British Journal of

PLAY THERAPY
Volume 2 December 2006

Published by the British Association of Play Therapists

British Journal of Play Therapy
An official publication of the British Association of Play Therapists (BAPT)
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SCOPE
The British Journal of Play Therapy is a
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 BRITISH JOURNAL
OF
PLAY THERAPY
Editor
ANNE BARNES
Notre Dame Centre, Glasgow, Scotland

Editorial Board
ANN CATTANACH VIRGINIA RYAN
Department of Social Policy and Social Work, Department of Social Policy and Social
University of York, York, England Work,University of York, York, England

CHRIS DANIEL-McKEIGUE JANET BARR

Postgraduate Studies, Liverpool Hope University, Notre Dame Centre, Glasgow, Scotland
Liverpool, England

SUE JENNINGS
Glastonbury, England

Advisory Board
MERKEL SENDER (Educational Psychology)
Summerfield Centre, London, England

MARY CARDEN (Child Protection)

Harpenden, Hertforshire, England

Correspondence to the Editor, Editorial Board and Advisory Board should be sent to the
Administrator, BAPT, 1 Beacon Mews, South Road, Weybridge, Surrey KT13 9DZ
info@bapt.uk.com
BRITISH JOURNAL OF PLAY THERAPY
2006 VOLUME 2 DECEMBER

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 to
investigate play therapy practice

Leong Min See 37 Child Survivor of the Tsunami:

A Case Study

Angie Naylor 46 The ethics of researching children in

non-directive play therapy

John Casson 55 The five story self structure:

A new therapeutic method on the
Communicube

Book Reviews 63

Notes for Contributors 65

Table of Contents 66

2

Editorial
I should like to thank readers for their patience and
continued willingness to bear with us in the
uncertainty about publishing dates. Initially my
hopes of being inundated with suitable material
were not realised. Waiting has been rewarded as I
am now pleased to present a selection of articles that
will satisfy varied interests. The scope of this edition
includes crisis intervention with a traumatised
child, research issues, and a small cluster of
variations on the theme of play therapy.
Diana Jansen is an experienced and insightful
sandplay practitioner. After attending a workshop
with her earlier in the year, I was delighted when she
agreed to contribute an account of her work. She
describes, with utmost sensitivity, how a very young
child’s grieving for his father was permitted to
unfold within the trusted relationship with his
therapist. Jansen draws on Jungian theory to add
dimension and depth to her understanding of the
wisdom of the psyche to heal.
In a brief report Leong Min See, a UK trained play
therapist from Malaysia, continues the theme of
sudden loss. She describes a short intervention with
a young girl affected by the tsunami of 2004. This
is a timely item as we reach the second anniversary
of the tragic catastrophe that devastated coastal
regions in southern Asia. It is striking how this
child, with an essentially secure family structure,
was able to use therapeutic help to process her
trauma and begin to make sense of her loss in a
remarkably rapid space of time.
An increasing number of play therapists are seeking
additional training in attachment related
approaches such as Theraplay in order to enhance
their skills in working with children and families.
This is especially important when new attachments
need to be formed, and where children may present
with early, unmet needs. Dave Myrow and his wife,
Sue Bundy Myrow, have visited the UK and Ireland
to give presentations and training on behalf of the
Theraplay Institute. In the autumn I was able to
satisfy a long held ambition to have them introduce
Theraplay north of the border. I am pleased to
present an article here that will provide a useful
introduction for those who would like to know
more about this rather different take on play and
therapy. Myrow takes us through the history and
framework of Theraplay, and illustrates its practice
with a generic case example. He then considers
recent research outcomes that strongly support the
efficacy of Theraplay with a range of presenting
problems.
3
Bri. J. Play Therapy, Vol. 2 (2006)
British Association of Play Therapists
Casson's article introduces us to his invention of the
Communicube, a structure that may appeal to play
therapists, and have applications for direct work
with some clients. Strands from play therapy and
from dramatherapy are inherent to this expressive
process. Casson introduces interesting case
examples to show how practitioners have been able
to adapt the approach for use with groups as well as
for individual work with children.
Daniel-McKeigue intrigues us with a fascinating
account of developments in her thinking about
research. She shares her quest for exciting and
innovative ways to try to capture creative principles
at work in the therapeutic process that emerge
through the dynamic matrix of exchange between
two human beings. In a complementary piece
Naylor provides us with a thorough exploration of
the literature surrounding the ethics of research in
play therapy. She tackles a thorny dilemma familiar
to the play therapist who does not want personal
research agendas to impinge on the delicate process
of therapy with a child. She shares questions on how
an essentially non-directive process may be
investigated in ways that are both rigorous and truly
free from negative impact on a vulnerable client
group. Naylor raises valuable points and in so doing
I feel also sets challenges both for debate and
practice that invite response.
Given that suitably rigorous articles were initially
slow to appear, it seemed wisest to produce Volume
2 in one larger edition this year, hence the
adjustment to cost. If I am able to hold back the
tide of those wishing to contribute to Volume 3 the
current status quo will also apply in 2007. However,
as I have some material already waiting, I feel
confident in forming the plan to publish earlier in
the year, and will aim for summer. The first edition
of Volume 4 will then be produced at the very
beginning of 2008, to be followed by a second later
in the year. I hope that my prediction of a gathering
momentum proves accurate. I will keep you
informed of progress via the BAPT magazine, and
ask for your forbearance in this, trusting that when
it arrives the journal will be a treat worth the
waiting.
I should like again to thank my colleagues on the
Editorial Board for their support, and also Lisa
Gordon Clark for her eagle-eyed proof reading. It
has been sad to lose Jo Carroll’s excellent services.
Her careful reading and clear comments on items
submitted to her is greatly missed. We wish her well
in her adventures.
Anne Barnes
Bri. J. Play Therapy, Vol. 2 (2006), pp 4-13
4

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 the
unconscious 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 and
what Kalff referred to as ‘the free and protected space’ of the sand tray itself. I have tried to illustrate this process
by describing the therapy of a three-and-a-half year old boy who created fourteen sandtrays. Through his ‘play’
in the sand he was able to mourn for the father he had lost and to re-connect with his own internal father. The
process led from a state of fragmentation to one of integration, and this coincided with a leap in his development
in his outer life.

Introduction The sandplay method conceived by Kalff includes

One of the most powerful ways I know of working
therapeutically, whether with adults or with
children, is with sandplay as the Swiss psychother-
apist, Dora Kalff, conceived it. I would like in this
article to give a brief description of her way of
working with sand, which differs in some essential
ways from the work of Margaret Lowenfeld. I would
then like to give an example from my work with
children to demonstrate how it can activate a
powerful psychic process, which enables healing.
this possibility of self-expression. When it reaches a
deeper level a spontaneous psychic process may be
initiated that can, in conjunction with the
therapeutic relationship and the free and protected
space of the sand tray, enable healing ( Kalff, 1986).
It may at the beginning of the work be merely one
of many forms of play the child experiences.
However, when a sandplay process is enabled, a new
sense of purpose and direction enters the play. I
shall demonstrate this process in a short case study
of a three-year-old boy.

Sand trays are an essential part of every play What is Sandplay?

therapist’s play equipment. There is nothing either
new or original about playing in the sand. A single
sand tray can reveal much about a child’s situation
in both their internal and external world. It can
enable a child to convey what, as yet, there are no
words to describe. It can act as an alternative way to
act out and express aspects of trauma in the same
way that other play materials can enable this
process. This was how Lowenfeld conceived the
sand tray work she pioneered in her work with
children
The use of sand for creative purposes is as old as
time. It was used by the medicine men of Mali who
drew patterns in the sand to divine the future. The
Navaho Indians hold sand painting ceremonies,
creating images of world order in order to bring
about universal harmony. Monks in Tibet create
beautiful mandalas in the sand as an aid to
meditation (Cunningham, 1997). Building in the
sand or playing at the seaside, all aspects of sand
have a fascination, for children especially. Some
 THE USE OF SANDPLAY WITH CHILDREN
people maintain that the sand itself has calming and
healing properties. I find sometimes that with a
distressed or troubled client just standing beside my
sand trays and sifting sand through their fingers can
have a calming effect.
For Dora Kalff, there was an ineffable quality to
play in the sand. The pictures her patients created in
the sand were not merely descriptive of something
that was consciously known. This play could go to
a much deeper level and produce psychic images;
‘images of the internal landscape’ was the way she
referred to this (Kalff, 1986), which were not
available to the conscious mind. It is often this
bypassing of the conscious, which happens far more
readily in children, that can effect healing in a
sometimes almost miraculous way.
Dora Kalff was a student and near neighbour of the
Swiss psychiatrist, C.G. Jung, on the outskirts of
Zurich. In the 1950’s Jung had heard of the work of
Margaret Lowenfeld, a child psychiatrist working in
London. He suggested that Kalff went to London
to study this new therapy, which Lowenfeld called
‘The World Technique’ (Mitchell & Friedman,
1996). Kalff returned to Zurich in 1956 and
adapted Lowenfeld’s work to her own Jungian
orientation.
The essence of Dora Kalff ’s sandplay is this: the
inner world can be given substance and materialised
through the hands. Through the combination of a
conscious and unconscious process the landscape of
the patient’s inner world can be represented in a
visible and three-dimensional form. For a moment
psyche and matter become indistinguishable. It
allows a return to the roots of childhood and to the
depths of our cultural history when psyche and
soma, body and mind, were undifferentiated (Ryce-
Menuhin, 1992).
Sandplay makes possible a return to pre-verbal
memory, which cannot be reached by talking alone.
These earliest memories are recorded not in the
mind but in the body. Jung wrote that ‘often the
hands know how to solve a riddle with which the
intellect has wrestled in vain’ (Jung, 1960, Par. 80).
5
It is this possibility of bypassing the conscious mind
that makes sandplay such a powerful medium. The
early experiences can be re-lived, remembered and
integrated into the conscious personality. Sandplay
allows the expression of every level of development
from pre-verbal and pre-symbolic to verbal and
finally to mental integration (Ryce-Menuhin,
1992). Jungian Sandplay is based on the Jungian
concept of the spontaneous self-healing of the
psyche, which can take place if the conditions are
favourable. In the holding environment of the
therapeutic relationship and what Kalff referred to
as the ‘free and protected space’ of the sandtray, this
process is enabled (Kalff, 1986).
The concept of the importance of play is a familiar
one also in the work of Winnicott. He believed that
it is through play that we are most completely
ourselves. He writes: ‘It is in playing, and only in
playing, that the individual child or adult is able to
be creative and to use the whole personality, and it
is only in being creative that the individual discovers
the self ’ (1988, p63). Through play the child can
express his/her spontaneity; what Winnicott
referred to as the ‘true’ rather than the ‘false’ self.
Through play in early life we discover the
transitional space (which lies between mother and
infant) where mother is a secure and affirming
presence and where we are free to play and to be
ourselves (Winnicott). It is vitally important in the
development of the young child to have this space.
Schiller once said that ‘man is most completely
himself when at play’ (as cited in Jung, 1936, p76).
Perhaps the sand can lead us back to this early
experience of unselfconscious play when our play is
a pure expression of the self and no expectations or
‘oughts’ interfere with this.
I should add here that the ability to make use of the
sand in terms of a healing process is not initially
possible for a severely traumatised child1. To allow
for the child’s play in the sand and his or her use of
symbols to facilitate healing it is necessary to have
had the ‘good enough’ (Winnicott, 1988)
experience of mother. Children who do not have
this fundamental security within their early
relationships, and who have not experienced the
6 THE USE OF SANDPLAY WITH CHILDREN
freedom to play, may not have the ability to
symbolise. They live in a world of concrete reality in
which the ‘as if ’ world of the symbolic reality is
outside their experience. For the abused and
disadvantaged child, there must first develop a
relationship of trust with the therapist; this is
perhaps the first positive relationship the child has
known. It may take some years, in this case, before
there is sufficient trust to allow the psyche to enable
a healing process.
What is depicted in the sand is a symbolic
expression. Symbolic expression is the natural
language both for children and for the unconscious
(Neumann, 1973). As sandplay therapists we must
learn the language of symbols in order to interpret
the communications in the sand. Jung described the
symbol as ‘an intuitive idea that cannot yet be
formulated in any other or better way’ (1954,
para.105). A symbol is never either this or that: the
essential nature of the symbol is that it contains a
paradox. The snake for instance is both a symbol for
the most primitive level of life, for evil, destruction
and deceit and it is also a symbol for healing and
transformation (Cirlot, 1971: Chetwynd, 1982). In
addition, of course, the snake will have a particular
association and resonance for each individual
person. One can never be dogmatic about symbols
but it is important to remember that they are an
essential aspect of our work in sandplay with both
children and adults.
Practical Considerations
Sometimes a sandplay collection is in a separate part
of the consulting room and sometimes it is in a
different room altogether. When working with
adults it is important that it is in a different space
from the verbal therapy. This creates a separation
between the verbal therapy and the sandplay, which
can at times create a new way of relating. This is
especially true when the transference and counter-
transference relationship is too powerful. If, for
1 Until now nothing has been published in relation to a sandplay process with severely damaged children. Agnes Bailey worked for many
years in the North East of England, with wonderful results, with this client group. Her work is now carried on by Mike Falcus. Anyone
interested in pursuing this further can contact him on his email: michael@falcus.wanadoo.co.uk or telephone: 0794 1650 788.
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 provides
a third dimension in which the problem can be
looked at and reflected upon by patient and
therapist together instead of the therapist being seen
as ‘the problem’.
I have two sand trays, one with wet and the other
with dry sand and I keep a watering can beside the
wet tray for extra wetness. Each of the trays sits on
a stand and the stands have casters so they can be
moved to any position in the room. The dimensions
of the trays are important. They are exactly the size
that can be taken in visually without the need to
move one’s head. They measure 22.5 x 28.5 inches
(57 x 72 cm) and are three inches deep. The trays
are half filled with fine silver sand and the base is
painted blue to give the impression of water when
the sand is cleared from it (Ammann, 1991). On the
shelves 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 CHILDREN
• marbles
• glass drops
• beads
• jewels
• coins
The list is endless. For the acquisitive it is an endless
source of delight searching for and collecting new
items!
I sit nearby and watch the child (or adult) as he/she
creates a picture; some give a running commentary
and others work silently. When the tray is complete
we look at the picture together and I might be aware
of two levels of experience: the story that the child
relates in relation to the tray and perhaps, also, the
deeper unconscious communication. But that I
keep to myself. We do not interpret at the time but
usually the deeper meaning becomes clear when we
review the slides together after the work has ended.
Kalff believed that an earlier interpretation could
interfere with the spontaneity of the process (Kalff,
1986).
After the tray is complete and when the child has
left, I take a photo. In addition I make a drawing
while the tray is being constructed, labelling the
objects in case it is difficult to identify certain
objects in the photo. The slide show at the end of
the process can act as a pictorial portrayal of the
therapeutic process and can often make it feel more
real because what has happened internally can now
be 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 sandplay
process of a three-year-old child to whom I shall
give the name Ben. It is relatively unusual to be able
to complete a process with such a young child; the
child is able to ‘play’ in the sand with objects but an
actual process where one is able to see the healing
process unfolding is fairly rare at the infant stage.
There must also be a sense of a good enough
nurturing experience from mother or caregiver for a
process to be enacted, as mentioned above. With
severely abused children, their internal world is too
7
chaotic to begin with and a secure and trusting
relationship with the therapist must precede the
process in the sand.
Ben was three and a half when our work together
began. His father, who suffered from manic
depression, had taken his own life a few months
previously. Since then the little boy had shown
signs of regression. He had begun to soil himself, he
clung to his mother more than usual and a slight
speech impediment had become more pronounced.
His mother, a primary school teacher, was very
aware of her son’s grieving process. She had
attempted to help him come to terms with father’s
death by creating a book telling the story of Ben and
his Daddy. This was illustrated with photos of Ben
with his father from birth until his sudden death.
Ben had come to his own conclusions about Father’s
death and explained to his mother that Daddy had
gone down to the river (bordering their house) to
get some air on a hot evening, fallen into the river
and drowned. The fire engines, police cars and
ambulances were unable to save him. Ben’s mother
was concerned about her son’s emotional stability,
fearing that the child might, like his father, have a
predisposition to mental illness.
Beginning the Journey
In Ben’s initial session he was very happy for his
mother to leave the room after our first ten minutes
together. He went straight to my shelves of toys and
climbed a small step-ladder I had provided for him.
He handed me the objects he wanted to use; a
horse-driven wagon, a red tractor and a boat. We
had the sand tray on the floor, as he was too little to
reach it on the stand. He added a great deal of water
and then tried to float the boat on the water until it
had all soaked into the sand. The wagon and horses
were driven round the tray. The wagon was then left
abandoned on its side in the top right corner while
the 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 he
was sitting (Figure 1).
The first tray often presents us with the problem
8 THE USE OF SANDPLAY WITH CHILDREN
and also gives some indication about the future
possibility of healing. My feeling about this tray was
that 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 literally
spilling over. I felt the wetness of the tray seemed to
be connected to his father’s drowning as well as to
his own and his mother’s tears. He had tried to keep
the little fishing vessel afloat but without success.
(In the second tray, created the following week, the
little fishing boat literally went under and was
buried in sand with only the tip of the mast
showing). The wagon in the top right corner
seemed to be about Ben’s own sense of
abandonment without a strong Daddy to draw his
own personal wagon, and to give a sense of direction
in his life. The horses are disappearing off to the left,
out of the picture. The left side of the tray is often
seen as representing the unconscious side of the
personality, the right side the conscious aspect
(Ammann, 1991). If the horsepower, or energy, in
relation to this child is moving towards the
unconscious it suggests regression. This was a reality
for Ben2. Regression in such a young child can be a
cause for concern, and the movement towards the
left of both the fishing vessel and the tractor also
reinforces this impression. However, the red tractor
Figure 1
Ben’s 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 separate
from mother), is only just beginning. A severe trauma, like the death of a parent, can throw the child back into a more infantile and
unconscious state.
in the position closest to Ben as he created the tray
is more positive. The tractor can plough up the land
and help new things to grow. It represents another
form of horsepower and the colour red, which Ben
used throughout the process in relation to himself,
is a colour suggesting warmth, energy and life as
well as anger. It stands out in this tray, which is
predominantly without colour. It feels like a positive
sign, as though this little tractor symbolises the part
of Ben that is able to survive the deluge of his own
and Mother’s sadness.
In his second tray Ben first placed six small wooden
cars in the top centre portion of the tray and they
too, like the fishing vessel, were pushed under and
buried. In the bottom half of the tray we have a
scene with dark grey buildings and a bridal couple
in the bottom right corner; ‘This’, Ben said, ‘is
Mum and Dad’. Pointing towards them is a large
black vehicle, a Bat mobile that is usually seen as the
vehicle of rescue. In this tray however it looks like a
huge, menacing, black arrow directed against the
parental couple. There was a strong feeling now of a
threatened Mum and Dad. There was also a sense
that the child’s own driving power and ego strength
was under threat, suggested by the six buried cars.
In addition, that part of him that had somehow
managed to keep afloat (in relation to the buried
fishing vessel) has literally gone under.
At this stage a large proportion of the sessions was
spent in re-enacting scenes concerned with Dad’s
death, with me fulfilling vital roles in the play.
There were endless games about rescuing Dad from
drowning in which I would be employed as the
ambulance man, the policeman, the doctor or nurse
in the hospital, the fireman who used his ladder to
get Dad out of the river, and so on. On the whole
our rescue operations were successful! The sand
trays occupied only a small proportion of the
sessions. By the second visit a strong attachment
had already formed between us and Ben looked
forward to his sessions and spoke about them to his
mother all week.
 THE USE OF SANDPLAY WITH CHILDREN
Developing Themes
The theme of abandonment occurs once again in
Ben’s third sand picture. He has placed the bridal
(parental) couple on the right and a baby bird in a
nest on the left. In between lies a baby in white that
is neither with the parents nor in the safe nest but
alone and abandoned in between the two. A canoe
travels across the lower portion of the tray and again
the movement is towards the left.
There was a recurring theme throughout Ben’s
fourteen trays. In almost every one there is the all-
important house. It made its first appearance in the
second tray. Among the dark, rather menacing
buildings surrounding the parental couple is a small
white adobe house, which he referred to first as a
lighthouse and then as ‘Ben’s House’. Later, this
same house became ‘Diana’s House’. I saw this as an
early sign that what had gone badly wrong in Ben’s
inner house had the potential for healing.
In the fifth tray Ben placed the entire doll’s house
in the sand tray. He purposefully emptied it of all
furniture and with infinite care brushed away every
grain of sand with the doll’s house broom. The
furniture was dumped in the front right corner
together with the figure of mother. It was as though
he was sweeping away unconscious material and
preparing the house that would represent himself in
subsequent pictures. He created an empty house
ready to be refurnished in his own way. I was
reminded of Winnicott’s emphasis on the infant’s
need to gain mental detachment from mother:
‘That is differentiation into a separate personal self
…’ (1940, p 197).
Central to Ben’s play was the recreation of the
house, which may be seen to represent the Self. His
father’s suicide had left Ben in pieces. This
fragmentation was expressed especially powerfully
in his sixth tray by three red soldiers lying in a pool
in the centre of the tray. Ben increasingly associated
3 The transference includes aspects of the patient’s relationships from the past, especially parental relationships, which he projects onto the
therapist. It can also represent aspects of the patient himself, which have not yet been realised. It has the possibility of disrupting the
therapeutic encounter, when the therapist represents destructive past relationships, but also contains the potential for healing. (Samuels,
Shorter & Plaut, 1987).
9
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 a
united couple. The soldiers are at risk from three
gunmen. Coming to the rescue there are a fire
engine, a repair vehicle, both placed beside the
house he now called Diana’s House, a man on
horseback and the busy broom. We can see here the
transference beginning to take effect with the
healing possibilities coming from Diana’s house.
The sixth picture was a turning point. After this
there was a definite change in the pattern of Ben’s
play. He no longer darted from one game to
another. With a great sense of purpose he went
straight to my shelves and brought down the figures
needed for his play.
Healing Begins
In the two trays that follow, Ben placed Diana’s
House, (initially referred to as the light house), and
Ben’s House, shared with Mum, side by side. He
created his own ‘I-land’ space in the tray’s centre,
and again swept the blue space clear of every grain
of sand. He placed a table on the island and two
chairs, one for himself and the other for me. In the
following tray, the second chair was for Mum while
a small boy in a red jumper, the figure he associated
with himself, occupies his own chair. The table is set
for breakfast (Figure 2). Ben prepared a plate with
three bananas for himself and a strawberry for me.
The three bananas seemed to emphasise his
masculinity and the red strawberry, like a red heart,
suggests a new possibility in relation to feeling. In
these two pictures there is a sense of everything
superfluous being cleared away. The security
coming from his mother’s house was set beside
Diana’s House. This demonstrated the healing
potential of the transference3. On the other side of
my house stands Ben’s own little ‘cottage’, the
individual house of the now potentially intact and
healed Self. This is the place that would become his
inner home. In the rear left corner are six cows that
10 THE USE OF SANDPLAY WITH CHILDREN
seem to promise a nurturing possibility. Nearest to
where I was sitting as he created the tray, on the left
side, he placed the repair lorry again, and this
seemed to communicate to me that the repair work
was in progress! In the bottom right corner of his
seventh tray he placed the large grey church, which
appeared first in the second tray. This seemed to be
connected with Dad’s funeral and burial. Beside the
church he put a tiny house. About this he said: ‘this
Figure 2
Ben’s Seventh Sandtray: ‘Breakfast for Two’.
is the house made for me by Dad and I helped him’.
Could this be the inner house that is now
developing within Ben, which Dad has played a part
in building?
In his ninth and thirteenth trays Ben created the
interior of his own house and this took up the entire
tray. He is inside the house as a small baby and
within the house is everything he will need for his
security and nurture: furniture for cooking and
toileting, a big secure bed, and also five candles that
represent light (like the light house), and are later
associated with Dad.
What was being enacted in the sand tray in terms of
Ben creating his own individual house was also
being enacted at home with Mum. She told me he
had asked for ‘the help of six strong men’ to move
the furniture in the way he needed it to be. In his
thirteenth tray Ben placed the entire doll’s house in
the tray again and the house was filled with all the
objects that had formed a part of his healing
process. Ben’s house was placed in the centre, inside
the doll’s house. Beside it to the left is ‘Diana’s
House’ and to the right is the married couple with
their baby, the now completed archetypal family;
mother, father and baby in white. The baby, which
Ben said ‘had to be taken out of the Mummy’s
tummy’, now beside the united parents, was
associated with his newly reborn Self. The inner
possibility of the completed family had to be
restored before healing could occur.
Completion
In the doorway of the house is a red carpet on which
stands 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 tray
and the red of the jumper of the boy who is himself
at the breakfast table in tray number eight. The
repair vehicle is pointing directly towards the house,
which is the ‘house lived in by Mum and me’. This
vehicle had been central to Ben’s repair process. I
had the feeling that the process with Ben was
nearing completion.
In one of his final sand pictures Ben created his
father’s grave, with two wet patches beside it
perhaps indicating his and his mother’s tears. He
commented, ‘I want to make it look pretty for
Mum’. He decorated the grave with marbles. These
he used also in his final sand tray to decorate the
birthday cake he and his mother had made for Dad.
His father’s 43rd birthday happened to be on that
day. Dad’s grave becomes linked to his birthday;
that is to say, a new father possibility is born! In this
last sand picture he placed a red octagonal tray in
the space previously cleared of every grain of sand to
create Ben’s ‘I-land’ space. Inside the tray he put a
helicopter. A large red marble below it and a red
candle above echoed the red of the tray. This felt like
a wonderful affirmation of Ben. The eight-sided
tray seemed to indicate a new sense of wholeness;
four is the number that represents totality and eight
seems to emphasise this coming together! The
helicopter suggested he was now ready to ‘take off ’
in life, in contrast to the earlier tendency towards
regression. Five blue marbles within the red tray
 THE USE OF SANDPLAY WITH CHILDREN
echoed by five blue marbles to the left express the
symbol of physical totality (composed of a head,
two arms and two legs). This seemed to represent a
significant shift in light of the previous sense of
physical regression, disintegration and
fragmentation that had been reflected in the chaos
Figure 3
Ben’s Fifteenth Sandtray: ‘Dad’s Birthday’
left behind in my room in early sessions.
A warm relationship had developed between Ben
and me during these eighteen sessions in which he
had created fourteen sand pictures. Now he was
quite clear that it was enough and it was time for us
to end. I remembered that in our sixth session I had
asked him how many more times he felt he would
need to come. Without hesitation he said, ‘eight
more’. This turned out to be exactly right. Of course
a three-year-old child has no concept of the number
eight or of the time that represents. However, in a
psychic process, which does not involve what is
known consciously, there is a clear sense of what is
needed, if we can only connect with this.
Ben’s Use of the House
The house as symbol of the Self was the outstanding
symbol Ben used in his healing process. In our floor
games, he made houses and used the doll’s house to
create a hospital, fire station, or home, according to
the game of the moment. In his sand trays the
house became the main feature of his pictures. In
the second tray he refers to the house, which is to
become Diana’s House as The Light House. (When
the work was finished he brought me a lighthouse
11
for my collection because he couldn’t find one
there). Later this house is used increasingly in
conjunction with ‘Ben’s House’ as he begins to use
me, in the transference, to enable his healing
process. Ben used the house to express both a place
of security and safety as well as an expression of his
increasing ability to recognise his own separate
internal space. The house becomes for Ben the
secure place that he shares with the now
archetypally complete family, where mother and
father are together again with baby Ben. It was also
the symbol for Ben’s increasing sense of his own
individual Self, a separate self from the house
inhabited by mother. In this process Ben has
recreated his own secure inner house after his sense
of inner fragmentation following the devastating
loss of his father. ‘Sandplay really is based on the
self-healing of the patient. Given a wound, a free
and protected place and an empathic witness, a self-
healing process can be initiated’ (Bradway &
McCord, 1997, p. 46).
Home is linked to our core and when
something is brought home to us it is
understood with our whole being…When the
house is transformed into a symbolic centre the
individual may find freedom to explore, go
out and go within, attuning to the dreaming
mind…The ground plan forms a mandala.
This permits encounters with the unknown or
terrifying through a prevailing sense of grace.
(Colcord, 1998, p 92).
The Healing Process
In his outer life, Ben had shown remarkable
development during the period of our work
together. His play was more focused and the earlier
signs of fragmentation in his behaviour had
disappeared. His speech had developed and his
mother commented on his development in relation
to both home and nursery school. He was better
able 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 as
he recreated his own inner home was a very moving
12 THE USE OF SANDPLAY WITH CHILDREN
experience. I learned through working with Ben
how true it is that a child’s 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 child’s
utterances must always be taken as symbolic, not
interpreted rationalistically, from the reason
standpoint of adult consciousness’ (Neumann,
1973, p.34).
Dora Kalff believed that children are closer to the
truth than adults and the younger the child, the
closer they are to it. This was certainly my
experience with Ben. One can conceal the truth
from children but at some level they already know it
so the concealment just leads to confusion. On the
final day of our work together Ben said to his
mother: ‘Daddy didn’t fall into the river, he jumped,
didn’t he?’ He was now ready to acknowledge the
truth consciously. That evening, in his bath (after
we had looked together at the slides of all his sand
trays), Ben said to his mother, ‘Looking at the
pictures with Diana was the bestest bit of the day. It
made me sad because I miss my Daddy, but he’s still
with me really, inside my head… there’s always
something ending and something else setting off,
Mummy’.
In this paper I have given a description of sandplay
as the Swiss psychotherapist, Dora Kalff, conceived
it. With a brief case study of a three-year-old boy I
have attempted to illustrate the unconscious process
as it unfolds during a sandplay process. I hope very
much that this will be of some interest to those play
therapists who are already using sandtrays in their
work with children.
Biography and Correspondence
Diana Jansen is a Jungian Analytical
Psychotherapist who works with both adults and
children. She first trained as a nurse and later as a
professional singer. Her husband’s early death from
cancer led her to train as a psychotherapist and also
as a sandtray therapist. Diana has chaired the British
and Irish Sandplay Society as well as the Association
for Psychotherapists in the North. Now, in her
second marriage, she enjoys a full life with a large
family of children and grandchildren.
Diana Jansen
Meadowfield House
Dalton
Northumberland
NE18 OAA
Tel: 01661 886200
Email: Diana.Jansen@btinternet.com
References
Ammann, R. (1991). Healing and Transformation in
Sandplay. USA: Open Court Publishing Company.
Bradway, K. & McCord, B. (1997). Sandplay -
silent worship of the psyche. London/New York:
Routledge.
Chetwynd, T. (1982). A Dictionary of Symbols.
London: Paladin.
Cirlot, J.E. (1971). A Dictionary of Symbols.
London: Routledge.
Colcord, M.E. (1998). Home Sweet Home.
Harvest, 44 (2).
Cunningham, L. (1997). Sandplay Therapy.
Journal of Sandplay Therapy, 6 (1).
Jung, C.G. (1936). Modern Man 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.15
London: Routledge & Kegan Paul.
Neumann, E. (1973). The Child. London: Karnac.
Ryce-Menhuin, J. (1992). Jungian Sandplay: The
Wonderful Therapy. London: Routledge.
 THE USE OF SANDPLAY WITH CHILDREN 13

