/
4o
By
MENTAL WELFARE
GWEN E.
Play Therapist,
CHESTERS, B.A.,
East London Child Guidance Clinic
play in the treatment of nervous disturbance is now generally recognised. Even in adult treatment there is play of a kind, though here the play is with ideas expressed mainly through words. For children the medium is less intellectualised, and play involves activity as well as speech. Concrete expression and experimentation are normal and necessary to the child, and provide therapy with a valuable instrument. In play, children can express ideas hardly realised by themselves, but clear to a competent observer. They can deal with phantasies which might otherwise prove overwhelming, and become the more free to meet real situations. The normal self-balancing and self-healing processes in the mind are restored, and harmonious intellectual development assured. Reassuring social contacts, the necessary complement of the child's relinquishing of the mother, are made possible, and the child's interests gradually extended. Play with an understanding companion both facilitates the solution of the child's problems and reassures him socially, so that stable development can be achieved. The play situation has a two-fold significance which must be more closely considered. John daubs paste on the board and Colin spreads wet sand on the windowsills and along the skirting boards. Joyce smears paint on her fingers, her table and her chair. Arthur washes his hands incessantly, and Mary cries if her frock is splashed. That is one aspect of the situation, and here is the other. John speaks in whispers, rarely smiles, glances apprehensively at the worker while playing, and makes no response to the other children. Colin protests if other children play near him, calls frequently to the worker to look at him, chatters and laughs to himself. Joyce never talks spontaneously, answers only in whispers and plays alone in a corner. Arthur demands much The value of
from the worker, takes material from the other children, but does not with them, while Mary makes no advances, and in response to talk only smiles. Play therapy for groups must provide for both the individual and the social problems of the child. The children brought for treatment show various kinds of disturbed behaviour. Some of them are withdrawn from their actual surroundings, while others are boisterous, aggressive and violent. Some children have particular fears, while others suffer from more general anxiety. Some are delinquent, some have physical symptoms, and some have special learning disabilities. But in general, along with the existence of more specific difficulties, is found a varying degree of social retardation, method is designed to meet both kinds of disturbance. A situation and the play is provided in which the child can express his problems and find some solution
help play
of them,
MENTAL WELFARE
41
We will consider first the provision made for the more specific difficulties, though it must be remembered that the treatment of these is not isolated from that of the social maladjustment. These difficulties are found to be related to the child's primitive interests and to the various phases of its development, and the play material is chosen on the basis of its capacity for the expression of these. Feeding bottles, food, sweets, water, pumps, rubber tubing, washing and scrubbing materials, sand, dough, plasticine, paper, matches, paints, chalks, crayons, hammering toys, drums, dolls, a doll's house, tea-sets, boats, engines, cars, farms and bricks?these and similar materials are found necessary. It will be noticed that there is little mention of set constructive or educative material, but such material fails to meet the more primitive needs we are considering, while those materials listed here lend themselves, when required, to more constructive use. The groups are small and play is left to the initiative of the child, the worker's attitude being one of friendly cooperation; and freedom of activity is allowed, though behaviour involving danger to the child, attacks on other children, and over-destructiveness is checked. Play is observed, co-operated in when necessary, and interpretations made when the solution of the problem for the child demands it. On the social side the child's difficulties are found to arise in the family situation with special reference to the child's position with the mother. The role allotted tacitly by the child to the adult, other than that assigned in more obvious phantasies, is noted. In general the children are found to be very demanding of adult attention and to play with little reference to their fellows. They are rarely capable of good reciprocal relationships, and many of them demand ceaseless attention and help from the worker. Such requests You watch what I'm doing," You're helping me," as You sit by me," You come over here," are frequent, and angry protest often follows on the inevitable diverting of attention to another adult or child. Where this is found to be the case arrangements are so made that the child's needs can for the time be met. As the existing outside environment, with