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Adlerian play therapy: Effectiveness on disruptive behaviors of early elementary-aged children

Dissertation
Author: Kristin K. Meany-Walen
Abstract:
Approximately 20% of children experience serious mental health problems severe enough to meet diagnosis criteria, and less than one third of these children receive the services they need. Identifying effective school-based counseling interventions provides a viable and accessible solution, especially for families with financial barriers. This randomized, controlled outcome study examined the effectiveness of Adlerian play therapy (AdPT) compared to reading mentoring (RM) with 58 kindergarten through third grade students who qualified with clinical levels of disruptive behavior in the classroom. Participants were identified as 48% Latino, 33% European American, and 19% African American. Approximately four-fifths of participants were male. Children were randomly assigned to AdPT (experimental group) or RM (active control group) for 16 sessions of treatment. Children in both groups participated in twice weekly, individual, 30-minute interventions that took place in their schools. Results from a two (group) by two (repeated measures) split plot ANOVA indicated that, compared to the RM group over time, the AdPT group demonstrated statistically significant improvement on (a) disruptive behaviors in the classroom, as directly observed by objective raters and as reported by teachers, and (b) stress in the teacher-child relationship, as reported by teachers. Teachers and observers were blinded to children's treatment group assignment. AdPT demonstrated moderate to large effect sizes on all measures, indicating the practical significance of treatment. Further, 72% of children receiving AdPT improved from clinical/borderline levels of disruptive behavior problems to more normative functioning post-intervention, demonstrating the clinical significance of results. Whereas further research is warranted, results from this preliminary study are promising and support the use of AdPT in elementary schools to meet the needs of children exhibiting disruptive classroom behavior.

TABLE OF CONTENTS

ACKNOWLEDGEMENTS iii

LIST OF TABLES vi

Chapter CHAPTER 1 INTRODUCTION 1

Statement of the Problem 5

Purpose of Study 6

CHAPTER 2 REVIEW OF LITERATURE 8

History of Play Therapy 8

Adlerian Theory 10

Basic Tenets 10

Counseling Process 15

The Progression of Adlerian Theory Applications 16

Home Environment 17

School Environment 17

School Guidance and Counseling 19

Play in the Counseling Process 20

Adlerian Play Therapy 21

Building an Egalitarian Relationship 23

Exploring the Child’s Lifestyle 24

Helping the Child Gain Insight 27

Reorientation/Reeducation 28

Adlerian Play Therapy in Schools 29

Play Therapy in Elementary Schools 30

Cognitive Functioning 32

Disruptive Behavior and Child Adjustment 33

Emotional Regulation 35

Teachers’ Role 36

School-based Play Therapy 37

Play Therapy Research in Elementary Schools 38

Current Status of Play Therapy 51

Conclusion 53

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CHAPTER 3 METHODS AND PROCEEDURES 55

