The Universality of Play

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Play is a complex communicative behavior that some therapists have used to open up a door for communication between themselves and their child clients. Play is a language that some believe transcends culture, a behavior so innate and fundamental that it’s structure and function are universal, though the content of play may be determined by language, race, and culturally-specific variables.  Some play therapists adhere to this perspective and report that, “Play therapy fits everyone regardless of culture,” (Change et al, 2005, pg. 75.)  The following is an exploration of this statement, which will consider the cultural dimensions of play therapy and its closely related cousin, art therapy, in an effort to determine the extent to which play is a universal communicative behavior with a universal function that can be used in a therapeutic manner.

Kaduson and Schaefer (2005) report that play has proven an effective individual, family, and group therapy intervention.  For children, play is the main conduit for passing and receiving social messages.  Children assign symbols to their feelings,concepts of self, family, and fears.  These symbols could be action figures, Barbie dolls, scenes in a sandbox, or drawings on paper.  Art is a subset of play because it is an imaginative expression of the child’s mind, which, if viewed from the eyes of a skilled therapist can be interpreted as a clear communication or as a cathartic experience (Malchiodi, 1998).  Play and art are social behaviors engaged in for reasons of expression and learning.  Snakes do not engage in play because snakes are mostly individualistic and have nothing to learn from play.  Lion cubs, on the other hand, learn a great deal from the rough play they engage in.  They learn of dominance and submission within the pride while they work on honing their motor skills, which they will use in the hunt once they are large enough to
participate.

Hinman (2003) states that, “Although pretend play has been shown to be present across cultures [Irwin, 1983], its expression can be mediated by cultural influences.”  This assertion of universality is complicated by the way in which the play behavior is mediated by cultural norms.  If play occurs in different languages, with different materials, and for varied purposes then is it still the same play?  It is easy to understand how language and materials have virtually no impact on the underlying purpose of play; to a child, a stick with a face on it can represent their mother just as easily as an expensive Barbie doll.  The purpose of play is subjective and therefore difficult to categorize.  Aggressive play, such as sports and play-fighting, develops motor skills and represents competition or the physical challenges of life while softer forms of play like word games or fantasy roleplay are explorations of the social rhealm, develop a strong sense of community in children.  Each of these types of play occurs to varying degrees in different cultures; but, what is underlying them all is the true purpose of play, which is to explore the definition of self and other.  Young children from all cultures struggle with this differentiation and they all use play to test the boundaries of the self and integrate an understanding of the other.

Play therapists believe that the skills they develop, which are most effective for their clients, are the same skills utilized by Rogerian clinicians with adult clients.  These qualities; empathy, warmth, and genuineness provide the therapeutic relationship with the ingredients needed for acceptance and the clients’ sense of freedom for honest and insightful expression no matter what its form (Nalavany et al, 2005.)  Clinicians in the field of play therapy need to be cognizant of the Outline for Cultural Formulation described in the DSM-IV, which states that a client’s cultural identity could be assessed by considering their cultural reference groups, the degree to which the client is involved in traditional cultures, and their language abilities and use (Hinman, 2003.)

Where We Stand Now

At this point, it is important to assess the current state of multicultural competence in the field of play therapy.  The counselor’s awareness of their own cultural values and biases, their knowledge of the client’s world view, and the counselor’s implementation of culturally appropriate methods; these are the guidelines for multicultural competency as outlined by the Association for Multicultural Counseling and Development (Chang et al., 2005.)

Using a self-report method, Ritter et al. (2002) found that play therapists considered themselves somewhat competent to competent in issues related to multiculturalism.  This rating was significantly higher for those who had the opportunity to take multicultural courses in their academic training.  The therapists rated themselves as most competent in terms of multicultural awareness and terminology but least competent in terms of racial identity development.  Interestingly, though training courses were correlated with high self-rating of competence, the rating of these courses was found to be below adequate.  A study done by Abrams et al. (2006) begs the question; does the race or ethnicity of a play therapist impact their professional experience?  This study looked at the work environment and clinical experiences of racially and ethnically diverse play therapists and found few differences between the experiences of minorities and their majority peers.

