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A psychodynamic, play-centred approach to work with a refugee child (Case study)

A psychodynamic, play-centred approach to work with a refugee child (Case study)

This lecture presents a case study using a psychodynamic model  for therapeutic work with a refugee child from Iraq.  The model draws on parent and teacher interviews, transference and counter-transference phenomena, and play behaviour to formulate a hypothesis about the causes of the child’s anxieties.  Importantly, the value of play and playfulness is emphasised throughout therapy.
‘Sam’ , an 11-year-old refugee child, presented with symptoms of post-trauma stress and anxiety.  His emotional responses manifested as acting out behaviour (verbally and physically assaulting others at school, anger outbursts), anxiety and developmental regression (fear of the dark, bedwetting, difficulties with trust), and occasional lowered mood.   The school counsellor who referred Sam for specialised counselling also described Sam as very competitive. 

The assessment process involved interviews with the client’s parents and teachers, observations of his play behaviour during counselling and at school, and an analysis of the transference and counter-transference.  Based on this material a hypothesis was made about what might be causing anxiety for Sam.  This included concerns about feeling unsafe and attacked – a common presentation for children from refugee backgrounds – as well as believing that he was overlooked in favour of others.  The client managed this by alternating between being aggressive in school and by regressing developmentally (acting younger than his age).

The therapeutic aims included establishing a safe and responsive relationship; facilitating the expression of affect; building self-confidence in Sam’s skills and abilities; and enhancing connections to others.  A major intervention strategy was to ‘enter the play’ and use metaphor to help reframe unhelpful coping mechanisms and to model more appropriate attachment relationships.  An attitude of playfulness was critical to the success of therapy. 

An evaluation of Sam’s psychological state revealed considerable improvement in his symptoms.  Post-counselling, he was better able to tolerate frustration and related more appropriately to others.  Sam also grew more confident in his own skills and abilities and learned more effective and appropriate ways to manage his anxiety

Speakers: Max Schneider
Areas of Interest / Categories: Child and Adolescent Health, Play Behaviour, STARTTS 2011


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