The Parents’ Guide to Play Therapy for Children

“The activities that are the easiest, cheapest, and most fun to do – such as singing, playing games, reading, storytelling, and just talking and listening – are also the best for child development.”

~Jerome Singer
Yale University Professor


Play therapy is typically used to help people manage conflicting emotions, ease anxiety, cope with phobias and other stressful situations, and improve thought processes and behaviors.

It provides individuals with a platform to express their innermost feelings, beliefs, thoughts, and emotions. This is accomplished through relaxed, unstructured “play sessions” with a therapist and/or other family members.

The goal is to provide these individuals with the tools they need to navigate rocky situations with confidence, patience, and perseverance.

The purpose of this guide is to give you all the “ins and outs” of play therapy, so you can determine if it is the right therapy for you and your child.


What is Play Therapy?

During the 1930s, play therapy was “officially” recognized as a psychiatric treatment for children [12, primarily between the ages of three and twelve-years-old.

The goal of play therapy is to teach children how to express their thoughts, feelings, beliefs, and perceptions, through therapeutic play. This form of therapy typically occurs in a safe, confidential playroom, where rules and guidelines have been suspended to make children feel more comfortable.

The result? They are free to explore their “worlds” without restrictions or limitations.

During play therapy, a trained counselor or psychologist observes and assesses a child’s thinking patterns, behaviors, decision-making, communication, and problem-solving skills, and play habits.

Play therapy also helps children express themselves and interact with others in healthier and more positive ways – i.e. cooperation, compromise, share, communication, respect, and compassion/empathy.

A play therapist encourages the child to explore events and situations in his life – good and bad (along with the accompanying emotions) – through play and non-verbal gestures. Play therapy is also used to awaken suppressed thoughts and emotions, and foster growth and development in children.


When is Play Therapy Used?

This form of child therapy is used to help children cope with social and emotional challenges, and inadequate communication, processing, and problem-solving skills. It is also used to improve undesirable behaviors, so children can interact with others in healthier and more positive ways.

Therefore, children, who have witnessed or experienced a traumatic event in their lives may benefit from play therapy. Examples include:

  • the death of a loved one
  • domestic violence
  • child abuse or neglect
  • a chronic illness
  • divorce
  • hospitalization
  • a personal or family crisis
  • family dysfunction
  • or any loss or change in their family dynamics or environment

Play therapy can also be used to help adolescents in certain cases. For example:

  • under performance in school
  • having a hard time developing and maintaining friendships
  • feeling uncomfortable interacting with others
  • having learning disabilities, anxiety, behavioral issues, depression, or anger/rage.

It can also be used to help those who are:

  • grieving
  • have autism spectrum disorder (ASD)
  • suffering from ADD or ADHD.

Is Play Therapy Just for Kids?

No! Play therapy is not just for kids. Children, teens, and also adults can benefit from play therapy. The truth is most people have lost their creativity and “playfulness” by the time they become adults, which is why play therapy can be so effective and beneficial from this age group.

The goal of play therapy is to help children, teens, adults – young, middle age, and even elderly, get back in touch with who they really are.

According to a growing number of studies, [1] “playing” or more specifically, self-exploration through play, can strengthen cognitive function, stabilize emotions, and improve behavior. As a result, researchers have concluded that play therapy could be valuable for all age ranges.

Other studies [2on play therapy have found that it can maximize learning, strengthen relationships (social and familial), and improve one’s emotional, mental, and physical health and well-being.

Individuals who participate in play therapy, have a chance to experience a variety of techniques and methods, such as art therapy, movement therapy, nature therapy, creative play therapy, dream therapy, fantasy or pretend play therapy, storytelling therapy, music play therapy, and social play therapy.

Play therapy can also be used to help children, teens, and adults, suffering from a variety of emotional and physical health issues.

Play therapy can be used to treat the following conditions in children, teens and adults:

  • Dementia & Alzheimer’s Disease
  • Grief & Loss
  • Post-Traumatic Stress (PTSD)
  • Obsessions & Compulsions (OCD)
  • Attention-Deficit Disorder (ADD) & Attention-Deficit Hyperactivity Disorder (ADHD)
  • Mood Fluctuations & Mood Disorders (Depression & Bipolar Disorder)
  • Anxiety
  • Developmental Issues
  • Delayed Emotional Development

Note: Although adults can engage in play therapy, it is not a common therapy approach for this age group. As such, to prevent any confusion, this guide focuses on play therapy for children (young children, pre-teens, and teens). Keep in mind that adults may be mentioned from time-to-time.


How Does Play Therapy Work?

Play therapy works by allowing children to address and work through complex and confusing feelings. More specifically, children can verbalize or exhibit their beliefs, feelings, and experiences at their own pace and in their own unique ways – without feeling pressured, intimidated, questioned, or threatened.

