Jesus said we have to watch and pray. He didn't say pray then watch. He said, "Watch and Pray" which means that you are not supposed to have a prayer that is not motivate by sight.
Jesus went on to say, "So that you don't fall into temptation". There, He has given us a reason why people fall into temptation – they pray then watch. Jesus is saying watch and pray which means it is a vision that has to give birth to your prayer life. It is about what you see that should make you pray.
If you can't see in the Spirit then don't pray because prayer must be according to what you have experienced in the Spirit.
That is the reason why most people are not prayerful.
Some people's prayer lives are weak because their vision is weak. Prayer is based on what you see; you open your eyes and what you see then leads you into prayer.
I have answered your question there; why you can't pray so hard even if you want to.
The day your eyes are opened and you will begin to see what is happening in the Spirit, prayer is automatic.
(Mathew 6 vs 22) There will be light that is if your eyes are focused and well-tuned. Whether or not you have Light in your body is determined by your eyes. The way you see yourself is very important. Are you seeing God and His angels surrounding you or you are seeing the devil and his demons?
(vs. 23) We have to be very careful. It is not everything that we call Light that is Light in the presence of God. Jesus is calling great darkness because it is no longer called darkness; it is now called Light. There is darkness that people call Light and they have stopped fighting it because they call it Light.
If you can't see, you can't pray. Even if you force yourself into prayer, it will not be productive because it has to be birthed by vision.
(Matthew 5 vs. 15) The candle gives light to the people that are in the house, not outside but inside of the house. There is light that you get from your own man of God, not from outside. If you belong to the house and you stay closer to the candle, you will receive Light from the candle.
God wants you to improve in your area of vision. If you can't see, you can't pray. If you pray without seeing, it is not prayer. Because there must be a reason why you are praying; the reason must be visible.
There is a first level of vision which is like natural. You can look at things and see that something is wrong and then you begin to pray. After prayer then comes the second level of sight.
(Genesis 31 vs. 10) There are systems that we work for that do not pay us. That is why I enjoy working for the Lord because He is not like any other boss in the world. In whatever capacity you find yourself in, find ways of serving God.
(vs. 10) Jacob had to do something physical for something supernatural could happen. Something physical has to be done to you so that something supernatural can happen to you.
(Genesis 31 vs 12) When you look at something physically, you need to lift up your eyes and see the dreams that are right above the physical.
The physical problems that we have in Africa are because of spiritual problems.
(vs. 12) The cattle were drinking but the angel of the Lord told Jacob not to look at the physical but to look above. And then Jacob entered into a dream realm.Danel If you look above every physical problem, you will get into the dream realm that will show you the cause of the problem. You won't be able to see it if you focus on the physical.
(Daniel 10 vs. 5) Daniel lifted his eyes and the he saw an angel. The things of the Spirit are not far, they are very close. You can just dedicate yourself to raise your eyes in order to see the things in the Spirit.
Above the things that are happening in your life are dreams and visions in the Spirit. I am training you to see beyond the physical. See what others are not seeing.
(vs. 7) Some of the things are not changed by what we do. First it has to be changed in the Spirit for it to happen in the physical. If the Persia on earth had confusion, it was because of the Persia in the Spirit. The Spirit is where seeds come from.
If you do not lift your eyes to see what is manipulating your economy, you haven't started praying.
There are demonic meetings in the Spirit where diseases and crises are planned and those on earth are just given to execute.
If you are made a leader of anything, create a relationship with God.
Look up; above the physical you will see what is causing things to happen in the physical. It is difficult to fix things on earth. If we could all access the Spirit realm because people that make things to change are spiritual people.
If you ask for sight from God, you will begin to see things that cannot be seen by ordinary people.
Do not run away from war, any problem or situation. The problem found you here so it must leave you here.
Never think of giving up. Never!
Let us lift our eyes and see what is happening in the Spirit. Get into the Spirit and correct things then you will see things changing for the good in the physical. Look up and see the dreams and visions hanging above the physical.
Thank you UFIC for sharing this insightful message of the man of God! God bless you all… I have really being inspired!
Thank you papa for this opportunity you've given us to learn the depth of Gods Word.
This sermon is so revealing. It's shocking. Thank you papa. Thank you so much.
Amen My Father… I receive the power to see what others cannot see. I will see the things of the Spirit by your eyes and spirit Papa.
God give me Sight to see beyond the physical.
Amen! My grand father! I pray that God give me the sight to see the things in Spiritual realm. It is so true that all the problem should be sorted in Spirit first.
Amen!!! The last day of fasting,while praying my eyes were opened to the spirit realm,before was a wire mesh fence ,where it touched the ground was a pathway to the other side ,where I saw an animal called panda, a black and white in colour .it was looking at me as looked at it also.I was back to the natural.Since that time I have not seen again.God restore my sight to see beyond the natural all the time,that I lift my eyes and see and correct things.I receive this Word and even as you pray for me.


Tonight, the San Francisco 49ers (0-0) will host the Minnesota Vikings (0-0) at Levi's Stadium in Santa Clara, California.
The 49ers open the 2015 regular season at home against the Vikings in the second of ESPN's two Monday Night Football games to finish the NFL's opening week. The 49ers are hosting the Vikings in the regular season for the first time since 2007, a game which Minnesota won 27-7. The 49ers have posted a 35-29-1 record on opening day in their 65-year history, including wins in four consecutive season openers and five of the past six.
The 49ers are coming off of an offseason that saw the exile of the team's head coach and much of the coaching staff, the loss of a number of free agents including the team's all-time rushing leader, Frank Gore, and the retirements of players like Patrick Willis and Justin Smith. Despite this, the players have remained confident and a lot of talent remains on the roster.
San Francisco enters the 2015 season under head coach Jim Tomsula, who was hired on January 14, 2015. Tomsula enters his ninth season with the 49ers after serving as the team's defensive line coach for the past eight seasons. In 2010, Tomsula served as the interim head coach for the final game of the regular season, earning a 38-7 win over the Arizona Cardinals.
#49ers Jarryd Hayne is ACTIVE for tonight's game.
On offense, the 49ers hope that the addition of WR Torrey Smith via free agency and QB Colin Kaepernick's offseason work will help give a boost to the team's passing game. RB Carlos Hyde takes over for Frank Gore who left for Indianapolis. The biggest question mark on offense has been the team's offensive line. Although, the same can be said for the Vikings.
In four career starts on Monday Night Football, QB Colin Kaepernick is 4-0 with 1,018 passing yards and 9 touchdowns. He has registered three of his top five highest passer ratings on Monday Night Football.
On defense for the 49ers, the biggest story is LB NaVorro Bowman, who is returning from a torn ACL and MCL suffered in January of 2014. The biggest question mark on defense is the starting cornerback spot opposite of Tramaine Brock. Kenneth Acker and Keith Reaser have been competing for the job.
This game also marks the debut of the 49ers' new black alternate jerseys in a game.
Last Meeting: 9/23/12, Vikings win 24-13, at Min.
Betting: The Vikings are 2 point favorites.
Who will have a better game on Monday night?


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Home/Auto Business/Sales report of the top-10 sub 4m SUVs for February 2021
Auto BusinessNewsOpinion
Sales report of the top-10 sub 4m SUVs for February 2021
Some were consistent, some surprised us!
Chirag Khanna Send an email March 6, 2021
Source: https://www.kianewscenter.com/
It is without any doubt that the Indians are loving the subcompact SUVs to their cores. As a result, all the manufacturers want a slice of this market. As of now, there are ten different sub-4m SUVs from different carmakers as they battle against each other in a race to see who finishes behind Maruti Suzuki.
In February of 2020, the total number of subcompact SUVs sold stood at 27,225 units; same time this year, a whopping 54,850 units sold meaning the YoY growth was 101.47%.
Having launched its jackpot-model in 2016, Maruti Suzuki has been enjoying the mammoth sales of the Vitara Brezza – recorded 11,585 units sold last month as opposed to the 6,866 units in the same period last year.
