Literature Review © 2017 Laureate Education, Inc. .docx

Literature Review
© 2017 Laureate Education, Inc.
1
Literature Review
Program Transcript
[MUSIC PLAYING]
NARRATOR: Have you ever thought about a literature review
as representing
your intellectual heritage or intellectual genealogy? In his
exploration of the
purpose of a literature review, Dr. Patton explains this
interesting perspective. He
also points out common errors to avoid when undertaking a
literature review.
MICHAEL QUINN PATTON: One of the things that we do as
scholar practitioners
is look at the knowledge created by other people. And we draw
on that
knowledge as a way of positioning our own work and
understanding where our
contribution to knowledge, our own research, fits in that larger
tradition. This is
often referred to as the literature review. And the way that you
go about knowing

the knowledge that others have generated, that you're going to
build on and
contribute to, is to conduct a literature review.
I tend not to like that terminology, because it sounds like the
purpose is to review
the literature. Literature review is actually a means to another
end. And it's that
end, it's that purpose of conducting the literature review that I
want to focus on.
The purpose is for you to understand your intellectual heritage,
your intellectual
genealogy. Anytime we undertake an inquiry into a particular
issue, we are
building on the knowledge of others. And we need to know what
that knowledge
is. It's part of our obligation as scholars, is to understand what
work has come
before us, what concepts we've inherited, what methods we've
inherited, what
measures we've inherited. Some of which we've adopted, some
of which we've
parted from. But we need to know that.
Because at the end of a program of study, a master's degree, a
program of
doctoral inquiry, you're going to be expected to be able to
locate your work within
that tradition. And so it means that you need to be able to
establish the people
who formulated the basic distinctions that you're drawing on.
Let me share with you some of the mistakes that I, from my
point of view, find
students engaging in when they undertake the literature review.

One of these is
to simply do an internet search to see how many articles they
can find on a topic.
Where they think that the game is how many citations you can
come up with to
show that you've done the literature review.
This isn't a quantitative game. It's not something where the
number of sources is
important. It's the quality of those sources and your engagement
with them, that
you are able to engage with what other people have done and
understand what's
relevant, what's not relevant to your own area of inquiry. So
that you're
positioning yourself out of those traditions that others have
engaged in.
Literature Review
2
A second error is to think that the game is to position your work
as unique. It is to
try to find something that nobody else has ever done, to say
nobody else has
ever studied this before. Likewise, for any given field, there are
burning questions
that have defined that field.

In sociology, which is my own field, all sociology derives from
what we call the
Hobbesian question of order. What holds society together? Why
doesn't society
fall apart? Every sociological question stems from that question
that Hobbes
asked. And therefore, if you look at sociology articles in the
premier journals, the
American Sociological Review, the American Journal of
Sociology, you'll find that
they typically begin with a reference to Hobbes or to Durkheim
time or to Weber
or to Marx who were asking the original burning questions in
psychology and
sociology.
In psychology, you'll find original references to Freud and to
Adler and to Jung
that go back to things like the notion of the unconscious. And
whether you agree
or disagree with various aspects of Freudian theory, the notion
that there's an
unconscious mind and that that unconscious mind makes a
difference in what we
do is a part of what has framed modern psychology.
And so you stand on the shoulders of people who are trying to
understand how
the mind works, and who have divided off from those original
classical theorists
and researchers about how the mind works. The burning
question in psychology
is, why do we behave as we behave? How do we think and feel?
How do we
know and engage the world? And so you need to know who the
classic people

were who were asking those questions, who their disciples were,
what were the
splits along the world, along the journey where one group went
in this direction
and another group went in another direction?
Up to the more recent published research, and up to the kind of
work that's now
going on that may not yet be published, where you can get in
touch with those
people who are engaged in research now. Find out what the
funded research is
from the National Institutes of Health, the National Institutes of
Mental Health, the
major foundations. And find out what cutting edge work is
going on so that you
have a full scale genealogy of what your intellectual tradition
is.
When you have finished that inquiry over a period of time,
you're able to then
say, these are the people on whose shoulders I stand. These are
the intellectual
traditions that I'm a part of. This is my intellectual DNA. Here
is what I've drawn
on. Here are the places where I'm departing from others. And
here is where I'm
going to make my contribution. That's the purpose of a
literature review. You're
positioning yourself in a stream of knowledge, in a flow of
knowledge.
As a part of that work, a third error that I think students often
make is to only read
second-hand and third-hand accounts of the classics. The
classics got to be

Literature Review
3
classics for a reason. People over the years read those works
and found the
thinking in them profound.
Yes, in some cases, the findings may be out of date. But a part
of what you ought
to be learning as you engage in a literature review and in your
intellectual history
is not just the specific findings. You are learning how scholars
think. You're
learning how scientists think. You're learning how a researcher
thinks.
So read those works not only for what they found out. Read
them for their
methods. Look for the methods-findings linkage. How did
particular findings yield
and come from particular methods? How did those methods
develop over time?
And how did the classic writers think about things, inquire into
things?
So as you're engaging in that, it has two streams that you're
paying attention to.
One is the theoretical stream. What are the findings? What are

the constructs
that you've inherited? And the other is the methodological
stream. What are the
methods of inquiries, the measures, the instrumentation, the
ways of going about
recording what you observe that we've inherited?
Both of those are your rich inheritance as scholar practitioners.
And one of the
things that you ought to come out of your education with is
knowing what that
intellectual heritage is, both conceptual and methodological,
and then where
you're going to make your contribution.
A. Write three (3) sentences(a total of 100 wordsor less),to
briefly explain what it means for a language to be compiled.
`
B. Some programming languages, for example Pascal, have used
the semicolon to separate statements, while Java uses it to
terminate statements. Which of these, in your opinion, is most
natural and least likely to result in syntax errors? Justify your
answer in three (3) sentences(a total of 100 words or less)
COUN 6626: Research Methodology and Program Evaluation

© 2019 Walden University 1
Week 4 Scholarly Article Content Analysis Preparation Guide
Please review the following information to help you prepare for
the Week 4 Assignment
Components of a Research Article
Title and Author Information: The title of the article is
important as it is a critical element for
identifying the article when searching data bases. In
professional counseling journals, the
author who most substantially worked on the draft article and
the underlying research becomes
the first author. The others are ranked in descending order of
contribution. However, in many
disciplines, such as the life sciences, the last author in a group
is the principle investigator—the
person who supervised the work.
Abstract: a brief (approximately 120 words) summary of the
entire article. It should include
• the problem under investigation or the hypothesis
• pertinent information on the participants
• brief review of methodology
• statistical analyses
• results of the study/implications of the study.
Introduction: begins with a broad statement of the problem
under investigation and then
proceeds to narrow the focus to the specific hypothesis(es) of
the study. The purpose of this

section is to introduce the reader to the overall issue/problem
that is being investigated and to
provide a rationale for the research. In order to accomplish
these tasks, the author needs to
review past research on the same topic and present previous
results.
Methods: provides a detailed description of how the current
study was conducted. This section
outlines the procedures that the researchers followed to recruit
participants, collect, and analyze
data. An overarching goal of empirical studies is the
replication of research. It is in the Method
section that authors need to specify their participants and
procedures to allow others to
duplicate the study. Think of this section as being an overview
of the procedures that tell you
the who, what, when, where and how of the research.
Results: reporting of the data. Also known as outcomes, the
purpose is to describe what was
found analyzing the data. In quantitative studies, it includes a
description of the statistical
analysis and tables and figures are often used to convey
important information in an organized
manner. In quantitative studies, the themes or explanations are
described along with the
processes used to determine these findings such as coding.
Discussion: reviews, interprets, and evaluates the results of the
study in a narrative form .
Discussion sections typically begin by listing the hypotheses
and then stating if the results
supported or contradicted the hypotheses. Next, writers usually
discuss similarities and
differences between the current findings and findings of
previous research. Any strengths or

weaknesses of the current study are also reviewed, and
suggestions are made on improving the
research design. Also called “findings”, the discussion can
include implications of the research
and how the results are connected to counseling practice.
Finally, a discussion section usually
ends with the writer providing suggestions for future research.
References: A list of all sources used during the development or
completion of the research or
the interpretation of the results. It is critical to document all
sources of information and all
research that was referenced or used to guide the study.
Week 4 Article Analysis
The following information is a step by step guide for
completing the worksheet.
Assignment Questions Tips
1. Peer Review
Is the article above a peer-
reviewed, scholarly source

