Beruflich Dokumente
Kultur Dokumente
Running head: CHILD CENTERED PLAY THERAPY FOR SEXUALLY ABUSED CHILDREN
Abstract
This paper explores the impact of CSA on children as well as adult survivors. The paper
asserts the importance of early intervention treatment for children. Child centered play therapy
(CCPT) is suggested as an ideal therapeutic intervention model for children that have been
Keywords
Children, Sexuality, Childhood Sex Abuse (CSA), Play Therapy, Sex Therapy, Child Centered
Trauma in childhood results when a child is exposed to severe physical abuse or sexual
abuse and feels betrayed, overwhelmed, and helpless. The child who has experienced
overwhelming life events develops coping mechanisms to keep him/her safe which can later lead
adolescence and adulthood (Namka, 1995). Sexual abuse can be so traumatic for children that
they suppress the event and it later resurfaces (Namka, 1995). Most children move through
developmental fears; however, the abused child carries their trauma related fears into adulthood.
Related fears include: fear of being hurt (physically or emotionally), fear of being alone, fear of
being kidnapped, fear of the dark, etc (Yancey, Hansen & Naufel, 2011, Brennan, 2006).
and emotional concerns (in childhood or later in adulthood) such as: depression, anxiety, social
skill deficits, feelings of shame and guilt, school problems, post traumatic stress disorder, self
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harm behaviors, regression (such as bed wetting, etc.), developmental delays, eating disorders,
obesity, low self esteem, conduct problems, aggressive behaviors, withdrawn behaviors,
sexualized behaviors, insomnia, anger, suicide attempts, relationship problems, as well as others
(Wilson, 2009).
CSA is a pervasive societal problem. One in four females and one in seven males are
estimated to experience an act of sexual abuse prior to the age of eighteen (Misurell, Springer &
Tryon, 2010). Other research reports higher prevalence rates stating that 27-32% of females have
experienced CSA and 13-16% of males (Yancey, Hansen & Naufel, 2011). Based on research
from adults, Levanthal (2001) estimated that less than 10% of CSA is actually reported. The
under-reporting of CSA represents a societal denial of this significant, sensitive issue. Children
and Sex in the same sentence makes most people so uncomfortable they would rather ignore
the issue further stigmatizing and shaming the victims. CSA becomes the invisible population.
Disclosure of CSA can also be difficult. The main inhibitors to disclosure are related to fear,
shame, and self blame. Other barriers include: respect for authority, rigid gender roles, and the
taboo surrounding sexual issues, lack of acceptance and supportive adults, and a lack of language
In the CSA literature, attention has been given primarily to the specialized training
required of forensic investigators, training of allied professionals (nursing, teaching, etc.) with
the goal of increasing efficacy and confidence in fulfilling their role as mandated reporters of
suspected abuse, and empirically testable therapeutic approaches (usually some form of cognitive
behavioral therapy). What seems to be lacking is attention to the specialized training required of
those who guide the victims/survivors (Oz, 2009). Studies have suggested that CSA victims are a
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heterogenic group, varying in age, ability level, socioeconomic status, education, gender and
The childs internalized shame stems from fear. Shame experiences bring forth beliefs of I am a
failure and I am bad. Fears of being vulnerable, found out, exposed, and further humiliated
are paramount (Namka, 1995). Shame convinces victims to keep the sexual abuse a secret which
further intensifies the shame. Experiences that cause shame alter the childs basic trust of others
and consequently are the heart of much dysfunctional behavior (Namka, 1995). Children may
absorb some of the shameful energy of the person who committed the offense. Sexual abuse
causes children to feel dirty and damaged. Additionally the child who has been involved in
sexual experiences beyond their ability to comprehend often adopts difficulties creating
Research confirms that CSA can be devastating and the impact can cause a myriad of
emotional, psychological, and behavioral problems that can last a lifetime if not treated.