Definition of Terms 55

Research Hypotheses 57

Instrumentation 58

Participants 62

Treatment 66

Experimental Group (AdPT) 66

Active Control Group (RM) 71

Data Collection 73

Data Analysis 75

CHAPTER 4 RESULTS 77

Hypothesis 1 78

Hypothesis 2 79

Hypothesis 3 80

Hypothesis 4 81

Clinical Significance 82

Total Behavior Outcomes 83

On-task Behavior Outcomes 84

CHAPTER 5 DISCUSSION 86

Adlerian Play Therapy’s Effects on Disruptive Behaviors 87

Adlerian Play Therapy’s Effects on Stress in the Teacher-Relationship Stress 93

Research Observations 95

Significant Emotional and Behavioral Needs of Students 95

The Impact of Banning Teacher Consultations 98

Teacher Feedback 100

Summary of Findings 103

Limitations of the Study 105

Recommendations for Future Research 107

Implications and Conclusions 108

Appendices A. INFORMED CONSENT: ENGLISH VERSION 113

B. INFORMED CONSENT: SPANISH VERSION 118

C ADLERIAN PLAY THERAPY SKILLS CHECKLIST 123

D. READING MENTORING PROTICOL 138

REFERENCES 141

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LIST OF TABLES Table 1 Demographic Information for Participants in Experimental and Active Control Groups.........................................................................................................................65 Table 2 Demographic Information for Adlerian Play Therapy Treatment Providers and Reading Mentoring Treatment Providers ..................................................................73 Table 3 Mean Scores on the Externalizing Problem Scales on the Caregiver-Teacher Report Form (C-TRF) ............................................................................................................78 Table 4 Mean Scores on the Total Behavior Scale on the Direct Observation Form (DOF)..79 Table 5 Mean Scores on the On-task Scale on the Direct Observation Form (DOF)…......... 81 Table 6 Mean Scores on the Total Stress scale on the Index of Teacher Stress (ITS)........... 82

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CHAPTER 1

INTRODUCTION

Children in elementary schools suffer each day due to a lack of resources available to meet their mental health needs. Mental Health America (MHA, 2009) estimated that 20% of children experience serious mental health problems severe enough to meet diagnosis criteria. However, only one third of these children receive the services they need. The surgeon general’s report (U.S. Public Health Services, 2000), as well as the President’s New Freedom Commission on Mental Health (2003), revealed that this discrepancy is related in part to a shortage in access to appropriate mental health services, a lack of mental health professionals trained to work with children, and the inaccessibility of services to the children in need. The reports also acknowledged a gap in mental health services for children and stressed the need for early intervention. One way for children to receive services at school is for teachers to refer students to school counselors or school-based counselors. The most common reason for student referral is disruptive classroom behavior (Abidin & Robinson, 2002). Disruptive behaviors include those externalized behaviors in the classroom that interfere with the teacher’s ability to teach and children’s ability to learn. Disruptive behaviors may include such behaviors as noncompliance, rule breaking, aggression, and destruction of property. These behaviors tend to remain stable without intervention (Barkley, 2007; Brinkmeyer & Eyeberg, 2003; Webster-Stratton & Reid, 2003). It is important to note

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that disruptive behaviors are usually a result of more significant underlying emotional problems (Abidin & Robinson, 2002). The consequences of failure to intervene early to meet the needs of these children are strained relationships, ongoing behavioral problems, difficulty in school, and poor social skills (Myers & Pianta, 2008). The President’s New Freedom Commission (2003) recommended that schools improve mental health services available for children. Teachers and school staff commonly use behavior modification strategies in an attempt to reduce children’s problematic behaviors. However, these types of teaching strategies do not provide students with the emotional support and counsel they may need. When children’s disruptive behaviors remain unchanged, the critical relationship between teacher and student may be damaged or strained due to the teacher’s frustration with a particular student (Abidin & Robinson, 2002; Hamre, Pianta, Downer, & Mashburn, 2007; Myers & Pianta, 2008). Thus, the importance of early interventions that are developmentally appropriate and responsive to early-elementary-aged children’s needs is evident. Children spend approximately 7 hours each day at school. Therefore, school becomes an optimal and convenient environment to provide mental health services to children. Play therapy is a developmentally appropriate intervention for children between the ages of 3 and 10 years because it utilizes the child’s natural mode of communication (Bratton, Ray, & Landreth, 2008; Kottman, 2003; Landreth, 2002). Children have a limited ability to verbally express their emotional needs. Therefore, play therapists use toys and play materials to help children communicate their needs in a developmentally

