The experience told by the child who lives in a shelter through therapeutic play

Objective: To understand the meaning of the experiences of children living in a shelter through therapeutic play. Method: Descriptive, qualitative study, carried out in a non-governmental philanthropic shelter located in the city of Santos (SP) Brazil. The sample was composed of five children between four and 11 years old, who agreed to participate in the study and were also authorized by their legal guardian. Observation during a dramatic therapeutic play session was the strategy used for data collection. Data were analyzed using Bardin’s content analysis technique. Results: Six categories emerged from the data, highlighting aspects of the child’s daily life in the shelter and at school, as well as the nostalgia for family and the way they deal with fear in the shelter. It is also worth mentioning the constant attempt to obtain the approval of the adult and the contentment experience while playing with this adult. Final considerations: The therapeutic play allowed the children to reflect on their experiences and have moments of catharsis. For the adult, it was possible to understand how it is to live in a shelter and the challenges faced by the children in this context.


introduction
Child development is strongly influenced by social, cognitive, and affective aspects, which must be in balance for the child development 1 . The family plays a fundamental role in it, helping children to become adults with good self-esteem, prepared to assume responsibilities and face challenges 2 .
Some children, however, do not have the opportunity to enjoy a functional family system and, for various reasons, are forced to live in shelters or foster homes. Family history of domestic violence and chemical dependency, abandonment or death of parents, homelessness and poverty are some of the situations that lead children to be referred to support institutions and that, in most cases, do not occur in isolation 3,4 .
However, despite the intention of protecting and safeguarding children's rights, institutionalization significantly interferes with the child's life trajectory, compromising their internal organization and their ability to form relationships, social and affectional bonds 1 .
The experience of one of the authors of this study as a collaborator in a shelter institution, participating in visits and adoptions campaigns, motivated her to learn more about the experiences of children in shelters. Then, the following questions arose: How is it like to live in a shelter? How is the interaction with other children and with team professionals? What are the dreams and expectations of these children?
Seeking to understand the meanings of the experiences of these children, the authors conducted this study to investigate how they perceive the shelter situation and what are their feelings in this context of life.
To achieve this objective, it is necessary to use strategies that favor communication with the child, since, before the school age, they have difficulty to verbally express their feelings. Thus, play, especially therapeutic play (TP), is effective in helping children express what they feel and think about the situation they live 5 .
TP is a type of structured play, conducted by a trained professional. This technique is based on the principles of play therapy, and it is used to relieve tensions and anxieties caused by the experience of unusual situations 5 .
Three types of TP are identified: dramatic or cathartic, which allows children to relive a stressful situation during play, expressing what they feel, think and relieving their tension; instructional, used when it is necessary to explain a situation or procedure to the child; and enabler, which helps children to develop and strengthen their potential in the use of physiological functions, according to their condition 5 .
The use of TP is widely disseminated in the literature and it is used in different contexts, with emphasis on situations related to health, disease and hospitalization [6][7][8][9][10][11][12][13][14] , but also with children who live in shelters 15 .
Thus, this study aims to understand the meanings of the experiences of children living in a shelter through therapeutic play.

