COMMENTS BY CLINICAL EDITOR: Suggestions for helping children with anxiety through family play therapy.
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geared more towards adolescents and adults, though Lund, Zimmerman, and Haddock (2002) argued that family therapy “can become child friendly with a little adaptation and creativity” (p. 448). Lund and colleagues (2002) reported many barriers that prevent therapists
from including young children in family therapy, including a belief that
it was acceptable to exclude children from family therapy
sessions if the therapist was uncomfortable with their presence. Willis, Walters, and Crane (2014) offered that marriage and family therapists (MFT) “tend to view child-focused work as the realm of child or play therapists rather than family therapists” (p. 288). I would argue that child-focused work is the duty of all therapists and should not be overlooked. Therefore, combining family therapy techniques and play therapy would better equip therapists who may be reluctant to include children in the process (Keith & Whitaker, not familiar with family therapy techniques, many parallels may be drawn between the two modalities that may make this combination
Willis et al. (2014) researched how involved children are in family therapy to assess therapeutic process and their participation in session. They cited previous studies showing that children have limited participation in family therapy and, worse, that they have been excluded from dialogue in family sessions altogether. In their study, they recorded sessions between sixteen licensed (12 LMFT) and graduate-level therapists and 30 families with children ages four to twelve to examine child participant talk time and therapeutic participation in family therapy. They found a positive relationship between total activity time and the child’s excitement about attending therapy and between the amount of child talk time and the child’s level of happiness towards the therapist, further supporting the notion that play-based techniques increase child talk time in family therapy and enhance the child-therapist relationship (Willis, Walters, & Crane, 2014).
Combining Play and Family Therapies Keith and Whitaker (1981) posited that there are many parallels between the process of play therapy and family therapy, notably, that structure is critical, scope is increased through magic and rituals, play constantly weaves the symbolic and the real, and body language is always implicit. They proposed that play therapy utilizes a “parental surrogate” to help children adjust on biopsychosocial levels to different settings in their world, such as home, school, and playground (Keith & Whitaker, 1981, p. 244). Play therapists are already familiar with how the interplay between symbolic and real is freely exhibited in the child’s self-expression (Landreth, 2012), as well as how structure is crucial to the process in both directive and non-directive approaches. Other concepts from family therapy, such as attending to family rituals and body language, can also be key to helping play therapists integrate children more fully into the therapy process. These are described in turn below.
Gentile (2013) described rituals as “very conscious reenactment[s] of our experience” that are intimate for the members involved (p. 163). Family routines and rituals practiced throughout the child’s life are displayed in the child’s many forms of play. Children and adults communicate implicitly through their behavior and body language. A therapist can obtain more information from the client’s visual body language than from the verbal elements of his or her speech or from the content of what s/he is saying (Borg, 2015).
There are many ways to incorporate play therapy into a family therapy session. Foremost among them is viewing parents as the experts on their family and encouraging them to share their parental expertise with the professionals (Lund et al., 2002). To open discussion, play therapists may use what they already have in the playroom, such as dolls, puppets, blocks, clay, and games. In family play therapy, the therapist also may ask the child to bring in his or her favorite toy and use techniques to engage the child and parents, such as circular therapeutic techniques for including play in family therapy, notably, art, verbal, storytelling, experiential, and non-directive techniques.
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