Children’s Use of Board Games in Psychotherapy (Book Review)

Author:  Bellinson, Jill
Publisher:  Northvale, NJ: Aronson, 2002
Reviewed By:  Karen Zelan, Summer 2005, pp. 57-59

Jill Bellinson’s interesting book on the therapeutic use of structured games promotes a developmental orientation toward children in psychotherapy. E.J. Anthony (1982) observes that psychodynamic psychotherapy with children is rather different from that with adults. One reason for this is the mental discontinuity between the adult therapist and the child patient. There are also discontinuities across childhood stages. Bellinson describes young “oedipal” children, whose play predilections take the form of dramatic scenes, as different from latency-age youngsters, who naturally prefer structured activities and games. Adolescents and adults more often converse directly in psychotherapy.

Bellinson laments that playing structured games with children in therapy is rarely discussed in the child therapy literature or viewed as therapeutically useful. At best, children’s game playing is seen as ancillary to treatment, not the treatment itself. Throughout her book, the author makes a strong case for the use of structured games as a method for building a therapeutic relationship. “[C]hildren show themselves in everything they play and do” (p. 2), writes Bellinson, so it is the therapist’s skill in gearing the therapeutic intervention to the child’s developmental readiness that holds the most promise for a therapeutic outcome. Children should not be pushed to progress beyond their current developmental level, nor should they be encouraged to regress to an earlier developmental stage.

Bellinson traces the developmental sequence that children spontaneously experience in their chosen play activities. As they leave a world dominated by pretend and fantasy, magical thought gives way to the ability to reason, to concentrate in school, and to internalize social values. Imaginative dramas are replaced by an interest in structured and rule-oriented play as oedipal children enter latency. Bellinson’s observations echo those of Jean Piaget (1965), who observed, some four decades ago, that children ages six and seven devise rules to games of marbles as they play with one another. In addition to revealing emotional problems, children’s spontaneous activity in psychotherapy often provides the forum for the development of social concepts. It is these aspects of child development that Bellinson speaks to when she urges therapists to make use of board games as a rich source for clinical understanding and intervention.

The psychodynamics of the young child’s life are revealed as he plays games with his therapist, just as he reveals himself when enacting dramas. “When children use toys or dolls or art supplies or other playroom materials, therapists watch to see what is created, used, and revealed in the play. Structured games, too, can be highly informative if they are seen as projective material…” (p. 62). In discussing “Tessa,” the author observes that the child assumed she would be permitted to play games any way she wished because it had been acceptable to play with other playroom materials the way she wanted. In fact, it was expected that she do so, precisely because the child’s choices reveal much about what is going on in her life, especially internally. Even if a child has not been in therapy for very long, the therapist’s first friendly and reassuring greeting is likely to communicate that the therapy hour is a special time and place for her to use for her own purposes. Children will reveal a central theme preoccupying them as they play games with their therapist, just as they do when at the dollhouse. When a particular theme resonates to events in her life, the child becomes ready to process the therapist’s statements both developmentally and psychodynamically.

A most important reason for the therapist to honor the difference between the oedipal child and the latency child is that the older youngster has become ready for school learning. The virtue of beginning instruction just when the child readies himself for more systematic thought has been widely recognized (White, 1963; Bruner, 1966; Newman et al, 1973; Elkind, 1979; Zelan, 1985, 199l). Latency children in therapy often present their learning dilemmas, either by direct talk or by their play enactments, especially within the structured game format.

Bellinson presents interesting case material bearing on school learning. In the child’s mind, structured classroom learning is often linked to structured activities generally, so it seems natural to him to associate to school problems while playing games with his therapist. In fact, many games require reading or calculating, which further encourages this association. A child’s need to win at games might stand for his need to succeed in life, to learn as capably as his peers, to please his teacher. In therapy, a child playing games often wishes to win to prove his competence or to please his therapist.

