The use of board games in child psychotherapy

A

Y A L A

O

R E N

Haifa, Israel

Abstract

Playing checkers, football or more recently, computer games, is an important part of the latency

child’s culture. The ability to play games demands a level of emotional development similar to that needed
to cope with the emotional/developmental demands characteristic of latency. A game shared by the therapist
and child provides a picture of the child’s development, patterns of interaction and internalised
representations, and is an arena where the therapist can intervene, verbally and non-verbally, in response to
the specific needs of the child. The child’s desire and need to play clash with the difficulties in coping with
the demands of the game. This raises the same issues that children confront during their maturation and
interactions with others. Observation and analysis of game play allow the skilled therapist to evaluate the
emotional development, internal representations, projections and patterns of relations of children and to
intervene to help them with their specific difficulties and conflicts and, importantly, do so in an enjoyable
way. The special challenges for the therapist using board games in psychotherapy come from the need
simultaneously to observe the game, play it ‘well’, plan actions, regulate the child’s anxiety level, maintain a
playing atmosphere and deal with transference and countertransference issues – all in the highly tense
atmosphere of competition. In the paper, I outline how board games can be used in psychotherapy, focusing
on projective and developmental domains. I present a scheme that links emotional development stages and
their expressions in game play, and use a case description to illustrate how it can be used in assessment,
treatment planning and following progress. Some of the dilemmas faced by the therapist using games in
therapy are also discussed.

Keywords

Psychodynamic psychotherapy; game play; board games; emotional development.

Introduction

In my work as a child psychotherapist, I have often been faced with a problem: many
children aged 6–12 refuse or avoid imaginary play and ask instead to play games – board
games or sports – during therapy sessions. While psychotherapy with children commonly
uses imaginary play, as well as projective techniques such as drawing or drama, the use of
board games is less common. Generally, when children refuse to play imaginary games or
draw, we talk with them about resistance to therapy and fantasy, or agree to play one
game as a ploy to keep them in the therapeutic relationship. Like many other therapists,

JOURNAL OF CHILD PSYCHOTHERAPY

VOL. 34 NO. 3 2008 364–383

Journal of Child Psychotherapy

ISSN 0075-417X print/ISSN 1469-9370 online ª 2008 Association of Child Psychotherapists

http://www.tandf.co.uk/journals

DOI: 10.1080/00754170802472893

I, too, often ‘gave in’ to children who refused to use imaginary play and agreed to play
games, hoping that, afterwards, they would agree to talk. I quickly realised, however, like
some before me (Bellinson, 2002), that for many children at this stage of development,
talking is not a natural language for interpersonal and inner discourse. This led me to
consider whether playing games could be used as a tool in psychotherapy.

Games are part of the culture of the 6–12-year age group. Children like playing games

and this seems to reflect their importance in children’s development. Less is written on
the use of structured play in psychotherapy than on imaginary play and opinions about it
are divided. There is general consensus in the literature that games allow examination,
strengthening and improvement of ego functions. They may assist in controlling urges,
checking reality, understanding the relations between action and outcome, regulation of
frustration and anxiety (Bow and Goldberg, 1986; Frey, 1986; Swanson, 1986),
practising coping with situations that resemble realistic ones in cooperation with others,
exercising self-discipline, responding to social norms, self-control, adaptive expression of
aggression and, in general, enhancing socialisation (Redl and Wineman, 1951). Authors
are divided however, whether games encourage or prevent expression of unconscious
fantasies, conflictual issues and other unconscious contents.

Solnit (1993) argues that games with rules serve as a defence against fantasies, prevent

imaginative play and regressive behaviour and are therefore undesirable in therapy. Bary
and Hufford (1990) contend that games serve to prevent dealing with primary pain by
focusing on action and tensions in the ‘here and now’ of the game. Berlin (1986) and
Peller (1954) see games as an expression of competition with siblings or parents, in
which the strong need to win represents the desire for victory in the Oedipal struggle. In
their view, games with structured, clear and rigid rules do not involve emotional and
creative investment except for this expression of competition In contrast, Eiferman
(1993) believes that even the wildest fantasies could be hidden within game play. The
rules of the game, which seem to be a defence, actually serve the purpose of the child’s
free expression. When following the rules of the game, children are free to express
fantasies, wishes and urges that are acceptable only in the framework of the game. The
rules release them from responsibility for their acts (within the game) and therefore
eliminate guilt. Eiferman (1993) disagrees that playing games prevents creativity. She
compares a game to music: the game developer is the composer, and the players are
musicians following the composer’s rules and instructions, but creating their own
interpretations. Bellinson (2002) emphasises the dynamic psychological meaning
expressed in the use of board games. The choice of the game, the way it is played and
the interaction with the therapist, reveal the emotional state, difficulties and interactions
of the children in their social and family frameworks. In her view the erroneous
conclusion that board games do not allow the expression of fantasy and unconscious
material is due to a limited focus on the content and mechanics (e.g. throwing the dice,
advancing on the board) of the game. Observation of how the game is played, the
decisions and reactions of the child allows insights into his/her emotional dynamics.

An issue frequently raised in discussions of board games, is that of cheating –

breaking the rules. Meeks (1970) views cheating in games as a means of maintaining
magical omnipotent thinking. He contends that children whose ability to cope and
adapt is underdeveloped cannot accept a reality that is impervious to their desires and

THE USE OF BOARD GAMES

365

wishes. Those who cheat are those who cannot accept losing a game without severe loss
of self-esteem. In a later article, Meeks (2000) suggests that it is cheating and breaking
rules that reveal the child’s inner world and particular problems. Bellinson (2002) claims
that cheating allows the expression of the child’s creativity, as well as providing a view of
their difficulties. She adds that telling children to stop cheating, as recommended by
Beiser (1970) is not productive. Children know that they are breaking the rules and that
this behaviour is unacceptable – their parents and teachers tell them so. She argues that
playing games according to the rules is not interesting in terms of therapy, whereas
cheating reveals an individual style and manner. The way in which children change the
rules provides important information on their emotional dynamics. Children who abide
strictly to rules lack spontaneity. They repress emotions by sticking to the rules; their
play lacks vitality. Bellinson (2002) argues that cheating at games is part of an inner
struggle with the rules of society. Therefore, the breaking of rules is to be expected in
psychotherapy either because the children are young and lack the ego strengths that
enable them to play within boundaries or because there is a conflict between abiding by
rules and resistance to authority. Observation of cheating in a game makes it possible to
identify the prominent themes and conflicts, and to work on them metaphorically.
Indeed, she considers that a game that does not include breaking rules is not a good tool
for therapy, but a waste of time.

