Play Therapy

UNIT 1 PLAY THERAPY

Structure
1.0 Introduction
1.1 Objectives
1.2 Defining Play Therapy
1.3 Salient Features of Play and Play Therapy
1.4 Basics of Play Therapy
1.5 Characteristics of Play Therapists
1.6 The Effectiveness of Play Therapy
1.7 Let Us Sum Up
1.8 Unit End Questions
1.9 Suggested Readings and References

1.0 INTRODUCTION
We don’t stop playing because we grow old; we grow old because we stop playing.
- George Bernard
As we are towards the end of your this course on school psychology, you might
have got a very fair idea that this is a very challenging field to work with the
school children. The first block has given you sound background knowledge of
school psychology as a discipline. In your second block you were acquainted
with various development factors where you also read about the assessment of
children in schools for various behaviour problems. The behaviour problems
were discussed at length in your third unit where you have read not only types of
behaviour problems but also why do they appear and how counselling could
help. As a school psychologist, you may face problem behaviour in school children
like indiscipline, child aggression, bullying, truancy, cheating etc. And, as a school
psychologist, you have also read in the section 2.3 of the second unit of your first
block, you have to play an important crucial role in the enhancement of the
status of children, youth, and adults as learners and productive citizens in schools,
families, and communities. To achieve this target, a school psychologist has also
to be trained so that he/she could intervene with the help of related therapies
whenever some problem behaviour is visible and/or reported there in a school
child. Hence is this block. And, we shall start with play therapy.

1.1 OBJECTIVES
By the end of this unit, you will be able to:
• define therapy, psychotherapy, and play therapy;
• illuminate the salient features of play and play therapy;
• describe the basics of play therapy;
• explain the importance of play therapy;
• elucidate the characteristics of play therapists; and
• design play therapy intervention for a hypothetical student. 5
Therapeutic Interventions
with Children 1.2 DEFINING PLAY THERAPY
As you might have some preconception about the meaning of play, so, let us
start with therapy. You might have somewhere come across the term ‘therapy’.
What general idea do you have about the meaning of therapy? Wikipedia defines
therapy as the attempted remediation of a health problem, usually following a
diagnosis. Where in medical terminology, it is used a synonym with treatment,
in psychology, it generally refers to psychotherapy. Psychotherapy is an English
word derived from two Ancient Greek words – psyche meaning breath, spirit,
and soul, and therapia meaning healing, and medical treatment. Wikipedia
explains psychotherapy or personal counseling with a psychotherapist as, “an
intentional interpersonal relationship used by trained psychotherapists to aid
a client or patient in problems of living. It aims to increase the individual’s sense
of their own well-being. Psychotherapists employ a range of techniques based
on experiential relationship building, dialogue, communication and behaviour
change that are designed to improve the mental health of a client or patient, or to
improve group relationships (such as in a family)”.

Frank (1988), a psychiatrist, defined psychotherapy as “the relief of distress or

disability in one person by another, using an approach based on a particular
theory or paradigm, and a requirement that the agent performing the therapy has
had some form of training in delivering this. It is these latter two points which
distinguish psychotherapy from other forms of counseling or caregiving.”

With this background information about therapy and psychotherapy, we can now
move on to the meaning and definition of play therapy.

Self Assessment Questions

1) What do you mean by play?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
2) How can play be used as a therapeutic intervention?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

As you have seen in the preceding paragraphs the meaning of therapy and its use
for psychological purposes as psychotherapy, you would be trying to develop
your own conception about play therapy. First, let us see what experts and
psychologists have to say about “play”.
6
Else (2009) writes, “playing children choose the content and purpose of their Play Therapy
actions, following their own instincts, ideas and interests, in their own way for
their own reasons” (see VanFleet, Sywulak, Sniscak, and Guerney, 2010). Thus,
Else considers that play is a process the players choose freely, and direct their
actions according to their wish and will, and to attain their perceived rewards.

Clark and Miller (1998, see VanFleet et al., 2010) have also defined the children’s
play on the basis of the following four parameters:
• It is non-literal.
• It is done for its own reasons and not directed toward an external goal.
• It is associated with positive feelings and is enjoyable.
• It involves flexibility in the use of the play objects as well as in the process.
The views of the above experts reveal the nature of ‘play’ as it mainly depends
on the players to choose their contents and processes. Flexibility in play and
leading to rewards and enjoy are another major criteria. If you have seen the
children playing, you might have yourself noticed that play is very dynamic group
process and depends on various factors like age, sex and personality structure of
the players, relationships with other players and rewards associated with winning.
And that’s why, keeping in view the importance of play in child’s psychosocial
development, the psychologists are devising and adopting play-based therapeutic
approaches to treatment/modification of behaviour of the children in schools. It
is also because it is the play which brings out the child’s inner world – his/her
feelings and perceptions etc. Another important reason of using play as a
therapeutic tool is that play helps in discharging the distress and overcoming
various problems. Here, let us see how ‘play therapy’ is defined.

