The effect of Gestalt play therapy in addressing symptoms associated with trauma in children in ...

218 Pages·2016·3.3 MB·English

The effect of Gestalt play therapy

in addressing symptoms associated with trauma

in children in middle childhood

by

Nanet van der Burgh

A mini-dissertation submitted in partial fulfilment of the requirements for the

degree

MSW (Play Therapy)

in the Department of Social Work and Criminology at the

UNIVERSITY OF PRETORIA
F ACULTY OF HUMANITIES

SUPERVISOR: Dr MP le Roux

January 2016

© University of Pretoria
DECLARATION OF ORIGINALITY

Full names of student: Nanet van der Burgh

Student number: 28178662

Topic of work: The effect of Gestalt play therapy in addressing symptoms

associated with trauma in children in middle childhood

Declaration:

• I understand what plagiarism is and am aware of the University’s policy in this regard.

• I declare that this mini-dissertation is my own original work. Where other people’s
work has been used (either from a printed source, internet or any other source), this

has been properly acknowledged and referenced in accordance with departmental

requirements.

Signature: ___________________________

Date: ___________________________

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© University of Pretoria
ACKNOWLEDGEMENTS

My sincere gratitude to:

• My Heavenly Father whose almighty presence never fails me. Thank you for opening

doors where it seems impossible.

• My supervisor, Dr MP le Roux. Thank you for your willingness to guide me through this
process and for teaching me the most valuable lessons in research and academic writing.
Thank you for acknowledging my passion and allowing me to undertake this study,
knowing that it would require an extensive amount of time and effort to complete.

• My family, for your love, understanding and unrelenting support throughout this

experience. A particular thanks to my husband, Gerhard, who supported me in every way

possible, and who stayed motivated on my behalf whenever my perseverance withered.

You are invaluable to me.
• My friends, for your kind support throughout the process, offering meals in aid of time-
constraints, delivering inspirational treats, and offering words of encouragement. A
particular acknowledgement to Willemien Rust (Heyns), Dr. Kim Brink-Flores, and Louie

Claassen (Strydom) who provided me with so much fruitful guidance in terms of the

research.

• Marion Delport, for your assistance in the statistical analysis of the data. Your kind and

resourceful assistance is much appreciated.
• Dr Francois Steyn, who also provided guidance in terms of the statistical analysis and -
presentation of the data.
• Dr Elna Steenkamp, who helped me through an extremely difficult period in this research

process. Thank you for the opportunity to learn from you in your approach to therapy and

healing.

• The organisations, Doxa Deo Moot Life centre and the children’s home, thank you for

allowing me this opportunity. A particular acknowledgement to Isabel, Izanda, and Jane
who went out of their way to accommodate me during this research study.
• All the participants, thank you for providing me with so much insight into your worlds and
allowing me to witness your inner wisdom in dealing with the difficulties that trauma pose.

Thank you for the valuable time we could spend together.

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© University of Pretoria
ABSTRACT

The effect of Gestalt play therapy in addressing symptoms associated with trauma in
children in middle childhood

Researcher: Nanet van der Burgh

Supervisor: Dr MP le Roux

Degree: MSW (Play therapy)

Institution: University of Pretoria

The prevalence and impact of childhood trauma is so extensive that it has come to be known
as a silent epidemic. Trauma affects children’s social, biological, psychological, and
emotional functioning, which impede their ability for healthy self-regulation. Conventional

therapies seem to have limited success in addressing the long-term consequences of

trauma, arguably due to a lack of understanding the neurobiological impact of trauma and its

effect on therapy with traumatised children. Researchers therefore recommend that
therapists in the field of child welfare review the way they work with traumatised children,
taking into consideration the neurobiological principles informing trauma interventions.

The goal of this research study was to explore the effect of Gestalt play therapy in
addressing symptoms associated with trauma in children in middle childhood. As this study
aimed to explore more efficient ways of working with traumatised children, applied research
was conducted. A mixed methods research approach was utilised in order to combine the

advantages of qualitative inquiry and quantitative evaluation. The researcher incorporated a

triangulation mixed methods design, combining the single-system design and the

phenomenological design at the same time and with equal weight. Data was collected at

three consecutive points in the research process to determine the prevalence of trauma-
related symptoms and how it changed over time. All three data-collection encounters
entailed structured and semi-structured interviews, for which a questionnaire and interview

schedule was used respectively. By means of purposive sampling, the researcher with the

assistance of social workers from the children’s home, selected five participants between

nine and 11 years, who presented with trauma-related symptoms, who have been residents

of a children’s home for more than six months, and who were not involved in any other form
of therapy at the time of the research.

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© University of Pretoria
The findings of the study were in accordance with literature on the impact of trauma,
especially on children in middle childhood, and furthermore correlated with a Gestalt
perspective of how trauma affects children. Trauma-related symptoms the participants

experienced reflected affect- and behaviour dysregulation, alterations in attention and

consciousness, distortions in attribution and worldview, and interpersonal difficulties. Though

the participants’ responses to trauma, as well as to Gestalt play therapy, varied;

improvement was noted in the overall prevalence of symptoms associated with trauma after
implementation of the Gestalt play therapy process. In this regard, the research findings
indicated a statistically significant improvement in the total prevalence of trauma-related

symptoms the participants experienced before being exposed to Gestalt play therapy, as

was confirmed by the qualitative findings.