Peer review is part of the editorial process an article goes
through before it is published in a peer-reviewed journal.
Once an article is submitted to a peer-reviewed journal, the
journal editors send that article to "peers" or scholars in the
field to evaluate the article. To determine if a journal is
peer reviewed (also sometimes called refereed journals),
try one or both of these steps:
• Look up the journal in the UlrichsWeb.com
(available on the A-Z Database List) and determine
whether it is identified as peer reviewed.
• Examine the journal’s website and review the
submission and editorial process for evidence of
peer review.
2. Problem Statement and
Research Question(s).
What is the (a) problem the
researchers were
investigating/purpose of the
research and (b) research
question the researchers were
trying to answer?
All studies have a research question that drives the
investigation (what the researchers are trying to learn).
Sometimes this is formally stated while other times the
reader must discover this information which can usually be
found in the Abstract or the Introduction section. The
Results section or the Discussion section will provide the

answer(s) to the research question. Research studies can
use either quantitative, qualitative or mixed methods to
investigate the question. Sometimes researchers are
investigating more than one intervention and so research
questions may include multiple parts. Be sure to review all
parts of the inquiry or use multiple questions to explain.
3. Sample/Participants
Describe the sample/participants
in the study (including how many
participants were in the study).
Participants are also known as the sample. Quantitative
studies generally have larger samples sizes than
qualitative studies. Case studies may have one main
“case” which may include a single person, a family, a
group, or community. You want to describe who (e.g.,
demographics) and how many persons participated in the
study.
4. Procedures:
Did the researchers secure

permission to conduct the study
and/or secure informed consent
from the participants?
Were there any cultural concerns
noted?
Informed consent is a critical part of ethical research. The
procedures for informed consent are usually described in a
methods section, however, not all authors specifically state
the informed consent process.
Cultural considerations are related to research procedures.
Consider whether there were cultural elements that may
have changed the way the study took place such as
language barriers, the need for an interpreter, and whether
the sample matches the population that the researchers
say they are studying.
The key is to consider what cultural factors are pertinent to
the research question. If you say you are studying an
intervention for depression, the sample needs to include
persons with depression. If a study is not specific to race
or gender, for example, that does not make it culturally
insensitive if the researches didn’t set out to learn about
that intervention specifically applied to race or gender.
5. Data:
Identify exactly what data was
collected by the researchers within

the study.
Is the data quantitative (numeric
data such as scores on
assessments like the Iowa Basic
Skills Test (IBST) or the Beck
Depression Inventory (BDI)?
Is the data qualitative (for
example, clinical intake interviews
or a narrative behavioral
observation?
The variables or phenomenon being investigated is
usually found in the introduction and method sections (and
sometimes the abstract). For example: if a researcher is
investigating an intervention for the treatment of
depression. The variable may be “level of depression” and
the data collected could be scores on the Beck Depression
Scale.
All data points represent something the researcher is trying
to investigate. Data can be quantitative (like a
measurement, frequency, or score that is represented by a
numeral) or qualitative (data captured using written or
spoken words, observations or photos). This includes
things like student academic or behavioral records,
historical documents, records, or artifacts like diaries,
journals or case notes.

6. Analysis:
What was the outcome/the
general findings of the study?
What is the answer to the
research question?
The authors identify if the results of the investigation
support their hypothesis and present the major findings.
The Results present the answer to the question the
researchers were trying to learn. Keep in mind that when
you are investigating an intervention, the findings could be
mixed. In other words, the intervention might be
successful, not successful, or partially successful.
7. Results/Discussion
Based on your understanding of

the findings, discuss how the
outcomes can be generally
applied to counseling practice.
The discussion is where what the authors present how the
results can be applied when working with clients or
students. The authors will articulate their greatest take
away is from the study outcomes and what they view as
most important to know to meet the needs of clients or
students with similar needs.
8. Application
How does this research apply to
the case study?
While there are similarities and differences between the
article and the case study on the worksheet, describe how
the general outcomes from the article relate to the case
study. Explain your insights into how the information from
the article could be useful to meet the needs of the case
study. NOTE: As a counselor, what did you learn from the
outcomes of the research study in the article that you could
use in developing treatment goals or action plans for the
child in the case study on the worksheet?

Week 4 Scholarly Article Content Analysis
Case Conceptualization:
Orion is a 4-year-old African American child. He comes into
counseling referred by his primary pediatrician. Orion has been
diagnosed with an autism spectrum disorder. He has difficulty
with communication, has deficits in empathizing with others’
intentions, and struggles with single-mindedness. Orion’s
parents and preschool teacher have noticed a pervasive pattern
of emotional dysregulation which includes frequent episodes of
hysterical crying. Orion’s parents are concerned that he is not
going to be promoted to kindergarten next year if he does not
improve his ability to relate positively with others and improve
his ability to regulate his emotions.
Article:
Kenny, M. C., & Winick, C. B. (2000). An integrative approach
to play therapy with an autistic girl. International Journal of
Play Therapy, 9, 11–33. doi:10.1037/h0089438
1. Is the article above a peer-reviewed, scholarly source?
Click or tap here to enter text.
Tip: Peer review is part of the editorial process an article goes
through before it is published in a peer-reviewed journal. Once
an article is submitted to a peer-reviewed journal, the journal
editors send that article to "peers" or scholars in the field to
evaluate the article.To determine if a journal is peer reviewed
(also sometimes called refereed journals), try one or both of
these steps:
· Look up the journal in the UlrichsWeb.com (available on the
A-Z Database List) and determine whether it is identified as
peer reviewed. Ulrich's is a directory. It is a searchable list of

periodicals (magazines, journals, newspapers, etc.). It provides
information about each periodical such as publisher, scope, and
whether the journal uses peer review.
· Examine the journal’s website and review the submission and
editorial process for evidence of peer review.
2. What is the (a) problem the researchers were
investigating/purpose of the research and (b) research question
the researchers were trying to answer?
Tip: All studies have a research question that drives the
investigation (what the researchers are trying to learn).
Sometimes this is formally stated while other times the reader
must discover this information which can usually be found in
the Abstract or the Introduction section. The Results section or
the Discussion section will provide the answer(s) to the research
question. Research studies can use either quantitative,
qualitative or mixed methods to investigate the question.
Sometimes researchers are investigating more than one
intervention and so research questions may include multiple
parts. Be sure to review all parts of the inquiry or use multiple
questions to explain.
3. Describe the sample/participants in the study. Be sure to
include how many participants were included in the study.
Tip: Participants are also known as the sample. Quantitative
studies generally have larger samples sizes than qualitative
studies. Case studies may have one main “case” which may
include a single person, a family, a group, or community. You
want to describe who (e.g., demographics) and how many
persons participated in the study.

4. Did the researchers secure permission to conduct the study
and/or secure informed consent from the participants? Were
there any cultural concerns noted?
Tip:Cultural considerations are related to research procedures.
Consider whether there were cultural elements that may have
changed the way the study took place such as language barriers,
the need for an interpreter, and whether the sample matches the
population that the researchers say they are studying.
The key is to consider what cultural factors are pertinent to the
research question. If you say you are studying an intervention
for depression, the sample needs to include persons with
depression. If a study is not specific to race or gender, for
example, that does not make it culturally insensitive if the
researches didn’t set out to learn about that intervention
specifically applied to race or gender.
5. Identify exactly what data was collected by the researchers in
the study.
Is the data quantitative (numeric data such as scores on
assessments like the Iowa Basic Skills Test (IBST) or the Beck
Depression Inventory (BDI)?
Is the data qualitative (for example, clinical intake
interviews or a narrative behavioral observation?
Tip: The variables (e.g., substance abuse) or characteristic (e.g.,
geographic location) being investigated is usually found in the
Introduction and Method sections (and sometimes the Abstract).
For example: if a researcher is investigating an intervention for

the treatment of depression. The variable may be “level of
depression” and the data collected could be scores on the Beck
Depression Scale.
All data points represent something the researcher is trying to
investigate. Data can be quantitative (like a measurement,
frequency, or score that is represented by a numeral) or
qualitative (data captured using written or spoken words,
observations or photos). This includes things like student
academic or behavioral records, historical documents, records,
or artifacts like diaries or case notes.
6. What was the outcome or the general findings of the study?
What is the answer to the research question?
Tip: The Discussion section is where what the authors present
how the results can be applied when working with clients or
students. The authors will articulate their greatest take away
from the study outcomes and what they view as most important
to know to meet the needs of clients or students with similar
needs.
7. Based on your understanding of the findings, discuss how
the outcomes can be generally applied to counseling practice.
Tip: The authors identify if the results of the investigation
support their hypothesis and present the major findings. The
Results section and the Discussion section present the answer to
the question the researchers were trying to learn. Keep in mind
that when you are investigating an intervention, the results

could be mixed. In other words, the intervention might be
successful, not successful, or partially successful.
8. How does this research article apply to the case study at the
top of the worksheet?
Tip: While there are similarities and differences between the
article and the case study on the worksheet, describe how the
general outcomes from the article relate to the case study.
Explain your insights into how the information from the article
could be useful to meet the needs of the case study.
NOTE: As a counselor, what did you interpret from the
outcomes of the research study in the article that you could use
in developing treatment goals or action plans for the child in the
case study on the worksheet?
International Journal of Play Therapy, (9)1, pp. 11-33 Copyright
2000, APT, Inc.
AN INTEGRATIVE APPROACH TO PLAY
THERAPY WITH AN AUTISTIC GIRL
Maureen C. Kenny
Florida International University

