What is play therapy?

Introduction

Children of all ages learn about their environment, express themselves, and
develop relationships with others through their play activity. Play is an integral
part of childhood, an activity that must be allowed to facilitate a
child’s
development.
In fact, play is seen as such an important aspect of a child’s life
that the United Nations made the right to play an inalienable right for children
across the world. Some adults have labeled play a child’s “work,” and this may be
an appropriate way of looking at children’s play. Just as work fosters
self-esteem for adults, so does play enhance the self-esteem
of children. Just as adults learn to solve problems through their work, children
learn to cope with and invent solutions to problems through their play.

Growth through Play

Through play, children grow and learn in a number of ways. First, play helps
children grow emotionally; children learn to express their feelings, understand
their feelings, and control their emotions through play by acting out a variety of
situations and roles. They learn to share and cooperate with other children as
well as language, they learn to think in symbols, and they learn that the same
object can have different functions and that things can break and be repaired.
They also act out rules and regulations in play with other children. They learn
that some things hurt other people and should therefore not be done, and they
realize that rules often serve a purpose of protection or safety. All these growth
processes are extremely important by-products of play, but perhaps the most
important aspect of play is that of communication, defined here as the sharing of information with other people,
either through language or through other ways of interacting. Children tell about
themselves and their lives through play. Even when they do not yet have language
skills, they possess the ability to play.

Role of Therapist and Setting

This aspect of communication through play is perhaps the most important element
of play therapy. In play therapy, a therapist uses children’s play to understand
them and to help them solve problems, feel better about themselves, and express
themselves better. Children often have difficulty telling adults what they feel
and experience, what they need and want, and what they do not want and do not
like. Often, they lack the language skills to do so, and sometimes they are too
frightened to reveal themselves for fear of punishment or rejection.

In play therapy, however, the therapist is an adult who is empathic, sensitive,
and—above all—accepting and nonthreatening. The child is made to feel comfortable
in the room with this adult and quickly recognizes that this person, despite being
quite old (at least from the child’s perspective), understands the child and
accepts his or her wishes and needs. Children learn to play in the presence of
this therapist or with the therapist, and through this play, they communicate with
the therapist. They reveal through their activity what they have experienced in
life, how they feel, what they would like to do, and how they feel about
themselves.

The toys and activities that play therapists use vary significantly, though
therapists take great care to equip the room in which they work with the child in
such a way as to allow maximum freedom and creativity on the child’s part.
Therapists generally have art supplies such as clay, crayons, and paints; toy
kitchen appliances and utensils; baby items such as bottles and rattles; a variety
of dolls and dollhouses; toy guns and soldiers; toy cars and boats; blocks and
erector sets; and stuffed animals. All these materials share several important
traits: They foster creativity, have many different uses, are safe to play with,
and can easily be used by the child for communication. On the other hand,
therapists rarely have things such as board games or themed toys (for example,
television action heroes), because these toys have a definite use with certain
rules and restrictions, are often used merely to re-create stories observed on
television, or are not very handy for getting children to express themselves
freely. Most of the time, the toys are kept in an office that is specifically
designed for children, not a regular doctor’s office. As such, the room generally
has a child-size table and chairs but no adult-size desk. It usually has no other
furniture but may have some large cushions that the child and therapist can sit on
if they want to talk for a while. Often the room has a small, low sink for water
play, and sometimes even a sandbox. Floor and wall coverings are constructed of
easily cleaned materials so that spills are not a problem. The room is basically a
large play area; children generally like the play therapy room because it is
unlike any other room they have ever encountered and because it is equipped
specifically with children in mind.

Therapeutic Process

There are many reasons a child may be seen in play therapy. For example, a
referral may come from a teacher who is concerned about a drop in the child’s
academic performance; from day-care personnel who are concerned about the child’s
inability to relate to other children; from the child’s pediatrician, who believes
the child is depressed but cannot find a physical cause; or from parents who think
the child is aggressive or withdrawn. Whatever the reason, therapy begins with an
intake interview. The intake is a session during which the therapist meets not
only with the child but also with the parents and siblings in an attempt to find
out as much about the child as possible to gain an understanding of what is wrong.
Once the therapist knows what is happening with the child, recommendations for
treatment are made. Sometimes the recommendation is for the entire family to be
seen in family
therapy. Sometimes the recommendation is for the parents to be seen.
Sometimes the recommendation is for play therapy for the child.

