Parents, insurance companies, schools, or managed care settings want results; there are “problems” that we as child play therapists are supposed to “fix”. But how can you work toward treatment goals while remaining true to the open-endedness of child-centered therapy, the most common play therapy theoretical orientation? On one hand you want results, and on the other you want to let the child guide the process.
An article in The Family Journal lays out a strategy for collaborating on treatment goals with a young client’s family. Here’s the problem as the article says it:
“Child-centered play therapists do not use specific techniques, specific toys, or interpretation to promote personal growth in children. Instead, play therapists have a firm belief in children’s ability to be the best determiner of what should be the focus of each therapy session. Given this theoretical base, there is a danger that setting behavioral goals at the onset of child-centered play therapy could lead therapists to act in a certain way, which would be incompatible with this theoretical model.”
Instead, the article recommends a process in which the therapist and family work to evolve treatment goals during the course of play therapy. Here are the steps:
1. At an initial (child-less) meeting, have the parents describe the child. Take special caution to “keep the focus of the consultation on the child’s issues, not on the parents’ issues.”
2. Work with parents to set strength-based treatment goals that focus on measurable solutions rather than on problems. However, the article writes that, “Whereas in other play therapy theoretical approaches, play therapists may select interventions based on the treatment goals, child-centered play therapists set goals as a way to assess treatment progress while maintaining a child-centered approach in the playroom.” In other words, the article recommends letting goals drive your measurements but not your treatments.
3. Explain how the child’s target behaviors naturally are addressed in play therapy. This takes background knowledge and skill – you will need to explain the theory of a child’s improvement through your approach to play therapy. Throughout, the therapist should be sensitive to cultural concerns and work to establish trust with the parents.
4. Start sessions; assess progress. Good case notes focused on observations that are relevant to the treatment goals can help the therapist keep parents up to date with improvement or lack thereof. Again, your notes should pinpoint real, observed behaviors that demonstrate change in the treatment goals.
5. Ongoing parent consultations. During these (child-less) consultations, the therapist works with the parents to update treatment goals and can offer suggestions for parenting skills and connect the family with community resources. Consider these consultations excellent opportunities to reinforce your relationship with parents.
Despite our belief that, given safety and opportunity, a child will work toward his or her own best mental health, as play therapists we can’t just sit on our haunches while other treatments fly past ours in goal-directed, managed care settings. In many situations, we have to show results. Hopefully with intention and care, we can have our cake and eat it too – letting our young clients direct the course their growth in the room, and yet still demonstrating the fact of this growth to parents and managed care entities.
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