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Play Therapy

by Ivo Peixoto, Elona Dashi, and Asilay Şeker
Play Therapy
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Contributors (7)
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Published
Jul 09, 2019

Brief historic overview

Historically, Play Therapy (PT) has emerged from the conceptual understandings found in psychoanalytic and humanistic psychology, psychotherapy and child development literature. In Europe in the early 1900s, Melanie Klein and Anna Freud (the daughter of Sigmund Freud) included play in their psychoanalytic treatment of children.

In 1935, Margaret Lowenfeld first published Play in Childhood documenting her in-depth observations of children whilst working at the ‘Clinic for nervous and difficult children’ in London. In the United States, Virginia Axline focused her work on conceptualising and documenting Non Directive Play Therapy (NDPT) by drawing from the humanistic and relational perspective of her teacher and colleague Carl Rogers (Axline, 1969). Rogers (1951) was instrumental in establishing treatment plans based on necessary and sufficient conditions for growth. These included therapeutic congruence, unconditional positive regard, empathic understanding and acceptance.

From these beginnings, several different theoretical models of PT have emerged. Based on Axline’s principles, the most well-known is Non-Directive or Child-Centred Play Therapy (CCPT) which has been further developed by Garry Landreth and colleagues and integrated into teaching parents or guardians the principles found in CCPT, known as Filial Play.

Description

PT is an effective means of responding to the mental health needs of young children and is widely accepted as a valuable and developmentally appropriate intervention.

Play is the natural world of the child. Children learn about themselves, others, and their world through play. Play is also considered a right for all children, everywhere, to achieve optimal development. The therapeutic potential of play has been extensively reviewed by Charles E. Schaefer

He states that play helps overcome resistance to therapy through the creation of a nonthreatening environment, while serving as a developmentally appropriate means of communication for children.

Play assists the child in a multitude of developmental tasks: it enhances the child’s ability to develop mastery that leads to a sense of efficacy and competence; it stimulates creative thinking and problem-solving skills; it offers a means to express and reenact strong emotions, making them more manageable and integrated; it allows role-playing and fantasy play, promoting empathy, affect regulation, curiosity and sense of agency. Developing themes and metaphors in play gives meaning to life by shaping the child’s belief systems. By the same token, the use of toys allows for creative and emotional expression, testing of limits, and role-playing reality. Play therapists have a sound theoretical rationale for selecting and placing toys and materials in a play therapy playroom. Types of toys include, but are not limited to, dolls and dollhouses, play kitchens, building blocks, farm and wild animals, toy knives and swords, dress-up costumes, art supplies, musical instruments, and puppets (Landreth 2002). Each play therapist’s theoretical orientation dictates whether play with the toys and games is child directed or directed by the professional.

Finally, it must be said that the experience and enjoyment of play is often, per se, therapeutic. It promotes corrective emotional learning and a sense of relatedness through the development of attachment in the therapeutic relationship.

Main uses

PT has an established and growing evidence-base and has been proven to be effective in addressing myriad of presenting problems in children.

Clinical conditions where PT can be applied as a therapeutic option include phobias and anxiety, depression, adjustment disorder, PTSD, ADHD, ODD, conduct disorder, autism and OCD.

PT can also be used as an alleviator in many nonclinical presentations in children either for overcoming sub threshold symptoms or psychosocial issues.

In this context, PT can be used when working with children who have shyness, peer relationship problems, poor stress tolerance or inadequate communication/social skills. It can also be used during times of grief or loss and for children with chronic illnesses.

PT can also help children with aggression, poor motor co-ordination and self-harming behavior.

Responses to family and relationship problems, such as family violence, parental separation, attachment problems, trauma and abuse can also benefit from PT.

Children who struggle with educational issues such as poor organizational skills, poor planning and execution of tasks, poor story comprehension can resort to PT, and there is evidence that CCPT has a significant positive impact on academic achievement and moderate to large treatment effect on second graders’ reading achievement scores and 4- to 6-year-olds’ receptive and expressive language skills.

PT also makes it possible to work with children who have learning disabilities and sensory impairment.

Other than Play Therapy’s individual application, it can also be used as a facilitator of other therapy techniques to help smaller children. Systematic desensitization techniques can be presented through PT for phobias and foster families and adopted children can participate in Filial/Family Therapy through play.

Interesting Fact: PT can be used even for combating obesity.

Efficacy

A summary of the effectiveness of PT, presented by Play Therapy International and Play Therapy UK in 2011 showed that, based on data from 8026 cases, between 74% and 83% of children receiving play therapy showed a positive change (Thomas, 2011). A meta-analysis of 93 controlled outcome studies (published 1953–2000) was conducted to assess the overall efficacy of play therapy and to determine factors that might impact its effectiveness. The overall treatment effect for PT interventions was 0.80 standard deviations. Further analysis revealed that effects were more positive for humanistic than for nonhumanistic treatments and that using parents in PT produced the largest effects. Play therapy appeared equally effective across age, gender, and presenting issue.

