Using Axline's eight principles of play therapy with Mexican-American children.
Despite the growing recognition of cultural issues in play therapy (Cochran, 1996; Coleman, Parmer, & Barker, 1993; Hinman, 2003; Landreth, 2001), there is a paucity of literature on the application of play therapy theories to children of diverse cultural backgrounds, especially Mexican-American children. The child/client-centered (hereafter referred to as client-centered) approach to play therapy has been recommended when the child and therapist are from culturally different backgrounds (Ramirez, 1999; Trostle, 1988). Specifically, goals of client-centered play therapy have the therapist continually strive to see the child's point of view, understand and accept the child, not impose beliefs or solutions on the child, and work within the framework of the family's values and beliefs to ensure a better chance of cooperation and positive outcomes (Ramirez, 1999).
Axline's (1947) eight principles of play therapy are commonly cited guidelines for client-centered play therapy (e.g., Harris & Landreth, 2001). The principles are the following (Axline, 1947, pp. 73-74):
1. The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
2. The therapist accepts the child exactly as he is.
3. The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
4. The therapist is alert to recognize the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behavior.
5. The therapist maintains a deep respect for the child's ability to solve his own problems if given an opportunity to do so. The responsibility to make choices and to institute change is the child's.
6. The therapist does not attempt to direct the child's actions or conversation in any manner. The child leads the way; the therapist follows.
7. The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognized as such by the therapist.
8. The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibilities in the relationship.
The use of Axline's principles with Mexican-American children has not been addressed systematically in the literature.
Therefore, the purpose of this article is to discuss Axline's eight play therapy principles as they may relate to traditional Mexican-American culture. It is important, however, to first define key terms used in this article. Mexican-American refers to individuals of Mexican descent, regardless of their country of origin (the United States or Mexico). Culture is "the ever-changing values, traditions, social and political relationships, and worldview created and shared by a group of people bound together by a combination of factors (which can include a common history, geographic location, language, social class, and/or religion), and how these are transformed by those who share them" (Nieto, 1996, p. 390). Worldview pertains to the subjective reality of both the child and therapist, and involves their "beliefs, values, and assumptions about people, relationships, nature, time, and activity" in their world (Ibrahim, Roysircar-Sodowsky, & Ohnishi, 2001, p.429). Ethnicity refers to membership in a group that has an historic origin, shared heritage and tradition, and characteristics that set it apart from other groups (Banks, 2003). Finally, race usually has been defined in terms of biological/physical differences (e.g., hair texture and skin color) (Atkinson, 2003).
Therapists are cautioned not to over--or under-emphasize cultural variables in their work with culturally different children (Kerl, 1998; Sue & Sue, 2003). Within-group differences exist, e.g., related to socio-economic status (SES), language proficiency, region, and acculturation level (Hanson, 2004). For example, mainstream American values may be reflected in childrearing practices of first-generation Mexican-American families who overall may be viewed as having traditional Mexican values. Additionally, therapists are reminded to always be aware that each child is an individual, and commonly cited group values, beliefs, and norms may not be relevant to or explanatory of any individual child's circumstances (Hanson, 2004; Kerl, 1998). Principle I
In Principle 1, Axline emphasized the need for a friendly child-therapist relationship, with good rapport being established as soon as possible. In this section, possible ways of enhancing rapport and relationship building with Mexican-American children are discussed, including issues related to the first meeting with the child, parent involvement, the setting, and language issues.
Establishing good rapport with the child should be paramount when a child first comes into the playroom. The first contact helps the child feel at ease and hopefully sets the stage for a relationship of trust with the therapist. It is recommended that the therapist engage the child in pleasant and casual chatting (platica) that contributes to a warm atmosphere (Clauss, 1998). This kind of responding reflects the valuing in Mexican-American culture of human interactions over task-orientation. The value is related to personalismo, meaning "warm, individualized attention and responsiveness in interpersonal interactions" (Zuniga, 2004, p. 197). In working with Mexican-American children and parents/guardians, offering a warm handshake and standing close to them may help reduce any anxiety they may have about the play therapy situation (Hinman, 2003).
An additional means of helping the child feel comfortable and welcomed into play therapy is the preparation of materials that are culturally familiar to the child. The physical setting of the playroom plays an especially important role in establishing initial rapport and may include visual and manipulative materials to encourage communication about the child's socio-cultural background. In particular, materials that lend themselves to nonverbal expression need to be readily available in the playroom. These include paints, crayons, clay, paper, pipe cleaners, and scissors, among others. Recommendations regarding culturally relevant materials, terminology, and the physical environment when practicing play therapy with Mexican-American children are provided in the literature (Bowers, 1996; Kranz, Ramirez, Flores-Torres, Steele, & Lund, 2005).