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sensitive and concrete manner. Play therapists use play because they respect the child’s development, and play therapists join the child in the child’s world. Other treatment interventions require the child to meet the therapist in the therapist’s adult world. Meta-analytic results for play therapy outcome research have shown play therapy to be an effective intervention for children with a variety of presenting concerns (LeBlanc & Ritchie, 1999; Bratton, Ray, Rhine, & Jones, 2005). The most thorough and comprehensive meta-analysis known to date, with a total of 93 controlled studies, revealed a large treatment effect (.80) for children who received play therapy compared to children who did not receive play therapy or children who received a comparable treatment. Studies included children who presented with a variety of concerns and in a variety of settings (Bratton et al., 2005). The meta-analysis further revealed that humanistic approaches to play therapy, primarily child-centered play therapy and nondirective play therapy, demonstrated an even larger treatment effect (.92) than directive approaches to play therapy. School-based outcome research has also shown play therapy to be an effective treatment for children with a range of issues (Baggerly & Jenkins, 2009; Blanco, 2009; Bratton, 2010; Fall, Balvanz, Johnson, & Nelson, 1999; Fall, Navelski, & Welch, 2002; Flahive & Ray, 2007; Garza & Bratton, 2005; Muro, Ray, Schottelkorb, Smith, & Blanco, 2006; Packman & Bratton, 2003; Paone & Douma, 2009; Post, 1999; Raman & Kapur, 1999; Ray, Schottelkorb, & Tsai, 2007; Shashi, Kapur, & Subbakrishna, 1999; Shen, 2002). Despite these studies, the field of play therapy has failed to be recognized as an evidence-based treatment (EBT). Classifying specific interventions as EBTs has become

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the primary objective for many mental health organizations. The current push within the Association for Play Therapy (APT), a professional credentialing organization for play therapists, is to conduct rigorous research which can propel play therapy towards gaining credibility and becoming an EBT for children (APT, 2009; Baggerly & Bratton, 2010; Frick-Helms & Drewes, 2010; Urquiza, 2010). As with any reputable modality of therapy, therapists identify with and work from numerous theoretical approaches. Play therapy is no different. Regardless of the therapeutic approach used, the common thread among all play therapists is that play is the primary method of communication. The integration of toys and play into mental health interventions began with Sigmund Freud from psychoanalytic theory. Following his reported experiences with Hans and Hans’s father, others have appreciated and implemented play into their theoretical work with children (Bratton et al., 2008). Virginia Axline (1974) was the first to document her use of nondirective play therapy, which has been continued and popularized by Garry Landreth. Nondirective play therapy is sometimes referred to as child-centered play therapy (CCPT), based on Rogers’s person-centered theory (Landreth, 2002). Since that time, other play therapists developed and adapted theoretical approaches to play therapy. In 1987 Terry Kottman completed her dissertation, which involved training therapists in the concepts and skills of Adlerian play therapy (AdPT). Kottman’s development of AdPT was based on Alfred Adler’s philosophy of individual psychology (1956/1964) and adapted to meet children’s developmental needs. Since that time, AdPT has been used by play therapists in clinic

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and school settings (Kottman, 2003). To date, no known research studies have been conducted with AdPT being the identified treatment. One requirement for research designs to be considered rigorous is the use of a clear treatment protocol (Chambless et al., 1998; Nathan & Gorman, 2002). Adlerian theory is the third most popular theoretical orientation of mental health professionals who use play therapy as therapeutic intervention (Lambert et al., 2007). Based on this knowledge, it seems logical for a treatment protocol to be developed. Terry Kottman, developer of AdPT, designed an Adlerian treatment protocol (Kottman, 2009) that can be used to determine the effectiveness of AdPT. Statement of Problem Government reports (President’s New Freedom Commission, 2003; U.S. Public Health Service, 2000) have brought national attention to the urgent need to identify effective interventions for children who suffer from emotional and behavioral disorders. Estimates indicate that one out of five children experiences distressing emotional problems, and fewer than one third of these children will receive treatment (MHA, 2009). This is largely due to (a) a shortage of mental health interventions that are responsive to the needs of young children and (b) the inaccessibility of services (President’s New Freedom Commission, 2003; U.S. Public Health Service, 2000). The U.S. Public Health Service (2000) and the President’s New Freedom Commission (2003) reports discussed the vital role of schools in the early identification and treatment of childhood disorders in order to prevent more severe and costly problems. Without treatment, disruptive behaviors show a high degree of stability over