Bellinson describes “Richard,” who plays chess in therapy, and the ways in which he attempts to control the game to assure his winning. Richard is an aggressive boy, upset at his reading failures and rejection by his classmates. He often calls his therapist “stupid,” likely a reflection of his own feeling when school subjects become challenging, or when he is at odds with his peers. Of the “metaphor” of the boy’s chess playing, Bellinson writes, “He feels inadequate when he loses at…chess…when he cannot read no matter how hard he tries, when he has a hard time getting ready for school in the morning” (p. 29). Richard well knew that chess is a difficult game, yet he became despondent when he lost to his uncle, concluding that losing in this situation meant he was a loser in general. Perhaps he chose the game of chess to prove his intelligence. The fact that he couldn’t read despite his ability to master a game requiring serious thought may have puzzled the boy. It may have represented his core conflict: how can I trust my self-perceptions if I’m smart at chess but “stupid” at reading?

When Richard’s self-esteem plummeted the minute he sensed he might lose a chess piece, he began to bend the rules to assure a victory. Bellinson identified with the boy’s feeling by saying of her own moves: “I sure did a dumb thing…No wonder I always lose and you always win” (p. 28). By calling herself “dumb,” she hoped to communicate to Richard that he might feel this way, too, especially when he loses to his uncle at chess. Yet, there are surely other ways of getting this idea across, such as a therapist commenting about “smart people” feeling “stupid” when they sometimes can’t think ahead far enough to play adroitly.

Bellinson’s ultimate aim was to connect Richard’s self-image as a chess player with his feelings about himself in real-life situations. Her persistent focus on the boy’s emotionality during games, and her insight that his impatience with the game was with life generally, led to changes in Richard’s attitude. He began to differentiate between the way he played chess in therapy, by bending the rules, and the “right way” to play, the way he played with his uncle. In a session before summer break, Richard confided to his therapist that he wished the end of his session would never come “because then we could stay in the playroom forever” (p. 3l). Whatever one may think about a therapist’s exact words—and they are important—just as significant for a child’s future adaptation is the linkage between being smart enough to learn chess and being intelligent enough to succeed in school.

Though Bellinson recognizes the promising effects of linking the child’s spontaneous game activities to school dilemmas, she doesn’t deal with the direct implications learning tasks have for school children. Many of these are suggested by the narratives she presents, as she and her young patients collaborate to understand the particulars of the child’s game-playing behavior. I once treated a child with learning problems, who was ambivalent about his father, a college dropout. The boy admired his father but nonetheless wished to differentiate himself by declining to repeat his father’s “failure.” He set about to prove his competence, not by learning to read, but by mastering chess, as Richard had done. In doing so, he revealed, however guiltily, that he was quite capable of thinking clearly and working hard. This ten-year old boy later disclosed that he was afraid of what he would learn by reading: once he began to read, he would learn that he was a “school success,” not a “school failure.” He chose to check out science books from the library, hoping to protect his father as he became expert in a field of interest quite different from his father’s.

Bellinson devotes a chapter to “therapeutic” games, those specifically designed to encourage children to talk about their innermost feelings, thus revealing important psychodynamic conflicts. The “Talking, Feeling, and Doing Game,” for example, consists of cards with questions the child is expected to answer. One of the “doing” cards asks, “Show what you would do if you turned into your mother” (p. 49).

The author and I part ways on the utility of these games. Many children declare them to be “fake” and complain that they are being manipulated to divulge thoughts and feelings they would rather keep to themselves. The presence of these games in the playroom causes some children to mistrust the therapeutic process. What’s more, the bulk of Bellinson’s book shows how regular games, designed to interest children of various ages, provide a genuine therapeutic forum for helping young patients think through their problems. Real games permit the child to share confidences as feelings and thoughts naturally arise, when he resonates safely to the game’s theme or the particulars of the interaction between himself and his therapist as they play. Playing real games, rather than attempting to maneuver the child into disclosing what he would rather not, assures the child that the therapist believes him capable of confiding when he is ready.

