Play therapy can be a confusing concept for parents. The decision to engage their children in therapy is often not an easy one to make; at times needing a firm recommendation from school to help parents reach the conclusion therapy is indeed needed. When parents are told the therapist will be conducting play therapy with their children, the response is often one of dismay. Many parents want a therapist to “fix” their children and are initially unwilling to “pay for someone to simply play with” their children. Play therapy is much more than “simple play.”
Several techniques are used in the treatment of young children. Most young children do not respond to traditional psychotherapy in which talking and reflecting is the focus. Most child therapists use some type of play therapy, often incorporating music therapy and/or art therapy as well. For certain behavioral issues, behavioral modification techniques are used in addition to other approaches. Generally, when behavioral techniques are used, the parents are involved in the therapy in the form of family therapy.
Two main approaches to play therapy are used: directed play or non-directed play. The actual play or game is determined by the issues being addressed and the experience and theoretical background of the therapist. Directed play is play in which the therapist instructs the child what and how to play; the course of the interaction is directed by the therapist. Non-direct play is play in which the child is free to choose the course of play with no direction from the therapist. Some therapists use a combination of the two; allowing the child to choose the play, but directing aspects of the play within the context of the game.
In a therapy session a therapist experienced in working with children will have various toys available for the client. Often the therapist who uses directive play will have the toys out of sight and bring out only the toys being used for that particular session. The therapist using non-directive or a combination of directive and non-directive often has toys visible on a shelf or in a toy box so the child can freely choose.
Early History of Play Therapy
Ana Freud and Melanie Klein were two of the first therapists to use play therapy in their work with children. Initially Ana Freud used play therapy to lure children into therapy. As their relationship developed, she was then able to shift the focus to more verbal interactions. Melanie Klein, on the other hand, used therapy as a substitute for verbal interaction. Klein considered play the natural expression of feelings and thoughts for children. She believed children’s verbal skills were not always sufficient to express their thoughts and feelings. Both therapists analyzed the play, but Freud believed this type of therapy was appropriate for neurotic children and Klein believed any child could benefit from play analysis.
In the late 30s different play therapy techniques began to emerge. One technique was called structured therapy and was based on psychoanalytic theories for a more goal oriented approach. Therapies in this category had the following commonalities:
- A psychoanalytic framework;
- at least a partial belief in the cathartic value of play; and
- the active role of the therapist in determining the course and the focus of the therapy.
During this time another category of play therapy was beginning to surface. The techniques used for “relationship therapies” were based on the importance of birth trauma in development. By the late 1940’s Virginia Axline introduced the basic rules of play therapy which were based on the client-centered approach to therapy introduced by Carl Rogers. Axline’s rules are the guideline for many non-directive approach techniques used today. These rules are:
- The therapist must develop a warm, friendly relationship with the child. Good rapport should be established as quickly as possible between the child and therapist.
- The therapist accepts the child “as is.”
- The therapist establishes a relationship in which the child feels free to express feelings completely.
- The therapist must the feelings the child is expressing and reflect those feelings back to the child in a way that enables the child to gain insight into the behavior.
- The responsibility to make choices and changes is entirely the child’s. The therapist must respect the child’s ability to do so if given the opportunity.
- The therapist does not attempt to direct the child’s conversation or actions in any way.
- The pace of the therapy is directed entirely by the child.
The therapist only sets limits necessary to anchor the therapy to reality and make the child aware of his or her responsibility in the therapeutic relationship.
The Psychoanalytic Approach to Play Therapy
In understanding what play therapy is used for in psychoanalytic child therapy, it is important to understand what it is not. It is not used for abreaction, recreation, or education for the child. It is used as a means to establish contact, observation, data collection, and promotion of interpretive communication. The therapist sets the parameters or rules for the play.
When the psychoanalytic therapist interprets the play, she uses several forms of statements determined by the situation and the progress of the therapy at the time. Comments may be:
- attention statements which brings awareness to the child of the factual context of his actions and/or words;
- reductive statements which attempt to demonstrate unnoticed patterns of behavior by reducing contrasting events to a common form;
- situational statements which help the child to become aware of situations causing specific affects or behaviors;
- transference statements which attempt to show the child his conflicts are reflected in the relationship with the therapist; and
- etiological statements which attempt to link current behaviors and early development for the child.
Various mateCredit: U.S. Navy photo by Photographer's Mate 3rd Class David J. Hewittrials used in analytical play therapy include paper, markers, crayons, Play-doh or modeling clay, blocks of various sizes for building, flexible family dolls with some doll furniture, hand puppet, a doll that can be fed a bottle and can be dressed and undressed, a few cars and trucks and some plastic dinosaurs and other animals. For latency-aged children a checker board and/or a chess set are good additions.
An example of a session based on the psychoanalytic approach follows.
George, a six-year old, is playing with plastic dinosaurs and several other smaller plastic animals. The little animals take the big dinosaurs and throw them about the room. The therapist attempts to connect the behavior with an affect and comments “Those little animals are sure angry with the big dinosaurs.” George responds, “Well, that’s because the big dinosaurs keep bossing the little animals around and they don’t like it.”
The therapist will follow up with additional comments as deemed appropriate according to the progression of the therapy.
The Non-directive Approach to Play Therapy
The non-directive approach to play therapy is often referred to as client-centered. In this approach, the therapist leaves the responsibility and direction of therapy to the child. According to Axline, client-centered play therapy gives children the opportunity to experience growth under favorable conditions. It allows children to realize their own power for change and achieving individualization. The methods are based on the assumptions individuals have it within themselves to solve their problems and individuals will strive for growth which makes mature behavior more satisfying than immature behavior.
While psychoanalytic play therapy requires the therapist be a professional with training and a background in psychology, client-centered play therapy is at times conducted by non-professionals who have been trained in the technique by professionals. However, non-professionals are usually supervised by a professional therapist. These non-professionals include teachers, caregivers and even parents.
Child psychologist, Dr. Haim Ginott, outlined what toys were effective in client-centered therapy. He contended many toys have behavior propelling qualities on their own and thus recommended toys which tend to elicit acting out behaviors and avoid those which evoke diffuse hyperactivity. He recommended toys permit reality testing, allow the expression of needs symbolically, and encourage insight and catharsis.
Therapist Louise F. Guerney suggested further guidelines. She recommends selecting toyCredit: U.S. Navy photo by Mass Communication Specialist 2nd Class Jon Husmans that can be used in a variety of ways, toys that encourage the feelings most difficult to deal with in “real life,” and toys that can be used by one or two people. According to Guerney controversial toys include guns, paints (especially finger paints) and books.
In client-centered play therapy the therapist uses a variety of verbal tools. Empathic responses are one tool the therapist uses. This is a reflection of the feelings of the child. A skilled therapist is able to not only reflect the obvious feelings, but is also able to reflect the underlying feelings of the child’s actions and thoughts. The therapist also empathically comments on the actions and thoughts (not just the feelings) of the child during session. In addition, the therapist uses some structuring even though it is client-centered therapy. Structuring deals with setting parameters of the environment, such as length of session; giving the child information so he knows what to expect.
An example of a session based on a client-centered approach follows.
George, a six-year old, is playing with plastic dinosaurs and several other smaller plastic animals. The little animals take the big dinosaurs and throw them about the room. The therapist comments “you’re angry and throwing the big dinosaurs around.” George responds, “They boss the little ones too much and I don’t like it.”
It should be noted that some therapists chose to not engage in play with the child while others believe it is part of the process and willingly engage in the child’s play during session.
Music Therapy and Art Therapy
Many child therapists incorporate music therapy and art therapy into their sessions with children. Music can be especially helpful in building rapport with adolescents. Therapists use lyrics to the songs to help adolescents who may not be able to express themselves adequately. It can open up and enable the client to freely express feelings usually hard to acknowledge.
Art therapy is often used with children and adolescents. Many therapists have cCredit: U.S. Navy photo by Mass Communication Specialist 2nd Class Barry R. Hirayamalients draw three pictures: a house, a person, and a tree. Art therapy is more than that. Many children and adolescents find drawing helps them express feelings they find hard to verbalize. Skilled therapists can interpret the drawings to help their clients gain insight as well as express their feelings.
Child therapists use many techniques to engage children and help them through difficulties. Play therapy is a great technique and has many facets that skilled therapists use. Studies have concluded that either approach—directive or non-directive can be helpful to children.
Schaefer, Charles E. & O’Connor, Kevin J. (Eds.). Handbook of Play Therapy. New York: John Wiley & Sons Inc., 1983
The copyright of the article "Play Therapy Techniques Used in Therapy with Children” is owned by Cheryl Weldon and permission to republish in print or online must be granted by the author in writing.