By Helen Roxborough, RN, MFT
(Nov/Dec 2002)

During the course of my career working with children in therapy, I have had the opportunity to play a “role” in many unique scenarios with these young clients as they work through the issues that bring them to my office in the first place. We talk to one another in the language of symbol and metaphor. The child gets to be the producer, director and central character in the enactment of their unconscious process. In the interest of exploring this territory with children, I have been shot, beheaded, carved into small pieces, crushed by an avalanche, and fallen into hot lava. I have been a bank robber, a very bad child and a mean teacher, as well as a doctor who cures teddy bears and stuffed animals, or a worried mother taking my doll-child to the doctor. Every day is a different adventure.

With grown-up clients, the work in therapy so often includes addressing the client’s resistances and defenses. These very defenses, however, protect the therapist as well as the client from the full impact of the unconscious material and the full intensity of its raw and unbounded form. There is no such taming of primitive forces, no defenses to battle with and few barriers to the unconscious content in active play therapy with children when the avenues of expression are the symbols and metaphors that abound in the child’s ability to pretend. The therapist is invited to participate in the drama associated with the child’s unconscious dilemma.

One example of this process occurred in the therapy of an eight year old boy diagnosed with attention deficit disorder, whose very emotionally distraught mother was unable to set behavioral limits with her son. For session after session he would lie down on the floor and direct me to “put him together.” There were imaginary drawers and cupboards of eyes and hands and legs and so forth, and he would quite specifically tell me, “now put on my arm,” or “now you made a mistake and put the feet on backwards” until all the body parts had been assembled. The final task was to insert the brain, and I was directed to put in the “wrong brain” each time. The client would then rise up like Frankenstein, arms outstretched in front of him, and stagger about the room, knocking things off the shelves aggressively and bumping into furniture. Over and over again we played out this scene until one day he told me to insert the “right brain” instead. The transformation was astonishing. He got up hesitantly, like a new born fawn, unsteady on his feet and looking somewhat awestruck. He required assistance back to the waiting room as he maintained his unsteady gait. The metaphor of the “wrong brain” and his diagnosis of attention deficit disorder and what this meant to him is apparent, further fueled by the lack of external limits in the home. This child would never be able to say in words that he felt like a ‘monster’ inside, but he could tell me this through his play, and he could also let me know, metaphorically, the status of his healing process. How wonderful that he could arrive at a new experience of himself, one that was no longer monstrous.

Another client, a four and a half year old girl, had difficulty adjusting to school, wanted the teacher's attention excessively, and had trouble making friends with peers. As an only child she had been indulged, with few limits so that her ‘creative expression’ would not be thwarted. Repeatedly in our sessions she directed me as her pretend mother to call up all her friends to come to her second birthday party. We wrapped playroom toys in doll blankets and Kleenex for her presents, and she instructed me to bake a birthday cake. She talked in a two year old voice and language as she delighted in opening all the presents and having this party. How clearly she was able to tell me about her developmental block--the very age at which she became stuck, unable to move towards autonomy and separateness. After many repetitions of this play, she was able to move on to more age appropriate activities, and to advance to the next psychological level of development. Play therapy allowed her to play out and resolve issues which could not have been approached in a verbal milieu.

In active play therapy, the therapist is invited to participate in the client’s unconscious expression in a highly personal way. This requires some courage on the part of the therapist to enter into a client’s world of pain and anguish, and for a time to be an integral part of the client’s internal experience. One client in particular reminds me of these somewhat exceptional demands: Therapy with this six year old boy was always a challenge. On one very significant occasion he instructed me to sing him a lullaby. We fashioned a ‘bed’ out of two chairs for him to lie on and I sat next to him and began to sing. “Rock a bye baby on the tree top.” He directed me to sing in a “croaky” voice, so I did my best. “When the wind blows the cradle will rock.” My client became upset that this was not ‘croaky’ enough, so I tried even harder. “When the wind breaks the cradle will fall.” This was still not croaky enough for my young client, so in an extremely uncomfortable voice that hurt my throat and my heart, I continued with “Down will come cradle, baby and all.” No words could explain more succinctly the residue of the extreme lack of early nurturing that this client had experienced, and I felt this personally and deeply as I played out with him his life drama in this moving session.

To be fully known, understood and accepted at a deep level is the wish and longing of us all. For clients in therapy this is the very profound element necessary for healing. With children in therapy, engaging with them actively through play provides an avenue for this expression and communication through symbol and metaphor. The demands on the therapist in this healing profession are great at times, but the rewards of witnessing growth, progress and relief from emotional distress is priceless.

Helen Roxborough, R.N., M.F.T. has a private practice located in Pleasant Hill. Her areas of specialty include sandtray and play therapy with children, family and couples therapy and women’s personal growth. Helen has taught graduate level courses in Marriage and Family Therapy, and has supervised interns in agency and private practice settings. She can be reached at (925) 685-8844.

Note: This article reflects the opinions of the author and not necessarily those of
East Bay CAMFT.