Integrating Play Therapy in the Home-Based Setting Module

Module Sections:

Assessment in Play Therapy

The assessment process in play therapy is crucial to successful play therapy. The clinician must seek to understand the child's past and present functioning, specific traumatic events leading to the conditions for which treatment was sought, experience and meaning of the events to the child, child's strengths and problem areas, and resources available to the child. According to Filley there are five primary assessment and treatment goals

  1. To assess the extent of the client's emotional vocabulary: how well can the child talk about his/her emotional state
  2. To assess the client's self-perception of his/her emotional life
  3. To target feelings that need particular therapeutic intervention
  4. To build relationships
  5. To assess client's self-perception of family dynamics

A thorough understanding of the child's background with, developmental history including relevant medical history beginning with conception and birth, social history, and school history are essential to creating a treatment plan that will address the issues presented.

The Assessment Process

The three step process should involve:

  1. Interview with the parents as well as an interview with the child. Assessment requires the therapist to stay present with the child and help them to find safe ways to express themselves. The therapist should be attuned to the child's sense of his/her own emotions and family experiences (e.g. sadness, anger, loneliness, fear, etc.). The therapist will be "listening" with all senses as the play is followed.
  2. Observations of the parents as they discuss their concerns about their child. The therapist should attend to how the parents interact (agree or disagree about the problem), their insight into the problem and how it relates to the family situation, their attempts to resolve the issues, how they feel about treatment options, how they feel about being involved in the treatment process, and how they interact with the child.
  3. Verbal interview as well as activities the family does together and separately. For example, the Family Art Assessment is an excellent way of understanding how the family works together. In this assessment, a large piece of newsprint is taped to a wall. Each family member is provided with one marker, each of a different color. The instructions for the family are: "using only your marker, draw a picture together but you cannot talk or make verbal noises to communicate." The family would draw for about 10 minutes with 3 minute and 1 minute warnings. The therapist draws the activity to a close asking the family to discuss a title for the picture and write it on the picture. The family is then asked to tell a story about the picture. Following this the paper is turned over and the family is asked to repeat the exercise with talking. The therapist is looking for how the family works together, how did they start, how they take turns, what their roles were, how they use body language to send messages, how they problem solve knowing they cannot talk, did they draw over someone's picture, ask permission to change a picture, and which drawing was easier to do for each member and why. The therapist makes observations about the process; the relationships expressed, and help the family to reflect on these observations and their experiences. In high conflict families members will often stay in their own section except for the powerful person who will often move throughout the picture.

Another example of a drawing exercise that can be easily done in the home is asking each member to draw a picture of their family in the rain. Rain is often considered a metaphor for grief or loss. Using this exercise in assessment, the therapist is looking for the activity in the picture (playing), do they have protection (umbrella, boots, outer wear), is there any sign of hope (colors, sun, rainbow), are there elements suggesting fear or doom (lightening, blackness). The members can share their pictures in session and these can suggest how members may be feeling or coping. In the resources section of this module is a section on drawing exercises.

Art is a wonderful activity for children and adults. Oleander states that

"the very act of drawing, with no therapist intervention whatsoever, is a powerful expression of self that helps establish one's self-identity and provides a way of expressing feelings" (p. 53).

Often children have a much easier time with these creative experiences because they are less concerned about being proficient in their art work. Adults tend to be hesitant to engage and more critical of the outcome. Interactive games and story-telling also provide important information for the therapist to understand the problem and the relationships in the family.

Audio Companion: Integrating Play Therapy