Multicultural Considerations

Multicultural considerations are essential in working with children and parents in family counseling. Counselors should discuss activities with parents and ask for their involvement to ensure that the play-based activities are sensitive to the cultural make up of the family. If parents are uncomfortable with a proposed activity, the counselor should explore the origin of the parents’ concerns and invite the parents to make modifications to the activity that will be in keeping with their beliefs, values and customs. For example, a mother from Korea may not feel comfortable with a counselor sitting on the floor and appearing potentially “lower” than the family members; however, she may be willing to sit at a table and chairs and complete the proposed activity. Another consideration is the types of supplies utilized for the play-based activities. For example, if using human figure puppets or dolls, a variety of ethnic groups and both genders should be represented. As an alternative, the counselor can use animal puppets or dolls to allow for the multitude of family configurations. It is also helpful to have a variety of occupations represented to avoid perpetuating stereotypes.

Play-Based Activities in Family Counseling 347

AN INTEGRATIVE MODEL AND INTERVENTION

In an attempt to organize and structure family sessions which include parents and children, an integrative model based on a variety of approaches (e.g., Strategic Family Therapy, Structural Family Therapy, Solution Focused Therapy, Narrative Therapy, Individual Psychology (Adlerian), and Cognitive Behavioral Therapy) can be useful. The goal of this integrative model is to engage all family members in the therapeutic process while understanding that each member may have a different goal for counseling. Additionally, family members’ ages may range widely requiring the counselor to communicate and intervene on multiple developmental levels simultaneously. The following will outline this model and provide a case example which uses this approach. Using this model, each session is approximately 50 minutes. The format of each session includes: Introduction Phase (5 minutes), Working Phase (30 to 35 minutes), and Inter-Session Break and Special Message Time Phase (15 to 20 minutes).

Supplies It is helpful to have an easel or large sheets of construction paper, a toy box with a wide range of expressive toys, markers, crayons, puppets, and some type of puppet stage in your office or family counseling room (Carmichael, 2006). With puppets, it is important to have a wide range of them for family members to select from. It is also useful to have puppets with dichotomous characteristics such as a puppy and a wolf, a lion and a lamb, etc. This can help identify family dynamics and allow children a variety of expressions.

Introduction Phase The Introduction Phase begins with the counselor greeting the family, shaking each person’s hand, and addressing each by their first name. From the moment of first contact, the counselor should closely observe the behaviors and communication style of each family member. The counselor should note nonverbal communication, the seating arrangement, children’s choice of toys, family power structure/hierarchy, parental discipline and any overt emotions present in the room (e.g., anxiety). Additionally, the counselor should pay attention to how a parent manages a child or multiple children. What are the parents’ expectations for greeting a new adult, managing the child’s belongings, entering a new space/room, etc. (Wachtel, 1994). Shortly after the session begins and introductions have been made, most children will begin exploring the various toys and items in the room. At this time, it can be beneficial to incorporate puppets to give children and parents guidance on how to participate in the therapy session. For example, the counselor might have each family member choose a puppet they think most

348 J. D. Wehrman and J. E. Field

represents them or have them select one without instructions and discuss what interested them in the puppet they chose. The puppets can assist in facilitating the remainder of the session as they help engage children and allow the family to communicate in metaphorical or abstract means about topics that are challenging to address directly. Through a puppet, family members may be more likely to describe what happens in the family and how the family member’s feel about the identified problem. For example, the family can discuss the bark coming from dad’s puppet as opposed to how dad raises his voice at the children when he is angry.

Working Phase A recommendation is that the working phase of counseling be initiated with the counselor and family constructing a family genogram. After explaining what a genogram is and why this activity can be useful for the family, the counselor should specifically inform the children how they can help with constructing the genogram. Drawing sample genograms on a sheet of paper will provide visual examples of what a genogram looks like. Using a large sheet of easel paper and markers, family members can see a representation of different generations and family patterns. This process often uncovers family strengths, interesting stories and family history that children may not be aware of. The counselor may sit on the floor with the child (if appropriate) and begin asking the family questions to construct the genogram. It may be useful to initiate the genogram by first drawing each child and then move to the parents, involving all family members in the process. The counselor utilizes strength based questions to elicit family successes and coping abilities as well as highlight resiliency. Next, the counselor explores the family’s reason for coming to counseling hearing each member’s response. If family members interrupt one another or move to new topics, the counselor can use a blocking strategy and state something such as, “We will come back to that but first I feel that it is important to hear from each member of the family.” If emotions become intense, the counselor can acknowledge the strong feelings while still making sure that each family member is able to explain their perspective about an identified family problem. The final task of the Working Phase is the construction of the “Weekly Check-In Scale”. The counselor asks the family, as a group, to identify when the concern/problem that brought them to counseling was the worst and allows the family to negotiate a specific time, i.e. last March. On the bottom of the paper that the genogram was drawn on, the counselor labels the identified time as a “1” and draw a line across the bottom of the paper with a “10” on the other side. The counselor states to the family that each number above a one indicates that the problem is getting smaller and that the family is doing better. A ten on the scale may represent that things are betterPlay-Based Activities in Family Counseling 349