Much like an artist defining the shape of a vase not by outlining it, but by the arrangement of the bouquet it contains, a multicultural play therapist is able to see how an individual client is largely defined by the cultural forces surrounding them.  Play and art therapists work in a world of metaphoric meaning, where even the conspicuously absent forces take symbolic form.  These forms can be made through the artistic use of a toilet paper roll by the client or made in China like a doll or action figure.  Examining the mechanisms of culture is key to understanding not only how it has played a role in the lives of our clients but in our own lives as well.  For instance, in a collection of essays written by culturally diverse clinicians, art therapist Jayashree George reflects on how her privileged life as an upper-caste Indian made her life as a student with middle-class American college peers very difficult.  In the dominant white culture of semi-populist American academia, her privileged status did not amount to anything and made her contemplate its significance (George et al., 2005.)

Multicultural play therapy is difficult in the cultural hodgepodge that is the typical American city.  The combining of many different cultures creates an amalgamation, or meta-culture, that cannot be ignored; but, it’s one that doesn’t necessarily play a huge role in the cultural microcosms (subcultures) in which many professional operate.  The needs of culturally diverse children and families cannot be assumed by any clinician, regardless of that clinician’s prior knowledge of that culture. Ultimately, all clients should be treated as individuals.  As play therapist and lecturer in social work at the University of Reading, Steve Farnfield, states in his review of Eliana Gil and Athena Drewes’ book Cultural Issues in Play Therapy, “… there is no shortcut to understanding and providing effective services to people in our cultural villages,” (Farnfield, 2006.)

Underlying Issues

There are a few underlying issues and considerations related to the process of therapy that the multiculturally competent therapist should be cognizant of.  As play therapy is directed at children, it is only natural that its methods be broadened to the family.  Family counseling introduces complex interpersonal dimensions for the therapist to explore and requires the therapist to be able to create a viable working relationship with clients and their families.  This can be a difficult task when those families have very different expectations of the therapist than he anticipates.  For instance, traditional Japanese families of children in counseling experience shame over their child’s therapy. To soothe this sense of shame it is important for a multicultural therapist to, first, acknowledge the shame and, second, to establish clear boundaries and rules of confidentiality to help alleviate feelings of failure by ensuring the parents’ position of authority.  Conversely, Mexican-American families look for closeness in warmth from a therapist (Hinman, 2003.)  It is clear that a multiculturally competent counselor will need to exercise a great deal of self-discipline in exploring the intricate ways these divergent perceptions can affect the professional relationship as credibility of method is key for all consumers.

Play is used in the assessment of childhood mental illness and, as is true for all methods of assessment, culture can be deeply ingrained in our measures.  Play is used to assess many disorders, from autism to posttraumatic stress disorder, but false positives must be avoided and can be through the intelligent appreciation of the various play behaviors of potential client cultures and subcultures.  Children from some cultures, which devalue early childhood play, may behave in ways considered markedly abnormal during assessment activities because they lack the knowledge of how to manage loose or unstructured play situations (Hinman, 2003.)

Minority status and ethnic identity, or the degree of membership in one’s ethnic group, are two cultural issues that could arise in therapy and can be explored through play.  Immigrant children, for example, may naturally over-identify with their minority group and distance themselves from the dominant group simply due to its ubiquitous presence (DeSteno & Saloevy, 1997, cited in Hinman, 2003.)  The multiculturally competent play therapist will have to be professionally prepared and, in terms of his materials, to explore the subjective experience of minority status and ethnic identity (Hinman, 2003.)

Materials

Materials are an important element of play therapy.  Children’s imaginations are seemingly limitless; but, play therapists can aid the child in the process by developing a playroom that is usable for virtually any family from any cultural background.  This is largely dependent on the local population, but necessary for establishing clear and open lines of communication and making available the helpful symbols for catharsis in play.

There are many types of materials in play therapy; the categories include art, kitchen, and dramatic play, which can be used for representing real life, aggressive-release play, or creative expression (Chang et al., 2005.)  Play therapists who work with a culturally diverse clientele find it is helpful to make readily available different shades of skin tone colored crayons, play-doh, and markers.

