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Integrating Play in Family Therapy: An Interview with Eliana Gil, Ph.D. Teresa M. Christensen and Jill M. Thorngren The Family Journal 2000; 8; 91 DOI: 10.1177/1066480700081017 The online version of this article can be found at: http://tfj.sagepub.com

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International Association of Marriage and Family Counselors

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THE FAMILY Christensen, Thorngren JOURNAL: / PLAY COUNSELING IN FAMILYAND THERAPY THERAPY FOR COUPLES AND FAMILIES / January 2000

v Interview

Integrating Play in Family Therapy: An Interview With Eliana Gil, Ph.D. Teresa M. Christensen University of New Orleans Jill M. Thorngren Montana State University, Bozeman

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liana Gil, Ph.D., is currently the director of the Starbright Training Institute for child abuse and neglect, play therapy, and family play therapy in Springfield, Virginia. She is also the coordinator for the Abused Children’s Treatment Program at the Inova Keller Center in Fairfax, Virginia, and a clinician in private practice in Rockville, Maryland. Among her previously noted credentials, Dr. Gil is also a registered play therapy supervisor, a registered art therapist, and a certified family therapist. She presents on various topics related to family and play therapy and serves as an adjunct faculty member at Virginia Tech and George Washington Universities. Dr. Gil also has made numerous contributions to the field of counseling through serving on various boards and publishing many articles and books. Currently, she serves on the boards of directors of both the American Professional Society on the Abuse of Children and the National Resource Center on Child Sexual Abuse. She has authored many books on play and family therapy, including Systemic Treatment of Families Who Abuse (1996a), Play in Family Therapy (1994), The Healing Power of Play: Therapy With Abused Children (1991), and Treating Abused Adolescents (1996b). As indicated by Dr. Gil and supported in family and play therapy literature, for various reasons, many family therapists struggle with families that include young children. Oftentimes, family therapists either intentionally or unintentionally exclude young children because they do not know how to or do not feel comfortable involving children actively in family sessions. As Robert-Jay Green commented in the forward to Gil’s book titled Play in Family Therapy (1994), Thus, in actual practice, the field we call “family therapy” usually consists of treating an individual parent, or only the parental couple, or sometimes an adolescent and one or both

parents. It rarely involves young children in conjoint family sessions for any length of time. (p. v)

As play and family therapists, we have struggled with actively integrating young children and their unique approaches of communicating in family therapy. Accordingly, Gil’s numerous publications and vast experiences have consistently spoken to us and assisted us in coconstructing family therapy sessions that effectively integrate the paradigms of play and family therapy. Consequently, we leapt at the opportunity to converse with Gil regarding her ideas, experiences, and feelings about play in family therapy. In early November 1998, we attended a workshop on Play Therapy for Children and Families in Crisis in Pocatello, Idaho. Dr. Gil was kind enough to engage in an afternoon of dialogue, which resulted in the following narrative. EVOLUTION Thorngren: First, we would like to get some background information about those experiences that led to your work with incorporating play in family therapy. Gil: My initial training was in family therapy where all the families I worked with were abused families. That meant that the presenting problem was related to the child and some problem or dysfunction in the parent-child interaction. My experience in family therapy left me dry about how you work with kids. I felt like there was almost a domino principle—that if you work with the families and help them get better somehow this will affect the child and the child will get better as a result. But I noticed that a lot of these kids had a variety of issues of their own that needed to be addressed in a safe environment. I began thinking to myself, “I like family therapy but I want to see these kids individually to see how they are away from their parents or do some of the work I think they need to have done.” Also, given my population, a lot of times there was not an intact family. I worked with children in foster placements,

THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES, Vol. 8 No. 1, January 2000 91-100 © 2000 Sage Publications, Inc. 91 Downloaded from http://tfj.sagepub.com by guest on May 16, 2007 © 2000 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.

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group home placements, and residential centers. I really felt these kids needed some experience, even if you maintain a systemic view. Therefore, I began working with the individual child and talking about systemic issues. But I still felt there was something important that was imperative that needed to happen for them. They needed family therapy, if possible. So I think in answer to your question, it came from a combination of exposure to the type of problem I was working with and my understanding of trauma. Sometimes children need an opportunity to have a healing experience, and sometimes that can be done alone away from the family at first and later with the family working in the child’s paradigm. The families I work with are sometimes those people who are involved in hurtful experiences. When I have a biological family who is willing to work and participate in treatment, or mandated, I always include family sessions to try to give them a reparative experience in terms of parent-child dyads. As I continued valuing the corrective manner that the child-therapist relationship could offer to a family, I realized that every child deserved that. So I started out as a “child therapist” and then quickly went to play in family therapy. I had to pursue my own training in play therapy because it wasn’t offered. I started tracking down every workshop, conference, and book on play therapy. I continued doing this until I felt well versed enough in play therapy. Ironically, now I end up, like so many people, introducing play therapy as a concept. So it has been just a very interesting evolution. Christensen: In your writing and throughout your workshop, you shared your perceptions about the “downplay” or hesitance of many training programs and professionals regarding play therapy and the inclusion of small children in family therapy. Would you please speak more about that? Gil: I think that first of all I have direct experience with that because I got a Ph.D. in family therapy. Throughout that entire family therapy program, any time there were young children, they were given pencils and papers and asked to go and draw something. My feeling in just watching this was “You go be out of the way while we do this important work with your parents.” When talking to family therapists, I realized that they do not particularly feel competent working with young children and are almost afraid of them because they’re not as verbal. Many family therapists do not feel they are skilled in engaging children in therapy and often get very frustrated with children when they don’t respond the way older kids can respond, like in terms of such limits as “sit down” or “speak when you’re spoken to.” So it’s been interesting to hear people say that “no” they do not have enough training in this area. On the average, in the entire course of their training, they maybe got a course in Child Psychopathology, which doesn’t tell you much about therapy. Or maybe they had a course in Child Development, which again doesn’t necessarily tell you much about therapy. When it comes to the

