Filial Therapy - Wiley Online Library

Filial Therapy: A Structured and Straightforward Approach to Including Young Children in Family Therapy Glade L. Topham1 and Risë VanFleet2 1

Oklahoma State University, United States of America

2

Family Enhancement and Play Therapy Center Inc., Boiling Springs, Pennsylvania, United States of America

This article describes Filial Therapy, a structured and straightforward approach to working with parents and young children in family therapy; it highlights the congruence between Filial Therapy and the values and principles of family therapy. The historical, theoretical and research foundations of Filial Therapy are described. The family science and child socialisation literatures are also briefly reviewed, linking key predictors of positive child outcome with the goals of Filial Therapy. Finally, we discuss the consistencies between Filial Therapy and experiential and structural models of family therapy. We conclude with a description of Filial Therapy followed by a case example to illustrate the process. Keywords: filial therapy, family therapy, young children, parent

Although many couple and family therapists routinely and effectively involve children in family therapy sessions, research shows a substantial portion fail to do so (Johnson & Thomas, 1999; Korner & Brown, 1990; Lund, Zimmerman, & Haddock, 2002). The most common reasons given are therapist discomfort (Johnson & Thomas, 1999) and a lack of understanding of how to effectively involve children and adults concurrently in sessions (Kindred, 2003; Korner & Brown, 1990). Since the development of family therapy over 60 years ago, a multitude of family therapy models have been developed, each with a unique and complex set of ideas about treating families. While some models have well-developed guidelines for treating children in family sessions, such as narrative therapy (Epston, Freeman, Lobovits, 1997), many are Address for correspondence: Glade L. Topham, Department of Human Development and Family Science, Oklahoma State University, 233 Human Environmental Sciences, Stillwater, OK 740786122. E-mail: [email protected]

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Young Children in Family Therapy

complex and difficult to translate into work with children particularly for therapists new to family treatment. For some therapists, including children in family therapy sessions can be confusing and overwhelming, it adds an element of unpredictability and uncertainty; the skills required to be effective are unique and do not easily translate from traditional talk therapy with adults. Filial Therapy, a play-based and relationship-focused treatment approach, provides a model for treating young children in family therapy that is structured and straightforward and can be learned in a relatively short amount of time. Training in Filial Therapy could be particularly valuable in helping therapists develop comfort and confidence when conducting family therapy with young children. In this article we expand on previous calls for increased use of Filial Therapy by family therapists (Johnson 1995; Kellam, 2001; Sori, 2005; Winek et al., 2003). We describe the treatment model and the historical, theoretical, and research foundations of Filial Therapy as well as its congruence with two popular models of family therapy. We describe the Filial Therapy treatment process and illustrate it with a case example. Play as a Foundation for Treatment

In a definitive clinical report for the American Academy of Pediatrics (AAP), Ginsburg (2007) concluded that ‘play … is essential to the cognitive, physical, social, and emotional well-being of children and youth’ (p. 183). Play is the means through which children learn perspective taking, language skills, problem solving, memory, creativity, self-confidence, motivation and an awareness of the needs of others (Davidson, 1998; Newman, 1990; Shonkoff & Phillips, 2000; Singer, Singer, Plaskon, & Schweder, 2008). Play facilitates the development of turn-taking, empathy, self regulation, impulse control, and motivation (Corsaro, 1988; Krafft & Berk, 1998). Furthermore, children are able to try on adult roles and conquer their fears by developing mastery over them (Barnett, 1990; Tsao, 2002). Perhaps most importantly, through play with their caregivers, children learn they are loved and important and develop self-confidence and self-esteem (Powers, 2009). Because of the central role of play in healthy child development and as a form of communication, parent–child play offers parents a unique opportunity to connect with their child and understand their feelings, motives, perceptions, thoughts and behaviours (Ginsburg, 2007; VanFleet, 2005). In his AAP report, Ginsburg stated that healthy child development and resilience are rooted in the fundamental connection that occurs when parents engage in child-led play. Given the important role of play in promoting a healthy parent–child relationship, nondirective parent–child play is a central component of several treatment approaches. For example, parent–child interaction therapy (PCIT; McNeil & Hembree-Kigin, 2010), Watch Wait and Wonder (Lojkasek, Muir, & Cohen, 2008) and child parent psychotherapy (CPP; Lieberman & Van Horn, 2008) all use forms of non-directive parent–child play to promote positive change. While each approach has its strengths, we believe Filial Therapy to be a particularly good fit for family therapists for several reasons. First, all children are included in treatment, not just a designated target child; second, the nature of play in Filial Therapy allows for THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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the inclusion of a wide range of ages of children (ages 2 to 12); third, it is designed to treat a broad range of presenting problems (i.e., trauma, behavioural disruption, grief and loss, problematic family processes, and so on); and fourth, Filial Therapy is time limited, structured, and straightforward. The above-mentioned treatment approaches lack one or more of these characteristics. In Filial Therapy parents learn and implement a set of skills that maximise the child’s ability to use play to develop, grow and, if necessary, heal from traumatic experiences. Furthermore, through filial play sessions, parents and children interact and see each other in new ways, strengthening the parent–child relationship. In the process parents replace non-productive parenting behaviours with ones that promote healthy child development. Filial Therapy Background and History

