therapeutic limits from an attachment perspective

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2009 14: 215Clin Child Psychol PsychiatryLisha O'Sullivan and Virginia Ryan

Therapeutic Limits from an Attachment Perspective

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Therapeutic Limits from an Attachment Perspective

LISHA O’SULLIVANMary Immaculate College, University of Limerick, Ireland

VIRGINIA RYANUniversity of York, UK

A B S T R AC T

This article applies attachment theory and relevant research to therapeutic limitsetting and focuses particularly on child-centred, non-directive play therapy(NDPT) practice. We review the role of limits in therapeutic change and examinewhether therapeutic limit setting exhibits properties similar to those evident intypical adult–child relationships, a topic not previously considered in the literature.The first section identifies properties considered inherent in optimal attachmentrelationships from a limit setting perspective, drawing particularly on Heard andLake’s (1997) extension of Bowlby’s attachment theory. The next section discussestherapists’ use of limit setting from an attachment standpoint, distinguishingfeatures of therapeutic limit setting which reflect properties evident in sensitiveadult–child attachments. Finally, implications for further research and practice inchild therapy are explored.

K E Y WO R D S

attachment, child therapy, limits in child therapy, play therapy, therapeutic relationships

Clinical Child Psychology and Psychiatry Copyright © The Author(s), 2009.Reprints and permissions: http://www.sapepub.co.uk/journalsPermissions.navVol 14(2): 215–235. DOI: 10.1177/1359104508100886 http://ccp.sagepub.com

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L I S H A O ’ S U L L I VA N is a qualified Play Therapist. She is a lecturer in the Department ofReflective Pedagogy and Early Childhood Studies at Mary Immaculate College, Universityof Limerick, Ireland.

V I R G I N I A RYA N is a Child Psychologist and qualified Play Therapist and Supervisor. Herclinical practise concentrates on play therapy and filial therapy for children referred by localauthorities in the Yorkshire and Lincolnshire areas, including court assessments. She is thedirector of the University of York’s Social Policy and Social Work Department’sMA/Diploma programme in non-directive play therapy in the UK, which leads to aprofessional qualification in play therapy.

C O N TAC T : Dr Virginia Ryan, Social Policy and Social Work Department, University of York,York YO10 5DD, UK. [E-mail: [email protected]]

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Introduction

T H E R E I S L O N G S TA N D I N G I N T E R E S T within both child and adult psychotherapyabout the relevance of attachment theory to clinical practice (Bowlby, 1988; Heard &Lake, 1997; Holmes, 1993, 2001; Schore, 2000, 2003). However, in our search of the litera-ture, we have not found any detailed discussion of therapeutic limit setting with childrenfrom the viewpoint of the attachment properties inherent in therapist–child relation-ships. Therefore, this article intends to examine the basis for setting limits in childtherapy from such an attachment perspective. We explore the relationship betweentherapeutic limit setting and the attachment properties displayed within typicaladult–child relationships.

Child-centred, non-directive play therapy (NDPT), a well established and researchedform of child therapy (Bratton, Ray, & Rhine, 2005), was chosen as an exemplar for ourdiscussion of therapeutic of limit setting. This choice was motivated by the character-istics of NDPT, which seem to closely mirror the spontaneous play and social interactionsof children with highly attuned carers in everyday life. The NDPT approach is thattherapists follow children’s lead during interactions, while the children themselvesidentify their issues and interests during therapy sessions. Therapists maintain adultlimits as necessary, based on the Rogerian principles of empathy, unconditional positiveregard and congruence (Landreth, 2002; Wilson & Ryan, 2005) The general ways inwhich relationships between therapists and children who receive non-directive playtherapy (NDPT) exhibit features of sensitive attachment relationships already havebeen discussed (Ryan, 2004a; Ryan & Wilson, 1995, 1996; Wilson & Ryan, 2005). Ryanand Wilson (1995) identified properties within attachment relationships that arerecreated in interactions between children and their therapists which seem to facilitatetherapeutic change. Elsewhere, extended attachment theory (EAT; Heard and Lake,1997) was employed in understanding complex NDPT cases on both individual andsystemic levels (Ryan, 2004a; Ryan & Bratton, 2008). We intend to employ Heard andLake’s model here again in our exploration of therapists’ use of limit setting from anattachment standpoint.

The first part of this article reviews properties considered inherent in attachmentrelationships. The following areas are highlighted, all of which are relevant to therapeuticlimit setting:

■ Developing a secure base and exploratory behaviour;■ Sensitivity, attunement and containment;■ Emotional and behavioural regulation;■ Developing competence; and■ Limits and boundaries within attachment relationships.

After this overview, the next section applies these concepts to therapeutic limit setting,with an emphasis on NDPT practice. The topics discussed are:

■ The role of limits in providing physical safety and emotional security;■ Limits and their relationship to emotional and behavioural regulation;■ The role of limits in facilitating exploration of feelings and experiences for children;

and■ Adult sensitivity to individual needs when setting limits.

The final section outlines research and practice implications for child therapy based onour discussion of limits and attachment properties within therapeutic relationships.

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Child–adult attachment relationships

This section reviews the properties considered inherent in child–adult attachmentrelationships, emphasizing the contribution of Extended Attachment Theory in explain-ing the interplay among different facets of the attachment system. Heard and Lake’s(1997) concept of the ‘attachment dynamic’ addresses certain gaps in Bowlby’s theory.They propose that the attachment system is composed of five instinctive goal-correctedbehavioural systems, with two kinds of potentiating systems as essential adjuncts to thesebehavioural systems. The potentiating systems include lower order and higher ordercapacities. The more basic capacities encompass the construction of internal workingmodels, basic psychological defence mechanisms and social responses, along with otherlow-level functions. Higher order capacities include the neocortical, psychologicalcapacities involved in creating meaningful symbols, planning, appraisal of self simul-taneously with evaluating others, valuing and aspiring towards ideals and other higherorder conscious mental functions.

