Chapter 14
Play Therapy
CHAPTER OVERVIEW
Play therapy has evolved from the efforts of several psychoanalytic therapists in the early 1900s
as well as the work of child guidance clinics. Play therapy may be either structured, with an
active counselor who determines the focus and selects the materials, or unstructured, with the
emphasis on an accepting relationship between the therapist and the child. This chapter presents
some approaches to play therapy that have not been covered in the previous chapters on
counseling theories. The material in this section also includes some important considerations for
counselors using play therapy as well as a number of specific techniques to be used in play
therapy situations.
CHAPTER OBJECTIVES
After completing this chapter the student will be able to:
1. Define play therapy and discuss the advantages of play therapy
2. Outline the empirical support for play therapy as well as the indications and
contraindications for it as an approach to working with children.
3. Explain ways to use play therapy in groups, with families and as a prescriptive
intervention
4. Outline play therapy work with specific child populations
5. Demonstrate basic skills, procedures and techniques that facilitate constructive client
change using play therapy.
6. Discuss the similarities and differences between play therapy and other ways of
working with children.
CHAPTER SUMMARY
Play is the natural medium of a child’s self-expression. Play is pleasurable and intrinsically
motivating. Play has a make-believe quality and is flexible. Play is a natural way for children to
express themselves, to act out sensitive material, to gain security and to increase their selfconfidence. Incorporating play into counseling has several advantages. The child has freedom of
choice. Play evokes fantasies and unconscious feelings. Play offers familiar tools for children to
use. The only limits are to keep the child and others safe. The child has a safe place to act out
feelings, to gain understanding, and to change.
The Association for Play Therapy (1997) defines play therapy as “the systematic use of a
theoretical model to establish an interpersonal process in which trained play therapists use the
therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve
optimal growth and development.” The therapeutic powers of play noted by Schaefer, Sweeney
and Kottman are as follows: overcoming resistance, communication, competence, creative
thinking, catharsis, abreaction, role play, fantasy, metaphoric teaching, attachment formation,
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relationship enhancement, positive emotion, mastering development fears, and game play.
Among Kottman’s conclusions is the recommendation that play therapy would not be the choice
for children with severe conduct disorder, severe attachment disorder, or manifest signs of
psychosis.
Play therapy has been effective with children with many types of difficulties such as abuse,
depression, fear, family violence, ADHD, stress and coping skills. Results of studies on the
efficacy of play therapy support its effectiveness for a variety of problems, populations and
setting regardless of clinical orientations. Common elements for effective play interventions are
having parents involved in the therapy and the length of treatment of thirty to thirty-five sessions.
Play therapy is applicable across cultural groups. When working with children from
multicultural backgrounds, counselors are advised to do the following: respect all aspects of the
child’s culture and choose play materials to express that respect; investigate the role of play in
diverse populations; become familiar with values, beliefs, customs, traditions, and language of a
child’s culture; recognize the on-going process of becoming culturally competent; match
philosophical basis of the play therapy theory to the cultural values; be aware of personal biases;
and interact with multicultural populations.
Parents who value individualism are likely to help their child develop autonomy, self-assurance,
competence, and a sense of being special. Parents who place a higher value on connections,
however, may help their child to become interdependent and humble, and to put others first.
The effective play therapist will have some of the following qualities: appreciation of and
respect for children, a sense of humor, a playful attitude, self-confidence, openness, acceptance,
willingness to use play and metaphors as communication tools, flexibility, comfort with children,
ability to set limits, and self-awareness.
Various theoretical approaches to play therapy are presented. Play therapy groups have been
successful. Authors discuss the encouragement, connection, and reality-checking function
present in groups. In small groups children have experiences that help them learn new skills,
explore their behavior, develop tolerance and find joy in working with other children. Group play
therapy may be considered as an option for children age 2 to 12 with similar problems or
experiences affecting their behavior. It is recommended that there be no more than six members
per adult, nor more than ten members with two adults. Other recommendations, as well as
advantages, are provided in the text. Group play therapy may be particularly beneficial for
children with social skills deficits. Groups for social skills and for children experiencing
parental divorce are reviewed.
Prescriptive play therapy involves a counselor tailoring the interventions for each child. The
counselor, therefore, must have knowledge of and skills to apply each approach to play therapy.
He/she must also understand the issues surrounding childhood disorders, relate the needs of
children with each diagnosis to treatment planning, and know the current outcome research to
match treatments to specific problems.
Play therapy with families has been recommended for various settings and presenting problems.
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Play in family therapy is used to change the family's emotional atmosphere, role expectations,
rigid self-image, and structure. The models of play therapy with families reviewed include filial
therapy and parent-child interaction therapy.
Play therapy has been identified as successful with specific child populations and problems. The
PMHP is a successful school-based play intervention based on the child-centered theories of
Virginia Axline. Other play therapy techniques for working with children who have witnessed
domestic violence, children with chronic illnesses, children with PTSD and children with autism
are discussed.
