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The humanistic-existential approach to child therapy: A methodology for practice and research

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The humanistic-existential approach to child therapy: A methodology for practice and research

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Content THE HUMANISTIC-EXISTENTIAL APPROACH
TO CHILD THERAPY: A METHODOLOGY
FOR PRACTICE AND RESEARCH
by
Yasaman Mottaghipour
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the*
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Education)
October 1982
UMI Number: DP24925
All rights reserved
INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.
In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.
UMI DP24925
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
Microform Edition © ProQuest LLC.
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unauthorized copying under Title 17, United States Code
ProQuest LLC.
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P.O. Box 1346
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UNIVERSITY OF SOUTHERN CALIFORNIA
T H E G R A D U A T E S C H O O L
U N IV E R S IT Y P A R K
LO S A N G E L E S . C A L IF O R N IA 9 0 0 0 7
This dissertation, written by
........Yasaman _ _ Mo ttaghipour........
under the direction of h&X... Dissertation Com
mittee, and approved by all its members, has
been presented to and accepted by The Graduate
School, in partial fulfillment of requirements of
the degree of
D O C T O R O F P H I L O S O P H Y
D IS S E C T A T IO b rG 0M M I
Chairman
ACKNOWLEDGEMENTS
I would like to thank the following people:
My parents, Mr. and Mrs. Mottaghipour who have given
me inspiration and continuous support, without them this
would not have been possible.
My brothers, Farhad and Bahram, for their moral
support.
My committee members, especially Dr. Carnes who has
given me support and encouragement during the past six
years.
Dr. Gordon Blount for his suggestions on different
parts of this dissertation.
Natalie Orlins who typed all my graduate work.
Finally, my teachers and friends in Iran and America
who have been significant in my life.
ii
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS........................ ii
Chapter
I. INTRODUCTION......................... 1
Background to the Problem ..................... 1
Problem ........................................ 4
Rationale and Significance ................... 5
Limitations ................................... 6
Definitions . ..... ....... .................... 7
Methodology’................................... 11
II. REVIEW OF THE LITERATURE........... 13
Psychoanalytic Viewpoint .................... 15
The-Child ................................. 18
The Therapist............................... 19
The Setting................................. 2 0
Structuring the Relationship ............. 21
Setting of Limits........................... 21
Goals of Therapy.................... 22
Structured Viewpoint ........................ 22
The Child.................................... 24
The Therapist............. ................. 2 5
The Setting................................. 2 5
iii
Page
Structuring the Relationship ............. 26
Setting of Limits........................... 26
Goals of Therapy........................... 2 7
Relationship Viewpoint ...................... 27
The Child.................................... 2 9
The Therapist............................... 29
The Setting................................. 3 0
Structuring the Relationship ............. 30
Setting of Limits.......................... 31
Goals of Therapy........................... 32
Client-Centered Viewpoint .................... 33
The Child.................................... 35
The Therapist............................... 36
The Setting................................. 3 7
Structuring the Relationship ............. 38
Setting of Limits........................... 38
Goals of Therapy........................... 39
Conclusions and Summary ...................... 3 9
III. A SYNTHESIS OF HUMANISTIC-EXISTENTIAL
PSYCHOTHERAPY .................................... 4 2
Introduction ................................. 4 2
The Formation of Humanistic-Existential
Psychology................................. 43
_________ iv
Page
The Humanistic Existential View ............. 4 6
Sources of Existential Anxiety ........... 48
Intentionality, Bad Faith and
Authenticity ............................. 50
Implications to Therapy .................... 52
Humanistic-Existential View Applied to
the Basic Components of Therapy ........... 54
The Cli e n t................................. 54
The Therapist . . . . ...................... 56
The Setting................................. 57
Structuring the Relationship ............. 57
Setting of Limits........................... 58
Goals of Therapy........................... 59
IV. A REVIEW OF THE LITERATURE OF THE
PSYCHOBIOLOGICAL CHARACTERISTICS
OF CHILDREN...................................... 6 0
Introduction ................................. 60
Piaget's Theory of Intellectual
Development................................. 60
General Introduction to Piaget's Theory
of Intellectual Development ................ 61
Preoperational Period (2-7 Years) ......... 65
Concrete Operational Period (7-11 Years) . 68
Review of Developmental Research Related
to Theoretical Concepts of Humanistic-
Existential Psychotherapy .................. 70
"Freedom" ............................. 70
"Intentionality" and "Choice" ............. 71
v
Page
"Anxiety".................................... 72
"Isolation"................................. 73
"Death"...................................... 73
"Meaninglessness," "Authenticity,"
and "Bad Faith"........................... 77
V. THE DEVELOPMENT OF A HUMANISTIC-EXISTENTIAL
PSYCHOTHERAPY APPLIED TO CHILDREN ............. 78
Introduction ................................. 78
Humanistic-Existential View
of Child Psychotherapy .................... 80
Outline of Philosophy of HE Therapy .... 81
Theoretical Questions ...................... 83
Implications to Therapy .................... 91
Humanistic-Existential Therapy Applied
to the Basic Components of
Play Therapy............................... 94
The Child.................................... 94
The Therapist............................... 94
The Setting................................. 9 6
Structuring the Relationship ............. 96
Setting of Limits........................... 97
Goals of Therapy........................... 97
Conclusions . . . . . . . . .................. 97
Limitations and Implications ............... 101
BIBLIOGRAPHY .......................................... 102
______________________________________________________________ vi
CHAPTER I
INTRODUCTION
Background to the Problem
A child's play is "his/her work," that is, the medium
by which he/she learns coordination, the use of fantasy, to
attach word symbols to objects and activities. Play is the
activity of the child. Children play as they grow. There
are different ways to define the word "play," for example,
"Freedom or room to act out," play as "to exercise or
occupy oneself; to have operation or effect; work" (Axline,
1950a, p. 68). Margaret Lowenfeld's definition of play is
activities "that are spontaneous and self-generating, that
are ends in themselves, and that are unrelated to 'lessons'
or to the normal physiological needs of the child"
(Lowenfeld, 1935).
Play helps the child with possibilities to "act out"
situations which are disturbing and confusing to him/her.
Rousseau was one of the first writers who recommended that
in order to understand children, study children's play and
to be able to educate them, the teacher should become a
child himself/herself (Lebo, 1955). It has been suggested
that play is to the child what verbalization is to the
adult. Play is a medium to express feelings and explore
relationships (Allen, 1942; Axline, 1969; Dorfman, 1951).
1
As a form of therapy, play therapy developed out of
attempts to provide the child a way for growth using his/
her natural language, play (Axline, 1955). In practice,
psychotherapy with children always takes a form of play
therapy. To be able to work with children the child
therapist uses play as a medium (Axline, 19 69; Moustakas,
1959) .
Erik H. Erikson (1963),in a book entitled Childhood
and Society, defined play therapy as:
Modern play therapy is based on the observa
tion that a child made insecure by a secret hate
against or fear of the natural protectors of his
play in family and neighborhood seems able to use
the protective sanction of an understanding adult
to regain some play peace. Grandmothers and
favorite aunts may have played that role in the
past; its professional elaboration of today is the
play therapist. The most obvious condition is
that the child has the toys and the adult for
himself, and that sibling rivalry, parental nagging,
or any kind of sudden interruption does not disturb
the unfolding of his play intentions, whatever
they may be. For to "play it out" is the most
natural self-healing measure childhood affords.
(p. 222)
Erikson explained his philosophy on why children need play
therapy as other child therapists demonstrate their
philosophy in explaining the need for therapy. Different
child therapists use different theories, but they all use
play in their work with children. Play has been used as a
medium (Axline, 1964, 1969; Moustakas, 1959) as a way to
relate to children (A. Freud, 1951), as a way to be able to
interpret the unconscious process of the child (Klein,
2
1932), as a structure to achieve the goals of therapy
(Conn, 1955; Levy, 1938; Solomon, 1938).
McNabb (1975) in his dissertation categorized
different psychodynamic theories of child psychotherapy
into four main approaches. The psychodynamic theories of
play therapy include the (a) Psychoanalytic, (b) Structural,
(c) Relationship, and (d) Client-centered approaches.
Based on theories of adult therapy, different approaches
were developed for children. There is no theory of child
therapy; rather they are, with some limitations and
modifications, adult theories applied to children. The
literature that is available in the area of play therapy is
mostly based on case histories and experiential work guided
by the therapist's orientation. There is no question that
there are similarities between the approaches in psycho
therapy with children, as there are in adult psycho
therapies. But there are important philosophical
differences in all therapies that lead to different
approaches. It is the author's belief that there is an
absence of an articulated humanistic-existential (HE)
theory of therapy in the area of psychotherapy of children.
The therapist with a humanistic-existential training and
orientation cannot find theoretical literature to use in
working with children. The humanistic-existential approach
to therapy is mostly based on psychotherapy with adults.
To form a humanistic-existential approach to children
3
certain conditions should be taken into consideration.
Children go through different developmental stages (Piaget,
1950). Therefore some concepts used in adult therapies
might not have relevance to children. In order to develop
a humanistic-existential theory of child therapy, the
applicability of major concepts in the humanistic-
existential approach to children must be examined.
Problem
The major purpose of the dissertation is to build a
humanistic-existential theoretical approach toward child
psychotherapy and to develop a methodology to use in
practice and for doing further research in the area of child
psychotherapy. The research will be directed towards two
main objectives:
1. To build a humanistic-existential theoretical
approach toward child psychotherapy by outlining and
examining the main concepts in humanistic-existential
philosophy and theory and their implications for child
therapy.
2. To develop a humanistic-existential approach to
child psychotherapy by constructing a methodology of
humanistic-existential child therapy.
4
Research Questions:
1. What are the capacities and characteristics of
children based on their physical and psycho
logical abilities and how can that affect
determination of a humanistic-existential
approach? In other words, how much of
humanistic-existential theory has relevance or
non-relevance to children based on their
developmental growth?
2. What would be the basic principles of
humanistic-existential approach to child
therapy?
This dissertation will attempt to answer the research
questions based on a procedure that is described in the
section on methodology.
Rationale and Significance
The humanistic-existential therapist lacks access to
methodological work in child psychotherapy. The absence of
theoretical work makes it difficult to engage in any
experimental research. For example, a researcher cannot
determine the effects of humanistic-existential play
therapy on children unless there is an articulated theory
available in the area of child therapy. A therapist cannot
demonstrate and examine the components and principles of a
_____ 5
humanistic-existential child psychotherapy unless there are
methodological works available on the subject.
It is believed that the first step behind any
experimental research should be a sound theoretical approach
(Hanson, 1961; Mouly, 1970). To be able to have an
experimental design in humanistic-existential child psycho
therapy, one must have methodological guidelines
(Kerlinger, 1964; Kinneavy, 1971). This study will
provide theoretical information which can aid in furthering
psychological understanding. Moreover, this study will
have educational value as there will be possibility of
experimental research in-the area of child therapy.
Further, this study will be of value to the therapist as
he/she employs the research in his/her work.
Limitations
1. The humanistic-existential approach will be
limited to a definition based on a comparative-analytical
search into humanistic-existential (HE) literature.
2. Review of child psychotherapy approaches for
comparative purposes will include only the four psycho
dynamic approaches in play therapy.
3. Developmental research regarding the children's
psychobiological abilities will be mostly based on Piaget's
work.
6
4. The age group suggested who will benefit most from
play therapy is 4-12 years and the theory and methodology
will only pertain to that group.
5. The research will be limited to the published
literature.
Definitions
The term "play therapy" will be used interchangeably
with "child psychotherapy." Play is a medium to express
feelings and explore relationships (Allen, 1942; Axline,
1969; Dorfman, 1951). Play is to the child what verbaliza
tion is to the adult, so in practice psychotherapy with
children always takes a form of play therapy.
The term humanistic-existentialism is used in psycho
therapeutic literature to present a view of the individual
and a view of therapy. Humanistic-existentialism is
defined by what it believes regarding the individual and
his/her conditions. In reviewing the literature it becomes
apparent that there are differences among the humanistic-
existential therapists as to the basic principles of
humanistic-existentialism. The word "existential
psychology" is used interchangeably with "humanistic
psychology" or humanistic-existentialism or existential-
humanism (Bugental, 1965; Corey, 1977; Greening, 1971;
Yalom, 1980). The Encyclopedia of Philosophy (Vol. Ill)
(1967) begins its definition of existentialism by
7
declaring, "existentialism is not easily definable."
Different books on the subject define HE as what the
approach stands for to the main contributors to HE
literature. Yalom (1980) described existential approach as
a term that comes with words such as "choice,"
"responsibility," "humanistic," and "Sartrean."
Bugental (1978), in his book Psychotherapy and Process:
The Fundamentals of an Existential-Humanistic Approach,
described existential-humanistic psychotherapy as:
A kind of psychotherapy that is centered on the
fact of being alive, that seeks to heighten
consciousness and that tries to work with the
fundamental life process of awareness as its main
means for bringing to the client the possibilities
for richer and more meaningful living. The basic
theory of this psychotherapy is called existential
because it has to do with the fact of existence.
The value orientation of this psychotherapy is
called humanistic because it sees the greater
realization of the potentials of human beings as
the most desirable outcome of therapeutic work.
(Preface v)
Bugental (1965) also stated that "the truest existentialism
is humanistic and the soundest humanism is existential"
(p. 10).
Ofman (1981) defined the term HE as that brand of non-
theistic existentialism of Sartre, de Beauvoir, Camus,
Hazel Barnes (1959, 1967) and Ofman (1967, 1970, 1976,
1980). He stated (Ofman, 1974) humanistic-existentialism
is represented by such writers as Bugental (1965, 1967),
May (1969), Corey (1966), Wheelis (1969), and Laing (1965,
1967).
8
Corey (1977) defined the existential therapy based on
its premise that humans cannot escape from freedom and
responsibility. The key writers of existential psychology
according to him are Frankl(1963), May (1953, 1958, 1961),
Maslow (1968), Jourard (1971), and Bugental (1965).
