Case Example ; Symbolic Reframing of Problems and Conflicts
Eight-year-old Tom was placed in foster care by court order as ungovernable,
improperly supervised at home, and a chronic runaway.
He refused to talk at all about his father.
According to his mother and foster mother, Tom did not know that his father
was in jail
The therapy sessions were usually conduct in the backyard or basement of his foster
home, due to the reality of transportation and childcare problems
In one of their early sessions, Tom and the clinical social worker caught a grasshopper.
Together, they fixed a cage for the grasshopper and discussed how to feed and
care for it .
The clinician then shifted the discussion and action from providing nurturance and
protection to the feeling level - wondering how the grasshopper felt all locked up, how
the grasshopper family felt without him, and what might happen to him. Tom quickly projected himself into the grasshopper's predicament and began to deal with the clinical social worker's "I wonder how-" comments.
Initially, Tom/grasshopper responded in terms of himself in foster care, although he did not openly spell this out.
In her collaborative conference with the foster mother, the clinician alerted her to Tom's
current identification with the grasshopper.
Together, they worked out strategies for the foster mother to handle this identification, the nurturance and projection issues that might be raised, the feelings related to separation and loss, and the acting out that might be triggered.
In the following session, Tom announced that they had to name the grasshopper.
Last week, he had thought about calling him Tommy, but Tommy didn't seem
After going through the pros and cons of several names, Tom was able to talk about the grasshopper's feeling of not belonging anywhere and not knowing who he was.
In the next session, Tom said, "Those were little-boy problems the grasshopper had before. He can manage those. Now, he's got grownup problems, so let's call him J.D "
(These are his father's initials ) This time Tom/J.D/ grasshopper responded to the clinical social worker's name "I wonder how- " in terms of imprisonment, aggression, and runaway issues. For many weeks, they worked with variations on this theme though telling stories and drawing pictures about the grasshopper. Finally, Tom was able to say, "I made my Dad go to jail. He spanked me and I got mad and told him the cops would put him in jail for beating me-and they did." (The reality was that on several occasions his father had beaten Tom severely, broken multiple bones, and caused internal bleeding.) Needless to say, Tom continued to work on these issues for some months before he was ready to be returned with his mother. During this period of Tom's foster placement, she was simultaneously working on her own personal and parenting issues with her social worker.
Along with each child's personally framed metaphor, the clinical social worker and child use the behavioral, affective, and cognitive dimensions of play therapy to process the problems and conflicts and restore psychosocial functioning. The behavioral dimension is used to focus the play activity on the problems and conflict at hand, clarify the difference between play and play therapy, and improve the child's ability to communicate with the clinician. While communicating through play may include direct verbalization as an integral part of the process, the main method of communicating is indirectly through the metaphor.
Their communication most often begins with and is related to the play action and thematic process. The affective dimension of the play process refers to steps taken by the child and clinical social worker to provide a growth-inducting or corrective psychosocial experience for the child. In this sense, the play represents the externalized expression of the child's feeling state, problem soving, and emotional growth. Again, the clinician acknowledges these feelings within the metaphor. The cognitive dimension refers to those actions taken by the clinician to facilitate children's understanding of self - their perceptions and thoughts about the feelings, relationships, behavior, and influencing events associated with the problems and conflicts of concern.
Within this overarching therapeutic goal of facilitating resolution of problems and conflicts and restoring psychosocial functioning, four therapeutic objectives are frequently addressed : binding anxiety, establishing behavioral limits, coping with situational stress, and changing self-defeating behavior patterns.
Binding Anxiety. Some childe clients are unable to express themselves due to immobilizing anxiety. They remain silent, change the subject, cry, or stutter. Sometimes the clinician is able to give the child something to do or something to hold onto that binds or reduces the level of anxiety. In this sense, throwing a ball or working on picture puzzle become play activities used to enable children to proceed with their concerns. Similarly, a teddy bear may serve as a transitional object between the world of home and the world of play therapy. Most of the time, the clinician responds indirectly to the symbolic metaphor in the play (The teddy bear looks worried.) less often with direct statements in response to the child's feelings illustrated by the play (You seem worried today.). A third technique is for the clinical social worker to enter the child's play and assume a role withen the make-believe in order to reenact and rework events in the child's own life. When enacting a departure from what actually happened, the clinician may present children with alternative reenactments, help them grapple with these alternatives, encourage them to experiment with new ways of coping, and enable them to explore the rigidity of their coping responses in differing situations (Burns, 1970). These and similar techniques in the context of the therapeutic alliance help a child client recognize the kinds of feelings being expressed indirectly through their behavior and develop means for handing them. In their use of activity and toys or other belongings to bind anxiety children convey their differing levels of awareness of the problem, current coping capacity, and the amount of directness that they can tolerate in confronting and dealing with their problem and ways of coping and adaptation.
Establishing Behavioral Limits. Children's need tp have their defenses supported and their acting out controlled rather than promoted appears frequently. Although accepting of the symbolic representation of all feelings, the clinician does not accept all behavior. A few simple rules about protecting the child client, the therapist, and the premises from undue harm are usually sufficient to anchor play therapy in safe reality. As absolute limits within sessions, children are not allowed to attack the social worker, hurt self or engage in dangerous activity. These limitations are established for the child's benefit and guard against children frightening themselves with their out-of-control behavior or developing guilt about harmful or destructive behavior. Such protective limits build a sense of security in the working alliance and the playroom as safe therapeutic holding environments (Winnicott, 1971). Limits on behavior actions and activities are always stated in a firm, friendly manner. Unenforceable limits are to be avoided. Routine clinical limits revolve around toys and time, and usually become treatment issues as children test the firmness of boundaries. For example, willful destruction of irreplaceable play material is not allowed ; destruction of play-doh or building-block creations is. Toys are not to be taken from the playroom. Similarly, with a preestablished time limit (usually fifty minutes), leaving early or extending the time become boundary issues to be handled within the therapeutic process according to individual need. In most instances, the last few minutes become clean-up time serve to bring closure to the therapeutic work, and provide a bridge back to the world of reality.
In general, the principle of as few limits as possible serves the clinical social worker and child client well. Occasionally, however, the therapeutic need arises for other limits to be set for reasons of ethics, law, social acceptability, or clinical appropriateness.
첫댓글 학상^^; 유료 의뢰 하세요
몇 장에 불과(?)하더라도 하는 사람에게는 몇 시간의 노동 분량이랍니다. 그냥 부탁하는 건 좀 심하신 듯 하네요...
공짜 좋아하면 대머리 된데요. 여성도 대머리 있다던데. 다 빠지지를 않아서 그렇지. 만약 정말로 머리숱이 없으시다면 죄송요^^
죄송합니다,,넘 급한 나머지 제가 ,,,넘 실수를 한거 같네염,, 반성하고 열심히 살아볼랍니당,,