A case study analysis of thematic transformations in nondirective play therapy

A multiple case study approach was employed in this intensive thematic analysis of the process of nondirective play therapy. Using a naturalistic research paradigm, this study undertook to identify and describe the principal verbal and play themes and their transformations emergent over a course of play therapy, as well as to identify and describe similarities and differences between the themes emergent in those two domains. Play and verbalization, two types of symbolic expression, were considered routes of access to the child’s evolution of personal meaning. The research participants in this multiple case study were 4 preschoolers, aged 3 to 4. Each participant received 20 weekly play therapy sessions which were videotaped and transcribed. Running notations were made on the verbatim transcripts as to participants’ play activities. Separate coding schemes were devised for the emergent play and verbal themes. Supplemental data collection, organization, and analysis procedures included a field notebook with post hoc descriptions of the sessions, session summary sheets profiling play and verbal themes, charts, and memos. This study, discovery-oriented and exploratory in nature, yielded rich descriptions of the intricacies of therapeutic change on two symbolic levels. From these descriptions were extracted not only information on the transformations in play and verbal themes but also an understanding of the qualitative changes which denote the phases of therapy, and insight into the process of evolving meaning across these phases. A central finding of this study was that the arrays of play and verbal themes and their patterns of transformations were highly individualized. However, a number of themes emerged in common to all cases: Exploration, Aggression, Messing, Distress, and Caregiving or Nurturance. Participants were observed to work through contrasting themes, with preschoolers’ therapy characterized as an active struggle with such intense, oppositional forces as birth and death, injury and recovery, loss and retrieval. Typical thematic transformations included movement from infantile vulnerability to mastery, from grief toward resolution, from fear to safety and protection. The beginning phase of therapy was found to be typified by exploratory play. The middle phase was typified by intensified involvement in play and by experiences of disinhibition. The end phase was characterized by two contrasting yet not mutually exclusive tendencies, namely, the introduction of a sense of hopefulness, confidence, and integration; and an improved capacity to deal with difficult psychological material. Entry into the middle and end phases was signalled by qualitative shifts in the child’s attentional, tensional, or relational state. The theoretical implications of this study included insight into the critical role of the child’s initiative and of the therapist’s permissiveness in the unfolding of symbolic expression. Each individual case contained specific theoretical implications for such classic problem and treatment phenomena as developmental delay and play disruptions. The practical implications of this study include emphasizing the need for practitioners to counterbalance attention to the child’s verbal expression with attention to transformations in play activity and play material usage. It is suggested that further research extend the ramifications of this exploratory study by examining the themes occurring in treatment within homogeneous populations according to problem configuration.

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