Once a child enters play therapy, the child meets with the therapist once
weekly for fifty or sixty minutes (sometimes, for very young children, sessions
can be as short as thirty minutes) for several weeks or months. During the
sessions, the child decides what to play with and how, and the therapist is there
to understand the child, help the child solve problems, and facilitate growth and
self-esteem. The therapist never recommends toys or activities to the child nor
speculates aloud what the child's play might symbolize; instead, the child
self-directs his or her play activity without guidance from the therapist. Often,
while the child is being seen, the parents are also in some type of therapy
session themselves. Children’s problems often arise because of problems in the family, which is why it is rare that only the child is in treatment. Parents
are often seen so that they can work on their relationship either with each other
or with the whole family, or to learn parenting skills.

The first thing that happens in play therapy is that the therapist and the
child get to know each other and develop a positive relationship. Once the child
begins to trust the therapist, the child starts to reveal his or her needs,
wishes, concerns, fears, and problems through play. The therapist observes and
interacts with the child to help the individual work out problems, deal with
strong feelings, accept needs, and learn to deal with often difficult family or
environmental circumstances. All this work is done through the child’s play in
much the same way as children use play while growing up. In addition to using play
activity, however, the therapist uses the trusting relationship with the child.
Play therapy fosters open and voluntary communication, promotes creative
problem-solving, and builds trust and mastery.

Example of Therapy

The process of play therapy is best demonstrated by an example of an actual
play therapy interaction between a child and therapist. A nine-year-old boy was
referred by his teacher because he was depressed and frightened, had difficulty
making friends, and was not able to trust people. In the intake interview, the
therapist found out that the boy had been severely physically abused by his father
and that he was abandoned by his birth mother at the age of two. His stepmother
had brought three children of her own into the blended family and did not have
much time for this child. In fact, it appeared as though he was left to his own
devices most of the time. The family had a number of other problems but refused
family therapy. Thus, the child was seen in play therapy. He had considerable
difficulty trusting the therapist and showed this reluctance in his play. He would
often start to play, then check with the therapist for approval, and then stop
before he became too involved in any one activity. After six weeks, he realized
that the therapist was there to help him, and he began to communicate about his
family through play.

The following exchange is a good example of what happens in play therapy. One day, the boy picked up a large wooden truck and two small ones. He proceeded to smash the large truck into the small red one over and over. He took the other small truck and put it between the large one and the small red one, as if to protect the red truck from being hit by the large one. In the process, the small blue truck was hurt badly and had to retreat. The boy repeated this activity several times. The therapist picked up a toy truck of her own and drove between the large truck and both of the small trucks, indicating that she had a truck that was tough enough to stop the large truck from hurting the small ones. The child was visibly relieved and turned to another activity.

What had happened? Before the session, the therapist had received a call from
the child’s social worker, who told her that the night before, the boy’s father
was caught sexually abusing his four-year-old stepdaughter, who shared this boy’s
room. The boy had awakened and unsuccessfully tried to stop his father. He ran to
a neighbor’s house, and this woman called the police. The father was arrested but
threatened to get revenge on both children before he was taken away. The boy had
play-acted this entire scene with the toy trucks. The father was the large truck;
the red truck, his sister; the blue one, himself. The relief sensed by the boy
after the therapist intervened is understandable, as her truck communicated to the
boy that he would be protected from his father.

Evolution of Play Therapy

Children use their play in play therapy not only to communicate but also to
solve problems and deal with overwhelming feelings. How this happens has been
explained and described by many different therapists and theorists since play came
to be viewed as an acceptable means of conducting therapy in the early 1930s,
based on the work of Melanie Klein, Hug Hellmuth, and Anna Freud. These three psychologists
developed theories and play therapy methods that were based on Sigmund
Freud’s earlier psychoanalytic theories. In this approach, free
play was considered most important, and the therapist did not generally become
engaged at all in the play. The therapist merely reflected back to the child what
was seen and occasionally interpreted to the child what the play may have
meant.

In the 1940s, Virginia Axline developed her approach to play therapy, which was similar to Klein’s
and Freud’s. Axline also believed in free play and did not play with the child.
She interpreted and emphasized an environment that put no limits or rules on the
child. She introduced the idea that children in play therapy need to experience
unconditional acceptance, empathic concern, and a nondirective atmosphere. In
other words, Axline’s approach to play therapy was to sit and observe and not be
involved with the child.

