1. Crucial Nature of the Relationship
Power Balance
In The King’s Speech Logue meets the Duke of York in 1926, and neither man knows how to deal with the other. For instance, they cannot agree where to meet: Logue decides, “We meet here” (at Logue’s office). Other professionals go to the Duke’s palace, but the Duke must go to Logue. What should they call each other? The Duke has no trouble calling his therapist “Logue,” but Logue decides to call Prince Albert, Duke of York, “Bertie,” his old childhood nickname. The trickiness in the power balance is decided entirely by the therapist, who insists on evening up their extremely skewed positions. This makes it possible for the two men to play and talk as equals in the future.
In my office I meet little children who do not understand who I am or what I do. I say “I’m a talking doctor,” or “I’m a worry doctor,” and “You’ll come here and we’ll talk and play.” Older children know I’m a psychiatrist, but don’t know what they should call me? “My first name is Lenore. My last name is Dr. Terr. You can use either.” Most children pick my last name. The purpose is to level the playing field—just so that we can meet on relatively equal terms. Like Logue’s, these initial decisions about the relationship are all mine.
Explanation of the Patient’s Problem
Formulation Logue tells the Duke he has mechanical difficulties with abdominal muscle strength. Logue says he believes that his treatment techniques will help. On another occasion, he makes sure to say, “I heard you at Wembley.” This means that Logue has always known the worst.
I evaluate 4-year-old Rosie. She is seeing me because nights at her home are interrupted by her screams until one of her parents lies down with her. Whenever she feels anxious, tired, or lonely, Rosie picks at her parents’ arm skin and fingers—instead of a blanket. I tell Rosie she is having trouble about wanting to grow up. “We’ll play a bit in my office, OK?” I have told her the truth—and given her a diagnostic formulation and a treatment plan (to play).
Early Demonstration of the Therapist’s Powers
In The King’s Speech, Logue sends Willy, a nine or ten-year-old boy, out to the waiting room to invite the Duke into his first session. The boy, obviously a stutterer, has just about beaten his problem. He strikes the viewer as highly admirable in his attempt to get his speech just right. To the Duke and Duchess, this is a clear example of Logue’s therapeutic prowess.
Rosie, age 4, glances around my office, looking for toys on my desk and on a small table. She discovers a little china cat—and she finds another—and another. She begins to “meow” and carefully move the cats about. Casually, I ask, “Do you see the one with the broken leg that I mended?” She finds it. “You hardly can tell, right?” “Any others?” She asks me. “Yes, here’s a bigger cat that a child knocked the eye out of a long time ago. I painted it in.” She looks astounded. “I couldn’t tell that,” she says. “More?” She asks. I show her a couple of other well-repaired toys. She says nothing further. She is satisfied.
2. The Essential Key to Play—Having Fun
Gadgets, Toys, Stuff that Moves
In “Bertie’s” first session, Logue demonstrates a recording device—quite a nifty gadget—and asks Bertie to recite Hamlet’s monologue while classical music blasts in his earphones. Bertie is discouraged, but Logue hands him the recording of the session before he leaves the office. Later the Duke listens at leisure. His Hamlet is almost flawless, with no stuttering.
Logue keeps model planes, glue, and plane parts “floating” about his office. The Duke fingers these objects and eventually assembles and glues them together as he directs his divided attention to Logue. This keeps interactions between the two men from getting too hot and contentious. The injection of fun—always obvious in play—enables their work to proceed without blockage.
I see a 5-year-old boy, named Nick, shortly after he had gone into hiding for several hours when his mother’s friend from out of town visited, bringing take-out food with her. Several months before that incident, Jack’s young mother was declared “cancer free,” following a year-long treatment for Hodgkin’s lymphoma. During that year, neighbors brought over take-out food on many occasions. After the hiding episode, Nick overhead another kindergarten boy crying at school because his mother had not yet come to pick him up. When the teacher reassured the boy, “Moms always come,” Nick was heard to mumble, “Not always.”
At my office Nick found the toys and got out an entire army of play soldiers and about a dozen dinosaurs. Each toy received his attention. One dino took on an army vehicle and immediately destroyed it, killing all the humans inside. I watched three or four iterations: always one-on-one fights; always humans being destroyed. Now my toys could be used as metaphors.
