Play Therapy: Resolution of Core Feelings through Play

A common assertion in play therapy texts is that children are unable to free associate, and therefore play is employed as an alternative medium of expression. When one considers that the natural mode of thought for the young child is associative in nature, upon first glance such an assertion may seem somewhat paradoxical. The young child happily produces a chain of associations as he or she flits from one thought to another in seemingly illogical fashion. So what does it mean to say that free association is developmentally inappropriate? I will first examine the reasons suggested by those psychodynamically oriented therapists, and then attempt to indicate how the application of cognitive-developmental principles provides a complementary set of explanations.

Anna Freud (1965) offered the most comprehensive account of the reasons why children do not make use of free-associative techniques and why they resist the verbal interpretations offered by the analyst. The psychodynamic considerations she raises can be cast into a general two-stage developmental framework, examining the reasons why free association is unworkable with both the (1) oedipal and the (2) latency-age child. It should be noted that the general psychoanalytic task is to bring unconscious material into consciousness.

Several reasons can be offered for why the young, oedipal child is unable to make use of free association toward this goal:

1. The natural mode of expression for the young child is action. Thus the oedipal child prefers to "act out" thoughts, fantasies, and conflicts rather than to talk about them, since the verbal facility for such expression is relatively weak.
2. The expression of id impulses may be too threatening. The analysis of primary process material depends upon strongly developed secondary thought processes, which have not yet been developed by the young child.
3. Unlike adult patients, the young child is less likely to accept a contract with the therapist to obey the "rules" of treatment, one of which involves free association.
4. The young child cannot adopt a long-term perspective in which temporary anxiety, experienced in the short run, is tolerated because it is viewed as necessary for long-term gain. Thus the young child chooses simply to avoid activities which cause immediate anxiety and discomfort.

Somewhat different reasons are invoked to explain why the latency-age child cannot make use of free association:

1. Latency, by definition, is a period during which id impulses are stifled. made latent. Numerous defenses and resistances are called upon to prevent the surfacing of threatening unconscious material.
a. Since the ego is precariously balanced and extremely fragile during the emergence of this new stage, the defenses which are mobilized may be particularly rigid.
b. Since emerging new defenses join the existing more primitive defenses, the repressive barrier is exceedingly difficult to penetrate.
2. Related to these changes in latency is an amnesia for the past and the urge to outgrow or reject the events in one's early childhood. The unveiling of id material runs counter to the ego's desire for mastery.
3. During latency there is also little motivation to engage in a contract with the therapist. The child does not understand the need to go "backward" in order to progress "forward."
4. Furthermore, there is a tendency for the child to externalize conflict; environmental solutions are thus preferred to internal or intrapsychic analysis and change.

What does a cognitive-developmental understanding add to this psychodynamic explanation? In order to answer this question, it is first necessary to distinguish between three related aspects of free association as a therapeutic technique with adults: the actual process itself, the intended effect, and the therapeutic goal:

1. The actual process requires that the patient suspend logical thinking and report everything that passes through his or her mind; one is urged not to censor thoughts.
2. The effect of so doing is to sidetrack or overcome repression and thereby to bring forth unconscious material into consciousness.
3. The therapeutic goal is to make interpretive connections by the analyst possible, and, as a result, bring unconscious material into the range of the patient's conscious insight.

A cognitive-developmental analysis of why this technique cannot be employed fruitfully with children can be directed toward two Piagetian stages of development, the preoperational and the concrete operational period, which correspond to the oedipal and latency periods, respectively. The natural mode of thought for the preoperational child is by definition associative or "transductive" as Piaget described it; the child does not reason inductively or deductively, but cognitively moves from one thought to another, stringing them together nonlogically. Thus, the actual process of free association would not seem to be the problem for the young child.