Second place went to Hyundai's Venue – 11,224 units sold this year (10,321 last year). The Venue finished ahead of its Korean sibling, the Sonet by Kia, which dialed in a sale of 7,997 units.
Tata Motors' Nexon came in a close fourth as it sold 7,929 units. It also managed to achieve a humongous YoY growth standing at 104%.
The latest entrant to this segment, the Kiger from Renault, was able to make 3,226 faces happy with its striking looks. Mahindra sold 3,174 units of its XUV300.
There was another close-call in the sales chart – this time, between the XUV300 and EcoSport. Mahindra sold 3,174 units, whereas Ford managed to sell 3,171 units.
Nissan Magnite, another new entry in the segment, has kept Nissan on its toes as the carmaker is finding it difficult to keep up with its demand selling 2,991 units last month. Brezza's rebadged sibling, the Urban Cruiser from Toyota, recorded a sale of a low 2,549 units.
Speaking of a low volume sale, Honda's WR-V came in last with just 1,004 units sold. To conclude – this segment is expected to only grow and not stay still. However, Ford should look into the EcoSport because it could be a brilliant car in a well-thought out package but is now too old to be selling. You can't keep face-lifting a car to sell in a market filled with brilliant entrants like the Magnite competing with the likes of Sonet and Nexon.
Similarly, in my opinion, Toyota made a bad call with launching the Urban Cruiser – sure, the Glanza is doing really well but that doesn't imply that the Urban Cruiser will mirror the sales of the Vitara Brezza. And let's not even get started with the WR-V…
Chirag Khanna
I can look at the headlights of a car and can tell which car it is. I am an automobile and motorsports (specializes in F1) geek, for starters. For the main-course, I write.
Honda finishes ahead of Tesla in the race to Level 3 Autonomy
A PHEV Lamborghini Urus is coming!
Maruti Suzuki trio Swift, Ignis and S-Presso scores 1-star in GNCAP crash tests!

redpajama_set_name: RedPajamaCommonCrawl


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Home COLUMNS AND OPINIONS Here is how you will be affected by the new taxes starting Monday
COLUMNS AND OPINIONSECONOMYGENERAL NEWSINSURANCEMARKETSREAL ESTATETECH
Here is how you will be affected by the new taxes starting Monday
by biasharadigest June 30, 2019
written by biasharadigest June 30, 2019
Sunday, June 30, 2019 17:59
By PAUL WAFULA
Local vehicle assemblers like Isuzu East Africa are expected to reap from the new government policy. FILE PHOTO | NMG
Attention will from this week shift to companies, suppliers and various government agencies as they start implementing some of the tax proposals for the new financial year that starts on Monday.
Treasury Cabinet secretary Henry Rotich made a raft of proposals in his 2019/20 budget statement, some of which will take effect tomorrow, with others were staggered to October and January next year.
Mr Rotich directed all government ministries, departments and agencies to give exclusive preference in procurement of motor vehicles and motor cycles to firms that have assembly plants in Kenya from July 1. He said the move would spur growth of local auxiliary industries and enterprises and create employment opportunities for the youth.
Also beginning tomorrow, all procurement of office accommodation by government will be standardised with uniform cost leases and existing contracts will be renegotiated to ensure a standard rate. This has set up government agencies operating in rented properties on a collision path with landlords.
Mr Rotich told the Sunday Nation the government will also, in the coming days, develop modalities that will guide implementation of electronic travel cards for public servants. Implementation of this policy promises to end the gravy train and wasteful expenditure that has seen public servants mint huge allowances on domestic and foreign assignments.
Kenyans will have three more months to enjoy cheaper prices of their favourite wines and whiskeys after Treasury pushed the implementation date of new taxes on alcohol from July 1 to October 1.
"Modalities of implementation will be worked out. Commencement date of various tax measures are indicated in the (2019 Finance) Bill, which are largely when the bill is passed," Rotich said in a text message.
The 2019 Finance Bill will see betting companies and those seeking to transfer property get less from their business activities in the coming days. This is after he proposed a 15 per cent increase in the rates of excise duty on cigarettes, wines and spirits in the 2019/20 financial year.
The increment will see prices of a 750ml bottle of wine increase by at least Sh18 since distributors and manufacturers will not pay an excise duty of Sh136, which is Sh18 more from the current rate.
Retailers always round up the prices of commodities and this means that the prices could even be more expensive.
Duty on a bottle of whisky will go up by Sh24 to Sh182 for a 750ml bottle. On its part, the excise duty on a packet of 20 cigarettes will increase by Sh8 to Sh61 per packet.
These proposals are generating heat in the alcohol industry, with players arguing they have been taking the biggest hit in new tax measures.
"The proposal to increase excise tax on wines and spirits by 15 per cent while retaining the annual inflation-adjusted tax escalation on all categories is not only detrimental to the industry's growth but also a drawback on the multi-agency efforts to address illicit alcohol in Kenya," Mr Gordon Mutugi, the head of Alcoholic Beverages Association of Kenya (ABAK), said in a statement.
On betting, gamblers will be required to pay a 10 per cent excise duty of the amount wagered or staked. The implementation of this policy will, however, wait until Parliament passes the Finance Bill and will be effective latest on January 1 in the event Parliament fails to pass the bill.
This means that gamblers will pay Sh10 for every Sh100 staked before the outcome of their betting. Should they win, they will pay another tax on the winnings but should they lose, then it is the betting company that will be required to submit the 10 per cent tax on the amount staked.
Other sectors to be affected in the new financial year include the digital economy that encompasses online and e-commerce firms. Taxing the digital economy has always been hard due to unparalleled reliance on intangibles.
Mr Rotich argues that massive use of data, widespread adoption of multi-sided business models and the difficulty of determining the jurisdiction in which value creation occurs are some of the challenges of bringing the sector under the tax net.
"This has led to erosion of our tax base, hence low tax revenue since the existing system is not equipped to deal with these emerging challenges," he added.
Players in the security services, cleaning and fumigation services, catering services offered outside hotel premises, transportation of goods (excluding air transport services), sales promotion, and marketing and advertising services will also in the coming days start paying withholding taxes on their income.
This is after Treasury proposed to expand the scope of application of withholding tax by subjecting these entities, other than management and professional fees, to withholding taxes as one of the ways of enhancing tax compliance.
In his budget statement, Mr Rotich said the customs measures will be communicated through the EAC Gazette and will be effective from July 1.
The proposals that take effect Monday include those that affect the steel and timber industries. Those who import timber should start getting better prices from Monday. In a bid to deal with the shortage of timber following the banning of logging of trees, Mr Rotich slashed import duty on raw timber from 10 per cent to 0 per cent.
Those transferring property will in the coming months pay a capital gains tax at the rate of 12.5 per cent, up from 5 per cent.
The measures are expected to help Mr Rotich fund the Sh3 trillion budget. According to his revenue collecting initiatives, Treasury hopes to raise Sh468.4 billion from salaried employees in Pay As You Earn taxes. This is an increment of about Sh65.1 billion more, compared with Sh403.3 billion that the government hopes to get by the end of the current financial year.
Those who buy second-hand motor vehicles will help the national Treasury raise Sh224 billion while selling properties at a profit will raise the government Sh4.6 billion in taxes.
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Caritas Family Solutions offers a variety of volunteer options for individuals and groups looking to make a difference in their local community. We do our best to match your time and talents with a volunteer opportunity that will be meaningful for both you and the clients we serve. No volunteer activity is too big or too small, sometimes the littlest things we take for granted have the biggest impact!
Please explore our current Volunteer Opportunities for ways you can help.
To begin the process of volunteering at Caritas, please complete the Volunteer Application Form. If you have a specific volunteer project in mind, please make note of it on your application.
Can I just volunteer once or do you require a longer commitment?
Volunteer projects can be a one-time occurrence for just an hour or so or a long-term, ongoing activity.
