Withers, R. (2013. Adlerian play therapy: an overview of theory. [Website article]. Retrieved from http://www.counselinginsite.com.
The use of toys, drawings and other activities to facilitate the therapeutic process with children is known collectively as play therapy. Children use play in order to make sense of the world around them, and also to express their own thoughts, feelings, and beliefs. Play is also an inherently therapeutic activity for children (Kottman 2003; Drewes & Schaefer 2010). Schaefer (1993) said that play “has the power to facilitate normal child development but also to alleviate abnormal behavior” (14). To this end, play therapy has become a widely accepted therapeutic modality for both children and their parents.
In seeking to facilitate children’s expression and exploration of their emotional world, therapists must turn loose of their world of reality and verbal expression and move into the conceptual-expressive world of children. Unlike adults, whose natural medium of communication is verbalization, the natural medium of communication for children is play and activity (9).
Though both Kottman and Landreth share similar views about the importance of play, their approaches to play therapy are different. Landreth, a child-centered therapist, is the founder and director of the Center for Play Therapy at the University of North Texas (Landreth 2002); Kottman is the foremost authority on and creator of Adlerian Play Therapy (Drewes & Shaefer (2010). However, with regards to the importance of play, they make the same basic point. Play provides the best medium to communicate with children.
There are a number of different theories about play therapy. The methodologies vary, even though they all share the same goal, which is to aid in the emotional and mental development of the child by empowering him or her in a safe and supportive environment. However, the fundamental beliefs about play seem to be quite similar.
Characteristics of Individual Psychology in APT
Terry Kottman has written a number of articles and books on Adlerian play therapy and is credited with adapting the theory of Individual Psychology for use with children (Drewes & Schaefer 2010). In the 1920s, Dr. Alfred Adler developed Individual Psychology as a holistic approach to therapy that emphasizes the role of social influence. Unlike Freud, who argued that life is already pre-determined, or Rogers, who believed that a person was born with innate abilities, Adler believed people were born as “blank slates” (van der Smissen 2003). A person is thus able to create their own lifestyle, but that lifestyle is influenced in both positive and negative ways by social interaction, feelings of inferiority, and courage (Kottman 2003).
Many of the principles of Individual Psychology are found in Adlerian play therapy. In her book, Kottman (2003) notes that Adler saw people as creative, goal-directed individuals with purposeful behavior. Adlerian play therapy adheres to these basic principles, in terms of how therapists conceptualize the child’s presenting issues. Because there is purpose behind behaviors, those behaviors can help a therapist understand what a child’s goal is, and understanding a child’s goal is critical if change is to occur.
Adlerian play therapists believe that children misbehave from a sense of discouragement. Snow, Buckley & Williams (1999) note four general goals of discouraged children. They are a) attention, b) power, c) revenge, and d) a display of inadequacy (329). Identifying the motive for these misbehaviors is a key part of Adlerian play therapy. Once identified, they can be addressed with interventions throughout the course of treatment. Some interventions involve educating the parent about the reasons for a child’s behaviors. Other interventions encourage the child to gradually extinguish maladaptive behaviors. Most interventions, though, seem to be designed to instill a sense of efficacy within the child in order to their discouragement.
Adlerian play therapists believe that children do not exist in a vacuum. They are “socially embedded” creatures with an innate desire to belong, both influencing and influenced by their own social system, be it a school or a Church or a family or a neighborhood. Because we all are born as blank slates, we are profoundly influenced by the social system in which we exist (Kottman 2001). This can obviously be both potentially positive or negative. In cases where a child has adopted a maladaptive behavior, the Adlerian play therapist would wager that such behavior was environmental in origin. Individual Psychology is based on the notion that a client must be treated holistically, which means that his or her social context must be taken into account as well. This is a crucial aspect of Adlerian play therapy as well.
Adler believed that one of the major indicators of mental health was a person’s sense of connection and belonging to a social scheme system, which he called social interest
(Corey 2008). In other words, a therapist can learn much about a client based on his or her relationships. Kottman notes that a child’s family is a crucial part of Adlerian play therapy. In an interview about APT, she said “Adler said that you can’t consider a person outside the context of their family, so one of the things [Adlerian play therapy does is] include the family as part of the context of understanding the child” (2009). In addition to the family, an Adlerian play therapist may examine a child’s relationships at school, Church, or in other social settings (Dewes & Schaefer 2010).