Samuels, S. & Shorter, B. & Plaut, F. (1986). A

Dictionary of Jungian Analysis, London: Routledge
& Kegan Paul.

Winnicott, D.W. (1998). Playing and Reality.

London: Penguin Books.

Winnicott, D.W. (1990). Maturation and the

Facilitating Environment. London: Karnac Books.
Bri. J. Play Therapy, Vol. 2 (2006), pp14-23
14

: An Introduction
Theraplay

David L. Myrow, Ph.D.

Buffalo, New York, USA

www.theraplace.com

Abstract

This article introduces Theraplay1, a therapeutic model that is becoming increasingly known for its focus on
promoting 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, speech
and 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 process
whenever possible, and is intended to be fun. This brief overview reviews the history of Theraplay, the principles
that guide it, its theoretical foundation in Object Relations and Attachment Theory (now supported by recent
findings in neurobiology), and notes recent scientific research that strongly supports its efficacy. Illustrations are
given from clinical practice. Keywords: Theraplay, play therapy, attachment, research, depression in children,
attention deficit, selective mutism, oppositional defiance, autistic spectrum, divorce.

The Beginnings: A Challenge
Among the social innovations of the 1960s in the
United States were two early intervention programs:
the Children’s Television Workshop (which
invented Sesame Street) and Head Start, a pre-
school program for underprivileged children. Early
in the development of Head Start, a consulting
psychologist, Ted Hurst, was awarded a contract to
provide psychological services for the Chicago
program. A great many of the preschoolers in Head
Start presented with serious mental health issues,
often manifested in social withdrawal/depression or
over activity/aggression. Hurst was concerned that
these children be provided direct services; rather
than merely be categorized while interventions were
sought via the public mental health system. He
needed an approach that worked quickly and
effectively (Myrow, 2000b).
Hurst appointed Ann Jernberg as Clinical Director.
Jernberg had been inspired by the work of Austin
Des Lauriers, a psychiatrist who sought new
approaches in working with autistic children (Des
Lauriers & Carlson, 1969). For example, he would
block their attempts to leave his presence and he
sometimes sang to them in an effort to
communicate. Viola Brody, also a student of Des
Lauriers, contributed to the strategies developed by
Jernberg (Jernberg, 1990; Brody, 1993). Jernberg
and her colleagues were able to accomplish
something remarkable with the Head Start
preschoolers: they developed a short-term (usually
about fifteen weeks) intervention that seemed to
offer the child alternatives to the withdrawn or
overactive coping strategies. Thus Theraplay was
brought to birth. After Jernberg’s death, her long-
time colleague, Phyllis Booth, wrote the second
edition of the essential Theraplay textbook
(Jernberg & Booth, 1999). Booth continues to
contribute to the development of the approach
through her work at the Theraplay Institute.

