Social and educational psychology

Teixeira R. (2014). Reaching Conversation Through Play: A Qualitative Change of Activity. Psychology in Russia: State of the Art, 7(3), 114-125.

Abstract

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This article illustrates the process of reaching conversation in the case of Anna, a 10- year-old girl, in a countryside Portuguese primary school, through neuropsychological habilitation and psychotherapy. This case identifies the theoretical and methodological concepts from Vygotsky’s cultural historical conceptualization in psychotherapy practice. Vygotsky introduced a new form of thinking in psychology, the concept of play, as a cultural and relational tool on a child’s (consciousness) development. During psychotherapy, Anna progressed through the following stages: 1) not playing (deploying the toys, with no relations between them or awareness of social rules); 2) worldplay (building worlds using wooden blocks and other toys, establishing relations between the characters and their possessions); and 3) imaginary situation (with no toys). At the end of this process, she was able to talk about her issues, communicating in a more adaptive way, especially in a schooled society. When she reached conversation, Anna’s activity was also changed. Therefore, there was a qualitative change regarding her needs, motives and ways of acting and reacting to herself, others, and cultural tools or events.

About the authors: Teixeira, Rute Gonçalves

Received: 06.08.2014

Accepted: 08.26.2014

Themes: Developmental psychology; Applied psychology and psychotherapy; Theories and approaches

PDF: http://psychologyinrussia.com/volumes/pdf/2014_3/2014_3_114-125.Pdf

Pages: 114-125

DOI: 10.11621/pir.2014.0310

Keywords: Vygotsky, play, activity, consciousness, language

Introduction

Nonclassical psychology, based on Lev Vygotsky’s cultural-historical conceptuali­zation, differs from other approaches by proposing that through the help of a sig­nificant other and by acting upon culture’s instruments, the mind is developed. By highlighting culture’s role on building higher human mental processes, becoming a human being is a likelihood but not a certainty of Homo sapiens sapiens. This likeli­hood is derived from the social division of labor (Leontiev, 1978a; Oliveira, 1993, Rego, 1995; Vygotsky, 1989).

As Zinchenko et al. (2013) exposed, Vygotsky’s theory proposed new concepts and paradigms of psychology, enabling progress in our way of perceiving and ac­ting on maladaptive functioning (Quintino-Aires, 2012). Maladaptive functioning is not caused by the lack of abilities to acquire culture but rather by the lack of practical opportunities to self-develop, which, in turn, are a consequence of social inequalities (Bourdieu, 1974; Marx, 1844; 1985; Quintino-Aires, J., 2006).

Vygotsky’s cultural-historical approach studies the human conscience, which is defined as an unfinished process and not a product of a phylogenetic evolution (Vygotsky, 1925/1999). This approach is characterized as a co-construction, which initially stems from biological necessities and motives and evolves through action and reaction into a culturally specific context.

According to Leontiev (1978a), if culture demands the individual to act upon cultural tools, human conscience will evolve in the following way: from the stage of an elementary sensory psyche (sensorial consciousness), to the stage of the percep­tive psyche (perceptive consciousness), passing through the stage of animal intellect (elementary mental processes), until reaching human consciousness (higher mental processes).

Human consciousness is neither a ready-made cultural product nor a spon­taneous development in the individual at birth. Transitioning between the dif­ferent stages of conscience and activity is not a natural or spontaneous process. The process results from the effect of human activity on culture that has its own objective laws in labor and social relations. Despite this objectivity surrounding the construction of human consciousness, subjectivity exists in the way humans acquire new necessities, means, motives and modus operandis; i.e.,, that is, human consciousness is as mutable as cultural instruments in a given historical time and context (Bock, 2001).

This idea is supported by Jomskaya (2005), who contended that personality and human consciousness problems can be assessed using neuropsychological analysis because the mind, which is not an abstract entity, and has concrete and objective brain connections.

Becoming a person and accessing psychological needs produce results from the construction of internalized systems, which are transferred from social rela­tionships to personality. Because human consciousness emerges as an external and effortful process, psychotherapists can facilitate this function (Quintino-Aires, J., 2006).

Despite differentiating us from animals, human consciousness is a develop­mental stage that not everyone attains; it is not a necessary and predictable human feature because it is primarily a historical co-construction that is culturally medi­ated, allowing subjectivity (Vygotsky, 1925/1999; Quintino-Aires, 2012).

