Therapist and child in play therapyPlay therapy is a form of therapy primarily geared toward children. In this form of therapy, a therapist encourages a child to explore life events that may have an effect on current circumstances, in a manner and pace of the child's choosing, primarily through play but also through language.

Play therapy, can help individuals communicate, explore repressed thoughts and emotions, address unresolved trauma, and experience personal growth and is widely viewed as an important, effective, and developmentally appropriate mental health treatment. 

History and Development of Play Therapy

Though some of the earliest theories and methods mentioned below are no longer practiced and may not be acceptable based on current research and ethical standards, they did play a part in advancing play therapy to the extent that it is now regarded as an established therapeutic approach. Some key individuals in the development of this therapy and their contributions to the field include:

  • Hermine Hug-Hellmuth, who is widely regarded as the world’s first psychoanalyst to specialize in treating children and the first person to use play as a form of therapy. In 1921, she introduced a formal play therapy process by providing the children in her care with the necessary materials to express themselves and advocated the use of play to analyze children.
  • Melanie Klein, who used play as an analytic tool as well as a means to attract the children she worked with to therapy. Klein believed play provided insight into a child’s unconscious.

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    David Levy    , who developed a therapeutic approach called “release therapy” in 1938. This was a structured approach that encouraged a traumatized child to engage in free play. The therapist then gradually introduced materials related to the traumatic event, allowing the child to re-experience the stressful event and release any unresolved emotions or actions.
  • Joseph Soloman, who used an approach called “active play” to assist children who displayed impulsivity and a tendency to act out. The approach was based on Soloman’s belief that expressing emotions such as fear and anger in play would result in more socially acceptable behavior.
  • Anna Freud, who presented theoretical arguments for the use of play as a means to build a positive relationship between the child and therapist, thus allowing the therapist better access to a child’s inner thoughts and emotions.
  • Carl Rogers, who developed person-centered therapy during the 1940s and 1950s. This type of therapy emphasizes the importance of genuineness, trust, and acceptance in the therapeutic relationship.
  • Virginia Axline, who developed nondirective play therapy by modifying Rogers’ approach into a play therapy technique that was more appropriate for children.
  • Roger Phillips, who posited the idea to combine cognitive therapy and play therapy in the early 1980s. Cognitive behavioral play therapy has been used to treat children as young as two years old.

The Neuroscience behind the Importance of Play

Though play is often regarded simply as a way for individuals, particularly children, to relax, scientific research has proven that play is a crucial factor in healthy child development. Studies show that newborn babies possess billions of brain cells; however, these young cells lack the complex neural interconnectivity that is characteristic of a mature, fully-functional human brain. Neuroscience has revealed that the majority of the brain’s growth takes place within the first five years of a child’s life, and the act of play contributes significantly toward the development of interconnections between neurons. These neural links play a major role in key areas of the child’s life, such as learning, social development, emotional development, and memory. 

Play is considered to be especially important for the healthy development of children who have experienced stressful events or past trauma. While the effects of trauma tend to reside in the nonverbal areas of the brain—the hippocampus, amygdala, thalamus, and brain stem—a person’s capacity to communicate and process adverse issues resides in the brain’s frontal lobes. As a result, children affected by trauma may find it difficult to let other people know that they need help. The physical and role-playing activities associated with play therapy have proven instrumental in helping to move traumatic memories and sensations from the nonverbal brain areas to the frontal lobes. 

How Does Play Therapy Work?

When children are experiencing adverse personal issues they will often act out or engage in inappropriate behavior. Parents may be eager to help but may find it difficult or impossible to offer effective aid if a child is unable or unwilling to discuss the problem. Play therapy is thought to be one of the most beneficial means of helping children who are experiencing emotional or behavioral challenges. Though the approach may benefit people of all ages, it is specially designed to treat children under 12. A typical session may last for 30-45 minutes and may be conducted with one child only or in groups.

During treatment, the therapist creates a comfortable, safe environment in which the child is allowed to play with as few limits as possible. This counseling space is often referred to as a playroom, and it comes equipped with a selection of specifically chosen toys that are meant to encourage the child to express his or her feelings and develop healthier behaviors. The child’s interactions with these toys essentially serve as the child’s symbolic words. This allows the therapist to learn about specific thoughts and emotions that a child may find difficult or impossible to express verbally.

Toys used in therapy may include a sandbox with associated miniature figurines, art materials, Legos or other construction toys, costumes or other clothing, stuffed animals, dolls, a dollhouse with miniature furniture, puppets, indoor sports equipment, and other indoor games. The therapist may also incorporate the use of tools and techniques such as clay, therapeutic storytelling, music, dance and movement, drama/role play, and creative visualization.

At first children in therapy are generally allowed to play as they wish. As treatment progresses, the therapist may begin to introduce specific items or play activities which are related to the issues the child is facing. Play therapy may benefit the child in a variety of ways such as encouraging creativity, promoting healing from traumatic events, facilitating the expression of emotions, encouraging the development of positive decision-making skills, introducing new ways of thinking and behaving, learning problem-solving skills, developing better social skills, and facilitating the communication of personal problems or concerns.

Play therapy may be nondirective or directive. Nondirective play therapy is grounded in the idea that if allowed optimal therapeutic conditions and the freedom to play, children in therapy will be able to resolve issues on their own. This approach is viewed as non-intrusive since there is minimal instruction from the therapist regarding how a child should engage in play. Directed play therapy involves much greater input from the therapist and is based on the belief that faster therapeutic results may be obtained than in nondirective play therapy sessions.

