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INTRODUCTION: DEVELOPMENTALLY
APPROPRIATE PLAY THERAPY
IN MIDDLE CHILDHOOD
ATHENA A. DREWES AND CHARLES E. SCHAEFER
The goal of this book is to enhance the ability of therapists to provide
developmentally appropriate play interventions for clients ages 6 to 12 years.
Indeed, this is the first book to provide clinicians with information about
developmentally sensitive and effective play therapy for children at this
age period. In the past, play and play therapy have been associated with
early childhood, and much of the literature has focused on the development and application of play therapy for children ages 5 years and younger.
Consequently, relatively little attention has been given by therapists and
researchers to the play of clients in middle childhood. This period is often
known as the “forgotten years” of development because most research has
been focused on early childhood development and adolescent growth.
Middle childhood is a very important period in a person’s life as essential
skills of adult life begin to be forged—namely, a person’s ability to engage in
productive work, develop competencies, and form friendships. In addition,
children this age experience major advances in their sense of self, regulation
http://dx.doi.org/10.1037/14776-001
Play Therapy in Middle Childhood, A. A. Drewes and C. E. Schaefer (Editors)
Copyright © 2016 by the American Psychological Association. All rights reserved.
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of emotions, and self-confidence. They become increasingly independent of
their parents and seek close connections with their peers. In addition, rulegoverned behaviors and personal achievements resulting from sustained
efforts are particularly valued and sought out (Collins, 1984). These qualities
form the foundation for continued psychological growth in adolescence and
adulthood.
In the middle years, the fantasy play so popular with preschoolers declines,
and a work orientation emphasizing intellectual mastery and physical competence replaces fantasy play as a compelling interest (Erikson, 1963).
Fantasy play is still engaged in by school-age children, but it is gradually
supplanted by the desire to play games and sports. As school-age children
become increasingly adept at putting internal states into words—fears, worries, anger, and other feelings—they are better able to delay acting on these
feelings (Davies, 1999).
The practice of play therapy with middle childhood clients must address
a wide range of developmental issues and a high rate of developmental change
(Russ, 2004; Vandermaas-Peeler, 2002). Therapists need an understanding of
development to formulate all aspects of treatment: diagnosis, treatment goals,
treatment approaches, and outcome.
This introduction provides an overview of the main developmental
tasks during middle childhood. These different aspects of a child’s development are interrelated, so change in one part will have an effect on the others.
The chapter contributors to this book will further explain how knowledge of
child development assists clinicians in implementing specific play interventions
for elementary school children.
CENTRAL DEVELOPMENTAL TASK
According to Erikson (1963), each of the eight stages of life from
infancy through adulthood has a central task that is psychosocial in nature.
Serious problems occur when a person doesn’t accomplish the task of his
or her developmental stage. Erikson stated that the key growth task of
school-age children is to develop “industry” (sense of productivity) versus
“inferiority” (sense of incompetence). Children this age learn to make
things, use tools, and acquire the skills to be a worker and a potential provider. They are motivated to succeed and willing to practice to develop
skills. For successful personality development in this stage, children need
to experience success in performing tasks. Feelings of inferiority arise when
this primary task is not accomplished. Inferiority feelings are reflected in
the sad pessimism of children who have little confidence in their ability to
do things well. Conversely, psychological strength is obtained when this
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central task is completed, which helps school-age children master the rest
of Erikson’s stages of life.
Many of the favorite play activities of school-age children involve a
sustained effort to be productive; examples include constructing objects
with blocks, making figures with clay, telling stories, acting out the role of a
superhero, solving puzzles, and throwing balls at targets. Successful completion of these challenging activities boosts a feeling of competence, whereas
failure results in a feeling of inadequacy. School-age children compare their
achievements with that of their peers to determine how competently they
are performing. Children with disabilities or severe developmental delays are
particularly at risk to develop inferiority feelings and are likely to need adults
to scaffold their play, modify the rules of games, and cultivate a unique talent
or interest so they can be successful.
MILESTONES IN CHILDREN’S PSYCHOLOGICAL DEVELOPMENT
DURING MIDDLE CHILDHOOD
Developmental milestones are age-specific tasks that most children can
do at a certain age range. The following sections provide a synopsis of these
milestones for children in middle childhood.
Emotional Development
Middle childhood children are continuing to expand their awareness
of their internal feelings and the causal connection between thoughts and
feelings—for example, thinking about a prior happy experience can make you
feel happier, whereas thinking about possible threats and dangers can make
you feel fearful. In regard to typical fears of school-age children (Bauer, 1976;
Carroll & Ryan-Wenger, 1999), as grade level increases there is a decrease in
the frequency of occurrence of fears with imaginary themes (e.g., fear of ghosts
and monsters), of bedtime fear (e.g., fear of the dark), and of frightening
dreams. There is a corresponding increase in the frequency of realistic fears
involving injury and physical danger (e.g., robbers or kidnappers breaking
into the house). Such fears are considered an adaptive aspect of development
with the primary focus of promoting survival. Fears decline steadily with age,
especially for girls, who express more fears than boys throughout childhood
and adolescence. Girls are likelier than boys to have trouble expressing anger.