its demands for or tacit assumption of a more independent and social attitude in the child, has failed to produce it, it is not felt that further expectance of self-help and ignoring of demands will foster a better social adjustment. Confidence must be restored at the infantile level before the child can progress. While he is accepted as he demands, any indication of more social feeling is fostered, and any opportunity of extending it taken. As he is over-demanding because he is anxious and feeling unvalued, and as normal relationships are reciprocal, If mere meeting of demands will not allay his anxiety or extend his interests. the made friendliness normal and this is to be done satisfactorily possible, child must feel of value, so that he can give as well as take. To this end suggestions of help are made though not insisted on, such suggestions being in line with the spontaneous offers of the children. Material for joint games is provided, so that the child's interest may be more readily diverted from and this includes balls, skipping-ropes and skittles. himself to his "
"
"
activity,
"
MENTAL WELFARE
42
Play under these circumstances throws light on the nature of the child's problems, gives him an opportunity of solving them, and brings him much relief. In general, the problems with which he seems most concerned are related to feeding, excretory processes and cleanliness-training, sexual development and family relationships. Certain kinds of play tend to predominate for a time, and there is frequently a preponderance of sand and water play. with engines and cars, drawing and painting, and dramatic Feeding-play, play are usual. play Generally speaking, the child makes use of material for the expression of his phantasies, and often after a time states openly their meaning for him. As play proceeds and problems are solved, modifications are noticed. Play becomes gradually more varied, sustained and constructive, and normal interest in play itself becomes evident, with the consequent satisfaction and pleasure. As illustration we may take the following case. On his first visit, Bill, a delinquent boy aged nine, referred for petty theft, rushed about the room shouting, pushed over tables and chairs, threw toys about, stamped on them and broke them, and made frequent attacks on the other children for the possession of their material. At the end of the hour his pockets were seen to be bulging and he was found to have commandeered several small toys?a doll, a car, and several animals. On his next visit he began by stamping on toys, but was given a hammer and a book of wall-paper patterns, and told he could hack it to pieces. He spent twenty minutes doing this, till he was breathless and red in the face. Eventually he brought one cover attached to the tattered remains of the rest of the book, and asked the worker to keep it for him till next week. He then fetched a feeding-bottle, removed the valve, cut a big hole in the teat, and walked about blowing the water out through the teat on to the floor and walls and attempting to blow it at the other children. For the next few visits his time was filled in the same way. One day, while blowing water about the room, he remarked spontaneously that he was urinating. There were still occasional bursts of rushing about. Once, when You don't give me enough sweets, so why should I restrained, he said: with (He was given his share of sweets with the other children.) you? play He began to light fires in a tin and burnt small dolls. He was given small "
"
"
"
the babies twists of paper with faces marked on them, and these he called and asked for more to burn. He also drowned them in a bowl of water, and put them on a boat and sank it. About the same time he took pieces of rubber tubing and pushed them through the dolls' house windows and up and down the stairs. He then started to play with farm animals, setting them up in seeming random order, and this play gradually developed. He spent much time building neat walls with stone bricks to enclose the farm, made sheds " food for pigs and sheep, which he into which he put troughs full of so that lined up in front of them, and put all the animals in safe enclosures He Miss." for wood and nails and made asked can't break out, recently they to the worker to look after till next time, as he did it a wooden cart, giving the bricks he sorted out for building walls. The paper-hacking, water-blowing, "
"
MENTAL WELFARE
43