We can accommodate various volunteer groups: youth groups, businesses, day-of-service groups, junior service leagues, bible study classes, etc.
Yes, and all our interns are considered volunteers. Internships fill quickly so please submit applications early.
Internships are available on a limited basis in our four regional offices: Belleville, East Alton, Carterville and Mt. Vernon.
Internships are reserved for individuals seeking a four-year degree in the social services field or a graduate degree in the counseling field.
Do I need to pass a background check to volunteer?
Long-term volunteers and interns must pass a background check, including the child abuse and neglect screening (CANTS) and fingerprinting by DCFS.
What types of activities do you have for volunteers?
Please see the opportunity directory for more!
Caritas Family Solutions accepts the services of all volunteers with the understanding that such service is at the sole discretion of the agency. Caritas reserves the right, at any time, to decline service or future service of the volunteer.


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Comics Should Be Good @ Comic Con International - Day Two
by Brian Cronin
in Comics, Comic News
Here's Kelson, with his experiences at the second day of Comic Con International in San Diego! For his first day's report, click here here.
Friday at Comic-Con really felt like a Saturday. The aisles were jammed, there were people with costumes everywhere, and every 30 seconds there was someone taking a picture, and someone else not seeing the camera, walking right in front of him.
I spent the morning in the comic book dealer's area, marked on the map as the "Gold and Silver pavillion." There were dozens of stores there, some focusing on more modern books, others focusing on the older, classic books. Last year it seemed like the number of actual comics dealers had dropped to disturbingly low levels. It seemed like there were more this year.
I also went looking for creators. I found the Studio Foglio booth, talked to him a bit, and got him to sign my copy of the latest Girl Genius trade. I've made a couple of trips through Artist's Alley. I keep looking for Joshua Middleton -- I've found his table, but either I hit the alley at all the wrong times, or he hasn't arrived yet.
Crowd control seemed to have improved since yesterday. The two big panels I went to were both upstairs, and they'd managed to tape or ribbon off areas for the lines. Most importantly, staff was keeping an eye on where the end of the line was going. It made for a much better experience (though I did accidentally get in the wrong line). Now, getting out of the panels, on the other hand... They've tried to make traffic flow only in one direction in each corridor on the west side of Sails Pavilion. It helps, but sometimes it's still a crush of people more reminiscent of a cattle drive than anything else.
The art show had its usual mix of fan and pro art, some comics-focused, some sci-fi and some fantasy. I noticed a lot more in the way of sculpture and textile work than I'm used to seeing here. There were actually a few pieces I was thinking of bidding on. I've never bid in the art auction before, so if I go back tomorrow, it'll be a new experience.
One panel I always try to attend is the Neil Gaiman spotlight. Even when he doesn't have his own panel, there's usually something he's working on, and he'll show up to a gigantic, packed room.
Today, he didn't have anything prepared for the panel (Stardust and Beowulf were covered yesterday), and still managed to be engaging and funny. Among other things, he talked about the very first San Diego Comic Con he attended, back in 1989 when only 9 issues of Sandman had come out and no one knew who he was. After a couple of other items, he opened the floor to questions.
While writing this section in the hall outside Ballroom 20, the following characters have walked past: a dozen Stargate troops. Witchblade. Two samurai. Several Renaissance women. A Navy captain. A number of schoolgirls. Green Arrow. Naruto. A Jedi in a full robe. Two pairs of catgirls. Someone in a dress with blue hair and a scythe. Several people with giant keys. A Death Star weapons technician. A woman in a corset and jeans. A man in a Jayne Cobb hat. A slave-girl Leia with a robe. And a chef. And of course hundreds of people in T-shirts and jeans or shorts (with the occasional suit).
TV show panels with actors can be interesting, especially if a show had been running several years and the cast has developed a camaraderie. The Babylon 5: The Lost Tales panel showed that, even though the show had been off the air for nearly a decade, that connection was still there when the cast returned to do the new movie. Peter Woodward especially was constantly making jokes at the others (and sometimes even JMS') expense, but the rest of them held their own. And the sock-puppet edition of the movie was... unnerving.
Something I've learned in the last few years is the importance of making reservations for dinner. You can either wait for two hours because everyone is trying to have dinner in the Gaslamp District at the same time, or you can go off the beaten track, or you can call ahead of time. This afternoon I made reservations at Royal India, and even though there was a mix-up with our reservation, they were very accommodating and actually set up an extra table so we could be seated in a few minutes instead of waiting.
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Development of the child's ego strength scale: An observation-based assessment of the board game behaviors in play therapy in Korea
Ji Yoen Lee, Young-ae Lee, Mee Sook Yoo
published 17 Apr, 2021
Read the published version in Child and Adolescent Psychiatry and Mental Health →
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The purpose of this study was to develop a scale for assessing children's ego strength through the observation of children playing board games in a therapeutic setting. To assess the ego strength of children in this developmental stage, it is necessary to observe their attitudes during game play therapy, which is the most comfortable psychotherapy technique for children at this developmental stage
Data were collected from 127 play therapists and play therapist-supervisors, who observed 55 children aged 7–9 who received play therapy in Korea. The scale was created through factor analysis and verification of criterion-related validity.
We generated a Child's Ego Strength Scale (CESS) consisting of five sub-factors (Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, Frustration Tolerance) through exploratory factor analysis. The scale met the goodness of fit criteria in a confirmatory factor analysis. The analysis of therapy sessions of children with strong and weak ego strength, as identified by play therapists, showed a significant difference between the two groups in all five sub-variables. There was a significant correlation between the CESS scores and scores of ego strength-related variables of the Rorschach scale, indicating good criterion-related validity.
The CESS appears to be a practical method for the assessment of ego strength in the field of child counseling.
ego strength
ego strength scale
board game attitude
observation-based assessment
early school-aged children
In children, ego strength is an index of current psychosocial health1 as well as an indicator of maturity and adaptation in later developmental stages.2,3 Therefore, it is necessary to consider ego strength not only in adulthood and adolescence, but also in early school-aged children, when they must use the ego function to adapt to outside influences. Particularly in the field of play therapy, which has been recognized as an effective psychotherapy approach to treating children's psychological problems since the late-20th century,4–6 evaluating the degree of ego strength is an effective method to assist children in the latency period who are experiencing emotional, behavioral, and adaptive problems. An awareness of a child's ego strength can help a therapist grasp the current adaptive function of the child, establish the treatment goal, and verify therapeutic effectiveness.
