Intensive child centred play therapy for children who have experienced adversity in Aboriginal and non-Aboriginal communities

  • Joanne Marie Wicks

    Student thesis: Doctor of Philosophy (PhD) - CDU

    Abstract

    Over the past decade, researchers have become increasingly interested in the effects of adverse childhood experiences on brain development, epigenetic modifications, and the risks of medical and psychological disorders throughout the lifespan. Although several studies have examined the negative impact of adversity on Australian Aboriginal children, few studies have explored the effectiveness of developmentally and culturally suitable therapies that are customised for Australian Aboriginal children who reside in remote locations. One of the challenges for Australian Aboriginal children is the limited accessibility and availability of therapeutic services. Therapies delivered in remote communities typically follows a traditional format of treatment, meeting no more than once a week, as remoteness increases. A possible way to elevate limited access to services is to provide an intensive format of therapy to children and their families.

    Child-centred play therapy (CCPT)—a therapeutic paradigm in which children are granted opportunities to direct their own play and to explore and address their challenges— has been shown to enhance the behaviour and well-being of culturally diverse children and children who have experienced adversity. In this thesis, Intensive Child Centred Play Therapy, or iCCPT, was evaluated to determine the feasibility and utility of an intensive model for children who experienced adversity. For this thesis, two studies were conducted in Northern Australia, implementing iCCPT, combined with a therapeutic parent and teacher program. The intensive model provided 30-minute individual CCPT sessions twice a day, over ten days. In both studies, parents and teachers completed Goodman’s Strengths and Difficulties Questionnaire or SDQ before and after the intervention. Additionally, a third study was conducted utilising an instrument called the PT-ISA, created to measure the characteristics and behaviours of children within sessions and across sessions so that therapist could tailor their therapy accordingly.

    The first iCCPT study was conducted in a primary school located in an Australian capital city. Seventeen children participated in an average of seventeen sessions over ten days. The SDQ from parents indicated that emotional problems, conduct problems, and hyperactivity subsided as a consequence of the program. Teachers SDQ scores revealed that hyperactivity decreased, and pro-social behaviour increased, after the program. These results, coupled with the responses during interviews, tentatively suggest that iCCPT may be an appropriate intervention for children with a history of adversity. The second iCCPT study was conducted in a remote Aboriginal Community. This pilot study included nine child participants who attended an average of fifteen sessions. Total difficulties form the SDQ, as reported by both parents and teachers, diminished after the program. In particular, emotional problems, as rated by teachers, decreased over time.

    The third study was conducted to provide a measure that could influence how therapists tailor therapy in accordance with the characteristics, trajectory, and needs of each child client. The PT-ISA form was designed to capture the characteristics and trajectory of children within sessions and across sessions, as a tool to predict clinical outcomes. Examples of characteristics are the extent to which the level of activity or proximity to therapist changes over time. The PT-ISA was used with seventeen children who participated in 11 to 20 sessions of CCPT. The results indicated many characteristics, such as the capacity of children to tolerate frustrations or their tendency to communicate with therapists verbally, predicted clinical outcomes. The research suggests how specific constellations of behaviour during sessions could indicate that therapy needs to be extended or modified.

    Future research should replicate the three studies separately, in a randomised control trial. This study could establish more definitively that an intensive Child Centered Play Therapy program may be feasible and effective in remote Australian Aboriginal communities for children who have experienced adversity.
    Date of AwardAug 2019
    Original languageEnglish
    SupervisorSimon Moss (Supervisor)

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