12-and-younger group in particular, many family therapists feel stymied. Now in some cases (the 13-and-older group—as long as the children are highly verbal), some family therapists feel differently, more competent. For example, I think Peggy Papp did some dynamic work when she talked about family sculpting because that could involve children and children could definitely get interested in role-playing pretend sculptures and things like that. But that’s been kind of a rarity. When you look at the literature in the family therapy field—I mean, Whitaker did some but he didn’t really say what he did and what he did also seemed to be more Whitaker than anything else is. There have been some notable exceptions, obviously, of people who have really paid attention to integrating play into family therapy but not a lot and not enough. Now on the other side of this integrated approach lay the play therapists. When I started really seeking out my own training in play therapy, I encountered lots of play therapists who feel totally comfortable with kids but uncomfortable with adults (“Don’t make me talk to those adults”). These therapists do not know what to say to parents; they do not know how to speak to them. It’s hilarious to watch these two separate groups of people working with the same population who feel reluctant to integrate them. Again I go back to it’s a sense of not feeling competent and that as soon as therapists feel that they know what to do, they have something to do. Then therapists know how to relate to and instruct other people/parents on how to do it. I have consistently found that once therapists have the tools, they use them, but it takes quite a long time for them to get comfortable. Even as I go around teaching people about family play, it’s one thing to know, “Okay, I need this, this, and this, and I understand how to run the activity.” It’s another thing for them to say, “But, okay, after the family finishes the activity, what do I do? What does this have to do with the therapy? How do I make connections?” TECHNIQUES Christensen: You commented in your writing and in your workshop that you often use play to spice up your repertoire of family interventions. Essentially, you are saying that you integrate play therapy and family counseling techniques. For example, you talk about using the narrative approaches, like the aquarium or puppet interview, to allow for the emergence of information and provide the families with the opportunity to coconstruct their environment in therapy. Can you speak more about that? Gil: Yes. Again, when holding these two different fields of study, I look at the possibility of integration. My original pressure came from feeling that when we did family therapy without play, when we did verbal family therapy with kids, we were putting a demand on them to communicate in a way that adults do. In other words, it

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Christensen, Thorngren / PLAY IN FAMILY THERAPY

seemed like it was not a user-friendly environment to kids and even the circular questioning or whatever, it’s still so verbally focused. I wonder what would happen if instead of putting the demand of the adult world on the child, we reversed it and put the demands of the child’s world on the adults. Just every now and then, as an experience, I would have the families interact with the play. The idea was, this was play in and of itself and could the play serve as a link, a bridge, between these two worlds that are so different—one so confident and verbal and the other so creative, pretending and nonverbal, like a fantasy world. This would be the bridge and at the same time with that bridge, we could cause some new interaction between parent and child that might be rewarding—that might not be so deeply immersed in negative patterns of relating. Essentially, my goal was to give people an opportunity to have them view each other differently. So a child, for example, whose parent had never played with them or been interested in their play could suddenly have a parent attentive to their play. This resulted in new perceptions of each other. They would share something that was important, definitely to the child and hopefully to the parent. It really was all about the bridge. The bridge became the metaphor for connecting two worlds. Christensen: Like creating a shared narrative or a common reality. Gil: Absolutely! Something that we can actually do together that doesn’t have to be right or wrong. It’s just who we are and the different things that come out, and time together. I also found that so many of the parents that I worked with had never actually been given the opportunity to play. Many parents came from backgrounds where they were the parents to their parents instead of being the child. Some parents never had a warm and nurturing environment, so in another way, I was providing the parent with something I hoped they would then be able to provide to their child. Some of family therapy is about modeling that for parents. Thorngren: It seems that you have been effective in integrating two realms of therapy. Would you say that play in family therapy is not a distinct approach, with specific step-by-step techniques, but really an integration of various interactions? Gil: Yes, and more! I think it requires somebody who is willing to expand his or her view of therapy in the sense of going beyond conscious material versus unconscious material, verbal versus nonverbal, then integrating the possibility of symbolism, metaphor, and metaphorical language. This is the kind of thing that many therapists do not feel comfortable with, as if they are not conversant with it. I go back to: Nobody starts out being conversant with anything. You have to experiment. You have to practice. Thorngren: In terms of specific techniques, you talk a lot about art and sand work. Would you give some examples of specific activities and techniques that have worked for you?

