Research Critical Analysis of a Journal Article 1
Table of Contents
Research Critical Analysis of a Journal Article
Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Balkin, R. S., & Kleist, D. M. (2017) and/or American Psychological Association (2014). Assignments should adhere to graduate-level writing and be free from writing errors. I have also attached my assignment rubric so you can see how to make full points. Please follow the instructions to get full credit and use the attached worksheet as required. I need this completed by 09/21/19 at 7pm.
Assignment – Week 4
Research Critical Analysis of a Journal Article
The purpose of this assignment is to allow you to practice the critical analysis of the contents of research articles. When you identify a research article, you want to begin by assessing whether the source of the article is scholarly and current. Once you have verified these elements, it is important to determine what the researchers were attempting to investigate, how the study was carried out, and what the outcomes were.
For this Assignment, you will critically examine the elements of a scholarly article. Because you will need to choose research articles that represent each type of methodology when you create your Final Project Annotated Bibliography, it is essential for you to understand the contents of a research article.
To Prepare
- Review the media programs and blog found in the Learning Resources which will introduce you to the critical elements of a scholarly article, how to identify them, and how to read scholarly articles.
- Review the Kenny, M. C., & Winick, C. B. (2000) article found in the Learning Resources. You will use this article to complete this Assignment.
- Review the Scholarly Article Content Analysis Preparation Guide, the Scholarly Article Content Analysis Worksheet including the briefcase conceptualization found in the Learning Resources and consider the “client” for any counseling implications. Note: You will use this Worksheet to complete this Assignment.
Assignment
- Complete the Scholarly Article Content Analysis Worksheet for the Kenny and Winick (2000) article.
- Analyze the contents of the article and apply the findings to the case conceptualization included in the worksheet.
- Critically analyze the article and identify all components:
- Is the article scholarly?
- What is the problem/purpose?
- What is(are) the research question(s)?
- Who are the participants?
- What are the ethical/cultural considerations?
- What data /information was collected from participants?
- How did the researchers describe the results/answer to the research question?
- How does this research apply to the case study?
Required Resources
Kenny, M. C., & Winick, C. B. (2000). An integrative approach to play therapy with an autistic girl. International Journal of Play Therapy, 9(1), 11–33. doi:10.1037/h0089438
Note: You will access this article from the Walden Library databases.
Document: Scholarly Article Content Analysis Preparation Guide (PDF)
Document: Scholarly Article Content Analysis Worksheet (Word document)
Required Media
Note: if you are having difficulty viewing the required media above using Google Chrome as your browser, please visit http://academicanswers.waldenu.edu/faq/239615 for instructions on how to enable Flash.
Laureate Education (Producer). (2016). Literature review [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 8 minutes.
Accessible player –Downloads– Download Video w/CC Download Audio Download Transcript
Credit: Provided courtesy of the Laureate International Network of Universities.
Laureate Education (Producer). (2017k). Purpose of research [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 15 minutes. This media piece is also in the resources of Week 2.
Accessible player –Downloads– Download Video w/CC Download Audio Download Transcript
Credit: Provided courtesy of the Laureate International Network of Universities.
Literature Review
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Literature Review Program Transcript
[MUSIC PLAYING]
NARRATOR: Have you ever thought about a literature review as representing your intellectual heritage or intellectual genealogy? In his exploration of the purpose of a literature review, Dr. Patton explains this interesting perspective. He also points out common errors to avoid when undertaking a literature review.
MICHAEL QUINN PATTON: One of the things that we do as scholar practitioners is look at the knowledge created by other people. And we draw on that knowledge as a way of positioning our own work and understanding where our contribution to knowledge, our own research, fits in that larger tradition. This is often referred to as the literature review. And the way that you go about knowing the knowledge that others have generated, that you’re going to build on and contribute to, is to conduct a literature review.
I tend not to like that terminology, because it sounds like the purpose is to review the literature. Literature review is actually a means to another end. And it’s that end, it’s that purpose of conducting the literature review that I want to focus on.
The purpose is for you to understand your intellectual heritage, your intellectual genealogy. Anytime we undertake an inquiry into a particular issue, we are building on the knowledge of others. And we need to know what that knowledge is. It’s part of our obligation as scholars, is to understand what work has come before us, what concepts we’ve inherited, what methods we’ve inherited, what measures we’ve inherited. Some of which we’ve adopted, some of which we’ve parted from. But we need to know that.
Because at the end of a program of study, a master’s degree, a program of doctoral inquiry, you’re going to be expected to be able to locate your work within that tradition. And so it means that you need to be able to establish the people who formulated the basic distinctions that you’re drawing on.
Let me share with you some of the mistakes that I, from my point of view, find students engaging in when they undertake the literature review. One of these is to simply do an internet search to see how many articles they can find on a topic. Where they think that the game is how many citations you can come up with to show that you’ve done the literature review.
This isn’t a quantitative game. It’s not something where the number of sources is important. It’s the quality of those sources and your engagement with them, that you are able to engage with what other people have done and understand what’s relevant, what’s not relevant to your own area of inquiry. So that you’re positioning yourself out of those traditions that others have engaged in.
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A second error is to think that the game is to position your work as unique. It is to try to find something that nobody else has ever done, to say nobody else has ever studied this before. Likewise, for any given field, there are burning questions that have defined that field.
In sociology, which is my own field, all sociology derives from what we call the Hobbesian question of order. What holds society together? Why doesn’t society fall apart? Every sociological question stems from that question that Hobbes asked. And therefore, if you look at sociology articles in the premier journals, the American Sociological Review, the American Journal of Sociology, you’ll find that they typically begin with a reference to Hobbes or to Durkheim time or to Weber or to Marx who were asking the original burning questions in psychology and sociology.
In psychology, you’ll find original references to Freud and to Adler and to Jung that go back to things like the notion of the unconscious. And whether you agree or disagree with various aspects of Freudian theory, the notion that there’s an unconscious mind and that that unconscious mind makes a difference in what we do is a part of what has framed modern psychology.
And so you stand on the shoulders of people who are trying to understand how the mind works, and who have divided off from those original classical theorists and researchers about how the mind works. The burning question in psychology is, why do we behave as we behave? How do we think and feel? How do we know and engage the world? And so you need to know who the classic people were who were asking those questions, who their disciples were, what were the splits along the world, along the journey where one group went in this direction and another group went in another direction?
Up to the more recent published research, and up to the kind of work that’s now going on that may not yet be published, where you can get in touch with those people who are engaged in research now. Find out what the funded research is from the National Institutes of Health, the National Institutes of Mental Health, the major foundations. And find out what cutting edge work is going on so that you have a full scale genealogy of what your intellectual tradition is.
When you have finished that inquiry over a period of time, you’re able to then say, these are the people on whose shoulders I stand. These are the intellectual traditions that I’m a part of. This is my intellectual DNA. Here is what I’ve drawn on. Here are the places where I’m departing from others. And here is where I’m going to make my contribution. That’s the purpose of a literature review. You’re positioning yourself in a stream of knowledge, in a flow of knowledge.
As a part of that work, a third error that I think students often make is to only read second-hand and third-hand accounts of the classics. The classics got to be
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classics for a reason. People over the years read those works and found the thinking in them profound.
Yes, in some cases, the findings may be out of date. But a part of what you ought to be learning as you engage in a literature review and in your intellectual history is not just the specific findings. You are learning how scholars think. You’re learning how scientists think. You’re learning how a researcher thinks.
So read those works not only for what they found out. Read them for their methods. Look for the methods-findings linkage. How did particular findings yield and come from particular methods? How did those methods develop over time? And how did the classic writers think about things, inquire into things?
So as you’re engaging in that, it has two streams that you’re paying attention to. One is the theoretical stream. What are the findings? What are the constructs that you’ve inherited? And the other is the methodological stream. What are the methods of inquiries, the measures, the instrumentation, the ways of going about recording what you observe that we’ve inherited?
Both of those are your rich inheritance as scholar practitioners. And one of the things that you ought to come out of your education with is knowing what that intellectual heritage is, both conceptual and methodological, and then where you’re going to make your contribution.
Purposes of Research
© 2017 Laureate Education, Inc. 1
Purposes of Research Program Transcript
NARRATOR: In this program, Dr. Patton explains and provides practical examples of five purposes for research, basic, applied, summative, formative, and action research. While all are legitimate and important purposes for research, basic and applied are most often used for thesis and dissertation research.
MICHAEL QUINN PATTON: One of the important contextual considerations in engaging in research as a scholar-practitioner is to understand the different purposes that inquiry can serve. And that inquiry determines who the audience is, what the standards are going to be for judging the quality of your work, and has implications for how you conduct the inquiry because it determines the standards that you’re going to attempt to meet as you do high-quality research. Different purposes serve different audiences and different needs and are judged according to different criteria.