“That’s not how human armies work, Nick. Generals plan a battle. Then mechanics come and check out the planes and tanks. Gas station guys fill up the gas tanks and other guys load bombs into the planes. Cafeterias feed the men. Ambulances come to get the wounded people to the hospitals. Surgeons operate. Nurses take care of hurt soldiers. Only dinosaurs fight alone.” Nick glanced at me. “Do you have that kind of stuff?” “Of course!” We took out everything. By now we had about 50 or 60 play objects on the floor and small tables. The dinosaurs had no chance. They were utterly and totally destroyed. Without my saying a word about cancer, Nick completely understood. As Hilary Clinton told us, “It Takes a Village” (1996). Nick’s and my “Village” took only one session. Nick was back on track. And, after he left, it took me at least 15 minutes to clean my office.
Play with the Arts
Logue and Bertie sing together in Logue’s office. Of course, singing is one way to prove to a stutterer that he does not have to stutter all the time. It is also a way to improve speech mechanics. Albert, Duke of York, actually sang, “Under the Spreading Chestnut Tree,” to the Boy Scouts of South Africa when he visited them before World War II began (as reported in Toronto, 2011 by the Canadian psychiatrist, Vivian Rakoff, MD, who was impressed with this royal performance when, as a boy, he saw it on newsreel film). In The King’s Speech, Logue and Bertie make up naughty and sometimes sorrowful lyrics to Stephen Foster tunes (a stretch of the truth, perhaps, because Foster sounds so very American). Similarly, adolescents make up powerful rap rhymes in their group or individual therapies. Sometimes they create incredibly moving art work. Each of these, in their own ways, releases the same sort of tensions the future King of England was releasing as he “played” with Logue.
In my office we draw, color, make up rhyming couplets, and even put together a three-dimensional project or two. Before Halloween, for instance Rosie and I constructed an elaborate crown for her to “trick or treat” with, because this little person, who had previously wanted to be a baby more than anything else, was beginning to think of herself as a princess.
Word Play
Ongoing jokes, bets, ironies, naughty words, and tongue twisters make the relationship between Logue and the Duke one of ongoing play. They bet for money, but then—Bertie doesn’t carry any. Like nasty schoolboys, they scream out filthy words into the atmosphere (some of which sounded more American then British). As Bertie prepares himself to be King, he refers to himself as, “Mad George the Stutterer.” The jokes and word games keep flying between the two men. We conduct the very same kinds of dialogues in our clinical practices, just not as clever.
A 7-year-old boy, named Sean, whom I treat these days for selective mutism—he will only speak in whispers—is starting to make dinosaur sounds with me while we fight. We bellow, groan, and moan together. I see this as a kind of movement toward health. We are indulging in sound play, not word play—in fact, it is just the opposite of words. I think I will bring in a recorder to treatment soon, so that Sean and I can both laugh at the ridiculous noises we make as our dinosaurs conduct their ongoing business. Sean’s selective mutism deserves a little stepping aside—some self-observation—to perceive how silly human foibles can be.
3. Reliance on Others to Facilitate Play
Helpers
When, in The King’s Speech, Logue asks the Duke’s family—royal though they may be—to aid in his treatment, we see the future Queen, Elizabeth Duchess of York, sitting on the future King’s chest. This, according to Logue, will improve her husband’s muscle tone. We see Bertie enunciating tongue twisters in the presence of his chauffeur. No one in the Duke’s personal household mocks him or gossips behind his back. (In fact, only his older brother, David, Duke of Windsor, does). We even see the Duke of York toying with Logues’ sons’ model airplanes, without a peep of protest coming from the boys. In other words, to aid the Duke’s speech therapy, others are asked, or are assumed to know, to be helpful.
The film makes us marginally aware that the British broadcasting industry is trying to help the afflicted man as well. According to contemporary treatment notes made by Logue, he arranged for the British Broadcasting Company (BBC) to produce backup broadcasting recordings for the King. If he began hesitating too drastically during an important speech, the backup recording would be employed. Not only was this an actual option for a stuttering king, but it was reassuring just to know it was there.