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Gil: As a matter of fact, I have just finished writing a chapter for somebody else’s book on family play therapy techniques. I went through and described a lot of techniques. I will talk about the ones that I seem to lean toward the most. I almost always start with the puppets, and I do not know exactly why. I think it’s the easiest thing to do. Sometimes the art requires people to work with materials and easels you have to bring in. Also, sometimes when you ask people to do art, there’s an immediate, “I can’t.” There’s a performance anxiety. I usually start with the puppets and this thing called the family puppet interview where the therapist has the family tell a story. After the story, there is a formal/structured kind of dialogue that goes on, which is designed to, in some ways, make meaning of the family’s story and issues. In other words, going from right brain to left brain activity pretty quickly. I think of it much more as family puppet sessions and I don’t go to the end point immediately. What I’m trying to do much more of now, and have experimented with over the years, is after the person, the people, tells the story to actually have the family therapy occur with the puppets. In other words, the therapist and family stay within the metaphor, within the characters. They do not take the puppets off their hands and the therapist starts talking only to the puppets that are in the story. As a therapist, you can do all the different kinds of play therapy interventions as if you were working with a family. You just stay with Mr. Owl, for example, “Owl, I notice that Mouse was trying to get your attention. I wondered if you noticed that?” and/or “Mr. Turtle, it looked like you were left out of the play altogether and I’m just kind of wondering what that was like for you? Have other people ever felt left out?” and so forth. Christensen: So it’s almost like externalizing the problem? Gil: Figuratively—exactly—and oftentimes it allows for a wonderful processing to occur. Again, the defensives are still down because you’re in character and all the interventions are being done with the characters. So you might say to them, “Well, during the week that comes, Mr. Turtle, I think that one of the things that you might want to experiment with is taking some flowers over to the Owl to see how the Owl responds,” and so forth. It is all still done in the metaphor. Then you close that session and it’s possible to come back and have that whole story told again or tell a new one with the same characters. It’s also possible that some of the interventions you give the family get translated in other ways. For instance, I remember one situation where the metaphor had to do with an alligator in the pond and we ended up talking about the alligator being threatening to others or the perception was that the alligator would hurt them. Finally the alligator said, “But, you know, I don’t really want them to run away. I want them to stay and play.” I said to him/the alligator, “If they stayed and played, what would you most like to do?” He replied, “Have a picnic.” So we talked about what kind of picnic the alligator would like to have with the other people in

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the story. The long and short of it was that the family went home and spontaneously during the week went on a picnic. Now that’s an interesting connection to make between unconscious material and conscious material. Likewise, another art technique we did with the family was drawing a fruit salad, where they have the experience of making a fruit salad together. This technique takes it from the less concrete to the more concrete and in the process of doing the fruit salad, one of the children was left out completely. It was actually the same alligator kid and so instead of doing anything, he drew an alligator coming to eat the fruit salad. Then the mother got mad at him. But it was one of those wonderful, systemic moments where she could see that, in fact, her attempts at ignoring him actually precipitated his acting out behavior. Christensen: So these techniques allow for the therapist and family members to give meaning to their interactions and manners of relating to one another. That was that particular family member’s role in his family. Wow! Gil: Exactly. So that family actually was very interesting, so much so that the mother was able to, over the weeks between the sessions, either look at the tapes or look at the art and come back and say, “You know what I noticed was . . . ” That is ideally what I want to have happen. Sometimes it won’t come from them. Sometimes it has to come from me, where I’ll show them the tape and say, “Now I want you to notice what happens right now. Now what did you see? What I saw was he kept asking what kind of fruit he should be and nobody paid attention to him. As no one paid attention to him, you could see him get really upset. Now he’s the alligator and he wants to be aggressive. How could you change that?” Slowly but surely, most families begin to grasp the concepts that therapists are trying to communicate. It is all very nonthreatening and that allows everyone in therapy to relax and get involved. For instance, sometimes people say to me, “What about the dads?” because everybody thinks that the men don’t participate. Some of the best puppet renditions have been by men who just totally get into using their voices. Furthermore, the selection of puppets is very interesting from the outset. What somebody chooses has some meaning to them, tells you a little bit, or suggests something. It is like I’m always saying, “What do you think is suggested by this?” That’s really where you need to go. So the family puppet technique is one that I like a lot. I’ll do that over time at different intervals. Sometimes they come in and want to do one and that’s fine. The key is the interaction with the metaphor, expanding the metaphor, and keeping the interventions there as opposed to going outside. Another technique that I like a lot has to do with family art stuff and there is a structured technique called the family art evaluation. There is a book written by Peterson and Hardin (1997) that describes this particular technique that I find incredibly informative. Rich metaphors come out of this activity,

