Introduction
Play therapy is a practical approach to addressing children’s many behavioral and emotional disorders. Such therapy is the best option for children with various behavioral deviations, as it is presented in a form understandable to the child and allows for the combination of socialization and mental development (Elbeltagi et al., 2023). In this case study, Lily, a 5-year-old girl, exhibits disruptive behavior at school and home. The task of the trainee play therapist is to develop a comprehensive therapy plan that focuses on emotional regulation, improving social interaction, and eliminating destructive behavior. Therefore, this paper outlines ten scheduled sessions with clients, including details and rationales, as well as potential ethical issues that may arise during the treatment of children.
10 Planned Session
Session 1
In the first session, it is crucial to establish communication and friendly relations with Lily. Play therapy should be based on mutual understanding and should be a safe and comfortable environment for the child. After we get to know each other, I will allow Lily to explore the playroom and choose a few toys she likes. The primary goal of the first session is to establish trust between the trainee play therapist and the child (Landreth, 2012). Such a trip contributes to creating a friendly and relaxed atmosphere, which is essential for effective therapy in the future.
Session 2
The second session focuses on the emotions the child is experiencing. Children diagnosed with ADHD often have trouble identifying and expressing emotions, resulting in aggression as a response (Hassani et al., 2021). To help Lily manage her emotional reactions to what is happening, I will utilize additional tools, such as cards representing different emotions and dolls, to support her emotional well-being. During the game, Lily will be asked to determine what emotions and feelings the doll can experience in the situation that we are acting out. It will help expand the child’s emotional range and enable her to express her feelings more effectively.
Session 3
In the third session, Lily will be introduced to techniques for emotional regulation, with a focus on controlling anger and aggression. During the game, the child will learn various techniques for managing anger and expressing disagreement. For example, these techniques include breathing and relaxation exercises. By learning to identify critical situations and take the necessary actions promptly to calm and relax, the child will become less aggressive and be able to establish positive social interactions.
Session 4
Once Lily has mastered basic anger management skills, the fourth session can focus on developing communication skills to interact with peers. I will develop several scenarios for a doll game where the toys will mimic Lily’s interactions with her classmates. During the game, the child will exhibit specific reactions to the dolls’ behavior and offer suggestions for more acceptable behavior. The use of various objects in games has a positive impact on a child’s communication skills (Orr, 2020). It will help improve Lily’s social skills and reduce her aggression.
Session 5
Session 5 will focus on the skills to focus and concentrate on completing tasks. The inability to concentrate and the rapid loss of focus to complete a task are hallmarks of ADHD (Sun et al., 2022). Therefore, it is essential to develop Lily’s diligence and focus skills in therapy. For this, both physical activity and various puzzles will be used, the implementation of which requires organization and concentration. It will help prepare the child for further schooling and teach her to follow instructions.
Session 6
The sixth session again focuses on the child’s emotions and experiences. Lily must develop a story that will allow her to express her feelings and thoughts. This technique helps develop the child’s communication and social skills, teaching them to process and share their experiences. In addition, it will teach the child to identify different emotions and their causes, which contributes to the development of skills for emotional regulation.
Session 7
In the seventh session, as a trainee play therapist, I will focus on relationships in the child’s family. Since Lily shows aggression in relationships with peers and at home, it is vital to understand the reasons for this behavior. For this, the child will be asked to play with dolls, provided that one of the dolls is a mother and the other is her daughter. During play, children often relay their emotions to others (Senko & Harper, 2019). Understanding the child’s perception is necessary to find optimal solutions.
Session 8
Repetition is essential for the child’s understanding and assimilation of information. Therefore, in the eighth session, Lily will be asked to use previously learned calming and relaxation techniques to regulate her response to situations with intense emotional experiences. It will help make Lily’s behavior and reaction to various incidents more adaptive.
Session 9
In the ninth session, the child’s response to various life changes will be explored. Situations such as school and changing environments can be stressful for a child. In Lily’s case, the stress of change is exacerbated by the anxiety inherent in children with ADHD (Hassani et al., 2021). Therefore, I will utilize various methods and tools to help the child adapt to future changes more effectively.
