Reflections

Feature
Healing through play
For With Kids see Play is an important part of child child at play could provide insight they need to work on the issues that are
[Link] development. Through play, a child into their thoughts and feelings. Since most concerning to them”, she adds.
learns about the world around then, research into understanding Play therapists are employed in a
them and processes their individual how children play and its beneficial number of different settings, and
experiences. Observing a child at play role in social and emotional wellbeing their role varies accordingly. Some
can give insight into problems they has developed into a form of age- are employed within the UK National
have, without the need to speak about appropriate therapy for children. Play Health Service, others in education
complex and emotionally charged therapy is a child-centred approach or social services, and some work
concepts. Play therapists use this to therapy whereby a dynamic independently. Play therapists within
principle to provide age-appropriate relationship is formed between a the health-care system often work as
psychodynamic therapy to children child and play therapist using non- part of an integrated multidisciplinary
with a variety of needs. In a related directive play. It is used for children team rather than outside it. This means
discipline, play specialists use tools such roughly between 3 and 11 years old that their insights from working with
as dolls or role play as a mechanism to as an alternative to traditional talking the child at play can be shared with
relate information to children. Play therapies. In play therapy, an individual other people involved in the child’s
specialists can thus explain complex child’s play choices are seen as the care. Some play therapists in the
ideas to young children, such as the primary medium of communication, health-care system will work with
need for examinations and treatments with speech a secondary medium if children who have chronic physical
in a health-care setting. The roles of applicable (it can be used for children illness or mental health problems,
play therapists and play specialists who are non-verbal or who have others will work with children who have
differ fundamentally, although both limited verbal skills). developmental or social disorders such
disciplines rely on the innate desire of The setting for play therapy is usually as autism. Therapists in this setting
a child to play and the potential for a play room arranged by the therapist, often also have training in occupational
learning through play. Whereas both mostly in one-to-one sessions. How­ or physical therapy and might use a
can be considered child-centred, only ever, some play therapists also do group combination of directive and non-
play therapy is child-led since it is work—for example, in small groups directive approaches in sessions.
non-directive—the therapist is present of children with shared experiences, In the education sector, a child could
and engaged with the child, but does such as those who have experienced be referred to a play therapist by a
not direct the play. Conversely, the domestic violence or refugees. During teacher if they are at risk of exclusion
work of play specialists is directive by a session, the child will have access to a due to behavioural issues or if they
design; specialists often work with an wide variety of play materials, including have emotional or social problems
explicit goal in mind and with specific art and craft supplies, role-playing that are affecting their educational
information to impart. props and costumes, sand and water development. For different groups
In the early 20th century, psycho­ stations, modelling clay, small figures of children, the methods used by
logists recognised that observing a of people and animals, dolls, musical the therapist might change slightly
instruments, puppets, and books. “We (eg, reduced number of toys on offer
believe that children, as all humans do, when a child might be overstimulated
have an inner drive towards healing”, as affects some children with autism),
says Gwen Galbraith who works for but the fundamental principles of being
the Scottish charity With Kids as a play alongside the child in non-directive
therapist. “We don’t set up any specific play remain the same with each session
tasks for children on the basis of their focused on the child rather than on
referral or our preconceived ideas of the their problem.
problems they need to work through. In the UK, play therapy resources
The therapist is alongside the child are usually more available in urban
during play, empathising and helping city settings, and therapists are
the child to understand the emotional employed in selected schools where
content behind their play”, she explains. need is greatest. In Galbraith’s opinion,
“We believe that children will choose— greatest benefit from play therapy is
Suzi Blair