Personal relationships are so important to girls that they fear doing or saying
anything that might cause a rupture. They imagine that if they express what
is really on their mind, their mother or friend will get angry and reject them
(Tyson, 1999).
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Cognitive Development
According to Piaget (as cited in Phillips, 1969), children at the elementary school level tend to be at the concrete operational stage of cognitive
development. Accordingly, they are developing the ability to reason logically
and organize their thoughts coherently. However, they tend to think in terms
of physical, concrete objects rather than hypothetical or abstract ideas, such
as love and duty. Their thinking becomes less egocentric, meaning that they
are able to think about and understand things from the viewpoint of others.
However, they tend to be focused more on the present and less on the future
consequences of their actions. Their growing verbal abilities enable them
to express their inner feelings, although complex emotions such as guilt or
resentment are difficult for them to comprehend (Landreth, Ray, & Bratton,
2009). They are moving away from magical thinking to a more accurate perception of reality and can now distinguish between fantasy and reality.
Their cognitive growth is especially noticeable in their ability to think
about solutions and consequences before they react to a problem. Compared
with preschool children, school-age children tend to be less easily frustrated,
less likely to fly off the handle when things do not go their way, and less
aggressive and also more caring about others, more likely to share and take
turns, and better able to make friends (Shure, 1994).
Cognitive abilities such as concentration and sustained attention also
improve significantly during the middle childhood years. Young elementary
school children (ages 6–8) tend to have an attention span of 15 to 30 minutes, whereas older children (ages 9–12) are likely to have attention spans of
30 to 45 minutes. Thus, play therapists usually prepare several play activities
to keep children this age engaged during a 50-minute therapy session. Their
selective attention is also much better in middle childhood than earlier,
meaning that they are capable of tuning out irrelevant distractions in order
to pay attention to a task.
Play Development
Piaget (1962) identified three stages in the development of children’s
play that provide a guide to appropriate materials and activities. Until the age
of 2 or 3, children’s play is largely sensory-motor in nature, whereas pretend/
symbolic play predominates in preschoolers ages 2 to 5. After age 5, “games
with rules,” including team games, become the preferred play activity of children, and this preference continues throughout adolescence and adulthood.
This shift from egocentric, symbolic play to social play, which requires the
players to follow rules and cooperate, illustrates how changes in play development prepare children for the tasks of adulthood.
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Moral Development
Children are mainly egocentric in their thinking when they enter middle childhood. During this period they move from a self-centered “What’s in
it for me?” attitude (e.g., if you do something for me, I would do something
for you) to wanting to gain social approval and conform to the expectations
and rules of people close to them. Children this age are also in the process of
forming a conscience, which is the depository of all they are learning about
their family’s values and standards. Occasionally, this conscience sends them
a clear signal when they betray what they know is right. This shift, from doing
what’s right because of the presence of an authority figure and fear of punishment to doing what’s right based on internal standards of conduct, is the basis
of moral behavior (Schaefer & DiGeronimo, 2000).
Moral principles of right and wrong lead to social rules that shape and
guide children’s interactions with others. According to Piaget (1962), when
school-age children follow rules while playing interactive games with peers,
they learn fairness, justice, and equality. These qualities lay the foundation
for ethical thinking and behavior (Damon, 1983). One of the most surprising findings from child development research is that children’s basic notions
of morality appear to arise less from adult instruction and more from interactions with peers while playing games. In these interactions, they come to
realize they can make their own rules based on principles of reciprocity and
fairness.
Social Development
Children in middle childhood have a strong need to be accepted
by their peers. They are very aware of themselves and other people as
members of a group, and they have a strong need to be accepted by their
peers. Thus, an important developmental task for children in middle childhood is to acquire social competence, which includes a compilation of desirable social skills that permit them to relate effectively in social situations.
Proficiency in conversation, empathy, reciprocity, cooperation, and ability
to have fun are skills particularly important for peer acceptance, whereas
bossiness, aggressiveness, and teasing are not appreciated by the peer group
(Nash, 2014).
In middle childhood, a child’s emotions of pride and guilt become
clearly connected with personal responsibility. Pride motivates children to
take on further challenges, and guilt prompts them to make amends and
strive for self-improvement.
Children this age are also acquiring greater control of their impulses,
which reduces emotional reactivity and lability. They continue to develop
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the capacity to feel empathy for another’s experience or life situation.
Their frequent peer interactions tend to foster growth in their emotional
maturity.