including many things that can be integrated into therapy. I believe that every now and then it’s the therapist’s job to sort of tease out things that can then be promoted with the family or that can be language that gets incorporated into what the family’s going to focus on. The family art evaluation allows this to happen. The family aquarium is another technique that I started using because it integrates individual issues as well as family issues. Essentially, it requires moving from a task that requires people to do a project where they draw a fish, any fish they want. Then, once the fish is drawn, they decorate it. They put on feathers, beads, and color it in. It gets to be a big project. That is the first piece of it, which is all about self-image and projection. Is it a shark as opposed to a dolphin? I’ve had kids who couldn’t limit themselves to one fish. They have to be two fish. You know, stuff like that. I’ve also had kids who’ve changed the function of the fish so it will be a shark but with a good heart. With a protective shark, they change the function of the animal. Then I have the family select a piece of blue-green poster board and ask them to create a body of water. I start out with the aquarium by saying, “This will be an aquarium.” But I found that sometimes people didn’t want to have an aquarium. They wanted to have an ocean—they wanted a pond, a lake, or whatever. So nowadays I lean toward a body of water and then the family together decides on the type of body of water. Once the body of water is decided on, the next part is to create an environment. Here they go into that poster board and add to the water. They add food, snakes, plants, a bottom, or whatever. Some people get really involved. They even go to the extreme of putting in barometers so that the water temperature is good or putting in filters so that the water is clean. Some continue making sure that there’s plenty of food and different kinds of food for people. Others make sure that there are caves or places where the kids can isolate or play. Then there is the other end of the continuum where these family projects possess the absence of such healthy things, thus representing a complete disregard for a nurturing environment. Examples include cutting off sunrays and including fishhooks where someone’s fishing and there’s danger. I had a real extreme case with a kid who was in a lot of trouble and a lot of pain. He drew himself with one eye out because all the other fish had picked it out and were eating his eye. I thought that was a very powerful metaphor. Sometimes there are body pieces in the aquarium because people had died and left body pieces. I mean, you get all kinds of variations on the themes. I’ve been trying simply to record all the things people include or don’t include. I’m trying to develop grading sheets so that you can actually look at this and then mark off things because there are times that certain aspects make my intuition go in certain directions, which sometimes people aren’t trained to do.

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Christensen, Thorngren / PLAY IN FAMILY THERAPY

Thorngren: It seems as if your activities allow you to get the symbolism and meaning out of what’s going on in the family. Gil: Absolutely. They also allow me to document it because it’s very hard to catch all of that. So I’m very invested in trying to develop grading sheets for the aquarium now. I’ve also started making available black poster board because I’ve had some families that didn’t want either the blue or the green; they thought they were too bright. Really what they’re talking about is flatness, depression, withdrawal, and isolation. So now I make different colors of poster boards available. Once the environment is set up, the last piece is that now all the fish must coexist. Here you get to see boundaries, alliances, conflicts, the family hierarchy, and how they relate. We have people separate the waters so that there’s one family member totally isolated from the others. This one kid I was telling you about changed his shark from something to fear to something that assisted and protected his family. Then he placed himself in the water behind the mother on one side and around the mother on the other. The mother looked at that and said, “I can see how much of my time he requires, how much he needs me.” This was a positive statement as opposed to what she usually would say, “He’s on me all the time.” She changed her thinking to “He needs me.” Then when she said, “Oh, do you have to have a shark?” He said, “But it has a heart of gold.” So again, she commented on how sometimes aggressiveness is what she notices about him but really he has a very sweet, tender side. That is the aquarium project and it’s been one of the most amazing experiences. Christensen: I’ll bet. As you described the activity, I thought about how this relates to many premises included in the social constructionist perspective. The family and the therapist were cocreating their environments, their realities, and their manners of relating to others. I was amazed at the symbolism and meaning for the individual and in terms of family systems. It also allowed me to envision how you are a part of the creation of their environments. Gil: Absolutely. It’s great. It’s a wonderful constellation of systemic thinking without failing to recognize the individual and the family’s dynamics. It is because of this that the aquarium has become sort of a staple that I do with most families. In addition, I started some maps, which is another example of an activity that follows this same kind of format and content. I’ve also done things like a family vase where family members are asked to draw a picture of flowers, decorate it, and then the family comes together to create a floral arrangement that makes up the vase. I’ve also got one called the carnival park where everyone is a carnival ride that they each make. They then have to put them in relationship to each other in the park and make each of those events have a cost to them. They put in the safeguards around who can ride it and who can’t. That has been very

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interesting. I also do a garden where everyone is given a piece of construction paper as their plot where they can choose to grow garden vegetables, flowers, trees, or whatever they want in their plot. Then they come together on a poster board and have all these plots coexisting. They have to find ways to get from one plot to another to irrigate the plots and so forth and so on. I’ve started with that basic principle of having this task where it’s projective initially and then systemic at the end and environmental or contextual. I just started free-associating and came up with a whole bunch of different activities like the ones that I’ve explained. Those are just some of the examples and are the ones I’m writing up in the chapter I mentioned earlier. When I teach the family play therapy class, the students have an assignment in groups of three or four of designing a play therapy technique. You should see the stuff they’ve come up with—it’s been fabulous. It’s been really good. Christensen: That seems to be a common theme—the creativity and allowing yourself to flow with your ideas, as you say “free associate.” That takes some skill and trust in yourself and the families that you work with. Gil: Absolutely. But it’s also responding to the people because they supply me with a lot of ideas. Somebody might bring up something that strikes a chord in me. For example, a guy that I was working with took his family to a racetrack for recreation. So when I got to this task, I said, “Okay, everyone draw a race car.” That was another technique that I just went to because that was important to their family. It is really an interesting kind of give-and-take; a creative kind of back-and-forth experience between the family and the therapist. Thorngren: In your work, you include play and art techniques combined with family dynamics. You gather a wealth of information. I think of many of the therapists that I know who would say, “I wouldn’t know where to begin with that.” How would you respond to them? Gil: I understand your hesitance but you have training in relating to people and that is what family play therapy is all about. The funny thing is, a lot of the play therapists already do all these techniques; they just don’t do them in the context of families. Oftentimes, they actually have a much easier transition than the family therapists do. I also think the family therapists can be taught. Especially if you write down on a piece of paper, “Buy poster board, this color, buy art supplies, etc., and here’s a checklist.” Honestly, my experience has been that most family therapists respond very well to specific ideas and activities. For example, with the family art evaluation, we actually started putting a rating sheet together. The last time I looked at it, we were up to something like 28 pages. We can’t seem to quite cut it down to where it needs to be. I think that if there was something available like a rating sheet where it could be submitted to a registered play therapist for consultation or

