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      The Non-linear Trajectory of Change in Play Profiles of Three Children in Psychodynamic Play Therapy

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          Abstract

          Aim: Even though there is substantial evidence that play based therapies produce significant change, the specific play processes in treatment remain unexamined. For that purpose, processes of change in long-term psychodynamic play therapy are assessed through a repeated systematic assessment of three children’s “play profiles,” which reflect patterns of organization among play variables that contribute to play activity in therapy, indicative of the children’s coping strategies, and an expression of their internal world. The main aims of the study are to investigate the kinds of play profiles expressed in treatment, and to test whether there is emergence of new and more adaptive play profiles using dynamic systems theory as a methodological framework.

          Methods and Procedures: Each session from the long-term psychodynamic treatment (mean number of sessions = 55) of three 6-year-old good outcome cases presenting with Separation Anxiety were recorded, transcribed and coded using items from the Children’s Play Therapy Instrument (CPTI), created to assess the play activity of children in psychotherapy, generating discrete and measurable units of play activity arranged along a continuum of four play profiles: “Adaptive,” “Inhibited,” “Impulsive,” and “Disorganized.” The play profiles were clustered through K-means Algorithm, generating seven discrete states characterizing the course of treatment and the transitions between these states were analyzed by Markov Transition Matrix, Recurrence Quantification Analysis (RQA) and odds ratios comparing the first and second halves of psychotherapy.

          Results: The Markov Transitions between the states scaled almost perfectly and also showed the ergodicity of the system, meaning that the child can reach any state or shift to another one in play. The RQA and odds ratios showed two trends of change, first concerning the decrease in the use of “less adaptive” strategies, second regarding the reduction of play interruptions.

          Conclusion: The results support that these children express different psychic states in play, which can be captured through the lens of play profiles, and begin to modify less dysfunctional profiles over the course of treatment. The methodology employed showed the productivity of treating psychodynamic play therapy as a complex system, taking advantage of non-linear methods to study psychotherapeutic play activity.

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          Most cited references24

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          The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes.

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            Mentalization and the changing aims of child psychoanalysis

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              An empirically validated hierarchy of defense mechanisms.

              We empirically examined the validity of ego mechanisms of defense as an explanatory concept for psychological health in 307 middle-aged men who were prospectively followed up for 40 years. Assessed on the basis of a two-hour interview when the men were 47 years old, the maturity (health) of the men's defenses correlated highly with independently assessed outcome measures. Evidence is offered that defensive style provides an independent dimension of mental health. First, childhood variables significantly predicted midlife mental health but not midlife maturity of defenses. Second, the bleaker the childhood the stronger the association of maturity of defenses with adult mental health. Third, the Bond Defense Style Questionnaire, administered to 131 of the 307 men six to eight years after the interview, identified the same styles of defense that were identified earlier by clinical assessment.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                10 October 2016
                2016
                : 7
                : 1494
                Affiliations
                [1] 1Department of Psychology, Istanbul Bilgi University Istanbul, Turkey
                [2] 2Division of Psychoanalysis, University College London London, UK
                [3] 3Research Institute of Synergetics and Psychotherapy, Paracelsus Private Medical University of Salzburg Salzburg, Austria
                [4] 4Clinical and Psychodynamic Psychology Department, Sapienza University of Rome Rome, Italy
                [5] 5Environment and Health Department, National Institute of Health Rome, Italy
                [6] 6Institute for Complexity Studies, Sapienza University of Rome Rome, Italy
                Author notes

                Edited by: Claudia Capella, University of Chile, Chile

                Reviewed by: Adriana Lis, University of Padua, Italy; Vera Regina Rohnelt Ramires, Universidade do Vale do Rio dos Sinos, Brazil

                *Correspondence: Sibel Halfon, sibel.halfon@ 123456bilgi.edu.tr

                This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2016.01494
                5056176
                3739516f-5ea6-4718-b33c-0d4bbd2195c8
                Copyright © 2016 Halfon, Çavdar, Orsucci, Schiepek, Andreassi, Giuliani and de Felice.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 July 2016
                : 16 September 2016
                Page count
                Figures: 2, Tables: 8, Equations: 0, References: 48, Pages: 15, Words: 0
                Funding
                Funded by: Türkiye Bilimsel ve Teknolojik Ara?tirma Kurumu 10.13039/501100004410
                Award ID: 215K180
                Categories
                Psychology
                Original Research

                Clinical Psychology & Psychiatry
                psychodynamic play therapy,play assessment,play profiles,complexity science,non-linear dynamics

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