and counseling is no longer needed. The counselor then asks each family member, individually, to identify where the family problem is on the scale and why he or she has given the problem this ranking. As family members state their number, the counselor records it on the scale along with the family member’s name and date of session. There are variations in constructing the weekly check in scale. For example, the scale can be drawn as a range from smiley (10) to frowning (1) faces (Duncan, Miller, & Sparks, 2004). Additionally, the counselor can ask each family member what he or she could do to move the family “problem” toward a ten on the scale. The counselor should explore and expand upon the family member’s understanding of his or her reported numbers and the accompanying behaviors from a Solution Focused perspective.

Inter-Session Break and Special Message Time Phase Next, the counselor takes a break and excuses him or herself from the session. Prior to leaving the room, the counselor should state how long he or she will be gone as well as invite the family to continue to play, engage in an activity or start to pick up the space if several different toys or props were used during the session. The counselor leaves the room and takes the break in another office or meeting room. During the break, the counselor collects his or her thoughts regarding the overall themes and direction of the session. This includes identifying particularly powerful interactions in the session and what the interactions represent for the family. During this time, the counselor constructs a special message, brief puppet show, bibliotherapy activity or other intervention to highlight what happened in the session and share with the family. The intent of the intervention is to provide an opportunity for the child to experience validation and normalization of the presenting concern (e.g., their behavior) and educate and reorient the child away from the problematic behavior (e.g., what the child wants the family to know—that is demonstrated through the behavior). The message or activity could also indirectly target the parents through validating their efforts or providing a model from which they can better assist their child. If using bibliotherapy, it is helpful to have a book shelf or file box with books organized by topic area. Then, if the session theme is anger, for example, the counselor can quickly extract the appropriate book for the bibliotherapy activity. A benefit of taking a break during the session is that the family is in a heightened state of receptivity to the counselor’s message or activity. The counselor has been gone from the session for a while and the family is curious to know what he or she will say and do upon returning. Families are commonly interested in feedback about how their family is functioning according to the counselor. Delivering a special message allows the counselor to reinforce behaviors that are working to address the family concern and discourage behaviors that maintain the problem in a nonthreatening manner.

350 J. D. Wehrman and J. E. Field

Additionally, taking the break at the end of the session allows the message or activity to be the last thing the family members hear. Following the break, the counselor reenters the room for the Special Message Time. The counselor conducts the activity (e.g., puppet show, draws a picture that depicts the feedback, etc.) or reads the message to the family and asks each family member to reflect what they hear. Upon finishing the message or activity, the counselor ends the session.

Subsequent Sessions At the beginning of each subsequent session, during the Introduction Phase, the counselor and family revisit the Weekly Check-In Scale. Each family member is asked to report their number on the scale the day of the session compared to previous sessions. On the scale, the counselor records each family member’s name and reported number as well as the session date. Beginning each session in this manner provides a measure of change between sessions that can be monitored over the course of counseling. Family members are routinely asked to talk about the behaviors that they use which makes the problem smaller and the family stronger. The Working Phase follows and will change each week depending on the family and their therapeutic needs. Each session ends with an Inter-Session Break and Special Message Time.

A Case Example: The Smith Family Names have been changed to respect privacy and confidentiality of the family members. The Smith family consisted of mom, age 25, Bobby, age 7, and Suzie, age 5. The family came to counseling as a result of Bobby’s declining grades and increasing number of disciplinary referrals at school. Upon arriving to the first session, it was quickly identifiable that mom was exhausted. Bobby had been diagnosed with ADHD and mom reported feeling overwhelmed with her responsibilities of being a parent. She had become somewhat paralyzed in her role as a mother. Initially, Bobby was angry and felt persecuted as he was the reason the family was coming to counseling. Suzie appeared well adjusted and content with being present. The session began with Bobby racing around the room going from item to item. Initially, mom attempted to correct his behavior but after a few minutes gave up and turned control over to whoever wanted to take charge of the situation whether it was the counselor or Bobby. The session began with the incorporation of puppets. The counselor moved to the floor, invited the children to pick a puppet, and began engaging them using the puppets. Initially mom sat in a chair adjacent to the children holding a puppet in her lap. After some time and observation passed, mom moved to the floor and began to use the puppet. In future sessions, the counselor utilized sand