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feedback that many family therapists would have an easier time incorporating play in their sessions. TRAINING Christensen: I hear you saying that it is a matter of learning by doing. This leads to training. What are some vital aspects of training someone specifically in utilizing play in family therapy? Gil: The biggest thing is learning by doing. I have found that once therapists give themselves a chance by taking a chance, they learn and gain confidence. I encourage people to go and practice with people that they work with, others in training programs, extended family members, or friends that have children. They can just say, “Come on over and let’s do this activity.” It’s definitely not something that’s going to be harmful to anybody. This gives therapists an opportunity to get the experience of doing it, watching it, observing it, decoding it, and listening to what families are communicating. Some kind of concrete experience so that you don’t have people say, “Well, the kid was just playing and he didn’t say anything.” Kids say volumes through play if you’re listening. Thorngren: Right. If you know how to look at it. Do you just hope and assume that the therapist understands children and play enough to understand the symbolism? Gil: No, which is exactly the main point that I’m trying to make with the field of family therapy. Family therapists must have some knowledge and experience with basic play and child therapy. Most family therapists have been very responsive, but again, there is some resistance. I believe resistance is really about fear of incompetence and inadequacy. I also believe that the resistance pertains to not knowing where to get these tools and/or thinking that maybe it’s a wee bit expensive to do that. There are certain therapists that are resistant because they contend that the adults in the family won’t want to do play in the family therapy sessions or that it won’t be seen as professional. I believe that in many situations this is a total projection on the part of the family therapist. Then I go back and say, “If you convey it as important work, are congruent, and know what you say is congruent with how you present it, people will see it that way as well.” Even with families where you can see a certain reluctance, I say to them, “You know, lots of times families initially aren’t comfortable with this or don’t understand exactly what we’re doing. You have to trust me on this one. Trust me and you may be surprised what comes out.” That usually works for me. In a sense, I cajole people sometimes. I never force them; I just strongly encourage them. Then even if they’re reluctant in specific ways, I try to get their involvement in other ways, like a puppet interview. Christensen: You basically enlist their involvement by asking them to construct and concretely express their own realities and stories.

Gil: Exactly! I become the audience and I listen to the individuals’ and families’ stories. Christensen: Okay. That makes a lot of sense. I hear you encouraging therapists to go ahead and kind of learn by getting into the fire and having the confidence to just do it. Gil: Yes. Therapists in general have to get into it. I also think that family therapists might want to expose themselves to play therapy information because most family therapists just don’t read play literature. It’s so funny when you think about it—how totally separate these fields are and yet they’re often working within the dynamics of family systems. I think that one of the biggest steps for many family therapists is to open themselves to reading and exposing themselves to play therapy. There are some wonderful books now that even include case studies on play therapy. So it does not even have to be dry material with straight didactics, just something to show how kids use play to communicate. For example, O’Connor’s (1991) book has to do with all the theoretical bases for play therapy and how they differ from each other. Therapists can expose themselves to that and then kind of decide what they lean toward. Then they can decide on specific techniques that they want to use. Thorngren: You are basically suggesting that family therapists expose themselves to play therapy and utilize some of those techniques and theories in their family sessions. Gil: Yes. Then if you do a play activity with the family and you feel like you have nothing to say, you have no idea what just happened, just say to them, “Thanks a lot for doing this. I’m going to think about this and review the material for a week or 2 and then we’ll talk about it some more.” This provides therapists with a chance to gather their thoughts. I think that a dilemma for many therapists is the feeling that they’re going to be under the gun to come up with some idea immediately or come up with an interpretation or revelation. Christensen: Yes, it is almost as if there is some sort of performance anxiety. As a play therapist and supervisor, not only have I observed this in others but I have experienced this as well. I have said to myself, “I’m going to need to do it right, or I’m going to need to perform, or I better make them get something out of this.” It seems as if that adequacy piece is a main dilemma that therapists encounter when incorporating play in family therapy. Gil: Exactly! Therapists get stuck in making sense of it or performing. I think that’s where the anxiety comes from. Therapists step into an area that they don’t feel completely well versed in and feel scared or inadequate. I think that is where theory comes into play. THEORY Gil: The really neat thing about play therapy is that play techniques in particular can lend themselves to any theoretical approach. So if you’re a narrative therapist,