Tenets of Adlerian Play Therapy
Individual psychology and Adlerian play therapy share three core tenets (Kottman 2001). The first one is social interest. Children have an innate ability and desire to connect with others, but they do not necessarily know how to make these connections in positive ways. Second, all behavior is goal-oriented. A therapist can learn to recognize these goals by observing the child’s play, his or her interactions with parents and siblings, and in speaking with teachers. Finally, lifestyle constitutes the third tenet of APT. This is the child’s unique, creative approach to life and to interacting with others. Kottman (2001) notes that this tends to cement around eight years of age. Children receive both positive and negative messages from their social groups, and both can have profound influence on their development. Because children see the world through the lens of a child, they can often come to faulty conclusions that persist as they grow into adulthood. Concepts such as socially appropriate behavior, views on race, attitudes towards the opposite sex, work ethic, and certainly self-esteem are just some examples of how social relationships can influence a child. Because APT acknowledges the role of social influence in a child’s development, it often involves mandates participation from the parents, family members, and sometimes the school if possible (van der Smissen 2003; Dewes & Schaefer 2010).
The Role of the Therapist and the Goal of APT
One of the major assumptions that APT makes about children is that maladaptive behaviors are the result of discouragement (Kottman 2003). Children can become discouraged by both internal and external forces, such as problems at school or in the home. They can also adopt irrational beliefs, fears, and points of view. Dewes & Schaefer (2010) note that one of the main goals of the therapist is to provide encouragement. Kottman (2001) writes that encouragement is an Adlerian technique wherein the therapist highlights the strengths of a child and praises their accomplishments, empowers the child with enough responsibility to inspire competence, and “demonstrates the courage to be imperfect to reinforce the child’s willingness to take risks and try new behaviors” (5).
In addition, the role of the therapist evolves over the course of treatment. It starts with building a strong relationship, continues as the therapist gathers information about the child and his or her family, turns directive as the therapist begins to confront maladaptive behaviors, and switches finally to a role of teacher and encourager (Kottman 2001).
The Four Phases
Adlerian play therapy is a process that moves through four distinct phases, each with their own unique goal and purpose. Several authors note that these phases are unique to Adlerian play therapy, as each phase stress fundamental Adlerian principles as critical for the therapeutic process (Snow, Buckley & Williams 1999; Kottman 1999; Kottman 2001; Kottman 2003; van der Smissen 2003; Watts & Garza 2008; Even & Armstrong 2010).
According to Kottman (1999) the main goal of the therapist during the first phase is to build a therapeutic relationship with the child and parent. Therapist and child make with one another a strong, egalitarian connection that remains over the course of treatment. The therapist uses basic counseling techniques such as reflective listening, paraphrasing, summarizing, and asking questions to affect the relationship, as well as techniques more specific to Adlerian play therapy, such as cleaning up the play room together with the child once the session is over (Kottman 1999). The child is asked to help clean up the room in order to facilitate the egalitarian relationship, as well as to encourage the child to take responsibility.
Phase two continues the relationship built in phase one as the therapist begins to explore the child’s lifestyle, his or her goals for certain behaviors, and faulty beliefs which they child may have adopted (Watts & Garza 2008). This is a research phase, as the therapist interviews the child and parent and examines the child’s various relationships. According to Kottman (2001):
During this phase, the therapist has the expectation that the child will answer questions and play out the various aspects of his or her lifestyle and that the parents will answer questions about the child, the parent’s family of origin, the marital relationship, family values, parenting methods, and so forth. There is little pressure for change on the part of the child or the parents, although they sometimes gain insight simply from the exploration process, which may lead to change (5).
The information gathered during this phase can be gathered directly, such as with asking specific questions of the child or parents, or indirectly, by the use of toys and drawings to see how the child conceptualizes his her own world (Kottman 1999). Even & Armstrong (2011) also note that many authors have suggested that Sandtray therapy is an effective and complimentary technique to use during this phase. Adlerians believe that children view their world subjectively, and Sandtray therapy can help the therapist examine how the child conceptualizes their world.
The third phase becomes more directive in nature, as the therapist begins to articulate their expectations for change. In a word, this phase is about insight. The therapist helps the parents to see what is and what is not working, as far as lifestyle and parenting are concerned. The child is also expected to participate in this process. Kottman (2001) writes that this insight will promote “major shifts in their attitudes toward themselves, one another, other people, and the world…” (6). This phase of Adlerian play therapy also serves to demonstrate how it differs from other modalities such as child-centered, which by comparison is non-directive and does not attempt to “fix” behavioral problems (Landreth 2002; Manassa 2009).