So let’s review what some of those purpose distinctions are so that you can position your work within a particular purpose and know what the audience and what the criteria are that come for that audience for judging the quality of your work. I’m going to distinguish five different purposes and take you through the implications of those.
I think it’s helpful to distinguish basic research, which is aimed at how to understand the way the world works, from applied research, which is understanding a problem and the nature of that problem. That’s distinguished from what we call summative evaluation, which is figuring out whether or not an intervention that’s trying to solve a problem is working. We distinguish that from formative evaluation, which is trying to improve that intervention aimed at solving a problem. And we distinguish that from action research, which is aimed at a very rapid response to a very immediate problem with quick turnaround.
So five kinds of purposes– contributing to basic knowledge about the world, basic research; understanding a problem, which is applied research; deciding if an intervention works, which is summative evaluation; deciding how to improve an intervention while we’re doing it, which is formative evaluation; and solving a very specific problem in the here and now, which is action research, research to take immediate action.
Let’s take an example and work through the implications of those purposes for both quantitative methods and qualitative methods. Because this is not a methodological distinction. This is a purpose distinction. You can use quantitative or qualitative methods to study any of these purposes. And indeed, you can use mixed methods to study any of these purposes. So these are purpose
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distinctions. When you’re doing basic research, you’re trying to understand how the world works.
So let’s say that we’re interested in the general field of addictions. And we want to know as a basic researcher what’s the nature of addiction. How does it happen in the brain? What physiological changes occur when a person is addicted? What are the patterns that lead them to get addicted?
We’re simply studying addiction. We’re trying to come up with perhaps a theory of addiction or test a theory of addiction. If people experience certain childhood patterns, they’re more likely to be addicted. If they have certain genes, they’re more likely to be addicted. But we’re just understanding addiction.
Now, we want to move to applied research. We see addiction as a problem, and we want to understand the nature of the problem. How does addiction affect people’s lives? What are they able to do and not able to do? How does it affect their relationships? How does it affect their job? How does it affect their skill? How does it affect their decision making? What’s the nature of the problem? What happens in the workplace where people are addicted?
Let’s understand quantitatively how many people have a certain addiction. Qualitatively, how do people recognize their addiction? Do they recognize their addiction? What helps people recognize their addiction? What happens in an addiction system, a family system as an addicted system?
Quantitative data may involve applying some family measurements that have been developed about family harmony, family stability. Qualitative study of applied research would involve interviewing family members about how their family is affected by a person who is addicted to alcohol or drugs.
But we’re trying to understand the problem. Why do we want to understand the problem? Well, usually because we want to try to solve it in some way. We want to fix it. We want to do an intervention. Our most common form of intervention is a program, a program that helps people overcome their addiction– a chemical dependency treatment program; a program for people who are addicted to pornography; a sexual addiction program; people who are addicted to food; weight reduction programs.
Let’s take chemical dependency. Basic research tells us how the brain and the body and the mind responds to addictive behaviors. Applied research tells us how that addiction affects people’s lives, why it’s a problem for society and for families. Now, we’ve got an idea about a program– a 12-step program or a behavior modification program. And we want to see if that program works.
Well, now, the purpose of that research is what we call summative evaluation. Summative evaluation takes its name from the idea of a summit or summing
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things up. It’s an overall judgment. Does this work? Does this particular model reduce people’s addictions, help them deal with their addictive behavior, become sober, stop eating badly, stop looking at pornography or engaging in sexually addictive behavior? Does it work on whatever the outcomes are?
If you’re studying the effectiveness of a model, of an intervention, of a program overall, you’re involved in summative evaluation. And that purpose is to decide to continue the program, to expand the program; should government fund it; should foundations fund it; should insurers pay for it because it’s been demonstrated to be effective? That’s summative evaluation.
Now, before you get to summative evaluation, you want to be sure that you’ve worked out the bugs in that intervention. You get feedback from the people going through the program. They say, well, I don’t like that so much, or let’s add that piece.
I worked with a well-known chemical dependency program that has groups. It has individual therapy. They have things that people read. They have a part of the program that helps people deal with their relationship with a higher power, helps them deal with each other. They have a part where family members come in. They have all these different components. There’s a lot to organize. There’s a lot to fit together.
Formative evaluation is about how to fit those pieces together, how to make them work. What kind of readings do people like? How often should family members come? What should they do when they come to the program? How do you facilitate people in the program interacting with each other? What kind of facilitation skills are needed? What helps people get through the program? Where are they likely to hit a wall? How can we anticipate and help them anticipate about week 10– about day 10, you’re going to hit a wall. We know that from looking at lots of people. Here is how we can help you get through that wall.
That’s formative evaluation. It comes from the metaphor of clay, of forming, of making it better. So formative evaluation is forming the model, forming the intervention to get it ready for summative evaluation. And the idea of the program itself came from applied research. And understanding that problem came from basic research.
So where does action research fit in? Well, action research is a way of solving a very specific problem. So let’s say we’ve got our addiction program, our chemical dependency program, and we notice that young people are dropping out. Middle- aged people stay. Older people stay. But young people really don’t like this program. We want to increase attendance of young people.
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We quickly do interviews with those young people. Why did you drop out? What turned you off here? Try to solve that specific problem of dropout. That gives you immediate action within the context of a here-and-now problem.
It’s rapid turnaround. You don’t have a high level of proof. You’re not trying to do big-time science. You’re trying to get reasonable evidence. People said this is why they’re dropping out. That seems to make sense. Here’s what they suggest we could do about it. Solve the problem. See if the solution works.
With formative evaluation, you’re primarily trying to help staff look at what they’re doing to improve the program, give them feedback– because staff in a program can get in their own heads, determined to do the model their way. Getting them feedback about what works and doesn’t work from the perspective of people in the program helps them open up. And they’re going to apply their own criteria. Does this make sense? Do they believe in the data? Do they believe in your sample? They’re the users of formative evaluation.
With summative evaluation, it’s the people who fund programs– the policymakers, the government people who would decide whether or not to fund this, foundation executives and program officers, third-party payers. They’re going to look at that evidence, and they’re going to say, are enough people getting helped to justify continuing to fund this program.
Not everybody gets helped. No program works for everybody all the time. So the criterion becomes how many people have to get help to what level to call this an effective program.
With applied research, you’re primarily dealing with planners, with program designers, with policymakers who are trying to understand the problem better. What really is this problem? Why do people get addicted? How does addiction affect their lives?
And they are looking for the quality of evidence, do you really understand the problem. Do you understand it in systems terms? Do you understand it for this particular population? Let’s say that, we know a lot about the problem for white middle-class people. Well, can we use that data on people of color? Can we use that data for black people? Can we use that data for young people, because it’s mostly middle-aged people?
And so they’re going to say, well, I don’t believe that data applies. I want to deal with people of color who are poor, and your data is all from middle-class people. What’s the problem for people of color? You’ve got to have a different kind of evidence. You’ve got to make sure your sample responds to them. Whether you’re doing testing data that’s quantitative or interviews that’s qualitative, make sure that the sample is a relevant sample for the people who want to intervene.
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With basic research, you’re trying to basically understand how the human being works or how the social group works. And there again, your primary audience is going to be scientists, other researchers, people who publish in refereed journals, who have standards of what constitutes– both within a quantitative experimental tradition and a qualitative tradition or a mixed-methods tradition– high-quality research within those traditions. And you would be submitting articles to journals that publish basic research and that have standards of evidence.
Well, that begins to formulate some basic knowledge about how human beings are that we can run through that cycle. A comprehensive understanding of the phenomenon and acting on the world as a scholar-practitioner would put all of these parts together within a total field so that it’s got a foundation of basic research.
This is how the world is. This is the nature of the problem that we’re interested in from applied research. Here are some programs, models, interventions that are trying to solve that problem and how they work. Here are ways that we’ve improved those programs and continue to improve them as new populations come along– immigrant populations, people who speak English as a second language, who haven’t been in this kind of program before. How do we make it work for them?
And we watch for specific problems that need to be solved here and now. It may take a survey of them for quantitative data– get client satisfaction, do open- ended interviews. These are not methodological distinctions. They are purpose distinctions. And knowing the purpose of your research becomes really important to be able to do an inquiry as a scholar-practitioner that actually meets that purpose.