While a psychiatrist conducts play therapy with a child, a parent may be present simply to watch. Like the BBC, the parent’s presence can provide a sense of backup. Familial observation also assists parents to become aware of how the child’s problem is manifest and how the problem may be helped at home. One or both parents may be engaged as co-players with their child inside the doctor‘s office (
Benham & Slotnick, 2006). The therapist then has a choice of playing with all of them, or of observing and commenting from outside the play. Another technique that enlists parents’ help involves teaching them how to do “floor play” with their child and then assigning a certain amount of floor play time for them at home (
Greenspan, 1997,
2003). Play therapists also show parents how to accompany children on play dates with peers (
Landreth & Bratton, 2006). Again this emphasizes the helpful “other” who supplements the child’s play therapy outside the psychiatric office.
In my practice I usually play with a child out of the sight of the parents. But I also ask parents to buttress this therapy with their own parent-child play (
Terr, 2003). I particularly like bedtime stories invented by a parent and a child, with the parent starting the tale, for instance, “Once there was a boy named Mergatroid who lived in Alabama” and then, asking for the little child’s additions to their mutual story (
Gardner, 1971; Emde, Wolf, & Oppenheim, 2003). I also like drawings worked on by both parent and child—using one big piece of drawing paper on the kitchen table, for example.
My most recent effort in engaging help for play from a parent has been to ask the mother of my selectively mute little patient, Sean, to accompany him on play dates with certain gentle peers. The idea is that in his mother’s encouraging presence, Sean will feel enabled to speak aloud. We have also decided to employ a calendar and funny sticker prizes to reward Sean whenever he employs speaking tones. A certain number of stickers leads to a coveted toy. This way, Sean’s family can augment the treatment I do in my office, modifying this boy’s behavior and helping him to speak without fear.
Those Who Harm Play
The Archbishop of Canterbury is presented in The King’s Speech as a person who repeatedly undermines Lionel Logue’s work. He questions Logue’s credentials (Logue has none, having been an actor who made a private study of elocution and speech). The clergyman also takes a dark, humorless approach toward the growing friendship between Logue and the Duke. It’s up to the Duke (who later is King), to put the Archbishop in his place.
Just as in the movie, there are occasional doubters, intruders, and otherwise unhelpful influences in play therapy. When children tell others that they go to a doctor “to play,” these others may sneer at the idea. One teacher at a school for underprivileged, emotionally disturbed youngsters where I consult commented to me incredulously: “You mean you actually play with kids in order to help them? Play,” he went on, “is a total waste of time.” He left the school at midyear. “He’s no fun,” an administrator told me shortly afterward. At this same school I repeatedly emphasize the idea of bringing in play to broaden children’s contexts. We use holidays to encourage groups of kids to work on projects together, to eat foods from around the world, to sing together as much as time will allow. We also use play at non-holiday times, giving kids proverbs, analogies, and trick languages to solve. These games teach young people to employ abstract thought as they are having an enjoyable experience.
4. Pithy Talk
Direct talk from the patient can be interjected into play whenever the doctor or patient ventures in that direction. The script of The King’s Speech calls for the Duke to begin bringing personal matters to Logue when his father George V dies. Bertie fingers a model plane as he recalls a nanny who didn’t like him; much preferring his older brother, David. He describes how mean and competitive David was and how distant both parents had been all through his upbringing. These descriptions are given as one- or two-sentence statements while the little model planes remain actively in the field of play. There is something about the miniaturization of play objects—small airplanes, dinosaurs, armies, doll houses—that allows one’s personal problems to become smaller, more compact, more manageable, more “talkable.” There is also something about larger-then-life superheroes that accomplishes the very same thing. The Duke tells Logue about his dad’s last words—“Bertie had more guts than anyone else.” In just one sentence Albert finds some peace with his great loss. This is almost identical to the very brief exchanges of pithy talk we psychiatrists have during our play sessions with children.
One idea behind interspersing pithy talk into play is to offer youngsters contexts (
Terr, 2009). The vulnerable child must be helped to understand the bigger world and his own inner world as it affects him. As Rosie, at age 4, began to play “grown-up princess” with my dolls, I was able to comment “you’re feeling more grown up, too.” This comment (a pithy one) separated the little girl from the princesses she was handling. But it lasted only a second. Another time, in the midst of an attempt on Rosie’s part to hide the toys she liked the best from anyone else who might come to my office (and to check the next week to make sure her imagined competitors had not moved anything) she commented, “I’ve decided to marry Jimmy” “Who’s he?” “He’s a friend of our family. He’s five and I like him.”