In the fourth and final phase of Adlerian play therapy, the therapist expects change from both parents and the child. By this point, they have learned new skills and attitudes and have begun actively using them in their daily lives. Kottman (2001) writes that more advanced counseling techniques are used at this point, such as role playing, modeling, and the use of metaphors (6). The therapist is seen as a teacher, mentor, and life coach for the family. The “curriculum” during this phase, according to Kottman (2001) “involves the provision of training and experience into assertiveness skills, negotiation skills, social skills, and other methods of positively interacting with others and coping with difficult situations and relationships” (7).
Watts & Garza (2008) argue that the Adlerian technique of acting “as if” is a useful tool to facilitate growth during the fourth phase. Corey (2008) notes that with traditional Individual Psychology, this technique is used to help a client overcome the natural fear of change by essentially rehearsing a new behavior or belief in the safety of the therapeutic session. Watts & Garza (2008) illustrate a modified version of the “as if” technique for use with children. Even though the final phase is ultimately about change, the authors suggest that the phases are fluid. Therefore, “the counselor can use procedures from the [fourth] phase, like acting as if, whenever a child seems ready to change a maladaptive belief or behavior” (115).
In summary, the four phases of Adlerian play therapy, while fluid, have distinct objectives. It begins with establishing of a strong relationship, then moves to examination and investigation. The third phase becomes more directive, with an expectation from the therapist for change. Finally, both parents and child are expected to undergo a paradigm shift that reflects a new and better understanding of their own behaviors and relationships. Throughout them all, the therapist uses the Adlerian notion of encouragement to effect change. In the final phase, distinctly Adlerian interventions such as “acting as if” and “spitting in the client’s soup” can be used with the child to identify and extinguish maladaptive behaviors (Kottman 1999).
The Crucial C’s
The fourth phase, which is also known as the reorientation/reeducation phase, is where the therapist can explore with the family what Lew & Bettner (1996) called the “Crucial Cs”. These are 4 characteristics that emotionally healthy possess.
According to Kottman (1999), children must learn how to connect with others; this teaches them cooperation and provides them with a sense of security. This relates directly to the Adlerian concept of social interest. Children who don’t know how to connect with others run the risk of isolating and thus feeling insecure.
Children must also feel capable. Kottman (1999) notes that capable children stand out in play therapy because they present as confident in their abilities to perform tasks. In Adlerian play therapy, the child helps the therapist clean up the play room once the session is complete. This both promotes the egalitarian relationship strived for in the first phase of treatment and provides children with a sense of responsibility and control.
The third “C,” according to Kottman (1999) is that a child must count; they must believe that they matter and that they are special. Children who believe themselves to be inconsequential may develop maladaptive behaviors as such as bullying as a way to compensate. The Adlerian technique of encouragement helps promote the feeling within children that they are important.
Finally, children must have courage (Kottman 1999). The courageous child feels free to take risks in the play room. The child who lacks courage is quiet, withdrawn, and full of doubt. Again, encouragement is used to help children learn that it is okay to take risks and try new activities without fear of criticism or failure.
As Kottman (1999) notes:
Thinking about children and their perceptions of self, others, and the world using the Crucial C’s can provide the Adlerian play therapist with a concrete model for conceptualizing problems, assets, and potential strategies for intervention. There are endless possibilities for using the Crucial C’s model in play therapy…” (296).
Strengths and Limitations
While researching this article, I found several articles that define Adlerian play therapy and how to use it, but empirical data with regards to its efficacy was lacking. Snow, Buckley & Williams (1999) present a case study of Adlerian therapy wherein they laud the egalitarian relationship between child and therapist and the encouragement the child receives during treatment, but it does not offer any conclusive evidence that Adlerian play therapy works any better than other modalities such as Child-centered or filial play therapy. Daigneault (1999) argues that Adlerian play therapy is compatible with other modalities, specifically narrative therapy. The author points out that both modalities hinge on a strong therapeutic relationship between client and therapist, and both address the impact of social influence on development. Portrie-Bethke, Hill & Bethke (2009) suggest that Adlerian play therapy can be integrated with adventure-based counseling to treat children with ADHD. These three articles all state that Adlerian play therapy works best with school-aged children and that social context and the therapeutic relationship are two of its strongest components. While I did not find supporting empirical data, I did not find any literature that criticized its use. To that end, the discussion about strengths and limitations will be based on my opinions as a future practitioner.
