How does play therapy help adhd
Furthermore, Children who have been through stressors usually experience shame, and these feelings distract them. Shame is a ‘collapsing’ of the self, making a child feel that he is essentially defective, not worthwhile, no good. He becomes intensely preoccupied with his state and cannot focus on his work. However in the playroom his sense of value and self-acceptance gets built back up as follows. I show the child that every detail of every action and decision he makes in play is valuable, important and meaningful. Yet, this feeling must not be seen to exist by the therapist alone, but to the child himself. Therefore I help the child to himself conclude that his feelings and actions are worthwhile and important. This is accomplished through the amazing play therapy technique called tracking. In this technique of ‘tracking,’ which in some ways is similar to the way a sportscaster describes a game, I describe back to the child every action he takes, every decision he makes and every feeling he expresses. This gives him a perspective on himself, a way to consciously perceive every detail of each action he takes and thereby to judge himself favorably. When a child is given an opportunity to create his own entire experience, and when this experience is validated and accepted by the therapist in the interpersonal venue, self-acceptance and self-value is always the natural result. For example a child was once playing and a toy came apart. I reflected back to her each step of her attempts to fix it. This enabled her to proudly affirm, “I know how to fix things.” Such self-realization is indeed the creation of true self-esteem. I demonstrate so much acceptance of the child’s actions in play that she learns to accept herself and conclude, “I am OK.” In addition the toys are carefully selected to include items that children of her age can easily and successfully manipulate. As successful experiences are validated and reflected back to him by the therapist, he learns to think “I can accomplish things.” All this builds up over time with weekly sessions and challenges and overcomes his feelings and thoughts of shame so that they no longer distract him in the classroom.
In addition fear often distracts children. Children are small and weak compared with adults, and they often may feel vulnerable, powerless and dependent. This generates fear that their needs will not be met. A child with ADHD is already distracted, but this emotion of fear preoccupies his mind and further distracts him. It simmers in the back of his mind and competes with the teacher for his attention. However playing out his fears in pretend scenes in the playroom, while the therapist recognizes, verbalizes and reflects his fears allows him to process them and gain mastery over them. Thus his fears don’t seem so intimidating and they don’t distract him to such a great extent.
For more information on how Play Therapy helps children to release repressed emotions, click here.
What Is Play Therapy?
Play has long been used as an alternative therapy tool to treat symptoms of children with problems such as attention deficit hyperactivity disorder (ADHD or ADD) and mood and anxiety disorders. Child psychiatrists and psychologists have long believed that playtime can be used for children to connect, learn, provide reassurance, calm anxiety, and, perhaps, improve self-esteem. Very young children express themselves through play, when meaningful discourse is not possible. Conversely, play is an indirect way for therapists to recast children’s perceptions, cognitions, and behaviors. As Carol Brady, Ph.D., a child psychologist practicing in Houston, says: “Children communicate metaphorically through play. As a therapeutic tool, it’s like giving a sugary pill instead of a bitter one.”
How Play Therapy Will Help at Home
Playing with a young child is essential for her to feel connected, secure, and attached. At home, playful parenting defuses power struggles and turns tense situations into enjoyable ones.
“Kids with ADHD hear lots of ‘Nos’ and ‘Be carefuls,’ and ‘Don’t do thats,’” says Lawrence J. Cohen, Ph.D., author of Playful Parenting (#CommissionsEarned). “Constantly being told ‘no,’ or having to hold themselves back, puts a strain on kids. This causes their symptoms to get worse.”
Play is a child’s natural way of recovering from daily emotional upheavals. While Cohen agrees that there are teachable moments, playtime is more about relationship building. “No child, with or without ADHD, readily comes up to me and tells me what’s on his mind,” he says. “If we don’t allow children to make this connection through play, they connect in a way that is aggravating and intrusive, and then we get into punishment mode.” Sound familiar?
Children with ADHD pose special challenges for potentially playful parents. Because of executive function challenges, they often find it hard to follow rules and stay with a project from start to finish. What’s more, their style of playing may spin out of control. “Enough already,” the exasperated parent might say. “If you can’t play this game right, we’re not going to play at all.” But it’s important to let them play freely. Otherwise, they get the message, “You’re not normal. I don’t want to play with you.”
[Free Download: The Friendship Guide for Kids with ADHD]
Play Therapy Techniques to Use at Home
Parents should follow their children’s lead. For the distractible child, who needs to expand his ability to stick with things, try engaging in narrative play with dolls or animal figures. “Let your child tell you what he wants to do,” says Cohen. “Let him be enthusiastic and not so worried about whether he is pleasing you.” It’s a balancing act. Your child should lead the way during playtime, and when he gets off track, gently redirect her back to what you were doing.
Writer and mother Megan Tietz found that a little play therapy with her two girls improves their behavior and attitude. She recommends four games:
Start With Play
I start the day by taking my girls outside and playing with them. We run in the grass, we dig in the dirt, we color the sidewalks with chalk, and then we head inside for baths, ready to start the day. I have noticed less whining and clinginess since we started this routine.
Toys That Help
Both of my girls adore puppets, which can redirect their emotions when they’re angry or sad. I transform my hand into a puppet character that can swoop in and intervene whenever it is called upon. A hand that talks in a silly voice gets my children to smile — and to reframe an upsetting situation.
[Could Play Therapy Improve Your Child’s Social Skills?]
Shake It Out
When mean words start flying, I say to the grouchy child, “Oh, no! Listen to those Meanies coming out of you. Let’s just shake them all out right now!” