Sandplay Articles

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Brit ish Jo urn al o f

PL AY THER APY

Pub lis hed b y t he Brit ish A ssocia tio n o f Pla y Th era pists

Volume 2 December 2006


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CORRES P ONDEN CECorrespondence to the Editor should be sentto BAPT, 1 Beacon Mews, South Road,Weybridge, Surrey KT13 [email protected]

SCOPE

The British Journal of Play Therapy is anational journal with a focus on the theoreticaland research aspects of Play Therapy practice.Its aim is to bring together the differenttheoretical and professional disciplinesinvolved in Play Therapy and this will bereflected in the composition of the EditorialBoard. Nevertheless we welcome submissionfrom all relevant professional backgrounds.

The journal thus aims to promote theoreticaland research developments in the fields of PlayTherapy practice. Submission of reviews,systematic reviews and research papers whichsupport evidence-based practice are alsowelcomed. Papers may assume any of thefollowing forms:

(a) Papers reporting original research findings.(b) Theoretical papers.(c) Review papers, which need not beexhaustive, but which should give aninterpretation of the state of research orpractice in a given field and, whereappropriate, identify its clinical implications.(d) Systematic reviews.(e) Brief reports and comments.

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The British Journal of Play Therapy iscurrently published once a year on behalf of the British Association of Play Therapists. Thecost reflects this and will be adjusted whenmore frequent publication is resumed.

Subscription rates include delivery (but notVAT or Sales Tax where this is payable).

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COPY INGNo part of this publication may bereproduced, stored or distributed by anymeans without permission in writing from theBritish Association of Play Therapists.

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Bri tish Jo urn al o f Pla y Th erap yAn official publication of the British Association of Play Therapists (BAPT)

Copyright The British Association of Play Therapists (2006) Allrights reserved.Registered Charity No. 1115673The British Association of Play Therapists is the trading name of The British Association of Play Therapists Ltd, registered inEngland & Wales (Company number 5477406). Registeredaddress: 47 Sedlescombe Road South, St. Leonards-on-Sea, EastSussex TN38 0TB


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Correspondence to the Editor, Editorial Board and Advisory Board should be sent to theAdministrator, BAPT, 1 Beacon Mews, South Road, Weybridge, Surrey KT13 9DZ

[email protected]

Advisory BoardMERKEL SENDER (Educational Psychology)

Summerfi eld Centre, London, England

MARY CARDEN (Child Protection)Harpenden, Hertforshire, England

EditorANNE BARNES

Notre Dame Centre, Glasgow, Scotland

Editorial Board

BRITIS H JOURN ALOF

PL AY THER APY

ANN CATTANACHDepartment of Social Policy and Social Work,

Uni versity of York, York, England

CHRIS DANIEL-McKEIGUEPostgraduate Studi es, Liverpool H ope Uni versi ty,

Liverpool, England

SUE JENNINGSGlastonbury, England

VIRGINIA RYANDepartment of Social Policy and Social Work,Universi ty of York, York, England

JANET BARRNotre Dame Centre, Glasgow, Scotland


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EDITORIAL

Anne Barnes 3

PAPERS

Diana Jansen 4 The Use of Sandplay with Children

David L Myrow 14 Theraplay : An Introduction

Chris Daniel-McKeigue 24 Playing in the field of research:Creating a bespoke methodology toinvestigate play therapy practice

Leong Min See 37 Child Survivor of the Tsunami:A Case Study

Angie Naylor 46 The ethics of researching children innon-directive play therapy

John Casson 55 The five story self structure:A new therapeutic method on theCommunicube

Book Reviews 63

Notes for Contributors 65

Table of Contents 66

BRITISH JOURNAL OF PLAY THERAPY 2006 DECEMBERVOLUME 2

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Introduction

One of the most powerful ways I know of workingtherapeutically, whether with adults or withchildren, is with sandplay as the Swiss psychother-apist, Dora Kalff, conceived it. I would like in thisarticle to give a brief description of her way of working with sand, which differs in some essentialways from the work of Margaret Lowenfeld. I wouldthen like to give an example from my work withchildren to demonstrate how it can activate a

powerful psychic process, which enables healing.

Sand trays are an essential part of every playtherapists play equipment. There is nothing eithernew or original about playing in the sand. A singlesand tray can reveal much about a childs situationin both their internal and external world. It canenable a child to convey what, as yet, there are nowords to describe. It can act as an alternative way toact out and express aspects of trauma in the sameway that other play materials can enable thisprocess. This was how Lowenfeld conceived thesand tray work she pioneered in her work withchildren

The sandplay method conceived by Kalff includesthis possibility of self-expression. When it reaches adeeper level a spontaneous psychic process may beinitiated that can, in conjunction with thetherapeutic relationship and the free and protectedspace of the sand tray, enable healing ( Kalff, 1986).It may at the beginning of the work be merely oneof many forms of play the child experiences.However, when a sandplay process is enabled, a newsense of purpose and direction enters the play. Ishall demonstrate this process in a short case study

of a three-year-old boy.

What is Sandplay?

The use of sand for creative purposes is as old astime. It was used by the medicine men of Mali whodrew patterns in the sand to divine the future. TheNavaho Indians hold sand painting ceremonies,creating images of world order in order to bringabout universal harmony. Monks in Tibet createbeautiful mandalas in the sand as an aid tomeditation (Cunningham, 1997). Building in thesand or playing at the seaside, all aspects of sandhave a fascination, for children especially. Some

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The use of Sandplay with Children

Diana Jansen

Psychotherapist and Sandtray Therapist

Abstract

In this paper I have given a brief description of Sandplay as it was first conceived by the Swiss psychotherapist,

Dora Kalff. Sandplay is used with wonderful results with both adults and children. I attempt to convey how theunconscious can, without interference from the conscious mind, lead towards what Jung referred to as the self healing of the psyche within a sandplay process. This process is enabled within the therapeutic relationship andwhat Kalff referred to as the free and protected space of the sand tray itself. I have tried to illustrate this processby describing the therapy of a three-and-a-half year old boy who created fourteen sandtrays. Through his playin the sand he was able to mourn for the father he had lost and to re-connect with his own internal father. Theprocess led from a state of fragmentation to one of integration, and this coincided with a leap in his developmentin his outer life.

Bri . J. Play Therapy , Vol. 2 (2006), pp 4-13


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people maintain that the sand itself has calming andhealing properties. I find sometimes that with adistressed or troubled client just standing beside mysand trays and sifting sand through their fingers can

have a calming effect.

For Dora Kalff, there was an ineffable quality toplay in the sand. The pictures her patients created inthe sand were not merely descriptive of somethingthat was consciously known. This play could go toa much deeper level and produce psychic images;images of the internal landscape was the way shereferred to this (Kalff, 1986), which were notavailable to the conscious mind. It is often thisbypassing of the conscious, which happens far morereadily in children, that can effect healing in asometimes almost miraculous way.

Dora Kalff was a student and near neighbour of theSwiss psychiatrist, C.G. Jung, on the outskirts of Zurich. In the 1950s Jung had heard of the work of Margaret Lowenfeld, a child psychiatrist working inLondon. He suggested that Kalff went to Londonto study this new therapy, which Lowenfeld calledThe World Technique (Mitchell & Friedman,1996). Kalff returned to Zurich in 1956 andadapted Lowenfelds work to her own Jungianorientation.

The essence of Dora Kalff s sandplay is this: theinner world can be given substance and materialisedthrough the hands. Through the combination of aconscious and unconscious process the landscape of

the patients inner world can be represented in avisible and three-dimensional form. For a momentpsyche and matter become indistinguishable. Itallows a return to the roots of childhood and to thedepths of our cultural history when psyche andsoma, body and mind, were undifferentiated (Ryce-Menuhin, 1992).

Sandplay makes possible a return to pre-verbalmemory, which cannot be reached by talking alone.

These earliest memories are recorded not in themind but in the body. Jung wrote that often thehands know how to solve a riddle with which theintellect has wrestled in vain (Jung, 1960, Par. 80).

It is this possibility of bypassing the conscious mindthat makes sandplay such a powerful medium. Theearly experiences can be re-lived, remembered andintegrated into the conscious personality. Sandplay

allows the expression of every level of developmentfrom pre-verbal and pre-symbolic to verbal andfinally to mental integration (Ryce-Menuhin,1992). Jungian Sandplay is based on the Jungianconcept of the spontaneous self-healing of thepsyche, which can take place if the conditions arefavourable. In the holding environment of thetherapeutic relationship and what Kalff referred toas the free and protected space of the sandtray, thisprocess is enabled (Kalff, 1986).