How to read and understand a scientific article Dr. Jennifer Raff
To form a truly educated opinion on a scientific subject, you need to become familiar with current research in that field. And to be able to distinguish between good and bad interpretations of research, you have to be willing and able to read the primary research literature for yourself. Reading and understanding research papers is a skill that every single doctor and scientist has had to learn during graduate school. You can learn it too, but like any skill it takes patience and practice. Reading a scientific paper is a completely different process from reading an article about science in a blog or newspaper. Not only do you read the sections in a different order than they’re presented, but you also have to take notes, read it multiple times, and probably go look up other papers in order to understand some of the details. Reading a single paper may take you a very long time at first, but be patient with yourself. The process will go much faster as you gain experience. The type of scientific paper I’m discussing here is referred to as a primary research article. It’s a peer-reviewed report of new research on a specific question (or questions). Most articles will be divided into the following sections: abstract, introduction, methods, results, and conclusions/interpretations/discussion. Before you begin reading, take note of the authors and their institutional affiliations. Some institutions (e.g. University of Texas) are well-respected; others (e.g. the Discovery Institute) may appear to be legitimate research institutions but are actually agenda-driven. Tip: google “Discovery Institute” to see why you don’t want to use it as a scientific authority on evolutionary theory. Also take note of the journal in which it’s published. Be cautious of articles from questionable journals, or sites that might resemble peer-reviewed scientific journals but aren’t (e.g. Natural News). Step-by-Step Instructions for Reading a Primary Research Article 1. Begin by reading the introduction, not the abstract. The abstract is that dense first paragraph at the very beginning of a paper. In fact, that’s often the only part of a paper that many non-scientists read when they’re trying to build a scientific argument. (This is a terrible practice. Don’t do it.) I always read the abstract last, because it contains a succinct summary of the entire paper, and I’m concerned about inadvertently becoming biased by the authors’ interpretation of the results. 2. Identify the big question. Not “What is this paper about?” but “What problem is this entire field trying to solve?” This helps you focus on why this research is being done. Look closely for evidence of agenda-motivated research.
3. Summarize the background in five sentences or less. What work has been done before in this field to answer the big question? What are the limitations of that work? What, according to the authors, needs to be done next? You need to be able to succinctly explain why this research has been done in order to understand it. 4. Identify the specific question(s). What exactly are the authors trying to answer with their research? There may be multiple questions, or just one. Write them down. If it’s the kind of research that tests one or more null hypotheses, identify it/them. 5. Identify the approach. What are the authors going to do to answer the specific question(s)? 6. Read the methods section. Draw a diagram for each experiment, showing exactly what the authors did. Include as much detail as you need to fully understand the work. 7. Read the results section. Write one or more paragraphs to summarize the results for each experiment, each figure, and each table. Don’t yet try to decide what the results mean; just write down what they are. You’ll often find that results are summarized in the figures and tables. Pay careful attention to them! You may also need to go to supplementary online information files to find some of the results. Also pay attention to:
• The words “significant” and “non-significant.” These have precise statistical meanings.
• Graphs. Do they have error bars on them? For certain types of studies, a lack of confidence intervals is a major red flag.
• The sample size. Has the study been conducted on 10 people, or 10,000 people? For some research purposes a sample size of 10 is sufficient, but for most studies larger is better.
8. Determine whether the results answer the specific question(s). What do you think they mean? Don’t move on until you have thought about this. It’s OK to change your mind in light of the authors’ interpretation — in fact, you probably will if you’re still a beginner at this kind of analysis — but it’s a really good habit to start forming your own interpretations before you read those of others. 9. Read the conclusion/discussion/interpretation section. What do the authors think the results mean? Do you agree with them? Can you come up with any alternative way of interpreting them? Do the authors identify any weaknesses in their own study? Do you see any that the authors missed? (Don’t assume they’re infallible!) What do they propose to do as a next step? Do you agree with that? 10. Go back to the beginning and read the abstract.
Does it match what the authors said in the paper? Does it fit with your interpretation of the paper? 11. Find out what other researchers say about the paper. Who are the (acknowledged or self-proclaimed) experts in this particular field? Do they have criticisms of the study that you haven’t thought of, or do they generally support it? Don’t neglect to do this! Here’s a place where I do recommend you use Google! But do it last, so you are better prepared to think critically about what other people say. A full-length version of this article originally appeared on the author’s personal blog (www.violentmetaphors.com). She gratefully acknowledges Professors José Bonner (Indiana University) and Bill Saxton (UC Santa Cruz) for teaching her how to read scientific papers using this method.
International Journal of Play Therapy, (9)1, pp. 11-33 Copyright 2000, APT, Inc.
AN INTEGRATIVE APPROACH TO PLAY THERAPY WITH AN AUTISTIC GIRL
Maureen C. Kenny Florida International University
Charles B. Winick Florida International University
Abstract: Autistic children who are brought for psychological treatment are usually experiencing social and emotional difficulties common to autism. In addition, their parents may be in need of support. An integrative approach to treatment that utilizes the rapport building component of nondirective play therapy with directive techniques is presented. This approach targets maladaptive behavior and parent education. This case study describes a brief course of therapy in which an 11-year-old autistic female client experienced increases in social behavior and compliance at home and displayed a less irritable mood. The course of her therapy and specific interventions are examined.
Play therapy is often recognized as an effective approach for the psychotherapeutic treatment of children (Cohen, 1995; O’Connor & Schaefer, 1994). Play therapy has undergone many revisions, and many applications of play techniques today are used with a variety of children. It is used to treat children who are victims of abuse and neglect (Kot, Landreth, & Giordano, 1998; Mann & McDermott, 1983; VanFleet, Lilly, & Kaduson, 1999), children of divorced parents (Mendell, 1983), cross- gender identified children (Rekers, 1983), and those children described as aggressive/acting out (Allan & Levine, 1993; Willock, 1983). In addition, play therapy is utilized in the treatment of children with obsessive-compulsive disorder (Gold-Steinberg, & Logan, 1999), learning
Maureen C. Kenny, Ph.D., and Charles B. Winick, Psy.D., Florida International University, Fort Lauderdale, Florida.
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disabilities (Guerney, 1983b), anxiety (Kottman, 1998; Oaklander, 1993), physical impairments (Salomon, 1983), and developmental disabilities (Leland, 1983).
Unfortunately, little has been written on the use of such techniques with children suffering from pervasive developmental disorders, such as autism. In fact, a survey of play therapists conducted by Phillips and Landreth (1998) reported that fewer than 20% of the respondents believed that pervasive developmental disorders and problems associated with mental retardation would be amenable to play therapy. It may be that play therapists dismiss the use of play therapy with these children, believing that such children have cognitive or play deficits that would inhibit the therapy (Phillips & Landreth, 1998). This paper will demonstrate the use of an integrative play therapy approach with a mildly autistic girl.
Play is described as a child’s occupation and the toys as the child’s tools (Erikson, 1950). Play, according to Axline (1969), is the most natural medium for self-expression and is an excellent means for communicating between adults and children and among children. In addition to its developmental value, play is also deemed to be psychologically necessary (Landreth, 1991). Play allows children to express their inner world as a means to express and explore their emotionally significant experiences and to “act out” these experiences and feelings in a self-healing process (Landreth, 1991). Play therapy emerged out of the naturally occurring phenomenon of play as a treatment that utilizes children’s natural language and process for making sense of the world (Holmberg, Benedict, & Hynan, 1998).
Child-Centered Play Therapy In 1947, Virginia Axline pioneered nondirective play therapy,
now commonly referred to as child-centered play therapy. She fashioned her therapy after the nondirective, humanistic approach of Carl Rogers (Landreth, 1991). The goal of this type of play therapy is self-acceptance, where children will learn to be themselves and feel accepted through understanding, warmth, and a sense of security from the therapist. Axline (1969) outlined eight basic principles of her play therapy that are essential for the success of the treatment. One of these principles
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emphasizes empathy and building a relationship with the child, wherein the child sets the direction for the play. The child is responsible for the progress of the sessions; the therapist does not force progress (Axline, 1969). In the playroom, children are allowed to make all decisions. No one criticizes them or tells them what to do. This is often an unfamiliar experience for children who are frequently told what to do. The therapist’s role is to facilitate growth in children by allowing them to act out their feelings. This is described by Axline (1969) as “an opportunity that is offered to the child to experience growth under the most favorable conditions” (p. 16). The therapist should be attuned to the feelings communicated through the child’s play and reflect these back to the child.
Autistic Disorder Autistic disorder is classified as a pervasive developmental
disorder with no known etiology. The symptoms consist of qualitative impairments in social interactions, verbal and nonverbal communication, and a markedly restrictive repertoire of activities and interests (American Psychiatric Association, 1994). These disturbances are present before age 3 and have a continuous course. Approximately 75% of autistic children function in the mentally retarded range (DSM- IV, 1994). The severity and chronicity of autism can place a serious burden on the family (Dawson & Castelloe, 1992).
The increasingly predominant view of autistic disorder as a developmental and biological disorder has led to the adoption of structured treatments and an abandonment of more psychologically oriented therapies. Treatment of autistic disorder has traditionally consisted of medications and other biological interventions and behavioral techniques such as behavioral modification. A wide range of drugs is used to reduce aggressive and self-injurious behaviors, increase attention span, control seizures, decrease agitation, reduce stereotyped behavior, and alter other maladaptive behaviors (Dawson & Castelloe, 1992). Behavioral techniques are used to teach language to autistic children and to help reduce inappropriate behaviors such as hand clapping and other self-stimulatory behaviors (e.g., toe walking, rocking,
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finger flapping) (Foxx & Azrin, 1973; Lovaas, Young, & Newsom, 1978; Russo, Carr, & Lovaas, 1980).
