The Intersections of Play Therapy, the COVID-19 Pandemic, and Lineages of Trauma

As the pandemic unfolded in waves and spikes around the world, there was a push for mental health research on the impact of the COVID-19 pandemic. Due to the overwhelm of mental health care systems, this doctoral work took the shape of a multi-study project that allowed for the exploration of different interactions between the topics of play therapy, trauma, and the COVID-19 pandemic that did not directly place pressure on practitioners and patients to be involved in research in the midst of mental health care. The COVID-19 pandemic has been collective and therefore this thesis reflects collective responses from play therapists and their approach to understanding impact and recovery, as well as a group analysis of themes from a play-based study on lockdown experiences of British children. The thesis is broken down into three sections: section one lays the foundation with a systematic literature review on child-centred play therapy (CCPT) and trauma, section two contends with the impact of the pandemic on play therapy & play therapists, and the third section explores a play-based research method used to engage children’s perspectives on lockdown. Section two includes three different qualitative analyses, each written up separately for publication, with two under review. Section three has two chapters, one that centres on the study findings and the second that centres the methodology. Section A: The systematic literature review, under review for publication, found that CCPT has created an evidence base for itself as an efficacious therapeutic intervention with trauma, but still requires further research. Sixty-seven percent of the included studies (n=9) reported statistically significant outcome findings, with poverty and adverse childhood experiences being the two most studied trauma (n=3, each). The findings highlighted potential tangible changes for future research including increased CCPT sessions, less restrictive operationalized understandings of trauma, the addition of child report measures or another way to include children’s perspectives and recruiting more registered or accredited play therapists to provide the therapy in such studies. Section B: The digital survey of play therapists around the world aimed to gather a breadth of perspectives on the impact of the COVID-19 pandemic on play therapists’, their practice, and their clients. It also engaged their clinical knowledge on trauma and collective trauma as well as their professional perspectives of recovery from the pandemic. This is the largest (n=490) and most international survey with play therapists on any topic to date. The responses were primarily engaged with using narrative analysis, except for three open-ended questions that were a better fit for more in depth qualitative analysis; they are identified below. The findings revealed that play therapists witnessed play behaviour related to the COVID-19 pandemic in sessions and their playrooms changed in response to public health measures as well as the need to bring relevant symbols into the playroom. Play therapists also reported to be experiencing burnout, and they had a range of perspectives on recovering from the pandemic. The latter was analysed with reflexive thematic analysis to create three themes: (1) Acknowledge: Avoiding the Voldemort Effect, (2) Address: Lockdown Disruptions, (3) Add: Reimagining Our World. Most play therapists believed the COVID-19 pandemic to be a collective trauma but had varying understandings of the term and also defined trauma inconsistently. The trauma and collective trauma definitions were analysed using a discourse analysis called interpretative repertoires where popular language trends were identified in their definitions and conceptualizations. The findings from that analysis can be used to inform education for mental health professionals in the future. Section C: Sand tray as a research method has limited albeit successful previous use, however it has been engaged inconsistently across designs of the previous research. This study utilised sand tray as a play-based research method, keeping play as the data to be analysed, rather than using play as a means to an end such as a verbal interview as had been done previously. The findings of the sand tray study of British children’s experience of the COVID-19 lockdowns (n=11) demonstrated feelings of loneliness, isolation, danger, and were missing signs of wellness. An adapted version of interpretative phenomenological analysis (IPA) that allowed for engagement with both the play content and the play process brought forth three group experiential themes: (1) Devoid and Desolate - missing signs of wellness, (2) Bigger than reality - tangible experience represented by symbols of fantasy, and (3) Play as Data - signs of wounding. There were also trends in the play process that matched previous studies using sand tray in previous collective traumas, both man-made and natural disasters. Taken together, the results from all five qualitative analyses indicate that there is a lingering mark of the pandemic on both mental health professionals, specifically play therapists, and impacts on children’s emotional experiences during lockdowns in particular. There are similarities to the results from these studies that match scholarship and previous research on collective trauma and the mental health impacts. The thesis concludes by discussing strengths and limitations to a multi-study and multi-method analysis with implications for research, clinical practice, education, and community care. It calls for education on collective trauma for mental health professionals as something theoretically different than individual trauma. This may impact the delivery of mental health treatment in the future and could provide support for more community involvement in pandemic recovery. This could possibly relieve the mental health system from some of the weight of the mental health crisis. It also provides support for increased access to play for children and young people and increased research with developmentally appropriate methods for gaining insights from children’s perspectives. The play-based research method of sand tray paired with the adapted IPA for visual data provides a novel approach to engaging with children’s experiences and feelings. This approach could be utilised in play therapy efficacy studies with trauma, as identified as a possible improvement to future CCPT research.

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2024

Author dc:creator

• Conroy, Sydney

Advisor dc:contributor.advisor

• Ramchandani, Paul

• Mental Health
• Play
• COVID-19 Pandemic
• Play Therapy
• Psychology

Licence

• https://www.repository.cam.ac.uk/bitstreams/f9f9cf82-4cb9-4bf9-acac-1b8d6e72a0cf/download
• http://purl.org/NET/rdflicense/allrightsreserved

Language dc:language

eng

DOI dc:identifier.doi

https://doi.org/10.17863/CAM.117776

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/383376