Heard and Lake’s five behavioural systems demarcate the ways in which a person’sself systems respond in relation to one another, and entail both intrapersonal and inter-personal components. These systems include:

1) The interpersonal careseeking system.2) The system of caregiving to others which is wholly interpersonal.3) The intrapersonal system for self-defence.4) The exploratory system, manifest in the intrapersonal exploratory self and the inter-

personal interest-sharing [with peers] self.5) The sexual system, which has both intra- and interpersonal components. (Heard &

Lake, 1997, cited in Ryan, 2004a)

They assume the centrality of an adult’s caregiving system to the harmonious function-ing of the interpersonal components of their other self systems (e.g., caregiving/careseeking, interest sharing with peers, and affectional sexuality). When an adult’s self-defence system infiltrates any interpersonal partnerships, different types of insecureattachment patterns may develop. These can be mapped out for partners in dyadic andtriadic relationships (Heard, 2001). Both more complicated family relationships anddevelopmental progress during childhood, not yet well developed within this new model,can also be viewed from this perspective (Heard, 1982; Heard & Lake, 1997).1

Developing a secure base and exploratory behaviourIt is well known that children’s attachment security can be defined as the state of beingsecure regarding the availability of an attachment figure. The concept of ‘secure base’(Bowlby, 1982) is described as the interplay between the attachment behaviour systemand the exploratory behaviour system when these systems are in ‘dynamic equilibrium’.Secure base behaviour also has been described as attachment behaviour underconditions of low activation, with disruptions in the exploration attachment dynamicviewed as a measure of insecurity in the attachment relationship (George & Solomon,1999; Heard, 1982; Holmes, 2001; Lieberman & Pawl, 1995). Therefore, in order toengage in exploratory behaviour, infants need to be guaranteed proximity to theirattachment figures, confident in the adults’ availability and responsiveness (Bowlby,1982; Waters, Crowell, Elliott, Corcoran, & Treboux, 2002). Beyond infancy, Bowlbystated that the growth of a goal-corrected partnership between children and their care-givers is a salient developmental task. Children’s developing communication skills facili-tate negotiation, with shared plans emerging in which their intimate relationships can

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continue in the absence of physical proximity (Bowlby, 1982; Hopkins, 1999). Through-out childhood and adolescence, the need for close proximity to secure base figureslessens, yet the ability to use primary figures as a base from which to explore and toretreat to in times of stress is considered conducive to healthy emotional well being intoadulthood (Bowlby, 1988; Waters et al., 2002).

Within Heard and Lake’s attachment dynamic, this formulation is extended andassumes that the reduction of attachment behaviour to the level of maintenance ofaccessibility automatically allows the exploratory system to be activated (Heard, 1982;Heard & Lake, 1997). They have also extended the exploratory system to include bothindividual exploration and socially shared exploration. Both types of exploration appearto develop first within intimate relationships during infancy and early childhood, andthen take two routes, with one route developing into sharing interests within peerrelationships and the other route developing into individual exploration. The meaning-fulness of individual exploration seems to be enhanced by both autonomous explorationand feelings of competence, and by accessing shared experiences that enhance relation-ships by focusing on what is meaningful to both/all parties who participate. Theseconcepts are relevant to our discussion below of limit setting and the development ofcompetence and autonomy in both typical child development and within therapeuticrelationships.

Sensitivity, attunement and containmentAinsworth and colleagues’ (1978) seminal concept of maternal attunement withinattachment relationships, based on observations of mothers’ capacity to respond sensi-tively to their infants’ signals, has been further refined over the decades, as we summarizein this section. There now is research support, from both meta-analytic and twins studiesfindings, for the assumption that maternal sensitivity plays a causal role in shapingattachment patterns from infancy onwards (e.g., Bakermans-Kranenburg, VanIjsendoorn, & Juffer, 2003; Bolhorst et al., 2003). Other research has examined the roleof individual child factors in attachment relationships. For example, Biringen andRobinson (see Bretherton, 2000) developed an emotional availability assessment ofparental attunement similar to Ainsworth’s original sensitivity scales, but placed greateremphasis on infants as active contributors to their attachment relationships. The role ofchildren in reciprocating their mothers’ overtures is inherent in this form of assessmentand significant work has already been undertaken examining these individual childfactors (Belsky & Cassidy, 1994; Hopkins, 1999; Vaughan & Bost, 1999).

Stern’s (1985) seminal work on the concept of maternal attunement stemmed fromintensive observations of infants and mothers playing, focusing on the mothers’ abilityto match their infants’ affect (Cairns, 2002; Heard & Lake, 1997). Stern extendedAinsworth’s concept, developing the notion of misattunement, including purposefulmisattunement and true misattunement (Cassidy, 1994; Stern, 1985). Belsky and PascoFearon (2002) studied the conditions under which early security/insecurity interacts withsensitive/insensitive caregiving. Findings suggest that early security is not perfectlyrelated to later maternal sensitivity; different combinations of early security/insecurityand sensitivity/insensitivity have different consequences for child development. In thiscontext, mothers’ capacity to contain distress and negative affect, first introduced byBion, seems significant in facilitating young children’s attachment exploration equi-librium (Holmes, 2001; Schore, 2003; Waters et al., 2002). Central to mothers’ modu-lating of negative affect is conveying that they will not become overwhelmed by theirchildren’s affective states (Fonagy et al., 1995; Holmes, 1993, 2001). Where motherssucceed in their ‘containment’, they appear to both understand and modulate their


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children’s negative affective states. It is assumed that under these conditions, securepatterns of attachment will develop, while mothers’ failure to contain and modulate theirinfants’ distress contributes to insecure patterns and to the development of children’sdefensive behaviours (Fonagy et al., 1995; Schore, 2000).

Schneider, Cavell and Hughes (2003) introduced the notion of ‘perceived contain-ment’, a concept directly relevant to our main discussion of therapeutic limits and attach-ment. They described this concept as ‘The child’s beliefs about the adult’s capacity toimpose firm limits and to prevail if there is a conflict in goals’ (Schneider et al., 2003,p. 95). Their US research compared 163 aggressive children and 103 prosocial childrenin Grades 2 and 3. Findings supported the hypothesis that children’s beliefs aboutcontainment relate to both measures of parenting and children’s externalizingbehaviour. As hypothesized, children with low perceived containment scores werereported to have more externalizing problems and a higher level of callous and un-emotional traits. Findings also revealed that children defined as high risk in the studyreported a stronger sense of containment where effective discipline strategies and anemotionally positive relationship were combined. In addition, they revealed a significantcorrelation between children’s containment beliefs and their level of problem behaviour,independently of parental discipline, illustrating the powerful effects of containmentbeliefs on children’s behaviour. While there was a lack of evidence to suggest a signifi-cant correlation between ineffective discipline and perceived containment, findings didsuggest that containment beliefs are an indicator of how responsive children will be toparents’ socialization efforts (Schneider et al., 2003).

