PTSD, Play Therapy, and the Lack of Research

Dr. Malchiodi’s blog post was written in response to my original post. The main purpose of writing my original post was to provide consumers with accurate information about their options for treatment for young children with posttraumatic stress disorder (PTSD). I offer these additional comments with that purpose in mind.

Dr. Malchiodi’s blog post layered confusion on top of an already muddled situation by implying that treating comorbid symptoms of children who have had traumatic experiences is equivalent to treating PTSD. There is a difference between treating a child who has suffered a trauma and shows some non-PTSD symptoms versus treating a child who has met diagnostic criteria for PTSD. Valid research needs to be "clean" regarding specific treatments for specific diagnostic issues.

We don't give chemotherapy to a patient who has some symptoms of possible cancer but not a cancer diagnosis, do we? We don't remove the cervix of a woman whose Pap smear shows atypical cells but not cancerous cells. It's opening Pandora's box if you call it evidence-based research for PTSD to study subjects who do not have a qualifying PTSD diagnosis or marked symptoms of PTSD.

The response by Dr. Malchiodi, however, made my point for me; there are no valid randomized trials of play therapy for PTSD. Unfortunately, she didn’t stop there. These responses by Dr. Malchiodi and the Association for Play Therapy would have been stronger if they responded like responsible scientists and simply admitted that there are no valid randomized trials of play therapy for PTSD. They could have said that there are several randomized studies of play therapy with children following traumatic experiences but those studies had limitations and did not actually study PTSD outcomes. Instead, they doubled down on their irresponsible claims by conflating studies of trauma-exposed children without PTSD symptoms with studies of children with true PTSD symptoms.

As sociobiologist Robert Trivers is known for saying, we deceive ourselves so as better to deceive others (Trivers, 2011). It appears to me that play therapists who are engaging in this discussion with me about the evidence base for play therapy and PTSD are trying to convince themselves that the way they treat PTSD is valid so as to better convince others of what they practice.

What is not clear to me is whether play therapists who spoke up truly do not understand basic principles of research and are innocently being misleading, or if they believe research standards are not terribly important and they are purposefully stretching the truth a bit because it is an accepted practice to be inexact in the imprecise profession of psychotherapy.

I commend play therapists for responding, however, because I think this discussion is important to have. Consumers are the ones caught in the middle as they try to sort through the claims and find the right treatments for their children. As I wrote in a previous post: “Consumers have more information about the shingles on the roofs of their homes and the breakfast cereal on their kitchen tables than they have about psychiatric care. The current marketplace allows confusion to thrive, and consumers are the losers."

I’m happy to let consumers decide if this discussion provides some useful information and clears up some confusion.