Session 10
Finally, during the tenth session, it is necessary to evaluate the intermediate results and Lily’s progress in addressing the main issues. It includes reviewing and discussing the skills the child has acquired in therapy. This assessment will analyze various stories and scenarios from Lily’s daily life. Based on this assessment, a further treatment plan should be developed to enhance and sustain the results.
Ethical Issues and Areas of Concern
The therapist’s work is based on established ethical principles that must be respected. However, working with children imposes additional responsibilities, increasing the number of potential ethical issues and areas of concern. One of the most significant concerns is the child’s privacy (Landreth, 2012). Before starting therapy, it is essential to discuss the terms of confidentiality with Lily’s parents. Given the child’s aggressive behavior and the likelihood of harm to themselves and others, it may be necessary to contact the appropriate authorities, about which parents must be warned.
Additionally, obtaining informed consent from both parents and the child is essential. It will help ensure that each party understands the therapy’s purpose, process, and potential outcomes. Moreover, this will help create a comfortable and safe environment by understanding what is happening to the child.
Child-centered therapy is generally grounded in the same ethical standards as other forms of therapy. According to Ashby et al. (2021), the practice is based on five fundamental principles, including “autonomy, nonmaleficence, beneficence, justice, and fidelity” (p. 1298). However, when working with children, these ethical considerations become significantly more critical.
For example, the Australasian Pacific Play Therapy Association (APPTA) establishes eight core principles. In addition to the five already mentioned, among the central ethical norms, APPTA identifies responsibility and self-respect, as well as the principle of autonomy, which encompasses respect for human rights and dignity, as well as respect for people’s needs and relationships (APPTA, 2021). Such a list of ethical considerations enables us to provide optimal conditions for therapy that are both comfortable for the child and their parents.
Additionally, in play therapy, specific concerns may arise that require the therapist to possess the necessary knowledge and competence. One such issue is the participation of the therapist, parents, or third parties in therapy (Landreth, 2012). Many factors must be considered to determine the best behavior, including the child’s progress, family relationships, and social skills.
Another difficulty is evaluating the results and motivating the child to continue therapy. Understanding progress is necessary to adjust the intervention strategy. However, it should occur in a way that does not add additional emotional pressure to the child. Additionally, refrain from using rewards at the end of sessions to motivate, as children “do not need a reward for playing” (Landreth, 2012, p. 156). Therefore, finding other ways to motivate the child and discussing them with parents in advance is necessary.
Conclusion
In conclusion, child-centered play therapy can effectively regulate the behavior and emotions of children with various disorders. In this case study, a play therapy strategy was developed for a 5-year-old child with ADHD and disruptive behavior at home and school. The role of the play therapist is to identify the main problems that require intervention and develop a comprehensive approach to address them. In addition, the applied techniques and methods should align with the ethical principles of building relationships between therapists and children.
References
APPTA. (2021). APPTA guidelines for ethical play therapy practice [PDF document].
Ashby, J. S., Wood, L., & Kiperman, S. (2021). Ethics in play therapy consultation and supervision. In Research anthology on rehabilitation practices and therapy: Concepts, methodologies, tools, and applications (pp. 1297–1314). Medical Information Science Reference/IGI Global.
Elbeltagi, R., Al-Beltagi, M., Saeed, N. K., & Alhawamdeh, R. (2023). Play therapy in children with autism: Its role, implications, and limitations. World Journal of Clinical Pediatrics, 12(1), 1–22.
Hassani, Z., Hosseinpour, F., Mirshoja, M. S., & Boozhabadi, A. (2021). Effectiveness of cognitive-behavioral play therapy on improving anxiety and aggression disorders in a child with ADHD: A case study. Case Reports in Clinical Practice, 6(3), 116-119.
Landreth, G. L. (2012). Play therapy: The art of the relationship. Routledge.
Orr E. (2020). Object play as a mediator of the role of exploration in communication skills development. Infant Behavior & Development, 60, 1-9.
Senko, K., & Bethany, H. (2019). Play therapy: An illustrative case. Innovations in Clinical Neuroscience, 16(5-6), 38-40.
Sun, W., Yu, M., & Zhou, X. (2022). Effects of physical exercise on attention deficit and other major symptoms in children with ADHD: A meta-analysis. Psychiatry Research, 311, 1-9.