All in all, thorough review (meta-analyses and systematic review), rigorous controlled research designs (RCT), quantitative and experimental explorations (SCED, quasi-experimental, and cohort), and qualitative studies support the use of play therapy with children ages 3 to 12 years old. Research signifies that PT is an effective intervention for children who present with externalizing and internalizing problems, self-concept issues, reactions to traumatic events and complexities, developmental delays, social-emotional challenges, and relationship difficulties. Research studies thematically support the use of play as the primary communication tool for young children. Last but not least, research supports the implementation of PT by well-trained and knowledgeable play therapists that have been educated and supervised in the practice of PT for results closer to optimal.

Bibliography

Axline,V.M (1969) Play Therapy, New York, Ballantine Books

Landreth, G. L. (2002) Play Therapy: The Art of the Relationship. 2 nd ed. NY:Brunner-Routledge O’Connor, K. J., Schaefer C., Braverman L.D (2016) Handbook of Play therapy, John Wiley& Sons, Inc. Rogers. C (1951) Client Centered Therapy: Its current practice, implications and theory. London Schaefer, C.E. (2011) Integrative Play Therapy. John Wiley & Sons, Inc.

Thomas J. (2011) Play Therapy in the UK

Comment from an expert and/or quote from a famous psychotherapist:

Play is a child’s work and this is not a trivial pursuit

Alfred Adler

Play bridges the gap between concrete experience and abstract thought

J. Piaget

Toys are the child’s words and play is the child’s language

Haim G. Ginott

Books, manuals, videos, application, published online courses or international association

Certified Courses

There are Certificate, diploma and master courses in play therapy with international accreditation:

Books

  • Axline, V. (1984) Dibs In Search of Self: The moving story of an emotionally lost child who found his way back. Penguin Books: Buckinghamshire.

  • Axline, V. M. (1989) Play Therapy. Churchill Livingstone: London

  • Cattanach, A. (2003) Introduction to Play Therapy. Hove: Brunner-Routledge

  • Clinics of Turkey - Psychotherapy Issue (2017) , Play Therapy Chapter

  • Gaskill, R. L. (2010). Neurobiology of play therapy. Play Therapy, 5(4). CA, USA:Association for Play Therapy.

  • Giordano, M., Landreth, G. & Jones, L. (2005) A Practical handbook for Building the Play Therapy Relationship. New Jersey: Jason Aronson

  • 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.

  • Kevin J. O’Connor, Charles E.Schaefer, Lisa D.Braverman, Handbook of Play Therapy (2016) John Wiley & Sons, Inc. USA

  • McCarthy, D. (2012) A Manual of Dynamic Play Therapy: Helping Things Fall Apart, the Paradox of Play. London: Jessica Kingsley Publishers

  • McMahon, L. (2009) 2nd Ed. The Handbook of Play Therapy. East Sussex: Routledge

  • Melanie Klein (1975) The Psychoanalysis of Children

  • Oaklander, V. (2007) Hidden treasure: A map to the child’s inner self. Bungay, Suffolk: Catch Limited.

  • Oaklander, V. (2007) Windows to Our Children A Gestalt Therapy Approach to Children and Adolescents. Gouldsboro, Maine: The Gestalt Journal Press. First published 1978

  • Sunderland, M. (2000) Using Story telling as a Therapeutic Tool with Children. Oxon: Winslow Press.

  • West, J. (1996) Child Centred Play Therapy. London: Arnold

Resources

The International Journal of Play Creative Art Therapies - This Journal will be published in addition to Play for Life, which is a practitioners' publication, published by PTUK and PTI, where articles may be written in a more informal style.

Popular Play Therapy Books - Books on this list may be purchased through PTUK either from Amazon or directly from us.

Play Therapy - Publications and Books - Play Therapy UK (PTUK) publications.

PTUK Members' Site Links - Below is a list of links to PTUK members' websites.

Professional Support Services - A range of management consultancy services to support other professionals and organisations who work with children are available from PTUK

Research Possibilities

Studies suggest that many and various research designs are contributory to the understanding of play therapy. RCTs and the replication of RCTs (meta-analyses and systematic reviews) for specific presenting problems and issues serve as the most credible evidence supporting the use of play therapy. However, RCTs are only one source of information on the process and outcome of play therapy. Small-group experimental, correlational, single-case experimental, and qualitative designs offer substantial information on the format and process of play therapy. In using these methods, play therapists benefit from conducting research through rigorous design implementation and staying within the confines of the design limitation when stating conclusions about their findings. Research studies conducted with detail and integrity offer valuable information to the field, even if they are limited in addressing the overall effectiveness of play therapy

Links to Societies

The accreditation of the Play Therapy United Kingdom (PTUK) Register was the first recognition of Play Therapy as a distinct professional at national government level in the world Play Therapy International (PTI) and its affiliated professional organisations administer these standards outside the UK, on behalf of PTUK, to ensure that practitioners of therapeutic play, play therapy and filial play coaching meet the standards required by the Register.

In order to become Certified Play Therapist it is necessary to follow certain qualification standards that follow a four stage training model

New

Zealand

Hong Kong

Malaysia

Africa

Malta

APAC

Singapore

Korea

South Africa

Indonesia

Greece

Affiliation:

Asilay Şeker

Elona Dashi

Ivo Peixoto

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