Method
This is a descriptive qualitative study, developed in a non-governmental philanthropic shelter, located in the city of Santos (SP), Brazil. At the time of the research, the institution had approximately 15 children, from zero to 18 years old.
This institution receives children and adolescents referred by the Child and Youth Court, and they remain there until they are adopted or return to their original home, always following a court order.
The sample was selected intentionally and consisted of three girls and two boys, aged four to 11 years old, who agreed to collaborate with the research. The legal guardians authorized their participation in the study. This age group is the one that most benefits from therapeutic play, especially those in the preschool age, from three to five years, which is the peak of symbolic play 16 .
As this is a qualitative study, the number of participants was defined during the data collection. According to the literature, the inclusion of new participants in a research should be terminated when the data collected is sufficient to understand the phenomenon or situation studied 17 .
For the reader to know a little more about the children in the study, a brief description of the main characteristics of each of them will be presented below.
Cinderella is ten years old, lives in the shelter with three brothers, two boys and a girl, aged 12, 14 and 17. Her 17-year-old brother returned to their parents' house by court order and the other two remain in the same shelter. She was referred three times to this institution; the last time, she returned after the neighbors witnessed fights between her parents. Her mother was admitted to a rehabilitation clinic due to constant drug use. She is communicative and very active, but has difficulties to read and write, with suspected attention deficit hyperactivity disorder (ADHD).
Wonder Woman is 11 years old and was transferred from another shelter, where she lived since the age of four with her 13-year-old sister. She is in the new institution by court order. She is a shy girl who speaks quietly and is not very communicative.
Hulk is four years old and lived on the streets with his parents and three brothers, aged two, seven and ten. He started to live in the institution after being referred by the judge of the childhood and youth court. He is a very cheerful boy who likes to play, but has difficulties obeying orders and is aggressive.
Elsa is six years old and lived in a support house that shelters deprived families that are unable to establish a home. She was brought into the shelter by the social worker, as her mother was about to give birth to another child. She is a kind, loving, shy girl and is very attached to her mother and brother. During the TP session, she worried all the time about the absence of her brother in the play.
Spider-Man is eight years old, is the brother of Elsa and came with her to the shelter. He is a very cheerful, affectionate, outgoing boy and loves to play, but has difficulties concentrating and sharing toys with children.
Data were collected in 2017, after approval of the project by the Research Ethics Committee of the Hospital Israelita Albert Einstein (protocol 1905269) and authorization by the person responsible for the institution where data collection was carried out.
The children's consented to participate in the research through the Consent Term for Minors, elaborated according to the child's comprehension ability, as recommended by Resolution 466, 2012, of the National Health Council 18 .
Data collection occurred during a dramatic TP session, which would initially be conducted individually. However, some children whose siblings were in the same institution resisted to play alone with the researcher, only agreeing to participate in the play together with their brother/sister.
The observations that occurred before and after the TP session were recorded in a field diary to assist in the subsequent analysis of the data. The material used in the TP sessions included: dolls to represent family members, professionals and other children in the shelter; everyday objects used in the house and in the shelter, such as telephones, pots, food, bathtub; modeling clay, assembling toys, pencils and paper 5,19 .
The TP session lasted an average of 30 minutes, ranging from 15 to 45 minutes, as recom-mended by the literature 5,19 . The sessions were recorded in video to enable the transcription of the observations in full. They were conducted by the first researcher, who spent some time interacting with the children before starting the play, to establish a bond of trust with them. The child was invited to play with the following question: "Let's play a child who lives in a shelter"?
The toys were offered in a bag to the child and the researcher explained that they could play as wished and that before the session ended, they would be notified. All children ended the play before the maximum time allowed.
The data were analyzed using Bardin's content analysis technique, which is characterized by a set of communication analysis strategies, used to identify what is said about a given theme through systematic and objective procedures 20 .
Initially, a comprehensive reading of the transcripts of the TP sessions was carried out, seeking to obtain an initial perception of the content. Then, successive readings were carried out to highlight the significant sentences, which were highlighted in the text 20 .
Each excerpt selected received a code in the categorization stage. These excerpts were initially grouped by the thematic differences that emerged and, later, grouped by similarity of content. Then, the synthesis of the speeches was elaborated, based on the interconnection between the theoretical assumptions and the empirical data 20 .

results
Six categories emerged from the data analysis and will be presented below, accompanied by excerpts from the transcription of TP sessions. The letter "C" identifies the child's verbalizations and the letter "R", the researcher's verbalizations.

reflecting on the daily life in the shelter
The children played out several situations related to their daily life at the shelter, such as preparing meals, taking care of hygiene and appearance, and sleeping.
She took the clay and put it in the pot, then started to feed her doll. C: Chomp, chomp -imitated the sound with her mouth, simulating that the doll was eating. C: Miss, she really likes this food that I made... Yours [doll] wants it too. Give it to her -she said, while offering food to the other dolls. (Cinderella) C: Miss, what is this, huh? -she asked me, taking the loofah. R: It is a loofah to bathe the dolls. C: It doesn't even look like a loofah -she said while putting the loofah inside the bathtub. C: They will take a shower. (Elsa) C: This will be the monster that will stay as a statue, taking care of the barbies' room -she said while taking a plastic dinosaur. C: I really don't like mess -she said while organizing the toys, C: No one can play when it's messy. During play, some children said that they liked the shelter. One of them even expressed that she preferred to live in this institution, as she came from another shelter. Another child, however, remained silent when the researcher asked her if she liked the shelter. C

Missing family and home routine
As expected, the loss of contact with family is very significant for the children, and sometimes they do not even understand why they were taken to a shelter. One child talks about how much she misses her parents and pets. C