Ego strength in children
Childhood is a time when one breaks away from the self-centered thinking of infancy, more realistic thinking becomes possible, and ego strengthens. Such ego function includes the perception and testing of reality, instinctive impulse regulation, satisfying object relations, remembering and synthesizing experiences, and defending against danger.7 Children with strong ego function will demonstrate flexibility in their lives8 and display self-confidence and psychological adjustment. However, children with weak ego function can become lethargic in even minor stress events due to a lack of impulse regulation and resistance to anxiety,9 and they can be more likely to face psychopathological diagnosis.10 Ego function, which helps children effectively cope with adversity and adapt to their environment, is referred to as ego strength,11 and may be classified as either strong or weak.12
In Erikson's psychosocial development perspective, ego strength is regarded as a characteristic expressed from birth. Erikson13 claimed that there are eight distinct and intrinsic ego strengths throughout one's lifetime: hope, will, purpose, competence, fidelity, love, care, and wisdom. According to Erikson's theory, people experience the extremes of ego strength and weakness while resolving the crises of each developmental stage over a lifetime.14–16 This theory has been supported by Johnson, Beebe, Mortimer, and Snyder,17 who demonstrated that adolescents with well-developed ego strength at a previous stage had more positive self-esteem, lower self-derogation and depressive affect, more positive wellbeing, and more positive intrinsic and extrinsic work values than those with less-developed ego strength. Moreover, such individuals were better adapted for school than those with less-developed ego strength. In contrast, those with weak ego strength have been found to become easily frustrated18 and unable to effectively cope with their problems.19 Moreover, it has been reported that sixth-grade elementary school students with weak ego strength are more likely to show less moral behaviors than students with strong ego strength.20
Play assessment of ego strength for children
Researchers initially discussed the concept of ego strength with a focus on treating patients with psychiatric disorders21,22 but gradually expanded it to include the assessment of general adaptive capacity.1 More recently, definitions of ego strength have been integrated into a type of coping mechanism. Thus, the components of ego strength have been summarized in the following: (1) the ability to withstand difficult situations and emotional tensions, (2) the ability to make reasonable judgments about these situations and to plan and implement solutions to deal with them, and (3) the individual conviction of one's ability to do these things.22 Ego strength is each individual's attitude toward a problem, reaction to frustration, and ability to adapt using one's own emotions,23 and it is the developmental foundation that supports ongoing changes.24
There is a need for objective and standardized measures that can be more effectively used in clinical settings to address ego strength.25 Although the Ego Strength Scale developed by Barron21 has been commonly used in clinical settings to measure ego strength,22 this scale is limited to use in adults and adolescents, as it was designed by extracting items related to ego strength from the Minnesota Multiphasic Personality Inventory (MMPI). In addition to Barron's Ego Strength Scale,21 Markstrom et al.1 developed a Psychosocial Inventory of Ego Strength (PIES) based on Erickson's theory for adolescents and adults. However, there is no scale for objectively assessing the degree of ego strength of children in the early school-aged period.
A number of researchers from psychoanalytic backgrounds have attempted to develop ways for assessing the ego functions of children through projective techniques.11 When these projection tests are applied to a child, they have the advantage of enabling the measurement of the emotional area of the child and of predicting potential defects.26, 27 Although these techniques have benefits, they take a long time to execute and the validity of the test cannot be guaranteed.22, 28
To solve these problems, we should adapt many child clinicians' suggestions in developing a new approach of play assessment that can comprehensively evaluate and analyze children's behavior from a multidimensional perspective.29, 30 In play assessment, children's behavior is observed with a focus on a specific area in the context of play; it has been shown to be a reliable observation system recognized for its stability, sensitivity, and validity compared with other psychometric instruments.31 Assessment based on these play observations can be used effectively, especially in clinical and therapeutic settings that deal with children's psychological difficulties including ego strength.
The availability of ego strength scale through child's board game play attitude
Early school-aged children experience a shift in development in which they move away from pretend play areas, which mark the preschool period, and begin to engage in more structured play with rules.32, 33 Thus, to assess the ego strength of children in this developmental stage, it is necessary to observe their attitudes during game play therapy, which is the most comfortable psychotherapy technique for children at this developmental stage.34 In particular, board games, unlike regular play, are goal-oriented and competitive, have rules, and require interaction and more cognitive abilities.33 Therefore, children must actively utilize an ego process based on secondary process thinking when playing board games.35,36 As such, therapists can gain information regarding a child's ego strength by observing children's game attitudes while playing board games during play therapy.
The primary reason to assess the degree of children's ego strength through board games is that these games have rules that determine the player's win or loss. This competitive characteristic of board games is based on a "model of power,"37 meaning that the balance of power between child and therapist is invariably broken during the therapy process when board games are used. Thus, ego strength becomes easier to test in a gaming situation. Then, the therapist can easily observe and understand the child's unconscious dynamics such as resistance, transference, and countertransference.32, 38, 39
Because of these projective features, clinicians who actively use games in play therapy have argued they can obtain diagnostically valuable information from a child's game attitude.40, 41 For example, Gardner 42 used the game of checkers as a diagnostic and therapeutic tool,36 and Fried 35 used chess as an analysis tool. In addition, Bow and Quinnell 43 identified a number of socio-emotional characteristics such as cognitive strategies, response to feedback, drive for mastery, and a sense of competency, all of which were observable while playing fine motor skill games with children.
Consistent with this theoretical and empirical evidence, Lee 34, 44 has demonstrated that children with weak ego strength have impaired function in areas such as cognitive strategy, frustration tolerance, impulse regulation, willingness to follow rules, and ability to deal with pressure. Moreover, children with weak ego strength experience more ego depletion while playing games, which may increase the likeliness of inhibition impairment.45 This can negatively affect the child's cognitive processes and ability to regulate emotions and impulses,46 resulting in decreased predictive ability,47 lowered cognitive performance,48, 49 and weakened self-control strength.50 These children appear to try to avoid cognitive dissonance and choose an easier cognitive task,49 show increased negative affect,46 and more often express negative feelings. Thus, structured games in play therapy may be a useful tool that may provide the therapist with opportunities to assess the weakness of the child's ego strength.
Ego strength classifying criteria through child's board game play attitude
Therapists can obtain a variety of information about ego strength through a child's attitude while playing a game. First, therapists can grasp the child's cognitive strategy. This concept includes judgment ability, such as the ability to anticipate what outcome the behavior will yield, logically identify cause and effect, and make concerted decisions.51 Further, cognitive strategy refers to the ability to think clearly and deliver one's thoughts to others along with memory, concentration,52, 53 and flexibility.43, 54
Second, therapists can identify coping ability.55,56 Children who are receiving counseling often exhibit various problematic behaviors because they have problems with self-control.46 Coping ability includes achievement and problem-solving skills, ability to respond to challenges,3 ability to cope flexibly with problems without being overwhelmed,19, 57 locus of control,3, 43 ability to withstand satisfying desires and immediate urges,58 and goal-oriented behavior to achieve desirable outcomes in the long term.59, 60
Third, therapists can understand children's frustration tolerance.43, 61 As games involve rules and competition,62 people who play games experience winning and losing. As capacity for achievement is an important developmental need for children in the latency period, children may be sensitive to wins and losses during games with their therapist. Thus, children with low ego strength are overly immersed in the game's outcome 63 and have difficulty withstanding frustration and anxiety.9, 40, 52, 53 Since enduring loss and frustration is important skill needed to accept and face reality,64 ego strength is defined based on frustration tolerance from a perspective focusing on inner ego function.
Fourth, therapists can understand children's interpersonal functioning. This refers to the ability to form social relationships and maintain emotional stability and a sense of value.25 A child has the opportunity to express feelings while playing games with the therapist 36 and further develop the therapeutic relationship.65 Thus, the therapist can grasp a child's interpersonal patterns through the attitude the child displays while playing the game. Therefore, the child's reaction to the therapist's feedback during the game are important observation variables.40 In addition, how a child asks for necessary help while playing a game 54 is also an important assessment opportunity for therapists.
Finally, the therapist can understand the child's ego restriction. Anna Freud 66 argues that the ego can avoid unpleasantness by avoiding uncomfortable situations. When experiencing an unpleasant or stressful situation, ego restriction sacrifices a child's development while controlling this discomfort. When playing a board game, the child views the therapist as being a more competent adversary and can escape from intense discomfort caused by losing the competition rather than anxiety or guilt. However, if the ego is restricted or inflexible, the child may be unable to withstand this discomfort and will ultimately withdraw, resulting in impaired development. Thus, by giving up one area after another, the ego becomes increasingly less tolerant, disinterested, and ultimately resigned to poor achievement.