Important also would be the availability of dolls and puppets representing various cultures or races; these were the most widely used multicultural items utilized by play therapists according to Chang et al., 2005.  A wide range of buildings, animals, figures, and plants are helpful for sand tray activities; but, in the same study, typical items were seen as universally applicable.

Efficacy is not dependent on materials, and realism may have a negative effect as, “… children and families often feel more comfortable or safer expressing themselves with less realistic representations of family members.” (Chang et al., 2005.)  This begs the question, are some of these multicultural considerations more about fitting the client into the compartmentalized worldview of the therapist or about providing the best care by entering their cultural world in a very literal way?

As a play therapist, immersion into another culture will drastically impact procedure.  For instance, Ji et al. (2008) suggest that, when working for a predominantly traditional Japanese population, to consider the waiting rooms first since first impressions are key.  Social distance in Japanese is referred to as uchi and soto, which mean inside and outside.  If the two intermix then the result is often haji, or shame.  Therefore, confidence and privacy are two characteristics of the therapist that can be communicated through expert placement and arrangement of the waiting room, thereby respecting one’s traditional Japanese client.  Using two rooms, one for high-energy activities and one for low energy activities is also suggested when working with Japanese children.  In the low energy room, Ji et al. (2008) suggest setting up a traditional wa-shitsu area to increase the child’s level of comfort through familiarity.  The wa-shitsu is a traditional arrangement in Japan that nearly all homes have.

Although most Japanese children love videogames, the girls are usually encouraged to use toys for pretend/fantasy, dolls and stuffed animals, while the boys are encouraged to play with balls, punching bags, and other physical or aggressive toys.  Sandboxes are very popular in the Japanese culture and play therapists are urged to make available Buddhist and Christian priest figurines, buildings, and artifacts for use in sand tray therapy.  Also, eastern and western cookware and utensils as well as culturally appropriate doll clothing and accessories are important materials for use by a western play therapist immersed in the Japanese culture (Ji et al., 2008.)

Not all materials are available to the play therapist and often it’s best to exhaust creative options for creating symbolic objects.  Barbie has had a pre-packaged black friend since the late 1960’s (Torres, 2007), but does she have a republican-biracial-Korean-American-feminist-experiencing-an-existential crisis-friend, hardly.  Some friends are best made with clay or crayon.

Immersion – A Therapist in a Far-Off Land

In a study of theraplay in a Korean context, Kim and Nahm (2008) suggest that all cultures are in a state of flux and a macro understanding of them will prove insufficient, as generational divides exist everywhere.  For instance, the older Korean population values solemnity, even during celebrations. Korean parents often sleep with their infants in the same bed and have distinct expectations from fathers and mothers.  For instance, sincerity and diligence is valued in a man, while self-sacrifice is valued in a woman.  These expectations are shifting, however, as fathers are becoming more involved in care-taking now more than ever before.

Forms of physical expression are different among Koreans.  For instance, brides may cry at their weddings, but not out of joy, rather, out of regret over leaving their family.  Also, physical contact such as hand shaking or hugging between friends and relatives is much more common and acceptable in Korea than in the United States.  One thing that is similar, though, is play.  Childhood play emphasizes movement, coordination, and imitation skills (Kim & Nahm, 2008.)

Garza & Bratton (2005) indicate that Child-Centered Play Therapy (CCPT) is effective in treating the externalization of the problem behaviors exhibited by Hispanic children but that cultural concerns have been identified.  For example, children in this study responded well to identifiably “Mexican” toys.  Similarly, Perezet al. (2007) speculates that Mexican-American children will have issues related to limit setting, defined by Ginott (1961).  Although forty-two of the fifty-four limits described by Ginott (1961) were deemed appropriate, Perez et al. (2007) clarified that Mexican-American clients in play therapy would differ in terms of; the sharing of play-room materials, their willingness and eagerness to play outdoors, family participation in therapy, and their willingness to express affection physically.