Greening (1971) described existential-humanism:
Existential humanism as a psychological orienta
tion combines aspects of both existentialism and
humanism in a way that recognizes the contribution
of both approaches, while attempting to avoid some
of their limitations. Thus it is more affirmative
than much of existentialism but more cognizant of
the finiteness and contingency accompanying man's
self-actualization than are some joy and growth-
centered humanists. Existential-humanism includes
existentialism's recognition of the chaos,
absurdity, contingency, despair and "throwness" of
man's being in a world where he alone is responsible
for his becoming. It also includes the humanistic
postulate that man has a huge potential to trans
form himself and an unsuppressible drive to
experience fulfillment in testing the limits of
that potential against the obstacles inherent in
existence. (p. 9)
As one reviews the literature in existentialism it
becomes apparent that different authors assume different
approaches to existentialism. Some describe the major
philosophical tenets; others list the main contributions to
HE literature and refer to their ideas. Some authors
combine approaches. As Bugental (1965) said, the third
force is more clear about what it opposes than about what
it supports. The discrepancies come from the fact that
some writers define existentialism (humanistic-
existentialism) based on existential philosophy, while some
describe it by mentioning the writers whose work is
existentialist or some writers by its application to therapy
and what it means. Yalom (198 0) in his book, Existential
Psychotherapy, gave a history of existential philosophy
which makes it clear how different movements affected each
other.
It is apparent that any HE view will be based on a
philosophy of existentialism with its application to
therapy. The definition of HE and its application to
therapy will be predicated on the literature chosen to
define the theory. The selection of a writer as belonging
to HE is arbitrary since there is no objective way to
determine who should be included or excluded. Although
existential therapists have differences, they also have
commonalities. They all are concerned with persons and
their existence.
For the purpose of this dissertation the author will
base the research definition of HE therapy on a review of
main concepts of existentialist literature with an emphasis
on contributions of James F. T. Bugental, Rollo May, and
Jean-Paul Sartre. The definition of HE will be limited
based on the fact that it does not include all the contri
butions to existential psychotherapy.
10
Methodology
The research design will be a descriptive comparative
analysis intended to arrive at a humanistic-existential
methodological approach to play therapy.
The procedure to accomplish the research:
1. A review of the major approaches to play therapy
and synthesis of .the basic components of play therapy. The
author will review the four psychodynamic approaches in
play therapy in two parts. First, what is the philosophy
behind the approach? Second, in each view what is the
approach toward the basic components of play therapy (the
child, the therapist, the setting, structuring the rela
tionship, setting of limits, goals of therapy). The
purpose of this review is to synthesize the literature on
theoretical and methodological work in play therapy, to
distill the basic principles of play therapy, to describe
how each approach is structured, and to use that structure
as a framework to build an HE approach to play therapy.
2. A synthesis of humanistic-existential psycho
therapy based on a comparative-analytical search of
humanistic-existential literature, with the basic
philosophical and theoretical components of the humanistic-
existential psychotherapy the outcome. The author will
review the main concepts of humanistic-existential therapy
with emphasis on the contribution of Bugental, May, and
Sartre. The purpose of this synthesis is to build a
11
framework of philosophical and theoretical principles from
which to approach a theory for working with children.
3. A review of the literature of the psychobiological
characteristics of children:
a. The literature based on Piaget developmental
studies of the psychobiological characteristics of
children as they relate to the basic concepts of HE
therapy.
b. Additional relevant research in child develop
ment on the basic concepts of HE.
The purpose of this review is to recognize the relevance of
key concepts of HE to children, for example, the meaning and
relevance of the concepts of "choice" or "death" to child
therapy. This part will be an examination of child's
developmental research as it is related to HE theory.
4. The development of HE psychotherapy applied to
children:
a. An outline of philosophy of HE therapy based
on key concepts of HE and their implication for child
therapy.
b. A methodology of HE child therapy based on HE
therapy as applied to basic components of play therapy
(the child, the therapist, the setting, structuring
the relationship, setting the limits, goals of
therapy).
12
CHAPTER II
REVIEW OF THE LITERATURE
This chapter is designed to review the literature
related to major theoretical approaches in the area of play
therapy. Literature related to play therapy covers a broad
range; for example, literature on process in play therapy,
literature dealing with types of children seen in play
therapy, or literature dealing with outcome research in
play therapy. Since the purpose of this research is to
arrive at an HE approach to play therapy the review of
literature will be limited to different theoretical
approaches to play therapy. Literature in different areas
of play therapy can be divided through the philosophical
and theoretical approach of therapists.
McNabb (1975) in his dissertation categorized
different psychodynamic theories of child psychotherapy
into four main approaches. In this research the same
categorization will be applied to review different
approaches in the area of play therapy. The psychodynamic
theories of child psychotherapy include; psychoanalytic,
structured, relationship, and client-centered.
The review will be approached from two objectives;
13
1. To review the major theoretical work in play
therapy based on four approaches.
2. To identify the essential components of play
therapy in each theory under the following headings:
a. The child. What kind of children are seen in
therapy? What is the view of each approach to
children?
b. The therapist. What is the role of therapist
in therapeutic situations?
c. The setting. What kind of setting is used in
each approach? What are the materials?
d. Structuring the relationship. How is.the
relationship formed in the therapeutic situation?
What is the relationship between therapist and the
child? -
e. Setting of limits. Most therapists assume
that limits are an essential part of therapy, there
fore the question is what kind of limits each
therapist has in the playroom.
f. Goals of therapy. What are the goals of
therapy?
Therefore the second objective of the review is to
synthesize the view of each approach toward the essential
components of play therapy.
In summary, the review will consist of two parts:
(a) a philosophical and theoretical review of each
________ 14
approach and (b) a review of the basic components of play
therapy from each point of view.
Psychoanalytic Viewpoint
The psychoanalyst's approach toward psychotherapy with
children is mostly based on the work of S. Freud. S. Freud,
in "The Relation of the Poet to Daydreaming [1908]" (1953),
wrote about children's play activity as:
We ought to look in the child for the first
traces of imaginative activity. The child's best
loved and most absorbing occupation is play.
Perhaps we may say that every child at play behaves
like an imaginative writer, in that he creates a
world of his own or more truly, he arranges the
things of his world and orders it in a new way that
pleases him better. It would be incorrect to say
that he does not take his world seriously; on the
contrary, he takes his play very seriously and
expends a great deal of emotion in it. The
opposite of play is not serious occupation, but
reality. Notwithstanding the large affective
cathexis of his play world, the child distinguishes
it perfectly from reality; only he likes to borrow
the objects and circumstances that he imagines
from the tangible and real world. It is only
their linking of it to reality that still distin
guishes a child's play from "daydreaming."
(pp. 173-174)
S. Freud did not develop these thoughts further. Rather,
in Beyond the Pleasure Principle (1922), he concluded that
the play activities in children are characterized by
repetitions, the aim being to master inner and outer
pleasant experiences. The idea of looking at children's
activity only as a form of repetition is still present in
psychoanalytic literature of child psychotherapy. S. Freud
did not actually work with children. His main interest was
___________ 15
to observe them as sources of data for his personality
theory. In his work with little Hans, he worked with the
father of the child (1955) .
Since the work of play therapists with a psychoanalytic
approach is shaped by psychoanalytic theory, the basic
psychoanalytic tenets are summarized as follows:
1. Psychic determination is the sine qua non of
all theories of personality development.
Every thought, feeling, or action has a cause,
and can be understood in terms of antecedent
conditions.
2. The same principles of behavior operate, under
different conditions and to a different extent,
in both normal and disturbed individuals. The
difference between the mentally ill and the
normal is a difference in degree, not of kind.
3. Psychoanalysis established the tremendous
power of repressed thoughts and feelings.
Children have an unconscious storehouse of
memories and feelings.
4. Anxiety and the mechanism of defense against it
are a major cause of repression to unconscious
ness and account for much of what seems irra
tional and unrealistic. This anxiety can arise
from inner conflict with the outside world.
This concept is necessary in the understanding
of neurosis.
5. There is abundant evidence of the importance of
past events in present behavior, but psychoana
lytic investigation demonstrated the long arm
of unconscious memory, reaching back to the
first five years of life.
6. Sexual feelings and conflicts in early child
hood are particular sources of difficulty,
whether the reasons for these are biological,
environmental, or a combination of both.
(Kessler, 1966, pp. 9-10)
In psychoanalytic literature play therapy started with the
16
application of theory to child psychotherapy. Hertha von
Hug-Hellmuth (1929) stressed the importance of play in
child analysis when working with children seven years of
age or younger. She did not develop a technique of play
therapy but used play as a substitute for free association.
Anna Freud and Melanie Klein used the analytical
method as described by S. Freud in different ways. They
differed basically in their techniques of analysis and
their ideas concerning the development of the child's ego
and superego (Woltman, 1955). Anna Freud's approach has
been developed by her followers into the "Vienna School of
Child Psychoalanysis." Her approach was to play in the
session with children as a means of having a relationship
with them. She did not use play as the central part of
therapy; it was more a technique to build a rapport between
therapist and child (A. Freud, 1928). She changed and
modified analytic methods in order to work with children.
She believed the basic problem in psychoanalytic technique
in working with children to be the absence of free associa
tion and recognized that children's activities, their
dreams, daydreams and fantasies can be used in analysis as
a replacement of free association (A. Freud, 19.28).
Anna Freud's approach (1928) to child psychotherapy
was based upon psychoanalysis, but when different
theoretical situations did not apply to children she found
an alternative way to explain the therapeutic situation.
________ 17
The period that she played with the child was the preana-
lytic period and its main purpose was to establish the
relationship.
Melanie Klein was influenced by the work of Karl
Abraham and Sigmund Freud. She developed the psychoana
lytic play technique referred to as the "English School of
Psychoanalysis." In Klein's view (1932), the child
divides the world into "good" and "bad" objects. She
stressed the play of opposites, using good/bad, give/
receive, and preserve/destroy in the object relationship
while working with children.
Klein (1955) also used child's play and activities as
replacements for adult's words. She advocated making deep
interpretations early in the course of therapy, and treat
ing every play act as having symbolic meaning. In these
ways she is different from other child analysts (Haworth,
1964). Two main objectives of her therapy were: (a) the
exploration of the unconscious as the main task of psycho
analysis, and (b) analysis of the transference as the
means of achieving the first objective (Klein, 1955).
The Child
Psychoanalysis views the child in terms of the
"tension-reduction" or regression hypothesis. The life of
the individual is controlled by inherent tendencies. There
is an inherent tendency to eliminate the stimulation and
18
maintain the situation. Children have feelings and
memories stored in their unconscious. Children have
emotional problems because of their inability to sublimate
their irrational feelings and emotions. Psychoanalysts'
view of the child parallels their view of adults. The
difference between children and adults stems from the fact
that children are in different developmental stages.
Anna Freud (1951) developed her technique to be used
for infantile neurosis. She also worked with phobic
children, obsessional children, hysterical children and
children with neuroses and anxieties.
Klein (1927) worked with very young children. She
believed that analysis should be a part of the educational
system because all children could benefit from it.
The Therapist
The therapist's main task is to explore the unconscious
of the child (A. Freud, 1928; Klein, 1955) to bring into
consciousness that which is unconscious no matter to which
psychic institution it belongs. The psychoanalyst
therapist, by recognizing limits of free association in
treatment of children, uses play, in its broad sense of the
word, to obtain information as a basis for interpretations.
Anna Freud and Melanie Klein both agreed on the
uselessness of free association (Woltman, 1955) , but A.
Freud rejected the idea that transference neurosis develops
_____________________________________________ 19
because of the original love objects. The parents are
still actively in the situation, they are not fantasy
objects which can be transferred to the analyst. Another
major difference that therapist has to deal with in
children is the fact that an adult usually comes to analysis
on his/her own but the child is brought to therapy by
another adult.
The psychoanalytical child therapist interprets play
just as an analyst does with adult verbal offerings (Klein,
1955). The child is the main focus and technique is
shaped by the therapist's experiences with children.
The Setting
Anna Freud used toys especially during the preanalytic
period (Murphy, 1960). She also used play technique for
diagnostic observation and used drawings in the analytical
phase. Klein in her work with children first saw the child
in his/her own home using his/her own nursery full of toys.
After observing that children were limited in their home
setting, she saw children in a playroom, based on the
belief that transference could be established and
maintained if the child was separate from his/her home life.
Each child had a box which contained toys chosen
especially for him/her. The child was aware of the fact
that the box belonged to him/her and no one else (Murphy,
1960).
20
Klein (1932, 1955) suggested that equipment in the
playroom should be simple and limited to what is needed in
analysis. The playroom should have a washable floor,
running water, a table, a few chairs, a little sofa, some
cushions and a chest of drawers.
Structuring the Relationship
In the psychoanalytic approach the therapist gets to
know the child and develops a rapport before starting the
analytic phase. Anna Freud (1951) played with the child
and did whatever the child did*-
The relationship between the therapist and the child
is not an equal one. The therapist is the person who knows
better than the child what the child needs. It is a rela
tionship in which the therapist does something to the child
which causes his/her cure (Kessler, 1966). It is the
therapist who directs where therapy goes and decides on
what is most beneficial for the child. Anna Freud (1951)
stated that the analyst must put himself/herself in the
place of the child's ego ideal for the duration of the
analysis and to achieve this goal the therapist must have a
higher authority than anyone else.
Setting of Limits
The psychoanalytic view on setting of limits follows
the general line that the therapist does not allow a
physical attack on himself/herself because such attacks
21
will arouse guilt within the child. Klein (1955) viewed
limits as an important part of the interpretive work. It
should not become a moral influence but the therapist
should not encourage the child to show aggressiveness
through destructive behavior.
Goals of Therapy
The goal of therapy is for the therapist to help the
patient reduce the unconscious and increase the awareness
(there is a limit to this) to be able to do adequate
sublimation, so that the child no longer shows any
behavioral and emotional problems. The process of therapy
aims at the child being able to deal with irrational
feelings and emotions.
