幼儿自闭症游戏治疗个案研究
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摘要
儿童自闭症是一种弥漫性发育障碍,起病于婴幼儿期。此类儿童具有社会交往的障碍、语言交往的障碍和异常的行为与兴趣。其治疗引起了社会的广泛关注。
游戏是儿童的语言,游戏治疗以游戏为媒介,让儿童通过游戏自然表达自己的感情,暴露问题,并解除困扰。儿童在游戏疗法中学会自我控制、自我指导、自由表达、接纳自我、更有创造性等。
箱庭疗法是游戏疗法的一种形式,儿童在治疗者所创造的“自由和受保护”的空间内利用沙、水和玩具模型游戏,有利于儿童自由地表达情感、有利于引发儿童的想象和唤醒他们的自我治愈潜能。
本个案研究通过一个3岁自闭症男孩历时1年半、共26次的游戏治疗对这些问题进行了探讨。研究发现,个案的游戏治疗经历了三个阶段,即“熟悉治疗环境阶段”、“治疗关系建立阶段”和“游戏治疗深入发展阶段”;考察治疗关系建立的指标包括“个案与治疗者之间的言语和非言语互动”、“个案与父母的关系处理”和“个案的‘第一次’行为”,建立的目标是“母子一体性”的形成;治疗者与个案父母关系的建立经过了“接纳事实”、“开放情感”和“具体指导”三个阶段;个案在治疗中游戏的发展表现为:动沙的力度增大,说明治疗深入了个案内心,其自我能量感在增强,游戏中的想象性成分不断增多,说明其对周围事物和他人关注了,开始“会”游戏,从单独游戏逐渐向简单合作游戏发展,说明其体验到了合作和互动的快乐,并从中渐渐获得自信,有助于个案将这种体验和自信迁移到日常生活中,尝试与他人互动;沙和水是个案游戏治疗中的重要治疗因素,沙可以调动自闭症幼儿的感触觉,唤醒其潜在能量,调整能量分配,水给自闭症儿童一种轻松感、包容感和满足感,并引发其想象。
从个案父母和老师的反馈来看,个案在各项诊断项目上的症状都有所减轻,游戏治疗取得了一定成效。
Children's autism is Pervasive Developmental Disorders and appears in babyhood. The autistic children have social communication disorders, language communication disorders and abnormal behaviors and interests. The therapy with autism has attracted extensive attention in our societyPlay is language of children. Play is medium of play therapy by which children express their natural feelings, uncover their problems and relieve their puzzles. Children learn how to control, direct, express and accept themselves and make themselves more creative.Sandplay Therapy is a kind of play therapy. Children play sand, water and miniatures in "free and protected" space provided by therapists. Sandplay makes children express their feelings freely, inspires their imagination and arouses their self-healing potential.The case study discussed these issues by play therapy with a 3-year-old autistic boy. The therapy had processed for one and a half year and included 26 sessions. The case study found: the boy's play therapy went through 3 phrases, including "knowing the therapeutic conditions well", "establishing of therapeutic relationship", "developing play therapy evolutionally"; the clues from which to judge relationship included "verbal and nonverbal interaction between therapist and the boy", "the boy's dealing with his parents ", "his 'first' behavior", the aim of establishing was to form "mother-child unity"; the relationship between therapist and the boy's parents passed through "admitting the facts", "opening their feelings" and "detailed guidance"; the development of the boy's play consisted in the larger degree of digging and moving sand(showing that the therapy went deep into the boy's mind and his sense of strength was improving), the increasing of imaginative plays(showing that the boy began to pay attention to others and knew how to play), from playing by himself to cooperating with therapist(showing that he felt the happiness in cooperating and interacting with others and was gaining self-confidence which was favorable to be transferred to his lives and be used to communicating with others), sand and water were very important therapeutic factors for the boy(sand could mobilize his sense of feeling and touching , awakening his energy and regulating it. water could provide relaxed feeling, sense of being contained and satisfied and
enlighten his imagination).From reflection of his parents and teachers, we knew that his symptoms based on diagnostic items had alleviated. The play therapy with the boy was resultfiil.