Children’s propensity to cheat while playing games is thoroughly discussed in Bellinson’s book. The author rightly asserts that cheating has psychological meaning. Just as the child’s choice of games and how to play them reveals much about her conflicts, so do the ways in which she chooses to cheat, or to act up in other ways, such as tossing the monopoly cards around the playroom or slamming them on the table. There are myriad individual reasons for a child’s cheating. Bellinson attempts to relate the reasons for cheating to preoccupying life events. A “doted-on” little girl’s cheating is an expression of her expectation that she will be given plenty in life, so she whimsically bends the game’s rules in order to share her good luck with her therapist.

Bellinson does not deal with teaching games to children in therapy, save for one poignant request from a young, apparently withdrawn patient, who engaged in dramatic play with her back to her therapist. Eventually the girl spotted the game “Uno” in Bellinson’s playroom and told her therapist that her brother had the same game at home. She asked, “Do you know how to play this game? Will you teach me how?” (p. 166). To a child, asking to be taught is entirely natural. As likely as not, psychotherapists have been trained not to teach—that is, to avoid giving directions and suggestions in order to confine the psychotherapy to working within the therapeutic relationship, helping with resistances, and rendering less than conscious content more accessible (Anthony, 1982). Yet, Anna Freud (197l) writes that psychotherapy with children ought to include a freeing of developmental processes from intrapsychic impediments in order to further the child’s growth. Moreover, Anthony (1982) himself contrasts a child’s need to grow up with an adult’s need to get well. Therapeutic work with children centered on their growing up includes encouraging and expanding their ego strengths and skills. Though Bellinson marks such concepts as “ego strength” or “unconscious content,” the reader does not know in which specific way the child’s ego has been enhanced by the therapist’s understanding of particular game behaviors, such as letting the therapist win; or in which way game-playing reveals the unconscious wish to win in real-life situations in a boy who strives to trounce his therapist with every chess move he makes. From Bellinson’s account we only know that the children in psychotherapy have appeared to improve in their life adjustments.

To the school child, the act of learning is part of growing up and is thus likely to surface frequently in the therapeutic hour. It is as if children have read R.W. White (l963) on the urgency children feel to become autonomous: “It is the child who strengthens his ego, actively exploring and testing a world in which, by happy design, a child’s initiative and intentions are often enough efficacious” (p. 94). Teaching a child a new game, when she specifically requests to learn it, promises to create new venues for revealing psychological conflicts, and affords the therapist an enlarged landscape in which to interact with a now more active, communicative child.

Bellinson concludes her book by emphasizing the virtue of following the young patient’s developmental predilections in his choice of activities as the therapeutic work unfolds. Besides creating interesting opportunities for understanding children’s emotional conflicts, as illustrated by many of Bellinson’s charming therapeutic narratives, it is an act of respect to honor developmental trends. “We must learn to work with the material [children] give us, even when the material is expressed in the form of structured games” (p. 167). We must learn to work with what latency-age children tell us, especially when it is articulated ever more clearly as they refine their game-playing expertise.

References

Anthony, E.J. (1982). The comparable experience of a child and adult analyst. Psychoanalytic Study of the Child, 37: 339-366.
Bruner, J. (1966). Toward a theory of instruction. Cambridge: Harvard University Press.
Elkind, D. (1979). Child development and education. New York: Oxford University Press.
Freud, A. (197l). The writings of Anna Freud: Problems of psychoanalytic training, and the technique of therapy. New York: International Universities Press.
Newman, C., Dember, C., & Krug, O. (1973). “He can but he won’t”: A psychodynamic study of so-called “gifted underachievers.” Psychoanalytic Study of the Child, 28: 83-l29.
Piaget, J. (1964). The moral development of the child. New York: Free Press.
White, R.W. (1963). Ego and reality in psychoanalytic theory: A proposal regarding independent ego energies. Psychological Issues, 3: l-2l0.
Zelan, K. (1985). Thoughts on what children bring to reading. Prospects, XV, 49-56.
Zelan, K. (1991). The risks of knowing: Developmental impediments to school learning. New York: Plenum.

Reviewer Note

Karen Zelan has written extensively on the psychology of children’s learning. She is the author of Between Their World and Ours:Breakthroughs with Autistic Children.

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