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Play therapy is a counseling method used to help children communicate their inner experiences through the use of toys. Non-directive play therapy, also called child-centered play therapy is a non-pathologizing technique based on the belief that children have the internal drive to wellness. Non-directive play therapists are trained to trust that children are capable to direct their own process rather than the therapist imposing their own ideas of what the child needs to do in therapy to work through any challenges they may be facing. This requires the therapist to enter the emotional world of the child rather then expecting the child to understand the therapist’s world, which is beyond their capability. Play therapy is based on the theory that play is a child’s language, the toys in the play room considered the “words” that a child uses to express their inner experiences and how they perceive and experience the world. The toys in the play room are then used by the child to “speak” to the therapist and communicate their inner thoughts and feelings. Within a play session and over the course of sessions, themes emerge in the child’s play, giving the therapist insight into the child’s experiences, thoughts, feelings and interpretations of their world.

Non-directive play therapy is based on respect for the child and confidence in their ability to direct their own process. It requires that the therapist maintain unconditional acceptance and positive regard for the child. Because children do not have the cognitive and language skills to communicate their emotional experiences, by observing a child’s play sequences and play themes, the therapist can gain great insight into the child’s inner world. By creating a safe, free and protected space, the child is provided the opportunity to work through deeper emotional fears, wounds and experiences. Children are given permission to express themselves in whatever way they are comfortable and are not required to “talk” (verbally), which often feels intimidating and scary to a child.

“The play therapy process can be viewed as a relationship between the therapist and the child in which the child utilizes play to explore his or her personal world and also to make contact with the therapist in a way that is safe for the child. Play therapy provides an opportunity for children to live out, during play, experiences and associated feelings. This process allows the therapist to experience, in a personal and interactive way, the inner dimensions of the child’s world. This therapeutic relationship is what provides dynamic growth and healing for the child.” (Landreth & Bratton, 2001).

It is not uncommon for children to express their inner thoughts and feelings in a maladaptive way at home and/or school because of their inability to articulate their experience. It is through their behavior that they communicate emotional distress. By reflecting a child’s process, feelings expressed in their play and play themes, the therapist begins to give the child a vocabulary of “feelings”. More importantly, by reflecting the child’s play and emotions, children feel understood and validated. They experience a connection with the therapist, which is often different from any other relationship they have. It is through this relationship and the therapist’s ability to “see” the child, that a child feels safe, understood, validated and begins to gain confidence.

Children often misinterpret their world and experiences, which can also lead to fears, anxieties, and misbehaviors. A common example of this is when parent’s separate and a child interprets this as something they have caused. As a result of this belief, a child may exhibit anxiety, depression, insecurity or defiance. A trained play therapist is able to interpret the child’s play and the themes that emerge such that the a reworking of these experiences can occur. As a child gains the sense of safety and realizes that the therapist will not react or respond in ways others maybe have, they begin to go deeper in their process. The will begin to play out deeper issues and/or verbalize their thoughts and feelings to the therapist. Often this working through occurs through the metaphor of the toys and the therapist can engage in a dialogue through the metaphor, helping the child to understand and rework the problem. When children are provided a safe and protected environment they will communicate their inner experiences, worries, conflicts and needs.

“By acting out through play a frightening or traumatic experience or situation symbolically, and perhaps changing or reversing the outcome in the play activity, children move toward an inner resolution, and then they are better able to cope with or adjust to problems.” (Landreth & Bratton, 2001)

For example, Mary, a 6 year old girl whose parents have just divorced has been experiencing extreme anxiety. As the therapist works with her, the themes that begin to emerge are caretaking. Mary engages in a play sequence with a horse family. She begins to play out the “baby” horse protecting and comforting the “mommy” horse. By engaging in conversation with the baby horse, the therapist can let her know that it is not her job to protect and take care of the mommy horse. That mommy horses know how to do that for themselves. They can then discuss how the baby horse might feel if it knows it doesn’t have to take care of the mommy horse anymore and what it might do instead.

This is an example of how toys provide safe objects for a child to play out their internal experiences in a symbolic manner. The toys provide enough distance and safety from their own feelings and reactions that they can express them through the use of the toys and their play. The therapist can enter into the metaphor of the child’s play to gain additional insight and to help them re-work scenarios that are parallel to challenges they may be experiencing in their life.

Scheduling a consistent appointment time each week is helpful in providing consistency and predictability for the child who enters play therapy. This also provides continuity and more efficient treatment. Eventually, the play therapist will begin to spread sessions out when a child begins to exhibit signs that they are ready for less frequent sessions.

A list of rules is not gone over at that initiation of therapy. If a child breaks a rule, i.e. throwing sand, trying to break a toy, then a limit is set: “I know it’s fun to throw sand, but the sand is not for throwing. You can play with it in the sand trays and toss it from hand to hand, or you can throw a ball.” Children require limits and boundaries in any relationship to feel safe and accepted. The relationship between a child and play therapist is no different. The therapeutic relationship established in play therapy is one of trust, acceptance, and in which the child is valued, but it is not without boundaries. During a child’s play time, they are allowed to be messy, are encouraged to explore, doing something in a specific or directed way is not required. The therapist in no way controls what the child does or how they do it. Limits are set if they are doing harm to themselves, the toys or the therapist. Limits are set if and when they are needed in order to help the child learn responsibility of self and self-control. Limits are set in a way, which validates the child’s feelings/desire, communicates the limit and gives alternatives i.e. “I know you would like to take that rock home with you. But it has to stay in the play room so it will be here for you next time. You can take the picture you made with you.” This then allows the child to learn the concept of self-control and making choices, rather then an adult attempting to control their behavior.