Watching children play, I often asked myself why they want to play and compete

even when the emotional tasks are very difficult for them. What is this need to compete
and why is it easier for some children than others? If games are not real, why do children
respond as though they are experiencing something real?

Winnicott (1971) calls the emotional space in which games occur the ‘playing space’

or ‘potential space’. If we view imaginary play as occurring between two extremes – the
inner world/‘me’ at one pole and reality/‘not me’/other at the other pole – then the
game is positioned closer to the reality pole. Because of this closeness, playing games can
cause more anxiety than imaginary play as it threatens the child’s experience of the
playing space as protected. On the other hand, like imaginary play, games are distinct
from reality and enable expression of emotions, thoughts and attitudes that usually
would not be exposed (Capel, 1968; Schaefer and Reid, 1986).

Interactions during structured play reflect coping patterns and internal representa-

tions of the child (Bellinson, 2002). When used appropriately, playing games brings out
the same issues as imaginary play, but in a different way, and one often more suited to
the latency period.

When participating in game play, the therapist presents the child with a new object

for identification, which, in addition to being an object of transference, interacts in a
real way within the ‘reality’ of the game. Therapists function as ‘subjective’ players
working towards the goal of the game in a reality that has rules. Unlike imaginary play,
where the therapist enables the expression of children’s dreams and refrains from
entering their subject reality, the game allows the child to see the therapist as a real
figure for identification. The therapist, like the child has to deal with situations of
frustration and can thus serve as a model for coping with difficult feelings by expressing
them appropriately and not disregarding them (Frey, 1986). Another feature of game
play, relevant in particular to Oedipal issues, is the need to relate to the game as an

366

A. OREN

independent third element in a triangle (him, me and the game). The game has its own
independent set of rules and practices (its own ‘personality’), which are not dependent
on the players (even if the players agree to change the rules, the rules belong to the game
and not the players) and exists as a separate entity to which each player has to relate.
This relationship between player and game exists in addition to each player’s conscious
and unconscious associations with the game and game playing and to the relations
between the players.

The ability to play games indicates the proper development of latency: it involves

recognition of reality, of the existence of others and the ability to cope with the external
world. It requires an internalised authority, experienced as coming from within and not
dictated from the outside. In many of the children who come to me for therapy, these
developmental achievements are not stable and they regress to earlier stages of
development in situations of stress and anxiety. These regressions occur in different
situations of their life, and are often the reason for their referral to therapy.

When systematically observing children at play I use two main perspectives. The first,

a developmental perspective, focuses on the child’s ability to fulfil the developmental
requirements needed to play a game. The second – a projective perspective – focuses on
the way in which play expresses the child’s internal representations, patterns of relations
and object relations. Information from both perspectives is used to formulate therapeutic
interventions. In the following sections, I will summarise some of the principles which
guide me in the psychotherapeutic understanding of the use of board games.

Emotional development needed to be able to play a game

As discussed above, games constitute an important component in children’s culture and
social activities. Since games come from the adult world (Habas, 2002), game developers
assume that players will have attained the level of emotional development needed to play
the game. This involves not only understanding the rules of games but also adequate
maturation along a number of developmental dimensions. I will now outline the more
important of these.

The wish to compete

Players want to try out their abilities under equal conditions and not win at any price.
To be able to compete fairly in a game the child must not experience losing as
annihilation, destruction or humiliation, but as something that is temporary and limited
and can be reversed in the next round. This ability is usually present in the latency child.
However, if it is not stable, stressful situations that occur in competitive games can cause
threat, anxiety and regression. In such anxiety-provoking situations, children experience
the game as one of survival and not competition.

The ability to regulate drives, particularly aggression, by sublimation

Drives, particularly aggressive ones, can be regulated by means of sublimation in the
game. A player who has achieved the necessary level of emotional maturity can cope

THE USE OF BOARD GAMES

367

with the frustration and anger that arise during and after a game, regulate them and treat
the situation as ‘only a game’.

The ability to delay gratification and action

Every game demands the ability to delay immediate gratification, to wait and act
according to a set of rules. The ability to delay gratification and action is a prerequisite
for development of thinking that is related to emotional experience (Bion, 1967). In
turn, development of this type of thinking requires an ability to deal with frustration
and ‘lack’ without resorting to omnipotent magical thinking, or filling the ‘lack’ with a
bad object. Thus, the ‘lack’ becomes an internal location where the apparatus of
thinking is created (Symington and Symington, 1996). Creation of this internal space in
which deliberation can take place is important for the ability to contain emotions, think,
plan and consider options before acting. During normal development, adults use graded
frustration (optimal frustration) to help children develop the tools necessary for
tolerating delayed gratification. An inability to deal with ‘lack’ or frustration results in
difficulty in delaying gratification – a place for thinking (Bion, 1967) or the ‘potential
space’, the space that makes fantasy and expectation possible (Winnicott, 1971), fails to
develop. These abilities are needed to play games and playing games helps to develop
them. Children who have difficulty delaying action find it difficult to wait for their turn.
They may move the other player’s piece for them, rush them, play with another toy or
fidget. This is related to the child’s neurological and emotional maturity, their level of
anxiety, and their ability to maintain coherence of self.