The present article describes the development of a child’s consciousness through play from a psychotherapeutic perspective. In this approach, play as well as con­science are not understood as an innate and spontaneous process. On the contrary, play is a construction, similar to every other human possibility, which means that it becomes a likelihood in the individual’s ontological development through culture. Culture, in its turn, is immersed in a historical context and provides certain instru­ments to which the individual will have different possibilities to interact, access and integrate, depending on the historical context. These possibilities for development and appropriation of cultural instruments through play are dependent on the stage of development of human consciousness (Monteiro, Ghedin, & Krnger, 2007).

Bordieu (1982) stressed the impact caused by social and cultural reproduction phenomena; for example, individuals who do not possess the interpreting instru­ments (brain structure) that allows access, fruition and full ownership of cultural experiences (i.e., cultural instruments) will not perceive cultural goods as well as its potentials, although these experiences are available to all social classes. This reason explains why historical relational therapy does not allow for the reproduction of these social inequalities; each individual who undergoes intervention is capable of developing and possessing cultural tools (means of production).

Language, which is culture per se, plays a central role in an individual’s psycho­logical development, despite the fact that the likelihood of becoming a conscious human being is associated with the available valorizations, incentives and (likely) cultural accesses, to a given individual, in a specific historic and cultural context. This idea is present in Vygotsky’s writing (1989, p. 36-37), as shown below:

The child begins to understand the world (.) also through speech. (.) “Natural” perception's immediacy is surpassed by a complex mediation process; speech as such becomes an essential part of the child's cognitive development. (.) The elements are separately categorized and, afterwards, connected to a phrase structure, allowing for speech to become essentially analytic.

Therefore, Vygotsky as well as Leontiev (1979a; 1978b) emphasized the role of culture in brain (re)organization, especially in the transition from the original brain to the emergence of higher mental functions. These authors proposed that what makes individuals act upon the world and cultural objects (language, events, objects, and persons) are our needs and motives. These needs, which are primarily of a vital nature, if properly guided by culture and the demands that are presented to individuals in a schooled society, transform into cultural needs.

Based on the studies of Marx (1985) and Vygotsky, the way through which in­dividuals appropriate (modus of production) these motives (means of production) might likely depend on the state of consciousness development.

According to this perspective, play is interpreted as a construction; when a child is born, he does not possess an interpreting instrument capable of translating cultural items, which explains why it is not possible to perceive a toy as a replica of social possessions. First, the child needs to achieve a certain amount of brain structure to perceive these cultural instruments (real or play make). Consequently, this allows the emergence of needs and motives to act on the human conscience, as indicated in this expression: “Play provides a background for changes in needs and in consciousness of a much wider nature” (Vygotsky, 1933/2002).

Therefore, Vygotsky’s theory deliberately ascribes a different role to play, plac­ing it, together with language, as a catalyzer of child’s development. This perspec­tive sharply contrasts with a more classical view on play, in which its primary drive is the search for pleasure, as indicated in this statement: “Only theories maintaining that a child does not have to satisfy the basic requirements of life, but can live in search of pleasure, could possibly suggest that a child’s world is a play world” (Vy­gotsky, 1933/2002).

Playing is not innate, it is a demand from the primary caregivers from whom a need is generated and whose nature is (primarily) cultural (and not exclusively vital). This need drives the individual to attend to these cultural objects and later on, to play accordingly to the cultural rules that are imbedded in the created nar­rative.

In play the object, to win, is recognized in advance (...). At the end of play develop­ment, rules emerge; and the more rigid they are, the greater the demands on the child’s application, the greater the regulation of the child’s activity, the more tense and acute play becomes (Vygotsky, 1933/2002).

Based on these premises, when analyzing play activity, one must focus on one’s own needs and motives as well as the cultural and relational incentives and ten­dencies (i.e., the system of values). Play is a place where development occurs as explained in the following: “This is the transitional nature of play, which makes it an intermediary between the purely situational constraints of early childhood and thought that is totally free of real situations” (Vygotsky, 1933/2002).

Supporting the claim that playing is not innate is the observation that children do not (actually) play; they (simply) handle objects, which cannot be considered evidence that they are playing, in a sense that neither relations nor social rules nor imagination are established. Transformation, through play, evolves in opposition to the biological directive prescribed by the principle of pleasure and immediacy as described in the following manner: “This is the way a very young child behaves: he wants a thing and must have it at once (...). I think, that if there were no develop­ment (...) of needs (...) there would be no play” (Vygotsky, 1933/2002).