In another longitudinal study of clinic-referred children with high aggression, Gomez,Gomez, DeMello and Tallent (2001) explored the effects of perceived maternal controland support on hostile, biased, social information processing and aggression. Theirfindings also suggest that children’s perceptions of their relationships with their mothershold predictions for social cognition which, in turn, influences social behaviours.Therefore these studies suggest that children’s beliefs regarding their carers’ ability tocontain and assert responsive control and support have consequences for developingemotional and behavioural regulation, discussed next.

Emotional and behavioural regulationThe interplay between instinctive behaviour systems in attachment theory is assumed tobe far reaching; much debate has centred on the relationship between attachmentsecurity and emotional regulation. Schore (1994, 2000, 2003), drawing on neurobiologi-cal theory, postulates that attachment is a dynamic, automatic, regulatory process that‘underlies the dyadic regulation of emotion’ (Schore, 2000, p. 34). Caregivers’ influenceon their children’s emotional regulation begins at birth (or arguably neonatally) andcontinues to act as a significant modulator of their children’s emotional life throughoutchildhood, as children’s self-regulatory skills mature (Cairns, 2002; Evans, Heriot, &Friedman, 2002; Magai, 1999; Thompson, 1994).

Children learn to independently regulate their emotions as an adaptive strategy intheir pursuit of attaining self-important goals within their attachment relationships.Several strategies, thought to be outside of awareness, may be used in varying contexts(Bowlby, 1982; Cassidy, 1994; Schore, 2003). Cole and O’Donnell define regulation as‘the ability to respond to the ongoing demands of experience with a range of emotionsin a manner that is socially tolerable and sufficiently flexible to permit spontaneousreactions when needed’ (Fox, 1994, p. 76). Securely attached children, then, are expectedto exhibit a flexible style of regulation and employ an extensive range of emotions(Cassidy, 1994; Cole, Michel, & O’Donnell Teti, 1994; DeRosnay & Harris, 2002).


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Individual differences also have been observed in children’s ability to regulate emotion.For example, when children showed dysregulation of their emotions, two distinctpatterns were observed, that of over-regulation and under-regulation (i.e., the atypicalfunctioning of regulatory processes, not unregulated emotions or the absence of regu-lation) (Cole et al., 1994). Cole et al. suggest that dysregulation of emotion does notnecessarily involve a single emotion. Rather, they explore the possibility that the absenceor dominance of a particular emotion may reflect an overall state of dysregulation in theemotion system. To illustrate this they cite the example of highly aggressive children forwhom anger and a tendency to perceive the world as hostile are dominant. FollowingWinnicott, they suggest these hostile, aggressive presentations may in fact function tomask feelings of loss, sadness, or low self-esteem which cannot be tolerated. Suchchildren therefore may experience over-regulation of aggressive, hostile emotions andunder-regulation of emotions such as sadness and loss.

Vondra and colleagues (2001) studied the relationship between attachment andchildren’s emotional and behavioural regulation longitudinally in a sample of 223children from US urban low-income families during infancy and preschool. Useful linkswere drawn between attachment and regulation, illustrating the crucial role caregiversplay in their children’s shift from external to internal locus of control. Their researchsupports earlier literature on attachment and regulation; attachment classification wasassociated with both concurrent and subsequent ratings of child emotional and behav-ioural regulation. Secure attachment across assessments was associated with betteremotional and behavioural regulation over the entire length of the study. Mothers ofsecurely attached children reported less externalizing behaviour patterns at 3.5 years,with the converse reported for insecurely attached children. Classification at 24 monthsand concurrent observer ratings of emotional and behavioural regulation during thesame assessment were predictive of regulation problems 1–2 years later, whereas earlierattachment history was not. The authors also identify theoretical and empirical cor-relations between children’s disorganized classification in infancy and controlling,coercive classification in preschool/school years. Vondra et al. (2001) suggest that therelationship between these attachment classifications, child behaviour problems andfamily risks requires further examination. They also suggest that the interplay betweenchildren’s emotional regulation and their attachment status and relationships needscloser examination.

Children’s internal models of attachment relationships provide the theoreticalframework for the above investigations. As is well known, attachment theory assumesthat the most significant means by which attachment relationships influence affect regu-lation in children is through the development of internal working models of their attach-ment relationships, in which both self and caregivers are represented, and which areoutside of conscious awareness (Bowlby, 1982; Heard & Lake, 1997). Within this instinc-tive, goal-corrected attachment system, internal working models function as cognitivemaps to predict how attachment goals can be attained (Belsky & Cassidy, 1994; Schore,2000, 2003). Stern’s (1985) concept of ‘the schema-of-a-way-of-being-with’, as a buildingblock of internal working models, proposes a network that includes input from both theexternal and internal worlds, and assumes that children form a neuropsychologicalmodel of representations of their interpersonal experiences. Heard and Lake (1997)have further developed the concept of internal models of experience in relationships(IMERs). These IMERs hold the history of relations individuals have had with theirenvironment, and the authors usefully link these models to the ways in which the attach-ment behavioural system operates. While there has been a variety of research toolsdeveloped for children to tap into these processes which are outside of conscious


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awareness (e.g., Buchsbaum, Toth, Clyman, Cichetti, & Emde, 1992), understanding andmapping the far reaching effects of internal working models throughout development,and their effects on children’s emotional self-regulation, remains a challenge (Belsky &Pasco Fearon, 2002). Our discussion of limit setting below will explore the specific roleof limit setting by carers in their children’s development of emotional and behaviouralregulation via IMERs.

