Chapter 9.Getting Started, Creating an Alliance, and Facilitating Play

Initiating play therapy requires patience, resourcefulness, and knowledge about children’s unique perceptions of the therapeutic situation. There are many reasons why a child might feel reluctant to engage in treatment. Although these may derive from the child’s individual personality and experience (shyness, rigidity, fear of “the doctor,” recent parental divorce), they often represent developmentally normative trends. A preschooler’s separation anxiety, a 7-year-old’s fear of losing recently acquired capacities for self-control, and a 10-year-old’s dread of dependency are familiar age-appropriate concerns that require the therapist’s tact and sensitivity (Freud 1966). Fears over loss of autonomy, the prospect of an unfamiliar adult’s intrusive scrutiny, and the risk of potentially mortifying self-exposure are powerful impediments to the child’s comfortable entry into the unknowns of a therapeutic relationship. Parents’ behaviors, including their explanation for the initial visit, can contribute to the child’s reluctance and protests. In Jeremy’s case, his parents, who often shrank from confrontations and their son’s ensuing angry reactions, failed to inform him about the initial meeting until the morning of the appointment; their previous extended consultation with the therapist, in which they had discussed ways to help prepare Jeremy for treatment, seemed to have been forgotten under the immediate pressure of having to deal with a resistant child. Not surprisingly, Jeremy responded with outrage, leading to a late arrival at school that morning; these outbursts were reprised when his mother picked him up at dismissal, ready to escort him to the therapist’s office for his first visit. His shock, sense of betrayal, loss of autonomy, and extreme anger at his parents further impeded a beginning alliance with Dr. Vargas.