Socioeconomic Subcultures

Multicultural considerations must not only be employed when working with clients of different races or ethnic backgrounds, but also with clients from different cultures defined by socio-economic variables.  Homeless children often need to convey the feeling of loss following an eviction or the excitement during an “I’m rich!” fantasy.  Homeless children are exposed to more stressful events, suffer higher rates of anxiety and depression, and experience shame as a result of their condition.

Play therapy has been shown to bolster homeless children’s self image, reduce inappropriate behaviors, and relieve anxiety. Common issues revolve around their experience as a homeless person and may relate to attachment, nurturance, or the brutal realities of gang-life and street violence (Baggerly, 2003.) The therapist should remain open to a wide spectrum of expressive behaviors and appreciate the crude nature of the child’s immediate surroundings.

Language as play – not everything is literal

Yolen (1992) reminds us that rhymes and childhood games are often geared toward, or closely associated with, developmental milestones.  In all cultures, children explore language through play while simultaneously developing social and motor skills. The content of play may differ, but often the structure and function remains universal. Imagination makes symbols out of anything and children are creatures often defined by their overflowing imagination.

Filial Therapy

Filial therapy is a model of counseling in which the therapist consults with the parents to teach them how to use play as a communication tool.  This not only aids the child but also builds the parent-child relationship, which is a major purpose for its use.  This consultation typically takes place in an educational group setting where the therapist instructs parents in CCPT, child development, and how to become the central agent of change in their own child’s life (Foley et al., 2006.)  The question posed is, how would such a complex form of family therapy need to adapt to fit families from different cultures?

Emergent research shows filial therapy is a promising method for German mothers, who come from a culture that has proven less receptive to play therapy in the past (Grkovic & Goetze, 2008.)  Like many others, a Jamaican mother who experienced filial therapy reported an increased level of empathy for her child, heightened awareness of the child’s needs, and an overall stronger relationship.

One main purpose of filial therapy is to increase parent acceptance of their children’s behavior. Jamaican parents have traditionally offered resistance to the idea of child rights and to mental health counseling in general.  Americans would view many of the disciplinary practices used in Jamaica as abuse and children there have traditionally been viewed as little more than economic property (Edwards et al., 2007.)  It is interesting to see how such a radical therapeutic practice can prove effective in such a seemingly harsh cultural environment.

In a study of filial therapy among Chinese families living in Canada, Yuen et al. (2002) emphasized the fact that Confucius’ conservative ideals play a major role in child rearing in the Chinese culture; those ideal emphasize parental control, obedience, strict discipline, filial piety, respect for elders, family obligations, maintenance of harmony, and negation of conflict.  These are in nearly direct conflict with the purpose of filial therapy and represent a clear example of how therapy can conflict with traditional values.  The results of the study showed that filial therapy significantly improved the child-parent relationship, lowered problem behaviors, increased empathy and acceptance, as well as lowering stress related to parenting.

Some may say that this indicates the problems with authoritarian parenting styles and equate that to the Chinese culture; rather, it is perhaps indicative of the fact that we tend to over-generalize foreign culture when we insist on the nuances of our own.  We try to impose a static state to foreign cultures rather than accept them as dynamic amalgamations of adaptive behaviors over time.  It is not that the traditional authoritarian or patriarchal culture is in any way inferior; but, instead, is just incomplete and maladaptive in an individualistic, technology assisted world in which highly constrained individuals falter.

The generational gap is significant between immigrant parents and their children; the parents find it more difficult to relate to their children and to interpret foreign norms as they express themselves in their children’s behavior.  This is true for immigrant Korean parents in the United States.  These parents tend to expect unconditional obedience but don’t know how to guide their children toward success in the new system.  Lee and Landreth (2003) found that filial therapy increased empathy and acceptance among immigrant Korean parents in the United States while decreasing stress related to parenting.  Again, this shows how filial therapy is aimed at strengthening the chong, or affectionate family bond, particularly focusing on mochong, or the mother’s love or affection.

When speaking of the use of western style methods of therapy among foreign immigrant populations, one has to wonder if similarities are a function of the immigrant status of the parents; are they more open to adjusting their traditional value sets than Domestic Chinese or Korean parents?  It would seem logical that immigrant parents expect clashes of culture and may, in a way, submit to practices they would otherwise resist.

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