Developing competenceHeard and Lake’s (1997) attachment dynamic outlined earlier includes the interestsharing system within the self’s exploratory system. Their formulation has been influ-enced by both Ainsworth et al.’s (1978) strange situation assessments and Winnicott’snotion of mutual play. Heard and Lake’s description of the interplay between children’sexploratory behaviour and their developing competence includes a sense of personalcompetence and a sense of social competence. They assume that within the exploratorysystem, the goal of the careseeker is a sense of competence and satisfaction that the care-seeker can cope with a given task, both without endangering self and without requiringcaregiver intervention. They assume that this system’s goals are highly likely to be over-ridden when careseeking behaviour is activated (Heard & Lake, 1997; Ryan, 2004a). Thecaregivers’ role of educating, instructing and guiding their children towards autonomyis also highlighted in Heard and Lake’s theoretical extension. The goal of caregiving isto support the child’s autonomy without the caregiver’s self-defence system becomingactivated. Therefore where children’s autonomy is perceived as a threat to self by theircaregivers, whether because of not feeling needed or because of feeling overlyconstrained by their children’s need for their guidance, then their children will not beable to fully experience, both personally and socially, satisfaction derived from their ownage-appropriate competence.

Correlations between attachment security and children’s capacity to engage in play,to problem solve and to relate to carers and peers, all part of their exploratory system,have been well documented (Hartup, 1989; Holmes, 2001). As Sugarmann summarizes:

‘Predictable emotional’ involvement on the part of the mother seems to facilitatethe rich unfolding of the toddler’s thought process, reality testing and copingbehaviour by the end of the second or beginning of third year. Mentalization orreflective function develops, allowing the toddler to label and find his internalexperiences meaningful. (2004, p. 206)

The term ‘reflective function’, as used above and in the attachment literature generally,describes both how children organize their own experiences and those of othersmentally, as well as how others’ behaviour becomes more meaningful by making senseof their own experiences (DeRosnay & Harris, 2002; Fonagy et al., 1995). The conceptof ‘mind-mindedness’, developed by Meins (1999), describes how responsive caregiverspromote psychological understanding, as well as security of attachment. Carers areassumed to have the capacity to respect their children as independent agents with theirown thoughts and feelings. By articulating these thoughts and feelings through discoursewith their children, carers are assumed to enhance their children’s ability to communi-cate and understand their own thoughts and feelings (De Rosnay & Harris, 2002; Meins,1999; Meins, Ferryhough, Fradley, & Tuckey, 2001). This notion has been likened toVygotsky’s concept of the ‘zone of proximal development’ within developmental theory(Hartup, 1989; Holmes, 1993; Howe & Fearnley, 2003; Maslin-Cole & Spieker, 1990). Fei-Yin Ng, Kenny Benson and Pomerantz (2004) investigated whether children’sachievement may moderate the effects of parents’ use of control and autonomy support.


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The authors reported on two studies of mothers’ responses to their children’s perform-ances. Mothers’ controlling responses were associated with a decrease in performanceover time, and autonomy support conversely predicted increased performance, particu-larly for low-achieving children. Their studies indicate that if the effects of parentpractices on children depend on child attributes, these attributes need to be taken intoaccount when considering the effects of parents’ use of control and autonomy supporton children. This research identifies the need for parental limits and boundaries to besensitive to children’s developmental needs in order to enhance developing competenceand autonomy, a theme we will return to later when discussing therapeutic limit setting.

Limit setting and boundaries within attachment relationshipsThe fundamental importance of carers’ limit setting on their children’s social andemotional development is widely accepted in the child development literature. This litera-ture is also highly concerned with the growing prevalence of behavioural difficulties inyoung children (Bates, Maslin, & Frankel, 1985; Belsky, Kung-Hua, & Crnic, 1998; Craig,2000; Farrell Erickson, Sroufe, & Egeland, 1985; Landy & Mena, 2001; Maccoby, 1980).Campbell (1995) summarizes earlier research with young children, stating that parentingthat is supportive, that has a positive emotional valence and which provides the appro-priate level of guidance goes hand in hand with children being able to trust themselves,develop a sense of self and engage with others in adaptive and positive ways. Studies alsoshowed, that parents’ inconsistent, negative and arbitrary care of their children ‘maypredate the onset of problems or may maintain problems once they emerge, fuellingchildren’s anger, frustration and non compliance’ (Campbell, 1995, p. 142).

One example of related research is De Vito and Hopkins’ study (2001) examining theconcurrent and joint effects of attachment pattern, marital satisfaction and parentingpractices on disruptive behaviour in preschoolers. Findings indicated a pattern ofinsecure, coercive attachment (Crittenden, 1995) was associated with preschoolers’disruptive behaviour. A combination of coercive attachment, marital dissatisfaction andpermissive parenting practices (parenting characterized by inconsistency, lack ofstructure and lack of control) were found to significantly contribute to variance indisruptive behaviour. The authors suggest that the parent–child relationship should becentral to treatment of behavioural problems. While parenting practices were only oneelement of the current study, findings support the possibility of a link between attach-ment security and parents’ ability to set clear limits and boundaries.

Research on children with conduct problems and their families (Patterson, 2002;Patterson, De Baryshe, & Ramsey, 2000) as well as training programmes developed forparents of children with conduct problems, also emphasize the need for clear and consist-ent limit setting within discipline approaches (Carr, 1999; Webster Stratton & Hancock,1998). The need to promote positive carer–child relationships in treatment strategies forchildren with behavioural problems is also prevalent in the literature, all of which reflecta growing trend towards integrating behavioural and attachment concepts (Clarke,Ungerer, Chahoud, Johnson, & Stiefel, 2002; O’Connor & Zeanah, 2003; Speltz, 1990).

While attachment theory clearly is significant in shaping conceptualizations ofchildren’s behavioural difficulties, there are a number of other processes which areassociated with maladaptive patterns of behaviour. Campbell, Shaw and Gilliom (2000)acknowledge the need for an ecological approach to understanding maladjustment.Biological, family, community and cultural dimensions are all identified as having asalient influence on development. Patterson (2002) has focused on factors such asparenting style; the influence of biological factors on behavioural difficulties (e.g., hyper-activity) are also identified in the literature (Campbell et al., 2000). This article’s focus


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on conceptualizing limit setting in NDPT from an attachment perspective discusses theinfluence of attachment security on children’s behavioural issues, while not precludingother causes and contextual issues.

We now turn to therapeutic limit setting and its relationship to the attachmentconcepts and research outlined earlier.

Therapeutic limit setting

The attachment concepts we will now apply to therapeutic limit setting include howtherapeutic limits provide physical and emotional security, the importance of therapists’sensitivity to children’s individual needs when setting limits, the role of therapeutic limitsin relation to emotional and behavioural regulation, and ways in which therapeutic limitsfacilitate exploration of feelings and experiences for children, with an emphasis onNDPT practice.

OverviewAcross orientations and throughout the history of child therapy practice, limit settinghas been considered a necessity. Bixler stated that “[r]estriction of behaviour is one ofthe few universal elements in therapy. Limits have a role in all treatment methods,whether the client is adult or child, withdrawn or aggressive’ (1949, p.1). Within NDPT,Axline (1947) stated that limits were required to both anchor play in reality and facili-tate children’s understanding of their responsibility in therapeutic relationships. Withinother therapeutic approaches, for example psychodynamic child therapy, limits areconsidered important in promoting catharsis. The re-experiencing of negative feelingswithin an uncritical relationship is assumed to facilitate therapeutic change (Boyd Webb,1991; Sugarmann, 2004; Wilson & Ryan, 2005). Limits therefore are viewed as address-ing both the practical restrictions of the therapy process and children’s therapeuticneeds. Protection of playroom and contents is deemed essential to the process, becauseloss/damage of possessions may influence therapists’ acceptance of children, diminishplayroom stock and raise financial considerations (Bixler, 1949; Rhoden, Kranz, & Lund,1981). Temporal limits, such as duration and frequency of sessions, are also importantbecause they reduce the potential for disruption to the therapeutic process (Ginott, 1976;Landreth, 1991; West, 1992).

Limits to provide physical and emotional securityA universally accepted assumption in therapy practice is that clients need to feel safewithin therapeutic relationships in order to heal themselves. Bowlby (1988), for example,included the provision of a safe base in his list of the five main tasks of therapists inestablishing therapeutic alliances. Within child therapy, even more strongly than withadult clients, therapists are responsible for ensuring children’s physical safety andemotional security (Bixler, 1949; Smith & Herman, 1994). By enhancing children’s senseof security and trust in their therapists as secure bases, and enabling children to regulatetheir own affect and behaviour more easily, to be discussed more fully below, limits intherapy are designed to facilitate children’s exploration of their intimate feelings andexperiences (Guerney, 2001; Landreth, 2002). This process for troubled children ofdeveloping therapeutic relationships appears to mirror the early experiences of childrenwith secure attachment relationships, who overall feel physically and emotionally securewith their carers and other significant adults (Ryan & Wilson, 1995).

Limiting children’s overt aggressive, self-destructive and other antisocial behaviour isa prime consideration in therapeutic limit setting. This limit serves to contain not just


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their behaviour, but also the affect associated with such behaviours, which couldpotentially overwhelm them, and lead to strong negative feelings of anxiety and guilt(Moustakas, 1959). Such negative feelings, often expressed by children as more extremeforms of internalizing or externalizing behaviour, and other conflicting or inadequatelyexpressed feelings, are assumed to be difficult for children and their carers to containwithin their attachment relationships. This lack of containment of feelings points todisruptions or insecurities within children’s primary attachment relationships and withinthe IMERs these children have developed. Setting and maintaining limits therefore areviewed as essential for helping children to perceive their therapists as containing and toestablish trust in their therapists, leading to more lasting changes in their IMERs.2

Disruptions in children’s exploration attachment dynamic within therapeutic relation-ships, similarly to their attachment relationships described earlier, are viewed as ameasure of the insecurity in children’s own internal models of experience in relation-ships (IMERs). Therapeutic interventions therefore are designed to alter children’sIMERs towards more secure patterns (Hodges, Steele, Hillman, Henderson, & Kaniuk,2003; Ryan, 2004b).

Following Heard and Lake’s model, disruptions in children’s exploration within the attachment dynamic during therapy may also be due to the disruption of theirtherapists’ caregiving responses. This is due to therapists’ intrapersonal system for self-defence having been activated, which in turn blocks children’s safe base behaviour.Therefore therapeutic limits also serve to promote the physical safety and emotionalsecurity of therapists themselves, a key feature of the attachment dynamic. Adults’ability to be sensitively attuned to their children’s exploratory and attachment needs,and to contain children’s strong affect, in both therapeutic and normal attachmentrelationships, is dependent upon adults’ own defensive systems being quiescent. Fortherapists, one role for both clinical supervision and personal therapy is to address theirown defensive responses which may inhibit their affective attunement to clients. Issuesof power, adult authority, control/submission and enforcement of limits in difficultcircumstances clinically are all issues which may be raised in both contexts. Limits have the important role of protecting therapists from undue anxiety and allowing themaintenance of an accepting attitude towards children. This attitude in therapists in turnprotects children against feelings of anxiety for their own well being and of guilt towardsadults, both of which they may experience if allowed to compromise their own or theirtherapists’ safety.

When to set limits, how to set them and at what point, has been explored frequentlyin the child therapy practice literature (e.g., Haworth, 1982; Landreth, 2002). Ginott andLebo’s (1963) original research into trends in limit setting in play therapy and later repli-cations indicated that limits on children’s behaviour compromising the safety and healthof children and therapists were widely used (Landreth & Wright, 1997; Rhoden et al.,1981). Non-directive practice asserts that most limits should not be set until needed.However, in order to ensure that therapists are emotionally prepared, children’s indi-vidual limit setting needs, therapists’ own potential responses to children’s needs, andthe settings’ demands are considered prior to therapy, in addition to setting basic limitsof time and space (Moustakas, 1997; West, 1992). Caregiving responses, in which thera-pists maintain acceptance and respond empathetically to children, are a critical featureof limit setting practice, not to be confused with permissiveness. Throughout the thera-peutic process, as Landreth has described, therapists need to remain openly caregivingand non-defensive, maintaining and communicating ‘a constant regard and respect forchildren regardless of their behaviour. Even during the setting of limits on a child’sattempt to break items, the person of the child is more important than the behaviour’


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(2002, p. 531). In non-directive practice, global clear limits (e.g., ‘Therapists are not forhitting’) also are recommended. Setting total limits avoids the risk of opaque interpret-ations by children and gives both children and therapists a greater sense of security(Dorfman, 1951). These dicta on therapeutic limit setting mirror the parenting andattachment research cited earlier. When clear and consistent limit setting was combinedwith effective discipline strategies and emotionally positive relationships, children’ssense of perceived containment within attachment relationships increased.