游戏是儿童的语言,游戏治疗以游戏为媒介,让儿童通过游戏自然表达自己的感情,暴露问题,并解除困扰。儿童在游戏疗法中学会自我控制、自我指导、自由表达、接纳自我、更有创造性等。
箱庭疗法是游戏疗法的一种形式,儿童在治疗者所创造的“自由和受保护”的空间内利用沙、水和玩具模型游戏,有利于儿童自由地表达情感、有利于引发儿童的想象和唤醒他们的自我治愈潜能。
本个案研究通过一个3岁自闭症男孩历时1年半、共26次的游戏治疗对这些问题进行了探讨。研究发现,个案的游戏治疗经历了三个阶段,即“熟悉治疗环境阶段”、“治疗关系建立阶段”和“游戏治疗深入发展阶段”;考察治疗关系建立的指标包括“个案与治疗者之间的言语和非言语互动”、“个案与父母的关系处理”和“个案的‘第一次’行为”,建立的目标是“母子一体性”的形成;治疗者与个案父母关系的建立经过了“接纳事实”、“开放情感”和“具体指导”三个阶段;个案在治疗中游戏的发展表现为:动沙的力度增大,说明治疗深入了个案内心,其自我能量感在增强,游戏中的想象性成分不断增多,说明其对周围事物和他人关注了,开始“会”游戏,从单独游戏逐渐向简单合作游戏发展,说明其体验到了合作和互动的快乐,并从中渐渐获得自信,有助于个案将这种体验和自信迁移到日常生活中,尝试与他人互动;沙和水是个案游戏治疗中的重要治疗因素,沙可以调动自闭症幼儿的感触觉,唤醒其潜在能量,调整能量分配,水给自闭症儿童一种轻松感、包容感和满足感,并引发其想象。
从个案父母和老师的反馈来看,个案在各项诊断项目上的症状都有所减轻,游戏治疗取得了一定成效。
Children's autism is Pervasive Developmental Disorders and appears in babyhood. The autistic children have social communication disorders, language communication disorders and abnormal behaviors and interests. The therapy with autism has attracted extensive attention in our societyPlay is language of children. Play is medium of play therapy by which children express their natural feelings, uncover their problems and relieve their puzzles. Children learn how to control, direct, express and accept themselves and make themselves more creative.Sandplay Therapy is a kind of play therapy. Children play sand, water and miniatures in "free and protected" space provided by therapists. Sandplay makes children express their feelings freely, inspires their imagination and arouses their self-healing potential.The case study discussed these issues by play therapy with a 3-year-old autistic boy. The therapy had processed for one and a half year and included 26 sessions. The case study found: the boy's play therapy went through 3 phrases, including "knowing the therapeutic conditions well", "establishing of therapeutic relationship", "developing play therapy evolutionally"; the clues from which to judge relationship included "verbal and nonverbal interaction between therapist and the boy", "the boy's dealing with his parents ", "his 'first' behavior", the aim of establishing was to form "mother-child unity"; the relationship between therapist and the boy's parents passed through "admitting the facts", "opening their feelings" and "detailed guidance"; the development of the boy's play consisted in the larger degree of digging and moving sand(showing that the therapy went deep into the boy's mind and his sense of strength was improving), the increasing of imaginative plays(showing that the boy began to pay attention to others and knew how to play), from playing by himself to cooperating with therapist(showing that he felt the happiness in cooperating and interacting with others and was gaining self-confidence which was favorable to be transferred to his lives and be used to communicating with others), sand and water were very important therapeutic factors for the boy(sand could mobilize his sense of feeling and touching , awakening his energy and regulating it. water could provide relaxed feeling, sense of being contained and satisfied and
enlighten his imagination).From reflection of his parents and teachers, we knew that his symptoms based on diagnostic items had alleviated. The play therapy with the boy was resultfiil.
引文
[1] http://www.achh.com/qtest/achhnew/news/2004-02-02/21.html
[2] http://www.achh.com/qtest/achhnew/article/2003-06-10/44.html
[3] http://www.spe-edu.net/info/2003-06-09/2988.htm
[4] 候志瑾.儿童孤独症的临床特征及矫正模式.心理发展与教育,1995,(4):55-57.