Play Therapy and Autism The use of toy-based therapy with autistic children is not a
unique concept. Some researchers have focused their attention on facilitating social responsiveness in these children by using toys in treatment. Dawson and Adams (1984) used toys to increase social skills and decrease perservative play. Research by Dawson and Galpert (1990) has shown that by having mothers imitate their autistic children’s play with toys, they were able to increase their children’s attention and decrease repetitive play. Leland (1983) suggests that toys afford the opportunity for children with developmental delays to control, create, and change aspects of their surroundings. In this manner, these children increase their awareness of the world around them, which helps them enhance their ability to make adaptive coping decisions.
Bromfield (1989) describes the successful treatment of a high functioning autistic boy with psychoanalytic-oriented play therapy. The treatment consisted of twice weekly play therapy sessions. This child had obvious autistic features (i.e., hand flapping, repetitive movements, and avoidance of eye contact), but he also had an uncommon feature for an autistic child. He displayed a desire for close relationships with others, especially the therapist. He often appeared sad at the end of therapy sessions. As the child progressed in therapy, he was able to communicate more clearly and comfortably than at the outset of therapy. A decrease in autistic motor behaviors was observed, and the child seemed able to handle frustration and anxiety more effectively (Bromfield, 1989).
In another case example of play therapy and autistic disorder, Turley (1998) described her existential play therapy approach. A 5-year- old girl, who was diagnosed with Pervasive Developmental Disorder and described as having “autistic like features” (limited verbalizations and social indifference), was treated with weekly sessions over the course of a year. In play, the girl primarily painted, played in the sand, and eventually expanded her interaction with the therapist and other toys. She mostly chattered nonwords and constantly tested the limits of
Play Therapy and Autism 15
the play therapy with such actions as taking toys from the room. Turley (1998) reported that the child’s mother stated that at the end of the year the child was happier and more verbal at home. Turley also reported that the girl was able to develop a capacity for happiness and self- expression, establish a relationship with a trusted adult, and have a more mainstreamed school placement at the year’s end.
Despite some documented play therapy success with autistic children, many therapists have been reluctant to use conventional forms of psychotherapy with such children. The repetitive and supposedly noncreative play of autistic children has been cited as one reason to prevent the use of traditional therapy (Wulff, 1985). However, for the autistic child who has difficulty communicating verbally, as in the case cited previously, play therapy may be the treatment of choice. Because these children are likely to be functioning at a reduced cognitive level, they may be more receptive to play therapy, regardless of their chronological age. Many higher functioning autistic children also respond to play therapy (Bromfield, 1989). Several researchers substantiate the use of play with autistic children. Wulff (1985) discussed the use of play as an assessment tool for autistic children because of their severe communication or language deficits. Given the success of imitative play in increasing autistic children’s social responsiveness, Dawson and Galpert (1990) suggest that play may be generalized to other psychological concerns.
An Integrative Play Therapy Approach The following case example illustrates how an integrative
approach to play therapy was used with a preadolescent autistic girl. The rationale for using a flexible, integrative approach is based on the multiplicity of difficulties displayed by this child as well as her developmental level. Procedures from different treatment approaches were combined into a coherent intervention sequence (Shirk, 1999). Judy (fictional name), an 11-year-old white female from an intact home, seemed unhappy, was noncompliant at home, and lacked some basic living skills. The integrative approach used combines (a) nondirective play therapy, (b) directive interventions focused on personal hygiene and social skills, and (c) parent education and support.
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Child-centered play therapy was chosen for its reliance on nonverbal communication as well as its accepting and open attitude toward the child. It was implemented throughout the treatment. Due to her cognitive delays, Judy still enjoyed play. The child-centered therapeutic components of this integrative model provide a medium in which children are accepted without outside intrusions. Additionally, play therapy allows children with developmental disabilities to discover the physical and emotional strengths they have in relation to their deficits (Carmichael, 1993). The more directive aspects were incorporated to specifically address the mother’s concerns about the child’s personal hygiene skills (often deficient in autistic children). This was introduced midway through the treatment. The use of more direction at times allowed the therapist to introduce tasks such as functional activities necessary for Judy to learn. This was based on Leland’s (1983) directive approach designed to improve social skills and responsiveness. As Rasmussen and Cunningham (1995) state, “Nondirective and focused therapy are not mutually exclusive” (p. 17). Finally, the therapist communicated with the mother in an educational and supportive manner while also using information from the mother to gain an understanding of the family dynamics. This component of the treatment was constant throughout the child’s sessions. Salomon (1983) suggested that parents of children with disabilities are in need of more support and information than other parents. Collateral work with parents addresses their needs and allows them to continue to support their children’s treatment. This collateral work is desirable (O’Connor, 1991) and contributes to the success of the treatment. It was hypothesized that this integrative approach would provide a comprehensive treatment for Judy and provide her parents with the necessary support.
Case Study Family background and personal history. Judy (age 11) is the
only child in an intact family. Her parents, Mr. and Mrs. C, were married for 5 years at the time of Judy’s birth. They obtained prenatal care, and there were no complications at birth. Both Mr. and Mrs. C. were in good health with no family history of autism on either side. Mrs.
Play Therapy and Autism 17
C. described Judy as meeting her early developmental milestones on time; however, by her 3rd year of life, signs of autism began to appear. She had deficient language skills, inordinate need for sameness, and some stereotypical behaviors.
Mr. C. was employed by the phone company and frequently worked long hours. Mrs. C. was not employed outside the home and had basically dedicated her life to helping Judy in seeking needed resources and services. Both Mr. and Mrs. C accompanied Judy to the first session, which was held on a Sunday morning. Mrs. C. provided most of the history and presenting problems. Mr. C. nodded in confirmation. Mrs. C. complained that Mr. C. spent too much time at work and, in turn, was not very involved in caring for Judy. However, Mr. C. contended that his efforts toward more active parenting were rebuffed by both Judy and Mrs. C. More specifically, he described an extremely attached relationship between Judy and her mother. He reported that at times when he had tried to spend time with Judy, Mrs. C. would criticize his ways or interfere. For example, on one Saturday, Mr. C. took Judy to the park to play ball. Rather than be pleased with the time Mr. C. spent with Judy, Mrs. C. complained that he did not take her jacket with him and that they returned late for lunch. Mr. C tried to explain that they were enjoying themselves and were not hungry enough to rush home. He cited this example to demonstrate what he perceived as his wife’s criticism of his attempts at a closer relationship with Judy.
Assessment. Mrs. C reported that Judy was diagnosed as autistic during her preschool years. Thus, she had participated in special education classes throughout her academic career. Mrs. C’s description of Judy’s schoolwork revealed activities consistently below her age level. Although formal intelligence testing was not completed, adaptive testing was conducted prior to initiating treatment. Jackson (1998) advises that “play therapists should routinely include some form of objective or subjective psychometric instruments in their daily practice for assessing” (p. 7). In addition, Leland (1983) suggests that the therapist meet with the parents to do an adaptive behavior evaluation. Performed by the therapist, adaptive testing revealed that Judy’s developmental level (in regards to everyday coping skills, tasks, and behaviors) was significantly
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below average. The Vineland Adaptive Behavior Rating Scale Interview Edition (Sparrow, Balla, & Cicchetti, 1985) was conducted with the mother during the session. The following scores were obtained: Communication Domain, 75; Daily Living Skills Domain, 67; Socialization Domain, 55; Motor Skills Domain, 90; and the Adaptive Behavior Composite, 287. All of the domain scales have a mean of 100 and a standard deviation of 15. Thus, Judy’s communication skills (receptive, expressive, and written communication), daily living skills (personal living habits, domestic tasks, and behavior), and socialization skills (interactions and sensitivity to others, use of free time) were significantly below average for her age. However, her motor skills (gross and fine motor coordination) were just slightly below average.
Presenting problems and current status of the child. At age 11, Judy was referred to a psychologist (CW) by her neurologist due to aggressiveness and oppositional behavior at home and school. Mrs. C. attributed these behaviors to Judy’s manifestation of autism. She depicted Judy’s developmental history as characterized by a lack of connection to other people. However, she emphasized that Judy had always maintained a positive maternal relationship. Judy’s teacher (who was contacted by phone) confirmed the close relationship of mother and child. The teacher stated that Judy often expressed love for her mother and, in turn, frequently called for her when she became agitated or upset at school. In general, the teacher explained that Judy was cooperative at school and performed the work assigned to her. Judy was in a contained special education classroom with other autistic children. The teacher also reported that Judy did not seem to have any significant attachments to the other children but did gravitate toward a few other girls in her class at lunchtime. Mrs. C. also described the ongoing power struggles between herself and Judy. More specifically, she stated that Judy sometimes required considerable prompting before completing daily tasks. Furthermore, Mrs. C. reported that Judy refused to either brush her teeth or let her mother brush them.