Filial therapy was first developed in the late 1950s and early 1960s by Bernard and Louise Guerney (Guerney, 1964; VanFleet, 2005). The Guerneys were well acquainted with the effectiveness of play therapy in treating children’s social, emotional, and behavioural problems, and hypothesised that parents could be trained to conduct special play sessions with their children, much like a play therapist. They believed because of the emotional bond parents share with their children, it would be more effective to have the parent rather than the therapist conduct these play sessions. The Guerneys experimented with parent–child conjoint sessions about the same time other family therapy pioneers began conjoint family sessions. The professional community responded to the Guerneys much like they did to other family therapy pioneers, with scepticism and concern. However, early research demonstrated positive results not just for children but also with parents and the quality of the parent–child relationship (Oxman, 1972; Stover & Guerney, 1967). Since those early studies, Filial Therapy has continued to grow in clinical use and popularity and is supported by an expanding body of research demonstrating its effectiveness (VanFleet, Ryan, & Smith, 2005). Filial therapy is offered in several different formats, including the original group format developed by the Guerneys (Ginsberg, Stutman, & Hummel, 1978; Guerney, 1964), a short-term, 10-session group format adapted by Gary Landreth (Landreth, 1991; Landreth & Bratton, 2006), and an individual family therapy model adapted by Rise VanFleet (VanFleet, 1994; VanFleet & Guerney, 2003). While there is a great deal of consistency across these different models there are some important differences. To avoid confusion we focus exclusively in this article on the individual family therapy model. In Filial Therapy, parents are taught to set aside their own feelings and needs and provide empathy and validation to their child during special 30-minute nondirective play times. Filial therapy is typically used with 2- to 12-year-old children, but ‘special times’ can be substituted for nondirective play sessions with adolescents. Parents conduct one-on-one nondirective play sessions with each child each week, or ‘special times’ with adolescents. They learn four skills needed to conduct nondirective play sessions: structuring, empathic listening, childcentered imaginary play, and limit-setting.

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Structuring: Parents are taught how to begin and end a play session to make the transitions clear to the child. Empathic listening: Parents are taught to temporarily put their own thoughts and

feelings aside; to attend fully to their child’s behaviors, intentions and feelings; and to verbally reflect their child’s behaviours and feelings throughout the play session. Child-centred imaginary play: Parents engage in pretend play when invited and

enact their child-assigned role as closely as possible in accordance with the child’s wishes. They learn to use facial expression, intonation and a little drama in their play, but at all times they follow the child’s lead. Limit setting: Parents set limits to maintain safety and boundaries during the session. They learn to use a firm but nonpunitive tone of voice to state limits clearly and specifically, to provide a warning if the child does not comply and to carry out the consequence. The child has two chances to self-correct after which the parent applies the consequence, usually ending the play session.

These four skills, when used effectively together, help parents balance their acceptance and nurturance with necessary boundaries. After teaching parents the skills and practicing them in role-play, therapists observe play sessions and provide direct feedback following the play sessions. If two parents or caregivers are participating in treatment they observe each other’s play sessions and participate in joint feedback sessions with the therapist. In these feedback discussions, therapists help parents to continue to improve their skills and awareness of their child’s feelings and needs, and understand what might prevent them from being fully attentive and available to their child. After parents become comfortable with the skills, they begin play sessions at home during the week and the therapist begins to work with the parent to generalise the filial skills to daily parent–child interaction. Theoretical Background