Therefore, playing has a relational origin and a cultural character in the sense that to play, it becomes necessary to comply with rules that govern social interac­tion and to control impulsiveness and to access imagination.

Additionally, playing evolves into having an affective nature, which is one of the reasons why, as a demand, it drives the individual to act, allowing for new needs. Spinoza (1677), referring to this process, stated that “It is clear that we neither strive for, nor will, neither want, nor desire anything because we judge it to be good; on the contrary, we judge something to be good because we strive for it, will it, want it, and desire it.” When we act upon an object (or a person, or an event), we build an attachment (affect, according to Spinoza) to it. When attached, we become ca­pable of tolerating the unpleasant parts of (culture) life, i.e., that is, while playing, we endure losing.

On the previous premise, children react affectively to relationships in which they are a part of as well as to the demands made by others. Playing is the means through which the child acts on those relationships, facilitating the generalization and the development of new concepts and brain connections.

Playing constitutes an essential component in the process of categorization, primarily through generalization. This categorization process allows the child to compare and organize the world. Only through acted experience on these cultural objects, is an individual capable of making this comparison. Therefore, this acting- upon-the-world can be considered as a fundamental developmental instrument, enabling the growth of imagination as a higher mental function. According to Ol­iveira (1993), this developmental process is neither linear nor closed:

Culture (...) is not thought by Vygotsky as something that is definite, in a static system, in which the individual submits himself, but as kind of “negotiation stage”, in which its members are in a constant motion of recreating and reinterpreting information, concepts and meanings.

In the Marxist view of man, there is an active part in appropriating cultural reality (Lenin, 1914):

The great basic thought, Engels writes, that the world is not to be comprehended as a complex of ready-made things, but as a complex of processes, in which the things ap­parently stable no less than their mind images in our heads, the concepts, go through an uninterrupted change of coming into being and passing away... this great funda­mental thought has, especially since the time of Hegel, so thoroughly permeated or­dinary consciousness that in this generality it is now scarcely ever contradicted. But to acknowledge this fundamental thought in words and to apply it in reality in detail to each domain of investigation are two different things.... For dialectical philosophy nothing is final, absolute, sacred. It reveals the transitory character of everything and in everything; nothing can endure before it except the uninterrupted process of becoming and of passing away, of endless ascendancy from the lower to the higher. And dialec­tical philosophy itself is nothing more than the mere reflection of this process in the thinking brain.

Through play, qualitative changes arise, namely, in cultural meaning; human perception is more than the sum of details essentially because of language. At the first stage of human perception development (a lower level of consciousness with only elementary mental processes), an object has no social meaning attached to it and language is not fully developed in the human’s brain. Language, or social meanings, does not yet regulate the child’s behavior. As the development of hu­man perception progresses, social meanings become attached to objects and social events. From this period, social rules and language regulate the ways of acting and reacting to the world. Social meanings govern the individual’s activity by accessing abstract thought and becoming emancipated from concrete and elementary perceptions. In an initial phase, the real situation is reproduced (through imitation) by resorting from little to no imagination. Imitation is simply memory in action because higher mental functions are not developed nor new needs, motives and desires, as expressed below:

(...) the essential of play is a rule that becomes an affect. “An idea that has become an effect, a concept that has turned into a passion” - this ideal of Spinoza’s finds its pro­totype in play, which is the realm of spontaneity and freedom. To carry out the rule is a source of pleasure. The rule wins because it is the strongest impulse (...) a rule is an internal rule, i.e., a rule of inner self-restraint and self-determination (...) play gives the child a new form of desires, i.e., teaches him to desire by relating his desires (Vygotsky, 1933/2002).

According to Vygotsky (1989, p. 25), language “has an essential role in organiz­ing higher mental functions” because it develops the ability to classify. Language activity, in addition to being a necessary prerequisite for play activity, enables the conceptualization of the social world and its tools. As a system organized by cul­tural rules, rules become progressively integrated into consciousness; i.e.,, that is, to speak implies to complicity with its rules, potentialities and restrictions. Addition­ally, social meanings are transformed in the sense that it becomes possible for them to acquire as many forms as there are levels of consciousness.

This is the reason why interpretation is so idiosyncratic, despite culture’s agreed, shared and objective meaning for every word (in the dictionary); everyone has his or her own subjectivity on how to incorporate rules, words and life experiences because personality allows the person to perceive and to (re)act.