Given the information that can be learned through game playing, there is a need to be able assess a child's ego strength and the corresponding attitudes in the clinical setting in an objective and quantifiable manner. With such a tool, child psychotherapists would be able to assess children's ego strength more appropriately and objectively. Moreover, with such a scale, child psychotherapists will be able to set appropriate therapy goals and to evaluate the therapeutic process, thus allowing for the effective management of child's problems. The main outcome of successful psychotherapy is improvement of ego strength and self-integrity.11 Thus, pre- and post-therapy assessment using such a scale will also help verify therapeutic effectiveness. Children who undergo psychotherapy that includes ego strength assessment using the newly developed scale in this study may be able to endure internal and external conflicts and grow stronger internally by using their internal resources effectively 67 and by learning to "go to pieces without falling apart."68
This study was divided into four stages to develop the Child's Ego Strength Scale (CESS): an observational assessment of board game behaviors in play therapy (Supplementary Table S1). In Stage 1, five factors and 154 items were pooled through literature review and clinical case analysis, which was composed of 172 game play therapy sessions with 35 children aged between 7 and 9 years. In Stage 2, the numbers of factors and items were adjusted to 4 and 55, respectively, and subsequent internal validity verification was conducted through structured interviews with 10 play therapy experts. In Stage 3, the preliminary scale was used to assess one-time individual game play therapy sessions held by a total of 127 play therapists and play therapy experts for the 468 children who ultimately participated. Then, we performed an Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), and based on these results, a total of five factors and 24 items were finally selected. In Stage 4, we analyzed 24 and 63 game play therapy sessions of children with high and low ego strength, respectively, and verified the difference between these two groups in order to test criterion-related validity. In addition, we evaluated the correlation between the scores of the developed scale and the Rorschach tests in 55 children who were receiving play therapy for internalizing and externalizing problems at child counseling centers in XXX area in order to verify concurrent validity.
Stage 1: Generate Item Pool
Stage 1 aimed to generate a pool of game play behaviors in which ego strength can be measured. Five factors and 154 items were extracted through literature review and clinical case analysis.
Participants. To extract the items through clinical cases, 172 counseling sessions with 35 children aged 7–9 years who used games in play therapy were analyzed. For this study, we collected information on the therapy sessions involving game playing for children who had received or were receiving play therapy from 2014 to 2016 at the counseling center of a university located in the Seoul area. We targeted children in this age range for several reasons. First, this period corresponds to the latency period of development in which children are increasingly aware of logical thinking and reality 69 and Oedipal obsession and accompanying magical thinking are reduced. Thus, children can act according to principles of reality rather than pleasure principles and are typically striving for aggression control and compliance.65 Children in this period tend to use games more than pretend play as a communication tool during counseling. Therefore, age range from seven to nine was considered to be the most appropriate age range for evaluating ego strength through game attitudes.
All game play sessions were video-recorded, and their contents were transcribed verbatim. The chief presenting complaints for each child were externalizing problems, such as attention problems and oppositional behavior, and internalizing problems, such as depression and anxiety. We excluded children who presenting complaints such as autism, developmental delay or psychosis at first because they could not use games therapeutically in play therapy.
Procedure and data analysis. Two sources of data were used to extract appropriate items from game playing behavior to measure ego strength: 1) literature review, through which the subcomponents of ego strength were extracted, and 2) clinical case analysis of play therapy. A total of 172 sessions of game play therapy were analyzed to extract the game attitudes appearing in children during the game. To this end, this researcher, who has a play therapy-supervisor certification and 20 years of experience in play therapy, and two other researchers, each with play therapist certifications with 15 and five years of experience, respectively, participated in qualitative analysis for item extraction.
Results. Five factors were extracted from literature review related to ego strength, and 154 items were extracted through clinical case analysis. Cognitive Strategies consisted of items corresponding to planning, predictive ability, memory, concentration, language skills, and attribution to the win or loss. Coping Strategies consisted of items corresponding to the willingness to follow rules, emotional control, impulse regulation, behavioral control, and problem-solving ability. Frustration Tolerance consisted of items corresponding to their reactions to a win and loss, accepting a win or loss in the game, ritual behavior, and expressing physical reaction. Ego Restriction consisted of items corresponding to trying, giving up, degree of change, and degree of task performance. Interpersonal functioning consisted of items corresponding to reciprocity, independence, receptiveness to feedback, and trust, all of which measured the quality of the relationship with the therapist.
Stage 2: Review and Revisions of CESS Factors and Items through Content Validity Verification
In Stage 2, after verifying the appropriateness of the five factors of the CESS, the five factors were confirmed. The number of items extracted was reduced from 154 to 55 through a content validity test.
Participants. Content validity tests were performed on the five factors and 154 items extracted from Stage 1. The participants for Stage 2 included 10 play therapist-supervisors with an average with more than 15 years of clinical experience in play therapy.
Procedure and data analysis. For Stage 2, we visited 10 play therapist-supervisors and conducted one-on-one structured interviews. The interview time was approximately one hour per therapist. We conducted a content validity test of the five CESS factors and 154 items to verify the appropriateness.
Results. The content validity test with the 10 play therapist-supervisors revealed some commonality between CESS items and factors, necessitating adjustments and deletions. Thus, duplicate items or items that were difficult to measure clearly were removed, reducing them from 154 to 55. Each item was scored using a five-point Likert scale ranging from strongly disagree to strongly agree.
Stage 3: Factor Analysis of the CESS
In this stage, the five factors and 55 items selected as the preliminary content from Stage 2 were ultimately finalized into a model with five factors and 24 items using factor analysis.
Participants. For Stage 3, 127 play therapists and play therapist-supervisors who provide counseling in the play therapy field tested the preliminary scale items that were confirmed in Stage 2. There were one-time individual game play therapy sessions held by a total of 127 play therapists and play therapy experts for the 468 children who participated, the subject of analysis in Stage 3. In play therapists and play therapist-supervisors, 40 years old and younger was the most common age for the therapists with 51.2% of the total; 76.4% had a master's degree, 55.1% had counseling careers of less than five years, and approximately 100 cases of play therapy to date was the most common response with 41.2%. All participants except one (99.2%) reported that they were receiving supervision for counseling. In children, the ages of the children in this study were relatively evenly distributed across first (7-year-olds), second (8-year-olds), and third (9-year-olds) grades; 75.9% of participating children were boys, and 59.4% had externalizing problems as their chief complaint.
Among the children, there were more boys (n = 355) than girls (n = 113) among the 468 children who participated (Table 2). This gender difference may be attributed to the fact that the participants of this study were children currently receiving play therapy. Studies of Korea's clinical settings have reported gender difference in base rate of boy-to-girl ratio. For instance, in Choi and Kim's study70 of 157 children aged 6 years or older who participated in play therapy, 111 (70.7%) were boys and 46 (29.3%) were girls. In Kim and Lee's study71 of the 51 children who were receiving counseling, 38 (74.5%) were boys and 13 (25.5%) were girls, while in Lee and Han's study72 of 14 children aged 4 to 9 years at a counseling center, 9 (64.3%) were boys and 5 (35.7%) were girls. As such, the number of boys receiving therapy was significantly higher than the number of girls in most cases, which appears to be reflected in higher number of boys in the current study.
Descriptive Statistics of Game Play Attitude Observation-Based Ego Strength Evaluation Scale (N = 468)
Skewness
Kurtosis
Coping Strategy
−0.03
Cognitive Strategy
Ego Restriction
Interpersonal Functioning
Procedure and data analysis. For Stage 3, the participants were asked to select between two and four children aged 7 to 9 years who were judged as having weak ego strength from their clinical cases and were either currently receiving counseling or had been in counseling in the past six months. Then, the preliminary scale was used to evaluate the game play attitudes of each participating child. For this study, we contacted play therapists at several clinics via email, phone calls, and direct visit surveys. We explained the research purpose and conducted a survey on play therapists who agreed to participate in the study by sending out a research bulletin via email, online survey (Google Online), and direct visit surveys. The survey took approximately 10–20 minutes to complete. Data from a total of 127 play therapists and their individual sessions with the 468 children who participated were collected.
Based on the survey results, the following descriptive statistics were performed to analyze the characteristics of the preliminary scale items confirmed in Stage 2. First, mean and standard deviation were calculated to evaluate bias and ratio characteristics of extreme values. Then, kurtosis and skewness were suggested to check the error and understanding level of the items. In addition, the overall correlation coefficient and range of the items were calculated, and the responses and reactions were examined to verify the normality of the data.
