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Play Therapy

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Fadwa Tarabolsi

on 26 June 2014

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Transcript of Play Therapy

Play Therapy
Achieving Insight Through Play

Children may express their feelings in a maladaptive way at home or school because of inability to articulate experiences
o Communicate emotional distress through maladaptive behavior

• By reflecting a child’s feelings in play, the therapist gives the child a vocabulary to express feelings
o Therapist makes child feel understood and validated, helps them gain confidence
• Toys provide safe objects for a child to play out internal experiences in a symbolic manner

• Toys provide enough distance from their feelings that they can express them through play

• Therapist enters into metaphor of child’s play to gain additional insight and help them rework scenarios that reflect actual experiences in their life
o Helps to remodel child’s maladaptive behavior into functionally adaptive behavior
o Problem takes form in emotion and language during play
o Therapist restructures meaning of child’s experience leading to insight
o From insight comes skill development and emotional regulation, child learns how to handle future difficulties, defense mechanisms, coping strategies
o Forms alternatives for the child to their previous unhealthy behaviors

(Jones & Landreth, 2002)

Theoretical/Philosophical Background
Limitations in Therapy
• Some clients may not benefit:
o May be hesitant to engage because they believe they are unable to use imagination, are anxious about self-expression, or are resistant to active participation
o Child needs to have achieved the preoperational level of development to engage in symbolic play

• Not appropriate for very small children and those with profound developmental delays

• Some view play therapy as a distraction to child’s actual problem, think it does not directly deal with problems or truly resolve anything

• Child may act something out with toys that is not actually happening around them
o leads therapist to think a problem exists that actually does not

• Requires long-term commitment, several sessions

• Children experiencing something like acute PTSD symptoms or self-harm may benefit more from CBT as a start to therapy

• Therapists practice outside of their scope, many not be sufficiently trained in play therapy

• Young children are not able to consent for treatment, causes therapists to think of parents as the client and not allow children to make choices for course of therapy

(Bratton & Ray, 2000) & (Carroll, 2000)

The Use of Limits
• Aim is to decrease behavioral and emotional difficulties that interfere with a child's normal functioning

• Within this aim is to improve communication and understanding between the child and significant individuals in his or her life

• Less obvious goals include improved verbal expression, improved impulse control, more adaptive ways of coping with anxiety and frustration, and improved ability to trust and relate to others

(Jones & Landreth, 2002)

Different theoretical approaches for play therapy:
1. Child centered play therapy
2. Gestalt play therapy
3. Psychodynamic play therapy
4. Solution Focused play therapy
5. Adlerian play therapy
6. CBT play therapy
7.Jungian play therapy.

Play therapy can takes different settings, such as schools, clinics
individual and group play therapy.
Effectiveness of play therapy in following children and family problems:
Anxiety and depression
Anger and aggression
Relationship problems
Single parenting, step-parenting
High conflict divorce
Adoption/foster care
Family substance abuse
Chronic illness
Association for Play Therapy (n.d). Retrieved April 4, 2014 from www.a4pt.org

Bratton, S., & Ray, D. (2000). What the research shows about play therapy. International Journal of Play Therapy, 9(1), 47-88.

Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment
Outcomes. Professional Psychology: Research and Practice, 36(4), 376.

Carroll, J. (2000). Evaluation of therapeutic play: A challenge for research. Child and Family Social Work, 5, 11-22

Chang, Catherine Y., Kelli Bell Ritter, and Danica G. Hays."Multicultural Trends And Toys In Play Therapy.." International Journal of
Play Therapy 14.2 (2005): 69-85. Print.

Chow, R. (2010, September 1) Cultural Diversity and Play Therapy. Association for Play Therapy. Retrieved from

Family Enhancement and Play Therapy Center. (n.d.). Retrieved April 4, 2014 from

Gil, Eliana, and Athena A. Drewes. Cultural issues in play therapy. New York: Guilford Press, 2005. Print.

Hall, T. M., Kaduson, H. G., & Schaefer, C. E. (2002). Fifteen effective play therapy techniques. American Psychological Association
33(6), pp. 515-522

Jones, E. & Landreth, G. (2002). The efficacy of intensive individual play therapy for chronically ill children. International Journal of
Play Therapy, 11(1), 117-140.

Jones, K. D., Casado, M., & Robinson E.H. (2003). Structured play therapy: A model for choosing topics and activities. International
Journal of Play Therapy 12(1) pp. 31-47

Kool, R. & Lawver, T. (2010). Play therapy: Considerations and applications for the practitioner.
Psychiatry (Edgemont), 7(10), 19–24.

Pehrsson, D. E. & Aguilera, M E. (2007). Play therapy: Overview and implications for counselors. American Counselors Association pp. 1-2

Play Therapy Institute of Colorado, (n.d.). Retrieved April 4, 2014 from

Providing Affordable Continuing Education Opportunities for Play Therapy Credentialing (n.d.). Retrieved April 4, 2014

The Center for Play Therapy. (n.d.). Retrieved April 4, 2014 from

Vaughn, K. M. (2012). Play Therapist's Perspectives on Culturally Sensitive Play Therapy.