Types of Play Therapists

Since then, the lack of limit setting (imposing rules or regulations on another person and then enforcing them in a predictable way), as well as the lack of active involvement with children in play therapy, has been criticized by play therapists. Nowadays, play therapists are more likely to get involved in play and to respond to children through play activity (as in the example), as opposed to using language to communicate with them. There are two major groups of therapists who use play therapy. Traditional psychoanalytic or psychodynamic therapists who are followers of Klein or Axline make up one group; however, even within this group, there is much diversity with regard to how involved the therapist becomes with the child’s play. The second group is composed of therapists who focus on the human interaction that takes place—that is, humanistic therapists.

Regardless of which group a play therapist belongs to, however, the primary
ingredients that were proposed many years ago remain intact. Free play is still
deemed important, and empathy is stressed in the relationship with the child. Many
therapists believe that the interpersonal matrix—the environment and the
relationship between two or more people who spend time together—that exists
between the child and the therapist is critical to changes noted in the child. A
national center for play therapy has been created at the University of North
Texas, and the field is represented by the Association for Play Therapy, located
in Fresno, California, which publishes three major quarterly periodicals:
The International Journal of Play Therapy, The
Association for Play Therapy Newsletter, and Play
Therapy. Recent trends in the field include the incorporation of play
therapy by elementary school counselors and early childhood educational entities;
the incorporation of play therapy in family therapy, in the form of filial
therapy, where parents are trained to use techniques with their children; and the
application of play therapy theory to children with special needs or disabilities
and children with limited language skills (such as children with severe
autism). Overall, a primary focus remains on the symbolism
(the use of indirect means to express inner needs or feelings; a way of sharing
oneself without doing so directly or in words) and metaphor expressed by children
through play.

Bibliography

Axline, Virginia Mae.
Dibs: In Search of Self. New York: Ballantine, 1990.
Print..

Axline, Virginia Mae.
Play Therapy: The Inner Dynamics of Childhood. Boston:
Houghton, 1947. Print.

Davis, Eric S., and Jennifer K. Pereira.
"Child-Centered Play Therapy: A Creative Approach to Culturally Competent
Counseling." Journal of Creativity in Mental Health 9.2
(2014): 262–74. Print.

Dodds, J. B. A.
Child Psychotherapy Primer. New York: Human Sciences,
1985. Print.

Gil, Eliana, and
Athena A. Drewes. Cultural Issues in Play Therapy. New
York: Guilford, 2005. Print.

Landreth, G. L.
Play Therapy: The Art of the Relationship. 2nd ed. New
York: Brunner-Routledge, 2002. Print.

Nemiroff, Marc A., and
Jane Annunziata. A Child’s First Book About Play Therapy.
Washington: American Psychological Assoc., 1990. Print.

Pass, Stephanie. "The Mummy at the Door: Play
Therapy and Surviving Loss." Journal of Infant, Child &
Adolescent Psychotherapy 13.2 (2014): 142–53. Print.

Reddy, Linda A., Tara
M. Files-Hall, and Charles E. Schaefer. Empirically Based Play
Interventions for Children. Washington: American Psychological
Assoc., 2005. Print.

Schaefer, Charles E.,
and S. E. Reid. Game Play: Therapeutic Use of Childhood
Games. 2nd ed. New York: Wiley, 2001. Print.

Schaefer, Charles E.,
and Heidi Kaduson, eds. Contemporary Play Therapy: Theory, Research,
and Practice. New York: Guilford, 2006. Print.

Schaefer, Charles E.,
and Kevin J. O’Connor, eds. Handbook of Play Therapy. 2
vols. Somerset: Wiley, 1983–1994. Print.

Swan, Karrie L., and Dee C. Ray. "Effects of
Child-Centered Play Therapy on Irritability and Hyperactivity Behaviors of
Children with Intellectual Disabilities." Journal of Humanistic
Counseling 53.2 (2014): 120–33. Print.

Trice-Black, Shannon, Carrie Lynn Bailey, and
Morgan E. Kiper Riechel. "Play Therapy in School Counseling."
Professional School Counseling 16.5 (2013): 303–12.
Print.