Integration of Structured Expressive Activities Within a Humanistic Group Play Therapy Format for...

PRACTICE

Integration of Structured ExpressiveActivities Within a Humanistic Group

Play Therapy Format for Preadolescents

Sue C. BrattonUniversity of North Texas

Peggy L. CeballosUniversity of North Carolina, Charlotte

Kelly Webb FerebeePrivate Practice

The integration of expressive activities in play groups with preadolescentsencourages them to reach more deeply into their own resources, enabling them tohandle future challenges more effectively. Developmental and therapeutic ratio-nale, along with research support, is given for the integration of creative activitiesinto a humanistic play group format for this population. Developmentally respon-sive activities that foster self-expression and interaction are described in detail toallow practitioners to incorporate them into their own work with this population.

Keywords: activity group counseling; expressive arts; play therapy;preadolescents

Preadolescence is marked by significant developmental changes thatcan make this a time of ambiguity and tumult for this age group.Increases in youth violence underscore the consequences of ignoringthe social-emotional needs of preteens, particularly those who viewthemselves as different and not fitting in with their peers (Packman& Bratton, 2003). The need to identify culturally and developmentallyresponsive interventions for children and adolescents has beenwell-documented in several recent reports (New Freedom Commissionon Mental Health, 2003; U.S. Public Health Service, 2000). Due to the

Sue C. Bratton, Ph.D., LPC, RPT-S, is an associate professor in the Department ofCounseling and Higher Education and director of the Center for Play Therapy, at theUniversity of North Texas. Peggy L. Ceballos, Ph.D., is an assistant professor at theUniversity of North Carolina at Charlotte. Kelly Webb Ferebee, Ph.D., LPC, NCC,RPT-S, is in private practice in Coppell, Texas. Correspondence concerning this articleshould be addressed to Sue C. Bratton, Department of Counseling and Higher Educa-tion, University of North Texas, 1155 Union Circle #310829, Denton, TX 76203-5017.E-mail: [email protected]

THE JOURNAL FOR SPECIALISTS IN GROUP WORK, Vol. 34 No. 3, September 2009, 251–275

DOI: 10.1080/01933920903033487

# 2009 ASGW

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unique developmental needs of preadolescents, researchers in thefield advocate for counseling interventions that are responsive to thisage group’s cognitive and emotional maturity (Akos & Martin, 2003;Flahive & Ray, 2007; Gerrity & DeLucia-Waack, 2007; Kulic, Horne, &Dagley, 2004; Milson, Akos, & Thompson, 2004).

While play therapy has gained recognition as a viable and develop-mentally responsive modality for a range of emotional and behavioralproblems in children (Bratton, Ray, Rhine, & Jones, 2005), preadoles-cent children may view conventional play therapy as juvenile (Ginott,1994). Slavson and Redl (1944) were among the first to advocate forproviding troubled preteens with a therapeutic setting and activitiestailored to their maturational needs. The incorporation of a varietyof expressive media within a play therapy group format offers preado-lescents a developmentally responsive means to express and under-stand self and others through the making and sharing of theircreations (Knill, Levine, & Levine, 2005; Landreth, 2002, Shen & Arm-strong, 2008). Thus, contemporary researchers have focused theirattention on the use of creative and expressive media in group workwith this population (Draper, Ritter, & Willingham, 2003; Finn, 2003;Flahive & Ray, 2007; Packman & Bratton, 2003; Paone, Packman, Mad-dux, & Rothman, 2008; Shen, 2007; Veach & Gladding, 2007).

A humanistic approach to conducting preadolescent groups is basedon ‘‘respect for the client’s subjective experience and a trust in thecapacity of the client to make positive and constructive consciouschoices’’ (Corey, 2005, p. 166). Bratton and Ray (2002) defined huma-nistic play therapy as a belief in a) the child’s natural striving towardgrowth, mastery and maturity; b) the child’s capacity for self-direction,self-regulation, self-responsibility, and socialization, and c) theimportance of the therapeutic relationship in facilitating the child’sgrowth. Shen and Armstrong (2008) further described the therapeuticrelationship from a humanistic perspective as based on the coreconditions proposed in person-centered theory (C. Rogers, 1942). Pro-viding clients with a non-judgmental accepting attitude has beenrecognized as culturally responsive by meeting clients where theyare, with no preconceived notions (Bailey & Bradbury-Bailey, 2007;Cohran, 1996; Constantine, 2001; Strupp, 1993). Additionally, theuse of expressive activities in group work has been found to becross-culturally effective (Flahive & Ray, 2007; Lee, 2007; Shen &Armstrong), supporting the utility of this modality with pre-adolescents from diverse ethnic and cultural groups.

This article explores developmental rationale and empirical supportfor the integration of structured expressive activities within a huma-nistic play therapy group approach with preadolescents. Group mem-ber screening, group structure and format, materials and activities,

252 THE JOURNAL FOR SPECIALISTS IN GROUP WORK /September 2009

and the group leader’s role are discussed. Finally, a brief case exampleprovides the reader with a glimpse into the process and providespractical examples of activities that practitioners can incorporate inschool and community settings.