Filial therapy is an integrated approach that draws from several different theoretical orientations including humanistic, interpersonal, psychodynamic, developmental, attachment, and behavioral and social learning theories. Parent–child play sessions are conducted in accordance with the principles of nondirective play therapy (Axline, 1947) based on the concepts of Rogerian therapy. Parents learn to provide their child with unconditional acceptance as they attend to and empathically reflect their child’s feelings and actions in play. Similarly, in sessions with the parents, the therapist strives to create an accepting, nonjudgmental atmosphere to feel safe, respected, and understood. In this atmosphere parents are able to attend more fully to the experiences and needs of their child and can discuss their own negative reactions and behaviours nondefensively as they work with the therapist to improve the parent–child relationship. Furthermore, as parents experience acceptance and respect from the therapist they tend to experience increased respect and acceptance for their child, and are also more receptive to the corrective guidance of the therapist. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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The work of Harry Stack Sullivan (1953) and interpersonal theory had an important impact on Bernard Guerney and the development of Filial Therapy, as it did on many of the founders of family therapy. Sullivan abandoned Freud’s drive theory and structural models of the mind in favour of understanding personality development as learning that takes place through interpersonal connectedness. Sullivan looked beyond the symptoms of an individual to the interpersonal context. He emphasised that human experience is the product of dynamic interaction between interpersonal influences and the internal meaning systems (intrapsychic processes and experiences) of the individuals (Evans, 1996). Guerney was also influenced by Leary (1957) who built upon and extended many of Sullivan’s ideas. Leary suggested that individuals develop ‘interpersonal reflexes’ based on their experiences in relationships that can become unconscious, automatic and rigid and driven by the need to reduce anxiety. In Filial Therapy an important focus of the post-play-session discussion with the parents is the dynamic relationship between parents’ behavioural responses to their child in play (‘interpersonal reflexes’) and their associated emotional or cognitive (intrapsychic) reactions. Therapists guide parents in recognising their reflexive responses to their child (e.g., inability to let the child take the lead in the play session), help parents explore and understand their emotional reactions (e.g., ‘I felt vulnerable and weak’), and help parents challenge associated constraining beliefs (e.g., ‘He just wants to make this miserable for me’). Therapists may briefly help parents connect their current reflexive responses and emotional and cognitive reactions to previous interpersonal experiences (e.g., past relationships when parents felt controlled). Through dynamic discussions across sessions, the rigidity of unconscious and automatic responses to the child are weakened, freeing parents to develop more productive and intentional patterns of interaction with their child. Psychodynamic and developmental theories come into play, particularly in postplay discussions with parents. In these discussions, therapists help draw parents’ attention to the developmental aspects of the child’s play, such as problem-solving or mastery, and help them become attuned to what may be going on for their child both in and outside of the play sessions. Children’s play is also viewed through a psychodynamic lens in that their play is viewed as symbolic of their internal worlds, including needs, anxieties, hopes, and fears. Tentative discussions with parents about the possible meaning of the child’s play using both these perspectives increase curiosity about the child’s internal world. Filial therapy also integrates ideas from attachment theory. An important focus of the dyadic parent–child work is to help parents develop greater attunement and appropriate responsiveness to each of their children and promote healthy and secure parent–child attachment relationships. Research has demonstrated the latter promote better adjustment among family members, healthier sibling relationships and improve family functioning as a whole (Berlin, Cassidy, & Appleyard, 2008). Finally, Filial Therapy also draws from behavioural and social learning theory principles, such as modelling, behavioural rehearsal, shaping, and reinforcement, particularly in training parents in nondirective play skills.

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Goals of Filial Therapy

The majority of treatment programs targeting the parent–child relationship take what Cavell and Elledge (2003) refer to as an ‘intervention-as-intervention’ approach. These target the immediate reduction of problem behaviours while neglecting broader relationship issues important for successful child socialisation. In contrast, Filial Therapy takes a ‘socialisation-as-intervention’ approach, which assists families with immediate needs, while fostering and strengthening patterns of interaction most predictive of healthy child development and positive child outcomes. Therefore the process of Filial Therapy would be the same whether used as prevention or as treatment for an existing problem. A number of parenting attitudes and practices have been shown to be key to healthy child socialisation and outcome. These include being aware of and responsive to children’s needs and wishes (Belsky & Fearon, 2009); parent emotional warmth and support (Baumrind, Larzelere, & Owens, 2010); parenting that values and validates children’s expression of negative emotion and helps work through it (Gottman, Katz, & Hooven, 1996); and effective limit setting with clear expectations, firm limits and use of reasoning (Baumrind et al., 2010). In contrast, parenting that is hostile and coercive, or permissive and indulgent (Baumrind et al., 2010), or psychologically controlling (i.e., parental intrusiveness, guilt induction and love withdrawal — Barber, Stolz, & Olsen, 2005) are particularly damaging to healthy child socialisation and the parent– child relationship. Consistent with this research literature, Filial Therapy helps parents to (a) become attuned to, accepting of and responsive to their child’s as well as their own internal experience (e.g., emotions, needs, desires); (b) understand child development in general, and specifically their child’s developmental needs and challenges; (c) increase confidence in their parenting ability; (d) learn to calmly and consistently set limits; and (e) identify and address issues that may negatively affect the way they relate to their children. Goals for children include: (a) learning to recognise, accept, and express their emotions fully; (b) increasing their self-confidence and self-esteem; (c) developing effective problem-solving and coping strategies and skills; (d) reducing or eliminating maladaptive behaviours and presenting problems; and (e) developing proactive and prosocial behaviors. In terms of overall family relationships, the goals of Filial Therapy are to: (a) increase children’s trust and confidence in their parents; (b) increase parents’ warmth for and acceptance of their children; (c) for parents in two-parent families to work together more effectively as a team; and (d) in general, to promote an accepting and cohesive family climate that fosters healthy child development (VanFleet, 2005). Ideally all primary caregivers (whether it be a single parent, two parents, or a parent and a grandparent) participate in play sessions (or ‘special times’ with adolescents) with each of the children each week. This increases the influence of Filial Therapy in helping families replace negative family patterns with those that are more productive and growth promoting. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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Filial Therapy Research