Charles B. Winick
Florida International University
Abstract: Autistic children who are brought for psychological
treatment are
usually experiencing social and emotional difficulties common
to autism. In
addition, their parents may be in need of support. An integrative
approach to
treatment that utilizes the rapport building component of
nondirective play
therapy with directive techniques is presented. This approach
targets
maladaptive behavior and parent education. This case study
describes a brief
course of therapy in which an 11-year-old autistic female client
experienced
increases in social behavior and compliance at home and
displayed a less
irritable mood. The course of her therapy and specific
interventions are
examined.
Play therapy is often recognized as an effective approach for the
psychotherapeutic treatment of children (Cohen, 1995;
O'Connor &
Schaefer, 1994). Play therapy has undergone many revisions,
and many
applications of play techniques today are used with a variety of
children.
It is used to treat children who are victims of abuse and neglect
(Kot,
Landreth, & Giordano, 1998; Mann & McDermott, 1983;
VanFleet, Lilly,
& Kaduson, 1999), children of divorced parents (Mendell,
1983), cross-

gender identified children (Rekers, 1983), and those children
described
as aggressive/acting out (Allan & Levine, 1993; Willock, 1983).
In
addition, play therapy is utilized in the treatment of children
with
obsessive-compulsive disorder (Gold-Steinberg, & Logan,
1999), learning
Maureen C. Kenny, Ph.D., and Charles B. Winick, Psy.D.,
Florida International University,
Fort Lauderdale, Florida.
12 Kenny & Winick
disabilities (Guerney, 1983b), anxiety (Kottman, 1998;
Oaklander, 1993),
physical impairments (Salomon, 1983), and developmental
disabilities
(Leland, 1983).
Unfortunately, little has been written on the use of such
techniques with children suffering from pervasive
developmental
disorders, such as autism. In fact, a survey of play therapists
conducted
by Phillips and Landreth (1998) reported that fewer than 20% of
the
respondents believed that pervasive developmental disorders
and
problems associated with mental retardation would be amenable
to play
therapy. It may be that play therapists dismiss the use of play
therapy

with these children, believing that such children have cognitive
or play
deficits that would inhibit the therapy (Phillips & Landreth,
1998). This
paper will demonstrate the use of an integrative play therapy
approach
with a mildly autistic girl.
Play is described as a child's occupation and the toys as the
child's tools (Erikson, 1950). Play, according to Axline (1969),
is the most
natural medium for self-expression and is an excellent means
for
communicating between adults and children and among
children. In
addition to its developmental value, play is also deemed to be
psychologically necessary (Landreth, 1991). Play allows
children to
express their inner world as a means to express and explore
their
emotionally significant experiences and to "act out" these
experiences
and feelings in a self-healing process (Landreth, 1991). Play
therapy
emerged out of the naturally occurring phenomenon of play as a
treatment that utilizes children's natural language and process
for
making sense of the world (Holmberg, Benedict, & Hynan,
1998).
Child-Centered Play Therapy
In 1947, Virginia Axline pioneered nondirective play therapy,
now commonly referred to as child-centered play therapy. She
fashioned
her therapy after the nondirective, humanistic approach of Carl

Rogers
(Landreth, 1991). The goal of this type of play therapy is self-
acceptance,
where children will learn to be themselves and feel accepted
through
understanding, warmth, and a sense of security from the
therapist.
Axline (1969) outlined eight basic principles of her play therapy
that are
essential for the success of the treatment. One of these
principles
Play Therapy and Autism 13
emphasizes empathy and building a relationship with the child,
wherein
the child sets the direction for the play. The child is responsible
for the
progress of the sessions; the therapist does not force progress
(Axline,
1969). In the playroom, children are allowed to make all
decisions. No
one criticizes them or tells them what to do. This is often an
unfamiliar
experience for children who are frequently told what to do. The
therapist's role is to facilitate growth in children by allowing
them to act
out their feelings. This is described by Axline (1969) as "an
opportunity
that is offered to the child to experience growth under the most
favorable conditions" (p. 16). The therapist should be attuned to
the
feelings communicated through the child's play and reflect these
back to

the child.
Autistic Disorder
Autistic disorder is classified as a pervasive developmental
disorder with no known etiology. The symptoms consist of
qualitative
impairments in social interactions, verbal and nonverbal
communication, and a markedly restrictive repertoire of
activities and
interests (American Psychiatric Association, 1994). These
disturbances
are present before age 3 and have a continuous course.
Approximately
75% of autistic children function in the mentally retarded range
(DSM-
IV, 1994). The severity and chronicity of autism can place a
serious
burden on the family (Dawson & Castelloe, 1992).
The increasingly predominant view of autistic disorder as a
developmental and biological disorder has led to the adoption of
structured treatments and an abandonment of more
psychologically
oriented therapies. Treatment of autistic disorder has
traditionally
consisted of medications and other biological interventions and
behavioral techniques such as behavioral modification. A wide
range of
drugs is used to reduce aggressive and self-injurious behaviors,
increase
attention span, control seizures, decrease agitation, reduce
stereotyped
behavior, and alter other maladaptive behaviors (Dawson &
Castelloe,
1992). Behavioral techniques are used to teach language to

autistic
children and to help reduce inappropriate behaviors such as
hand
clapping and other self-stimulatory behaviors (e.g., toe walking,
rocking,
14 Kenny & Winick
finger flapping) (Foxx & Azrin, 1973; Lovaas, Young, &
Newsom, 1978;
Russo, Carr, & Lovaas, 1980).
Play Therapy and Autism
The use of toy-based therapy with autistic children is not a
unique concept. Some researchers have focused their attention
on
facilitating social responsiveness in these children by using toys
in
treatment. Dawson and Adams (1984) used toys to increase
social skills
and decrease perservative play. Research by Dawson and
Galpert (1990)
has shown that by having mothers imitate their autistic
children's play
with toys, they were able to increase their children's attention
and
decrease repetitive play. Leland (1983) suggests that toys afford
the
opportunity for children with developmental delays to control,
create,
and change aspects of their surroundings. In this manner, these
children
increase their awareness of the world around them, which helps

them
enhance their ability to make adaptive coping decisions.
Bromfield (1989) describes the successful treatment of a high
functioning autistic boy with psychoanalytic-oriented play
therapy. The
treatment consisted of twice weekly play therapy sessions. This
child
had obvious autistic features (i.e., hand flapping, repetitive
movements,
and avoidance of eye contact), but he also had an uncommon
feature for
an autistic child. He displayed a desire for close relationships
with
others, especially the therapist. He often appeared sad at the end
of
therapy sessions. As the child progressed in therapy, he was
able to
communicate more clearly and comfortably than at the outset of
therapy.
A decrease in autistic motor behaviors was observed, and the
child
seemed able to handle frustration and anxiety more effectively
(Bromfield, 1989).
In another case example of play therapy and autistic disorder,
Turley (1998) described her existential play therapy approach.
A 5-year-
old girl, who was diagnosed with Pervasive Developmental
Disorder
and described as having "autistic like features" (limited
verbalizations
and social indifference), was treated with weekly sessions over
the
course of a year. In play, the girl primarily painted, played in
the sand,

and eventually expanded her interaction with the therapist and
other
toys. She mostly chattered nonwords and constantly tested the
limits of
the play therapy with such actions as taking toys from the room.
Turley
(1998) reported that the child's mother stated that at the end of
the year
the child was happier and more verbal at home. Turley also
reported
that the girl was able to develop a capacity for happiness and
self-
expression, establish a relationship with a trusted adult, and
have a
more mainstreamed school placement at the year's end.
Despite some documented play therapy success with autistic
children, many therapists have been reluctant to use
conventional forms
of psychotherapy with such children. The repetitive and
supposedly
noncreative play of autistic children has been cited as one
reason to
prevent the use of traditional therapy (Wulff, 1985). However,
for the
autistic child who has difficulty communicating verbally, as in
the case
cited previously, play therapy may be the treatment of choice.
Because
these children are likely to be functioning at a reduced
cognitive level,

they may be more receptive to play therapy, regardless of their
chronological age. Many higher functioning autistic children
also
respond to play therapy (Bromfield, 1989). Several researchers
substantiate the use of play with autistic children. Wulff (1985)
discussed
the use of play as an assessment tool for autistic children
because of their
severe communication or language deficits. Given the success
of
imitative play in increasing autistic children's social
responsiveness,
Dawson and Galpert (1990) suggest that play may be
generalized to
other psychological concerns.
An Integrative Play Therapy Approach
The following case example illustrates how an integrative
approach to play therapy was used with a preadolescent autistic
girl.
The rationale for using a flexible, integrative approach is based
on the
multiplicity of difficulties displayed by this child as well as her
developmental level. Procedures from different treatment
approaches
were combined into a coherent intervention sequence (Shirk,
1999). Judy
(fictional name), an 11-year-old white female from an intact
home,
seemed unhappy, was noncompliant at home, and lacked some
basic
living skills. The integrative approach used combines (a)
nondirective
play therapy, (b) directive interventions focused on personal
hygiene