The ability to regulate anxiety

It is expected that children, like adults, will feel tension but not anxiety when playing a
game. Children who have not gained control and self-regulation may experience the
frustration and anxiety in the game as too strong. They may regress to magical
omnipotent thinking and change the rules of the game (Meeks, 1970) or lose control,
act out or stop playing. The ability to regulate anxiety is central to the ability to play
according to rules. When anxiety is overwhelming, the game may be experienced as a
dangerous reality, and the safe ‘playing space’ is lost.

The need for a flexible enough superego

A flexible superego makes it possible for the player to enjoy the option of expressing
regulated, sublimated aggression. For instance, the child may enjoy taking the
opponent’s checkers, removing them from the board without apologising or feeling
guilty, but will not express aggression by destroying or overturning the game. When the
superego is rigid, the child finds it difficult to express aggression and desires. Such
children are afraid to attack or defeat the opponent – for example, in checkers, they will
avoid taking the opponent’s pieces, and apologise for being forced to make a move that
is perceived as aggressive. They request permission and guidance, and assist the
opponent instead of acting in their own interests. Their game lacks playfulness.

368

A. OREN

Attainment of a reasonable level of separation-individuation

Games are played between at least two subjects, each with his/her own interests and way
of thinking. The ability to compete requires individuation, so that each player can look
after him or herself, even if his or her moves contradict the opponent’s interests.

Many children who come to therapy have not developed this level of individuation.

They view adults as parts of themselves and expect them to act in their (the child’s)
interest. They may experience moves an opponent makes in his own interests as an
assault. To maintain a relationship with the opponent, children must give up
omnipotence. We may see children ignoring their opponent’s individuality and playing
in place of the opponent, as if they share the same goals.

Attainment of a positive, stable self-esteem and the ability to bear
frustration and loss

Children with weak or unstable self-esteem cannot bear frustration in games. They
experience losing as an injury, destruction or humiliation as for them it is a game of
survival. Losing is not seen as an isolated event but a blow to self-esteem. They are
willing to cheat in order to win. They lack the narcissistic store needed to restore
homeostasis following stress (Kohut, 1977). The fear of potential humiliation and pain
of losing engages grandiose defences with the hope that the child’s ‘success’ will be
mirrored in others and reflected back to the child. In young children, such grandiosity is
accepted and parents in their role as self-objects (Kohut, 1977) assist them to internalise
the experience of positive self-esteem and develop an ability to regulate self-esteem.
Older children who remain grandiose and controlling generate anger in others who find
it difficult to feel empathy for them.

Attainment of a sense of coherence of self

Children may lack a coherent, stable and long-lasting sense of self. Children who have
been deprived or suffer from organic dysfunctions may have difficulty experiencing
themselves within their own skin (Anzieu, 1995). This may be expressed in their need
to create a shell for themselves without which their self is experienced as unstable and
fluid. They may do this by constantly talking to create a vocal shell, constantly touching
themselves or others, or constantly moving to validate the existence of a skin ego. This
constant activity may at first seem to reflect poor regulation of action, but it reflects their
need simply to move, with no other purpose. Similar ‘purposeless’ constant movement
can be observed in children with skin hyposensitivity, who move in order to feel their
body and their existence, and thus compensate for the lack of an adequate sense of skin.
The need to wait for a turn in the game facilitates detection of such behaviour.

The ability to bear difficult feelings

Another developmental requirement for game playing is the ability to tolerate feelings of
deprivation, jealousy, greed and destructiveness, and maintain contact with the other

THE USE OF BOARD GAMES

369

players. This means seeing the other player as a rival, not an enemy or intruder and not
wanting to eliminate the opponent because of envy (Klein, 1975). Children who cannot
tolerate an opponent’s victory or accept someone else’s success are liable, out of greed, to
want to grab what the other child has or, out of envy, to wish to destroy the opponent.
They may experience the other player as hostile or destructive and find it difficult to
maintain a play relationship. They experience the game as reality – there is no playing
space. When jealousy comes from the Oedipal position, the playing space is not
destroyed, but the children are jealous of their opponent’s successes.

The ability to understand the importance of uniform rules for everyone
or at least the ability to accept them

Latency children feel the need for rules and generally set rules amongst themselves before
playing a game. They realise that rules ensure an equal contest. When rules are imposed
they are liable to be experienced as aggressive, and their purpose may not be understood.
The players must be capable of agreeing on the game rules, often through negotiation, as
without such agreement there can be no game. Observation of children about to play
reveals that typically one player announces a rule that he or she wants, and this is followed
immediately by a short or long, noisy or quiet negotiation. The ability to reach agreement
depends upon each player being able to recognise the other players as subjects.

The ability to abide by rules

Being able to accept rules does not mean necessarily that children can abide by them
without feeling threatened. Children who have difficulty accepting anything they cannot
control are liable to experience game rules as hostile because they did not set them. When
feeling threatened, children may knowingly break the rules or regress to magical,
omnipotent thinking and behaviour (Meeks, 1970). This may appear to be cheating.

Attainment of effective and adaptive defence mechanism

Because the game necessarily increases tension and sometimes anxiety, defences ranging
from the highly developed to the more primitive can be observed. Each child responds
in accordance with his level of development and his ability to feel the other as available
emotionally and holding. Children who have not developed mechanisms such as
sublimation and rationalisation use less mature ones to deal with threat during the
game. For example, they may deny that they threw the dice claiming that they fell by
themselves, blame the opponent for the failure (projection), declare that they are
champions (grandiosity) to protect against feelings failure and low self-esteem or say that
they ‘don’t care’ about losing (reaction formation).

Development of the ability to play games

The developmental achievements, needed for successful game playing, discussed above,
are usually attained by children aged 6–12. However, many of the children who are

370

A. OREN

referred to us for therapy have not reached such stable emotional development and
regress under the stress of competition and tension. Yet, despite the emotional
difficulties game playing presents to them, most school-age children want to play with
their peers who become increasingly important to them. Playing games is an important
mechanism of socialisation.