DEVELOPMENTAL NEEDS OF PREADOLESCENTS

There is ambiguity in the literature regarding an exact age rangefor preadolescents. Most authors define this period of development asencompassing the ages of 9 to 13 years (Bratton & Ferebee, 1999;Oesterreich, 1995; Packman & Bratton, 2003; Packman & Solt,2004); however, Sprenger (2008) proposed that preparation for prea-dolescence can start as early as age 8 when (a) the child’s brain pre-pares for higher levels of planning and thinking, and (b) the childbegins to articulate feelings and show a higher concern toward fittingin with peers. According to Erikson’s (1982) conceptualization ofpsychosocial stages of development, preadolescents’ task during thisperiod is industry versus inferiority, a time marked by a need to becompetent and productive in mastering new skills. Toward the end ofthe preadolescent period, the psychosocial task of identity versusidentity confusion (Erikson) becomes all-important as preteens con-cern themselves with defining ‘‘self’’ in relation to peers. Hamachek(1988) explained that in order to successfully define a self-conceptduring this stage, preadolescents need to develop self-acceptance,as well as form positive close relationships with others without losinga sense of self. The formation of intimate friendships during thepreadolescent years influences later stages of development and isviewed as predictive of adults’ ability to engage in intimate relation-ships (Bratton & Ferebee, 1999; Sullivan, 1953). As preteens becomemore influenced by opinions of peers and start comparing themselvesto others, their developing sense of self is impacted (Berk, 2003).Thus, the use of group work with this population has received muchattention in the literature (Akos, Hamm, Mack, & Dunaway, 2007;Gerrity & DeLucia-Waack, 2007; Kulic et al., 2004; Milson et al.,2004).

Akos et al. (2007) provided a detailed explanation of how groupprocess is beneficial to preadolescents. The authors stated: (a) throughgroup cohesion, preadolescents fulfill the need to be accepted andvalued; (b) universality helps preadolescents realize that their feelingsare shared; and (c) the group format allows members to socialize, learnthrough interpersonal relationships, and imitate behaviors. Theauthors further emphasized how groups can help preadolescentsbuild social competence.

Bratton et al./EXPRESSIVE ACTIVITIES WITH PREADOLESCENT GROUPS 253

According to Piaget (1977), cognitively, preadolescents operate atthe concrete operational stage and are just beginning the process ofdeveloping abstract thought. Thus, interventions, such as play=activity therapy that provide activities that help bridge the gapbetween concrete and abstract, would seem most appropriate(Landreth, 2002). As mentioned earlier, preteens’ psychosocial pushtowards ‘‘industry’’ means that they not only enjoy experimenting withnew ideas and behaviors, they also develop a sense of competence byengaging in creating and producing things (Hamachek, 1988). Thus,the incorporation of structured expressive activities into group workwith preadolescents presents a developmentally responsive means tomeet the unique and varied maturational needs of this age group.

RATIONALE FOR EXPRESSIVE MEDIA

According to Gladding (2005) the use of expressive arts can bebeneficial as a therapeutic intervention because it offers a non-threatening symbolic means of exploration to engage in self-awareness. Malchiodi (2005) stated that expressive modalities engageclients in self-expression, active participation, imagination, andmind-body connection. The author further emphasized that expressivemedia stimulate all the senses: visual, auditory, kinesthetic, and tac-tile; thus, eliciting expression of thoughts and feelings the individualmay be unaware of or have difficulty accessing. Expressive modalitiesallow users to access the right hemisphere of the brain, which enablesaccess to emotions, experiences, and creativity (Lahad, 2000). Expres-sive media provide opportunities for creativity to emerge through theuse of drawing, painting, sculpting, music, movement, writing, photo-therapy, collages, sandplay, imagery, fantasy, drama, improvisation,puppetry, and woodworking. Through these various creative andexpressive modalities the individual has the opportunity to takeelements of his or her own personality and restructure them intonew forms. The individual becomes the author of both the processand the product of creativity (Fleshman & Fryrear, 1981).

Appropriately structured creative art activities provide preteenswith opportunities to change perceptions about self, others, and theworld as they try out new roles and solutions within the safety ofthe group. Rubin (1984b) emphasized the therapeutic value of expres-sive media for preteens, who naturally use art materials, play andactivity to express themselves symbolically:

In art or play the child may . . . fulfill symbolically both positive wishesand negative impulses, without fear of real consequences. He can learn


to control the real world by experimenting with active mastery of tools,media, and ideas and feelings expressed in the process. He can gainsymbolic access to and relive past traumas, and can rehearse andpractice for the future . . . can learn to be in charge in a symbolic mode,and thus come to feel competent to master reality. The child cannot learnto control and organize himself, if the structure does not ultimately comefrom within. (Rubin, 1984a, p. 29)

Furthermore, using expressive activities facilitates the process ofcreative self-development that can continue long after termination,providing preadolescents with inner resources that can draw on tohandle future challenges more effectively (Rubin, 1984b).

EMPIRICAL SUPPORT FOR USE OF EXPRESSIVE MEDIAIN PREADOLESCENT PLAY THERAPY GROUPS

A review of the literature revealed a scarcity of research on theuse of expressive media in humanistic group work with preadoles-cents. Nevertheless, the handful of experimental studies identifiedwere well-designed, controlled studies—all of which were conductedin the past five years in school settings. Utilizing a randomized con-trolled design, Packman and Bratton (2003) examined the effects ofusing a variety of structured and unstructured expressive activities(e.g., collage, drawing, clay, sandtray, and puppetry) within a huma-nistic play therapy group format with 29 preadolescents diagnosedwith learning difficulties. Preadolescents receiving 12 weekly groupplay therapy sessions demonstrated statistically significant reduc-tions, from pre- to posttesting, in total problem and internalizing pro-blem behaviors compared to the no treatment control. Resultsshowed that play therapy demonstrated a large treatment effect ontotal and internalized problem behaviors and a moderate treatmenteffect on externalized problems. Post hoc analysis of the anxietyand depression subscales revealed large treatment effects for thehumanistic play group. Using a similar research design, Paoneet al. (2008), followed the humanistic group play therapy protocolused in Packman and Bratton’s research. The researchers studiedthe effects of using structured expressive activities within a groupplay=activity therapy format on the moral reasoning of 61 at-risk9th graders. Findings showed that students receiving 10 sessionsof the group play intervention showed a statistically significantdifference over time compared to the talk therapy group.

