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Section 17
Treatment with Child & Mother in the Playroom

Question 17 | Test | Table of Contents


Counterconditioning Anxiety
The treatment in the case to be reported is not completely new (e.g., Prince, 1961) but illustrates the use of a relatively specific playroom technique for a limited range of problems. For reasons that we did not explore, the patient's mother had developed the habit of reacting with anxiety and tension to the patient and of putting demands upon her that in turn elicited tension and anxiety on the patient's part. As far as we could tell during interviews with the mother, the behavior of the father towards the patient was not disturbed. For this reason we saw no reason to see the father in treatment but instead decided to concentrate upon the reactions of the mother and child to each other.

By carefully introducing the mother into the playroom where the child was being seen, we intended that each would learn to be more comfortable in the presence of the other. As we planned it, the process would be analogous to, or perhaps identical with, counterconditioning (Wolpe, 1958). The first step would be the encouragement of the patient's free, spontaneous play with a few rules as possible. During this time the mother would become accustomed to the situation by observation of the playroom activities and discussion with a second therapist. As soon as it seemed appropriate, we would bring the mother into the playroom, for brief periods at first, and encourage her to prompt the child's spontaneous play. We planned to terminate treatment after eight sessions at the most on the assumption that the mother would learn some skills that would generalize to the home.

Case History
The patient, the eight-year-old daughter of middle-class parents in an urban community, was first brought to the Clinic at the suggestion of school authorities. The initial complaint was that the patient was telling tall tales and outright lies at school and home. There was no evidence of abnormal maturation.

The patient's teachers reported that she had done very well at school and that her work was neat, complete, and very accurate. However, her' teacher was concerned not only by the lying episodes but also that the patient had no friends in her school room. The patient's mother reported that a friend of hers, when asked for an opinion, had said that the patient was under too much pressure at home. This friend said that the patient was told to do too many things and given her choice too seldom. The patient's mother said that this was the way she ran her household. At home the patient might mutter or mumble defiance but would continue doing what she was told.

By the time the patient was brought to the Clinic for assessment and treatment, the lying had almost stopped. The patient's mother said that she was still concerned because she had become aware that the patient was not as happy as she should be. Detailed inquiries were made about family discipline. It was learned that the mother usually took the lead in disciplining the children, particularly towards the end of the day when she became irritable. She saw herself as being too hard on the patient and had tried to be more lenient, but found it very difficult.

Doll materials were used in order to evaluate the patient's attitudes towards both school and home. In doll play, which was structured by the therapist to involve a dispute between a parent doll and a little girl doll, the patient took the role of an obedient, submissive little girl. In doll play with a school situation, the patient had her doll chose to go to the library and read rather than go out and play with the other children. These and other indications suggested to us that the patient was not a severly disturbed little girl but that she had learned to inhibit much of the free, spontaneous emotional expression appropriate to a child of eight. Instead she showed an unusual concern with accuracy, neatness, and adult approval. We also learned that she could quickly relax and play boisterously in the playroom.

Treatment Procedures
The treatment was carried out during five play sessions with the patient. One therapist took the child to the playroom with instructions to adapt himself to what she did in order to keep her as relaxed and happy as possible. A second therapist talked with the mother and explained that the general procedures would be much as we have outlined them above. The major rationale given to the mother was that it should prove useful to know some of the procedures that a therapist used in working with a child. After the explanation to the mother, she and the second therapist went to the observation room to watch what occurred in the playroom. The fact that this observation would occur was explained to the patient and the observation room was shown to her. The knowledge that she was being watched did not seem to inhibit the child after she had returned to the playroom. In each future session the mother and second therapist made it a point to always let the child and her therapist known whenever they entered the observation room.

In the observation room the second therapist explained to the mother that in working with disturbed children it was important to keep the rules as simple as possible and to always explain the reasons for them honestly. When it appeared that the patient was playing happily and enthusiastically in the playroom, they knocked on the playroom door and explained that they would like to sit in and watch for a few minutes. The mother sat quietly to one side and did not say anything during this first time in the playroom. The two therapists talked with each other and with the child, ignoring the presence of the mother. After a very few minutes, the mother was again taken to the observation room where she and the second therapist watched the play. The mother said that she was impressed by the child's liveliness and enthusiasm in playing. Reasons for the child's greater spontaneity with therapist and the objectives of treatment with the child were discussed. It was pointed out that one of the objective of play therapy was to find out what things bothered the child and to help her with these. A useful technique was to notice the problems as they arose in play, make guesses at their meaning in the child's life, and then discuss them without necessarily expecting the child to participate in the discussion. If something important was hit upon, the reaction of the child often showed this was so.

During the second session the procedure was repeated with the length of time that the mother spent in the playroom increased. It became noticeable that the patient was somewhat more subdued when her mother was in the room, although she still played well. This was pointed out to the mother while in the observation room and the reasons for it discussed.

During the third session, while the mother and one therapist were observing, the patient became very exuberant. The necessity of limits were discussed with the mother, not only for the sake of the child but for the sake of the adult in the situation. It was pointed out that these limits might vary depending upon the child's needs and upon what the therapist would or could accept but that honest explanations for the limits should always be given.

During the fourth session, the mother stayed in the playroom during most of the session. The patient was somewhat more subdued at first, but became more relaxed as the hour went on. An effort was made to involve the mother in the play by having the therapist remain passive while encouraging the mother to respond to the child's leads. When the mother attempted to encourage the child to perform better, the child became frustrated and turned to something else. The therapist pointed out to both of them what had happened and what the effects had been. The therapist took a more active role until the child was playing happily again.

The fifth session was also spent with the mother in the playroom during most of the hour. Again an effort was made to keep the child as relaxed and free as possible while encouraging the mother to participate naturally in the play. The effects and meaning of various interactions between them were discussed with the intent of making the effects of each upon the other as positive as possible.
- Schaefer, Charles, The Therapeutic Use of Child's Play, Jason Aronson Inc., New York: 1979.

Play Therapy Practice, Issues, and Trends

- Homeyer, Linda, Play Therapy Practice, Issues, and Trends. Board of Trustees of the University of Illinois. 2008.

Personal Reflection Exercise #3
The preceding section contained information about treatment with both the child and mother in the playroom. . Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
The effect of mother-infant group music classes on postnatal
depression-A systematic review protocol

- V Colella, C., McNeill, J., & Lynn, F. (2022). The effect of mother-infant group music classes on postnatal depression-A systematic review protocol. PloS one, 17(10), e0273669. https://doi.org/10.1371/journal.pone.0273669


Peer-Reviewed Journal Article References:
Stauffer, S. D. (2019). Ethical use of drawings in play therapy: Considerations for assessment, practice, and supervision. International Journal of Play Therapy, 28(4), 183–194.

Stutey, D. M., & Wubbolding, R. E. (2018). Reality play therapy: A case example. International Journal of Play Therapy, 27(1), 1–13.

Swank, J. M., & Smith-Adcock, S. (2018). On-task behavior of children with attention-deficit/hyperactivity disorder: Examining treatment effectiveness of play therapy interventions. International Journal of Play Therapy, 27(4), 187–197.

QUESTION 17
What is the major rationale given to the mother when explaining the need to involve her in play therapy? To select and enter your answer go to Test.

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