I will now briefly outline the relationships between the child’s emotional

development and play behaviour. The scheme is summarised in the accompanying
table (Table 1), which I find very useful in teaching and workshops and clinically for
evaluating the level of development of the child and following progress. In the table,
development in relation to ability to play games is ordered from left to right and the
developmental dimensions are listed in the left-most column.

The development achievements that enable children to play games (to the right of the

bold line in the table) are those characteristic of latency. These children’s main
experience is one of competition: they want to compete on equal terms, demonstrate
their abilities and enjoy wining ‘by the rules’. Their emotional experience is of tension,
but not anxiety. Failure or losing is not experienced as destruction because the
personality is well established. When losing a game, the children do not feel lost or
inferior, but sad. They think that can do better next time, hope to improve and
remember that they have won in the past. They experience a continuity of self (Ogden,
1986) and the experience of losing is focused and not generalised.

These developmental achievements, however, may not be stable. Thus, even if most

of the experiences in playing are of tolerable competition, situations may arise when the
child regresses to an experience of survival.

Children at lower stages of development (on the left of the bold line in the table) are

unable to play games or can play only in a limited way. Their behaviour is uncontrolled
and they act according to their inner world and wishes, disregarding the rules of the
game. Inability to delay gratification or action is reflected in inability to wait their turn
to play. Lack of separation/individuation may make them unable to play against another
individual, seeing the opponent as a provider, or an object of the child rather than an
independent subject. They need stimulation from the outside to provide a sense of self-
existence and may experience the game as reality – the playing space is not maintained
as a safe place. The anxiety associated with the game is experienced as threatening the
child’s sense of self, and generates fear of destruction or humiliation. The dominant
experience during the game is one of survival.

Many of the children who come to therapy are at developmental stages, which enable

them to play games but not as a latency child would. During therapy, we can see
improvement in their play but it should be remembered that development of the
different emotional abilities (rows in table) is not necessarily parallel or concomitant.

The position the therapist takes needs to correspond to that of the child. A child who

is experiencing the game as a struggle for survival will require a parental approach
including assistance with regulation and calming, while for a child who is experiencing
the game as a competition, a position closer to a competitive peer is the more
appropriate.

It should be noted that children who suffer learning disabilities or attention

disorder may have difficulty playing board games because of the organic impairment

THE USE OF BOARD GAMES

371

Table

1

Development

of

the

ability

to

p

lay

games

Developmental

dimensions

Development

in

relation

to

ability

to

play

games

Expected

achievements

Regulation

of

aggression

Throws

the

game,

destroys,

damages

–

uncontrolled

aggressiveness

Outbursts;

stops

playing

Curses,

accuses

Expresses

frustration

IN

WORDS

Able

to

regulate

aggressiveness,

to

put

it

into

words

Understanding

rules

and

ability

to

play

according

to

them

No

rules,

everything

is

according

to

internal

self

and

wishes

Rules

are

experienced

as

aggressive

against

him

Partial

acceptance

Rigid

acceptance

Initial

acc

epta

nce

;

begin

s

to

u

n

derstand

the

importance

of

external

rules

to

all

the

p

arti

ci

pants

Discussion,

attempt

to

adapt

rules

flexibly,

by

agreement

Und

ersta

nds

ag

re

ed

rule

s,

inte

rpe

rson

al

and

internal

negotiati

o

n

o

f

rule

s

Tries

to

play

by

the

rules

Difficulty

to

keep

to

rules

for

the

length

of

the

game

Able

to

play

by

the

rules

with

help

Complies

with

rules

after

agreement

between

players

A

b

le

to

co

m

p

ly

wi

th

ru

le

s,

to

b

e

co

n

si

d

er

at

e

and

en

jo

y

su

cce

ss

p

la

yi

n

gb

yt

h

e

‘r

ea

l’

ru

le

s

Defence

mechanisms

Split,

disintegration

Projection,

de

nial

,

projective

identification

Sense

of

omnip

ot

ence

Idealization,

reaction

–

devaluation,

formation

Uses

fantasy

for

comfort

Sublimation

and

rationalization

Regulation

of

anxiety

Overwhelming

anxiety,

no

inner

space

for

play

Annihilation

anxiety

Fear

of

loss,

destruction

of

the

object

or

the

self

Fear

of

losing

the

love

of

the

object

Calming

through

a

calming,

containing

object

C

as

tr

at

ion

an

xi

et

y,

th

en

tens

ion

ins

tead

of

anxiety

Con

ta

inm

en

t

o

f

anxiety

and

calming

oneself,

internal

calming

o

bject

Delaying

gratification

Unable

to

delay

gratification

Needs

immediate

gratific

ation,

gree

dy,

takes

ev

eryth

ing

Can

use

substitute

or

partial

gratification

Able

to

delay

a

little

because

can

anticipate

T

ol

er

at

es

te

m

p

or

ar

y

d

el

ayf

or

th

es

ak

eo

f

the

goal,

ac

companie

d

by

tension

Ability

to

postpone

gratification,

delay

and

create

space

for

thinking

(cont

inued

)

372

A. OREN

Table

1

(Continued

)

Developmental

dimensions

Development

in

relation

to

ability

to

play

games

Expected

achievements

Regulation

of

activity

Acting

out,

cannot

stop

or

delay

actions

Play

instead

of

the

other

M

ov

eso

rp

la

ys

with

a

toy

(de

p

endent

on

matu

ri

ty

and

le

vel

of

anx

iety)

