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KAWA MODEL CASE STUDY NON DIRECTIVE PLAY THERAPY Aileen Duff
Queen Margaret University
08004355
AIMS AND OUTLINE OF PRESENTATION
Application of a Case study using the Kawa Model
Non Directive Play Therapy
Show how Therapy can be evaluated
Evidence Based Practice and Play Therapy
THE MEANING OF PLAY “Play is a transaction between a child and the environment that is intrinsically motivated, internally controlled and free of many of the constraints of objective reality”
(Bundy,1991)
Play is spontaneous, enjoyable, voluntary and non goal directed.
An essential element in childhood – fundamental in growth and development.
Through play children learn about the world and their relationships
Enables children to express aggression and buried feelings
(West, 1992)
PLAY THERAPY DEFINITION
Play Therapy is a relationship between the child and the therapist in the setting of the playroom, where the child is encouraged to express himself freely, to release pent up emotions and to work through his fear and anger so that he comes to be himself and functions in terms of his real potential and abilities.
A form of therapy for children where the therapist leaves responsibility and direction to the child. This approach emphasizes empowering the client, self-awareness, decision-making, and acceptance of the client's self.
Play Therapy Non Directive Play Therapy
Axline, (1986)
KAWA MODEL IN PLAY THERAPY Water - Child’s Life Flow
River Sides and Bottom , represent the child’s life environment – physical and social context
Rocks - circumstances that might be disrupting the child’s life flow
Driftwood - personal attributes and resources
(Lim & Iwama,2006)
MEET BEN
Born 2005 – 6 yrs old Volatile Early Parenting
Relationships Many House Moves Traumatic bereavement Started school 2010 - Difficult
behaviours School participation limited –
impact on friendships Sociable Enthusiastic Child, with a
good ability to play Grandmother has custody of three
siblings – impact on roles
Ben Occupational Profile
Many House Moves
Traumatic bereavement
Born 2005 – 6 Yrs Old
Difficult Early Parenting Relationships
Started school 2010 - Difficult behaviours- Now only attending for limited time .
CONCEPTUALISATION OF BEN’S RIVER
Family –grandparents& siblings
School
Play Therapy
Extended Family
Impact on ability to make friendships
Tragic Bereavement
Separation anxiety – limited
participation at school
Enthusiasm Conversational Behaviours
Sociable
Ability to Play
NON DIRECTIVE PLAY THERAPY Uses play rather than verbal exchange as principal means of
communication
Based on Carl Rodgers Client- Centred Therapy
Importance of the Therapeutic Relationship
Allows children to work through and encourage alternative ways of managing anxiety and emotions
Allows children to bridge the gap between experience and understanding
(Axline,1969; Landreth,2002)
RATIONALE FOR REFERRAL TO PLAY THERAPY
Used to treat children’s emotional and behavioural problems
Children lack capacity for abstract thought and express themselves through play and activity
Regain control, decrease anxiety and aggression
As the child guides the sessions, it is responsive to their unique and varied developmental needs.
(Landreth,2002; Miller & Boe 1990; West,1992)
GOALS OF PLAY THERAPY To provide a trusting relationship and a safe space’ for Ben
to discover his strengths and begin deal with l emotional issues
To enable Ben to experience a feeling of control To enable Ben to develop a positive self concept To enable Ben to experience some understanding of his
emotions and behaviours
In time, -to allow Ben to function comfortably within his external
environment ( particularly school)-To maximise the opportunity for Ben to pursue developmental
milestones. Landreth(2002)
INTERVENTION - PLAY ACTIVITIES
Emotional relaxation
Expression – opens communication
Safe containment
Creative medium
Sensory/tactile – compensates for lost early play ?
Actively engaged in creating a story
Plays out themes
Facilitated two way engagement
Connecting to experiences
Uniqueness of own
personality
West,1992; Lu et al(2010); Ryan and Wilson (2000)
EVALUATION OF THE PROCESS OF THERAPY
Therapy Evaluation
Objective Measures
Child Reports
Parent, Therapist or
Teacher Reports
(Naylor,2005;Dods, 1987)
EVALUATION THE PROCESS OF THERAPY Initial issue that brought Ben therapy
Within Play If maladjusted or regressive play develops -More Balanced PlayLess focussed, more emotionally appropriate
Child Therapist Relationship Improved through engagement in activityGreater connection with outside world
BehavioursAggression, Anger, Regression, ImpulsivenessMore appropriate in a variety of settings
Internally within the childImproved self esteem, confidence, appropriate maturity and
attachment (Naylor,2005)
EVALUATION OF BEN’S THERAPY
•Happier at home; getting on well with family
•Friends and coping with school
Ben
•Improvement in home behaviours
•Not necessary to stay at school
•More supported/able to return to roles
Gran
•Less separation anxiety
•Fewer behaviours in classroom
•Member of school community
School
EVIDENCE BASED PRACTICE IN PLAY THERAPYo A Challenge for research ?
