Incorporating Play Therapy Into Evidence-Based Treatment With Children Affected by Obsessive Compulsive Disorder, Article Critique Example

In “Incorporating Play Therapy into Evidence-Based Treatment with Children Affected by Obsessive Compulsive Disorder”, Amie Myrick and Erick Green present information about current research on pediatric OCD in an accessible and professional manner (2012). The authors provide useful information- mainly about what research is not currently available. During the authors’ discussion of integrating play therapy with evidence-based approaches, they explain that the most common manuals list few OCD treatment activities (pp. 78-79). Thus, it seems that the authors seek to supplement the generalized manuals for OCD treatment with evidence-based treatment approaches, such as pharmacological intervention and cognitive-behavioral education which teaches coping skills. The creativity of the authors propels their argument and provides hope for pediatric OCD- despite the clinical tone which the authors initially project.

key words: obsessive compulsive disorder, OCD, play therapy, critique, evidence-based treatment, pediatrics

Introduction

For children with Obsessive Compulsive Disorder (OCD), uncertainty frightens. Even an action as joyful and imaginative as pretend play can create a confused discomfort in which the repetition of comforting behaviors is obstructed. However, when skillfully handled by a professional, this interruption provides an opportunity for these children to express the complex emotions which are often bottled by the demands of living with OCD. In a 2012 article in the International Journal of Play Therapy, Myrick and Green (2012) write that play therapies can be combined with medicinal intervention and with evidence-based treatment approaches to create a ‘gold standard’ of pediatric OCD treatment. Alone, the authors argue, the efficacy of each treatment component lessens.

Summary

Myrick and Green (2012) begin their discussion of pediatric therapies for OCD by explaining the difficulties of arriving at the proper diagnosis despite the shared symptoms which multiple psychological disorders share. Additionally, pediatric OCD cases appear to exhibit fewer and subtler symptoms than those studied in the adult counterparts (pp. 75-76). The authors carefully avoid making definitive statements regarding diagnosis and connected conditions. Since pediatric OCD symptoms and diagnoses themselves are frequently misunderstood, it is unsurprising that “causes of pediatric OCD are still largely understudied” (p. 76). Neurobiologists study genetic development and chemical balances; behavioral theorists examine negative reinforcement of compulsive behaviors; cognitive theorists suggest that compulsive behaviors detract from the sense of personal responsibility which children with OCD feel as a result of a belief that their private thoughts contributes to the worsening of the disorder (pp. 75-76).

The authors explain that the externalization of OCD can be retrained to exhibit positive social coping skills and overall progress. Myrick and Green suggest narrative therapies, such as the child’s creation of a letter to their OCD trigger(s); the authors also recommend rating and mapping symptoms, developing and practicing coping strategies, and exposure-response prevention, respectively. The latter draws upon metaphorical understanding to decrease the number of fears of the child with OCD. Setting and meeting goals comprises a crucial gauge for the individualized success of each child in an often-generalized system of care (pp. 79-80).

Critique

Myrick and Green present a straight-forward, simple analysis of the development of pediatric OCD and of potential therapies, especially play therapy (2012 In the process, the authors also undermine the credibility of the treatment approaches which they cite as evidence-based support for their advocacy of play therapy. As they write:

“…[Pharmacotherapy and cognitive-behavioral treatment] are the only two treatment modalities that have been successfully studied and empirically validated… Cognitive– behavioral treatment (CBT) combined with exposure response prevention (ERP) is recommended as the ‘gold standard’ of treatment for children ages 6–17 years” (pp. , 76).

However, the authors fail to acknowledge that the limitations of current research also hinder the validity of the results of their ‘gold standard’ approach. As the number of combined treatments increases, it becomes more difficult to separate the successful and unsuccessful components of a treatment approach, calling the practicality of the article’s argument into question. The range of six to seventeen years likewise seems impractical, as though the authors felt the need to be clinical and place specific guidelines on an idea which is largely subjective in interpretation and therapeutic application.

Nonetheless, Myrick and Green (2012) pose an experimental theory of therapeutic integration which merits closer examination. For example, the authors’ use of a symptom map allows children with OCD to fulfill an important role in their own treatment, to visually convey important information which is often difficult to verbally express, and to discover the creative side of order. In the authors’ treatment plan, the child exhibiting OCD must become an active and positive force for their own recovery, because additional education, therapy, and homework provide the positive reinforcement which this cognitive-behavioral emphasis requires (pp. 76-77).

Conclusion

Myrick and Green encounter serious threats to the validity of their proposed ‘gold standard’ approach, but this issue could easily be resolved by calling the approach what it is: experimental. It remains a creative and promising approach which remains experimental since the cited research- by the authors’ own admissions- is limited and often contradictory. Some ideas simply transcend the world’s readiness to receive them, and the array of evidence-based therapeutic approaches to pediatric OCD questions everything as possible until something is proven. The authors’ point is more effectively conveyed by the case studies, which examine the intimate personal dynamics which children with OCD encounter as they learn to cope with these triggers, which are often concealed within the general anxiety and fear of the disorder itself. Children with OCD may use this ‘gold standard’ approach to move past their own inner obstructions to progress: blame, self-resentment, and other insecurities.

References

Myrick, A. C., & Green, E. J. (2012). Incorporating play therapy into evidence-based treatment with children affected by obsessive compulsive disorder. International Journal of Play Therapy, 21(2), 74-86. doi:10.1037/a0027603