Structured Viewpoint
Structured play therapy stems from psychoanalysis.
The major theorists using this approach have a few differ
ences but they all agree structured play therapy offers
economy of effort and a close approximation of the desired
results. The structured therapists agree with the basic
tenets of psychoanalytic theory in reference to the
development of personality.: They differ in the techniques
they use.
Hambridge (1955) described structured play therapy as
a technique in the playroom in which the therapist designs
a number of specific stimuli situations which the child
22
plays out. This type of approach has been used by David
Levy (1938, 1939) as "release therapy," by J. C. Solomon
(1938, 1940, 1948, 1955) as "active play therapy," and by
Jacob Conn (1939, 1955) as the "play interview."
David Levy's (1939) theory of release therapy was
based on the rationale that after a child experiences a
traumatic event, the re-experiencing of it would allow the
child to "release" the pain and tension it caused. He
believed that when a child re-experiences an event his/her
role changes from a passive to an active one. In the play
situation the child is able to be active and take control
of the situation.
J. C. Solomon (19 5 5) developed a theory which
emphasized the importance of the integration of the ego as
primary in the development of self. He used play
techniques with the child as a way of doing direct therapy,
as a diagnostic tool, and a research device. Solomon used
an active therapeutic technique in working with children.
Jacob Conn (1939) developed his method of "play inter
view" which provides information quickly. In "play inter
view" the therapist might take a number of roles.
Depending on the situation and the child's responses the
therapist might talk as a doll (representing a member of
the family) or stay as a therapist and introduce new topics
of conversation. The therapist's emphasis is on planned
life situations.
23
Hambridge (1955) in his article (Structured Play
Therapy) gave a summary of different methods in the
structured play therapy. Depending on the kind of situa
tion and what the problem is the therapist will choose
his/her method. Different situations that a therapist
might design in play therapy are: (a) new baby at mother's
breast, (b) balloon bursting, (c) peer attack, (d) punish
ment or control by elders, (e) separation, (f) genital
differences, (g) the invisible boy (or girl) in the bedroom
of the parents, (h) birth of a baby, (i) specific threats,
(j) acting out dreams, (k) other individual play, or (1)
testing play.
The Child
The views of structured therapists are similar to
those of psychoanalysts because.'of their common philosophy.
The structured approach is based on psychoanalytic
philosophy and theory, therefore the view of the child and
why children have emotional problems is the same.
The kind of children seen by structured therapists
includes the fearful child (Conn, 1941b), the timid child,
the dependent child (Conn, 1941a), the child with castra
tion fears (Conn, 1955), and the anxious child (Conn, 1955).
Solomon (194 8) made a distinction between children
based on their personality types. The "aggressive-
impulsive" group, "anxiety-phobic" type, "regressive
24
reaction-formation" group and "schizoid-schizophrenic." He
suggested that each group could benefit from treatment but
differently, based on their personality type.
The Therapist
Theoretically, structured therapist views play therapy
in the same way as psychoanalyst therapist. However, their
approach is different. The structured therapist takes more
of an active role in the play situation. He/she structures
the play and at the same time participates in them.
Structured therapists use different methods in psycho
therapy with children: David Levy (1939) "release therapy,"
J. C. Solomon (1938) "active play therapy," and J. Conn
(1955) "play interview."
The Setting
Structured therapists believe that the nature of play
should be carefully selected and planned based on the
child's problem. Therefore the toys that are selected are
determined based on what kind of situations the therapist
is going to work on.
Structured therapists mostly use dolls in their thera
peutic work; however, other toys are also used when they
are needed. The dolls represent the members of the family.
Solomon (1948) used a doll to represent the therapist.
Hambridge (1955) suggested different kinds of material
based on specific problems that the therapist is working
__________ 25
through. For example, the situation of "invisible boy (or
girl) in the bedroom of the parents" requires a mother
doll, a father doll, a self doll, and a bed for the parents.
Structuring the Relationship
Hambridge (1955) stated that the therapist should
introduce structured play when the therapeutic relationship
has developed to the point that there will be neither
anxiety nor disruptive acting out. The therapist should
facilitate the play, not enter it. Solomon (1948) stressed
the importance of the relationship in therapy:
There is little question that this is the more
important aspect of therapy. Even though immediate
or manifest anxiety is more easily provoked by
active than passive methods, it is readily relieved
by the introduction of a doll representing the
therapist toward which the child can abreact some
of his feeling, thus relieving a burden from super
ego. (p. 405)
As a whole, like the psychoanalyst, the structured
therapist attempts to be more aware of the patient1s needs
than the patient himself/herself. The therapist takes the
major responsibility.
Setting of Limits
Solomon (1948) suggested that the therapist sets some
defined limits. Any attack on property or the therapist
should be stopped but without anger. The child can attack
the doll therapist but not the therapist. Structured
26
therapists limits are to stop any damaging and destructive
behavior toward the property, therapist or child.
Goals of Therapy
The general goal of therapy in the structured approach
is the same as in psychoanalysis since the philosophy
behind both approaches is the same. In more specific ways
each structured therapist had different kinds of goals to
achieve during the therapeutic work. J. C. Solomon's
(1955),goals in therapy can be summarized as: release of
aggression or hostility, secondary integration (reparative
mastery), i.e., directing the energy toward more acceptable
behaviors and helping the. child to learn to deal with time
in a three-dimensional manner.
Relationship Viewpoint
A theoretical background to relationship therapy is
available in the work of Otto Rank and Alfred Adler
(Moustakas, 1959). The work of relationship therapy as a
specific philosophy and practice in psychotherapy with
children was described by Jessie Taft (1933), Frederick
Allen (1942), and C. E. Moustakas (1959). The relationship
viewpoint has an existential orientation, emphasizing the
present and dealing with the present situation.
Otto Rank (1936) stated:
Allow the patient to understand himself in the
immediate experience which permits living and
understanding to become one where, for the first
27
time we find a striving for an immediate under
standing of experience, consciously, in the very
act of experiencing. (p. 34)
The relationship therapist stresses the development of
relationship as crucial, i.e., the therapist and the
patient as individuals and their relationship with each
other are the most important, factors of therapy. As
Moustakas (1959) put it, relationship therapy is different
from psychoanalytic therapy in that, although in both
approaches relationship between the therapist and child is
essential, the nature of the relationship is different. In
relationship therapy, the relationship is both means and
end. In psychoanalysis, relationship is a way to achieve
the other goals in therapy.
Jessie Taft (1933) based her approach on the
existential orientation and stressed the importance of the
present. She believed in the curative power of the rela
tionship between the therapist and child, and defined
therapy as "a process in which the individual finally
learns to utilize the allotted hour from beginning to end
without undue fear, resistance, resentment, or greediness"
(p. 17). She emphasized the importance of time limit in
the therapeutic relationship and since the time limit is
set on the calendar before the beginning of the therapy
relationship, then the termination is viewed as an integral
part of the process.
28
Frederick Allen (1942), like Jessie Taft, was concerned
with the problem of differentiation and individuation.
Although he used a physiological rather than a philosophical
frame of reference, he also pointed out the importance of
the relationship between the therapist and the child as
being the crucial factor in successful therapy.
Clark Moustakas (1959), in his book Psychotherapy with
Children, the Living Relationship, stated, "Relationship
therapy is a unique growth experience created by one person
seeking and needing help and another person who accepts the
responsibility of offering it" (p. 1).
The Child
The relationship approach views the child as free.
The child must be encouraged to maintain his/her own
identity, ideas and perception of reality. Allen (1942)
believed in the child's capacity for growth and accepted it.
He believed that the child should take responsibility in
the growth process. Moustakas (1953, 1959) discussed his
therapeutic work with the following types of children: the
disturbed child, the normal child, the adjusted child in
conflict, the creative child and the handicapped child.
The Therapist
The therapist in the relationship therapy should imply
the three basic attitudes of acceptance, respect and faith
(Moustakas, 1966). The therapist's personal development is
__________________________________________ 2 9
important as Jessie Taft (1933) stated:
Therapy as a qualitative affair must depend upon
the personal development of the therapist and his
ability to use consciously for the benefit of his
client, the insight and self discipline which he
has achieved in his own struggle to accept self,
life and time, as limited, and to be experienced
fully only at the cost of fear, pain and loss. I
do not mean that knowledge is not necessary, that
they are, but they are of no value therapeutically
without the person. (p. 19)
In the relationship approach the therapist is equal to the
child, and is not one who is aware of the need of the child.
It is the child who knows what is best.
The Setting
Moustakas (1959) described this position on the
setting of the therapy room:
1. The playroom should be brightly colored, and be in
an unstructured fashion.
2. There should be no attempt to indicate the
identity of toys and how to use them.
He believed that the playroom and toys should be arranged
in an unstructured fashion, so the child can make of it
what he/she wants.
Structuring the Relationship
The relationship is the most important factor in
relationship approach. Allen (1942) stated that the basic
structure of therapy is relationship and occurs regardless
of whether it is the child or adult who needs help.
_________________________________________ 30
Moustakas (1959) stressed the importance of structuring the
relationship in the early phases of therapeutic process.
Structuring the relationship should involve introducing the
child to the playroom and creating a warm relationship.
Further, he pointed out, it is through structuring that the
therapist conveys attitudes of faith, acceptance and
respect to the child. The child is able to achieve a clear
understanding of freedom and come to terms with it through
a structured relationship (Moustakas, 1959).
Moustakas (1953, 1959) emphasized the importance of
relationship and responsibility of both therapist and
client repeatedly. The central focus is a significant
relationship in which the adult maintains a deep concern
for the growth of the child. The individuality of the
child and an understanding of the capacity for self-growth
within the-child comprises the basic elements. He believed
that the child cannot experience a meaningful process in a
dishonest relationship. On the whole, the curative factor
and the most important factor in the relationship therapy
is an equal -relationship between the therapist and the
child.
Setting of Limits
Taft (1933) stated that the limits of time in therapy
represent the necessity of accepting limitations as a whole
and therefore symbolizes the whole problem of living. To
31
Moustakas (1959), the setting of limits was one of the most
important aspects of play therapy. He stated that there
would be no therapy without limits.
Moustakas (1959) mentioned the basic limits in the
therapeutic situation as:
1. There is a time limit in the therapeutic process.
2. There is a limit in the use of play material. The
child can use them in playroom, but not in the home.
3. The child is not permitted to abuse physically the
therapist or his/her clothing.
4. When the child leaves the playroom he/she cannot
come back during the same session.
5. There are always health and safety limits in
regard to the child.
He believed that it is through limits that the therapy
becomes real and the child feels a sense of security.
Goals of Therapy
The goals of therapy in relationship therapy follows
the view of the child and the reasons for the emotional
problems. The child no longer creates the problem. The
child achieves self-acceptance and self-respect (Moustakas,
1966). The goal of therapy is for the child to be aware of
oneself and accept the conditions of one's life.
32
Client-Centered Viewpoint
Carl Rogers' theory of personality grew out of his
experience in working with individuals (Hall & Lindzey,
1970). Carl Rogers' work was a basis for client-centered or
non-directive play therapy. Dorfman (1951) gave a descrip
tion of client-centered play therapy as "play therapy based
upon the central hypotheses of the individual's capacity
for growth and self-direction." One of the main contribu
tions to the literature of play therapy was provided by
Virginia Axline. Her work was mostly-based on the theory of
Carl Rogers. McNabb (1975) gave a summary of Carl Rogers'
work which has most relevance to the work of Virginia
Axline:
1. Characteristics of the infant: An infant per
ceives his experience as reality and has pre
disposition toward activation in reality per
ceived. He behaves wholistically and engages
in a valuing process, moving toward those
things positively valued.
2. Development of the self: Part of the actualiz
ing tendency in the child becomes differentiated
and symbolized in awareness, which is described
as self-experience. This awareness becomes
elaborated, through interaction with the envi
ronment into a concept of self.
3. Need for positive regard: This universal
trait develops from awareness of self. It is
reciprocal in that when the person satisfies
another, it becomes self-satisfying. Thus the
expression of positive regard by a significant
other can be more compelling than the organismic
valuing process.
4. Development of the need for self regard: . This
is a learned need developing out of self
experience and the need for positive regard.
33
5. Development of conditions of worth: In the
event that the person experiences only uncon
ditional positive regard, no conditions of
worth develop. Self regard should be
unconditional— hypothetically fully functioning.
6. Development of incongruence between self and
experience: Experiences are perceived selec
tively. Those in accord are accurately
symbolized to awareness; those not in accord
are denied awareness.
7. Development of discrepancies in behavior: Some
behaviors maintain self concept so as to make
congruence. Others are unrecognized or
distorted so as to be consistent.
8. Experience of threat and the process of
defense: An incongruent experience is per
ceived as threatening. This leads to the
development of anxiety. Rigidity, distortion,
and inaccurate perception of reality result due
to omission of data and intensionality.
9. Process of breakdown and disorganization:
When a person has a large degree of incongru
ence between self and experience and the
defense is unsuccessful, disorganization results.
10. Process of Reintegration: Because the person
is able to experience conditions of worth in
an atmosphere of unconditional acceptance an
increase in unconditional self-regard occurs.
(pp. 53-55)
The approach of Virginia Axline and Elaine Dorfman to
play therapy is based on client-centered theory. They both
made adaptions and modifications to client-centered therapy
based on their experience and contact with children. Axline
wrote many articles and books about non-directive play
therapy. Her approach is based on a secure relationship
between the child and the adult, in which the child has the
freedom and room to become in his/her own terms.
34
Axline (1969) stressed that the play session is the
child's hour and the therapist should not intrude into it.
As a therapist she did not participate in child's play.
Axline (1950a) stated:
One of the essentials in this experience is the
fact that the child's statement of himself is for
his benefit only. He is not concerned with
pleasing this other person in the playroom. He is
not concerned with experienced knowledge, that the
capacities within himself are living factors that
the child can enjoy and express and control.
(p. 69)
The Child
What kind of a child comes to therapy room and why?