1 The appellation “Theraplay” is a registered service mark of the Theraplay Institute. Early in its history, this was done as a way to ensure
that practitioners using the method were actually professionally trained in this specific approach. The intention is to make sure that the
techniques are used ethically, appropriately, and correctly. The Institute maintains control of the service mark and its use.
 THERAPLAY: AN INTRODUCTION
Initially the treatment was with individual children
in preschool classrooms. Eventually Jernberg started
to include the family crucible in her psychotherapy
work (Jernberg & Booth, 1999). To this she
applied an application of Object Relations Theory
(Winnicott, 1957) and Attachment Theory
(Bowlby, 1969) that was well ahead of her time.
Besides drawing on the work of Bowlby and his
followers, Jernberg drew from the strategic therapy
of Milton Erickson (as cited in Haley, 1973).2
Jernberg’s focus was always on what worked, to
create intense moments of connection. As has been
advanced more recently in psychoanalytic thinking
(Tronick, 1998), change seems to happen most
when there is a profound sense of emotional
engagement – a “moment of meeting” - with the
client (Lyons-Ruth, 1998). Recent discoveries by
neurobiologists (Siegel, 1999) reveal in detail the
effects of early infant interactions on infant
attachment and development. Perhaps most
importantly it has become clear that warm, physical
contact plays an essential role in beginning the
process of self-regulation, starting with regulation of
affect (Schore, 2001). Mäkelä (2003) has articulated
how recent advances in neuroscience are applied in
Theraplay. Forty years ago, Jernberg anticipated
these developments. Instead of looking for
pathology, Jernberg looked toward looked toward
health, and studied the interactions of typical
parents and their children in search of activities that
might promote better functioning in children who
were struggling. Her model makes a direct
connection between Attachment Theory and
practical parenting. This helps to formulate the
therapeutic interventions that are likely to help.
An Elegant Model of Parent-Child Interaction
Jernberg postulated that the child’s needs for
parenting and, consequently, the parents’ responsi-
bilities, may be seen in the four dimensions of
Structure, Engagement, Nurture, and Challenge
(SENC) (Jernberg & Booth, 1999):
2 In this approach, the therapist assumes increased responsibility for the therapeutic effort and may use unconventional techniques such as
paradoxical interventions. (For example, to a child who kicks off his shoe while entering the playroom, the therapist comments, “Wow! You
have strong legs!”)
15
Structure
The parent builds a holding environment
(Winnicott, 1957), takes charge of defining physical
boundaries and setting limits. For a newborn this
involves schedules and routines for feeding,
sleeping, changing. Soon the parent teaches the
child about herself, “These are your ears.” A little
later the parent helps the child to differentiate,
“These are your eyes, and these are my eyes”.
Structuring takes different forms at the various
developmental stages. For the school age child, it
includes getting homework done and setting norms
of behaviour with peers. For the teenager, there
might be curfews and help organizing the search for
college or a job.
Engagement
The parent connects emotionally with the child.
There is a sense of immediacy and intimacy.
Accurate affective attunement is essential. In
interaction with the infant, this is seen in mirroring
behaviour that is in synchrony with affective
volume and tone. As the child develops, attending
to his emotional states and teaching the words for
them helps the child know himself and feel known.
For a child who avoids closeness (for example a
parentified, obsessive-compulsive child), sometimes
little surprises can help the child let go and have
fun. An anxious seven-year-old might be delighted
to find that he could jump further and further
distances from a tabletop into the arms of an
enthusiastic parent, who ends the “game” by
swinging the child around in a circle and then
gazing into his eyes.
Nurture
The parent protects and comforts the child, feeds
and clothes her. Warm, physical touch supports the
process of self-regulating. When the boy scrapes his
knee playing ball, Dad checks it out, gives it a kiss
16 THERAPLAY: AN INTRODUCTION
and a bandage, and sends him back to play
(assuming no stitches are needed!). Grandmother
makes treats for after school snacks.
Challenge
The parent notices the child’s budding capacities
and provides situations to help them develop.
Parents hold the infant upright when beginning to
walk and then reach out to coax the toddler to
venture his first independent steps. The five-year-
old is taught to tie his own shoelaces. By
accomplishing ‘just-enough challenges’, children
start to feel competent and develop self-confidence.
Jernberg’s model has always seemed elegant and
brilliant. The reader is challenged to identify a
parental role or corresponding child need that
doesn’t seem to be covered by at least one of the
dimensions. The model guides the therapist’s
diagnostic and prescriptive thinking, as the reader
will see below. This thoughtful scheme can be a
guide when working with clients of any age,
including adults. One asks, when working with an
adult, “what does this client seem to have missed
growing up in his family, and how is this manifested
now in relationships?”
The Marschak Interaction Method
(MIM): An Assessment Tool for
Understanding Parent-Child Interaction
To assess these different aspects of a child-parent
relationship, Jernberg developed the Marschak
Interaction Method analysis (MIM). In the MIM, a
child and her parent sit adjacent to each other at a
small table. The two of them engage in eight or
nine activities while the therapist observes, usually
via a one-way window, and makes a video. The
tasks are selected to elicit the concerns that have
been identified in the initial interview. MIMs can
be done with a variety of caregivers, for example,
with children and grandparents or with young
3 For a fascinating overview of the work and lives of Bowlby and the other Attachment Theorists, the reader is referred to Robert Karen’s
(1998) delightful volume.
adults living in group homes and their key workers.
The approach can help inform any therapist about
the dynamics in relationships in a systematic way.
Some social workers and psychologists have
described to the author how they are including
MIM analyses as part of custody recommendations
in divorces.
One of the most helpful aspects of the MIM is that
it permits a focussed investigation of the attachment
relationship. This suggests specific ways that the
therapist might intervene. The MIM provides a
bridge from our theoretical understanding of a
child’s development to actual relationship processes.
For example Attachment Theory3 has guided
attention to the role that affective attunement plays
in the early child-parent relationship (Stern, 1985;
Schore, 2001). Simply put, a caregiver’s astute
recognition and responsiveness to a child’s commu-
nications (nonverbal information is probably most
important, even as the child matures) promote
neurobiological and psychological developments
that are most likely to help the child relate to others
in a rewarding way. Thus she comes to feel worthy
and competent to meet life’s challenges (Siegel,
1999 & 2003). If however the caregiver regularly
fails to recognize and respond to the child
empathically, misattunement arises and various
problems in functioning can occur (Siegel, 2003).
For example, a mother with postpartum depression
may not have the wherewithal to respond to her
child. Or a child may be born with a painful
physical condition that so preoccupies her
consciousness that she does not experience a parent’s
loving efforts to care for her.
These early caregiver-child interactions form
memories that evolve into patterns of expectation
about relationships with others. When a child’s
behaviour is dysregulated or profoundly self-
defeating, we may suspect issues in the early
attachment relationship. The therapeutic challenge
is how to set the stage so that the child might be able
to come to a different sense of himself.
 THERAPLAY: AN INTRODUCTION
Theraplay as a Way to Reach Troubled
Children
In creating Theraplay, Jernberg hoped to reach back
to the innate capacity of the child in order to
encourage a more positive sense of herself to
develop. Jernberg hoped that hands-on, physical
experiences resembling those enjoyed by healthy,
typical parent-child dyads would provide a more
direct way for troubled children and their parents to
generate healthy interactions.
As Theraplay evolved, a number of characteristics
began to distinguish it from traditional methods:
• The focus is on healthy parent-child
relationships rather than on the child’s pathology or
internal processes.
• The therapist is in charge of the session,
planning and organizing the experiences to meet the
child’s needs.
• The activities are designed to meet the child’s
emotional stage of development rather than the
child’s physical age. Therefore many games have a
regressive aspect. Nevertheless, these experiences are
designed to meet the child’s unresolved early needs
while remaining ego-syntonic with the child’s
current sense of herself.
• The treatment includes physical, interactive,
emotionally attuned play. This helps with building
attachment as well as developing self-regulation.
• The therapist (not a toy or symbolic item) is the
main playroom object. The therapist utilizes the
child’s nonverbal behaviour to make physical and
emotional contact throughout the session.
• Immediacy is central: the focus is on the
experience at the moment rather than on history,
pretend play, or interpretations.
• Nurturing touch is a natural and integral aspect
of the interaction. In this Theraplay guided by the
wealth of research in the past few decades
detailing the essential role that touch plays in
healthy physical and emotional development (Field,
1995; Mäkelä, 2003, 2005). Great care is taken to
ensure that touch is used respectfully and that it is
geared to the treatment plan.
17
• Parents are included in the assessment and
the treatment process, and are encouraged to bring
what they learn into interactions at home.
A Protocol for Treatment
Unlike early Child Centred and Psychoanalytic
approaches, Theraplay considered the role of
attachment figures from the beginning. Soon after
Jernberg began to develop the approach, she saw the
value of including parents in the process (Jernberg
and Booth, 1999). In her initial work with families,
Jernberg had two therapists involved in a treatment
session:
1) the child’s therapist, who worked one-on-one
with the child in the playroom, and
2) the interpreting therapist, who joined the
parents in observing the work via a one-way
window, in an adjacent room.
This method continues to be utilized by the
Theraplay Institute. It allows parents to learn about
their child and to understand what the child’s
therapist is attempting to do. The focus is usually
on strengths and also on the child’s efforts to get
his/her needs met. This intensive approach is not
always practical. Many practitioners (including the
author) utilize an alternative format in which the
therapist works with the child for the first half of a
session, then meets with the parents for the second
half 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 review
the child’s needs and efforts toward the goals.
As presently practised in agencies and private
therapy 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 the
MIM videos and build a treatment plan;
4) Individual Theraplay, with parents observing
directly or via video;
18 THERAPLAY: AN INTRODUCTION
5) Family Theraplay, with parents joining the
session;
6) Termination;
7) Post-treatment check-up/s (after a few months
or over the course of a year).
The length of treatment can vary from about fifteen
sessions for the more typical case, to two or more
years with severely attachment-disordered or
traumatized children.
Theraplay in Other Settings
Some situations require a departure from this
protocol. For example, social workers,
psychologists, speech and occupational therapists
often use Theraplay in schools, where they may not
have ready access to parents.
Tony: A Hypothetical Seven-year-old
Two-year-Old
In order to illustrate the application of Theraplay in
clinical practice, we will consider the case of
“Tony,” a composite of cases seen by the author.
Seven-year-old Tony, in an intact family, had started
Day Care at six weeks when his Mum’s employer
required that she return to full time work. She
regretted this, having stayed at home for a few years
after the birth Tony’s older brother. The parents
changed Tony’s care arrangements twice: when he
was 9 months for logistical reasons, and again at 27
months because they felt that the care was not
attentive and warm enough. By the time that they
brought him for treatment, Tony avoided physical
closeness, and had tantrums whenever he couldn’t
get his way. He broke many of his toys, and
sometimes took others’ things. Family outings to
parks and restaurants were often disastrous: Tony
might bully other young children or refuse to sit still
for a simple meal together. His parents had had few
problems raising his twelve-year-old brother, and
were perplexed about Tony’s behaviour. How might
one conceptualize these concerns and intervene as
expeditiously as possible to help Tony and his family
grow together and enjoy life?
At the first meeting, with Tony’s parents, a careful
social history was obtained, including the physical
history, the quality of relationships with adults and
other children, school progress, and involvement in
organized activities. In discussing Tony, special
attention was given to looking at the care history.
Also, the therapist wanted to know what it was like
to live with this boy; what the parents had tried in
their efforts to reach him; what specific behaviours
were problematic; what did his parents perceive as
his strengths; and how they played and had fun
together. Given the history, the therapist also
provided some psychological education for the
parents, reframing some of the acting out behaviour.
For example, Tony’s ambivalence might reflect his
desire for emotional closeness and fear of it. Mum
was given support for her sadness at not having been
able to be more available to Tony when he was very
young. The main focus however was on what could
be done now to help. Finally the principles of
Theraplay, including the idea that unresolved
regressive needs can often be addressed even in older
children, were offered to help them start to think
about a process that could help their son get better.
The stage was set for the Marschak Interaction
Method analysis.
For the first MIM, Mum and Tony were seated next
to each other behind a small table. Mum was given
a stack of instruction cards. She was asked to read
the directions for each activity aloud first and to
decide at what point to commence each task. The
therapist then retired to the other side of the one-
way window and gave the signal for Mum to start.
The first activity invited Mum and Tony to have
two toy animals play together. As soon as Mum
read the directions, Tony took his toy and “bopped”
Mum’s with it. Mum asked him not to do this, but
he repeated the bopping. Mum then suggested they
have a race. This helped Tony to calm down. The
two then engaged in seven additional MIM tasks. A
week later, Dad and Tony came for the second
MIM. The first task was for the two to “put hats on
each other.” Dad put a nice baseball hat on his son,
attempting to look him in the eye. Tony avoided
eye contact, and, laughing, grabbed a lady’s hat and
 THERAPLAY: AN INTRODUCTION
put it on Dad. Dad put away the box of hats and
went on to the next of his eight activities.
Reviewing the videos with the parents, observations
were organized along the SENC dimensions. For
example, even though he sometimes resisted, Tony
became calmer and focussed more when parents
structured and took charge of the activities.
Although they offered eye contact, he seldom
returned it. He seemed to crave nurturing but
defended against their efforts to provide it. In the
few cases when they persisted in challenging him to
try a slightly frustrating task, he gave up too easily.
The parents started to see that this was an anxious
boy whose negative and avoidant behaviour kept
him from what he really wanted and needed. Tony
in some ways behaved like a rapprochement-stage
child who was struggling for autonomy (Mahler,
Pine & Bergman, 1975). He threw tantrums when
frustrated, yet tried to engage his parents but always
on his terms rather than theirs. He was highly
ambivalent and constantly tried to control
situations to make sure his needs were met. He was
full of shame generated by his negative attention
seeking, which brought endless “corrections” from
teachers and an inconsistent combination of
punishments and indulgences from his perplexed
parents. When the therapist explained that, though
Tony was seven-years-old physically, he was mostly
two-years-old emotionally, Mum and Dad started to
make more sense of his behaviour. The therapist
and they devised treatment goals designed to reach
out to the toddler in Tony and help him move on
developmentally:
• Tony will be comfortable with emotional
intimacy and be able to have fun with his parents
and others. His laughter will be genuine.
• Tony will accept clear, consistent, firm limits
from adults.
• Tony will accept nurture from his parents end
enjoy his role as a child in the family.
• Tony will be able to manage frustration
appropriate for his age and increase self- regulation
generally. He will be able to ride out challenges.
His parents will look to provide just enough
challenge to stretch him developmentally.
19
To accomplish these goals, the following methods
were planned:
A. Individual and then Family Theraplay,
including psycho-educational work with Mum and
Dad to help them develop management strategies at
home that coordinated with the Theraplay sessions.
B. Coordination with school personnel, to help
them understand Tony’s behaviour and support the
work.
Theraplay begins
Child-centred play therapy practitioners are usually
surprised to find that there are few toys visible in the
playroom. When using Theraplay, the therapist is
the primary “object” in the room, and the focus is
on how child and therapist interact.
In the waiting room Tony alternated between sitting
at a table working on a puzzle and coming over to
his Mum’s chair, asking her when the session would
begin. This behaviour resembled that of a two and a
half year old who plays independently, then
sporadically checks in with Mum for “refuelling.”
The therapist took Tony’s hand and they headed to
the playroom. Once there, it was explained that
shoes were to be removed. Tony kicked off his
sneakers and lunged toward a beanbag chair.
However the therapist kept holding his hand and
carried Tony over to the beanbag chair. It was
explained that a video would be made for parents to
see later so that they could learn some of the games
that were to be played. The therapist stated the two
rules of the playroom: “First, No one gets hurt –
neither You (gently touching Tony’s chest) nor I.
Second, Everybody has as much fun as possible!”
Tony smiled, perhaps relieved that this wasn’t going
to be all torture or a “lecture session” from an adult.
Then the therapist performed a “check-in.” The
therapist pointed to the boy’s very dark brown eyes,
“even darker than mine!” (a move, which caused
Tony to look at the therapist’s eyes for a moment).
Appealing to the seven-year-old part of him, the
therapist counted Tony’s fingers: “Let’s see, there
should be 10, right? 10-9-8-7-6 on this side and 1-
20 THERAPLAY: AN INTRODUCTION
2-3-4-5 on this hand. Hmmm – 11!” The therapist
smelled his hair (lovely!) and felt how soft it was.
They checked to see if Tony could touch his chin
with his tongue. It was noted that when Tony
smiled, he made dimples. The therapist used his
fingers like a callipers to show Tony how his biceps
became bigger when he pointed his fists toward his
ears rather than forward. The therapist noticed that
Tony had a little bruise on a forearm, and put a drop
of lotion on it - then more lotion for a scratch on his
hand. When his toes were counted, Tony
unexpectedly pulled off a sock to show a bruise on
his shin. This “invitation” was most fortuitous,
because then the therapist took his feet and used
them to “pop” the therapist’s inflated cheeks, which
led to some very hearty, baby-like laughs, and a
chance to play This Little Piggy. In sum: within the
first few minutes of his first Theraplay session, it
was possible to get this typically unhappy,
uncooperative boy engaged in activities that
identified some of his delightful qualities and
engaged core affect.
From this initial activity, the therapist applied lotion
to his and Tony’s arms and initiated a Slippery Arm
Game (each player has to try to pull the other over
to his side), followed by a Hopping Race. Tony
loved winning the first race. However, for the
second race, he became dysregulated, jumped the
gun for the “start,” and had to be called back for a
re-start. This gentle, firm insistence on adult-in-
charge is a big part of Theraplay. It is an important
contributor in rehearsal for regulation of affect.
There is an ebb-and-flow to Theraplay sessions.
The therapist provides the same kind of variety that
a parent does when playing with an infant. When
the child needs a break from interaction and eye
contact the parent waits or gently soothes the infant
until he or she is comfortable to resume more
intense contact. In a Theraplay session, the
therapist moves from being in-close to a little less-
intense; from sitting to being up and jumping
around; from being soft to being loud, all of which
assists the child in modulating his affect and
behaviour.
The next activity was a Staring Contest. Therapist
and child sat cross-legged, with knees touching. The
therapist gently held Tony’s shoulders and Tony put
his hands on the therapist’s arms. This provided –
literally - a “holding environment”! When the signal
was given, each tried to keep eyes open the longest.
The last activity was Guess the Goodies, an activity
that helps build trust. Still sitting with knees
touching, an envelope was brought out with Tony’s
name on it. The therapist said, “There are some
delicious goodies in this envelope. Close your eyes
and I’ll put one in your mouth, and then you can
open your eyes and tell me what it is.” Tony quickly
guessed when he was fed an M&M, but then Tony
became resistant. He would accept another morsel
(perhaps a jelly bean or tiny cookie), but
immediately take it out and examine it. It was
tempting to say, “no, you can’t look, you’re breaking
the rules.” Instead, the therapist commented, “Oh,
I see you wanted to know for sure what it was.” A
correction would have added to Tony’s shame
experiences.
Meeting with Parents
Tony then waited in the playroom, while his parents
viewed the video of the session. The parents saw
how Tony responded to the regressive experiences
by becoming calm and engaged. The Staring
Contest was role-played so that parents could try
this at home. This format continued over the next
five meetings.
Later in Treatment: First Session with Parents
Before bringing in Mum and Dad, Tony was seen
individually, and some of his favourite games were
repeated. 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 led
through a Check-in, as described in the initial
individual session. Towards the end, Tony suddenly
insisted, “I’m hungry.” It was explained that a fun
 THERAPLAY: AN INTRODUCTION
eating game would occur later in the session, but
that didn’t satisfy him. He folded his arms and
pouted. After Hughes (1999), the therapist
interpreted (not usually a Theraplay move), “I
wonder if you’re angry that we can’t do exactly what
you want right now. Maybe you think I don’t like
you if I won’t let you do it right now.” This was
successful, and so it was possible to move on to the
next game, Tunnels.
For Tunnels, the three adults made parallel arches.
On the signal, Tony had to crawl through before the
count ended and the tunnels collapsed. On
succeeding crawls the number of counts was
reduced, so that Tony’s parents eventually caught
him in warm hugs. Moving to a quieter game with
a large Nurturing component, Mum and Dad sat
facing each other, with Tony in Dad’s lap. Mum
played Guess the Goodies. This gave Tony a chance
to have a feeding experience with his Mum, to
renew and extend intimacy and nurturing from the
early years, and with Dad symbolically and literally
holding him.
This session concluded with a Blanket Swing. Tony
lay in a folded blanket, facing his parents while the
therapist took the opposite end and they slowly
rocked their seven-year-old, singing, “Twinkle,
twinkle, little star. What a handsome boy you are!
Dark brown eyes and very smart. We love you with
all our heart!” At first, Tony wiggled in the blanket,
even turned over to hide his eyes. By the third time,
he was looking into his parents’ eyes and seemed
quite relaxed.
The Many Applications of Theraplay
This case is an example of Theraplay with a child
whose changes in caregivers in his early years
probably played a part in developing insecure
attachments with his parents. Theraplay has many
more applications. Although it is used most often
with pre-schoolers to early teens, elements of
Theraplay can be utilized with older teens and even
with geriatric clients. In day-to-day practice, where
most of the children experience problems of over
activity, depression, obsessive-compulsive
21
behaviour, or oppositionality, Theraplay can work
very quickly and effectively by itself. When
children present with other situations – divorce or
loss of a caregiver, for example - Theraplay activities
can quickly build trust and comfort, making it
easier to utilize more traditional, Child-Centred or
Cognitive methods. Theraplay has great utility with
children who have Autistic Spectrum and Pervasive
Developmental Disorders (Bundy-Myrow, 2000).
Group Theraplay (Rubin & Tregay, 1989), which
has had wide application in school classroom
settings, has also been used with children with
Autistic Spectrum disorders.
Research on Efficacy
Clinicians who use Theraplay have reported success
with even the most challenging cases (cf. Munns,
2000; Mäkelä, 2005; Koller and Booth, 1997;
Lindaman and Haldeman, 1994, as well as
numerous articles in the Theraplay Institute
Newsletter). Mäkelä and Vierikko (2004) have
reported systematic assessment of Theraplay with
disadvantaged children and their families. Franke
and Wettig in Germany have done by far the most
comprehensive and robust assessment. In a
controlled, longitudinal study conducted between
1998 and 2005, sixty children diagnosed with both
speech-language and severe behaviour disorders
were given Theraplay treatment and compared to
thirty non-symptomatic children over time. A much
larger, multi-centre study looked at the results of
Theraplay treatment conducted in nine different
settings, including a centre for early intervention, a
kindergarten in a socially impoverished area, a
family therapy psychology practice, and practices
for speech-language pathologists. The children
ranged in age from two years and six months to six
years-11 months. Presenting problems included
attention deficit, oppositional defiance, shyness,
social anxiety, selective mutism, lack of social
mutuality and aggressiveness. Assessment included
tabulation of 53 symptoms seen as relevant to
Theraplay intervention. The findings (reported in
Wettig, Franke, and Fjordbak, 2006) showed
consistently strong effects. Problems seen as having
a more biological basis (e.g., attention deficit
22 THERAPLAY: AN INTRODUCTION
problems and autistic-spectrum concerns) had
strong and statistically significant effects, but to a
somewhat more modest degree. The authors rate
their research on standards written by the American
Psychiatric Association for evidence-based
treatment; based on these criteria, their work
appears to be robust and compelling.
Theraplay is a very different approach from what
most of us have learned in our training. The
conceptual scheme is based on Attachment Theory
and the clinical approach is physical, therapist-
directed, affectively engaging – and aims to be fun!
It is not possible to learn how to do Theraplay from
reading a book. Experiential training is the only
way to really “get it,” and to see how powerful it can
be. Since it makes emotional and even a few
physical demands (comfort with touch, for
example) on the therapist, it is not every one’s cup
of tea. However, in the author’s own training, and
in many years of training colleagues, it has been a
very pleasant surprise to find how many people
really take to Theraplay once they try it.
Correspondence
David L. Myrow, Ph.D.,
822 Center Road,
West Seneca,
New York 14224, USA
drdave@theraplace.com
References
Author’s Note: In addition to the resources noted
below, the reader is encouraged to visit the web site
of the Theraplay Institute, www.theraplay.org, for
the latest information on Theraplay applications
and research, as well as about the Third
International Theraplay Conference, to be held in
Chicago in July 2007.
Bowlby, J. (1969). Attachment and Loss. Vol.1:
Attachment. New York: Basic Books.
Brody, V. A. (1993). The Dialogue of Touch:
Developmental Play Therapy. Treasure Island,
Florida: Developmental Play Training Associates.
Bundy-Myrow, S. (2000). Group Theraplay for
children with Autism and Pervasive Developmental
Disorder. In E. Munns (Ed.), Theraplay: Innovations
in Attachment-Enhancing Play Therapy (pp 301-
320). Northvale, NJ: Jason Aronson.
Des Lauriers, A. & Carlson, C.F. (1969). Your
Child is Asleep – Early Infantile Autism: Etiology,
Treatment, and Parental Influence. Homewood,
Illinois: Dorsey
Field, T.M. (1995). Touch in Early Development.
NJ: Laurence Ehrlbaum Associates
Haley, J. (1973). Uncommon Therapy: the Psychiatric
Techniques of Milton H. Erickson, M.D. New York:
Norton.
Hughes, Daniel A. (1999). Building the Bonds of
Attachment. London: Jason Aronson.
Jernberg, A.M. (1990). Theraplay: a New Treatment
Using Structured Play for Problem Children and
Their Families. Oxford: Jossey-Bass
Jernberg, A.M. & Booth, P.B. (1999). Theraplay:
Helping Parents and Children Build Better
Relationships through Attachment-Based Play.
California: Jossey-Bass.
Karen, R. (1998). Becoming Attached. USA: Oxford
University Press (second release).
Koller, T.J. And Booth, P. (1997). Fostering
attachment through family Theraplay. In K.J.
O’Connor, and L.M. Braverman (Eds.), Play
Therapy Theory and Practice: A Comparative
Presentation (pp 204-233). New York: Wiley.
Lindaman, S. and Haldeman, D. (1994). Geriatric
Theraplay. In C.E. Schaefer and K.J. O’Connor
(Eds.), Handbook of Play Therapy, Vol. 2: Advances
and Innovations. New York: Wiley.
 THERAPLAY: AN INTRODUCTION 23

Lyons-Ruth, K. (1998). Implicit relational
knowing: its role in development and psychoana-
lytic treatment. Infant Mental Health Journal, 19
(3), pp 282-289.
Mahler, M.S., Pine, F., and Bergman, A. (1975).
The Psychological Birth of the Human Infant. New
York: Basic Books.
Mäkelä, J. (2003). What Makes Theraplay®
Effective: Insights from Developmental Sciences. The
Theraplay® Institute Newsletter, Fall/Winter 2003.
Mäkelä, J. (2005). The importance of touch in the
development of children. Finnish Medical Journal
60, pp 1543–9.
Mäkelä, J. and Vierikko, I. (2004). From heart to
heart: Interactive therapy for children in care: Report
on the Theraplay project in SOS Children’s Villages in
Finland 2001-2004. Billrothstr. 22A-1190 Vienna,
Austria: SOS-Kinderdorf International
Siegel, Daniel J. (1999). The Developing Mind: How
Relationships and the Brain Interact 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 states
of consciousness and the process of therapeutic
change. Infant Mental Health Journal, 19 (3), pp
290-299.
Winnicott, D.W. (1957). Mother and Child. New
York: 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). New
York: Guilford Press.

