The idea of play therapy

“We are never more fully alive, more completely ourselves or more deeply engrossed in anything than when we are playing”. -Charles Schaefer

Play is the primary way that children learn about the world, understand how different things work, express their thoughts and feelings, develop their physical skills, develop their mental skills, and develop effective social skills and bonds. As children grow, their use of language becomes more sophisticated, but throughout childhood, they usually express much more of themselves in their play. We can understand children better if we understand their play. Rather than engaging in verbal communication, we often learn more about their thoughts, feelings, motivations, and struggles by watching children play. Children more effectively communicate their thoughts and feelings through play than they do through verbal communication. As the child plays, the therapist begins to recognize themes and patterns or ways of using the materials that are important to the child. Over time, the clinician helps the child begin to make meaning out of the play.

The Association for Play Therapy (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” (www.a4pt.org). Although the idea of play therapy was introduced over 80 years ago, this therapeutic approach has only begun to experience major growth and development within the last 20 years and is still considered to be relatively new in modern therapy practices. Within the past 10 years, play therapy has become more recognized as an effective intervention to reduce challenging behaviors associated with social, emotional, behavioral, and learning difficulties in adults, children and adolescents. While researching this approach, I found it increasingly difficult to find information relative to the proven clinical practice of play therapy as most of the information pertaining to play therapy still focuses widely on reliability and studies to prove that it is even an effective practice.

Because play is so familiar to children, it is a zone of comfort that permits counselors to approach clients in a nonthreatening environment. When children play, they feel safe. They don’t respond to simply talking and listening to an adult conversation. Play Therapists use play to help children express feelings about many issues. Children can use play to address feelings about loss and divorce. Children who have been victims of abuse or have experienced a trauma can also benefit. Even a child who is having trouble with peer relations or conduct in school can benefit from play. Children often express their feelings behaviorally and this can be misdiagnosed as ADD/ADHD resulting in these children being medicated unnecessarily. Effects of trauma, loss, and divorce can mimic the symptoms of ADD/ADHD. Instead of using medication as the first option of treatment, children and their therapists can utilize play therapy to work on those feelings. The main goal of play therapy is to eliminate behavioral and emotional difficulties that prohibit a child to function normally, especially in regards to improved communication and understanding between the child and his parents, family, and peers. By using play therapy techniques, the therapist can allow a child or adult to become more aware of their emotions and eliminate any negative behavior that may be a direct result of their emotional and behavioral difficulties. Less obvious goals of play therapy include improved verbal expression, ability for self-observation, improved impulse control, more adaptive ways of coping with anxiety and frustration, and improved capacity to trust and to relate to others. Although play therapy has been proven to be effective for children with various kinds of disorders, it is not as helpful for certain types disorders or illnesses, such as children with the most severe degree of autism and schizophrenia (Landreth, 2002). These two types of children live so exclusively in their own world that they cut off interaction with the outside world completely. Because they lack the ability and/or willingness to interact with people and objects, I believe that play therapy might not be the best therapeutic approach for these children.

Play Therapy involves the use of role playing, toys, blocks, dolls, puppets, and games to help the child recognize, identify, and verbalize feelings and to communicate what has happened to them and how they feel about these events in their lives. Often, a child will allow a doll or puppet to say things that the child does not feel they are free to tell to anyone. Skilled therapists also use drawing and art work to allow feelings to flow and become expressed. The therapist observes how the child uses play materials and identifies themes or patterns to understand the child’s problems. Play therapy is particularly effective with children who cannot, or do not want to talk about their problems. Through a combination of talk and play the child has an opportunity to better understand and manage their conflicts, feelings, and behavior. Sand play therapy is one form of play therapy which allows greater exploration of deep emotional issues. Sand play therapy is suitable for children and adults and allows them to reach a deeper insight and reconciliation of a range of issues in their lives such as internal conflicts that manifest as anxiety and depression, as well as penetrating the depths of personality to experience the self directly. Through a safe and supportive process, clients place miniature figurines in a small sand box to express confusing feelings and inner experiences. This creates a visual representation of the unconscious and reveals concerns that are inaccessible any other way. As materials contained in the unconscious emerge visually and symbolically, it is integrated into a person’s sense of self and can be activated to elicit behavioral change. Sand play therapy is an expressive and creative way of working which does not rely on traditional “talk” therapy.