Limits and emotional and behavioural regulationA common aim in psychotherapy is to enhance clients’ self-regulating capacity (Holmes,2001; Sable, 2004), whereby they ‘flexibly regulate emotional states through interactionswith other humans (interactive regulation in interconnected contexts) and without otherhumans (auto regulation in autonomous contexts) as well as [having] the resilientcapacity to adaptively shift between these dual regulatory modes’ (Schore, 2003, p. 281).

As we have already outlined, Heard and Lake extended Bowlby’s exploratory systemto include both these capacities, namely ‘socially shared exploration’ and ‘individualexploration’. Both types of exploration develop first within intimate relationships.Particularly pertinent to child therapy are the findings that children who are presentingwith insecure or disorganized attachment patterns consequently may experience diffi-culty or delay in regulating emotion (Cassidy, 1994; Green & Goldwyn, 2002). Wherecaregivers, for a variety of reasons, fail to support the shift from adult control tochildren’s increasing internal control of their behaviour and emotions, difficulties duringpreschool and school years can be forecast. These subsequent difficulties in self-regulation can result in developmental deviations, including internalizing or externaliz-ing behaviour difficulties (Dozier, Albus, Fisher, & Sepulveda, 2002; Wolfe, 1999). Childtherapy therefore helps referred children to enhance their self-regulatory capacitieswithin their developmental capabilities by first enhancing their capacities within therapyand then generalizing to their primary attachment relationships.

Across orientations in child therapy, therapeutic limits aim to enhance children’sability to regulate their emotions and behaviour. Developing self-control, responsibility,incorporating children’s own feelings and environmental demands into behaviourresponses, and enhanced ability to recognize and express feelings appropriately areuniversal goals of child therapy. Helping children in this way also prevents them fromdeveloping a false sense of omnipotence, and provides children with another way toanchor their play therapy in reality (Axline, 1947; Guerney, 2001; Landreth, 2002; Smith& Herman, 1994; Wilson & Ryan, 2005). At the early and middle stages of therapy, somechildren may want or need their therapists to control the encounter completely.However, even when therapists ultimately are the ones to control children’s out-of-control behaviour, the children themselves decide what happens next. Some non-directive therapists provide children with alternative means to express feelings, with thechoice to do so remaining the child’s, while other therapists set limits and allow childrento find alternative means of expression for themselves (Landreth’s [1991] ACT model,for example, advocates acknowledging children’s feelings, communicating the limit andtargeting acceptable alternatives).

Limits, when set effectively within therapeutic relationships, offer both an alternative,more appropriate way of expressing feelings and a way of promoting mastery anddecision making in children (Bixler, 1949; Trotter, Eshelman, & Landreth, 2003). InNDPT, children’s need to break limits, and the internal process of gaining self control,is considered more important than broken limits. Testing of limits, followed by firm,consistent, non-defensive empathetic responses by therapists, is assumed to facilitate


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children’s shift from therapists needing to take control of situations to children them-selves developing increased internal control (Landreth & Wright, 1997). As Landrethnotes:

Before children can resist following through and expressing feelings in a waydictated by first impulses, they must have an awareness of their behaviour, a feelingof responsibility and exercise self control. (1991, p. 210)

This process in therapy is similar developmentally to children increasing their capacityfor self regulation by relying less on their caregivers to control their emotions andbehaviour (Cassidy, 1994; Izard, Fine, Mostow, Trentacosta, & Campbell, 2002). It also issimilar to the developmental research findings of Fei-Yin Ng et al. (2004) cited earlieron the decrease in controlling responses and the increase in autonomy support fromparents needed to increase their children’s autonomy and competence, especially whentheir children are low achieving. The therapeutic experience of effective limit setting alsoseems to enhance children’s ability to find acceptable ways to channel feelings, takeresponsibility for their actions, and enhance their self-control and regulatory capacitybeyond the playroom. During the course of therapy, limits facilitate children indistinguishing between their motivating feelings and their actions, thus enhancing theirability to exercise self-control outside the playroom as well. Guerney (2001) suggeststhat the therapeutic relationship is crucial: therapists’ caregiving responses of acceptanceand empathy of children’s desire to express their impulses are the key factor thatultimately reduces children’s need to actually do so directly. It is assumed that whentherapy is effective, children’s IMERs change, normal developmental trajectories arerestored and children develop age appropriate, internal loci of control, with all of theseskills integrated into their general functioning (Boyd Webb, 1991; Landreth, 1991, 2002;Norton & Norton, 2002; Ryan & Wilson, 1995, 1996).

Therapeutic limits facilitating exploration of feelings and experiencesAccording to the attachment dynamic described above, children are able to activate theirexploratory system when their careseeking, caregiving and defensive systems are notactivated. For highly defended and insecurely attached children, their exploratorysystem is most fully active when, over time, significant adults begin to be directly experi-enced as trustworthy and caregiving. During therapy, as in any dynamic relationship, theattachment dynamic is worked on and reworked, and becomes activated in a variety ofways, in order to alter children’s IMERs. EAT’s two routes of socially shared explorationof interests with peers and individual exploration may both be addressed. Whenchildren’s exploratory systems are activated at different points in therapy, some childrenlearn new ways to experience themselves as individuals and learn to play in a satisfyingway alone, and without their therapist’s direct involvement. Other children, or the samechildren at different times, concentrate on learning to play socially in a more satisfyingway. As well as directly shared, child-led play with their sensitively attuned therapists,which may be a new experience that did not occur in their earlier development or maybe a previous experience not available currently with their carers, children also use playtherapy to explore social interactions with peers and siblings. Often by assigning thera-pists a child’s role, children set up scenes to explore their current social relationships,including relationships with siblings and ‘best’ friends. Children also learn to movebetween initiating and carrying out activities alone and including their therapists in theiractivities, either to ask for help when required or to enjoy sharing activities and interestswith them directly, again a necessary developmental task for children and often a signthat therapy is nearing completion (Wilson & Ryan, 2005).