Munns, E. (ed) (2000). Theraplay: Innovations in

Attachment-Enhancing Play Therapy. London: Jason
Aronson.

Myrow, D. L. (2000a). Applications for the

attachment-fostering aspects of Theraplay. In E.
Munns (ed.), Theraplay: Innovations 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 with 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, affect
regulation, and infant mental health. Infant Mental
Health Journal. 22 (1-2), pp 7-66.
Bri. J. Play Therapy, Vol. 2 (2006), pp 24-36
24

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 research
investigation. The author suggests that it is advisable to consult the development of research design within the
wider field of the arts therapies. It is acknowledged that quantitative methods have earned respect as credible
approaches to research within this genre. Alternatively it is recognised that a qualitative approach may be
efficacious for certain investigations within the creative arts therapies. The particular benefits of working within
a qualitative paradigm are explored: the affinity with the therapeutic medium; the utilisation of the therapist’s
skills; the opportunity to use a combination of approaches within the design; the concept of bricolage; the ability
to triangulate data and the more complex concept of crystallisation. The application of these principles are
applied to the author’s 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 ideas
within 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.

Introduction: the impetus to the search for
an appropriate methodology within play
therapy
The author is conducting a research study,
supported by the NHS North West Region
Research and Development Directorate, to
elucidate how play therapists perceive change in the
play therapy dynamic with children. Consulting
with therapists is regarded as a first step toward
establishing what effect play therapy has on child
clients. It is hoped that this will help identify an
appropriate assessment tool that can be used to
monitor the progress of therapy. This would be
useful on an individual basis with clients and on a
larger scale to conduct outcome studies that would
document the efficacy of the play therapy approach.
Play therapy as a creative arts therapy
When designing a research study a researcher would
naturally draw inspiration and seek direction from
previous investigations. However play therapy is an
emerging profession without a strong research
tradition, and previous evaluation in the field both
within the United Kingdom (Carroll, 2000, 2001;
Daniel-McKeigue, 2004) and internationally is
scant (Broomfield, 2003; LeBlanc & Ritchie,
2001). To provide guidance on how to examine the
process of play therapy through the discipline of
research I would suggest that we may learn from the
experience of other investigators involved in
therapies particularly those working with children
and within the arts therapies.
Play therapy is not always included in the definition
 PLAYING IN THE FIELD OF RESEARCH
of the ‘arts therapies’; this is a generic term that is
used to describe a variety of arts therapy
practitioners. Cattanach, editor of ‘Process in the
Arts Therapies’ (1999), uses the term to include art
therapists, dance therapists, dramatherapists, music
therapists and play therapists. However, within the
same publication Barham (1999) outlines that the
only officially recognised Arts Therapists within the
Council for Professions Supplementary to Medicine
(CPSM) are Art, Drama and Music. Now known as
the Health Professions Council (HPC), this
regulatory body (at June 2006) recognises that the
arts therapy profession has four protected titles, art
therapist, art psychotherapist, dramatherapist and
music therapist. In a previous publication that
summarised the available research within the arts
therapies Payne (1993) does not acknowledge play
therapy and focuses on art, drama, dance movement
and music therapies. In contrast, American writer
McNiff (1998) is inclusive in his definition of the
arts therapies. He outlines an arts-based approach
to research and does not specify the limits of the
definition but collectively describes the creative art
therapies as ‘an outgrowth of psychology’s aesthetic
aspect’ (p.15).
Play therapists themselves may not necessarily
regard their practice as an arts therapy. Currently
(at June 2006) the British Association of Play
Therapists (BAPT) is seeking professional
validation by either the HPC or the United
Kingdom Council for Psychotherapy (UKCP).
There is some dispute as to the most appropriate
category: arts therapy or child therapy. I would
suggest that play therapists are ambivalent about
their profession being regarded as an arts therapy
and I would go further to propose that they may be
more inclined for it to be recognised as a child
psychotherapy. Similarly other arts therapies also
have an allegiance to psychotherapy, for example
dramatherapists continue to debate whether this
should be integrated into their title in the same way
as art psychotherapists (British Association of
Dramatherapists (BADth) Conference 2005)
I would suggest that play therapists differ from the
other arts therapy professions in that they are less
25
likely to consider themselves as artists in the same
way that an art therapist, dramatherapist or music
therapist may have a particular skill within a certain
craft. Nevertheless play therapists do share the
media of the creative arts therapies within their
approach, for example image making, role-play,
voice and percussion.
For the purpose of this paper I propose to consult
other therapy practitioners, primarily those who
also rely on the creative arts as the principle means
of communication. I will use the term ‘arts
therapist’ in the spirit of Cattanach and McNiff to
embrace a wide range of creative art therapy
practitioners including play therapy.
Quantitative versus qualitative research
It is vital that the practice of play therapy is
underpinned with research and proves to be
evidence-based. It is important that investigation is
not intrusive to the client’s therapeutic process but
takes place in harmony with clinical work (Daniel-
McKeigue, 2004). In 1993 Junge and Linesch
outlined that hitherto art therapy researchers had
relied on traditional quantitative research methods.
They exhorted practitioners to move away from the
empirical studies that had been regarded as
‘legitimizing’ the profession and embrace new
paradigm research. Postmodern thinking has
challenged the underlying philosophy of
quantitative paradigms and given birth to
qualitative approaches that focus on the
investigation of experience as well as effect. Driven
by philosophies such as humanism and feminism it
is conceivable that within qualitative design the
research can be adapted to and congruent with the
phenomenon being investigated. Linesch (1994)
compares the ‘subjective, open-ended, intuitive and
qualitative’ nature of art therapy practice and
contrasts it with the attempts to research the process
that are generally ‘objective, narrowly focussed,
empirical and quantitative’ (p.185). Arts therapists
are familiar with the struggle for acceptance of their
therapeutic approach within the psychological
therapies; perhaps practitioners are wary of
repeating this conflict within the field of research,
26 PLAYING IN THE FIELD OF RESEARCH
concluding that if an ‘acceptable’ methodology is
selected then the therapeutic approach will be
ratified.
Within ten years of Junge and Linesch’s recommen-
dation the investigative tide may have changed.
Barham (2003) identifies that qualitative
approaches are frequently the methodological
approach of choice for arts and play therapy
researchers within the School of Psychology and
Therapeutic Studies at Roehampton University.
This is apparently synchronous with their
psychological counsellor counterparts and in
contrast to their psychology colleagues within the
deanery (Barham, personal communication by
email 13.01.2006). In parallel, within the world of
child psychotherapy Midgely (2004) highlights a
small but significant change in the research culture
that is beginning to embrace the qualitative
paradigm and notes a small number of published
research articles in this style since 2003. He
attributes this change to a shift within academic
institutions that have begun to support such
methodologies within their clinical awards.
However the credibility of research may continue to
be 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 by
Kim, Ryu, Hwang and Kim (2005) who state that
they recognise the ‘empirical, heuristic and
subjective 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, and
does little to convey their confessed understanding
of a practitioner/researcher. Kim et al propose an
‘expert system’ (p.59) based on a computer
programme of diagnosis that will assist art
psychotherapy research. However it is likely that in
systematically unifying theories they will overlook
and lose the individual detail and variation in
human experience. In contrast qualitative
approaches would highlight such nuances. In the
spirit of Animal Farm (Orwell, 1946) there is a
danger that we will fall into the same trap as the
quadrupeds that chanted ‘four legs good, two legs
bad’ (p.4), asserting the supremacy of one state of
being to the detriment of another. It is in fact not
necessary to prove that one paradigm is superior to
another or even to establish their equality, but rather
to recognise the merits of each approach and their
benefit for certain investigations.
Describing the situation within child psychotherapy
Midgely (2004) uses a vivid description of two
Greek sea monsters, Charybdis and Scylla, who each
lie on either side of a strait, in trying to avoid one
you are sure to become victim to the other. He
draws comparison to opposing standpoints within
the profession and proposes that in the same way
that Jason and the Argonauts managed to navigate
between them, qualitative approaches can offer an
alternative course between ‘the Scylla of large-scale
quantitative research and the Charybdis of the
clinical case study’ (p.92).
By sailing too close to the dominant ideologies
of evidence-based practice and the logic of the
randomized control trial we risk losing what
is most distinctive and most central to the
psychoanalytical approach. Yet if we steer too
far the other way, and insist on maintaining
an exclusive reliance on our traditional
methods of ‘clinical wisdom’, we are at risk.
(p.91)
Whilst it has been demonstrated that qualitative
approaches are emerging, their validity continues to
be a topic of debate and is played out on many
stages. McLeod (2001) suggests that they remain
on the ‘margins of the counselling and
psychotherapy research enterprise’ (p.14). Within
the health sciences Mays and Pope have made a
significant contribution to promoting the merits of
qualitative approaches and their application. In
1995 they published a series of articles to address
the resistance to the acceptance of such
methodologies 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;
 PLAYING IN THE FIELD OF RESEARCH
Pope, Ziebland & Mays, 2000; Meyer 2000). The
proof of the pudding will be in the publishing; the
acceptance of qualitative approaches will be
signified when journals such as the BMJ themselves
print substantial research articles in this modality.
Qualitative and quantitative methodologies are not
mutually exclusive; indeed both approaches could
be married within a study (Pope & Mays, 1995).
Essentially it is important that a methodology is
chosen that is an effective means of eliciting data, it
must also be in harmony with the needs of the
clients/participants involved and congruent with
the focus of the study. Qualitative approaches do
offer certain benefits to arts therapy researchers as
such research design can be both sympathetic to the
underlying philosophy of the creative arts and
therapies and also promote ethical practice.
However to what extent should practitioners
incorporate the ‘framework of artistic experience’
(Grainger, 2001, p.11), that is so important to arts-
based researchers and arts therapists, within the
methodology?
Art-based and arts-based research
Proponents of art-based research1 argue that arts
therapists do not need to look outside of their
profession to find congruous research models since
the discipline itself is intrinsically valid as an
investigative method of enquiry. McNiff (1998),
an advocate of art-based research, describes that
whilst he is sympathetic to the philosophy of
qualitative research, particularly hermeneutic,
phenomenological or heuristic models, he is also
satisfied with the validity of the creative arts as a
research methodology in itself. He cites numerous
examples of therapists, many involved in graduate
studies, who have used their therapeutic medium as
the means of investigation. This viewpoint is also
supported within other non-therapy arts disciplines,
for example Daykin (2004) endorses an arts-based
research2 approach that has a similar philosophy. She
utilises musical expression as a research tool in her
consideration of the impact of insecurity and ill
1 Art-based research is a term adopted by therapy practitioners to describe the use of elements of the creative arts therapy experience
within an inquiry, see McNiff 1998.
2 Arts-based research describes inquiry that utilises a creative medium – but is not necessarily related to therapy.
27
health on music practitioners and concludes that
‘music and music making can offer useful resources
for inquiry’ (p.8).
I would question whether a solely creative arts based
approach would have sufficient credibility to be
useful as a means of investigation. Arts-based
research is a method that would utilise, indeed
maximise the therapist’s skills but there could be a
danger of collusion, by using an investigative tool
that is so closely connected to the topic under
investigation. Would the design offer sufficient
challenge and could the data be considered as
reliable or judged as having any degree of accuracy?
Payne (1993) further suggests that arts based
research would have little credibility outside of the
field. Whilst the randomised control trial may no
longer be the gold standard of research practice,
qualitative methodologies that endeavour to
elucidate the nature of experience still struggle for
recognition alongside the more traditionally
accepted quantitative approaches (Pope & Mays,
1995). This is supported by my own experience of
submitting a qualitative based study to an NHS
research ethics committee. It was reviewed by a
group whose principle expertise was within a
quantitative paradigm, which influenced their
judgement and opinion of my proposal.
Malchiodi (1995) proposes that art therapists’
understanding of the therapeutic process is borne
from their own experience of the ‘powerful and
personally 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
therapeutic space, and how we define these as
artists. The answers to our search will not
come from our clinical expertise alone, but
rather from our knowledge of art and from an
intimate, personal connection to our own
artmaking. (p.156)
28 PLAYING IN THE FIELD OF RESEARCH
It seems important that creative arts therapists
embrace their art form and use their advanced
understanding and expertise to enhance the research
that they conduct.
Therapy as research, research as therapy
Within the field of therapy it is also proposed that
the process of therapy is itself research. Coming
from a Rogerian perspective O’Hara (1986)
suggests that ‘client-centred therapy is, itself, a
heuristic investigation into the nature and meaning
of human experience’ (p.174) in which the therapist
is engaged as a co-researcher. It is true that the
processes and nature of both therapy and qualitative
research share some similarities; for example the
emphasis on self-reflection, the collaborative nature
of inquiry, the rich description and attention to
depth and detail. However does this journey of
discovery offer the appropriate discipline and
scrutiny necessary to be described as research?
Case study as research
The process of therapy is often described by
therapists in case studies which convey the practice
and meaning of therapy; indeed much of the
innovatory work of pioneer psychotherapists in the
early 1900’s, conducted by practitioners such as
Freud, Jung and Klein, was communicated by
publication of work in this format. This is a one
sided depiction; rarely do clients tell their own story
(Sands, 2000). Hitherto play therapy practitioners
in the United Kingdom have largely relied on the
presentation of single cases to underpin their
approach (Cattanach, 1992, 1994, 1999, 2003;
Carroll, 2000, 2001; Jennings, 1999; Ryan
&Wilson, 1998; Wilson, Kendrick & Ryan, 1992).
However in contrast to the predecessors in adult
psychotherapy, contemporary play therapy
practitioners are more reserved in what they publish
and pay due regard to the ethical complexities of
describing interventions with clients as described by
Polden (1998).
McNiff (1998) suggests that it is the rich
description and the element of storytelling within a
case study approach that contributes to its
effectiveness, he regards ‘artistry and the power of its
rhetoric’ (p.162) as key. Conversely it may be
suggested that it is this lack of objectivity and the
editing necessary to create a case study that
transforms it into a work of fiction. Newsom
(1992) disputes the accounts of child clients
proffered by practitioners such as Axline, Klein and
Winnicott by suggesting that they “seemed too neat
and the children too articulate: could the mute
Dibs, after only a short time in therapy, really have
uttered the poetic words ‘I am a builder of cities’?”
(p.89).
Utilising a case study may not be as objective or
reliable as an investigative study may purport to be
since it is not subject to the rigours of a research
process, however it may still have some merit in
illustrating innovative practice. The Royal College
of Psychiatrists (2000) endorse a principle explained
by the Royal College of Physicians (1996) that
understanding may emerge from clinical practice.
The original intention of the work may not be to
formulate research, however the implication is that
the resulting knowledge may be equally significant.
The evolution of research from case study
to formal investigation
Perhaps the focus on narrative case study within
play therapy is consistent with the relative infancy
of the play therapy profession; as the discipline
develops so may the research expertise evolve into
more formalised investigations. Such a progression
seems to be mirrored in the other arts therapy
disciplines that are establishing an increasing
foundation of evidence-based practice. McLeod
(2001) supports this idea based on his observations
of the development of the psychology and
psychotherapy professions and proposes that ‘there
is a necessary relationship between the historical
development of a profession or academic discipline
and the methods of inquiry which it espouses’
(p.11). He describes the early stages as ‘formative’
where the focus is on descriptive research that may
 PLAYING IN THE FIELD OF RESEARCH
rely on case study. This evolves into a second stage
of ‘consolidation and routinisation’ where
innovative practice from the first stage will be tested
to establish reliability. However McLeod cautions
that in the second stage the drive for verification
may lead to the rejection of the value of discovery in
research, which has predominated in the first stage
(2001). Perhaps this explains why quantitative
methods become so dominant and qualitative inves-
tigations become the pariah of the research world.
The practitioner-researcher
However some arts therapy practitioners suggest
that using therapy as inquiry has little relevance in
the research world (Payne 1993) and dismiss the
credibility of research by practitioners who rely
solely on their therapeutic skills, arguing that such
an approach is essentially flawed and does not
recognise that ‘researching is a discipline in itself ’
(Barham, 2003 p.6). Presenting case studies is an
important impetus to research that should not be
undermined; however to undertake subsequent
investigation therapists may not be able to rely on
their existing skills. Proponents of qualitative
research within the health services, Dingwall,
Murphy, Watson, Greatbatch and Parker (1998,
p.167) use a metaphor from an unlikely text to
illustrate that it is not enough to be an experienced
health practitioner, researchers must develop
specialist research specific expertise:
A child does not catch a gold fish in water at
the first trial, however good his eyes may be,
and however clear the water: knowledge and
method are necessary to enable him to take
what is actually before his eyes and under his
hand. So it is with all who fish in a strange
element for the truth which is living and
moving there: the powers of observation must
be trained, and habits of method of arranging
the materials presented to the eye must be
acquired before the student possesses the
requisites for understanding what he
contemplates.
Martineau (1838)
How to Observe Morals and Manners
29
Noticing
In contrast Mason (2002) exhorts professionals to
research their own practice and whilst his primary
focus is on teachers he applies this definition widely
to include people who work in a ‘caring or
supportive capacity’ (p.1). He strives to take some
of the mystique out of research and encourages
practitioners to utilise their current expertise. He
suggests that researchers can begin by being alert to
‘noticing’ and considers that this is a discipline that
is integral to research. Observation is one of the
strengths of arts therapy practice, which is also
inherently 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 challenging
experience; I recognise that I have required specialist
research advice and needed to develop particular
expertise. However, to discover that I had some
transferable skills from my therapy practice, such as
observation, listening, interview technique,
evaluation and self-reflection that could contribute
to the process of research has been a definite
advantage. It is possible that otherwise I may have
felt more deskilled by the process.
The therapist-researcher: advantage or oxymoron?
In the same way that it is possible for creative arts
therapists to employ their specialist media within an
investigation, it is also possible for them to utilise
some of their therapeutic skills, indeed this may
make the research process more accessible to them.
A balance must be established between taking
advantage of the familiar and taking a risk into the
unknown. So the arts therapist may endeavour to
embrace their skills as a practitioner and enhance
their investigation by accepting the challenge of
applying other methodologies. However in
contrast to Mason, Rowan offers a caveat against the
therapist-researcher, implying that it may be an
oxymoron: ‘the lot of the practitioner-researcher is
generally an unhappy one…it is almost impossible
to carry it out’ (1993, p ix).
So the arts therapist may endeavour to embrace
30 PLAYING IN THE FIELD OF RESEARCH
their skills as a practitioner and enhance their
investigation by accepting the challenge of applying
other methodologies. However in contrast to
Mason, Rowan offers a caveat against the therapist-
researcher, implying that it may be an oxymoron:
‘the lot of the practitioner-researcher is generally an
unhappy one…it is almost impossible to carry it
out’ (1993, p ix).
Hybrid approach – triangulation and
crystallisation
Payne (1993) cautions practitioners that ‘a sole
reliance on traditional (research) approaches denies
us access to the richness available in the process and
other phenomena intrinsic to practice’ (p.33).
However she also suggests that therapists must
ensure that they communicate their research in a
way that is understandable, and perhaps acceptable
to colleagues from other disciplines. In practice
there is evidence to suggest that arts therapists
seeking a method to investigate the experience of
their craft will use a hybrid approach that utilises a
conglomerate of different methodologies, which
may include their therapeutic medium (Stromstead,
2001; Barham, 2003; Grainger, 2001). It is
interesting to note that art-based researchers also
seem to use a combined approach to design; the use
of the media is augmented with other methodology.
McNiff (1998) promotes this integrative design as
having currency within the arts therapy professions
suggesting that a ‘pluralistic approach to research
corresponds to the diversity that exists within the
profession’ (p.49).
Stromstead (2001) exemplifies this combined
approach. As an Authentic Movement practitioner
she attempts to illuminate both the process and the
impact of the medium. Her study depends
principally on the organic method, she also utilises
aspects of heuristic practice and relies on using her
therapeutic medium of Authentic Movement itself
to express the data. This amalgamation of method-
ological approaches does incorporate the
therapeutic method as a means of investigation, in
the same way as an art-based approach.
There seems to be strength in the use of a diversity
of approaches that may also contribute to
triangulation, a process that describes how data can
be verified from a variety of sources (Denzin &
Lincoln, 2005; Tindall, 1994). Triangulation is a
technique used in navigation and surveying that
uses the rules of trigonometry to identify a fixed
point from knowledge of two other coordinates.
Richardson (2000) suggests that the concept of
triangulation is too limited for ‘postmodernist
mixed genre texts’ (p.933), and suggests that three
sides need not limit perspective but that this process
is multidimensional. She offers an alternative
illustration of ‘crystallisation’ which recognises that
‘crystals grow, change, alter…are prisms that reflect
externalities and refract within themselves, creating
different colours, patterns and arrays, casting off in
different directions…crystallisation provides us
with a deepened, complex, thoroughly partial,
understanding of the topic’ (p.934). A combined
methodological approach provides a variety of
perspectives from which to both establish data and
view the data. Such verification will not ensure
validity 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 and
Lincoln (2005, p.4) as bricolage, an adaptive
approach to research design. A French word,
bricolage does not have a direct English equivalent.
The common translation of do it yourself does not
adequately summarise the nuances of this
expression; I draw upon the interpretation of
Brandon (2002), McLeod (2000), and Papert
(1994) to translate. Bricolage describes an approach
to construction that is in direct contrast to that of
engineering; it utilises a creative resourcefulness and
inventive spirit, to make the most of whatever
materials are to hand in response to the constantly
changing requirements of the job in hand. Such an
approach within the field of research would allow an
investigation to develop in an organic way and
respond to the process and the findings as they
emerge. Papert (1994) outlines that bricolage may
 PLAYING IN THE FIELD OF RESEARCH
be compatible with an alternative learning style in
which experimentation and playing are key, as
opposed to reliance on analytical thinking. There is
a danger that such resourcefulness may be regarded
as an inability to anticipate eventualities. However
it is not always possible to predict the course of an
investigation and it may be helpful to be free to
respond to the development of the research process.
A bricolage approach may not always be necessary
or warranted; what is important is that such an
approach is beneficial to the study. In effect
bricolage is not ‘making do’ but adopting the most
effective approach for the investigation.
I would also suggest that there may be some
sympathy with the term bricolage to the play
therapy approach itself. A play therapist needs to be
a Jack (or more likely a Jill) of all trades in order to
respond to needs of the client, working with a
variety of media such as clay, paper, paint,
percussion, dressing up clothes. Indeed maybe
bricolage is the play therapist’s specialist craft. In
the nature of being client-centred play therapists are
themselves a bricoleur or bricoleuse, a resourceful
and creative person. In collaboration with a child,
to facilitate expression and communication, they
use play and art materials in new creative ways. It is
perhaps natural that a client-centred practitioner
would naturally conduct research in this bricoleur
fashion, becoming a ‘research-centred’ practitioner,
allowing an investigation to have an organic quality
and freely respond to the demands of the study.
Creating a bespoke methodological design
to investigate what therapists perceive as
change in play therapy practice.
In the light of the preceding discussion I will, in this
final section of the paper, consider the development
of my own investigation into how therapists
perceive change within play therapy. It is important
to acknowledge that this focuses on a singular
perspective and that the findings would need to be
clarified in the light of other research conducted
with child clients, family, and other relevant parties.
The aim of this initial investigation was to build on
31
the limited existing research in the field of play
therapy and the associated arenas of the arts
therapies.
As there is not a custom-made methodology for arts
therapy research, practitioner researchers need to
develop a bespoke research design that reflects the
particular needs of the study and is sympathetic to
the therapy and modality. Since a principle
consideration of this study was to preserve the
process of therapy and investigate the natural course
of therapy without disturbing it, a non-invasive
design was necessary that would rely on the
therapist’s reflection on their practice. For this
reason a qualitative methodology has been adopted
that will elucidate the nature of the experience
rather than attempt to establish a ‘truth’ about the
phenomenon.
Heuristic model
In order to facilitate the self-reflection of the
primary researcher and to engage other therapists as
co-researchers to reflect on their own practice I have
elected to adopt a heuristic methodological
approach. The heuristic model, pioneered by
Moustakas (1990, 1994), is informed by humanistic
philosophy which is compatible with and
sympathetic to the therapeutic process. Indeed
Moustakas’ work has contributed to the
development of play therapy practice (Cattanach,
1992; Moustakas, 1997). This heuristic framework,
which has been used in a number of therapy based
studies (Atkins & Lowenthal, 2004; Fenner, 1996;
Moustakas, 1990; O’Hara, 1986), focuses on ‘a
process of internal search through which one
discovers the nature and meaning of experience and
develops methods and procedures for further
investigation and analysis’ (Moustakas, 1990, p.9).
Therapists are already accustomed to some of the
investigative skills utilised in this approach within
their practice, self- reflection, rapport building and
communication skills for example. The
methodology also harnesses a creative approach that
is familiar to the arts therapist. During the sixth
and final stage of the process, data is subject to a
creative synthesis that attempts to express the
32 PLAYING IN THE FIELD OF RESEARCH
essence of the findings and may take a number of The individual interviews have evolved and
forms such as poetry, sculpture, movement or incorporate a creative element; the interviewee is
music. A heuristic approach can satisfy the drive to invited to draw or describe an image or metaphor
produce credible research and also embrace the that symbolises change by expressing the child client
creativity and sensitivity of the play therapy before therapy and after closure. This has served as
approach, that arts based researchers would be keen a useful introduction to the interview; it uses the
to preserve. play therapist’s craft and allows for the creative
expression of tacit understanding which can be
The research will focus on working with a small difficult to communicate solely using language.
number of therapists, through individual
During the process of supervision it became
interviews, focus groups and diary keeping. Such
apparent that to truly investigate the question from
an investigation will generate data that is rich in
the therapist’s viewpoint it would be helpful to enter
description and that will contribute to the depth of
into the process of play therapy myself and witness
understanding. It will be the role of subsequent
the process from within. This developed into a
research, which may draw upon a quantitative
collaborative inquiry with another practitioner who
paradigm, to investigate the principles elucidated by
documented her process of being my therapist in a
this study and consider the breadth of their
research journal.
application.
To facilitate the process of creative synthesis, which
Anticipating the development of the study
could so easily be heavily influenced by a sole
researcher, a number of other arts professionals,
It was necessary to anticipate the development of
with specialisms in art therapy, music and dance
this investigation in an initial proposal that was
have worked with the raw data from the co-
submitted for funding from the North West
researchers and created their own visual image of the
Research and Development Directorate and for
tacit nature of the play therapy relationship.
registration as PhD research at Manchester
Metropolitan University. In addition the process of
Triangulation and crystallisation
applying for ethical approval from the NHS Central
Office for Research Ethical Committees (COREC)
These evolutionary elements of the investigation
required that the study be clearly described. Such
have further contributed to the process of
delineation could forestall the opportunity for
triangulation that hopefully will serve to strengthen
organic development of the process. However
the final depiction of the data. This maturation of
there is a degree to which the heuristic framework
the research is also indicative of crystallisation; the
itself facilitates flexibility and means that there is
research is growing, changing and altering as it
some capacity for the research to evolve in a living
develops, in the same way as a crystal may evolve
and natural way.
until a balance or equilibrium is reached. The
research process will be subject to further
Acting as a bricoleur
weathering and development. The result will be a
multidimensional investigation that will contribute
I would suggest that I have been able to be a
to the understanding of what therapists perceive as
research-focused practitioner and have drawn upon
change within the play therapy dynamic and which
my creative resourcefulness by acting as a bricoleur
may lead to further research and analysis.
in developing further strands to the investigation in
response to the changing demands of the research.
This has enhanced the original proposal and further Conclusion
contributed to the process of triangulation.
Consistent with a relatively youthful profession play
 PLAYING IN THE FIELD OF RESEARCH
therapy has a limited body of research, which
hitherto has focussed on knowledge gathering from
the presentation of case studies. It is possible to
draw upon the expertise of other researchers,
particularly within the arts therapies, for guidance
when formulating a research investigation.
Customarily quantitative design has been the
approach of choice and qualitative frameworks have
struggled for recognition within arts therapy as in
other professional fields. By exploring the author’s
study, which investigates the nature of change
within play therapy, it has been demonstrated that
there is merit in working within a qualitative
paradigm. A number of principles are encouraged
by qualitative design that are conducive to
sensitively researching the therapy model. Elements
of the play therapy craft itself can be harnessed and
utilised in the design, practice, and analysis of the
research: by using the therapists skills, using arts
media in the data collection, and conducting a
creative synthesis of the findings. Such an approach
has facilitated the researcher to be a bricoleur and to
‘play’ with research in order to find the most
effective means to establish greater understanding
about the therapy model, approaching the question
from a variety of angles to ensure triangulation and
contribute to crystallisation. The author’s research
has adopted a heuristic framework that has allowed
the research to evolve in an organic way in response
to the demands of the research and the emerging
findings, despite the constraints of funding and
ethical approval that provide boundaries to the
investigation.
It is my hope that the conclusions of the study that
I am conducting will usefully contribute to the
research base of play therapy and inspire further
investigation; perhaps bespoke design will become
part of an emerging tradition of research within the
profession.
Acknowledgements
My thanks to Dr Juliet Goldbart, Manchester
Metropolitan University, for her helpful comments
on an earlier draft of this manuscript.
33
Biography and Correspondence
The author is qualified both as a play therapist and
dramatherapist and is registered with the required
professional bodies: the British Association of Play
Therapists (BAPT); the British Association of
Dramatherapists (BADth); and the Health
Professions Council (HPC). This work was carried
out whilst the author was a student on the doctoral
programme at Manchester Metropolitan University,
funded by a research fellowship from the North
West Region National Health Service Research and
Development Directorate, United Kingdom. The
research was supported by her employers: 5
Boroughs National Health Service Trust and
Liverpool Hope University where she is award
director of the Play Therapy training.
Liverpool Hope University,
Hope Park,
Liverpool,
L16 9JD, England
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Bri. J. Play Therapy, Vol. 2 (2006), pp 37-45
37

