Autism therapy is one form of therapy for children who have been diagnosed with an Autistic Spectrum Disorder. Autistic Spectrum Disorders (ASD) include classic Autism, Asperger’s Syndrome, and Pervasive Developmental Disorder, and the method of autism therapy that I practice, play therapy for children, can be used in each case.
It has been a popular myth for many years that autistic children are not normal, are mentally retarded, can not improve with therapy, or that only drug therapy, behaviour therapy or Cognitive Behavioural Therapy should be attempted. Most parents could only hope for a mild improvement in their children’s symptoms, nothing approximating a possible cure for autism. The fact that play therapy for children with autism can be incredibly effective and may even remove ALL of the child’s autistic features has largely been overlooked by the media and by parents of autistic children themselves. The article below outlines my experience using autism therapy for children with ASD’s, and describes how much potential many of these children have for an amazing recovery from this very painful and saddening disorder.
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The Autism Myth of the “Broken” Child: The Surprising Effectiveness of Psychodynamic Play Therapy and Parent-Child Therapy for Autistic Spectrum Disorders.
A “broken” child is one who does not get better. It is a child who is believed to have a biological illness whose symptoms are to be “managed” or coped with while holding out little hope for improvement or “cure.” Within the current field of children’s mental health, Autism has become such a disorder, and as a result the autistic child and his family are frequently given little hope for recovery.
Autism has become not so much a diagnosis as a sentence, or prophecy, for the child and its parents, of irreversible defect and intense suffering. This medical-model view of Autism, which understands Autism as being caused by a deficit in the brain, heredity, or imbalanced nutrition, is increasingly becoming the lone voice that people hear when they seek information on this disorder. Unfortunately for children diagnosed with disorders in this spectrum, Autism is perhaps the most misunderstood mental disorder of our time (ADHD is a close second). It is also becoming increasingly popular as a diagnosis, as Asperger’s Syndrome (a mild form of autism) is gradually becoming the new Attention Deficit Hyperactivity Disorder in terms of over-diagnosis, diagnosis by general medical practitioners and non-psychodynamic psychiatrists who do not have clinical experience with autistic children, poor understanding of the causes, and misdirected treatments such as drug therapy and behavioural therapy which rarely produce the desired results.
Public opinion on Autism has also become negatively influenced by the popular media, who report the medical-model view of Autism as if it was based in known, scientific fact (it is not), and as if it were the only theory available. Meanwhile, the myth of the “broken” autistic child does serious harm to children with Autism and their families, since children who could be recovering in psychodynamic therapy continue to suffer unnecessarily.
Based on my experience as a psychotherapist who practices psychodynamic Play Therapy and Parent-Child Therapy with autistic children, the biological explanation for Autism is a myth that is not proven when one considers the evidence that emerges in the psychodynamic therapeutic treatments of autistic children. Autistic children can not only improve when treated with psychodynamic Play Therapy and Parent-Child Therapy, but, depending on the severity of the autism and the age of the child, they can become children who are no longer autistic.
The Reality: Psychodynamic Play Therapy & Parent-Child Therapy
“Psychodynamic” can be simply defined as the interplay of forces or influences within the mind, or brain. In contrast to behavioural therapy (i.e. ABA therapy), which connects behaviour with observable antecedents and consequences, psychodynamic therapy finds the reasons for behaviour to be much more complex than what we can view on the surface. This perspective considers the child to be more than how he or she behaves on the outside; the child also has an inside, or a mind which holds feelings that can becomes disharmonious and conflicted. So, in the simplest terms, the psychodynamic approach examines how children’s feelings lead them to behave in certain ways.
Similar to behavioural therapy, drug therapy also examines behaviour as a surface phenomenon to be taken more or less at face value, with the added component of the brain and its chemistry which, we are told, cause the behaviour in question. Again, the psychodynamic perspective considers the child to be more than its brain, just as the child is more than its behaviour. Lying beneath brain chemistry and behaviour are feelings – sadness, hurt, fear, anger, shame, envy, love, hate – which can fall into conflict with each other and cause difficult behaviour. The psychodynamic therapist seeks to understand how difficult feelings can make us behave in ways which are not necessarily in our best interest. Once the feelings and conflicts that underlie behaviour start to make more sense to the child, the behaviour often decreases over time, eventually becoming extinct.
The major challenge to doing psychodynamic therapy with autistic children (and all children) is that they rarely can put their difficult feelings into words. Indeed, not knowing how to talk about their conflicted feelings, or not knowing what they are feeling at all, is an important reason why their behaviour does not change. Behaviour remains foggy and mysterious to the extent that we struggle to describe how we are feeling when we do things. Children’s difficulty in talking about why they do the things they do, or why they feel things, is one reason why expecting a child to think about what they did wrong (often in their rooms or Time Out), is usually an unrealistic expectation. Children require wise adults to help them understand their feelings and behaviour, and this is where parents and therapists come in.
