Play Therapy

WHY PLAY?

In recent years a growing number of noted mental health professionals have observed that play is as important to human happiness and well-being as love and work (Schaefer, 1993). Some of the greatest thinkers of all time, including Aristotle and Plato, have reflected on why play is so fundamental in our lives. The following are some of the many benefits of play that have been described by play theorists.

Play is the child’s language and …

Play is a fun, enjoyable activity that elevates our spirits and brightens our outlook on life. It expands self-expression, self-knowledge, self-actualization, and self-efficacy. Play relieves feelings of stress and boredom, connects us to people in a positive way, stimulates creative thinking and exploration, regulates our emotions, and boosts our ego (Landreth, 2002). In addition, play allows us to practice skills and roles needed for survival. Learning and development are best fostered through play (Russ, 2004).

WHY PLAY IN THERAPY?

Play therapy is a structured, theoretically based approach to therapy that builds on the normal communicative and learning processes of children (Carmichael, 2006; Landreth, 2002; O’Connor & Schaefer, 1983). The curative powers inherent in play are used in many ways. Therapists strategically utilize play therapy to help children express what is troubling them when they do not have the verbal language to express their thoughts and feelings (Gil, 1991). In play therapy, toys are like the child’s words and play is the child’s language (Landreth, 2002). Through play, therapists may help children learn more adaptive behaviors when there are emotional or social skills deficits (Pedro-Carroll & Reddy, 2005). The positive relationship that develops between therapist and child during play therapy sessions can provide a corrective emotional experience necessary for healing (Moustakas, 1997). Play therapy may also be used to promote cognitive development and provide insight about and resolution of inner conflicts or dysfunctional thinking in the child (O’Connor & Schaefer, 1983; Reddy, Files-Hall, & Schaefer, 2005).

WHAT IS PLAY THERAPY?

… toys are the child’s words!

Initially developed in the turn of the 20th century, today play therapy refers to a large number of treatment methods, all applying the therapeutic benefits of play. Play therapy differs from regular play in that the therapist helps children to address and resolve their own problems. Play therapy builds on the natural way that children learn about themselves and their relationships in the world around them (Axline, 1947; Carmichael, 2006; Landreth, 2002). Through play therapy, children learn to communicate with others, express feelings, modify behavior, develop problem-solving skills, and learn a variety of ways of relating to others. Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development.

APT defines play therapy as “the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.”

HOW DOES PLAY THERAPY WORK?

Children are referred for play therapy to resolve their problems (Carmichael; 2006; Schaefer, 1993). Often, children have used up their own problem solving tools, and they misbehave, may act out at home, with friends, and at school (Landreth, 2002). Play therapy allows trained mental health practitioners who specialize in play therapy, to assess and understand children’s play. Further, play therapy is utilized to help children cope with difficult emotions and find solutions to problems (Moustakas, 1997; Reddy, Files-Hall, & Schaefer, 2005). By confronting problems in the clinical Play Therapy setting, children find healthier solutions. Play therapy allows children to change the way they think about, feel toward, and resolve their concerns (Kaugars & Russ, 2001). Even the most troubling problems can be confronted in play therapy and lasting resolutions can be discovered, rehearsed, mastered and adapted into lifelong strategies (Russ, 2004).

WHO BENEFITS FROM PLAY THERAPY?

Although everyone benefits, play therapy is especially appropriate for children ages 3 through 12 years old (Carmichael, 2006; Gil, 1991; Landreth, 2002; Schaefer, 1993). Teenagers and adults have also benefited from play techniques and recreational processes. To that end, the use of play therapy with adults within mental health, agency, and other healthcare contexts is increasing (Pedro-Carroll & Reddy, 2005; Schaefer, 2003). In recent years, play therapy interventions have also been applied to infants and toddlers (Schaefer et. al., 2008).

HOW WILL PLAY THERAPY BENEFIT A CHILD?

Play therapy is implemented as a treatment of choice in mental health, school, agency, developmental, hospital, residential, and recreational settings, with clients of all ages (Carmichael, 2006; Reddy, Files-Hall, & Schaefer, 2005).

