The most frequently expressed concern about Play Therapy is the perception that there is no apparent treatment goal and that activities are purely about play. This could not be further from the truth!
What is Play Therapy?
Play Therapy is a type of therapy intended for children that uses play to communicate. Play is a natural medium for children, and unlike adults, children do not typically engage in conversation about what is bothering them, especially younger children. Often it is because of the child’s developmental growth—they are not yet able to articulate their thoughts and feelings. Another common reason is that a child may not feel emotionally safe in expressing their thoughts and feelings. When children struggle, they often act out their struggles and exhibit behavior that are perceived as problematic and prompt parents to reach out for help.
A word to parents
It is important to keep in mind that every therapist utilizes play therapy differently. Some may adhere to one form of play therapy while most use an eclectic approach; a combination of both non-directive and directive play therapies.
If you have questions about the type of play therapy and play activities your child is participating in, ask! You have a right to be informed of the therapist’s treatment plan and how session activities are designed to reach treatment goals.
Parents can also expect therapists to work directly with them to facilitate growth and change for their child. Change requires the parent(s) to interact with their child differently, and these new ways of interaction but be implemented with consistency. Do not be discouraged if you hear the therapist repeating themes and recommendations. We are fully aware that change takes time and are appreciative of any effort parents make for the sake of their child – this is good parenting!
*See below of answers to frequently asked parent questions.
What does it look like?
Yes, it looks like play—but there is a therapeutic goal in mind. Generally, all forms of play therapy aim to provide a child with a safe place where they feel their inner world is unconditionally understood and accepted, help them learn to identify, deepen, reflect on, express, process, and manage difficult thoughts and feelings, to expand their window-of-tolerance (or their resilience to arousing stimuli), and to develop a positive self-concept.
Play Therapy examples:
Bubble play: A therapist instructs a child to pop the bubbles with a certain part of their body, such as their arms, feet, elbows, or chin. This is a challenging activity that not only engages a child’s interest but is also a good exercise to help a child exercise self-control, turn-taking, and adherence to structure.
Squiggles Drawing: A therapist folds a piece of paper into eight squares and directs the child to draw a different squiggle in each box. The squiggles may be drawn in whatever form and color(s) the child wishes. The therapist next helps the child cut and arrange the squiggles to create a storyline. Often children create stories reflecting events that are going on in their own lives, and a therapist can use the child’s storyline to explore and process thoughts and feelings.
A therapist may alternate between several play activities at a time. It is in the transitions between activities that provides optimal arousal, regulation, and attunement. For example, a therapist may engage a child in a challenging play activity to stimulate arousal and follow with a calming activity to help the child learn how to better regulate strong arousing emotions outside of the session (i.e. such as anger or frustration).
Types of Play Therapy
Two major forms of play therapy include Non-Directive Play Therapy and Directive Play Therapy. Non-Directive Play Therapy allows the child to direct the play. The therapist often does not directly intervene and instead maintains a position of curiosity and mirrors, tracks, and reflects the child’s play. In Directive Play Therapy, a therapist will engage the child in specific activities to meet a specific goal. Within both Non-Directive and Directive Play Therapy, there are different types of play a therapist will engage children in:
Free Play – This type of play is often used during assessment phases; the therapist observes the child in numerous play activities to evaluate the developmental level, attachment style and needs, and behavioral concerns, etc.
Bibliotherapy – The therapist will use storytelling, creative writing, and reading to teach essential concepts. For example, a therapist may engage a child in a story writing activity about anger, exploring a time when the child (or the character that represents the child) recalls being angry and how the child (or the character) wishes the feeling would have been soothed.
Expressive Arts Therapy – A therapist will engage the child in activities that involve drawing, painting, clay, poetry, and dance/movement, etc.
Filial Therapy - In this type of play, a therapist will teach parents how to conduct one-on-one child-centered play sessions with their own children. Parents are learning to interact with the child the same way that the therapist interacts with the child. This occurs both in session and parents are asked to continue to implement the same strategies at home.
Sand Tray Therapy - A therapist will allow the child to create a concrete manifestation of their imagination using sand, water, and other miniature objects that are often symbolic of the child’s inner world
Imaginary Play – This type of play is often non-directive. A therapist encourages the child to engage in dress up, play with dollhouses, kitchen sets, puppets, blocks, or other objects that allow the child to break down the shield surrounding their inner world.
Theraplay
A third and increasingly popular play therapy method is Theraplay. Theraplay uniquely engages both the parent(s) and child in various play activities that encourage relationship attunement, and improve parent-child interaction and growth along four dimensions: Challenge (aimed at helping a child build on their sense of confidence and acceptance), Engagement (aimed at helping a child feel seen, heard, understood and accepted), Nurture (aimed at helping a child soothe and calm), and Structure (aimed at restructuring the parent-child hierarchy and creating a safety sense of predictability).
Theraplay is also unique in that it encourages physical touch between parent and child. Touch is often first modeled by the therapist between the therapist and parent and the therapist and child.
Frequently Asked Questions
1.How do I know that Play Therapy is helping my child?
This is a tricky question. First, make sure you understand the treatment plan, which will vary because treatment plans are tailored to the unique needs of the client. Knowing the treatment plan will make it easier to observe changes because you will know exactly what you are looking for.
Second, if you are not implementing learned skills at home with your child, therapy becomes much less effective. I cannot stress this enough! Change in your child will require you to make changes, too. This is not easy and it takes consistent effort and patience (with yourself and your child).