The limitations of the preoperational period which make use of free association problematic would appear to be as follows:

1. The effect of the free-associative process, to bring unconscious material into consciousness, may not be tolerated by the young child. Fantasy material, directly produced by the child, may be extremely frightening to the extent that the tendency toward "realism" is operative during this period. That is, the child's confusion between fantasy and reality may cause him or her to interpret a scary thought as a "real" event and not just the product of his or her thoughts or imagination. This, in turn, would stifle further productions.
2. Whereas the young child may generate associations, the prelogical child is unable to appreciate the connections and to view them as casually or meaningfully related. The lack of logical thought makes it impossible for the young child to understand, much less accept, the therapist's analysis of the freeassociative productions. Thus, the therapeutic goal cannot be achieved.
3. The egocentrism of the preoperational period further mitigates against the acceptance of an interpretation by the therapist, since the young child cannot yet adopt the psychological perspective of another person. Thus, the young child cannot utilize different perspectives as a potential means of correcting his or her own perspective.
4. Finally, Inhelder and Piaget (1958) have pointed out that the form and complexity of adult language, not yet mastered by the young child, is unsuited to his or her affective needs. For this reason young children create their own system of symbols and signifiers, those found in make-believe play. Therefore, direct interpretations made by the therapist are not likely to be understood.

Assuming that certain limitations of preoperational thought are overcome during the period of concrete operations, why should the use of free association also be problematic at this more advanced stage?

1. The advent of concrete operations brings with it a general penchant for the logical organization and classification of the objects, events, and occurrences in the child's world, a thrust which runs counter to the demands of free association. Thus, the concrete-operational child would have considerable difficulty engaging in the actual process of free association.
2. The newfound logical abilities which emerge during this period are directed toward an analysis of concrete events in the external world, as the title of this stage implies. The child shows little interest in analyzing internal events such as thoughts, wishes, or fantasies. To the extent that one can coerce a child of this stage to produce associations, they will tend to be a logical ordering of publicly observable phenomena in the real world, that is, lion, tiger. elephant, zebra, kangaroo, or Staubach, Plunkett, Bradshaw, Tarkenton! Thus, the intended effect of the free-associative process will not be achieved.
3. The very ability to think about one's thinking, to reflect on one's thoughts, may simply not be present at this cognitive-developmental level. The analysis of free-associative material may well depend upon a form of introspection which requires higher level skills of abstraction that do not emerge until the period of formal operational thought, at adolescence- Thus, although the child of this stage is able to think logically about certain concrete events, the therapeutic goal will not be realized given that he or she cannot treat his or her own internal thoughts as an object of reflection.

From this type of analysis, then, we can appreciate why free association is an inappropriate technique for children. Clinicians have long been aware of this fact, an awareness which has promoted the search for alternative therapeutic techniques. However, this conclusion has typically been based on psychodynamic considerations. There has been much less emphasis on how cognitive-developmental factors influence or limit the effectiveness of free-association as a technique. The primary purpose of this examination and review has been to illustrate how a consideration of the developing child's cognitive level can illuminate our understanding of how effective a particular form of therapeutic intervention might be. As such, it sets the stage for the next section, which will explore how cognitive-developmental factors influence the child's understanding of emotions, motives, and the self.
- Schaefer, Charles & Kevin O'Connor, Handbook of Play Therapy, John Wiley & Sons, New York: 1983.

Pretend Play, Coping, and Subjective Well-Being in Children

- Russ, Sandra W., Primary Process Thinking, Divergent Thinking, and Coping in Children., Journal of Personality Assessment 52:539–48.,1988.

Personal Reflection Exercise #6
The preceding section contained information about why children cannot free associate. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Developmental Stages of Social Emotional Development in Children

- Malik, F., & Marwaha, R. (2022). Developmental Stages of Social Emotional Development in Children. In StatPearls. StatPearls Publishing.

Peer-Reviewed Journal Article References:
Halfon, S., Yılmaz, M., & Çavdar, A. (2019). Mentalization, session-to-session negative emotion expression, symbolic play, and affect regulation in psychodynamic child psychotherapy. Psychotherapy, 56(4), 555–567.

Meany-Walen, K. K., Cobie-Nuss, A., Eittreim, E., Teeling, S., Wilson, S., & Xander, C. (2018). Play therapists’ perceptions of wellness and self-care practices. International Journal of Play Therapy, 27(3), 176–186.

Siu, A. F. Y. (2021). Does age make a difference when incorporating music as a rhythmic-mediated component in a theraplay-based program to facilitate attunement of preschool children with social impairment? International Journal of Play Therapy, 30(2), 136–145.

Online Continuing Education QUESTION 20
Anna Freud's account of the reasons why children do not make use of free-associative can be cast into what two-stage developmental framework? Record the letter of the correct answer the CEU Test.