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Christensen, Thorngren / PLAY IN FAMILY THERAPY

then you’re doing puppet stories. I mean, you can address the narrative questions within the story of the puppets. Thorngren: So you are saying that therapists from a variety of theoretical backgrounds can effectively utilize this approach. For example, therapists within a narrative context may choose to utilize circular questions. Gil: Certainly. Therapists can do whatever their orientation might be. Whatever theory they bring into it they can use play to think about things in that particular way. Therapists simply need to add a few more things. I have a lot of the theoretical material around family therapy. All of the different theories—structural, strategic, and narrative—hold the same philosophies and techniques when it comes to play. So now it’s a question of having so much more available to me where I can pick and choose from various aspects of play and family therapy. Families just come in with so many different needs and different ways of being, different ways of asking for help, different ways of everything. Thorngren: It seems like by opening yourself up to this whole other realm, you have all these other options. As if you’re never going to run out of ways of relating to children and their parents. Gil: That, for me, is just wonderful. I always feel like, well, there are always other things I can do. I never feel, in that sense, stuck per se because I always think to myself, “I wonder what this incredibly structured rigid family would do if I asked them to do a scribble together or if I bring the puppet in and ask them to do a family puppet story.” It is energy. It’s like when I talk about art techniques and the fluid paints as opposed to the more restrictive materials. It’s the same kind of thing. I see verbal therapy as more restrictive because it’s confining. Even when we speak, we use words in a certain kind of way. You think I mean something; I think I mean something else. There’s so much more opportunity to err in communication, but much more important, it’s the control around what I do and don’t say. But when you move into some of the other areas of play, families don’t have as much control. That is what I find so exciting. Christensen: It really is like many other therapeutic approaches. Therapists possess their personal philosophies about people, life, and counseling and use their beliefs to guide them in their relationships in therapy. You are basically proposing an approach that allows for families and therapists to communicate their thoughts and feelings through various materials and mediums of self-expression and play. Gil: Right, exactly! It really is about who the therapist is as a person that guides what they do with their clients. That is what theory is all about. Theory guides therapists in how they relate to people. Therapy is simply another relationship. Thorngren: It seems as if you are talking about multiple influences. What are your ideas about reciprocal influences between therapists and their clients?

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Gil: That is another piece of it, which may be more about me personally than this approach to therapy. Because of my work with abused families, I often found myself feeling fatalistic and pessimistic. Sometimes I found myself experiencing these feelings of helplessness or feelings of depression. Sometimes what was happening, in essence, was I was picking up all of the family’s stuff—all the negativity. Now I know that family therapists do not use the word countertransference but you can use different language and just say, “This is the impact of this family on me.” I thought to myself, the child must feel this, the child must feel down and heavy. One of the things I know to be true about play is that it frees energy up. It does get you physically involved and it does release energy. How about that as an option? In some ways, I said, “I can’t continue to do this. This is way too heavy. It’s bringing me down. I’m going to try something else.” So there’s that little part that has to do with me, and it relates to my theoretical beliefs. I know the value of play. I really treasure what it can provide not only for children and families but for me as well. I thought, “I’m going to try this out and just see what happens.” I didn’t want to get stuck in specific techniques of some theory but just try it out. I am pleased with the results. It has been amazing that we’ve been able to do play therapy in even the most tragic situations, the most stressful of situations, the most crisis oriented, where most people would go, “Oh well, you can’t play with a family that’s having that problem.” Well, you can practically do it with any family having any problem because, in fact, if you believe it to be true so will the family. If the family does respond differently, make different contact and relate to each other in a different and new way. It is incredibly and potentially beneficial. If, in fact, what we’re trying to do in therapy is give people an improved sense of well-being then this certainly contributes to that. The research on play says that play actually releases endorphins so people actually have physiological well-being as a result of it. So why not open up that channel, that opportunity for people to communicate both intentional and unintentional meaning. SPECIFIC ISSUES Thorngren: You mention that play is appropriate for practically all families. Have you ever encountered families that were resistant, had special issues, or had dynamics that prevented them from finding play in family therapy to be of some use? Gil: I believe that play is useful when dealing with most populations on various issues. I have many examples of how this approach was effective with people who were guarded, resistant, and didn’t want to deal with therapists. Therapists were part of the system in their eyes because they’re mandated to be there. I’ve given them puppets or artwork and suddenly you’re on a different plane. The fact that they’ve shared that experience of

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THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / January 2000

expressing themselves through play, sand, or art makes them, in a way, have contaminated feelings of positive regard. Christensen: It seems to relate to your thoughts about the influence of clients on counselors, and vice versa. I got that from you through your workshop and even from talking to you now. You exhibit passion, excitement for, and a genuine belief in utilizing play in family therapy. Are you simply suggesting that therapists somehow express their passion for play therapy through their interactions within their family sessions and that will influence parents to give play a chance? Gil: Absolutely. That is what I say to people when they’re going to start family play therapy. I tell them, “Get comfortable enough with it so that you believe it because if therapists can’t convey to families that this is important, valuable, and useful then they are just not going to be able to sell it in that particular way.” Christensen: Those seem to be some key things. In terms of using this approach with any population, you were talking specifically about the severely traumatized. Are there any specific differences or techniques that you’d change based on a given issue or population? Gil: The only group that I’ve really been concerned about is people who act out in a violent way. Now that’s the only place where I’ve found that sometimes this material actually loosens them—“loosens” is the best way to explain it—to the point that whatever internal controls could be there aren’t there. Sometimes that leads to negative themes being introduced or the themes actually translating it to negative or dangerous behaviors. So that’s one place where I’m pretty careful. As a matter of fact, somebody called me the other day to consult on a pretty violent guy. I said, “You know, play just might not be the best place to go. He needs so much more control and structure and he doesn’t need to be emotive. He needs to actually ‘tuck it in’.” Play sometimes frees things up as opposed to helping a person learn to control inappropriate displays of anger. The other thing is that in terms of using this, it’s not something that I use in every session. I’m pretty careful or purposeful about when I introduce it. I always tell people ahead of time, “I am a family play therapist. Now what that means is I will work with your child and I will work with you but there are going to be times that I’m going to invite some of your family members to come in together. There are going to be times when I’m going to invite everyone to come in. Sometimes when we come in you’ll talk, sometimes, however, I’ll ask you to do some play activities.” I do that with all the families I work with. I want them to know ahead of time so that they won’t be surprised by any of my invitations to play. SCHOOLS Christensen: What are your thoughts about how you could employ play in family therapy in the school system?