Next, Exploratory Factor Analysis (EFA), reliability analysis, and correlation analysis were performed using SPSS 22 to identify the factor components. Finally, Confirmatory Factor Analysis (CFA) was conducted using AMOS to confirm the suitability of the factor structure.
Item finalization through correlation of preliminary items and iterative verification of reliability. Before analyzing the factor structure of the preliminary scale, I determined the degree of correlation between items by analyzing the overall correlation of each sub-factor and analyzed the internal consistency of the items. Analysis revealed that the correlation of 9 out of 55 items (11, 12, 13, 15, 22, 23, 24, 26, 55) was not statistically significant; thus, the nine items were removed. Afterwards, multiple factor analysis and item analysis were conducted to remove items with low factor loadings and reliability problems and that posed duplication problems in terms of content validity. Thus, 22 problematic items (7, 9, 10, 17, 18, 19, 20, 28, 29, 34, 35, 36, 41, 42, 43, 44, 45, 46, 47, 48, 49, 52) were eliminated based on these criteria. The final selection included 24 items.
Descriptive statistics of the scale items. Descriptive statistics were performed on the items to verify the validity of the final scale, and the results are shown in Table 1. Overall, the item scores were evenly distributed from one to five points with a mean at the three-point level. There were no items exceeding ± 3 in skewness, and kurtosis did not exceed ± 7, indicating that the items used in this study had no problem with normality.73, 74
Exploratory factor analysis. To identify the factor structure of the five factors of Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, and Frustration Tolerance that were theorized in process of the scale development, the principal axis factoring method was applied for EFA. The factorial rotation method used was the varimax technique, which is an orthogonal rotation method. The results of the EFA on the CESS showed that the KMO was .87, indicating a satisfactory selection of variables for factor analysis.75 In addition, Bartlett's sphere formation test, which indicates the suitability of the factor analysis model, was χ2 = 4975.167 (p < .01). This indicates both that factor analysis is appropriate and that there is a common factor, meaning that the existing data for evaluating ego strength through game play attitude observation were suitable for factor analysis.
A criterion for the number of factors was based on the Kaiser standard (Eigenvalue > 1.0) and the scree test standard.76, 77 As shown in Figure 1 and the results from the EFA presented in Table 2, the items with eigenvalue of 1 or more among the 24 items of the scale were classified into five factors. Factor 1 accounted for 27.8% of the total variance with a factor loading ranging from .60 to .79, Factor 2 accounted for 13.3% with a factor loading ranging from .64 to .78, Factor 3 accounted for 8.6% with a factor loading ranging from .57 to .83, Factor 4 accounted for 6.8% with a factor loading of .60 to .82, and Factor 5 accounted for 4.6% with a factor loading ranging from .50 to .72. Thus, the five factors accounted for 61.2% of the total variance. Further, the five extracted factors were consistent with the theoretical concepts selected by the researcher at Stage 1 to measure ego strength through game play attitude observation.
Exploratory Factor Analysis (N = 468)
Factor Loadings
Common Value
Complains of injustice when he/she loses
−.03
Suspects the therapist of foul play when he/she loses.
Tries to invalidate the game by saying it was a "practice round" when he/she loses
Flips the board and throws the cards or game tools when he/she loses
Blames the win or loss on external factors
Cries or gets angry when he/she loses in the game a few times because he/she is unable to withstand the loss
Can appropriately use the strategies needed to win
Remembers the game rules well
Verbally explains the rules of the game appropriately so that the therapist can understand them.
Moves his/her piece by predicting the therapist's next behavior
Displays flexibility in changing strategy depending on the situation
Is not distracted by surrounding stimuli and concentrates on the game.
Says, "I won't play," and refuses to begin when listening to the game rules explained and they sound a bit complicated and difficult
Does not choose games that have slightly complicated rules
Stops playing after a bit for games with slightly complicated rules.
Tries to play alone for games he/she is not good at and with the therapist for games he/she is good at
Causes therapist to feel that he/she is interacting with the child when playing games with him/her.
Can appropriately ask the therapist for help when necessary
Enjoys playing games with the therapist.
Is receptive to the therapist's feedback when playing the game.
Frustration Tolerance
Expresses tension as a behavior when he/she seems to be losing
Expresses excessive frustration in the style of having lost everything when he/she loses even once
Waits patiently for the therapist without prodding when the therapist spends a bit of time thinking during his/her turn.
Does not stop playing and finishes the game even if he/she seems to be losing.
Explained variance %
Cumulative explained variance %
Confirmatory factor analysis. Next, CFA was conducted to examine whether the items and factors obtained through EFA fit the theoretical model. All scores were greater than .90 were considered to indicate a good fit, χ2 = 1172.504, p <.01, goodness of fit index indicator (GFI) = 0.944, Tucker-Lewis Index (TLI) = 0.945, and comparative fit index (CFI) = 0.965.78, 79 The root mean square error of approximation (RMSEA) = 0.048 was less than .08; based on the fitness index criterion, this factor structure can be evaluated as having good fit.80-83 In addition, the average variance extraction value was above .5, and the conceptual reliability value was above .7, verifying the validity of all sub-factors. The factor structure model of this scale is shown in Figure 1.
Correlation and reliability of game play attitude observation-based ego strength evaluation scale. The correlation between the whole scale and each sub-factor and the reliability are shown in Table 3. Each of five factors had a correlation ranging between .20 and .74 (for all correlations, p < .01) and was found to have a statistically significant positive correlation. The correlation between the overall scale and each sub-factor ranged between .51 and .74 (for all correlations, p < .01). Thus, all showed statistically significant positive correlation. These results show that each sub-factor measures a different domain of ego strength while simultaneously measuring one overarching super-concept. In addition, the Cronbach's alphas were .84, .86, .85, .82, .70, and .70 for the whole scale, Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, and Frustration Tolerance, respectively. These results show that this scale has strong internal consistency among the items. In addition, the correlation coefficients between the sub-factors (rs ranging from .20 to .56) were lower than those between the whole scale and sub-factors (rs ranging from .51 to .74). These results show that the sub-factors constituting the scale developed in this study satisfy the criteria that they should be homogeneous yet somewhat independent.84
Intercorrelations Between Factors and Internal Consistencies (N = 468)
Cronbach's α
.20**
Note. Mean (M); Standard Deviation (SD); F1 = Coping Strategy; F2 = Cognitive Strategy; F3 = Ego Restriction; F4 = Interpersonal Functioning; F5 = Frustration Tolerance; Total =Total Scale Score.
*p < .05, **p < .01
Stage 4: Verification of Criterion-Related Validity
Participants. Participants in Stage 4 included 25 play therapists and play therapist-supervisors who each had more than 10 years of clinical experience. To verify the criterion-related validity of this scale, 25 participants were each asked to select two children aged 7 to 9 years from their clinical cases, one should be judged to have strong ego strength, the other should be judged to have weak ego strength. These two children were either currently receiving counseling or had received counseling within the past six months. Of the 89 sessions with children that were analyzed, there were 24 game play therapy sessions of children evaluated to have strong ego strength and 63 game play therapy sessions of children evaluated to have weak ego strength.
In addition, 55 children aged between 7 and 9 years who received play therapy at two child counseling centers in Seoul area had their game playing attitudes analyzed to verify the scale's concurrent validity. Children aged 7, 8, and 9 years were 30.9% (N = 17), 41.8% (N = 23), and 27.3% (N = 15), respectively, while 72.7% (N = 40) were boys and 27.3% (N = 15) were girls.