Understand that some children, especially young children and teens, [1] find “traditional talk therapy” scary or anxiety-provoking, which can lead to restricted self-expression and unproductive counseling sessions.

Keep in mind that one of the main purposes of play therapy is to help children understand that they are in control of how much they share with others.

Thus, the goal of play therapists is to encourage children to use creative exploration or creative play to address and work through their issues. It is the opposite of “traditional therapy,” which supports interrogation (interviewing) and reflection.

Sand Play

For example, sand play therapy can help relieve chronic stress, associated with a turbulent or abusive home environment, and storytelling play therapy can help a child talk about his experiences, through his “stories.”

Moreover, puppet, doll, or animal play therapy can help a child express how she feels about her parents’ divorce – or the birth of a new child. Lastly, art therapy can help a pre-teen or teen express how she feels about having little-to-no friends at school.

Therefore ultimately, play therapy can help children express themselves more effectively, through non-verbal gestures and creative exploration.

Note: Children, who are experiencing trauma or distress, tend to “act out” or engage in risky, impulsive, and unacceptable behaviors, as a way to “deal” with their confusing, upsetting, and conflicting feelings.

The truth is some children are unable to express themselves as they would like, so they resort to “acting out” or misbehaving to alert loved ones that something is wrong.

As a result, it can be difficult, as a parent, to determine what is really going on with your young child or teen. Studies [3suggest that play therapy is an effective treatment approach for children under the age of twelve, who are experiencing emotional distress and/or exhibiting “undesirable,” reckless behaviors, or dangerous behaviors.


Are There Different Types of Play Therapy?

Yes! There are three common types [12of play therapy. These types include

  • (1) child-centered play therapy
  • (2) child and family play therapy, and
  • (3) group-based play therapy.

Child-centered play therapy

One of the most common types of play therapy is child-centered play therapy. This type of play therapy resembles individual child therapy, but only in that the child and the therapist are alone in the playroom.

In most cases, everything else is different when it comes to individual therapy for children and play therapy for children.

Child-centered play therapy is often used when there is suspected child abuse or neglect. This type of play therapy involves one-on-one sessions with the therapist. The benefit of having more individualized “play sessions” is to provide a safe and comfortable environment for children to express themselves.

Child-centered play therapy can also be used to address anxiety, attention-deficit disorder (ADD), attention-deficit disorder (ADHD), obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), post-traumatic disorder (PTSD), and abuse and neglect.

Child and family play therapy

Child and family play therapy involves the inclusion of the child’s mother, father, siblings, caregivers, and extended family (if possible). It can also include those, who are like family.

This type of play therapy is used to help a child, who is suffering from extreme separation or social anxiety, or when there is suspected child abuse or neglect involved. During child and family play therapy, the therapist does not play a direct role in the “play” or activities.

Rather, he simply sits back and observes what is happening – i.e. how the family members are interacting with each other.

Shortly before the session ends, the therapist gathers the parents or caregivers to discuss what he observed – i.e. areas of strength and areas of improvement. During this time, children, extended family, and close friends are dismissed from the room.

This type of play therapy is extremely beneficial for parents and children because it helps parents learn how to be better parents – and have a better relationship with their children.

Child and family play therapy focuses on four areas [12] :

  • empathetic or compassionate listening
  • (2) imaginary or creative play
  • (3) setting appropriate restrictions, and
  • (4) the importance of structure.

However, it is important to note that each session is personalized to address the family’s issues.

Group-based play therapy

The third type of play therapy is group-based play therapy. These sessions typically involve a large group of children who play together while the therapist observes them.

Sometimes, the therapist participates in the “play session,” however, most of the time, she simply stays in the background, watching, and taking notes. The goal of this type of play therapy is to help children improve their self-esteem and self-confidence, and their communication and social skills.

The therapist’s main objective is to watch how the children interact with each other. Group-based play therapy is typically used with children who feel uncomfortable working with a therapist by themselves. Thus, group-based play therapy hinges on the preference or security of the child and his family.


What Happens During Play Therapy?

The playroom is considered the “counseling room.” And inside lies a variety of toys (Legos, puppets, dolls, stuffed animals, a complete dollhouse with tiny people and furniture), tools, and activities (music, dance and movement, video games, role-play (acting), art materials, storytelling, clay, a sandbox, creative visualization, costumes, etc.).

These are specifically chosen to help children express themselves in healthier and more productive ways.

Children are also taught how to behave more appropriately in various situations. The therapist then observes and assesses the child’s interaction with the items to better understand her thoughts, feelings, and beliefs – things that can be hard, if not impossible for some children to adequately verbalize.

The first play therapy session typically involves an intake interview with one or both of the parents. During this time, the therapist gathers information about the child and the issues.