It was concluded that Gestalt play therapy incorporates suggestions for trauma-informed

interventions with traumatised children, and with its strong sensory base and utilisation of

non-verbal and creative techniques, was an appropriate therapeutic intervention for

addressing trauma-related symptoms in children in middle childhood. Based on these

conclusions, it is recommended that professionals who work with traumatised children
consider trauma-informed practices in the restoration of self-regulation through non-verbal
and creative measures in the context of a safe and accepting relationship. As this research
involved a small and limited study sample, further research that could add to the

transferability of the findings is advised.

Key concepts

• Trauma

• Complex trauma

• Trauma-related symptoms
• Neurobiology
• Self-regulation
• Gestalt play therapy

• Middle childhood

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© University of Pretoria
TABLE OF CONTENTS

DECLARATION OF ORIGINALITY ....................................................................................... i

ACKNOWLEDGEMENTS ..................................................................................................... ii
ABSTRACT ......................................................................................................................... iii

CHAPTER 1

GENERAL INTRODUCTION TO THE RESEARCH STUDY ................................................. 1

1.1 INTRODUCTION ..................................................................................................... 1

1.2 THEORETICAL FRAMEWORK ............................................................................... 8

1.3 RATIONALE AND PROBLEM STATEMENT ......................................................... 10

1.4 GOAL AND OBJECTIVES ..................................................................................... 11

1.5 RESEARCH DESIGN AND METHODOLOGY ...................................................... 12

1.6 KEY CONCEPTS .................................................................................................. 14

1.7 LIMITATIONS OF THE STUDY ............................................................................. 15

1.8 CONTENTS OF THE RESEARCH REPORT ........................................................ 16

CHAPTER 2

TRAUMA AND THE IMPACT OF TRAUMA ON CHILDREN IN MIDDLE CHILDHOOD .... 17

2.1 INTRODUCTION ................................................................................................... 17

2.2 CONCEPTUALISING TRAUMA ............................................................................ 17

2.3 THE IMPACT OF TRAUMA ................................................................................... 20
2.3.1 Symptoms associated with trauma ........................................................................ 20
2.3.1.1 Affect and behaviour dysregulation ....................................................................... 21
2.3.1.2 Alterations in attention and consciousness ............................................................ 22

2.3.1.3 Distortions in attribution and worldview .................................................................. 23

2.3.1.4 Interpersonal difficulties ......................................................................................... 23

2.3.2 The neurobiology of trauma ................................................................................... 25

2.3.2.1 The structure and function of the brain .................................................................. 25

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2.3.2.2 The neurobiological effects of trauma .................................................................... 27

2.3.2.3 The brain’s response to threat ............................................................................... 32

2.3.3 Diagnoses associated with trauma ........................................................................ 34

2.3.4 Individual responses to trauma .............................................................................. 36

2.3.4.1 Resilience ............................................................................................................. 36

2.3.4.2 Factors moderating the impact of trauma .............................................................. 37

2.4 CHILDREN IN MIDDLE CHILDHOOD EXPOSED TO TRAUMA ........................... 40

2.4.1 Middle childhood as developmental stage ............................................................. 40

2.4.1.1 Physical development ........................................................................................... 41

2.4.1.2 Cognitive development .......................................................................................... 42

2.4.1.3 Psychosocial development .................................................................................... 43

2.4.2 The influence of early childhood trauma ................................................................ 45

2.4.3 Manifestations of trauma in children in middle childhood ....................................... 47
2.4.3.1 Affect and behaviour dysregulation ....................................................................... 47
2.4.3.2 Alterations in attention and consciousness ............................................................ 48
2.4.3.3 Distortions in attribution and worldview .................................................................. 49

2.4.3.4 Interpersonal difficulties ......................................................................................... 50

2.5 SUMMARY ............................................................................................................ 51

CHAPTER 3

TRAUMA-INFORMED INTERVENTIONS ........................................................................... 52

3.1 INTRODUCTION ................................................................................................... 52

3.2 LIMITATIONS AND SHORTCOMINGS OF CONVENTIONAL

INTERVENTIONS ................................................................................................. 52

3.2.1 Re-traumatisation .................................................................................................. 52

3.2.2 The inability to access relevant brain areas ........................................................... 53

3.2.3 The verbal and rational dominance of conventional intervention modalities ........... 53

3.3 SUGGESTIONS FOR INTERVENTIONS .............................................................. 54

3.3.1 Establishing safety and competence ..................................................................... 54

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3.3.2 Dealing with the stress response ........................................................................... 55

3.3.3 Fostering integration and self-regulation through non-verbal measures ................. 55

3.4 OVERVIEW OF GESTALT PLAY THERAPY ........................................................ 56

3.4.1 Gestalt therapy ...................................................................................................... 57

3.4.2 Gestalt play therapy .............................................................................................. 58