Gil: That brings forth something that I wanted to talk about. In general, I believe that it all comes down to the fact that children just tend to be low priorities across the board. I find that therapists must be advocating for children to have therapy, permanency placement, to be heard, and for their schools to respond to their social and emotional needs. I think that this is a necessary aspect for all therapists, everywhere you go. This is mainly because I believe that people think of children as not necessarily that important. That is a pretty sad commentary. I was working at the county when I went to school at George Washington. One of the things that I found out was that I was going to have to do a practicum, which meant internship. It was just such an interesting experience; it was one of the best experiences because my art therapy supervisor, Barbara Sobol, is one of the most gifted human beings I’ve ever met. I learned so much from her. I talk to her all the time and she’s one of the best gifts that I’ve been given. Barbara was very interested in working with the schools and we were trying to figure out what to do. So she got together a little art therapy mobile unit, went to the schools, and said, “Look, I can come in before school and/or at a convenient time and work with kids in groups and do some art therapy stuff.” She started and it was great to watch them. She’d go out there with her little art cart and she’d have these kids do these amazing projects. Now one of the projects Barbara taught me, which has become one of the projects that we’re doing with the kids in group therapy, is something called “Build a Safe Environment.” I love this because the kids are given an animal to choose from. They get in a basket of animals and they choose an animal. Then they create an environment for the animal. They use poster board, wood, telephone spools, and wire. Some of their environments are just hilarious. That safe environment process has, again, been one of the most incredible things I’ve seen people do. It’s about mastery, it’s about creating a reality, and it’s about learning from the child what is and what is not relevant or dangerous or safe. It’s just an amazing thing. So she would go out and do the safe environments with the kids in the schools. Barbara was doing it as a pilot project and the hope was that everyone would think of it as useful; then they would encourage therapists to come back and she could get funding. Likewise, at the last APT conference, there were people doing sand therapy in the schools and I think this is a really important thing. I mean, it’s just like all those medical units that are in the streets now. People won’t come to get their vaccine so let’s go out to them. I think the same thing could be said of play, particularly play in family therapy. I think we really need to make it available to people who ordinarily wouldn’t seek it or get it. Thorngren: You are suggesting that we almost advocate for play and family therapy. Gil: Absolutely. A woman that I worked with named Monica McGoldrick who created the materials on

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Christensen, Thorngren / PLAY IN FAMILY THERAPY

ethnicity and family therapy runs a play therapy institute in New Jersey. So she and I hooked up and my interest was in teaching family therapists play techniques. I basically approached her and she approached me. I asked, “Could I go and teach family therapists and integrate a play therapy component into a standard family therapy program?” We have been doing that for a little more than 2 or 3 years now and it’s been just an amazing experience. Now one of the students from that program who graduated has started a family play therapy project within the institute. That is very exciting, especially because initially many of the family therapists were hesitant. They would say, “I just don’t get it.” They didn’t quite understand why we were teaching them this. Slowly but surely I’ve won over probably 80% of them. There is still a group that believes that it is too expensive, “I don’t feel comfortable with it, I don’t work with kids, I don’t want to work with kids, and so forth.” SUPERVISION Thorngren: Would you please address supervision issues related to play in family therapy? Gil: The Family Institute is very much team oriented and so what we do there is have families come in where we do a variety of play therapy activities with them. The person who is bringing the case in either does it alone or I do cotherapy with them. Then after the family leaves, we process all the information. We use those little sheets that I mentioned developing before. Like the one for sand tray where I take them through a process of, “Let’s start at the very beginning. What is it about what this person or family chose that’s interesting to you?” Then the example that I always give is this woman who chose to be Goldilocks on one hand and an innocent bystander on the other. That’s a perfect example of how much is communicated. Goldilocks was obviously an adventurer, explorer, intruder, and very assertive about getting her needs met. Then this woman was also an innocent bystander. I then ask my supervisees, “What does that tell you right away about this woman?” Obviously, she’s holding a lot of ambivalence about how much she can go out into the world and how much she needs to retreat. Well, this was a woman with phobia. We don’t initially jump to what the problem is. I encourage my supervisees to just “listen to the story. Let’s see what you can learn.” So we go through everybody’s puppets and what that might suggest and sometimes there’s association between puppets. For example, the match story, where the father was a judge, the girl was a policeman, and the other girl was a lawyer. You have to wonder what that suggests about this family system. I suspect a need for authority, external authority, a need for maintenance roles, looking at what is right and wrong. So there’s probably punishment and strict consequences. That was also interesting in terms of this particular family. Then, after we’ve gotten the symbols, I say, “Okay, tell me about the story. How did