In some cases, depending on the age, communication level, and maturity level of the child, a therapist may also do another intake session with just the child to get a better idea of what is needed to resolve the issues. This assessment allows the therapist to decide the best treatment approach for the child.

At the beginning of each “play session,” children are encouraged to play freely – without structure or guidance. However, after a while, the therapist introduces certain items and/or activities that correspond with the issues the child or children are grappling with.

The children can then express themselves without coming right out and saying what is bothering or hurting them.

As a result, the play therapist develops a treatment plan that helps these children address and tackle their emotional or physical distress. The therapist sits down with the child and asks questions in relation to the toy or activity he is playing or interacting with, to better glean the root cause of the child’s anguish and distress.

This form of therapy is more relaxed, and less structured than more “traditional child therapies,” so children can feel free enough and safe enough to communicate how they really feel – without directly saying it.


What Techniques, Approaches, and Methods Are Commonly Used During Play Therapy?

Play therapists use a variety of techniques, approaches, and methods during sessions. In fact, the two main play therapy approaches are nondirective play and directive play. Although another less common play therapy approach is Adlerian play therapy.

Nondirective play therapy

What is nondirective play therapy? This therapy approach is based on the idea that children can resolve issues by themselves – if given the chance to play freely without interruption, and if the environment is right – safe, secure, and comfortable. In other words, this approach is considered “less pushy” and “more relaxed,” mainly because there is minimal instruction or guidance on how to play during the sessions.

Directive play therapy

What is directive play therapy? This approach relies on the therapist’s feedback to accelerate progress. More specifically, this approach involves more participation from the therapist and is based on the belief that parents can achieve quicker results if the therapist is directly involved in the sessions. Understand that many, if not most, play therapists use a combination of nondirective and directive approaches when treating children.

Adlerian play therapy

What is Adlerian play therapy [5]? This approach was created specifically for middle-school kids. It is used with pre-teens, who exhibit undesirable social skills, have a hard time interacting with peers, and are unable to develop or maintain friendships.
The aim is to help these children re-learn how to interact with others in healthy ways and behave appropriately in various situations. But, even though this approach was developed for middle-school kids, it can still be used with other populations, such as young children, teens, and even adults.

Because there are different types of play, there are also different approaches to play therapy. According to a study, [4the various approaches to play therapy include Adlerian child play therapy, child-centered play therapy, group therapy, child and family therapy, cognitive-behavioral play therapy, structured trauma play therapy, nondirective play therapy, and directive play therapy.

Other play therapy approaches, techniques and methods include:

  • Ball Play

During ball play [12], a group of children take turns tossing a ball around. Whenever a child catches the ball, he has to share (with the group) something that makes him happy.

  • Stuffed Animal Play

During stuffed animal play [12], a child is encouraged to play with his own stuffed animals or specifically-chosen stuffed animals presented by the therapist. The purpose of asking a child to bring his own stuffed animals to “play sessions” is to create a safe and comfortable therapeutic environment for him.

  • Doctor and Nurse Play

Doctor and nurse play[12] is especially beneficial for children who have chronic illnesses and those, who have had or will have a stressful or traumatic procedure or surgery performed on them.

This technique involves encouraging these children to examine their dolls or stuffed animals, so the illness, procedure, or surgery doesn’t feel so scary. The goal of this technique is to help children feel more in control of their own bodies.

  • Baby Doll Play

During baby doll play, [12] a therapist uses the dolls to model appropriate, healthy, and positive behaviors. First, however, the therapist observes how the child interacts with and plays with the dolls to glean the true nature of the child’s distress.

The therapist is most interested in how the child treats the dolls – what his natural instincts are when taking care of another person or thing.

For instance, if a child begins to mistreat a doll, it could mean that the child is being mistreated or abused by his parents or caregivers. It is important to note, however, that it also may not signal maltreatment or abuse. In other words, other factors are also considered when making a final diagnosis.

  • Baby Bottle Play

During baby bottle play, [12] a child uses a baby bottle to prepare for the arrival of a new baby sister or brother. This technique is beneficial for children, who feel uneasy or unhappy about the change in their position in the family. The result? The child is less resentful or upset about the new sibling.

  • Magic Wand Play

Magic wand play [12] involves giving a child a “magic wand” and instructing the child to make three wishes with one of them consisting of a real-life issue he is grappling with.

  • Bubble Play

Bubble play [12] encourages a child to pop bubbles to ease his stress or help him bond with other kids during group sessions.

  • Block Play

Block play [12] involves erecting a wall made of building blocks and allowing a child to use balls to knock the blocks down. The goal of this method is to help the child release his anger in a healthy and productive way.

