Play Therapy for Cancer

What is Play Therapy?

Children communicate naturally through play. Play therapy is a form of counselling which allows children to communicate their feelings, through playing with toys and play materials, and this becomes their form of language. The trained therapist is able to hear and understand what children say, by their way of playing.

As children develop their cognitive skills before their language skills, play therapy can give them a safe place to express their feelings, and as the therapist listens to their “play language” the children can work their way through difficult emotions and fears. In this way play therapy can alleviate stress and give children a feeling of having more control over their emotions.

For children play therapy is a form of play, as well as an exploration of their inner world, which may otherwise be difficult to assimilate. It gives the opportunity to explore this inner world, in a language that they are fluent in (play), as opposed to feeling pressurised and frustrated as they try to express and explore in a language that they are not yet fluent in.

The trained therapist will observe how and what the child plays with in order to diagnose their mental and emotional health. Whilst a family member can play with a child, a trained therapist will allow children to “play out” whatever the children need to express.

The room is a safe space for the children and the toys are specifically chosen to allow them to:

  • Explore real life situations
  • Express their feelings in the way most comfortable to them
  • Express their needs
  • Deal with inner conflicts

Play Therapy and Childhood Cancer

Apart from the medical treatments, another important aspect of the healing process for children with cancer is to be allowed to heal, by being children again. It has been revealed by research that children need more than only medical care to heal and recover, as wholly as possible. They need to be able to “play.” This is one way to help them psychologically and emotionally, whilst they undergo the physical treatments.

Research done in the late 1970s revealed that 59% of childhood cancer survivors with a mean age of 5 years, 7 months were considered to be impaired psychologically.

The areas where most difficulty was evident were:<.p>

Internalising problems:

  • Feelings of loss of control
  • Hopelessness
  • Depression
  • Anxiety
  • Frustrations

Externalising problems:

  • Withdrawal
  • Aggression
  • Non-compliance

Other common difficulties

  • Poor self-esteem
  • Poor self-image
  • Changing sense of identity, more negative
  • Decreasing social competence
  • Learning problems

Play therapy can help children with cancer express their trauma, negative emotions and then integrate their experiences in a healthier way. It can enable children to move beyond the crisis of childhood cancer, helps children deal psychologically as well as physically with cancer and build resilience.

Research

Below are some samples of research done about the efficacy of play therapy and the importance of play to children.

1.The authors conducted a meta-analysis of 93 controlled outcome studies, published 1953 to 2000, to assess the overall efficacy of play therapy and to determine factors that might impact its effectiveness.

The overall mean treatment effect was 0.80 standard deviations, considered a large treatment effect. Further analysis revealed that effects were more positive for humanistic than for non-humanistic treatments, and that utilizing parents in their child’s play therapy produced larger overall treatment effects than play therapy conducted by a professional.

Play therapy appeared equally effective across age, gender, presenting issue, and clinical vs. psychotherapy, and further suggest that doubts about the efficacy of play therapy can be laid to rest.

2.Gestalt Play Therapy can assist in restoring a sense of wholeness as part of the healing process for oncology child patients. It can benefit a hospitalised child in ways such as allowing the child to rehearse his medical experience and gain a feeling of mastery over procedures, while allowing him to strengthen the self concept and increase self esteem.

3.Research carried out at Case Western Reserve University shows that observing children as they play can give a good indication of how emotionally charged their memories will be. The research shows that playing out emotions during therapeutic play can help children who are experiencing traumatic situations. It can also help them process their emotions more easily.

4.The number of long-term, adult survivors of childhood cancer therapy will continue to increase, and almost 75% will have a chronic health problem resulting from their cancer therapy, whereas 40% will have a severe, disabling, or life-threatening condition or death caused by a chronic condition that resulted from their therapy.

In addition to being followed by their primary care physician, all long-term survivors of childhood cancer therapy should attend a specialised late effects clinic yearly and be evaluated by a member of the oncology team, either the physician or the pediatric oncology nurse practitioner, who initially treated them.

A psychologist and social worker should always be present, and subspecialists should be available on or near the site as needed.

What Happens in a Play Therapy Session?

Parents firstly have the opportunity to voice their concerns about the child and/or the family unit. In some cases the therapist may also wish to get information from other significant adults or the child’s school.

The aim of a play therapy session is for the child to communicate about their feelings, behaviour and thoughts, using play as the tool. For this to be effective, an important focus is to build a trusting relationship between the therapist and child, as this relationship plays a vital part in the functioning of the therapy.

In the play room there will be a great selection of play materials so that the child has a wide choice to choose from. The selection may include puppets, art and craft materials, sand and water, clay, small figures, dressing up props, musical instruments and books.

The child is the one who leads the session, so the format in this sense is free and there is no pressure put on the child to talk about their difficulties. The trained therapist will use specific techniques in order to assess how the child reacts to the world, events and the people who inhabit their world. Gently the therapist will lead the child to help them gain an awareness of their feelings and allow them to express their feelings safely.

A Brief History of Play Therapy

Some of the great thinkers of all time, such as Aristotle and Plato, reflected on play and why it is so fundamental in our lives.

Some of the modern day roots of play therapy can be attributed to child psychotherapy pioneers Anna Freud, Margaret Lowenfeld and Melanie Klein.

Elements of play therapy emerged from child psychotherapy, whilst the theoretical foundations can be attributed to Humanistic Psychology. During the 1940s a client centred therapy was being developed by Carl Rogers. This person centred therapy approach was very different to the previously diagnostic and prescriptive model.

Influenced by Carl Rogers, in the 1940s, Virginia Axline began to develop non-directive play therapy. She established these 8 fundamental principles of play therapy.

  • The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
  • The therapist accepts the child exactly as he is.
  • The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
  • The therapist is alert to recognise the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behaviour.
  • The therapist maintains a deep respect for the child's ability to resolve his own problems if given an opportunity to do so. The responsibility to make choices and to institute changes is the child's.
  • The therapist does not attempt to direct the child's actions or conversation in any manner. The child leads the way; the therapist follows.
  • The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognised as such by the therapist.
  • The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship.

A number of therapists have stood out since Axline’s time for advancing her formulations. These therapists include Moustakas, Schaefer and Landreth. They have also devised differing models which integrate elements of systemic family therapy, solution focused therapy, narrative therapy and cognitive behavioural therapy.