(Carrol, 2000)
o Positive Outcomes Across Many Modalities (94 studies)Ray et al (2001); Wilson & Ryan (2001)
Parent’s Views Reductions in Parent-Child StressObserved improvements in behaviours
Brattan et al(2005)
Ray(2008)
o Children’s Views o The importance of the Therapeutic Relationship
Carrol, J (2000)
Jaeger and Ryan (2007)
WIDER POLICY
Developmental approach Develop more positive self
concept Building upon strengths ;
support family solutions Experience a feeling of control Self accepting Trusting of themselves and
others Learning – in a positive
environment
Getting it Right for Every Child Objectives of Play Therapy
Changing Practice Contexts : Reduced funding / EBP/
Mergers /Changing Cultural Contexts of Play
REFLECTIONS USING KAWA Holistic non-mechanistic approach
Occupation Focussed Interventions
Setting – Captures the complexities of contextual factors
Clinical Reasoning
Longitudinal aspect and Cross Sectional Aspect
Benefits of play therapy
“SPRINGBOARD TO BOUNCE INTO THE FUTURE” (WEST,1992)
REFERENCES I Axline (1986) Dibs – In Search of Self . New York. Ballantine
Books. Blunden, P. (2001). The therapeutic use of play. In: L.Lougher
(Ed.), Occupational therapy for child and adolescent mental health (pp. 67–86). Edinburgh: Churchill Livingstone.
Bratton, S., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A Meta-analytic review of the outcome research. Professional Psychology: Research and Practice, 36(4), 376-390.
Carroll, J. (2002). Play therapy: The children’s views. Child & Family Social Work, 7, 177-188.
Dodds(1987) A Child Psychology Primer – suggestions for the Beginning Therapist. New York. Human Sciences Press Incorporated.
REFERENCES II Finlay, L.(2004) The Practice of Psychosocial Occupational Therapy.
3rd ed. Cheltenham. Nelson Thornes. Galligan, A. (2000)The Place Where We Live : The Discovery of Self
through the Creative Play Experience. Journal of Child and Adolescent Psychiatric Nursing. 13(4) 169-176.
Hammond. D.,(2010) If We Don't Let Our Children Play, Who Will Be the Next Steve Jobs? Online [http://www.huffingtonpost.com/darell-hammond/if-we-dont-let-our-children_b_1017485.html
Humphry, R. (2002).Young children’s occupations: Explicating the dynamics of developmental processes. American Journal of Occupational Therapy, 56,171–179.
Jaeger, J and Ryan, V (2007) Evaluating clinical practice: using play-based techniques to elicit children’s views. Clinical Child Psychology and Psychiatry, 12(3), 437-450.
REFERENCES III Landreth(2002) Play Therapy :The Art of the Relationship. UK.
Brunner-Routledge. Lim, H. & Iwama, M.K. 2006. Emerging models- An Asian
perspective: The Kawa (River) Model. In Duncan, E.A.S. (ed). 2006. Foundations for practice in occupational Therapy. 4th Edition. Elsevier Limited: London.
Miller, C., & Boe, J. (1990). Tears into diamonds: Transformation of child psychic trauma through sandplay and storytelling. The Arts in Psychotherapy, 17, 247-257.
Naylor, A (2005) When a Child Plays - Analysing Change in Non-Directive Play Therapy. Counselling and Psychotherapy Journal. 16(5) 29-31.
Ray, D., Bratton, S., Rhine, T., Jones, L., (2001) The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10(1), 85-108.
REFERENCE IV Rigby,P, Rodger,S (2006) Developing as a Player. In :Rodger S,Zivaini j
(eds) Occupational Therapy with Children:understanding children’s occupations and enabling participation. Oxford. Blackwell.
Rodger, S.(2010) Occupation Centred Practice with Children. A Practical guide for Occupational Therapists. Queensland. Wiley Blackhall.
Ryan V., Wilson, K. (2000) Case studies in nondirective play therapy. London. Jessica Kingsley Publishers.
Scaletti, R. &Hocking C. (2010) Healing through story telling: An integrated approach for children experiencing grief and loss. New Zealand Journal of Occupational Therapy,52(2),66-71
West, J. (1992) Child-Centred Play Therapy. London. Arnold Publishers.
Wilcock, A.(2006) An Occupational Perspective of Health. New Jersey. Slack Incorporated