  • Balloon Play

During balloon play, [12] a group of children are instructed to keep balloons up in the air for as long as possible. The goal of this technique is to “break the ice” during group sessions and encourage peer-to-peer bonding.

  • Sensory Play

Sensory play [12] consists of encouraging children to play with shaving cream, flour, pudding, or sand to express themselves in a safe and comfortable environment.

  • Emotions Thermometer Play

The emotions thermometer [12] play technique involves asking a child to gauge his emotions, from zero (happy smiling face) to ten (a sad frowning face). The child is then asked to list situations or experiences that make them feel one of those ways. In other words, where is he on the emotions thermometer?

For example, “What kinds of situations are zeros on the thermometer (makes you happy)?” And, “What kinds of situations are tens on the thermometer (makes you sad)?” “What kinds of situations make you feel right in the middle – not too good (zeros) and not too bad (tens)?”

  • Storytelling Play

Storytelling play [12] involves asking a child to tell a story beginning with the phase, “Once upon a time…” The hope is that this “story” reveals the child’s hopes, dreams, worries, fears, goals, etc.

  • Superhero Play

During superhero play [12] the therapist asks the child to draw his very own superhero, complete with his very own costume and “superpowers.” The therapist explains that this superhero should be based on who he would like to be. The goal is to help the child see how his skills and abilities are real-life “superpowers” – “superpowers” that can and will help him navigate and conqueror troubling situations.

  • Puppet Play

Puppet play [12] involves using puppet representations. For instance, a therapist provides a child and his family with a variety of puppets. She then asks the child and his family members to select the puppets that best represent them. Afterward, the therapist asks the family to use their puppet “mini-mes” to tell a story.

The therapist then interviews each person about the story, and talks, in general, about what the story means to each person. The purpose of this activity is to point out family interactions that may be preventing the child from resolving issue(s) and moving on with his life.

  • Dance/Movement Play

Dance/movement play therapy [12] involves prompting a child to move or more specifically, dance or hopscotch or hula hoop to relax. The hope is that by moving it will boost his energy and improve and uplift his mood, attitude, and behavior.

  • Sand Play Therapy

Sand play therapy [6] is a non-verbal, therapeutic activity that involves the use of a sandbox, toy figurines, and water to create a miniature world that reflects the child’s innermost thoughts, fears, concerns, worries, beliefs, struggles, and dreams. This technique is typically used alongside “traditional talk therapy,” and is considered a valuable communication tool for children and adults of all ages.

  • Music/Song Play

Music/song play [12] involves providing a child with a wide variety of musical instruments and asking him to create a song using the instruments. It may also involve asking a child to select a song that best represents how he is feeling or what he is experiencing at the current time.

The therapist then asks the child why he chose that particular song or instrument. The goal of this technique is to help boost a child’s self-esteem and self-confidence and strengthen the therapist/child relationship.

  • Coloring Play

During coloring play, [12] the therapist and child work together to discover the colors that best represent his current feelings (i.e. yellow is for happy, blue for sad, brown is for neutral, and red for angry). The therapist then asks the child to create a timeline of his experiences using colors to represent his feelings.

  • Dollhouse Play

Dollhouse play [12] involves giving a child a dollhouse and dolls and asking him to select the doll that best represents him – and his family. The therapist then asks the child to “act out” five different scenarios – scenarios that typically occur daily. It is important that these scenarios also include immediate family members – parents and siblings.

These scenarios may include breakfast time, lunchtime, dinner time, birthdays or holidays, housecleaning, nap time, bedtime, and/or playtime. The goal of this activity is to better understand the family dynamics.

  • Communication Games

Communication games [12]may involve drawing cards and verbalizing what the card says. For instance, a card may something like, “Pretend your boyfriend or girlfriend just broke up with you at school in front of your classmates – what do you say or do?” If the child can explain to you what he would *probably* say, he is rewarded with a Hersey Kiss.

This game is best played with a group of children. The child, who scores the most Hersey Kisses wins the game. This method helps the therapist better gauge the child’s reactions in certain situations, so he can suggest healthier ways of dealing with them.

  • Self-Control Games

Lastly, self-control games [12] are meant to help children improve their self-control. Self-control games commonly used during play therapy are “Follow the Leader” and “Simon Says.”

These games require that the participants follow what the therapist or leader does – i.e. patting head, kicking feet, waving hello, turning around, or jumping on one foot.

The goal of self-control games is to teach children how to follow directions and control their behaviors, so they do not end up misbehaving or acting recklessly or impulsively.


Is Play Therapy Effective? If So, How Effective?

Yes, according to a recent study, [17play therapy is effective for the majority of children; however, the level of effectiveness depends on the therapist, the issues, and the willingness of the child to engage in the therapy process.

Therefore, it is important to understand that every therapy, including play therapy, isn’t right for every person. Thus, play therapy may be effective for some, but not for others.

