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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Play Therapy: Basics and Beyond is a comprehensive and insightful guide to the practice of play therapy. Presenting foundational and advanced skills with humor and fun, this book brings the practice of play therapy to life through real-life examples, interactive exercises, and thought-provoking reflections. For those new to play therapy or seeking to deepen their expertise, Play Therapy: Basics and Beyond offers both a proven methodology and practice tools for counselors to connect with their child clients in deeply meaningful ways.
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Seitenzahl: 824
Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Title Page
Copyright Page
Dedication Page
Preface
Plan of the Book
Becoming a Trained Play Therapist
Acknowledgements
Basic Concepts
1. Introduction to Play Therapy
Therapeutic Powers of Play
Personal Qualities of a Play Therapist
Appropriate Clients for Play Therapy
Paradigm Shift From Talk to Play
Play Therapy Dimensions Model
Skills, Strategies, and Techniques (Oh My!)
Issues to Consider
Questions to Ponder (Because We Know You’re a Thoughtful Person)
2. History of Play Therapy
Psychoanalytic or Psychodynamic Play Therapy
Structured Play Therapy
Relationship Play Therapy
Child-Centered Play Therapy
Limit-Setting Therapy
Theories for Working With Children Who Have Attachment Issues
Approaches Based on Theories for Work With Adults
Approaches Integrating Different Theories
Short-Term, Time-Limited, Solution-Focused Play Therapy
Prescriptive or Integrative Play Therapy
Questions to Ponder
3. Theoretical Approaches to Play Therapy
Adlerian Play Therapy
Child-Centered Play Therapy
Cognitive-Behavioral Play Therapy
Ecosystemic Play Therapy
Gestalt Play Therapy
Jungian Analytical Play Therapy
Psychodynamic Play Therapy
Theraplay
Emerging Approaches to Play Therapy
Choosing a Theoretical Orientation or Approach
Questions to Ponder
Basic Skills
4. Logistical Aspects of Play Therapy
Setting Up a Space for Therapy
Choosing and Arranging Toys
Explaining the Play Therapy Process
The Initial Session
Ending a Session
Writing Session Reports
Termination
Questions to Ponder
5. Tracking
How to Track
Monitoring Children’s Reactions to Tracking
Applications in Different Theoretical Orientations
Examples of Tracking
Practice Exercises
Questions to Ponder
6. Restating Content
How to Restate Content
Focusing Restatements of Content
Influencing by Restating Content
Monitoring Reactions to Restating
Applications in Different Theoretical Orientations
Examples of Restating
Practice Exercises
Questions to Ponder
7. Reflecting Feelings
How to Reflect Feelings
What to Reflect
Monitoring Children’s Responses
Expanding Concepts and Vocabulary
Applications in Different Theoretical Orientations
Examples of Reflecting Feelings
Practice Exercises
Questions to Ponder
8. Setting Limits
What to Limit
When to Limit
Practical Considerations in Limiting
Cultural Considerations in Limit-Setting
Styles of Limiting
Examples of Limit Setting
Practice Exercises
Questions to Ponder
9. Returning Responsibility to the Child
When to Return Responsibility
How to Return Responsibility
When Not to Return Responsibility
Applications in Different Theoretical Orientations
Examples of Returning Responsibility
Practice Exercises
Questions to Ponder
10. Dealing with Questions
Nature of Children’s Questions
Types of Responses
Asking Questions
Practice Exercises
Questions to Ponder
11. Integration of Basic Skills
Deciding When to Use a Skill
Integrating and Infusing Skills
Practice Exercises
Questions to Ponder
Advanced Skills and Concepts
12. Recognizing and Communicating Through Metaphors
Why Metaphors Are Important
Recognizing Metaphors
Understanding the Meaning
Using the Metaphor to Communicate
Helping Clients Shift Their Metaphors
Therapeutic Metaphors
Practice Exercises
Questions to Ponder
13. Advanced Play Therapy Skills
Metacommunication
Mutual Storytelling
Co-Telling a Story With the Child
Role Playing and Engaging in Play
Play Therapy Strategies
Practice Exercises
Questions to Ponder
14. Assessing Themes and Patterns in the Child’s Play
Play Themes
How the Child Plays Out the Presenting Problem and Other Significant Concerns
Using Your Understanding of Play Therapy Patterns and Themes
Practice Exercises
Questions to Ponder
15. Working With Parents, Caregivers, and Teachers
Working With Parents and Caregivers
Psychoeducational Programs for Teaching Parents Nondirective Play Therapy Skills
Parent/Caregiver Consultation Models
Research Support for Working With Parents and Caregivers as an Adjunct to Play Therapy
Working With Teachers
Practice Exercises
Questions to Ponder
16. Professional Issues in Play Therapy
Legal and Ethical Issues
Cultural Competence and Cultural Humility
Inclusion of Aggressive Toys in the Playroom
Technology in the Playroom
Public Awareness of Play Therapy and Professional Identity of Play Therapists
Advice to Beginning Play Therapists
Practice Exercises
Questions to Ponder
References
Appendix A
Theory and Play Therapy Resources
Adlerian Theory/Adlerian Play Therapy
Person-Centered Theory/Child-Centered Play Therapy
Cognitive-Behavioral Theory/Cognitive Behavioral Play Therapy
Gestalt Theory/Gestalt Play Therapy
Jungian Theory/Jungian Play Therapy
Narrative Theory/Narrative Play Therapy
Psychodynamic Theory/Psychodynamic Play Therapy
Theraplay
Integrative/Prescriptive Play Therapy
Appendix B
Philosophical Assumptions Underlying Counseling and Play Therapy Theories
Appendix C
Index
About the Authors
Technical Support
End User License Agreement
List of Tables
Appendix B
Table B1 Question 2a
Table B2 Question 2c
Table B3 Question 2d
Table B4 Question 2e
Table B5 Question 2f
Table B6 Question 2g
Table B7 Question 3
Table B8 Question 4
Table B9 Question 5
Table B10 Question 6
Table B11 Question 7
Table B12 Question 8
Table B13 Question 9
Table B14 Question 10
Table 3.2 Question 11
Table 3.2 Question 11a
Table 3.2 Question 12
Table 3.2 Question 12
Table 3.2 Question 12
List of Illustrations
Chapter 1
Figure 1 Full Play Therapy Dimensions Model Diagram
Guide
Cover
Table of Contents
Title Page
Copyright
Dedication
Preface
Acknowledgements
Begin Reading
References
Appendix
Index
About the Authors
Technical Support
End User License Agreement
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Play Therapy
Basics and Beyond
TERRY KOTTMANJEFFREY S. ASHBY
Copyright © 2024 American Counseling Association. All rights reserved.
American Counseling Association2461 Eisenhower Avenue, Suite 300Alexandria, Viriginia 22314
Published in the United States of America
Publisher’s Cataloging-in-Publication Data
Names: Kottman, Terry, author. | Ashby, Jeffrey S., author.Title: Play therapy : basics and beyond / Terry Kottman and Jeffrey S. Ashby. -- 3rd ed.Description: Alexandria, VA : American Counseling Association, [2024] | Includes bibliographical references and index.Identifiers: LCCN 2024934614 ISBN 9781556204210 (paperback)Subjects: LCSH Play therapy | PsychotherapyClassification: LCC RJ505.P6 K643 2024 | DDC 616.89’1653--dc23LC record available at https://lccn.loc.gov/2024934614
To Rick and Jacob—my two favorite people in the universe.
—Hugs, Terry
To Lucy, Samuel, John and Emily, Eliza, and Isaac.
—Always, Jeff
Preface
Over the past 35 years, the demand for mental health professionals and school counselors who have training and expertise in using play as a therapeutic modality in working with children has increased tremendously. There has been a commensurate demand for trained play therapists. I (TK) designed the first edition of Play Therapy: Basics and Beyond to provide an introduction to the different skills used in play therapy combined with an atheoretical orientation to the basic concepts involved in play therapy. It was a practical introduction to play therapy concepts and skills. The book stressed the application of various play therapy strategies across a wide range of theoretical orientations. The second edition contained updated references, new developments in the field of play therapy, along with expanded information about professional issues and multicultural applications of play therapy. Building upon the second edition, this third edition has expanded the clinical examples, exercises, and questions for readers to consider. We have also added an extra chapter to this edition on assessing themes and patterns in the child’s play.
The book has been widely used to teach introductory play therapy and child counseling courses, and its primary intended audience is students enrolled in these courses. Because the book provides information about many different theoretical orientations, it can be helpful no matter the theoretical orientation of the professor, the program, or the student. The book is also for clinicians who want to have more knowledge and understanding of play therapy but do not have access to formal training in the field.
With these two audiences in mind, we have made some assumptions about the backgrounds of those using the book as their entry to the world of play therapy. We assumed that the reader has some basic background in counseling, psychology, social work, or some other related field—many of the terms and concepts used in this book are borrowed from other mental health-related areas. We also assume that the reader has some knowledge and exposure to children and at least a general understanding of child development.
Plan of the Book
Chapters 1 through 3 compose Part 1, Basic Concepts. In Chapter 1, “Introduction to Play Therapy,” we provide an explanation of the paradigm shift necessary to move from talk as therapy to play as therapy, several definitions and rationales for play therapy, descriptions of the therapeutic powers of play, information about appropriate clients for play therapy, and descriptions of characteristics and experiences needed by therapists who want to use play as a treatment modality. In Chapter 2, “History of Play Therapy,” the reader will learn about the evolution of play therapy. Chapter 3, “Theoretical Approaches to Play Therapy,” contains expanded descriptions of nine selected contemporary approaches to play therapy, focusing on the theoretical constructs, the stages of play therapy, the role of the therapist, goals of therapy, approaches to working with parents, and distinctive features of each approach. We have also added information about several “burgeoning” new approaches to play therapy to expand the theoretical orientation options.
Chapters 4 through 11 compose Part 2, Basic Skills. In Chapter 4, “Logistical Aspects of Play Therapy,” the reader will learn about setting up a space for play therapy, choosing and arranging toys, explaining the play therapy process to parents and children, handling the initial session, assessing children’s play behavior, dealing with paperwork, ending a session, and terminating the therapy process. Several basic play therapy skills are used in most approaches to play therapy: (a) tracking behavior, (b) restating content, (c) reflecting feelings, (d) limiting, (e) returning responsibility to the child, and (f) dealing with questions. The application of these skills varies depending on the therapist’s theoretical orientation and the therapy stage, but most play therapists use them at one time or another. In Chapters 5 through 10, we define each of these skills, delineate the purpose for their use in the play therapy process, and explain how they can be applied in various situations in play therapy. To make each skill more concrete and accessible to the reader, we provide examples of the application of the skill and invite the reader to practice it using exercises tailored to demonstrate various situations in which the skills would be appropriate. At the end of each chapter, the reader will find practice exercises designed to hone the application of the specific skill. We believe that all play therapists need to look at their own thoughts, feelings, attitudes, and personal issues to become truly skillful in working with children. The “Questions to Ponder” at the end of each chapter are our attempt to facilitate this self-examination process. In Chapter 5, “Tracking,” the reader will learn about using tracking to establish a relationship with the child. Building rapport is also the focus of Chapter 6, “Restating Content.” The reader can explore strategies for reflecting feelings to help the child learn to understand their emotions in Chapter 7, “Reflecting Feelings.” In Chapter 8, “Setting Limits,” we provide the reader with several different techniques for limiting inappropriate behavior in the playroom. In Chapter 9, “Returning Responsibility to the Child,” a rationale and description of methods for returning responsibility to the child will help the reader explore this important skill. Because all children in the playroom ask questions, the reader will learn how to understand possible meanings and how to handle queries in Chapter 10, “Dealing with Questions.” In Chapter 11, “Integration of Basic Skills: The Art of Play Therapy,” we provide an explanation of and practice in methods for deciding which skill to use when and for integrating different skills to create a combined intervention that works more smoothly and more efficaciously than an isolated skill would. The reader will also explore the need to blend the therapist’s personality and interactional style with play therapy skills to present a more natural flow of interaction with the child.
Chapters 12 through 16 compose Part 3, Advanced Skills and Concepts. Much of the communication that takes place in play therapy comes in the form of metaphors. Chapter 12, “Recognizing and Communicating Through Metaphors,” contains descriptions of strategies and practice exercises for learning to understand possible meanings of children’s metaphors. The reader will also learn and practice ways to use metaphors created by children to facilitate communication with them in their own natural language. In this chapter there is also information on designing therapeutic metaphors and other storytelling techniques that can be used in play therapy. Chapter 13, “Advanced Play Therapy Skills,” includes information on using metacommunication, visualization strategies, art techniques, sand tray play therapy, and role playing/playing with children in play therapy. In this chapter, the reader will find examples of the application of each of these advanced skills and exercises that provide guided practice in their use. Chapter 14, “Assessing Themes and Patterns in the Child’s Play,” is a new chapter we added based on requests from other professionals who have used the book in the past as a cross-theoretical guide for helping play therapists explore the themes present in children’s play. In the years since the previous two editions of this book, the research in the field has suggested that one of the main factors that increase the efficacy of play therapy is working with parents. There have also been some suggestions in the literature that consulting with teachers of children who are struggling in school can also enhance the efficacy of play therapy. Chapter 15, “Working with Parents and Teachers,” is an overview of the information available concerning filial therapy, Kinder Training, Parent-Child Interaction Therapy, Familial Encouraging Connection Therapy, and Adlerian parent and teacher consultation. Because play therapy is an emerging profession, it is essential that individuals interested in the field stay informed about professional issues that can have an impact on the field. To facilitate this process, in Chapter 16, “Professional Issues in Play Therapy,” we include information on the following issues: (a) legal and ethical issues, (b) cultural competence and cultural humility, (c) inclusion of aggressive toys in the playroom, (d) technology in the playroom, and (e) advice to new play therapists from experts in the field.
Becoming a Trained Play Therapist
Reading this book will not transform the reader into a trained play therapist. To become a play therapist, it is essential to thoroughly study the concepts and information in this text, explore specific theoretical approaches in more depth, learn more about both beginning and advanced-level play therapy skills, and gain experience working with children using play therapy interventions under the supervision of a play therapy professional. We believe that an introductory play therapy class should require the students to conduct multiple play therapy sessions for which they receive feedback from experienced play therapists before venturing to conduct other play therapy sessions (also under the supervision of a trained and experienced play therapy supervisor). We also believe that an individual who wishes to become a play therapist must continue to work on their own personal issues. Several organizations (e.g., Association for Play Therapy, Canadian Association for Child and Play Therapy, British Association of Play Therapy) have provided guidelines for the training and supervised clinical experience necessary to become a trained play therapist.
Acknowledgements
Thanks to my students and my clients over the past 40 years (Yikes!!) of doing play therapy—you help me learn more about play therapy every time I have the pleasure and privilege of hanging out with you.
Thanks to the baristas (and bakers) at Cup of Joe in Cedar Falls, Iowa, who have kept me supplied with single tall iced gingerbread lattes, smoothies, and muffins for months while I worked semi-diligently on this book. Dawn, Leah, Lex, Megan, Vanessa, Xandra, Toby, Monica, Caleb, Indo, Amy, Nora, Isaac, Sue, and Rae, you have kept me going.
Terry
Thanks to play therapy and adventure therapy students at Georgia State over the (many) years. I have learned from you, been inspired by you, and am honored to know you.
Jeff
Basic Concepts
1Introduction to Play Therapy
Kendrick walks into a room in which there is an assortment of toys on the shelves and the floor—puppets, a dollhouse and dolls, cars, trucks, a wooden stove and refrigerator, plastic snakes and spiders, figures of animals and superheroes, and many other play materials. He looks around the room and chooses several different figures for play—a tiger, a wolf, a dinosaur, and a family of deer. He starts telling a story about the smallest deer getting “bullied” by the tiger, wolf, and dinosaur. He tries to tell the bigger deer that this is happening to the smallest, but the bigger deer ignores him. A man who is sitting with him talks to him about his play, acknowledging what is happening in the story, reflecting the feelings of the smallest deer, and making comments about what is happening between the smallest deer, the other members of the deer family, and the other animals.
This is play therapy.
•••
Ginny and her parents come into a room that has some large pillows on the floor. A woman is sitting on the floor next to the pillows. Ginny’s parents go to sit on chairs in the corner with a man who talks to them. The woman on the floor is excited that Ginny is there and announces that they are going to have such fun together. The woman brings out several different hats. As she and Ginny try on hats and make faces in a mirror, the man with her parents explains what the woman and Ginny are doing and why, telling the parents that they will soon join in the fun.
This is play therapy.
•••
Bae-Hoon enters a room with a table in the middle. On the table are a dollhouse, some doll furniture (including a bathtub), some family figures (two parents and three children), and a sand tray figure of a tornado. A person sitting at a table in the room suggests that Bae-Hoon show what happened when he and his family were huddled in their bathtub for safety while a tornado destroyed their house. Bae-Hoon and the person at the table use some blocks to build a house, which Bae-Hoon knocks down several times while crying.
This is play therapy.
•••
Play therapy is an approach to counseling young children in which the counselor uses toys, art supplies, games, and other play media to communicate with clients using the “language” of children—the language of play. Because children under age 12 have relatively limited ability to verbalize their feelings and thoughts and to use abstract thinking and verbal reasoning, most lack the ability to come into a counseling session, sit down, and use words to tell the therapist about their problems. (Imagine a child coming into a therapist’s office, sitting down on the couch, and saying, “I’ve just been feeling out of sorts lately.” Not likely.) Children tend to lack the introspective and interactional skills required to take full advantage of the “talking cure” in traditional therapy. In play therapy, children can come into a session and use toys, art, stories, and other play tools to communicate with the therapist.
This ability to use play as a natural form of reasoning and communication makes play an appropriate modality for therapeutic intervention with young children (Landreth, 2024). In play therapy, the play can be a means for (a) establishing rapport with children; (b) helping therapists understand children and their interactions and relationships; (c) helping children reveal feelings that they have not been able to verbalize; (d) allowing children to constructively act out feelings of anxiety, tension, or hostility; (e) teaching socialization skills; and (f) providing an environment in which children can test limits, gain insight about their own behavior and motivation, explore alternatives, and learn about consequences (Thompson & Henderson, 2016).
Therapeutic Powers of Play
The Association for Play Therapy has defined play therapy as “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” (Association for Play Therapy, n.d., para. 1). While that definition is a mouthful, at its core is the notion that play therapy is an approach to counseling clients using the “therapeutic powers of play” (Reddy et al., 2005, p. 4). Schaefer (1993) and Schaefer and Drewes (2009, 2014) generated lists of therapeutic powers of play, suggesting that each of these powers, or factors, has specific beneficial outcomes for clients. Some of these therapeutic factors are self-expression, access to the unconscious, direct and indirect teaching, catharsis, abreaction, positive emotion, counterconditioning fears, stress inoculation, stress management, therapeutic relationship, attachment, social competence, empathy, creative problem-solving, resiliency, moral development, accelerated psychological development, self-regulation, and self-esteem. Not all play therapy approaches activate all of these therapeutic factors, but the list offers a framework for understanding how play therapy brings about positive change for the child. When play therapy is effective, these therapeutic factors are the mechanisms of change.
Self-Expression
Because young children lack the language skills, vocabulary, and abstract thinking abilities of older children and adults, they may have difficulty expressing themselves with words. As explained by Schaefer and Drewes (2009), “In play, children are able to express their conscious thoughts and feelings better through play activities than by words alone” (p. 5). Because play is the usual mode of communication for the child, using play as a therapeutic modality facilitates the child’s capacity for self-expression. The child can use play materials to indirectly communicate thoughts, feelings, and experiences that they cannot express in words or that might be too threatening to communicate directly. In addition, as a counselor your willingness and ability to speak in the child’s language can convey a respect for the child that they might never have experienced. By watching how the child plays, what toys they choose, and when they switch from one activity to another, you can receive multifaceted messages from the child.
The following scenario illustrates how the child can use play for self-expression:
The parents of Levi (age 6) are excited because they are receiving a 6-month-old baby boy as a foster child. They are a little worried because Levi has not expressed any interest, curiosity, or enthusiasm about having a brother. Levi comes into the playroom, picks up a baby doll, and puts it in the trash can. He then proceeds to take all of the other “baby things”—the bottles, the doll clothes, the doll blanket—and stuffs them all into the trash can. He looks around for other items connected with the baby doll, doesn’t see anything else, looks rather nervously at you, and goes over and begins to play with some blocks.
Access to the Unconscious
Children are often not aware of unconscious conflicts and issues (which are, after all, unconscious). Because the toys and play objects in the playroom are chosen as neutral vehicles on which the child can project meaning, they can be used by the child to reveal unconscious material “into concrete form” (Gil, 2013, p. 53). In the relationship with the play therapist, the child can use the toys to bring unconscious desires and impulses into consciousness and to express them symbolically.
The following scenario illustrates how the child can use play to access the unconscious:
Niamh (age 8) was physically abused by her father, who is now in jail. She plays with a doll that looks like an adult male, moving its limbs and then suddenly twisting its head off before she puts it in a jail. She initially appears startled, then she smiles at you and says, “I guess that took care of him. I didn’t even know I wanted to do that, but I did.”
Direct and Indirect Teaching
Many children lack the skills that they need to survive in the world. One method of teaching social skills, problem-solving skills, negotiation skills, coping skills, and assertiveness skills to children is to use toys, art, and play materials to provide them with direct instruction and allow them to practice these skills in a fun way that optimizes their learning (Kottman & Meany-Walen, 2016, 2018).
Metaphoric/indirect teaching is a method of using storytelling and play narratives to expose clients to new insights, perspectives, and coping strategies without evoking defensive reactions. It also allows clients to address issues indirectly without having to overtly acknowledge situations or issues that might feel threatening or overwhelming. By using stories, interactive play, and artwork to explore issues and present different ways of looking at situations, the play therapist can subtly help children examine their cognitive and affective patterns and teach them new skills and attitudes.
The following scenario illustrates how you could use play to metaphorically teach problem-solving skills:
Jamar (age 6) and Journey (age 4) are playing in the sandbox with several plastic dinosaurs. Jamar’s dinosaur tells Journey’s dinosaur to dig a hole to bury his treasure in. Journey uses one of the bigger dinosaurs to hit Jamar’s dinosaur, saying, “I don’t have to do what you tell me to do.” Jamar’s dinosaur starts to hit Journey and the dinosaur she is holding. You stop Jamar’s dinosaur from hitting Journey and her dinosaur by reminding them, “It’s against the playroom rules to hit anyone. Remember, everyone needs to be safe in our playroom.” Then you say to Journey’s dinosaur, “You need to work out a way to let the other dinosaurs know you don’t like it when they tell you what to do,” and then you say to Jamar’s dinosaur, “I bet you can think of another way to respectfully ask Journey’s dinosaur to help you dig the hole for your treasure.”
Catharsis
Catharsis involves the expression of powerful feelings, resulting in emotional release or completion of previously denied, inhibited, or interrupted affect (Ayling, 2019). Because the play therapist is a caring and empathic adult who will continue to accept children no matter what emotions they express, many children take advantage of the freedom of the play therapy setting to express strong emotions (both positive and negative) that they might not ordinarily be willing or able to communicate. The sense of release that follows the expression of powerful feelings, especially those that might not be acceptable to many others, can be a growing experience for children.
The following scenario illustrates how the play therapy process can facilitate catharsis:
Lilliana (age 8) reports that she has again gotten into a fight on the playground of her school. She grabs a plastic sword and starts hitting the dragon puppet, yelling, “I hate her! I hate her! I hate her!” She dissolves into tears, crying and saying, “She doesn’t like me just because I’m Mexican! She thinks my hair is too straight and my skin is too brown! She says she doesn’t understand me just because I have an accent. I hate her. And the teachers on the playground say I am the bad one. She is the one who is being mean, and I am the one who gets into trouble. It’s not fair! I hate all the teachers too.”
Abreaction
Abreaction allows children to symbolically relive stressful or traumatic events and reexperience the feelings associated with those events. The purpose of abreaction is to provide children with a vehicle through which they can release some of the negative thoughts and emotions attached to painful experiences. In play therapy, children can reenact “bad stuff” over and over again if necessary. This process helps them gain a sense of mastery over their own negative experiences and interactions, which may assist them with “working through and resolving certain aspects of trauma” (Locatelli, 2020, p. 37).
The following scenario illustrates how play therapy can trigger and facilitate a child’s abreactive response:
During the pandemic, Derrick’s (age 4) beloved grandmother became sick with COVID-19 and was admitted to the health center at the retirement community where she lived. Because of the pandemic restrictions on visitation, Derrick and his mother were not allowed to go into the health center to be with his grandmother, but they often went there to wave at her through the window and show “get well” signs. During one of these visits, Derrick’s grandmother went into cardiac arrest and died. Although Derrick’s mother quickly moved him away from the window, he witnessed the nurses rush to his grandmother and start to “beat on her chest.” He started having nightmares about this experience, waking up crying and screaming, “Grammy! We need to help my Grammy! They are hurting her!” In play therapy, after pandemic restrictions on in-person sessions were lifted, Derrick would take an older-looking female figure and have several other adult figures beat on her body, sobbing and crying as he did this. Although Derrick continued this playroom activity for several sessions, the intensity of his emotional reaction gradually diminished. After a time, he could say how much he missed seeing his grandmother and wished she would come over to their house for dinner like she used to do.
Positive Emotion
Playing together is fun and play therapy can provide children with an experience of laughing and having a good time in an accepting environment. There is preliminary evidence that fostering positive emotions can improve cognitive performance, creativity, problem-solving, and self-regulation (e.g., Stifter et al., 2019). Because many of the children who come to play therapy have not had the opportunity to experience or express positive emotions, the play therapy process can be a revelation to them and significantly enhance their well-being (Kottman, 2014).
The following scenario illustrates how play can promote positive feelings in the therapeutic relationship:
Bonnie (age 6) puts on a puppet show for you. With the puppets, she tells a joke, giggling, and rolling around on the floor of the playroom. She tells you, “I love being here with you. I never want to leave. Nobody else thinks I am funny. You always laugh at my jokes. And you always listen to me like I’m important or something.”
Counterconditioning Fears
As a natural function of growing up, children experience certain fears— of the dark, of being alone, and so forth. In certain cultures, there are objects or concepts that typically evoke anxiety in individuals (e.g., several Native American tribes, such as the Navajo, believe that they must not speak of the dead for fear that evil spirits or witches will harm them; Prue-Owens, 2021). For some children, the circumstances in their lives may have created situations in which they feel fearful. In play therapy, children can express and sometimes master these fears by interacting with the toys, art supplies, and play media in a way that lets them experience fear and recognize that they have the skills for coping with fear and taking care of themselves. Schaefer and Drewes (2009) suggested that play therapy can facilitate the counterconditioning of fears because “two mutually exclusive internal states are not able to simultaneously co-exist, such as anxiety and relaxation or depression and playfulness” (p. 7).
The following scenario illustrates how play therapy can help children learn to express and cope with their fears:
Dakota (age 8) starts to shake when he sees your newly acquired, Halloween-themed plastic severed hand that has blood on the wrist. Looking nervous, he uses the lion puppet to push it off the shelf and toward the door of the playroom. You say, “You seem really scared about that and want it out of the room.” In a whisper, you ask, “What do you want to happen next?” Without acknowledging the question, Dakota hands you the lion puppet and whispers, “I wish someone would get rid of it.” Because you know that in Dakota’s Navajo culture, a person might be considered contaminated by touching a dead person or parts of a dead person, you use the lion puppet to pick up the severed hand, put it in the trash can, and put a lid on the trash can. You turn to Dakota and ask, “How is that?” He says, “Can we put it and the lion puppet out in the hall? I don’t think they will hurt anyone out there as long as the lid is on the trash can.” As soon as the trash can is out in the hall, you say, “We got rid of that without anybody having to touch it.” Dakota smiles shyly without looking at you and says, “We needed it to be gone, but we didn’t want it to hurt anyone else either. Now we are safe.”
Stress Inoculation
Stress inoculation allows play therapy clients to anticipate and learn to manage stressful feelings (Cavett, 2014). Often children become anxious in anticipation of stressful events in their lives, such as starting a new school year, moving, going to the dentist, or having a medical procedure. Before these stressful events, children can reduce their anxiety if they play out the event as a way to learn what to expect and to become more comfortable with what is going to happen (Wohl & Hightower, 2001).
The following scenario illustrates how play can be useful in inoculating a child to a stressful situation:
Camila (age 9) uses a courtroom diorama to depict her upcoming testimony about her uncle sexually abusing her. Initially, when she engages in this play, she is very tense and agitated, almost tearful. As she plays through what she has been told will happen in the courtroom, she seems to gradually become more relaxed, even smiling as she repeats comments made by her foster parents, the lawyer representing her, and her court-appointed advocate about how the experience will go.
Stress Management
Stress is a nearly universal experience for children and adults and the “effect of stress on our emotional and physical health can be devastating” (Fink, 2017, p. 1). In addition to stressors directly experienced by children (e.g., changes in parenting structure due to divorce, pressure to perform in school), children are also exposed to indirect “crossover” stress that can occur when stress experienced by one family member leads to stress for another family member, such as when a parent’s work stress undermines parenting, communication, and anger management (Liu & Doan, 2020). Several authors (e.g., Razak et al., 2018) have identified the value of play as a stress-management resource, and Ray (2011) noted that “all children use play therapeutically as a way of dealing with stress” (p. 11). Stress management in play therapy can include the process of children discharging the tensions of their daily lives and/or learning and practicing stress management techniques (e.g., controlled breathing and mindfulness).
The following scenario illustrates how play can be useful in helping a child learn strategies or techniques to deal with the unpleasant aspects of stress:
Alicia (age 10) has developed test anxiety and has “meltdowns” at school whenever she has to take a test, even when she is fully prepared for it. You teach her several anxiety management techniques, such as deep breathing and muscle relaxation. You also ask her to help a stuffed bear learn to manage her stress about climbing a tree by using some of the same anxiety management techniques you want Alicia to learn and practice.
Therapeutic Relationship
The therapeutic relationship between the play therapy client and the therapist allows the client to express themselves in the natural language of play (Post et al., 2019). You can foster this positive relationship through empathy, acceptance, establishing safety, acceptance, and witnessing the child client’s experience (e.g., Bent et al., 2022; Winburn et al., 2020). While providing a foundation for specific play therapy interventions, this positive relationship also fosters resilience (Post et al., 2019). Numerous authors have identified the therapeutic relationship as one of the common factors across various play therapy approaches that facilitate change (e.g., Mora et al., 2018).
The following scenario illustrates the therapeutic relationship in play therapy:
You know that Dequan (age 8) loves to play Plants vs. Zombies on his Nintendo Switch. You ask him if he would rather draw some of the zombies from the game on the whiteboard or practice walking like a zombie around the playroom. You and he start walking around the playroom, taking turns deciding which zombie you are going to imitate. He laughs and says, “No other grown-up will play like this with me.”
Attachment
Some children who come to play therapy have limited attachment to other human beings. The process of play therapy provides several avenues for increasing these children’s connectedness to others. Play therapy can provide a corrective relationship with a secure adult that allows children to change in attachment over time (Pleines, 2019). Through shared fun, children frequently grow to feel affection and a sense of connection to the therapist. Using role play and fantasy play, the therapist can begin to build a child’s empathic responses, which can generalize to a stronger sense of connection to other people. It is sometimes helpful to include the parents or an additional child in several play therapy sessions or involve the child in a group to maximize the sense of connection with peers. The play therapist can also work with parents to help them learn strategies for forming attachments with their children.
The following scenario illustrates how the play therapy process can be used to set the stage for the formation of an attachment between the therapist and a child:
Isla (age 5) has been in several foster families, moving three times in the past year. Two of these moves were triggered by her own inappropriate behavior, and the third one was necessitated by the foster family’s inability to care for her special medical needs. She is referred to play therapy because she does not seem willing to connect with her current foster family. You ask her foster parents to attend sessions with her, inviting them to play with you and Isla, suggesting simple games like “Simon Says,” “red light, green light,” “pitch and catch,” “Mother, May I?”, memory-matching games, and Chutes and Ladders. You use tracking, restating content, and reflecting feelings to let Isla know you are paying attention to what is important to her, and you coach her foster parents to do the same. Isla gradually begins to smile more and make eye contact with her foster parents. After 10 sessions of doing this, at the end of the session, Isla gives her foster mother and father a big hug and says, “I love you both!”
Social Competence
Social competence is an umbrella term that describes a constellation of social skills, including empathy, cooperation, conversational proficiency, and having fun (Nash, 2014). Social competence is foundational to academic and social success in children (Denham et al., 2012) and can be a protective factor against behavioral problems, such as violence and aggression, as well as functional impairment (Blalock et al., 2019). Many children referred for play therapy lack social competence and have not experienced success in building relationships with others. Because the play therapist consistently demonstrates a caring, supportive attitude toward them, play therapy clients begin to believe that they may be worthy of love and positive attention. The play therapy relationship allows the client to see social competence practiced by the therapist and provides a context for developing and practicing social skills. Some play therapists (Knell, 2009a, 2016; Kottman & Meany-Walen, 2016) have taught social skills and other strategies for building positive social relationships, either in group or individual modalities.
The following scenario illustrates using play to enhance social competence in play therapy:
Keefer (age 7) comes to his first four sessions bossing you around, correcting you, and generally being rude. You reflect feelings, restate content, track his behavior, return responsibility, and make encouraging comments. Keefer starts his fifth session by saying, “You look fat today. Fatty, fatty, fatty!” You respond (in a neutral voice), “When you say things like that, my feelings get hurt. I am guessing that if you say things like that to other people, it probably hurts their feelings, and they might not want to be around you.” He says, “Lots of kids don’t want to play with me at school.” You ask, “It sounds pretty lonely. Might you want to learn some other ways to talk to people so they want to play with you?” When he replies in the affirmative, you ask if he wants to use the puppets to practice talking to people so that they will want to be friends with him, and he agrees to try it. (You may also have to deal with your own countertransference about him being rude and calling you names that can easily evoke emotional reactions—even from therapists.)
Empathy
Empathy, the ability to understand the feelings and perspectives of others, is an important social skill that many children who come to play therapy lack. Empathy is important for successful relationships, and deficits in empathy are related to a variety of presenting issues in play therapy (e.g., oppositional defiant disorder, conduct disorder, attention-deficit/hyperactivity disorder [ADHD]; Fantozzi et al., 2021). In the cooperative engagement that often occurs in play therapy, children develop empathy by taking on different roles and learning to identify and understand the affective and cognitive perspectives of others.
The following scenario illustrates how play can increase a child’s empathy and ability to take on the perspectives of others:
AhnJong (age 10) is having difficulty making friends at school. She is in the gifted program and tends to be dismissive of her classmates’ feelings. She is unwilling to consider the possibility that their opinions and feelings could be valid. After you have worked hard to establish a relationship with her, you tell her you would like to do a puppet show, and she says, “If you have to, I guess I can sit here and be bored.” You do a puppet show in which you have a peacock puppet tell the various other animal puppets that they are “stupid,” they don’t know anything, their opinions don’t matter, and so forth. You have the other puppets give the peacock puppet feedback, talking to the peacock about their feelings and responses to her comments. As she watches, she goes from appearing disinterested to paying close attention. At the end of the puppet show, she says, “You aren’t as dumb as I thought you were. Maybe I can be nicer to the other kids at school if that’s the way they feel.”
Creative Problem-Solving
The ability to see problems from different angles and generate multiple solutions is significantly related to well-being (e.g., Tan et al., 2019). Since play is a creative process in and of itself, play therapy can effectively facilitate the development of creative problem-solving. To play, children must generate ideas from their imaginations to fuel the action. In play therapy, children continually use creative thinking to solve problems in innovative and constructive ways. By not making decisions for the child, not providing solutions to difficult situations, and not telling the child how to play, you consistently return responsibility to the child and encourage creative thought and problem-solving.
The following scenario illustrates how you can use play as a method to encourage a child to solve problems creatively:
Presley (age 5) is frustrated because some cars that he had used to play “chase” in his session last week were broken by another boy who comes to the playroom. Presley throws the cars on the floor and says, “There’s nothing in here I want to play with. I only wanted to play chase—nothing else.” You reply, “I know you are disappointed, and I bet you can figure out something else you could use to play chase.” Presley looks around the room, grabs some blocks, and says, “These can be my cars. I invented these for playing chase. They will be much better than those old things I played with last week.”
Resiliency
Play therapy clients have often faced significant life stressors and numerous adverse experiences (Ray et al., 2021). Through play, clients can develop a greater sense of resiliency in the face of adversity. In play therapy, you can provide opportunities for children to “bounce back” from setbacks and develop protective factors that will buffer the negative effects of stressors. You can encourage children to try activities that they would not usually try, taking care to point out children’s efforts in these endeavors. By acknowledging children when they are working hard and when they are making progress, rather than waiting for them to be 100% successful, you will help build their sense of competence and resiliency (Kottman & Meany-Walen, 2015). This process is also reinforced by not doing things for play therapy clients that they can do for themselves. By returning the responsibility for making decisions and getting things done in the playroom to children, you can help reinforce qualities of resilience.
The following scenario illustrates how the play therapist can use play to foster resiliency:
Cassandra (age 8) begins to get frustrated when she cannot get the toy cash register to stay closed. She starts to throw it on the floor, but then she looks at you and puts it back on the shelf, saying, “I hate that dumb thing. I didn’t want to play store anyway.” Knowing that she has played store for the past six sessions, you reflect her feelings by saying, “You’re feeling really frustrated by the cash register not working the way you want it to work. I know you like playing with the cash register even though you are saying you don’t. What else could you try to make it work the way you want it to work?” If she replies, “I hate stuff that doesn’t work. I am just giving up,” you might say, “You just want to quit trying to make it work. Can I tell you something another kid tried to get it to work that seemed to help?” If she answers in the affirmative, you could give her several suggestions for getting the cash register to close (and hope she is willing to try one of them, and that it works).
Moral Development
Play therapy provides an opportunity for social interaction that can act as an avenue for moral development (Li & Tomasello, 2022). For instance, “gameplay experiences help children move beyond the early stage of moral realism, in which rules are seen as external restrictions arbitrarily imposed by adults in authority, to the concept of morality that is based on the principles of cooperation and consent among equals” (Schaefer & Drewes, 2009, p. 8). Cooperative play and playing games both allow children to enhance their social skills, increase communication strategies, and practice rule-governed behavior through behavior rehearsal. This is true whether children are playing a casual game of pitch and catch, a simple game based on luck, such as Chutes and Ladders, or a highly structured game that requires advanced skill, such as chess or checkers. Specially designed therapeutic games, such as Feelings Bingo and the Talking, Feeling, and Doing Game (R. Gardner, 1973), can provide children with these opportunities and also expand their skills and insights in other ways related to their particular therapeutic goals.
The following scenario illustrates how you can use gameplay to help a child elevate moral judgment, practice social skills, and reinforce rule-governed behavior:
Morris (age 9) does not follow the rules at school. He gets angry with his teacher because “he keeps telling me what to do. He has no right.” He has very few friends because he is unwilling to compromise with his peers about what to play and how to play on the playground. You suggest playing one of the games available in the playroom to help Morris explore his ideas about rules and reasons for having rules. Morris chooses the game Jenga. Having never played the game, Morris wants to stack up the pieces and knock them down. Explaining the rules, you tell him that to play and win the game, players must take turns, with both players paying attention to the arrangement of the pieces as they try to remove them in order to avoid making the entire structure collapse. As the two of you take turns pulling and pushing the Jenga pieces out of the stack, Morris protests “you are just making these rules up, and I don’t have to follow them.” You invite him to make up his own rules about how to play, so he takes the pieces, stacks them up, and knocks them down. After several times doing this, he says, “It isn’t much fun without you too. Will you play with me?” You go back to playing with the original rules and after a time, he says, “This is much more fun. I get it now. We have to take turns for this game to work, and I have to pay attention to what you are doing and what I am doing.”
Accelerated Psychological Development
Play is widely viewed as a primary factor in supporting psychological development in children (e.g., Holmes et al., 2019). As a result, play therapy can be an important factor in bringing a child’s delayed development closer to a normal range. Specifically, play therapy can facilitate cognitive development (e.g., Etemadzadeh et al., 2023), language development (Rezaee Rezvan et al., 2022), and social-emotional development (Schottelkorb et al., 2020). Through the therapeutic relationship and specific play activities chosen by the play therapist, the child’s psychological development can be accelerated.
The following scenario illustrates how the play therapist can use play to foster accelerated psychological development:
Izzy (age 8) is known in her school as an “angry” child. She even introduces herself to new adults by saying, “Hi! My name is Izzy. I have anger management problems.” She tends to go from 0–60 with angry reactions with very little provocation, and she likes to blame others for her behavior. She uses the excuse, “I’m just not in control of my feelings and reactions. I am just like Mei from the movie Turning Red.” You invite her to roleplay the role of Mei, suggesting that what Mei needed to learn in the movie was to “calibrate” her feelings—that there were lots of choices between not being angry and exploding with rage. You work with her to brainstorm a list of words related to anger (e.g., disgruntled, irritated, enraged, annoyed, frustrated, miffed, furious, peeved, fuming, livid, aggravated, exasperated). Over several sessions, using one 3 × 5 card for each word you generate, you collaborate with Izzy on creating drawings to illustrate the intensity of each of these angry feelings and then arrange them in the order of intensity, asking her to use her body to express each word. You invite her to practice using the words for each level of intensity to express her feelings and work on calibrating her reaction’s strength.
Self-Regulation
Self-regulation is the modulation and management of emotions, thoughts, and actions to behave deliberately (Bailey & Jones, 2019), and poor self-regulation is considered a transdiagnostic aspect of a range of internalizing and externalizing disorders in children and adolescents (Eadeh et al., 2021). Play therapists can use a variety of techniques to help clients identify and name a range of emotions, both positive and negative. Play therapy can also help clients develop self-control of maladaptive impulses, which is the core of self-regulation in children (Robson et al., 2020), using a variety of interventions, including familiar games like freeze tag, “Simon Says,” and “Mother, May I?” (Yaeger & Yaeger, 2014).
The following scenario illustrates how the play therapist can use play to foster self-regulation:
Liam (age 4) is a new foster child, having recently moved in with a foster family when his mother’s parental rights were terminated. He is having difficulty settling down in his new home, is having trouble sleeping, experiences nightmares every night, and has two or three 20- to 30-minute temper tantrums every day. His foster parents ask you to give them some ideas on how to help him settle into their family. You sense that they are anxious and frustrated with this process and suggest several books to help them learn to coregulate with him, which will help him begin to self-regulate. These books include Goodnight Love: A Bedtime Meditation Story (Kim, 2023), Bellies to the Sky: A Bedtime Breathwork Book (Canning, 2021), Sleepy Time Nighty-Night (Park, 2023), and Listening to My Body (Garcia, 2017). In your sessions, you use bibliotherapy to introduce Liam to several ways of dealing with his emotional reactions: Amaya’s Anger: A Mindful Understanding of Strong Emotions (Garcia, 2021), Feelings Ninja (Nhin, 2021), Great Big Breath (Long, 2023), and A Little Spot of Anger (Alber, 2019). You work with Liam using puppets, figures, and role-playing to act out the self-regulation techniques described in these books.
Self-Esteem
Self-esteem involves feelings of self-acceptance and self-respect (Orth & Robins, 2014). Because of a variety of adverse experiences, play therapy clients often lack these core feelings (Ray et al., 2021). Many children who come to play therapy lack a sense of competence, which negatively affects the development of positive self-esteem. They frequently feel as though they are not capable people. One of the jobs of a play therapist is to provide opportunities for children to prove to themselves that they have the potential to be successful. Play is an excellent avenue for helping children practice doing things that they can do well. They can also explore their own thoughts, feelings, and behaviors and project themselves into a number of different experiences, both real and imaginary. Because play therapists offer unconditional acceptance of clients, they have the freedom to experiment with who they are and who they want to be.
The following scenario illustrates how the play therapist can help a child to think for herself, make decisions for herself, and discover herself:
