Introduction
“Birds fly, fish swim, children play.” -Gary Landreth
If you have ever been at an event with children and adults, you have seen the importance of play. As the adults mingle, the children run around, explore outside, or run to their toys. When children bump up against the adults in conversation, they are often told to “go play!”.
If we know that children’s most natural means of communicating and relating to their world is through play, it makes sense that their therapy would be in the language they know best. The language of play!
Definition and overview of play therapy
Don’t let the name fool you. Play therapy is not trivial, it is a serious and well-researched therapeutic approach and a powerful tool to help children function and thrive. Play therapy does not teach children how to play. Instead, it uses the powers inherent within play to help children work through challenges in a developmentally appropriate way.
Though humans have used play therapeutically for thousands of years, therapy with children, specifically play therapy, was first documented in the work of Melanie Klein, a student of Sigmund Freud.
“She found that through the use of play, children were able to project their feelings and anxieties. This non-verbal behavior was therefore seen as a window into the child’s unconscious” (Play Therapy, n.d.).
Throughout the twentieth century, more theorists would arise and make efforts to approach pediatric mental health treatment.
Through research initiated by Dr. Charles Schaefer and Dr. Athena Drewes (2014), they found that play helps children in a wide range of ways, including:
- Play facilitates communication
- Play fosters emotional wellness
- Play enhances social skills and relationships
- Play increases personal strengths
- Play helps children develop problem-solving skills
- Play allows children to express themselves without words
- Play helps children experience their emotions in real time
- Play helps children to form relationships with themselves and others
- Play helps children build a sense of esteem and empowerment
While there are many different approaches to play therapy interventions, most child therapists would agree that the powers of play are the “secret sauce” that makes play such an effective approach when working with children.
Importance of self-expression in child development
Most would agree that one of our primary needs as human beings is the need to be seen and understood. When we feel overlooked or misunderstood, mental health issues increase and our relationships become strained.
Before children can communicate verbally, they self express through their cries, coos, body movements, and facial expressions. Once children begin to speak, we tend to bombard them with questions and information.
Though children can and do communicate verbally, that is only one way they self express. We know that through play, children are able to express what they see, hear, think, feel, and wish. Play allows children to express feelings that are hard to describe, explore concepts that don’t make sense yet, and find new solutions to problems or difficult emotions they may be experiencing. Play also gives children a sense of mastery over how they express themselves. It would not make sense to give a five year old a pencil and encourage them to write an essay about the story of their life. But give them a puppet, dolls, or dress up materials and they will show us their world.
Types of Play Therapy
Play therapy is an umbrella term that is used to describe a therapeutic approach that considers play as the vehicle for change within a child’s world. Under the play therapy umbrella are several approaches which fall into two categories: directive play therapy and non-directive play therapy.
Simply put, directive play therapy is just what it sounds like. The therapist leads or “directs” the focus of the session. The therapist may have a specific skill they are trying to teach and will use play materials to help the child learn.
Non-directive play therapy is an approach where the therapist sets aside any agenda and allows the child to lead. Non directive play therapists believe what one of the pioneers of play therapy, Gary Landreth, expressed: “toys are children’s words and play is their language”. Just like an adult would go to therapy and express themselves verbally, non-directive play therapists observe a child’s play as their communication skill. They do not lead, change, or provoke through play. Instead they are trained to listen by watching and reflecting the child’s play and emotional expressions. The goal of non-directive play therapy is to empower children to feel a sense of competence over their world.
Techniques and Materials
If “toys are children’s words” then the toys offered in play therapy are especially important. Play therapists are intentional about the toys they select. Generally, toys fall in to the following categories to allow for full expression of emotion (Playroom | Center for Play Therapy, n.d.):
Real life and nurturing toys: dolls, doll houses, food, money, animals, medical supplies, etc.
Acting out and aggressive toys: aggressive animals, swords, shields, handcuffs, etc.
Creative and expressive toys: art materials, sand, dress up clothes, instruments, etc.
Therapeutic Goals and Objectives
Much like therapy for adults, the heart of play therapy lies within the child’s trust in the therapist and the therapist’s regard for the child. To facilitate a secure, trusting, and safe relationship the therapist focuses on accepting the child exactly as they are. The therapist is predictable in their responses to the child, only sets limits when limits are needed, and believes that the child has an inherent capacity towards growth and healing.
With a solid foundation of established safety, specific treatment goals can bloom. In non-directive play therapy, there are four expected outcomes associated with treatment (Hicks, 2024):
- Increased self esteem: “I am capable”
- Improved self regulation: “I can manage the ups and downs of life”
- Increased world view: “I can consider another person’s perspective”
- Increased emotional vocabulary: “I can express how I’m feeling”
Role of the Therapist
The play therapist’s role is to convey respect and acceptance of the child in a safe environment. They are not the child’s teacher, friend, or parent. They are a supportive presence who encourages the child to make decisions for themselves, consider their feelings, and explore new ways of approaching their challenges. Mental health professionals who are trained as play therapists are generally fairly permissive as we see the playroom as a practice ground for responsible decision making. There is power in helping children learn how to make responsible decisions, rather than be told what and how to act.
