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Because play is a major outlet through which children demonstrate what is on their mind, whether they have words or not, a branch of therapy has developed around understanding children and their needs by observing their play and helping solve problems through play. Play therapy is typically targeted to children ages 3 to 11 who have social, emotional, or behavioral difficulties. Play therapy is real therapy conducted in the medium of play.

Play therapy takes place in a comfortable playroom where few rules are imposed on a child, allowing the child free and spontaneous expression of feelings. The therapist, schooled in child psychology, usually has an array of toys that children can use to act out their feelings. In addition, the therapist may ask children questions about the toys they’re using that reveal hidden worries and concerns.

Play therapists pay special attention to the child’s choice of play objects, the types of play the child engages in, and well as the style of play. In addition, the therapist and child set up a trusting relationship between them that has therapeutic value. Through play therapy, children learn to express their thoughts and feelings in appropriate ways, learn about the feelings of others, learn ways of controlling their own behavior, and learn how to solve problems they encounter.

When It's Used

Parents sometimes think that play therapy is “just play.” But play is important to children. Not only can play be a window into their inner world, but a lot can happen that is therapeutic and should not be dismissed just because it is conducted through the medium of play. Children can come to discover ways of thinking and behaving that help them flourish.

Play therapy is helpful for children who are in distress for some reason, who display overt behavioral problems, or who have experienced a dramatic upset in their life, such as the death of a parent or parental divorce. It’s often used when children are facing serious medical procedures or struggling with chronic illness, and many children’s hospitals offer play therapy.

Play therapy is considered helpful for children who have experienced physical or emotional abuse or for those who have been bullied. It has been shown to be of help to children who have experienced war and other atrocities. Children who are persistently sad or anxious can find play therapy a safe and confidential way to work out their problems, as can those who are angry or have trouble adjusting to change.

Play therapy is also sometimes used with adults. Role-playing, for example, is a technique widely used in play therapy that is also incorporated into such standard adult therapies as cognitive behavioral therapy. Creative writing, music, and art may all be adapted for therapeutic purposes.

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What to Expect

Parents play an important role in play therapy for children. The therapist usually starts by conducting an interview with one or both parents or caregivers to gather information about the child and learn what the presenting problem is.

The therapist may then interview the child separately and watch the child play on his or her own. Simply observing how parents and child interact at this juncture can provide the therapist with information about the parent-child relationship, the nature of the child’s attachment, and how well the child and parents manage a separation.

The therapist may also ask the child and parent (or caregiver) to play together in order to observe how they interact. Based on the information and observations, the therapist discusses their findings with the parent and decides on an approach to the treatment of the child.

Play therapy usually occurs in weekly sessions for an average of 20 sessions lasting 30 to 45 minutes each. The therapy will be tailored to the individual child and the nature of the problems they are struggling with. Over time, the child typically comes to trust the play experience and the therapist, and a supportive relationship develops that fosters progress.

In addition to watching how children play with objects in the playroom, therapists notice whether there are any changes in play from session to session. Highly repetitive play may be an important indicator of a problem that requires exploration. Some therapists have playrooms equipped with one-way mirrors so that they can observe the child at play without being intrusive. They may also videotape one or more sessions for later review and detailed observation.

How It Works

Play is used to understand what is on a child’s mind because play is children’s natural medium of expression. While play therapy, like all therapy, is conducted by way of appointment, few rules may be imposed on the child’s play, and it is the choice of play objects and how they are used that often provide clues to a child’s developmental level, their family and social relationships, the difficulties they are experiencing in life, and their inner world. A child may be given access to trucks and phones and other toys, to drawing and painting materials, to dolls and action figures, to puppets, to stuffed animals, to masks and costumes, to sand play, and more. A child may be asked to tell a story about their family through the use of puppets. Or a child may be given a magic wand and asked to make a few wishes.

Sometimes play therapy is more directed, and a therapist might engage with the child in a play situation. For example, the therapist and child might role-play an experience the child finds overwhelmingly stressful, such as the first day of school, allowing the child to express their anxieties while discovering that their worst fears do not materialize. During the role-play, the child might be asked to play out a variety of scenarios and to come up with ideas for making them turn out as they wish.

Or the therapist may construct play activities the therapist believes will help a child heal from emotional injuries. As a play partner, the therapist can help children with social or emotional deficits learn to communicate and interact more skillfully.

Unlike many other forms of therapy, play therapy is directed by the child. Yet children typically draw or play out scenarios that mirror problems in their real lives. The play therapist might engage in a narrative that articulates and interprets the inner experience of the child.

The freedom to direct the therapy helps children in many additional ways: It communicates complete acceptance, it helps children discover themselves, it helps them develop a sense of self-mastery, and it is a stimulus to learning new ways of behaving. Both directive play and nondirective play have their uses. Play therapists may use both approaches depending on the circumstances.

What to Look for in a Play Therapist

A play therapist is a licensed mental health professional who has additional training and experience in play therapy. The Association for Play Therapy provides training and accreditation for Registered Play Therapists. The program involves special training in childhood problems as well as direct clinical supervision. Licensed mental health professionals, school counselors, and school psychologists with a master’s or doctoral degree are eligible for training.

Experience counts: It is advisable to seek a therapist who has not just extensive training but experience using play therapy to treat children presenting with concerns similar to yours.

As with all forms of therapy, it is important to find a play therapist with whom you feel comfortable. Look for someone with whom you can establish clarity of communication and a sense of good fit.

You might ask a prospective therapist such questions as:

  • How often have you dealt with problems such as those my child is experiencing?
  • How do you know whether my child is a good candidate for play therapy?
  • How does play therapy work?
  • What is a typical plan of treatment, and how long is a typical course of therapy?
  • How do you measure progress?
Play Therapy International
Evidence-Based Practice Statement: Play Therapy. 2016. Association for Play Therapy U.S.
Bratton, S.C., Ray, D., Rhine, T., Jones, L. The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice. 2005;36(4):376–90.