PLAY - any voluntary activity engaged in for the purpose of enjoyment.

- play activities vary greatly from child to child and among different age, cultural, and socioeconomic groups. THERAPY - in the broadest sense, is a term that can be applied to any form of treatment for any illness or disorder PLAY THERAPY - is a psychoanalytic technique used by psychiatrists to help children understand their feelings and thoughts and motivations better. - in play therapy, the psychiatrist attempts to interpret the childs verbal and nonverbal cues.

Sigmund Freuds Psychosexual Development

Stage Age

Characteristics

Freud termed the infant period the oral phase because infants are so interested in oral stimulation or pleasure during Birth to 1 Oral Stage this time. If this need is not met, the child may develop an oral year fixation later in life, examples of which include thumb-sucking, smoking, fingernail biting and overeating. Childrens interest focus on the anal region as they begin toilet training. Elimination takes on new importance for them. 1 to 3 Children find pleasure in both the retention of feces and Anal Stage defecation. Too much pressure can result in an excessive need years for order or cleanliness later in life, while too little pressure from parents can lead to messy or destructive behavior later in life. Childrens pleasure zone appears to shift from the anal to the 3 to 6 genital area. Masturbation is common during this phase. Phallic years Children may also show exhibitionism, suggesting they hope Stage this will lead to increased knowledge of the two sexes. A time in which childrens libido appears to be diverted into 6 to 11 concrete thinking. Latent

Stage

years

Stage Age
Genital Stage

Characteristics

The onset of puberty causes the libido to become active once 11 to 18 again. During this stage, people develop a strong interest in the years opposite sex. If development has been successful to this point, the individual will continue to develop into a well-balanced person.

Erik Eriksons Psychosexual Tasks

Stage
Infancy (birth to 18 months)

Important Basic Events Conflict

Trust vs. Mistrust Feeding

Outcome
Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust.

Autonomy vs. Toddler (2 to 3 years) Shame and Doubt

Preschool (3 to 5 years)

Initiative vs. Guilt

School Age (6 Industry vs. to 11 years) Inferiority

Children need to develop a sense of personal control over physical skills and Toilet Training a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Children need to begin asserting control and power over the environment. Exploration Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Children need to cope with new social and academic demands. Success leads to School a sense of competence, while failure results in feelings of inferiority.

Stage

Important Basic Events Conflict

School

Outcome
Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.

School Age (6 Industry vs. to 11 years) Inferiority

Teens need to develop a sense of self and personal identity. Success leads to an Adolescence Identity vs. Social ability to stay true to yourself, while (12 to 18 Role Confusion Relationships failure leads to role confusion and a weak years) sense of self. Young adults need to form intimate, Young loving relationships with other people. Intimacy vs. Adulthood Relationships Success leads to strong relationships, Isolation (19 to 40 while failure results in loneliness and years) isolation. Adults need to create or nurture things that will outlast them, often by having Middle children or creating a positive change Adulthood Generativity vs. Work and that benefits other people. Success leads Stagnation Parenthood (40 to 65 to feelings of usefulness and years)

Jean Piaget s Cognitive Developmental Stages

STAGE OF DEVELOPMENT

AGE SPAN

NURSING COMPLICATIONS

Sensorimotor Neonatal Reflex Primary circular reaction

1 mo

y Stimuli are assimilated beginning mental images. y Behavior entirely reflexive.

into

1-4 mo

o Hand -mouth and ear-eye coordination develop. o Infant spends much time looking objects and separating self from them.

Secondary circular reaction

4-8 mo

y Infant learns to initiate, recognize, and repeat pleasurable experiences from environment. y Memory traces are present

Coordination of secondary reactions

8-12 mo

o Recognizes shapes and sizes of familiar objects o Because of increased sense of separateness, infant experiences separation anxiety when primary caregiver leaves.
y Child is able to experiment to discover new properties of objects and events y Capable of space perception and time perception as well as permanence

Tertiary circular reaction

12-18 mo

Invention of new means through mental combinations

18-24 mo

o Transitional phase to the preoperational thought period o Uses memory and imitation to act o Can solve basic problems, foresee maneuvers that will succeed or fail o Good toys for this period: those with several uses, such as blocks, colored plastic rings

