POINT
The Rationale for the Relationship in Play Therapy as the Foundation of Change ALICIA DONOVAN LPC-S, RPT
Play therapists rely on research to understand behavior and theoretical orientation may provide them with a lens through which to understand the child’s behavior and direct the course of treatment. While research provides a foundation from which we approach client treatment, relying on research can promote rigidity in our approach and restrict our presence within the therapeutic relationship.
The movement in favor of prescriptive and manualized therapy research evidence in supporting clinical practice. Shedler (2018) purports that though the use of evidence based therapies is promoted as the gold standard of care, it is a weak indicator of progress in therapy. Furthermore, as client populations continue to diversify, the play therapist must be diligent to increase their
The most influential factor in a successful therapeutic relationship is the relationship between the therapist and the client (Hanser, 2018). The importance of establishing this relationship in a manner that connects the play therapist to the client cannot be understated. It is imperative that the rapport building stage is framed in the context of establishing a relationship with the client rooted in authenticity and unconditional acceptance. Conversely, assessing a client’s initial behaviors from a seminal lens can promote highlighting of pathology rather than strengths.
A number of studies have found that the therapist providing the treatment is more important to the outcome than the type of treatment therapy do not return after the initial session with one reason being a failure to connect with the therapist (Lambert & Barley, 2001). A connect with, remain in, and get the most from therapy (DeAngelis, 2019).
Norcross & Lambert (2018) suggest the relationship has a larger effect size on therapeutic outcomes than techniques and that the “person” of the therapist is intertwined into therapeutic outcomes and cannot be separated. In practice, a play therapist must be fluid and adapt to the child’s needs in the moment. Play therapists who focus heavily on research based strategies may miss opportunities to connect and solidify the therapeutic relationship. There are numerous opportunities during treatment for a breakdown in the therapeutic alliance. These may include a disagreement on treatment goals, the client’s misinterpretation of methods used, or a mistrust of the therapeutic process. Various theoretical approaches have framed this breakdown in terms of “client resistance” but if we address these changes as client pathologies we lose the ability to connect and repair. Eubanks, et. al (2018) asserts that collaborative repair is necessary for addressing and repairing therapeutic ruptures, and can lead to better outcomes.
While it is important to use evidence based practice in order to ensure safety and obtain direction in client care, as Garry Landreth (2002) aptly stated, “the relationship is the therapy.”
THE MIDDLE GROUND It Depends... TERRY KOTTMAN, PHD, LMHC, RPT-S
After much deep consideration and wide-ranging conversations with other play therapists, here’s my unequivocal answer: It depends… On the one hand, research, when it’s done well, is necessary and can be incredibly useful. Research is important in counseling, psychotherapy, and play therapy because it helps us (a) stay accountable for our work by providing empirical support that what we are doing in our playrooms works; (b) explore the value of innovative ideas and play therapy practices; (c) bring external to identify and deliver appropriate and effective interventions, and (e)
respond effectively to increased pressure from managed care
to deliver evidence-based interventions (Bratton & Swan, 2017; McLeod, 2014). Fortunately, the quality of play therapy research
20 | PLAYTHERAPY | June 2022 |
www.a4pt.org
continues to improve, moving toward manualization of treatment; generalizability; inclusion of active control and comparison groups; and use of independent raters (Ray, 2006; Ray & McCullough, 2016).
On the other hand, rigidly adhering to strict manualized treatment protocols can undermine therapist creativity and detract from the magical connection that happens between a child and a play therapist. Always feeling pressure to rigidly adhere to an intervention without adapting treatment to the children’s culture, personality, circumstances, needs, interests, and preferred modes of expression
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