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time, often leading to the development of a host of serious problems across the child’s lifespan, including antisocial behavior, violence, drug abuse, and juvenile delinquency (Barkley, 2007; Brinkmeyer & Eyeberg, 2003; MHA, 2009; Webster-Stratton & Reid, 2003). The importance of early intervention as a means of altering a course of increased and more severe behavioral problems is clear. Schools have access to children in need and can provide resources for children and mental health professionals. Teachers have prolonged contact with children and are aware of students who demonstrate disruptive or problem behaviors in the classroom (Abidin & Robinson, 2002). These students are frequently referred by teachers for counseling. A secondary problem is that, although play therapy is a developmentally appropriate intervention for early elementary-age children and has empirical evidence to demonstrate its effectiveness (Baggerly & Bratton, 2010; Bratton, 2010; Bratton et al., 2005), it has yet to be considered an EBT. Research adhering to the accepted criteria for rigorous research must be conducted to lay the foundations of best practices (Nathan & Gorman, 2002). Purpose of Study The overarching aim of this study is to establish an effective treatment intervention for elementary-aged children with disruptive behaviors. More specifically, this investigation is designed to determine the effectiveness of Adlerian play therapy in reducing disruptive behavior in children in elementary school who have been identified

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as having disruptive behaviors by teachers and reducing teacher stress related to children with disruptive behaviors.

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CHAPTER 2

REVIEW OF LITERATURE

History of Play Therapy Beginning in the early 1900s, mental health and development professionals such as Sigmund Freud, Melanie Klein, Anna Freud, Jean Piaget, and Virginia Axline worked with children and emphasized the need for therapeutic interventions to be appropriate for children’s developmental level. These individuals were pioneers in establishing the methods that today’s play therapists believe are necessary to best help children who are experiencing emotional difficulties (Landreth, 2002). These professionals experienced and documented significant differences between children and adults. They each acknowledged the intrinsic value of children’s free play, highlighted the importance of a safe relationship, and emphasized children’s creativity and ability to engage in self- directed meaningful play (Bratton et al., 2008). Play therapy is a developmentally responsive mental health treatment of choice for children between the ages of 3 and 10, based on the belief that play and activity are a child’s natural mode of communication (Axline, 1974; Bratton et al., 2008; Erikson, 1977; Kottman, 2001b, 2003; Landreth, 2002). Typically, young children cannot yet accurately communicate about abstracts concepts verbally; thus, in play therapy they have an opportunity to communicate through their natural mode of expression. Play is

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spontaneous and free from external objectives or rewards (Landreth, 2002). Through play, children symbolically express their experiences and interpretations of the world. Play therapy involves an empathetic, genuine, and unconditional relationship fostered by the therapist and experienced by the child. The child is provided a collection of carefully selected toys in which he or she can express a range of emotions, thoughts, and experiences. Toys are not used as a method of manipulating children to speak; rather, toys are used as the natural form of expression by children (Kottman, 2001a, 2001b; Landreth, 2002). Over the course of play therapy’s history, therapists and researchers have been intrigued with finding the most helpful way to work with children. Some well-accepted theories of play therapy include child-centered (Landreth, 2002; Landreth & Sweeney, 1997); psychoanalytic (Lee, 1997); cognitive-behavioral (Knell, 1997); Jungian (Allan, 1997); developmental (Brody, 1997); Gestalt (Oaklander, 1988); ecosystemic (O’Conner, 1997); prescriptive (Schafer, 2001); and Adlerian (Kottman, 1987, 1997, 2001a, 2001b, 2003). While theorists differ in their conceptualization of how children change through play therapy, play therapists agree that engaging in play, the child’s natural medium of communication, is the most appropriate mode of working with children. For the purposes of this study, Adlerian play therapy (AdPT; Kottman, 1987, 2001a, 2001b, 2003, 2009; Kottman, Bryant, Alexander, & Kroger, 2009), based on the work of Alfred Adler, will be explored in more detail and translated into its use with children.