Language is also an important issue in establishing rapport with Mexican-American children in play therapy. The therapist's communication needs to parallel the child's language ability. If the child is Spanish-dominant, it is recommended that the therapist be Spanish-proficient so that the child can feel competent in expressing himself/herself and in being understood. Even when the therapist is not completely fluent in Spanish, mastering a few words or phrases can be beneficial for rapport building and may have a powerful effect on the relationship between the therapist and child (Altarriba & Bauer, 1998).
Therapists should establish a working relationship with the child's parents/guardians, since joining with the child's parents/ guardians can be beneficial in the assessment and treatment process (Hinman, 2003). This joining may be particularly critical in working with Mexican-Americans because of the role of the family as the "central operating focus" in their culture (Zuniga, 2004, p. 194). The family's effect on the psychological development of Mexican-American youth deserves special consideration in play therapy. Therapists working with Mexican-American children must demonstrate sensitivity and respect for this cultural value and encourage discussions about their families, preferably during the initial sessions of the therapy process (D'Andrea & Bradley, 1995).
For decades, the importance of multiculrural competencies has been emphasized in the counseling and psychotherapy literature. Specifically, this emphasis has increasingly been seen in play therapy literature (Coleman et al., 1993; Ritter & Chang, 2002). Sue and Sue (2003), who have been at the forefront of this discussion, have described commonly recognized multicultural competencies that fall in the following major domains: awareness, knowledge, and skills. Several of the competencies described below are closely related to Axline's Principle 2 that involves accepting the child as is.
The first major competency domain is the therapists' awareness of their own specific culture and how it affects their worldview. A sub-competency in this domain is the therapists' examination of their feelings and experiences related to their own culture and racial/ethnic and SES group, including examination of their progression through racial identity development phases. It has been suggested that, because most play therapists are White Euro-Americans (Ryan, 2002, as cited in Baggerly, 2003), it is imperative for them to examine their progression through racial identity development phases (Baggerly, 2003). There are a number of models of White racial identity development, including one by Sue and Sue (2003) who proposed the following five phases: conformity, dissonance, resistance and immersion, introspection, and integrative awareness. The racial identity represented in the phases ranges from being ethnocentric and minimally aware of one's own racial identity (conformity phase) to having a non-racist White Euro-American identity, that is characterized, for example, by an understanding of the self as a cultural and racial being (integrative awareness).
A second sub-competency in the awareness domain is that therapists should be aware of their own values, biases, and assumptions that might interfere with play therapy with the culturally diverse child. Otherwise, they may be more likely to attempt to impose their own values and standards on the child. There is a natural tendency for therapists to view the client from their own frame of reference, which may be significantly different from Mexican-American children's reality. For example, dependence on the family (that is common in the Mexican-American culture) may be viewed as overly dependent by therapists of a differing culture (Kerl, 1998).
Therapists should be comfortable with differences that exist between themselves and the Mexican-American child. They should realize and accept that difference is not deviance, deficiency, deprivation, or disadvantage (Sue & Sue, 2003). Webb (1969) described a case that emphasized that, when the child feels self-respect and respected by the therapist, potential impediments to therapy (e.g., alienation and differing values) are diminished. It is imperative that therapists convey that they respect the child and his/her culture, regardless of their differences, including SES. Mexican-American children are disproportionately of lower SES (Aguirre & Turner, 2004). Frequent self-reflection by therapists is advised to address possible feelings of guilt over their own economic status. Baggerly (2003) suggested that the play therapists' "guilt may lead to disdain and a 'blame the victim' attitude, thereby diminishing warmth and acceptance of children" (p. 92).
The second major cultural competency domain is knowledge. Therapists should understand the Mexican-American child's worldview as much as possible. The importance of ethnicity and its effect on the child's worldview should not be underestimated. Therapists should possess knowledge regarding the child's culture and an attitude of openness and acceptance of the culture (Kerl, 1998). The reader is referred to descriptions of Mexican-American culture that are available in the literature (e.g., Organista, 2003; Ramirez, 1998). Additionally, it is recommended that therapists become acquainted with Mexican-American families outside the office, e.g., by volunteering for activities sponsored by Mexican-American associations (Kerl, 1998).
The third major cultural competency is therapeutic skill and is related to therapists using appropriate techniques and defining goals that are consistent with the child's cultural values and life experiences (Sue & Sue, 2003). Therapists should not only be able to generate a wide variety of verbal and non-verbal responses (e.g., "cuento" therapy; see Martinez & Valdez, 1992), but their verbal and nonverbal communication should be both culturally accurate and appropriate. Because so much of nonverbal communication is typically subconscious, it is critical that play therapists be aware of nonverbal communication and its possible meaning (Sue & Sue, 2003). For example, physical closeness and contact are generally more acceptable in traditional Mexican-American than mainstream American culture. In Mexican-American culture, upon meeting and separating, handshakes (between acquaintances) and embracing (between friends) are the norm (Ramirez, 1998). If therapists react by backing away, the child may interpret this as aloofness and/or feelings of superiority (Sue & Sue, 2003). As another example, the lack of eye contact, especially between children and adults, is a Mexican-American norm that is valued as a sign of respect. In this case, therapists may interpret it negatively and inaccurately as a sign of, e.g., shyness, unassertiveness, and/or depression (Sue & Sue, 2003).