and social skills, and (c) parent education and support.
16 Kenny & Winick
Child-centered play therapy was chosen for its reliance on
nonverbal communication as well as its accepting and open
attitude
toward the child. It was implemented throughout the treatment.
Due to
her cognitive delays, Judy still enjoyed play. The child-centered
therapeutic components of this integrative model provide a
medium in
which children are accepted without outside intrusions.
Additionally,
play therapy allows children with developmental disabilities to
discover
the physical and emotional strengths they have in relation to
their
deficits (Carmichael, 1993). The more directive aspects were
incorporated to specifically address the mother's concerns about
the
child's personal hygiene skills (often deficient in autistic
children). This
was introduced midway through the treatment. The use of more
direction at times allowed the therapist to introduce tasks such
as
functional activities necessary for Judy to learn. This was based
on
Leland's (1983) directive approach designed to improve social
skills and
responsiveness. As Rasmussen and Cunningham (1995) state,
"Nondirective and focused therapy are not mutually exclusive"
(p. 17).
Finally, the therapist communicated with the mother in an

educational
and supportive manner while also using information from the
mother to
gain an understanding of the family dynamics. This component
of the
treatment was constant throughout the child's sessions. Salomon
(1983)
suggested that parents of children with disabilities are in need
of more
support and information than other parents. Collateral work
with
parents addresses their needs and allows them to continue to
support
their children's treatment. This collateral work is desirable
(O'Connor,
1991) and contributes to the success of the treatment. It was
hypothesized that this integrative approach would provide a
comprehensive treatment for Judy and provide her parents with
the
necessary support.
Case Study
Family background and personal history. Judy (age 11) is the
only child in an intact family. Her parents, Mr. and Mrs. C,
were
married for 5 years at the time of Judy's birth. They obtained
prenatal
care, and there were no complications at birth. Both Mr. and
Mrs. C.
were in good health with no family history of autism on either
side. Mrs.

C. described Judy as meeting her early developmental
milestones on
time; however, by her 3rd year of life, signs of autism began to
appear.
She had deficient language skills, inordinate need for sameness,
and
some stereotypical behaviors.
Mr. C. was employed by the phone company and frequently
worked long hours. Mrs. C. was not employed outside the home
and
had basically dedicated her life to helping Judy in seeking
needed
resources and services. Both Mr. and Mrs. C accompanied Judy
to the
first session, which was held on a Sunday morning. Mrs. C.
provided
most of the history and presenting problems. Mr. C. nodded in
confirmation. Mrs. C. complained that Mr. C. spent too much
time at
work and, in turn, was not very involved in caring for Judy.
However,
Mr. C. contended that his efforts toward more active parenting
were
rebuffed by both Judy and Mrs. C. More specifically, he
described an
extremely attached relationship between Judy and her mother.
He
reported that at times when he had tried to spend time with
Judy, Mrs.
C. would criticize his ways or interfere. For example, on one
Saturday,
Mr. C. took Judy to the park to play ball. Rather than be pleased
with the
time Mr. C. spent with Judy, Mrs. C. complained that he did not

take her
jacket with him and that they returned late for lunch. Mr. C
tried to
explain that they were enjoying themselves and were not hungry
enough to rush home. He cited this example to demonstrate
what he
perceived as his wife's criticism of his attempts at a closer
relationship
with Judy.
Assessment. Mrs. C reported that Judy was diagnosed as
autistic during her preschool years. Thus, she had participated
in special
education classes throughout her academic career. Mrs. C's
description
of Judy's schoolwork revealed activities consistently below her
age level.
Although formal intelligence testing was not completed,
adaptive testing
was conducted prior to initiating treatment. Jackson (1998)
advises that
"play therapists should routinely include some form of objective
or
subjective psychometric instruments in their daily practice for
assessing"
(p. 7). In addition, Leland (1983) suggests that the therapist
meet with
the parents to do an adaptive behavior evaluation. Performed by
the
therapist, adaptive testing revealed that Judy's developmental
level (in
regards to everyday coping skills, tasks, and behaviors) was
significantly

18 Kenny & Winick
below average. The Vineland Adaptive Behavior Rating Scale
Interview
Edition (Sparrow, Balla, & Cicchetti, 1985) was conducted with
the
mother during the session. The following scores were obtained:
Communication Domain, 75; Daily Living Skills Domain, 67;
Socialization Domain, 55; Motor Skills Domain, 90; and the
Adaptive
Behavior Composite, 287. All of the domain scales have a mean
of 100
and a standard deviation of 15. Thus, Judy's communication
skills
(receptive, expressive, and written communication), daily living
skills
(personal living habits, domestic tasks, and behavior), and
socialization
skills (interactions and sensitivity to others, use of free time)
were
significantly below average for her age. However, her motor
skills (gross
and fine motor coordination) were just slightly below average.
Presenting problems and current status of the child. At age 11,
Judy was referred to a psychologist (CW) by her neurologist due
to
aggressiveness and oppositional behavior at home and school.
Mrs. C.
attributed these behaviors to Judy's manifestation of autism. She
depicted Judy's developmental history as characterized by a lack
of
connection to other people. However, she emphasized that Judy
had
always maintained a positive maternal relationship. Judy's
teacher (who

was contacted by phone) confirmed the close relationship of
mother and
child. The teacher stated that Judy often expressed love for her
mother
and, in turn, frequently called for her when she became agitated
or upset
at school. In general, the teacher explained that Judy was
cooperative at
school and performed the work assigned to her. Judy was in a
contained
special education classroom with other autistic children. The
teacher also
reported that Judy did not seem to have any significant
attachments to
the other children but did gravitate toward a few other girls in
her class
at lunchtime. Mrs. C. also described the ongoing power
struggles
between herself and Judy. More specifically, she stated that
Judy
sometimes required considerable prompting before completing
daily
tasks. Furthermore, Mrs. C. reported that Judy refused to either
brush
her teeth or let her mother brush them.
Conceptualization and model application. During the initial
sessions, it became clear that many of Judy's difficulties were
related to
her autism, but also tied into family dynamics. The therapist
hypothesized that Judy's anger was related to her relationship
with her

mother. Although unable to express it directly, Judy appeared at
times to
feel suffocated by her mother. She may have resented the
constant
attention she was given and the lack of independence afforded
her by
her mother. Further, the therapist believed that the issue with
control of
one's self was paramount for Judy. Having to rely on others,
mostly her
mother, for many of her needs, appeared to leave her feeling
helpless at
times. She was unable to communicate this frustration verbally,
but
rather expressed her frustration in the form of oppositional
behavior at
home and school. Given Judy's unexpressed feelings, it was
further
believed that child-centered play therapy would grant her the
ability to
direct her own actions.
The use of directive techniques and more structured play
therapy was based on Leland's (1983) work. He advises that the
play
sessions be structured only as much as is needed to assist the
child in
learning to modify a few socially unacceptable behaviors.
Leland (1983)
states that "the more retarded the child appears in the therapy
sessions,
the greater the amount of directed play and directed intrusions
must
come from the therapists" (p. 437). The goal is to raise the level
of

functioning of the children and assist them in controlling
behavior. The
rationale behind this approach is that as children learn to do
more for
themselves, they will be happier and more self-confident. The
structure
is introduced in the play because behavioral change requires
modification. Leland proposes that if the child learns through
play to
cope with problems, this learning may be generalized into daily
living.
Although this technique differs from nondirective play therapy,
the
rationale is that it will lead to greater socially acceptable
behavior by the
child, a desired outcome of therapy.
Parent training and education with Mrs. C. proved valuable.
Play therapy does not require any parent involvement (Guerney,
1983a),
and many play therapists do not see the need for concurrent
work with
parents. However, Landreth (1991) advises that parents should
be
included in some form of therapeutic procedure whenever
possible.
Parent education provides a means by which the child's therapist
can
interact with the parents to gain information (Brems, 1993).
Leland
(1983) stresses the importance of including parents to increase
the pace
of progress. For example, the parents can administer
reinforcement at

20 Kenny & Winick
home for behavioral change. Additionally, parents who are
involved in
the treatment process are more likely to keep their children in
treatment.
Support from the child's therapist can be invaluable to parents
experiencing stress (Brems, 1993), and utilizing parental
motivation for
change does seem to increase the probability of success
(Guerney,
1983a). Given these notions and the presenting problems, it was
determined that neither Mr. nor Mrs. C. required individual
psychotherapy; instead, the therapist would provide support and
education regarding autism and education and effective
parenting skills.
The weekly sessions with Judy lasted 45 minutes, and Mrs. C
was seen
for the remaining 15 minutes of the hour. In addition, she was
encouraged to call the therapist with any concerns or issues that
might
occur during the week. Mr. C, who worked on the day of the
sessions,
was unable to attend regularly. The therapist encouraged Mrs.
C. to
relate to her husband what was discussed in the sessions.
Further, since
Mr. C. was present at the first session, he was also informed by
the
therapist to contact the therapist with any questions or
observations. He
appeared supportive of the therapy, but given his work
schedule, he was
unable to participate weekly.

