Application of play therapy in registrar training

With the development of the behavioural, cognitive and biological treatments, the clinical art of play therapy is in danger of being lost to child psychiatry trainees. Historically, play therapy was regarded as a long-term therapy in which the therapist played with a child, who often threw questionable objects at the therapist, who responded with ‘deep’ interpretations, while a social worker spoke separately to parents. This approach was discarded with the advent of family therapy approaches and considerations of resource availability. However, the insights provided by a relatively short play-based interaction with appropriate children has been found by the present author and trainee registrars to provide a therapeutic experience for the child and considerable insights regarding the child’s concerns. We present two illustrative cases in which a small number of free play sessions allowed the child to choose to play or draw.

A 9-year-old boy was referred to the service due to low mood, after he had made suicidal statements. He and his mother recently relocated from his home state to Sydney, leaving behind his friends and grandparents. He was given the freedom to choose what he wished to do and elected to draw what he called ‘a system’, whereby he drew the life cycles of a flower and a tree alongside each other. His drawing proved to be very elaborate and creative. At each stage, both would grow further until the tree was chopped down and the flower died. This opportunity was used to draw a comparison between this and how it might have felt for him to be suddenly ‘cut off’ from his home environment, facing a new life in a foreign city. He then elaborated a story of a young boy living there alone, after his immediate family had all passed away from a disease. The chopped down wood was used to build a farmhouse. His grandfather remained and cared for him, until he grew old and passed away. He was able to talk about how the boy felt sad and alone, although he derived some comfort from the farm animals. This session was very useful in terms of allowing the patient to talk about his emotions in an indirect and less confronting manner. Because he enjoyed the session, rapport was built, and he felt comfortable to talk freely.

In a second case, a 7-year-old boy presented with oppositional behaviour and tantrums at school and at home following the recent separation of his parents. During his play sessions, he chose to play with Lego blocks and created an elaborate army where he was the general with a base camp, soldiers, planes and tanks. Each session was characterised by an intense battle against the approaching enemy fought on multiple battle-fronts with ground and aerial attacks. His soldiers would frequently launch rescue missions for kidnapped soldiers. After every session, his army always won without any casualties. Despite his denial of a connection to his family battles, he was able to say ‘I’m like my dad’. His behaviour improved after this. These sessions provided him with an opportunity to use his imagination to process the conflict associated with the separation of his parents in a non-threatening way. This experience allowed him to explore and be the master of his play environment. In the real world, he did not have any control over his real-life situation, but within the playroom, he was imbued with a sense of control to make positive changes in his inner world.

In both cases, the children experienced a therapeutic intervention, while the registrars learnt and experienced the value of therapeutic play for children.