A play therapist is advised that keeping the child safe in the therapy is the top priority. The
therapist should seek training and continuing supervision, understand the developmental process
of the child, and learn ways to stimulate the child’s participation. By showing interest in the
child as well as demonstrating warmth, caring, acceptance, the therapist creates an environment
of safety and allows the child opportunities to express freely. Counselors should assess children
who are potential play therapy clients on their ability to form a relationship with an adult, to
accept the play therapy environment, to learn new ways of coping, to gain insight and their
attention span and cognitive ability.
Criteria for assessing the progress toward play therapy goals include the following: the child
demonstrates increased confidence and relaxation; the child can summarize what has been
learned; the play patterns, interactions, or body language have changed; and the child more
openly raises a problem or concern.
Play media and strategies are reviewed. Play media are the materials and props a counselor may
use in sessions. These are categorized as real-life toys, acting-out toys, and aggressive-release
toys. Particular attention is given in this chapter to the beneficial uses of art, puppets, and sand.
KEY CONCEPTS
1.
2.
3.
4.
5.
Play therapy includes structured and non-directive modes, depending on the counselor's
orientation.
Play techniques should be a primary method for counseling with children in the early
stages of cognitive development because of their limited cognitive development and
ability to verbalize their thoughts and feelings.
Counselors must make decisions on setting limits in play therapy, in selecting play
media, and the amount of counselor involvement in the play.
A variety of play techniques is available for use by counselors.
A growing body of evidence indicates that play therapy can be an effective counseling
intervention for clients of all ages.
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KEY TERMS, CONCEPTS, and PERSONALITIES
Filial play therapy – A play therapy model that is based on the principles of child-centered
therapy and directly involves parents in an effort to teach parents how to understand their child.
Prescriptive play therapy – A model of play therapy wherein counselors tailor their interventions
to the child, integrating their knowledge of many theories of play.
Primary Mental Health Project (PMHP) – a school-based intervention that uses play therapy and
focuses on elementary children at risk for problems
Parent-child Interaction Therapy (PCIT) – a play therapy model developed to treat children
exhibiting behavioral problems
Sandplay – A self-healing form of play therapy. The sand is utilized to soothe the child as well
as allowing the child to resolve conflicts through developing a sense of control.
REVIEW QUESTIONS
1. Common characteristics of play include all of the following except:
A. alleviates abnormal behavior.
B. expression of self.
C. extrinsically motivating.
D. increases self-confidence.
2. Abreaction is a therapeutic power of play that is described as:
A. developing a working alliance with the counselor.
B. a natural medium of self-expression which encourages understanding.
C. repeating play activities to help reduce anxiety and fear.
D. the ability to process and adjust to difficulties by reliving them with appropriate
emotional expressions.
1. The therapeutic power of play which encourages problem-solving skills so that innovative
solutions to dilemmas may occur, is described as:
A. creative thinking.
B. communication.
C. role play.
D. metaphoric teaching.
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2. List any four suggestions from the text for those who use play therapy with multicultural
populations:
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
5. List any six qualities of the effective play therapist that Kottman (2001) identified:
1. _____________________________ 2. _________________________________
3. _____________________________ 4. __________________________________
5. _____________________________ 6. __________________________________
6. Parent-child Interaction Therapy (PCIT) was developed to
A. Treat children with autism
B. Treat children of absenteeism
C. Treat children for behaviors associated with conduct disorder
D. Treat only pre-school children
7. The perspective that requires knowledge of a wide range of approaches so as to tailor the
intervention to the child is called __________________ play therapy.
A. prescriptive
B. group
C. ecosystemic
D. Jungian analytical
8. The family play therapy model that is based on the principles of child-centered therapy and
directly involves the parents in an effort to teach parents how to play with their children is
referred to as:
A. PMHP
B. Co-joint play therapy.
C. expressive play therapy.
D. filial play therapy
9. List the three categories of toys that are commonly used in play therapy.
1. ________________ 2. ____________________ 3. _______________________
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10.
All of the following are considered benefits of the visual arts except:
A. access to the unconscious.
B. arts can be easily combined with other play methods.
C. symbolizes emotions in tangible ways.
D. allows for universal interpretation .
11.
Play material should be chosen based on which of the following criteria:
A. providing an opportunity to test reality
B. encouraging expression of thought and feeling
C. facilitating relationship between child and other
D. all of the above
10.
Counselors who want to use puppets
A. should train as ventriloquist
B. should look for puppets with universal symbolism
C. should find firm, rigid puppets
D. should find a puppets with a range of emotions
ESSAY QUESTIONS
1. Several measures to assess play therapy outcomes were discussed. Discuss at least
three different ways to determine whether play therapy has been effective and
explain how you could incorporate those measures into your practice.
2. This chapter focuses on play therapy as an intervention with clients age 2-12. How could
these interventions be successful with adolescents, couples, employed people, and geriatric
clients? How would you incorporate play therapy techniques into counseling an adolescent or
adult client?
ACTIVITIES
1. Get finger paints or play-doh and play with them. Notice the feeling of them on your hands.
What happens when you begin using them? Do your feelings change? How can this be
therapeutic?
2. Create a plan for a playroom in the setting of your choice (school, community agency,
hospital, etc.) What does the room look like? Be specific. What toys, games, materials,
equipment are in the room? Draw a plan for the room.
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