Play therapy is a form of non-verbal, counselling/psychotherapy, that incorporates play to support children in navigating a variety of psychosocial, behavioural, emotional, social, and relational challenges. Most commonly used to support children between the ages of two (2) to twelve (12), Play Therapy is specifically designed to meet children at their level, and engage in assessment, prevention, and treatment in a non-threating way.
Play therapy may look as though it is “just play” and holds no further value other than fun (which is a great value), but it actually offers a great deal more. Research shows play therapy is effective in treating a variety of behavioural and mental health issues, along with capacity for learning, increasing concentration, and more.
Why Play Therapy?
Adults can struggle with communicating certain experiences, feelings, and challenges in a traditional therapeutic setting; children, given their age and stage of development, lack the cognitive and communicative skills required to verbalise certain experiences, even more so. Separation anxiety, family breakdowns, and bullying, for example, are experiences that many children have, and struggle with, and the emotional toll often manifests in behavioural challenges. This can then result in a child being labelled as “shy,” “naughty,” or “socially awkward,” where in fact they may be missing an appropriate opportunity for communication.
Play, being the language of children, coupled with a therapeutic setting, can support a child in making sense of, and working through, what may troubling them. A child who is experiencing anxiety may use dolls to play out their fears, another child who may be struggling with aggression and control may use dress ups and role play to depict their experiences of powerlessness (a main driver of aggressive behaviour). Through role play, puppeteering, dress ups, and more, a child begins to tell their story through character representation and can develop a variety of new skills and capacities, such as:
· Social interaction and competence
· Emotion regulation
· Receptive and Expressive language
· Flexibility and daily functioning
· Problem solving
· Cooperating and negotiating with others
· Self-esteem and independence
· Empathy and respect
· Intrinsic motivation
· Self-direction and self-control
· On task behaviour, and
· Increases in attention span
What Play Therapy Can Help With
At Kidspoint we often see children coming to play therapy for a variety of reasons, including foster care, anxiety and mental health issues, selective mutism, autism, ADHD, and behavioural challenges. Play therapy is often used for experiences of significant stress such as palliative care, grief and loss, abuse of any kind, hospitalisations, and traumatic experience e.g. car crash. Play Therapy can support children in the aforementioned areas, and in many other common areas also:
· Trauma and crisis
· Anxiety disorders
· Anger management
· School-related problems
· Social issues
· Family changes/separation/breakdown
· Chronic illness/hospitalisation/surgery
· Significant separations
· Self-concept and self esteem
· Bonding and Attachment
· Foster, adoption and identity issues
· Prenatal and birth trauma
A Non-Directive Approach
Regarding child-centered play therapy (developed by Virginia Axline in the 1940’s), a non-directive method of therapy, children communicate their inner experiences using toys, the therapeutic relationship, and a safe environment. In a room full of specific kinds of toys, children enter and can play with all the toys in almost any way they wish; they get to choose. No direction or guidance from the therapist is given, about what the child should or shouldn’t do (unless a limit must be set for safety reasons).
Children make sense of everything through play. By meeting a child in that space, in that world, a play therapist can go with the child into their life and see it from the child's point of view. Requiring no verbal exchange even, supporting a child in making sense of their world, and develop new skills through action, exploration, trial and error, emotional expression, and more.
Research on Play Therapy
It may seem as though Play Therapy is money poorly spent, at first glance, that playing with toys as a process for emotional healing and mental health support, may appear like a long toy bow to stretch. Great! You are questioning it, and here, we encourage questioning all modalities. It is important to understand that any intervention is evidence based, and ethical, not to mention logically sound and holistic. So here are some studies that demonstrate the efficacy of Play Therapy as a therapeutic intervention, and the outcomes that have been found.
Some General Information:
Two Meta Analytical studies of Child Centred Play Therapy (CCPT) published in 2014, and 2015 (Ray, et al.; & Lin & Bratton) found:
In four studies, two of which were follow up studies, Blanco et al. (2011; 2012; 2015; 2017) found:
In another Meta-Analysis, a Systemic Review, and other studies (Bratton, et al., 2005; Aja, 2018; Cheng & Tsai, 2014; Stulmakera & Ray, 2015; & Schottelkorb, et al., 2012) CCPT was found to:
n five recent studies, including randomized control trials, (Wilson & Dee, 2018; Swank & Smith-Adcock, 2018; Ritzi, Ray, & Schumann, 2017; Swan & Ray, 2014; Bratton, et al., 2013) CCPT was found to:
Looking at a literature review, several case studies, and two doctoral theses (Hillman, 2018; Salter, Beamish, & Davies, 2016; Carrizales, 2015; Morgenthal, 2015; Balch & Dee, 2015; and Josefi & Ryan, 2004) CCPT can be seen as:
Aja, A. P. (2018). The Efficacy of Play Therapy in Treating Anxiety in Young Children: A Systematic Review. California State University, Long Beach: ProQuest Dissertations Publishing.