Conceptualization and model application. During the initial sessions, it became clear that many of Judy’s difficulties were related to her autism, but also tied into family dynamics. The therapist hypothesized that Judy’s anger was related to her relationship with her
Play Therapy and Autism 19
mother. Although unable to express it directly, Judy appeared at times to feel suffocated by her mother. She may have resented the constant attention she was given and the lack of independence afforded her by her mother. Further, the therapist believed that the issue with control of one’s self was paramount for Judy. Having to rely on others, mostly her mother, for many of her needs, appeared to leave her feeling helpless at times. She was unable to communicate this frustration verbally, but rather expressed her frustration in the form of oppositional behavior at home and school. Given Judy’s unexpressed feelings, it was further believed that child-centered play therapy would grant her the ability to direct her own actions.
The use of directive techniques and more structured play therapy was based on Leland’s (1983) work. He advises that the play sessions be structured only as much as is needed to assist the child in learning to modify a few socially unacceptable behaviors. Leland (1983) states that “the more retarded the child appears in the therapy sessions, the greater the amount of directed play and directed intrusions must come from the therapists” (p. 437). The goal is to raise the level of functioning of the children and assist them in controlling behavior. The rationale behind this approach is that as children learn to do more for themselves, they will be happier and more self-confident. The structure is introduced in the play because behavioral change requires modification. Leland proposes that if the child learns through play to cope with problems, this learning may be generalized into daily living. Although this technique differs from nondirective play therapy, the rationale is that it will lead to greater socially acceptable behavior by the child, a desired outcome of therapy.
Parent training and education with Mrs. C. proved valuable. Play therapy does not require any parent involvement (Guerney, 1983a), and many play therapists do not see the need for concurrent work with parents. However, Landreth (1991) advises that parents should be included in some form of therapeutic procedure whenever possible. Parent education provides a means by which the child’s therapist can interact with the parents to gain information (Brems, 1993). Leland (1983) stresses the importance of including parents to increase the pace of progress. For example, the parents can administer reinforcement at
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home for behavioral change. Additionally, parents who are involved in the treatment process are more likely to keep their children in treatment. Support from the child’s therapist can be invaluable to parents experiencing stress (Brems, 1993), and utilizing parental motivation for change does seem to increase the probability of success (Guerney, 1983a). Given these notions and the presenting problems, it was determined that neither Mr. nor Mrs. C. required individual psychotherapy; instead, the therapist would provide support and education regarding autism and education and effective parenting skills. The weekly sessions with Judy lasted 45 minutes, and Mrs. C was seen for the remaining 15 minutes of the hour. In addition, she was encouraged to call the therapist with any concerns or issues that might occur during the week. Mr. C, who worked on the day of the sessions, was unable to attend regularly. The therapist encouraged Mrs. C. to relate to her husband what was discussed in the sessions. Further, since Mr. C. was present at the first session, he was also informed by the therapist to contact the therapist with any questions or observations. He appeared supportive of the therapy, but given his work schedule, he was unable to participate weekly.
Treatment and Case Illustration of Technique The application of nondirective play therapy. During the initial
stages of therapy (sessions 1-7), Axline’s (1969) child-centered play therapy was utilized as the sole therapeutic approach. It was hypothesized that Judy would respond positively to the essentially unrestricted nature of the play sessions. For the most part, Axline’s eight principles of nondirective play therapy were diligently applied during the initial course of Judy’s psychotherapy. The following is an exploration of some of these principles within the context of Judy’s psychological treatment.
From the outset, the therapist established limits of play therapy sessions consistent with that described by Axline (1969), Landreth (1991), and Leland (1983). According to Axline, “The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship” (Axline, 1969, p. 74). The therapist explained that Judy
Play Therapy and Autism 21
could do almost anything she wanted in the sessions. A few exceptions were noted. Judy was told that she could not physically hurt herself or the therapist, nor was she permitted to damage any of the toys. She was also informed that she could play with anything she wanted in the playroom. Finally, she was told that she would be there for 45 minutes (the therapist showed her the time on the wall clock), at the end of which she could rejoin her mother.
Judy was compliant with the majority of the limits pertaining to the playroom. For example, she almost always immediately entered the therapy room at the start of a session and left at the end of the session. On several occasions, she asked to leave the playroom to see her mother. The therapist responded by reflecting Judy’s feeling, “You miss your mom and want to see her now.” The therapist then showed Judy on the clock how much time was left in the session and when she could see her mother.
Axline (1969) stipulates that “The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible” (p. 73). Rapport was quickly established as Judy realized that the therapist would allow her to make her own choices regarding toys and type of play. During the first session, Judy was reluctant to leave her mother and enter the play therapy room, so her mother accompanied her. However, soon after entering the room and seeing the toys, she seemed to forget that her mother was there, and Mrs. C was able to leave. During the first few sessions, Judy barely interacted with the therapist. At times, she appeared indifferent to his presence. However, after several sessions, in an attempt to engage him she began to show him the toys with which she was playing. Rapport was maintained throughout the therapy through light-hearted reminiscence about shared experiences. For example, Judy had a proclivity for playing with plastic food and dishes. Toward the middle and latter stages of therapy, a comment from the therapist such as, “I never would have expected you to choose to play with those . . .” elicited a smile from Judy. She tended to choose the same toys each session, evidence of the autistic feature of perservative play.
Axline’s (1969) principle that “The therapist accepts the child exactly as he is” (p. 73) was employed consistently. Judy clearly had
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limitations not manifested by the typical child in play therapy. For example, Judy’s entire communication with the therapist took the form of grunts, gestures, and body language. The therapist, expressing no frustration or resentment when unable to understand Judy’s vocalizations, accepted this type of communication. When Judy would host a tea party in the session, she would hand the therapist a cup and grunt. The therapist would take the cup and respond with a “Thank you.” At times, Judy would continue to grunt and gesture until the therapist understood what she wanted.
Additionally, Judy would frequently fail to respond to the therapist. His attempts to track her play seemingly went unheard. Although this was at times frustrating for the therapist, he accepted her lack of acknowledgment of his words. For example, he would frequently reflect on her actions, “You are feeding the baby.” This would elicit no response from Judy. The therapist had hoped she would come to acknowledge him at least minimally. On some occasions, she would turn her body into the corner and not let him see her play activity. The therapist did not intrude into her play but rather waited for a signal from Judy to join.
The therapist found it essential to the therapeutic success that Judy be allowed to express any feelings. Axline suggested that “the therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely” (1969, p. 73). The therapist allowed for direct expression of feeling, as well as symbolic expression through play. Judy frequently expressed anger in the sessions. On one occasion, Judy appeared angry when entering the therapy office. She began to play with the plastic food as was usual, but then she started to throw some pieces of food she did not like. The therapist reflected that she appeared angry and allowed her to throw the food back in the toy box, but not at him.
Judy’s autistic need for constancy was evident in the playroom. On one occasion, a stuffed animal that Judy enjoyed playing with was missing from the room. She searched frantically for it, with no success. At once realizing what she was looking for, the therapist stated, “You are looking for the dog.” She stared at him blankly. He stated that it was missing, and that he thought someone else must have taken it. Judy ran
Play Therapy and Autism 23
from the room and began crying and screaming. The therapist followed her and tried to reflect her anger and sadness. He led her back to the room where they continued to search together. Eventually, Judy found another, smaller stuffed dog and seemed content to play with it.
Axline’s (1969) fourth principle is that “the therapist is alert to recognize the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behavior” (p. 73). This principle easily applied to the work with this girl since her communication was largely nonverbal and needed to be understood by the therapist. In an effort to promote insight, reflections often focused on central issues in the play. For example, reflections pertaining to anger often focused on Judy’s relationship with her mother. One day, Judy did not want to enter the playroom. She threw a temper tantrum in the waiting area. The therapist spoke softly to her and told her to come with him to the playroom, where she could stay angry if she wanted. The therapist also made statements such as, “You are real mad about being here this morning” and “You don’t want to come in, and you are angry that your mom brought you here.” Judy’s reluctance to enter the therapy room may have been her way of communicating her anger at her mother for what she perceived as not giving her a choice (i.e., being able to choose whether she wanted to come to therapy or not). Mrs. C. explained that they had driven by a McDonald’s that morning on the way to the session, and Judy had begun to cry out. Mrs. C. did not stop, as they would have been late for the session.
