A SHORT TERM PLAY THERAPY INTERVENTION WITH CHILDREN

A SHORT TERM PLAY THERAPY INTERVENTION WITH CHILDREN UNDER FOSTER CARE Selin Kitiş, MA & Yudum Akyıl, Ph. D Introduction Result • CBCL: There is a decrease in children’s anxiety scores after the s Present Study • According to Bowlby’s attachment theory (1982), the infant is born with a biologically rooted motivational system to form attachment with others in order to seek comfort, support, and nurturance. This attachment relationship becomes a prototype for the future relationships and influence following experiences and perceptions of intimate relationships by acting as a framework comprised of mental constructs for understanding self, others, and the world (Bowlby, 1973; Bowlby, 1980). Any disruption in this primary relationship between the infant and the caregiver can have significant consequences, which include cognitive, social, and emotional difficulties in future life by creating an internal working model that views the world as potentially unsafe and uncaring as well as the perception of feeling unwanted and unloved (Bowlby, 1951). This is the case for many of the children under government protection who are very likely to have many early adversity experiences. • According to Bowlby (1988), corrective experiences can compensate early adversities and enable development of secure attachment. Correspondingly, foster and adopted children are able to overcome early adversity experiences and form secure attachment with their subsequent parents (van der Dries, Juffer, van Ijendoorn, Kranenburg, 2009). • • Adoption and foster care appears to be effective systems for children who suffered from early adversity to catch-up in their physical, social-emotional, and cognitive development by providing corrective attachment experiences and adequate stimulation. However, they are not magical wands, which destroy all of the delays and difficulties. Adoptive and foster families face with difficulties and dilemmas that are unfamiliar to biological parents. Difficulties that come with the child who have earlier traumatic experiences challenge their expectations and parenting skills, and they generally do not have a role model who can help • them with being an adoptive or foster parent. Children, too, deal with the struggles of passing to family life from institution. Neglect and adverse experiences in institutional care, the characteristics of their new family, and the confusion of being abandoned and being protected by their new family, continue to challenge and affect their social, emotional, and cognitive development (Juffer et al. , 2011). • Foster and adopted families need to have an adequate training and be supported after the placement in order to cope with these difficulties as well as to support the child’s adjustment period to the new family as foster and adopted children are vulnerable groups to develop mental health and attachment difficulties, especially in the first periods of the placement. Teaching the significance of attachment and presenting the symptoms as a communication vehicle for developmental gaps is an important part of this training. Additionally, parents need to be helped to • recognize their opportunities for symbolic re-parenting in a stable, nurturing and interactive environment and to learn giving sensitive responses to the child’s complicated signals in order to strengthen the attachment, development and adjustment of the child. Correspondence to: Meltem Yılmaz, MSc. • Turkey is in a rapid transition and transformation process in the context of child protection services that it has started to lean towards family based services instead of institutions, and requires support and improvement for foster families who start to live with their foster child and are likely to have difficulties in their adjustment period. • This is the pilot study of a short-term structured play therapy model that is adapted from different therapy approaches, which are applied in other countries. The study aims to support foster parents in dealing with the difficulties and tackling the issues of adjustment period in a better way by creating a protective ground with an early intervention targeting the attachment between foster parents and their children. intervention, but no significant findings. • Story Stem: Children’s disorganized attachment scores are decreased after the intervention, but no significant findings. • Play Assessment: Significant increase in Imagination, Organization, and Complexity scores 4 Averages 3. 5 3 2. 5 2 1. 5 1 0. 