In another randomized, controlled study, Flahive and Ray (2007)investigated the effectiveness of a 10 week play-based counseling


group utilizing sandtray media with 56 preadolescents identified byparents or teachers as exhibiting behavioral problems. The interven-tion included an unstructured time for group members to make theirsandtray scenes and a more structured time for processing theircreations. Results from teacher report revealed statistically significantdifferences in total, externalizing, and internalizing problems betweenthe sandtray group and control group over time, while parentsreported statistically significant differences only on externalizing pro-blems. Interestingly, the control group demonstrated a worsening ofexternalizing, internalizing, and total problem behaviors over the10 week treatment period, while the experimental group showed smallimprovements or stayed the same. The authors concluded thatthe intervention was effective in preventing participants from experi-encing an increase in behavioral problems. Recently, Shen andArmstrong (2008) conducted a similar study with 37 seventh gradegirls. Participants were randomly assigned to a control and an experi-mental group to investigate the effectiveness of group sandtray inenhancing participants’ self-esteem. Results revealed a statisticallysignificant improvement in self-esteem for the treatment group whencompared to the control group over time.

Shen (2007) compared the effects of using Gestalt expressive playactivities (Oaklander, 1988) versus a cognitive-verbal approach anda no- treatment control group on 73 Taiwanese seventh and eighthgraders. Students were randomly assigned to the two experimentaltreatment groups. The control group was formed from children on await list. Results revealed statistically significant improvement inboth treatment groups’ overall behavioral and emotional strengths,as reported by teachers, with the Gestalt expressive arts groupintervention accounting for the greatest gain in target behaviors.

Research on the use of structured expressive activities within ahumanistic play therapy group format provides empirical support forits use with practitioners, particularly in school settings. However,in order to establish this approach as an evidence-based practice,additional research replicating these studies with larger sample sizesacross multiple settings is needed.

SCREENING AND ASSESSMENT OF GROUP MEMBERS

Screening and purposeful selection of group members is essential informing preadolescent groups to maximize their therapeutic potential.Heterogeneous grouping is recommended, with a goal of selecting groupmembers whose coping styles complement each other (Packman &Bratton, 2003). As a general rule for preadolescent children, group


members should be of the same gender and not more than one yearapart in developmental age (Kulic, Dagley, & Horne, 2001; Sullivan,1953). A primary consideration when screening potential group mem-bers is their level of interest in and capacity to form peer relationships(Ginott, 1975). Preadolescents who experience a high level of socialanxiety and who show great difficulty connecting with others wouldbenefit from individual treatment prior to starting group. Similarly,preadolescents who have experienced a traumatic event, such as sexualabuse or multiple abandonments will benefit from individual treatmentto reinforce self-concept and develop an interest in establishing relation-ships prior to participating in a group (Bratton & Ferebee, 1999).

Practitioners must be careful to assess group members’ backgroundhistory as well as presenting issue to minimize the possibility of expos-ing group members to inappropriate behaviors and information.Because school settings have different guidelines than community set-tings, the process of forming play therapy groups vary. Greenberg(2003) offered specific considerations for conducting groups in schoolsettings, such as the need to gain support from administrators and tea-chers, and issues around confidentiality. Although the way in which apractitioner forms groups can vary between community and school set-tings, in both situations we recommend the use of a screening process.

In order to gather information that can help identify a potentialgroup member’s readiness for group, the authors recommend as partof screening and selection of group members an initial parentinterview and at least one individual session with each prospectivemember. Formal and informal screening measures can be utilizedto aid in the selection process. The parent interview has the followingpurposes: (a) explaining the details about the group; (b) gatheringrelevant information; and (c) obtaining consent forms prior to screen-ing. This meeting gives practitioners an opportunity to establish acollaborative relationship with parents, learn about cultural factorssuch as socio-economic status and parental values that form part ofthe client’s worldview, gather relevant history such as past traumaticevents that can affect a member’s readiness to be in group, andobtain assessments and parental consent.

Standardized measurements such as the Child Behavior Checklist(CBCL) and the Behavioral Assessment System for Children (BASC)can be administered to individual group members as well as parentsand teachers to screen for severity of behavioral concern and to iden-tify coping style. Assessment results can assist the leader in selectinggroup members whose behaviors and coping styles complement eachother Additionally, the same instruments can be used to monitorprogress throughout the counseling process by gathering data frommultiple sources (preadolescent, parent and teacher). We recommend


establishing regular intervals, e.g., every 8 weeks, for individuallyassessing group members’ improvement to determine effectiveness ofthe intervention and members’ readiness for termination. Practi-tioners can also informally assess each potential member’s readinessfor group by structuring an activity that requires social interaction,such as with a small group of peers in school settings or with familymembers in a community agency setting. During this screening,practitioners should pay particular attention to potential group mem-ber’s desire and ability to interact with others, and note expression ofinformation and=or behaviors that would be inappropriate for a groupsetting. For example, as stated previously, a preadolescent who actssexually or is overly aggressive, first needs individual counseling; thischild is not appropriate for group as these behaviors and=or informa-tion can be harmful to the other children. Additionally, individualsessions with potential group members can provide additional screen-ing information and allow the counselor to form a connection withindividual group members prior to the beginning of group.

STRUCTURE AND FORMAT

Gil (1994) stated that play therapists often rigidly adhere to eithernon-directive or a structured approach. Instead, we suggest an inte-gration of unstructured and planned activities in a humanisticapproach with groups of preadolescents. We have found both typesof activities useful and necessary for working with this age group inmeeting their unique needs. A well-designed space provides manyopportunities for spontaneous self-directed creative expression; how-ever, preadolescent children are often self-conscious and hesitant tointeract with other group members. Structured activities can reduceanxiety and encourage group members to begin to interact with eachother more quickly. In addition, a structured activity is an effectivemeans of introducing an expressive media that group members maybe unfamiliar with, providing them with instructions and ideas abouthow to use it. Structured activities can be planned for assessment pur-poses, to facilitate individual self-expression, or to facilitate groupdynamics. The balance between use of structured versus unstructuredactivities is based on the clinician’s understanding of the unique needsof group members and the stage of group development. As preadoles-cents begin to feel safe in the group, they start assuming more respon-sibility and require less structure. Thus, practitioners would typicallyuse more structured activities during the first group meetings andmove toward unstructured time as members start to assume moreresponsibility and leadership within the group.


Leadership skills can be facilitated through group membersalternating being in charge of choosing and directing the activity forthe group. Preadolescents need opportunities to explore, create, negoti-ate, problem solve, resolve conflicts, and explore alternative behaviorswithin the safety of a therapeutic group. Thus, the intrinsic value ofproviding unstructured opportunities for group members to interact,as well as presenting structured activities, cannot be over-emphasized.

Preadolescent groups are similar to Yalom’s description of groups(1995). The goal is to facilitate opportunities within the group thatlead preadolescents to learn about others and themselves throughgroup interactions. As preadolescents learn to assume responsibilityin interpersonal relationships within the group, they are able to trans-fer such learning to interactions outside of the group (Landreth, 2002).However, given the cognitive and emotional developmental level ofpreadolescents, differences exist between adult groups and groupsdesigned for this age group. Greenberg (2003) explained that adultgroups are more cohesive and focused. Additionally, the author statedthat adults are more open to express their emotions and confront eachother during group than children, preadolescents, and adolescents.Thus, group leaders should not expect to see therapeutic factorsdevelop in the same way as in an adult group. For example, cohesionis not an essential part of group therapy with this age group(Landreth, 2002). Additionally, preadolescents will not process expres-sive activities=creations as long or as in depth as adult clients. Theirabstract thought process is not fully developed, and they are less likelyto express their thoughts and emotions as extensively as adults.

The setting and materials should be inviting and stimulate bothself-expression and interaction with others. Preadolescents often havea need to expend excess energy, thus require space to move about. Anoptimal setting provides space for projects to be worked on as a group,as well as providing space for individuals to work in solitude. A roundvinyl tablecloth placed on the floor can serve as a workspace for arts=crafts and serve as a place for the group to gather around to processgroup activities. Expressive activities and materials should be selectedto provide a wide variety of choices for group members and for thefollowing purposes: (a) to stimulate peer interaction; (b) to promotecreative expression; (c) to encourage exploration of feelings, thoughts,and experiences; (d) to facilitate the acting-out of real life concerns;and (e) to encourage the development of effective problem-solving=coping strategies. At a minimum, preadolescents should be providedwith a variety of expressive arts=craft media and a selection of puppetsand sand tray miniatures that can represent important people andreal-life events, as well as allow for symbolic expression. Media shouldbe culturally responsive by including materials representative of


diverse cultural groups. For example, sandtray miniatures shouldhave people from different ethnic backgrounds and objects, such asmusical instruments, can be representative of various cultures. Smithand Smith (1999) included a comprehensive list of expressive materi-als, activities, and equipment for a fully-equipped space for preadoles-cent groups. For smaller spaces, or for when facilities do not allow for adedicated space, Bratton, Ceballos, and Sheely (2008) offered adetailed description of materials for a mobile expressive art cart.

Based on their research experience, Packman and Bratton (2003)provided a detailed description of a 50 minute group play therapy for-mat for adolescents in a school setting and suggested guidelines forincorporating structured activities, unstructured, group member-ledactivities and a group snack time for closure. Smith and Smith(1999) provide a similar group activity therapy format for use in com-munity settings. Draper, Ritter, and Willingham (2003) described aformat used to conduct sandtray groups with adolescents in school set-tings, including a description of counseling skills and techniques thatcan be applied when conducting group work with preadolescents,regardless of expressive media used.

Selection and Use of Expressive Activities

Selection of expressive media and activities should rely on consid-eration of groupmembers’ needs, readiness and preferences. Expres-sive media can have impact individuals differently and may elicitthoughts and feelings that all group members might not be ready toshare with others. Landgarten (1987) first proposed a relationshipbetween art mediums and clients’ level of control over their creations.She explained that the type of media used impacts clients’ level ofself-expression, defensiveness, and affective state. Figure 1 providesa guide for selecting expressive media that was based on Landgarten’soriginal conception. Bratton et al. (2008) originally adapted Landgar-ten’s work based on their experiences in facilitating creative=expressive activities in supervision groups. For the purpose of thisarticle, we have refined it further for consideration in choosing mediafor preadolescent groups. In general, the higher the expressive med-ium is found on the list the more in control the client feels over theexperience, including control over his=her emotions and thoughts.

Structured expressive activities can be selected for the purpose ofindividual expression or collaborative work within the group. Indivi-dual work refers to activities that require each group member to workindependently for the purpose of self-expression and sharing creationswith each other; whereas collaborative work refers to group membersworking together on an activity for the purpose of enhancing


interpersonal communication, practicing new ways of interacting,developing social skills, and problem-solving. The more individualizedactivities should be used when group members are becomingacquainted and are being asked to share about themselves. Collabora-tive group work is best used after group members feel a greater senseof safety and connectedness. Structured activities also provide abeneficial means to bring closure to the process of termination.

GROUP LEADER’S ROLE

From a humanistic perspective the role of the group leader is tofacilitate growth and healing by providing empathy, unconditionalacceptance, and freedom to make choices, while maintaining a safecontrolled environment (Landreth, 2002). The leader is not focusedon the behavior to be changed, but on trusting the inner self-actualization force of group members that can only be freed once thecore conditions are experienced (C. Rogers, 1942). Thus, these condi-tions should be present at all times and expressed equally whenprocessing structured activities as well as unstructured group time.

During unstructured time, the humanistic group leader uses skills tofacilitate group process including reflection of feelings and content, as

Figure 1 Expressive media.


well as responses designed to facilitate problem-solving, cooperation, andconnections between group members. It is especially important to reflectnon-verbal behaviors and interactions that occur among group membersin order to encourage awareness of self and others and facilitate move-ment towardsmore positive social behaviors. Often, themostmeaningfulinteractions between group members occur during unstructuredactivities. The case example following this section provides examples ofhow the leader facilitates group process during unstructured time.

When incorporating structured expressive activities, the group lea-der acts as a guide and witness to the process while preadolescentsengage in the creation of their art work. The group leader is an activeobserver attending to group members’ body language, interactionsbetween members, and similarities=differences that emerge as theymake their creation. Once group members have finished their crea-tions, the group leader takes on the role of facilitator by verbally pro-cessing the activity. In order to strengthen safety within the group, itis important for the group leader to respect group members’ level ofreadiness to engage in sharing their personal creations with eachother. For this reason, it is highly recommended for clinicians to haveprior personal experience with various expressive mediums toenhance their sensitivity to this process.

When processing expressive activities with this population, it isimportant for facilitators to consider group members’ capacity forabstract thought. Adapted from Bratton et al. (2008) and drawing onthe work of Violet Oaklander (1988), Figure 2 offers four levels of

Figure 2 Levels of processing expressive activities=creations withpreadolescents.


processing as guidelines for encouraging preadolescents to reflect ontheir creations. The levels are generally organized based on psychologi-cal readiness and cognitive development. Levels one and two are usedmost in the initial stages of preadolescent groups, because they offergroup members the most control over personal disclosure and the mostconcrete means of expression. Level four processing requires a higherlevel of abstraction and emotional readiness, and thus should be usedwith clinical discretion. The reflections=questions offered as examplesfor each level can be adapted to processing individual or groupcreations, and are used along with group counseling responses typicallyused to foster awareness, interaction, and connection among groupmembers.

CASE EXAMPLE

The following example is from a preadolescent play therapy groupfacilitated by the first author in a school setting. Identifiable informa-tion has been changed to protect participants’ anonymity. The groupconsisted of three 11-year-old girls whose parents had recentlydivorced. The girls were referred by their mothers for behavioralconcerns that they perceived had escalated since the divorce. Mariawas referred for extreme shyness and withdrawal from peers;Shaunda was referred for aggressive behavior; and Kim was referredbecause her mom was concerned about her perfectionistic tendenciesand over-responsibility for her mom and two younger brothers. In allthree cases, the girls rarely saw their fathers. Brief examples of howgroup process was facilitated during structured and unstructuredexpressive play activities are described in order to provide the readerwith a glimpse of a preadolescent play therapy group in action.

For the purpose of this article greater attention is given to the use ofstructured activities. A structured clay activity during the beginningphase of the group is described, followed by excerpts from an unstruc-tured, group member-led activity that occurred during the middlephase of group, ending with a structured activity used during the ter-mination phase. The scope of this article necessitated limiting thenumber of activities described. For additional resources, Bratton andFerebee (1999) provided detailed examples of numerous structured,expressive play activities for use with preadolescent groups.Oaklander (1988), Gladding (2005), and Malchiodi (2002) are excellentresources for expressive=creative activities that can be adapted for apreadolescent group. The structured activities described below wereselected because of our repeated success in using them with groupsof preadolescents. The degree of structure and direction from the


therapist can be modified in keeping with the therapist’s theoreticalorientation and the needs of the group. We recommend allowing groupmembers the freedom to create their art as they perceive it, even if itdeviates from the directions given. The importance of the creation liesin the process, not in the final product.

Beginning Phase: Clay Animal/Creature Activity

The use of clay can help preadolescents overcome barriers to theiremotions and experiences (Oaklander, 1988). Bratton and Ferebee(1999) affirmed that clay can help preadolescents develop and enhancetheir sense of self because it allows them to have a sense of mastery andcontrol, while also providing them a developmentally responsive meansof expression. When using clay, preadolescents are in charge of theircreation; they can shape and reshape the clay as necessary, giving themthe power to change their creation at any moment. In our experience,using Model Magic or Play-Doh instead of clay is preferred when usedin the beginning stage of group to afford group members with morecontrol over their emotions and experience while doing the activity.

The clay animal=creature activity is a favorite of ours for the firstgroup session because of the soothing properties of the clay, andbecause it offers a nonthreatening means for group members to beginto interact with each other. The primary objective of the activity in afirst session is for members to make a personal creation to symboli-cally represent self that allows them to share positive aspects of selfwith other group members in a manner that is psychologically safe.The Appendix provides detailed directions for introducing the activityand a brief guided imagery, along with a list of needed and optionalmaterials.

Case Example

After allowing members to explore the clay tactically, the groupleader provided a brief guided imagery to facilitate members shapingan animal=creature that they would most like to be, and then providedadditional materials for decorating or adding detail to their creation.The girls worked intently on their creation for approximately 20minutes, applying fabrics, feathers, sequins, etc. to adorn theircreature and make an environment for it to live in. Following theguidelines for processing presented in Figure 1, group members wereencouraged to ‘‘tell about’’ their creation and give it a name. Additionalquestions to facilitate interpersonal sharing among group membersincluded, ‘‘What is your animal=creature good at? What does youranimal like to do? What does your animal wish it could do or have?’’


As members disclosed information about their creature, I reflectedtheir verbal and nonverbal content to facilitate self-awareness, andto encourage interaction and sharing among group members. Shaundawas the first to volunteer to describe her creature, ‘‘My creature is aunicorn with beautiful feathers, so she can fly anywhere she wantsto go. She proceeded to fly her unicorn around as she described it,and when she put it down it fell over on its ‘‘horn.’’ Shaunda giggled,‘‘Except sometimes it falls on its face!’’ Kim shared next, ‘‘Mine is awhale that can swim and fly and can live on the bottom of the oceanfor days at a time. It likes the ocean because it is peaceful and calm,but then when it wants to, it can come up to the surface and fly any-where in the world. ‘‘Maria was last to go and very quietly said, ‘‘mineis a butterfly.’’ When prompted to say something her butterfly liked todo, she replied, ‘‘It likes to fly way up high, so it can look down and seeeverybody and what they are doing.’’ While each members’ creationwas ripe with opportunities to expand on its meaning, now was notthe time to over-interpret or ask too many questions; the goal wasfor each member to have a positive experience of sharing self withothers. Because it is especially important in the first session for thegroup leader to link similarities between group members to foster uni-versality, group safety, and a sense of belonging, I commented, ‘‘Youall made creatures that like to fly,’’ which stimulated a conversationbetween Shaunda and Kim about why they liked to fly . . . so they couldgo anywhere they wanted, do what they wanted (giggling), and getaway from others when they wanted. Maria nodded her head in agree-ment and smiled shyly. I noticed that Shaunda had spent a long timefinding a long, sharp nail for a horn, and because Shaunda had beenable to laugh at herself when her unicorn fell over because of theweight of the nail, the leader commented, ‘‘Unicorn, I noticed you havea really sharp looking horn, and . . .Shaunda interrupted and replied,‘‘That’s so the other animals know I’m the boss . . . they better not messwith me.’’ Kim asked, ‘‘What if they want to play with you, but they arescared you’ll hurt them with your horn?’’ Shaunda thought a minuteand didn’t seem to know what to say. The group leader responded toKim, ‘‘Sounds like that could be scary for your whale, can you haveyour whale tell that to the unicorn?’’ Shaunda looked at me and said,‘‘That’s a silly thing to do.’’ I responded, ‘‘It’s sort of like putting on aplay, where you pretend you are the animals and give them a voice.’’Shaunda asked, ‘‘Can we say anything we want?’’ I let them know theycould say anything, as long as they all agreed that it was okay.’’ Kimresponded, ‘‘Okay, I’m ready (and takes her whale over by theunicorn); unicorn, I want you to play with me, but I’m afraid you willhurt me with your horn.’’ ‘‘Me, too,’’ said Maria quietly. Shaundareplied, ‘‘I’m not really going to hurt you, I just look mean.’’ I replied:


‘‘Unicorn, you want the others to know that just because you have ahorn, doesn’t mean that you would hurt them.’’ This interaction letto a discussion of Shaunda not having many friends, which allowedMaria to share that she didn’t have any friends at school. Kim cameto the rescue and let them know she would be their friend. This activ-ity typically ends with the group cooperating on a group project withtheir animal=creatures, but the girls spent the time discussing theissue of friends, other happenings at school, and sharing briefly abouttheir home life. We ended with a snack to help group members transi-tion back to their classrooms.

Staying with the metaphor of their creations allowed group mem-bers the distance they needed to feel safe enough in the first sessionto share openly with each other, disclose similar struggles and feelings,and foster connections among members. Typically, in a first session,the group leader limits responses to those consistent with level 1 and2 presented in the previous section. However, in this group, members’seemed ready to enter into the metaphor of their creations, whichproved to be a catalyst for sharing of meaningful aspects of their life.

Middle Phase: Unstructured Play Activity

The following excerpts occurred during the unstructured portion ofa group session on a day that Kim was absent and thus not able to pro-vide a buffer between Maria and Shaunda . . . a session that proved tobe a turning point in their relationship. I was aware that Maria wasbecoming increasingly overwhelmed by Shaunda’s boisterous andaggressive play with the puppets in her attempt to get Maria to playwith her, and reflected, ‘‘Maria, you don’t seem to like having the pup-pet right in your face.’’ Shaunda responded by throwing her puppetdown and saying, ‘‘I didn’t want to play puppets anyway,’’ as shewalked over to the cooking area and looked around. I responded, ‘‘Thatdidn’t work out the way you wanted, so you decided you’d do some-thing else.’’ Shaunda opened the mini-fridge and turned to Maria,‘‘I know—we can make cookies. Do you want to help?’’ Maria smiledshyly and shook her head yes and moved closer to Shaunda, helpingput the cookie dough on the sheet to bake, and stated, ‘‘My grand-mother lets me make cookies with her, but my mom says that I maketoo big of a mess, and that she is too busy to help.’’ ‘‘Mine, too,’’ saidShaunda, ‘‘she never lets me help in the kitchen, especially sinceDaddy left.’’ I acknowledged their shared feeling, ‘‘You both wishyou could spend more time with your mom.’’ While they decoratedtheir cookies, the girls continued to discuss how things were differentat home since the divorce. Both were able to share feelings that hadnot surfaced before. Near the end of the session I reflected on the


similarities in their home life, their wish that their mothers wouldspend more time with them, and how much they had enjoyed makingcookies together. They both shared how much fun they had decoratingcookies and couldn’t wait to tell Kim next week and make cookiesagain with her. In this example, as the group leader, my goals wereto enhance members’ self-awareness and awareness of their impacton each other, encourage decision-making by reflecting what washappening between members, and make connections between groupmembers’ mutual interests and similar experiences to foster cohesive-ness. From a humanistic perspective, it is important for the leader torefrain from taking charge of problem-solving situations, as thiswould deprive preadolescents of the opportunity to discover theirown solutions; instead the leader should notice and reflect on mem-bers’ pro-social solutions and negotiations.

Termination Phase: Mandala Activity

The creation of mandalas for spiritual and healing purposes havebeen practiced for thousands of years across cultures (Malchiodi,2002), however, Carl Jung was the first to acknowledge their thera-peutic power (Bertoia, 1999). Young (2001) explained that mandalasallow for the expression of one’s self-concept and one’s ideal self andfoster self-awareness. According to Malchiodi, mandalas allow for theintegration of aspects of self and reflect one’s potential for transfor-mation. The mandala activity is a favorite for terminating groupsessions because of its integrative properties, and because it allowsmembers to take away a tangible representation of their growthwithin the group experience. Mandala-making consists of creatingan image within a circular space. Incorporating collage techniquesprovides preadolescents with flexibility in use of media andself-expression. According to N. Rogers (1993) a collage is commonlyless difficult than drawing and allows for focus on the process ratherthan on the product. The Appendix provides detailed directions forintroducing the activity, along with a list of needed and optionalmaterials.

The group leader begins by asking members to draw or choose a cir-cle of any size, and to then draw and=or use any of the provided mate-rials to express who they are and what is important to them, includingany thoughts, feelings and wishes. After group members finish, theleader asks members to describe their creations and facilitates proces-sing by asking questions such as ‘‘What do you like most?’’ or ‘‘Wasthere anything you needed that you couldn’t find?’’ Additionally, theleader reflects on what was observed while participants were creatingtheir mandalas.


Case Example

These excerpts are taken from Maria, Shaunda, and Kim’s lastgroup session. The group was ending because the school year wasending. They had been together for 11 weeks and, according to theirteachers’ and parents’ report on the CBCL, as well as my subjectiveassessment, each had made progress in their presenting issue. Forpreadolescents, the importance of belonging and fitting in with peerscan be a powerful incentive to modify behavior in order to find accep-tance in the group. Maria, Shaunda, and Kim clearly felt a sense ofbelonging in the group and had become more cohesive, evidenced bytheir trust in sharing personal aspects of self. Over the course of thegroup, Maria had been able to share painful experiences of her father’sverbal abuse of her mom and herself. Group members were able to sup-port her and dispute the messages she had heard from her father—that she was stupid and worthless, just like her mom. As a witnessto this process, I firmly believe that the acceptance Maria experiencedfrom her peer group was more powerful than what she would havereceived in individual counseling. Her increased self-confidence wasevident in her posture, her smile and her participation in class discus-sions, as reported by her teacher. Because she had made the mostgrowth, and because of space limitations, I will focus most on Maria’smandala and her experience during our last session.

The group began their mandalas the week before their last sessionto allow ample time for making and for sharing their creations, as wellas for closure of our time together. They were quieter than usual andtook extra care in finding just the right materials, pictures, words, etc.to complete their project. During the last session, they spent time put-ting the final touches on their creations until each seem satisfied. Forthe first time since we had been together, Maria volunteered to sharefirst. Maria first commented how much she liked what she had made;and after a brief pause, added that she used to think that she was notcreative or good at art, so she wouldn’t try. Shaunda and Kim said thatthey wished they could be as artistic as she was and gave Maria sev-eral examples of her creativity. Maria smiled broadly and began toshare herself—the positive, as well as the pain from her past—throughher mandala. She saved the part she had worked on the longest, thecenter, until last, adding that it was her favorite part. In the centershe had made several layers, with colorful cellophane and sequinedfabric covering colorful feathers that could barely be seen. She saidthat the center represented the good parts of herself—the parts thatshe liked and was becoming more aware of. She lifted up the fabricwhere the colorful feathers could be seen and said that representedShaunda and what she had learned from her, and then underneath


the feathers, she had drawn a pool of water covered in glitter, with alarge blue sequin inside and she said that represented Kim and whatshe would remember about her. Although Maria was not able to saymore words, her message was powerful—that the bond that she hadformed during the group had a powerful impact on her self-conceptand her belief that she would be able to have similar relationshipsin the future. The impact her creation had on Shaunda and Kimwas tangible. They clearly understood the message—no words werenecessary.

After Shaunda and Kim shared their mandalas, we ended the groupwith a longer than usual snack time. At their request from last week,we had a celebration that included a cake (made in the microwave inthe cooking area) that they decorated. By this point in the group’sjourney, the snack served not only as a transition back to the class-room, but also as a social time for sharing important events in theirlife at home and school. During their last session together, theyreflected on the fun they had together over the past 11 weeks, and alsoshared feeling sad that the group was ending. To facilitate a healthytermination, I helped them process their happiness and sadness, bothimportant dimensions of the close relationship they had developed.The girls decided that they wanted a group picture to remember theirexperience. They all decided to add their group photo to their mandalacreations to take home as a reminder of their time together.

Through the group process, Maria, Shaunda and Kim had not onlyfelt safe enough to express their perceptions and concerns about theirparents’ divorce, they had also formed intimate relationships witheach other, which seemed to be the catalyst for their enhancedself-acceptance and sense of competence, all of which are importantdevelopmental tasks for preadolescents (Berk, 2003; Hamachek,1988; Sullivan, 1953). Although each member began the group withdistinct coping styles and personalities, they had connected initiallythrough their feelings of rejection and loss of their father in their livesand to a lesser a degree to a loss of their mother’s emotional presenceafter the divorce. Their diverse personalities had served to enhanceeach other’s coping behaviors and provided role models for rehearingnew behaviors. The use of structured expressive activities helpedbridge the gap between concrete and abstract thinking which is essen-tial for therapeutic success with this age group, while at the same timeproviding opportunities for developing a sense of competence andindustry as they experimented with creating projects of their ownimagination. Through the use of symbol and metaphor, they were pro-vided opportunities to express feelings, thoughts and experiences thatmight have been too threatening and=or too abstract for them toexpress in talk therapy. The unstructured time in the group allowed


participants to spontaneously deal with problems as they arose andexperiment with finding solutions that were mutually acceptable.

Because of my humanistic orientation, I did not attempt to solveproblems for them, instead, within the safety and acceptance of thegroup, participants were made aware of each other’s feelings andhow their actions affected each other. This resulted in participantshaving the opportunity to try on new behaviors and practice new waysof interacting. For example, Shaunda became less bossy as she under-stood the impact her behavior had on others. She also became moresensitive to Maria’s feelings, as Kim modeled compassion and altru-ism. From Shaunda, Maria learned to be more assertive, as she movedfrom being afraid of Shaunda’s boisterous and aggressive manner(which reminded her of her father) to admiring her courage to standup for what she wanted. Kim, who came to the group with many posi-tive coping behaviors, learned from Shaunda that she didn’t alwayshave to go along with what others wanted and assume responsibilityfor other’s feelings. As the group progressed, she became freer in herplay and more expressive of her needs and wishes.

CONCLUSION

Almost since the beginning of time, play and expressive=creativeactivities have been used in connection with physical and mentalhealing practices (Feder & Feder, 1981). Both play therapists andart therapists have extolled the value of creative expression in ther-apy for preadolescent children. The integration of structured andunstructured expressive activities within a humanistic play therapygroup format provides an empirically supported and developmentallyresponsive treatment modality for preadolescents that offers manypotential benefits. Expressive media provide preadolescent childrena concrete and symbolic means to express thoughts and feelings thatthey may be unable to fully communicate verbally. The use of struc-tured activities can reduce anxiety, particularly in initial sessions,and encourages interaction between group members. Allowing timefor unstructured play is invaluable in providing spontaneous oppor-tunities to respond to the inevitable discord that arises during groupand to experiment with more satisfying ways of resolving conflictsand relating to peers. Intimate relationships formed during groupcan provide a foundation for the development of healthy relation-ships into adulthood. Finally, the self-creative process awakenedduring therapy can continue long after group members leave thegroup setting, providing internal resources for meeting life’schallenges that lie ahead.


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APPENDIX

SAMPLE STRUCTURED EXPRESSIVE PLAY ACTIVITIES

Clay Animal/Creature

Materials needed. Provide each group member with a fist-sizeportion of Model Magic#, clay, or similar material and a solid surfacesuch as a table or plastic serving trays. Supplying a selection of toolssuch as a rubber mallet, a garlic press, plastic knife, and special claytools, allow group members shape their creation. If clay is used for theactivity, it is important to have wet paper towels, and a container withwater. In addition, craft materials such as cellophane paper, sturdypaper plates, assorted beads, colored feathers, markers, and scissorsprovide preadolescents the opportunity to personalize their creature.

General directions. Begin by giving each group member a portion ofthe clay=magic model. The group leader encourages each member tobecome familiar with their material by asking them to touch, pinch,roll, and squeeze it. Asking members to explore the clay with theireyes open and again with their eyes closed allows them to experiencethe tactile nature of the clay more fully. Members are asked to sharewith questions such as ‘‘Describe how it feels? Is it cold or warm? Doyou notice any differences when you have your eyes open or closed?Do you like how it feels?’’ Some group members may experience some


anxiety at the beginning, thus allowing sufficient time to explore thematerial is important.

Once group members feel comfortable with the material, they areinstructed to close their eyes while the group leader introduces theactivity. The activity can be presented in numerous ways to matchthe needs, preferences, and experiences of a particular group. Askinggroup members to begin to create with their eyes closed reduces anxi-ety and self-consciousness, as well as facilitates focus. The following isa brief guided imagery that we have found that preadolescents seem toidentify with:

Imagine that you have traveled through time into the future wherehuman life as we know it no longer exists. The world is inhabited bythousands of varieties of animals and creatures, big and small—somelook like animals that we know today, and others are like no creaturethat you have ever seen. If you could be any animal or creature in thisnew world, what would you be? Think about what you look like andbegin to shape your animal=creature. When you feel like your creationis mostly formed, open your eyes and look at it and then finish what itneeds. You can use any of the materials in the room to make your crea-ture or create a place for it to rest.

When group members finish, they are encouraged to ‘‘tell about’’their creation and give it a name if they want to. Additional ques-tions to facilitate interpersonal sharing among group membersinclude, ‘‘What is your animal=creature good at? What makes youranimal=creature strong? What does your animal like to do? Whatdoes it dislike to do? What does your animal have a hard time with?What other animals=creatures does your animal get along with (andnot get along with)? Is there anything your animal needs that itdoesn’t have?’’

Mandala

Materials needed. Provide a variety of drawing materials such aspastels, crayons, and markers; as well as magazines and a wide vari-ety of craft materials. Paper plates or construction paper of differentcolor provide an inexpensive, easy, and sturdy surface for creatingmandalas.

General directions. The following directions are adapted fromMalchiodi (2002). After providing a developmentally responsive intro-duction to the mandala concept, the group leader can start by saying‘‘Draw or choose a circle of any size to create a mandala that repre-sents who you are or how you see yourself. Inside the circle, you can


draw and=or use any of the materials you choose to express your feel-ings, thoughts, wishes, or anything you want about yourself. These areonly suggestions; there is no right or wrong way to create your man-dala. You can use any of the materials that you want.’’ Once groupmembers finish making their mandalas, the group leader can askmembers to describe their creations. The group leader can facilitateprocessing by using the levels of processing and by asking questionssuch as ‘‘What do you like most about what you did?’’ or ‘‘How didyou feel when you were creating it?’’ ‘‘Do you like how it turnedout?’’ ‘‘Does it represent who you are?’’ Additionally, the leader reflectson what was observed while participants were creating their manda-las, as well as finding opportunities to connect group members byreflecting on similarities as well as interactions that occurred amonggroup members.

The creation of mandalas can be used during the closing phase ofgroup. Group members can be asked to create a mandala that repre-sents their feelings and thoughts about the group or they can beinstructed to create a mandala that represents who they are as agroup. It is necessary to provide group members with a space and apaper large enough to work on comfortably as they create the groupmandala.


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