Play therapy treatment plans have been utilized as the primary intervention or as an adjunctive therapy for multiple Mental Health Conditions and Concerns (Gil & Drewes, 2004; Landreth, Sweeney, Ray, Homeyer, & Glover, 2005), e.g. anger management, grief and loss, divorce and family dissolution, and crisis and trauma, and for modification of Behavioral Disorders (Landreth, 2002), e.g. anxiety, depression, attention deficit hyperactivity (ADHD), autism or pervasive developmental, academic and social developmental, physical and learning disabilities, and conduct disorders (Bratton, Ray, & Rhine, 2005).

Research supports the effectiveness of play therapy with children experiencing a wide variety of social, emotional, behavioral, and learning problems, including children whose problems are related to life stressors, such as divorce, death, relocation, hospitalization, chronic illness, assimilating stressful experiences, physical and sexual abuse, domestic violence, and natural disasters (Reddy, Files-Hall, & Schaefer, 2005). Play therapy helps children:

Become more responsible for behaviors and develop more successful strategies.
Develop new and creative solutions to problems.
Develop respect and acceptance of self and others.
Learn to experience and express emotion.
Cultivate empathy and respect for the thoughts and feelings of others.
Learn new social skills and relational skills with family.
Develop self-efficacy and thus a better assuredness about their abilities.

Meta-analytic reviews of over 100 play therapy outcome studies (Bratton et. al., 2005; Leblanc & Ritchie, 2001) have found that the overall treatment effect of play therapy ranges from moderate to high positive effects. Play therapy has proven equally effective across age, gender, and presenting problems. Additionally, positive treatment effects were found to be greatest when there was a parent actively involved in the child’s treatment.

HOW LONG DOES PLAY THERAPY TAKE?

Each play therapy session varies in length but usually last about 30 to 50 minutes. Sessions are usually held weekly. Research suggests that it takes an average of 20 play therapy sessions to resolve the problems of the typical child referred for treatment. Of course, some children may improve much faster while more serious or ongoing problems may take longer to resolve (Carmichael, 2006; Landreth, 2002).

HOW MAY MY FAMILY BE INVOLVED IN PLAY THERAPY?

Families play an important role in children’s healing processes. The interaction between children’s problems and their families is always complex. Sometimes children develop problems as a way of signaling that there is something wrong in the family. Other times the entire family becomes distressed because the child’s problems are so disruptive. In all cases, children and families heal faster when they work together.

The play therapist will make some decisions about how and when to involve some or all members of the family in the play therapy. At a minimum, the therapist will want to communicate regularly with the child’s caretakers to develop a plan for resolving problems as they are identified and to monitor the progress of the treatment. Other options might include involving a) the parents or caretakers directly in the treatment by modifying how they interact with the child at home and b) the whole family in family play therapy (Guerney, 2000). Whatever the level of involvement of the family members, they typically play an important role in the child’s healing (Carey & Schaefer, 1994; Gil & Drewes, 2004).

WHO PRACTICES PLAY THERAPY?

The practice of play therapy requires extensive specialized education, training, and experience. A play therapist is a licensed mental health professional who has earned a Master’s or Doctorate degree in a mental health field with considerable general clinical experience and supervision.

With advanced, specialized training, experience, and supervision, mental health professionals may also earn the Registered Play Therapist (RPT) or Registered Play Therapist-Supervisor (RPT-S) credentials¹ conferred by the Association for Play Therapy (APT).

AUTHORS

The information displayed for the general public and mental health professionals in this section was initially crafted by JP Lilly, LCSW, RPT-S, Kevin O’Connor, PhD, RPT-S, and Teri Krull, LCSW, RPT-S and later revised in part by Charles Schaefer, PhD, RPT-S, Garry Landreth, EdD, LPC, RPT-S, and Dale-Elizabeth Pehrsson, EdD, LPC, RPT-S. Linked mental health conditions and concerns and behavioral disorders were drafted by Pehrsson and Karla Carmichael, PhD, LPC, RPT-S respectively. Research citations were compiled by Pehrsson and Oregon State University graduate assistant Mary Aguilera. APT sincerely thanks these individuals for their contributions!

STAGES IN PLAY THERAPY

As a parent, you will play a crucial role in every phase of your child’s play therapy which, typically, proceeds through as many as seven phases.

During your very first meeting with your child’s play therapist, he or she will conduct an intake interview during which you will be asked questions about your child’s early development, current functioning and presenting problem. It is very important to be as open and honest as possible during the intake as this information will form the foundation of the play therapist’s understanding of both your child’s difficulties and the treatment plan. Most play therapists will also complete a separate intake interview with your child to get a solid sense of his or her experience of the problems and to make sure your child feels fully engaged in the treatment process right from the beginning.