The concept of the importance of play is a familiarone also in the work of Winnicott. He believed thatit is through play that we are most completelyourselves. He writes: It is in playing, and only inplaying, that the individual child or adult is able tobe creative and to use the whole personality, and itis only in being creative that the individual discoversthe self (1988, p63). Through play the child canexpress his/her spontaneity; what Winnicottreferred to as the true rather than the false self.Through play in early life we discover thetransitional space (which lies between mother andinfant) where mother is a secure and affirmingpresence and where we are free to play and to beourselves (Winnicott). It is vitally important in thedevelopment of the young child to have this space.Schiller once said that man is most completelyhimself when at play (as cited in Jung, 1936, p76).

Perhaps the sand can lead us back to this earlyexperience of unselfconscious play when our play isa pure expression of the self and no expectations oroughts interfere with this.

I should add here that the ability to make use of thesand in terms of a healing process is not initiallypossible for a severely traumatised child 1. To allowfor the childs play in the sand and his or her use of symbols to facilitate healing it is necessary to havehad the good enough (Winnicott, 1988)experience of mother. Children who do not havethis fundamental security within their earlyrelationships, and who have not experienced the

THE USE OF SANDPLAY WITH CHILDREN 5


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freedom to play, may not have the ability tosymbolise. They live in a world of concrete reality inwhich the as if world of the symbolic reality isoutside their experience. For the abused and

disadvantaged child, there must first develop arelationship of trust with the therapist; this isperhaps the first positive relationship the child hasknown. It may take some years, in this case, beforethere is sufficient trust to allow the psyche to enablea healing process.

What is depicted in the sand is a symbolicexpression. Symbolic expression is the naturallanguage both for children and for the unconscious(Neumann, 1973). As sandplay therapists we mustlearn the language of symbols in order to interpretthe communications in the sand. Jung described thesymbol as an intuitive idea that cannot yet beformulated in any other or better way (1954,para.105). A symbol is never either this or that: theessential nature of the symbol is that it contains aparadox. The snake for instance is both a symbol forthe most primitive level of life, for evil, destructionand deceit and it is also a symbol for healing andtransformation (Cirlot, 1971: Chetwynd, 1982). Inaddition, of course, the snake will have a particularassociation and resonance for each individualperson. One can never be dogmatic about symbolsbut it is important to remember that they are anessential aspect of our work in sandplay with bothchildren and adults.

Practical Considerations

Sometimes a sandplay collection is in a separate partof the consulting room and sometimes it is in adifferent room altogether. When working withadults it is important that it is in a different spacefrom the verbal therapy. This creates a separationbetween the verbal therapy and the sandplay, whichcan at times create a new way of relating. This isespecially true when the transference and counter-transference relationship is too powerful. If, for

example, the therapist becomes cast as the all-powerful mother one can, as therapist, find oneself caught in a no-win situation. The sand tray providesa third dimension in which the problem can be

looked at and reflected upon by patient andtherapist together instead of the therapist being seenas the problem.

I have two sand trays, one with wet and the otherwith dry sand and I keep a watering can beside thewet tray for extra wetness. Each of the trays sits ona stand and the stands have casters so they can bemoved to any position in the room. The dimensionsof the trays are important. They are exactly the sizethat can be taken in visually without the need tomove ones head. They measure 22.5 x 28.5 inches(57 x 72 cm) and are three inches deep. The traysare half filled with fine silver sand and the base ispainted blue to give the impression of water whenthe sand is cleared from it (Ammann, 1991). On theshelves beside the trays are the miniature figures.Every category of figure is represented to include:

humans of every kind gods, goddesses mythological figures animals of every kind birds fish insects snakes reptiles of all kinds

and objects both beautiful and ugly such as:

buildings all modes of travel stones shells nests feathers driftwood

leaves

THE USE OF SANDPLAY WITH CHILDREN6

1 Until now nothing has been published in relation to a sandplay process with severely damaged children. Agnes Bailey worked for manyyears in the North East of England, with wonderful results, with this client group. Her work is now carried on by Mike Falcus. Anyoneinterested in pursuing this further can contact him on his email: [email protected] or telephone: 0794 1650 788.


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marbles glass drops beads jewels coins

The list is endless. For the acquisitive it is an endlesssource of delight searching for and collecting newitems!

I sit nearby and watch the child (or adult) as he/shecreates a picture; some give a running commentaryand others work silently. When the tray is completewe look at the picture together and I might be awareof two levels of experience: the story that the childrelates in relation to the tray and perhaps, also, thedeeper unconscious communication. But that Ikeep to myself. We do not interpret at the time butusually the deeper meaning becomes clear when wereview the slides together after the work has ended.Kalff believed that an earlier interpretation couldinterfere with the spontaneity of the process (Kalff,1986).

After the tray is complete and when the child hasleft, I take a photo. In addition I make a drawingwhile the tray is being constructed, labelling theobjects in case it is difficult to identify certainobjects in the photo. The slide show at the end of the process can act as a pictorial portrayal of thetherapeutic process and can often make it feel morereal because what has happened internally can nowbe seen as an external and visual experience.

Sandplay process of a three-year-old boy

I would like to give a brief summary of the sandplayprocess of a three-year-old child to whom I shallgive the name Ben. It is relatively unusual to be ableto complete a process with such a young child; thechild is able to play in the sand with objects but anactual process where one is able to see the healingprocess unfolding is fairly rare at the infant stage.There must also be a sense of a good enoughnurturing experience from mother or caregiver for aprocess to be enacted, as mentioned above. Withseverely abused children, their internal world is too

chaotic to begin with and a secure and trustingrelationship with the therapist must precede theprocess in the sand.

Ben was three and a half when our work togetherbegan. His father, who suffered from manicdepression, had taken his own life a few monthspreviously. Since then the little boy had shownsigns of regression. He had begun to soil himself, heclung to his mother more than usual and a slightspeech impediment had become more pronounced.His mother, a primary school teacher, was veryaware of her sons grieving process. She hadattempted to help him come to terms with fathersdeath by creating a book telling the story of Ben andhis Daddy. This was illustrated with photos of Benwith his father from birth until his sudden death.Ben had come to his own conclusions about Fathersdeath and explained to his mother that Daddy hadgone down to the river (bordering their house) toget some air on a hot evening, fallen into the riverand drowned. The fire engines, police cars andambulances were unable to save him. Bens motherwas concerned about her sons emotional stability,fearing that the child might, like his father, have apredisposition to mental illness.

Beginning the Journey

In Bens initial session he was very happy for hismother to leave the room after our first ten minutestogether. He went straight to my shelves of toys andclimbed a small step-ladder I had provided for him.

He handed me the objects he wanted to use; ahorse-driven wagon, a red tractor and a boat. Wehad the sand tray on the floor, as he was too little toreach it on the stand. He added a great deal of waterand then tried to float the boat on the water until ithad all soaked into the sand. The wagon and horseswere driven round the tray. The wagon was then leftabandoned on its side in the top right corner whilethe horses galloped off to the left. Finally the tractor,which was busy ploughing up the wet sand, was

placed near the front of the tray close to where hewas sitting (Figure 1).

The first tray often presents us with the problem



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and also gives some indication about the futurepossibility of healing. My feeling about this tray wasthat it expressed a certain amount of fragmentation.Ben had left sand, water and toys scattered over my

entire room, and it felt as though he was literallyspilling over. I felt the wetness of the tray seemed tobe connected to his fathers drowning as well as tohis own and his mothers tears. He had tried to keepthe little fishing vessel afloat but without success.(In the second tray, created the following week, thelittle fishing boat literally went under and wasburied in sand with only the tip of the mastshowing). The wagon in the top right cornerseemed to be about Bens own sense of abandonment without a strong Daddy to draw hisown personal wagon, and to give a sense of directionin his life. The horses are disappearing off to the left,out of the picture. The left side of the tray is oftenseen as representing the unconscious side of thepersonality, the right side the conscious aspect(Ammann, 1991). If the horsepower, or energy, inrelation to this child is moving towards theunconscious it suggests regression. This was a realityfor Ben 2. Regression in such a young child can be acause for concern, and the movement towards theleft of both the fishing vessel and the tractor alsoreinforces this impression. However, the red tractor

in the position closest to Ben as he created the trayis more positive. The tractor can plough up the landand help new things to grow. It represents anotherform of horsepower and the colour red, which Ben

used throughout the process in relation to himself,is a colour suggesting warmth, energy and life aswell as anger. It stands out in this tray, which ispredominantly without colour. It feels like a positivesign, as though this little tractor symbolises the partof Ben that is able to survive the deluge of his ownand Mothers sadness.

In his second tray Ben first placed six small woodencars in the top centre portion of the tray and they

too, like the fishing vessel, were pushed under andburied. In the bottom half of the tray we have ascene with dark grey buildings and a bridal couplein the bottom right corner; This, Ben said, isMum and Dad. Pointing towards them is a largeblack vehicle, a Bat mobile that is usually seen as thevehicle of rescue. In this tray however it looks like ahuge, menacing, black arrow directed against theparental couple. There was a strong feeling now of athreatened Mum and Dad. There was also a sensethat the childs own driving power and ego strengthwas under threat, suggested by the six buried cars.In addition, that part of him that had somehowmanaged to keep afloat (in relation to the buriedfishing vessel) has literally gone under.