VanFleet (2004) defined play therapy as, “a broad field that uses children’s natural
inclination to play as a means of creating an emotionally safe therapeutic
environment that encourages communication, relationship – building, expression,
and problem resolution for the child” (see VanFleet et al., 2010).

Wilson and Ryan (2005) described play therapy as, “a means of creating intense
relationship experiences between therapists and children or young people, in
which play is the principal medium of communication. In common with adult
therapies, the aim of these experiences is to bring about changes in an individual’s
primary relationships, which have been distorted or impaired during development.
The aim is to bring children to a level of emotional and social functioning on par
with their developmental stage, so that usual developmental progress is resumed”
(see VanFleet et al., 2010).

According to the Association for Play Therapy (APT), United States, the play
therapy is, “the systematic use of a theoretical model to establish an interpersonal
process wherein trained play therapists use the therapeutic powers of play to
help clients prevent or resolve psychosocial difficulties and achieve optimal
growth and development” (www.a4pt.org, 2011).

Landreth (2002) defined play therapy as: “A dynamic interpersonal relationship

between a child (or person of any age) and a therapist trained in play therapy
procedures who provides selected play materials and facilitates the development
of a safe environment and a safe relationship for the child (or a person of any
7
Therapeutic Interventions age) to fully express and explore self (feelings, thoughts, experiences, and
with Children
behaviours) through the play, child’s natural medium of communication, for
optimum growth and development”.

1.3 SALIENT FEATURES OF PLAY AND PLAY

THERAPY
The views of experts and psychologists given above might have enlightened you
about play therapy and some of its essential features. Let us extract or recapitulate
these features for a clearer understanding of this therapeutic intervention.
1) Play is not just any random activity. It is purposeful.
2) It is directly related to the development of a child – be it physical and motor
development, social and emotional development.
3) Play gives the children an opportunity to utilise their creativity and develop
their imagination.
4) It helps them socialise and learn cooperation as well as competition.
5) It helps boost their physical and emotional strength.
6) Plays help them understand the reality and severity of the loss.
7) It helps them make decisions, negotiating in various situations and finding
solutions the various problems.
8) Plays also have binding effects and the child learn attachments which is
essential for feelings of safety and security.
9) Plays give them an opportunity to express themselves and their feelings.
10) Play is an integral part of the lives of children.
11) Plays can be used to help children overcome their distress and psychological
problems.
12) Play is another type of communication but play therapy does not necessarily
require any language or verbalization from the target child.
13) It is one of the most developmentally appropriate therapeutic interventions
for the prevention or treatment of many types of child problems (VanFleet
et al., 2010).
14) Because play takes place when a child feels security both physically as well
as emotionally, play therapy relies on the development of a child-focused
relationship as the therapist has to become a part of the world of the target
child for minutely but naturally examining his/her behaviour, thoughts and
feelings, etc. Through this relationship, the therapist has to provide
psychologically and emotionally secure environment to that target child so
that he/she could overcome his/her problems, gain mastery over fearful
thoughts or anxious feelings, and could achieve psychosocial health as a
result of therapist’s interventions.

The task of the therapist, this way, is highly challenging as he has to gain the
confidence and trust of the child for being a part of his world to understand him/
her in order to help him/her through therapeutic interventions.

8
So, it is clear now that the major purpose of a play therapist is to help the child Play Therapy
gain/regain psychological health and smooth functioning in school as well as the
peer group or society. As the child uses play to explore his/her world, the therapist
has to join the child in that play. He has to play a role of the child and professional.
He need not only to observe the behaviour of the target child but also to record.
He, being a professional therapist has also to note down his/her own personal
reactions towards the observed behaviour of the child/children. He has to take
the developmental history of the child by talking to his parents, relatives, teachers
and friends. The relationship the child is having with his/her family members,
friends, classmates, teachers and others might be a reason of the problem
behaviour. So, each bit of information has significance in designing/applying
therapeutic interventions for the child.

Self Assessment Question

1) In light of the above features of play and play therapy, how would you
design your playroom for therapeutic interventions of the children?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

1.4 BASICS OF PLAY THERAPY

Let us learn the basics of play therapy which might be useful for you to gain the
basic understanding of the process. However, you should not “start applying/
using any therapy without the supervision of a trained therapist”. For practical
experience and know-how to, you should work for a reasonable time under the
direct supervision of a trained practitioner.

Suppose you are a trained play therapist. For applying play therapy, now there
are two main requirements: (1) a student who is to be benefited from your play
therapy, and (2) a well – equipped playroom consisting of items like clays, crayons,
toy cars, books, stuffed animals, toy kitchen appliances, puppets, dolls, musical
instruments etc. where you would be applying play therapy.

Now, you are required to, first of all, prepare a complete history of the child
which is to be followed then by a clinical assessment. Then, in consultation with
the caregiver, and depending upon the problem, history and needs of the child,
you need to plan/choose a treatment modality appropriate and suitable for the
child.

9
Therapeutic Interventions You also need to give due importance to trust-factor by being the friend of the
with Children
child because in the absence of child’s trust in you (play therapist) it would be
highly difficult for you to move ahead. Similarly, you will also have to build a
good rapport with the child for taking successful play sessions. Depending upon
the child’s personality, problem and needs, and on the bonding between the child
and the therapist, the therapy may range from 12 – 15 sessions to two years or
more. The duration of one therapy session may be usually 30 – 60 minutes per
day and you may meet the child twice a week or more frequently.

When you meet the child for play therapy session, you should try to make him/
her feel safe and comfortable. You may use a directive or non-directive approach.
But, the therapy is child-centered and play-based. You should not suggest the
child what materials or activities he/she should choose. For the most part, the
child is to be allowed to choose the materials. It will help them understand and
express their internal feelings. It is the beginning of the healing process. You
should be cautious that you should not miss the sessions in unplanned manner as
it may disrupt the progress of therapy.

Whenever required, you need to talk to the parents of the child because they are
also required to be sensitized about the needs of the child. You may need to
counsel not only the parent of the child but also the teachers because they are
also in continuous touch with the child (your client) and their behaviour/dealing
with the child may negatively affect your efforts. So, to seek their due support,
you may need to counsel them too. Sometimes, you may need to call the parents
to participate in the therapeutic session.

You are required to minutely observe the progress of your sessions. The child’s
behaviour is going in which direction and whether moving in the direction of
your targets is to be constantly watched and monitored. At the end of the session,
you have to tell the child that it is time to stop now and to put the toys back from
where they were picked up. If any day, the child wants to go back early, you
should allow but, before leaving, inform the child/guardian about the date and
time of the next session.

Last but not the least, from the ethical point of view, you are supposed to maintain
the confidentiality of the information of the child. You need not to discuss the
name, address, problem, etc. of the case where it is not required. It may lessen
the child’s trust in you and reduce the feelings of safety which in turn would
hinder the progress of your therapy.

1.5 CHARACTERISTICS OF PLAY THERAPISTS

This is a general observation that the professionals in their respective fields are
expected to have certain specific qualities and characteristics by their academic
qualifications or background experiences. This is true for play therapists as well.
To be a successful play therapist, there are certain qualities which one need to
posses and/or develop. Axline (1947) introduced eight such principles:

First Principle: “The therapist must develop a warm, friendly relationship with
the child, in which good rapport is established as soon as possible”.

Second Principle: “The therapist accepts the child exactly as he is”.

10
Third Principle: “The therapist establishes a feeling of permissiveness in the Play Therapy
relationship so that the child feels free to express his feelings completely”.

Fourth Principle: “The therapist is alert to recognise the feelings the child is
expressing and reflects those feelings back to him in such a manner that he gains
insight into his behaviour”.

Fifth Principle: “The therapist maintains a deep respect for the child’s ability to
solve his own problems if given an opportunity to do so. The responsibility to
make choices and to institute change is the child’s ”.

Sixth Principle: “The therapist does not attempt to direct the child’s actions or
conversation in any manner. The child leads the way; the therapist follows”.

Seventh Principle: “The therapist foes not attempt to hurry the therapy along. It
is a gradual process and is recognised as such by the therapist”.

Eighth Principle: “The therapist establishes only those limitations that are
necessary to anchor the therapy to the world of reality and to make the child
aware of his responsibility in the relationship”.

However, later researchers cautioned the therapists by suggesting that if they

possess these qualities to a high degree, they would be considered an “ideal”
person and the client/child would not identify themselves with these therapists.
So, what should be done then? Depending upon one’s situations, keeping and
maintaining the flexibility, one may try to recognise those qualities and
characteristics which are going to (a) help develop and maintain the mutual trust
between the therapist and the client, and (b) result ultimately in the positive and
desired change in the client.

1.6 THE EFFECTIVENESS OF PLAY THERAPY

Play therapy is applied world wide in various settings. Many studies have reported
encouraging results that it can be effectively used with children who are suffering
from various academic, learning, social, emotional, and behavioural problems.
Some of such major problems include anxiety, depression, social developmental
problems, anger control/management difficulties, abuse, low self-esteem autism
and ADHD etc. Josefi and Ryan (2004) reported a case study of a 6½ year old
boy who was suffering from severe autism. The boy was given 16 play therapy
sessions and it was found that there was improvement in pretend play, attachment,
emotional responses, autonomy, coping with changes, social interaction, and
self-regulation of basic needs for nurture. The researchers emphasised that the
effectiveness of play therapy for autistic children is noticeable because the child
is unconditionally and positively regarded and accepted, and the treatment is
planned at the developmental level of the child.

Similarly, it has been found that play therapy has significant positive effect on
the children with ADHD as the kids who participated in play therapy sessions
were less stressful to their teachers, revealed lesser anxiety, reduced emotional
distress, improved self-efficacy, enhanced self-concept and compliance to
treatment (Ray, Schottelkorb, and Tsai, 2007). Because the kids might not be
able to verbally express themselves through words or language, play therapy is
11
Therapeutic Interventions particularly helpful for them to give an opportunity to express themselves through
with Children
play. Marvasti (1988) found that the child is able to express his/her emotions
through play in a play therapy situation and this emotional expression may be
more accurate even than his/her verbal statements.
Drewes (2001), Van Dyke & Wiedis (2001), and Webb (2001) have reported that
play therapy has provided an effective treatment for children who were exposed
to traumatic events in their lives. As these children were not able to clearly
articulate their thoughts and feeling, play provided the most effective approach
to trauma resolution. After Hurricane Katrina, the most prominent natural disaster
of 2005 in United States, one child under observation during the study used the
figures of a child and mother in a dollhouse and acted out those incidents which
occurred during the Katrina storm. This child represented that a tree had fell
through the roof and she hid the figures of that child and mother under the bed at
that time in order to save the terrified child and mother from that falling tree.
This way, she played out that terrible episode which had a traumatic impact on
her in a safe environment thereby releasing her stressful feelings and thoughts
(Hebert & Ballard, 2007).
The results of a study involving 381 elementary school counselors showed that
more than 73% of the respondents reported that play therapy is an “effective or
highly effective tool” for working with students (Ray, Armstrong, Warren and
Balkin, 2005). Ray et a. (2005) further reported that the less use of play therapy
by school counselors could be attributed to the lack of time to spend counseling
students and inadequate or insufficient training in this field. Although in India
also, the use and research on play therapy is very limited, the effectiveness of
play therapy has been reported in a 12 – year old girl who was diagnosed for
mixed disorder of conduct and emotion (Panicker, Hirisave, and Srinath, 2004).
It is also pertinent to mention here that Dutta and Mehta (2006) reported, “child-
centered play therapy [along with reflective parent counselling] was effective in
children with somatoform disorders as it helped them to systematically address
and resolve various emotional issues that they were unable to express verbally”.
They further remarked that “Play therapy is not a commonly used method in
child guidance clinics in India and it is strongly advocated that it should be
incorporated in such clinics”.
Most of the play therapists quote three major reasons of the effectiveness of play
therapy: it is developmentally appropriate, experiential, and child-driven. Being
developmentally appropriate means that it gives full freedom to the child to use/
speak their own language and to make meaning out of their words with their
own language. In very beautiful words, Landreth (1991) said, “Play is to the
child what verbalization is to the adult …Toys are used like words by children
and play is their language”. The second reason is its being experiential (Norton
and Norton, 1997). It allows the kids to get their total selves also involved in
their own healing. While playing, they trust themselves and use their momentary
experiences to manipulate and control the situations. Thus, through play, they
catch hold on their life circumstances and by control they heal themselves. Thirdly,
the effectiveness of play therapy lies in its being child-driven. Because the child
is resilient, he/she also possesses the inner strengths and a natural predisposition
for self-healing (Norton and Norton, 1997). Given the opportunity, they help
themselves and the playroom supports it. Landreth (1991) rightly explains it,
that when properly facilitated, children “take the therapeutic experience where
12 they need to be”. These major reasons explain why play therapy works effectively.
 Play Therapy
1.7 LET US SUM UP
There are growing instances where we are finding that even very young school
kids and children are under extreme stress to perform well. It has not only reduced
their play time but also has severe effects on their psychosocial and emotional
health. They are not finding enough room to express themselves or time with
parents to share their feelings and emotions. This is, in the long run, affecting
their behaviour. Hence, working on the philosophy of prevention is better than
cure, we need to what suggested by Landreth (2002) that play therapy should be
integrated into the school-based mental health services in order to enhance the
children’s potential for learning.

Also, keeping in mind the availability of trained play therapists in India, we need
to work on the training of in-service teachers in therapeutic interventions because
it is they who directly deal with the students in the class room, interact with
them, observe them and may help them. This training may provide them additional
skills to promote the well-being and development of the children besides their
academic performance.

1.8 UNIT END QUESTIONS

1) Critically evaluate the play therapy in terms of its success in treating children
with problem behaviour.
2) Is it essential for the play therapists to posses certain characteristics?
3) “Toys are used like words by children and play is their language”. Comment.
4) Write an essay on the effectiveness of play therapy.
5) If you have to develop a treatment strategy for an autistic student, how would
you design and implement play therapy?

1.9 SUGGESTED READINGS AND REFERENCES

Carmichael, K. D. (2006). Play Therapy: An Introduction. Upper Saddle River,
NJ: Pearson Merrill Prentice Hall.

Landreth, G. L., Joiner, K., & Solt, M. D. (2003). Play Therapy Training Directory
(5th ed.). Denton, TX: Center for Play Therapy.

References
Axline, V. M. (1947). Play therapy: The inner dynamics of childhood. Cambridge,
MA: Houghton Mifflin.
Drewes, A. (2001). The possibilities and challenges in using play therapy in
schools. In A.A. Dawes, L.J. Carey, & C.E. Shaefer (Eds.), School-based play
therapy. New York: John Wiley & Sons.

Dutta, R. and Mehta, M. (2006). Child-centered play therapy in management of

somatoform disorders. J. Indian Assoc. Child Adolesc. Ment. Health, 2(3),
85 – 88.

13
Therapeutic Interventions Frank, J. (1988). “What is Psychotherapy?”. In Bloch, Sidney (ed.). An
with Children
Introduction to the Psychotherapies. Oxford: Oxford University Press.

Hebert, B. & Ballard, B. (2007). Children and trauma: A post Katrina and Rita
response. Professional School Counseling, 11(2), 140-144.

Josefi, O., and Ryan, Y. (2004). Non-directive play therapy for young children
with autism: A case study. Clinical Child Psychology and Psychiatry, 9, 533 –
551.

Landreth, G. L. (1991). Play therapy: The art of the relationship. Muncie, IN:
Accelerated Development Incorporated.

Landreth, G. L. (2002). Play therapy: The art of the relationship (2nd ed.). New
York: Brunner-Routledge.

Marvasti, J. A. (1988). Play therapy with sexually abused children. In S. M.

Sgroi (Ed.),Vulnerable populations, Volume 2 (pp. 1-41). New York, NY:
Lexington Books.

Norton, C. C. and Norton, B. E. (1997). Reaching children through play therapy:

An experiential approach. Denver, CO: Publishing Cooperative.

Panicker, A.S.; Hirisave, U., and Srinath, S. (2004). Play therapy in mixed disorder
of conduct and emotion. Indian Journal of Clinical Psychology, 31, 151 – 156.

Ray, D., Schottelkorb, A., and Tsai, M-H. (2007). Play therapy with children
exhibiting symptoms of Attention Deficit Hyperactivity Disorder. International
Journal of Play Therapy, 16, 95 – 111.

Ray, D.C., Armstrong, S.A., Warren, E.S., & Balkin, R.S. (2005). Play therapy
practices among elementary school counselors. Professional School Counseling,
8, 360-365.

Van Dyke, A., & Wiedis, D. (2001). Sandplay and assessment techniques with
preschool –age children. In G.L. Landreth (Ed.), Innovations in play therapy:
Issues, process, and special populations. Philadelphia, PA: Brunner-Rutledge.

VanFleet, R, Sywulak, A. E., Sniscak, C. C., and Guerney, L. F. (2010). Child-

Centered Play Therapy, New York: Guilford.

Webb, P. (2001). Play therapy with traumatized children: A crisis response. In

G.L. Landreth (Ed.), Innovations in play therapy: Issues, process, and special
populations. Philadelphia, PA: Brunner-Routledge.

14