Initially, Judy’s demeanor was extremely irritable, and she only minimally acknowledged the therapist. She often acted as if the therapist did not exist by failing to include him in her play or to acknowledge him. She seemed content as she played with different toys in the playroom. The therapist used consistent reflection of Judy’s actions and their effect on the environment. For example, the therapist would say, “You do not want me to play with you” or “You like to enjoy the toys by yourself.” On occasion, Judy was oppositional during the session. She would angrily move the toys around the room and refuse to acknowledge any of the therapist’s statements. Mrs. C. usually indicated that this behavior was precipitated by a disagreement or fight between herself and Judy prior to coming to the session. To this extent, Judy’s
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excessive anger was viewed as related both to frustration at the frequent difficulty of coping with the world around her and resentment of the limits and structure provided by Mrs. C. On a deeper level, Judy struggled between dissatisfaction with excessive maternal dependency and recognition of her frequent inability to maintain independent functioning. The therapist would reflect these feelings of frustration to Judy in an attempt to help her gain insight.
Application of directive techniques. Midway through therapy, Mrs. C reported that Judy seemed to be making significant progress. More specifically, she reported fewer mother-daughter arguments and a reduction in Judy’s irritability. For example, Judy was much more compliant at home when asked to do something by her mother, and her temper tantrums decreased in number. However, the problems with personal hygiene remained. Based on the mother’s concerns about these activities of daily living, it was decided that at this time, specific skill activities would be introduced into the play therapy. Hence, after eight sessions with Judy, the therapist introduced Leland’s (1983) more directive techniques in working with children with developmental delays.
The directive play therapy differed from Axline’s approach in that Judy was not always given the “responsibility to make choices and to institute change” (Axline, 1969, p. 73). Additionally, in the directive play therapy sessions, the therapist did attempt to direct Judy’s actions. The fact that Judy may never independently develop the capacity to solve problems (given her cognitive deficits) and make choices led the therapist to provide directive interventions. Judy’s mom reported that Judy refused to brush her teeth, and she was concerned about Judy’s dental health and also the smell of her breath. The therapist took responsibility for introducing and following through on this behavior. Specifically, structured coping tasks were introduced into the play therapy. For example, the therapist tried to help Judy learn to brush her teeth.
The therapist began by introducing a toothbrush and a doll in the session. He brushed the doll’s teeth and then complimented the doll on how pretty her teeth looked. He would say such things as “Your teeth are so clean and bright.” Then, he would encourage Judy to help brush
Play Therapy and Autism 25
the doll’s teeth. Judy did not respond positively to these attempts. She often ignored the therapist and refused to participate. The tooth brushing activity seemed to bring about incredible anxiety for Judy. The therapist encouraged Judy’s mother to use a doll at home and then encourage Judy to brush her own teeth. Her mother reported that she would “freak out” at home when she attempted to work with her on this task. This “freaking out” may be interpreted as Judy’s frustration at being unable to do this herself and resentment of her mother’s and the therapist’s intervention. This approach was clearly not successful with Judy.
Judy’s social skills were targeted as well, as it was believed that this would lead to more positive social interactions. In the session, the therapist would wait for Judy to do something (e.g., play with a doll). Then the therapist would make an observation about the play (e.g., “You are feeding the baby”). If Judy responded, she would be reinforced by being allowed to continue to play. However, if she did not acknowledge the therapist, he would intervene and stop the activity (removal of reinforcement), explaining that play could not continue until the child gave some type of response. This technique was used by Judy’s therapist in her treatment to increase social reciprocity. The therapist would announce that it was time for Judy and him to work on making friends. This verbal introduction served to let Judy know that the structured part of the hour was beginning. In one session, Judy began to prepare food with toy plates and play dough. The therapist asked if she was making lunch. She did not respond at all. The therapist then informed her that the toys would be put away if she did not respond (punishment). Judy quickly glanced at him but would not speak. She continued to roll the play dough into a pizza. The therapist informed her again of his request and began to put the plates away. Judy blurted out “pizza . . . pizza” and moved to hand the therapist some. He smiled and thanked Judy, letting her know that he enjoyed having pizza with her. The next time he made an observation, “That is a big pizza!”, Judy looked up at him and smiled. There appeared to be long-term effects from this approach. By the end of therapy, Judy was smiling and jumping excitedly when she was the therapist.
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In Judy’s treatment, the skill activity would be introduced for a part of the session. After a period of time, Judy would be allowed to resume nondirective play therapy. Judy’s demeanor usually became more upbeat when the coping skill task was abandoned. For example, she would begin to smile and excitedly take out the toys with which she wanted to play. In order to remain as nondirective as possible, Judy was given the responsibility both to make choices and to lead the play during the remaining unstructured parts of each session. At these times, Judy selected both the toys to be used and the manner in which they would be played.
Parent education/training. From the beginning of Judy’s treatment, the therapist spent time alone with Mrs. C. The therapist encouraged parental patience with the therapeutic process and to look for slow, steady progress. An educational approach was used to help Mrs. C. understand Judy’s limitations. As with many parents of autistic children, Mrs. C. was feeling high levels of stress and concern for her child (Sanders & Morgan, 1997). She spoke about the demanding nature of raising a child with a disability and expressed concern that she was not doing her best as a mother. She blamed herself for having an autistic child. She also expressed stress over her lack of free time and feelings of fatigue. The therapist helped Mrs. C. understand that she would likely struggle with Judy throughout her life. Further, Mrs. C.’s feelings about raising an autistic child were explored. She was encouraged to focus on small successes with Judy. For example, if Judy learned to master tooth brushing, Mrs. C. would no longer have to perform it for her. Mrs. C. began to realize that even this small achievement would provide relief from the constant fighting with Judy over this self-care habit.
Results of Therapy Judy seemed to continue to benefit from nonstructured aspects
of play therapy. Mrs. C. reported that Judy’s neurologist had remarked how much calmer Judy appeared, both before and during the appointment. Since Judy’s physician had not prescribed any medication, he complimented the therapist on Judy’s progress. Mrs. C. also explained that Judy’s teacher had noticed positive behavioral changes at school. Judy was exhibiting fewer temper tantrums and angry outbursts.
Play Therapy and Autism 27
She was more compliant with her teacher’s requests as well. The teacher also noticed that during the times that Judy would get upset, she would not cry for her mother as much as she had in the past.
As time progressed, Judy also became more attached to the therapist, as evidenced by her including the therapist into her play more often. Additionally, Judy’s physical proximity to him increased and she rarely turned her back to him. Mrs. C. reported that Judy would often get excited before her therapy sessions. She would frequently ask when they were going to return and get ready quickly before the session. Judy made emotional and behavioral changes resulting from the therapeutic interventions. However, Judy continued to avoid the structured task in therapy. Her changes were observed at home, school, and by significant people in her life (i.e., parents, teacher, and physician). After 11 sessions, Judy’s mother reported feeling satisfied with Judy’s and her own progress, and therapy was terminated.
CONCLUSION
This case presented an integrative play therapy approach for a preadolescent autistic girl with emotional and behavioral problems. In this case, the approach that integrated both directive and child-centered play therapy and parent education was partially successful. The early phase of treatment focused on a relationship-oriented intervention that allowed Judy to play nondirectively with the toys, while establishing a relationship with the therapist. Later, more directive techniques were focused on deficit behaviors. Judy clearly responded much more positively to the child-centered play therapy, and her emotional progress and behavioral changes can be attributed to such. The fact that Judy responded positively to only the nondirective play therapy is of clinical and theoretical interest. The child-centered play therapist provides the core conditions of empathy, warmth, and genuine respect for the child (Carmichael, 1993). This experience, if conducted properly, should be beneficial for any child. Child-centered play therapy allows the child to feel competent and begin to establish a greater sense of self-esteem, something that many autistic children may be lacking given their
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reliance on others. Judy’s affect improved during the course of the therapy, and her play repertoire increased.
When more direction was introduced to the sessions, Judy became noncompliant. Despite the fact that Judy needed instruction on various coping skills and activities of daily living, the play therapy did not seem to be the arena to address these concerns. When the therapist introduced the structured tasks, Judy’s attitude and mood changed. She became much more sullen and less cooperative. The therapist’s directive nature may have been a repetition of the other authority figures in Judy’s life. She was resistant to the guiding, and it appeared to make her angry. In addition, the attempts at increasing Judy’s social skills proved somewhat successful. Judy made gains in this area and near termination would often seek out the therapist for play. However, it is not clear whether the applications of the nondirective approach were responsible or the structured approach. Certainly, Judy’s socialization may have increased as a result of Axline’s approach, the one that Judy seemed to favor.
The parent education and support components of the treatment proved fruitful. The time the therapist spent with the mother provided her with an opportunity to share her feelings of frustration over raising an autistic child. To this end, the therapist could be supportive but also help the mother with situations that would arise at home. Mrs. C. seemed to develop realistic expectations of her daughter, which motivated her to be more sensitive. She was able to plan activities for Judy’s future that would encourage growth. Finally, the information Mrs. C. provided gave the therapist insight into Judy’s behavior outside of the session.