Play Therapy for Adults

Play therapy can also be used to treat issues faced by teenagers and adults. By adulthood, most people have lost their ability to playfully explore themselves. Play therapists are trained to help adolescents, adults, and even the elderly relearn the values of play. Playful exploration has been proven to enhance both cognitive and physical behaviors, and there is a significant amount of research from the fields of neurophysiology and molecular biology that supports play therapy as a valid therapeutic technique for those past childhood. A growing number of organizations and experts are dedicated to play research and advocacy, believing that play is important for people of all ages.

Play has been shown to optimize learning, enhance relationships, and improve health and well-being. Adults and children engaged in a therapeutic alliance that focuses on play have an opportunity to choose from a variety of modalities such as movement (body play), sand play, dream play, nature play, social play, pretend (fantasy) play, creative play, storytelling, and vocal play. Play therapy may be used to address a variety of health challenges experienced by adults, especially if incorporated with other treatment modalities. One of the most significant benefits is that play can provide a comfortable and safe environment that may prompt an adult to approach more serious issues.

Play therapy can be used to treat (in children or adults):

Guidelines for Effective Play Therapy

Play therapy has proven to be an effective therapeutic approach for people from all age groups, though minors respond particularly well to this type of treatment. Therapists may employ several general guidelines and practices in treatment in order to foster the greatest benefits for people in their care.

When working with a child, a therapist may provide adjunctive therapy for adults who play key roles in the child’s life. Throughout therapy, the therapist will typically place emphasis on the promotion of mental health and psychosocial development, explaining treatment plans to the person receiving treatment and a child's legal guardians, if necessary. Therapists may also coordinate treatment with doctors or other health care professionals to ensure that a child's welfare remains the treatment priority. If inappropriately touched by a child in treatment, the therapist may find it best to explain that it is important that each person’s body is respected, document the event, then discuss the situation with the child's legal guardians at the earliest opportunity. A therapist may also find it necessary to make arrangements to prevent the child, or any person they are treating, from feeling abandoned, should there be a break in treatment.

Training for Play Therapists

Mental health professionals who seek specialized training and experience in play therapy may earn their credentials from the Association for Play Therapy (APT). The APT is a nationally recognized professional institution which aims to further the play therapy modality and advance the expertise and knowledge of mental health professionals involved in the clinical practice, instruction, and supervision of play therapy. The APT offers two standard credentials: the Registered Play Therapist TM (RPT) and the Registered Play Therapist-Supervisor TM (RPT-S).

Applicants desiring to become a Registered Play Therapist TM must:

  • Possess an active individual state license which allows him or her to independently provide clinical mental health services.
  • Have earned a master's degree or higher in a mental health field, with special emphasis on areas such as child development, psychotherapy, theories of personality, ethics, or child and adolescent psychopathology.
  • Have two years of general clinical experience (as required for state licensure) and 2000 hours of general mental health clinical experience.
  • Complete 150 hours of play therapy instruction from APT-approved providers or tertiary level academic institutions.

To become a Registered Play Therapist-Supervisor TM, an applicant must also have 500 hours of experience in play therapy, conducted under supervision, plus an additional 50 hours of field-specific supervision.

The Registered Play Therapist TM (RPT) credential lasts for one year, and it must be renewed annually to maintain active status. To qualify for renewal, the applicant must have a current and active state license to offer clinical mental health services and follow a continuing education cycle by receiving 18 hours of instruction specific to play therapy from a tertiary level academic institution or an APT-approved provider every 36 months.

References:

  1. Bratton, S. C., Ray, D., Rhine, T. & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 376-390. Retrieved from http://www.moplaytherapy.org/uploads/media/Research_The_efficacy_of_play_therapy_with_children.pdf
  2. British Association of Play Therapists. (2013). History of play therapy. Retrieved from http://www.bapt.info/play-therapy/history-play-therapy
  3. Eugster, K. (2007). Play therapy: How it helps children feel better and improve behavior. Retrieved from http://www.kathyeugster.com/articles/article003.htm
  4. Guerrero C. & Vega, C. (2014). Credentialing guide: Registered play therapist (RPT) and Supervisor (RPT-S). Retrieved from http://c.ymcdn.com/sites/www.a4pt.org/resource/resmgr/RPT_and_RPT-S_Credentials/RPTS_Guide.pdf
  5. Homeyer, L. E. & Morrison, M. O. (2008). Play therapy: Practice, issues and trends. Retrieved from http://www.journalofplay.org/sites/www.journalofplay.org/files/pdf-articles/1-2-article-play-therapy.pdf
  6. Play Therapy United Kingdom. (n.d.). An introduction to play therapy. Retrieved from http://www.playtherapy.org.uk/Resources/Articles/ArticleMBIntro1.htm
  7. Sprunk, T., Colwell, N. K., Mitchell, J. A., Smith, J., Carmichael, K. & Frick-Helms, K. (2012). Play therapy best practices. Retrieved from http://c.ymcdn.com/sites/www.a4pt.org/resource/resmgr/Publications/Play_Therapy_Best_Practices.pdf
  8. Ward-Wimmer, D. (2002). Introduction: The healing potential of adults at play. Retrieved from http://www.psychceu.com/Schaefer/intro.pdf