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One example of a child exploring social relationships in therapy is eight-year-oldHenry, who assigned his therapist the role of class victim (male) and took the role of aclass bully himself. He explored how other children failed to help, and then did help thevictim defend himself when attacked. Limits, although not overtly addressed within thisplay sequence, seemed a very necessary precondition for this role play. Henry alreadyseemed trusting that his therapist was able to contain his strong feelings and to ensurethat neither the ‘victim’ nor the ‘bully’ was actually hurt in play. Henry realized that histherapist was willing to go along with the play and pretend to be helpless, victimized,and militated against, but he also seemed to accept that his own power would becontained within his dominating role. While symbolically his therapist lost control,Henry appeared to distinguish this play from true adult impotence or his therapist losingphysical control of their therapeutic encounter.

Setting limits often occurs more directly than in the example of Henry above, as wediscussed earlier, and is therapeutic when therapists continue to enable children to beself expressive and exploratory, along with continuing to experience strong emotions(Smith & Herman, 1994). Often, empathic limit setting enhances children’s symbolicexploration of their related experiences and feelings and moves beyond aggression todeeper feelings of sadness or betrayal, as Winnicott’s formulation suggests. For example10-year-old Cathy wanted to throw bricks at her therapist, but when her behaviour waslimited, along with her feelings being acknowledged and accepted, she went on to throwthe bricks (safely) at a ‘bad witch’ across the room, who had put an enchantment on herand then misused her. In this context, studies have found that child therapists are leastlikely to set limits on children’s symbolic expressions. They distinguish between symbolicdestructive acts and overt aggressive acts, with therapists permitting feelings to beexpressed both verbally and symbolically (Ginott & Lebo, 1961; Rhoden et al., 1981;Wilson & Ryan, 2005). This permissiveness in symbolic and verbal expressions of feelingsis based on therapists’ core belief that symbolic expression facilitates catharsis, and therelease of previously overwhelming feelings. Symbolic expression, or imaginative play,also is assumed to contribute to the restoration of normal developmental trajectories,skill building, problem solving ability, decision making and the development of languageand inner speech (Lloyd & Marzollo, 1972; Ryan, 1999; West, 1992), as imaginative playdoes in normal development. Again, these practice considerations correlate with attach-ment research discussed earlier. An extensive range of emotions and a flexible style ofemotional regulation which is neither over- nor under-regulated are hallmarks ofsecurely attached children, and are all aims in play therapy.

Sensitivity to individual needs when setting limitsThe role of empathic attunement in therapeutic relationships has been seen to possessqualities similar to that of maternal attunement described earlier (Holmes, 1993; Schore,2001; Stern, 1985). Effective limit setting practices in child therapy seem to requiresimilar levels of attunement. In NDPT, unconditional positive regard and empathy arecore practice skills and need to be maintained during the limit setting process (Kirschen-baum & Land Henderson, 1989). Therapists’ incorporating of empathetic responseswhen setting limits also conveys to children within therapy that they are being under-stood and respected, even if their behaviour is being restricted (Moustakas, 1997).

As well as the individually tailored responses that employing empathic responseswithin therapeutic relationships implies, in NDPT therapists are trained to view eachchild individually, responding flexibly to every child’s developmental needs (Ryan, 1999;West, 1992). While limits may be communicated verbally, it is through direct, consistentexperience that children learn to view the playroom as a safe place. In working with


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younger children in particular, therapists’ language needs to be chosen carefully andtheir verbalization accompanied by appropriate actions (Landreth, 2002; Wilson &Ryan, 2005). In this context Smith and Herman (1994) explore the notion that for sometherapists, their socialization within their culture unconsciously leads them to viewaggressive behaviour as more acceptable from younger children than older children, aview therapists may wish to take to supervision and personal therapy if these viewsthreaten their feelings of unconditional positive regard with older children. Thispotential practice dilemma also implies that what is acceptable or indeed therapeutic forone child may not be so for another. It highlights the importance of therapists beingresponsive to each child’s individual needs when setting limits. In order to makedevelopmentally appropriate responses and to give developmentally appropriaterationales for setting limits, therefore, therapists need a firm grounding in child develop-ment, along with an understanding of each child’s unique level of cognitive andemotional functioning (Ryan, 1999; West, 1992).

Another important part of the limit setting process is therapists providing, or helpingchildren themselves to develop, alternative ways to express their feelings that are bothsocially acceptable and self satisfying. The amount of autonomy therapists allow eachchild in expressing their feelings will depend upon their individual capacities, based onboth developmental and cultural considerations. Young and developmentally delayedchildren, for example, may not have the capacity to recognize alternatives; older, out-of-control children may not initially have the necessary level of self-control to explorealternatives. Children’s developmental capacity therefore is an important factor toconsider when setting limits in therapy. Children in the Piagetian preoperational andconcrete operational stages of development will need developmentally appropriatereasons for setting limits in the playroom (Ryan, 1999). Non-verbal communicationsaccompanying limit setting are essential for very young children (Wilson & Ryan, 2005).Because young children will still be in the process of moving from external to internalloci of control, they generally are more reliant on their therapists to contain over-whelming experiences and provide physical and emotional security. The relationshipbetween attachment insecurity and difficulties with self-regulation (Schore, 2000) canlead to older children having similar difficulties during therapy.