and rushing about have ceased, there have been no more raids the cupboards, and the more settled play continues, while he has several times swept the floor and put away the toys before going home. There is a similar modification in social behaviour. The child progresses from the need to monopolise the worker to the acceptance of its contemporaries as satisfactory substitutes. Several stages have been noted here. There is the engrossing of attention in the child's own activity, then requests for the worker to do the same thing as the child, followed by the acceptance of other workers and children who wish also to do the same thing. Joint games such as ball games appear next, and in these other children are eventually allowed to join. Finally the child makes spontaneous suggestions of play to other children, and follows these out happily with due consideration of the claims of the others, with increasing interest in what is being done, and without dependence on absorbed adult attention. The usual trend may be illustrated by one case. Sally, aged 4, referred for general backwardness, filled her first visit with such commands as Sit " Sit not sit on and there?No, there, 'ere," by me," (Let me) your lap," " Hold it." She piled toys on the worker's knee, saying each time 'Ere it still till was and sat eaten. If She other children y'are." accepted chocolate, or if the worker's attention was diverted for a moment, she said: approached " Want Mummy and went out of the room. There was no settled play, and no conversation beyond requests and Yes and No replies to talk. This sort of behaviour continued for several visits, and on arrival each time she Gimme some chocolate." After two visits she left oft asking for her said: mother, but told anyone who came near to go away. On her third visit she Eat took some chocolate from her mouth and gave it to the worker, saying, at sometimes and her She some. it," subsequently always gave putting played the worker to bed on the floor, and lay down beside her. In this game she spontaneously included other workers. She nursed dolls, sang to them and put them to bed. She helped put the toys away, but when it was first suggested that she should play ball, she took the ball and put it in the cupboard, then continued her usual commands. Soon afterwards she said: Want to jump," and climbed on to the table, from which she jumped into the worker's arms. She then accepted the suggestion to play ball, and played for some time, laughing and making comments about the game. Her next visits were divided between playing ball and jumping, but she was unwilling to let other children join in, and threw toys at them. One day she joined the worker spontaneously in sweeping up sand, and accepted the suggestion to play Ring o' roses with the other children. After playing for some time, joining in the singing and laughing when she fell down, she turned to the little girl whose hand she had been holding, stroked her arm and said: "Oh, a nice little girlie." She patted and hugged her. Then they rolled over on the floor, laughing all the time, and stopping to hug and kiss one another. On subsequent visits there was the same rolling game, and the spontaneous playing of ball and Ring o' roses with the other children. She moved freely about the room, coming back
fire-lighting on
"
"
"
"
"
"
"
"
"
"
"
MENTAL WELFARE
44 and then
"
the worker with the request Sit on yer lap." She played o' tea to worker a the and the other children, cup tea-party games, offering she from them. still She though grabbed toys began to play with sand and " soon her hour and castles, pies spent making cups o' tea," allowing the other children to play with sand at the same tray, and when she grabbed cups from them gave them a substitute. Often she agreed to return what she had taken. She now makes no protest, and continues playing, when other children approach the worker. She includes her in her tea-party play and talks to her, but no longer monopolises her. When the other children arrive she greets them spontaneously, saying Hello," or calling their names, and her conversation is becoming more developed and general in its reference. She shows an increasing pleasure in play with other children, tolerance of their claims, and interest in what she is doing. As a more general consequence of play we find that anxiety is relieved, aggression modified, and interests satisfied and released for more advanced activities, while a growing friendliness and general happiness are shown. It may be thought that all children play, yet in spite of it become ill, difficult and unhappy, and the suggested remedy of more play may be doubted. But play for most children is directed and limited by the practical demands of ordinary circumstances, and by insufficient insight and emotional difficulties in those in charge of them. Play-therapy, however, provides for play under conditions specially designed for it, and with the possibility for the child of reconstituting sound social relationships. Similar play for groups in nursery and kindergarten schools would do much to lessen the difficulties that form part of the experience of all children, and would add greatly to the possibility of their intellectual efficiency and general happiness. The harmful effect of emotional disturbance on intellectual output is recognised. There are many children whose difficulties do not become so acute as to make treatment seem necessary, and who nevertheless are handicapped emotionally and intellectually, with the result that their potential capacity remains unrealised. It has been found, too, in working with defective children, that the relief of their other difficulties is followed by a considerably improved standard of performance. now
to
"
"
"
4o
By
MENTAL WELFARE
GWEN E.