[5] 黄伟合.儿童自闭症及其他发展性障碍的行为干预.上海:华东师范大学出版社,2003,6:11-41.
[6] 林节.儿童孤独症研究进展.江苏健康护理,2002,(1):5-9.
[7] http://www.xlzx.cn/zixun/celerity_show.php?fid=2&tid=7371
[8] 杨晓玲.儿童孤独症.中国医刊,2000,(10):399-401.
[9] 黄伟合.现代行为心理学对幼儿自闭症的治疗及其效果.中国行为医学科学杂志,2001,(4):380-381.
[10] 王成美、穆朝娟、王延祻.关于儿童孤独症治疗现状的思考.中国行为医学科学杂志,2002,(4):468.
[11] Kathy,E., Janek,D. Art therapy with children on the autistic spectrum. London: Jessica Kingsley Publishers Ltd, 2001.
[12] Julia,M. Playing, laughing and learning with children on the autism spectrum. London: Jessica Kingsley Publishers Ltd, 2002.
[13] 弗洛伊德著,滕守尧译.诗人的白日梦.情爱与文明.安徽文艺出版社,1987.
[14] 李淑贤.婴幼儿游戏的发展(续).学前教育研究,1996,(4):7-8.
[15] 王小英.国外关于游戏功能研究的新进展.学前教育研究,1998,(1):56.
[16] Boucher, J. Interventions with children with autism methods based on play. Child Language Teaching and Therapy, 1999,(1):1-5.
[17] Libby et all. Spontaneous play in children with autism: a reappraisal. Journal of Autism and Developmental Disorders, 1998,(6):487-489.
[18] Black.M., Freeman,B.J.& Mongomery, J.Systematic observation of play behavior in autistic children. Journal of Autism and Childhood Schizophrenia, 1975,(4):363-371.
[19] Libby,S. Powell,S. Messer, D. & Jordan,R. Imitation of pretend playacts by chitdren with autism and Down's syndrome. Journal of Autism and Developmental Disorders, 1997,(4):365-382.
[20] Williams,E., Reddy, V. & Costell,A. Taking a closer look at functional play in children with autism. Journal of Autism and Developmental Disorders, 2001,(1):67-77.
[21] Baron-Cohen,S., Leslie,A. & Frith,U. Does the autistic chid have a "theory of mind"? Cognition, 1985,(21):37-46.
[22] Klein.M.The psychoanalyticplay technique. American Journal of Childhood Education, 1995, (49):223-237.
[23] 盖瑞·兰爵斯著、高淑贞译.游戏治疗:建立关系的艺术.台北:桂冠图书公司,1994,8.
[24] 高峻岭.游戏治疗儿童心理障碍.中华儿科杂志,2002,(5):271-272.
[25] Mittledorf,W., Hendricks,S. & Landreth,G. Play therapy with autistic children. Innovations in Play Therapy. Philadelphia, PA: Brunner-Routledge, 2001: 257-269.
[26] Bromfield,R. Psychodynamic play therapy with a high-functioning autistic child. Psychoanalytic Psychology, 1989,(4):439-453.
[27] Lanyado,M. Asymbolic and symbolic play: developmental perspectives in the treatment of disturbed children. Journal of Child Psychotherapy, 1987,(2):33-44.
[28] Wolfberg,P.J. & Schuler, A.L. Integrated play groups: A model for promoting the social and cognitive dimensions of play in children with autism. Journal of Autism and Developmental Disorders, 1993,(3):467-488.
[29] Mundschenk,N.A. & Sasso,G.M. Assessing sufficient social exemplars for students with autism. Behavioral Disorders, 1995,(2):62-78.
[30] Maclennan,B.W. Modifications of activity group therapy for children. International Journal of Group Psychotherapy, 1977,(1):85-96.
[31] 张日昇.咨询心理学.北京:人们教育出版社,1999,9:37-221.
[32] Barbara.L.B & E.Anna Goodwin著、陈碧玲.陈信昭译.沙游治疗:不同取向心理治疗师的逐步学习手册.台北:心理出版社,2001,8:8-12.