Two examples show these developmental differences dramatically. John, a six-year-oldchild with profound autism, experienced his therapist’s consistency week after week ofgiving him two biscuits and a drink each time he came to the playroom. As Johndeveloped more autonomy within his play therapy, he was able to indicate to histherapist his strong desire for more biscuits. His therapist’s acceptance of his strong wish,her limit setting in refusing to give him another biscuit, and her targeting of an alterna-tive, by showing him a plastic, play ‘biscuit’ instead, and pretending to bite on it playfullyherself, led John to activate his capacity for rudimentary symbolic play for the first time(Josefi & Ryan, 2004). In this example John’s profound developmental delay necessi-tated that his therapist both give him a clear alternative object and demonstrate what todo with it. At the other end of the spectrum, Patricia, an overly mature 13 year old,experienced her therapist’s ability to withstand her verbal aggression and contemptduring early months of therapy, and to withstand Patricia’s attempts to wheedle confi-dential information about other clients from her therapist. Patricia’s therapist made noattempts to target other alternatives when setting confidentiality limits. It was Patriciaherself who decided to begin playing messily and symbolically in a younger, aggressiveway with paints and clay later in her therapy (Ryan, 2007a).

In these two examples the therapists responded in a developmentally appropriate way,giving John a high level of support in targeting alternatives and allowing Patricia the


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autonomy she needed to find her own alternative, symbolic means to express her strongfeelings. These examples illustrate the attunement and sensitivity required by childtherapists in order to respond to each child’s unique needs in setting limits. They alsoshow ways in which limit setting is embedded within therapeutic relationships, similarlyto the ways in which attuned, sensitive carers of securely attached children contain andrespond to their children’s ongoing feelings and thoughts.

Implications and conclusion

Therapists’ application of therapeutic limits has been explored here from an attachmentperspective. We have discussed how sensitive limit setting seems to enhance the attach-ment components within therapeutic relationships, such as the provision of a secure basefrom which children begin to explore, attunement to individual needs, containment,developing competence, promoting self regulation, and the provision of those limits andboundaries necessary to support physical and emotional safety.

While this article is particularly concerned with identifying properties in the childtherapy practice of limit setting that are similar to those inherent in sensitive adult–childrelationships, there is as yet no direct, qualitative or quantitative research reported inthe literature to support our propositions. We are preparing an article outliningexploratory research with non-directive play therapists on limit setting from an attach-ment perspective. However, over the longer term a more ambitious research project isneeded to examine the ways in which child therapists set limits in their work and howthey impact on the development of therapeutic relationships from an attachmentperspective.

In NDPT the overall approach to setting limits is well specified, yet individual thera-pists may vary in the level of restrictions they impose (Wilson & Ryan, 2005). Therapistsseem to be encountering increasing diversity in the children with whom they work, andfurther European research is needed to investigate how factors such as children’sdevelopmental capacities, gender, culture and presenting difficulties impact on thera-peutic limit setting. Research going back to Ainsworth’s Uganda studies has raised cross-cultural issues for attachment theory and practice. Van Ijzendoorn and Sagi (1999) stressthe need to balance universal trends with contextual determinants. In the NDPT litera-ture, the efficacy of play therapy with diverse populations is reported (Bratton et al.,2005). Wilson and Ryan (2005) highlight the need for therapists to consider individual-ized ways of modulating emotion across cultures, an issue which would be of value toresearch further for therapeutic limit setting.

Gender issues and therapeutic limits also warrant more research attention. Boys aregenerally considered more at risk of developing externalizing problems such as conductdisorder and oppositional defiant disorder (Eme & Kavanaugh, 1995). Although notconsistently found, evidence suggests that boys may exhibit a stronger relationshipbetween attachment insecurity, maternal depressive symptomatology and externalizingproblems than girls (Munson & McMahon, 2001). The interaction of factors such asattachment insecurity, child gender, and maternal responsiveness has a significantinfluence on the developmental trajectory of externalizing problems. The relationshipbetween insecurity in boys and externalizing behaviour may have implications for howchildren respond to limit setting in therapy. The gender of the therapist also is likely toimpact on therapeutic processes and is an important area of study.

In addition, the role of therapists’ sensitive attunement during limit setting needsfurther study, similarly to parent–child attachment research. Research on limit settingneeds to be conducted across child therapy orientations, and not just NDPT, paying


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particular attention to attachment properties as they are expressed within each orien-tation. Such investigations may have wider implications regarding the type of inter-vention best suited to meeting individual children’s needs. Findings may have particularrelevance for children presenting with emotional and behavioural problems where limitsare a significant feature of their therapy.

Another area of further research, on how individual child therapy can work inconjunction with other interventions, such as parent training and family support, alsoseems timely. Intervention strategies for parents of children with conduct problems, asmentioned earlier, emphasize the need for clear and consistent limits, while promotingthe affective component of the relationship. Research on filial therapy, in which parentsare trained and supervised to conduct special, non-directive play sessions with their ownchildren, has shown that filial therapy promotes statistically significant change overallcompared with matched control groups (Bratton et al., 2005; Ryan, 2007b). However,limit setting in filial therapy, which models itself on NDPT, and its relationship tochildren’s improving attachment relationships with their parents during therapy, has notbeen investigated specifically and merits further work. In addition, play therapists’ andfilial therapists’ method of setting limits within therapeutic relationships and the appli-cations of this method in other contexts with parents, teachers and other professionalsrequires research. Finally, this article has suggested that children receiving therapy maybenefit from their therapist’s deeper consideration of the attachment properties inherentin limit setting prior to and during interventions. This is because limit setting seems tohave a pivotal role in establishing therapists as children’s secure base, containing theirunmanageable feelings and enhancing their self-regulation and exploration of difficultthoughts and feelings.

Notes

1. Heard and Lake’s theory is evolving, and they are continuing to formulate and describethe roles and activity levels of each system in relation to one another (McCluskey, 2005;Ryan, 2004a). Their current formulations will be employed here.

2. In order to promote more secure attachment relationships directly (a topic beyond theremit of this article) and in order to give children the security of familiar and importantadults when meeting new or transient therapists, increasingly child therapists are includingcarers in interventions, ranging from requesting carers to bring their children and remainnearby during therapy, or becoming co-therapists, to having carers as the main therapeuticchange agents for their own children in filial therapy, after learning and receiving directsupervision from qualified therapists (Ryan, 2007b; Wilson & Ryan, 2005).

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