At this stage a large proportion of the sessions wasspent in re-enacting scenes concerned with Dadsdeath, with me fulfilling vital roles in the play.There were endless games about rescuing Dad fromdrowning in which I would be employed as theambulance man, the policeman, the doctor or nursein the hospital, the fireman who used his ladder toget Dad out of the river, and so on. On the wholeour rescue operations were successful! The sandtrays occupied only a small proportion of thesessions. By the second visit a strong attachmenthad already formed between us and Ben lookedforward to his sessions and spoke about them to his

mother all week.


Figure 1Bens First Sandtray: The Deluge

2 A very young child is so close to the unconscious, as consciousness and self-consciousness (in other words, a sense of a self that is separatefrom mother), is only just beginning. A severe trauma, like the death of a parent, can throw the child back into a more infantile andunconscious state.


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Developing Themes

The theme of abandonment occurs once again inBens third sand picture. He has placed the bridal

(parental) couple on the right and a baby bird in anest on the left. In between lies a baby in white thatis neither with the parents nor in the safe nest butalone and abandoned in between the two. A canoetravels across the lower portion of the tray and againthe movement is towards the left.

There was a recurring theme throughout Bensfourteen trays. In almost every one there is the all-important house. It made its first appearance in thesecond tray. Among the dark, rather menacingbuildings surrounding the parental couple is a smallwhite adobe house, which he referred to first as alighthouse and then as Bens House. Later, thissame house became Dianas House. I saw this as anearly sign that what had gone badly wrong in Bensinner house had the potential for healing.

In the fifth tray Ben placed the entire dolls housein the sand tray. He purposefully emptied it of allfurniture and with infinite care brushed away everygrain of sand with the dolls house broom. Thefurniture was dumped in the front right cornertogether with the figure of mother. It was as thoughhe was sweeping away unconscious material andpreparing the house that would represent himself insubsequent pictures. He created an empty houseready to be refurnished in his own way. I wasreminded of Winnicotts emphasis on the infants

need to gain mental detachment from mother:That is differentiation into a separate personal self (1940, p 197).

Central to Bens play was the recreation of thehouse, which may be seen to represent the Self. Hisfathers suicide had left Ben in pieces. Thisfragmentation was expressed especially powerfullyin his sixth tray by three red soldiers lying in a poolin the centre of the tray. Ben increasingly associated

the colour red with himself. The number three is of course his age but it could also represent his broken-in-three self as he is no longer held together by aunited couple. The soldiers are at risk from three

gunmen. Coming to the rescue there are a fireengine, a repair vehicle, both placed beside thehouse he now called Dianas House, a man onhorseback and the busy broom. We can see here thetransference beginning to take effect with thehealing possibilities coming from Dianas house.The sixth picture was a turning point. After thisthere was a definite change in the pattern of Bensplay. He no longer darted from one game toanother. With a great sense of purpose he wentstraight to my shelves and brought down the figuresneeded for his play.

Healing Begins

In the two trays that follow, Ben placed DianasHouse, (initially referred to as the light house), andBens House, shared with Mum, side by side. Hecreated his own I-land space in the trays centre,and again swept the blue space clear of every grainof sand. He placed a table on the island and twochairs, one for himself and the other for me. In thefollowing tray, the second chair was for Mum whilea small boy in a red jumper, the figure he associatedwith himself, occupies his own chair. The table is setfor breakfast (Figure 2). Ben prepared a plate withthree bananas for himself and a strawberry for me.The three bananas seemed to emphasise hismasculinity and the red strawberry, like a red heart,

suggests a new possibility in relation to feeling. Inthese two pictures there is a sense of everythingsuperfluous being cleared away. The securi tycoming from his mothers house was set besideDianas House. This demonstrated the healingpotential of the transference 3. On the other side of my house stands Bens own little cottage, theindividual house of the now potentially intact andhealed Self. This is the place that would become hisinner home. In the rear left corner are six cows that


3 The transference includes aspects of the patients relationships from the past, especially parental relationships, which he projects onto thetherapist. It can also represent aspects of the patient himself, which have not yet been realised. It has the possibility of disrupting thetherapeutic encounter, when the therapist represents destructive past relationships, but also contains the potential for healing. (Samuels,Shorter & Plaut, 1987).


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is the house made for me by Dad and I helped him.Could this be the inner house that is nowdeveloping within Ben, which Dad has played a partin building?

In his ninth and thirteenth trays Ben created theinterior of his own house and this took up the entiretray. He is inside the house as a small baby andwithin the house is everything he will need for hissecurity and nurture: furniture for cooking and

toileting, a big secure bed, and also five candles thatrepresent light (like the light house), and are laterassociated with Dad.

What was being enacted in the sand tray in terms of Ben creating his own individual house was alsobeing enacted at home with Mum. She told me hehad asked for the help of six strong men to movethe furniture in the way he needed it to be. In histhirteenth tray Ben placed the entire dolls house in

the tray again and the house was filled with all theobjects that had formed a part of his healingprocess. Bens house was placed in the centre, insidethe dolls house. Beside it to the left is Dianas

House and to the right is the married couple withtheir baby, the now completed archetypal family;mother, father and baby in white. The baby, whichBen said had to be taken out of the Mummys

tummy, now beside the united parents, wasassociated with his newly reborn Self. The innerpossibility of the completed family had to berestored before healing could occur.

Completion

In the doorway of the house is a red carpet on whichstands the red repair vehicle. Here again is the red of his new possibility, the colour of, passion,sentiment and the life-giving principle (Cirlot,1971, p.54) This is reflected repeatedly in the red of the strawberry and of his tractor in the very first trayand the red of the jumper of the boy who is himself at the breakfast table in tray number eight. Therepair vehicle is pointing directly towards the house,which is the house lived in by Mum and me. Thisvehicle had been central to Bens repair process. Ihad the feeling that the process with Ben wasnearing completion.

In one of his final sand pictures Ben created hisfathers grave, with two wet patches beside itperhaps indicating his and his mothers tears. Hecommented, I want to make it look pretty forMum. He decorated the grave with marbles. Thesehe used also in his final sand tray to decorate thebirthday cake he and his mother had made for Dad.His fathers 43rd birthday happened to be on that

day. Dads grave becomes linked to his birthday;that is to say, a new father possibility is born! In thislast sand picture he placed a red octagonal tray inthe space previously cleared of every grain of sand tocreate Bens I-land space. Inside the tray he put ahelicopter. A large red marble below it and a redcandle above echoed the red of the tray. This felt likea wonderful affirmation of Ben. The eight-sidedtray seemed to indicate a new sense of wholeness;four is the number that represents totality and eightseems to emphasise this coming together! Thehelicopter suggested he was now ready to take off in life, in contrast to the earlier tendency towardsregression. Five blue marbles within the red tray


seem to promise a nurturing possibility. Nearest towhere I was sitting as he created the tray, on the leftside, he placed the repair lorry again, and thisseemed to communicate to me that the repair workwas in progress! In the bottom right corner of hisseventh tray he placed the large grey church, whichappeared first in the second tray. This seemed to beconnected with Dads funeral and burial. Beside thechurch he put a tiny house. About this he said: this

Figure 2Bens Seventh Sandtray: Breakfast for Two.


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echoed by five blue marbles to the left express thesymbol of physical totality (composed of a head,two arms and two legs). This seemed to represent asignificant shift in light of the previous sense of

physical regression, disintegration andfragmentation that had been reflected in the chaos

for my collection because he couldnt find onethere). Later this house is used increasingly inconjunction with Bens House as he begins to useme, in the transference, to enable his healing

process. Ben used the house to express both a placeof security and safety as well as an expression of hisincreasing ability to recognise his own separateinternal space. The house becomes for Ben thesecure place that he shares with the nowarchetypally complete family, where mother andfather are together again with baby Ben. It was alsothe symbol for Bens increasing sense of his ownindividual Self, a separate self from the houseinhabited by mother. In this process Ben hasrecreated his own secure inner house after his senseof inner fragmentation following the devastatingloss of his father. Sandplay really is based on theself-healing of the patient. Given a wound, a freeand protected place and an empathic witness, a self-healing process can be initiated (Bradway &McCord, 1997, p. 46).

H ome is linked to our core and when somethi ng is brought home to us i t i s understood wi th our whole beingWhen the house is transformed i nto a symboli c centre the individual may find freedom to explore, go out and go wi thi n, attuning to the dreaming mindThe ground plan forms a mandala.This permits encounters wi th the unknown or terrifying through a prevailing sense of grace.

(Colcord, 1998, p 92).