Play Therapy with Child Survivor of the Tsunami:

A Case Study

Leong Min See

Bureau on Learning Difficulties, Penang, Malaysia

www.seri.com.my/boldpace

Abstract
This presentation aims to provide a case example of how play therapy can provide an effective therapeutic
intervention for trauma experienced by child survivors of natural disasters. It illustrates how play therapy can
assist psychological recovery. It describes the author’s work with a nine-year-old girl who experienced the tsunami
of 2004 and saw her sister swept away. Keywords: Non-directive play therapy, tsunami, trauma.

Introduction goodbye to the deceased. It helps them to

I practise as a play therapist in Penang, Malaysia. I
work in an organisation that aims to provide
appropriate interventions for children with learning
difficulties and children with emotional and
behavioural difficulties. I also work one day a week
in a local hospital as outreach from my organisation.
My principle task is to provide play therapy services
to children aged between three and twelve years of
age who have experience of loss and grief, trauma,
abuse, family breakdown, and chronic illness. After
the tsunami in 2004 the mental health dept of the
local hospital called on those interested to form a
team to provide therapy to families who were
traumatised. I was one of the team members who
worked with the children. From there comes the
article.
Play therapy can help child survivors of a tsunami
by offering a space in which the feelings can be
expressed and contained. It helps children to make
sense of their experience in the tsunami and helps
them learn how to cope with anxiety and stress
related to their experience. Play therapy provides
children with a safe space to accept the loss and say
acknowledge and express their pain, explore their
thoughts and feelings about death and dying while
finding meaning in life and living (British
Association of Play Therapists website).
Norliza was referred for play therapy three weeks
after the tsunami (a pseudonym has been adopted to
safeguard the confidentiality of the child). At the
time of the referral the family consisted of mother
and father, two older sisters, Norliza (9) and a little
sister of four. Norliza had witnessed her six-year-old
sister being swept away by the big wave into the sea
and later found dead. Norliza was very close to this
sister. The child suffered flash backs of the tsunami,
she dared not go to the beach and would cry when
asked to go anywhere near it. She also reported
missing her sister very much. The therapy with
Norliza provides insight into emotions of terror,
rage, denial and unresolved grief. Repeated
memories of the tsunami, remained vivid to the
child in the immediate aftermath of the trauma.
Early intervention was provided to give the child a
series of opportunities to play out her experiences in
an effort to help her gain some understanding of,
and control over the overwhelming and devastating
experience she had endured.
38 CHILD SURVIVOR OF THE TSUNAMI
I conducted one-hour sessions of play therapy with
Norliza on a regular two-weekly basis for a total of
seven sessions. I explained to her at our first meeting
that we would have six sessions when we first met,
and then there would be a review. The sessions were
held in a meeting room at the clinic near where
Norliza lives. I kept a supply of toys in two large
bags. I set up the room before the child arrived. I
displayed the toys on the mat, using drawing papers
to separate each category of toys. The play therapy
approach was child-directed where the child
initiates play, art making or conversation and the
therapist follows her lead (Cattanach, 1992).
Play Therapy Sessions: Themes and Level
of Engagement
From the beginning, Norliza engaged with me
Repeated play of the tsunami
easily; she was interactive and responsive. The main
play medium Norliza chose was human figures,
animals, stones, trees, houses, vehicles, doctor’s kits,
doll house, soft toys, hand puppets and art
materials. Norliza created a routine where she would
start the sessions by playing with toys and ended
with drawing activities.
Expression of the Traumatic Experience
During the first session, Norliza was not prepared to
play out her experience of the tsunami. She explored
the toys and used the blocks to make houses and car
parks, and said everything was fine. I felt that this
reflected Norliza’s initial coping responses in an
unfamiliar environment of the therapeutic play
space and in the presence of an unfamiliar adult.
From the second session onwards, as Norliza
 CHILD SURVIVOR OF THE TSUNAMI 39

became more acquainted with the environment and

with the play therapist, she started to play out her
powerful feelings related to her experience of the
tsunami. During the second and third sessions
Norliza repeatedly played out vivid images of the
big wave sweeping away the houses, hotels, animals,
cars, human beings. She said the big wave came and
swept everything and the people were dead. She
buried the dead people and the dead cats, explaining
her actions verbally while playing with the figures.
The repeated play of the tsunami provided her with
cathartic ventilation of her inner emotional turmoil
through the externalisation and provision of a three Burying the dead
dimensional form for her feelings through the
drawing that disclosed her terror, shock and
physicalisation of play (Jennings, 1999). It is also
frightening experience during the tsunami. Norliza’s
useful to note the symbols of play ritual, “burying
drawings revealed herself, her two younger sisters
the dead”, as an indicator of her psychological need
and other people running away from the big wave
to seek closure.
that was chasing behind them; someone was
climbing up a coconut tree. Those who did not
During the second session Norliza also made a

Drawing of the tsunami

40 CHILD SURVIVOR OF THE TSUNAMI
manage to run away were swept to
the sea. In the drawing, there were
people who were praying hard to
save their lives, and also dead
people. These were vivid and
detailed images. It may be useful
to observe that prayers play an
important part in the child’s
attempt at making sense of
unpredictable events like a natural
disaster. Her religious upbringing
as a Moslem may provide a helpful
framework in eventually accepting
and coming to terms with her
trauma and loss.

Expression of Anger, Pain and

Survival Guilt

Norliza used violent images both Exploded volcanos

in her drawings of a volcano, and
in repeated play of a policeman being thrown and killed as he hit against a stone. The drawing that Norliza
made during the third session showed the explosion of a volcanos in which the girls were burnt to death.
Although Norliza did not express it verbally I felt that the symbols may have represented rage about the loss
and terror that she had experienced (as indicated by the explosion), and also anger towards public authority,
represented by the police, for letting the disaster happen when their normal role was to protect and keep the
children safe.

Another drawing showed a mother and two girls

having a picnic at the beach, and all of them were
dead when the big wave pulled them to the sea. In
fact, Norliza’s mother did not join them in the
picnic; it was the father who brought the children to
the beach. The drawing may reflect Norliza’s
underlying feelings of survival guilt and her wish
that she would have died instead of her sister. I
simply repeated the story line she gave, and reflected
that it was a huge experience for them, when they
were having fun, a picnic on the beach, and the big
wave suddenly appeared and pulled them into the
sea. I empathised with their helplessness, shock and
fear. Norliza listened in silence.

Norliza expressed loss and her pain of losing her

sister through a doll who represented a grandmother Policeman thrown and killed when he
who was very sad after she lost her granddaughter in smashed against a stone
 CHILD SURVIVOR OF THE TSUNAMI 41

the tsunami. I think it was too

painful for Norliza to express her
feelings directly and so she chose the
grandmother figure to speak for her.
Norliza also expressed her wish for
her sister to come alive by pretending
to be a doctor who tried very hard to
treat the girl and manage to save the
girl’s life. Her play at this stage seems
to represent her ambivalent feelings
and the stages of her grief reaction
between accepting the loss and
seeking to recover the lost “object” Mother and two girls having a picnic
(Kinchin & Brown, 2001). She
appeared to be seeking mastery in
fantasy in order to overcome
powerlessness typically felt in trauma.

Acceptance of the Loss

During the third session, Norliza

continued to pretend to be the doctor
who tried very hard to save the lives
of the patients but failed to do so. By
taking the healer role as a doctor
whose patients died, Norliza was
going through a critical point in her
grieving process of accepting the loss
of her sister. She may have been
allowing herself to feel the reality of Sad grandmother (left) who lost her
her own powerlessness. The process grandaughter (lying on sofa) in the tsunami
was astonishingly rapid. It may be
remembered that although there were
only seven sessions in total, these
took place over a period of fourteen
weeks. The additional time that this
afforded Norliza in which to
assimilate the work done may have
been helpful for the process.

Self-protection

From the fourth session onwards

there was a change in Norliza’s play
content and drawings. Norliza no
longer played out repeatedly the
Dying patients
42 CHILD SURVIVOR OF THE TSUNAMI
scene of the tsunami. She played building new
houses and farms for people and animals to live.
There were vehicles, wild and tame animals and the
town looked busy. There were three police to guard
the house. Her play showed that she was going
through a transition period, and her need for
security and protection when incorporating herself
to the safe house. According to Baker, Sedney and
Gross, (1992), one of the psychological tasks for
bereaved children is the need to feel safe and
protected after they have witnessed traumatic death.
Here the police were helpful and supportive
suggesting that
Norliza was beginning
to be able to trust
again.