Axline (19 69) answered the question:
They have problems and they do not know exactly
how to solve them. They drain off some of their
tensions by their aggressive behavior, but that
very behavior generates more trouble for them. It
is the misdirected drive for self-realization
within them that seems to cause their maladjustment,
(pp. 57-58)
Different kinds of children are seen in therapy: the
aggressive child, the disturbing child, the noisy child,
the withdrawn child, the handicapped child and children
with behavioral speech and study problems.
Axline (1950a, pp. 72-73) mentioned four kinds of
feelings that children express:
1. Those feelings for which the child takes the
responsibility;
2. Those feelings for which the child does not take
the responsibility;
35
3. Those feelings that are directed at a person who
is part of the child's real world; and
4. Those feelings that are directed against either a
toy or an unseen participant that the child places in
playroom through imagination.
Axline (1969) held two basic premises: (a) the child loves
growing and strives for it constantly, and (b) there are
certain basic needs within each individual which the
organism is constantly striving to satisfy.
The client-centered view of the child is basically the
same as client-centered theory of adults.
The Therapist
The eight basic principles which are guidelines in non
directive play therapy are (Axline, 19 69):
1. The therapist must develop a warm, friendly
relationship with the child, in which good
rapport is established as soon as possible.
2. The therapist accepts the child exactly as he
is. ■
3. The therapist establishes a feeling of permis
siveness in the relationship so that the child
feels free to express his feelings completely.
4. The therapist is alert to recognize the feelings
the child is expressing and reflects those
feelings back to him in such a manner that he
gains insight into his behavior.
5. The therapist maintains a deep respect for the
child's ability to solve his own problems if
given an opportunity to do so. The responsi
bility to make the choices and to institute
change is the child's.
36
6. The therapist does not attempt to direct the
child's actions or conversation in any manner.
The child leads the way; the therapist follows.
7. The therapist does not attempt to hurry the
therapy along. It is a gradual process and is
recognized as such by the therapist.
8. The therapist establishes only those limita
tions that are necessary to anchor the therapy
to the world of reality and to make the child
aware of his responsibility in the relation
ship. (pp. 73-74)
The Setting
While the ideal situation would be to have a furnished
playroom, play therapy can be done in a corner of a
classroom, as the therapist can bring the materials in a
suitcase (Axline, 1969). If the conditions make it possible
to furnish a special room, the following suggestions were
made by Axline (19 69):
1. The room should be sound proofed.
2. The room should have a sink with hot and cold
water.
3t. Windows should be protected by gratings or screens.
4. Walls and floors should be protected with a
material that is easily cleaned and that withstands clay,
water, or mallet attack.
5. If it is possible, the room should be wired for
phonographic recordings and provided with a one-way screen.
It should be used for furtherance of research and as an aid
for student therapists.
___________ 37
She also suggested a list of play materials for the playroom
which covers most toys. She stressed that play material
should be simple in construction and easy to handle.
Structuring the Relationship
The relationship between the therapist and child is the
key to the success or failure of therapy. Axline (1969)
believed that the child should understand the nature of
therapy contacts and be able to use them fully. The rela
tionship between the child and therapist is an equal one.
The therapist does not take the role of authority. The
therapist leaves it to the child to decide what to do and
how to do it. There is a close and special relationship
between the child and therapist based on the eight
principles mentioned in "The Therapist" section.
Setting of Limits
The limits in non-directive play therapy are very few
but very important, mostly concerning material things.
Axline (1969) stressed the following:
1. Common sense protection for the safety of child.
2. To protect the child from guilt feelings emphasis
should be placed upon confining the therapy to play therapy.
3. There is a time limitation, both in the length of
the session and length of therapy.
4. The therapist should not allow any physical attack
nor destructive behavior toward materials. On the whole,
38
consistency of the therapist gives the child security and
allows a feeling of acceptance.
Goals of Therapy
Successful therapy provides a release of feelings,
resulting in insight that brings about more positive self-
direction (Axline, 1969). The goals of therapy in client-
centered play therapy are generally the same as in adult
theory; i.e., they are focused on the process of reintegra
tion. The person is able to experience warm and uncondi
tional acceptance and as a result an increase in uncondi
tional self-regard occurs (Rogers, 1951).
Conclusions and Summary
The four main approaches to play therapy were dis
cussed. There are certain similarities among them, as they
all use play as the medium of the session. The psychoana
lytic and structured theorists both utilize psychoanalytic
theory, and both agree that the therapist should do some
thing for the child. It is the therapist who decides,
plans and directs the session. The differences between
psychoanalytic and structured approach are the technique
and application of the theory.
The relationship and the client-centered therapists
take a more humanistic approach and give the direction and
responsibility of the session to the child. The child is
the person who does something and guides the session.
39
Client-centered therapy comes close to relationship therapy,
but the focus is riot on the relationship itself but on the
therapist and child as separate individuals (Moustakas,
1959). The therapist in client-centered approach makes
reflections and clarifications, and has empathic under
standing and unconditional regard for the client.
Most of the literature that has been reviewed is not
recent, because the review had its focus on the theories of
play therapy rather than recent research. The articles
written about play therapy are mostly case histories and
explanation of positions of different theorists. Play
therapy is still in the process of finding a suitable
approach, method, and technique.
In the four approaches that have been reviewed, the
basic theory always comes from an adult theory of psycho
therapy, with modifications and adjustments which make it
possible to apply it to the psychotherapy of children. In
all four approaches there are basic elements that are
attended to. In each approach there is a philosophy behind
the theory of psychotherapy. After the formation of a
theory of play therapy there are certain principles to
follow which stem from the approach. In all the approaches
there is definition of the conditions of the child, the
therapist, the setting, structuring the relationship,
setting of limits and finally the goals of therapy all
based on the orientation of approach.
40
' This chapter was an attempt to review play therapy
theory, and to look at each of the basic elements in each
approach. In summary, a review of the theories of play
therapy has demonstrated that a theory of play therapy has
in all cases grown out of theories developed originally for
adults, and subsequently been modified to meet children's
needs and capacities.
41
CHAPTER III
A SYNTHESIS OF HUMANISTIC-EXISTENTIAL
PSYCHOTHERAPY
Introduction
I believe that one cannot understand psychological
disturbances from the outside, on the basis of a
positivistic determinism, or reconstruct them with
a combination of concepts that remain outside the
illness as lived and experienced. I also believe
that one cannot study, let alone cure, a neurosis
without a fundamental’ respect for the person of
the patient, without a constant effort to grasp
the basic situation and to relieve it, without an
attempt to rediscover the response of the person
to that situation, and . . . I regard mental‘ill
ness as the "way out" that the free organism, in
its total unity, invents in order to be able to
live through an intolerable situation. (Sartre,
1971, p. 6)
In the above passage Sartre stated the basic assump
tions of a humanistic-existential approach to psychology,
how to understand psychological disturbances and how to
approach them. This view is different from the positiv
istic deterministic view on which psychoanalysis and
behaviorism are based (Singer, 1965; Yankelovich & Barrett,
1971) .
The therapist's view or philosophy concerning human
beings is the basis upon which he/she understands and
approaches psychodynamics and, therefore, has a direct
relationship to the process of therapy. Differences
42
between a humanistic-existential philosophy and a
Cartesian philosophy--the basis of psychoanalysis— would
result in differences in therapeutic approaches. Therefore
an examination of HE philosophy and its background will be
most relevant to HE psychotherapy.
The purpose of this chapter is to build a framework of
philosophical and theoretical principles from which to build
an approach for working with children. To arrive at this
objective this chapter will include a review of the history
of existential philosophy and a synthesis of humanistic-
existential psychotherapy with the basic philosophical and
theoretical components of a humanistic-existential psycho
therapy the outcome. The author will review the main
concepts of humanistic-existential psychotherapy with
emphasis on the contributions of James Bugental, Rollo May
and Jean-Paul Sartre.
The Formation of Humanistic-
Existential Psychology
"Existentialism" is not easy to define. As one reviews
the literature in existentialism it becomes apparent that
most texts define existentialism by defining terms that are
related to existence.' Yalom (1980) explained that there is
an existential "tradition" in philosophy and a formal
existential "school" of philosophy. Traditionally, most
philosophers have been concerned with issues of life and
death. The formal school of existential philosophy started
_________________________ 43
with the work of Kierkegaard (Yalom, 1980). Heidegger and
Jasper are creators of existential philosophy in this
century who were influenced by two older century thinkers,
Kiekegaard and Nietzche (Barrett, 1962).
Although a formal existential "school" of philosophy
is the backbone of existential psychotherapy, there are
modifications and alterations when philosophical issues are
applied to clinical situations. Psychotherapists with
different clinical backgrounds adopted the existential view
which resulted in distinct approaches to therapy. One of
these groups was existential analysts who objected to S.
Freud's view of human nature. They all agreed that
analysts must approach the patient from a phenomenological
point of view and enter the patient's experiential world.
Their work was introduced to the American psychotherapeutic
community by Rollo May's book, Existence (1958).
Humanistic psychology was also a reaction to
behaviorism as well as Freudian psychoanalysis which
resulted in what is called the "third force" in psychology
(Bugental, 1965). Humanistic psychology has five basic
postulates:
1. Man as man, supersedes the sum of his parts.
2. Man has his being in a human context.
3. Man is aware.
4. Man has choice*
5. Man is intentional. (Bugental, 19 65,
pp. 11-12)
Bugental (1965) also described the characteristics of a
441
humanistic orientation in psychology:
1. Humanistic psychology cares about man.
2. Humanistic psychology values meaning more than
procedures.
3. Humanistic psychology looks for human rather
than non-human validation.
4. Humanistic psychology accepts the relativism
of all knowledge.
5. Humanistic psychology relies heavily upon the
phenomenological orientation.
6. Humanistic psychology does not deny the contri
bution of other views but tries to supplement
them and give them a setting within a broader
conception of the human experience. (pp. 13-14}
It is apparent that humanistic psychology is more an
orientation and a general view toward, human being than a
school of therapy. Humanistic existentialism is an
existentialist approach to therapy with a humanistic
orientation (Bugental, 1965; Greening, 1971). The
existential "school" in Europe has emphasized the limits
and tragic dimensions of existence (Yalom, 1980).
Humanistic existential psychotherapy has an existential
philosophy brought to the United States from Europe but
with a humanistic orientation which reflects American
mentality. It is the author's opinion that the term
humanistic existential psychotherapy, although based on
existential philosophy, is actually a modification of an
existential philosophy to the American culture. American
culture has more emphasis toward optimism, pragmatism and a
limitless horizon (Yalom, 1980), therefore humanistic
existential psychotherapy emerged as a response to the
American culture. Humanistic existential literature has
____________ 45
been connected to the work of Sartre, Camus and de Beauvoir
(Barnes, 1959; Ofman, 1976). The term humanistic
existentialism has been used only in American literature
related to psychotherapy (Bugental, 1978; Greening, 1971;
Ofman, 1976, 1980).
The Humanistic Existential View
The first principle of existentialism is that
"existence precedes essence" which means "man is nothing
else but what he makes of himself" (Sartre, 1965, p. 36).
This view of human being is basically different from self
as a computer, rat or an instinctual being. As a result, a
definition of human being is not possible and by the same
token everything is possible. There is no human nature,
each person chooses his/her own nature.
This view has significant implications for therapy.
How a therapist views human beings has important applica
tion to psychotherapy. As Singer (1965) stated:
. . . the definition of psychopathology depends
upon the psychotherapist's conception of the
nature of man (including as an ingredient his
belief as to whether it is possible for human
nature to accept or reject itself) and upon the
psychotherapist's philosophical position in rela
tion to this conception. Whether he considers it
"good" to accept or reject "human universals." A
therapist then deems nonpathological all these
aspects of behavior which are in accordance with
his idealized image of man; all that is in variance
with this image is pathological. (p. 12)
Existentialism views self as what he/she makes of himself/
herself. There is no predisposition as to essence of human
46
being except that human being exists and he/she is free to
choose his/her own definition. Human essence is not
determined by instinctual tendencies (as in psychoanalysis),
neither is he/she seen as a stimulus-response organism (as
in behaviorism); he/she is free to choose. Sartre stated
that there exists universal human conditions. There is not
a universal human essence but each of us is born into a
world with certain human conditions. He explained:
It is not by chance that today's thinkers speak
more readily of man's condition than of his nature.
By condition they mean, more or less definitely,
the a priori limits which outline man's fundamental
situation in the universe. Historical situations
vary; a man may be born a slave in a pagan society,
or a feudal lord or a proleterian. What does not
vary is the necessity for him to exist in the
world, to be at work there, to be there in the
midst of other people and to be mortal there. The
limits are neither subjective nor objective, or
rather, they have an objective and a subjective
side. Objective because they are to be found every
where and are recognizable everywhere; subjective
because they are lived and are nothing if man does
not live them, that is, freely determine his
existence with reference to them. (Sartre, 1965,
p. 52)
In the humanistic-existential view there is no map nor
blueprint to direct individual as to how to live his/her
life. Human being is thrown into the world with no guide
lines and he/she has to construct his/her own rules by
his/her actions. Each individual lives his/her life
without any outside knowledge about how to live. We never
know enough to feel safe and secure nor to be able to
predict. Bugental (1965) explained this feeling of not
47
knowing as contingency:
Contingency means that what will become actual is
contingent upon many influences, many variables,
so many that they may well be infinite in number.
The fact of contingency means that I never can
predict with complete assurance. The experience of
contingency means that I live with an anxiety.
(p. 22)
This kind of anxiety, a response to an unknown and unpre
dictable situation, is what existentialists call existential
anxiety (Bugental, 1965; Keen, 1970; Ofman, 1976).
Existential anxiety is different than neurotic anxiety
(Bugental, 1965; May, 1967). Neurotic anxiety is to
distort reality by believing that a person can achieve
certainty, a certainty which defines the existential
reality (Bugental, 1965).