Once it became clear that language is not the primary way that young children communicate about their inner lives, the pioneers of play therapy began to study the activity that children like to do most in order to see if they could learn more about their minds, feelings and behaviours. Child experts began to study children’s play, since this was most children’s preferred activity.
What they found was that if one closely observes children’s play – the ideas, themes and issues that come up between characters, cars, or figurines that the child creates – much could be learned about the child himself. Play came to be understood as the primary way young children express what is going on inside of them. Instead of talking about problems, children tend to play out their problems. For example, a child who is afraid of the dark will symbolize this by playing with dolls or figures who are likewise afraid the dark, or a little girl who is struggling to separate from her mother will set up a similar situation in her play.
This was a “Ureka!” experience for individuals curious about what goes on in children’s minds, since play appeared to be equivalent to language for what it could express about the inner workings of the child’s mind. Play could be “read” or interpreted – like a book, a dream, or a painting, and therapists slowly began to read things into the play of children and develop more accurate theories about why and how they struggle. And so, psychodynamic Play Therapy was born.
The next thing that play therapists found was that if you observe the themes in a child’s play, and speak to the child about these themes, difficult behaviours and conflicts begin to disappear from the child’s real life outside of the play and the therapy room. It seemed that symbolizing one’s struggles through play, and having these ideas put into explicit language by a trusted person, worked to gradually alleviate a conflict or a behavioural problem (individuals involved in any creative art can attest to the therapeutic effect of playing, creating and expressing).
One simple example of the therapeutic effect of playing in therapy is the boy who is afraid of the dark. This boy might make up a story in the play where a boy figure is afraid the dark, so the therapist could then say that the boy himself could also be afraid the dark. The child might say yes, and the therapist could wonder with the boy about what he might really be afraid of. Perhaps now in the play the boy makes the boyfriend figure yell at the mom figure in a way that clearly scared the boy. Then the therapist could say that the boy might be afraid of the dark because of the yelling that he heard, and the boy could confirm, deny or elaborate on this hypothesis. Then it might be possible for the boy to talk about his own experience.
And so, gradually over a number of sessions, the boy’s fear of the dark is addressed in the play and in the relationship between the therapist and the child. They work as collaborators to construct a theory about the boy’s troubles, and because this is still “play” for the child, it feels safe to approach. Over time and much work and playing, the boy’s fear of the dark decreases.
This is one simple example of how play therapy can work. The struggle with an autistic child is that sometimes they cannot play with toys, or they play in idiosyncratic ways that can be difficult to understand. Play therapists also may find it difficult to understand the autistic child’s strange behaviour at first. But, experience has taught me that it only takes longer to grasp the autistic child’s play, and that the autistic child’s play and his behaviour are always comprehensible after a period of time spent with the child, whether it is playing together, drawing pictures together, or struggling to communicate at all.
If the child cannot play or draw, but can only “behave” in difficult-to-manage ways, this too can be examined and interpreted to the child. For example, the child is running around spinning himself and screaming, and the therapist might say that he can see what the child is doing, and he wonders if the child is feeling something, perhaps afraid, which makes the child need to move and spin.
Over time, putting children’s actions into words has the effect of influencing these actions and changing them. All behavioural problems are emotional problems at their core, in that all behaviour is caused by a feeling that one is having, or not having. Making these connections for the child more conscious and explicit has been shown to have a potent effect on the child’s subsequent behaviour and feelings.
In my own practice, I have found play therapy to be an effective treatment that can change the way autistic children feel and behave. The effectiveness of therapy does depend on the age of the child and the severity of the Autism: in general, the younger the child is and the milder their Autism is, the greater the effectiveness of the therapy. Therapy in which sessions occur at least twice per week is usually more effective than one session per week. If children do not have some language by preschool age, the challenge for the therapist is heightened. I have also found that the more the parents are involved in the therapy, the better the outcome. Therefore, one treatment choice for autistic children is Parent-Child Psychotherapy.
Parent-child Psychotherapy is a treatment in which the parents and the child attend therapy sessions to talk and play together under the guidance of the therapist. The parents, child and therapist become collaborators who can think and talk together about what the child is doing, playing or saying, with the goal of reaching good hypotheses about what the child’s behaviour means and how the child is feeling.
If Parent-Child Psychotherapy is not the chosen treatment, the parents and the therapist can meet for parent sessions outside of the child’s play sessions in order to think and learn together about the child and how to help him most effectively. Finding the best school placement, thinking about psychological or psycho-educational assessment of the child, and how to respond to the child at home, are possibilities that can be explored in these sessions.
Before therapy commences, an assessment, or introductory phase of therapy, occurs, in which the parents and child meet with the therapist for a number of sessions in order to understand the nature of the problem in more depth. The child may or may not be autistic or have autistic features, and an accurate, thorough assessment is warranted before treatment begins, tests are performed, or referrals are made.
While therapeutic outcome varies due to the great variety of children currently being diagnosed with disorders in the autistic spectrum, psychodynamic Play Therapy is currently the only treatment which consistently looks for deeper, more meaningful ways of understanding this mystifying problem, so that it is no longer such a mystery to the child or to his parents.