Cultural Issues in Play Therapy / Edition 1

by Eliana Gil PhD, Athena A. Drewes PsyD, RPT-S, Joyce C. Mills PhD, LMFT, RPT-S

Overview

This important resource presents the latest information on brain-behavior relationships and describes ways school practitioners can apply neuropsychological principles in their work with children. Bridging the gap between neuropsychological theory, assessment, and intervention, the text addresses complex topics in a straightforward, easy-to-understand fashion. The authors challenge previous conceptions about brain functions and present the cognitive hypothesis-testing model, an innovative method that helps practitioners form accurate understandings of learner characteristics and conduct meaningful and valid individualized interventions with children with a range of learning and behavior disorders. Including case studies and examples that illustrate what practitioners might actually see and do in the classroom, the volume also features a number of useful reproducible worksheets and forms.

Product Details

ISBN-13:	9781593853808
Publisher:	Guilford Publications, Inc.
Publication date:	07/21/2006
Edition description:	Older Edition
Pages:	216
Product dimensions:	6.00(w) x 9.00(h) x (d)

About the Author

Eliana Gil, PhD, RPT-S, ATS, is a founding partner and senior clinical and research consultant in a private group practice, the Gil Institute for Trauma Recovery and Education, in Fairfax, Virginia. Dr. Gil is an approved marriage and family therapy supervisor; a registered play therapist/supervisor; a registered art therapist; a Circle of Security certified parent educator; and a Level II Theraplay provider. She is a former president of the Association for Play Therapy, which honored her with its Lifetime Achievement Award. Dr. Gil is the author of numerous publications on child abuse prevention and treatment. Originally from Guayaquil, Ecuador, she is bilingual and bicultural.
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Athena A. Drewes, PsyD, RPT-S, is a licensed psychologist, certified school psychologist, and registered play therapist and supervisor. Dr. Drewes is semi-retired in Ocala, Florida. She has over 40 years of clinical and supervision experience with children and adolescents experiencing complex trauma and sexual abuse in school, outpatient, and inpatient settings. She is a past board member of the Association for Play Therapy and a founder and president emeritus of the New York Association for Play Therapy. A frequently invited guest lecturer around the United States and internationally, Dr. Drewes has published 11 books on play therapy.

Read an Excerpt

Cultural Issues in Play Therapy

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By Eliana Gil Athena A. Drewes

The Guilford Press

ISBN: 1-59385-012-3

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Chapter One

From Sensitivity to Competence in Working across Cultures

ELIANA GIL

I have always felt that the action most worth watching is not at the center of things but where edges meet. I like shorelines, weather fronts, international borders. There are interesting frictions and incongruities in these places, and often, if you stand at the point of tangency, you can see both sides better than if you were in the middle of either one. This is especially true, I think, when the apposition is cultural. -Anne Fadiman, The Spirit Catches You and You Fall Down (1997, p. x)

Ahnna was adopted at the age of 41/2 from an orphanage in China. Her history prior to that age was virtually unknown, except that her mother had died during childbirth and her birth father was unable and unwilling to care for her (he apparently held the infant responsible for his wife's untimely death). Uncharacteristically, a grief-stricken extended family was not available to raise Ahnna. The maternal grandmother was widowed and had cared for Ahnna from infancy until 11/2 years of age. When Ahnna's grandmother died, of lymphatic cancer, the father had remarried, and his wife had just given birth to a son. Ahnna's father remained unwilling to provide her with a home, and thus Ahnna was placed in the orphanage.

Ahnna was brought to the United States by her adoptive parents, Scott and Joelle, whohad gone through years of infertility treatment and had waited to adopt a child for over 3 years. Scott and Joelle were college sweethearts and had both been raised in the Midwest. When Scott secured a position with a national high-tech company, he and his wife relocated to the East Coast. They quickly discovered that the metropolitan area in which they had settled was very fast-paced, and they were homesick for their families. They planned to return to their home state as soon as Scott could establish a good work record, save money, and find another work position closer to home. They traveled to China with great anticipation and chose Ahnna due to her compliant behavior in the orphanage, as well as her "sweet appearance."