This case demonstrates the partial effectiveness of a time-limited therapy approach with a preadolescent girl with autism. The effective aspects of the treatment were the child-centered play therapy and collateral work with the mother. Judy was treated in 11 play sessions, over the course of 3 months, with progress noted by her parents, teacher, and neurologist. In contrast to the length of treatment in the Bromfield (1989) case (5 years of twice weekly therapy), the present autistic child showed success in a relatively short period of time (11 sessions). This case further illustrates the importance of the therapist looking beyond
Play Therapy and Autism 29
the diagnostic label of a child when planning treatment. Another therapist may have abandoned the idea of play therapy completely, believing the child would not benefit from such treatment. However, in this case, child-centered play therapy was adapted and employed with success, whereas the more directive techniques proved less successful.
Although in this case there was limited but consistent contact independently with the mother, a more systemic focus may have helped in understanding the family dynamics. Future play therapists may need to examine the presenting problems in the context of the family situation. In this case, much of Judy’s oppositional behavior could be viewed as her frustration with her inability at times to function independently. Through the use of play therapy, she was able to regain feelings of pride and self-acceptance. However, work with both parents may have proved fruitful. The therapist could have explored more fully Mrs. C.’s reluctance to let Mr. C. get involved in the child care, as well as both parents’ feelings about having a child with autism and its effect on their relationship. Sanders and Morgan (1997) have shown that parents of children with autism perceive a great deal of stress associated with finding the time and effort to make use of their free time. Because of the demands of raising a child with autism, parents have less time and energy to spend in activities outside the home. Thus, the therapist may be able to help the parents explore their feelings and provide suggestions.
CONTRAINDICATIONS
Play therapy may not be helpful for all children with autistic disorder, specifically those who engage in repetitive, stereotypic play with toys. Additionally, the cognitive level of the child should be considered before such an approach is implemented. More specifically, depending on the level of mental retardation of the child, he or she may not be physically able to work in a play therapy modality. Bromfield (1989) cautions that working with autistic children can be difficult, since often their cognitive limitations affect their verbalizations. Despite these limitations, it seems that some high functioning autistic children can benefit from child-centered play therapy.
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Gold-Steinberg, S., & Logan, D. (1999). Integrating play therapy in the treatment of children with obsessive compulsive disorder. American Tournal of Orthopsychiatry, 69(4), 495-503.
Guerney, L. (1983a). Client-centered (Non-directive) play therapy. In C. Schaefer & K. O’Connor (Eds.), Handbook of play therapy (pp. 21-64). New York: John Wiley and Sons.
Guerney, L. (1983b). Play therapy with learning disabled children. In C. Schaefer & K. O’Connor (Eds.), Handbook of play therapy (pp. 419-435). New York: John Wiley and Sons.
Holmberg, J., Benedict, H., & Hynan, L. (1998). Gender differences in children’s play therapy themes: Comparisons of children with a history of attachment disturbance or exposure to violence. International Tournal of Play Therapy, 7(2), 67-92.
Jackson, Y. (1998). Applying APA ethical guidelines to individual play therapy with children. International Tournal of Play Therapy, 7(2), 1-15.
Kot, S., Landreth, G., & Giordano, M. (1998). Intensive child-centered play therapy with witnesses of domestic violence. International Tournal of Play Therapy, 7(2), 17-36.
Kottman, T. (1998). Billy, the teddy bear boy. In L. Golden (Ed.), Case studies in child and adolescent counseling (2nd ed.) (pp. 70-82). Upper Saddle River, NJ: Prentice Hall.
Landreth, (1991). Play therapy : The art of the relationship. Muncie, IN: Accelerated Development, Inc.
Leland, (1983). Play therapy for mentally retarded and developmentally disabled children. In C. Schaefer & K. O’Connor (Eds.), Handbook of play therapy (pp. 431-454). New York: John Wiley and Sons.
Lovaas, O., Young, D., & Newsom, C. (1978). Childhood psychosis: Behavioral treatment. In B.B. Wolman (Eds.), Handbook of treatment of mental disorders in childhood and adolescence. Englewood Cliffs, NJ: Prentice Hall.
Mann, E., & McDermott, J. (1983). Play therapy for victims of abuse and neglect. In C. Shatter & K. O’Connor (Eds.), Handbook of play therapy (pp. 283-307). New York: John Wiley and Sons.
32 Kenny & Winick
Mendell, A. (1983). Play therapy with children of divorced parents. In C. Schaefer & K. O’Connor (Eds.), Handbook of play therapy (pp. 320-354). New York: John Wiley and Sons.
Oaklander, V. (1993). From meek to bold: A case study of gestalt play therapy. In T. Kottman & C. Schaefer, (Eds), Play therapy in action: A casebook for practitioners (pp. 281-300) Northvale, NJ: Jason Aronson.
O’Connor, K. (1991). The play therapy primer: An introduction of theories and techniques. New York: John Wiley & Sons.
O’Connor, K., & Schaefer, C. (1994). Handbook of play therapy (Vol. 2). New York: John Wiley & Sons.
Phillips, R., & Landreth, G. (1998). Play therapists on play therapy: II Clinical issues in play therapy. International Journal of Play Therapy, 7(1), 1-24.
Rasmussen, L., & Cunningham, C. (1995). Focused play therapy and non-directive play therapy: Can they be integrated? Tournal of Child Sexual Abuse, 4(1), 1-20.
Rekers, G. (1983). Play therapy with cross-gender identified children. In C. Schaefer & K. O’Connor (Eds.), Handbook of play therapy (pp. 369-386). New York: John Wiley and Sons.
Russo, D. C, Carr, E.G., & Lovaas, O. (1980). Self-injury in pediatric populations. In J. J. Ferguson & C.B. Taylor (Eds.), The comprehensive handbook of behavioral medicine, Vol. 3. New York: Spectrum Publications.
Salomon, M. (1983). Play therapy with the physically handicapped. In C. Schaefer & K. O’Connor (Eds.), Handbook of play therapy (pp. 455-469). New York: John Wiley and Sons.
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COUN 6626: Research Methodology and Program Evaluation
Week 4 Scholarly Article Content Analysis
| Case Conceptualization:Orion is a 4-year-old African American child. He comes into counseling referred by his primary pediatrician. Orion has been diagnosed with an autism spectrum disorder. He has difficulty with communication, has deficits in empathizing with others’ intentions, and struggles with single-mindedness. Orion’s parents and preschool teacher have noticed a pervasive pattern of emotional dysregulation which includes frequent episodes of hysterical crying. Orion’s parents are concerned that he is not going to be promoted to kindergarten next year if he does not improve his ability to relate positively with others and improve his ability to regulate his emotions. |
| Article:Kenny, M. C., & Winick, C. B. (2000). An integrative approach to play therapy with an autistic girl. International Journal of Play Therapy, 9, 11–33. doi:10.1037/h0089438 |
| 1. Is the article above a peer-reviewed, scholarly source?Click or tap here to enter text.Tip: Peer review is part of the editorial process an article goes through before it is published in a peer-reviewed journal. Once an article is submitted to a peer-reviewed journal, the journal editors send that article to “peers” or scholars in the field to evaluate the article. To determine if a journal is peer reviewed (also sometimes called refereed journals), try one or both of these steps:· Look up the journal in the UlrichsWeb.com (available on the A-Z Database List) and determine whether it is identified as peer reviewed. Ulrich’s is a directory. It is a searchable list of periodicals (magazines, journals, newspapers, etc.). It provides information about each periodical such as publisher, scope, and whether the journal uses peer review. · Examine the journal’s website and review the submission and editorial process for evidence of peer review. |
| 2. What is the (a) problem the researchers were investigating/purpose of the research and (b) research question the researchers were trying to answer?Click or tap here to enter text.Tip: All studies have a research question that drives the investigation (what the researchers are trying to learn). Sometimes this is formally stated while other times the reader must discover this information which can usually be found in the Abstract or the Introduction section. The Results section or the Discussion section will provide the answer(s) to the research question. Research studies can use either quantitative, qualitative or mixed methods to investigate the question. Sometimes researchers are investigating more than one intervention and so research questions may include multiple parts. Be sure to review all parts of the inquiry or use multiple questions to explain. |
| 3. Describe the sample/participants in the study. Be sure to include how many participants were included in the study.Click or tap here to enter text.Tip: Participants are also known as the sample. Quantitative studies generally have larger samples sizes than qualitative studies. Case studies may have one main “case” which may include a single person, a family, a group, or community. You want to describe who (e.g., demographics) and how many persons participated in the study. |
| 4. Did the researchers secure permission to conduct the study and/or secure informed consent from the participants? Were there any cultural concerns noted?Click or tap here to enter text.Tip: Cultural considerations are related to research procedures. Consider whether there were cultural elements that may have changed the way the study took place such as language barriers, the need for an interpreter, and whether the sample matches the population that the researchers say they are studying.The key is to consider what cultural factors are pertinent to the research question. If you say you are studying an intervention for depression, the sample needs to include persons with depression. If a study is not specific to race or gender, for example, that does not make it culturally insensitive if the researches didn’t set out to learn about that intervention specifically applied to race or gender. |
| 5. Identify exactly what data was collected by the researchers in the study.Is the data quantitative (numeric data such as scores on assessments like the Iowa Basic Skills Test (IBST) or the Beck Depression Inventory (BDI)?Is the data qualitative (for example, clinical intake interviews or a narrative behavioral observation?Click or tap here to enter text.Tip: The variables (e.g., substance abuse) or characteristic (e.g., geographic location) being investigated is usually found in the Introduction and Method sections (and sometimes the Abstract). For example: if a researcher is investigating an intervention for the treatment of depression. The variable may be “level of depression” and the data collected could be scores on the Beck Depression Scale.All data points represent something the researcher is trying to investigate. Data can be quantitative (like a measurement, frequency, or score that is represented by a numeral) or qualitative (data captured using written or spoken words, observations or photos). This includes things like student academic or behavioral records, historical documents, records, or artifacts like diaries or case notes. |