[33] 邱学青.游戏治疗在我国特殊儿童教育实践中的运用.中国特殊教育,1996,(3):37-41.
[34] 王国芳.儿童精神分析中的游戏治疗概述.心理学动态,2000,(4):29-33.
[35] 关少化、刘振民、叶平枝、庞霭梅.关于对幼儿心理及行为问题实施游戏矫正的研究报告.学前教育研究,2002,(3):34-36.
[36] 叶平枝.集体游戏矫正幼儿社交退缩的个案研究.中国心理卫生杂志,2003,(1):27-29.
[37] 樱井素子、张日昇.在澳大利亚某重度语言障碍学校进行箱庭疗法的尝试——爱玩砂的8岁男孩的箱庭疗法过程.心理科学,1999,(4):350-353.
[38] 邱学青.孤独症儿童游戏治疗的个案研究.学前教育研究,2001,(1):36-37.
[39] http://www.dqsy.net/xlyz/lxlzx/1-4al/2004-10-26/10021.html.
[40] 钟向刚.沙盘游戏疗法及其在幼儿心理教育中的实效研究.中国期刊网优秀博硕士学位论文全文数据库,2002年6月.
[41] 李资渝.洛温菲尔德的沙盘游戏治疗理论及其在幼儿园中的应用.中国期刊网优秀博硕士学位论文全文数据库,2002年6月.
[42] 范国平、高岚、李江雪.“沙盘游戏”的理论分析及其在幼儿教育中的应用研究.心理学探新,2003,(2):51-54.
[43] http://www.xlzx.cn/zixun/celerity_show.php?fid=2&tid=7371.
[44] 陈国泰,杨晓玲.走出孤独的世界.北京:人民卫生出版社,2000,4:118-121.
[45] Allen.F.Psychotherapy with children. New York: Norton, 1942: 293.
[46] Charles E.Schaefer, & Donna M.Cangelosi. Play Therapy Techniques, U.S.A:Jason Aronson Inc, 1993.
[2] http://www.achh.com/qtest/achhnew/article/2003-06-10/44.html
[3] http://www.spe-edu.net/info/2003-06-09/2988.htm
[4] 候志瑾.儿童孤独症的临床特征及矫正模式.心理发展与教育,1995,(4):55-57.
[5] 黄伟合.儿童自闭症及其他发展性障碍的行为干预.上海:华东师范大学出版社,2003,6:11-41.
[6] 林节.儿童孤独症研究进展.江苏健康护理,2002,(1):5-9.
[7] http://www.xlzx.cn/zixun/celerity_show.php?fid=2&tid=7371
[8] 杨晓玲.儿童孤独症.中国医刊,2000,(10):399-401.
[9] 黄伟合.现代行为心理学对幼儿自闭症的治疗及其效果.中国行为医学科学杂志,2001,(4):380-381.
[10] 王成美、穆朝娟、王延祻.关于儿童孤独症治疗现状的思考.中国行为医学科学杂志,2002,(4):468.
[11] Kathy,E., Janek,D. Art therapy with children on the autistic spectrum. London: Jessica Kingsley Publishers Ltd, 2001.
[12] Julia,M. Playing, laughing and learning with children on the autism spectrum. London: Jessica Kingsley Publishers Ltd, 2002.
[13] 弗洛伊德著,滕守尧译.诗人的白日梦.情爱与文明.安徽文艺出版社,1987.
[14] 李淑贤.婴幼儿游戏的发展(续).学前教育研究,1996,(4):7-8.
[15] 王小英.国外关于游戏功能研究的新进展.学前教育研究,1998,(1):56.
[16] Boucher, J. Interventions with children with autism methods based on play. Child Language Teaching and Therapy, 1999,(1):1-5.
[17] Libby et all. Spontaneous play in children with autism: a reappraisal. Journal of Autism and Developmental Disorders, 1998,(6):487-489.
[18] Black.M., Freeman,B.J.& Mongomery, J.Systematic observation of play behavior in autistic children. Journal of Autism and Childhood Schizophrenia, 1975,(4):363-371.
[19] Libby,S. Powell,S. Messer, D. & Jordan,R. Imitation of pretend playacts by chitdren with autism and Down's syndrome. Journal of Autism and Developmental Disorders, 1997,(4):365-382.
