INTRODUCTION
Play
therapy is a specialized area in the health-care profession with the objective
to meet the child on a level that he or she comprehends, and to facilitate the
child’s process of completion in an ever-changing world.
FIGURE VERSUS GROUND
When
the child enters the play therapy room, he or she perceives the environment as
a total unit that merges as the figure. Spontaneous awareness of a specific
item changes the child’s awareness and the item now becomes the figure against
the environment as the ground. As the child explores, his or her perceptions
form one figure after the other, similar to the everyday life where the process
of emerging figures and receding grounds occur continuously.
The
child in the play therapy room own private, personal, inter-personal and social
values that gives impetus to the choice of figure. The meaning of the child’s connectedness
to a specific item as a figure is a critical aspect for the play therapist to
keep in mind. The art of Gestalt therapy comes to play when the therapist attends
to both the child’s figural process and awareness of his or her own.
Many
play therapists do not recognize the importance of the play therapy room and
the items purposely placed. During the play therapy sessions the room and items
displayed communicate the play therapist’s deep understanding of the child’s
need. In no way the room must bear resemblance to a toy store, cluttered with
detail to the point of being distracting and thus complicating the child’s figure-ground
configuration. An overly busy play therapy room is an away game, removed from an
authentic therapeutic milieu where the child’s vulnerability is at stake.
The
play therapist treats the setting like a theatre stage with some recognizable items
always in the same place. This creates stability and a safe environment to
accommodate the meaningful manifestation of the figure against what is perceived
as the ground. An inflatable punch bag in the corner, a table and chairs, a
sand tray and sheets of paper are usually sufficient as for older children and
teenagers a beanbag or two, a music instrument and some Cd's can be added.
A
seasoned play therapist, and depending on the nature of the assessment, the
severity of the case, anticipation of follow-up sessions and family history
introduces distinct items along the road as the child progresses. A cabinet
holding a family of dolls, dinosaurs, pencils, clay or any other choice of
medium is preferable and used as a tool to guide the child in a specific
therapeutic direction. If the figure does not merge for the child after
introducing a new item, the therapist follows the child’s process by assessing
the readiness or resistance to be engaged in a specific area of the problem
play. Keeping an openness to reevaluate
his or her understanding of the child and changing the medium accordingly is
sometimes a necessity. Practice makes perfect. However, premature change can
result in missing the opportunity to assist the child in working through and
not around his or her pain. For example: The play therapist takes the boy on
her lap and reads him a story to calm him down after he acted out and refused
to play with the dough that reminded him of his mother that passed away. Apart
from the fact that physical contact with children is a taboo the play therapist
kept the boy from learning self-nurturing skills by taking a stuffed animal in
his arms. The play therapist also missed the analogy between his reactions in
the here-and-now and his likely reaction to the loss in his past. Resistance was
the void and memories the point of departure, but both the therapist and the
child bypassed and passively avoided the fertile ground as the in-between. The
void became infertile and fixation summoned the end.
Having
to deal with a severe trauma or loss it is most likely for the child to be
resistant as a means to testing the water. Being able to acknowledge the
subsistence of memories or demonstrate the emotional capacity to resist
interaction indicates the readiness of the heartbroken child to start finishing
the unfinished business.
The
child’s physical reactions such as sweaty palms, palpitating heart, shivering
or crying is awareness-in-motion and an excellent medium for the play therapist
to bring the child’s I-boundaries home.
The
rule of the thumb is to regard the play therapy room as the ground for the
here-and-now, where myriad interactions are embedded to define the figure and
give it meaning.
ESTABLISHING BOUNDARIES DURING THE
INITIAL CONTACT
In
the Gestalt therapy a distinction is made between the self and the non-self and
when contact happens in a healthy manner I
am I, you are you, but also you and I are we.
All
children have an inclination to explore boundaries in order to establish
I-boundaries in an unfamiliar setting, however the child that comes to play
therapy might present this trying out of boundaries in a more subtle way.
Mutual
agreement on the physical aspects of the play therapy sessions gives both
parties the opportunity to explore the flexibility within the relationship, to
facilitate the removal of obstacles and permitting the restoration of the natural
equilibrium. The child can be asked to bring a small calendar or dairy to the
initial session and the play therapist might choose to have a daily planner
against the wall on which he or she notes the agreed upon sessions. Not only
does the child develop an awareness of more children being in need of therapy,
but he or she can also keep track of the days in between sessions, develop a
sense of scheduled therapeutic inputs and acknowledge his or her responsibility
to show up for the session allocated to him or her. Depending on the child’s
age and intellectual capacities the play therapist gives the child the
responsibility to share in presence or absence of the therapist his or her experiences
with primary caregivers, but also explaining the therapist’s responsibilities
where a crime, injustice of life-threatening situations exist or merge. Systematic
and caregiver support excludes talking about the child in his or her absence
where such conversations tend to get legs.