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Adlerian Theory Alfred Adler initially referred to his theory of personality and psychotherapy as individual psychology, based on his belief in the uniqueness and creativity of each person to develop an individual lifestyle, belief about self, and fictional goals (Adler, 1927/1998, 1956/1964). Social interest is a major tenet of individual psychology and refers to how one connects with others. People strive to feel a sense of belonging. Starting in infancy, people subconsciously construct lifestyles that assist in creating a relatively stable path toward their perception of how they belong in the world. All persons are in constant movement from being in a position in which they perceive themselves inadequate, or inferior, to actively striving for superiority, or a sense of perfection, significance, and mastery (Adler, 1956/1964). Adlerian therapy is a phenomenological approach to therapy, based on a belief in the individual’s perception of reality. Adler focused heavily on the influence of early childhood and family-of-origin as paramount in individuals’ development of their perception of their significance in relationships. Subsequent Adlerian theorists emphasized the experiences of early childhood and the impact a child’s early experiences have on the development of the person (Dinkmeyer, 1965; Dreikurs, 1950; Dreikurs & Soltz, 1964; Muro & Dinkmeyer, 1977). The following section attempts to describe basic beliefs about human nature according to Adlerian theory. Basic Tenets Overriding all Adlerian concepts is what Adler termed Gemeinschaftsgefühl, which is loosely termed social interest in English. Social interest is translated to mean

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one’s feeling of connection to a community, including family, other people, and the metaphysical world. It refers to one’s ability to cope in the social world and one’s interrelatedness with all humankind (Adler, 1927/1998, 1956/1964). According to Adler, everyone is born with the potential to develop social interest. This involves meeting one’s needs for belonging, as well as contributing to others (Dreikurs, 1950). Adler also emphasized the value of social embeddedness, his belief that all humans are born into a social environment, their original family, and cannot be studied in isolation (Adler, 1927/1998; Dinkmeyer, 1965). People constantly interact with others, as one part of a larger society. The individual’s view of society and how he or she contributes to society is an indicator of healthy functioning (Adler, 1956/1964). Every individual impacts the social world with and/or without conscious recognition. Both consciousness and unconsciousness are parts of a person’s experiences (Adler, 1927/1998; Dreikurs, 1950). In Adlerian terms, the unconscious is just out of a person’s awareness and can be thought of as an area of one’s life that is not understood but which can become understood. Regardless of a person’s level of conscious awareness, every action or behavior is purposeful and goal driven and causes a reaction from the social world (Dinkmeyer, 1965; Dreikurs & Soltz, 1964). Thus, people must assume responsibility for their behavior because it inevitably affects all others. People do not need to understand or be aware of their goals of behavior in order to be responsible for their actions (Adler, 1956/1964; Mosak & Maniacci, 2008). Adlerians believe in the holism of each person; persons cannot be reduced to any one area of being. Individuals are not determined by hereditary nor environment; rather,

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they are creative, self-determined, and free to make choices (Adler, 1927/1998). People create lifestyles that remain fairly consistent through the lifespan largely based on their perceptions of their experiences, beginning with their first experience in society, their family (Adler, 1927/1998, 1956/1964; Dinkmeyer, 1965; Dreikurs, 1950; Mosak & Maniacci, 2008). Because children’s cognitive functioning, including logic and judgment, are not fully developed, they may draw erroneous conclusions about themselves, others, and the world. Regardless of the accuracy of self-convictions, children interpret these mistaken beliefs and behave in life as if these are true. The amalgamation of one’s perceptions of the world becomes one’s lifestyle. Lifestyles then become the lens through which people view life. Starting in childhood, people develop cognitions based on early perceptions of their experiences about themselves, others, and the world which help them to understand, predict, and control life. One’s lifestyle is not good or bad, right or wrong. It is simply a way in which one navigates through the world towards one’s fictional goal (Adler, 1927/1998, 1956/1964; Dinkmeyer, 1965; Dreikurs, 1950; Mosak & Maniacci, 2008). The primary goal for all people is to feel a sense of belonging with the larger community (Dreikurs & Soltz, 1964). People create fictional goals which they then strive to meet out of response to their experiences (Adler, 1927/1998, 1956/1964; Dreikurs, 1950; Mosak & Maniacci, 2008). Fictional goals, albeit typically unconscious, provide individuals with security in the world and secure their self-concept. People continuously strive to reach these goals and believe they will overcome all life’s challenges when they reach their fictional goals.

