PLAY - any voluntary activity engaged in for the purpose of enjoyment. - play activities vary greatly from child to child and among different age, cultural, and socioeconomic groups. THERAPY - in the broadest sense, is a term that can be applied to any form of treatment for any illness or disorder PLAY THERAPY - is a psychoanalytic technique used by psychiatrists to help children understand their feelings and thoughts and motivations better. - in play therapy, the psychiatrist attempts to interpret the child·s verbal and nonverbal cues.

Sigmund Freud·s Psychosexual Development .

smoking. fingernail biting and overeating. Children¶s interest focus on the anal region as they begin toilet training. Latent Stage years . Masturbation is common during this phase. while too little pressure from parents can lead to messy or destructive behavior later in life. 1 to 3 Children find pleasure in both the retention of feces and Anal Stage defecation. A time in which children¶s libido appears to be diverted into 6 to 11 concrete thinking. Children¶s pleasure zone appears to shift from the anal to the 3 to 6 genital area. Too much pressure can result in an excessive need years for order or cleanliness later in life. Elimination takes on new importance for them. If this need is not met. the child may develop an oral year fixation later in life. Phallic years Children may also show exhibitionism.Stage Age Characteristics Freud termed the infant period the ³oral phase´ because infants are so interested in oral stimulation or pleasure during Birth to 1 Oral Stage this time. examples of which include thumb-sucking. suggesting they hope Stage this will lead to increased knowledge of the two sexes.

people develop a strong interest in the years opposite sex. the individual will continue to develop into a well-balanced person. If development has been successful to this point. .Stage Age Genital Stage Characteristics The onset of puberty causes the libido to become active once 11 to 18 again. During this stage.

Erik Erikson¶s Psychosexual Tasks .

care. while failure results in feelings of inferiority. Mistrust Feeding Outcome Children develop a sense of trust when caregivers provide reliabilty. to 11 years) Inferiority Children need to develop a sense of personal control over physical skills and Toilet Training a sense of independence. Children who try to exert too much power experience disapproval. Autonomy vs. Exploration Success in this stage leads to a sense of purpose. resulting in a sense of guilt. Toddler (2 to 3 years) Shame and Doubt Preschool (3 to 5 years) Initiative vs. A lack of this will lead to mistrust. . Success leads to feelings of autonomy. Children need to cope with new social and academic demands. Children need to begin asserting control and power over the environment. failure results in feelings of shame and doubt. and affection.Stage Infancy (birth to 18 months) Important Basic Events Conflict Trust vs. Success leads to School a sense of competence. Guilt School Age (6 Industry vs.

Social ability to stay true to yourself. to 11 years) Inferiority Teens need to develop a sense of self and personal identity. Success leads Stagnation Parenthood (40 to 65 to feelings of usefulness and years) . Success leads to a sense of competence. Intimacy vs. often by having Middle children or creating a positive change Adulthood Generativity vs. Adults need to create or nurture things that will outlast them. Work and that benefits other people. Young adults need to form intimate. while failure results in feelings of inferiority. while (12 to 18 Role Confusion Relationships failure leads to role confusion and a weak years) sense of self. Isolation (19 to 40 while failure results in loneliness and years) isolation. School Age (6 Industry vs. Success leads to an Adolescence Identity vs. Adulthood Relationships Success leads to strong relationships.Stage Important Basic Events Conflict School Outcome Children need to cope with new social and academic demands. Young loving relationships with other people.

Jean Piaget s Cognitive Developmental Stages .

into 1-4 mo o Hand -mouth and ear-eye coordination develop. Secondary circular reaction 4-8 mo y Infant learns to initiate. and repeat pleasurable experiences from environment. y Behavior entirely reflexive. y Memory traces are present . o Infant spends much time looking objects and separating self from them.STAGE OF DEVELOPMENT AGE SPAN NURSING COMPLICATIONS Sensorimotor Neonatal Reflex Primary circular reaction 1 mo y Stimuli are assimilated beginning mental images. recognize.

such as blocks. infant experiences separation anxiety when primary caregiver leaves.Coordination of secondary reactions 8-12 mo o Recognizes shapes and sizes of familiar objects o Because of increased sense of separateness. colored plastic rings . y Child is able to experiment to discover new properties of objects and events y Capable of space perception and time perception as well as permanence Tertiary circular reaction 12-18 mo Invention of new means through mental combinations 18-24 mo o Transitional phase to the preoperational thought period o Uses memory and imitation to act o Can solve basic problems. foresee maneuvers that will succeed or fail o Good toys for this period: those with several uses.