Sources of Existential Anxiety
Existentialists believe that existential anxiety is
not pathological. Tillich (1952) has identified three
sources of existential anxiety. Bugental (19 65) applied
them to the therapeutic situation and added a fourth
contingency of human existence. The four contingencies
that produce anxiety are reviewed by Keen (1970), pp.
67-68) as follow:
1. The first contingency of human existence is that
death is the logical extreme of human finitude, human
beings are powerless against chance factors that control
them.
2. The second contingency of human existence is the
necessity to act. Human being has to make choices but
uncertain how to do so, which puts all the responsibility on
him/her. The fact that human beings have to make choices
and suffer their consequences places a heavy responsibility
on their shoulders.
3. The third contingency of human existence is the
threat of meaninglessness. There is no meaning in life
except that which one gives it. The world does not possess
a special meaning separate and apart from one's construc
tion. Human beings have different orientations to life but
the question is whether life is meaningful. "We may say
that life is meaningless because we find no meaning
intellectually, but to live life under the threat of
meaninglessness is accompanied by anxiety" (Keen, 197 0,
p. 67) .
4. The fourth contingency of human existence is the
isolation of the individual. Human beings share experiences
and are related but at the same time they are alone and
separate.
The four sources of existential anxiety derive from
the conditions of human being: these conditions are funda
mental to the basic tenets of existential philosophy.
Human being in this world is alone; he/she is born without
a predetermined essence; his/her life is based on his/her
actions and their consequences; human being is mortal, is
____________ 49
going to die; and if there is any meaning to his/her life
he/she must create it.
Intentionality, Bad Faith
and Authenticity
Another fundamental concept in humanistic existential
psychotherapy is intentionality. Human being is
intentional, which means consciousness is intentional.
Human being is always conscious of something, so it is a
view, an attitude. Ofman (1980) explained the relation of
intentionality to human being as:
That attitude has an intention, a way of relating
to the object of purview according to the deepest
project, cosmology, or personal myth. This basic
project or personal myth suffuses all of a person's
actions. It is evident everywhere. In effect, the
person defines himself by his freely chosen
personal ideology. (p. 840)
Therefore patient's intentions become an important aspect
of therapy. The humanistic existential therapist pays
close attention to the basic project of his/her patient.
Intentionality can be understood in terms of human
consciousness. Humanistic existentialists think of reality
in terms of: (a) being-in-itself, which includes all of
nonconscious reality; and (b) being-for-itself, which is
the being of self. In being-for-itself or consciousness,
human being is conscious of something, which is a point of
view (Ofman, 1976). The concept of human consciousness and
intentionality is interwoven with human freedom. Human
being is free to choose and act based on his/her
_____________________________________________ 50
intentions. The humanistic existentialist view of the
unconscious based on the existentialist view of person is
different from that held by psychoanalysis. The
humanistic-existentialists believe that individual is
aware and conscious of his/her world and in explaining the
unanswerable questions in regard to his/her personality
they use the concept of bad faith (Sartre, 1953). Sartre
(1953) stated that psychoanalysis uses the term unconscious
as if it is possible to have a censor without a censorship.
He posited that person is in bad faith when he/she is lying
to himself/herself and there is no unconscious as such
which consists of repressed thoughts and memories. Human
being is in bad faith when he/she lives in a "serious
world" as described by.Barnes (19 59):
. . . man cannot bear the realization that all the
values he lives by, his purposes, his projects are
sustained by his own free choice; he finds it too
great a strain to accept sole responsibility for
his life. Therefore he takes refuge in the belief
that somehow the external world is so structured
that it guarantees the worth of its objects, it
provides specific tasks which have to be done, it
demands of each person a definite way of living
which is the right one . . . the order of things is
absolute. It is a serious world. (p. 48)
Human being is in bad faith when he/she believes that
his/her actions can be explained in terms of external rules
or an unconscious over which he/she does not have control.
The question, then, is how a person can live and face the
realities of existence. Bugental (1965) defined the main
task of psychotherapy as aiding the patient in his/her
___________ , _____________ 51
efforts (a) to discard the distortions of awareness which
arose to forestall existential anxiety, and (b) to accept
the responsibilities and opportunities of authentic being
in the world. Both phases are based upon the concept of
authenticity. A definition of authenticity is given by
Bugental (1965) as: "A person is authentic in that degree
to which his being in the world is unqualifiedly in accord
with the giveness of his own nature and of the world"
(pp. 31-32). Ofman (1980) described the same idea in
regard to authenticity as:
For the existentialist the fundamental principle
of being is authenticity. The belief that the
only way for a person to fulfill his full humanity
is to recognize that his being is his individual
freedom cleaved to its twin, responsibility.
(p. 844)
A review of existential literature reveals that words
such as "freedom," "choice," "responsibility," "encounter,"
"bad faith," "meaninglessness," "isolation," "death,"
"intentionality," "authenticity" are central to existential
thought. The existential view of individual and his/her
relation to the world is defined and based on these
concepts (Bugental, 1965; Keen, 1970; May, 1958; Ofman,
1976, 1980; Sartre, 1953).
Implications to Therapy
Rollo May (1958) stated the implications of the work
of existential therapists in relation to psychotherapeutic
techniques which is summarized as:
52
1. The first implication is the variability of
techniques among the existential therapists.
2. The second implication is that psychological
dynamisms always take their meaning- from the existential
situation of the patient's own, immediate life.
3. The third implication in existential therapy is
the emphasis on presence. The relationship of patient and
therapist is taken as a real one. In existential therapy
"transference" gets placed in the new context of an event
occurring in a real relationship between two people.
4. The fourth implication for technique in
existential analysis is that therapy will attempt to
"analyze out" the ways of behaving which destroy presence.
5. The fifth implication has to do with the goal of
the therapeutic process. The aim of therapy is for the
patient to experience his/her existence as real. The
purpose is that he/she become aware of his/her existence
fully, which includes becoming aware of his/her potential
ities and becoming able to act on the basis of them.
6. The sixth implication which distinguishes the
process of existential therapy is the importance of commit
ment; the fact that "decision precedes knowledge." The
patient cannot permit himself/herself to achieve insight or
knowledge until he/she is ready to decide, takes a
decisive orientation to life, and has made the preliminary
decision along the way (pp. 78-87).
_____________________________________________________ 53
Humanistic-Existential View Applied
to the Basic Components of Therapy
In the second chapter, The Review of the Literature,
the author described the process of psychotherapy with
children from several perspectives: the child, the
therapist, the setting, structuring the relationship,
setting of limits and goals of therapy. It is now time to
describe HE psychotherapy with these questions in mind:
(a) How is a client seen from an HE point of view? (b)
What is the role of therapist in humanistic-existential
psychotherapy? (c) What kind of setting do HE therapists
use? (d) How is the relationship between client and
therapist different from other psychotherapeutic orienta
tions? (e) What are the limits in HE psychotherapy? and
finally, (f) What are the goals of therapy?
The Client
The HE view of the client is based on a philosophy and
a view of human being. As Sartre (1971) stated, mental
illness is a "way out" for the patient to be able to live
through intolerable situations. The same view of mental
illness is expressed by Laing (1967) and Szasz (1961), who
labelled it "problems of living." Rollo May, in his book
Existential Psychology (1961), identified six ontological
characteristics of human being:
1. Every person is centered in himself; and an
attack on this center is an attack on his
existence.
54
2. Every person has the character of self-
affirmation, the need to preserve his
centeredness: courage.
3. All persons have the need and possibility of
going out from their centeredness to partici
pate in other beings.
4. The subjective side of centeredness is aware
ness .
5. The uniquely human form of awareness is self-
consciousness. Man exists in a dimension that
cuts across and includes both' conscious and
unconscious, both cognition and conation, this
dimension is intentionality, the bridge between
subject and object. Anxiety is the experience
of the threat of non-being.
6. The consciousness itself implies always the
possibility of turning against one's self,
denying one's self (pp. 74-83).
Understanding the ontological characteristics of human
being contributes to the knowledge of HE therapist and how
he/she sees his/her client. May (1953) believed that
today's individual does not know what he/she feels. As
children they were always told what they should feel and
what they are feeling, which is a violating act. Violation
is defined as invalidation of one's experience by another
(Blount, 1976; Cooper, 1967; Laing, 1967; Ofman, 1980).
Blount (1976) in his dissertation defined the concept of
violation as:
a) One person in a position of power or influence
toward another, wherein
b) the person in power disconfirms the experience
of another by
1) denying the other's perception, or
2) undermining the other's perception, or
3) refusing to affirm the other's perception,
c) and the disconfirmation is committed in a
manner that is covert; i.e., the disconfirma-
tion is denied by the disconfirming party.
(pp. 13-14)
55
Humanistic existential therapists believe that violation is
the basis for psychopathology (Blount, 197 6; Ofman, 1980;
VandenBerg, 1972). That is the reason why the client is in
therapy in the first place. The client brings to therapy a
combination of anxiety and pain (Bugental, 1978), he/she
does not want to feel the pain and anxiety, does not like
how he/she feels, and his/her system (project) is not
working for him/her anymore.
The Therapist
The next question is: What is the role of therapist
in an HE therapy? Bugental (1978) made a distinction
between two kinds of therapists: innersearch therapists
and action therapists. In the former the therapist focus
is on what the client finds within himself/herself and in
action therapies the focus of attention is on what the
therapist does. The humanistic existential therapist is an
innersearch therapist. May (1969) described his role as a
therapist as:
My task as a therapist is to be conscious, as best
I can, of what the intentionality of the patient
is in a particular session. . . . To draw out
this intentionality so that the patient cannot
escape becoming aware of it too. (p. 247)
Humanistic existential therapists mostly agree that the
notion of psychotherapy is not a science or a technique,
but a way of being (Bugental, 1978; May, 19 61; Ofman,
198 0). The research regarding the therapist variable in
_________________________________________________________________56
effective psychotherapy supports this stand (Truax &
Mitchell, 1971).
Bugental (1978) argued that an ideal therapist should
be committed to his/her work, believe in the intrinsic
healing process of the client, should have a sense of
presence and have a cultivated sensitivity. These
characteristics for an ideal therapist mostly speak of
personality traits and value system of the therapist rather
than which techniques he/she should use.
The Setting
The kind of setting used in humanistic-existential
psychotherapy is based on the therapist's preference and
the situation. Bugental (1978) stated that he has a couch
in his office and it is up to his clients to use it or not.
The process of therapy can go on in a hospital room or a
private office; therefore the kind of setting really
depends on the therapist and the situation he/she is
working in.
Structuring the Relationship
Bugental's (1978) list of characteristics of an ideal
existential-humanistic client—therapist relationship
includes: mutuality, honesty, respect, and trust. The
humanistic-existential therapist is not out to change
his/her client as in psychoanalysis or behaviorism; neither
does he/she take the position of a superior person who
57
knows what is best for the client. Humanistic existential
therapist enters into the therapeutic relationship on an
equal basis to the client. The therapist position is that
the client is where he/she should be because of his/her
reasons. The client chooses to be in the state that he/she
is. The task of a humanistic-existential therapist is to
help the client to attend to the realities of his/her life
and be aware of them. The humanistic-existential therapist
is different from other therapists because he/she is not
intent on manipulating the client nor taking control of
his/her life nor telling him/her what is best for him/her.
Setting of Limits
The concept of limits also is based on the therapist's
personal needs and preferences. As Singer (1965) stated in
regard to the setting of limits:
. . . The nature and expression of these need
systems define the personality of the therapist and
that these self-definitions communicate themselves
to the patients from the earliest moments of the
therapeutic exchange. (p. 153)
The therapist should set limits and also be clear about
them from the start of the therapeutic encounter. The
limits imposed should include the prevention of physical
attack on the therapist. Singer (1965) believed that
setting the limits facilitates the patient-therapist rela
tionship and helps the patient to feel that he/she is
dealing with a real person. Rational limits help the
58
patient to prevent the development of unnecessary feelings
of guilt.
Goals of Therapy
The main goal of humanistic-existential therapy is to
help the person come into authenticity and experience
his/her life as real (Bugental, 1965; May, 1958; Ofman,
1980). To arrive at this goal, the therapist should be
authentic and therapeutic relationship becomes the main
focus of the psychotherapy.
59
CHAPTER IV
A REVIEW OF THE LITERATURE OF THE
PSYCHOBIOLOGICAL CHARACTERISTICS
•OF CHILDREN
Introduction
The purpose of this chapter is to review the relevant
literature in child development in order to develop a
humanistic-existential approach to child psychotherapy. To
arrive at this objective, the chapter will include a general
review of Piaget's theory of intellectual development and a
review of developmental issues related to basic concepts of
HE. A general review of Piaget's theory of intellectual
development will provide information regarding the
capacities and abilities of children who are seen in play
therapy. It can also be used in therapy in regard to how
much of theoretical concepts are applicable to working with
children. A review of developmental issues related to
basic concepts of HE can be used in order to develop a -
humanistic-existential approach to child therapy.
Piaget's Theory of Intellectual
Development
Piaget's theory breaks intellectual development into
four main periods: sensori motor (birth to 2 years),
60
preoperational (2-7 years), concrete operational (7-11
years), and formal operational (11 years and above). The
two stages of intellectual development that include most of
the age range of children seen in play therapy are:
preoperational (2-7 years) and concrete operational (7-11
years). It is necessary for a therapist working with
children to have a general understanding of the cognitive
processes of his/her clients. For the purposes of this
dissertation a description of the main characteristics of
these two periods (preoperational and concrete operational)
will be presented.
General Introduction to Piaget's Theory
of Intellectual Development
Draz and Rahmy (1976) presented a number of conditions
that should be considered before one speaks of the develop
mental stages. Their criteria were:
i
1. The order in which the behaviors appear must be
constant, irrespective of any acceleration or
retardation related to such factors as acquired
experience, social environment and individual
aptitude which might cause variations in the
chronological age.
2. Each stage must be defined, not simply by some
dominant characteristic but by a global struc
ture characterizing all the new behavior
peculiar to that stage.