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People do not arrive in a satisfied state of being; rather, they are in a constant state of becoming. Life has no intrinsic meaning; people create their own meaning of life. Based on their perceptions of life, their created lifestyle, and fictional goals, individuals will draw their own conclusions about the meaning of life. People then behave as if their perceptions of their world are accurate (Adler, 1927/1998; Dinkmeyer, 1965). Mosak and Maniacci (2008) highlighted this concept with the following examples. In general, persons who are optimistic take chances, do not become discouraged, and respond to the world based on their beliefs that they are capable of overcoming adversity. They can differentiate between failing and being a failure. Pessimists tend not to engage with life. They become discouraged, fear failure, refuse to try, or prove inadequacy. They perceive themselves as failures rather than as people who failed in an isolated situation. Inevitably individuals develop faulty or inferior thoughts and feelings (Adler, 1927/1998, 1956/1964; Mosak & Maniacci, 2008). Inferiority feelings reflect the discrepancy between how persons view themselves and how they believe they should be. Inferiority feelings are not limited, pre-prescribed, or necessarily logical. When persons shift from inferiority feelings to an inferiority complex, acting as if they are inferior, they become discouraged in life and relationships. Compensation is a defense mechanism labeled by Adlerians. It is used to overcome inferiority feelings (Adler, 1956/1964). Individuals compensate in other areas for areas in which they perceive they are lacking. As with all behavior, compensation can be useful or useless. For example, a child who

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feels inferior in his reading ability compared to his peers may compensate by acting out behaviorally to distract the teacher’s attention from his lack of reading skills. Courage is another key component of Adlerian theory (Mosak & Maniacci, 2008). Courage is not synonymous with bravery. Rather, courage refers to the willingness one has to engage in life’s challenges when the consequence is unknown or negative. People with courage take chances and actively engage with life, knowing they may not succeed. When people become discouraged, they lack the willingness to engage in life’s demands. Discouraged people may choose behaviors that negatively impact society. This is in direct contrast to social interest (Adler, 1927/1998). Life’s challenges are present in five areas known as life tasks. Society/friendship, work, sex/love, spirituality, and self are the five life tasks that challenge humans throughout the life span. Adler (1927/1998) acknowledged the first three life tasks, and over the development of individual psychology, Harold Mosak (Mosak & Maniacci, 1998) included the additional two tasks. The society or friendship life task is the way in which persons cooperate with society. Their contribution to society is the work task. The work task for children is cooperation and success in school (Dinkmeyer, 1965). Adler was a pioneer in feminist-type theory and referred to the sex task as people’s challenge in defining how to relate to the other sex, rather than the opposite sex; the love task also involves the close, intimate union between two people. The spiritual realm is each person’s journey in defining his or her belief in the nature of the universe. Lastly, the self task is a person’s tolerance and acceptance of his or her self (Mosak & Maniacci, 2008).

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Counseling Process Adler firmly believed in the necessity of a collaborative, friendly relationship between client and counselor. This type of relationship must be established in order for the client to trust the therapist, feel safe, be willing to explore his or her lifestyle, accept feedback and education from the therapist, and have the courage to change. Mosak and Maniacci (2008) listed the conditions of faith, hope, and love as necessary but not sufficient for change. Faith is the feeling of security and trust in the relationship as well as the client’s and therapist’s belief that the therapy can and will be effective. Hope is the client’s belief in self and an inner feeling of encouragement that things can be different. The attitude we are in this together falls under the condition of hope within the relationship. Love is another necessary condition; the client must feel that the counselor cares about him or her. The counselor’s role is to empathize with and support the client, not pity, console, or become a victim of the client. The process of Adlerian therapy is a collaborative and educational process in which the primary goal is to foster and enhance social interest by helping the client to become enlightened about his or her life patterns. The therapist begins by building the relationship with the client. As the therapist interacts with the client, he or she is collecting information from the client to understand and interpret the client’s lifestyle. As the counselor begins to develop a picture of the client’s way of navigating through life, the counselor makes soft interpretations and relays that information back to the client so the client can become aware of some of his or her out-of-conscious processes. Counselors educate clients about their personal freedom to make decisions about their

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lives, help clients to create alternate goals, and encourage clients to become autonomous (Adler, 1956/1964; Mosak & Maniacci, 2008). The Progression of Aderian Theory Applications Dinkmeyer (1965) emphasized the importance of understanding child development. According to Dinkmeyer, in order to optimize healthy development, children need to perceive that they are unconditionally loved, relatively free from danger and threat, belong and are accepted within a group, are significant and contribute to others, are free to make choices, and are responsible for their choices and actions. Positive physical touch is also vital to healthy development. Starting in infancy, children who perceive their physiological and biological needs as not only being met but being met with nurturance and affection appear to be related to healthy, nurturing, and secure relationships throughout their life (Dinkmeyer, 1965). Infants are born into a family, their first social group. Starting from this point children develop ways to meet their needs. They cry when they feel hungry, wet, or discomfort to get the attention of adults who can take care of them. How infants interpret their wishes as being met contributes to their view of their place in the world (Dreikurs, 1950). Dreikurs noticed that children adapt their crying and other behavior in accordance to how adults meet their needs. Thus, children begin to co-operate with the social world. Dreikurs concluded that children who experience love and nurturance with boundaries and limits are more likely to become responsible, cooperative, and useful members of society. Based on Dreikurs’s observations and conclusions of how children develop

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lifestyles, he focused his work on child development and parenting models (Dreikurs, 1950/1964). Home Environment Three main factors of the child’s environment contribute to the child’s development and lifestyle. The influence and combination of family atmosphere, family constellation, and parenting style each play a vital role in the child’s perception of how he or she belongs in the family (Dreikurs & Soltz, 1964). Family atmosphere is influenced by social class, religion, ethnicity, social influences, and the relationship between parents. Family constellation is the characteristic relationship between family members; this includes birth order, length of time between siblings, family beliefs about gender, and gender roles. The constellation evolves as more children join the family, sibling illness that may occur, and other events happen that contribute to the ways in which persons find their place in the family. The way in which parents encourage, protect, and discipline their children impact the way children perceive their role in the family. Children develop best when they feel love and acceptance from their parents, are permitted to take chances, are protected from danger, and experience the limits and natural consequences of society (Dinkmeyer, 1965; Dreikurs & Soltz, 1964). Based on the child’s view of the combination of these influences, the child uses his or her creative powers to establish how he or she belongs and contributes to the family (Dreikurs & Soltz, 1964). School Environment Dinkmeyer (1965) acknowledged the school’s role in providing an atmosphere for mental health and social development. Children gradually change their place in the world

Full document contains 164 pages
Abstract: Approximately 20% of children experience serious mental health problems severe enough to meet diagnosis criteria, and less than one third of these children receive the services they need. Identifying effective school-based counseling interventions provides a viable and accessible solution, especially for families with financial barriers. This randomized, controlled outcome study examined the effectiveness of Adlerian play therapy (AdPT) compared to reading mentoring (RM) with 58 kindergarten through third grade students who qualified with clinical levels of disruptive behavior in the classroom. Participants were identified as 48% Latino, 33% European American, and 19% African American. Approximately four-fifths of participants were male. Children were randomly assigned to AdPT (experimental group) or RM (active control group) for 16 sessions of treatment. Children in both groups participated in twice weekly, individual, 30-minute interventions that took place in their schools. Results from a two (group) by two (repeated measures) split plot ANOVA indicated that, compared to the RM group over time, the AdPT group demonstrated statistically significant improvement on (a) disruptive behaviors in the classroom, as directly observed by objective raters and as reported by teachers, and (b) stress in the teacher-child relationship, as reported by teachers. Teachers and observers were blinded to children's treatment group assignment. AdPT demonstrated moderate to large effect sizes on all measures, indicating the practical significance of treatment. Further, 72% of children receiving AdPT improved from clinical/borderline levels of disruptive behavior problems to more normative functioning post-intervention, demonstrating the clinical significance of results. Whereas further research is warranted, results from this preliminary study are promising and support the use of AdPT in elementary schools to meet the needs of children exhibiting disruptive classroom behavior.