Does play therapy really work?

Many treatment modalities are available to clients, with some that take on a hands-on interactive approach, such as play therapy. Play therapy (PT) is a form of treatment that usually does not involve any medical procedures; instead, it often combines talk therapies, like cognitive-behavioral therapy (CBT), with playful, expressive, and interactive therapeutic techniques.  Anyone of any age may benefit from play therapy, but it is most commonly used in treating young children. 

The notion that play can be a valuable form of therapy for children to express themselves as their caregivers learn to understand them better has a basis in the beginnings of psychological theory. In 1909, Sigmund Freud told a parent to observe his child at play to help him overcome a phobia, which was the first documented use of play therapy as a theoretical model.

Since Freud's early use of this modality, more psychologists have studied and practiced the techniques, creating new techniques, including some used with adults, such as art therapy. PT has become a recognized specialty in psychology that is often the first choice of psychologists for their young clients. Understanding PT for children may take more than a single, isolated experience. Understanding how play therapy works, the potential benefits, and the effectiveness of the treatment can help you develop a plan for your child or family as you consider treatment modalities to meet your particular needs.

How is play beneficial? 

Play work is often used to treat mental health concerns because it is a child's natural way of communicating and understanding their environment. Most children play and use their imagination to express themselves in everyday life. They also play to develop motor skills, complex thinking, communication skills, social skills, creativity, and cognition.

If you observe a child playing, you might notice that they mimic the interactions of people around them, showcasing how they've been taught to see the world and relationships. They might mimic their parents with role playing, pretend to join a career they like or learn valuable problem-solving skills. Through experimentation, children learn more about their world in a way that makes sense to their growing mind. 

Often, play is children’s natural medium to express themselves through exercise or movement, improving mental well being by allowing them to stay active and learn throughout their activities. As they partake in these actions, they can form a personality, make friendships, and consider their dreams for their future. Consider how you played as a child and ask yourself how it might have impacted you as an adult. Looking back at their own childhood can help parents get perspective on their child’s problems and understand why PT is an effective interpersonal process for their optimal growth.

What is play therapy?

A trained therapist may use many different types of play to help their clients resolve psychosocial difficulties.

The client may play alone or with others. They may play with the professional or with their own parents or siblings. During the session, the counselor may observe and speak with the individual to evaluate their mental health. A common technique used during play is a set-up situation that encourages a child to play freely, enthusiastically, and imaginatively. When play counselors interact with the client, they rely on their training to help them guide the child to discovering insights that have a positive change on how they experience their world.

Through activities such as playing with sand, engaging with animals, or playing a board game, the play counselor can better understand who the client is at that stage of their life. 

Mental health objectives

Play therapy is often used to treat symptoms of mental health conditions and achieve optimal growth. When a child plays to build life skills, they can express any distressing emotions through a structured and imaginative environment. PT is often used for adults experiencing brain injuries or developmental disabilities to allow them a non-verbal or more expressive form of communication. 

PT may be effective for the following mental health challenges or experiences: 

• Physical or sexual abuse* 
• Domestic violence
• Anger management
• Attention-deficit hyperactivity disorder (ADHD) 
• Anxiety disorders 
• Autism spectrum disorder (ASD) 
• Chronic illness
• Behavioral challenges
• Crises
• Psychosocial difficulties
• Depressive disorders 
• Developmental concerns 
• Grief or loss 
• Learning disabilities
• Traumatic events, such as natural disasters 
• Unresolved trauma due to parental separation or divorce

While PT is used most often with children aged three to 12, it may also be advantageous for teenagers, adults, and older adults. Play counselors can also use PT with infants or toddlers. 

People of different age groups may play in different ways. Children often play with more imagination than others and may enjoy and feel comfortable with many types of play. Play for teenagers and adults may include board games, card games, art, sports, or recreational activities such as hiking or camping. Older adults may be limited in what they can do physically. However, they may also enjoy games, art creation, and recreational activities. There are play counselors who specialize in many age groups.

While some techniques may be used by school counselors, social workers or school psychologists, play therapy is almost always provided by a licensed mental health professional with a master's or Ph.D. Beyond their degree in the mental health field, they have training and experience in play therapy. Some counselors decide to complete extra specialized training and get more experience in PT under the supervision of someone already in the field; this allows them to become a registered play therapist supervisor, also known as a RPT-S.

The counselor is often in charge of determining what techniques to use and what types of play to include. However, they might not tell a client what to play with or how to play. Instead, the counselor can observe and use their training to make observations and play with the client. With some clients, parents may be involved in sessions. 