In Principle 3, a feeling of permissiveness in the relationship is established so that the child feels tree to express his/her feelings completely. Therapists should not necessarily expect Mexican-American children to be comfortable with permissiveness, especially at the beginning of play therapy. Rigid boundaries are typical in child rearing of Mexican-American children (Koss-Chioino & Vargas, 1999). Even highly disturbed children may have difficulty going beyond what they are used to having as boundaries with adults. Therefore, Mexican-American children may need additional time and encouragement to adjust to the permissive boundaries.
In Axline's Principle 4, therapists are to alertly recognize the feelings the child expresses and reflect them back in such a manner that the child gains insight into the behavior. In the case of the Mexican-American child, special issues regarding the child's verbal and nonverbal language of self-expression should be recognized and understood to assure that the therapist's reflections are accurate and effective.
Verbal expression is an important part of the child's affective world. The first (dominant) language is associated with early life experiences, thoughts, and feelings (Guttfreund. 1990). The use of either the first or second language by the Mexican-American child in play therapy plays a significant role in the expression of emotions. Communicating in either the dominant or non-dominant language exclusively has limitations. Expression of painful events may be inhibited when communicating in the dominant language, and communication in the non-dominant language may be affected by the child focusing more on issues, such as English pronunciation, than meaningful content (Altarriba & Santiago-Rivera, 1994).
Depending on the child's English and Spanish proficiency, a bilingual approach that incorporates the use of both languages may be optimal (Altarriba & Santiago-Rivera, 1994). Children may switch from one language to another as a way to reduce anxiety, with the language choice serving to strengthen the ego. The literature suggests that, when individuals learn emotion words in their first language, those words are stored at a deeper level of representation than their second language counterparts (Santiago-Rivera & Altarriba, 2002). Therefore, the mother tongue may serve to revive the past experiences, and allow for better access to affect-laden material (Marcos, 1988). Also, the mother tongue may help the Mexican-American child release more emotionally-charged material, and at the same time place distance from this material by using the second language as a defensive strategy (Clauss, 1998).
In addition to verbal expression, nonverbal characteristics, such as the tone of voice and body movements, play a vital role in a child's self-expression (Sue & Sue, 2003). In particular, Mexican-American children tend to have a field-dependent/sensitive (as opposed to field-independent) cognitive style that is associated with a reliance on social cues and nonverbal communication of feelings (Zuniga, 2004). Therapists should understand these expressions to better comprehend the play activity and the child's psychological development (Chazan, 2001). Through the process of play therapy, therapists reach the child's emotional world on his/her level of communication (Landreth, 1993). Being attentive to what the child communicates though activity and behavior will allow therapists to enter and perceive the child's private world (Harris & Landreth, 2001).
In play therapy, children use sounds, gestures, and facial expressions to transmit feelings in a natural way. Toys are a safe vehicle for the expression of feelings and attitudes that may be threatening to the child. According to Landreth (2002), play may be particularly useful in cultures where the free expression of feelings is restricted. In traditional Mexican-American culture, the expression of negative feelings and emotions, such as aggression and anger, is not encouraged (Zuniga, 2004). The parents place importance on behaviors that are socially-conforming and respectful, and they have the expectation that these behaviors will be present during play therapy. Therefore, toys serve as means of transporting feelings, such as, fears, anxieties, and guilt, to objects instead of people, freeing the child from his/her own painful experiences (Landreth, 1993).
Principles 5 and 6
In Principle 5, therapists should have a deep respect for the child's ability to solve his/her problems if given an opportunity to do so. It is the child's responsibility to make choices and institute change. A closely related principle, Principle 6, maintains that therapists should not attempt to direct the child's actions or conversation in any manner. The child leads the way, and the therapists follow. Play therapy has many opportunities for making decisions, such as, medium choices in art and what to include in the playhouse (Cochran, 1996). It is believed that, when play therapists allow the child to control the play sessions, the child will express his/her stories and experiences and use play as the narrative to address his/her concerns (Baggerly, 2003).
