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Kawa model case study – non directive play 2


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Kawa model case study – non directive play 2

  1. 1. KAWA MODEL CASE STUDYNON DIRECTIVE PLAY THERAPYAileen DuffQueen Margaret University08004355
  2. 2. AIMS AND OUTLINE OF PRESENTATION Application of a Case study using the Kawa Model Non Directive Play Therapy Show how Therapy can be evaluated Evidence Based Practice and Play Therapy
  3. 3. THE MEANING OF PLAY “Play is a transaction between a child and the environment that is intrinsically motivated, internally controlled and free of many of the constraints of objective reality” (Bundy,1991) Play is spontaneous, enjoyable, voluntary and non goal directed. An essential element in childhood – fundamental in growth and development. Through play children learn about the world and their relationships Enables children to express aggression and buried feelings (West, 1992)
  4. 4. PLAY THERAPY DEFINITIONPlay Therapy Non Directive Play Therapy Play Therapy is a  A form of therapy for relationship between the children where the child and the therapist in the setting of the therapist leaves playroom, where the responsibility and direction child is encouraged to to the child. This approach express himself freely, to emphasizes empowering release pent up emotions and to work through his the client, self-awareness, fear and anger so that he decision-making, and comes to be himself and acceptance of the clients functions in terms of his self. real potential and abilities. Axline, (1986)
  5. 5. KAWA MODEL IN PLAY THERAPY Water - Child’s Life Flow River Sides and Bottom , represent the child’s life environment – physical and social context Rocks - circumstances that might be disrupting the child’s life flow Driftwood - personal attributes and resources (Lim & Iwama,2006)
  6. 6. MEET BENBen Occupational Profile  Born 2005 – 6 yrs old  Volatile Early Parenting Born 2005 – 6 Yrs Old Relationships  Many House Moves Difficult Early Parenting Many House Moves Relationships  Traumatic bereavement Traumatic  Started school 2010 - Difficult Started school 2010 bereavement - Difficult behaviours behaviours- Now only attending for  School participation limited – limited time . impact on friendships  Sociable Enthusiastic Child, with a good ability to play  Grandmother has custody of three siblings – impact on roles
  7. 7. CONCEPTUALISATION OF BEN’S RIVER Separation anxiety Behaviours – limited participation atFamily – schoolgrandparents School Tragic& siblings Bereavement Impact on ability to make Play Therapy friendships Extended Family
  8. 8. NON DIRECTIVE PLAY THERAPY Uses play rather than verbal exchange as principal means of communication Based on Carl Rodgers Client- Centred Therapy Importance of the Therapeutic Relationship Allows children to work through and encourage alternative ways of managing anxiety and emotions Allows children to bridge the gap between experience and understanding (Axline,1969; Landreth,2002)
  9. 9. RATIONALE FOR REFERRAL TO PLAY THERAPY Used to treat children’s emotional and behavioural problems Children lack capacity for abstract thought and express themselves through play and activity Regain control, decrease anxiety and aggression As the child guides the sessions, it is responsive to their unique and varied developmental needs.  (Landreth,2002; Miller & Boe 1990; West,1992)
  10. 10. GOALS OF PLAY THERAPY To provide a trusting relationship and a safe space’ for Ben to discover his strengths and begin deal with l emotional issues To enable Ben to experience a feeling of control To enable Ben to develop a positive self concept To enable Ben to experience some understanding of his emotions and behavioursIn time,-to allow Ben to function comfortably within his external environment ( particularly school)-To maximise the opportunity for Ben to pursue developmental milestones. Landreth(2002)
  11. 11. INTERVENTION - PLAY ACTIVITIES Actively engaged Uniqueness of Creative in creating a story own medium personality Plays out themes Expression – opens communicationFacilitated two Safe containmentway Emotional relaxationengagement Connecting to Sensory/tactile – experiences compensates for lost early play ? West,1992; Lu et al(2010); Ryan and Wilson (2000)
  12. 12. EVALUATION OF THE PROCESS OF THERAPY Child Reports Parent, Thera Objective pist or Measures Teacher Reports Therapy Evaluation (Naylor,2005;Dods, 1987)