Ignoring the issue is not going to make it go away and furthermore even the child that
suppresses the abuse in childhood may have problems throughout their lifespan. There is a major
contradiction with the expectations of children these days as well. On one hand, they are growing
up in a hyper-stimulating, technology driven era where they are bombarded with knowledge
from the internet, they are over scheduled with activities and responsibilities and are treated like
miniature adults; on the other hand, they lack experiences, wisdom, and emotional maturity to
comprehend and make sense of the world around them. At times parents and other adults can
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regard children as resilient, and that belief may be true but it is not an excuse to avoid
confronting a childs issues particularly in regard to CSA. When the topic of CSA is
uncomfortable for adults, children can sense that and it further perpetuates the secrecy and
shame. Children can benefit from therapy to help them deal with the sexual abuse as well as the
other symptoms that may or may not have emerged from the CSA. Early treatment for children
will promote healing and can prevent further and future emotional and psychological damage.
Adults communicate through language and words, although most of our communication
is non-verbal. Play is considered the language of children and it is an ideal treatment for children
that have been affected by CSA. Play therapy is a developmentally relevant treatment for
children and a key approach in resolving childrens psychosocial and emotional difficulties
(VanFleet, Sywulak & Sniscak, 2010). Cognitive Behavioral Therapy (CBT) as well as group
therapy has also been recommended for working with this population however I feel that
individual child centered play therapy is the best therapeutic intervention model for CSA
victims/survivors.
Children that have been affected by sexual abuse have among other things, lost their
sense of trust and control. In treatment models such as CBT and group therapy, the therapists
have the best intentions to treat the child in crisis but they are working on their own agenda and
in the therapists time frame. I feel as though the child centered model allows the child to have
control as well as work through issues at their own pace and at their own level of comfort, when
they feel prepared to process their trauma. Many treatment models for CSA victims can be
overwhelming for children when they are not ready to manage their trauma and therapists have
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pre-prepared and directed activities for the child to complete. The child is in a position, yet
again, to please the adult and lacking power and control in the situation. The therapist may tell
them that they do not have to do anything but they may still feel obligated to do as the therapist
says or suggests.
A strong therapeutic relationship is arguably the most important component and provides
a reparative experience in child-centered play therapy (CCPT) (VanFleet, Sywulak & Sniscak,
2010). Building rapport and a trusting therapeutic relationship is CCPT is vital especially when
working with children that have experienced trauma. CCPT allows the child to be in control of
his or her environment and therefore they are able to work through their issues at their own pace
as opposed to other play therapy modalities in which the therapist chooses the materials and asks
questions for their own agenda. Children are able to build trust with the therapist and test the
limits in a safe environment. Simply building a strong supportive relationship with their therapist
is progress. CCPT is a process and allowing the child to work through their trauma helps them to
develop a sense of control and mastery over themselves as well as their environment. Americans
fast paced culture demands immediate gratification but the process of therapy needs to be valued
Client centered approaches are considered the most beneficial approach (Walker et. al,
2009). If play is a childs language, then toys can be thought of as the words. Through play
therapy the child can work through their challenges and issues using the toys (pre-selected by
therapist to facilitate emotional growth) that they choose, revealing their inner dialogue. The play
therapy toys represent the thematic stages in CCPT that children naturally progress through in
play therapy. These stages are a warm-up stage, followed by an aggressive stage, regressive
stage and finally a mastery stage (VanFleet, Sywulak & Sniscak, 2010). Some examples of
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warm-up toys include: art supplies, paper, clay, play-doh, toy cars, small plastic animals, toy
medical kit, and chalkboard. Communication toys are also important for the play therapy room
and they include toys such as a phone, megaphone, binoculars, and walkie-talkies. Aggression
toys include: inflated bop bag, dart guns, toy weapons, plastic soldiers, dinosaurs, rope,
aggressive puppets (wolf, dragon, monster, etc.), and foam bats or swords. Nurturance (family)
toys include: doll house and doll family, puppet family or animals, baby dolls, blankets, baby
bottles, kitchen set, child sized table and chairs, etc. (VanFleet, Sywulak & Sniscak, 2010).