Participates

in

opponent’s

activity

Can

await

turn

Action

after

thought;

creativity;

space

for

thinking

Separation/

individuation

Acts

as

though

the

opponent

is

nonexistent

Symbiosis

A

ct

s

as

th

ou

gh

the

other

is

a

pa

rt

of

him/

her

;

cl

aims

to

be

p

la

yin

g

wi

th

an

ot

her,

bu

t

tak

es

the

op

po

ne

n

t’s

turn

Needs

Auxiliary

ego

The

other

as

a

whole

object

Makes

sure

that

the

other

acts

for

his/her

own

sake

Two

subjects

playing,

two

subjects

in

a

relationship,

internalized

representation

Sense

of

being

Needs

sensory

input

in

order

to

feel

that

exists

Self-stimulation

Needs

to

speak,

to

hear,

or

to

move

all

the

time

‘We

both

bring

me

up’

(self-object)

Activity

and

tension

give

a

sense

of

existence/stability

Coherent

self

Self-esteem

Every

frustration

is

a

narcissistic

injury

–

insult,

humiliation

Co

llects

su

ccesses

at

any

p

ri

ce

Draws

encouragement

from

previous

or

partial

successes

Practices

losing

and

winning

Narcissistic

store

enables

reliance

and

tolerance

of

losing

and

failure

without

destruction

Unable

to

play

a

game

Survival

–

parental

position

required

for

calming

and

regulation

Peer

competition

THE USE OF BOARD GAMES

373

itself. The difficulties they experience in playing games and the multiple failures in life
situations lower their self-esteem. It is difficult to differentiate game playing problems
due to organic causes from those related to the stage of emotional development and
parents or therapists are liable to confuse the causes. For example, a child played
checkers with his father who claimed that his son was cheating by moving a checker one
row beyond the correct place. Examination revealed that the child did not clearly
differentiate the rows and was in fact making a mistake and not cheating. The result was
that the child was afraid to play – he realised that he was not behaving properly, but did
not understand what he was doing wrong.

Another area of difficulty is assessment of regulation of aggression in children who are

afraid to express aggression. They will not show aggression in play but will strive to
please the opponent and apologise for successful moves. Children in the schizoid–
paranoid position will be afraid of destroying the object or of being destroyed in
revenge. Those in the depressive position will be afraid of losing the love of the other
and fear that their opponent will refuse to play with them More developed children may
experience internal conflicts as in neurotic individuals.

The game as an expression of projections and object representations

Interactions in game play activate representations from the players’ inner worlds, which
influence their behaviour in the game. The structured and seemingly ‘safe’ setting of the
game, protected and distant, enables difficult emotional content to be expressed in a
legitimate way, as ‘it is only a game’. A broad range of projections, coping patterns, and
internalised object relations can be expressed and many unconscious or conscious but
forbidden issues find legitimate expression within the game (Eiferman, 1993). The rules
of the game free the players of responsibility for actions performed while playing, and
provide a protected space for expressing wishes, urges, fantasies and resistance. Children
who enter the world of the game experience it with full emotional force. It incorporates
tension, anxiety, opportunities for success and victory over other players, and the threat
and experience of loss. In games, children may experience themselves as soldiers moving
over the board, commanders of ‘an army’ or, as in the Monkey Island game, both as
monkeys trying to flee crocodiles or as the devouring crocodiles. Thus games, despite
their rules and formal structure provide, like other projective psychotherapy techniques,
provide an insight into the inner world of the child.

This is illustrated by the case of David, a 10-year-old Jewish boy, adopted at the age

of seven months. He was removed from his biological family because of abuse and
neglect. He felt that he didn’t belong and was referred because of conflicts with his
adopted parents. Of all many options available, he chose to play Monopoly. In the early
sessions, he bought only buses, as if telling me ‘I am in-between, always travelling, with
no home, no place, no family’. As treatment progressed, he began purchasing properties
but only in the city in which he lived. Later he also bought a house there. It was as
though he found his place and said ‘This place is important to me.’ He preferred to buy
in ‘his’ city, than to accumulate property and money in general. Thus he played
according to the rules, but not according to the goal of the game, which was to
accumulate as many assets as possible. When he had bought all the properties and

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A. OREN

houses in his city, that is, after he found his home and his place, he no longer wanted to
play Monopoly. He also felt more ‘at home’ in therapy and began to show interest in
other issues.

Projective elements may often be subtle. For example, Orah was playing the game

‘Cluedo’, where the players have to solve a murder and one of many characters could be
the murderer. She chose only those characters that she knew could not be the murderer
in that particular play round, saying that she did not want to be the murderer. This was
because of her fear of being bad, aggressive and destructive, which influenced her
choices despite the distance and protection of the structure of the game.

Fear of aggression, of destroying the object, of revenge or of loss of love of the object

may cause a child to be afraid of taking pieces from his opponent in checkers.
Sometimes this may be the result of internalisation of a relationship with an object that
cannot tolerate aggression. This would make it dangerous to attack the opponent, even
in a game, as there is no certainty that he/she could contain his/her aggression and
might fall apart or take revenge.

Another projective element is illustrated in this game of Monopoly. Yosi was very

successful, accumulated a lot of money and left me almost penniless. Suddenly he gave
me all his money. It emerged that his motivation was a fear that I would be left without
anything to give him. Thus he gave me the means to fulfil my parental function – his
basic experience was that a parent did not have enough resources to respond to his
needs. He may also have felt guilty that he had so much and I so little, or perhaps that
he was greedy. Children often give something to their opponent so that the game can
continue, but they do not give away all they have.

These examples illustrate how playing board games exposes patterns of relations and

internal representations similar to those seen in imaginary play and in interpersonal
relations in general, despite the different setting.

Case discussion: Nathaniel

Nathaniel was an intelligent six-and-a-half-year-old Jewish boy, the elder of two
brothers. He was diagnosed with ADD by developmental specialists and was
unmedicated. His parents, with whom I met from time to time, described him as
disobedient and antagonistic. He ‘did what he liked’ and when he did not get his way
responded with angry outbursts that frightened him and his parents, who often
reacted angrily. Difficulties in self-regulation began when he was a toddler and led to
conflicts with his parents, particularly the mother who described her own parents as
aggressive and controlling. Nathaniel found it difficult to accept anything that came
from outside himself without his wish or approval. The outside world appeared to
him as unclear and often hostile, and this perception often led to clashes at school and
home.