an opposite operation or continuation of reasoning back to a starting point(follows a route through a maze and then reverses steps) .Preoperational Thought 2-7 yr Concrete Operational Thought 7-12 yr y Can arrive at answers mentally instead of through physical attempt y Comprehends simple abstractions but thinking is basically concrete and literal y Child is egocentric(unable to see the viewpoint of another) y Centering or focusing on a single aspect of an object causes distorted reasoning o Concrete operations include systematic reasoning o Uses memory to learn broad concepts(fruit) and subgroups of concepts(apples and oranges) o Child is aware of reversibility .

present and future y Adult or mature thought y Good activity for this period: ³talk time´ to sort through attitudes and opinions .Formal Operational Thought 12 yr y Can solve hypothetical problems with scientific reasoning y Understands causality and can deal with the past.

there play is little organization of responsibilities Children play with an Playing organized organized structure or with rules compete for desired goal or outcome games School-age Cooperative .Types of Play Age Type of Play Description Example Infant Observation Child watches particular Watching a mobile play intently. although not actively engaged in it. Two children play side Playing separately by side but seldom similar push toy attempt to interact with each other with Toddler Parallel Preschooler Associative Children play together in Engaging in typical backyard a similar activity.

Toys Appropriate for Specific Age group .

Age Infancy Toy/Game 1-3 months: Mobiles Parent s face Rattles Stuffed animals 4-6 months: Squeez toys Boxes or blocks Play pens Plastic boats Rattles Toy/Game 7-9 months: Cloth texture toys Rubber duckies Blocks and boxes Large colorful balls 10-12 months Building blocks Rings of assorted sizes that fit on a center post Stacking toys Play peek-a-boo Putting things in and out of a container Pulling toys .

big wheels Backyard play Imaginative and dramatic play Trucks Pre-school Squeaky frogs Waddling ducks Rocking horses Pegs to pound Blocks to stack Toy telephone Large balls School Age Imitate parents (drive a car) Electronic games Books Crafts Board and card games Team sports Complex puzzles .Age Toddler Toy/Game Age Toy/Game Trycycle.

improved impulse control. To improved verbal expression. and improved capacity to trust and to relate to others.Purpose of Play Therapy: To decrease those behavioral and emotional difficulties that interfere significantly with a child's normal functioning To improved communication and understanding between the child and his parents. To treat problems that are interfering with the child's normal development . ability for selfobservation. more adaptive ways of coping with anxiety and frustration.

Axline Principles of Play Therapy:  Must develop a warm and friendly relationship with the child. The responsibility to make choices and to institute change is the child s.  Accepts the child as she or he is. The child leads the way.  Does not hurry the therapy along.  Only establishes those limitations necessary to anchor the therapy to the world of reality and to make the child aware of his/her responsibility in the relationship .  Maintains a deep respect for the child s ability to solve his/her problems and gives the child the opportunity to do so.  Does not attempt to direct the child s actions or conversations in any manner. It is a gradual process and must be recognized as such by the therapist.  Is alert to recognize the feelings the child is expressing and reflects these feelings back in such a manner that the child gains insight into his/her behavior. the therapist follows.  Establishes a feeling of permission in the relationship so that the child feels free to express his or her feelings completely.

‡ Sociology As children talk with playmates during play. ‡ Safety and Security Be sure to screen all toys for safety. if a toy can fit through the center of a toilet tissue tube. As a rule. . it is too small for safe play. they develop both language and social skills. They should have no sharp edges and no small parts that can be swallowed or aspirated.Principles involved in Play Therapy: ‡ Microbiology Toys should be washable to prevent spreading of disease. ‡ Psychology Play may be used to help assess children s level of knowledge and feelings about their condition so that more individualized nursing care can be planned.

 Use therapeutic responses and positive reinforcements to child.  Supervise therapeutic play.  Provide the specific materials that are needed for the child and orient it to them.  Reflect only on what the child expresses (verbal expression)  Do not criticize play.Guidelines  Be certain that the toys offered will not lead children into danger. For example. children who are playing modeling clay may eat it.  Allow the children to choose the articles with which they want to play. .

Nursing Responsibilities: Before:  ü Prepare all the necessary materials needed for the activities  ü Introduce yourself to the patient  ü Inform the parents/guardian the purpose of the therapy During:  ü Create a friendly relation to the patient  ü Establish a feeling of permission  ü Ask the parents/guardian about the background information of the patient  ü Stay close to the patient After:  ü Communicate to the parents on the understanding of the childs psychological needs.  ü Evaluate the outcome of the activity  ü Do after care .

.The End. . .

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