A few months after the adoption, Scott and Joelle brought Ahnna to therapy because she was smearing feces, wetting the bed at night, hitting other children in kindergarten, whining and complaining of stomachaches, and becoming aggressive with the family dog. Ahnna was also masturbating in her bed, distressing both her parents, who panicked that this suggested that Ahnna had been sexually abused. They were distraught, weary, and desperate. Their dreams of a happy family had dissipated into a sea of distress. Although they had anticipated some difficulties with the child, they were shocked and somewhat disgusted with Ahnna's behavior. Their expectations were gravely challenged, and they felt incompetent and ashamed.

A number of issues are highlighted in this case, to which I return later in this chapter.

CHANGING VIEWS OF WORKING ACROSS CULTURES

When I first started taking courses on "cultural issues" in the 1970s, there was a predictable and exclusionary focus on ethnicity. Most conferences and workshops that I attended utilized a panel format in which individuals from different ethnicities would speak about their particular ethnic groups. I clearly remember that the speakers would offer similar introductory statements and emphasize the limitations of their presentations. In fact, it was made resoundingly clear that each individual could only speak to his or her experience within a specific ethnic group or culture, and all speakers took great caution not to generalize. Inevitably, audience members left with a perception that they had been trained in cross-cultural sensitivity, when in fact they had been exposed to an extraordinarily narrow view of culture.

This approach was used in the literature as well, and more and more information appeared about specific ethnic groups (Boyd-Franklin, 1989; Falicov, 1998; Gopaul-McNicol, 1993; Koss-Chioino & Vargas, 1999; Sue & Morishima, 1982; Uba, 1994). This was a worthwhile and important first step, in that it allowed readers to become familiar with rather global aspects of cultural diversity. However, as McGoldrick (1998) states emphatically, "theoretical discussions about the importance of ethnicity are practically useless ... as are 'cookbook' formulations" (p. 22). She cautions that the systematic integration of material on ethnicity in any mental health professional training "remains a 'special issue,' taught at the periphery of psychotherapy training and rarely written about or recognized as crucial by therapists of the dominant groups" (p. 5).

Over time, more sophisticated debate has resulted in careful consideration and discussion of how mental health professionals and others who provide service delivery to the general public can become more sensitive and indeed more responsible in their interactions with clients or patients of different cultural backgrounds. Numerous books on working cross-culturally have enriched the literature with various philosophical, political, and social approaches (Carter, 1995; Lee, 1997, 1999; McAdoo, 1993; Paniagua, 1994; Pinderhughes, 1989; Tseng & Hsu, 1991). Recent efforts seek to examine and ponder the issues in our contemporary context, and advocate more action to demonstrate increased awareness and expressed good intentions (Mason & Sawyerr, 2002; McGoldrick, 1998). Fewer books have focused on cross-cultural work with children (Canino & Spurlock, 2000; Gibbs, Huang, & Associates, 1998; Webb, 2001).

Historically, this issue has not been embraced easily. Many of my colleagues initially resisted cross-cultural training, stating that the training was irrelevant because "I don't do that kind of work.... I don't see minority groups in my agency or practice." Allen and Majidi-Ahi (1998) note that "on the therapist's part, there may be a tendency either to deny that race is an issue in the interaction [with clients] or to overcompensate by attributing all of the client's problems to cultural and racial conflict" (p. 153).

The current climate of acknowledged deficits and a move toward the development of cross-cultural competence reflects the need to take more concrete action, and to remain vigilant to many therapists' resistance to and discomfort with integrating cross-cultural thought and action into their service delivery. There is a consensus that a first step in becoming cross-culturally competent is for a therapist to develop an understanding of his or her own ethnic identity and cultural values. McGoldrick (1998) states, "We are all migrants, moving between our ancestors' traditions, the worlds we inhabit, and the world we will leave to those who come after us. For most of us, finding out who we are means putting together a unique internal combination of cultural identities" (p. 8).

It has become clearer and clearer over time that reading about different cultures is not sufficient to elicit a change in behavior (in either therapists or clients), and it is irresponsible to believe that service delivery does not need to shift or expand in order to be effective with diverse populations.