The Healing Process

In his outer life, Ben had shown remarkabledevelopment during the period of our worktogether. His play was more focused and the earliersigns of fragmentation in his behaviour haddisappeared. His speech had developed and hismother commented on his development in relationto both home and nursery school. He was betterable to interact socially and was no longer needing

to revert to babyhood when he was with his mother.

For me, witnessing the process of this young child ashe recreated his own inner home was a very moving


left behind in my room in early sessions.

A warm relationship had developed between Benand me during these eighteen sessions in which hehad created fourteen sand pictures. Now he wasquite clear that it was enough and it was time for usto end. I remembered that in our sixth session I hadasked him how many more times he felt he wouldneed to come. Without hesitation he said, eightmore. This turned out to be exactly right. Of coursea three-year-old child has no concept of the numbereight or of the time that represents. However, in apsychic process, which does not involve what is

known consciously, there is a clear sense of what isneeded, if we can only connect with this.

Bens Use of the House

The house as symbol of the Self was the outstandingsymbol Ben used in his healing process. In our floorgames, he made houses and used the dolls house tocreate a hospital, fire station, or home, according tothe game of the moment. In his sand trays thehouse became the main feature of his pictures. Inthe second tray he refers to the house, which is tobecome Dianas House as The Light House. (Whenthe work was finished he brought me a lighthouse

Figure 3Bens Fifteenth Sandtray: Dads Birthday


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experience. I learned through working with Benhow true it is that a childs natural form of communication is through symbolic language. Of course the child thinks his world is real, never the

less, it is a symbolic world. For this reason a childsutterances must always be taken as symbolic, notinterpreted rationalistically, from the reasonstandpoint of adult consciousness (Neumann,1973, p.34).

Dora Kalff believed that children are closer to thetruth than adults and the younger the child, thecloser they are to it. This was certainly myexperience with Ben. One can conceal the truthfrom children but at some level they already know itso the concealment just leads to confusion. On thefinal day of our work together Ben said to hismother: Daddy didnt fall into the river, he jumped,didnt he? He was now ready to acknowledge thetruth consciously. That evening, in his bath (afterwe had looked together at the slides of all his sandtrays), Ben said to his mother, Looking at thepictures with Diana was the bestest bit of the day. Itmade me sad because I miss my Daddy, but hes stillwith me really, inside my head theres alwayssomething ending and something else setting off,Mummy.

In this paper I have given a description of sandplayas the Swiss psychotherapist, Dora Kalff, conceivedit. With a brief case study of a three-year-old boy Ihave attempted to illustrate the unconscious processas it unfolds during a sandplay process. I hope very

much that this will be of some interest to those playtherapists who are already using sandtrays in theirwork with children.

Biography and Correspondence

Diana Jansen is a Jungian AnalyticalPsychotherapist who works with both adults andchildren. She first trained as a nurse and later as aprofessional singer. Her husbands early death fromcancer led her to train as a psychotherapist and alsoas a sandtray therapist. Diana has chaired the Britishand Irish Sandplay Society as well as the Associationfor Psychotherapists in the North. Now, in her

second marriage, she enjoys a full life with a largefamily of children and grandchildren.

Diana Jansen

Meadowfield HouseDaltonNorthumberlandNE18 OAA

Tel: 01661 886200Email: [email protected]

References

Ammann, R. (1991). Heali ng and Transformation in Sandplay. USA: Open Court Publishing Company.

Bradway, K. & McCord, B. (1997). Sandplay - si lent worshi p of the psyche. London/New York:Routledge.

Chetwynd, T. (1982). A Dictionary of Symbols.

London: Paladin.

Cirlot, J.E. (1971). A D ictionary of Symbols.London: Routledge.

Colcord, M.E. (1998). Home Sweet H ome.Harvest , 44 (2).

Cunningham, L. (1997). Sandplay Therapy.Journal of Sandplay Therapy, 6 (1).

Jung, C.G. (1936). Modern M an in Search of a Soul.London: Kegan Paul.

Jung, C.G. (1960). Collected Works, Vol. 8,London: Routledge & Kegan Paul.

Jung, C.G. (1954). Collected Works, Vol.15London: Routledge & Kegan Paul.

Neumann, E. (1973). The Child. London: Karnac.

Ryce-Menhuin, J. (1992). Jungian Sandplay: The Wonderful Therapy. London: Routledge.



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Samuels, S. & Shorter, B. & Plaut, F. (1986). ADicti onary of Jungian Analysis, London: Routledge& Kegan Paul.

Winnicott, D.W. (1998). Playing and Reality.London: Penguin Books.

Winnicott, D.W. (1990). M aturati on and the Facili tati ng Environment. London: Karnac Books.



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The Beginnings: A Challenge

Among the social innovations of the 1960s in theUnited States were two early intervention programs:the Childrens Television Workshop (whichinvented Sesame Street) and Head Start, a pre-school program for underprivileged children. Earlyin the development of Head Start, a consultingpsychologist, Ted Hurst, was awarded a contract toprovide psychological services for the Chicagoprogram. A great many of the preschoolers in HeadStart presented with serious mental health issues,often manifested in social withdrawal/depression orover activity/aggression. Hurst was concerned thatthese children be provided direct services; ratherthan merely be categorized while interventions weresought via the public mental health system. Heneeded an approach that worked quickly andeffectively (Myrow, 2000b).

Hurst appointed Ann Jernberg as Clinical Director.

Jernberg had been inspired by the work of Austin

Des Lauriers, a psychiatrist who sought newapproaches in working with autistic children (DesLauriers & Carlson, 1969). For example, he wouldblock their attempts to leave his presence and hesometimes sang to them in an effort tocommunicate. Viola Brody, also a student of DesLauriers, contributed to the strategies developed byJernberg (Jernberg, 1990; Brody, 1993). Jernbergand her colleagues were able to accomplishsomething remarkable with the Head Startpreschoolers: they developed a short-term (usuallyabout fifteen weeks) intervention that seemed tooffer the child alternatives to the withdrawn oroveractive coping strategies. Thus Theraplay wasbrought to birth. After Jernbergs death, her long-time colleague, Phyllis Booth, wrote the secondedition of the essential Theraplay textbook(Jernberg & Booth, 1999). Booth continues tocontribute to the development of the approachthrough her work at the Theraplay Institute.

14

Theraplay : An Introduction

David L. Myrow, Ph.D.Buffalo, New York, USA

www.theraplace.com

Abstract

This article introduces Theraplay 1, a therapeutic model that is becoming increasingly known for its focus onpromoting parent-child attachment. First developed in America, Theraplay is currently being used in at least

eleven countries and in a wide variety of settings including schools, mental health clinics, private practice, speechand language therapy agencies, and residential treatment facilities. Theraplay differs from Child Centred or Non-directive approaches in that it is therapist-directed, includes physical contact, involves parents in the processwhenever possible, and is intended to be fun. This brief overview reviews the history of Theraplay, the principlesthat guide it, its theoretical foundation in Object Relations and Attachment Theory (now supported by recentfindings in neurobiology), and notes recent scientific research that strongly supports its efficacy. Illustrations aregiven from clinical practice. Keywords: Theraplay, play therapy, attachment, research, depression in children,attention deficit, selective mutism, oppositional defiance, autistic spectrum, divorce.

1 The appellation Theraplay is a registered service mark of the Theraplay Institute. Early in its history, this was done as a way to ensurethat practitioners using the method were actually professionally trained in this specific approach. The intention is to make sure that thetechniques are used ethically, appropriately, and correctly. The Institute maintains control of the service mark and its use.

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and a bandage, and sends him back to play(assuming no stitches are needed!). Grandmothermakes treats for after school snacks.

Challenge

The parent notices the childs budding capacitiesand provides situations to help them develop.Parents hold the infant upright when beginning towalk and then reach out to coax the toddler toventure his first independent steps. The five-year-old is taught to tie his own shoelaces. Byaccomplishing just-enough challenges, childrenstart to feel competent and develop self-confidence.

Jernbergs model has always seemed elegant andbrilliant. The reader is challenged to identify aparental role or corresponding child need thatdoesnt seem to be covered by at least one of thedimensions. The model guides the therapistsdiagnostic and prescriptive thinking, as the readerwill see below. This thoughtful scheme can be aguide when working with clients of any age,

including adults. One asks, when working with anadult, what does this client seem to have missedgrowing up in his family, and how is this manifestednow in relationships?

The Marschak Interaction Method(M IM): An Assessment Tool forUnderstanding Parent-Child Interaction

To assess these different aspects of a child-parentrelationship, Jernberg developed the MarschakInteraction Method analysis (MIM). In the MIM, achild and her parent sit adjacent to each other at asmall table. The two of them engage in eight ornine activities while the therapist observes, usuallyvia a one-way window, and makes a video. Thetasks are selected to elicit the concerns that havebeen identified in the initial interview. MIMs canbe done with a variety of caregivers, for example,

with children and grandparents or with young

adults living in group homes and their key workers.The approach can help inform any therapist aboutthe dynamics in relationships in a systematic way.Some social workers and psychologists have

described to the author how they are includingMIM analyses as part of custody recommendationsin divorces.