Nathaniel’s parents often acted in an inconsistent and rigid manner, frequently

argued in his presence and provided him with different explanations for events that took
place so that he could not rely on their interpretation of reality. They found it difficult
to help him regulate himself and to use their authority in a way that he could accept.
These tense relations made it difficult for Nathaniel to internalise his parents as

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regulating and calming and to build positive and supportive internal objects. He felt that
he could either control his parents or be controlled by them. The result was an ongoing
power struggle in which the parent felts at times weak, angry or guilty that they used
power and control. Nathaniel preferred to identify with the aggressive, controlling
elements. Nathaniel was the first child, and the parents were anxious of any deviations
from ‘normal’ fearing ‘how he will turn out’. This often led to demands that he behave
in ways not appropriate for him.

Although offered many alternatives, Nathaniel insisted on playing board games

despite his relatively young age. His desire to play was a major consideration in choosing
this method. He was very active. It was hard for him to wait his turn. He got excited,
moved around, moved my pieces during my turn and made suggestions as to what I
should do. It was very important for him to win even if it wasn’t by the rules. A great
deal of fantasy and omnipotence covered up his low self-esteem. His activity and
restlessness made those around him, including his parents and me feel anxious.

Nathaniel’s aggressiveness increased each time the environment did not adapt to his

inner world and desires. When such a situation arose during a game, he would throw
the game board over or stop the game, or alternatively try to impose his own rules. The
competition itself caused anxiety and regression, as though the opponent was likely to
destroy or humiliate him. His control of his aggression was minimal, evidently
influenced also by his attention disorder.

Nathaniel knew the rules of the game but when his anxiety rose, he experienced them

as imposed from the outside, against him, as cruel and unfair and not as something he
had accepted at the start of the game. He tried to play by the rules but would break
them whenever there was a danger – even partial – of losing. For example, in Snakes and
Ladders, he would refuse to go back when he landed on a snake. It is important to
remember that Nathaniel was relatively young and would not be expected to play as an
older child would.

When calm, he would use rationalisation, as when he explained to me why he didn’t

succeed in a particular move. When anxious, however, he regressed to less developed
mechanisms, such as omnipotence (for example when he decided on new rules), denial
(as when he claimed that he hadn’t thrown the dice yet if they were not in his favour) or
projection (as when he would blame me for his mistakes).

Nathaniel could not use his parents to help him calm down because he did not trust

anything outside himself. He thought they would tell him not to do what he wanted or
would be angry with him. He tried to regulate his anxiety by moving constantly and by
magical, omnipotent thinking. Examples of this included moving his pieces on the
board as he liked, disregarding the rules, throwing the dice many times and refusing to
follow instructions. Such behaviours led to angry responses from others as reported by
his parents, made me feel unsure of myself when they occurred in therapy sessions and
increased his anxiety. In such highly anxious states, Nathaniel experienced a fear of
annihilation, and felt he must act to save himself. When anxiety levels were lower and
more under his control, his experience ranged from fear of losing the object (that he
could destroy me or his parents or that I/they would take revenge on him, i.e. self and
object would be destroyed), to the fear of losing the love of the object (the parent or I
would be displeased or angry with him.)

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A. OREN

Nathaniel was able to forego immediate gratification and use alternative gratifications

such as counting how much he had already gained or collecting large numbers of items
even if these did not contribute to the goal of the game. This showed an ability to use
what he had in order to cope with what he did not have. In this way, he weakened the
feeling of deprivation and narcissistic injury stemming from his lack of success. These
methods were successful as long as his anxiety remained at a manageable level.

Nathaniel found it difficult to stay still. He moved constantly, put his hands on the

game board, and touched and moved game items when it was not necessary. Frequently
he couldn’t wait his turn and played when it was my turn. This also indicated his
difficulty in recognising that someone else was playing against him, that the game did
not take place in his inner world with the other player simply being his pawn. His
attempts to ignore my presence as a separate other were reflected in his attempts to force
me to act by his rules. By ignoring the rules of the game, he also denied the existence of
the game as an independent entity. When his anxiety levels were high, this difficulty
increased and he was able to perceive me only as a self-object that acted for him.

Nathaniel’s difficulty with separation became more apparent towards the end of each

session. He would ignore signs that the session was coming to an end, and when the
time came, he would run outside, avoiding the parting process. Acknowledging parting
would have required the recognition that I was not part of him or subject to his control.

Nathaniel’s sense of self was weak and he did not feel contained and protected in his

skin ego (Anzieu, 1995). To cope with this he moved constantly, the movement serving
as a way to feel himself. At times of tension, he would lean against me using my body,
not as an act of attachment or love but rather using me as a container. His self-esteem
was low, for example, at the start of a game he would declare grandiosely that he was a
winner and try to accumulate victories at any cost.

Process of therapy

My observations led me to conclude that Nathaniel did not play from an experience of
competition but of survival. From the projective perspective, Nathaniel experienced
internal objects as forbidders and not helpers. This caused him to try to control me. His
self-representation was that of a weak helpless individual unable to influence his fate and
he used magical and grandiose, omnipotent thinking to defend against this. I decided
that the appropriate initial position for the therapist was that of a calming and regulating
parent.

At the beginning of the therapy, whenever a stressful situation arose in a game,

Nathaniel would do anything that came to mind without consideration for the rules or
would apply his own rules. If I did not do what he told me, he would end the game with
an outburst, yelling and crying. This pattern was similar to behaviour reported by his
parent’s and teachers. His omnipotent attitude led to opposition and anger to those
around him. This in turn would exacerbate his anxiety and aggressiveness, his refusal to
abide by the rules we agreed on (as though they were a hostile reality imposed on him),
and would lead to outbursts of rage and crying.