Withdrawing Energy
from the Past and
Reinvesting in Other
Relationships

From the fourth

session onwards,
Norliza’s play showed
that she was no longer
pre-occupied with
flash backs of the
tsunami. Her play
reflected emerging
New houses and farms themes of hope in her
current life. One of her drawings shows colourful houses in the housing areas with blue clouds and a yellow
shining sun. Another drawing shows a four-storey hotel with flowers, ocean, hillside and a swimming pool.
She said nobody lived in the hotel and nothing happened. This may be a sign of recovery, the ‘rebuilding’
phase after a disaster, awaiting occupation for life to go on (Herman, 1992).

Colourful houses Four-storey hotel

 CHILD SURVIVOR OF THE TSUNAMI 43

During the time when Penang was alerted to Dengue Fever, in February 2005, Norliza pretended to be the
doctor treating the patients with Dengue fever. She also drew a poster to alert people to the importance of
keeping the environment clean in order to get rid of the dengue mosquitoes. This is parallel to the child’s
pre-occupation with the thematic issue of protecting and guarding oneself against ‘natural disaster’, which
can be
unpredictable
and dangerous.
The drawings
that Norliza
made during
the sixth session
represents her
current family
re l a t i o n s h i p s
without her
deceased sister.
This suggests
that Norliza
was at the
fourth stage of
grief process,
able to re-
engage with
people around
her and
renegotiate her
c l o s e Poster: ‘Keep the Environment Clean’
re l a t i o n s h i p s
with her other sisters (Baker, Sedney & Gross, Norliza has depicted herself in black although the
1992). In the drawing with her two older sisters sisters are colourful. Perhaps the lack of colour in

Norliza & her youngest sister Norliza’s parents and the youngest sister
44 CHILD SURVIVOR OF THE TSUNAMI
comparison to her
older sisters may
represent Norliza’s
sense of loss of
her special
companion, while
her sisters still
have each other.1

In the last session,

Norliza played
building houses
and nurturing the
girl. She also
made a drawing
of the zoo,
perhaps a fun
activity that she
had enjoyed in
the past and
expected to enjoy
Norliza and her two older sisters
again.

Afterwards

During the review session,

Norliza’s mother revealed
that Norliza was no longer
suffering flash backs of
tsunami. A follow-up
phone conversation with
Norliza’s mother six
months later showed that
Norliza was adapting well
to her life without her
sister. According to the
mother Norliza showed no
signs of worry or anxiety
when she heard the news of
the Indian earthquake. It is
worth noting that Norliza
Nurturing the girl comes from a large family:
I think that she had formed a close relationship with all of her sisters and therefore derived a strong sense of
security from this support. It is common for older sisters to look after the younger ones in her culture and

1Although the lack of obvious hands in this picture may suggest helplessness, I feel that it probably signifies the long sleeves worn by
Moslem females to cover their arms.
 CHILD SURVIVOR OF THE TSUNAMI 45

the involvement of extended family is usually active, The Efficacy of Play Therapy With Children: A
so probably she has been able to gain a sense of Meta-Analytic Review of Treatment Outcomes.
security not only from her parents and sisters but Professional Psychology: Research and Practice, 36 (4),
from the closely-knit extended family as well. pp376-390.

Conclusion
British Association of Play Therapists, Internet
The play therapy provided Norliza a space to www page at URL: http://www.bapt.uk.com
express and contain her traumatic experience, to (accessed 04/11/06).
accept the loss and say goodbye to her beloved sister.
She showed repetitive play typical of trauma victims
during three of the sessions. She was given the Cattanach, A. (1992). Play Therapy with Abused
opportunity to acknowledge and express her pain, Children. Jessica Kingsley.
explore her thoughts and feelings about death and
dying while finding meaning in life and living. It
Eth, S. and Pynoos, R. S. (1985). Post-Traumatic
seems likely that her experience of close family
Stress Disorder in Children. American Psychiatric
relationships and community helped her to feel safe
Press.
enough to explore and resolve her trauma in a
relatively short time (although the normal grieving
process would clearly be expected to take its
Herman, J. L. (1992). Trauma and Recovery.
course). Bratton, Ray, Rhine & Jones (2005)
Pandora.
suggest that a small number of sessions could be
effective for children in crisis situations. This may
Jennings, S (1999). Introduction to Developmental
apply where there is likely to be a pre-existing
Play Therapy. London: Jessica Kingsley Publishers.
baseline of security.
Joseph, S., Williams, R. and Yule, W. (1997).
Correspondence Understanding Post-Traumatic Stress. Wiley.

Min See Leong Kinchin, D. and Brown, E. (2001). Supporting

Bureau on Learning Difficulties Children with Post-traumatic Stress Disorder. David
Penang Fulton Publishers.
Malaysia
Shelby, Janine S. (2000). ‘Brief Therapy with
minsee@gmail.com
Traumatized Children: A Developmental
boldpace@yahoo.com
Perspective’. In Kaduson, Heidi Gerard & Schaefer,
Charles E. (Eds.), Short-Term Play Therapy for
References and Further Reading Children. New York & London: The Guilford Press.

Baker, J., Sedney, M. and Gross, E. (1992). Webb, N. B. (1991). Play Therapy with Children in
Psychological Tasks for Bereaved Children. Crisis. New York & London: The Guilford Press.
American Journal of Orthopsychiatry. 62 (1), 105 –
115.

Bratton, S., Ray, D., Rhine, T. & Jones, L. (2005).

Bri. J. Play Therapy, Vol. 2 (2006,) pp 46-54
46

The Ethics of Researching Children in

Non-Directive Play Therapy

Angie Naylor
School of Education
Liverpool John Moores University

Abstract
This paper brings together various theoretical standpoints to highlight the key issues in research with children
engaged in therapy and the complexities this can involve. Children’s rights, power dynamics and their impact on
the research process can be understood within discourses of childhood. Trust between the child and
therapist/researcher is a further dynamic as well as issues of informed consent, gatekeepers, confidentiality and
the possible impact on the intervention. Whilst research into the process of Non-directive Play Therapy is
important, this needs to be understood and acknowledged within a multi-faceted child-centred framework.
Keywords: Non-directive play therapy, ethics, children.

Introduction NDPT. This potentially vulnerable client group

There is a growing need for the ethics of researching
children in non-directive play therapy (NDPT) to
be further explored and debated. This paper draws
attention to the particular considerations that need
to be highlighted when conducting research that
involves children engaged in non-directive play
therapy. It seeks to encourage debate and further
consideration of these key issues.
Background
Ethical concerns are of paramount importance
when conducting research with children and even
more so when therapy is in process. Thus method-
ological concerns centre on the area of ethics and
practice when conducting research with children in
this setting. Ethical issues are a key consideration in
research with children and in particular in research
with abused or neglected children taking part in
must be given particular consideration when
seeking to ‘research’ their experiences.
More specifically, there is clearly a need to define
ethical guidelines in research into play therapy. The
British Association of Play Therapists (BAPT)
Ethical Basis for Good Practice in Play Therapy
(2002) states that research must be approved by an
appropriate Ethics Committee prior to the research
commencing and that this ethical approval will be
from the institution in which the research will be
conducted. The lack of research into the area of play
therapy in the UK may be due to the limited
guidelines and clear access routes to the children for
the keen researcher. Additionally, many play therapy
studies give very little attention to reflecting on
ethical concerns and what we can learn from them.
For example Wilson & Ryan (2002) reflect little on
the methodology or analysis employed and thus the
ethical considerations are not highlighted.
 THE ETHICS OF RESEARCHING CHILDREN
Various professional bodies have issued ethical
guidelines for research involving children. The
British Medical Association (BMA) states that 15
professional bodies include reference to children’s
consent to research (BMA, 2001). The British
Paediatric Association (renamed the Royal College
of Paediatrics and Child Health (RCPCH)
published specific guidance on the conduct of
medical research with children in 1992 and was
revised by RCPCH in 2000. As Neill (2005)
highlights, the guidelines are very medically based,
focusing on research on children rather than with
them and importantly for NDPT, not considering
qualitative research, which usually involves small
samples. There is a clear emphasis on physical risks
rather than potential psychological harm.
Fig 1: Six principles for research involving children
(RCPCH Ethics Advisory Committee, 2000)
1. Research involving children is important to
benefit all children and should be conducted in an
ethical manner.
2. Children are not small adults; they have an
additional, unique set of interests.
3. Research on children should only be done if
comparable research cannot be done on adults.
4. Research not of direct benefit to the child is not
necessarily unethical or illegal.
5. All proposals involving medical research on
children should be referred to a research ethics
committee.
6. Legally valid consent should be obtained from
the child, parent or guardian as appropriate.
Parental consent for school children should also
have the child’s agreement.
The potential impact of the research process on the
child at the time of data collection and after is
addressed by The National Children’s Bureau
(NCB) Guidelines for Research (2003). The NCB
has subscribed to the British Sociological
Association Statement of Ethical Practice and added
material specific to research with children around
informed consent; child protection and confiden-
tiality; monitoring the impact on the child; and
payment to participants. In addition, Alderson
47
(1995) in Listening to Children provides an excellent
consideration of issues surrounding participatory
research with children, as do Save the Children
(Neill, 2005).
Ethical considerations though can often make
research with children, essentially in a clinical
setting, difficult. Issues of confidentiality,
anonymity and protection from harm can make it
difficult for researchers who are outside of the
playroom and play therapy process. However, a
process that is essentially non-directive and free
from therapist intervention may find it difficult to
justify ‘intrusive’ research, i.e. in the form of
administering scales or measurements within the
playroom setting.
Clearly, the way that a research project is planned
should prioritise the needs of the child client.
However, this in itself can cause complications. As
Daniel-McKeigue (2004) argues, there is the danger
that a study that was designed to be sensitive to all
the issues may not significantly add to the body of
knowledge, and the lack of research in this area
reflects the complexity of this issue. Alternatively
the therapeutic method may be over-analysed to the
extent that the natural process is ignored or missed.
Research & Children’s Rights
Clearly, the current thinking around children can
have a huge impact on our practice of research. As
Neill (2005) argues, traditionally research involving
children has been on rather than with them.
However, the last two decades have seen a shift in
thoughts concerning children in research, and
children have begun to be involved as participants
in their own right. Such changes concerning the
recognition that children have a valuable
contribution to make and have rights may be partly
attributed to the United Nations (UN) Assembly
adopting the Convention on the Rights of the Child
in 1989. This has impacted on current thinking
around research and children in several ways.
Children’s participation and autonomy rights were
given more emphasis alongside protection and
nurturance rights. The UNCRC (1989) emphasise
48 THE ETHICS OF RESEARCHING CHILDREN
that children have the right to freedom of speech
and opinion, to be consulted and taken account of
and to challenge decisions made on their behalf
(Lowden, 2002). The concept of the child at the
centre of the research process is one that is
supported by the Children Act 1989 and the
UNCRC (1989). Such legislative measures
encourage children’s voices to be heard and their
opinions sought on matters that affect them.
The UNCRC (1989) considers two fundamental
challenges to traditional practices in respect of
children. Firstly, the means by which the best
interests of the child are assessed must primarily
demonstrate consideration for the extent to which
all of their human rights are respected. Secondly,
children must have the opportunity to be heard and
listening to children through research can be argued
to be an essential element in ensuring their
protection. However, the welfare model of childcare
may have perpetuated the view that children lack
the capacity to contribute to their own well-being,
not having a valid contribution to make.
Additionally, Morrow (1999) argues that in UK
social policy research, relatively few studies have
been based on children’s accounts of their
experiences.
There has been a huge shift towards acknowledging
children as social actors with views and under-
standings that adults might learn from them driven
by pressure on individuals and agencies to ‘consult
children’ or ‘listen to children’ for research and
policy initiatives. However, it should be noted that
whilst this is a positive move, involving children in
research or consultation may have unanticipated
consequences and may not always lead to the
expected outcome for children involved in the
process (Cree, Kay & Tisdall, 2002). Caution
perhaps needs to be noted when trying to involve
children in research as although including their
views will undoubtedly strengthen the research,
participation in research may not always be in the
child’s best interests. How children are actually
listened to, the approach used to involve children in
research and the ways in which the subsequent
results are interpreted needs serious consideration.
For example, Carroll (2000) reports methodological
challenges in attempting to include children’s
opinions about the play therapy experience.
Advocacy for children seems to have only seriously
begun since the implementation of the Children
Act 1989. It can be argued that this gives the child
a voice and to provide representation. The role of
the advocate, as of the play therapist, is to express
the voice of the child, both to the child and to those
who have the responsibility of making decisions for
the child. The underlying reasons for working with
a child, whether it is to assess, enable the child to
express a view, provide therapy or a mixture of these
should be transparent in this process (Colton,
Sanders & Williams, 2001). Perhaps, part of the
difficulty in finding appropriate ways of including
children in the research process is that in the UK as
in many other countries, we do not have a culture of
listening to children and the consequence of this
means we are not used to talking to children to try
to ascertain their views and opinions. The challenge
for social research may be to find suitable routes for
sourcing children’s opinions and experiences and
developing appropriate methods and strategies to
deal with ethical dilemmas that may arise (Morrow
& Richards, 1996).
Morrow (1999) states that as well as the usual
ethical guidelines, there are four key considerations
in research with children. Firstly, children’s
competencies, perceptions and frames of reference
may be different at different ages, having
implications for the consent process, data collection
methods and interpretations. Adult responsibilities
to children must be considered because children can
be vulnerable to exploitation in interactions with
adults. Awareness of the differences in power
between the adult researcher and child participant
must be considered and could become problematic
at the point of interpretation and presentation of
research findings. In addition, access to children has
to be mediated via adult gate-keepers, and this has
implications for the consent process.
 THE ETHICS OF RESEARCHING CHILDREN
Power Issues in the Research Process
Research with children will undoubtedly raise
methodological and ethical issues. Not only is the
balance of power a sensitive issue within NDPT but
also in any research carried out with children. There
is clearly the potential for the adult researcher to
influence the process at every stage of data
collection and interpretation. The differences in
power and status between adults and children
certainly present an ethical challenge.
Although the view of childhood has shifted, society
does seem to continue to view children as
vulnerable, incompetent and in need of protection.
Children can be viewed as inherently vulnerable
because of their physical weakness, and their lack of
knowledge and experience, which renders them
dependent upon the adults around them and
structurally vulnerable because of their total lack of
political and economic power and their lack of civil
rights deriving from historical attitudes and
presumptions about the nature of childhood
(Lansdown, 1994).
Certainly, research with children in the UK has
tended to be dominated by concerns about groups
of children who are vulnerable in some way
(perhaps for funding and social policy reasons). This
has undoubtedly contributed to the dominant
conceptualisation of children as weak, passive and
open to abuse (Morrow & Richards, 1996).
Children’s assumed lack of competence means that
their ability to make decisions about whether to
participate in research and therefore competence to
provide valid sociological data is questioned.
Morrow & Richards argue that mainstream
developmental psychology often perceives children
to be less competent than adults, and can impose
methods and interpretation on data collected from
children which may be quite out of line with what
the children meant; rarely do researchers return to
their research participants to confirm.
The concept of the ‘vulnerability’ of children within
the research process has an impact on discussions of
ethical dilemmas in play therapy research. There is
49
often seen to be a need for protection for children
from exploitative researchers, and as the objects
rather than the participants of research. Morrow &
Richards argue that we need to move away from
such epistemological assumptions about what
children are, based on a specific formulation of the
category ‘child’, if we are to attempt a social analysis
of children’s experiences, and hence see children as
social actors in their own right. Certainly, an overly
protective stance towards children could actually
reduce children’s potential to participate in research.
Research with children can present a powerful
tension between two sometimes conflicting social
goals; that is protecting individual children from
harm and exploitation, while at the same time
increasing our body of knowledge about children in
order to develop beneficial interventions such as
play therapy. However by ‘protecting’ children from
any involvement in research we commit ourselves to
ignorance about children’s views and important
aspects of their experiences of NDPT. Thus the
methods employed, the research populations and
participants, as well as the interpretation of the data
collected, are all influenced by the view of children
that we take.
Children receiving therapy are rendered to some
extent vulnerable due to their experiences and this
will consequently raise ethical questions in the
research process. These may not be adequately
addressed. The key aim in such research must be to
ensure that the research process in no way exposes
the child to any further ‘damage’ or abuse. Ethical
guidelines that avoid undue intrusion, and methods
that are non-invasive and non-confrontational
might help to lessen the ethical problems of
imbalanced power relationships between researchers
and researched at the point of data collection and
interpretation
Trust
The distinctive ethical dimension of NDPT
practice is the trust placed by child clients in
practitioners. This trust is not only essential to
achieving therapeutic goals for the client but also for
the practitioner to establish the quality of
50 THE ETHICS OF RESEARCHING CHILDREN
relationship and interaction that makes the work
possible. Ethical researchers need to take account of
the quality of trust required to make play therapy
possible and also seek the highest possible levels of
trustworthiness and integrity for themselves with
regard to the relationship with the people being
researched and all other people involved directly in
the research.
Perhaps then the person best placed to carry out
research with children in therapy is the therapist
him or herself. However, even this can be
problematic, as the therapist may already sense a
need to try to compensate for a power imbalance.
This could be made more difficult by introducing a
research dynamic that involves the child without
then compromising the relationship. Many children
referred for play therapy have a history of neglect,
abuse or trauma; that is to say they have experienced
abusive relationships with adults in the past. It is
essential that the therapy does not repeat these
dynamics but works to empower the child and
demonstrate the capacity to form positive
productive relationships. If the therapist is working
to nurture a child within therapy then it may seem
to be represent a conflict of interests to introduce a
dynamic which is not strictly of benefit to the
individual. However if the aim of the research is to
study a phenomenon with a view to finding out
more about current practice as a means of
informing future practice, then this may primarily
benefit subsequent clients rather than the individual
client who is participating in the research.
Furthermore the research could also be construed as
being of benefit to the therapist, developing their
skills, knowledge, career etc. Since therapy should
prioritise the client’s needs, Daniel-McKeigue
(2004) proposes that research conducted whilst
therapy is in progress is likely to represent a conflict
of interests and may repeat the pattern of imbalance
of power in relationships that the child has
previously experienced.
Informed Consent
General discussions around research ethics are often
centred around two key preoccupations: informed
consent and protection of research respondents. In
the UK, consent is usually taken to mean consent
from parents or guardians and it could be argued in
this respect children are to a large extent seen as
their parents’ property, devoid of the right to say no
to research. In practice, researchers usually obtain
consent from a wide range of adult gatekeepers
(parents, school teachers, head-teachers, school
governors, local education authority officers and so
on in the case of school-based research) before they
are allowed anywhere near the children, and may
feel unwilling to jeopardise their research project by
asking the children explicitly for their ‘informed
consent’ (Morrow, 1999).
Informed consent is a difficult issue for the play
therapy researcher, who is faced with two essential
considerations: firstly how to go about obtaining it;
and secondly how to ensure that the consent really
is ‘informed’. Participants in research projects
should of course be fully informed and provide
consent to their involvement. All research
participants, including children, have the right to
have explained to them, in language appropriate to
their level of understanding, all aspects of the
research that may affect their willingness to
participate. Children and the adults responsible for
them, have the right to discontinue participation in
the research at any time. It is worth considering that
children may also be deprived of the right to
consent by a gatekeeper wishing to protect the
child’s or their own interests.
In relation to informed consent in research, the
BAPT Ethical Basis for Good Practice in Play
Therapy (2002) states that play therapists do not
put pressure or coerce clients to participate in
research. When the research involves participants,
the researcher must obtain the informed consent of
the participant, or if legally incapable, the person
holding legal responsibility for the participant.
Guidance is given as to how ‘informed consent’ can
be interpreted. This includes that the person has:
• the capacity to make a voluntary choice;
• an understanding of the research aims,
objectives, methods and procedures;
 THE ETHICS OF RESEARCHING CHILDREN
• been able to ask questions and receive answers
regarding the research;
• given their voluntary and continuing
permission for their involvement.
The NCB poses several questions for researchers,
with the understanding that the child gives the
consent rather than their parent or guardian:
Fig 2: Questions for researchers obtaining
informed consent from children (NCB in Neill,
2005)
• Have children been told about the research in a
way that they can understand?
• Are the children clear that they can agree or
refuse to take part – without any adverse
consequences?
• Is the child clear that he or she can withdraw at
any time?
• Has the researcher agreed a signal with the child
to enable them to do so easily?
• Have the researchers considered how very
young children, children with learning disabilities,
or children with communication problems are to
be informed and their consent gained?
• If the research is to take place in schools, how
does the researcher ensure that each individual child
has given their informed consent to participate?
The most appropriate way to research NDPT may
well be whilst the therapy is in progress. However
requesting informed consent from a minor
depending on their age is likely to involve the parent
or guardian. Determining who is competent to give
consent, and implications following from this, is
one of many of the issues that would be crucial to
resolve when dealing with the matter of researching
children in therapy. A further dilemma is gaining
‘informed consent’ in the context of a therapeutic
approach that relies on play as the primary means of
communication. Methods of consent through the
process of play may not be deemed as appropriate
and fulfil the criteria on consent forms issued by
ethical committees.
There has been extensive discussion in the research
51
literature about consent and children. Alderson’s
(1995) Ethical Guidelines suggest that children and
young people must agree to take part in a research
study and this agreement should be open for review
before and during the interview itself. The consent
should be free from pressure or undue persuasion on
a child or young person to take part, especially when
this person is in a position of power over that child
or young person (Masson, 2004). Additionally
some children may give consent in order to ‘please’
their therapist; researchers need to be aware of this
potential dynamic. Children and young people
should be able to give informed consent by knowing
and understanding the purpose of the research.
However, in practice it can be difficult to negotiate
such principles. Cree, Kay & Tisdall (2002) argue
that without the active support of adults who have
responsibility for children and young people (that
is, their parents, carers and child care workers) they
would have had no research study. Parents are more
likely to consent to the child’s participation in the
project when the researcher has been introduced by
a trusted professional (social worker or child care
worker). Likewise, children are more likely to agree
if both their social worker/childcare worker and
parents seem supportive of the research. Therefore
trust in one individual or agency is passed onto the
researcher resulting in a kind of ‘sponsorship’. This
then makes it impossible to be certain that all
children and young people have made their own
‘freely given’ decision to participate. Such practical
realities are not unique to research with children. As
Lindsay (2000) comments research is always an
‘intrusion’ as people who consent to be research
participants rarely have a full understanding of what
they are letting themselves in for.
Gatekeepers
When considering the more practical aspects of
carrying out research with children in play therapy,
gatekeepers to the research data collection are
perhaps necessary for the child’s ‘protection’ but can
make access to research participants difficult for the
potential researcher. The NCB (2003) recognises
the need for children themselves to give consent to
52 THE ETHICS OF RESEARCHING CHILDREN
participate but recognises that often it is necessary
to seek permission from the child in order to
approach the parents. As a researcher outside of the
therapy process, access to the appropriate client
group can be difficult, as Carroll (2002) found
when seeking to gather children’s views on play
therapy for her study. She maintains that actually
collecting the sample was a technical challenge due
to the issue of gatekeepers even though the children
had been identified via play therapists, and were
contacted via training courses and the British
Association of Play Therapists.
The extent to which the children presented in the
study are representative of the wider population can
present an ethical challenge. Often researchers may
have to rely on the various gatekeepers’ decisions to
carry out the research, which in turn influences the
research participants that can be included in the
study. For example in Carroll’s (2002) play therapy
research, she indicates that the children included are
not a representative sample and therefore she cannot
know if another group of children would feel the
same. It is often not possible to say that because
certain elements changed in the children under
study, that these would be the same for other
children attending play therapy, although there may
be common elements. It could be expected that
therapists (gatekeepers) would select children whose
therapy was deemed successful.
There can be routine reasons for access difficulties,
which are likely to be experienced by all those
conducting research with children. Researchers can
only usually get access to children via the
cooperation of a number of different ‘gatekeepers’.
Some professional ‘gatekeepers’ see the merits of
such research and make it their concern but others
may not be so willing to do this. Scepticism about
the usefulness of the study, pressure in jobs and
feeling unable to take on yet another external
demand can all be detractors.
Confidentiality
The codes of ethics and guidelines for good practice
provide a good starting point (Cree, Kay & Tisdall,
2002). However, they can never be more than this
because ambiguities and complexities will always
remain. Issues such as informed consent, power and
confidentiality are central to any research, but
become all the more complex in research with
children, particularly in such a sensitive area as
NDPT. Indeed, the questions of access and consent
are both fundamentally tied up in the wider issue of
confidentiality. In most ethical research guidelines,
confidentiality implies giving attention to
anonymity in research reports, and making it clear
when a researcher may need to pass on information
to others (such as if a child discloses that they are
being abused or are abusing someone else).
The NCB (2003) makes it clear in the context of
research there must be limits to any guarantee of
confidentiality or anonymity in the case of child
protection:
“Where a child or young person divulges that
they or others are at risk of significant harm,
or where the researcher observes or receives
evidence of incidents likely to cause serious
harm, the researcher has a duty to take steps to
protect the chid and other children.”
(NCB, 2003: 3)
Children and young people should be told at the
onset of the research that if such information is
shared, confidentiality cannot be guaranteed. This
type of initial boundary setting will undoubtedly
impact on trust and honesty within the researcher-
client relationship.
Impact on Intervention
The final ethical consideration is how to collect data
and conduct research into the therapeutic process
without influencing that process in some way.
Research into non-directive play therapy raises the
issue of the impact on the therapy itself of such an
intervention. As Daniel-McKeigue (2004) notes
one of the major issues that children explore in
therapy is self-esteem. The idea is that the therapist
should be engaged as a neutral facilitator of the
child (someone who is not involved in the child’s
 THE ETHICS OF RESEARCHING CHILDREN
life). However, by requesting consent to research the
therapy, the therapist’s own needs are then
introduced and this could affect the relationship.
Some children have learned from experience to
please or pacify adults regardless of their own needs;
the therapy process should help to redress the
balance. However, this balance would undoubtedly
be affected by the therapist’s introduction of a
request for consent. Whether the child actually has
the capability to refuse the request of an adult is an
issue.
Summary
The numerous complexities and challenges in
involving children in research, particularly those
engaged in the sensitive process of non-directive
play therapy have been highlighted. As discussed the
therapeutic relationship is based on a foundation of
trust and the integrity of the therapeutic
relationship must be placed before any research.
Introducing a study may challenge the confiden-
tiality boundary (usually only broken if the child is
deemed to be ‘at risk’). To what degree this would
influence the course of therapy and affect the child’s
willingness to share their concerns or to participate
fully in the sessions may be difficult to predict.
Clearly though children should be involved in
research and have the right to have their voices
heard. It would be difficult to research the play
therapy process fully without including the child
client’s experiences or views. There are major
challenges involved in this aim though. The various
ethical challenges such as gaining access to
appropriate populations and gatekeepers can form
challenges in themselves. However, it could be
agued that in terms of collecting valid and reliable
data within non-directive play therapy, the primary
concern of the researcher is the impact on the
process itself and hence the subsequent data
collection. It is therefore necessary to source of a
way of collecting data on the NDPT process with
the minimum disruption to the therapy itself. In
this way, the delicate process of NDPT may be one
step further towards being better understood.
53
Biography and Correspondence
Angie Naylor is a Senior Lecturer at Liverpool John
Moores University, where she is Route Leader for
the Early Years Education Degree Course. As a
Psychologist and after working as a
therapist/counsellor in the voluntary sector, Angie’s
research interests center on the concept of change in
child therapy and child psychology as a whole. She
has researched the area of Non-Directive Play
Therapy for several years and is soon to defend her
Doctorate in the subject. She has published in
national journals and acted as guest speaker in Play
Therapy Conferences.
Angie Naylor
School of Education,
Liverpool John Moores University,
Barkhill Building, Barkhill Road,
Liverpool L17 6BD.
Email: A.Naylor@ljmu.ac.uk
References
Alderson, P. (1995). Listening to Children: Children,
Ethics and Social Research. London: Barnardos.
British Association of Play Therapists (2nd edition,
August 2006). An Ethical Basis for Good Practice in
Play Therapy. BAPT
British Medical Association (2001). Consent, Rights
and Choices in Health Care for Children and Young
People. London: BMJ Books.
Carroll, J. (2002). Play therapy: the children’s views.
Child and Family Social Work, 2002, 7, 177-187.
Colton, M., Sanders, R. & Williams, M. (2001).
An Introduction to Working with Children. A Guide
for Social Workers. London: Palgrave.
Cree, V.E., Kay, H. & Tisdall, K. (2002). Research
with Children: sharing the dilemmas. Child and
Family Social Work, 7, 47-56.
54 NON-DIRECTIVE PLAY THERAPY
Daniel-McKeigue, C. (2004). Transforming 117-82.
Therapy into Research. Is it possible to conduct
research that investigates the process of play therapy United Nations (1989). Convention on the Rights
without affecting the delicate balance of the of the Child. UNICEF, URL (consulted on 28
relationship between the child and therapist, which October 2004): http://www.unicef.org
is central to the therapy? British Journal of Play
Therapy, 1(1), May 2004. Wilson, K. and Ryan, V. (2002) Play therapy with
emotionally damaged adolescents. Emotional and
Lansdown, G. (1994). Children’s rights. In B. Behavioural Difficulties, 7(3), 178-192.
Mayall (Ed.), Children’s Childhoods Observed and
Experienced, (pp 1-12). London: The Falmer Press.