Treatment and Case Illustration of Technique
The application of nondirective play therapy. During the initial
stages of therapy (sessions 1-7), Axline's (1969) child-centered
play
therapy was utilized as the sole therapeutic approach. It was
hypothesized that Judy would respond positively to the
essentially
unrestricted nature of the play sessions. For the most part,
Axline's eight
principles of nondirective play therapy were diligently applied
during
the initial course of Judy's psychotherapy. The following is an
exploration of some of these principles within the context of
Judy's
psychological treatment.
From the outset, the therapist established limits of play therapy
sessions consistent with that described by Axline (1969),
Landreth (1991),
and Leland (1983). According to Axline, "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" (Axline, 1969, p. 74). The therapist explained that
Judy
could do almost anything she wanted in the sessions. A few
exceptions
were noted. Judy was told that she could not physically hurt
herself or

the therapist, nor was she permitted to damage any of the toys.
She was
also informed that she could play with anything she wanted in
the
playroom. Finally, she was told that she would be there for 45
minutes
(the therapist showed her the time on the wall clock), at the end
of which
she could rejoin her mother.
Judy was compliant with the majority of the limits pertaining to
the playroom. For example, she almost always immediately
entered the
therapy room at the start of a session and left at the end of the
session.
On several occasions, she asked to leave the playroom to see
her mother.
The therapist responded by reflecting Judy's feeling, "You miss
your
mom and want to see her now." The therapist then showed Judy
on the
clock how much time was left in the session and when she could
see her
mother.
Axline (1969) stipulates that "The therapist must develop a
warm, friendly relationship with the child, in which good
rapport is
established as soon as possible" (p. 73). Rapport was quickly
established
as Judy realized that the therapist would allow her to make her
own
choices regarding toys and type of play. During the first
session, Judy
was reluctant to leave her mother and enter the play therapy
room, so

her mother accompanied her. However, soon after entering the
room
and seeing the toys, she seemed to forget that her mother was
there, and
Mrs. C was able to leave. During the first few sessions, Judy
barely
interacted with the therapist. At times, she appeared indifferent
to his
presence. However, after several sessions, in an attempt to
engage him
she began to show him the toys with which she was playing.
Rapport
was maintained throughout the therapy through light-hearted
reminiscence about shared experiences. For example, Judy had a
proclivity for playing with plastic food and dishes. Toward the
middle
and latter stages of therapy, a comment from the therapist such
as, "I
never would have expected you to choose to play with those . .
." elicited
a smile from Judy. She tended to choose the same toys each
session,
evidence of the autistic feature of perservative play.
Axline's (1969) principle that "The therapist accepts the child
exactly as he is" (p. 73) was employed consistently. Judy
clearly had
22 Kenny & Winick
limitations not manifested by the typical child in play therapy.
For
example, Judy's entire communication with the therapist took
the form

of grunts, gestures, and body language. The therapist,
expressing no
frustration or resentment when unable to understand Judy's
vocalizations, accepted this type of communication. When Judy
would
host a tea party in the session, she would hand the therapist a
cup and
grunt. The therapist would take the cup and respond with a
"Thank
you." At times, Judy would continue to grunt and gesture until
the
therapist understood what she wanted.
Additionally, Judy would frequently fail to respond to the
therapist. His attempts to track her play seemingly went
unheard.
Although this was at times frustrating for the therapist, he
accepted her
lack of acknowledgment of his words. For example, he would
frequently
reflect on her actions, "You are feeding the baby." This would
elicit no
response from Judy. The therapist had hoped she would come to
acknowledge him at least minimally. On some occasions, she
would turn
her body into the corner and not let him see her play activity.
The
therapist did not intrude into her play but rather waited for a
signal
from Judy to join.
The therapist found it essential to the therapeutic success that
Judy be allowed to express any feelings. Axline suggested that
"the
therapist establishes a feeling of permissiveness in the
relationship so

that the child feels free to express his feelings completely"
(1969, p. 73).
The therapist allowed for direct expression of feeling, as well as
symbolic expression through play. Judy frequently expressed
anger in
the sessions. On one occasion, Judy appeared angry when
entering the
therapy office. She began to play with the plastic food as was
usual, but
then she started to throw some pieces of food she did not like.
The
therapist reflected that she appeared angry and allowed her to
throw the
food back in the toy box, but not at him.
Judy's autistic need for constancy was evident in the playroom.
On one occasion, a stuffed animal that Judy enjoyed playing
with was
missing from the room. She searched frantically for it, with no
success.
At once realizing what she was looking for, the therapist stated,
"You
are looking for the dog." She stared at him blankly. He stated
that it was
missing, and that he thought someone else must have taken it.
Judy ran
from the room and began crying and screaming. The therapist
followed
her and tried to reflect her anger and sadness. He led her back
to the
room where they continued to search together. Eventually, Judy

found
another, smaller stuffed dog and seemed content to play with it.
Axline's (1969) fourth principle is that "the therapist is alert to
recognize the feelings the child is expressing and reflects those
feelings
back to him in such a manner that he gains insight into his
behavior" (p.
73). This principle easily applied to the work with this girl
since her
communication was largely nonverbal and needed to be
understood by
the therapist. In an effort to promote insight, reflections often
focused on
central issues in the play. For example, reflections pertaining to
anger
often focused on Judy's relationship with her mother. One day,
Judy did
not want to enter the playroom. She threw a temper tantrum in
the
waiting area. The therapist spoke softly to her and told her to
come with
him to the playroom, where she could stay angry if she wanted.
The
therapist also made statements such as, "You are real mad about
being
here this morning" and "You don't want to come in, and you are
angry
that your mom brought you here." Judy's reluctance to enter the
therapy
room may have been her way of communicating her anger at her
mother
for what she perceived as not giving her a choice (i.e., being
able to
choose whether she wanted to come to therapy or not). Mrs. C.
explained that they had driven by a McDonald's that morning on

the
way to the session, and Judy had begun to cry out. Mrs. C. did
not stop,
as they would have been late for the session.
Initially, Judy's demeanor was extremely irritable, and she only
minimally acknowledged the therapist. She often acted as if the
therapist
did not exist by failing to include him in her play or to
acknowledge
him. She seemed content as she played with different toys in the
playroom. The therapist used consistent reflection of Judy's
actions and
their effect on the environment. For example, the therapist
would say,
"You do not want me to play with you" or "You like to enjoy
the toys by
yourself." On occasion, Judy was oppositional during the
session. She
would angrily move the toys around the room and refuse to
acknowledge any of the therapist's statements. Mrs. C. usually
indicated
that this behavior was precipitated by a disagreement or fight
between
herself and Judy prior to coming to the session. To this extent,
Judy's
24 Kenny & Winick
excessive anger was viewed as related both to frustration at the
frequent
difficulty of coping with the world around her and resentment
of the
limits and structure provided by Mrs. C. On a deeper level, Judy

struggled between dissatisfaction with excessive maternal
dependency
and recognition of her frequent inability to maintain
independent
functioning. The therapist would reflect these feelings of
frustration to
Judy in an attempt to help her gain insight.
Application of directive techniques. Midway through therapy,
Mrs. C reported that Judy seemed to be making significant
progress.
More specifically, she reported fewer mother-daughter
arguments and a
reduction in Judy's irritability. For example, Judy was much
more
compliant at home when asked to do something by her mother,
and her
temper tantrums decreased in number. However, the problems
with
personal hygiene remained. Based on the mother's concerns
about these
activities of daily living, it was decided that at this time,
specific skill
activities would be introduced into the play therapy. Hence,
after eight
sessions with Judy, the therapist introduced Leland's (1983)
more
directive techniques in working with children with
developmental
delays.
The directive play therapy differed from Axline's approach in
that Judy was not always given the "responsibility to make
choices and
to institute change" (Axline, 1969, p. 73). Additionally, in the
directive

play therapy sessions, the therapist did attempt to direct Judy's
actions.
The fact that Judy may never independently develop the
capacity to
solve problems (given her cognitive deficits) and make choices
led the
therapist to provide directive interventions. Judy's mom
reported that
Judy refused to brush her teeth, and she was concerned about
Judy's
dental health and also the smell of her breath. The therapist
took
responsibility for introducing and following through on this
behavior.
Specifically, structured coping tasks were introduced into the
play
therapy. For example, the therapist tried to help Judy learn to
brush her
teeth.
The therapist began by introducing a toothbrush and a doll in
the session. He brushed the doll's teeth and then complimented
the doll
on how pretty her teeth looked. He would say such things as
"Your teeth
are so clean and bright." Then, he would encourage Judy to help
brush
the doll's teeth. Judy did not respond positively to these
attempts. She
often ignored the therapist and refused to participate. The tooth
brushing activity seemed to bring about incredible anxiety for