Through play the child is able to test out various situations and behaviors in a supportive
environment (Webb, 1991). For children that have been sexually abused they may be in the
warm-up phase for an extended period of time, testing the limits and building rapport with the
therapist. The aggressive phase they will be able to work through their feelings of anger, loss of
control, power, shame, fear, etc. The regression phase allows opportunity for the child to nurture
and feel nurtured. In this phase play themes emerge around attachment, acceptance, love and
nurturance (VanFleet, Sywulak & Sniscak, 2010). They will be able to work through their issues
of trust as well. As regressive themes begin to fade and the child is gaining confidence themes
reflecting mastery surface. Play may reflect victories, pride, winning, etc. Problematic behaviors
show considerable improvement during this stage as well (VanFleet, Sywulak & Sniscak, 2010).
Unconditional positive regard and acceptance encourages the child to feel safe enough to
be able to explore their inner selves without censorship. In this environment children are able to
try out different roles, work through conflicting emotions and thoughts, and try to figure out
what the world is like. The child is able to form a relationship with the therapist, and through this
relationship they are able to develop trust, improve self-esteem, and self efficacy (Gil, 1991).
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In non-directive child-centered play therapy, the child is in control, within some gently
but firmly set limits. Most children often feel that they do not have control over situations in their
lives. During play therapy they are able to work through these experiences in an environment
that they are able to control. They can make the story be how they want it to be, they are in
charge of the outcome. This feeling of control is vital to their emotional development as well as
positive mental health. Children are able to use play as a means for developing problem-solving
skills, ways to relate to others, expressing their feelings, and working on their behaviors, all at a
safe psychological distance from reality (VanFleet, Sywulak & Sniscak, 2010).
and it is fundamental skill for CCPT therapists. Empathic listening is a skill of attunement,
beginning with the recognition of feelings and culminating in a response that actively conveys
the identified feelings in an accepting and nonjudgmental manner to the child (VanFleet,
Sywulak & Sniscak, 2010, p.26). The therapist does not ask questions in CCPT yet they are
keenly attuned to what the child is saying and doing and comment on it while recognizing the
emotions the child is explicitly or implicitly conveying (VanFleet, Sywulak & Sniscak, 2010).
When therapists reflect direct questions with empathic comments, the child learns to trust their
own instincts and builds self esteem and self efficacy (VanFleet, Sywulak & Sniscak, 2010).
The four basic skills that a CCPT therapist utilizes with children are structuring, empathic
listening, child- centered imaginary play, and limit setting (VanFleet, Sywulak & Sniscak, 2010).
Structuring includes setting boundaries, organization (time limits) and rules in the moment as
opposed to bombarding the child with various rules and regulations stifling their control and
creativity. Empathic listening is used throughout the play session from beginning to end,
allowing the child to take the lead as the therapist stays attuned with the child expressing their
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actions, thoughts, and feelings. Child centered imaginary play is significant in working with
children that have been affected by sexual abuse. In order to resolve the trauma of sexual abuse
in a healthy way, the trauma must be re-experienced through the retelling of the events in the
context of the relationship (Webb, 1991). Setting limits is important during imaginary play
especially with the CSA population. Children may want to take off their clothes for example. At
this moment the therapist would interject that In the playroom, one of the rules is that we keep
our clothes on. Then the child may pick up a doll and take their clothes off. The therapist would
continue to reflect for the child their actions as well as their feelings and to give permission to
the child in a non-judgmental way to validate their feelings and recognize their traumatic
experience. Imaginary play is directed by the child and the therapist shall participate if the child
invites them however, they are to bequeath creative freedom to the child and allow the child to
tell the story as the therapist in imaginary play is merely a prop (Gil, 1991).
Conclusion
Childrens sexuality in general is a taboo topic, and perhaps one of the most sensitive
issues relating to children and sexuality is children that have been victims of sexual abuse.
Childhood sex abuse (CSA) is a substantial problem in American culture and treatments for
sexuality education in combination with child centered play therapy will facilitate emotional
healing for children and possibly prevent future emotional and psychological damage.
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References
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