Dissertations and Theses

Date of Award

2024

Document Type

Dissertation

Department

Psychology

First Advisor

Sasha Rudenstine

Second Advisor

Steven Tuber

Third Advisor

Diana Puñales-Morejon

Keywords

play, humor, fantasy, metaphor, working alliance

Abstract

The importance of play in child development is well-documented: the capacity to play is associated with psychological health, and the cognitive and affective processes involved in play, such as fantasy, symbolism, narrative organization, divergent thinking, and affective expression, relate to areas of adaptive functioning. Research also illustrates that the inability to play is associated with adverse experiences in children, and that play therapy can facilitate the development of play and subsequent psychological health. In addition to its relation to psychological health, the capacity to play in childhood is inextricably linked to the infant-caregiver relationship. There is less literature on what play looks like in adults, and specifically in adult psychotherapy. Some theorists have conceptualized adult play as cognitive flexibility, free association, humor, use of metaphor, and “as if” thinking. In addition to considering how patients exhibit playfulness in psychotherapy, some literature suggests that therapists use play in an effort to soften patients’ defenses and disrupt rigid narratives. In the present study, 14 short-term (20 sessions) alliance-focused adult psychotherapy treatments were analyzed using both quantitative and qualitative methods. Videotaped psychotherapy session data was coded for play moments, and quantitative self-report measures of working alliance and psychosocial distress were also collected with the aim of better understanding the role of play in the psychotherapeutic process. Three categories of play emerged: (1) humor, (2) fantasy, and (3) metaphor. Total play moments predicted both patient- and therapist-rated working alliance, and fantasy moments (not humor or metaphor) predicted patient-rated working alliance. Patient-initiated humor was associated with less psychosocial distress. Implications for training and supervision are discussed, including the benefits of encouraging a playful stance in clinicians in training.

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