Source: Canva
What is Play Therapy and How Does It Work?
Play therapy is a type of therapy, primarily used with children, to enter their world and understand what kinds of things they are processing at any given moment. It can look like placing a child in a circle of toys, role playing imaginary characters, or using a sandtray to depict scenes. The key is to let the child lead and not to interfere with the direction in which they want to go.
Sandplay therapy (SPT) is one common medium used in play therapists’ offices. Foo & Pratiwi (2021) have measured a significant decrease in anxiety related symptoms when SPT is optimized. Choline, an advantageous metabolite marker linked to learning, memory, and concentration, was found to increase in participants with childhood trauma after receiving SPT treatment.[1] For children who experience trauma such as divorce, hospitalization, or loss of a loved one, play therapy can mitigate the accompanying negative effects and act as a buffer to prevent severe psychosocial or emotional issues from developing.[2]
Why Play Therapy?
Children will often repeat certain narratives over and over again until they’ve processed them through play. For example, if a child’s best friend suddenly stops playing with them at school, the child may need to work through that confusion through reenactment. When something in the world is frightening or traumatizing in any way, the child can make better sense of the situation by acting it out and having the ability to anticipate what will happen next. They can set the pace of the reenactment as well as gain distance from the situation because rather than the child re-experiencing the fear, the toy or doll can now stand in for them.
Research has shown that play therapy is an effective intervention for decreasing anxiety in elementary school aged children, improving disorders like generalized anxiety disorder, agoraphobia, social anxiety, and separation anxiety.[3-5] With adults, the brain is typically more developed, so talking is usually an effective method for processing issues. Despite the fact that talking is a viable and reliable option for adults working through problems, the incorporation of playful elements can still be tremendously beneficial for the average person. Similar to how bringing pinecones into a session (as a form of ecotherapy) can spark memories, ideas, and conversations about nature that might not otherwise have organically arisen, using painting or crafts can elicit unique feelings or thoughts in a client. Adults with developmental disabilities can also benefit immensely from toy-based play therapy, as the objects or role play can function as a bridge into their world.
Drama, somatic, and art therapy are closely related to play therapy in that they all involve additional engagement from the body and mind than just speech. Drama therapy has been shown to improve self-awareness and help people materialize their hidden feelings through action.[6] Additionally, research has demonstrated how somatic experiencing can be therapeutic for people with PTSD, and how creative art-based expression has positive effects on physiological and psychological health.[7, 8] Play therapy is unique in its broadness, as it can encompass the other three as well. Due to its range, it is usually possible to find some form of play therapy that works for each child. Younger children may prefer to act as a dinosaur, while older kids may prefer to use a toy dinosaur in a sandtray. As the brain develops through childhood, analytical skills are built through the limbic brain, and a kid becomes better able to-- for example-- construct more complex sandtray arrangements and then discuss their choices.[9]
Symbolism in Play Therapy
In the world of play therapy, symbolism is a key element for understanding the broader context of a child’s play. However, a delicate line must be walked: no selection of an object nor appearance of a recurring narrative is ever completely random or arbitrary (in other words, everything is clinically relevant), yet the therapist must be careful not to draw assumption-based conclusions about the symbolism. For example, a child may select a toy weapon. This does not necessarily indicate pathology or a history of abuse. Instead, it might represent desire on the child’s part for some power and control-- something children typically lack in the world.
Figure 1: Themes of toy selection
Note: This table was produced by Andrewjeski (2019) [10]
Play Therapy Extends Beyond the Session
Parents sometimes place their children in play therapy to give them “me” time. Rachael Sofian, a psychotherapist at Seattle Anxiety Specialists trained in play therapy, notes that children rarely truly crave autonomy. Instead, they seek connection. When done mindfully, it can be effective for parents to engage in play therapy at home. In fact, the greatest results from having a child in play therapy come from the integration of certain attunement techniques into home life. “Reflecting” is a term for the non-directive play therapy technique where the adult or therapist verbalizes the choices of the child. “You’re brushing that doll’s hair” and “you’re moving the car really fast” are examples of reflecting that can help foster connection between the child and adult.[11]
However, Sofian recommends consulting a professional play therapist for tailored advice before implementing techniques at home. By starting a child in play therapy, the therapist can get to know them and discover important patterns, and then communicate activities or exercises for the parent to try out with the child later. Without professional involvement a parent may run the risk of causing harm to the child, for instance, by setting aside play time but multi-tasking or forgetting to be fully present.
