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Susan Scheftel Ph.D.
Susan Scheftel Ph.D.

What Happens in Play Therapy?

What Mrs. Piggle-Wiggle Knew

Those who remember early seasons of Saturday Night Live may recall a hilarious sketch with Laraine Newman as a child therapist: meaning not only that she consulted with children, but that she was literally a child herself. Sitting atop her desk in pigtails, a frilly dress and Mary Janes, she cites as the most important of her credentials her ability to identify with her patients: The absurdity of the image notwithstanding, there is something spot on about the joke. As this character says to the surprised parents in front of her: “Who is better qualified to know the mind of a child but another child?”

Odd as it is, children are hard for grownups to understand. Many adults seem to regard children (not to mention their own children) as an alien species.. Even the cliché of an inner child suggests a painful interior journey to find one’s way back to the long buried bedrock of our childhood self. Why should it be so out of reach? Like Russian dolls, each stage of childhood is embedded within all of us.

Therein lies the rub. If our childhoods were painful, conflicted or constricted, being surrounded by ever present reminders (i.e. our children) can be tough. Children are the avatars of our early selves, and depending on how we feel about our past, we may have greater or less difficulty relating to our children.

In addition, most children have their difficult moments. Being assertive, opinionated, resistant and negative are the ways kids establish themselves as separate beings. Seamless cooperation is the exception, not the rule. Children also move around a lot since the development of their minds goes in tandem with the development of their bodies.

It is frequently these very basic, and surprisingly normal disconnects that bring parents to seek psychotherapy for their children. There are many kinds of therapies for children. My version is not high-tech. Colloquially it is called “play therapy”.

In this kind of treatment, all that needs to occur is for the child to enter the therapist’s office and stay for a forty- five minute session. Whatever happens in the privacy of these appointments provides privileged access to the child’s mind. There is an opportunity for a new relationship with the therapist to develop; one that will inevitably draw upon the child’s primary relationships, but also give him or her a chance for something new. One can learn about a child’s inner world by interacting in the shared environment of the consulting room The same setting can elicit a myriad of different reactions. I have toys in the office, enough that some children have even thought it was a toy store. Yet not all see it that way. Children who are not content or depressed will react in ways consistent with the world inside their minds: “Why don’t you have anything to play with? I am bored.”

In fact I have board games, families of dolls, knights, princesses, animal figurines, puzzles, dollhouses, cars, cards, watercolors, markers, crayons, castles, blocks, a drawer full of babies of every size shape and race, miniature notebooks and toy food: quite an extensive playground for the imagination. Most young children who visit me eventually will draw or play out dramas that mirror problems and concerns from the parallel universe of their real lives. Play can be a superb vehicle for expressing thoughts and feelings that are hard to directly put into words. Often children show aspects of themselves to the child therapist that have been misunderstood in the family environment or at school. For example, a child whose parents think he or she is unspeakably naughty and ill- behaved plays out scenarios of tender caretaking in the dollhouse, and is never loud or demanding with the therapist; the child who never speaks in school is garrulous and chatty in the office, while the child who is inhibited and docile may create scenes of swashbuckling bravado, or even at times murder and mayhem. The basic principle is that the therapy session is a little like a dream, the play an illuminating portal into a child’s mind. Like dreams, “child’s play “ is infinitely complex. Deciphering the many layered rebus of a dream or similarly a child’s fantasy is challenging, and not simple. That is why regular sessions are a must, since all children take time to understand.

Along with the continuity and regularity of the sessions, the therapist must tolerate all manner of often peculiar and primitive content, (as long as it is played, spoken, symbolized and not acted out). Fascinatingly, many children who are brought to me with behavior problems, quickly lose those symptoms since they “play it out ”, rather than acting it out in their real life situations. Where else might a child have an adult’s undivided attention and a place to do or say anything at all. Not being a parent or a teacher permits a therapist to have the unique privilege of meeting a child authentically on his or her own terms.

Some parents are reluctant to have their children enter therapy since they do not understand how it works. “We are not ready for the big guns.” as one parent put it. ”Will it stigmatize him?” is a question I have often heard. Perhaps they suspect the child will be subjected to interrogation or humiliating confrontation, assuming the child will face me in the chair and talk like a little adult, albeit one whose feet dangle above the floor. Oh children use the chair all right: sometimes they stand on it, try to jump off of it, lie upside down on it, but rarely will they just sit . As for the proverbial couch , kids lounge on it, cover themselves with the pillows, make it into a fort, or transform it into an island from which to escape from alligators.

Children typically like coming to therapy and do not find it a chore or intimidating. Younger children tend to “skip” out when the session is over. Near my door I have a whimsical button that says “Easy” on it; if pressed, a mechanical voice intones “That was easy” . For many children, this is the self -appointed exit move. Why was it easy? Perhaps because the therapy room feels like a place where one’s true self is welcomed.

Some parents wonder how to characterize me. , I suggest that parents call me a “feelings doctor” or a “worries doctor.” One six year old, upon completing her treatment, gave me a card: “Dear Dr. Susan. You are the best worries doctor that I ever had”. I was the first in fact.

Yet a spoon full of sugar does not always make the medicine go down. Despite the enjoyment factor, there can be moments when emotions heat up and children balk. In adults we call this push- back ”resistance” and it often arises when important but difficult conflicts come to the surface. Once articulated and tolerated by the therapist, the child is relieved.

When I was a child myself, a favorite book was Mrs. Piggle-Wiggle. She was a playful and eccentric woman who knew how to help children with all manner of problems. This book is still a classic. What was Mrs. Piggle -Wiggle’s secret? She could handle all the silliness, stubbornness, messiness and aggression that go along with childhood. Along with all my esteemed teachers and supervisors, Mrs. Piggle- Wiggle remains an important role model. Like her, a child therapist can “let the wild rumpus begin” and yet contain it. It’s not that hard when you know the ropes.

About the Author
Susan Scheftel Ph.D.

Susan Scheftel, Ph.D., is an assistant clinical professor of medical psychology in psychiatry at the Columbia Psychoanalytic Institute for Training and Research

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