The
therapist and child further explore the need that might arise to take toys and
items from the therapy room home; possible resistance to therapy, changes in
sleeping and eating patterns, collaboration with the physician or health-care practitioner,
the availability of stuffed animals for emotional relief and channeling
feelings of aggression towards the punch bag.
Depending
on the play therapist’s preference and social circumstance behavioral taboos
like vandalism, the carrying of weapons or harmful objects and in some
instances swearing and cursing can be talked over.
SMALL DEATHS IN THE PLAY THERAPY ROOM
According
to Friedman (1994:97-98) the “Growth in a healthy organism necessarily involves
three stages: the place where it starts from, the place where it is going to
and the space in between.” The in-between can be propelled by feelings of
enthusiasm and zest or impeded by feelings of anxiety, fear and suppression.
When
a child is in need for therapy, the assumption can be made that he or she is in
distress. Where a gradual or momentarily change creates a void a causal
relationship between distress and change is noted. Change implies loss and today’s
loss implies tomorrow’s gain under healthy circumstances. To gain after
experiencing a loss often asks for physical and psychological trail and error,
learning and progressing – healing is a process that comes through struggle,
effort and growth.
Children
between ages of 5-7 perceive loss as factual and incident specific; and are
able to attach a feeling, action or emotion to the incident or loss.
Pre-adolescents
between the ages of 8-12 have an added awareness of family members’ and
friends’ reactions to, and depending on the nature of the incident or loss,
include religious symbols or abstract mentioning.
Adolescents
between the ages of 13-17 express their emotions and actions in essays or self-written
poems, using both concrete and abstract symbols to reason the incident or loss
and often display an array of unsettling reactions and emotions, questioning or
calling upon religious entities and battle dark or evil forces. Awareness of
own mortality and self-destructive thoughts are not uncommon.
In
the Gestalt theory the most urgent needs are treated first (figure and ground)
and acquires a high degree of self-awareness. Most children and pre-adolescents
have a more natural way to align with the existing environment and find
closure. Adolescents exhibit a sense of inadequacy and frustration to
re-establish personal and environmental connections after loss and has the
tendency to nurture unfinished business for phony personal gain.
Apart
from the high incidence of factors listed as a cause of loss, family
circumstances often elicit a mourning process.
Children
of all ages depend on their primary caregivers and/or family system for the
completion of their physical and psychological development according to the
Gestalt theory and respond incapacitated in a non-nurturing environment.
Factors such as insufficient bonding and attachment, pathogenic family
structures and inadequate parenting styles provoke feelings of uncertainty,
manifest in conflict and reflect on low self-esteem. Parental figures and
caregivers act as role models for the adult-in-the-making and their qualities
draw into psychological energy needed for acquiring life skills and
homeostasis. Taken in account that every child comes from a place that serves
as a dwelling for the family, natural and economical disasters, elongated
warfare, pandemic diseases and high-risk areas will take its toll.
Unidentified
or overlooked losses necessarily create a void and can manifest in symptoms such as aggression, denial,
frantic behavior, withdrawal, negotiation, and narcissism. The mourning process
is therefore not necessarily elicited by the death or desertion of a loved one,
but can be brought on by minor losses also referred to as small deaths.
The
Gestalt therapy focuses on the total-person-environment
configuration and advocates the personal growth model, where childhood
circumstances and the reactions upon can be changed.
Increased
self-awareness and adapting healthy coping mechanisms are subject to breaking
down the child’s narrative, finding a storyline through contact, awareness and
attention, where the whole is larger than the sum of its parts. Recognizing and
dealing with previous losses in the here-and-now creates the opportunity for
the child to accept self-responsibility, his/her developmental phase,
intellectual capacity and support system permitted.
PERLS’S 5-LAYER MODEL AND PLAY THERAPY
In
the earlier stages of development children think of toys as living objects and
rituals like going to bed with the same stuffed animal, blanket, bedtime story
or song is the beginning of self-nurturing behavior.
Play
is a medium for children to explore, exchange views, make rules up as they play
along and alter rules with or without a quarrel. Play is a medium to discover
the self and the outer world of non-living and living objects. Children in play
easily move from one activity to the other, role-play characters, narrate feelings,
emotions and parts of speech as if all objects in the play area are alive. Constant
interruption, criticism, belittling and scorn by caregivers underestimate of
the value of the child’s play and ignite feelings of shame and guilt.