One of the most helpful aspects of the MIM is thatit permits a focussed investigation of the attachmentrelationship. This suggests specific ways that thetherapist might intervene. The MIM provides abridge from our theoretical understanding of achilds development to actual relationship processes.For example Attachment Theory 3 has guidedattention to the role that affective attunement playsin the early child-parent relationship (Stern, 1985;Schore, 2001). Simply put, a caregivers astuterecognition and responsiveness to a childs commu-nications (nonverbal information is probably mostimportant, even as the child matures) promoteneurobiological and psychological developmentsthat are most likely to help the child relate to othersin a rewarding way. Thus she comes to feel worthyand competent to meet lifes challenges (Siegel,1999 & 2003). If however the caregiver regularlyfails to recognize and respond to the childempathically, misattunement arises and variousproblems in functioning can occur (Siegel, 2003).For example, a mother with postpartum depressionmay not have the wherewithal to respond to herchild. Or a child may be born with a painfulphysical condition that so preoccupies her

consciousness that she does not experience a parentsloving efforts to care for her.

These early caregiver-child interactions formmemories that evolve into patterns of expectationabout relationships with others. When a childsbehaviour is dysregulated or profoundly self-defeating, we may suspect issues in the earlyattachment relationship. The therapeutic challengeis how to set the stage so that the child might be able

to come to a different sense of himself.

THERAPLAY: AN INTRODUCTION16

3 For a fascinating overview of the work and lives of Bowlby and the other Attachment Theorists, the reader is referred to Robert Karens(1998) delightful volume.


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Theraplay as a Way to Reach TroubledChildren

In creating Theraplay, Jernberg hoped to reach backto the innate capacity of the child in order toencourage a more positive sense of herself todevelop. Jernberg hoped that hands-on, physicalexperiences resembling those enjoyed by healthy,typical parent-child dyads would provide a moredirect way for troubled children and their parents togenerate healthy interactions.

As Theraplay evolved, a number of characteristics

began to distinguish it from traditional methods: The focus is on healthy parent-childrelationships rather than on the childs pathology orinternal processes. The therapist is in charge of the session,planning and organizing the experiences to meet thechilds needs. The activities are designed to meet the childsemotional stage of development rather than the

childs physical age. Therefore many games have aregressive aspect. Nevertheless, these experiences aredesigned to meet the childs unresolved early needswhile remaining ego-syntonic with the childscurrent sense of herself. The treatment includes physical, interactive,emotionally attuned play. This helps with buildingattachment as well as developing self-regulation. The therapist (not a toy or symbolic item) is themain playroom object. The therapist utilizes thechilds nonverbal behaviour to make physical andemotional contact throughout the session. Immediacy is central: the focus is on theexperience at the moment rather than on history,pretend play, or interpretations. Nurturing touch is a natural and integral aspectof the interaction. In this Theraplay guided by thewealth of research in the past few decadesdetailing the essential role that touch plays in

healthy physical and emotional development (Field,1995; M kel, 2003, 2005). Great care is taken toensure that touch is used respectfully and that it isgeared to the treatment plan.

Parents are included in the assessment andthe treatment process, and are encouraged to bringwhat they learn into interactions at home.

A Protocol for Treatment

Unlike early Child Centred and Psychoanalyticapproaches, Theraplay considered the role of attachment figures from the beginning. Soon afterJernberg began to develop the approach, she saw thevalue of including parents in the process (Jernbergand Booth, 1999). In her initial work with families,Jernberg had two therapists involved in a treatmentsession:

1) the childs therapist, who worked one-on-onewith the child in the playroom, and2) the interpreting therapist, who joined theparents in observing the work via a one-waywindow, in an adjacent room.

This method continues to be utilized by theTheraplay Institute. It allows parents to learn about

their child and to understand what the childstherapist is attempting to do. The focus is usuallyon strengths and also on the childs efforts to gethis/her needs met. This intensive approach is notalways practical. Many practitioners (including theauthor) utilize an alternative format in which thetherapist works with the child for the first half of asession, then meets with the parents for the secondhalf and shows them a video of the play session.This allows discussion of the activities used with the

child and permits therapist and parents to reviewthe childs needs and efforts toward the goals.

As presently practised in agencies and privatetherapy settings, the protocol for a course of Family-based Theraplay is as follows:

1) Initial interview with parents;2) MIM with each parent;3) Feedback session with parents to review theMIM videos and build a treatment plan;4) Individual Theraplay, with parents observingdirectly or via video;

THERAPLAY: AN INTRODUCTION 17


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put it on Dad. Dad put away the box of hats andwent on to the next of his eight activities.

Reviewing the videos with the parents, observations

were organized along the SENC dimensions. Forexample, even though he sometimes resisted, Tonybecame calmer and focussed more when parentsstructured and took charge of the activities.Although they offered eye contact, he seldomreturned it. He seemed to crave nurturing butdefended against their efforts to provide it. In thefew cases when they persisted in challenging him totry a slightly frustrating task, he gave up too easily.The parents started to see that this was an anxiousboy whose negative and avoidant behaviour kepthim from what he really wanted and needed. Tonyin some ways behaved like a rapprochement-stagechild who was struggling for autonomy (Mahler,Pine & Bergman, 1975). He threw tantrums whenfrustrated, yet tried to engage his parents but alwayson his terms rather than theirs. He was highlyambivalent and constantly tried to controlsituations to make sure his needs were met. He wasfull of shame generated by his negative attentionseeking, which brought endless corrections fromteachers and an inconsistent combination of punishments and indulgences from his perplexedparents. When the therapist explained that, thoughTony was seven-years-old physically, he was mostlytwo-years-old emotionally, Mum and Dad started tomake more sense of his behaviour. The therapistand they devised treatment goals designed to reachout to the toddler in Tony and help him move on

developmentally:

Tony will be comfortable with emotionalintimacy and be able to have fun with his parentsand others. His laughter will be genuine. Tony will accept clear, consistent, firm limitsfrom adults. Tony will accept nurture from his parents endenjoy his role as a child in the family. Tony will be able to manage frustrationappropriate for his age and increase self- regulationgenerally. He will be able to ride out challenges.His parents will look to provide just enoughchallenge to stretch him developmentally.

To accomplish these goals, the following methodswere planned:

A. Individual and then Family Theraplay,

including psycho-educational work with Mum andDad to help them develop management strategies athome that coordinated with the Theraplay sessions.B. Coordination with school personnel, to helpthem understand Tonys behaviour and support thework.

Theraplay begins

Child-centred play therapy practitioners are usuallysurprised to find that there are few toys visible in theplayroom. When using Theraplay, the therapist isthe primary object in the room, and the focus ison how child and therapist interact.

In the waiting room Tony alternated between sittingat a table working on a puzzle and coming over tohis Mums chair, asking her when the session wouldbegin. This behaviour resembled that of a two and a

half year old who plays independently, thensporadically checks in with Mum for refuelling.The therapist took Tonys hand and they headed tothe playroom. Once there, it was explained thatshoes were to be removed. Tony kicked off hissneakers and lunged toward a beanbag chair.However the therapist kept holding his hand andcarried Tony over to the beanbag chair. It wasexplained that a video would be made for parents tosee later so that they could learn some of the games

that were to be played. The therapist stated the tworules of the playroom: First, No one gets hurt neither You (gently touching Tonys chest) nor I.Second, Everybody has as much fun as possible!Tony smiled, perhaps relieved that this wasnt goingto be all torture or a lecture session from an adult.

Then the therapist performed a check-in. Thetherapist pointed to the boys very dark brown eyes,even darker than mine! (a move, which causedTony to look at the therapists eyes for a moment).Appealing to the seven-year-old part of him, thetherapist counted Tonys fingers: Lets see, thereshould be 10, right?10-9-8-7-6 on this side and 1-



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2-3-4-5 on this hand. Hmmm 11! The therapistsmelled his hair (lovely!) and felt how soft it was.They checked to see if Tony could touch his chinwith his tongue. It was noted that when Tony

smiled, he made dimples. The therapist used hisfingers like a callipers to show Tony how his bicepsbecame bigger when he pointed his fists toward hisears rather than forward. The therapist noticed thatTony had a little bruise on a forearm, and put a dropof lotion on it - then more lotion for a scratch on hishand. When his toes were counted, Tonyunexpectedly pulled off a sock to show a bruise onhis shin. This invitation was most fortuitous,because then the therapist took his feet and usedthem to pop the therapists inflated cheeks, whichled to some very hearty, baby-like laughs, and achance to play This Little Piggy. In sum: within thefirst few minutes of his first Theraplay session, itwas possible to get this typically unhappy,uncooperative boy engaged in activities thatidentified some of his delightful qualities andengaged core affect.