3. These structures must demonstrate a process of
integration in which each structure grows out
of the preceding one is in turn integrated into
the following one. (p. 16)
The above criteria make it clear that there is no exact age
61
in which a stage starts; the age at which the stage occurs
varies considerably both within and among cultures. The
course of development is a continuous process. Phillips
(1975) stated that the child is not- always in the same
stage of development in different substantive areas.
Actually, the child may even show different levels of
achievement in problems involving similar mental operations.
This phenomenon is called horizontal declage.
The process of development is influenced by different
factors (Ginsburg & Opper, 1969; Phillips, 1975). The
first factor affecting development is maturation: heredity
provides the child with various physical structures
affecting his/her intellectual development. The second
influence on development is experience or contact with
objects, with the two subcategories of "physical experience"
and "logico-mathematical experience" (Piaget & Inhelder,
1969). The physical experience of the contact of the child
results in knowledge acquired directly from the objects
themselves; for example, the knowledge that tomatoes are
red. On the other hand, the logico-mathematical experience
results from experiences that come when the child constructs
relationship among objects— an internal coordination of
individual's actions— and not through physical experience
(Ginsburg & Opper, 1969; Phillips, 1975). The third
factor that influences development is social transmission,
which is acquisition of knowledge through other people.
62
It can be a parent explaining something to the child or
obtaining information from reading a book. Piaget's view
of the role of language in the development of behavior is
in contrast to other psychologists (Gruber & Voneche, 1977).
Piaget believed that logical thinking is basically non-
linguistic and derives from action. In other words, it is
not the language of the child that controls or shapes
his/her thought. The language is important and sometimes
controls behavior, but the child's thinking is not formed
only by his/her language. The child acquires knowledge and
receives new information through his/her actions, which
might be more advanced than his/her verbal behavior. The
fourth factor and the most important one affecting develop
ment is equilibration, which integrates the effects of the
other three factors (Ginsburg & Opper, 1969). Equilibra
tion is a function of every living system. It is a process
of achieving equilibrium between external stimuli and the
activities of the organism (Elkind, 1967). Piaget defined
the relation between equilibration and other developmental
factors as:
. . . equilibrium is a form (and equilibration a
structuration), but this form has a content and
this content can only be heredity or acquired by
physical or social learning. However as none of
these three factors acts alone, it would be useless
to try to isolate the equilibration factor; it
intervenes in every heredity or acquired process
and intervenes in their interactions. (Gruber &
Voneche, 1977, p. 836)
63
Piaget viewed learning from two perspectives. In a
narrow sense, the acquisition of new responses to a
specific situation, and from a broader perspective, the
acquisition of a new structure of mental operation which
results in the equilibration process and is viewed as a
developmental process (Ginsburg & Opper, 1969).
Two principle characteristics of intellectual
functioning over the life span are: organization and
adaptation (Flavell, 1963). Adaptation is composed of two
related but conceptually different subproperties: assimi
lation and accommodation. Assimilation and accommodation
are defined by Flavel (1963) as:
The process of changing elements in the milieu in
such a way that they can become incorporated into
the structure of organism is called assimila
tion. . . . The first aspect of adaptation has
been called assimilation. The second aspect, the
adjustment to the object, Piaget labeled accommo
dation— i.e., the organism must accommodate its
functioning to the specific contours of the object
it is trying to assimilate. (p. 15)
In other words, assimilation is a taking in of the environ
mental data, and accommodation is the outgoing aspect of an
operative process and the changes that take place in the
individual cognitive system as a result of environmental
intrusions (Klausmeir & Hopper, 1974) . The function of
assimilation and accommodation during developmental growth
forms a definitional basis for developmental periods. A
general description of preoperational and concrete opera
tional periods will follow.
64
Preoperational Period (2-7 Years)
A summary of Flavell (1963) principle characteristics
of preoperational thought are:
1. Egocentrism: The preoperational child is ego
centric with respect to representations. The child
repeatedly demonstrates a relative inability to take the
role of the other person, that is, to see his/her own
viewpoint as one of many possible and to try to coordinate
it with the others. There are two other difficulties which
derive directly from the child's egocentrism. First, the
child— lacking other role orientation— feels neither the
compunction to justify his/her reasoning to others nor to
look for possible contradictions in his/her logic. He also
finds it difficult to treat his/her own thought process as
an object of thought.
2. Centration and decentration: One of the most
pronounced characteristics of preoperational thought is its
tendency to center, as Piaget says, attention on a single,
striking feature of the object of its reasoning to neglect
of other important aspect and by so doing to distort
reasoning. The child is unable to decenter.
3. States and transformation: The child in preopera
tional period is much more inclined to focus attention on
the successive states or configurations of a display than
on the transformations by which one state is changed into
another. Preoperational thought is static and immobile.
65
4. Equilibrium: A principle characteristic of pre
operational thought is a relative absence of state
equilibrium between assimilation and accommodation— the
assimilatory network— the child's cognitive organization—
tends to rupture and dislocate itself in the process of
accommodating to new situations. The child is unable to
accommodate to the new by assimilating it to the old in a
coherent, rational way, a way which manages to preserve
intact the fundamental aspects of the previous assimilatory
organization.
5. Action: The preoperational thought tends to
operate with concrete and static images of reality rather
than with abstract, highly schematic signs--thus, although
the child does represent reality rather than simply act in
it; his/her representations are much closer to overt
actions, in both form and operations, than is the case for
older children and adults.
6. Irreversibility: The most important single
characteristic of preoperational thought for Piaget is its
irreversibility. A cognitive organization is reversible,
as opposed to irreversible, if it is able to travel along a
cognitive route (pursue a series of reasonings, follow a
series of transformations in a display, etc.) and then
reverse direction, in thought, to find again an unchanged
point of departure. In a general way, a thought form which
is reversible is one which is flexible and mobile, in
66
stable equilibrium, able to correct your distorting super-
ficials by means of successive quick-moving decenterings.
But the preoperational thought is not reversible.
7. Concepts and reasoning; Piaget refers to the
first, primitive concepts used by a young child as precon
cepts. In the preoperational thought, these preconcepts
tend to be action-ridden, imagistic, and concrete, rather
than schematic and abstract— Piaget uses the term trans-
ductive for the type of reasoning by which the preopera
tional child links various preconcepts. Neither true
induction nor true deduction this kind of reasoning
proceeds from particular to particulare. (pp. 156-160)
The child in the preoperational period is in an inter-
creative phase of cognitive growth. The child is changing
to "why" rather than "what" questions. The child has
primitive concepts of morality and shows a generalized
immaturity in coping intellectually with problems concern
ing time, causality, space, measurement, number, quantity,
movement and many others (Phillips, 1975). The child
between the ages of 5 and 7 goes through a transition
phase in which the preoperational traits change to traits
characteristic of concrete operations. Two aspects of this
transition are important (Flavell, 1963) . One is the child
is more able to do a specific task. In most of Piaget's
experiments the lower age limit of children is about four
years. The second important characteristic of the
67
transition to concrete operations is that the child becomes
more flexible, mobile, decentered and reversible in his/her
operations (Flavell, 1963).
Concrete Operational Period
(7-11 Years)
The concrete operational child like the preoperational
child operates based on representation as opposed to direct
attention (Ginsburg & Opper, 1969). The question is, what
are the cognitive differences between the preschool and
school age child? A broad difference which includes all
the particulars is that the older child seems to have in
his/her control a coherent and integrated cognitive system.
The child is able to organize and manipulate the world
around him/her (Flavell, 1963). The concrete operational
child focuses on several aspects of a situation at the same
time, is sensitive to transformations and can reverse the
direction of his/her thinking (Ginsburg & Opper, 1969).
The child is able to use the rules of logical inquiry, and
is capable of solving manipulative problems that can be
seen, touched and reordered. This is the major difference
which is seen through child's action and intellectual
functioning in several tasks. In terms of the three inter
dependent aspects of thought, centration-decentration,
static-dynamic and irreversibility-reversibility, the
concrete operational child is able to concentrate on more
than one thing, his/her thought process is more dynamic and
68
he/she has the ability to reverse his/her thought (Phillips,
1975).
Piaget in order to describe the structure of cognitive:
functioning used concepts such as groupings, which consist
of groups and lattices (Flavell, 1963) . The abstract
structures (the groupings, groups and lattices) whose
origin are not psychological are used to explain the
child's ability to deal with different specific tasks such
as classification, conservation of quantity, conservation
of number, distance, time and many others. A detailed
account of different groupings and their function in the
concrete operational period is beyond the scope of this
dissertation. For more detailed information regarding
different kinds of groupings the reader is directed to
Piaget's work or the Flavell (1963) book: The Develop
mental Psychology of Jean Piaget.
A review of developmental stages of preoperational and
concrete operational child makes it clear that according to
Piaget the child between the ages of 2-11 years old tends
to operate with concrete and static images of reality
rather than with abstract, highly schematic signs
(Flavell, 19 63; Ginsburg & Opper, 1969; Gruber & Voneche,
1977; Phillips, 1975). Although the thought of the child
in concrete operational period is more dynamic, reversible
and is able to pay attention to different things at the
same time, but still lacks the ability to grasp and
69
comprehend abstract thought. The key concepts of
humanistic-existential psychotherapy such as "freedom, 1 1
1 1 intentionality, 1 1 etc. are all abstract ideas. Therefore
the next part of the chapter will be an examination of
research in relation to these concepts.
Review of Developmental Research Related
to Theoretical Concepts of Humanistic-
Existential Psychotherapy
This part of the chapter will cover a review of
developmental research in relation to theoretical concepts
of humanistic-existential psychotherapy as it was developed
in Chapter III. The implications of this review to a
humanistic-existential approach for children will be
discussed in the next chapter.
"Freedom"
The main principle of existentialism is that human
being is born free. Human's freedom and its consequences
is the core of humanistic-existential psychotherapy.
"Freedom" is an abstract concept but the question is: Is
the child aware of his/her freedom? May (19 53) explained:
. . . around the age of two, more or less, there
appears in the human being the most radical and
important emergence so far in evolution, namely
his consciousness of himself. He begins to be
aware of himself as an "I." As the foetus in the
womb, the infant has been part of the "Original We"
with its mother, and it continues as part of the
"Psychological We" in early infancy. But now the
little child for the first time, becomes aware of
his freedom. He senses his freedom, as Gregory
Bateson puts it, within the context of the
70
relationship with his father and mother. He
experiences himself as an identity who is separated
from his parents and can stand against them if need
be. (p. 84)
It seems clear why it is so hard to determine the age at
which the child becomes aware of his/her freedom. The
reasons for coming to such conclusion and its implications
in terms of therapy will be discussed in Chapter V.
"Intentionality" and "Choice"
The question of intentionality and choice are also
important factors in dealing with children. Do children
make choices? At what age does the child make his/her own
choices and are his/her actions intentional? Again the
concepts of "intentionality" and "choice" as it. is
discussed in humanistic-existential psychotherapy from an
adult's point of view are abstract concepts. Developmental
research does not deal with, such issues in terms of: Do
children have a choice? Blount (1976) in his dissertation
argued that in the violating act the victim has a part. He
added that "there is evidence to lead one to believe that
this collusion can and does begin at a quite early age"
(p. 34). Studies of young children who have been treated
in a deprived condition (lack of care, attention, and
emotional warmth) show that young children's mortality
decrease as their treatment in the hospital improved
(Bakwin, 1942; Ribble, 1938). Blount (1976) stated that
"What is significant about these studies is that they pose
71
the question of intentionality in infants; did the infants
who lacked attention and caring decide to die?" (p. 35).
Several developmental psychologists see the infant as both
interactive and intentional (Elkin, 1961; Kessen, 1973).
Blount (197 6) concluded that although the child is
extremely weak and dependent, he still has a choice,
". . . it is no less a choice even though he sees it as his
only choice, it is not; others have chosen differently in
remarkably similar circumstances" (p. 36).
" Anxiety1 1
May (1977), in his book The Meaning of Anxiety, argued
that most of what is called children's fear is a mask of
anxiety in young children. Children fear things that are
imaginary, that they never had any experience with. Their
fears are often unpredictable and shifting and unrelated to
reality. May (1977) cited Jersild's research in which four
hundred children were asked about their fears. Jersild's
research showed that children fear animals, darkness,
heights or being attacked by ghosts or kidnappers. May
(1977) argued that since: (a) imaginary "fears" of the
child increase with age, and (b) it is difficult to predict
when a child is afraid, that these so-called fears could be
regarded as "appearances in objectivated form of underlying
anxiety" (p. 92).
72
From May's argument it can be concluded that children
experience anxiety at an early age. They express their
anxieties in the form of fears of darkness or wild animals.
This process is similar to the expression of adult
anxieties. Adult fears of things or places is usually a
mask for inner anxieties.
"Isolation"
Human beings are related and share experiences but at
the same time they are separate and apart (Keen, 1970) . Do
children have any understanding of the fact that
individuals are separate and apart from each other?
Developmental research does not include literature related
to the concept of "isolation" as such. Although in
children a fear of separation (separation anxiety) has been
recognized (Bowlby, 1969; Miller et al., 1974). However,
the separation anxiety declines by the age of 4 when the
child can perceive the position of objects removed from the
immediate locale (Bauer, 1978) .
"Death"
There is more developmental research about the concept
of death than about other concepts, such as choice or
freedom, although the concept of death and its meaning to
children is mostly neglected compared to other subjects in
developmental child psychology (Anthony, 1972; Yalom, 1980).
One concept that is related to children's understanding of
73
the concept of death is animism. Animism comes from the
concept that initially there is little or no differentia
tion between subjective and objective realities (Lonetto,
1980). The concept appears before the use of social
language, as animism has been related to general develop
ment of children across different cultures. The role that
animism plays in a specific culture will result in
differences within cultures. Piaget (1960) described the
animism of the child in terms of four stages: In the first
stage, will is attributed to inanimate objects. In the
second stage, will is attributed to everything that moves,
which occurs at about the age of 7 or 8. In the third
stage, will is attributed to things that apparently move by
themselves, which occurs beyond 8 years of age. In the
last stage, will is attributed to things in the same way as
adults attribute such characteristics. Safier (1964) in his
study of boys 4-10 years of age found a three-stage
developmental sequence of animism and death that supports
the work of Piaget (1960).
