What is play therapy?

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Play therapy is a method of treating children who have emotional problems, psychological difficulties, or mental disorders. It is conducted in a room specifically equipped for this purpose with toys and activity materials to aid the child in solving problems and to enhance mental health. It most commonly involves one child and one therapist, though it can be conducted with groups of children.
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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

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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.

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