THE EXPANDING DEFINITION OF "CULTURE" AND ITS IMPLICATIONS FOR TREATMENT

Falicov (1998) has best defined a broader view of "culture": "Culture is those sets of shared world views, meanings, and adaptive behaviors derived from simultaneous membership and participation in a variety of contexts, such as language; rural, urban, or suburban settings; race, ethnicity, and socioeconomic status; age, gender, religion, nationality; employment, education, and occupation; political ideology; stage of acculturation" (p. 14). Within this context, attention to culture occurs in all service delivery situations.

Certain issues have been articulated as critical in the provision of cross-cultural treatment. Giordano and Giordano (1995) provide the following key organizing guidelines for therapists:

Assess the importance of ethnicity to patients and families.

Validate and strengthen ethnic identity.

Be aware of and use clients' support systems.

Serve as a "cultural broker."

Be aware of "cultural camouflage."

Know that there are advantages and disadvantages in being of the same ethnic group as a client.

Don't feel you have to "know everything" about other ethnic groups.

Try to think in categories that allow at least three possibilities.

Other authors have highlighted additional salient issues. Ramirez (1998) discusses personal distance, self-disclosure, and the process of entering treatment as critical concerns for culturally competent therapists. Gibbs and colleagues (1998) note that research has identified many client variables as relevant to cross-cultural therapy-for example, "attitudes toward mental health and mental illness; belief systems about the causes of mental illness and dysfunctional behavior; differential symptomatology, defensive patterns, and coping strategies; help-seeking behaviors; utilization of services; and responsiveness to treatment" (p. 8). Inclan and Herron (1998) underscore the importance of delving into such issues as immigrant status, poverty (and socioeconomic strata in general), status changes, and generational issues. In addition, LaFromboise and Graff Low (1998) point to the need for cross-cultural therapists to make decisions about collaborating with traditional healers and evaluating their clients' desire for "ceremonial healing" (p. 133).

McGoldrick (1998) defines ethnically self-aware and sensitive therapists as those who "achieve a multiethnic perspective, which is open to understanding values that differ from their own, and no longer need to convert others or give up their own values" (p. 22). An emphasis on the building of competence and self-evaluation (with training programs taking the lead) appears to be emerging as this field of study continues to evolve across disciplines (Lu, Lum, & Chen, 2001; Roysircar, Sandhu, & Bibbins, 2003; Zimmerman, 2001).

FROM BUILDING SENSITIVITY TO OBTAINING KNOWLEDGE RESPONSIBLY TO DEVELOPING ACTIVE COMPETENCE

When mental health professionals ponder the daunting task of becoming cross-culturally competent, a number of steps must be taken for optimal outcomes. I view this process as involving three distinct levels of response that build upon each other. In my experience, some therapists fall short of the desired outcome because they achieve the first or second level of response independently of the other two.

Building Sensitivity

Building sensitivity entails introspection and a focus of attention on the interactions between self and others. Most training programs set a foundation for cross-cultural sensitivity by inviting students to explore their own cultural and ethnic identification. Being aware of one's own biases and values will assist in the recognition of client issues in this arena. Making sure that the topic is acknowledged and discussed in one's personal and professional life is also critical, in that it creates conscious attention to this topic. Books that stimulate thinking and discussion in this area are highly recommended and contribute greatly to developing ongoing awareness and sensitivity (Tatum, 1997; Webb, 2001).

I am fully bicultural, with high acculturation in both my cultures. As I have described in the Preface to this book, I moved to the United States from Ecuador full time when I was 14 years old. It was especially distressing to me that my quincianera (a ritual dance/party given for girls in many Hispanic cultures when they reach age 15) was an experience I would miss, after years and years of anticipating this rite of passage. My acculturation caused great family rifts, and my mother's overprotection and mistrust are still palpable when I think back to my teenage years. I know that working with Hispanic youth is a challenge for me, since I tend to sympathize (nonsystemically) with the plight of bicultural youth. At the same time, I learned many heroic values from my parents, especially my mother, who brought her children to a new country to offer them a better education and more opportunities. As I prepared to meet Ahnna, I thought about my own journey here (albeit at a much older age) and the difficulties and rewards of acculturation. I also recognized my hesitation in working with parents of a bicultural child. I worked hard at self-evaluation during treatment with this family, understanding well that my own identity as bicultural would affect how I viewed this child and family. I decided to forgo a set agenda, but rather to continue interacting with Ahnna and her parents, learning about myself and sharing aspects of myself as the therapy progressed.