Lindsay, G. (2000). Researching children’s

perspectives: ethical issues. In A. Lewis & G.
Lindsay (Eds) Researching Children’s Perspectives.
Buckingham: Open University Press.

Lowden, J. (2002). Children’s rights: a decade of

dispute. Journal of Advanced Nursing, 37(1), 100-
107

Masson, J. (2004). The Legal Context. In S. Fraser

et al. (Eds) Doing Research with Children and Young
People, pp.43-58. London: Sage/Open University.

Morrow, V. (1999). “It’s Cool …Cos You Can’t Give

Us Detention and Things, Can You?!”: Reflections
on Research with Children. In P. Milner and B.
Carolin (Eds) Time to Listen to Children: Personal
and Professional Communication, 203-15. London:
Routledge.

Morrow, V. & Richards, M. (1996) The ethics of

social research with children: an overview. Children
and Society, 10, 90-105.

National Children’s Bureau (2003). Guidelines for

Research. National Children’s Bureau, London.

Neill, S.J. (2005). Research with children: a critical

review of the guidelines. Journal of Child Health
Care, 9(1), 46-58

Royal College of Paediatrics and Child Health

Ethics Advisory Committee (2000). Guidelines for
the Ethical conduct of Medical Research Involving
Children. Archives of Disease in Childhood, 82(2):
Bri. J. Play Therapy, Vol. 2 (2006), pp 55-62
55

THE FIVE STORY SELF STRUCTURE

A new therapeutic method on the Communicube

John Casson Ph.D.

Dramatherapist (HPC reg),
Psychodrama Psychotherapist (UKCP reg),
Supervisor, Senior Trainer.

Abstract
This paper introduces the concept of the Communicube and the Communiwell, two structures that have been
developed as communication tools for the 21st century. It presents a therapeutic method of using these tools, the
Five Story Self Structure. Information is provided on the origin, design and theory. In order to demonstrate the
flexibility of the tool brief examples of practice with adults are given followed by more detailed accounts of work
conducted by dramatherapists with school age children in Britain and France. Keywords: Communication, play,
levels, self, structure, miniature, patterns, story, container, assessment, therapy, education, distance, fun.