When
the child is subjected to a severe personal or interpersonal trauma or loss, play
activities cease as the unknown factor impacts the I-boundary, manifests as the
ground against a disrupted figure.
Play therapy sessions reintroduce the child to a familiar world of
pastime and encourage healthy engagement with the outer world.
To
recapitulate Perls’s theory on neurotic fixation the organism moves back and
forth between the five layers of the personality and with insufficient coping
mechanisms fails to reach a state of homeostasis. (Perls, 1973) Neurotic
fixation happens when the organism applies this inability to adapt in other
areas of his or her life and imbalance becomes the norm. The locus of control shifts external
and I-boundaries are blurred into a state of being neither fish nor fowl. The
opposite also happens where boundaries become rigidify to the point of
inflexibility and exhibited as narcissism.
The
healthy organism integrates the five layers of personality as a whole and can
move between the wants and needs of each layer without getting anxious rather
than embracing the process. Gestalt is about coming face to face with the self
and the awareness of the fullness of possibilities.
A
child in distress mourns the interruption of his or her self-regulation and fixates
in the false layer by denying or rejecting the overwhelming evidence of loss
that causes imbalance. The child’s behavior changes, he or she cries often, has
difficulty to fall asleep, acts like a clown, cannot complete simple
assignments, regresses by talking like a toddler and gets easily upset to name
a few. When the loss and the
effect thereof can no longer be denied the phobic layer surfaces and he or she
becomes frantic in trying to find familiar elements and reassuring symbols.
Restlessness
and frantic activities on physical and/or psychological level absorb large
amounts of energy and due to the intensity thereof have a limited lifespan. The
third layer or the impasse as a turning point is an unavoidable destiny after the
activities in the false and phobic phases and the vista of deliberation opens
up. The nothingness of the impasse is the realm of the void or in-between and
leaves the child and play therapist with a wide range of possibilities.
The
child can regress to the previous phases even though with less intensity,
whilst longing for the falsely acquired gains from outsiders’ sympathy and
support or move on to the next layer, namely the implosion or ‘death” layer.
Fixation can occur during any of the layers if the organism’s self-awareness
lingers undirected for too long.
The
child experiences a deep sense of exhaustion, but also a willingness to
reestablish contact with the outer world. Perls (1969) writes: This fourth
layer appears either death or as fear of death. The death layer has nothing to
do with Freud’s death instinct. It only appears as death because of the
paralysis of opposing forces.” Suicidal behavior, dark thoughts, substance
abuse and other harmful practices during the implosion phase can occur. Giving
the intrusive happening the final resting place is a vital part of regaining
homeostasis, but this at can create a void as well. The child can get so
attached to the effects of the loss that losing the lost is a lost in its own
right.
When
fixation happens during this phase mourning becomes pathological - a
superficial weaponry and tool to hide from the self and manipulate the outer
world with. The child who is unable to regain his or her zest for life becomes Child Loss, opposed to Child who has experienced loss. Letting
go is not to forget, letting go is to use the loss as a stepping-stone.
In
the preceding play therapy sessions the seeds were already embedded for the
fifth layer, known as the explosion phase to come. The explosion phase happens
when child accept the loss as a part of daily life without feeling victimized.
The completion of the gestalt fills the child with ecstatic happiness and
satisfaction for a core transformation happened. This state authenticates the I-figure
to attend to personal needs and has genuine interest in the we-ground.
Using
the layers of the neurotic personality as described by Perls (1969) as a
therapeutic barometer, the therapist is aware of possible points of fixation
and repudiation of responsibility.
The
layers are not rigid and smaller entities of different phases show when play
comes into therapeutic action, for the
whole is larger than the sum of its parts.
IN SUMMARY
Childhood
is a time of discovery, a time of wonder. Childhood is precious and fleeting.
Meeting a child interrupted is to play we don’t play anymore.
FURTHER READING
Friedman,
N.1994. Perls “Layers” and the Empty Chair. The Gestalt Journal. XVI(2).
Perls,
F.S. 1967. Gestalt Therapy Verbatim.
Moab, Utah: Real People Press.
Perls,
F.S. 1973. The Gestalt Approaches and
Eyewitness to Therapy. New York: The Gestalt Journal.
Polster,E.
& Polster,M. 1973. Gestalt Therapy
Integrated. New York: Bruner/Mazel Publishers.