3.4.3 The Gestalt play therapy process .......................................................................... 62

3.4.3.1 Building a therapeutic relationship ......................................................................... 62

3.4.3.2 Enhancing sensory and bodily awareness ............................................................. 64

3.4.3.3 Strengthening the sense of self ............................................................................. 65

3.4.3.4 Emotional expression ............................................................................................ 67

3.4.3.5 Self-nurturing ......................................................................................................... 69

3.4.3.6 Addressing persistent inappropriate process ......................................................... 70

3.4.3.7 Termination ........................................................................................................... 70
3.5 GESTALT PLAY THERAPY AS IT RELATES TO SUGGESTIONS FOR
TRAUMA INTERVENTIONS ................................................................................. 71

3.5.1 Sense of safety and control ................................................................................... 71

3.5.2 The use of creative activities to access relevant brain areas ................................. 72
3.5.3 Integration and self-regulation through non-verbal measures ................................ 73
3.5.4 Caution against re-traumatisation .......................................................................... 74
3.6 THE PLANNING OF THE GESTALT PLAY THERAPY INTERVENTION
PROCESS FOR TRAUM ATISED CHILDREN IN MIDDLE CHILDHOOD .............. 76
3.6.1 Planning the Gestalt play therapy process ............................................................ 76
3.6.1.1 A safe therapeutic relationship .............................................................................. 77

3.6.1.2 Promoting sensory and bodily awareness ............................................................. 77

3.6.1.3 Strengthening the sense of self ............................................................................. 77

3.6.1.4 Emotional awareness and expression ................................................................... 78

3.7 SUMMARY ............................................................................................................ 78

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CHAPTER 4

RESEARCH FINDINGS ...................................................................................................... 80

4.1 INTRODUCTION ................................................................................................... 80

4.2 RESEARCH METHODOLOGY ............................................................................. 80

4.3.1 Research approach ............................................................................................... 80

4.3.2 Type of research ................................................................................................... 81

4.3.3 Research design ................................................................................................... 81

4.3.4 Study population and sampling .............................................................................. 83

4.3.5 Data collection ....................................................................................................... 84

4.3.5.1 Quantitative data collection ................................................................................... 85

4.3.5.2 Qualitative data collection ...................................................................................... 87

4.3.6 Data analysis ......................................................................................................... 88

4.3.6.1 Quantitative data analysis ..................................................................................... 89
4.3.6.2 Qualitative data analysis........................................................................................ 90
4.3.7 Pilot study.............................................................................................................. 93
4.3 ETHICAL CONSIDERATIONS .............................................................................. 94

4.3.1 Informed consent and voluntary participation ........................................................ 94

4.3.2 Avoidance of harm ................................................................................................ 95

4.3.3 Debriefing of participants ....................................................................................... 96

4.3.4 Privacy, anonymity and confidentiality ................................................................... 96

4.3.5 Deception of participants ....................................................................................... 97

4.3.6 Competence of the researcher .............................................................................. 97

4.4 RESEARCH FINDINGS ........................................................................................ 97

4.4.1 Section A: Biographical information of the participants .......................................... 97

4.4.2 Section B: Empirical findings ................................................................................. 99

4.4.2.1 The presentation of the quantitative findings ......................................................... 99

4.4.2.2 The prevalence of trauma symptoms................................................................... 102

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4.4.2.3 Prevalence of individual trauma symptoms .......................................................... 105
 Accumulated prevalence of individual trauma indicators .............................. 106
 Change in prevalence for individual trauma indicators ................................. 106
4.4.2.4 Changes in prevalence of trauma symptoms for the respective symptom

categories............................................................................................................ 110

 Theme 1: Symptom category: Affect dysregulation ...................................... 111

 Theme 2: Symptom category: Behaviour dysregulation ............................... 120

 Theme 3: Symptom category: Alterations in attention and consciousness ... 130
 Theme 4: Symptom category: Distortions in attribution and worldview ......... 139
 Theme 5: Symptom category: Interpersonal difficulties ................................ 146

4.4.2.4 Change in prevalence of trauma symptoms for individual participants ................. 150

4.5 SUMMARY .......................................................................................................... 152

CHAPTER 5

KEY FINDINGS, CONCLUSIONS AND RECOMMENDATIONS ...................................... 154

5.1 INTRODUCTION ................................................................................................. 154

5.2 KEY FINDINGS OF THE RESEARCH STUDY ................................................... 154

5.2.1 Literature ............................................................................................................. 154

5.2.2 Prevalence of trauma symptoms ......................................................................... 156
5.2.3 Change in the prevalence of trauma symptoms ................................................... 159
5.2.4 Methodology and theoretical framework .............................................................. 161
5.3 CONCLUSIONS .................................................................................................. 162

5.4 RECOMMENDATIONS ....................................................................................... 166

5.4.1 Recommendations for practice ............................................................................ 166

5.4.2 Suggestions for future research ........................................................................... 168

5.5 ACCOMPLISHMENTS OF THE GOAL AND OBJECTIVES ................................ 169

5.6 CONCLUDING STATEMENT .............................................................................. 170

REFERENCES ................................................................................................................. 172

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