Measurements. The Rorschach test 85 measures the respondent's cognitive style and psychodynamic construct based on the respondent's response to ten inkblot cards. The evaluator directly assesses the child's personality characteristics on the types of variables of the comprehensive system of this test, including resistance to stress, affect control, interpersonal skills, egocentricity, cognitive organization skills, copying deficit skill, presence of depression and perception disorder, excessive vigilance, and degree of compulsion.86 The Rorschach test provides an optimal opportunity to measure ego impairment because it induces the respondent to use cognitive, affective, and human or representational resources to organize an ambiguous and complex task.87 Thus, a number of researchers have verified the diagnostic efficacy and validity of the special indexes of the Rorschach CS,88, 89 and contributed to measuring ego strength by using certain variables of the Rorschach test or developing Rorschach Prognostic Scale (RPRS) and Ego Impairment Index (EII). 90, 91
Procedure and data analysis. The CESS was designed in a way such that higher scores are associated with weaker ego strength in order to improve clinical efficacy in detecting problematic behaviors. Thus, two positive items from F2: Cognitive Strategy, F4: Interpersonal Functioning, and F5: Frustration Tolerance were reverse scored. First, the participating children undergoing therapy were divided into strong ego strength and weak ego strength groups, and a t-test was performed to analyze differences in scores of the five factors of the CESS between the two groups in order to determine criterion-related validity of the CESS.
Next, concurrent validity of the CESS was determined by analyzing the correlations between the scores of the 5 factors of the CESS and scores of all variables of six special indexes of Rorschach CS (Perceptual Thinking Index; PTI, Depression Index; DEPI, Copying Deficit Index; CDI, Suicide Constellation; S-CON, Hypervigilance Index; HVI, Obsessive Style Index; OBS) and the seven sections of structural summary (Core Section, Ideation Section, Affect Section, Mediation Section, Processing Section, Interpersonal Section, and Self-Perception Section). Two clinical psychologists interpreted the Rorschach test of 55 children, and the inter-rater reliability was good, with .89.
Group Differences. As shown in Table 4, a significant difference between the two groups emerged through the analysis of the game play therapy sessions of children who were reported to have strong and weak ego strength to verify the criterion-related validity. As the CESS is designed in a way that higher scores represent weaker ego strength, a higher score on the CESS indicates weak ego strength. The children reported to have weak ego strength had significantly higher mean scores on the overall scale and in the sub-variables of Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, and Frustration Tolerance. This suggests that this scale can distinguish between groups with strong and with weak ego strength.
Verification of Differences in Scores Between Strong and Weak Ego Strength Groups (N = 89)
(N = 24)
Ego Weakness
M (SD)
−6.41***
Note. ***p < .001
Concurrent Validity: Correlations between CESS and Rorschach. In order to determine concurrent validity of the CESS, we analyzed the correlations between the scores of the five factors of the CESS and scores of all variables in the seven sections of the comprehensive system of the Rorschach test (Core Section, Ideation Section, Affect Section, Mediation Section, Processing Section, Interpersonal Section, and Self Perception Section) and six special indexes (Perceptual Thinking Index, PTI; Depression Index, DEPI; Copying Deficit Index, CDI; Suicide Constellation, S-CON; Hypervigilance Index, HVI, and Obsessive Style Index, OBS).
The results are shown in Table 5. Mild to moderate correlations were obtained between the CESS factors and Rorschach variables. With regard to Rorschach index, the correlations between F5 (Frustration Tolerance) and F2 (Cognitive Strategy) factors and the CDI were significantly positive, r = .33 (p = .013) and r = .29 (p = .033), respectively. In addition, F3 (Ego Restriction) factor was significantly positively correlated to Depression index (DEPI), r =. 27 (p = .049). These results indicate that weaker ego strength is associated with lower social skills and coping skills or increased avoidance. The F1 (Coping Strategy) factor and the other CS variables, Afr (degree of interest in affective stimuli), S (white space response), and S-% (proportion of distorted form that involve use of white space), were also significantly positively correlated, r = .48 (p = .000), r = .41 (p = .002), and r = .31 (p = .023), respectively.
These results indicate that children who display greater number of inappropriate coping strategies are more likely to show emotional response, passively express frustration, and lose judgement ability so that they have a distorted perception of a situation when frustrated. F2 (Cognitive Strategy) factor was significantly negatively correlated with DQ+ (Developmental quality; assessment of a person's ability to analyze and synthesize information) r = − .27 (p = .048), showing more use of inappropriate cognitive strategies is indicative of lower organizing skills using cognitive resources. F3 (Ego Restriction) factor was significantly correlated with number of response r = − .30 (p = .029), Pure C (number of pure color response) r = .35 (p = .009), a (number of flexibility responses) r =- .34, (p = .012), and Dd (unusual detail response) r =- .30, (p = .026). These results show children with high degree of ego restriction are unable to actively express the characteristics of their experience and are likely to have impulsive emotional response.
Pearson correlations between CESS and Rorschach indices (N = 55)
.29*
DEP1
S-CON
Number of response
-.30*
Pure C
.48***
-30*
DQ+
S-%
Note. F1 = Coping Strategy; F2 = Cognitive Strategy; F3 = Ego Restriction; F4 = Interpersonal functioning; F5 = Frustration Tolerance; Copying Deficit Index (CDI); Depression Index (DEPI); Perceptual Thinking Index (PTI); Suicide Constellation (S-CON); Hypervigilance Index (HVI); Obsessive Style Index (OBS); the ratio of pure F response among the total responses (Lambda); pure color response (Pure C); Cooperative movement (COP); affect ratio (Afr); White space (S); active response (a); unusual detail response (Dd); Developmental quality (DQ+); White space distortion (S-%).
*p < .05, **p < .01, ***p < .001
F4 (Interpersonal functioning) factor was significantly correlated with COP (cooperative movement) r = − .27, (p ≤ .043) and Dd (unusual detail response) r = − .28 (p = .042). This demonstrates that children who show behaviors that are more inappropriate in interpersonal functioning are less able to positively interpret interactions with others and have poor sensitivity, such as difficulty detecting small details. F5 (Frustration Tolerance) factor was significantly correlated with Lambda (crude index of responsiveness) r = .27 (p = .036) and COP (cooperative movement) r = − .27 (p = .044). This shows that children with lower frustration tolerance are less able to utilize various resources in the environment and experience positive interaction with others.85
This article describes the empirical procedures employed in developing and evaluating the CESS, a scale designed to assess children's ego strength by observing and rating their attitudes while they are playing board games in a therapeutic setting.
Factors and Components of Items
As the establishment of a stable factor structure plays a very important role in the validation process,92 this study underwent several stages of development. Through this process, we developed the CESS, which consists of five factors and 24 items, and tested its reliability and validity.
The content validity of the CESS was achieved by (a) examining existing scales and both domestic and foreign literature on ego strength, (b) qualitatively analyzing video recording and transcripts of the 172 sessions in game play therapy to generate five sub-factors and 154 preliminary items, and (c) verifying the content validity of the pre-extracted items and developing a final preliminary scale comprising five factors of Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, Frustration Tolerance and 55 items.
Second, with regard to factor structure validity, we asked 127 play therapists and play therapist-supervisors to assess the game play attitudes of children evaluated as having weak ego strength among the children counseled in the past six months using the preliminary scale. We then analyzed data from one-time individual game play therapy sessions for the 468 children to identify the factor structure of the scale. Through an item analysis, nine items without statistically significant item correlation were deleted, and, after deleting 22 additional items with low factor loadings and reliability problems through several factor analyses, 24 items were finally selected. Thus, the five factors were labeled Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, and Frustration Tolerance. An exploratory factor analysis and a confirmatory factor analysis revealed that the CESS was appropriately composed of items measuring the five constructs and that each factor measured one unified construct of ego strength.
Validity and Reliability of CESS
There was significant correlation between the game play behavior observation-based CESS and the sub-factors in terms of construct validity. We also analyzed 89 game play therapy sessions of children with strong and weak ego strength identified by 24 play therapy specialists and verified the between-groups difference. There was significant difference between the two groups both on their overall scale scores and in all five factors: Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal functioning, and Frustration Tolerance. The concurrent validity of the CESS was determined by analyzing the correlation between the CESS score and Rorschach Comprehensive System (Rorschach CS) scores. The results showed that of the five factors of the CESS, the frustration tolerance and cognitive strategy factors were significantly positively correlated with copying deficit index (CDI). An increase in CDI score particularly indicates impairment of the interpersonal skills and social comfort that are needed for problem solving.85 The findings of this study illustrated that children with low frustration tolerance and poor cognitive strategies have insufficient resources to deal with stress and impaired coping skills.