Typically, you should see some change in the first six weeks. If you are seeing change, then therapy is working.
2. How long will my child have to be in therapy?
The short answer is that It depends, but typically somewhere between 18 to 26 weeks. The long answer is that it depends on the child and the scope of their concerns, the parent(s) and their willingness to participate in the change process, and the therapist’s own approach, which varies and can affect the treatment length.
3.How long are sessions?
Play therapy sessions are usually held weekly and range from 30 to 50 minutes, depending on the child’s age, the developmental level, and attention span.
4.What do sessions look like?
This varies depending on the therapist you are working with and their treatment approach. With my clients, it can take up to three sessions to complete an assessment and gain a full understanding of the child’s/parents’ concerns. My assessment phase includes an individual assessment between the child and therapist as well as an assessment session between the parent(s) and child.
Once the initial assessment is completed, I prefer to meet with the parents for follow-up after every two to three play therapy sessions with the child. It does not always work out this way! Parents often, and rightfully, have concerns they wish to discuss with the therapist prior to session and there may be something that comes up during the play therapy session that needs to be discussed with the parent more immediately.
During the play therapy session, the therapist will engage the child in unstructured (or free play) or in any number of play therapy activities. When a therapist meets with the parents, there is usually a discussion about the activities used, as well as some level of psychoeducation with the parents regarding session observations. Parents may also be taught skills they can implement at home.
When parents are present in session, they are often engaged in the play activity. At first, parents may be asked to participate in the play and are guided by the therapist. In later sessions, the parent is likely to lead the play activities with minimal intervention from the therapist.
5.What sorts of behaviors is the therapist looking for?
Therapists are trained to recognize themes during play, and there are several themes and subthemes. Generally, therapists will keep an eye out for behaviors such as anger, rage, being easily irritated, separation anxiety or unreasonable fear, unusually strong startle reactions, isolation, decreased sense of worth, and acting out sexually or inappropriately. These behaviors are often indicative of trauma.
Therapists may look for your child’s attachment styles by observing for some of the following:
Does the child respond to people? signal discomfort? appear to be easily comforted? appear outgoing or seem passive or withdrawn? explore his/her surroundings? respond positively to parents? keep him/herself occupied? show signs of reciprocity? seem relaxed and happy? look at people when communicating? show emotions in a recognizable manner? react to pain and pleasure? engage in age-appropriate activities? respond to parental limit setting? demonstrate normal fears? react positively to physical closeness? show a response to separation? note the parent's return? show signs of empathy? show signs of embarrassment, shame or guilt? behave as though he/she likes him/herself? show pride in accomplishments? share with others? accept adult imposed limits? try new tasks? appear to be developing a conscience? have positive interactions with siblings and/or peers?
For older children...
is the adolescent/teen aware of personal strengths and weaknesses? comfortable with his/her sexuality? engaging in positive peer interactions? performing satisfactorily in school? exhibiting signs of conscience development? free from severe problems with the law? aware of parent's values? accepting of adult-imposed limits? involved in interest outside the home? developing goals for the future? emotionally close to parents?
Therapists may look for your parent-child attachment styles by observing for some of the following:
Does the parent respond to exhibit interest in and encourage age appropriate development? respond to child's cues? enjoy and initiate close physical contact? enjoy reciprocal interactions with the child? initiate positive interactions? identify positive qualities in the child? use disciplinary measures appropriate for the child's age? provide effective comfort? accept expressions of autonomy? respond supportively when the child shows fear? show interest in the child's school performance? accept expressions of negative feelings? provide opportunities for child to be with peers? handle problems between siblings with fairness? assign the child age-appropriate responsibilities? know the child's likes and dislikes? give clear messages about behaviors that are approved or disapproved of? comment on positive behaviors as well as negative? show affection?
For older children, does the parent…
trust the adolescent? show interest in and acceptance of adolescent's friends? display in interest in the teenager's school performance? exhibit interest in adolescent's activities? have reasonable expectations regarding chores and household responsibilities? stand by the adolescent if in trouble? show affection?
6.Which children benefit from PT?
I believe people of all ages can benefit from play therapy, although it is typically used with children and adolescents between 3-12 years old. Play Therapy can help a child/adolescent in some of the following circumstances:
• aggressive or angry behavior
• anxiety, depression, grief
• attention deficit hyperactivity disorder (ADHD)
• autism spectrum disorder (ASD)
• domestic violence, abuse, or neglect
• eating disorders
• family issues, like divorce, separation, or death of a close family member
• natural disasters or traumatic events
• problem behaviors in school
7.How can I find a play therapist in the Valley?
When searching for a play therapist, keep in mind that a therapist does not have to be certified in play therapy in order to work with children. Certification processes are extensive and take a long time. You can find many skilled play therapists who are working toward certification, and whose information may not necessarily be posted on various organizations because of this. The best way to see if a therapist is a good fit for you and your child is to call them and ask about their experience and approach.
In addition to completing a general internet search, Psychology Today (https://www.psychologytoday.com/us) is a popular resource for finding any type of therapist.
Written by Anna Trujillo M.S., MFT-INTERN.
You can learn more about Anna and book an appointment with her by visiting here.
The Association for Play Therapy (https://www.a4pt.org/page/TherapistDirectory) and The Theraplay Institute (https://theraplay.org/directory/) are more specific resources to search for certified practitioners.