There are two important studies regarding the concept
of death in childhood: Maria Nagy's (1948) research and
Sylvia Anthony's (1972) research. Nagy (1948) in her
research of 378 children between the ages of 3-10 years
asked their idea about death. The research consisted of
children's compositions and drawings with their discussions
about death. The children came from different schools,
74
religions and social backgrounds. From her findings, she
concluded that:
1. The child who is less than 5 years of age usually
does not recognize death as an irreversible fact; in death
he/she sees life.
2. Between the ages of 5 and 9, death is most often
personified and thought of as a contingency.
3. Only at the age of 9 and later does the child
begin to view death as a process which happens to us
according to pertain laws (pp.' 3-27).
In the first stage, the child is in the process of denial.
There is no definite death. Death is seen as: (a) a
departure, (b) gradual and temporary. In the second stage
the child is in the process of acceptance and, either (a)
death is imagined as a separate person, or (b) death is
identified with death. In the third stage death is seen as
cessation of bodily activities.
Anthony (1972) asked 98 children (5-10 years) to do a
story-completion test. The questions were open-ended
without explicit reference to death. Approximately 50% of
the children referred in their story to death. Another
part of the Anthony (1972) research with children regarding
the concept of death was with 8 3 children who were asked to
define the word "dead" inserted into a test of general
vocabulary. One hundred percent of children 7 years or
older and two-thirds of children 6 years and older
75
indicated comprehension of the meaning of the word "dead."
Three out of 2 3 children of 6 years or younger were
ignorant of the meaning of the word. Anthony (1972) found
that school age children thought a lot about death in their
fantasies as well as in their play.
Rochlin (19 67) studied children's play (between the
ages of 3-5 years old) and found out that the subject of
death comes up in child's play constantly. He believed
that children's knowledge of death, including the
possibility of one's own death is acquired at an early age
and sooner than is generally supposed.. In fact, a review
of research related to the subject of death in children
(Alexander & Alderstein, 1958; Anthony, 1972; Childers &
Wimmer, 1971; A. Freud, 1960; Furman, 1974; Kastenbaum &
Aisenberg, 1972; Klein, 1948; Lonetto, 1980; Mitchell,
1966; Nagy, 1948; Rochlin, 1965, 1967) shows that children
have an understanding of the concept of death in one way or
other. Different writers disagree on the exact age and
kind of understanding the children have about death, but
they all agree that "between the extremes of 'no under
standing' and explicit, integrated abstract thought there
are many ways by which the young mind can enter into rela
tionship with death" (Kastenbaum & Aisenberg, 1972, p. 9).
76
"Meaninglessness," "Authenticity,"
and "Bad Faith"
The concepts of "meaninglessness," "authenticity," and
"bad faith" also were included in Chapter III as the key
concepts of HE psychotherapy. However, to the knowledge of
the author, there is no developmental research regarding
these concepts. The developmental research did not deal
with the questions such as, do children understand the
concepts of "meaninglessness" or "authenticity"?
This chapter included a general review of the
intellectual development of the child between the ages of
2-11 years old. Also, a review of the developmental
research in relation to the HE concepts was included. The
implications of this review to development of an HE approach
to child psychotherapy will be discussed in the next
chapter.
77
CHAPTER V
THE DEVELOPMENT OF A HUMANISTIC-EXISTENTIAL
PSYCHOTHERAPY APPLIED TO CHILDREN
Introduction
The purpose of this study was to build a humanistic-
existential approach to child therapy. The two main
objectives of the study, as were formed in Chapter I, were:
1. To build a humanistic-existential theoretical
approach toward child psychotherapy by outlining and
examining the main concepts in HE philosophy and theory and
their implications for child therapy.
2. To develop a humanistic-existential approach to
child psychotherapy by constructing a methodology of
humanistic-existential child therapy.
In order to arrive at these objectives the following topics
were discussed:
Chapter II: A Review of the Major Approaches to Play
Therapy. The purpose of this chapter was to use the
structure of play therapy approaches as a framework to
build a humanistic-existential approach to play therapy.
Each of the four psychodynamic theories of play therapy
were reviewed in two parts. First, what is the philosophy
behind the approach? Second, in each view what is the
______ 78
approach toward the basic components of play therapy (the
child, the therapist, the setting, structuring the relation
ship, setting of limits, and goals of therapy) . The same
framework will be used in this chapter to build a
humanistic-existential approach to play therapy.
Chapter III: A Synthesis of Humanistic-Existential
Psychotherapy with the Basic Philosophical and Theoretical
Components of a Humanistic-Existential Psychotherapy the
Outcome. The purpose of this synthesis was to build a
framework of philosophical and theoretical principles from
which to approach a theory for working with children. The
chapter included two parts: (a) The main philosophical and
theoretical concepts of HE were identified, and (b) HE
psychotherapy was applied to the basic components of therapy
(the client, the therapist, the setting, structuring the
relationship, and goals of therapy).
Chapter IV: A Review of the Literature of the
Psychobiological Characteristics of Children. The purpose
of this chapter was to review the general developmental
characteristics of the children who are seen in play
therapy, in addition to the relevance or nonrelevance of
HE concepts to children. The chapter included: (a) a
review of the Piaget theory of intellectual development,
and (b) a review of developmental research related to key
concepts of humanistic-existential therapy.
79
The development of humanistic-existential psychotherapy
applied to children was based on the knowledge of previous
chapters and consists of:
1. An outline of philosophy of HE therapy based on the
key concepts of HE and their implications for child therapy.
2. A methodology of HE child therapy based on HE
therapy as applied to the basic components of play therapy
(the child, the therapist, the setting, structuring the
relationship, setting the limits, and goals of therapy).
The development of the humanistic-existential approach
to children is limited to the information that is presented
in this dissertation.
Humanistic-Existential View
of Child Psychotherapy
The HE view of child therapy is based on the HE view
of adult therapy the same as other play therapy theories.
The basic philosophical and theoretical structure of HE
applies to child therapy. The humanistic-existential
therapist's view of the individual's nature, and based on
that view of therapy, does not change because he/she is
working with children. However, as-in other play therapy
approaches, it is essential to take into consideration the
child's capacity and ability as one of the basic factors of
therapy.
80
Outline of Philosophy
of HE Therapy
Each of the four psychodynamic theories of play
therapy consists of two parts. First, what is the
philosophy behind the approach? Second, in each view what
is the approach toward the basic components of play therapy?
An outline of philosophy of HE therapy based on the
synthesis of humanistic-existential psychotherapy will be
presented in this section to put forth the philosophy
behind a humanistic-existential child therapy.
1. HE therapy is based on the premise that "existence
precedes essence." There is no predisposition as to
essence of the human being except that the human being
exists and he/she is free to choose his/her own definition.
This view of the individual is different from the psycho
analysis or behaviorism view which is based on positivistic
determinism.
2. HE therapy is based on the premise that the
individual is thrown'into the world with no guidelines and
each individual lives his/her life without any outside
knowledge about how to live.
3. HE therapy is based on the premise that this
feeling of not knowing, which is termed contingency
(Bugental, 1965), produces existential anxiety. There are
four contingencies that produce existential anxiety and
represent the conditions of human existence.
81
4. HE therapy is based on the premise that the four
contingencies that produce anxiety are: death, necessity
to act, threat of meaninglessness, and the isolation of the
individual. The human being is mortal, has to make choices
and take responsibility for his/her action; there is no
special meaning in his/her life except that which one gives
it and he/she shares experiences and is related to others
but at the same time is alone and separate.
5. HE therapy is based on the premise that the human
being is free to make choices. His/her choices are not
determined by external factors, and it is the individual
who makes choices and is responsible for his/her choices.
Therefore the concepts of freedom, choice, responsibility
and consequences of the person's actions are all inter
related and important in HE therapy. The HE therapist
structures the process of therapy based on the client's way
of relating to the world, which is formed by the client's
actions and their impact on other individuals as well as on
himself/herself.
6. HE therapy is based on the premise that violation
is the basis of psychotherapy (Blount, 1976; Ofman, 1980;
VandenBerg, 1972). Violation (invalidation of one's
experience by another) is the reason why the client is in
therapy in the first place.
7. HE therapy is based on the premise that the human
being is intentional. The individual is aware and bases
82
his/her actions on his/her intentions. There are two ways
that each individual deals with conditions and realities of
his/her life. First one, the individual believes that
his/her actions can be explained in terms of external
factors and he/she does not have any control over his/her
life in which he/she lives in bad faith. Second one, the
individual takes responsibility for his/her actions and
accepts the giveness of his/her own nature and of the world.
8. HE therapy is based on the existential view of the
individual and his/her relation to the world which is
defined and based on the above premises.
Theoretical Questions
There are a number of issues in terms of the applica
tion of HE key concepts to children. Although the
discussion that follows is a hypothetical one, it appears
essential for an HE child therapist to examine these
questions.
Do children understand the concept of "freedom"? In
other words, do children understand the notion of human
beings born free to determine their own life? "Freedom" as
such is an abstract concept and, according to Piaget's
theory of intellectual development, is beyond children's
grasp. According to May (1953), a clinical psychologist, a
child at an early age becomes aware of his/her freedom.
There seem to be contradictory views in regard to the
83
concept of "freedom." It is difficult to determine at what
age children are aware of their freedom. Developmental
research does not deal with such a concept regarding
children. For example, it would be difficult to determine
the thought of a 5-year-c>ld child in regard to the concept
of "freedom." Examples of play therapy literature show
that children have a sense of identity and can stand
against adults if need be (Axline, 1964; May, 1953;
Moustakas, 195 3) .
It becomes clear that there are two different levels:
(a) A child sitting and talking about the concept of
"freedom," which developmental research shows that
children are not able to do. (b) A child shows in his/her
behavior a sense of identity and acts as if he/she is in
control of his/her life, which the examples of play therapy
sessions prove is true. It is essential for an HE child
therapist to be aware of the fact that children can stand
against adults and are capable of making decisions. The
theoretical knowledge that children in their actions show
understanding of their freedom determines the therapist's
view of the child, expectations of the child, and his/her
way of being with a child. The HE child therapist views
the child as free and able to choose in relation to his/her
conditions, which is in contrast with psychoanalysis and
behaviorism deterministic view. The therapist in dealing
with the child does not take the position that he/she
__________________________________ 8 4
knows the child's- unconscious and can decide what is best
for the child. The child and therapist are in equal
positions and both are not determined by external rules.
This theoretical position determines what goes on in play
therapy between the therapist and the child.
The next issue to be considered is: Do children
understand the meaning of death? Kastenbaum (19 67) stated
that comprehension of the sentence "I will die" requires
operations such as "self-awareness," "logical thought
operations," "conceptions of probability," "necessity,"
"causation of personal and physical time," "finality," and
"separation," which is beyond the child's cognitive
abilities to grasp these concepts. However, as the review
of the literature in regard to the concept of death showed:
"between the extremes of 'no understanding' and explicit,
integrated abstract thought there are many ways by which
the young mind can enter into relationship with death"
(Kastenbaum & Aisenberg, 1972, p. 9).
Developmental research regarding the concept of death
showed that children relate to and have an understanding of
the concept of "death." The children's fears and images of
death are not the same as adults, but they are aware of
death and its relation to life. The HE concept of "death"
holds true to HE child therapy with limitations. The'
child's view of death does not necessarily follow the
therapist's view of death.
85
Another key concept of HE psychotherapy is "necessity
to act." Do children make choices? Do children understand
that they have a choice? Do children act intentionally and,
if children make choices, do they take responsibility for
their actions? Blount (1976) argued that the child at an
early age has a choice and makes choices. Yalom (1980)
explained that a child's response to death is based on a
process of knowing too much too early and then a system of
denial is based on that. What Yalom (1980) discussed was
the child's response to death, though the process of denial
was the child's intentions. The child decides or makes a
choice or intends to deny his/her knowledge of death is
what can be inferred from Yalom's (198 0) statement.
The children's ability to deny their feelings towards
death means that they intend to do that. The child decides
to deny his/her understanding of death which is upsetting
to him/her. HE therapists do not believe that there is
somebody else in the child's mind. The child decides and
based on his/her decisions makes choices. It is the
author's opinion that the child is in trouble if he/she
does not take responsibility for his/her actions and does
not accept his/her conditions. The feelings become over
whelming and the child gets lost and loses his/her sense
of identity. As has been argued, the concept of "necessity
to act" applies to HE child therapy and constructs the
process of therapy.
86
Another theoretical question is: Do children under
stand the meaning of "isolation"? Developmental research
deals with the separation anxiety which declines by the age
of 4 when the child can perceive the position of objects
removed from the immediate locale (Bauer, 1978). In
clinical studies children talk about their loneliness and
fear of separation (Axline, 1964; Moustakas, 1966). The HE
child therapist can apply the concept of "isolation" to
working with children by his/her awareness of the child's
need of understanding and fear of separation. The HE child
therapist by entering in the child's world can recognize
the child's loneliness and separation.
The HE child therapist has to pay attention to the
application of the interrelated concepts of freedom,
choice, responsibility and consequences of the person's
actions. The child at an early age is able to say "no" to
adults which shows his/her sense of self and independence.
The child's way of relating to his/her surroundings shows
his/her way of being. The HE child therapist's main
consideration is the child's behavior and subsequently its
consequences. The child's actions, their impact, and
his'her taking responsibility for them are the main issues
of therapy.
Another theoretical consideration is the concept of
"violation." The HE therapist's theoretical belief is that
violation is the basis of psychopathology. Therefore the
87
HE child therapist should be aware of his/her own behavior
in relation to the child and also the interaction of the
child with significant adults in his/her life. A child's
behavior could be affected by the expectations of adults in
his/her life. For this reason, the interpersonal relation
ship of the child with adults and the child's response to
that is significant.