When PT was first used, it was often through a directive approach. The counselor told the child what to play with and asked them questions to evaluate their condition. They then observed and sometimes participated in play with the child, steering the play and the conversation the way they wanted it to go. Directive PT is still used in certain situations if the play counselor deems it the best option. However, this type of therapy may be considered outdated. It focuses on pathology and may assume that children cannot heal themselves.

Many forms of modern PT are child-centered, allowing the child to be the focus of the therapy. Through this form, children have more options of what to play with, how to play, and what topics to discuss. They make these choices known through the process of their place. 

Child-centered PT is an outgrowth of person-centered therapy. This modality is a type of therapy that assumes that the client has the drive to become healthier. They also have the means to do it for themselves with limited input from the counselor.

The play counselor's job in child-centered PT is to give them unfailing positive regard, empathy, understanding, and a sense of congruity. The child is the one who directs their own play and, in the end, makes the healing happen.

How can parents participate? 

Counselors sometimes include parents in PT sessions. They may ask the parent to play with the child while they watch from behind a two-way mirror. This process allows the parent to interact with the child as they do at home while the counselor watches and makes observations. 

The play counselor may also ask the parent to play with their child at home and take notes or journal about the experience. This homework assignment allows parents to be a part of their child's therapy while contributing to their child's healing and maturation.

The Adlerian version of PT combines direct, child-centered, and parent-assisted therapy techniques. The counselor, the child, or the parent may direct the play experience at different times. Often, the goal of treatment is to help the child become more interested in social experiences, gain insights, and learn new skills.

Psychologists specializing in PT have combined theories with many traditional therapy types. Because of this, a part of choosing a play counselor may be choosing the type of therapy you want for yourself or your child. The following are a few of the schools of thought that have been put to work by play counselors.

Cognitive-behavioral therapy (CBT) is often considered one of the most effective treatment modalities for adults looking to examine their thought process and gain more control over it. Since thoughts influence feelings and feelings influence actions, getting familiar with how to manage your thoughts can improve your mental health considerably.

Cognitive-behavioral play therapy takes those concepts and applies them to children at play. The play counselor and child direct the play session through toy cars, action figures, puppets, dolls, construction toys like sandboxes, or other modes of expressive play while partaking in CBT conversations and techniques. CBPT is considered a psycho-educational therapy and may be a short-term form of structured PT.

In dyadic PT, two children interact during play. The goal is for children to learn how to make friends. They may partake in multiple forms of play, including conversation through toys, sandbox play, or art creation. This form of PT can also help children develop interpersonal skills like giving and making compromises. 

Ecosystem play therapy considers the child's development and challenges, which helps the counselor create a treatment plan for the child's sessions. The challenges may be traumatic family dynamics, past adverse experiences, or bullying at school, among other topics. 

Experiential play therapy combines child-centered PT with relationship therapy.

Evidence-based play therapy is based on the results of current PT research. Counselors rely on recognized scientific outcomes to determine the course of treatment. Considerations for this plan include the individual characteristics of the child, their culture, their unique likes and dislikes, and how other children with the same factors have fared in different types of PT.

In gestalt play therapy, the focus is to help the client be more self-aware, develop their sense of responsibility, and stay in touch with the present moment. 

Counselors use group therapy for two or more children. The children may be siblings or may instead be together often in another type of situation, such as an educational setting.

Integrative PT takes the wisdom of two or more other types of play therapy and combines them to provide the best possible solution for an individual child.

The focus of Jungian play therapy is the inner self of the client. The counselor helps the client identify the symbolism in their fantasy play. The goal is to feel whole as an individual and confident in one's personality. 

Object relations therapy is used most often for children with attachment disorders. The focus of the play session is on the relationship between the counselor and the child at play, which may be structured to mimic other relationships in the child's life to address attachment wounds and create a safe space for the child to be expressive. 

Psychoanalytic PT borrows from the field of psychoanalysis. The focus is creating a play situation that may cause unconscious thoughts to surface so the counselor can explain the meaning of those thoughts in a way the child can understand.

Psychodynamic PT deals with the conscious and unconscious emotional difficulties the child expresses through play. 

Relationship 

As the counselor demonstrates that they accept, respect, and have faith in the child, the child and counselor develop a positive relationship. This relationship forms the basis of therapy that seeks to resolve emotional difficulties and bring healing.

Animal-assisted 

In animal-assisted PT, the counselor works with one or more animals in treating a client. The counselor directs the play to a certain extent and ensures the animal's and client's safety and health. Interacting with an animal may bring out expression and emotion in shy children who struggle to verbalize thoughts. 