It is noteworthy that the results of this study showed significant correlations between two of the Rorschach CS sub-factors of ego strength and the coping impairment index. This result indicates that the construct of this scale, which measures ego strength, is valid based on the exiting theory defining ego strength as a coping mechanism.22 Moreover, the ego restriction factor of the CESS was significantly and positively correlated with the Depression index (DEPI) on the Rorschach CS. According to Exner,85 high DEPI is indicative of individuals with depressed or unstable affect and a tendency to be self-absorbed and avoidant. In this study, children with greater degree of ego restriction were less able to respond actively to the environment and showed avoidance due to lowered energy level.
Other findings from the present study indicated that the children who displayed a greater number of inappropriate coping strategies were more likely to show emotional responses and lost the ability to make reasonable judgements when they were angry. The children with a greater number of inappropriate cognitive strategies had lower cognitive organizational skills, whereas those with greater degree of ego restriction were unable actively to express their experiences and had a tendency to show impulsive emotional responses. In addition, lower interpersonal functioning and frustration tolerance were indicative of the inability to cooperate with others and to use available resources from the environment due to the lack of sensitivity.85 Taken together, these results suggest that the CESS may be a useful tool in measuring ego strength.
The results of the scale reliability verification indicated that Cronbach's alpha was .84 for the whole scale and .70 to .86 for the sub-factors. As described above, this scale can be regarded as an instrument with relatively high reliability and validity as well as an observational tool that consists of items and factors appropriate for measuring ego strength in children based upon game attitudes.
The study's main strength is its development of a game play assessment tool for child patients. As many researchers and clinicians have suggested that children's ego strength can be assessed by observing game attitudes, this study is meaningful in that it developed this as a measurable scale. In fact, this study began with the practical need of researchers, who have 20 to 35 years of clinical experience in play therapy. Through this clinical experience, we could perform the practical task of selecting meaningful items through video and conducting the verbatim analysis of the children's game play therapy scenes as well as an extensive literature review. A long clinical experience served as a basis for item extraction and selection and allowed me to develop a more realistic scale for clinical use.
Therefore, when using this scale, therapists can observe children's game attitudes more systematically and specifically in terms of ego strength and work to objectify them. This is expected to contribute to case formulation and therapists' goal setting for children in counseling, as its therapeutic effectiveness can also be verified. Board games are commonly used by children counselors in elementary schools in Korea. Thus, use of this scale in school counseling settings may aid school counselors to identify children's ego strength and developing a profile of strengths and weaknesses using each of the sub-factors.
The current study has the following limitations. First, although many behaviors observed in the clinical setting were extracted to develop this scale, most were ultimately deleted in the final item selection process. However, some of the deleted items may measure children's ego strength more specifically. Thus, additional research is needed to continuously test the validity of the scale through the process of selecting and revising the scale with more specific and accurate items to assess children's ego strength.
Second, the results of this study are limited to narrow age groups as the children analyzed in this study were aged 7 to 9 years who were receiving play therapy in Korea that utilizes board games as a therapeutic tool. Although this age range was chosen because children aged 7 to 9 are at the most appropriate developmental phase to measure the child's ego strength through the observation their game attitudes, future study is needed to verify the reliability of the CESS in children aged 10 years or older.
Third, there was a difference in the number of boys and girls in the samples of this study, as boys are significantly more likely to be referred to counseling than girls in Korea. Thus, a future research that considers gender and presenting symptoms is needed.
CESS is a play assessment scale of child's board game behaviors for ego strength. Our study is consistent with previous research suggesting that therapists can easily observe a child's unconscious dynamics through the child's game play behavior.32, 38, 39 It is important to note that coping strategy was the first among the sub-factors of this scale. This is consistent with the integration of the ego strength concept with coping mechanism, a shift from its initial pathologic implication.22 One point to consider in the study results is that ego restriction was included in CESS. Ego restriction is caused by external stimuli such as competition failure, unlike denial and avoidance, which are used to escape internal stimuli such as anxiety or guilt. Therefore, the result of this study that a defense mechanism of ego restriction can be observed in a child when playing a game is noteworthy in therapy session. CESS consists of conscious and unconscious factors that represent the ego strength of children, and we believe that CESS may useful to assess the ego strength of child patients in play therapy sessions.
CESS: Child's Ego Strength Scale; Rorschach CS: Rorschach Comprehensive System; RPRS: Rorschach Prognostic Scale; EII: Ego Impairment Index; PTI: Perceptual Thinking Index; DEPI: Depression Index; CDI: Copying Deficit Index; S-CON: Suicide Constellation; HVI: Hypervigilance Index; OBS: Obsessive Style Index; DQ+: Developmental quality; Pure C: number of pure color response; Dd: unusual detail response; COP: cooperative movement; Afr: degree of interest in affective stimuli; S: white space response; S-%: proportion of distorted form that involve use of white space; CDI: copying deficit index.
Ethics approval and consent to participate:
All procedures and materials for this study were approved by an Institutional Review Board in Sookmyung Women's University, Korea (SMWU-1605-HR-025, Registered 03 March 2017 - Retrospectively registered, https://irb.sookmyung.ac.kr/). The participating therapists and the guardians of the children were asked to sign an informed consent prior to their participation in the study.
The authors declare that there is no conflict of interest.
The datasets generated and/or analysed during the current study are not publicly available because of individual privacy considerations and limitations from ethics approval. The datasets are available from the corresponding author on reasonable request. Note that verbatim-transcribed data are in Korean.
The authors alone are responsible for the writing and content of this article. Data collection was performed by YAL and was supervised by MSY. JYL, YAL analysed the data and wrote the first draft of the manuscript. All authors read and approved the final manuscript.
The authors thank many play therapists and children clients, their parents of Center for Play Therapy at Sookmyung Women's University, for their participation and devotion of this study.
1 Graduate School of Psychotherapy, Play Therapy, Sookmyung Women's University, 100 Cheongpa-ro 47-gil, Youngsan-gu, Seoul, Korea, 04310. 2 Graduate School of Psychotherapy, Play Therapy, Sookmyung Women's University, 100 Cheongpa-ro 47-gil, Youngsan-gu, Seoul, Korea, 04310. 3 Mee Sook Yoo, Department of Child Welfare and Studies, Sookmyung Women's University, 100 Cheongpa-ro 47-gil, Youngsan-gu, Seoul, Korea, 04310.
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Studying: Bachelor of Applied Science (Parks, Rec & Heritage). Charles Sturt University.
Why Cycling: I like the competitiveness and the chance to see the world.
Favourite cycling memory: 1st Oceania Time Trial Championships (2017).
2019 cycling goal: Make the Australian National Team.
2019 off the bike goal: Keep chipping away at Uni.
Me in three words: What a pelican.
My dream race: World Championships.
I am inspired by: My coach, Stu Shaw.
Favourite song: Australian Crawl – Oh no not you again.
If I wasn't a cyclist I would be: An environmentalist.


AS Scottish Borders rushes towards 100 redundancies in its cuts package, around 45 continuing education staff should at least know the ropes.
A significant aspect of their work when mills and new tech companies have been closing around their ears is, of course, the redundancy support unit. They've worked with 3,929 employees facing redundancy. Make that 4,029.
The "nae luck" award in this saga goes to Rory Macleod. The seconded director at Community Learning Scotland, which is being closed next month in a quango cull, will have no chance of returning to his vacant post. You guessed it: head of continuing education in Borders.
Macleod, heaven forbid, fears a jinx. Last summer he raised thousands with a charity walk in Nepal. The day he left, the king was shot dead. Keep clear of this man.


Prof. Lei's author profile published on Angew.Chem.Int.Ed., 2011, 12136.
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