Social meanings are appropriated by an individual according to his or her own conscience structure. The different stages of conscience are associated with quali­tative differences in needs, motives and feelings. Consequently, there is a relation between sensible contents (due to sensorial or perceptive consciousness), social meanings (brain transformed by language) and personal meanings (human con­sciousness supported by higher mental processes), as expressed in the following manner: “Meaning attribution is a result of crystallization of human experience, representing the multiple ways through which Man appropriates generalized hu­man experience” (Leontiev, 1978a, p. 94).

Therefore, language can be used to refer to objects and identify their character­istics, actions and relations, enabling an individual to become emancipated from social meanings and to create personal meanings. Words organize things into sys­tems, i.e., that is, words code and attribute meanings to our experiences (Quintino-Aires, 2006).

Introduction to the case

Anna is a 10-year-old girl in the third grade at a countryside Portuguese primary school. She should be in the fourth grade; however, she can neither unto read nor write; she has relational and emotional problems. Anna’s case fulfilled the crite­ria to be included in Instituto Quintino Aires’s Project - Psychotherapy at School Project. This project was established for children who have problems with school adaptation, namely, learning and connecting with others.

Furthermore, Anna had problems that compromised her school adaptation, e.g., for example, she did not speak much, only several words or short and gram­matically incorrect phrases, which did not belong to socially accepted categories; she was easily distracted; she did not play with her peers; and she did not answer her teachers’ questions, becoming very distressed when she had to talk in public. During these moments, she always remained absolutely silent, looking detached, until she broke into tears and became completely despondent. She was always alone, both on the playground and in the classroom, confining herself to silence and not using language.

Psychotherapy at School Project typically began with an initial neuropsycho­logical assessment, followed by the first series (twelve sessions, weekly) of neu­ropsychological habilitation and psychotherapy. At this point, we made another neuropsychological assessment and moved to the second series (making a total of twenty-four sessions, in this case, due to the school’s calendar). In the initial ses­sions, it became obvious that Anna had a language problem.

The adults around her thought she would eventually grow out of her problems and spontaneously develop language. Therefore, the people around her did not of­fer enough incentives for optimal language development, believing that just being around people who talked with each other would make her develop new needs, motives and therefore conversation as a new form of activity.

Anna’s caregivers believed that she did not speak much because she had lived in another European country, in an urban zone, from birth until she was four years old. They considered the child’s lack of language development as a consequence of changing countries and languages.

These beliefs were maintained by the parents despite Anna’s lack of progress. First, contrary to their expectations, she did not develop language skills since they relocated to Portugal (from age four onwards); second, although she lived in a for­eign country between birth and her fourth birthday, she was primarily “exposed” to the Portuguese language, which was not a foreign language.

These theories concerning the problem and its solution sharply contrasted with our case conceptualization. Anna was not capable of expressing herself to another person, not because she was born in another country but because language was not fully organized in her brain. Throughout her history, there was a lack of language incentives from the adults around her, and therefore, her cognitive functions were as elementary as her language. Her developmental phase did not allow her to use language as a cultural tool to interact with others in a cultural way, with social rules, which is one of the reasons why she was always alone. Consequently, there were no demands that impelled her to practice verbalizing her thoughts or emotions to oth­ers; neither her thoughts nor her emotions were organized through verbalization within a secure relationship.

Because she was unable to organize her thoughts and emotions through lan­guage, she became distressed when questioned in the classroom. She did not have the cultural tools to interact with adults. Thus, her world view, motives and needs were only vital, not cultural, as well as her ways of acting and reacting. She still had a biological Dyatel’nost (activity) without the cultural tool for classifying the world using language.

Anna’s development through play: Language and activity

Anna was far from meeting “the basic requirements of life,” as proposed by Vygot­sky (1933/2002), which are necessary to sustain an adaptive life in a schooled so­ciety, i.e.,that is, she was not adapted to performing the school’s tasks and its social demands. That type of achievement required the development of high mental func­tions, and she was at the elementary level, without proper language development.

Because the most important cultural tools, according to Vygotsky’s cultural- historical approach, in promoting development are language, play and obschenie (authentic therapeutic relationship), we chose to emphasize these aspects in ther­apy; e.g., for example, in the psychotherapy phase, Anna could always choose be­tween playing, drawing or talking.

During her initial sessions in November 2013, she chose to draw. It was difficult to access her drawing intentions by relying solely on her own verbalizations, as il­lustrated in the following example:

— “I’m going to draw a fruit that is a tree,” she said.

After being questioned, she replied:

— “It’s a fruit that has some kind of spikes and I think it’s called a pine.”