Play Therapist,
CHESTERS, B.A.,
East London Child Guidance Clinic
play in the treatment of nervous disturbance is now generally recognised. Even in adult treatment there is play of a kind, though here the play is with ideas expressed mainly through words. For children the medium is less intellectualised, and play involves activity as well as speech. Concrete expression and experimentation are normal and necessary to the child, and provide therapy with a valuable instrument. In play, children can express ideas hardly realised by themselves, but clear to a competent observer. They can deal with phantasies which might otherwise prove overwhelming, and become the more free to meet real situations. The normal self-balancing and self-healing processes in the mind are restored, and harmonious intellectual development assured. Reassuring social contacts, the necessary complement of the child's relinquishing of the mother, are made possible, and the child's interests gradually extended. Play with an understanding companion both facilitates the solution of the child's problems and reassures him socially, so that stable development can be achieved. The play situation has a two-fold significance which must be more closely considered. John daubs paste on the board and Colin spreads wet sand on the windowsills and along the skirting boards. Joyce smears paint on her fingers, her table and her chair. Arthur washes his hands incessantly, and Mary cries if her frock is splashed. That is one aspect of the situation, and here is the other. John speaks in whispers, rarely smiles, glances apprehensively at the worker while playing, and makes no response to the other children. Colin protests if other children play near him, calls frequently to the worker to look at him, chatters and laughs to himself. Joyce never talks spontaneously, answers only in whispers and plays alone in a corner. Arthur demands much The value of
from the worker, takes material from the other children, but does not with them, while Mary makes no advances, and in response to talk only smiles. Play therapy for groups must provide for both the individual and the social problems of the child. The children brought for treatment show various kinds of disturbed behaviour. Some of them are withdrawn from their actual surroundings, while others are boisterous, aggressive and violent. Some children have particular fears, while others suffer from more general anxiety. Some are delinquent, some have physical symptoms, and some have special learning disabilities. But in general, along with the existence of more specific difficulties, is found a varying degree of social retardation, method is designed to meet both kinds of disturbance. A situation and the play is provided in which the child can express his problems and find some solution
help play
of them,
MENTAL WELFARE
41
We will consider first the provision made for the more specific difficulties, though it must be remembered that the treatment of these is not isolated from that of the social maladjustment. These difficulties are found to be related to the child's primitive interests and to the various phases of its development, and the play material is chosen on the basis of its capacity for the expression of these. Feeding bottles, food, sweets, water, pumps, rubber tubing, washing and scrubbing materials, sand, dough, plasticine, paper, matches, paints, chalks, crayons, hammering toys, drums, dolls, a doll's house, tea-sets, boats, engines, cars, farms and bricks?these and similar materials are found necessary. It will be noticed that there is little mention of set constructive or educative material, but such material fails to meet the more primitive needs we are considering, while those materials listed here lend themselves, when required, to more constructive use. The groups are small and play is left to the initiative of the child, the worker's attitude being one of friendly cooperation; and freedom of activity is allowed, though behaviour involving danger to the child, attacks on other children, and over-destructiveness is checked. Play is observed, co-operated in when necessary, and interpretations made when the solution of the problem for the child demands it. On the social side the child's difficulties are found to arise in the family situation with special reference to the child's position with the mother. The role allotted tacitly by the child to the adult, other than that assigned in more obvious phantasies, is noted. In general the children are found to be very demanding of adult attention and to play with little reference to their fellows. They are rarely capable of good reciprocal relationships, and many of them demand ceaseless attention and help from the worker. Such requests You watch what I'm doing," You're helping me," as You sit by me," You come over here," are frequent, and angry protest often follows on the inevitable diverting of attention to another adult or child. Where this is found to be the case arrangements are so made that the child's needs can for the time be met. As the existing outside environment, with its