[20] Williams,E., Reddy, V. & Costell,A. Taking a closer look at functional play in children with autism. Journal of Autism and Developmental Disorders, 2001,(1):67-77.
[21] Baron-Cohen,S., Leslie,A. & Frith,U. Does the autistic chid have a "theory of mind"? Cognition, 1985,(21):37-46.
[22] Klein.M.The psychoanalyticplay technique. American Journal of Childhood Education, 1995, (49):223-237.
[23] 盖瑞·兰爵斯著、高淑贞译.游戏治疗:建立关系的艺术.台北:桂冠图书公司,1994,8.
[24] 高峻岭.游戏治疗儿童心理障碍.中华儿科杂志,2002,(5):271-272.
[25] Mittledorf,W., Hendricks,S. & Landreth,G. Play therapy with autistic children. Innovations in Play Therapy. Philadelphia, PA: Brunner-Routledge, 2001: 257-269.
[26] Bromfield,R. Psychodynamic play therapy with a high-functioning autistic child. Psychoanalytic Psychology, 1989,(4):439-453.
[27] Lanyado,M. Asymbolic and symbolic play: developmental perspectives in the treatment of disturbed children. Journal of Child Psychotherapy, 1987,(2):33-44.
[28] Wolfberg,P.J. & Schuler, A.L. Integrated play groups: A model for promoting the social and cognitive dimensions of play in children with autism. Journal of Autism and Developmental Disorders, 1993,(3):467-488.
[29] Mundschenk,N.A. & Sasso,G.M. Assessing sufficient social exemplars for students with autism. Behavioral Disorders, 1995,(2):62-78.
[30] Maclennan,B.W. Modifications of activity group therapy for children. International Journal of Group Psychotherapy, 1977,(1):85-96.
[31] 张日昇.咨询心理学.北京:人们教育出版社,1999,9:37-221.
[32] Barbara.L.B & E.Anna Goodwin著、陈碧玲.陈信昭译.沙游治疗:不同取向心理治疗师的逐步学习手册.台北:心理出版社,2001,8:8-12.
[33] 邱学青.游戏治疗在我国特殊儿童教育实践中的运用.中国特殊教育,1996,(3):37-41.
[34] 王国芳.儿童精神分析中的游戏治疗概述.心理学动态,2000,(4):29-33.
[35] 关少化、刘振民、叶平枝、庞霭梅.关于对幼儿心理及行为问题实施游戏矫正的研究报告.学前教育研究,2002,(3):34-36.
[36] 叶平枝.集体游戏矫正幼儿社交退缩的个案研究.中国心理卫生杂志,2003,(1):27-29.
[37] 樱井素子、张日昇.在澳大利亚某重度语言障碍学校进行箱庭疗法的尝试——爱玩砂的8岁男孩的箱庭疗法过程.心理科学,1999,(4):350-353.
[38] 邱学青.孤独症儿童游戏治疗的个案研究.学前教育研究,2001,(1):36-37.
[39] http://www.dqsy.net/xlyz/lxlzx/1-4al/2004-10-26/10021.html.
[40] 钟向刚.沙盘游戏疗法及其在幼儿心理教育中的实效研究.中国期刊网优秀博硕士学位论文全文数据库,2002年6月.
[41] 李资渝.洛温菲尔德的沙盘游戏治疗理论及其在幼儿园中的应用.中国期刊网优秀博硕士学位论文全文数据库,2002年6月.
[42] 范国平、高岚、李江雪.“沙盘游戏”的理论分析及其在幼儿教育中的应用研究.心理学探新,2003,(2):51-54.
[43] http://www.xlzx.cn/zixun/celerity_show.php?fid=2&tid=7371.
[44] 陈国泰,杨晓玲.走出孤独的世界.北京:人民卫生出版社,2000,4:118-121.
[45] Allen.F.Psychotherapy with children. New York: Norton, 1942: 293.
[46] Charles E.Schaefer, & Donna M.Cangelosi. Play Therapy Techniques, U.S.A:Jason Aronson Inc, 1993.