Let's play we don't play anymore

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.