Play-Based Activities in Family Counseling 351

tray and therapeutic games to provide other methods of family interaction. Bobby was able to express his anxiety related to attempting to control his environment and understand that his mother was ready to be “in charge” and provide structure and stability for their family. While the specific play portion of the session changed each week, every session ended with an inter session break and special message time which the family often accepted with excitement. The benefit of incorporating play into the family sessions was that it artfully engaged Bobby and allowed him and his mother to communicate differently. Rather than using his behaviors to act out his emotions, he vented through play to a receptive mother who had time, space, and support to understand what he could not voice. After a few sessions, little correction of his behavior was needed and Bobby and his mother began scheduling regular, mutual play time at home. Over the course of counseling, Bobby was able to receive encouragement and validation for his hard work in changing his behavior. Mom was able to observe limit setting and a variety of skills modeled by the counselor and began to incorporate them into her parenting. Ultimately, the family began incorporating many of the activities learned in the sessions into their daily routines and soon no longer required therapeutic services. Bobby felt encouraged and loved. Mom felt love reciprocated from her children as well as self confidence in her ability to provide familial structure and stability as she raised two children in a single parent household.

CONCLUSION

Working in a family counseling session with parents and children can seem overwhelming. This article presents a model to assist family counselors in incorporating play-based interventions into their work with families. Children have much to offer in the sessions, and if structured effectively, play therapy can result in progress and success for the entire family (Thompson, Bender, Cardoso, & Flynn, 2011). It is important to expect some parent resistance to play-based activities, explain the importance of the activities for the children in the session, and work to be comfortable with the activities in the session to serve as a model for parents. In implementing the strategies outlined, family counselors can take steps to not only incorporate children into their family sessions but also work toward therapeutic change for the whole family.

REFERENCES

Baggerly, J., & Exum, H. A. (2008). Counseling children after natural disasters: Guidance for family counselors. The American Journal of Family Counseling, 36, 79–93.

352 J. D. Wehrman and J. E. Field

Blitstein, S. (1982). Playful therapy: The water pistol shootout. Social Work, 27(2), 190–192. Carmichael, K. D. (2006). Play counseling: An introduction. Upper Saddle River, NJ: Pearson Education. Doherty, W. J., & Simmons, D. S. (1996). Clinical practice patterns of marriage and family counselors: A national survey of counselors and their clients. Journal of Marital and Family Counseling, 22(1), 9–25. Donovan, D. M, & McIntyre, D. (1990). Healing the hurt child: A developmentalcontextual approach. New York, NY: W.W. Norton. Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed outcome-informed counseling. San Francisco, CA: John Wiley & Sons. Hill, A. (2006). Play counseling with sexually abused children: Including parents in therapeutic play. Child and Family Social Work, 11, 316–324. Gil, E., & Sobol, B. (2005). Engaging families in therapeutic play. In C. E. Bailey (Ed.), Children in therapy: Using the family as a resource. New York, NY: W.W. Norton. Johnson, L., & Thomas, V. (1999). Poverty and crisis in children’s services: The need for services integration. Journal of Clinical Child Psychology, 23, 413–424. Levine, P. A., & Kline, M. (2006). Trauma through a child’s eyes: Awakening the ordinary miracle of healing. Berkeley, CA: North Atlantic. Miller, L. D., & McLeod, E. (2001). Children as participants in family counseling: Practice, research, and theoretical concerns. The Family Journal: Counseling and Counseling for Couples and Families, 9(4), 375–383. Orton, G. I. (1997). Strategies for counseling with children and their parents. Pacific Grove, CA: Brooks/Cole. Rotter, J. C., & Bush, M. V. (2000). Play and family counseling. The Family Journal: Counseling and Counseling for Couples and Families, 8(2), 172–176. Smith, S. M., Rosen, K. H., McCollum, E. E., Coleman, J. U., & Herman, S. A. (1996). The voices of children: Preadolescent children’s experiences in family counseling. Journal of Marital and Family Counseling, 22(1), 69–86. Thompson, S. J., Bender, K., Cardoso, J. B., & Flynn, P. M. (2011). Experiential activities in family therapy: Perceptions of caregivers and youth. Journal of Child and Family Studies, 20, 560–568. doi:10.1007/s10826–010–9428-x VanFleet, R. (2000). Understanding and overcoming parent resistance to play counseling. International Journal of Play Counseling, 9(1), 35–46. Wachtel, E. F. (1994). Treating troubled children and their families. New York, NY: Guilford. Wehrman, J. D. (2008). Promoting play and caregiver-child interaction: The strategic use of special time. Play Therapy Magazine, 3, 14–17 Wittenborn, A. K., Faber, A. J., Harvey, A. M., & Thomas, V. K. (2006). Emotionally focused family counseling and play counseling techniques. The American Journal of Family Counseling, 34, 333–342.

Copyright of American Journal of Family Therapy is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email