Depending on the play therapist and your child’s presenting problem the therapist may decide to conduct a pre-treatment assessment. The assessment may be as simple as having you complete one or more questionnaires. Your child may be asked to complete a variety of pretreatment measures ranging from questionnaires, to drawings, to more formal testing. Sometimes the play therapist will choose to observe your child at play either alone or with you and/or other family members. However it is completed, the assessment process provides the play therapist with additional information about your child’s difficulties and the best ways to go about treating them. Assessments can also be very useful in helping the play therapist evaluate your child’s progress during treatment.

Having completed the intake and any pre-treatment assessments, your child will begin treatment. The first few sessions are referred to as the Introduction phase. During this phase your child will be getting used to the play therapist, the playroom, and the play therapy process. The more shy or anxious your child is, the more difficult this period may be. You can help by providing your child with a lot of encouragement so he or she will give the treatment a chance to begin working.

After anywhere from one to several sessions, your child will enter into the Tentative Acceptance phase of treatment. During this phase, your child will probably look forward to the play therapy sessions and be eager to enter the playroom and to interact with the play therapist. For you as a parent, this is usually one of the easiest treatment phases.

As the play therapy begins to work, your child will begin to make some changes. While these changes are necessary, they may not be easy. Initially, change makes all of us uncomfortable. We are trying to behave in ways we are not used to and may fluctuate between attempts to engage in healthy new behaviors and attempts to retreat to older, more comfortable patterns. This is called the Negative Reaction phase. Some children pass through this phase with virtually no problems. Other children go through a period where their problems actually get worse and they may actively resist going to the play therapy sessions. Once again, you may need to provide your child with a great deal of support to get through this phase. Let your child know you have confidence in the therapy process and his or her ability to be happier and healthier in the long run.

The Introduction, Tentative Acceptance and Negative Reaction phases may all pass quite quickly, potentially in as few as three or four sessions, or they may last for several months. Once these phases pass your child will enter the Growing phase. This is the most important and, usually the longest, part of the play therapy process. During this phase your child will come to better understand his or her difficulties, how to best resolve those difficulties and how to live a much happier and playful life. Surprisingly, this phase can be a bit difficult for parents. Typically, children will make significant advances and then slide right back into some of their problem behaviors or symptoms. These regressions can frustrate both children and parents. Again, everyone needs to trust the process, celebrate the gains and try not to worry too much about any occasional slips.

The last phase of play therapy is called the Termination phase. It begins when your child’s behavioral and emotional functioning have stabilized to the point that you, your child and the play therapist are all confident in your child’s ability to maintain those gains without regular play therapy sessions. Surprisingly, this phase can be difficult for children. Adults in therapy are pleased when their symptoms subside and soon realize they can maintain the improvement on their own. They see the end of therapy as a sign of their success. Children often enter therapy only reluctantly and do so at a point when they are experiencing all sorts of symptoms and distress. Gradually, they become comfortable with the play therapist and the play therapy process and begin to experience symptom relief, becoming happier and more playful. Then, just as things are going well, they find it time to end therapy. For some children, this feels more like a punishment than a reward and they may react with a temporary recurrence of their symptoms. Just as with earlier rough spots in the play therapy process, it will be important for you to maintain your confidence in your child’s ability to continue to be happy and healthy and to convey that confidence to your child. With everyone’s efforts, the end of therapy can truly be a celebration of your child’s gains and a genuinely happy and playful event.

No matter the particular course of your child’s play therapy, you will play a variety of very important roles all along the way. The play therapist will rely on you to help determine how well the therapy is progressing and to report any changes, good or bad, as they arise. Depending on the nature of your child’s difficulties, the play therapist may also ask you and/or various other family members to participate directly in one or more of your child’s play therapy sessions. This can be a great way for you, your child and the play therapist to work together to ensure everyone is getting the most out of the treatment. Lastly, the play therapist will also work with you and advise you in ways to support your child between sessions. After all, you are the most important person in your child’s life and no amount of play therapy can ever replace the support and guidance you are there to provide.

Contributed by:

Kevin O’Connor, PhD, ABPP, RPT-S

Co-founder, Association for Play Therapy

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