Introduction The Communicube

During doctoral research (1996-2002) into The Communicube is a transparent, open, five level
dramatherapy and psychodrama as psychothera- structure. Light reflects off the shelves, which are
peutic interventions with people who hear voices each printed with a grid of twenty-five squares.
(auditory hallucinations) I invented the Five Story These grids float within the structure like a series of
Self Structure; I was looking for a safe way of transparent chessboards, one above the other. When
working with people who may be overwhelmed by objects such as buttons, stones or other small objects
complex experience. It soon became clear that it was are placed in the grid squares they may be reflected
useful to other clients, including children and by the other shelves, the images on one level faintly
young people who were not struggling with mirrored in another; colours glitter; shadows fall
psychosis or voices. Over the following six years this through the structure; a floating world holds within
way of working has developed and is now being it the tension of opposite polarities and related
used by therapists of different orientations. The objects, whether close or distant, echoing the larger
Communicube is a communication tool; the Five cosmos.
Story Self Structure is one method of using this tool.
The decision to use five levels was deliberate: there
is a top, bottom, middle and two intermediate
levels. It is important that there is a central level
with a central square through which all diagonals
pass: this is psychologically integrating. Five is also
archetypal: I write further about this in the users’
manual (Casson, 2005), which comes with the
structure. The pun on story/storey is also deliberate:
the structure evokes different stories on different
storeys.
Illustration: The Communicube
55
56 THE FIVE STORY SELF STRUCTURE
Beginning with buttons
The Communicube was invented during research: I
was looking for safe ways to enable adults who hear
voices to represent and work with their voices. I
chose to work in miniature, as I thought this would
put clients in control who often feel powerless in
relation to persecutory hallucinations. In button
sculpting, a method designed to encourage
projective play, clients arrange buttons in symbolic
patterns. Materials required are as follows: a piece of
paper, (it is useful to offer the client a choice of
different colours as the colour chosen for the
ground may well have meaning); a collection of
buttons of all shapes, sizes and colours; and some
blutak (this may be used to hold objects on their
side or on top of each other). Other objects may also
be provided, such as coins, buckles, keys, small light
bulb (of the kind used in a torch), a bit of chain, a
shell, a hook, a small feather, a diamante brooch,
stones and other small found items (it is useful to
include both attractive and unappealing attributes).
Whilst little animals, figures and miniature
symbolic objects can be useful it is perhaps
preferable to use abstract objects as these can
represent anything the client wishes: for example,
“This pearl button represents the moon,” or “This
orange button is my brother.” To provide sufficient
variety there should be at least 200 buttons/objects
of all shapes, colours and sizes to choose from.
I tend to introduce the use of buttons in the
following way. I ask the client to choose a piece of
coloured paper (the colour chosen is often
significant for the individual). The paper forms a
stage-space with a boundary, onto which the client
places at least seven buttons chosen from the
collection. I ask the client to choose seven because it
provides sufficient initial variety - more may be
added later if needed. I make no comment on this
first occasion regarding the choice, as I prefer to
trust the unconscious process. I simply invite the
person to make a pattern with the selection. Pattern
recognition is an activity of the right brain (Casson,
1998) and we are thus bypassing left-brain
dominance and working non-verbally at this point.
Once the client has created a pattern I invite
him/her to look at it and decide whether to add or
change anything, or leave it as it is. The client often
has a feeling that the pattern is “just right” when
this activity is completed.
I then invite the client to tell me about the pattern.
This might lead to story making, or significant
meaning may spontaneously emerge. The pattern
may well be an image of the self. Anton, a
psychiatric patient, chose different buttons to
represent various aspects of himself, the roles he
played and his hallucinated voices. Looking at the
complex arrangement he had created he said: “I’m a
whole person; sometimes people judge just one
aspect of me.”
After making a non-specific pattern the client may
choose to explore a thematic sculpt using the
buttons. Sculpting is placing objects or people into
a symbolic arrangement with the aim of clarifying
intrapsychic or interpersonal elements or issues, and
for creative purposes, (Casson, 2004). For example,
the therapist might invite the client to make an
arrangement of the buttons as if they were members
of a family. Alternatively the client might
spontaneously make an arrangement depicting a
situation or relationship. Jennings (1987, 153)
advised that it is important to de-role
buttons/objects before putting them back in the box
at the end of the session. “This fat marble was my
boss but now it’s a marble again.” She also suggested
that a record be made of the pattern of the buttons,
so that when using the method again after three
months or so, a comparison can be made. Dr. Peta
Hemmings (2001) has written of her use of button
sculpting with bereaved children and families. She
has also used the method with supervisees.
The Five Story Self Structure
Many different methods may be used with the
Communicube. Therapists and clients are
continuing to invent new ways. The original
method devised, The Five Story Self Structure,
combines the simplicity of button sculpting with
story making and a way of mapping intrapsychic
elements and interpersonal relationships in
 THE FIVE STORY SELF STRUCTURE
miniature. This serves to enhance the observer ego -
the part of us that is able to stand back from our
experience and reflect - promoting insight and
integration. It can help clarify the inter-connections
between different levels of experience. It provides
sufficient distance from material that might
otherwise overwhelm, enabling people to play, to
think about, observe and share perceptions of self,
other and their world. It is fun.
The structure is best positioned on a white base so
the items placed on it can be clearly seen. While
some individuals may prefer to use black or another
colour, the base should be plain so as not to confuse
the picture created by the pattern of buttons. The
process may proceed as follows:
1) I show the person the structure and ask them
what they see, notice, imagine that it is. Often the
structure has reminded people of the three-
dimensional chess set in Star Trek or, alternatively, a
multi-storey car park, office block, department store
or house. We might explore this image and develop
a story. The structure clearly intrigues people and if
they are willing to continue to use it we move on to
step 2.
2) I produce the buttons and offer the opportunity
to choose buttons and place them wherever the
person wishes. This might also lead to story making
or to developing a pattern. This step gives the
person maximum freedom to project whatever they
will onto the structure. Alternatively we might miss
this step and pass straight to stage 3.
3) I invite the person to choose one button to
represent themselves and to place it wherever they
are or wish to be (two buttons may be chosen here
- a real self and an ideal self ).
4) When working with someone who hears voices I
ask them to choose other buttons to represent the
voices and place those in relation to the button
representing the self.
5) The client is then asked to choose and place more
buttons to represent “other aspects of yourself, or
57
people or things in your life.” As clients talk of
various elements in their experience I encourage
them to symbolise each element. For example when
someone says, “I feel stuck” I would invite them to
find a button that represents their experience of
feeling stuck and place it where they feel it belongs
in the structure.
6) Buttons now represent roles, and there may be
dialogues between objects on the structure. I may
ask, “What might the dark blue button say to the
white stone?” The drama within the structure can
develop so that objects may be moved: “If the small
yellow button wants to be safer and more powerful,
where might it move and what other button might
help it? Shall the red button stay on this level or do
you need to move it to another level, now that the
green one has been moved up?” New roles may
emerge and buttons or other objects be found to
symbolise these. “What will this silver buckle say as
it enters the structure? What is the response of the
other buttons?”
7) Clients are now asked to step back and look at
the pattern they have created from different sides
and angles, and to relate what they notice. Often
shadows and reflections of buttons on different
levels, or new alignments between elements become
apparent during this observing stage.
8) They are then invited to “Look from above so
you can see the whole pattern through the different
layers (of the transparent shelves). What do you
notice? Are there any changes you want to make?”
9) Finally clients are asked to reflect and verbalise
their feelings and observations.
This has proved an extraordinarily flexible and
useful technique. The structure facilitates play and
concentration; it fascinates and focuses (due to its
interesting, concentric design). It enables people to
explore creatively, through stories and patterns
(right brain activities), their mental/spiritual
‘geography’. They can in effect create a ‘three-
dimensional’ model of their psyche and so observe
structure emerge from chaos. With such structure
58 THE FIVE STORY SELF STRUCTURE
emerges meaning. Miniaturisation also places the
person in control and allows him to feel powerful.
Viewed from above the whole Communicube is
instantly visible: a mandala containing disparate
elements yet integrated into one metaphor for the
self. Jung (1972) considered the mandala to be a
symbol for the Self.
The different levels of the Communicube do not
have intrinsic meaning: their significance is for the
individual client to attribute. It is in effect a toy
theatre of the Self - a world in miniature. Working
thus through projected play promotes
symbolisation: the concrete becomes metaphor, a
means of communication and of forming
relationship.
Further developments
The Communiwell is a circular version, which
instead of the grid of squares has three concentric
circles. Some people prefer this version: it offers
clients and therapists a choice. The Communicube
and Communiwell are being further developed as
tools in therapeutic work with couples, groups,
families, supervision, team building and in
education.
Illustration: The Communiwell
The game ‘Quintessence’
‘Quintessence’, a game of free association, can be
played in therapy groups and for pleasure.1 The
1The rules of the game are in the Communicube users’ manual, Casson, 2005.
game proceeds as each player chooses an object and
places it in the structure, and explains to the group
what it symbolises in the context of a story or
memory. The next player chooses another item
prompted by their free association with what a
previous player has said. A pattern of associations
builds up until the group decide by consensus what
is the Quintessence, that is the underlying theme of
these associations. An object is then placed to
symbolise this on the central square on the central
level. The group may then further explore the
emergent issues in drama. One therapist told me
that her group of adolescent anorexic girls disclosed
more during a game of Quintessence than they
would in a typical session.
Working with Children: Examples of
Group and Individual Practice
1. Debra Kaatz, a dramatherapist who works with
children in a primary school (aged 4-11) in the
South of France, writes (personal communication,
May 30, 2005):
Using the Communiwell, each child has created
a completely different world. When I have used
it in pairs with several children who have some
difficulties with each other or with
concentration the enjoyment has overcome
those difficulties. It is like a modern sand tray.
Debra noticed that, after playing with the
Communiwell, the children’s drawings became
more three-dimensional. She believed that the
structure had stimulated their spatial awareness.
2. Sue Seager, a dramatherapist working with school
children in the north of England, writes about how
the Communiwell helped a group of ten-year-old
girls achieve resolution (personal communication,
May 23, 2006):
The three girls in this group had initially been
referred for dramatherapy group work to offer
them the opportunity to explore feelings. All
59 THE FIVE STORY SELF STRUCTURE
the girls had been identified as having issues
concerning self-esteem, self-confidence,
interaction with peers, turn taking and listening
skills by the staff who had referred them. It was
hoped that the girls might find new, more
appropriate coping strategies in conflict
situations.
For the first few months it was clear the creative
structures offered in the sessions were benefiting
the girls. They showed empathy and
consideration for each other’s needs. The
dramatherapy space was invaluable in providing
‘time out’ from the usual pace of life, away from
any academic pressure, in which their feelings
could be acknowledged and witnessed.
It is important to state that throughout this
time, despite previous traumas, the children’s
home environments were reasonably stable.
However, as time progressed the sessions were
disrupted by one child who was experiencing
further crises at home. The ground rules were
not being kept and it was difficult to meet the
needs of all the girls, whose diverse individual
issues impacted negatively on their work
together. I felt it more appropriate for them to
have individual sessions but was reluctant for
this idea to come from myself rather than the
group.
I was particularly concerned about child A as
her pattern had always been to push boundaries
until they could no longer ‘hold’ her. I
recognised it was fundamental that she felt
‘held’ so she could begin to trust that some
adults could cope with her emotions and keep
her safe. I felt that closure of the group might
reinforce her long term coping strategies of
controlling and disociation. It was important
that the girls made the decision to change the
way they worked therapeutically and the
Communiwell greatly assisted this process in a
way that was most remarkable.
Child A was reluctant to join the two other girls
when I produced the Communiwell and
59
suggested we use it to look at how the group was
functioning at the present time.
Child B and Child C were captivated by the
variety of buttons. They explored their colours,
sizes and textures for some time. I also offered
some small animals and other miniature objects
for the children to use.
Child A sat observing in the ‘watching space’
whilst the exploration took place.
Child B chose a sun button to represent herself
and Child C a small elephant. Both these were
placed at the centre of the Communiwell on the
top level. Various other choices were made by
the girls to represent the creative things we had
used in the group - puppets, stories, musical
instruments and so on. Other buttons were
chosen to represent listening to each other and
feelings about the work.
Child B asked Child C if she could place a
candlestick at the centre of the level to represent
anything they had forgotten.
Child C then chose three small buttons to
symbolize the watching space.
Child B then asked Child A if she could put a
button on for her.
Child A nodded, watching closely all the time.
Child B chose two buttons, a bright gold one
and a pink one. She placed them on the outer
circle and commented that this was Child A
playing with her ball while the rest of the group
were trying to do something else.
Child A asked to join in and moved the two
buttons representing her and the ball to the
centre next to the other pieces. She commented
this was where she really wanted to be but she
was aware she stopped herself from being there.
The other two children made comments to this
effect and Child A was able to listen without
60 THE FIVE STORY SELF STRUCTURE
disengaging. It was rare for Child A to be able
to do this.
On the second level of the Communiwell I
asked the group if there was anything else they
wanted to sculpt. They decided to show me
what it was like in their classroom. Again each
child chose objects and buttons to represent
various actions and feelings.
Child B placed a button to represent all the
time she had been absent from class and one to
show the anxious feelings around this when she
was unaware of what was expected of her.
Child C selected a small butterfly, which she
wanted to float around this level. She felt it was
hard to concentrate on her work.
Child A placed four buttons to represent hard
work, her angry and muddled feelings, putting
her head down on the table and refusing to
work. Before the session closed the girls were
able to look down and reflect on the structure
and relate the two levels to each other.
Child A remarked, ‘I know there are things I
would like to do on my own with Sue. When I
get angry I don’t want to join in with everyone
else’.
The other girls agreed they would like some
individual sessions. So we decided we would
have three further sessions together before
commencing individual work. In the closing
sessions that followed we kept the original
pieces on the two top levels and explored one
situation in the playground on the middle level,
the girls’ relationships with each other on the
second to bottom level and on the final level
how they hoped the group would be if they
worked together again.
There were no disruptive incidents in these
closing sessions. The girls were able to talk
through situations, actions and feelings and
how these were interrelated. They had formed
their own conclusions about their present needs
with the aid of the Communiwell. The objects’
small size, and the distance achieved by this
form of projective representation, had allowed
the girls to ‘look in’ on themselves. This process
had increased their self-awareness. The girls all
went on to experience some valuable individual
work and came together to work in the group at
the close of the dramatherapy project.
I was not sure what I was going to offer the girls
with the Communiwell when I introduced it.
However, I had an intuitive feeling that it would
be useful and the process would unfold. This
happened far beyond my expectations and
demonstrated the versatility of the Five Story
Self Structure. I now feel the ways in which this
can be used are unlimited.
3. Sue Seager further writes of using the approach in
individual work with a boy:
The use of the Communiwell proved an
invaluable tool for Harry (aged 12) to examine
the process and consequences of an aggressive
incident in which he had been involved. Harry
began to look at strategies as to how he could
achieve self-regulation to control his behaviour.
He selected small animals and buttons to
represent the children, teacher, feelings and
consequences of his actions and used the
Communiwell to re-enact each stage of the
incident. He was able to identify at what points
he made things a lot more difficult for himself
and play out an alternative path. As well as
applying his insight to how his body felt when
he began to feel angry, he later commented that
he felt this experience had enabled him to avoid
some other possible incidents. This enabled him
to see his progress and further acknowledge his
power and responsibility in making choices. He
also explored how his choices affected his
friends’ behaviour and how they benefited in
turn.
 THE FIVE STORY SELF STRUCTURE
Shadows and Reflections
4. When objects are placed on the transparent
shelves they may be mirrored by the other levels and
their shadows fall through the structure. These
shadows and reflections may result in startling
insights. Jo Christensen, a dramatherapist, has
researched the use of the Communicube and story
making with troubled adolescents who are
struggling at school. She describes how Lucy chose
buttons to represent members of a family. She
placed the buttons carefully into the structure as she
created a ‘perfect’ family. Moving the buttons
around she told a tale about an idealised day on the
beach. Christensen (2004) writes:
At the end of the story I invited Lucy to view
the structure from above and comment on the
relationships she could see between the different
members of the family. Lucy made a couple of
comments but continued to uphold the notion
of an ideal family. I asked her if she could see
anything else in the structure. Lucy looked
carefully. When Lucy spoke her voice was lower.
She shared that she was able to see other people.
Each member of the family (button) cast a
reflection on the structure and it was these
reflections that held the ‘shadow’ family. Lucy
was able to consider a very different family
dynamic that existed in the ‘shadow’ family.
Relationships were much more difficult and
there was less movement around the structure.
At times sharing the stories of the ‘shadow’
family appeared to be very uncomfortable for
Lucy. Yet it was through this work that she was
able to communicate a far from ideal family.
Lucy could work safely using this method
knowing she did not have to reveal which
aspects belonged to her real family and which
aspects belonged to the family she desired. The
structure by its very nature could contain both
the good and the bad.
61
How and why is the Communicube
effective?
The Communicube and the Communiwell
combine the following therapeutic factors:
• a containing structure;
• the integrative holding of diverse elements and
polarities so that the whole is visible;
• the focusing effect of the structure: its ability to
encourage concentration;
• distance afforded by the use of miniature
objects to symbolise aspects of people’s experience
that might otherwise be overwhelming;
• the availability of different perspectives and the
development of the observer ego;
• the generative power of the structure which
evokes archetypal imagery and energy;
• its open flexibility and neutrality: meaning
emerges but the meaning is decided by the client;
• the value of the structure as an
intermediary/transitional object between client and
therapist (evoking Winnicott’s ‘playground’, 1991,
p. 47 and Bannister’s ‘the space between’, 2003, p.
27); creative fun of pattern making.
Pattern recognition is a right brain activity. At birth
the right brain is more developed than the left-
brain. This ensures that within hours and days of
being born babies can recognise their mother’s face,
facial recognition being an instantaneous
appreciation of a complex pattern. This helps to
promote attachment and therefore forms the
bedrock of human psychological development.
Faces communicate feelings and so there is a close
relationship in the right brain between patterns,
faces, feelings and communication. The way the
mother/carer looks at the baby promotes brain
development and affect regulation (Schore, 1994).
Through the subtle modulation of facial patterns
the parent communicates, non-verbally, potentially
integrative and developmental signals (or their
reverse: destructive, negative messages). The infant
absorbs these messages and patterns into the very
fabric of their nascent self-structure. Often, when
we struggle in life, the patterns we have difficulty
62 THE FIVE STORY SELF STRUCTURE
with are those that are fundamental to our struggle:
the patterns of our emotional life, our relationships,
and different parts of ourselves. The Communicube
facilitates communication about these complex
patterns. Psychotherapy has not only to do with
examining old, dysfunctional patterns but also with
creating and exploring new patterns. Using the
Communicube we can build a more complex
picture of ourselves, create new patterns and gain an
overview of the whole, thus achieving greater
insight and integration.
Conclusion
This new tool offers clients a metaphoric container
and an opportunity to play, explore, strengthen the
observer ego and integrate split off aspects of the self
into a greater whole. We live in a diverse and
complex world: the Communicube enables players
to model this complexity. We all need structure in
our lives. When people are struggling with the chaos
of trauma, complex feelings and conflicted
interpersonal relations, the Communicube and the
Communiwell can provide a containing structure to
achieve some order and discover meaning. The Five
Story Self Structure, as a therapeutic method,
promotes communication in a way that can be both
powerful and fun.
Biography John & Correspondence
Before training as a therapist, John’s background
was in theatre and education. His MA research was
into the shamanic healing dramas of Sri Lanka. His
PhD involved research into what people who hear
voices (auditory hallucinations) find helpful or not
helpful in dramatherapy and psychodrama. He has
been a therapist for over 22 years, 11 of which were
in NHS mental health services. He now works in
private practice and is a senior trainer with the
Northern School of Psychodrama.
62 Shaw Hall Bank Road, Greenfield,
Oldham, Lancs
OL3 7LE
Tel: 01457 877 161
joncassun@beeb.net
References
Bannister, A. (2003). Creative Therapies with
Traumatised Children. London: Jessica Kingsley
Publishers Ltd.
Casson, J. (1998). Right/Left Brain and
Dramatherapy. Journal of the British Association for
Dramatherapists. 20 (1).
Casson, J. (2004). Sculpting. Prompt: the newsletter
of the British Association of Dramatherapists,
Summer.
Casson, J. (2005). An Instruction Manual for the
Therapeutic method of the Five Story Self Structure,
concerning theory and practice. Failsworth:
Communicube Ltd.
Christensen, J. (2004). ‘I’m Telling:’ The Use of the
Five Story Self Structure with Adolescents in a School
Setting. Unpublished M.A. research essay:
University of Plymouth.
Hemmings, P. (2001). Button Sculpting:
Counselling Bereaved Children. Bereavement Care,
20 (2).
Jung, C. G. (1972). Man and his Symbols. London:
Aldus Books Limited.
Schore, A. N. (1994). Affect Regulation and the
Origin of the Self, The Neurobiology of Emotional
Development. New Jersey: Lawrence Erlbaum
Associates Inc.
Winnicott, D. W. (1991). Playing and Reality.
London: Tavistock/Routledge.
 BOOK REVIEWS
PLAY THERAPY
A Non-directive Approach
for Children and Adolescents
Second Edition
Authors: Kate Wilson & Virginia Ryan
Date Published: 2005
Publisher: Baillière Tindall
ISBN: 0 7020 2771 5
Price: £17.99 (amazon.co.uk)
This new edition of a key text is most welcome. The
two authors write from an impressive knowledge
and experience base: Kate Wilson applies expertise
in social work and therapeutic insight; Virginia
Ryan, child psychologist and play therapist, brings
to bear her many years of clinical practice and court
work; each has experience of devising and delivering
courses about children’s needs and complex families.
The book exemplifies the York training in that it
combines an academically rigorous approach to
theory with thorough attention to child-centred,
professional practice issues, including the core skills
intrinsic to the Non-directive approach. In my
opinion these elements render the volume second to
none as a handbook for therapists at all levels of
experience. As teacher and supervisor of trainees I
feel that this is essential reading for students.
Experienced therapists will also find a valuable
resource here whether they are looking for
authoritative guidance in their practice, wish to
inform and underpin their thinking when providing
evidence within a legal framework for example, or
hone their skills generally. Above all it promotes
faith in Non-directive principles, and helps to think
about ways in which one might act not prescrip-
tively but in thoughtful and imaginative response to
an individual child’s needs.
The structure of the book is satisfying. The first
chapters offer a historical overview of therapeutic
approaches to work with children and young
people, carefully define what constitutes Non-
directive play therapy, and place it in context.
Discussion follows of the central importance of the
role of symbolic play in children’s mental and
63
emotional development, and as a medium for
therapy. The authors elicit Piagetian concepts and
attachment theory, for example, in order to present
an integrated perspective that includes complex
processes and states such as formation of mental
schemas, consciousness and memory. This is
followed by an exploration of emotional
development that draws extensively on Erikson’s
delineation of stages. The authors then turn their
attention to practice matters. Case material is used
judiciously throughout to provide clear illustration
of the process of therapy, clinical management, and
that primary concern of trainees – how do you
actually behave in the playroom (when your
experience has been to relate to children as a teacher,
social worker or clinical psychologist)? Examples are
given of successful and less successful empathic
responses, how acceptance may be conveyed (or
not), the uses of congruence, and how to apply
reflective principles when speaking to a parent who
is highly critical in front of a child. The value of
recording and analysing sessions is clearly explained;
what confidentiality does and cannot encompass;
assessment and planning; and finally working with
children in statutory settings. Figures and boxes are
an effective addition, as they help to clarify and
summarise important material.
I feel the updating of this book has been extremely
important on two counts. Firstly, it is essential that
the rationale for Non-directive play therapy is
firmly rooted in child development, an area in
which research continues to extend understanding.
Although the section on theory is not a particularly
easy read, careful study will be rewarded. Time and
attention are required to absorb the richness of
material. Useful references guide the reader more
deeply into specific areas. Secondly, the authors
address issues pertaining to professional accounta-
bility in considerable detail. For example, clear
guidelines are given in respect of the suitability of
cases for levels of ability and experience of
practitioners, including students at different stages
of their training. I find that trainees and
inexperienced therapists are often attracted to work
with the most needy clients. It is understandable
that this should be so, as a grasp of complex clinical
64
issues is as yet undeveloped, and there may be
external pressures to solve the most distressing cases.
Wilson & Ryan provide very sound explanations in
this regard that, if adhered to, will help to ensure a
responsible approach. Always characteristic clarity
of thought and sound rationale is delivered that
supports the highest regard for children’s well being.
I wholeheartedly recommend this volume to all who
wish to practice in play therapy or to understand the
underlying processes. It will also help other
professionals, parents and carers who wish to gain
greater insight into central themes in children’s play
and behaviour. The fundamental principles and
guiding light underpinning this book’s aims are
firmly rooted in children’s needs at any stage of
development. This informs all, from moment to
moment practice of skills in the playroom, interpre-
tation of children’s communications to others,
working with parents and carers, to advocacy in the
wider arena of society.
Anne Barnes
MA/Diploma in Play Therapy
Notre Dame Centre
Glasgow
The Metaphor of Play: Origin and
Breakdown of Personal Being
Author: Russell Meares
Date Published: 2005
Publisher: Routledge
ISBN: 1 58391 967 8
Price: £18.99 (amazon.co.uk)
This book was of great interest to me as a play
therapist, as it provides a very broad and expansive
discussion of the development of a child’s sense of
self. The discussion progresses to look at the inner
life of the individual and the effect of disruptions to
the growth of this private domain.
Russell Meares, Emeritus Professor of Psychiatry at
the University of Sydney, Australia, leads a hospital
programme for the treatment of and research into
borderline personality disorders. Meares takes the
reader on a thought-provoking exploration of the
self, which he regards as one of the numerous
different forms of consciousness which shift and
change during ordinary existence. His sensitivity
and deep theoretical understanding of the skills and
attitudes involved in the therapeutic process filled
me with renewed awe and he concludes that ‘the
experience of self arises in the context of a particular
form of relatedness.’ In my opinion this book is an
essential read for play therapists aiming to deepen
their therapeutic work with children.
Meares considers the importance of play in the
formation and development of the self and reaffirms
the critical role of play for the evolution of a mature
psychic life. He makes comparison with Winnicott’s
concept of the ‘transitional space’ in his exploration
of the meaning and significance of play. Core skills
and attitudes, such as acceptance and empathy that
are familiar to all non-directive practitioners, are
seamlessly interwoven throughout the text, as are
the author’s self-awareness and sense of timing.
A concise look at developmental features and a
thorough explanation of the workings of memory
are extremely useful. This leads into a very readable
and informative section relating to traumatic
memory. The focus then turns to the treatment of
developmental trauma that so often underpins the
difficulties of day-to-day life for our young clients.
This publication is a joy to read and emphasises the
relationship as the transformational element in
therapy. Meares’ primary achievement in this book
is to clarify fully the form of relatedness necessary
for that transformation.
Michelle Cassidy
Play Therapist
Notre Dame Centre, Glasgow
NOTES FOR CONTRIBUTORS 65

Volume 3: 1st May 2007

BRITISH JOURNAL OF PLAY THERAPY
2006 VOLUME 4 DECEMBER

EDITORIAL

Anne Barnes 3

PAPERS

The use of sandplay with children

Diana Jansen 4

Theraplay: An Introduction
David L Myrow 14

Playing in the field of research:

Creating a bespoke methodology to investigate play
therapy practice
Chris Daniel-McKeigue 24

Child survivor of the tsunami:

A Case Study
Leong Min See 37

The ethics of researching children in

non-directive play therapy
Angie Naylor 46

The five story self structure:

A new therapeutic method on the Communicube
John Casson 55

Book Reviews 63

ISSN 1744−1145
02

Laser Proof

British Association of Play Therapists 9 771744 114001

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