| 6. What was the outcome or the general findings of the study?What is the answer to the research question?Click or tap here to enter text.Tip: The Discussion section is where what the authors present how the results can be applied when working with clients or students. The authors will articulate their greatest take away from the study outcomes and what they view as most important to know to meet the needs of clients or students with similar needs. |
| 7. Based on your understanding of the findings, discuss how the outcomes can be generally applied to counseling practice.Click or tap here to enter text.Tip: The authors identify if the results of the investigation support their hypothesis and present the major findings. The Results section and the Discussion section present the answer to the question the researchers were trying to learn. Keep in mind that when you are investigating an intervention, the results could be mixed. In other words, the intervention might be successful, not successful, or partially successful. |
| 8. How does this research article apply to the case study at the top of the worksheet?Click or tap here to enter text.Tip: While there are similarities and differences between the article and the case study on the worksheet, describe how the general outcomes from the article relate to the case study. Explain your insights into how the information from the article could be useful to meet the needs of the case study.NOTE: As a counselor, what did you interpret from the outcomes of the research study in the article that you could use in developing treatment goals or action plans for the child in the case study on the worksheet? |
COUN 6626: Research Methodology and Program Evaluation
© 2019 Walden University 1
Week 4 Scholarly Article Content Analysis Preparation Guide
Please review the following information to help you prepare for the Week 4 Assignment
Components of a Research Article
Title and Author Information: The title of the article is important as it is a critical element for identifying the article when searching data bases. In professional counseling journals, the author who most substantially worked on the draft article and the underlying research becomes the first author. The others are ranked in descending order of contribution. However, in many disciplines, such as the life sciences, the last author in a group is the principle investigator—the person who supervised the work. Abstract: a brief (approximately 120 words) summary of the entire article. It should include
• the problem under investigation or the hypothesis • pertinent information on the participants • brief review of methodology • statistical analyses • results of the study/implications of the study.
Introduction: begins with a broad statement of the problem under investigation and then proceeds to narrow the focus to the specific hypothesis(es) of the study. The purpose of this section is to introduce the reader to the overall issue/problem that is being investigated and to provide a rationale for the research. In order to accomplish these tasks, the author needs to review past research on the same topic and present previous results. Methods: provides a detailed description of how the current study was conducted. This section outlines the procedures that the researchers followed to recruit participants, collect, and analyze data. An overarching goal of empirical studies is the replication of research. It is in the Method section that authors need to specify their participants and procedures to allow others to duplicate the study. Think of this section as being an overview of the procedures that tell you the who, what, when, where and how of the research. Results: reporting of the data. Also known as outcomes, the purpose is to describe what was found analyzing the data. In quantitative studies, it includes a description of the statistical analysis and tables and figures are often used to convey important information in an organized manner. In quantitative studies, the themes or explanations are described along with the processes used to determine these findings such as coding. Discussion: reviews, interprets, and evaluates the results of the study in a narrative form . Discussion sections typically begin by listing the hypotheses and then stating if the results supported or contradicted the hypotheses. Next, writers usually discuss similarities and differences between the current findings and findings of previous research. Any strengths or weaknesses of the current study are also reviewed, and suggestions are made on improving the research design. Also called “findings”, the discussion can include implications of the research and how the results are connected to counseling practice. Finally, a discussion section usually ends with the writer providing suggestions for future research. References: A list of all sources used during the development or completion of the research or the interpretation of the results. It is critical to document all sources of information and all research that was referenced or used to guide the study.
COUN 6626: Research Methodology and Program Evaluation
© 2019 Walden University 2
Week 4 Article Analysis
The following information is a step by step guide for completing the worksheet. Assignment Questions Tips
1. Peer Review
Is the article above a peer- reviewed, scholarly source
Peer review is part of the editorial process an article goes through before it is published in a peer-reviewed journal. Once an article is submitted to a peer-reviewed journal, the journal editors send that article to “peers” or scholars in the field to evaluate the article. To determine if a journal is peer reviewed (also sometimes called refereed journals), try one or both of these steps:
• Look up the journal in the UlrichsWeb.com (available on the A-Z Database List) and determine whether it is identified as peer reviewed.
• Examine the journal’s website and review the submission and editorial process for evidence of peer review.
2. Problem Statement and
Research Question(s).
What is the (a) problem the researchers were investigating/purpose of the research and (b) research question the researchers were trying to answer?
All studies have a research question that drives the investigation (what the researchers are trying to learn). Sometimes this is formally stated while other times the reader must discover this information which can usually be found in the Abstract or the Introduction section. The Results section or the Discussion section will provide the answer(s) to the research question. Research studies can use either quantitative, qualitative or mixed methods to investigate the question. Sometimes researchers are investigating more than one intervention and so research questions may include multiple parts. Be sure to review all parts of the inquiry or use multiple questions to explain.
3. Sample/Participants Describe the sample/participants in the study (including how many participants were in the study).
Participants are also known as the sample. Quantitative studies generally have larger samples sizes than qualitative studies. Case studies may have one main “case” which may include a single person, a family, a group, or community. You want to describe who (e.g., demographics) and how many persons participated in the study.
COUN 6626: Research Methodology and Program Evaluation
© 2019 Walden University 3
4. Procedures: Did the researchers secure permission to conduct the study and/or secure informed consent from the participants?
Were there any cultural concerns noted?
Informed consent is a critical part of ethical research. The procedures for informed consent are usually described in a methods section, however, not all authors specifically state the informed consent process. Cultural considerations are related to research procedures. Consider whether there were cultural elements that may have changed the way the study took place such as language barriers, the need for an interpreter, and whether the sample matches the population that the researchers say they are studying. The key is to consider what cultural factors are pertinent to the research question. If you say you are studying an intervention for depression, the sample needs to include persons with depression. If a study is not specific to race or gender, for example, that does not make it culturally insensitive if the researches didn’t set out to learn about that intervention specifically applied to race or gender.
5. Data:
Identify exactly what data was collected by the researchers within the study.
Is the data quantitative (numeric data such as scores on assessments like the Iowa Basic Skills Test (IBST) or the Beck Depression Inventory (BDI)? Is the data qualitative (for example, clinical intake interviews or a narrative behavioral observation?
The variables or phenomenon being investigated is usually found in the introduction and method sections (and sometimes the abstract). For example: if a researcher is investigating an intervention for the treatment of depression. The variable may be “level of depression” and the data collected could be scores on the Beck Depression Scale. All data points represent something the researcher is trying to investigate. Data can be quantitative (like a measurement, frequency, or score that is represented by a numeral) or qualitative (data captured using written or spoken words, observations or photos). This includes things like student academic or behavioral records, historical documents, records, or artifacts like diaries, journals or case notes.
6. Analysis:
What was the outcome/the general findings of the study?
What is the answer to the research question?
The authors identify if the results of the investigation support their hypothesis and present the major findings. The Results present the answer to the question the researchers were trying to learn. Keep in mind that when you are investigating an intervention, the findings could be mixed. In other words, the intervention might be successful, not successful, or partially successful.
COUN 6626: Research Methodology and Program Evaluation
© 2019 Walden University 4
7. Results/Discussion
Based on your understanding of the findings, discuss how the outcomes can be generally applied to counseling practice.
The discussion is where what the authors present how the results can be applied when working with clients or students. The authors will articulate their greatest take away is from the study outcomes and what they view as most important to know to meet the needs of clients or students with similar needs.
8. Application
How does this research apply to the case study?
While there are similarities and differences between the article and the case study on the worksheet, describe how the general outcomes from the article relate to the case study. Explain your insights into how the information from the article could be useful to meet the needs of the case study. NOTE: As a counselor, what did you learn from the outcomes of the research study in the article that you could use in developing treatment goals or action plans for the child in the case study on the worksheet?