Judy. The
therapist encouraged Judy's mother to use a doll at home and
then
encourage Judy to brush her own teeth. Her mother reported that
she
would "freak out" at home when she attempted to work with her
on this
task. This "freaking out" may be interpreted as Judy's
frustration at
being unable to do this herself and resentment of her mother's
and the
therapist's intervention. This approach was clearly not
successful with
Judy.
Judy's social skills were targeted as well, as it was believed that
this would lead to more positive social interactions. In the
session, the
therapist would wait for Judy to do something (e.g., play with a
doll).
Then the therapist would make an observation about the play
(e.g., "You
are feeding the baby"). If Judy responded, she would be
reinforced by
being allowed to continue to play. However, if she did not
acknowledge
the therapist, he would intervene and stop the activity (removal
of
reinforcement), explaining that play could not continue until the
child
gave some type of response. This technique was used by Judy's
therapist
in her treatment to increase social reciprocity. The therapist
would
announce that it was time for Judy and him to work on making
friends.

This verbal introduction served to let Judy know that the
structured part
of the hour was beginning. In one session, Judy began to
prepare food
with toy plates and play dough. The therapist asked if she was
making
lunch. She did not respond at all. The therapist then informed
her that
the toys would be put away if she did not respond (punishment).
Judy
quickly glanced at him but would not speak. She continued to
roll the
play dough into a pizza. The therapist informed her again of his
request
and began to put the plates away. Judy blurted out "pizza . . .
pizza" and
moved to hand the therapist some. He smiled and thanked Judy,
letting
her know that he enjoyed having pizza with her. The next time
he made
an observation, "That is a big pizza!", Judy looked up at him
and smiled.
There appeared to be long-term effects from this approach. By
the end of
therapy, Judy was smiling and jumping excitedly when she was
the
therapist.
26 Kenny & Winick
In Judy's treatment, the skill activity would be introduced for a
part of the session. After a period of time, Judy would be
allowed to
resume nondirective play therapy. Judy's demeanor usually

became
more upbeat when the coping skill task was abandoned. For
example,
she would begin to smile and excitedly take out the toys with
which she
wanted to play. In order to remain as nondirective as possible,
Judy was
given the responsibility both to make choices and to lead the
play during
the remaining unstructured parts of each session. At these times,
Judy
selected both the toys to be used and the manner in which they
would be
played.
Parent education/training. From the beginning of Judy's
treatment, the therapist spent time alone with Mrs. C. The
therapist
encouraged parental patience with the therapeutic process and
to look
for slow, steady progress. An educational approach was used to
help
Mrs. C. understand Judy's limitations. As with many parents of
autistic
children, Mrs. C. was feeling high levels of stress and concern
for her
child (Sanders & Morgan, 1997). She spoke about the
demanding nature
of raising a child with a disability and expressed concern that
she was
not doing her best as a mother. She blamed herself for having an
autistic
child. She also expressed stress over her lack of free time and
feelings of
fatigue. The therapist helped Mrs. C. understand that she would
likely

struggle with Judy throughout her life. Further, Mrs. C.'s
feelings about
raising an autistic child were explored. She was encouraged to
focus on
small successes with Judy. For example, if Judy learned to
master tooth
brushing, Mrs. C. would no longer have to perform it for her.
Mrs. C.
began to realize that even this small achievement would provide
relief
from the constant fighting with Judy over this self-care habit.
Results of Therapy
Judy seemed to continue to benefit from nonstructured aspects
of play therapy. Mrs. C. reported that Judy's neurologist had
remarked
how much calmer Judy appeared, both before and during the
appointment. Since Judy's physician had not prescribed any
medication,
he complimented the therapist on Judy's progress. Mrs. C. also
explained that Judy's teacher had noticed positive behavioral
changes at
school. Judy was exhibiting fewer temper tantrums and angry
outbursts.
She was more compliant with her teacher's requests as well. The
teacher
also noticed that during the times that Judy would get upset, she
would
not cry for her mother as much as she had in the past.

As time progressed, Judy also became more attached to the
therapist, as evidenced by her including the therapist into her
play more
often. Additionally, Judy's physical proximity to him increased
and she
rarely turned her back to him. Mrs. C. reported that Judy would
often
get excited before her therapy sessions. She would frequently
ask when
they were going to return and get ready quickly before the
session. Judy
made emotional and behavioral changes resulting from the
therapeutic
interventions. However, Judy continued to avoid the structured
task in
therapy. Her changes were observed at home, school, and by
significant
people in her life (i.e., parents, teacher, and physician). After
11 sessions,
Judy's mother reported feeling satisfied with Judy's and her own
progress, and therapy was terminated.
CONCLUSION
This case presented an integrative play therapy approach for a
preadolescent autistic girl with emotional and behavioral
problems. In
this case, the approach that integrated both directive and child-
centered
play therapy and parent education was partially successful. The
early
phase of treatment focused on a relationship-oriented
intervention that
allowed Judy to play nondirectively with the toys, while
establishing a
relationship with the therapist. Later, more directive techniques

were
focused on deficit behaviors. Judy clearly responded much more
positively to the child-centered play therapy, and her emotional
progress
and behavioral changes can be attributed to such. The fact that
Judy
responded positively to only the nondirective play therapy is of
clinical
and theoretical interest. The child-centered play therapist
provides the
core conditions of empathy, warmth, and genuine respect for the
child
(Carmichael, 1993). This experience, if conducted properly,
should be
beneficial for any child. Child-centered play therapy allows the
child to
feel competent and begin to establish a greater sense of self-
esteem,
something that many autistic children may be lacking given
their
28 Kenny & Winick
reliance on others. Judy's affect improved during the course of
the
therapy, and her play repertoire increased.
When more direction was introduced to the sessions, Judy
became noncompliant. Despite the fact that Judy needed
instruction on
various coping skills and activities of daily living, the play
therapy did
not seem to be the arena to address these concerns. When the
therapist

introduced the structured tasks, Judy's attitude and mood
changed. She
became much more sullen and less cooperative. The therapist's
directive
nature may have been a repetition of the other authority figures
in
Judy's life. She was resistant to the guiding, and it appeared to
make her
angry. In addition, the attempts at increasing Judy's social skills
proved
somewhat successful. Judy made gains in this area and near
termination
would often seek out the therapist for play. However, it is not
clear
whether the applications of the nondirective approach were
responsible
or the structured approach. Certainly, Judy's socialization may
have
increased as a result of Axline's approach, the one that Judy
seemed to
favor.
The parent education and support components of the treatment
proved fruitful. The time the therapist spent with the mother
provided
her with an opportunity to share her feelings of frustration over
raising
an autistic child. To this end, the therapist could be supportive
but also
help the mother with situations that would arise at home. Mrs.
C.
seemed to develop realistic expectations of her daughter, which
motivated her to be more sensitive. She was able to plan
activities for
Judy's future that would encourage growth. Finally, the
information

Mrs. C. provided gave the therapist insight into Judy's behavior
outside
of the session.
This case demonstrates the partial effectiveness of a time-
limited
therapy approach with a preadolescent girl with autism. The
effective
aspects of the treatment were the child-centered play therapy
and
collateral work with the mother. Judy was treated in 11 play
sessions,
over the course of 3 months, with progress noted by her parents,
teacher,
and neurologist. In contrast to the length of treatment in the
Bromfield
(1989) case (5 years of twice weekly therapy), the present
autistic child
showed success in a relatively short period of time (11
sessions). This
case further illustrates the importance of the therapist looking
beyond
the diagnostic label of a child when planning treatment. Another
therapist may have abandoned the idea of play therapy
completely,
believing the child would not benefit from such treatment.
However, in
this case, child-centered play therapy was adapted and
employed with
success, whereas the more directive techniques proved less
successful.