consciously or unconsciously—the toys most likely to occur when children are

700 [Link]/child-adolescent Vol 2 October 2018

in a stable family placement and when a child undergoing an examination. limb braces or teaching a child with For the meta-analysis of play
therapies see Prof Psychol Res Pr
parents or carers are supported at the The important role of play therapists diabetes how and when to measure
2017; 48: 390–400
same time as the child. In addition, and play specialists in child health their blood glucose levels.
For the analysis by Play Therapy
she says that better outcomes are seen is increasingly appreciated within Play is also exploited as a means UK see [Link]
in younger children, but emphasises multidisciplinary teams. Sue Reardon, of alternative treatment for children uk/Research/Research1
the individuality of experience. For Manager of the Play Specialist Team at outside the roles of play therapists For the play specialist team at
example, older children who have the Noah’s Ark Children’s Hospital for and specialists. For example, the Noah’s Ark see
[Link]
experienced a single traumatic event Wales (Cardiff, UK), says, “Attitudes charity Breathe offers magic therapy hospital-play-specialist-team/
might have a greater positive outcome towards play specialists have changed programmes to improve motor skills For the UK Department of
from play therapy than younger over the years in a positive way. of children with physical disabilities Health recommendations see
children who have experienced The multidisciplinary team value and improve confidence, self-image, [Link]
aboutnhsservices/documents/
significant complex trauma. and rely on the expertise of play and mood in children with mental nsf%20children%20in%20
Research into the effectiveness of specialists.” The UK Department of health problems. For children with hospitlaldh_4067251%5B1%5D.
play therapy has generally shown Health recommends provision of play physical disabilities, undertaking pdf

positive results. However, most studies facilities in the hospital setting to occupational health exercises as For more on Breathe see
[Link]
are small, and the different treatments maintain the emotional wellbeing of part of a fun activity not only makes
For more on medical virtual
and populations studied make them children undergoing treatment. It also taking part in therapy more appealing reality see Reflections
difficult to compare. As with talking recommends that an inpatient child but could also improve long-term Lancet Child Adolesc Health 2018;
therapies and cognitive therapies, hard should have daily contact with a play adherence. Play can also be used to 2: 88–89
outcomes for play therapy are difficult specialist. teach augmentative and alternative
to define and measure. Self-reported Research has shown that interaction communication methods to children
subjective outcomes, such as mental with a play specialist can lessen the who struggle to communicate, such as
health questionnaires completed by need for sedation during some types those with autism or developmental
the child or parent, are often used, of examination and treatment, as delay. Tools such as tablet computers,
and a 2017 meta-analysis of play well as reduce recovery time. That recorded speech devices, and symbol
therapies suggests little consistency play specialists routinely use directive arrays can be used to enable the child to
between studies in the method used play in hospitals is appropriate given communicate; play, especially directive
to measure outcome. Play Therapy the setting, especially in acute care play modelled by the caregiver or a
UK’s analysis of data from more than situations when treatment must be specialist, can be an effective way to
8000 children over 7 years show that immediate and there is little time to teach children to use such tools. For
a vast majority of children who receive develop a relationship with the child. children with cerebral palsy and other
play therapy have a positive change in For children with chronic diseases, play gross motor impairments, artificial and
their behaviour and their emotional specialists will often use a combination augmented reality can be used to create
and mental health. The children were of non-directive and directive play a virtual environment with which the
assessed before and after treatment approaches—enabling normal play in child can interact. Such technology
using the Goodmans Strengths and children whose activities are restricted offers a means to enable play that
Difficulties Questionnaire; 74% of while also using play to explain medical would otherwise not be possible in the
those who scored in the normal or procedures and to give children the context of severely limited motor skills,
borderline ranges and 83% who ability to make decisions regarding and preliminary research suggests
scored in the abnormal range showed their treatment. It is empowering improvements in arm function and
improvement by this measure. Small for children to process and articulate postural control in children with
differences in effectiveness by gender how a particular treatment makes cerebral palsy.
were noted (73% of boys vs 79% of them feel—so that aspects that The increased awareness of the
girls had improvement) and a slight make them feel stressed (eg, noise importance of play as a means of
general decline in effectiveness by age from machinery) can be explained or supporting health in children is
at referral was also seen (from 80% at avoided—or to have control over even welcome. With heightened awareness
age 6 to 71% at age 12). small decisions, such as the timing or will hopefully come increased
Another discipline which uses the location of treatment, or choice of opportunities for access to therapy for
child’s capacity to learn and process companions during examinations. children who could benefit from such
emotional distress through play is that Play specialists can also help to teach support, including further provision
of play specialists. A play specialist in a child how to use medical devices of training for new therapists to meet
a hospital setting might use dolls or and supports—for example, teaching demand.
role-play to explain a treatment plan, a child with talipes the importance of
or they might provide distraction to adherence to support devices such as Fiona Mitchell

[Link]/child-adolescent Vol 2 October 2018 701