An important piece of most play therapist’s work is their time spent with parents. Most play therapists would agree that children will feel better sooner when their parents are an active part of their treatment. Depending on the therapist’s approach, parents can be involved in a number of ways. This could include:
- Establishing goals for their child’s care
- Consulting with the therapist regarding how to respond to their child’s behavior
- Joining the child in session to learn new ways of connecting with each other
Additionally, play therapists are trained in child development. As a result, they can help parents understand developmental milestones and age appropriate expectations.
Setting up the Environment
When I was a kid, one of my favorite memories was going to the dentist. We saw a pediatric dentist whose office felt like a play zone. There were fish tanks, toys, murals, and even a Nintendo-64. My dentist spoke the language of children. Looking back, I imagine that his job was easier because the kids who saw him weren’t as afraid as they could have been. He made the dentist feel like a healing place. Teeth still got cleaned and cavities were filled, but in an environment that felt safe instead of scary.
Though most adult therapy offices feature a couch, pictures, and plants, play therapy is traditionally done in a playroom. But unlike most playrooms, a play therapy room is carefully equipped with specific toys, games, and art supplies. Within the playroom, children do the work of therapy in a setting that feels safe.
As play therapists, we do our best to ensure the playroom stays consistent from week to week. To do this, we carefully clean the room after each session. Children are encouraged to keep the toys in the playroom so they can return to them, week after week.
Play Therapy In Action: Eli
When I explain play therapy to unfamiliar listeners, it almost sounds like magic. Most people ask: “How does it work?” and “How is play therapy different from just playing with a child?” To illustrate this concept, I will share an example. Note that identifying information has been changed:
5 year old Eli had been seeing me for several months. He was referred by his parents who were concerned about the physical symptoms he frequently expressed. He did well in school and got along with other children, but he woke up most mornings complaining of stomach aches. No matter how much his parents tried talking to him, the pain did not go away. When the doctor could not find a clear cause for his symptoms, play therapy was suggested.
Throughout our time together, Eli gravitated towards the same type of independent play, week after week. He would create elaborate artwork with felt and pom-poms and glue. Other times he would use the dollhouse and play out scenes of kids playing soccer against each other at recess. Eli would be the referee. Sometimes he would initiate conversation, but most of the time he created art and played alone.
In time, Eli began including me in his play during the therapy session. He started asking me questions. He went from a timid child to one that felt empowered enough to communicate his needs. I observed that Eli was someone who had learned to internalize his feelings, likely leading to the onslaught of distressing physical feelings. His parents noticed that he started expressing himself at home and soon, instead of feeling sick, he started saying: “I feel scared”.
With his fear, we found ways to approach it. We learned that a child in his class was bullying him and contributing to his difficulty going to school. Eli began asking his teacher for help when he felt overwhelmed. After a while, Eli was waking up without stomach aches.
Eli’s story demonstrates the power of play. Because he didn’t yet have the words or confidence to say: “I feel scared” he showed me his need for predictability and control. He was able to practice assertiveness in his play and with me. And with more confidence, he learned to apply those same skills with his parents and teacher.
Conclusion and Call to Action
Play therapy is not magic, it is therapy in a language that allows children to fully express themselves.
Next time we assume a misbehaving or worried child needs to be “talked to”, may we remember this:
Though children can communicate verbally, they act and feel at a pre-verbal level. Without the development of abstract reasoning, they are not yet able to connect the dots between their thoughts, emotions, behaviors, and goals for the future. They live in the present moment and are driven by impulse more than logic. When we approach children where they are, we begin to see the world as they see it. Then, we can join them in creating a new world that aligns with what they need.
Blog written by Sentier therapist Lily Ferreira, MSW, LICSW, RPT
Sources
Hicks, B. (2024, January 4). SMART Goals and Child-Centered Play Therapy: How to Bridge the Gap in a School Setting. Play Therapy Podcast. Retrieved May 1, 2024, from https://www.playtherapypodcast.com/smart-goals-and-child-centered-play-therapy-how-to-bridge-the-gap-in-a-school-setting/
Playroom | Center for Play Therapy. (n.d.). Center for Play Therapy. Retrieved May 1, 2024, from https://cpt.unt.edu/playroom
Play Therapy. (n.d.). Help to Heal. Retrieved March 29, 2024, from https://www.helptoheal.co.uk/method/play-therapy
Schaefer, C. E., & Drewes, A. A. (Eds.), (2014). The therapeutic powers of play: 20 core agents of change (2nd ed.). Hoboken, NJ: Wiley.
