What Is Play Therapy?

It's more than just playing with toys

Play therapist often provide art supplies.

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Play therapy is a form of counseling or psychotherapy that uses play to assess, prevent, or treat psychosocial challenges. Although play therapy can be used with adults, it’s most commonly used with children. 

From the outside, play therapy looks like it's just about having fun with toys. However, research shows play therapy is effective in treating a variety of mental health issues and behavior disorders.

Why It’s Used

Children lack the cognitive and verbal skills to talk about some issues. Grief, for example, can be very complex and a child may have trouble putting their thoughts and feelings into words.

Play can be a hands-on way for children to work on issues that are distressing to them. They can act out scenes, address specific problems, or create characters who share their emotions.

Children often act out their feelings with toys. A child who has lost a loved one may use puppets to portray a sad character who misses a friend. Or, a child who has witnessed domestic violence may use a dollhouse to depict a child hiding under the bed because the adults are fighting.

Depending on the type of play therapy that is being employed, the therapist may intervene at various points in the play to help resolve an issue. Or, the play therapist may observe the child as the child is helping a character work through his feelings.

Play therapy can help children:

  • Develop self-efficacy so they can feel more assured about their abilities
  • Learn new social skills
  • Develop better interpersonal skills
  • Cultivate empathy and respect
  • Learn to identify and express emotions in a healthy way
  • Learn and practice better problem-solving skills
  • Become more responsible for their behaviors

Issues Play Therapy Addresses

Play therapy is often used to help children process stressful life events such as relocation, hospitalization, physical and sexual abuse, domestic violence, and natural disasters.

It can also be used to treat mental illness or behavioral problems. Here are some of the most common issues addressed in play therapy:

  • Trauma and crisis
  • Anxiety disorders
  • Depression
  • ADHD
  • Autism spectrum disorder
  • Grief and loss
  • Anger management
  • Aggression
  • Divorce
  • School-related problems
  • Social issues
  • Physical and learning disabilities

Common Tools and Approaches

Many play therapists have a dedicated play therapy room that is filled with items that help with the therapeutic process. Some common play therapy toys include:

  • Action figures
  • Therapeutic games, like The Talking, Feeling, and Doing Board Game or The Stop, Relax, and Think Board Game
  • Dollhouse with dolls
  • Puppets
  • Art supplies
  • Sand tray with figurines
  • Animal figurines
  • Toy cars
  • Blocks
  • Play handcuffs
  • Musical toys
  • Kitchen with pretend food

Non-Directive Approach

Play therapy comes in two basic forms: non-directive (or child-centered) and directive.

In child-centered play therapy, children are given toys and creative tools and they’re allowed to choose how to spend their time. They aren’t given any direction or guidance about what they should do or how they should solve their problems.

The non-directive approach is a type of psychodynamic therapy. The basic premise is that when allowed to do so, children will find solutions to their problems.

The entire session is usually unstructured. The therapist may observe the child quietly or may comment on what the child is doing.

The therapist may become involved in the play if invited to do so by the child. But, ultimately, the choice is left to the child.

Directive Approach

In some situations, play therapists may use directive strategies. Each session may have a specific topic or goal to be addressed.

A child may be told, “Today we’re going to play with puppets. This will be your puppet,” or the therapist may choose a specific game for them to play.

The therapist may also get involved in the play to direct the story. For example, if a child is using puppets to depict a child being bullied, the therapist may intervene to help the puppet find ways to stand up to the bully or find help.

Types

In addition to the basic approaches, there are also several different types of play therapy. Here are some of the most common types:

  • Filial Therapy: The parents get involved and the therapist teaches the parent how to interact with the child through play. The goal is to close a communication gap between the child and parent.
  • Sand Tray Therapy: The child can create a scene in a small box filled with sand using miniature toys, such as people and animals. The scene created acts as a reflection of the child's own life and allows a chance to resolve conflict, remove obstacles, and gain self-acceptance.
  • Bibliotherapy: The therapist and the child may read books together to explore specific concepts or skills.
  • Imaginary Play: A child may be given toys that spark the imagination such as clothing to play dress up, a dollhouse, puppets, or action figures. It may be directive or non-directive.
  • Cognitive Behavioral Play Therapy: The therapist may use play to help a child learn how to think and behave differently. A doll may be given advice about how to change her thinking or the therapist may ask the child to give a stuffed animal advice on how he can cope with a stressful situation. 

    Family Involvement

    Families are usually an important part of a child’s treatment. The level of involvement, however, is determined by the therapist.

    Sometimes, parents may attend sessions with a child. If the goal is to work on family issues, the parents may be directly involved in the play therapy (such as in the case of filial therapy).

    In other circumstances, a child may attend sessions alone. The therapist will usually then communicate with the caretakers about treatment goals and progress.

    Group Therapy

    Play therapy may be used in group settings. For example, a children’s grief group may include same-age children who engage in play therapy to help them deal with their loss. They might play with puppets, play games that help them identify their feelings, or engage in art projects as a group.

    Some schools offer play therapy groups. Children might work in a group setting with a play therapist to address social skills, like how to share, show kindness, and be respectful.

    Session Length

    Play therapy sessions vary in length depending on the treatment goals and the child’s needs and abilities. Most sessions last between 30 and 50 minutes. Appointments may be scheduled anywhere from once a month to twice a week.

    On average, 20 play therapy sessions are necessary to resolve issues, but some children improve much faster while others may require many more therapy sessions.

    Research on Play Therapy

    It’s common for parents to question whether play therapy is time and money well spent. It can seem like a stretch to think that playing with toys provides much in the way of emotional healing. 

    But studies conclude that play therapy can be very effective for children and their families. Here are just a few examples of research studies on play therapy:

    • Decreased hyperactivity in children with ADHD: A 2012 study published in the journal ADHD Attention Deficit and Hyperactivity Disorder found that cognitive-behavioral play therapy showed a significant decrease in hyperactivity in children who had been diagnosed with ADHD. The children showed improvements after eight group therapy sessions.
    • Reduced behavior problems, fewer internalizing problems, improved academic performance: A 2015 study reviewed 52 other play therapy studies. It concluded that play therapy provides significant treatment effects for a variety of problems, including behavioral issues, depression, and anxiety. Children attended an average of 12 therapy appointments.
    • Reduced aggression: A 2017 study examined the effect of play therapy on children with behavioral concerns. The children were between the ages of 6 and 9 and they received 20 sessions of therapy (two sessions per day for 30 minutes for 10 days). Based on caregiver responses to the Child Behavior Checklist, children showed a decrease in behavior problems, including aggression and rule-breaking.
    • Improved parent-child relationship in adoptive families: A 2017 study found that filial play therapy was effective in helping adoptive families bond. After seven sessions, lasting 30 minutes each, parents empathic behaviors increased, parent-child relationship stress decreased, and adopted children’s behavior problems improved.

    Finding a Play Therapist

    A licensed mental health professional with a master’s or higher professional degree is able to use play therapy in treatment. Some therapists have specialized training in play therapy, while others do not.

    Therapists who specialize in play therapy may be registered play therapists. The Association for Play Therapy offers credentialing for registered play therapists.

    If you think your child may benefit from play therapy, talk to your pediatrician. The pediatrician can assess your child’s needs and make a referral to a qualified mental health professional.

    You can also search for a play therapist on the Association for Play Therapy website. The directory contains an up-to-date list of registered play therapists around the world.

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    Article Sources
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