Balch, J. W., & Dee, R. (2015). Emotional Assets of Children With Autism Spectrum Disorder: A Single‐Case Therapeutic Outcome Experiment. Journal of Counseling and Development, 93(4), 429-439.
Blanco , P. J., Holliman, R. P., Muro, J. H., Tolan, S., & Farnam, J. L. (2017). Long Term Child-Centered Play Therapy Effects on AcademicAchievement with Normal Functioning Children. Journal of Child and Family Studies, 26(7), 1915-1922.
Blanco, P. J., & Ray, D. C. (2011). Play Therapy in Elementary Schools: A Best Practice for Improving Academic Achievement. Journal of Counseling and Development, 89(2), 235-243.
Blanco, P. J., Muro, J. H., Holliman, R., Stickley, V. K., & Carter, K. (2015). Effect of Child-Centered Play Therapy on Performance Anxiety and Academic Achievement. Journal of Child and Adolescents Counseling, 1(2), 66-80.
Blanco, P. J., Ray, D. C., & Holliman, R. (2012). Long-Term Child Centered Play Therapy and Academic Achievement of Children: A Follow-Up Study. International Journal of Play Therapy, 21(1), 1-13.
Bratton, S. C., Ceballos, P. L., Sheely-Moore, A. I., Meany-Walen, K., Pronchenko, Y., & Jones, L. D. (2013). Head Start Early Mental Health Intervention: Effects of Child-Centered Play Therapy on Disruptive Behaviors. International Journal of Play Therapy, 22(1), 28–42.
Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The Efficacy of Play Therapy With Children: A Meta-Analytic Reviewof Treatment Outcomes. Professional Psychology: Research and Practice, 36(4), 376-390.
Carrizales, K. E. (2015). Transcendence through play: Child-centered play therapy and young children with autism. ProQuest Dissertations & Theses Global.
Cheng, W. Y., & Tsai, M. H. (2014). The effect of play therapy on socially withdrawn children's behaviors and self-concept. Bulletin of Educational Psychology, 46(2), 165-185.
Guest, J. D., & Ohrt, J. H. (2018). Utilizing Child-Centered Play Therapy With Children Diagnosed With Autism Spectrum Disorder and Endured Trauma: A Case Example. International Journal of Play Therapy, 27(3), 157–165.
Hillman, H. (2018). Child-Centered Play Therapy as an Intervention for Children With Autism: A Literature Review. International Journal of Play Therapy, 27(4), 198–204.
Josefi, O., & Ryan, V. (2004). Non-Directive Play Therapy for Young Children with Autism: A Case Study. Clinical Child Psychology and Psychiatry, 9(4), 533–551.
Lin, Y.‐W., & Bratton, S. C. (2015). A Meta‐Analytic Review of Child‐Centered Play Therapy Approaches. Journal of Counseling and Development, 93(1), 45-58.
Morgenthal, A. H. (2015). Child-centered play therapy for children with autism: A case study. ProQuest Dissertations & Theses Global.
Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-Centred Play Therapy in the Schools: Review and Meta Analysis. Psychology in the Schools, 52(2), 107 - 123.
Ritzi, R. M., Ray, D., & Schumann, B. (2017). Intensive Short-Term Child-Centered Play Therapy and Externalizing Behaviors in Children. International Journal of Play Therapy, 26(1), 33–46.
Salter, K., Beamish, W., & Davies, M. (2016). The Effects of Child-Centered Play Therapy (CCPT) on the Social and Emotional Growth of Young Australian Children With Autism. International Journal of Play Therapy, 25(2), 78–90.
Schottelkorb, A. A., Doumas, D. M., & Garcia, R. (2012). Treatment for Childhood Refugee Trauma: A Randomized, Controlled Trial. International Journal of Play Therapy, 21(2), 57–73.
Stulmakera, H. L., & Ray, D. C. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127-133.
Swan, K., & Ray, D. (2014). Effects of Child-Centered Play Therapy on Irritability and Hyperactivity Behaviors of Children With Intellectual Disabilities. Journal of Humanistic Counseling, 53(2), 120-133.
Swank, J. M., & Smith-Adcock, S. (2018). On-Task Behavior of Children With Attention Deficit/Hyperactivity Disorder: Examining Treatment Effectiveness of Play Therapy Interventions. International Journal of Play Therapy, 27(4), 187–197.
Wilson , B. J., & Dee, R. (2018). Child‐Centered Play Therapy: Aggression, Empathy, and Self‐Regulation. Journal of Counselling and Development, 96(4), 399-409.