Norfolk (Nebraska) St& Hospital
PROBLEMIt is an accepted fact that child clinic practices vary appreciably, but only one study to date(') has attempted to assess the nature and magnitude of such variations. Even this study was largely confined to census-taking and to probing only several of the more general aspects of treatment application. Consequently, a need exists for further supplementary data to provide a more complete perspective of prevailing procedures. Accordingly, a cross-sectional survey of child clinics in the United States was conducted in order to determine some of the conditions attending play activity as a therapeutic medium.
METHODS AND RESULTSQuestionnaires were prepared and distributed to 298 outpatient child clinics(2) in the United States, 40% being returned in sufficiently completed form to enable tabulation of the data. The number of clinics responding to any particular question varied somewhat, ranging from 87 to 118. The returned questionnaire findings indicated the following trends:1. In the matter of theoretical orientation, 75% of the reporting child clinics regarded their therapeutic practice as subscribing to psychoanalytic (as distinct from Freudian) principles. Of the remainder, 17y0 described their viewpoint as essentially nondirective, 5yo directive, with 3% claiming to achieve a compromise between these two schools of thought.2. As to the authority most representative of the thinking of each in relation to child therapy, a majority (27%) named Frederick Allen. Anna Freud was next most frequently mentioned (IS%), followed by Sullivan, Kanner, Axline, and Erickson, in that order. Ten percent of those polled regarded themselves as primarily eclectic in this regard, declining mention of any single authority as having a dominant influence on their thinking.3. As to group therapy with children, only 26% utilized this approach in conjunction with play media, while By0 engaged in group therapy without the aid of any play activity. With two exceptions, all reporting use of the group method also included individual therapy as an integral part of the treatment program. 4. In commenting upon the role of the psychological examination in pretreatment planning, 41% regarded it as a routine part of the diagnostic work-up, 49% included it in most but not every instance, while 10% used it only occasionally.5. Among the factors contributing to a decision for or against the use of play media in any given instance, 71y0 stressed the specific nature of the problem as a major determinant, 50% the intelligence level, and only 6% the chronicity of the child's problem.6. Age was not considered by any of the clinics to be a prime determinant of whether or not to include play activity as part of the treatment procedure. Sixtyeight percent listed the oldest child seen in play therapy as varying from 12 to 15 years, while the remainder recorded the maximum age as ranging from six years to the mid-twenties.7. The youngest children reported in face-to-face psychotherapy were five-yearolds of superior verbal s...