Having to face fear in the shelter
Situations of physical violence experienced by the child with more aggressive children is one of the factors that cause fear, due to the possibility of physical injury.
C: Sometimes these new boys scare me -she said softly, referring to some children recently ad- One child was constantly worried, reserved and did not interact a lot. She was also afraid of the presence of other children; she flinched any time that one of them entered the place or interfered in the game and asked to end the TP session.
C: Miss, can I play with all the toys? -said, staring at the toy bag. R: Yes. After a few minutes, she looked inside the bags, suspicious, and slowly removed the toys, one by one, placing them on the floor and organizing them to start playing [...]. At all times, she spoke quietly, making it difficult to understand a few words. When another child entered the room, she flinched, stopped playing and looked at the researcher… C: Miss, can we put the toys away? Won't you be upset? -and started putting the toys in the bag. (Wonder Woman) Children also seemed to fear being forgotten and sometimes asked the researcher to take pictures or film them. They also asked the adult to come and visit them on other occasions.
Come back another day to play with me -she said, while putting the toys in the bags. C: Miss, can you take a picture of me with your camera? So that you don't forget me. (Wonder Woman) One of the children said that she was afraid because she had to sleep away from her sister who was in the same shelter. At home, they slept together, but in the shelter, they had to sleep in separate rooms, due to the age difference between them.
C: I have a very big sister, who lives here [in the shelter] with me -she said, while playing with the modeling clay. C: You know, I'm afraid, because they won't let me sleep in bed with my sister. (Cinderella) Some children also did not want to be distant from their siblings, showing constant concern for their sibling while playing, as if they feared being separated at any time. It is also worth noting that in the shelters, the objects are shared among the children, so they were always careful so that other children did not take the toys from the TP session. C

Seeking approval from the adult
During play, their need to obtain approval became clear, as they asked repeatedly what the adult thought about the way they played and said they liked to play with her. It was also common for the child to ask the researcher to come back to visit at the shelter and to bring a gift. C