In Filial Therapy, parent–child play is used as a medium for addressing a host of child, parenting and parent–child relationship difficulties. The research literature demonstrates the effectiveness of this approach (Ray, Bratton, Rhine, & Jones, 2001; VanFleet, Ryan, & Smith, 2005). Some positive child outcomes include an increase in children’s expression of emotion (Glass, 1986), reduction in child depression and anxiety (e.g., Tew, Landreth, Joiner, & Solt, 2002), an increase in child self-confidence (e.g., Costas & Landreth, 1999; Yuen et al., 2002) and a decrease in child behavior problems (e.g., Grskovic & Goetze, 2008; Jang, 2000). Parenting outcomes include a decrease in parent stress (e.g., Kale & Landreth, 1999; Yuen et al., 2002), an increase in parent acceptance of the child (e.g., Bratton & Landreth, 1995; Landreth & Lobaugh, 1998), parents allowing more self-direction for the child (Smith & Landreth, 2003) and increased parent empathy (Glover & Landreth, 2000; Jang, 2000) and improved parent–child relationships (Grskovic & Goetze, 2008). Filial therapy has been shown to be an effective intervention for parents and children from a wide range of backgrounds and presenting issues or complaints including foster parents (Guerney & Gavigan, 1981), single parents (Bratton & Landreth, 1995), incarcerated mothers and fathers (Harris & Landreth, 1997; Landreth & Lobaugh, 1998), parents from a variety of cultural and ethnic backgrounds (e.g., Grskovic & Goetze, 2008; Kidron & Landreth, 2010), parents of chronically ill children (e.g., Tew et al., 2002), parents of children with conduct problems (Johnson-Clark, 1996), parents of children with pervasive developmental disorders (Beckloff, 1997), parents of children with learning difficulties (Kale & Landreth, 1999), non-offending parents of sexually abused children (Costas & Landreth, 1999), and parents of children who have witnessed domestic violence (Smith & Landreth, 2003). Although researchers have not examined the relationship between Filial Therapy and broader systemic change using quantitative methodology, this has been consistently demonstrated by a few qualitative studies. Parents report family communication has become more effective with more open discussion, give and take, expression of emotion and respect for others’ opinions and feelings. They also report transferring skills of empathy, validation, and acceptance into their couple relationships resulting in increased understanding and a stronger sense of unity (Bavin-Hoffman, 1997; Lahti, 1992; Wickstrom, 2009). Congruence Between Filial Therapy and Family Therapy

Several principles of Filial Therapy highlight its congruence with family therapy. These include avoiding pathologising the child or parent, focusing on the parentchild relationship as the primary mechanism for change and challenging a linear or medical model of therapy. Rather than seeking to uncover and treat pathology Filial therapy is a strength-based approach focusing on education and skill development in identifying and working through barriers to family progress. It assumes individuals and families naturally resolve problems and overcome challenges in the context of well functioning family relationships.

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While Filial Therapy addresses many of the goals of parent training it is much broader in scope, targeting not only parenting skills and treating child problems, but also family relationships and family functioning. As a family-systems intervention it specifically targets family subsystems (i.e., all parent–child subsystems and the co-parent subsystems) and generalises individual and subsystem change to broader family dynamics. This approach to family systems change is supported by attachment research, which shows the quality of attachment in the parent–child dyad affects family relationships (Berlin et al., 2008) and by Filial Therapy research, which shows participants consistently report improvements in family communication, conflict management and mutual empathy and respect (Bavin-Hoffman, 1997; Lahti, 1992; Wickstrom, 2009). Because of the emphasis on fostering healthy family relationships, Filial Therapy is consistent with a variety of family therapy theoretical perspectives and here we discuss parallels with experiential and structural family therapy models. Consistency With Experiential Family Therapy

Within experiential family therapy problems are viewed as resulting from a denial of emotional experience. Individuals learn to ignore and discount their own emotional experience and avoid emotional expression in order to meet expectation of society and family members. This begins in early childhood when parents see negative emotion to require correction and punishment like child misbehavior. One result of emotion suppression is family relationships may be distant and lack emotional intimacy (Nichols, 2009). Experiential family therapy helps family members develop an awareness of and acceptance of their own and other family members’ emotional experience, leading to increased respect for individuality and increased self-esteem of family members. This is achieved by creating an in-session emotional experience and helping family members establish honest and genuine emotional contact with each other (Napier & Whitaker, 1978; Satir, 1972). Likewise Filial Therapy helps family members develop awareness and acceptance of their own and each other’s emotions where the primary experiential activity is the parent–child play session. These play sessions provide an opportunity for children to express their feelings, needs and fantasies, and for parents to develop understanding and acceptance for and validate their children’s experience. They also help parents become less constrained and more playful with their children. Parents develop awareness and acceptance of their own emotion in post-play discussions with the therapists as they explore their reactions to the play sessions in the context of therapist validation. As parents conduct play sessions with each of their children, observe the other parent’s play sessions and meet with the therapist in post-play discussions, emotional expression becomes an integrated part of family culture. Consistency With Structural Family Therapy

