Play Therapy: What is it?
February 5th-11th, 2023 is International Play Therapy Week and we are here to celebrate play therapy in all of its developmentally appropriate glory! As an LGPC working towards her registered play therapy credential, I am passionate about the therapeutic powers of play and providing accessible care for all of my patients. As a clinician, the theoretical underpinnings of play therapy deeply resonate with me and I’d love to share with you a brief introduction to this amazing approach!
What is play therapy and why should we pursue it?
Play therapy is an evidence based practice that has decades (over 70 years!) worth of research demonstrating its efficacy for children who need support with their self-confidence, interpersonal relationships, aggressive behaviors, impulse control, emotional regulation, logical reasoning, decision making, academic functioning, self-concept, anxiety, and depression. While play therapy writ large has an effect size of .80 (for those of you trying to remember your stats classes–this is considered a “large effect size”), non-directive play therapy has an effect size of .92! All this to say, while play therapy can, at times, feel really far removed from caregivers’ concrete concerns (e.g. “My kid is having daily meltdowns, hits their sibling, and can’t tolerate not getting their way and you’re spending your time with them playing games???”), the data supports that this indirect approach is both developmentally appropriate and effective.
At its core, therapy is about helping us process, or make sense of, life. When we’ve made sense of something, we can either approach it differently in the future or have a less intense reaction to a trigger when we encounter it. When adults go to therapy, they sit down and talk. When kids go to (play) therapy, they play–which is actually the same thing, done in a developmentally appropriate way. Play therapy legend Garry Landreth captured this when he said: “Toys are their words and play is their language”.
Although many of the children I work with have been talking for years by the time we meet, a therapeutic approach that does not require verbal processing is still essential to make it maximally accessible and productive. The brain is a muscle and the regions that are oldest (i.e. matured first) are strongest; they are the ones we rely on when our brains get tired. From infancy until (on average) age 3, children predominantly flex the region of the brain muscle responsible for processing pictures (i.e visual stimuli) and emotions. The region of their brain that makes sense of the world through pictures and feelings has a three year advantage over the region of the brain responsible for verbal communication–it is the region our brains default to when we’re making sense of new information and/or are feeling overwhelmed. Since therapy is designed to help kids process uncomfortable and challenging parts of their lives, their brain IS going to get tired and have an easier time communicating in the modality with which they have the most practice.
Play–be it pretend play (e.g. storytelling, dress up, make believe), expressive play (e.g. artistic, musical, movement based play), sensory/regulation-based play (e.g. fidgets, kinetic sand, catch, dance), mastery play (winning/losing, competition games), or any other type of play kids bring to the playroom–relies on engaging with visuals (e.g. a doll, a ball, a crayon) and feelings (e.g. excitement at finding this toy, anger that the crayon broke, disappointment that the pretend dinosaur didn’t get invited to the birthday party). Play allows the child to process life with a little bit of distance. Rather than didactically reviewing with a child their difficulty with emotional regulation and impulse control (which will contribute to a sense of shame, since that conversation does not address underlying reasons why the child is having difficulty with said executive functions), they stretch their frustration tolerance week after week as they build a clay house and the walls keep caving in (or the Chutes and Ladders board sends them 20 spaces back or the other player got the CandyLand “Princess Lolly” card that they really, really wanted).
But my child is a (pre) teen!
If you’re reading this and despairing that your child is “too old” to play these elementary games, fear not! While the most robust body of research shows that play therapy is an efficacious approach for children aged 3 to 12 years old, it is becoming increasingly common for teens and adults to benefit from play therapy interventions as well. When I work with adolescents, I titrate it up. “Play” isn’t always a doll house or action figures; it can be seeing themes through the media they consume or characters they align with–pop culture is fair game!
Another consideration is that chronological age (i.e., your child is 13 years old) does not always match developmental age (i.e., your child’s impulse control matches the developmental norms of a 9 year old). When this is the case, their brains can continue to benefit from the play-based tenets (e.g., returning responsibility to the child, engaging in topics the child enjoys, making reflective statements), even as the content may shift. Additionally, some adolescents find significant value (and relief) in being able to engage in “regressive” play–for example, middle schoolers playing board games that Hasbro designed for preschoolers. When we see the forest and the trees, we recognize that the adolescent a) is using this time to emotionally exhale from the stresses associated with transitioning from childhood to adulthood (which is quite valuable and will support widening their window of tolerance) and b) is still practicing the same building block skills (e.g. tolerating non-preferred outcomes, seeing alternative perspectives, offering empathy) associated with the original presenting concerns.
Okay, but why not just play at home?
You should play at home, too! Because we’re often regulated when we play, each play experience has the potential to help your child’s brains shift so that “regulated” becomes the default mode. There are, however, some significant differences between play and play therapy, namely the presence of the therapist. The therapist is trained to respond therapeutically:
How I respond (the words, but also my tone of voice, rate of speech, facial expression, body language, etc.), when I respond (knowing when to stay silent is important, too), and where I’m positioned in the room all are done intentionally to offer your child co-regulation and unconditional positive regard, which makes therapy a safe place to explore hard stuff.
I look for themes and I notice shifts (in the materials they select, how they play with the items, how they respond to pressure or non-preferred outcomes) which gives us great data to discuss in parent check-ins. I can let you know what I’ve noticed so you can have an idea of which skills to be on the lookout for as they begin to generalize to life outside of the playroom.
I create a safe space for kids to try out different responses and approaches. Outside of therapy, our impulse is often to try and stop challenging behavior. I am uniquely positioned (in a way that’s not always feasible outside of the playroom) to be able to see the value in challenging behaviors and be a safe outlet for them. Think of the kiddo who is wrestling with themes of power and fair play–my letting them cheat at cards week after week helps them come to the conclusion on their own that winning feels hollow when it’s not earned, difficult as it is to reign in the impulse to bend the rules to get the winning card. This is a really valuable lesson for them, strongly internalized by their lived experience, and not easily available within the context of family game night. Or take, for example, the child who keeps changing the rules of our game and yells at me for not keeping up; I get to model not knowing and I get to show them that I mean it when I say they get to bring their full selves–even when that’s unpleasant for me–and I will still greet them with a genuine smile next week. In time, my consistent approach yields trust; given that the relationship between patient and therapist is the single most curative factor of therapy, this is super significant.
Whether your child does or does not invite me into their play (both are okay!), I’m interspersing their play with comments to increase their awareness of everything from their sense of agency to their use of growth mindset (“You changed your mind; you didn’t like how that turned out, so you tried it a different way”, “Woah, you went from not knowing how to do it, to trying different ways, and now you’ve figured it out!”)
I’m giving language (helping bridge their “picture/feelings” region with their “logical reasoning/language” region) to their play; I’m simultaneously reducing their cognitive load (which allows them to tolerate more frustration and persevere and/or problem solve when the play doesn’t go the way they wanted or expected it to) and giving them lots of repetitions of language paired with their experience (which will help them internalize the language and work towards being able to do it themselves).
I’m intrigued; tell me more!
Janelle McCarthy, LGPC
Licesed Graduate Professional Counselor