Virginia Association for Play Therapy. (n.d.). Retrieved April 4, 2014 from
Theoretical/Philosophical Ideas
• Children enter into dynamic relationship with therapist that enables them to express, explore, and make sense of their difficult and painful experiences

• Idea of being in control of play can help give a child confidence

• Child may feel out of control with the events playing out in their life, sense of control during playtime is important

• Provides a child with an opportunity to “play out” their thoughts, feelings, and problems just as an adult “talks out” their difficulties in therapy

• Play therapists trained to trust that children are capable of directing their own play process rather than therapist imposing their own ideas of what child needs to do in therapy

(Kool & Lawver, 2010)
Alyssa Rickard Fadwa Tarabolsi Kristen Brozek
• Piaget: most children in their first decade of life have neither meaningful expression nor ability to comprehend complex issues, motives, and feelings because they lack the ability of abstract thinking

• Piaget: when a child is in second period of intellectual development, called preoperational stage, child begins symbolic play

• Virginia Axline: meaningful expression in the process of play exists, language is important to regulating emotions

• Play therapy seeks to balance symbolic play and language expression in an age-appropriate manner that is most beneficial to children

• Grounded in various theoretical models including psychoanalytic, client-centered, cognitive-behavioral, Adlerian, and family play therapy

• Underlying these theoretic models is the idea that there are active forces embedded in play that can be utilized to help children overcome developmental challenges

(Kool & Lawver, 2010).
• Children require limits and boundaries in any relationship to feel safe and accepted

• Therapeutic relationship established in play therapy involves trust and acceptance, child is valued, but is not without boundaries

• Child is allowed to be messy and encouraged to explore, doing something in a directed way is not required

• Therapist in no way controls what the child does or how they do it

• Limits are set when needed to help the child learn responsibility and self-control

• Limits are set in a way that validates the child’s feelings and desires, communicates the limits, and gives alternatives to maladaptive behaviors

(Kool & Lawver, 2010)
Limitations in Research
• Better designed studies needed that examine the question of which play therapy technique is most effective, with which clients, under what circumstances?

• There is literature that supports the efficacy of play therapy

o Very little is empirically based, lack of controlled studies
o Large portion of the research that exists uses a narrative case study format, which is rarely accepted as clinical research
o Case studies contain very small samples, making it difficult to generalize the findings to the universal population
o Case studies are frequently conducted by a practitioner or researcher, the information they report is subjective

• they make assumptions about the significance of a child’s play

(Bratton & Ray, 2000) & (Carroll, 2000)

Play therapy shows many positive improving in many aspects in children including;

1. Communication
2. Emotional regulation and
3. Self-actualization
4. Relationship enchantment
5. Moral judgment
6. Stress management
7. Ego booster or self-esteem improvement
8. Perpetration for life
Places for Play Therapy
Family Enhancement and Play Therapy Center
Association For Play Therapy
Play Therapy Institute of Colorado
St Louis Center for Play Therapy Training
Center For Play Therapy

Techniques of Play Therapy
Play therapy is used to help children express their emotions

strategic use of play within therapeutic contexts to promote specific therapeutic outcomes

Techniques for play therapy are adjusted according to the counselors orientation, but main techniques include
Establishing feelings of respect and understanding
Recognition of feelings
Creating a healthy and safe environment for the child
8 Basic Principles
1. Develop a warm and friendly relationship

2.Accept the child as he/she is

3.Establish a feelings of permission in the relationship so that the child feels free to express his or her feelings completely

4.Is alert to recognize the feelings the child is expressing and reflects these feelings back in such a manner that the child gains insight into his/her behavior

5.Maintains a deep respect for the child’s ability to solve his/her problems and gives the child the opportunity to do so

6.Does not attempt to direct the child’s action or conversation in a manner. The child leads the way, the therapist follows

7.Does not hurry the therapy along. It is a gradual process and must be recognized as such by the therapist.

8.Only establishes those limitations necessary to anchor the therapy to the world of reality and the make the child aware of his/her responsibility.
Structured vs. Unstructured
Unstructured therapy is unplanned and free flowing. Allows the child to lead the therapy.

Structured therapy is:

Thoroughly planned out by the therapist
Used to lead therapy in a way that is seen as beneficial to the therapy

A mixed version can be used to provide the best of both worlds
Structured Play
Need to be chosen to address appropriate age level

Sometimes only used after Unstructured Play Therapy

Essential in helping children address important issues without forcing them to face an issue when they are not ready

Opening Stage, Working-through Stage, Termination Stage

Books, Drawings, paintings, collages, arts and crafts, pretend play, puppet play, sand-play…etc.

Intensity is defined by how the activity:
Creates anxiety
Challenges child to disclose
Increases self-awareness
Focus on feelings
Concentrate on the here and now
Beginning Stage

Activities chosen for this stage need to be:

Less intense
Establishing therapeutic alliance
Focus on things the child enjoys
Working-Through Stage
Activities in this Stage will:

Work to help the client understand their feelings

Help to get client to disclose information

Work on fixing problem behavior
Termination Stage
Activities in this stage will:

Address skills that will help in the real world

Provide the child with positive feedback of progress

Prepare for the end of therapy
Using a puppet to create a symbolic client

Party Hats on Monsters

Worry Can

The Mad Game

Color Your Life
Notion 1
play is universal and similar across all cultures and it is natural form of communication in children

Notion 2
Therapist should increase awareness, personalization, and modifications to successfully work with multicultural population
Cultural Diversity & play therapy
Recommendations for applying play therapy with multicultural population:

•Gain awareness of personal biases

•Examine how play is viewed in cultural groups

•Understand the dynamic dimensions of identity

• Don’t be afraid to ask questions

•Adjust the techniques and methods

Cultural Diversity & play therapy
Effectiveness of Play Therapy
Effectiveness of Play Therapy
Effectiveness of Play Therapy
Full transcript