Structural family therapy views problems as typically resulting from inflexible family structures that prevent the family from adapting to the demands of changing circumstances. Common problems include rigid role assignment in which there is THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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an exaggerated complementarity in family roles that detract from individual growth; disengagement, where boundaries between family members are rigid leaving family members emotionally isolated; enmeshment, where boundaries between family members are diffuse, compromising family members’ autonomy; and either little parental hierarchy with children and parents sharing power or an exaggerated hierarchy in which children have no voice (Minuchin, 1974). Family structure is observed and modified during family interaction with enactments, the hallmark of structural family therapy. Here the therapist encourages specific family interaction and then works to modify family structure such as reinforcing boundaries or solidifying parental hierarchy. As new patterns of interaction are regularly repeated, a more functional structure is solidified in the system (Nichols, 2009). Filial therapy is a strength-based approach that seeks to resolve difficulties by fostering improved patterns of family interacting, with the parent–child play sessions similar to enactments in structural family therapy. Although the therapist does not intervene in the room in the moment during play sessions, direct feedback is given to parents after each session to modify and shape the interaction. The instructions and the feedback parents receive regarding the parent–child play sessions help parents establish clear boundaries in interaction with their children. Rigid boundaries are weakened in disengaged parent–child dyads as parents learn to tolerate emotional intensity and learn to respond in warm and supportive ways. Similarly, boundaries are strengthened in enmeshed parent–child dyads as parents learn to put their needs on hold and attune to and accept their child’s emotions, needs, and wishes. Both during the play and in post-play discussions with the therapist parents learn to distinguish between their own and their child’s emotions. In play sessions parents learn to let their child make his or her own decisions and solve his or her own problems in a context of nonpossessive warmth. In Filial Therapy a hierarchy in the family is established by clear and consistent limit setting, but is also reinforced by the nurturing elements of warmth, reflection, and validation. Where two parents (or caregivers) are participating, executive postplay discussions with parents help develop a unified, co-parenting alliance. Filial therapy also helps address the exaggerated complementarity of parental roles (e.g., disciplinarian vs. nurturer). The individual parent–child play sessions enable each parent to develop confidence and comfort in various parenting roles with each of their children without reflexively stepping aside for the other parent to fulfill less comfortable roles. Outline of Filial Therapy

While the process of Filial Therapy has been detailed elsewhere (VanFleet, 2005, 2006) it is briefly outlined here. The sequence of Filial Therapy involves several phases: assessment, training, supervised play sessions, home play sessions, and generalisation. Typically it requires 15 to 20 one hour sessions, although it can take longer with severely distressed families. The phases of Filial Therapy are outlined below. Assessment: The therapist first meets with the parents to discuss their concerns and the presenting problems, listens empathically, and obtains further information

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about the family and the situation. Without children present parents can talk freely about their challenges and frustrations including any problems in the co-parenting relationship. The second session typically involves a family play observation followed by further discussion and final recommendations for treatment. Training: Training typically takes 3-4 one hour sessions. The therapist demonstrates short nondirective play sessions with each of the children in the family while parents observe. The therapist then trains the parents in four play session skills, culminating in mock play sessions in which the therapist plays the child’s role while parents practise the skills. The therapist provides immediate and encouraging feedback to facilitate the parents learning to conduct the play sessions. Supervised play sessions: Parents take turns conducting filial play sessions with each of their children while the other parent and therapist observe. Without the child present the therapist discusses the experience with the parent(s), offers positive feedback and suggests one or two improvements for next time. This helps parents to make continual progress without feeling overwhelmed. Therapists typically observe each parent conducting four to six play sessions, after which most parents become quite skilled. Home play sessions: Parents hold weekly half-hour play sessions with each of their

children at home and meet with the therapist to discuss the home sessions, the children’s play themes and questions that arise. Parents often observe each other’s home sessions as well. Home play sessions can continue as long as children and parents wish. Generalisation: Near the end of therapy, therapists help parents begin to use their newly mastered skills outside the play sessions in everyday life. This is accomplished in a deliberate way to ensure that parents become competent and confident in applying what they have learned. A Case Study