Art therapy is used for people of all ages as a separate discipline from PT. However, art can be a part of PT that allows children to develop new skills and the confidence that goes along with them while expressing their feelings freely. Adults often use art therapy as well, which can effectively treat challenges like grief.

Filial 

Filial therapy is used for siblings. In this modality, the counselor teaches the parent to do child-centered PT with their children.

Older children, teenagers, and adults often benefit from gameplay therapies. The counselor may observe or interact with clients as they play a board game, card game, or a sport like billiards or bowling. This process may allow older clients to engage in activities they consider play.

Narrative  

Narrative play is similar to storytelling. The child or client may be prompted to tell a story, or the child and the counselor may create a story together. As the story takes shape, the counselor helps the client deal with complex emotions and thought patterns during the experience. The story may showcase subconscious thoughts or patterns the client is unaware of. 

PT often involves playing with toys. Toys may include toys children often play with, such as dolls, stuffed animals, toy cars, blocks, or Legos. They can also include specialty toys designed specifically for PT, such as fidget toys. 

Sand play is a popular form of therapy, not only for children but also for people of all ages. Interacting with the sand can be calming, allowing expression to happen more effortlessly. The client may play in a sandbox or run their fingers through the sand in a sand tray. Sand play therapy often focuses on the symbolism behind the play, while sand tray therapy helps the client process their experiences with others and within themselves. Jungian therapy is often combined with the sand play modality.

In sensory-motor PT, the client does activities that engage both their body and their mind. This therapy modality might involve practices like a ropes course, obstacle course, or going to the gym. 

Trauma-focused  

Trauma-focused PT helps clients experiencing post-traumatic stress disorder (PTSD) or mental health concerns due to a past adverse event. As they play, the client learns coping strategies and skills that help them address the memories associated with their past. These healthy coping mechanisms may have a number of benefits, including giving the client ways to manage their stress and emotions. 

Does it work?

PT works for clients of all ages, and various forms exist. A licensed counselor can tap into the therapeutic powers of play to facilitate a beneficial experience for the client.

Play counselors may refer to the powers of play, the different ways that play can benefit the person using the techniques. A few powers of play include: 

• Direct or indirect learning
• Self-expression
• Improved relationships
• Healthy attachments
• Releasing unwanted emotions or beliefs 
• Reducing stress
• Solving problems creatively
• Building self-esteem

Numerous research studies have shown how effective PT can be. Although certain scholars have condemned this type of therapy as one that hasn't yet been studied adequately, one scholarly review found 93 play therapy controlled-outcome studies to compare and contrast. The therapies shown to be most effective in these studies were humanistic or involved the parents in the process. 

Children or clients who have the chance to engage in PT enjoy a variety of benefits. The outcomes of their PT might include the following: 

• They feel a greater sense of responsibility. 
• They become more successful in school, within the social scene, or in their careers.
• They learn how to come up with creative solutions to problems.
• They come to respect themselves and others more.
• They develop a more significant ability to experience and express their emotions.
• They learn or increase their ability to feel empathy and respect for the thoughts and feelings of others.
• They learn to handle social situations more effectively.
• They learn healthy ways to interact with other family members.
• They receive positive responses to their abilities and become more self-assured.

How to become a play therapist

If PT intrigues you, you might consider becoming a play therapist. PT can offer a lucrative profession with a relatively high salary while often being an enjoyable and fulfilling use of time. If you're considering putting yourself or your child in play therapy, you might also want to know what special preparations therapists must go through to become play counselors. To become a play counselor, counselors often go through the following steps: 

• Receiving a master's degree or higher in a mental health field
• Applying for a mental health license or certification for clinical practice in their state
• Attending psychology classes that focus on the use of play in the therapeutic process
• Going through supervised training hours in a clinical setting 
• Meeting the criteria to be registered with the Association for Play Therapy
• Achieving PT certification in their state
• Conforming to the standards and code of conduct of the PT board in their state 

Counseling options 

There are many ways to get started with therapy or sign your child up for sessions. One standard method of finding support involves asking a pediatrician or primary care provider for a referral. However, you're not alone if you face barriers to reaching out for support. In these cases, online PT can be a potential option for teens and adults. Through a platform like BetterHelp for adults or TeenCounseling for teens aged 13 to 19, individuals can receive several therapy modalities from home. 

On an online platform, clients can fill out a quick questionnaire with their preferences for therapy and get matched with a provider knowledgeable in the area they are concerned about. In addition, one meta-analysis of over 17 studies found that online therapy can be more effective than in-person therapy for treating specific mental health concerns, such as depression.