Playing Together: DIR and Child Psychodynamic Therapy

ABSTRACT

This article describes the integration of the developmental, individual difference, relationship model (DIR) and relational child psychodynamic therapy. DIR is an effective treatment for many children with uneven development, not only for those on the autistic spectrum. The importance for child psychodynamic therapists to understand individual differences, as delineated by occupational and speech/language therapists, and to include parents within the treatment will be discussed throughout this article and in a particular case. An understanding of individual differences makes psychoanalytic formulations, especially about the body, more accessible and actionable. Overlooking the contribution of individual differences to a child’s play and development has consequences for progress in treatment. Together, DIR and child psychodynamic therapy can most effectively integrate “psyche” and “soma” (Winnicott, 1949). The child psychodynamic therapist’s particular expertise, in such areas as countertransference enactments and unconscious meaning, crucially contributes to this integration.

Acknowledgments

I would like to thank Dr. Stephanie Pass.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. The DIR model is often referred to as “floortime.” Floortime is a technique that supports social-emotional and cognitive development through affect-rich play based interactions. DIR is a model that is a comprehensive, multidisciplinary, and individual approach to assessing and treating children.

2. DIR practitioners have continued to develop tools, including the Profectum Parent Toolbox (Cawn, Osgood, Robinson, White, & Wieder, 2015), A Checklist for Language Development (Gerber et al., 2016), and Visual Spatial Cognitive Profile (Wieder & Wachs, 2012). While there is much evidence for developmental models (Cullinane, 2013), evidence for the DIR model continues to grow. For example, Dr. R.Solomon used the DIR model in his rigorous, randomly assigned research study of the PLAY Project. (Solomon, Van Ergen, Mahoney, Quon-Huber, & Zimmerman, 2014).

3. There were obviously exceptions, especially Kerry Novick and Jack Novick (2005), who emphasized that “working with parents makes therapy work,” but parents were not usually in the child’s session.