Discussion
The analysis of the children's speeches during play made it possible to understand their experiences in the shelter, regarding their daily life routine, such as bathing, eating and sleeping.
The activities at the school were also highlighted. Going to school represented a pleasant moment in the day and an opportunity to leave the institution and walk around the city. One of the children (Hulk) played out this moment, using the cars to symbolize the children and identifying himself as the driver of the school transport vehicle. He was the youngest child in the group, still in the pre-school phase, which explains the strong presence of symbolism in his make-believe games.
A study developed with children in shelters also pointed out the details of daily life in the institution in the reports. The children commented on the rules and routines of the shelter, why they were sheltered and how they interacted to the other children and adults in the institution, whom they called "uncles" and "aunts" 15 .
The organization of the environment was also a routine activity in the shelter. One of the children (Wonder Woman) played out the supervision of children by the caregivers, using a plastic dinosaur to take care of the dolls' room.
The shelter is a new home for children, where they perform routine activities and establish new relationships with the institution's employees and the other children. The institution represents a new social and affective support network 1 .
A significant aspect that emerged from the data of the present study was the fact that, while in the shelter, the child has to deal with the absence of the family and the nostalgia for the rou-tine at home. One of the most evident themes in the plays was the preparation of meals.
A previously mentioned study, developed with children who were victims of violence and lived in a shelter, also found that the children often played house in TP sessions, with verbalizations and gestures related to domestic chores 15 .
Despite the undeniable importance of shelters for vulnerable children, the distance from the family, the loss of affective bonds with the family of origin and the lack of alternative affective bonds in the institution have a significant impact on social and affective development 1 .
Furthermore, despite the comfort, well-being and possibilities of development that a shelter provides for the child, the characteristics of this environment are different from the characteristics of a home 1 . On this fact, the report of one of the children (Elsa) stands out: she got irritated and stopped playing when the researcher referred to the people of the shelter as her family.
The institution where the study was carried out seeks to favor the contact between the children and their family of origin, promoting visits to the families. One of the children (Cinderella) reported during play that she was taken by one of the caregivers to visit her mother. She also talked about the vacation period, when she was received by other families, having the opportunity to receive more individualized care, different from the shelter.
Shelter institutions work to promote the reintegration of the child into their biological or extended family. However, if this is not possible, the children are referred to a foster family, so that, during their stay in the shelter, the child is prepared and encouraged to form and strengthen new family bonds 21 .
Another aspect that was revealed in the play was the feeling of fear, associated with the absence of a significant person for the child and with the possibility of being attacked by other children. One girl (Cinderella) said she could not sleep with her older sister, as she used to in her home, and that she felt afraid for not having her company. The sisters could not sleep together because they were in different age groups, and thus were accommodated in separate rooms.
It is observed that in the same way that children in shelters must learn to live with the lack of bonds, they also need to learn to deal with institutional rules and routines 15 .
Most of the times, shelters face difficulties and are unable to provide individualized care for the children, either due to the reduced number of caregivers in relation to the number of children, the unpreparedness of these caregivers to deal with them or, also, due to the rotation of employees, which makes it difficult to form emotional bonds 1 .
The fear associated with the violence experienced inside and outside the shelter was also evident in the play, when the children reported that others were aggressive. One of them (Wonder Woman) even asked to end the play as soon as another child approached. Suspicious and very shy, she had recently come from another institution, and was still not adapted.
In this regard, considering the child's behavior of promptly ending play, it is emphasized that in situations that cause anxiety, the child becomes tense and does not concentrate, being unable to play.
The referral of children and adolescents to shelter institutions has been increasing every day, due to the higher occurrence of abuse of minors. This is an important protection measure; however, it is also a factor of vulnerability since situations of violence can be repeated in this setting 22 .
Playing also showed its cathartic function when a child (Cinderella) talked about how she arrived at the shelter, after a neighbor reported her parents' fight. Despite living in a situation of violence, she did not want to leave her family, and expressed her anger by throwing toys on the floor.
A study carried out in Vila Velha (ES) with children and adolescents who were in a shelter after living on the streets also pointed out that, despite recognizing the shelter as a place that offers housing and food and ensures the continuity of studies, the majority wanted to return to their family of origin 23 These same findings were also identified in another study that was previously mentioned, which found that children who lived in a shelter after being victims of violence expressed the desire to return to their home, with their family, even if they experience violence 15 .
The family has great importance for the child's life and, even if it is not functional, it is recognized by the child as a support system, where they can get affective and social support 22,23 .
Reflecting on the attempt to obtain the adult's approval during play, the concern to live up to the adult's expectations is perceived, as if the children were constantly seeking attention and affection. They seem to crave more lasting relationships when they ask the researcher to return to visit.
Regardless of the desire to obtain the approval of the adult, the opportunity to play freely made the moment of the TP session very pleasant, giving children the opportunity to take control of the situation and feel empowered to decide and take initiatives.
The therapeutic play provides a unique feeling of well-being to institutionalized children, as it enables effective communication with the adults around them and gives children the opportunity to express their feelings, fantasies, desires and experiences, as well as criticisms of the environment where they live and their family relationships 15 .
The use of play to approach children who are victims of violence is an important strategy, as it helps them to create their spaces, social bonds and, consequently, to feel self-confident and able to seek solutions to their problems 22 .
Although the play seemed to be enjoyable, almost all the children decided to end the TP session, and looked restless, sad, or aggressive at that moment. Sometimes, it was as if the situation played out in the session led the child to relive stressful situations, such as the absence of parents and the loss of pets, or even fear of violence in the shelter, which led them to stop playing.
Children in shelters constantly experience situations of loss or frustrated expectations, such as being taken away from parents and siblings, loss or death of a pet and changes in the social environment, such as leaving home or changing schools 24 .
Loss is one of the most disorganizing processes in human life, and it is not only associated with the loss people, but also with any process that involves life changes, which are called small deaths 25 . The losses considered as "small deaths" are symbolic deaths which can cause anguish, fear and loneliness, leading to feelings of pain and sadness 26 .
Although the data from this study made it possible to understand the experience of the children who live in a shelter, conducting research involving other types of shelters can increase the visibility of this context of children's life. It is worth noting that, as this study was carried out in a philanthropic institution, the care and resources available for the care of these children differ from the reality of most public shelter institutions.
It is also worth mentioning that one of the limitations of the study was the reduced number of children who were in the shelter during the data collection period, as, at the time, some children who met the inclusion criteria had been referred for adoption or returned to their homes.

Final considerations
The possibility of using play as a communication tool was once again proved effective in giving a voice for children in shelters to talk about themselves. This is also a valuable strategy for developing research in the context of institutionalization of children, which still represents an important knowledge gap.
The results of this study showed peculiarities of the experience of the children in the shelter, which otherwise would not be revealed, considering the limited ability to express feeling and thoughts in this period of development.
The daily life in the shelter, the trips to school, the nostalgia for the family and home routine, the insecurity of being in a strange environment, the fear of violence and, especially, the fear of being forgotten by the adult, clearly emerged during play.
Playing proved to be a pleasant experience for the children and, more than that, it gave them the opportunity to benefit from the cathartic function of dramatic TP, leading them to reflect on experiences and freely express feelings.
The routine use of TP with vulnerable children, such as those living in shelters, can be extremely useful. The adults who care for these children must provide the conditions for this practice, assuming the role of facilitator of therapeutic play in this social context.
It is believed that the results obtained in this study will contribute to raise awareness on the real needs of this population among the professionals who work in shelters, who will be able to provide more effective and quality care. collaborations FA Almeida: supervision on project design, data collection and data analysis; submission of work and presentation; preparation of the article for submission to this journal.
DF Souza: project design, data collection and data analysis. CB Miranda: manuscript preparation and submission to this journal.