We now provide a case example to illustrate the process and outcomes of Filial Therapy. Identifying information has been changed to protect the privacy of the family involved. Mandy and Phil were parents of two children, Carrie, age 10, and Davey, age 7, diagnosed with diabetes a year before. While injections and blood tests were not a problem, Davey frequently hid candy and other forbidden sweets in his room, despite his parents being very strict about his diet and rarely bringing sweet foods home. In the past year Davey had become increasingly oppositional, and their paediatrician suggested therapy. During family assessment Mandy and Phil reported more frequent disagreements, mainly about Davey’s diabetes management, as well as increasing marital distress. Davey’s sister, Carrie, often complained she should not be penalised in her food choices just because her brother had a problem. She was angry and withdrawn when informed she would have pizza without any cake or icecream for the family celebration of her tenth birthday. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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The therapist noticed during the family play observation that Carrie played quietly in one corner of the playroom while the parents focused on Davey and frequently completed tasks for him when he became frustrated. During the discussion Mandy and Phil said these patterns were typical and were concerned Davey required inordinate amounts of their time and they were ‘probably not giving Carrie her due’. The therapist recommended Filial Therapy. Mandy and Phil learned the play session skills quickly and without a problem. During the supervised play session phase, Phil held the first play session with Davey. Davey selected the doctor doll and began throwing it around the room, eventually pretending to hit and kick it. Davey called the magic wand a ‘giant needle’ and began giving painful injections to the doctor. It was difficult for Phil to simply reflect this behaviour, but he was able to tolerate it and comment exceptionally well on Davey’s feelings: ‘You’re really mad at that doctor. You’re punishing him. Now he has to get a GIANT shot. The doctor is crying now. He hates that.’ During her play session with Mandy, Carrie at first seemed uninterested. Later she asked her mother to play ‘hangman’ with her on the whiteboard. During the discussion both parents expressed surprise and alarm about Davey’s aggressive play. Through empathic listening the therapist eventually helped them to understand Davey’s feelings were quite normal, that he may have unresolved feelings about doctors, his diabetes and a loss of control of his life circumstance. The therapist praised Phil’s ability to reflect these feelings, while Mandy expressed concerns about Carrie’s aloofness and apparent disinterest. The therapist urged the parents to give the process time. Both parents continued to improve their play session skills through the use of postplay feedback. Their understanding of their children’s feelings also improved from session to session. Davey continued to play aggressive medical themes before becoming a ‘world famous doctor’ who admonished his patients about what they could and could not eat. Mandy and Phil were able to see Davey’s distress more clearly, and although still worried about his diabetic control they realised they needed to become a little more relaxed with family meals. Carrie’s play evolved over time. She enjoyed dress-up play and directed scenes in which she was glamorous and ‘famous’, and her parents (during alternate sessions) had to play the role of her adoring public. In discussions with the therapist, Mandy and Phil began to see how their concerns about Davey had drawn their attention away from Carrie. In addition to weekly play sessions, they made plans to inquire about Carrie’s school days, friends and interests more frequently and to occasionally take her for a special outing. After five supervised sessions, the family began their home play sessions. They noticed Davey’s oppositional behaviours decreasing with each play session. As Davey took more control of the play and his parents offered him more choices on a daily basis, he no longer needed to control the household. Carrie also seemed more engaged, laughing freely as her parents dressed and played different roles based on her requests. Mandy and Phil reported that Carrie was more relaxed at home and took more interest in family activities. As the therapy entered the final stage of generalisation and discharge, Mandy and Phil said they noticed less strain, both as individuals and as a couple. They had been so worried about the diabetes they had not been enjoying each other or their

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children. Filial therapy gave them tools for co-parenting under the difficult conditions of family chronic illness, while adding an element of playfulness back into their lives. As the family enjoyed their time together, the medical management became more routine and less intrusive in their lives. They continued filial play sessions after therapy finished and reported during a phone call 6 months later they were all still doing well. Filial therapy brought the family together in a more relaxed way, helped the parents offer more warmth and support to both children, aided the family in a more flexible approach to diabetes management and allowed them to enjoy life together once again.

Application to Diverse Presenting Problems

A key strength of Filial Therapy is its use of nondirective parent–child play to target a range of child emotional and behavioural problems, parenting difficulties and problematic patterns of family interaction. Like other family therapy approaches, it can be integrated with various interventions — for example, psychiatric consultation and crisis intervention, marital therapy when problems extend beyond the coparenting relationship, or individual therapy when a parent suffers from mental health issues like depression (VanFleet, 2005). It can also be used for difficult challenges like integrating blended families. Conclusion