There are numerous ways of becoming sensitized to (or sensitive of) others' plight. The most obvious way is to empathize with other persons by trying to understand their experiences, their struggles, their resources, and motivations. This is easier said than done, and it is a step that is often skipped partially or entirely. In my mind, an honest exploration at the point of contact is a valuable and rewarding process.

For example, when I first started working with adult sex offenders, I discovered countertransference unlike any I had experienced in the past. I became uncertain of my own ability (or willingness) to work with clients who had this particular problem, and I remember consulting with a colleague about the intensity of these feelings and the way they destabilized me. My colleague counseled me to make efforts to develop sensitivity to sex offenders-something I found challenging but not impossible. I began by listening to her as she described to me the personal histories of many of the sex offenders she had treated. As I listened, I heard stories reminiscent of those told by my clients who were adult survivors of abuse. It didn't take long to realize that we were sometimes discussing the same population. Many sex offenders have their own histories of severe abuse, and although there is no linear causal relationship between past and current behaviors, I came to view the two as connected: Histories of abuse contribute to maladaptive adult functioning, particularly repetition of dysfunctional patterns. As I understood this correlation, my sensitivity grew. It then became apparent to me that I could be sensitive to the history of abuse and its inherent pain, without excusing the behaviors that caused pain to others.

Continues...

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Excerpted from Cultural Issues in Play Therapy by Eliana Gil Athena A. Drewes Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Part I	Background and General Considerations
1	From Sensitivity to Competence in Working across Cultures	3
2	Play in Selected Cultures: Diversity and Universality	26
3	Suggestions and Research on Multicultural Play Therapy	72
4	The Impact of Culture on Art Therapy with Children	96
Part II	Play Therapy with Major Cultural Groups
5	Play Therapy in the African American "Village"	115
6	Therapeutic Play with Hispanic Clients	148
7	Musings on Working with Native American Children in Play Therapy	168
8	Play Therapy with Asian Children	180
Appendix	Multicultural Play Therapy Resources	195
	Index	207

Interviews

Mental health professionals working with children and families, including child and school psychologists, social workers, play and art therapists, counselors, family therapists, and psychiatrists; students and trainees in these fields.

Editorial Reviews

"This book is a wonderful addition to the library for anyone who works with children, whether in play therapy or not….The discerning descriptions of parent-child interactions paint pictures that can guide practitioners away from ethnocentric thinking and towards understanding the variables attendant on the child's background and worldview." (on the first edition)

Journal of Ethnic and Cultural Diversity in Social Work

"As a Black clinician, I appreciate the depth with which racial injustice and White privilege are addressed in this book. Readers will benefit from the transparency around challenges with race and culture in the play therapy room and the need to provide culturally responsive treatment. The authors are reflective and consider how racial, ethnic, and other disparities affect mental health practice with oppressed and marginalized communities. I felt inspired by the case examples and vignettes to continue examining my own beliefs, values, and biases to prevent them from showing up with the clients I serve."—Althea T. Simpson, MBA, LCSW, RPT-S, Black Play Therapy Society, Woodbridge, Virginia

"Gil and Drewes have created a strikingly different second edition that positions cultural sensitivity as one of the most salient issues of our time. What differentiates this edition is a deeper dive into the interacting psychosocial stressors that affect various subcultures. For play therapy educators, the book provides a platform to guide students through relevant yet often difficult content, with a focus on clinical principles, reflection, awareness, and self-evaluation. The volume is rich in poignant case examples. I recommend this second edition as required reading in graduate-level play therapy and child/family psychotherapy courses. Be prepared for growth!"—Mary Anne Peabody, EdD, LCSW, RPT-S, Social and Behavioral Sciences Program, University of Southern Maine

