Play therapy and transference and counter transference

  

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

· Working with Children and Adolescents: The Case of Claudia (pp. 15–17) 

Note: Depending on your concentration, you may not receive a case study book until a later term. Therefore, if you did not receive a copy of Social Work Case Studies: Concentration Year in your previous course, use the linked PDF provided here. If you did receive the book referenced above, you may find the cases there or use the PDF. PRACTICE

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Working With Children

and Adolescents:

The Case of Claudia

Claudia is a 6-year-old, Hispanic female residing with her biological mother and father in an urban area. Claudia was born in the United States 6 months after her mother and father moved to the country from Nicaragua. There is currently no extended family living in the area, but Claudia’s parents have made friends in the neighborhood. Claudia’s family struggles economically and has also struggled to obtain legal residency in this country. Her father inconsistently finds work in manual labor, and her mother recently began working three nights a week at a nail salon. While Claudia is bilingual in Spanish and English, Spanish is the sole language spoken in her household. She is currently enrolled in a large public school, attending kindergarten.

Claudia’s family lives in an impoverished urban neighborhood with a rising crime rate. After Claudia witnessed a mugging in her neighborhood, her mother reported that she became very anxious and “needy.” She cried frequently and refused to be in a room alone without a parent. Claudia made her parents lock the doors after returning home and would ask her parents to check the locks repeatedly. When walking in the neighborhood, Claudia would ask her parents if people passing are “bad” or if an approaching person is going to hurt them. Claudia had difficulty going to bed on nights when her mother worked, often crying when her mother left. Although she was frequently nervous, Claudia was comforted by her parents and has a good relationship with them. Claudia’s nervousness was exhibited throughout the school day as well. She asked her teachers to lock doors and spoke with staff and peers about potential intruders on a daily basis.

Claudia’s mother, Paula, was initially hesitant to seek therapy services for her daughter due to the family’s undocumented status in the country. I met with Claudia’s mother and utilized the initial meeting to explain the nature of services offered at the agency, as well as the policies of confidentiality. Prior to the

SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR

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meeting, I translated all relevant forms to Spanish to increase

Paula’s comfort. Within several minutes of talking, Paula noticeably

relaxed, openly sharing the family’s history and her concerns

regarding Claudia’s “nervousness.” Goals set for Claudia included

increasing Claudia’s ability to cope with anxiety and increasing her

ability to maintain attention throughout her school day.

Using child-centered and directed play therapy approaches,

I began working with Claudia to explore her world. Claudia was

intrigued by the sand tray in my office and selected a variety

of figures, informing me that each figure was either “good” or

“bad.” She would then construct scenes in the sand tray in which

she would create protective barriers around the good figures,

protecting them from the bad. I reflected upon this theme of good

versus bad, and Claudia developed the ability to verbalize her

desire to protect good people.

I continued meeting with Claudia once a week, and Claudia

continued exploring the theme of good versus bad in the sand tray

for 2 months. Utilizing a daily feelings check-in, Claudia developed

the ability to engage in affect identification, verbalizing her feelings

and often sharing relevant stories. Claudia slowly began asking me

questions about people in the building and office, inquiring if they

were bad or good, and I supported Claudia in exploring these

inquiries. Claudia would frequently discuss her fears about school

with me, asking why security guards were present at schools. We

would discuss the purpose of security guards in detail, allowing

her to ask questions repeatedly, as needed. Claudia and I also

practiced a calming song to sing when she experienced fear or

anxiety during the school day.

During this time, I regularly met with Paula to track Claudia’s

progress through parent reporting. I also utilized psychoeducational

techniques during these meetings to review appropriate

methods Paula could use to discuss personal safety with Claudia

without creating additional anxiety.

By the third month of treatment, Claudia began determining

that more and more people in the environment were good. This

was reflected in her sand tray scenes as well: the protection of

good figures decreased, and Claudia began placing good and bad

PRACTICE

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figures next to one another, stating, “They’re okay now.” Paula reported that Claudia no longer questioned her about each individual that passed them on the street. Claudia began telling her friends in school about good security guards and stopped asking teachers to lock doors during the day. At home, Claudia became more comfortable staying in her bedroom alone, and she significantly decreased the frequency of asking for doors to be locked.

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7. What local, state, or federal policies could (or did) affect this case?

Chase had an international adoption but it was filed within a specific state, which allowed him and his family to receive services so he could remain with his adopted family. In addition, state laws related to education affected Chase and aided his parents in requesting testing and special education services. Lastly, state laws related to child abandonment could have affected this family if they chose to relinquish custody to the Department of Family and Children Services (DFCS).

8. How would you advocate for social change to positively affect this case?

Advocacy within the school system for early identification and testing of children like Chase would be helpful.

9. Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?

There was a possibility of legal/ethical issues related to the family’s frustration with Chase. If his parents had resorted to physical abuse, a CPS report would need to be filed. In addition, with a possible relinquishment of Chase, DFCS could decide to look at the children still in the home (Chase’s adopted siblings) and consider removing them as well.

Working With Children and Adolescents:

The Case of Claudia

1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?

Specific intervention skills used were positive verbal support and encouragement, validation and reflection, and affect identification and exploration. Knowledge of child anxieties/fear and psychoeducation for the client and her mother were also utilized. Child-centered play therapy was utilized along with sand tray therapy to provide a safe environment for Claudia.

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2. Which theory or theories did you use to guide your practice?

I used theoretical bases of child- (client-) centered nondirective

play therapy.

3. What were the identified strengths of the client(s)?

Client strengths were a supportive parenting unit, positive peer

interactions, and the ability to engage.