“Guess what?” I said. “What?” “Maybe he’ll turn out handsomer than your mother’s husband.” Rosie put her hand over her mouth, shocked. Then she began to giggle. I giggled, too. I’d just expanded her world about 20 or 25 years. “Guess what?” she asked me. “My birthday comes soon.” We figured out exactly when it would come and counted the days. Rosie was discovering an important context—the future.
Now, she picks up a puzzle, moves the parts around, and dares me to put them back in place. We are back into play, testing out our relative merits as child and adult—same theme, but now staying within our chosen metaphor. The pithy talk will wait, like Rosie’s hidden toys, until next week.
5. A Little Drama
Movies have to create high drama or the audience will fall asleep. Good therapy often contains drama, too, but for very different reasons. Drama is a powerful tool in breaking up patients’ resistances.
In the case of Logue and the Duke, a dramatic instance comes about in 1937 when they take a walk in the park near Buckingham Palace. Edward VIII, Albert’s older brother David, is now engaged in a battle with key members of the government about his right to marry Wallace Simpson, his twice-divorced “ladyfriend.” Logue tells Bertie that he soon will be King. Bertie won’t hear of such things and declares Logue to be traitorous. Logue tries to apologize, but the Duke refuses see him. Then, Logue’s prediction comes true. Edward VIII abdicates, “to marry the woman I love.” The new King desperately needs help. He will be crowned on the same date in 1938 that had already been selected for his brother. He must speak in public and “live” on air.
Logue prepares the King. They use Westminster Abbey to practice. Logue wants to lighten the atmosphere. Horsing around, he sits down on St. Edward’s throne and man-handles the Stone of Scone. The new King is appalled. “Stop it,” he says, no stutter, no stammer. Logue does not stop. “Listen to me,” the King shouts at Logue. “I have a voice!”
The psychiatric consulting room cannot match this kind of scriptwriting. But there is still a place in psychiatry for dramatics. Consider Nick, the boy whose mother had been declared cancer-free a year before. One session of Army vs. Dinos diminished Nick’s extreme anxiety. But 6 months afterward, Nick’s two-and-a-half-year-old sister, Adair, stopped bothering to “go to the potty” and started using baby talk. She had been well trained for quite a while, but she now declared herself to be an infant. We could detect no obvious reason for this. The staff at the nursery school Adair attended noticed the regressive behavior, too. I guessed she somehow must have learned of the cancer. “Could Adair come to you and play?” her mother wanted to know. After all Nick had had considerable success.
Nick, now 6 years old, greeted me excitedly in our waiting room and asked, “Can I come in with Adair?” He agreed to play quietly with my toy cars and planes and, of course, with the army and dinosaurs while I met with Adair. So both children enter the office with their mother, who watches passively. Adair quickly locates my dolls and declares one of them—the only one she wants—to be “Princess.” The princess dances, Adair tells me, and then she demonstrates a great dance. The princess sings. Adair demonstrates once again. The princess has a nifty wardrobe. Other princesses want to have tea. “Oh, oh—will that work out?” I ask, doubtfully. “I mean, is the princess going to need diapers and not use the palace toilets during the tea party?”
This is too much for Adair. She puts down her doll and starts looking around the office for something else of interest. Nick, seemingly engrossed with his army, senses the change. “Adair,” he emphatically orders, “Get back to Princess!”
This is high, high drama, indeed. Nick’s two-and-a-half-year old sister picks up the doll once again, giving me another chance to attack her problem through play. “Dance, dance,” she initiates, “Sing, sing.” “Isn’t it fun to be a grown up princess?” I say. This time my approach is entirely positive, not negative. And this time Adair accepts the idea. “The princess likes being big,” she tells me, all smiles now. I have prearranged with Nick’s and Adair’s mother to tell her little girl all about the cancer and the complete cure when they are home. Currently, Adair is almost always dry at home. No more baby talk. At school, the teacher comments that she is much, much improved. Not as perfect a result, perhaps, as Nick’s, but good enough to let Adair’s development lead her forward without further intervention.