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it start?” You look at not only the content of “Well, it started with this point” but also “Who started it?” Now we are looking at the systemic parts of who creates the story, who participates, who’s left out, are some of the ideas better than others, does someone say, “Oh, that’s terrible, let’s do this.” Does someone acquiesce, comply, dominate, and so forth. Next we get into the content in terms of: What is the story about? What is this story trying to tell us about this family? Essentially we free-associate about these aspects. We free-associate if the story has a problem, which it usually has built in. How did that get resolved? Is there a resolution? Is it an adaptive resolution? Then we go back into, “What do you think this might suggest about interactions between family members and/or issues that are most prevalent?” It’s a whole process that we go through and my hope is that they will begin to be able to do this process on their own. Christensen: You really focus on empowering both families and therapists. Gil: Exactly. In terms of supervision, that is when I started going into having these little sheets of paper that would have them organize their thinking about what they were looking at. Then when they got to the portion about queries, that meant, “Well, what questions would you pose now?” The building of questions is a really important piece because you have to stay so much within the metaphor and you have to try to understand. I look for whether or not my supervisees can state what the story is. Can they list at least five family dynamics that they observed? Can they tell me something about the structure of this family, the hierarchy of this family, or anything else from watching them? I have my little list that’s called “observational categories” that just goes through a lot of those structural therapy aspects. Also in terms of the story, there are other dimensions like: Is there symbolic play? Is there a level of enjoyment? Is affect available? Those kinds of things. Then basically they summarize this material and then come out with, “Well, here’s what we’ve learned from this.” The next piece of it is how does this relate to the therapy? How do you translate this into something therapeutic? The therapeutic questions or dialogues would need to be focused on the unique needs of the family at hand. In other words, supervisees need to list themes to start with. Then they must make decisions about what we were going to have to bring. We, as a group, formulate the questions. I like to have people working in tables and making a list of questions. I am very invested in supervisors or trainees and in having them trusting and respecting their intuition. For example, “What is your gut reaction?” That’s really important. You trust that material and it always has meaning. Likewise, if you have a reaction to the story or the puppets, it always has some kind of importance. So, yes, it is a process that’s similar to what I encourage the families to do, and that’s basically the training process.

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Christensen: You appear to utilize a supervision process that parallels your approaches to therapy. You also seem to lean toward group supervision. Is that your preferred mode of supervision? Gil: Definitely. Group supervision provides numerous benefits over just individual supervision. Just the reactions of “What does this suggest to you?” The more people you have, the more ample opportunity you’re going to have to gather information and ideas. What you were saying earlier is a really important piece to me. I don’t always articulate this but concerning cocreation, in that I’m not an expert telling people what’s going on or what they need to do to fix it, I’m really someone who helps reflect back to them what they already know, in both supervision and therapy. CONCLUDING REMARKS Thorngren: Is there anything else you’d like to talk about, such as any special issue or anything that you haven’t already addressed? Gil: Let me think about that. Well, once again, just backing into something I said earlier that’s been so helpful to me. I’ve come to the conclusion that one of the reasons why I haven’t had severe burnout or haven’t stopped doing this is because I have integrated all these different aspects that have therapeutic value, not only for the families that I work with but for myself as well. I feel better when I work with puppets. I feel better when I work with those aquariums. I get so excited by what people produce and the level of interest that I have is remarkable. The value that I place on that is just amazing and all of that I find just so stimulating. I think it is really important that if you find yourself, especially working with resistant populations or court mandated people, and you’re feeling like your job is really hard and draining, etc., there’s probably something you can do to add and restore yourself, to access energy, and to encourage yourself to have different experiences. Again, I know family therapists don’t like the word

countertransference but there is an impact of each group of people that you work with. I can get just as much from my clients as they can get from me. I just marvel at people and it isn’t so much about me. I keep saying this to people because they tend to project things on me. But there’s nothing special about what I do. There’s a trust that I have. It is a hope that I feel and conveying that to people goes a very long way. They begin trusting me and they find what they need to within themselves. That has been very comforting to me to know that it isn’t about theory or technique. It is to some extent more about who you are and what you do in your relationships with others. It is also about being receptive to what children and families do and who am I with them. Thorngren: We both appreciate your time and energy! Thank you.

REFERENCES Gil, E. (1991). The healing power of play: Therapy with abused children. New York: Guilford. Gil, E. (1994). Play in family therapy. New York: Guilford. Gil, E. (1996a). Systemic treatment of families who abuse. San Francisco: Jossey-Bass. Gil, E. (1996b). Treating abused adolescents. New York: Guilford. O’Connor, K. J. (1991). The play therapy primer: An integration of theories and techniques. New York: John Wiley. Peterson, L. W., & Hardin, M. E. (1997). Children in distress: A guide for screening children’s art. New York: Norton.

Teresa M. Christensen is an assistant professor in the Department of Educational Leadership, Counseling, and Foundations at the University of New Orleans. Jill M. Thorngren is an assistant professor at Montana State University, Bozeman.

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