demands for or tacit assumption of a more independent and social attitude in the child, has failed to produce it, it is not felt that further expectance of self-help and ignoring of demands will foster a better social adjustment. Confidence must be restored at the infantile level before the child can progress. While he is accepted as he demands, any indication of more social feeling is fostered, and any opportunity of extending it taken. As he is over-demanding because he is anxious and feeling unvalued, and as normal relationships are reciprocal, If mere meeting of demands will not allay his anxiety or extend his interests. the made friendliness normal and this is to be done satisfactorily possible, child must feel of value, so that he can give as well as take. To this end suggestions of help are made though not insisted on, such suggestions being in line with the spontaneous offers of the children. Material for joint games is provided, so that the child's interest may be more readily diverted from and this includes balls, skipping-ropes and skittles. himself to his "
"
"
activity,
"
MENTAL WELFARE
42
Play under these circumstances throws light on the nature of the child's problems, gives him an opportunity of solving them, and brings him much relief. In general, the problems with which he seems most concerned are related to feeding, excretory processes and cleanliness-training, sexual development and family relationships. Certain kinds of play tend to predominate for a time, and there is frequently a preponderance of sand and water play. with engines and cars, drawing and painting, and dramatic Feeding-play, play are usual. play Generally speaking, the child makes use of material for the expression of his phantasies, and often after a time states openly their meaning for him. As play proceeds and problems are solved, modifications are noticed. Play becomes gradually more varied, sustained and constructive, and normal interest in play itself becomes evident, with the consequent satisfaction and pleasure. As illustration we may take the following case. On his first visit, Bill, a delinquent boy aged nine, referred for petty theft, rushed about the room shouting, pushed over tables and chairs, threw toys about, stamped on them and broke them, and made frequent attacks on the other children for the possession of their material. At the end of the hour his pockets were seen to be bulging and he was found to have commandeered several small toys?a doll, a car, and several animals. On his next visit he began by stamping on toys, but was given a hammer and a book of wall-paper patterns, and told he could hack it to pieces. He spent twenty minutes doing this, till he was breathless and red in the face. Eventually he brought one cover attached to the tattered remains of the rest of the book, and asked the worker to keep it for him till next week. He then fetched a feeding-bottle, removed the valve, cut a big hole in the teat, and walked about blowing the water out through the teat on to the floor and walls and attempting to blow it at the other children. For the next few visits his time was filled in the same way. One day, while blowing water about the room, he remarked spontaneously that he was urinating. There were still occasional bursts of rushing about. Once, when You don't give me enough sweets, so why should I restrained, he said: with (He was given his share of sweets with the other children.) you? play He began to light fires in a tin and burnt small dolls. He was given small "
"
"
"
the babies twists of paper with faces marked on them, and these he called and asked for more to burn. He also drowned them in a bowl of water, and put them on a boat and sank it. About the same time he took pieces of rubber tubing and pushed them through the dolls' house windows and up and down the stairs. He then started to play with farm animals, setting them up in seeming random order, and this play gradually developed. He spent much time building neat walls with stone bricks to enclose the farm, made sheds " food for pigs and sheep, which he into which he put troughs full of so that lined up in front of them, and put all the animals in safe enclosures He Miss." for wood and nails and made asked can't break out, recently they to the worker to look after till next time, as he did it a wooden cart, giving the bricks he sorted out for building walls. The paper-hacking, water-blowing, "
"
MENTAL WELFARE
43