While I do not agree with some of Adler’s beliefs, such as the importance of birth order, I believe social interest is crucial. How we relate to others, how we are accepted by others, and how we are affected by relationships is critically important to mental health. While I consider myself a cognitive-behaviorist, I do think that many of our irrational thoughts come from the social environment in which we live, so to that end, I see the two theories as complimentary. I also believe that a therapeutic relationship is crucial, and that encouragement, especially with children, is the key to empowering change. Adlerian play therapy is also more directive, at least in some phases, than other play therapies such as child-centered. While I do not have any criticisms about child-centered play therapy, Adlerian play therapy better suits my personality and style, given the attention is pays to goals and behaviors within a social context. Finally, several articles note that Adlerian play therapy works best when the parents and even the school can be involved (Dewes & Schaefer 2010; Kottman 1999; 2001). While this strikes me as difficult to accomplish, it is nonetheless important if one is to understand the child within the context of his or her family and social surroundings. Perhaps its greatest strength is that it promotes encouragement and ultimately strives to empower both the child and his or her parents with positive lifestyle changes. I find this directive, results-driven model to be quite appealing.
As I previously noted, empirical data about Adlerian play therapy is lacking. While this is not necessarily a limitation, it could conceivably be an issue with an agency that prefers empirically based therapies. Adlerian therapy also works best with children under the age of 10, which means its target population is somewhat limited in scope. I also do not know if Adlerian play therapy can be used with developmentally delayed or mentally retarded children, as I found no research in that area. Finally, one of Adlerian play therapies strengths is also a potential limitation. If including the family is crucial, is Adlerian play therapy effective if the family, for whatever reason, is unable or unwilling to participate? In my career, I work with children who are in DSS custody and are moved from placement to placement. One child on my case load has been moved 3 dozen times over the last nine years. I would think that this mode of therapy would be difficult to execute in a situation like that. It seems like Adlerian play therapy hinges on the assumption that the child lives in a relatively stable home, in that he or she has at least one parent or guardian who is a constant. This is often not the case for foster children. There are certainly aspects of APT that would be beneficial, but given the importance of family in the process, I wonder how effective it would be with a child who is essentially a nomad.
While I agree with its major tenets and beliefs, Adlerian play therapy is probably not a therapeutic model I would use in my practice, simply because this is an age range with which I do not intend to work. However, it is clear to me that play therapy can be beneficial to children. Several articles note that play therapy works best with children under the age of 10 (Kottman 1999; Kottman 2001; Dewes & Schaefer 2010). I see myself working with teenagers and adults.
If anything, my research into this subject has served to remind me of the Adlerian principles that do make the most sense to me. While I do not offer much credence to birth order, I do think we all have a desire to belong, and that one’s social interest is directly related to one’s mental health. Perhaps the most important principle of Adlerian play therapy that I plan to use is the notion that behavior is purposeful and goal-directed. In my current position as a case manager, I often discuss this idea with parents and foster children. For example, I have a 15 year old female in one of my placements who tends to make hurtful statements about other family members that she passes off as “jokes.” In a recent supervision session with her, I actually told her about Adler’s view of behavior, and challenged her to look at her own motivations for saying such hurtful things. Was it anger that motivated her, or jealousy, or something else? As she spoke with me about the issue, she began to talk about her biological father, and the abuse she had suffered from him. What she did not realize was that she was allowing the anger she felt about her father to poison the positive relationships she had in her current placement. It was a profound moment for us both, as she realized how that anger had shaped her behavior, and I saw firsthand the efficacy of that Adlerian intervention.
In summary, I do not see Adlerian play therapy or its interventions only as ways to address negative behaviors. While the example I used was used for that purpose, I had spent most of that meeting praising this young girl for the tremendous amount of progress she has made over the last year. When I first met her, I had to have her hospitalized on suspicion of suicidal intent. Now, she is doing so well that I can “nit-pick” with her and address comparatively smaller issues, such as her sometimes inappropriate sense of humor.
Adlerian play therapists use encouragement as a direct intervention with children, and I find this to be both a simple and effective technique to use with any client, be they child, teenagers, or adult. It is especially helpful with my foster children, as so many of them have grown up in environments that turn them into the very essence of an Adlerian disturbed individual.
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