There is considerable evidence that supports the efficacy of play therapy for improving social and emotional skills, self-awareness, self-regulation, empathy, communication, increasing intelligence, decreasing anxiety, and helping with the recovery process after trauma.[12-14] By placing power into the child’s hands and allowing them to direct a play session, they gain an invaluable sense of control and autonomy. Trained professionals who can reflect, validate, and ask questions in a neutral and curious manner add to the power of play therapy. The therapeutic benefits are not limited to children or the brick-and-mortar therapy room, though. Elements of therapeutic play can be implemented into virtual therapy, home life between the parent and child, as well as psychotherapy sessions for adults.
Contributed by: Maya Hsu
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 Foo, M., & Pratiwi, A. (2021). The effectiveness of sandplay therapy in treating generalized anxiety disorder patients with childhood trauma using magnetic resonance spectroscopy to examine choline level in the dorsolateral prefrontal cortex and centrum semiovale. International Journal of Play Therapy, 30(3), 177–186. https://doi.org/10.1037/pla0000162
2 Li, W. H. C., Chung, J. O. K., Ho, K. Y., & Kwok, B. M. C. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC pediatrics. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4787017/
3 Hateli, B. (2021). The effect of non-directive play therapy on reduction of anxiety disorders in young children. Counselling and Psychotherapy research. Retrieved from https://www.researchgate.net/publication/352540147_The_effect_of_non -directive_play_therapy_on_reduction_of_anxiety_disorders_in_young_children
4 Kool, R., & Lawver, T. (2010). Play therapy: Considerations and applications for the practitioner. Psychiatry (Edgmont (Pa. : Township)). Retrieved January 13, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989834/
5 Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2014). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107–123. https://doi.org/10.1002/pits.21798
6 Chang, W.-L., Liu, Y.-S., & Yang, C.-F. (2019). Drama therapy counseling as mental health care of college students. International journal of environmental research and public health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801780/
7 Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of traumatic stress. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518443/
8 Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American journal of public health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/
9 Sokolowski, K., & Corbin, J. G. (2012). Wired for behaviors: From development to function of innate limbic system circuitry. Frontiers in molecular neuroscience. Retrieved January from https://www.frontiersin.org/articles/10.3389/fnmol.2012.00055/full
10 Andrewjeski, K. (2019). The symbolism of play behavior in child-centered play therapy. UNLV Theses, Dissertations, Professional Papers, and Capstones. Retrieved from http://dx.doi.org/10.34917/18608580
11 Allen, V., Folger, W., & Pehrsson, D.-E. (2007). Reflective process in play therapy: A practical model for supervising counseling students. Researchgate. Retrieved from https://www.researchgate.net/publication/234565195_Reflective_Process_in_Play_Therapy_A_Practical_Model_for_Supervising_Counseling_Students
12 Mirahmadi, Z., & Hemmati, G. (2016). The effectiveness of group play therapy on social skills of female students with intellectual disability. Physical Treatments - Specific Physical Therapy, 6(2), 115–123. https://doi.org/10.18869/nrip.ptj.6.2.115
13 Chinekesh, A., Kamalian, M., Eltemasi, M., Chinekesh, S., & Alavi, M. (2013). The effect of group play therapy on social-emotional skills in pre-school children. Global journal of health science. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825459/
14 Godino-Iáñez, M. J., Martos-Cabrera, M. B., Suleiman-Martos, N., Gómez-Urquiza, J. L., Vargas-Román, K., Membrive-Jiménez, M. J., & Albendín-García, L. (2020). Play therapy as an intervention in hospitalized children: A systematic review. Healthcare. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551498/