The Therapeutic Action of Play in the Psychodynamic Treatment of Children: A Critical Analysis

This paper critically appraises the therapeutic action of play in psychodynamic child therapy and identifies obstacles to utilizing play therapeutically with children. An examination of the functions of action and verbal means of communication as well as their roles in shaping therapeutic relationships in treating children is provided in light of recent theoretical advances. The significance of engaging children directly through play and for redressing the balance between action and verbalization in child therapy is discussed.

Therapeutic Assessment with Children in Family Therapy

Therapeutic Assessment with Children (TA‐C) is a brief semi‐structured intervention in which psychological assessment is used to help families with children and adolescents to change. In this paper we introduce the TA‐C model, describe its semi‐structured format and exemplify how it can be applied by family therapists.     

Emotionally Focused Family Therapy and Play Therapy for Young Children Whose Parents Are Divorced

ABSTRACT

Divorce is common and can pose risks to those involved. Although divorce affects all parts of the family system, young children face extraneous challenges due to their unique developmental stage and limited cognitive ability. Emotionally focused family therapy (EFFT) works to enhance attachment bonds by restructuring a family’s negative interaction cycle and can be useful for repairing relationships between parents and their children who are suffering negative effects of parental divorce. Whereas adults have the skills to express themselves verbally, young children often use imaginary play to convey their emotional experiences and unmet attachment needs. By using play therapy techniques within an EFFT framework, adults and children can better communicate their perspectives concerning difficult life events such as parental divorce.     

Harnessing the Power of Play in Emotionally Focused Family Therapy With Preschool Children

Emotionally focused family therapy (EFFT) is an attachment‐based therapy model that has been used with older children and adolescents. More recently, it has been suggested for use with young children. EFFT holds promise as a clinical treatment for young children coping with attachment problems, but more detailed guidelines are needed for implementing the model with this age‐group. Whereas preschool and kindergarten age children are less able to participate in talk therapy than older children, accommodations need to be made to this approach when the identified patient is a young child. This article offers a variety of play therapy activities that may be incorporated within an EFFT framework to strengthen the emotional bonds in families with children ages four to six.     

Factors Influencing the Degree and Pattern of Parental Involvement in Play Therapy for Sexually Abused Children

Although much has been written about the role of therapists in children's recovery from child sexual abuse, relatively little attention has been paid to the role of nonoffending parents. This study investigated the work of a team of therapists who sometimes included such parents in therapy sessions with children. The study sought to understand what factors were influencing the degree and pattern of parental involvement and to understand what effect these patterns of parental involvement were having on the process and outcomes of therapy. The study successfully identified a range of factors influencing the patterns of parental involvement, but more research will be needed to understand the effect on outcomes.     

Therapeutic Use of Fact Sheets in Family Therapy with Children and Adolescents With Functional Somatic Symptoms

Functional somatic symptoms signal distress and reflect an activation of the body's stress‐regulation systems. Many different types of stressors – physical, emotional or both – may activate the body's stress‐regulation systems. If stress‐related disruptions are extreme or are not limited in time, functional somatic symptoms may emerge, signalling that the body remains in a state of activation and somatic distress. In this paper, we describe the development of therapeutic fact sheets, which are used as part of our multimodal, family‐based, rehabilitation intervention for children and adolescents presenting with functional somatic symptoms. The fact sheets provide information about functional somatic symptoms – including their assessment and treatment – from a stress‐system framework. They are used in the context of a family intervention to facilitate engagement with the family and to reduce parental anxiety and reactivity. Whilst the fact sheets were initially developed for parents, over time we found that the sheets were also useful in managing anxiety in the medical and school systems. A key goal of this article is to share this resource with other clinicians working with children/adolescents with functional somatic symptoms.     

No Small Change: Process‐Oriented Play Therapy For Children of Separating Parents

This article looks at a process‐oriented play therapy for children adversely affected by parental separation. Process‐oriented play therapy is a therapeutic method that involves the therapist directly entering the ‘world of play’ with the child, by amplifying various modes of expression and helping underlying meaning to emerge, in order to help children access aspects of their life they feel they have no say in. One particular case has been used as an example, involving ‘Jim’ (pseudonym) and his mother, who attended the play therapy session.     

Reflections on the Therapeutic Action of Desire

When feelings of love and desire for an external object are so powerful that they distract from the treatment relationship or manifest as an erotic transference, they can undermine or destroy an analysis. Likewise, when the analyst's erotic responses are more than he or she can tolerate, acting out can prove fatal. Conversely, when the erotic is contained, desire can become an important part of the therapeutic action. An extended clinical example is presented to explore these themes and related variables of repressed and liberated desire as well as the connection between age and erotic longing.     

All Work and no Play? Understanding the Needs of Children with Caring Responsibilities

This article draws on research with children who provide care for parents with serious mental health problems and signals ongoing research that uses photographic participation methods with these groups of vulnerable children. The intention of this article is to highlight the need to move away from popular and simplistic representations of children with caring responsibilities (young carers) as victims of their parents’ illnesses, as ‘little angels’ whose caring work is condoned through rewards or as (exploited) informal domestic workers whose childhoods are inevitably compromised by the caring activity they undertake. Recommendations are made for generating deeper understanding about the lives and needs of children who are affected by parental impairment that is congruent with the thrust of current UK policy, Every Child Matters and the 2004 Children Act.     

Evaluating Therapeutic Intervention with Sexually Abused Children

The progress of sexually abused children attending community-based treatment programmes run by selected voluntary agencies was evaluated on several different dimensions. By the end of the treatment programmes, improvement was apparent in the children's scores on the Children's Depression Inventory and self-esteem scores and in behaviour (CBCL) reports from parents. Young people over the age of 11 years reported for themselves improvements in the CBCL total problem and internalizing scores, but no improvement in the externalizing scores. The reasons why many therapists had difficulty providing all the necessary information were explored in interviews with senior managers and suggestions are made for improving the ways in which abused children's progress through treatment can be evaluated. © 1997 John Wiley & Sons, Ltd.     