Preoperational Thought

2-7 yr

Concrete Operational Thought

7-12 yr

y Can arrive at answers mentally instead of through physical attempt y Comprehends simple abstractions but thinking is basically concrete and literal y Child is egocentric(unable to see the viewpoint of another) y Centering or focusing on a single aspect of an object causes distorted reasoning o Concrete operations include systematic reasoning o Uses memory to learn broad concepts(fruit) and subgroups of concepts(apples and oranges) o Child is aware of reversibility , an opposite operation or continuation of reasoning back to a starting point(follows a route through a maze and then reverses steps)

Formal Operational Thought

12 yr

y Can solve hypothetical problems with scientific reasoning y Understands causality and can deal with the past, present and future y Adult or mature thought y Good activity for this period: talk time to sort through attitudes and opinions

Types of Play
Age Type of Play Description Example

Infant

Observation

Child watches particular Watching a mobile play intently, although not actively engaged in it. Two children play side Playing separately by side but seldom similar push toy attempt to interact with each other with

Toddler

Parallel

Preschooler

Associative

Children play together in Engaging in typical backyard a similar activity; there play is little organization of responsibilities Children play with an Playing organized organized structure or with rules compete for desired goal or outcome games

School-age

Cooperative

Toys Appropriate for Specific Age group

Age Infancy

Toy/Game 1-3 months: Mobiles Parent s face Rattles Stuffed animals 4-6 months: Squeez toys Boxes or blocks Play pens Plastic boats Rattles

Toy/Game
7-9 months: Cloth texture toys Rubber duckies Blocks and boxes Large colorful balls 10-12 months Building blocks Rings of assorted sizes that fit on a center post Stacking toys Play peek-a-boo Putting things in and out of a container Pulling toys

Age
Toddler

Toy/Game

Age

Toy/Game Trycycle, big wheels Backyard play Imaginative and dramatic play

Trucks Pre-school Squeaky frogs Waddling ducks Rocking horses Pegs to pound Blocks to stack Toy telephone Large balls School Age Imitate parents (drive a car)

Electronic games Books Crafts Board and card games Team sports Complex puzzles

Purpose of Play Therapy:

To decrease those behavioral and emotional difficulties that interfere significantly with a child's normal functioning To improved communication and understanding between the child and his parents. To improved verbal expression, ability for selfobservation, improved impulse control, more adaptive ways of coping with anxiety and frustration, and improved capacity to trust and to relate to others. To treat problems that are interfering with the child's normal development

Axline Principles of Play Therapy:

 Must develop a warm and friendly relationship with the child.  Accepts the child as she or he is.  Establishes a feeling of permission in the relationship so that the child feels free to express his or her feelings completely.  Is alert to recognize the feelings the child is expressing and reflects these feelings back in such a manner that the child gains insight into his/her behavior.  Maintains a deep respect for the child s ability to solve his/her problems and gives the child the opportunity to do so. The responsibility to make choices and to institute change is the child s.  Does not attempt to direct the child s actions or conversations in any manner. The child leads the way, the therapist follows.  Does not hurry the therapy along. It is a gradual process and must be recognized as such by the therapist.  Only establishes those limitations necessary to anchor the therapy to the world of reality and to make the child aware of his/her responsibility in the relationship

Principles involved in Play Therapy:

Microbiology Toys should be washable to prevent spreading of disease. Safety and Security Be sure to screen all toys for safety. They should have no sharp edges and no small parts that can be swallowed or aspirated. As a rule, if a toy can fit through the center of a toilet tissue tube, it is too small for safe play. Sociology As children talk with playmates during play, they develop both language and social skills. Psychology Play may be used to help assess children s level of knowledge and feelings about their condition so that more individualized nursing care can be planned.

Guidelines
 Be certain that the toys offered will not lead children into danger.  Allow the children to choose the articles with which they want to play.  Provide the specific materials that are needed for the child and orient it to them.  Reflect only on what the child expresses (verbal expression)  Do not criticize play.  Use therapeutic responses and positive reinforcements to child.  Supervise therapeutic play. For example, children who are playing modeling clay may eat it.

Nursing Responsibilities:
Before:  Prepare all the necessary materials needed for the activities  Introduce yourself to the patient  Inform the parents/guardian the purpose of the therapy During:  Create a friendly relation to the patient  Establish a feeling of permission  Ask the parents/guardian about the background information of the patient  Stay close to the patient After:  Communicate to the parents on the understanding of the childs psychological needs.  Evaluate the outcome of the activity  Do after care

The End. . .