For instance, it may not be suitable for some mental health conditions, and emotional and behavioral problems like clinical severe depression and suicidal thoughts. However, it can ease stress and improve thinking patterns and behaviors – in some children, if used correctly.

Play therapy can also be effective for some adults. It may improve cognitive function and “correct” inappropriate or undesirable behaviors like smoking, doing drugs, drinking excessively, gambling, overeating, etc. It can also strengthen relationships, sharpen learning processes, and improve emotional and physical health.

Adult play therapy is commonly used to help adults address lingering health problems, chronic illnesses, accidents and injuries, developmental or learning delays, and aging. The “unstructured” play therapy environment allows adults to relax, so they can communicate the issue(s) that are bothering them.


How Often Does Play Therapy Occur and How Long Does Each Session Take?

Play therapy sessions typically occur once a week for 30-50 minutes. The therapy process occurs, at minimum, 20 sessions [18]. In fact, according to a study [7on play therapy, it takes approximately 20 play therapy sessions to adequately address the issue(s) a child is experiencing.

It is important to note, however, that it could last longer than 20 sessions, depending on the complexity of the issue(s). On the flip side, some children may require fewer than 20 sessions to resolve the issue(s). Thus, the number of therapy sessions varies, depending on the child and the situation.

Note: It may take between 6 and 8 sessions for trust to develop between your child and the therapist, so it is important to be patient and allow the process to naturally unfold.


Do Most Health Insurance Plans Cover Play Therapy Sessions?

Unfortunately, it is unknown if most health insurance plans cover play therapy. The best person to answer this question is an insurance rep at your insurance company.

If you are unable to reach a rep at your insurance company, you’ll probably be able to find that information in the annual packet that was sent to you when you selected a health insurance plan. You can also log-in to your account and find the information under the “Coverage” tab linked to your health insurance plan.

Lastly, you may want to contact the therapist’s office and ask the billing department rep if she can research your plan and tell you if play therapy is covered under it. It is important for you find this information out before you take your child to the therapy session.

If you want to be prepared for that first session, you will need to have your insurance information handy and have a good understanding of the co-pay or deductible due at each session.

FYI: You may be required to pay some or all of the costs, so clarify this in advance.

Note: Some health insurance plans require that you receive prior approval for play therapy, while others do not. Moreover, some plans cover therapy sessions, but only to a certain extent – i.e. partially or only for a limited number of sessions. Still, some plans require a referral from your child’s pediatrician.

Listed below are some questions you may want to ask an insurance rep or a rep in the therapist’s billing department:

  • Does my plan cover mental health services?
  • What is my deductible and has it been met for the year?
  • How many play therapy sessions does my plan cover, per year?
  • How much will I be expected to pay, per deductible or co-play, each session?
  • Is prior approval or a pediatrician-based referral needed to schedule an appointment with a play therapist?

How Much Does Play Therapy Cost?

The cost of play therapy sessions varies, depending on the age of the child, the complexity of the issue(s), the therapist’s fees, the number of sessions, and the location.

However, an estimate of how much a therapy session could cost is listed below:

  • $150 – $200 (or more), per 50-minute play therapy session.

Should I Be Involved in My Child’s Play Therapy Sessions?

Many parents wonder if they should be involved in their child’s play therapy sessions, and the truth is: it depends. Every counselor, therapist, psychologist, and social worker has a different approach, so your child’s therapist may or not request parental and/or family involvement.

The determining factors may include the age of the child, the maturity level of the child, and the complexity of her issues.

In general, there should be at least one parent present during play therapy sessions when the child is younger than 11. However, for pre-teens, having one or both parents present may be uncomfortable and embarrassing.

And, there really is no good reason to be involved in teen “play sessions” – although there may be exceptions to this rule – i.e. insecure, anxiety-ridden, socially-awkward, developmentally-delayed, and immature teens.

Listed below are some things to consider if you are trying to decide if you should be involved in your child’s play therapy sessions:

  • Some children have a hard time “opening up” when their parents are around. On the flipside, other children “open up” more when their parents are around. You know your child better than anyone, so if your child tries to avoid contact with you in many or most cases, and she is a pre-teen or teen, you may want to forgo getting involved in their “play sessions.” However, if your child feels comfortable “hanging” with Mom and Dad, then by all-means join-in on the therapy process.

Note: Most pre-teens and teens value their privacy, so do not be offended, if your child asks you not to attend the therapy sessions.