Other theoretical questions are: Do children under
stand the meaning of "meaninglessness1 . 1? In other words, do
they understand that there is no meaning in the world
except what one gives it? With reference to the child's
response to the conditions of life are the following
questions: Do children deal with their life in an
authentic way? Or, do children live in bad faith? And
finally, how do they view themselves and their intentions?
Developmental research does not deal with such issues.
According to Piaget, the preoperational child is egocentric
which means he/she is not able to treat his/her own thought
process as an object of thought or take other's viewpoint
(Flavell, 1963). Therefore it would be difficult for the
child to reflect on his/her own actions. Singer (1965)
stated that the capacity to "shift one's perceptual
approach, a capacity necessary for genuine activity, can be
observed most strikingly in the play activities of
children" (pp. 67-68) . Singer (1965) stated the child's
quality to get involved, the child's use of creative
88
imagination, openness to experience, willingness to stand
uncertainty and readiness for surprise, which he called
"childlikeness," as being necessary criteria of emotional
well-being. These are the criteria for an authentic way of
life. The child has the qualities to deal with his/her
life in an authentic way. The HE child therapist can use
these criteria in play therapy to examine the child’s way
of dealing with his/her life situations and conditions.
Several conclusions seem to be appropriate in
examining the relevance or nonrelevance of HE concepts to
child therapy.
1. As was mentioned before, according to Piaget's
theory of intellectual development, the preoperational and
concrete operational child is not able to comprehend
abstract thought. Basic HE concepts are philosophical
issues and abstract.
2. Developmental research lacks information in regard
to the key concepts of HE with the exception of the concept
of "death." Review of the research as to the child's
knowledge of death showed that, although children at
different age groups have different kinds of understanding
of death, it is not the same as an adult's view.
3. Piaget argued that language plays a limited role ir
the formation of the child's thought (Gruber & Voneche,
1977). A child thinks nonverbally and has his/her own
personal system of meaning which is not necessarily the
89
same as an adult's. Therefore it is difficult to determine
exactly what goes on in the child's mind, which explains
the lack of and/or contradictory results of research.
4. May's (1977) argument that most of the children's
fears are a result of underlying anxiety is another way of
looking at children's behavior. Developmental psychologists
describe and explain a child's behavior as it appears.
Clinical studies, on the other hand, deal with a child's
behavior in terms of the motive behind the behavior and
interpretations of it. For this reason, there is contra
dictory evidence as to the child's understanding and
comprehension of humanistic-existential concepts.
5. HE key concepts from the child's point of view are
abstract thoughts and beyond the child's comprehension.
The child can live them, e.g., child is authentic, but
there is no research to show that they experience
authenticity or not. Also, in regard to concepts of
"choice" and "intentionality," the child's behavior seems
to show that they make choices. There are two levels:
(a) A child sitting and talking about these abstract levels,
which developmental research shows that children are not
able to do. (b) A child shows in his/her behavior applica
tion of HE concepts and has some understanding of it, which
research confirms.
6. An examination of key concepts of HE and their
implications to child therapy shows that HE basic.-
90
philosophy applies to children only with limitations. In
regard to each concept there are issues to be considered,
also the lack of developmental research in regard to
certain issues is an important variable. Further research
in regard to key concepts of HE and their relevance to
children could be most helpful to an HE child therapist.
Implications to Therapy
This section deals with several general points which
may be necessary for an HE therapist working with children
to take into consideration.
1. One of the important aspects of Piaget's work is
that a child thinks differently than adults. An HE
therapist working with children should recognize this
aspect.
2. According to Piaget's developmental theory, the
psychological structures change from one age level to
another. However, an individual of any age continually
organizes his/her response to the environment. Therefore a
child confronted with tragedies of life, e.g., death of a
known person, will respond to it, but not necessarily the
same as an adult.
3. In working with children, determining the level of
cognitive functioning is important in understanding the
level of communication a child is able to achieve during
therapy.
_________________________________________________________________ 91
4. In working with severely disturbed children, the
therapist has to keep in mind that a severely disturbed
child passes through Piaget's stages at a slower rate than
their chronological age or IQ would predict (Delany &
Fitzpatrick, 1976) .
5. The latter brings out another factor, that the
exact age of the child at each level of functioning varies
based on cultural, social and economical background. The
exact age of the child has not been emphasized in regard to
different topics discussed in this dissertation for the
same reason. Therefore the knowledge of different levels
of functioning is more important than the knowledge of the
exact age a child is in a certain stage. In fact, too much
emphasis on the exact age of each child functioning in each
stage and substage can affect the therapist's work in the
way that he/she looks at the child's abilities with a
limited scope.
6. According to Piaget, children talk at each other
instead of to each other and also make up names for things
and assume that everyone understands it (Elkind, 19 67). An
HE child therapist should recognize this factor which is
based on the young child's inability to put himself/herself
in another person's view.
7. Piaget views the process of play in the child
starting at a concrete level of experience before he/she is
able to develop to the abstract level. The child, by using
___________________ 92
play as a medium, is able to generalize his/her emotional
experience to a more abstract level (Piaget, 1962). One of
the most important applications of HE theory to child
therapy is in the playroom where the child's feelings and
emotional experiences regarding his/her own conditions,
e.g., concept of "death" or "isolation," can be dealt with
at a concrete level which is then generalized into a more
abstract level.
8. One of the major components of violation has been
defined as one person in a position of power or influence
toward another (Blount, 1976). HE therapists working with
children should pay extra attention to this factor, since
children by their nature are usually in positions that put
adults in a more powerful place.
9. The HE therapist emphasizes the importance of
commitment (May, 1958). The HE child therapist should be
aware of the fact that there are children in play therapy
because of their parents. It is true that in most cases
parents bring their children to therapy. However, the HE
child therapist should pay attention to the situation and
the reasons the child is in play therapy; e.g., the child
is in play therapy because he/she has problems or it is the
parents who have problems or both. In sum, the HE child
therapist should be aware of the reasons the child is in
therapy and also the child's readiness for therapy.
93
Humanistic-Existential Therapy Applied
to the Basic Components
of Play Therapy
The Child
The HE view of the child is based on the HE philosophy
and view of the individual* The six ontological character
istics of human beings, as stated by May (1961) and cited
in Chapter III, are how the HE child therapist views
his/her client. The HE child therapist views a child as
free and able to choose in relation to his/her conditions.
The child is in trouble because of being told what he/she
should feel and what he/she is feeling, which is a
violating act (May, 1953). The reason that the child is in
therapy is because he/she gave up his/her own self.
Moustakas (1959) stated that at the root of the child's
difficulty is denial of his/her self.
What kind of children are seen in therapy? The HE
child therapist can work with different kinds of children.
The clinical work in this area will show what kind of
children would benefit most from HE child therapy.
The Therapist
What is the role of an HE child therapist in a
therapeutic situation? An HE therapist working with
children does not have a different view of therapy than one
working with adults, although a therapist working with
94]
children should have complete familiarity with child
developmental abilities and children’s cognitive function
ing.
The HE child therapist's emphasis is on the present.
The therapist begins with the living experiences of the
child and is aware of what goes on at the moment, which is
different from psychoanalysis where there is emphasis on
the past. The HE child therapist provides a situation in
therapy in which the child feels free to express himself/
herself. The therapist views the child as a person who is
capable enough to deal with his/her own problems.
The HE child therapist views the notion of psycho
therapy not as a science or a technique but a way of being.
Erikson (1963) stated that the modern play therapist is an
understanding adult who helps the child, which is the same
role grandmothers and favorite aunts have played in the
past. It is the therapist's way of being which helps the
child most. A therapist's warmth, presence, availability,
and understanding are more important than a specific
technique. As a whole, the role of the HE child therapist
is not that different from the HE therapist working with
adults, except he/she should be aware of the psychobiolog-
ical characteristics of children and their levels of
communication.
______ : _______________________ 95
The Setting
The kind of setting that is used is based on the HE
child therapist and the conditions* The HE therapist can
use unstructured toys since that helps the child's imagina
tion. The conditions for the playroom, mentioned in
Chapter II (p. 37) by Axline (1969), are inclusive and
adequate.
Structuring the Relationship
How is the relationship formed in the therapeutic
situation? What is the relationship between the therapist
and the child? The therapist-child relationship is based
on: honesty, respect, mutuality and trust. The HE child
therapist does not plan to change the child or do something
to him/her as in psychoanalysis or behaviorism. The HE
child therapist does not take the position of superior and
does not act as he/she knows better what is right for the
child. The HE child therapist enters into the therapeutic
relationship on an equal basis with the child. The
humanistic-existential view of the individual is an inter
personal one, therefore the relationship is the most
important factor. The child is in the therapy room because
of problems in his/her relationship. The bond established
between the therapist and child and their relationship is
crucial in helping the child to deal with his/her
problems.
_________________________________________________________________ 96
Setting of Limits
The concept of limits is based on the HE child
therapist's personal needs and preferences. The therapist
should be clear about the limits and make sure that the
child understands them. The limits imposed should include
the prevention of physical attack on the therapist. Other
limits can be established as was mentioned in Chapter II by
Axline (1969) and Moustakas (19 59) . It seems that imposing
different limits for the purpose of therapy should come out
of clinical practice and experience with different
situations.
Goals of Therapy
The main goal of humanistic-existential therapy is to
help the person come into authenticity and experience
his/her life as real (Bugental, 1965, May, 1958; Ofman,
1980). To apply this to child therapy an HE child
therapist needs to help the child to come into his/her own
self. The child needs to come to his/her own feelings and
have a separate identity as an individual.
Conclusions
An HE approach to children cannot be separate and
apart from the HE philosophy and psychotherapy. Conse
quently, a synthesis of HE philosophy and psychotherapy was
essential. An examination of the key concepts of HE therapy
and its application to children was necessary to build an
97
HE approach to child therapy. The purpose of this research
was to develop a humanistic-existential theoretical
approach toward child psychotherapy and to suggest a
methodology to use in practice and for doing further
research in the area of HE child psychotherapy. The two
main objectives of the study were a framework for developing
an HE approach to children. The central research questions
were:
First Research Question
1. What are the capacities and characteristics of
children based on their physical and psycho
logical abilities and how can that affect
determination of a humanistic-existential
approach? In other words, how much of a
humanistic-existential theory has relevance or
non-relevance to children based on their
developmental growth?
The research in psychobiological abilities of
children was reviewed. It has been argued that key
concepts of HE has relevance to children as long as a
therapist views children as children act and live human
conditions and limitations, but they do not think as adults
and are not able to participate in intellectual conversa
tions in regard to their behavior and way of life. It has
also been argued that a child therapist has to be informed
98
about his/her client's cognitive abilities, since the
communication between the therapist and child is the
principle factor in therapy.
Second Research Question
2. What would be the basic principles of
humanistic-existential approach to child
therapy?
The key concepts of HE therapy were identified. Also,
humanistic-existential therapy was applied to the basic
components of play therapy. The HE view of the child, the
therapist, the setting, structuring the relationship, the
setting of limits and goals of therapy were discussed. As
in other play therapy approaches, the humanistic-
existential approach to children is mostly based on the HE
approach to adults. The source of the information and
backbone to the approach is based on HE philosophy and
therapy.
HE child therapy is different from other child therapy
approaches as HE theory is different from other therapeutic
theories. HE child therapy comes close to relationship
child therapy as both approaches have an existential
orientation. There is no question that different approaches
to child therapy have commonalities as in approaches in
adult therapy. However, the theoretical differences
between the approaches make significant differences in
99
therapeutic encounters. An examination of the theoretical
concepts and their implication could be used in practice
and research to further psychological knowledge in regard
to children.
The developmental research in regard to HE key
concepts is very limited and inadequate. At this point,
the lack of an inclusive and substantive developmental
research about the main concepts of HE psychotherapy makes
it impossible to construct a theory of HE child therapy
that can be confirmed. However, the possibility of
constructing a theory of HE child therapy exists with
further research in developmental psychology and in
clinical work in regard to HE concepts and their implica
tions to child therapy.
The author attempted to make a guideline and a
framework for developing an HE theory of child therapy by
examining the relevance of HE concepts to children.
The HE therapist working with children applys his/her
knowledge of HE therapy in his/her work. Hopefully, this
dissertation as a framework is a starting point for
constructing an HE child therapy that can be confirmed with
substantive research and clinical work.
The proposal of the application of HE psychotherapy to
the basic components of play therapy (the child, the
therapist, the setting, structuring the relationship, the
setting of the limits, and goals of therapy) is a guideline
100
for an HE therapist working with children. The application
of HE therapy to children needs modification and
examination of the HE philosophy, theory and therapy. This
dissertation attempted to build a framework and guideline
until further research is done in different specific areas
of the child therapy.
Limitations and Implications
The development of an HE approach to children is
limited in one respect. The HE approach to children is
theoretical and hypothetical. The selection of theoretical
literature is also a limitation to study.
The findings of this study, though limited, have
several valuable implications toward research and practice
of child therapy. The HE child therapist in practice can
use this study as a source for his/her work. Further
research should be directed toward the examination of HE
concepts in play therapy. Also, research can be directed
toward adding information to the HE view of play therapy
components. The effectiveness of HE child therapy with
children can also be examined. The student or therapist of
counseling and psychotherapy can profit by understanding
more about children. Such an awareness cannot only help
the development of more knowledgeable therapists, but also
to more successful therapy with children, who have been the
main concern of this study.
101
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Nonverbal and demographic correlates to levels of androgyny, masculinity, femininity, and undifferentiated sex-role categories, with female clients in a therapeutic setting

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Creator Mottaghipour, Yasaman (author)

Core Title The humanistic-existential approach to child therapy: A methodology for practice and research

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-516636

Unique identifier UC11245623

Identifier usctheses-c26-516636 (legacy record id)

Legacy Identifier DP24925.pdf

Dmrecord 516636

Document Type Dissertation

Rights Mottaghipour, Yasaman

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA