PLAY THERAPY

INTRODUCTION
• Play Therapy is a method of meeting and responding to the
mental health needs of children.

• It is extensively acknowledged by experts as an effective

and suitable intervention in dealing with children’s brain
development.

• Provides them a way, to express their experiences and

feelings through a natural, self-guided, self-healing process.
• According to Jean Piaget, "play provides the child with the
live, dynamic, individual language crucial for the expression
of the child’s subjective feelings for which collective
language alone is inadequate.“

• Play helps a child develop mastery over his innate abilities

resulting to a sense of worth and aptitude.

• During play, children are driven to meet the essential need

of exploring and mastering their environment.
• It also contributes in the advancement of creative thinking.

• Play likewise provides a way for children to release strong

sentiments making them feel relieved.

• During play, children play out undesirable life experiences

by breaking them down into smaller parts, discharging
emotional states or frames of mind that go with each part,
integrating every experience back into the understanding
they have of themselves and gaining a higher level and a
greater degree of mastery.
• Play therapy is a form of counseling or psychotherapy that
uses play to communicate with and help people, especially
children, to prevent or resolve psychosocial challenges.

• This is thought to help them towards better social

integration, growth and development, emotional modulation,
and trauma resolution.
• Play therapy can also be used as a tool for diagnosis. A
play therapist observes a client playing with toys (play-
houses, pets, dolls, etc.) to determine the cause of the
disturbed behavior. The objects and patterns of play, as
well as the willingness to interact with the therapist, can
be used to understand the underlying rationale for behavior
both inside and outside of therapy session.
 TYPES OF PLAY THERAPY

CHILD – BASED GROUP BASED

PLAY THERAPY PLAY THERAPY
FAMILY – BASED
PLAY THERAPY
 CHILD BASED PLAY THERAPY
• In child-based play therapy, the counseling involves only the
child and the therapist in the room.
• The therapist provides a variety of toys for the child to not
only play with, but also for them to find a connection with
the toy so that they are also expressing themselves as well.
• Child-based is typically used for those who are at-risk,
show disruptive behaviors, and who even might be
depressed.
• Children learn to respect themselves and gradually learn to
accept who they are as individuals.
• They learn that their feelings are acceptable and how to express
their feelings responsibly.
• Children also learn to be creative and resourceful in confronting
problems; as well as learning self-control and self-direction.
• Child-based therapy also teaches children how to learn to
independently make choices and to be responsible for their
choices.
• This type uses two approaches
• Non-Directive
• Directive
 NONDIRECTIVE PLAY THERAPY
• Non-directive play therapy, also called client-centred and
unstructured play therapy, is guided by the notion that if
given the chance to speak and play freely under optimal
therapeutic conditions, troubled children and young people
will be able to resolve their own problems and work toward
their own solutions.
• Is a non-intrusive method in which children are encouraged
to work toward their own solutions to problems through play.
It is typically classified as a psychodynamic therapy.
 DIRECTIVE PLAY THERAPY
• Directive play therapy is guided by the notion that using
directives to guide the child through play will cause a faster
change than is generated by nondirective play therapy.
• The therapist plays a much bigger role in directive play
therapy.
• Therapists may use several techniques to engage the child,
such as engaging in play with the child themselves or
suggesting new topics instead of letting the child direct the
conversation himself.
• In directive therapy games are generally chosen for the child,
and children are given themes and character profiles when
engaging in doll or puppet activities.
• This therapy still leaves room for free expression by the
child, but it is more structured than nondirective play
therapy.
• includes more structure and guidance by the therapist as
children work through emotional and behavioral difficulties
through play. It often contains a behavioral component and
the process includes more prompting by the therapist.
Directive play therapy is more likely to be classified as a type
of cognitive behavioral therapy.
 FAMILY BASED PLAY THERAPY
• Parent Child Interaction therapy
• developed by Sheila Eyberg as an intervention for children
between the ages of 2 - 7 who have extreme behavior issues
• Behaviour change through parent child relationship by attempting
to build the warmth and understanding between the child and the
adult.
• The first phase of PCIT, called Child-Directed Interaction to
strengthen the bond between the child and the parent.
• The second phase, called Parent-Directed Interaction focuses on
enhancing child compliance, or diminishing noncompliance
• Filial therapy
• developed by Bernard and Louise Guerney in the 1960s for children aged 3-10
years old
• brought the idea that the parent‟s relationship with the child, could be a more
efficient vehicle than a therapist-child relationship to facilitate growth
• The aim of filial therapy is not to focus on any particular behavior problem, but
to promote lifelong skills for parents to maintain a supportive (and therefore
therapeutic) relationship with their children
• Parents are trained to respond to child emotions by reflective reasoning and
taught to influence child’s behaviour through acceptance then by using the
approach of correction (utilizes group training)
• treat various child problems, including depression, anxiety, conduct disorders ,
ADHD, trauma, abuse and families undergoing structural changes.
• Theraplay

• Ann Jernberg developed it in 1967.

• Main focus is to foster a secure attachment between the child
and the care giver.
• Therapists use Marshack Interactional Method- find strengths
and weaknesses in the relationship
• Interventions are tailored to strengthen the weaker aspects of
the relationship and support strong relationship dimensions.
• Foster and adoptive families
 GROUP BASED PLAY THERAPY
• In group-based play therapy, sessions involve a group of children
that may be going through the same; if not similar situation.
• Relate to others and help children improve their social skills
• Those that express negative classroom behaviors can have a
positive outcome from attending group therapy sessions.
• Therefore, group therapy can be most common in school
settings.
• In addition, the children also experienced a sense of self-worth,
and an increase in empathy for other individuals.
HISTORY
• Since the time of Plato, we can see the significance of play.

• In the 18th century, Rousseau in his book Emilie wrote about

the importance of observing play as a vehicle to learn and
understand children.

• Friedrich Frobel, in this book, The Education of Man

emphasized the importance of symbolism in play.
• The first documented using the therapeutic use of play was in
1909 when Sigmund Freud published his work with “Little
Hans”. Little Hans was a five year old child who was suffering
from a phobia. Freud recommended that his father take note
of Hans play to provide insights that might assist the child.

• In 1919, Melanie Klein ( psychoanalyst) began to implement

the technique of using play as a means of analyzing children
under the age of six. She believed that child's play was
essentially the same as free association used with adults, and
that as such, it was provide access to the child's unconscious
• Anna Freud utilized play as a means to facilitate positive
attachment to the therapist and gain access to the child's inner
life

• In the 1930’s David Levy developed a technique he called

release therapy. A child, who had experienced a specific
stressful situation, would be allowed to engage in free play.
• Virginia Axline (1950) summarized her concept of play therapy,
stating, "A play experience is therapeutic because it provides a
secure relationship between the child and the adult, so that the
child has the freedom and room to state himself in his own
terms, exactly as he is at that moment in his own way and in his
own time".

• Counselor-educators such as Alexander (1964); Landreth; Muro

(1968); Myrick and Holdin (1971); Nelson (1966); and
Waterland (1970) began to contribute significantly, especially in
terms of using play therapy as both an educational and
preventive tool in dealing with children’s issues.
• 1973 Moustakas work concerned with the kind of
relationship needed to make therapy a growth experience.
His stages start with the child's feelings being generally
negative and as they are expressed, they become less
intense; the end results tend to be the emergence of more
positive feelings and more balanced relationships.

• Sue Jennings and Ann Cattanach integrated elements of non-

directive play therapy to formulate a British Play Therapy
movement.
• In 1992, The British Association of Play Therapist was
started by a group of professionals studying at the
institute of Drama therapy. Since then, BAPT has
developed the British Play Therapy movement and now
accredits a number of training courses in the Uk.
 SOME BASIC ASSUMPTIONS OF
PLAY THERAPY
• Play is revealing on many levels
• Intervention in play world generalises to other life arenas
• The child’s environment is "good enough," so changes within
the child will be supported and sustained by others
• Play therapy can be most effective when the therapist does
not direct but allows the child to take responsibility for the
direction of the play therapy .
 UNDERLYING THEORY
• Piaget observed that most children in their first decade of
life had neither meaningful expression nor the ability to
comprehend complex issues, motives, and feelings because
they lacked the ability of abstract thinking.
• Piaget also noted that when a child is in his or her second
period of intellectual development, called preoperational,
the child begins assimilative play with the ability to form
symbols.
• As the cognitive horizon expands, play becomes more
complex with rules, moral judgment, and language
development.
• Virginia Axline saw meaningful expression in the
process of play, which furthers our current
understanding of how important language is to
regulating emotions and bridging action to symbol and
thought.

• Play therapy seeks to balance symbolic play and

language expression in an age-appropriate manner that
can be most beneficial to the child.
COGNITIVE DEVELOPMENT
THEORIES THAT CONTRIBUTE TO
PLAY
 PIAGET
• Piaget defined play as assimilation, or the child's efforts to make environmental stimuli
match his or her own concepts.
• Piagetian theory holds that play, in and of itself, does not necessarily result in the
formation of new cognitive structures.
• Piaget claimed that play was just for pleasure, and while it allowed children to practice
things they had previously learned, it did not necessarily result in the learning of new
things.
• Play is seen as a "process reflective of emerging symbolic development, but contributing
little to it”
• Example : A child who puts on a raincoat and a firefighter's hat and rushes to rescue his
teddy bear from the pretend flames in his play house is practicing what he has
previously learned about fire fighters.
 VYGOTSKY
• Play actually facilitates cognitive development.
• Children not only practice what they already know-they also learn
new things.
• In discussing Vygotsky's theory, Vandenberg (1986) remarks that
"play not so much reflects thought (as Piaget suggests) as it
creates thought”.
• Example : a child in the block center who announces to his teacher,
"Look! When I put these two square blocks together, I get a
rectangle!" has constructed new knowledge through her play
ANALYTICAL PLAY THERAPY APPROACH
• Assumption : An analyst facilitates an emotionally and
physically safe environment to activate a child's
individuation process ("becoming a whole psychological
individual")
 TWO MAIN TECHNIQUES TO
ACTIVATE INDIVIDUATION PROCESS
• Incorporating a symbolic or analytic attitude
• Occurs when an analyst provides sustained attention to
images produced by a patient through dreams, fantasies,
and identification to myth, music, and art.
• The symbolic attitude shifts the child from impulsiveness
and affect/behaviour dysregulation to containment and
self-modulation of internal emotional states.

 executing well-timed verbal interpretations

 CLIENT BASE
• perfect for kids because the techniques provide children
means to communicate and to work through tough times

• Ideal age to begin? - 2-3 years old, when a child can

manipulate materials – best time to make play and art into a
therapy process- Traditional age range – 3 to 12 yrs.

• But is being increasingly being be used with adolescent,

adults and geriatric population
 WHAT PROBLEMS CAN BE DEALT
WITH?
• Can help address children’s issues like:

1. adjusting to a divorce or overcoming separation

2. anxiety or impulsivity
3. healing from traumatic events such as sexual abuse or a
significant loss
4. learning difficulties
5. Coping with issues of attachment and separation,
6. Coping with issues related to self and identity
• Can help with teen and adult clients, a therapist usually
starts by asking them to talk about their situations-
often includes transitioning to sand tray play therapy,
doing an art activity or playing an active game etc

• this helps older clients in viewing things from another

perspective, gaining a deeper understanding of their
problem or making a shift in their thinking, feeling or
behavior.
TECHNIQUES
 PLAY THERAPY (SENSORY)
• Within a sense
-Over-seeking and under-seeking to balance
-Thus, the idea is to reach homeostasis

• Increasing range of senses

• Integration of senses (helping in perception of multiple

senses without sensory overload)
 THERAPIST AND CHILD
• When the child is at solitary play then the therapist should
be at the observer level.
• When the child comes at observer level the therapist should
act as the model for parallel play or the second option can
be if the child is not observing in parallel play then s/he can
join the child.
• The therapist should be one step level above the child and
try to get the child to match that state but there should be
no mismatch in skills otherwise it can lead to less fun and
low confidence in child.
• First target when we reach parallel play is to take the cognitive
stage of play forward.
-Integrating motor and cognitive skills to develop interest of child in
the game.
-Competency and skills of playing the game will develop as
interest develops in the play.
-The play becomes interesting for the child when he can play on his own
and there is autonomy.
- Unknowingly, sometimes bad memories can be created which can lead
to behavioural problems as children depend a lot on experiential
learning.
- Play should be flexible and not rigid.
 PLAY THERAPY DON’TS
• Interrogation
• Volume increasing constantly
• Too much info and too fast
• Imposing personal space
• No language about play
• Instructive/Corrective
• Prescriptive/Judgemental
 NON-INSTRUCTIVE PLAY
• Let the child pick up hints from the environment
• Balance energy level
• Give pauses to think, process, create
• Mindful of space and continued interaction
• Give it a name
• With time restrict space and time
• Give alternate on the same level
 MATERIAL OF PLAY
• Readiness
• Comfort on both sides
• Age appropriateness, chronological age and developmental
age
• Gross motor and fine motor skills
• Cognitive skills
• Social skills
• Emotional skills
 KEY AREAS OF DEVELOPMENT
• P- Physical
• I-Intellectual
• L-Language
• E-Emotional
• S-Social
 SOCIAL STAGES OF PLAY
• Solitary
• Observer (2-3)
• Parallel (2.5-3.5)
• Associative (3-4)
• Cooperative/Coordinated (4-6)
 HIERARCHY BETWEEN SOCIAL AND
COGNITIVE
• Different for every child and therapist should be aware of
this.
+2- Asking
+1- Responding
0-Passive
-1- Crying
-2- Hitting
 COGNITIVE STAGES OF PLAY
• Sensory
• Cause & Effect
• Rough & Tumble (Vestibular and Proprioception)
• Construction
• Pretend (concrete to abstract)
• Rule based
• Invented Rule
2 WAYS WE CAN CALL IT A CONSTRUCTION
• Able to articulate
• Make something that has features
 PLAY THERAPY METHODS
• Real-life/Family/Nurturing Toys:
• Used to act out relational issues and social conflicts.
• Examples: Dolls, doll house furniture, play kitchen, medical kit,
play money, costume jewellery.

• Acting Out/Aggressive Toys:

• Used to work out anger and violent thoughts and feelings in a
safe environment where the counselor can help direct aggression
constructively.
• Examples: Handcuffs, balls, dartboard, drum, blocks, toy soldiers,
inflatable punching toy, toy gun
• Creative Toys:
• Used as a means for expression when words are difficult to find or if child
is unable to verbalize their emotion and experiences.
• Examples: Colored chalk, play-doh, hand puppets, paper, colored pencils,
markers, crayons, paint

• Scary/Pretend/Fantasy Toys:
• Used as a metaphor for working through effects of negative persons or
circumstances contributing to poor mental health.
• Examples: Snakes, ghosts, costumes, villain figurines
• Sandtray:
• “[Sandtray therapy] is often used with children, but can
be applied to adults, teens, couples, families, and groups
as well. Sandtray therapy allows a person to construct his
or her own microcosm using miniature toys and colored
sand. The scene created acts as a reflection of the
person’s own life and allows him or her the opportunity to
resolve conflicts, remove obstacles, and gain acceptance
of self.”
 TECHNIQUES USED
• The Mad Game
• The Mad Game, developed by Patricia Davidson and described
by Hall, Kaduson, and Schaefer (2002), can be used to show
children that it’s okay to feel anger and to encourage them to
express it in a healthy way.

• The Slow Motion Game

• This technique can be applied to help the child learn about self-
control.
• It begins with the therapist explaining what self-control is and
describing how it is sometimes difficult to maintain our self-
control if we are moving very fast.
• Bubble Breaths
• This technique is a great way to introduce mindful breathing as well as a good
mechanism for dealing with intense emotions like anger or anxiety (Kilpatrick,
n.d.).

• Second Story Technique

• This technique is a great way to get the child to focus on his strengths rather than
dwell on the details of the trauma he has suffered (Kilpatrick, n.d.).

• Positive Postings
• This talk therapy technique from Jacqueline Melissa Swank will help the therapist
assess and improve the child’s sense of self-esteem and encourage positive self-
talk.
• This technique can also be adapted for use in group and family therapy sessions.
 THERAPY WORKSHEET
• Small Talk Family Discussion Cards Handout
• Anger Stop Signs Worksheet
• My Changing Family Worksheet
• Dealing with Bullying Worksheet
• Emotion Faces Handout
• About Me Sentence Completion Worksheet
• Why I’m Grateful Worksheet
• Using Rewards and Punishments Handout
• Goal Sheet Worksheet
• What is Worry? Worksheet
• My Fears Worksheet
 PRAISING CHILDREN
• I’m grateful for you.
• You don’t have to be perfect to be great.
• This family wouldn’t be the same without you.
• I’m excited to spend time with you.
• Seeing you happy makes me happy.
• I learn new things from you every day.
• Watching you grow up is the best.
HOW CAN AN EMOTIONAL CHILD
BENEFIT FROM PLAY THERAPY?
 PLAY THERAPY FOR ADULTS
• For adults, play fosters adaptive behaviour such as
• Creativity
• Frey (1983) describes four categories of children’s play:
physical, manipulative, symbolic, and games. Adult
activities in each of these categories hold enormous
creative potential.
• Jung believed that the key to unlocking his creative
potential was to engage in the constructive play he had
particularly enjoyed as a child.
• Role Rehearsal
• Children bandage imaginary hurts; spend hours
pretending to cook, shop, travel, and go to school; and
be everything from a firefighter to ballet dancer.
• Adults do the same thing in much subtler ways.
• Example:, Halloween , Loud conversation with oneself
before an interview.
• Mind - Body Integration
• Play is a holistic experience in that it invites our total being
into the process.
• It uses both hemisphere of our brain
• The left, analytical, side is essential in deciding what to do
next, which strategies get us the win etc
• The right, artistic, side allows us to enjoy the experience -
When we are laughing, singing, moving about happily, or simply
engrossed in a pleasant diversion (i.e., play), we tend to take
fuller breaths, thus getting a better oxygen exchange.
• General muscle tension is eased which reduces fatigue and
generalized body aches and stiffness.
 SHOULD PLAY THERAPY BE
CULTURALLY SENSITIVE?
• Play behaviour of children, not universal across different
cultures
• Therapists should be able to differentiate between
pathological and cultural play variants
• Play therapy focuses on expression of emotion through
play: however certain cultures favour indirect and subtle
forms of communication
• Lesser structure in play therapy, makes parents from
certain cultures like Asians believe that the therapist is
only “playing” with the kid, as they focus more on
achievement and goal orientation
 CULTURALLY SENSITIVE PLAY
THERAPY
• Having culturally sensitive materials in play rooms
• Culture-neutral items and culture-specific items (eg-
homes that are representative of all levels of
socioeconomic families; dolls of varied ethnicities etc)
• Use of multicultural artifacts
• Play therapists described the need to be aware of the
child, the culture of the child, and the awareness of
differences
 INTEGRATION OF PLAY THERAPY
WITH OTHER THERAPIES
• Cognitive Behavioural Play Therapy
• a developmentally sensitive treatment for young children that
relies on flexibility, decreased expectation for verbalizations by
the child, and increased reliance on experiential approaches

Music Play Therapy

- integration of the basic principles of nondirective play therapy
and music therapy provides a basis for a new combined therapy
modality best called nondirective music play therapy
 REFERENCES
• Charnigo, A. (2015). Play Therapy: Comparing and contrasting the different types and
effects (Doctoraldissertation, Penn State York).
• Child Therapy: 19 Counseling Techniques & Worksheets for Kids [ PDF]. (2019,
February 08). Retrieved
from https://positivepsychologyprogram.com/child-therapy/
• Gil, E. (2016). Play in family therapy. New York: The Guilford Press.
• Knell, S. M. (1998). Cognitive-behavioral play therapy for
preschoolers: Integrating play and cognitive-behavioral
interventions. Journal of Clinical Child Psychology, 27(1), 28-33.
doi:10.1037/12060-008
• Lind, M. (2011). Filial Therapy and Parent-Child Interaction
Therapy: Building Bonds that Heal (Doctoral dissertation, Adler
Graduate School).
• Moreno, J. J. (1985). Music play therapy: An integrated
approach. The Arts in Psychotherapy,12(1), 17-23.
doi:10.1016/0197-4556(85)90004-8
• Mosier, K. (2018, November 07). 5 Play Therapy Methods. Retrieved
from https://www.christiancounselingco.com/5
types-of-play-therapy/
• O'Connor, K. (2005). Addressing Diversity Issues in Play
Therapy. Professional Psychology: Research And Practice, 36(5),
566-573. doi: 10.1037/0735- 7028.36.5.566
• "Play Therapist's Perspectives on Culturally Sensitive Play Therapy" (2012).
University of New Orleans Theses and Dissertations. 1491.
THANK YOU!