  • Also, keep in mind that younger children may become anxious or frightened if their parents aren’t around, so in this case, it may be best that you stay close by, if not directly involved in the “play sessions.” Maybe, you can hover in the background, while the therapist and your child “play” and talk. In this scenario, you aren’t directly involved, but your child knows you are there if she needs you.
  • Being involved in play therapy can also be beneficial for you, as the parent. In other words, you may learn some valuable parenting tips and how to effectively handle behavioral problems with your child. Then, you’ll be able to take the skills you learned and the tools you attained back home with you to use when the therapist isn’t around. Practicing what you and your child learned from therapy sessions at home may help you be a better parent while reducing your child’s anxiety and fear of therapy.

Thus, you should prepare to attend the first couple of play therapy sessions – regardless of your child’s age.

Then, if your child requests that you remain involved, stay, however, if your child (pre-teen or teen) requests that you leave the therapy sessions; respect her wishes and allow her to develop a trusting relationship with the therapist.

Remember, teens naturally crave independence and privacy, so don’t become upset, hurt, angry, or offended, if your presence is not wanted.

The good news is the therapist will keep you informed of your child’s progress, even if you are present during the play therapy sessions. However, how the amount of information the therapist shares with you about the specific issues will vary, due to confidentiality requirements.

But, before a therapist will share any information with you about your child’s issues, he will first discuss it with your child.

In other words, the therapist will seek your child’s permission to divulge sensitive, traumatic, and hidden events, situations, experiences, beliefs, and feelings with you. There should be no “secrets” between the therapist and your child, or it will lead to mistrust and an ineffective therapy process.

Your child needs to feel in control of the situation. So the best way to ensure that the therapy process is a success is to respect your child’s privacy – and not pry.


What are the Pros and Cons of Play Therapy?

Listed below are some pros and cons of play therapy? [11]

Pros

There many benefits associated with play therapy, such as fostering your child’s creativity and imagination, aiding in your child’s healing and recovery, helping your child more effectively express and manage her emotions, teaching your child how to make better decisions, teaching your child how to have a more positive mindset and exhibit healthier behaviors, helping your child problem-solve, communicate, and socialize/interact with others in a more appropriate manner.

Other benefits of play therapy include:

  • A more relaxed platform for your child to process and express her emotions, especially if she is unable or unwilling to express them in a more “traditional talk therapy” environment
  • A decline in undesirable behaviors and an increase in your child’s ability to manage and regulate her emotions and actions
  • The introduction, development, or strengthening of independent and creative thought processes
  • The development of your child’s social skills and strengthening of your child’s ability to show respect to others
  • Healthier and stronger parent-child and family relationships
Cons

While there are plenty of pros to play therapy, there are also a couple of cons, such as a lack of research studies [14highlighting the short-term and long-term effectiveness of play therapy. In fact, researchers have found mixed results [13when studying the pros and cons of play therapy.

The skills of the therapist can also be a con. For instance, a play therapist, who makes an honest effort to get to know the child and understand her history, can greatly improve the odds of a successful therapy; however, if the therapist isn’t fully invested in the child and her problems, it could cause a failed therapy process.

Also, if the play therapist isn’t well-trained or “seasoned” with children and their issues, therapy may be unsuccessful. The therapist must also have experience with children, in general, and with counseling children, who have mental health conditions, or who are dealing with psychological or emotional distress.

Other disadvantages [9 of play therapy include:

  • Play therapy is not a “direct” form of therapy. It also doesn’t “directly” deal with the trauma or issues. As a result, it can end up being more of a hindrance or distraction than assistance or relief. For instance, if a child becomes aggressive with the therapy dolls, it doesn’t necessarily mean she is being abused by her parents – although it may look that way. Therefore, it is almost impossible to get a true diagnosis just from play therapy.
  • If directly involved, play therapy can actually make you, the parent, distressed. In other words, it can trigger anxiety or memories of your own traumas.
  • It can take a while to experience a significant change in your child’s thinking patterns and behavior. So, for some children and families, this form of child therapy can be long and “draggy.” Patience is key when engaging in play therapy.

What Should I Look for in a Play Therapist?

If you are considering play therapy for your child, it is important to select a play therapist that is well-trained in child development, family dynamics and family therapy, child psychology, and play therapy approaches (i.e. child-centered, Adlerian, group, and cognitive-behavioral), techniques, and methods.

In addition, look for a mental health professional with a background (experience and education) in psychology.

This mental health professional should be a child counselor, psychologist, or social worker. Also, select a therapist that the Association for Play Therapy (APT) has certified as a registered play therapist (RPT).

Lastly, only “hire” a therapist, who you and your child feel comfortable with. If you and/or your child do not trust or feel safe with the therapist, look for a new play therapist you do feel safe and comfortable with.


What Should I Ask a Play Therapist During the Initial Consultation?