4. What were the identified challenges faced by the client(s)?

The client faced environmental challenges. Due to socioeconomic

status, the client resided in a somewhat dangerous neighborhood,

adding to her anxiety and fear. The client’s family also lacked an

extended support system and struggled to establish legal residency.

5. What were the agreed-upon goals to be met to address the

concern?

The goals agreed upon were to increase the client’s ability to

cope with anxiety and increase her ability to maintain attention

at school.

6. Did you have to address any issues around cultural competence?

Did you have to learn about this population/group

prior to beginning your work with this client system? If so,

what type of research did you do to prepare?

Language barriers existed when working with the client’s

mother. I ensured that all agency documents were translated

into Spanish. It was also important to understand the family’s

cultural isolation. Their current neighborhood and culture is

much different than the rural Nicaraguan areas Claudia’s parents

grew up in. To learn more about this, I spent time with Paula,

learning more about her experience growing up and how this

affects her parenting style and desires for her daughter’s future.

7. What local, state, or federal policies could (or did) affect

this situation?

The client and her parents are affected by immigration legislation.

The client’s family was struggling financially as a result of their

inability to obtain documented status in this country. The client’s

mother expressed their strong desire to obtain legal status, but

stated that lawyer fees, court fees, and overwhelming paperwork

hindered their ability to obtain legal residency.

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8. How would you advocate for social change to positively affect this case?

I would advocate for increased availability and funding for legal aid services in the field of immigration.

9. How can evidence-based practice be integrated into this situation?

Evidenced-based practice can be integrated through the use of proven child therapy techniques, such as child-centered nondirective play therapy, along with unconditional positive regard.

10. Describe any additional personal reflections about this case.

It can be difficult to work with fears and anxiety when they are rooted in a client’s environment. It was important to help Claudia cope with her anxiety while still maintaining the family’s vigilance about crime and violence in the neighborhood.

Working With Children and Adolescents:

The Case of Noah

1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this client situation?

I utilized structured play therapy and cognitive behavioral techniques.

2. Which theory or theories did you use to guide your practice?

For this case study, I used cognitive behavioral theory.

3. What were the identified strengths of the client(s)?

Noah had supportive and loving foster parents who desired to adopt him. He quickly became acclimated to the foster home and started a friendship with his foster brother. He started to become engaged in extracurricular activities. Noah was an inquisitive and engaging boy who participated in our meetings.

4. What were the identified challenges faced by the client(s)?

Noah faced several challenges, most significantly the failure of his mother to follow through with the reunification plan. He has had an unstable childhood with unclear parental role models. There may be some unreported incidences of abuse and trauma.

Ruffolo, M. C., & Allen-Meares, P. (2013). Intervention with children. In M. J. Holosko, C. N. Dulmus, & K. M. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions (pp. 41–69). Hoboken, NJ: Wiley.

Taylor, E. R. (2009). Sandtray and solution-focused therapy. International Journal of Play Therapy, 18(1), 56–68. 

Note: Retrieved from Walden Library databases.

Malawista, K. L. (2004). Rescue fantasies in child therapy: Countertransference/ transference enactments. Child and Adolescent Social Work Journal, 21(4), 373–386.

Note: Retrieved from Walden Library databases.

van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics, 12, 293–317. Retrieved from http://www.traumacenter.org/products/pdf_files/neurobiology_childhood_trauma_abuse.pdf

van der Kolk, B. A. (2005a). Child abuse & victimization. Psychiatric Annals, 35(5),374–378. Retrieved from http://www.traumacenter.org/products/pdf_files/neurobiology_childhood_trauma_abuse.pdf

van der Kolk, B. A. (2005b). Developmental trauma disorder. Psychiatric Annals, 35(5), 401–408. 

Note: Retrieved from Walden Library databases.

Gil, E. (1991). The healing power of play: Working with abused children. New York, NY: Guilford Press: 

Chapter 2, “The Child Therapies: Application in Work With Abused Children (pp. 26–36) (PDF)

Chapter 3, “The Treatment of Abused Children” (pp. 37–82) (PDF)

Optional Resources

SOCW 61 discussion 1 week 8

Discussion 1 – Week 8 Attachment

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Play Therapy

Children who have been abused or traumatized in some way may benefit from working with a therapist. Children often reenact trauma through repetitious play in order to establish mastery over their emotions and integrate experiences into their history on their own terms. Through the use of toys and props, children may naturally share their emotions and past experiences without feeling the pressure they might encounter with traditional talk therapy.

For this Discussion, review the course-specific case study for Claudia and the Chiesa (2012) and Taylor (2009) articles.

Work #3 (Title of work #3 Play Therapy)

1. In a separate file Answer in APA format with at least 2 citations per paragraph with one whole page of written answer and a second page for references an explanation of ways play therapy might be beneficial for Claudia. Using the insights gained from the articles, describe ways you might have worked with Claudia to address her fears and anxiety related to the mugging she witnessed.

Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

SOCW 61 discussion 2 week 8

Discussion 2 – Week 8 Attachment

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Transference and Countertransference

Specific skills and knowledge are essential for a social worker working with children. Understanding transference and countertransference is crucial to a healthy therapeutic relationship. Both transference and countertransference can be evident in any client–therapist relationship, but are especially important in working with children because of a common instinct among adults to protect and nurture the young. The projection or relocation of one’s feelings about one person onto another, otherwise known as transference, is a common response by children (Gil, 1991). Countertransference, a practitioner’s own emotional response to a child, is also common.

For this Discussion, review the Malawista (2004) article.

Work #4 (Title of work #4 Transference and Countertransference)

2. In a separate file Answer in APA format with at least 2 citations per paragraph with one whole page of written answer and a second page for references your explanation why transference and countertransference are so common when working with children. Then, identify some strategies you might use to address both transference and countertransference in your work with children.

Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

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