Although in this case there was limited but consistent contact
independently with the mother, a more systemic focus may have
helped
in understanding the family dynamics. Future play therapists
may need
to examine the presenting problems in the context of the family
situation. In this case, much of Judy's oppositional behavior
could be
viewed as her frustration with her inability at times to function
independently. Through the use of play therapy, she was able to
regain
feelings of pride and self-acceptance. However, work with both
parents
may have proved fruitful. The therapist could have explored
more fully
Mrs. C.'s reluctance to let Mr. C. get involved in the child care,
as well as
both parents' feelings about having a child with autism and its
effect on
their relationship. Sanders and Morgan (1997) have shown that
parents
of children with autism perceive a great deal of stress
associated with
finding the time and effort to make use of their free time.
Because of the
demands of raising a child with autism, parents have less time
and
energy to spend in activities outside the home. Thus, the
therapist may
be able to help the parents explore their feelings and provide
suggestions.
CONTRAINDICATIONS
Play therapy may not be helpful for all children with autistic

disorder, specifically those who engage in repetitive,
stereotypic play
with toys. Additionally, the cognitive level of the child should
be
considered before such an approach is implemented. More
specifically,
depending on the level of mental retardation of the child, he or
she may
not be physically able to work in a play therapy modality.
Bromfield
(1989) cautions that working with autistic children can be
difficult, since
often their cognitive limitations affect their verbalizations.
Despite these
limitations, it seems that some high functioning autistic
children can
benefit from child-centered play therapy.
30 Kenny & Winick
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Cambridge, MA: Houghton Mifflin.
Axline, V. (1969). Play therapy (Rev, ed.). Cambridge, MA:
Riverside
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Brems, C. (1993). A comprehensive guide to child
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functioning autistic child. Psychoanalytic Psychology, 6(4),
439-
453.
Carmichael, K. (1993). Play therapy with children with
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Cohen, D. (1995). Psychosocial therapies for children and
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Dawson, G., & Adams, A. (1984). Imitation and social
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Dawson, G., & Castelloe, P. (1992). Autism. In C. E. Walker &
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Roberts (Eds.), Handbook of clinical child psychology (2nd ed.)
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Dawson, G., & Galpert, L. (1990). Mother's use of imitative
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facilitating social responsiveness and toy play in young autistic
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Erikson, E. (1950). Childhood and society. New York: Norton.
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Gold-Steinberg, S., & Logan, D. (1999). Integrating play
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Holmberg, J., Benedict, H., & Hynan, L. (1998). Gender
differences in
children's play therapy themes: Comparisons of children with a
history of attachment disturbance or exposure to violence.
International Tournal of Play Therapy, 7(2), 67-92.
Jackson, Y. (1998). Applying APA ethical guidelines to

individual play
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Kot, S., Landreth, G., & Giordano, M. (1998). Intensive child-
centered
play therapy with witnesses of domestic violence. International
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(Ed.), Case
studies in child and adolescent counseling (2nd ed.) (pp. 70-82).
Upper Saddle River, NJ: Prentice Hall.
Landreth, (1991). Play therapy : The art of the relationship.
Muncie, IN:
Accelerated Development, Inc.
Leland, (1983). Play therapy for mentally retarded and
developmentally
disabled children. In C. Schaefer & K. O'Connor (Eds.),
Handbook of play therapy (pp. 431-454). New York: John Wiley
and Sons.
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Englewood Cliffs, NJ: Prentice Hall.
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therapy (pp. 283-307). New York: John Wiley and Sons.

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Mendell, A. (1983). Play therapy with children of divorced
parents. In C.
Oaklander, V. (1993). From meek to bold: A case study of
gestalt play
therapy. In T. Kottman & C. Schaefer, (Eds), Play therapy in
action: A casebook for practitioners (pp. 281-300) Northvale,
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of
theories and techniques. New York: John Wiley & Sons.
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(Vol. 2).
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therapy: II
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Therapy, 7(1), 1-24.
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and
non-directive play therapy: Can they be integrated? Tournal of
Child Sexual Abuse, 4(1), 1-20.
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(pp. 369-386). New York: John Wiley and Sons.
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populations. In J. J. Ferguson & C.B. Taylor (Eds.), The
comprehensive handbook of behavioral medicine, Vol. 3. New
York: Spectrum Publications.
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Sanders, J. & Morgan, S. (1997). Family stress and adjustment
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139-148.
How to read and understand a scientific article
Dr. Jennifer Raff
To form a truly educated opinion on a scientific subject, you
need to become familiar
with current research in that field. And to be able to distinguish
between good and bad
interpretations of research, you have to be willing and able to
read the primary research
literature for yourself. Reading and understanding research
papers is a skill that every
single doctor and scientist has had to learn during graduate

school. You can learn it too,
but like any skill it takes patience and practice.
Reading a scientific paper is a completely different process
from reading an article about
science in a blog or newspaper. Not only do you read the
sections in a different order than
they're presented, but you also have to take notes, read it
multiple times, and probably go
look up other papers in order to understand some of the details.
Reading a single paper
may take you a very long time at first, but be patient with
yourself. The process will go
much faster as you gain experience.
The type of scientific paper I'm discussing here is referred to as
a primary research
article. It's a peer-reviewed report of new research on a specific
question (or questions).
Most articles will be divided into the following sections:
abstract, introduction, methods,
results, and conclusions/interpretations/discussion.
Before you begin reading, take note of the authors and their
institutional affiliations.
Some institutions (e.g. University of Texas) are well-respected;
others (e.g. the Discovery
Institute) may appear to be legitimate research institutions but
are actually agenda-driven.
Tip: google “Discovery Institute” to see why you don’t want to
use it as a scientific
authority on evolutionary theory.
Also take note of the journal in which it's published. Be
cautious of articles from
questionable journals, or sites that might resemble peer-

reviewed scientific journals but
aren't (e.g. Natural News).
Step-by-Step Instructions for Reading a Primary Research
Article
1. Begin by reading the introduction, not the abstract.
The abstract is that dense first paragraph at the very beginning
of a paper. In fact, that's
often the only part of a paper that many non-scientists read
when they're trying to build a
scientific argument. (This is a terrible practice. Don't do it.) I
always read the abstract
last, because it contains a succinct summary of the entire paper,
and I'm concerned about
inadvertently becoming biased by the authors' interpretation of
the results.
2. Identify the big question.
Not "What is this paper about?" but "What problem is this entire
field trying to solve?"
This helps you focus on why this research is being done. Look
closely for evidence of
agenda-motivated research.
3. Summarize the background in five sentences or less.
What work has been done before in this field to answer the big
question? What are the
limitations of that work? What, according to the authors, needs
to be done next? You
need to be able to succinctly explain why this research has been
done in order to
understand it.

4. Identify the specific question(s).
What exactly are the authors trying to answer with their
research? There may be multiple
questions, or just one. Write them down. If it's the kind of
research that tests one or more
null hypotheses, identify it/them.
5. Identify the approach.
What are the authors going to do to answer the specific
question(s)?
6. Read the methods section.
Draw a diagram for each experiment, showing exactly what the
authors did. Include as
much detail as you need to fully understand the work.
7. Read the results section.
Write one or more paragraphs to summarize the results for each
experiment, each figure,
and each table. Don't yet try to decide what the results mean;
just write down what they
are. You'll often find that results are summarized in the figures
and tables. Pay careful
attention to them! You may also need to go to supplementary
online information files to
find some of the results. Also pay attention to:
• The words "significant" and "non-significant." These have
precise statistical
meanings.
• Graphs. Do they have error bars on them? For certain types of
studies, a lack of
confidence intervals is a major red flag.

• The sample size. Has the study been conducted on 10 people,
or 10,000 people?
For some research purposes a sample size of 10 is sufficient,
but for most studies
larger is better.
8. Determine whether the results answer the specific
question(s).
What do you think they mean? Don't move on until you have
thought about this. It's OK
to change your mind in light of the authors' interpretation -- in
fact, you probably will if
you're still a beginner at this kind of analysis -- but it's a really
good habit to start forming
your own interpretations before you read those of others.
9. Read the conclusion/discussion/interpretation section.
What do the authors think the results mean? Do you agree with
them? Can you come up
with any alternative way of interpreting them? Do the authors
identify any weaknesses in
their own study? Do you see any that the authors missed? (Don't
assume they're
infallible!) What do they propose to do as a next step? Do you
agree with that?
10. Go back to the beginning and read the abstract.
Does it match what the authors said in the paper? Does it fit
with your interpretation of
the paper?
11. Find out what other researchers say about the paper.

