, I meant self-knowledge!
DeleteDirective play involves the therapist setting the stage and bringing the materials- the child participates. examples include last night's coloring and making the emotion sandwich. Non-Directive play involves the therapist as therapist, in the psychoanalytical sense. The child would have many child friendly materials available with which to become engaged (as in figurines, sand table, etc.) As the child plays the therapists observes and assesses. I a thinking of Annie's young man (Evan?) and how he played so particularly that Anne was concerned about some serious underlying possible causes.
ReplyDeleteI have not worked with children and families, although I have had lots of informal experiences over the years.
Tomorrow I am going to use CBT and Solution Focused intervention techniques as I introduce the pilot program I wrote, STRIDE PLUS.
Hi Gail,
DeleteThank you for bringing up Annie's case presentation from Internship III. That is a perfect example of non-directive therapy!
Christine
Hello Everyone,
ReplyDeleteThanks to Rebecca and Jennifer's excellent presentation, I now have a greater understanding of directive therapy when working with children. Therapists in this position use activities, projects and toys to help guide a conversation pertaining to feelings, thoughts and behaviors.
Non-directive therapy allows the child to guide the session through his/her own natural play. The therapist then interprets these actions in a therapeutic manner. The therapist may or may not be invited to participate in a child's play in a non-directive approach.
I do not have experience working with children under the age of 13. I appreciate the material from this week especially the role plays, videos and lectures. I found the information extremely helpful in gaining a better understanding of what child therapists do. I hope to gain more experience with this population, especially as my own baby grows into a child and I witness the importance of age 0-5. I am hoping that I will be able to shadow social workers on the child unit at the Brattleboro Retreat. This is an inpatient unit for children ages 3 to 11. I have heard from other social workers that it is a "state of the art" program in regards to clinical programming, toys and staff training. I also know this unit was recently renovated with kids in mind.
I found the information in regards to family therapy extremely applicable to my current internship. I do not have any formal training in family therapy, yet I find myself doing this on almost a daily basis. I am looking forward to the Family Therapy elective this Spring.
In the required video, I liked how the therapist gave the parent permission to not get involved in his children's argument. I have found myself doing the reverse, giving the child permission to be a kid and not be involved in their parent's issues.
Christine George
Hi Christine,
DeleteI too have no experience with working with young children, and also found this week's lectures and role play very helpful as a result. I now feel like I've at least received a grounding in what that sort of therapy looks like, as well as what sorts of things are effective in it. Ditto with family therapy.
It sounds like you're in a great place to learn about child therapy. There's nothing like learning from the best! Best of luck with that.
Thanks Christine, I was unaware the Retreat took children under 5. I would love to know more about that if you have a chance to shadow. Thanks
DeleteWhen I read the first question about Play therapy, I was a little confused. My initial reaction was, "Is that a trick question? It's right there in the title." Basically, Directive Play therapy is...well...directed. The therapist goes into the session knowing that there's a certain issue that the child is facing, and directs the play towards talking about or dealing with this issue. Non-directive play therapy on the other hand isn't directive. The therapist plays with the child, observes what issues the child is bringing up with their play, and sort of rolls with it. In that way the therapist can get a clearer picture of what issues the child is struggling with as well as how they are coping with them. The th. can then, through the collaborative process of play, help the child process those issues. Rebecca and Amanda, for instance, did a fantastic role-play showcasing Directive Play Therapy. They had an idea of what the child had to work on (anger coping skills) and they developed play activities that would teach her those skills.
ReplyDeleteAs for my experience of working with children and families...that's easy. I haven't had any. The closest I came was sitting in, in my first internship, some therapy sessions with teens struggling with substance use. Or, at least their parents thought they were struggling with it. Most of the teens I saw were in the pre-contemplative stage and didn't think they had a problem at all. Therefore, most of the therapy I observed was Motivational Interviewing, designed to help them consider how the drug use was affecting their lives. These kids were too old for Play Therapy, so this is not the greatest example, but so far I haven't worked with any little children.
I certainly think you can incorporate other intervention strategies into Play Therapy. CBT would probably be pretty easy to intertwine, I would think. In the process of playing, if emotions come up, I would think it would be quite natural to start talking (or playing it out) what was going on in their heads when they reacted angrily, or sadly, etc. I could see Solutions Focused Therapy maybe working its way in too. If the child (maybe an older, more cognitively aware child) was struggling with an issue, a Directive Play Therapist could surely design an activity designed to help the child find some exceptions. I don't know about MI, though. I'm not sure how you'd work that in.
All of my experience when working with children is in non directive play therapy. I have my own personal beliefs in children making independent choices and understanding themselves which is why I have stayed away from directive play therapy, although I see a place for it and think its also important. One thing that comes to mind when thinking about these different types of therapy is when I was working with a small group of children in a school. I had just read them the book The Way I Feel which is a wonderful children's book that highlights all the different feelings a child may experience during the day. When I read it to Group 1, I invited the children to tell me how they were feeling- with this group, I decided to go first. Myself and the other adult running the group shared a feeling word. Immediately after we shared, all the children choose which feeling they wanted to share based on what myself and the other adult said. With the second group we decided to not share, and the children only had themselves and had to think more about how they were actually feeling instead of trying to figure out which adult they wanted to mimic. I have only worked with children in a school setting, but I have noticed in such a large social group like a classroom there is a lot of wanting to please adults and fit in. I noticed with the first group it was not at all about the feelings which happened to be happy and sad, but more about doing what the adults were doing. In order to avoid this we tried to have the children come up with their own feeling of the day and the group was much more interesting. With my experience working with children I think there needs to be a strong inviting and containing emphasis in therapeutic groups because in a school setting there can be a lot of isolating when it comes to children sharing and interacting with each other.
ReplyDeleteHi Annie -
DeleteI think the first group's reaction to searching for a "word" is typical of this age group in particular. They are not only following your lead as a role model, but are looking to get the "right answer" and please the teacher or group leader by giving a response they think they want to here, and therefore not being wrong and ultimately gaining praise. I think it's great that you were able to recognize this and change your approach for group number two. Great observation skills!
Rebecca
Annie,
ReplyDeleteYou brought up a great point about kids wanting to mimic adults and I like that the second group had the opportunity to share a feeling independently, instead of trying to copy an adult and worrying about whether it was right or wrong. The were just allowed to express themselves and be themselves.
Christine McGovern
I think the most significant differences between directive and non-directive play therapy are inhibition and economy. In non-directive there is less inhibition of the evidence, for lack of a better word, but is also less economic. In directive we can progress more be economically as we draw upon our own and others' prior experience.
ReplyDeleteI have worked extensively with adolescents. Whereas my play with them has been limited to recreational sports, these activities have nonetheless been been very revealing.
William,
ReplyDeleteDo you think there is a difference between directive and non-directive play between young children and adolescents?
Christine McGovern