However, children from traditional Mexican-American families are usually not accustomed to taking the lead when adults are present. Mexican-American culture values conformity and deference to adults in decision-making; deviations are disciplined (Organista, 2003). Traditional Mexican-American's social relationships tend to be hierarchical in nature. Mexican-American children are viewed as subordinate to adults, and are expected to deter to authority (Altarriba & Bauer, 1998). In traditional Mexican-American families, adherence to convention and respect for authority are emphasized (Jensen, 2004; Koss-Chioino & Vargas, 1999; Zuniga, 2004). There is a central belief that respeto (respect) is inherently due to all persons, regardless of their social status (Ho, 1992). Children are taught to respect their elders, which is an important part of being bien educado (well educated). A well educated child in this context has been raised properly and is one who interacts and relates to others (especially adults) with respect and dignity (Brice, 2002; Zuniga, 2004). For example, children are expected to be submissive and display unquestioning obedience to adults (Mejia, 1983). Not disagreeing and arguing take precedence over being correct. The related concept of being gente hecha y derecha (decent people) further underscores the importance placed on being educated in and possessing a desired system of values for living. Here, the expectation is that, when children follow directions and are obedient and compliant, they are more likely to please their parents and other adults and become "decent" people (Fontes, 2002).
Because Mexican-American children tend to expect adults to tell them what to do and guide them, solving their own problems is foreign to many of them. Therefore, therapists may need to guide the child to problem resolution and consider the possibility of moving from more to less directive play to ease the child into the Axlinian growth process (Carmichael, 1991). The initial sessions may take longer until the child learns that he/she is the "director" of the play in play therapy.
Axline's Principle 7 indicates that therapists should recognize that therapy is a gradual process and not attempt to hurry it along. If there are cultural differences between therapists and the child (such as in the previously cited examples), the child may be particularly guarded and take longer to accept and progress through the therapy. If the pace of therapy is slowed, this is not necessarily a reflection of the therapists' skills and/or the child's lack of progress in therapy. Moreover, since the timing of interpretations is critical in play therapy, therapists should be especially watchful of the need to wait for the timing to be right when intervening with Mexican-American children. Another issue is that lengthy play therapy in private settings may be a luxury for many Mexican-American children who are disproportionately poor (Sue & Sue, 2003). Consequently, play therapy offered in schools can be a more realistic option for these children (Cochran, 1996).
In Principle 8, limitations set by therapists are only those that are necessary to anchor therapy to the world of reality and make the child aware of his/her responsibilities in the relationship. Among the limitations that Axline recommends is adherence to the time limits of the appointment. Although this is a realistic and desirable limitation, therapists should be aware that, in traditional Mexican culture, there is a relaxed approach to time, including promptness to appointments (Zuniga, 2004).
Summary and Conclusions
Although the importance of cultural issues in counseling and psychotherapy has been recognized for decades, the use of Axline's eight principles of play therapy with Mexican-Americans has not been systematically addressed in the literature. In this article, applications of client-centered play therapy were described using Axline's eight principles of play therapy as focal points in therapeutic approaches with children reared in traditional Mexican-American cultural settings.
Among the most critical issues discussed were the need for therapists to have a deep awareness of their own specific culture and how that affects their worldviews; to be sensitive to their values, biases and assumptions that might interfere in play therapy with the Mexican-American child; and to convey their respect for the child regardless of cultural differences. It is recommended that therapists attempt to understand as much as possible about the worldview and culture of the Mexican-American child and be able to engage in culturally appropriate verbal and nonverbal communication. Also discussed were recommendations for developing rapport, such as, using materials that are culturally familiar, and the particular need to assure a positive relationship with the parents due to the centrality of family in traditional Mexican-American families. Other issues addressed included the therapists' Spanish proficiency, and the role of language in the expression of the child's emotions. Therapists are reminded, however, that they should not over- or under-emphasize cultural variables; individuals are members of multiple groups (e.g., SES, geographic, and ethnic); there are significant within-group differences in cultural variables; and each individual may or may not be reflective of commonly recognized group values, beliefs, and norms.
In conclusion, this article represents a first step in the exploration of cultural considerations relative to Axline's principles in play therapy with Mexican-American children. Supportive evidence is needed before firm conclusions can be drawn. Additionally, many of the recommendations discussed also may be helpful to therapists as they work with other Hispanic groups. A thorough understanding of cultural beliefs, attitudes, values, practices, and, in many cases, language will assist therapists in establishing rapport, and working effectively with culturally diverse children.
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Sylvia Z. Ramirez, Leila L. Flores-Torres, and Peter L. Kranz, University of Texas--Pan American; Nick L. Lund, Northern Arizona University.
Correspondence concerning this article should be addressed to Sylvia Z. Ramirez, Ph.D., University of Texas--Pan American; Dept. of Educational Psychology; 1201 W. University Dr.; Edinburg, TX 78541; Email:firstname.lastname@example.org
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|Title Annotation:||educational psychology research|
|Author:||Lund, Nick L.|
|Publication:||Journal of Instructional Psychology|
|Date:||Dec 1, 2005|
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