  13. 13. EVALUATION THE PROCESS OF THERAPY Initial issue that brought Ben therapy Within Play If maladjusted or regressive play develops -More Balanced Play Less focussed, more emotionally appropriate Child Therapist Relationship Improved through engagement in activity Greater connection with outside world Behaviours Aggression, Anger, Regression, Impulsiveness More appropriate in a variety of settings Internally within the child Improved self esteem, confidence, appropriate maturity and attachment (Naylor,2005)
  14. 14. EVALUATION OF BEN’S THERAPY • Happier at home; getting on well with Ben family • Friends and coping with school • Improvement in home behaviours Gran • Not necessary to stay at school • More supported/able to return to roles • Less separation anxiety School • Fewer behaviours in classroom • Member of school community
  15. 15. EVIDENCE BASED PRACTICE IN PLAY THERAPYo A Challenge for research ? (Carrol, 2000)o Positive Outcomes Across Many Modalities (94 studies) Ray et al (2001); Wilson & Ryan (2001) Parent’s Views Reductions in Parent-Child Stress Observed improvements in behaviours Brattan et al(2005) Ray(2008)o Children’s Views o The importance of the Therapeutic Relationship Carrol, J (2000) Jaeger and Ryan (2007)
  16. 16. WIDER POLICYGetting it Right for Every Child Objectives of Play Therapy  Developmental approach  Develop more positive self concept  Building upon strengths ; support family solutions  Experience a feeling of control  Self accepting  Trusting of themselves and others Changing Practice Contexts : Reduced funding / EBP/  Learning – in a positive Mergers /Changing Cultural environment Contexts of Play
  17. 17. REFLECTIONS USING KAWA Holistic non-mechanistic approach Occupation Focussed Interventions Setting – Captures the complexities of contextual factors Clinical Reasoning Longitudinal aspect and Cross Sectional Aspect Benefits of play therapy “SPRINGBOARD TO BOUNCE INTO THE FUTURE” (WEST,1992)
  18. 18. REFERENCES I Axline (1986) Dibs – In Search of Self . New York. Ballantine Books. Blunden, P. (2001). The therapeutic use of play. In: L.Lougher (Ed.), Occupational therapy for child and adolescent mental health (pp. 67–86). Edinburgh: Churchill Livingstone. Bratton, S., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A Meta-analytic review of the outcome research. Professional Psychology: Research and Practice, 36(4), 376-390. Carroll, J. (2002). Play therapy: The children’s views. Child & Family Social Work, 7, 177-188. Dodds(1987) A Child Psychology Primer – suggestions for the Beginning Therapist. New York. Human Sciences Press Incorporated.
  19. 19. REFERENCES II Finlay, L.(2004) The Practice of Psychosocial Occupational Therapy. 3rd ed. Cheltenham. Nelson Thornes. Galligan, A. (2000)The Place Where We Live : The Discovery of Self through the Creative Play Experience. Journal of Child and Adolescent Psychiatric Nursing. 13(4) 169-176. Hammond. D.,(2010) If We Dont Let Our Children Play, Who Will Be the Next Steve Jobs? Online [ dont-let-our-children_b_1017485.html Humphry, R. (2002).Young children’s occupations: Explicating the dynamics of developmental processes. American Journal of Occupational Therapy, 56,171–179. Jaeger, J and Ryan, V (2007) Evaluating clinical practice: using play-based techniques to elicit children’s views. Clinical Child Psychology and Psychiatry, 12(3), 437-450.
  20. 20. REFERENCES III Landreth(2002) Play Therapy :The Art of the Relationship. UK. Brunner-Routledge. Lim, H. & Iwama, M.K. 2006. Emerging models- An Asian perspective: The Kawa (River) Model. In Duncan, E.A.S. (ed). 2006. Foundations for practice in occupational Therapy. 4th Edition. Elsevier Limited: London. Miller, C., & Boe, J. (1990). Tears into diamonds: Transformation of child psychic trauma through sandplay and storytelling. The Arts in Psychotherapy, 17, 247-257. Naylor, A (2005) When a Child Plays - Analysing Change in Non-Directive Play Therapy. Counselling and Psychotherapy Journal. 16(5) 29-31. Ray, D., Bratton, S., Rhine, T., Jones, L., (2001) The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10(1), 85-108.
  21. 21. REFERENCE IV Rigby,P, Rodger,S (2006) Developing as a Player. In :Rodger S,Zivaini j (eds) Occupational Therapy with Children:understanding children’s occupations and enabling participation. Oxford. Blackwell. Rodger, S.(2010) Occupation Centred Practice with Children. A Practical guide for Occupational Therapists. Queensland. Wiley Blackhall. Ryan V., Wilson, K. (2000) Case studies in nondirective play therapy. London. Jessica Kingsley Publishers. Scaletti, R. &Hocking C. (2010) Healing through story telling: An integrated approach for children experiencing grief and loss. New Zealand Journal of Occupational Therapy,52(2),66-71 West, J. (1992) Child-Centred Play Therapy. London. Arnold Publishers. Wilcock, A.(2006) An Occupational Perspective of Health. New Jersey. Slack Incorporated