5 0 1 2 3 4 Imagination Organisation 5 Complexitiy 6 7 8 Involvement *Data was analyzed with non-parametric Wilcoxon test on SPSS. Method Sample: 6 foster families. ID 1 2 3 4 5 6 Child’s Gender* 1 2 1 1 1 2 Child’s Age 5 3 6 4 Months in Foster Care 7 16 2 9 12 42 SES** 3 2 5 3 4 4 * 1: Male, 2: Female ** 1: Low, 5: High Intervention: 14 sessions of semi-structured attachment based play therapy with foster families. Each play session included structured family game and free play in which parents follow child’s lead. • Session 1: Psycho-education about attachment and parenting • Session 2: Intake (just parents) • Session 3: Introduction & Assessment • Session 4: Mirroring & Family Drawing • Session 5: Attachment-Based Family Games • Session 6: Body Drawing • Session 7: Feedback (just parents) • Session 8: Emotion Recognition • Session 9: Emotion Regulation • Session 10: Foster Family Story with Toys • Session 11: Feedback (just parents) • Session 12: Life Book • Session 13: Termination & Assessment • Session 14: Termination & Feedback (just parents) Measures: • Child Behavior Checklist (CBCL) • Parents filled before and after the intervention • Story Stem • Child’s scores are coded for pre and post assessments • Play Assessment • Child’s scores are coded for each play session • Intake and termination parent sessions are qualitatively coded for Thematic Analysis melyilmaz@ku. edu. tr Correspondence: Selin Kitiş, MA. skitis@ku. edu. tr • Thematic Analysis: • Intake: • Parenting: Trying to understand the reason behind the child’s behavior, difficulty with limit setting, concern about others, desire to be a good parent, effort to educate the child, fear of giving the child back to the biological parents, anxiety about child’s well-being • Parents’ Perception of the Child: Child’s positive change after the placement, child’s difficulty with emotion regulation, child’s good qualities (ex: compliant, social, clever), child’s challenging behaviors (ex: lying, over-eating) • Termination: • Parenting: Trying to understand the child’s mind, sensitivity to child’s signals, toleration for child’s challenging behavior, concern about the child’s future, taking responsibility for the mistake as a parent, desire to be a good parent • Parents’ Perception of the Child: Child’s good qualities (social, compassionate) • Effects of Participating the Program: Improvements in child (decrease in challenging behavior, improvement in emotion regulation, cognitive/academic/social development), improvements in parenting skills (understanding the child better, learning how to play with the child, strengthening the relationship with the child), parents’ positive perception of the process References Bowlby, J. (1951). Maternal care and mental health. World Health Organization Monograph Bowlby, J. (1958). The nature of the child's tie to his mother. The International journal of psychoanalysis, 39, 350. Bowlby, J. (1973). Attachment and loss. Vol. 2: Separation: Anxiety and anger. New York: Basic Books. Bowlby, J. (1980). Attachment and loss, volume 3: loss; sadness and depression. Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American journal of Orthopsychiatry, 52(4), 664. Bowlby, J. (1988). Attachment, communication, and therapeutic process. A secure base: Parent -child attachment and healthy human development, 137, 157 Van den Dries, L. , Juffer, F. , van IJzendoorn, M. H. , & Bakermans-Kranenburg, M. J. (2009). Fostering security? A meta-analysis of attachment in adopted children. Children and youth services review, 31(3), 410 -421. Juffer, F. , Palacios, J. , Le Mare, L. , Sonuga‐Barke, E. J. , Tieman, W. , Bakermans‐Kranenburg, M. J. , & Verhulst, F. C. (2011). II. Development of adopted children with histories of early adversity. Monographs of the Society for Research in Child Development, 76(4), 31 -61. Istanbul Bilgi University Discussion • CBCL and Story Stem: 14 sessions may not be enough for symptom decrease and change in attachment patterns. • Play Assessment: Intervention appears to be effective in increasing the child’s play capacity. This might help with improvement in child’s psychological well-being as the child starts to express himself/herself and work through his/her issues symbolically within the play. Intervention appears to be effective in increasing the child’s play capacity. • Thematic Analysis: • Intervention seems to be effective in improving parents mentalization abilities and parenting skills. • Parents’ perception of the child positively changed. They started to give more attention to positive qualities than challenging behaviors. • Parents’ tolerance for difficulties increased, probably because they started to better understand the child’s reactions. • Child’s challenging behaviors were decreased and expression capacities were increased. This might be associated with the more sensitive parenting and improved play capacity as well as the interventions within the sessions. • Each family indicated that they earned a lot from the program in the means of parenting and understanding their child better. Indications of “learning how to play and interact with the child” and “understanding the child better” is important as they are among the main purposes of the intervention. • Limitations: • Limited number of participants • Each child had unique acquisitions from the process, but it was not possible to show some improvements objectively. • The program was applied by a single therapist. It should be repeated by different therapists with more participants. • Suggestions: • The program can be applied with more participants by different therapists. • Similar programs can be planned for different age groups. • Extended treatment models can be integrated for more severe cases. • Group version of the program can be used in order to reach more families. • More detailed measurement methods can be used to investigate the change process within the sessions. Kazım Karabekir Cad. No: 2/13 34060 Eyüp İstanbul/Turkey İstanbul Bilgi University: Kazım Karabekir Cad. No: 2/13. 34060. Eyüp, İstanbul/Turkey.