and rushing about have ceased, there have been no more raids the cupboards, and the more settled play continues, while he has several times swept the floor and put away the toys before going home. There is a similar modification in social behaviour. The child progresses from the need to monopolise the worker to the acceptance of its contemporaries as satisfactory substitutes. Several stages have been noted here. There is the engrossing of attention in the child's own activity, then requests for the worker to do the same thing as the child, followed by the acceptance of other workers and children who wish also to do the same thing. Joint games such as ball games appear next, and in these other children are eventually allowed to join. Finally the child makes spontaneous suggestions of play to other children, and follows these out happily with due consideration of the claims of the others, with increasing interest in what is being done, and without dependence on absorbed adult attention. The usual trend may be illustrated by one case. Sally, aged 4, referred for general backwardness, filled her first visit with such commands as Sit " Sit not sit on and there?No, there, 'ere," by me," (Let me) your lap," " Hold it." She piled toys on the worker's knee, saying each time 'Ere it still till was and sat eaten. If She other children y'are." accepted chocolate, or if the worker's attention was diverted for a moment, she said: approached " Want Mummy and went out of the room. There was no settled play, and no conversation beyond requests and Yes and No replies to talk. This sort of behaviour continued for several visits, and on arrival each time she Gimme some chocolate." After two visits she left oft asking for her said: mother, but told anyone who came near to go away. On her third visit she Eat took some chocolate from her mouth and gave it to the worker, saying, at sometimes and her She some. it," subsequently always gave putting played the worker to bed on the floor, and lay down beside her. In this game she spontaneously included other workers. She nursed dolls, sang to them and put them to bed. She helped put the toys away, but when it was first suggested that she should play ball, she took the ball and put it in the cupboard, then continued her usual commands. Soon afterwards she said: Want to jump," and climbed on to the table, from which she jumped into the worker's arms. She then accepted the suggestion to play ball, and played for some time, laughing and making comments about the game. Her next visits were divided between playing ball and jumping, but she was unwilling to let other children join in, and threw toys at them. One day she joined the worker spontaneously in sweeping up sand, and accepted the suggestion to play Ring o' roses with the other children. After playing for some time, joining in the singing and laughing when she fell down, she turned to the little girl whose hand she had been holding, stroked her arm and said: "Oh, a nice little girlie." She patted and hugged her. Then they rolled over on the floor, laughing all the time, and stopping to hug and kiss one another. On subsequent visits there was the same rolling game, and the spontaneous playing of ball and Ring o' roses with the other children. She moved freely about the room, coming back
fire-lighting on
"
"
"
"
"
"
"
"
"
"
"
MENTAL WELFARE
44 and then
"
the worker with the request Sit on yer lap." She played o' tea to worker a the and the other children, cup tea-party games, offering she from them. still She though grabbed toys began to play with sand and " soon her hour and castles, pies spent making cups o' tea," allowing the other children to play with sand at the same tray, and when she grabbed cups from them gave them a substitute. Often she agreed to return what she had taken. She now makes no protest, and continues playing, when other children approach the worker. She includes her in her tea-party play and talks to her, but no longer monopolises her. When the other children arrive she greets them spontaneously, saying Hello," or calling their names, and her conversation is becoming more developed and general in its reference. She shows an increasing pleasure in play with other children, tolerance of their claims, and interest in what she is doing. As a more general consequence of play we find that anxiety is relieved, aggression modified, and interests satisfied and released for more advanced activities, while a growing friendliness and general happiness are shown. It may be thought that all children play, yet in spite of it become ill, difficult and unhappy, and the suggested remedy of more play may be doubted. But play for most children is directed and limited by the practical demands of ordinary circumstances, and by insufficient insight and emotional difficulties in those in charge of them. Play-therapy, however, provides for play under conditions specially designed for it, and with the possibility for the child of reconstituting sound social relationships. Similar play for groups in nursery and kindergarten schools would do much to lessen the difficulties that form part of the experience of all children, and would add greatly to the possibility of their intellectual efficiency and general happiness. The harmful effect of emotional disturbance on intellectual output is recognised. There are many children whose difficulties do not become so acute as to make treatment seem necessary, and who nevertheless are handicapped emotionally and intellectually, with the result that their potential capacity remains unrealised. It has been found, too, in working with defective children, that the relief of their other difficulties is followed by a considerably improved standard of performance. now
to
"
"
"