Even though I have many objects in my room including dolls, cars, animals and hero

figures, Nathaniel chose to play games and refused imaginary play. I decided to go along

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with him believing that he knew what he needed. From the many games on display, he
chose Piccolo, which consists of cards with pictures of fruits of different kind, number
and colour and a bell. Each player in turn places a previously unseen card on a pile.
When two cards match, the player who rings the bell first collects all the open cards.
Nathaniel announced that he was very good at this game but was tense. He succeeded in
the first couple of turns but after I won and took some of his cards, he would search
though his cards after I had played my turn, place a winning card on the pile and ring
the bell. I asked him whether he had mixed up the rules and he said that this was the
right way to play. When I asked him whether I too could play like this he did not agree.
The fear of losing, so concretely apparent when his cards moved to me, was so
overwhelming that he was unable to play by the rules. I felt that there was no point
continuing with the game and asked him whether he wanted to stop. He did not agree
and wanted to continue to play in that way. This illustrated how in an anxiety-
provoking situation he became omnipotent and controlling. His anxiety was not
expressed as anxious behaviour; rather his behaviour gave me the experience of being
ignored as a subject. My immediate countertransferential reaction was anger and the
desire to force him to recognise me as a subject and to enforce the rules of the game, a
reaction that was a complement to his transference. Such a cycle was typical of many
reported interactions with his parents and others – a recurrent spiral of anxiety, a battle
for control and an increase in anxiety and rage.

Becoming aware of my countertransferential reaction, I decided to take the position

of a parental regulator to help him reduce his anxiety. This is difficult during the game
since game playing itself causes tension. In competitive games, the child’s experience of
the therapist as a holding and containing environment is countered by his experiencing
the therapist as a competitor. In children with inadequate internalisation of mother as a
holding and containing environment, this is an additional source of anxiety. Containing
by the therapist in the passive sense (Alvarez, 1992) is not sufficient, especially as the
therapist is experienced as hostile. An active position to regulate anxiety and modify his
experience of the other as imposing or hostile is needed.

In the competitive game with me as the opponent, Nathaniel’s experience of me as a

containing environment was weakened. His solution to this separation was to lean on
me physically. Through the physical contact, he felt ‘held’ by me; I became a ‘skin’
(Anzieu, 1995) or a physical container for him. The contact may also have represented a
defence against anxiety by adhesive identification (Meltzer, 1994).

Nathaniel continued to fight me in the game and the game enabled me to regulate

the experience for him. I told him that I agreed to play by the new rules (i.e. that he
could look for a winning card) for as long as he felt he needed to but that he should play
by the ‘proper’ rules when he felt he could. After several turns in which he won a large
number of cards (that I let him win) and his narcissistic store was somewhat replenished,
he stopped looking for winning cards before playing his turn and played by the rules.
However, he placed his hand over the bell so that only he could ring it. Thus I chose to
reduce his anxiety by agreeing to change the rules, making the change a part of our
relationship and fostering his acknowledgement of my existence. While this may be seen
as ‘giving in’, I saw this as the preferred intervention at this stage as it prevented his
customary way of regulating anxiety, namely the omnipotent disregard of the other.

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A. OREN

Nathaniel experienced the possibility of losing in the game as a threat of annihilation.
Typical of the schizoid–paranoid position, he could not recall that he had succeeded
previously (no historic self) but experienced only the danger of the moment. My
interventions served gradually to ‘adjust’ the game, creating a sort of interim or extra-
parental reality that was calming and empathic, until he gained strength to deal with the
‘real’ game.

When at a later point in therapy Nathaniel refused to accept the rules of the game he

had chosen, I suggested that we agree on different rules, even those that gave him an
advantage. From then on, whenever he encountered a difficulty that in the past would
have led to an eruption or cessation of the game, Nathaniel would announce that he
wanted to decide on a different rule. This was a sign of his desire to overcome the
difficulty and not to destroy the game and the atmosphere of playing together. The rule
that he made was still based on his decision alone, but was presented to me for
agreement. Thus while he did not give up his control over the rules of the game he
related to me as an ‘other’ to whom he had to explain things and whose agreement had
to be obtained.

As treatment progressed, Nathaniel was able to change the rules through negotiation

and compromise. He could see me more as separate from him and both against him and
for him at the same time. He was thus able to cope with ambivalence and not see me as
either good or as bad, and he as all-powerful or helpless (i.e. move from schizoid/paranoid
to depressive position). At points of difficulty, I would stop the game and suggest
negotiation of a rule that would make it easier for him ‘in the meantime’. He asked for
agreement on ‘discounts’ for him (e.g. throwing the dice twice), but limited these in
advance to one or two items only. Often, at the start of a game we would decide whether
to play according to our own rules or whether he was ready to play according to the
regular rules ‘like a big boy’. This served to acknowledge the existence of the real game
entity and our ultimate goal of coping with reality – an important step in treatment. The
very request for agreement and negotiation over the rules and concessions moved him
from an experience of action driven solely by his inner world to negotiation with others in
the outside world. This was evidenced in his requests to negotiate with me before and
during the game and his desire to reach a compromise. He recognised someone other
than himself, reflecting a degree of separation, and began to see ‘the other’, as someone he
could negotiate with and not only struggle against or deny. Flexing the rules to match his
ability enabled him to win and thus strengthened his narcissistic store and sense of worth,
and gave him a sense of being able to influence the environment. I accepted this influence
and let him feel that I was not destroyed by his aggressiveness.