During middle childhood, the formation of friendships is of great importance to children. A friendship is a mutually agreed on relationship in which
children like each other’s personal qualities and respond to one another’s
needs, desires, and interests. Once a friendship is formed, trust is a defining
feature. As a result, a violation of trust is considered a serious breach of friendship. Friendships remain fairly stable over middle childhood. Friendships
tend to be with same-age and same-gender peers (Serbin, Powlishta, Gulko,
Martin, & Lockheed, 1993) and are usually based on proximity, common
interests, or other perceived commonalities. These preferences are important
to consider in the formation of play therapy groups for children this age.
In regard to sex differences, girls tend to have fewer but emotionally
closer friends than boys, and they tend to form more exclusive cliques and
shifting peer alliances. Boys’ play, in contrast, is marked by larger play groups,
more competitiveness, rule-governed team play, and a greater preference for
outdoor physical activity (Hughes, 2010). Boys have a strict dominance hierarchy composed of rankings that represent the relative power of those in a
group hierarchy.
For older school-age children, this is the period to develop “chumships.”
Chumship can be defined as an intimate, one-to-one relationship with a peer
of about the same age, interests, and gender. According to Sullivan’s (1953)
interpersonal theory, children this age, for the first time, can form a close
attachment to a same-sex friend—an attachment characterized by intimacy
and reciprocity. Having a best friend prevents loneliness while promoting
self-worth, social skills, and status. It also prepares children later in life for
intimate adult relationships.
USING PLAY THERAPY IN MIDDLE CHILDHOOD
Middle childhood children face a myriad of problems that benefit from
the use of play therapy alone or play therapy integrated with more traditional
talk therapy (e.g., cognitive–behavioral or traditional counseling). This age
group is no stranger to sexual abuse; physical abuse and neglect; parental
divorce; death of a parent, grandparent, sibling, teacher, or pet; bullying; loss
of friendships; medical issues and surgery; and relocation of the family home,
along with additional stressors such as community violence, domestic violence, school shootings, and domestic acts of terrorism. Indeed, this age group
is often barraged with stressors that tax their developmental level, physiology,
and tenuous coping strategies.
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For some children, use of play-based techniques integrated into their
treatment help them express and process their fears and anxieties and mitigate their social skill difficulties. For other children, who have past unresolved
traumas that trigger horrific images of situations too difficult to express, play
therapy can allow for the nonverbal abreaction and catharsis necessary to
master traumatic experiences.
Role-playing through puppets can be extremely beneficial in regular
therapy as well as play therapy in allowing for the trying on of skills and
problem-solving strategies as well as in helping change distortions in thinking about problems and situations. Use of group play therapy allows for a
playful, flexible environment in which peers can learn cooperative play while
building friendships. The chapters in this book will help clinicians understand how best to integrate play therapy into their work regardless of the type
of treatment approach they are using.
PLAN OF THE BOOK
Greater knowledge of the developmental issues facing children in
middle childhood will enable child clinicians to create more effective interventions for this age group by informing the choice of treatment goals and
strategies. A broad range of play therapy interventions for specific disorders
of these children are described in the chapters of this book.
The chapters are divided into four sections based on clinical problem.
Part I presents play interventions for internalizing disorders, such as anxieties and fears. The four chapters in this part address trauma from sexual
abuse as well as from natural and human-made disasters through use of
cognitive–behavioral play therapy and the use of play therapy in overcoming
anxiety. Part II presents play interventions for externalizing disorders, with
five chapters that address such disruptive behavior problems as aggression
and attention-deficit/hyperactivity disorder. Treatment approaches include
cognitive–behavioral, Theraplay, narrative therapy, and group play therapy
models. Part III presents play interventions to strengthen relationship skills
and includes chapters on peer pair counseling and child–parent relationship
therapy. Finally, Part IV presents play interventions for autism spectrum disorder. The three chapters in this section cover different levels of functioning
in children who are on the spectrum.
The goal throughout this volume is to highlight developmentally appropriate play therapy practice for clients in middle childhood. Each chapter provides practical applications that can be immediately implemented, together
with a discussion of the theory and research underlying each approach.
Case illustrations are included to bring the information to life. Our plan
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throughout is to demonstrate how to think developmentally in play therapy.
The editors firmly believe that a consideration of developmental factors is
critical to successful psychotherapy with children. Developmentally appropriate
practice refers to play interventions that are compatible with an individual
client’s interests, needs, and abilities.
In recent years, the play therapy literature has expanded to include
books on how to apply developmentally appropriate play therapy for infants
and toddlers (Schaefer, Kelly-Zion, McCormick, & Ohnogi, 2008), preschoolers (Schaefer, 2010), adolescents (Gallo-Lopez & Schaefer, 2005), and adults
(Schaefer, 2003). The present volume on children in middle childhood ensures
that therapists have detailed clinical guidelines for applying developmentally
appropriate play therapy throughout the entire human life cycle. A distinctive
feature of play therapy is that it is the only form of psychotherapy that is sensitive to the developmental needs of clients across such a broad age span.
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Carroll, M. K., & Ryan-Wenger, N. A. (1999). School-age children’s fears, anxiety,
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