Child’s Play at APsaA: Discovering Psychoanalytic Play Therapy

by Esha Bhandari

Starting college, I thought I had everything figured out. I was going to study the social sciences, enlist myself as a research assistant in a few of my university’s psychology research labs, and then eventually I’d get my Ph.D. and begin my life as a clinical psychologist. By my junior year, I had taken nearly every psychology course that was offered at my university—courses that spanned what I thought was every field in the discipline, including social psychology, clinical psychology, cognitive psychology, developmental psychology, cultural psychology, educational psychology, psychology and the law, and community psychology.

Then, late one night in my research lab, I received an email inviting applications for an externship to that year’s meeting of the American Psychoanalytic Association (APsaA) in New York City. I pondered the word “psychoanalytic,” which, like many psychology majors at most U.S. universities, I barely recognized. I’d heard it mentioned somewhere in relation to “popular psychology,” along with the name “Freud” and terms like “Oedipal.” But here was evidence of a national association entirely devoted to psychoanalysis. How could that be? What went on at their conference?

Out of sheer curiosity, I applied and was fortuitously accepted. Little did I know that this decision would transform my entire outlook on psychology and my plans for a future career.

One feature of the externship was being assigned a practicing psychoanalyst as a mentor. My mentor ended up being Dr. Susan Donner, a child, adolescent, and adult psychiatrist and psychoanalyst from Los Angeles. I was especially excited to be her mentee because of my interest in developmental psychology and my hope that one day I’d be able to study the treatment of children as a clinical psychologist. Together, Dr. Donner and I attended several wonderful sessions of relevance to my interests. But there was one session in particular that will always stay with me.

At that session, the presenting psychoanalyst discussed a young patient with whom she was working through certain behavioral problems that were disrupting the child’s academic and social progress. Her parents complained that she was shy and reserved and didn’t seem to interact very much with her teacher or fellow students. Superficially, it seemed to be the case of an inhibited child who simply needed some help coming out of her shell. But, because the child’s verbal expression was so limited, the analyst decided to employ some techniques of psychodynamic play therapy, in which the shared activity of play can facilitate communication and associative work even in minimally verbal patients. Children will naturally “play out” unresolved conflicts which can be observed and interpreted by the analyst. When searching for a succinct way to summarize the wide-reaching purposes of play therapy, I believe Punnett and Green describe it best: “Psychoanalytically oriented play therapy emphasizes symbolic meaning and is focused on anxieties, defenses and fantasies in order to understand the underlying dynamics of the presenting symptom(s)” (47).

In the case we heard presented, such a child might have been expected to express fear and tentativeness in her play activity. But, as we heard, the child’s play revealed quite the opposite. From the start, she conjured violent and tumultuous scenarios of inclement weather destroying cities and gigantic monsters murdering people. As the therapeutic relationship developed over time, the psychoanalyst continued to see signs that the child’s timid behavior was likely masking great turmoil, both internal and environmental. Gradually helping the child to put into words her hitherto muted feelings of rage, fear, and doubt eventually disclosed harsh and punitive treatment by the parents. But what was most surprising to me was the fact that the child’s emotional states included those not only of a victim but also of an aggressor. The child revealed her emotional hurt by depicting authoritative figures damaging helpless toy characters, but she was also communicating hostile reactions to callous parenting by assuming perpetrator roles in her play. The analyst’s simultaneous work with the girl’s parents also helped them better understand their own histories of frustration and the effect their behavior was having on their daughter. These two approaches, in tandem, ultimately led both to an improved developmental trajectory for the child herself and a healthier dynamic among all members of her family.

Listening to the details of this treatment, I was struck by the efficacy of the psychoanalytic approach. Until then, I’d thought I’d been exposed to every mode of diagnosing and treating children’s mental health conditions, from cognitive behavioral therapy to humanistic therapy, biopsychological approaches, and beyond. But psychoanalysis seemed to offer another, potentially quite powerful way to help children that I’d never been exposed to before and that I soon discovered was, in fact, largely ignored—but why? —in the world of clinical psychology I sought to enter.

My curiosity had been piqued. So, I applied to the externship program again the following year and was able to attend a second APsaA conference. My goal this time was to focus more intensively on learning about different psychoanalytic approaches to working with children. I listened to a variety of papers by analysts working with children and adolescents on problems ranging from grief to eating disorders. As my knowledge-base grew, the more I was amazed by the holistic and integrative approach of psychoanalysis, particularly in the context of play therapy. The sessions which applied play therapy were not only about uncovering unspoken trauma, but could also be used to overcome learning differences, cope with difficult life events, and manage intense feelings (Bromfield, 2).

The breadth of this singular treatment approach was expansive and seemed highly successful in achieving therapeutic goals, especially with the aid of judicious psychopharmacology. I found that play therapy employs a variety of techniques to help treat children, but what lies at the core of all kinds of play therapy is this: providing a safe space (the “holding environment” provided by the psychoanalyst) for children to face themselves and others in their life who may be contributing to internal conflicts. In a world where children are often judged or punished for their thoughts and feelings, an analyst can create an alternative atmosphere of privacy and safety in which the child can discover a sense of self and communicate disavowed conflicts and traumatic experiences (Bromfield, 3-4).

Before attending this conference, I was certain that I wanted a research-based career that only focused on developing the therapies for children that I had learned the most about in my college classes.  Now, I am fortunate enough to have been exposed to the positive outcomes for children as a result of play therapy; however, I am aware there is a dearth of awareness when it comes to teaching and applying psychoanalysis as a therapeutic option. My experiences as an extern at the APsaA meetings in 2019 and 2020 were so powerful that I’ve been inspired to pursue a different sort of career—one in which I am eager to incorporate psychoanalytic techniques and therapies as a future child psychiatrist.

 

Works cited

Bromfield, Richard N. 2003. “Psychoanalytic Play Therapy,” in Foundations of Play Therapy. Ed. Charles E. Schaefer. New York: Wiley, 1-13.

Punnett, Audrey, and Eric J. Green. 2019. “Psychoanalytic Play Therapy.” Play Therapy 14.3, 46-48.

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