In the example, her intentions were to draw a chestnut in its thorny shell; how­ever, she was unable to express it in her own words; the categories for “fruits” and for “trees” were not separated as a cultural accepted classification. Because the cat­egorization of the world and, consequently, activity depend on how people orga­nize different categories, this exercise illustrated that her world view and activity were still undeveloped. Her drawing was poor, which was congruent with Anna’s elementary perception of the world and vital activity at this stage of therapy.

From her 3rd session until her 7th session, she chose to play with the World-play box. The purpose of this box is to build worlds with wooden blocks and toys be­longing to different categories (elements of nature, including animals; elements of everyday cultural life, including human figures) to establish relations between the characters and its possessions.

Because the World-play box has these cultural categories, the child needs a cer­tain brain structure to build the relations with those objects to construct a “habit­able” world, according to social rules. Therefore, through this activity, Anna was able to develop mental categories within a therapeutic relationship, acting and re­acting to the unfolding narratives created by dialogues.

Before she was able to attain those achievements, Anna was unable to perceive cultural relations between those objects; she could perceive only vital relations (e.g., animals eating other animals). In our perspective, she needed first to be a part of a therapeutic relationship where social rules, language and cultural artifacts (grosso modo) could be shown to her.

During the first sessions with World-play, Anna did not actually play. During this initial phase, she did not know how to play; she simply deployed the toys, displaying neither relations nor social rules between them. In fact, there were no architectural rules on deploying the world. It simply was not a world by itself.

Based on these initial observations, the first therapeutic task for the therapist was to name the toys as replicas of the human world and to initiate action and reac­tion from Anna with simple questions, such as: “Oh! That’s a house. Who lives in this house?” This question involves a cultural relation because houses are built for humans to live in. These questions were composed with the explicit purpose of enabling Anna to look into her own world and, by acting, to change her perception and activity.

By repeating this task, Anna slowly progressed into building a world conjointly with the therapist, even though she was still not playing. At the end of her 6th ses­sion during the first series, she displayed imagination and social rules. Anna started building worlds with wooden blocks and other toys as well as establishing relations between characters and their possessions.

However, despite progress, dialogue during play was lacking. Few words were shared between the characters and, perhaps more importantly, she did not fully include the therapist in playing (e.g., Anna held all of the toys in her hands and did not assign any play role to the therapist).

— “I’m going to eat you!” said Anna, grabbing the toys (an alligator and a fish) with both hands.

— “Oh! No! ..”, replied the therapist, who was interrupted as the alligator de­voured the fish. If not interrupted, the goal was to continue to apply the non-clas­sical cultural historical approach techniques, used with Anna from the beginning of her therapy, such as contingency, engenwelt and nominating (Quintino-Aires, 2006).

Eventually, as therapy progressed, she reached the required mental structure that allowed her to play. From the 7th session until the 3rd session of the second series, several imaginary situations were enacted (within the same theme) using no toys, resorting only to imagination and dialogues, which constitutes the essence of play.

At this stage, Anna was emancipated from her biological perception; she no longer required the use of visible toys to guide her play narrative. As a higher men­tal function, her imagination and her language allowed her to play freely regarding vital activity. She acquired new needs and motives that guided her activity, namely, social rules that always play an intrinsic role in the play activity.

In the imaginary situation, Anna assumed several roles, whereas the therapist, following Anna’s script, always played the police officer role. Furthermore, at the beginning of the session, Anna after choosing to play “Mr. Little Green Frog” al­ways assumed this character. “Mr. Little” lived in an imaginary village where ani­mals, with human-like features, lived in houses, establishing social, family and work relationships.

We consider this development to be an important milestone in Anna’s therapy because it indicated not only that her world view became organized into categories but also that she could establish relations between them. In other words, she was able to develop imaginary social relations that fit her own social and cultural con­text.

In a typical therapy session, the following play narrative unfolded. Action be­gan with “Mr. Little” presenting a theft complaint to the police station. In the initial sessions of the imaginary situation phase, the stolen goods, although congruent and befitting the rural background in which Anna lived in, belonged to different categories: flowers, fruits and trees were stolen from him, as though they were part of the same classification.

The “police officer” role played, in our view, a fundamental part in organizing these thoughts, helping her to question her own verbalizations. For instance, the police officer said: “So, they robbed your flowers, fruits and trees. Suspicious! How is that possible? No one could rob from you a tree and a flower in the same way!”

As therapy progressed, the progressive organization of the complaint from “Mr. Little” became evident. During the last session, the thieves had only stolen items belonging to the flower category: tulips and roses.