Two major approaches of play therapy are Non-directive (Child-Centered) play therapy and Directive (Cognitive Behavioral Model) play therapy. A skilled practitioner will adopt a mix of both approaches according to each individual child and their circumstances. In non-directive play therapy, the therapist remains supportive, but non-intrusive, and responsibility and direction are left to the child, which emphasizes empowering the client, self-awareness, decision-making, and acceptance of the client’s self. In directive play therapy, the therapist aquires responsibility for guidance and interpretation of the therapy by taking an active role in the play and structuring the session for assessment, diagnostic, and treatment purposes. One key concern of non-directive techniques is that young children may not necessarily have the cognitive skills and emotional capacity to repair and master traumatic experiences on their own. Upon researching the information that I found on the different ways to apply play therapy to therapeutic sessions, I personally found directive play therapy to be the most efficient. I like the idea of having more control over sessions and getting the information I need to successfully identify problems and issues for the child. Though both practices use similar ways of play and creative expression for the child, in my opinion directive therapy seems to be the best approach for my own personal counseling style.

One issue that comes up most often in regards to the boundaries of play therapy is hugging and/or physical contact. In any therapeutic relationship, it is important for the client to realize that the therapist cares. Therapists accomplish this in traditional “talk” therapy by attentive listening, reflecting, and empathy with little to no touch involved. This can be quite different when working with children in a play setting. Children can be naturally very impulsive, and may hug the therapist in response to a positive or negative feeling. It is important for the therapist to be aware that hugging and touch are used in many different types of relationships and have a variety of meaning. An ethical response to this issue is to abstain from hugging all clients, especially child clients (McGuire & McGuire, 2001). On the other hand, if a therapist is hugged by a child, remaining stiff may send a negative message to the client (Landreth, 1999). Although I found the literature on ethical issues in play therapy to be lacking, the information I did find was illuminating. It certainly caused me to think more in-depth about the many ethical situations that are specific to working with children and to play therapy. This means being aware of potential ethical issues before they arise and planning in advance on how I would react to those situations. I liked the direction that the literature appears to be heading, which is providing play therapists with more effective and universal guidelines for ethical problem solving.

The practice of play therapy requires extensive specialized education, training, and experience. A play therapist is a licensed (or certified) mental health professional who has earned a Master’s or Doctorate degree in a mental health field with considerable general clinical experience and supervision (www.a4pt.org). Unfortunately, according Dr. Garry Landreth, who is one of the major key contributors to the field of play therapy, many therapists practicing play therapy do not have the specialized training needed with less than half of the therapists currently practicing play therapy having taken a graduate course in the field. Children are a special client population, and simply having a degree in counseling or another similar field does not qualify a person to provide therapy for them (Corey, Corey, & Callanan, 2007).

When Dr. Landreth (2001) outlined what play therapy can do for children he also told us what areas of development are often a struggle for children and adults alike. Children start their lives with an amazing skill to play that far too often gets lost in the confusion of the adult world. Many adults still cannot claim responsibility for their actions or to accept themselves for who they are as people. Play, whether with games, puppets, drums, clay, sports, motion, drawing, drama, dolls, sand, or whatever else is available, invites a cascade of positive effects. There are endless possibilities for the use of play therapy with adults (Schaefer, 2003). Play therapy for adults can also allow the bonding with others to form healthy relationships for people who may have experience only with serious dysfunctional interactions. When adults enter into play therapy, they are able to gain access to their inner child. Very often, emotional repression and unhealthy feelings are formed in childhood and adults learn to ignore surface exhibition of these emotional traumas. However, with adult play therapy the person has the space to realize and act out those feelings and they can reach a resolution and closure, allowing them to become happier, healthier people.

In the limited amount of research that I found on the topic of play therapy, it seems as though there is a lack of consistency among the definitions and its implementation. Some articles and texts clearly defined play therapy; others seemed to distort a traditional definition to fit their purpose. I honestly do not know if there truly is a pure form or definition of play therapy. I did however, through my research, find that the various techniques of play therapy used seemed to be quite effective at helping children to deal with a wide array of issues.

In conclusion, I believe that play therapy is a fun, innovative, valid, and effective means of helping clients to express feelings that they have unconsciously repressed or avoided. It can be a very healthy outlet and can be useful at times when traditional talk therapy simply doesn’t work. Dr. Landreth (2002) states that “play is a child’s language and toys are his/her words.”