Filial therapy is a strength-based, relationship-focused intervention that utilises parent–child play to directly intervene in the parent–child and co-parenting subsystems in order to treat a variety of child, parent, and family relationship problems. Parents develop skills that foster their children’s’ development, establish parent– child relationship patterns and increase role flexibility and unity in co-parenting. Filial therapy is consistent with the values and principles of family therapy and its structured and straightforward approach is ideal for therapists inexperienced in treating young children in family therapy. References Axline, V.M. (1947). Play therapy. Cambridge, MA: Houghton-Mifflin. Barber, B.K., Stolz, H.E., & Olsen, J.A. (2005). Parental support, psychological control, and behavioral control: Assessing relevance across time, culture, and method: I. Introduction. Monographs of the Society for Research in Child Development, 70(4), 1–13. Barnett, L.A. (1990). Developmental benefits of play for children. Journal of Leisure Research, 22, 138–153. Baumrind, D., Larzelere, R.E., & Owens, E.B. (2010). Effects of preschool parents’ power assertive patterns and practices on adolescent development. Parenting Science and Practice, 10, 157–201. Bavin-Hoffman, R., Jennings, G., & Landreth, G. (1996). International Journal of Play Therapy, 5, 45–58. Beckloff, D. (1997). Filial therapy with children with spectrum pervasive developmental disorders. Dissertation Abstracts International: Section B. Sciences and Engineering, 58(11), 6224B. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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Belsky, J., & Fearon, R.M.P. (2009). Precursors of attachment theory. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed.; pp. 295 316). New York: Guilford. Berlin, L.J., Cassidy, J., & Appleyard, K. (2008). The influence of early attachments on other relationships. In J. Cassidy & P.R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 333–347). New York: Guilford Press. Bratton, S., & Landreth, G. (1995). Filial therapy with single parents: Effects on parental acceptance, empathy, and stress. International Journal of Play Therapy, 4, 61–80. Cavell, T.A., & Elledge, L.C. (2004). Working with parents of aggressive, school age children. In J. Briesmeister & C. Schaefer (Eds.), Handbook of parenting training: Helping parents prevent and solve problem behaviors (3rd ed.; pp. 379–423). Hoboken, NJ: Wiley & Sons. Corsaro, W.A. (1988). Peer culture in the preschool. Theory into Practice, 27, 19–24. Costas, M., & Landreth, G. (1999). Filial therapy with nonoffending parents of children who have been sexually abused. International Journal of Play Therapy, 8, 43–66. Davidson, J.I.F. (1998). Language and play: Natural partners. In E.P. Fromberg & D. Bergen (Eds.), Play from birth to twelve and beyond: Contexts, perspectives and meaning (pp. 175–183). New York: Garland. Epston, D., Freeman, J., & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton Professional Books. Evans, F.B. (1996). Harry Stack Sullivan: Interpersonal theory and psychotherapy. New York: Routledge. Ginsberg, B.G., Stutman, S.S., & Hummel, J. (1978). Group filial therapy. Social Work, 23, 154–156. Ginsburg, K.R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119, 182–191. Glass, N.M. (1986). Parents as therapeutic agents: A study of the effects of filial therapy. Dissertation Abstracts International: Section B: Sciences and Engineering, 47(7-A), 2457. Glover, G.J., & Landreth, G.L. (2000). Filial therapy with Native Americans on the Flathead Reservation. International Journal of Play Therapy, 9, 57–80. Gottman, J.M., Katz, L.F., & Hooven, C. (1996). Parent meta-emotion philosophy and the emotional life of families: Theoretical models and preliminary data. Journal of Family Psychology, 10, 243–268. Grskovic, J.A., & Goetze, H. (2008). Short-term filial therapy with German mothers: Findings from a controlled study. International Journal of Play Therapy, 19, 39–51. Guerney, B. (1964). Filial therapy: Description and rationale. Journal of Consulting Psychology, 28, 303–310. Guerney, L.F., & Gavigan, M.A. (1981). Parent acceptance and foster parents. Journal of Clinical Child Psychology, 10, 27–32. Harris, Z.L., & Landreth, G.L. (1997). Filial therapy with incarcerated mothers: A five week model. International Journal of Play Therapy, 6, 53–73. Lieberman, A.F., & Van Horn, P. (2008). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: Guilford Press. McNeil, C.B., & Hembree-Kigin, T.L. (Eds.). (2010). Parent-child interaction therapy (2nd ed.). New York: Springer Business. Jang, M. (2000). Effectiveness of filial therapy for Korean parents. International Journal of Play Therapy, 9, 21–38.