Play therapy has been widely researched as an effective and developmentally appropriate method for working with children dealing with (but not limited to) the following: depression, grief and loss, social adjustment problems, speech difficulties, trauma, hospitalization, reading difficulties, selective mutism, enuresis and encopresis problems, fear and anxiety, abuse & neglect, aggression/acting out behaviors, attachment difficulties/issues, autism, burn victims, chronic illness, parental separation/divorce, deaf and physically challenged children, withdrawn children.

©Copyright 2009 by Leslie H. Petruk, MA, LPC, NCC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Leslie and/or see her GoodTherapy.org Profile

A recent study by the Center for Disease Control, published in the American Journal of Preventive Medicine, is being touted as evidence that some very common treatments for trauma lack empirical evidence of success in helping children and adolescents. The study, which reviewed a small percentage of the available literature, found evidence for the effectiveness of cognitive behavioral treatment, but not for six other kinds of therapy, including what may be the most widely used interventions – play and art therapy.

But the data may not be as convincing as the researchers, and especially the mainstream media (http://uk.reuters.com/article/healthNewsMolt/idUKN0933795420080909?pageNumber=2&virtualBrandChannel=0&sp=true), conclude. The literature review looked at only a dozen studies, and neglected to consider a good body of evidence that does lend support for play and art therapy with traumatized children. Some books written on the subject include Empirically Based Play Interventions for Children, edited by Linda A. Reddy, Tara M. Files-Hall and Charles E. Schaefer (2005); Helping Abused and Traumatized Children by Eliana Gil (2006); and Contemporary Play Therapy: Theory, Research, and Practice edited by Charles E. Schaefer and Heidi Gerard Kaduson (2008). The CDC study can be examined here: http://www.ajpm-online.net/article/S0749-3797(08)00528-X/abstract

Meanwhile, a collaborative effort between the Swedish Red Cross and a team of psychological researchers from Haugesund University College, Norway has produced a large, longitudinal study on the effect of mass trauma on both children and adults. More than five hundred Swedes were interviewed over several years after surviving the Indonesian Tsunami of Christmas 2004. Researchers hope that their results – which so far have revealed a “complex process of grief” in survivors – will pave the way for a better understanding of trauma.

Click here to contact Daniel and/or see his GoodTherapy.org Profile©Copyright 2008 by GoodTherapy.org All Rights Reserved. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Daniel and/or see his GoodTherapy.org Profile
Therapist Seattle

Click here to contact Jennifer and/or see her GoodTherapy.org Profile

In our current over-scheduled, over-pressured world, families are confronting problems they have little capacity to do anything about. We can tend to cope by getting stuck in a narrow range of behaviors and responses even if they are not helpful. A child who has learned to have temper tantrums when she is angry, and her parents who have learned to punish or pamper her, are stuck in maladaptive, non-growthful environments—‘a bad play’. It’s like playing the same part in the same play on the same stage day after day.

A key component in this play is often our children’s behavioral, emotional and leaning difficulties that are so disruptive or dysfunctional – all we want to do is stop it. As parents, educators and fellow child / family therapists, we can understandably respond by focusing on getting rid of the most glaring and painful symptoms. Another way to handle these situations is to focus on development as the key to transforming our lives and our children’s lives—including maladaptive behaviors.

The Family Development Program does just that. The goal is to help children, parents, and families develop and grow emotionally and socially. How? Well, families, in a combination of group and individual therapy and coaching, are helped to practice new ways of relating to each other where it’s possible to impact positively on each other. We can create new plays, try out new parts, change the stage, i.e.) reshape the environments we are in, into ones that allow us all to create new possibilities and make new choices.

Children who have been identified as having learning disabilities or Pervasive Developmental Disorders, or who are using drugs, or are having trouble getting along with peers, teachers or their parents, can, along with their families, become active creators of new learning and emotions. How? By learning to reshape the various maladaptive and non-developmental environments they inhabit into developmental ones.

The A Family: Three siblings – Middle and Jr. High school aged. The youngest, we’ll call John, was diagnosed with ADHD and ODD, has fits/ outbursts that are very annoying, disruptive and sometimes scary to the rest of the family. John’s role in the family play was clearly the unmanageable ‘crazy’ one, even according to him. That is his label. We had a series of group sessions where we created other roles for one another to help shake up the stuckness and change the increasing destructiveness between them. Instead of getting ‘the bad boy’ to stop, we worked on creating various ensemble performances between them, including:
1-John performing as a positive leader to his older, ‘healthy’ siblings,
2-Scenes where they all had fits then practiced various ‘take twos’
3-Siblings arranging a ‘fit competition’ between one another
4-Presenting/performing their new strategies to their parents and shaping new roles for the parents to play in the ‘fit’ scenes.

This helped the A Family see the choice making element to their lives, to take responsibility for working more effectively as a sibling and family team, and to practice other roles.

In this way, we were stimulating development versus changing a particular behavior. It was no longer a problem that demanded a solution or a behavior that needed changing, but a stimulus and resource for development. John didn’t get ‘fixed’, but instead became a creator of an environment in which he and others could learn about attending to one another and to the total environment.

Through the use of play, improvisation, creative imitation and performance, we help children take responsibility for their learning and emotions. Adults are able to break out of coercive methods that have little to do with developing children as active and responsible. Our capacity to perform is very important to our emotional growth and development. As performers in every day life, we can constantly create and recreate what we do. For example, we can ‘take two’: “I’m not sure if this conversation is going so well for us, can we take two/ try again/ start over” -Like scenes in the play of life.

The Family Development Program helps children and adults to develop socially, emotionally and cognitively by supporting them in doing what they don’t know how to do. Creating something new is what development is all about.

Jennifer Bullock, M.Ed., M.L.S.P.,LPC, NCC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jennifer and/or see her GoodTherapy.org Profile