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Section 16
Positioning in Child Therapy

Question 16 | Test | Table of Contents

There is some controversy in the use of the method regarding how the therapist should be positioned in the playroom since the therapist participates and relates at the direction of the child. In keeping with the warm and friendly attitude of the therapist and the studies of how such attributes are expressed (Carkhuff & Berenson, 1969; Stollak, 1979), it is our practice to have the therapist place him or herself on the same physical plane as the child so that the power of height over the child will be replaced by the more egalitarian face-to-face and eye-to-eye contact. The distance should not violate the 36 inches usually considered the comfortable distance between persons in our culture unless the child comes closer or initiates an activity that includes a closeness component, such as playing a board game or wishing to be held on the therapist's lap to play baby. The rationale here is that closeness can have the effect of crowding some children and violating their personal needs for space. As with other variables, children will communicate when they are ready for greater physical intimacy. The therapist's task is to be ready to respond when the child signals.

Behaviorally, this means remaining three or four feet from the child and moving as he moves, unless closer or greater distance is indicated. (A game involving throwing can require greater distance to be a meaningful experience.)

Another question frequently addressed to the client-centered play therapist is whether the empathic responses are not in fact reinforcements. Implied is the notion that these responses are "teaching the child selectively" whatever provokes a response from the therapist, and shaping the child's behavior toward an increase or decrease of such responses (as would suit the child's dynamics).

It would seem foolish to deny that such expressions of understanding and acceptance are not reinforcing. Countless studies of reinforcement have demonstrated that a mere shake of the head, smile, or touch are reinforcers even to infants. The therapist is aware that by selecting and responding to only some of the material available (it would be impossible to respond to every word and act that takes place for most children), there will be a differential effect upon the child. Therefore he or she attempts to be responsive to all types or categories of expressions emanating from the child, in order to avoid unintentionally communicating that certain ones have greater value than others. Thus the child's choice of expressions is not limited by the therapist but still rests with the child. For example, a child is throwing rings on a ring-toss.

THERAPIST: Responds to the child's Yea! with: That one landed just where you wanted it (warm tone).
When ring misses spindle, child looks over in a rather expressionless way.

THERAPIST: That one didn't quite make it (in same tone as when ring landed).

The therapist should respond with a comment relating to the child's perception of the situation with about the same amount of emotion in both cases. Without this equal attention, the child might in time begin to feel that the therapist is attracted by success and turned off by failure. The play session must be a place where the child can dare to fail and still be accepted. This basic concept cannot be violated if the therapist wants to maintain the attitude of acceptance believed necessary for full growth in the sessions. Therapists must monitor themselves to be certain that their own spontaneous approvals of certain behaviors do not communicate that these are preferred. A safeguard is to be certain that equal attention and affect are offered the child for success and failure, mature versus immature reactions, pretty versus ugly products. Reviewing tapes of the sessions, receiving supervision, or observer feedback can help the therapist accomplish this important task.
- Schaefer, Charles & Kevin O'Connor, Handbook of Play Therapy, John Wiley & Sons, New York: 1983.

Personal Reflection Exercise #2
The preceding section contained information about positioning in child therapy. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Considerations for Upright Particle Therapy Patient
Positioning and Associated Image Guidance

- Volz, L., Sheng, Y., Durante, M., & Graeff, C. (2022). Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance. Frontiers in oncology, 12, 930850. https://doi.org/10.3389/fonc.2022.930850

Peer-Reviewed Journal Article References:
Halfon, S., Yılmaz, M., & Çavdar, A. (2019). Mentalization, session-to-session negative emotion expression, symbolic play, and affect regulation in psychodynamic child psychotherapy. Psychotherapy, 56(4), 555–567.

Meany-Walen, K. K., Cobie-Nuss, A., Eittreim, E., Teeling, S., Wilson, S., & Xander, C. (2018). Play therapists’ perceptions of wellness and self-care practices. International Journal of Play Therapy, 27(3), 176–186.

Siu, A. F. Y. (2021). Does age make a difference when incorporating music as a rhythmic-mediated component in a theraplay-based program to facilitate attunement of preschool children with social impairment? International Journal of Play Therapy, 30(2), 136–145.

QUESTION 16
Why should the therapist remain three or four feet from the child and move as the child moves, unless closer or greater distance is indicated? To select and enter your answer go to Test.