156



Johnson, L. (1995). Filial therapy: A bridge between individual child therapy and family therapy. Journal of Family Psychotherapy, 6, 55–70. Johnson, L. & Thomas, V. (1999). Influences on the inclusion of children in family therapy. Journal of Marital and Family Therapy, 25, 117–123. Johnson-Clark, K. (1996). The effect of filial therapy on child conduct behavior problems and the quality of the parent-child relationship. Dissertation Abstracts International: Section B. Sciences and Engineering, 57(4), 2868B. Kale, A.L., & Landreth, G.L. (1999). Filial therapy with parents of children experiencing learning difficulties. International Journal of Play Therapy, 8, 35–56. Kellam, T.L.T. (2001). Filial therapy: A family systems intervention. Family Therapy, 28, 63– 72. Kidron, M. & Landreth, G. (2010). Intensive child parent relationship therapy with Israeli parents in Israel. International Journal of Play Therapy, 19, 64–78. Kindred, R. G. (2003). A qualitative study of marriage and family therapists’ knowledge, attitudes, and behaviors about child inclusive family therapy. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(8-B), 3922. Korner, S. & Brown, G. (1990). Exclusion of children from family psychotherapy: Family therapist’s beliefs and practices. Journal of Family Psychology, 4, 420–430. Krafft, K.C., & Berk, L.E. (1998). Private speech in two preschools: Significance of open ended activities and make-believe play for verbal self-regulation. Early Childhood Research Quarterly, 13, 637–658. Lahti, S. (1992). An ethnographic study of the filial therapy process. Dissertation Abstracts International: Section B: The Sciences and Engineering, 53(8-A), 2691. Landreth, G.L. (1991). Play therapy: the art of the relationship. Levitown, PA: Accelerated Development. Landreth, G.L., & Bratton, S.C. (2006). Child parent relationship therapy (CPRT): A 10session filial therapy model. New York: Routledge. Landreth, G.L., & Lobaugh, A.F. (1998). Filial therapy with incarcerated fathers: Effects on parental acceptance of child, parental stress, and child adjustment. Journal of Counseling and Development, 76, 157–165. Leary, T. (1957). Interpersonal diagnosis of personality. New York: The Ronald Press. Lojkasek, M., Muir, E., & Cohen, N.J. (2008). Watch, wait, and wonder: Infants as agents of change in a play-based approach to mother-infant psychotherapy. In C.E. Schaefer, S. Kelly Zion, J. McCormick & A. Ohnogi (Eds.), Play therapy for very young children (pp. 279–305). Lanham, MD: Jason Aronson. Lund, L.K., Zimmerman, T.S., & Haddock, S.A. (2002). The theory, structure, and techniques for the inclusion of children in family therapy: A literature review. Journal of Marital and Family Therapy, 28, 445–454. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press. Napier, A., & Whitaker, C. (1978). The family crucible: The intense experience of family therapy. New York: Harper and Row. Newman, L.S. (1990). Intentional and unintentional memory in young children: Remembering vs. playing. Journal of Experimental Child Psychology, 50, 243–258. Nichols, M.P. (2009). Family therapy: Concepts and methods (9th ed.). Boston, MA: Pearson. Oxman, L.K. (1972). The effectiveness of filial therapy: A controlled study. Doctoral dissertation, Rutgers University, The State University of New Jersey. Dissertation Abstracts International: Section B: The Sciences and Engineering, 32(8-A), 6656. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

157


Powers, S. (2009). This issue and why it matters. Zero to Three, 30, 3. Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001). The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10, 85–108. Satir, V.M. (1972). Peoplemaking. Palo Alto, CA: Science and Behavior Books. Shonkoff, J.P., & Phillips, D.A. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press. Singer, D.G., Singer, J.L., Plaskon, S.L., & Schweder, A.E. (2003). A role for play in the preschool curriculum. In S. Olfman (Ed.), All work and no play: How educational reforms are harming our preschoolers (pp. 59–101). Westport, CT: Greenwood Publishing Group. Smith, N., & Landreth, G.L. (2003). Intensive filial therapy with child witnesses of domestic violence: A comparison with individual and sibling group play therapy. International Journal of Play Therapy, 12, 67–88. Sori, C.F. (2006). Filial therapy: An interview with Rise VanFleet. In C.F. Sori (Ed.), Engaging children in family therapy: Creative approaches to integrating theory and research in clinical practice (pp. 91–116). New York: Routledge. Stover, L., & Guerney, B.G., (1967). The efficacy of training procedures for mothers in filial therapy. Psychotherapy: Theory, Research and Practice, 4, 110–115. Sullivan, H.S. (1953). The interpersonal theory of psychiatry. New York: W.W.. Tew, K., Landreth, G.L., & Joiner, K.D. (2002). Filial therapy with parents of chronically ill children. International Journal of Play Therapy, 11, 79–100. Tsao, L. (2002). How much do we know about the importance of play in child development? Childhood Education, 78, 230–233. VanFleet, R. (1994). Filial therapy: Strengthening parent-child relationships through play. Sarasota, FL: Professional Resource Press. VanFleet, R. (2005). Filial therapy: Strengthening parent-child relationships through play (2nd ed.). Sarasota, FL: Professional Resource Press. VanFleet, R. (2006). Introduction to Filial Therapy [DVD]. Boiling Springs, PA: Play Therapy Press. VanFleet, R., & Guerney, L. (2003). Casebook of filial therapy. Boiling Springs, PA: Play Therapy Press. VanFleet, R., Ryan, S.D., & Smith, S.K. (2005). Filial therapy: A critical review. In L.A. Reddy, T.M. Files-Hall, & C.E. Schaefer (Eds.), Empirically-based play interventions for children (pp. 241–264). Washington, DC: American Psychological Association. Wickstrom, A. (2009). The process of systemic change in filial therapy: A phenomenological study of parent experience. Contemporary Family Therapy, 31, 193–208. Winek, J., Johnson, L., Krepps, J., Lambert-Shute, J., Shaw, L., & Wiley, K. (2003). Discover the moments of movement in filial therapy: A single case qualitative study. International Journal of Play Therapy, 12, 89–104. Yuen, T., Landreth, G., & Baggerly, J. (2002). Filial therapy with immigrant Chinese families. International Journal of Play Therapy, 11, 63–90.

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