At another time, he chose to play Enchanted Island, a game in which the players have

to collect pearls and cope with problems on the way to the ultimate goal of rescuing a
princess. In the game, the player chooses one of several possible paths from his/her
present position. Thus the game enables the examination of different possibilities. While
playing, Nathaniel got to a point where he could not win anything. In the next turn, he
decided to jump to a distant point on the board – ‘Cause I feel like it,’ as he put it. This
was not a reaction to the lack of a good option – he did not even check the possibilities,
rather he wanted to impose his inner omnipotent world on the game reality. He was
aware that he was not following the rules. I intervened by asking him to examine his

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situation before moving (‘maybe it’s not so bad?’) but not preventing his move. Nathaniel
chose to look again and discovered that the game reality offered him an opportunity for
greater success than the place to which he had jumped. I speculated that he realised that
reality is not necessarily stressful, limiting, and essentially against him, but that good
things can happen in reality which make it worth giving up omnipotence or avoidance.

In addition to having to relate to me as a separate person, Nathaniel had to relate to

the game as an independent third element in the triangle (him, me and the game) as
discussed above. An example of this relationship was seen when Nathaniel would ‘talk’
to the dice to convince them to fall favourably, knowing that he would have to ‘obey
their decision’. When feeling omnipotent, Nathaniel would negate the independent
existence of the game entity by disregarding the rules and in the same way also ignore
my subjectivity.

I thought it important to help him also by verbal encouragement. I commented on

each success, including playing by the rules, expressed my sympathy when he lost in
games of chance and tried to help him play successfully. I thus took on two roles:
playing against him and also helping him play against me. To enhance his experience of
me as holding during competitive play, I refrained from the use of interpretations,
which at this stage of the therapy could be experienced as narcissistic blows.

Towards the end of the therapy, Nathaniel was able to enjoy the game and ‘real’

winning, by the rules, relying on encouragement and previous success when his
situation in the game was difficult, and weighing his moves by judgment and not
impulse. The magic omnipotent defences were replaced by rationalisation (he explained
what he did and what I did) or by sublimation (he battled with me in the game but
recognised me as a subject that looks after her own interests). His anxiety lessened but
would still appear occasionally in games at times when tension was appropriate. His self-
esteem improved and he was able to ‘help’ me when I was in a losing position.

The improvement in Nathaniel’s ability to delay action was readily illustrated in his

behaviour while waiting for his turn. At the beginning of therapy he was unable to wait
and played instead of me, taking my turn. As therapy progressed, he would take a toy,
car or gun and play with them when it was my turn to play. He did not intend to play
another game but said that he was playing ‘while you are thinking’. Later on, during my
turn he would give me advice on how to make my moves or explain to me what I did
wrong, replacing activity with talk. Older children are able to replace talking or doing
during their waiting periods with thought or internal speech.

Nathaniel’s parents and teachers reported that his improvement in therapy was

paralleled in improved behaviour outside.

Concluding remarks

A game shared by a therapist and a child provides a picture of the child’s internal state in
terms of the different aspects of development, patterns of interaction and internalised
representations. It enables interventions that are not only verbal but also involve actions
and interactions in response to the specific needs of the child.

The playing of games is an integral part of the child’s life experience and their use in

therapy provides a socially, culturally and developmentally appropriate therapeutic tool.

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A. OREN

The clash between the child’s desire and need to play and the difficulties in coping with
the demands of game play raises the same issues that children confront during their
maturation and interaction with others. Observation and analysis of game play allow the
skilled therapist to evaluate the emotional development, internal representations,
projections and patterns of relations of children and provide a means of intervention to
help them with their specific difficulties and conflicts. Importantly, it does so in an
enjoyable way.

Board game play enables and demands the use of a wide range of interventions in the

course of therapy. Thus, early in therapy, when Nathaniel was unable and therefore
refused to accept the rules of the game he had chosen, the appropriate intervention was
at a non-verbal level: mutual, negotiated agreement on different rules that suited his
needs and were acceptable to me. This fostered individuation and countered his
tendency to treat others as his peons or as hostile, but not separate entities. Giving him
the responsibility to decide whether to play by ‘our rules’ or ‘like a big boy’
acknowledged reality and the goal of growth. The second level of intervention was
verbal: encouragement and praise, calling his attention to options during the game,
participation in his sorrow and anger when he lost, and reminding him of previous
success so that he could use his narcissistic store to reduce the damage to his self-image.
The third level of intervention was through mirroring and interpretation in reference to
the game, but including metaphorical statements that reached beyond the game. Thus
when Nathaniel responded with anger or by changing rules in the middle of the game
and claimed it was not fair, I said that perhaps he was feeling that the rules were
deliberately made to his disadvantage and perhaps that I was against him, as well.

The use of board games in psychotherapy raises many challenges for the therapist, of

which I will mention only a few. The fact that I play as a competitor and not just an
actor in imaginary play that the child creates, demands that I concentrate on the game
itself. If I played the game as though I did not care about it (without ‘playfulness’), the
child would notice and complain or say that I am ‘not really playing’. On the other
hand, a competitive game that naturally increases tension can also increase my
transference and countertransference. The therapist may be influenced by transference
arising from childhood experiences to game playing, rules and competition and by the
countertransference to the child’s actions and feelings. He/she must simultaneously
observe the game, play it ‘well’, plan actions, regulate the child’s anxiety level and
maintain a playing atmosphere – all this in the highly tense atmosphere of competition.
It is not easy to maintain an observer’s stance while being a player in the game and
exposed to the tension of winning (and feeling guilty for defeating a mere child) and
losing (and feeling defeated by a mere child). Can the therapist provide an experience of
a holding, calming and enabling environment (Winnicott, 1982) in the midst of the
great tension and competition between the therapist and the child? This complexity of
roles and interactions and the flexibility needed, makes board games a challenging
technique for the therapist.

In my experience, the prominent elements of the child’s emotional world are

expressed in every game they play. The choice of the game, the way it is played, whether
and how the rules are followed or broken, reactions to winning or losing, interactions
with the opponent, all provide us with a window into the child’s world. The better we

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381

are able to read this language, the better use we can make of game playing for the benefit
of therapy. The fact that children like games and choose to play them in the treatment
room makes them a very powerful and effective tool in therapy.

6 Shimkin Street

Haifa

Israel

e-mail: [e-mail]

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