Play Therapy: A Paradigm for Work with Families*

The dream-like, open-ended process of play therapy has much in common with the family therapy style of the authors. This paper provides a partial list of similarities between play therapy and family therapy. It reviews methods for using play with families and considers the question of indications and contraindications for play therapy with families. Clinical examples are utilized to illustrate throughout the paper.     

Child-Parent Relationship Therapy with Extra-Familial Abused Children

Sexual abuse by a perpetrator outside of the family is the most prevalent form of child sexual abuse. It is associated with serious consequences for both the child and his family. Surprisingly, however, the issue of extra-familial sexual abuse has received very little research and clinical attention. The purpose of the current study was to explore the effectiveness of Child-Parent Relationship Therapy (CPRT), which uses nondirective play therapy tools, among parents of extra-familial abused children and their parents. In order to do so, data was collected from 51 parents who participated in CPRT, at three points in time: pretreatment stage, at the beginning of the first meeting; and in the post treatment stage. The data included the parents’ reports via three questionnaires: Parenting Stress Inventory (PSI), Compassion Fatigue Self-Test (CFST), Child Behavior Checklist (CBCL). Overall, the results indicated a decrease in internalizing and externalizing symptoms among the children, as well as in parenting stress and in parental secondary trauma symptoms. This study contributes to the literature on interventions with victims of extra-familial child abuse and their parents. Specifically, the results highlight the benefits and importance of involving both parents and children in therapeutic interventions for victims of extra-familial child sexual abuse, with particular emphasis on the benefits of Child-Parent Relationship Therapy.     

On the Project of Using Psychoanalytic Ideas in Systemic Therapy: A Discussion Paper*

Recently in Australian and New Zealand systemic therapy forums, there has been a tentative renewal of interest in psychoanalytic thinking. These local discussions have tended to reference psychoanalytic ideas as part of the struggle to understand emotional experience, and the therapy relationship. This paper reviews the patterns in these discussions, and then considers the wider context of the appearance of this interest in terms of the history and development of systemic theory. Some tentative comments are made about the project of using psychoanalytic ideas in systemic theory and practice.     

Identifying Therapeutic Action in an Attachment-Centered Intervention with High Risk Families

This paper describes an attachment-based intervention for mothers known to Child Welfare Services where past and current trauma complicates family preservation and promotion of child well being. The first part of the paper describes the innovative Attachment-Centered Parent–Child Therapy service that has been delivered to high-risk families with children from 0 to 3 years of age. The intervention uses a group format that has the added benefits of enhancing social support and being highly cost effective. The intervention also integrates video filming both in terms of capturing essential features of the group intervention for review and supervision of clinical staff, and is fundamental in the observation-based empirical assessments. Quantitative data from an initial pilot study supporting the efficacy of the intervention is presented. As well, qualitative data is presented including a case study that highlights therapeutic action shown to positively impact the quality of the mother–child relationship.     

Babies and Young Children in Nurseries: Using Psychoanalytic Ideas to Explore Tasks and Interactions

Anxiety about the emotional experience of young children in nursery has been central in thinking about the development of nursery provision. The main theory of emotion that has been applied to nursery practice has been attachment theory. This article proposes that there is a need to open up our conceptual framework for thinking about emotional interactions in nursery and introduces concepts from psychoanalytic theory that may assist in this. It illustrates the application of these concepts to thinking about nursery tasks and interactions by reference to existing studies of nursery provision. © 2006 The Author(s). Journal compilation © 2006 National Children's Bureau.     

Short Term Family Therapy with Emotionally Disturbed Children*

This study found that short term family therapy using Zuk's “go between process” effected significant improvement in the interpersonal functioning of the family, as perceived by the identified client. The subjects were white, middle-class, intact families who have sons attending classes for emotionally disturbed children at the Centennial School of Lehigh University.     

Trauma Focused Cognitive Behavioral Therapy with Children of Incarcerated Parents

This paper explores children’s trauma symptoms related to parental incarceration and lays the groundwork for the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) within a clinical community-based setting treating children and adolescents affected by parental incarceration. Children and adolescents who experience parental incarceration are more likely to develop symptoms of post-traumatic stress disorder (PTSD): depression, anger, aggression, and isolating and self-harming behaviors. Although parental incarceration is a known source of trauma, there are no documented studies examining effective clinical treatments to reduce the effects of the trauma experienced by these children and adolescents. Except for children and adolescents affected by parental incarceration, TF-CBT, a promising model for treating and reducing the symptoms of PTSD, has been successfully applied to various populations affected by trauma. Children of incarcerated parents resemble populations treated with TF-CBT in earlier applications. In this paper, we present a case illustration that examines the application of TF-CBT with one child who experienced trauma symptoms related to parental incarceration, while discussing the results of that application and the potential for broader applicability of TF-CBT within community-based organizations that treat the population of children and families affected by parental incarceration.     

Issues of Psychoanalytic Technique with Adoptees

Treatment issues relevant to the psychoanalytic treatment of the adoptee are presented; clinical formulation is encouraged within broad ego-diagnostic parameters. The adoptee's internal cathexis of the biological mother is identified as a core dynamic and the binary transference involving the adoptee's displaced relation to a dual set of parental representations is described. A metapsychological bias, predicated upon differential perceptions of the status of self and object representations is described and related to the adoptee's treatment. Various transference/countertransference dyads are discussed, as are corresponding technical considerations.