From this initial activity, the therapist applied lotionto his and Tonys arms and initiated a Slippery ArmGame (each player has to try to pull the other overto his side), followed by a Hopping Race. Tonyloved winning the first race. However, for thesecond race, he became dysregulated, jumped thegun for the start, and had to be called back for are-start. This gentle, firm insistence on adult-in-charge is a big part of Theraplay. It is an importantcontributor in rehearsal for regulation of affect.

There is an ebb-and-flow to Theraplay sessions.The therapist provides the same kind of variety thata parent does when playing with an infant. Whenthe child needs a break from interaction and eyecontact the parent waits or gently soothes the infantuntil he or she is comfortable to resume moreintense contact. In a Theraplay session, thetherapist moves from being in-close to a little less-intense; from sitting to being up and jumpingaround; from being soft to being loud, all of whichassists the child in modulating his affect andbehaviour.

The next activity was a Staring Contest. Therapistand child sat cross-legged, with knees touching. Thetherapist gently held Tonys shoulders and Tony puthis hands on the therapists arms. This provided

literally - a holding environment! When the signalwas given, each tried to keep eyes open the longest.

The last activity was Guess the Goodies, an activitythat helps build trust. Still sitting with kneestouching, an envelope was brought out with Tonysname on it. The therapist said, There are somedelicious goodies in this envelope. Close your eyesand Ill put one in your mouth, and then you canopen your eyes and tell me what it is. Tony quicklyguessed when he was fed an M& M, but then Tonybecame resistant. He would accept another morsel(perhaps a jelly bean or tiny cookie), butimmediately take it out and examine it. It wastempting to say, no, you cant look, youre breakingthe rules. Instead, the therapist commented, Oh,I see you wanted to know for sure what it was. Acorrection would have added to Tonys shameexperiences.

Meeting with Parents

Tony then waited in the playroom, while his parentsviewed the video of the session. The parents sawhow Tony responded to the regressive experiencesby becoming calm and engaged. The StaringContest was role-played so that parents could trythis at home. This format continued over the nextfive meetings.

Later in Treatment: First Session with Parents

Before bringing in Mum and Dad, Tony was seenindividually, and some of his favourite games wererepeated. Tony was then made into a human Jack-in-the-Box by building a box of pillows around him.When the parents were brought into the playroom,they pretended to search for their boy. On a pre-determined cue, Tony jumped out. Parents were ledthrough a Check-in, as described in the initialindividual session. Towards the end, Tony suddenlyinsisted, Im hungry. It was explained that a fun

THERAPLAY: AN INTRODUCTION20


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Lyons-Ruth, K. (1998). Implicit relationalknowing: its role in development and psychoana-lytic treatment. Infant M ental Health Journal, 19(3), pp 282-289.

Mahler, M.S., Pine, F., and Bergman, A. (1975).The Psychological Birth of the Human Infant. NewYork: Basic Books.

Mkel, J. (2003). What M akes Theraplay Effective: Insights from Developmental Sciences. TheTheraplay Institute Newsletter, Fall/Winter 2003.

Mkel, J. (2005). The importance of touch in thedevelopment of children. Finni sh Medical Journal 60 , pp 15439.

Mkel, J. and Vierikko, I. (2004). From heart to heart: Interactive therapy for chi ldren i n care: Report on the Theraplay project in SOS Chi ldrens Vi llages in Finland 2001-2004. Billrothstr. 22A-1190 Vienna,Austria: SOS-Kinderdorf International

Munns, E. (ed) (2000). Theraplay: Innovati ons in Attachment-Enhancing Play Therapy. London: JasonAronson.

Myrow, D. L. (2000a). Applications for theattachment-fostering aspects of Theraplay. In E.Munns (ed.), Theraplay: Innovati ons in Attachment Enhancing Play Therapy (pp 55-77). Northvale, NJ:Jason Aronson.

Myrow, D. L. (2000b). Theraplay: the early years.In E. Munns (Ed.), Theraplay: Innovations in Attachment-Enhancing Play Therapy (pp 3-8).Northvale, NJ: Jason Aronson.

Rubin, P. & Tregay, J. (1989). Play wi th them - Theraplay groups in the classroom. Springfield, Ill.:Charles C. Thomas.

Schore, Allan N. (2001). The effects of a secure

attachment on right brain development, affectregulation, and infant mental health. Infant Mental Health Journal. 22 (1-2), pp 7-66.

Siegel, Daniel J. (1999). The Developing M ind: H ow Relationships and the Brain I nteract To Shape Who We Are. New York: Guilford Press

Stern, D.N. (1985). The Interpersonal World of the Infant . New York: Basic Books.

Tronick, E. Z. (1998). Dyadically expanded statesof consciousness and the process of therapeuticchange. Infant M ental H ealth Journal, 19 (3), pp290-299.

Winnicott, D.W. (1957). Mother and Child. NewYork: Basic Books.

Wettig, H.G., Franke, U., and Fjordbak, B.S.(2006). Evaluating the effectiveness of Theraplay.In Schaefer, C.E. and Kaduson, H.G.,Contemporary Play Therapy (pp 103-135). NewYork: Guilford Press.



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Introduction: the impetus to the search foran appropriate methodology within playtherapy

The author is conducting a research study,supported by the NHS North West RegionResearch and Development Directorate, toelucidate how play therapists perceive change in theplay therapy dynamic with children. Consultingwith therapists is regarded as a first step towardestablishing what effect play therapy has on childclients. It is hoped that this will help identify anappropriate assessment tool that can be used tomonitor the progress of therapy. This would beuseful on an individual basis with clients and on alarger scale to conduct outcome studies that woulddocument the efficacy of the play therapy approach.

Play therapy as a creative arts therapy

When designing a research study a researcher wouldnaturally draw inspiration and seek direction from

previous investigations. However play therapy is anemerging profession without a strong researchtradition, and previous evaluation in the field bothwithin the United Kingdom (Carroll, 2000, 2001;Daniel-McKeigue, 2004) and internationally isscant (Broomfield, 2003; LeBlanc & Ritchie,2001). To provide guidance on how to examine theprocess of play therapy through the discipline of research I would suggest that we may learn from theexperience of other investigators involved intherapies particularly those working with childrenand within the arts therapies.

Play therapy is not always included in the definition

Playing in the field of research:Creating a bespoke methodology to investigate play

therapy practice

Chris Daniel-McKeigue

Manchester Metropolitan University, U.K., and Liverpool Hope University

Abstract

There is limited research available within the field of play therapy to draw upon when formulating a researchinvestigation. The author suggests that it is advisable to consult the development of research design within thewider field of the arts therapies. It is acknowledged that quantitative methods have earned respect as credibleapproaches to research within this genre. Alternatively it is recognised that a qualitative approach may beefficacious for certain investigations within the creative arts therapies. The particular benefits of working withina qualitative paradigm are explored: the affinity with the therapeutic medium; the utilisation of the therapistsskills; the opportunity to use a combination of approaches within the design; the concept of bricolage; the abilityto triangulate data and the more complex concept of crystallisation. The application of these principles are

applied to the authors own investigation which uses a heuristic framework to discover more about the nature of change within play therapy. In the spirit of heuristic research the author invites readers to respond to the ideaswithin this paper and would welcome correspondence via letter or Email. Keywords: arts therapies, heuristic,methodology, play therapy, qualitative research, researcher-practitioner, art-based, arts-based.

Bri . J. Play Therapy , Vol. 2 (2006), pp 24-36


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of the arts therapies; this is a generic term that isused to describe a variety of arts therapypractitioners. Cattanach, editor of Process in theArts Therapies (1999), uses the term to include art

therapists, dance therapists, dramatherapists, musictherapists and play therapists. However, within thesame publication Barham (1999) outlines that theonly officially recognised Arts Therapists within theCouncil for Professions Supplementary to Medicine(CPSM) are Art, Drama and Music. Now known asthe Health Professions Council (HPC), thisregulatory body (at June 2006) recognises that thearts therapy profession has four protected titles, arttherapist, art psychotherapist, dramatherapist andmusic therapist. In a previous publication thatsummarised the available research within the artstherapies Payne (1993) does not acknowledge playtherapy and focuses on art, drama, dance movementand music therapies. In contrast, American writerMcNiff (1998) is inclusive in his definition of thearts therapies. He outlines an arts-based approachto research and does not specify the limits of thedefinition but collectively describes the creative arttherapies as an outgrowth of psychologys aestheticaspect (p.15).

Play therapists themselves may not necessarilyregard their practice as an arts therapy. Currently(at June 2006) the British Association of PlayTherapists (BAPT) is seeking professionalvalidation by either the HPC or the UnitedKingdom Council for Psychotherapy (UKCP).There is some dispute as to the most appropriate

category: arts therapy or child therapy. I wouldsuggest that play therapists are ambivalent abouttheir profession being regarded as an arts therapyand I would go further to propose that they may bemore inclined for it to be recognised as a childpsychotherapy. Similarly other arts therapies alsohave an allegiance to psychotherapy, for exampledramatherapists continue to debate whether thisshould be integrated into their title in the same wayas art psychotherapists (British Association of

Dramatherapists (BADth) Conference 2005)

I would suggest that play therapists differ from theother arts therapy professions in that they are less

likely to consider themselves as artists in the sameway that an art therapist, dramatherapist or musictherapist may have a particular skill within a certaincraft. Nevertheless play therapists do share the

media of the creative arts therapies within theirapproach, for example image making, role-play,voice and percussion.

For the purpose of this paper I propose to consultother therapy practitioners, primarily those whoalso rely on the creative arts as the principle meansof communication. I will use the term artstherapist in the spirit of Cattanach and McNiff toembrace a wide range of creative art therapypractitioners including play therapy.

Quantitative versus qualitative research

It is vital that the practice of play therapy isunderpinned with research and proves to beevidence-based. It is important that investigation isnot intrusive to the clients therapeutic process buttakes place in harmony with clinical work (Daniel-

McKeigue, 2004). In 1993 Junge and Lineschoutlined that hitherto art therapy researchers hadrelied on traditional quantitative research methods.They exhorted practitioners to move away from theempirical studies that had been regarded aslegitimizing the profession and embrace newparadigm research. Postmodern thinking haschallenged the underlying philosophy of quantitative paradigms and given birth toqualitative approaches that focus on the

investigation of experience as well as effect. Drivenby philosophies such as humanism and feminism itis conceivable that within qualitative design theresearch can be adapted to and congruent with thephenomenon being investigated. Linesch (1994)compares the subjective, open-ended, intuitive andqualitative nature of art therapy practice andcontrasts it with the attempts to research the processthat are generally objective, narrowly focussed,empirical and quantitative (p.185). Arts therapistsare familiar with the struggle for acceptance of theirtherapeutic approach within the psychologicaltherapies; perhaps practitioners are wary of repeating this conflict within the field of research,

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concluding that if an acceptable methodology isselected then the therapeutic approach will beratified.

Within ten years of Junge and Lineschs recommen-dation the investigative tide may have changed.Barham (2003) identifies that qualitativeapproaches are frequently the methodologicalapproach of choice for arts and play therapyresearchers within the School of Psychology andTherapeutic Studies at Roehampton University.This is apparently synchronous with theirpsychological counsellor counterparts and incontrast to their psychology colleagues within thedeanery (Barham, personal communication byemail 13.01.2006). In parallel, within the world of child psychotherapy Midgely (2004) highlights asmall but significant change in the research culturethat is beginning to embrace the qualitativeparadigm and notes a small number of publishedresearch articles in this style since 2003. Heattributes this change to a shift within academicinstitutions that have begun to support suchmethodologies within their clinical awards.

However the credibility of research may continue tobe associated with what Junge and Linesch (1993)describe as the single predominant paradigm of Western science, positivism and the empirical,quantitative model (p.61). This is exemplified byKim, Ryu, Hwang and Kim (2005) who state thatthey recognise the empirical, heuristic andsubjective nature of current art psychotherapy

methods (p.59). Their pictorial representation of an arts therapy researcher in a white laboratory coat(2005, Fig.1) seems an incongruous image, anddoes little to convey their confessed understandingof a practitioner/researcher. Kim et al propose anexpert system (p.59) based on a computerprogramme of diagnosis that will assist artpsychotherapy research. However it is likely that insystematically unifying theories they will overlookand lose the individual detail and variation inhuman experience. In contrast qualitativeapproaches would highlight such nuances. In thespirit of Animal Farm (Orwell, 1946) there is adanger that we will fall into the same trap as the

quadrupeds that chanted four legs good, two legsbad (p.4), asserting the supremacy of one state of being to the detriment of another. It is in fact notnecessary to prove that one paradigm is superior to

another or even to establish their equality, but ratherto recognise the merits of each approach and theirbenefit for certain investigations.

Describing the situation within child psychotherapyMidgely (2004) uses a vivid description of twoGreek sea monsters, Charybdis and Scylla, who eachlie on either side of a strait, in trying to avoid oneyou are sure to become victim to the other. Hedraws comparison to opposing standpoints withinthe profession and proposes that in the same waythat Jason and the Argonauts managed to navigatebetween them, qualitative approaches can offer analternative course between the Scylla of large-scalequantitative research and the Charybdis of theclinical case study (p.92).

By sailing too close to the dominant ideologies of evi dence-based practi ce and the logic of the randomized control tr ial we risk losing what is most distinctive and most central to the psychoanalyti cal approach. Yet if we steer too far the other way, and insist on maintaining an exclusive reliance on our traditional methods of clini cal wi sdom, we are at risk.

(p.91)

Whilst it has been demonstrated that qualitativeapproaches are emerging, their validity continues tobe a topic of debate and is played out on manystages. McLeod (2001) suggests that they remainon the margins of the counselling andpsychotherapy research enterprise (p.14). Withinthe health sciences Mays and Pope have made asignificant contribution to promoting the merits of qualitative approaches and their application. In1995 they published a series of articles to addressthe resistance to the acceptance of suchmethodologies in the British Medical Journal (BMJ)(Mays & Pope, 1995a; 1995b; Pope & Mays, 1995)and again in 2000 they are series editors of a set of articles with a similar agenda (Mays & Pope, 2000;



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Pope, Ziebland & Mays, 2000; Meyer 2000). Theproof of the pudding will be in the publishing; theacceptance of qualitative approaches will besignified when journals such as the BMJ themselves

print substantial research articles in this modality.

Qualitative and quantitative methodologies are notmutually exclusive; indeed both approaches couldbe married within a study (Pope & Mays, 1995).Essentially it is important that a methodology ischosen that is an effective means of eliciting data, itmust also be in harmony with the needs of theclients/participants involved and congruent withthe focus of the study. Qualitative approaches dooffer certain benefits to arts therapy researchers assuch research design can be both sympathetic to theunderlying philosophy of the creative arts andtherapies and also promote ethical practice.However to what extent should practitionersincorporate the framework of artistic experience(Grainger, 2001, p.11), that is so important to arts-based researchers and arts therapists, within themethodology?

Art-based and arts-based research

Proponents of art-based research 1 argue that artstherapists do not need to look outside of theirprofession to find congruous research models sincethe discipline itself is intrinsically valid as aninvestigative method of enquiry. McNiff (1998),an advocate of art-based research, describes thatwhilst he is sympathetic to the philosophy of qualitative research, particularly hermeneutic,phenomenological or heuristic models, he is alsosatisfied with the validity of the creative arts as aresearch methodology in itself. He cites numerousexamples of therapists, many involved in graduatestudies, who have used their therapeutic medium asthe means of investigation. This viewpoint is alsosupported within other non-therapy arts disciplines,for example Daykin (2004) endorses an arts-based research 2 approach that has a similar philosophy. Sheutilises musical expression as a research tool in her

consideration of the impact of insecurity and ill

health on music practitioners and concludes thatmusic and music making can offer useful resourcesfor inquiry (p.8).

I would question whether a solely creative arts basedapproach would have sufficient credibility to beuseful as a means of investigation. Arts-basedresearch is a method that would utilise, indeedmaximise the therapists skills but there could be adanger of collusion, by using an investigative toolthat is so closely connected to the topic underinvestigation. Would the design offer sufficientchallenge and could the data be considered asreliable or judged as having any degree of accuracy?

Payne (1993) further suggests that arts basedresearch would have little credibility outside of thefield. Whilst the randomised control trial may nolonger be the gold standard of research practice,qualitative methodologies that endeavour toelucidate the nature of experience still struggle forrecognition alongside the more traditionallyaccepted quantitative approaches (Pope & Mays,1995). This is supported by my own experience of submitting a qualitative based study to an NHSresearch ethics committee. It was reviewed by agroup whose principle expertise was within aquantitative paradigm, which influenced their

judgement and opinion of my proposal.

Malchiodi (1995) proposes that art therapistsunderstanding of the therapeutic process is bornefrom their own experience of the powerful andpersonally fulfilling experience of artmaking(p.155) therefore she concludes that:

identifying the efficacy of art therapy will come from deeper understanding and exploration of media, the art process and therapeut ic space, and how we define these as artists. The answers to our search will not come from our clini cal expertise alone, but rather from our knowledge of art and from an intimate, personal connection to our own artmaking. (p.156)


1 Art-based research is a term adopted by therapy practitioners to describe the use of elements of the creative arts therapy experiencewithin an inquiry, see McNiff 1998.2 Arts-based research describes inquiry that utilises a creative medium but is not necessarily related to therapy.


