Chapter 5.Basic Psychodynamic Concepts and Their Use in Play Therapy

The spontaneous nature of the play, Dr. Chen’s attention to Alex’s affective experience and to the meanings of his narratives and behaviors, and her attempts to verbalize aspects of their interaction mark this vignette as an example of psychodynamic play therapy. Early in the treatment, child and therapist begin to develop their relationship by entering a mutual playing state; their joint participation in imaginary play creates a safe, intermediary space within which the treatment can begin to unfold. Following a brief period of guardedness and reserve, important aspects of Alex’s inner life—conscious attitudes and beliefs, as well as unconscious fears, fantasies, conflicts, and defenses—are gradually revealed through his reactions to Dr. Chen as well as in the contents of his play. He eventually demonstrates that he worries about power and control, fears helplessness and bodily injury, struggles to manage aggressive feelings, wishes to surround himself in protective armor, and equates tough attitudes with boyishness. Working mostly but not exclusively within the play itself, Dr. Chen finds ways to talk to Alex about his use of grandiosity as a defense against feeling scared, vulnerable, and out of control. Her knowledge of his developmental capacities and sensitivities allows her to address potentially uncomfortable issues without causing him to feel exposed and criticized. For example, she verbalizes his fear that girls are preferred to boys, but she does not link this to known sibling rivalry in his real life. Moreover, despite imagery that derives from body-based phallic and anal issues (erected fortresses, launched missiles, exploded bombs) and references to oedipal-phase curiosities (“spying” and “infiltrating”), Dr. Chen makes no attempt to comment on earlier phases of Alex’s development.