"Gil and Drewes offer a timely update to their original edition, taking into account such momentous changes as the current racial justice movement and the COVID-19 pandemic. The authors offer personal testimonies, case studies, and practical play interventions that readers can immediately apply to their work with children from marginalized communities. This book should be on the shelves of both emerging and seasoned play therapists, and can be useful for courses on child welfare, diagnosis and assessment, and cultural diversity. Readers are challenged to acknowledge how White privilege and bias may appear in the playroom, and are guided to effectively diagnose and treat of children from various subcultures. I highly recommend that every play therapist use this book as a guide to build the foundation of antibias clinical work with children and families."—April D. Duncan, MSW, LCSW, RPT-S, Founder and CEO, BMH Connect

"A valuable tool for play therapists of all skill levels. It provides a working definition of 'culture' and goes to the heart of issues involved in conducting play therapy with children from differing cultures and subcultures. Chapters offer effective techniques and strategies to employ in clinical practice. This is a wonderful and timely book."—John Paul Lilly, MS, LCSW, RPT-S, private practice, Provo, Utah​

From the Publisher

"This book is full of valuable information, offering many useful ideas about the increasingly diverse child populations who come, or are sent to, American mental health services....There is much to be learned about cultural differences in play and play therapy from this information-rich volume. It will also be useful to professionals of many disciplines teaching child development in an increasingly multicultural world." (on the first edition)

Child and Adolescent Social Work Journal

"This book provides an informative, helpful 'wake-up call' for play therapists to be culturally competent, not just culturally sensitive....The editors and contributing authors present literature reviews, play therapy strategies, case illustrations, and a sensitive portrayal of various different cultures and applicable approaches....This book is a great resource for multicultural competent play therapy strategies, and a sensitive exploration of the role of cultural similarities and differences in play therapy." (on the first edition)

Journal of Child and Family Studies

Reviewer: Ileana Ungureanu, MD, PhD, LMFT, CFTP (Adler School of Professional Psychology)
Description: A needed and awaited second edition after the publication of the first edition in 2005, this book comes to us with updated and much enriched content about working with kids through play therapy from a multicultural perspective, covering not only race and ethnicity as the first edition focused on, but extended to other cultures and subcultures such as LGBTQIA, immigrant, or the deaf communities.
Purpose: The authors' intent for the second edition is to bring the issues of multiculturalism and social justice in play therapy up to date to the changes that are happening in our society through a global pandemic and especially a social justice reckoning. These are more than worthy objective, much needed in today's recognized mental health crisis affecting especially children and adolescents. The authors meet and exceed these objectives, masterfully describing and proposing techniques and, at the same time, humbly self-reflecting on how privilege gets in the way.
Audience: The book is written for child and adolescent mental health professionals and play therapists, both seasoned and budding ones. In my opinion, this book should be a required book in any graduate level program where there are offered courses on child and adolescent counseling/therapy. Gil, a world renowned play therapist and author of a number of books that are required readings in the play therapy field, and her colleague, Drewes, another reputable play therapist, meet and exceed the needs of their intended audience with this work that will become another required reading.
Features: This book is a gem that should be read by any mental health practitioner working with children, whether through play therapy or not. It is a book that not only provides specific interventions and clinical examples, but also invites self-reflective practice and in-depth awareness of how issues related to social justice and white privilege, including our own biases, influence the process and outcome of therapy/counseling. The vignettes and case examples of working with different communities, such as kids of color, immigrants, or the deaf community, provide an excellent model on how to approach therapeutic play with cultural sensitivity.
Assessment: This second edition is a must-have book for play therapists or any practitioners working with children and adolescents. There is richness and variety in the cases presented in their real-life context, with narratives about living with stressors imposed by dynamics of societal power and privilege, along with tips for how to address them in play therapy with cultural humility, sensitivity, and self-refection. The second edition has significant updates in structure and content. This book is not only an updated version, but can be considered a new book, with more than 90% of new content contextualized to the challenges of the current era, including teletherapy and video games as normative play.

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