Listed below are some questions you should ask potential play therapists:

  1. What happens during play therapy? How does it work?
  2. How many play therapy sessions does your child have to have before you see results?
  3. What is your education and experience in play therapy?
  4. Are you certified, as a registered play therapist by the Association for Play Therapy (APT)?
  5. How long have you been practicing play therapy? What have the results been?
  6. How long will each session last? How long will my child be in therapy – i.e. how many sessions or weeks total?
  7. How much do you charge for each play therapy session?
  8. Will my child be alone or will he be in a group with other children, during the therapy sessions?
  9. Are parents required to be involved in the “play sessions” or is involvement voluntary?
  10. Do you have any references I can contact?

Can I Engage in Play Therapy With My Child at Home?

Yes – to a certain extent. You can reinforce what the therapist is teaching your child during play therapy at home[18]. However, you should get your agenda approved by the therapist before you start practicing play therapy techniques at home with your child.

Why? Because, it could disrupt the therapist’s treatment plan, thereby confusing your child. So, if you want to practice play therapy at home with your child, check with the therapist first and take direction from her.

The good news is there are some activities you can do at home to help your child accomplish her therapy goals – with the blessing of most therapists. For instance, one of the best things you can do for and with your child is “play” with her. Don’t ask too many questions during playtime, or it may influence your child’s train of thoughts.

Rather, notate what you observed afterward, and discuss it with the therapist during your child’s next “play session.” Actively engage with your child regularly.

Do not just watch her play with siblings, alone, or with peers. Get down on her level, and really “play” with her. And, listen to her. Pay attention. The main goal of engaging in play therapy at home should be to listen and learn. Allow your child to take the lead, and make playtime at home, as fun and enjoyable, as possible.


Is Play Therapy Available at School? And, If So, How is It Used?

Yes, many school systems utilize play therapy to support and motivate students. Students may benefit from playgroups that focus on improving social skills.

More specifically, cognitive-behavioral play therapy (CBPT) may help students develop or strengthen their social skills, which, in turn, may accelerate their academic progress, and help them better manage their emotions and behaviors.

The hope is that play therapy will help students become more skilled at developing and maintaining friendships, and interpreting social cues. It is for these reasons that in-school play therapy is the ideal way for students to learn appropriate social skills.

According to a recent study, [13] play therapy can effectively serve as a counseling tool for elementary school counselors.

In fact, numerous studies [15have found that in-school play therapy with elementary school students, suffering from ADHD, conduct disorder, OCD, autism, cerebral palsy, anxiety or anxiety disorder, and those, who are aggressive and at-risk may benefit from this school-based intervention.

The truth is all of these issues and conditions can severely impede the development of a child’s social skills.

The good news is a school counselor can add play therapy tools, specifically, cognitive therapy play therapy tools into school guidance programs, so they are available any child, who needs them.

As a result, school counselors can help preschoolers, kindergarteners, elementary school students, middle school students, and high school students with personal issues, social skills, and academic progress – all within the confines of school.

Yet, study results indicate that all students could benefit from play therapy. In fact, researchers suggest that this form of school counseling could provide students of all ages with opportunities to apply their social skills training in a controlled environment.

Another form of therapy commonly use in school-settings is group play therapy [15. Group play therapy provides students with opportunities to polish their skills, appreciate their social capabilities, attain the approval of peers, and exercise patience and self-control.

In-school play therapy groups can also be used to help elementary school students learn new skills and become more self-aware of their emotions, behaviors, thoughts, beliefs, and environment.

Lastly, small in-school playgroups may provide students with an incentive to explore and address social and emotional challenges with other students, who are either experiencing the same thing or experiencing something similar.


Do Hospitals Use Play Therapy? If So, In What Capacity?

Yes! The truth is no one wants to be hospitalized, especially children. However, in-hospital play therapy [21can make the visit less stressful and more bearable. Play therapy can “normalize” the experience and create a distraction for hospitalized children.

In-hospital play therapy[21can ease a child’s nerves, while he waits to be admitted to the hospital, before a procedure, surgery, or intravenous treatment (i.e. chemotherapy), during a treatment (if the child is conscious and able to play), throughout the hospital stay (to reduce stress, boredom, depression, and anxiety), and at the end of a procedure, surgery, or intravenous treatment (to help the child better understand what happened and how it is going to affect his life).

Therapeutic toys may include stuffed animals brought from home, dolls and a dollhouse, support/therapy animals, a magic wand, etc. In-hospital sessions typically range in length from 30 minutes to an hour.

Other benefits of in-hospital play therapy are:

  • Supports a child’s development and independence
  • Relieves stress, anxiety, and boredom
  • “Normalizes” the hospital environment
  • Helps a child become more familiar with hospital procedures and equipment
  • Helps a child better cope with the hospital admittance process
  • Assists with the communication process between the child, the family, and health care professionals
  • Provides a child with the tools to manage and cope with a diagnosis, procedure, surgery, illness, and treatment, so he feels more in control of the situation
  • Helps a child gain confidence and improves his self-esteem
  • Aids in the assessment and diagnosis of an illness or injury
  • Teaches a child healthy coping skills to help him manage pain and discomfort
  • Prepares a child and his family for surgeries, treatments, and procedures by using terms that everyone can understand
  • Encourages family participation (i.e. parents and siblings)
  • Encourages children to communicate what they are thinking and feeling

It is important to understand that “playing” is a form of self-expression. It can help deliver important messages and communicate a child’s fears, insecurities, traumas, etc. This is beneficial for the child’s family, nurses, physicians, and other medical staff because it alerts them to things they need to monitor with the child.

In-hospital play therapy [23can also help a child process his emotions in a more accurately and positively. Thus, stuffed animals (i.e. teddy bears) are extremely beneficial play therapy tools because they are highly transferable.

In other words, children can hold them close, regardless of what is happening, for example, getting blood drawn, getting vaccinated, or having an infusion or medical treatment or procedure.


In Summary…

Growing up can be hard, especially when your child is dealing with issues, health problems, trauma, mental health conditions, or emotional distress. These issues are worsened when the child is unable to effectively communicate her true thoughts, fears, beliefs, worries, and concerns.

The child wants to tell her loved ones how she feels, but can’t for some reason. As a result, life can become extremely scary for her.

Play therapy provides a child with an outlet to express herself – without having to directly say the words. Keep in mind “playing” and using “non-verbal gestures” is to a child what “having a voice” and “using one’s words” is to an adult.

It is a way to express one’s emotions, develop and explore friendships and relationships, interpret and describe experiences, events, and situations, share one’s wishes with others, and attain peace and happiness.

References

  1. Badamian, R., & Moghaddam, N. E. (2017). The effectiveness of cognitive-behavioral play therapy on flexibility in aggressive children. Journal of Fundamentals of Mental Health, 19, 133–138.
  2. Blanco, P., Holliman, R., Muro, J., Toland, S., & Farnam, J. (2017). Long-term child-centered play therapy effects on academic achievement with normal functioning children. Journal of Child & Family Studies26(7), 1915–1922.
  3. Wilson, B. J., & Ray, D. (2018). Child‐centered play therapy: Aggression, empathy, and self‐regulation. Journal of Counseling & Development, 96(4), 399–409.
  4. Allen, B., & Hoskowitz, N. A. (2017). Structured trauma-focused CBT and unstructured play/experiential techniques in the treatment of sexually abused children: A field study with practicing clinicians. Child Maltreatment, 22(2), 112–120.
  5. Smith, S. L. (2003). Adlerian play counseling interventions.
  6. Psychology Today. (2019). Sand play therapy.
  7. Carmichael, K. (2006). Legal and ethical issues in play therapy. International Journal of Play Therapy, 15, 83-99.
  8. Landreth, G. L. (2002). Therapeutic limit setting in the play therapy relationship. Professional Psychology: Research and Practice, 33(6), 529-535.
  9. Kool, R., & Lawver, T. (2010). Play therapy: considerations and applications for the practitioner. Psychiatry, 7(10), 19–24.
  10. Foroughe, M. F., & Muller, R. T. (2011). Dismissing (avoidant) attachment and trauma in dyadic parent-child psychotherapy. Psychological Trauma: Theory, Research, Practice, and Policy.
  11. Karjala, T. (2017). Pros and cons of play therapy: Advantages of play therapy for children. Creative Counseling Center.
  12. Selva, J. (2017). 50 play therapy techniques, toys and certification opportunities. Positive Psychology.
  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, 6(2), 163–167.
  14. Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001). The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10, 85-108.
  15. Laura J. Fazio-Griffith and Mary B. Ballard. (2014). Cognitive-behavioral play therapy techniques in school-based group counseling: Assisting students in the development of social skills. Counseling.org.
  16. 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, 6(2), 163–167.
  17. Meany, W. K. K., Bratton, S. C., & Kottman, T. (2014). Effects of Adlerian Play Therapy on Reducing Students’ Disruptive Behaviors. Journal of Counseling & Development, 92(1), 47–56.
  18. Kingsley, E. (2019). How to practice ADHD play therapy at home. ADDitude.
  19. Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107–123.
  20. Blanco, P. J., & Ray, D. C. (2011). Play therapy in elementary schools: A best practice for improving academic achievement. Journal of Counseling & Development, 89(2), 235–243.
  21. Koukourikos, K., Tzeha, L., Pantelidou, P., & Tsaloglidou, A. (2015). The importance of play during the hospitalization of children. Materia Socio-Medica, 27(6), 438–441.
  22. Huggies. (2019). Play therapy for children in hospital.
  23. Jun-Tai, N. (2008). Play in hospital. The Therapeutic Care Journal.

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