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rely on case study. This evolves into a second stageof consolidation and routinisation whereinnovative practice from the first stage will be testedto establish reliability. However McLeod cautions

that in the second stage the drive for verificationmay lead to the rejection of the value of discovery inresearch, which has predominated in the first stage(2001). Perhaps this explains why quantitativemethods become so dominant and qualitative inves-tigations become the pariah of the research world.

The practitioner-researcher

However some arts therapy practitioners suggestthat using therapy as inquiry has little relevance inthe research world (Payne 1993) and dismiss thecredibility of research by practitioners who relysolely on their therapeutic skills, arguing that suchan approach is essentially flawed and does notrecognise that researching is a discipline in itself (Barham, 2003 p.6). Presenting case studies is animportant impetus to research that should not beundermined; however to undertake subsequentinvestigation therapists may not be able to rely ontheir existing skills. Proponents of qualitativeresearch within the health services, Dingwall,Murphy, Watson, Greatbatch and Parker (1998,p.167) use a metaphor from an unlikely text toillustrate that it is not enough to be an experiencedhealth practitioner, researchers must developspecialist research specific expertise:

A child does not catch a gold fish i n water at

the first trial, however good hi s eyes may be,and however clear the water: knowledge and method are necessary to enable him to take what is actually before hi s eyes and under hi s hand. So i t i s wi th all who fi sh in a strange element for the truth which is living and moving there: the powers of observation must be trained, and habi ts of method of arranging the materials presented to the eye must be acqui red before the student possesses the requisites for understanding what he contemplates.

Martineau (1838)How to Observe M orals and M anners

Noticing

In contrast Mason (2002) exhorts professionals toresearch their own practice and whilst his primary

focus is on teachers he applies this definition widelyto include people who work in a caring orsupportive capacity (p.1). He strives to take someof the mystique out of research and encouragespractitioners to utilise their current expertise. Hesuggests that researchers can begin by being alert tonoticing and considers that this is a discipline thatis integral to research. Observation is one of thestrengths of arts therapy practice, which is alsoinherently evaluative; therapists are trained to be

reflective practitioners and to use the process of supervision. For myself, entering the field of research as a novice has been a challengingexperience; I recognise that I have required specialistresearch advice and needed to develop particularexpertise. However, to discover that I had sometransferable skills from my therapy practice, such asobservation, listening, interview technique,evaluation and self-reflection that could contributeto the process of research has been a definiteadvantage. It is possible that otherwise I may havefelt more deskilled by the process.

The therapist-researcher: advantage or oxymoron?

In the same way that it is possible for creative artstherapists to employ their specialist media within aninvestigation, it is also possible for them to utilisesome of their therapeutic skills, indeed this maymake the research process more accessible to them.A balance must be established between takingadvantage of the familiar and taking a risk into theunknown. So the arts therapist may endeavour toembrace their skills as a practitioner and enhancetheir investigation by accepting the challenge of applying other methodologies. However incontrast to Mason, Rowan offers a caveat against thetherapist-researcher, implying that it may be anoxymoron: the lot of the practitioner-researcher is

generally an unhappy oneit is almost impossibleto carry it out (1993, p ix).

So the arts therapist may endeavour to embrace



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their skills as a practitioner and enhance theirinvestigation by accepting the challenge of applyingother methodologies. However in contrast toMason, Rowan offers a caveat against the therapist-

researcher, implying that it may be an oxymoron:the lot of the practitioner-researcher is generally anunhappy oneit is almost impossible to carry itout (1993, p ix).

Hybrid approach triangulation andcrystallisation

Payne (1993) cautions practitioners that a sole

reliance on traditional (research) approaches deniesus access to the richness available in the process andother phenomena intrinsic to practice (p.33).However she also suggests that therapists mustensure that they communicate their research in away that is understandable, and perhaps acceptableto colleagues from other disciplines. In practicethere is evidence to suggest that arts therapistsseeking a method to investigate the experience of their craft will use a hybrid approach that utilises a

conglomerate of different methodologies, whichmay include their therapeutic medium (Stromstead,2001; Barham, 2003; Grainger, 2001). It isinteresting to note that art-based researchers alsoseem to use a combined approach to design; the useof the media is augmented with other methodology.McNiff (1998) promotes this integrative design ashaving currency within the arts therapy professionssuggesting that a pluralistic approach to researchcorresponds to the diversity that exists within theprofession (p.49).

Stromstead (2001) exemplifies this combined approach. As an Authentic Movement practitionershe attempts to illuminate both the process and theimpact of the medium. Her study dependsprincipally on the organic method, she also utilisesaspects of heuristic practice and relies on using hertherapeutic medium of Authentic Movement itself to express the data. This amalgamation of method-ological approaches does incorporate thetherapeutic method as a means of investigation, inthe same way as an art-based approach.

There seems to be strength in the use of a diversityof approaches that may also contribute totriangulation, a process that describes how data canbe verified from a variety of sources (Denzin &

Lincoln, 2005; Tindall, 1994). Triangulation is atechnique used in navigation and surveying thatuses the rules of trigonometry to identify a fixedpoint from knowledge of two other coordinates.Richardson (2000) suggests that the concept of triangulation is too limited for postmodernistmixed genre texts (p.933), and suggests that threesides need not limit perspective but that this processis multidimensional. She offers an alternativeillustration of crystallisation which recognises thatcrystals grow, change, alterare prisms that reflectexternalities and refract within themselves, creatingdifferent colours, patterns and arrays, casting off indifferent directionscrystallisation provides uswith a deepened, complex, thoroughly partial,understanding of the topic (p.934). A combinedmethodological approach provides a variety of perspectives from which to both establish data andview the data. Such verification will not ensurevalidity but will contribute to the understanding of the phenomena being researched.

Bricolage

An amalgamative approach or research repertoire(Grainger, 2001, p.9) is described by Denzin andLincoln (2005, p.4) as bricolage, an adaptiveapproach to research design. A French word,bricolage does not have a direct English equivalent.

The common translation of do it yourself does notadequately summarise the nuances of thisexpression; I draw upon the interpretation of Brandon (2002), McLeod (2000), and Papert(1994) to translate. Bricolage describes an approachto construction that is in direct contrast to that of engineering; it utilises a creative resourcefulness andinventive spirit, to make the most of whatevermaterials are to hand in response to the constantlychanging requirements of the job in hand. Such anapproach within the field of research would allow aninvestigation to develop in an organic way andrespond to the process and the findings as theyemerge. Papert (1994) outlines that bricolage may



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be compatible with an alternative learning style inwhich experimentation and playing are key, asopposed to reliance on analytical thinking. There isa danger that such resourcefulness may be regarded

as an inability to anticipate eventualities. Howeverit is not always possible to predict the course of aninvestigation and it may be helpful to be free torespond to the development of the research process.A bricolage approach may not always be necessaryor warranted; what is important is that such anapproach is beneficial to the study. In effectbricolage is not making do but adopting the mosteffective approach for the investigation.

I would also suggest that there may be somesympathy with the term bricolage to the playtherapy approach itself. A play therapist needs to bea Jack (or more likely a Jill) of all trades in order torespond to needs of the client, working with avariety of media such as clay, paper, paint,percussion, dressing up clothes. Indeed maybebricolage is the play therapists specialist craft. Inthe nature of being client-centred play therapists arethemselves a bricoleur or bricoleuse, a resourcefuland creative person. In collaboration with a child,to facilitate expression and communication, theyuse play and art materials in new creative ways. It isperhaps natural that a client-centred practitionerwould naturally conduct research in this bricoleurfashion, becoming a research-centred practitioner,allowing an investigation to have an organic qualityand freely respond to the demands of the study.

Creating a bespoke methodological designto investigate what therapists perceive aschange in play therapy practice.

In the light of the preceding discussion I will, in thisfinal section of the paper, consider the developmentof my own investigation into how therapistsperceive change within play therapy. It is importantto acknowledge that this focuses on a singular

perspective and that the findings would need to beclarified in the light of other research conductedwith child clients, family, and other relevant parties.The aim of this initial investigation was to build on

the limited existing research in the field of playtherapy and the associated arenas of the artstherapies.

As there is not a custom-made methodology for artstherapy research, practitioner researchers need todevelop a bespoke research design that reflects theparticular needs of the study and is sympathetic tothe therapy and modality. Since a principleconsideration of this study was to preserve theprocess of therapy and investigate the natural courseof therapy without disturbing it, a non-invasivedesign was necessary that would rely on thetherapists reflection on their practice. For thisreason a qualitative methodology has been adoptedthat will elucidate the nature of the experiencerather than attempt to establish a truth about thephenomenon.

Heuristic model

In order to facilitate the self-reflection of theprimary researcher and to engage other therapists asco-researchers to reflect on their own practice I haveelected to adopt a heuristic methodologicalapproach. The heuristic model, pioneered byMoustakas (1990, 1994), is informed by humanisticphilosophy which is compatible with andsympathetic to the therapeutic process. IndeedMoustakas work has contributed to thed

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