Who are the (acknowledged or self-proclaimed) experts in this
particular field? Do they
have criticisms of the study that you haven't thought of, or do
they generally support it?
Don't neglect to do this! Here's a place where I do recommend
you use Google! But do it
last, so you are better prepared to think critically about what
other people say.
A full-length version of this article originally appeared on the
author’s personal blog
(www.violentmetaphors.com). She gratefully acknowledges
Professors José Bonner
(Indiana University) and Bill Saxton (UC Santa Cruz) for
teaching her how to read
scientific papers using this method.
Purposes of Research
© 2017 Laureate Education, Inc. 1
Program Transcript
NARRATOR: In this program, Dr. Patton explains and provides
practical
examples of five purposes for research, basic, applied,
summative, formative,
and action research. While all are legitimate and important

purposes for
research, basic and applied are most often used for thesis and
dissertation
research.
MICHAEL QUINN PATTON: One of the important contextual
considerations in
engaging in research as a scholar-practitioner is to understand
the different
purposes that inquiry can serve. And that inquiry determines
who the audience
is, what the standards are going to be for judging the quality of
your work, and
has implications for how you conduct the inquiry because it
determines the
standards that you're going to attempt to meet as you do high-
quality research.
Different purposes serve different audiences and different needs
and are judged
according to different criteria.
So let's review what some of those purpose distinctions are so
that you can
position your work within a particular purpose and know what
the audience and
what the criteria are that come for that audience for judging the
quality of your
work. I'm going to distinguish five different purposes and take
you through the
implications of those.
I think it's helpful to distinguish basic research, which is aimed
at how to
understand the way the world works, from applied research,
which is
understanding a problem and the nature of that problem. That's

distinguished
from what we call summative evaluation, which is figuring out
whether or not an
intervention that's trying to solve a problem is working. We
distinguish that from
formative evaluation, which is trying to improve that
intervention aimed at solving
a problem. And we distinguish that from action research, which
is aimed at a very
rapid response to a very immediate problem with quick
turnaround.
So five kinds of purposes-- contributing to basic knowledge
about the world,
basic research; understanding a problem, which is applied
research; deciding if
an intervention works, which is summative evaluation; deciding
how to improve
an intervention while we're doing it, which is formative
evaluation; and solving a
very specific problem in the here and now, which is action
research, research to
take immediate action.
Let's take an example and work through the implications of
those purposes for
both quantitative methods and qualitative methods. Because this
is not a
methodological distinction. This is a purpose distinction. You
can use quantitative
or qualitative methods to study any of these purposes. And
indeed, you can use
mixed methods to study any of these purposes. So these are
purpose

distinctions. When you're doing basic research, you're trying to
understand how
the world works.
So let's say that we're interested in the general field of
addictions. And we want
to know as a basic researcher what's the nature of addiction.
How does it happen
in the brain? What physiological changes occur when a person
is addicted? What
are the patterns that lead them to get addicted?
We're simply studying addiction. We're trying to come up with
perhaps a theory
of addiction or test a theory of addiction. If people experience
certain childhood
patterns, they're more likely to be addicted. If they have certain
genes, they're
more likely to be addicted. But we're just understanding
addiction.
Now, we want to move to applied research. We see addiction as
a problem, and
we want to understand the nature of the problem. How does
addiction affect
people's lives? What are they able to do and not able to do?
How does it affect
their relationships? How does it affect their job? How does it
affect their skill?
How does it affect their decision making? What's the nature of
the problem?

What happens in the workplace where people are addicted?
Let's understand quantitatively how many people have a certain
addiction.
Qualitatively, how do people recognize their addiction? Do they
recognize their
addiction? What helps people recognize their addiction? What
happens in an
addiction system, a family system as an addicted system?
Quantitative data may involve applying some family
measurements that have
been developed about family harmony, family stability.
Qualitative study of
applied research would involve interviewing family members
about how their
family is affected by a person who is addicted to alcohol or
drugs.
But we're trying to understand the problem. Why do we want to
understand the
problem? Well, usually because we want to try to solve it in
some way. We want
to fix it. We want to do an intervention. Our most common form
of intervention is
a program, a program that helps people overcome their
addiction-- a chemical
dependency treatment program; a program for people who are
addicted to
pornography; a sexual addiction program; people who are
addicted to food;
weight reduction programs.
Let's take chemical dependency. Basic research tells us how the
brain and the
body and the mind responds to addictive behaviors. Applied

research tells us
how that addiction affects people's lives, why it's a problem for
society and for
families. Now, we've got an idea about a program-- a 12-step
program or a
behavior modification program. And we want to see if that
program works.
Well, now, the purpose of that research is what we call
summative evaluation.
Summative evaluation takes its name from the idea of a summit
or summing
things up. It's an overall judgment. Does this work? Does this
particular model
reduce people's addictions, help them deal with their addictive
behavior, become
sober, stop eating badly, stop looking at pornography or
engaging in sexually
addictive behavior? Does it work on whatever the outcomes are?
If you're studying the effectiveness of a model, of an
intervention, of a program
overall, you're involved in summative evaluation. And that
purpose is to decide to
continue the program, to expand the program; should
government fund it; should
foundations fund it; should insurers pay for it because it's been
demonstrated to
be effective? That's summative evaluation.

Now, before you get to summative evaluation, you want to be
sure that you've
worked out the bugs in that intervention. You get feedback from
the people going
through the program. They say, well, I don't like that so much,
or let's add that
piece.
I worked with a well-known chemical dependency program that
has groups. It
has individual therapy. They have things that people read. They
have a part of
the program that helps people deal with their relationship with a
higher power,
helps them deal with each other. They have a part where family
members come
in. They have all these different components. There's a lot to
organize. There's a
lot to fit together.
Formative evaluation is about how to fit those pieces together,
how to make them
work. What kind of readings do people like? How often should
family members
come? What should they do when they come to the program?
How do you
facilitate people in the program interacting with each other?
What kind of
facilitation skills are needed? What helps people get through the
program?
Where are they likely to hit a wall? How can we anticipate and
help them
anticipate about week 10-- about day 10, you're going to hit a
wall. We know that
from looking at lots of people. Here is how we can help you get

through that wall.
That's formative evaluation. It comes from the metaphor of clay,
of forming, of
making it better. So formative evaluation is forming the model,
forming the
intervention to get it ready for summative evaluation. And the
idea of the program
itself came from applied research. And understanding that
problem came from
basic research.
So where does action research fit in? Well, action research is a
way of solving a
very specific problem. So let's say we've got our addiction
program, our chemical
dependency program, and we notice that young people are
dropping out. Middle-
aged people stay. Older people stay. But young people really
don't like this
program. We want to increase attendance of young people.
We quickly do interviews with those young people. Why did
you drop out? What
turned you off here? Try to solve that specific problem of
dropout. That gives you
immediate action within the context of a here-and-now problem.
It's rapid turnaround. You don't have a high level of proof.
You're not trying to do

big-time science. You're trying to get reasonable evidence.
People said this is
why they're dropping out. That seems to make sense. Here's
what they suggest
we could do about it. Solve the problem. See if the solution
works.
With formative evaluation, you're primarily trying to help staff
look at what they're
doing to improve the program, give them feedback-- because
staff in a program
can get in their own heads, determined to do the model their
way. Getting them
feedback about what works and doesn't work from the
perspective of people in
the program helps them open up. And they're going to apply
their own criteria.
Does this make sense? Do they believe in the data? Do they
believe in your
sample? They're the users of formative evaluation.
With summative evaluation, it's the people who fund programs--
the
policymakers, the government people who would decide
whether or not to fund
this, foundation executives and program officers, third-party
payers. They're
going to look at that evidence, and they're going to say, are
enough people
getting helped to justify continuing to fund this program.
Not everybody gets helped. No program works for everybody all
the time. So the
criterion becomes how many people have to get help to what
level to call this an
effective program.

With applied research, you're primarily dealing with planners,
with program
designers, with policymakers who are trying to understand the
problem better.
What really is this problem? Why do people get addicted? How
does addiction
affect their lives?
And they are looking for the quality of evidence, do you really
understand the
problem. Do you understand it in systems terms? Do you
understand it for this
particular population? Let's say that, we know a lot about the
problem for white
middle-class people. Well, can we use that data on people of
color? Can we use
that data for black people? Can we use that data for young
people, because it's
mostly middle-aged people?
And so they're going to say, well, I don't believe that data
applies. I want to deal
with people of color who are poor, and your data is all from
middle-class people.
What's the problem for people of color? You've got to have a
different kind of
evidence. You've got to make sure your sample responds to
them. Whether
you're doing testing data that's quantitative or interviews that's
qualitative, make
sure that the sample is a relevant sample for the people who
want to intervene.

With basic research, you're trying to basically understand how
the human being
works or how the social group works. And there again, your
primary audience is
going to be scientists, other researchers, people who publish in
refereed journals,
who have standards of what constitutes-- both within a
quantitative experimental
tradition and a qualitative tradition or a mixed-methods
tradition-- high-quality
research within those traditions. And you would be submitting
articles to journals
that publish basic research and that have standards of evidence.
Well, that begins to formulate some basic knowledge about how
human beings
are that we can run through that cycle. A comprehensive
understanding of the
phenomenon and acting on the world as a scholar-practitioner
would put all of
these parts together within a total field so that it's got a
foundation of basic
research.
This is how the world is. This is the nature of the problem that
we're interested in
from applied research. Here are some programs, models,
interventions that are
trying to solve that problem and how they work. Here are ways
that we've
improved those programs and continue to improve them as new
populations

come along-- immigrant populations, people who speak English
as a second
language, who haven't been in this kind of program before. How
do we make it
work for them?
And we watch for specific problems that need to be solved here
and now. It may
take a survey of them for quantitative data-- get client
satisfaction, do open-
ended interviews. These are not methodological distinctions.
They are purpose
distinctions. And knowing the purpose of your research
becomes really important
to be able to do an inquiry as a scholar-practitioner that actually
meets that
purpose.

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