Second, an important change occurred as far as the therapist’s integration in playing is concerned. Play developed from a one-person perspective to a two-per­son, co-constructed perspective, where dialogues became longer and more orga­nized.

Through play activity, Anna practiced not only her language but also different ways of relating to authority figures because she played the role of different charac­ters while interacting with the police officer. In every imaginary situation session, Anna never became blocked or avoided interaction with the “police officer.” On the contrary, she defended her characters’ points of view.

Finally, these therapeutic gains were observed outside the therapy sessions, as Anna started enacting this play narrative with her newfound friends, whom she had befriended. She was now able to interact with them in an adequate and adap­tive way, in real-life situations.

The first time Anna “entered” the “police station,” she did not even knock on the door, nor did she say “good morning,” as prescribed by social convention. On the contrary, she started interacting by yelling her complaints through a speech that was difficult to understand.

By playing, Anna was able to express herself by gaining the structure she need­ed, which is likely why she chose to talk instead of play from the 3rd session in the second series.

When she reached conversation and was capable of conversing, she was able to talk about her difficulties and emotions relating to her peers, adults and herself, as illustrated in the following examples: “I cried when the other girls from my class wouldn’t play with me....” “I’m always afraid that my mother will get angry and shout at me and I can’t take that.” “When I have to tell something to my mother, I just can’t do it. Words just seem to get stuck. They just don’t come out.” “I’m unable to talk. I can’t handle my feelings and it gets stuck here.”

Discussion

Anna came a long way until she was able to talk about herself, although the proc­ess is still unfinished. She still needs to acquire further self-knowledge through language activity, especially through peer relationships. Later, if her development unfolds as expected, she will develop other needs and motives as well as develop another level of consciousness. Anna has already acquired the basic cultural tools required to interact with others. This process became possible through the develop­ment of new needs, motives and activity.

Through therapy and play activity, Anna developed a new form of conscious­ness, needs and motives. Play, as Vygotsky (1933/2002) conceptualized, involves re­lationship, tension (drama), social rules and imagination in action. During therapy, imagination requires an external activity and is not solely a mental acquisition. This acquisition will eventually occur as the individual acts in the external world, trans­forming the brain’s connections and developing high mental functions.

Vygotsky (1933/2002) said that in the play phase, the child starts by imitat­ing the real situation because of the constraints of the elementary mental func­tions. “Mr. Little’s imaginary situation was, at first, an imitation of a real robbery. Although real in a certain way, it could only be considered a fantasy because an animal “talked” to a human figure and there was tension in the dialogues and the enactments followed social rules.

Therefore, in Vygotsky’s terms, Anna played. This was only possible because in a previous stage, Anna formed a relationship with a therapist, which allowed her to build worlds, organizing her perception of the world.

Through play, Anna developed her own cultural concepts and meanings, which provided a unique but socially adequate way to position herself before different per­sons in diverse hierarchical levels (adults and peers). Simultaneously, she learned how to act and react when she experienced distressful emotions.

Play activity acted on Anna’s developmental process in a parallel fashion; she was forced to articulate her speech to be understood by another character. Play ac­tivity also organized her thoughts and developed her brain structure, allowing her to attain high mental functions.

Anna’s primary activity, her needs and motives (tools of interacting with the cultural world) as well as her ways of acting and reacting had changed; Anna did not play at the beginning of therapy because as long as her needs remained vital, she could not access social demands and incentives. It became necessary to feel safe in a mutually contingent therapeutic relationship to achieve playing as a social tool in a child’s development.

Play activity progressed through two distinct phases. In the first phase, Anna was still exclusively guided by perception; i.e.,, that is, toys commanded the narra­tive development because the likelihood of imagining (due to the absence of brain structure) did not exist. In the second phase, by relating with the therapist, Anna developed by gthe skill to imagine, emancipating her from immediate perception, as illustrated by the imaginary situation of “Mr. Little.”

At the end of this stage, she talked about her issues, communicating in a more adaptive way, especially in a schooled society. As she reached conversation, Anna’s activity was also changed. Therefore, her progress constituted a qualitative change in her needs, motives and ways of acting and reacting to herself, others, cultural tools or events.

Acknowledgments

To Professor Quintino Aires and my colleagues at Institute Quintino Aires:

I would like to express my gratitude for this opportunity to develop myself, through these challenges, in my professional life. Presenting this case and therefore writing about it have made me act on and react to my own scientific perspectives. Thank you for the challenge.

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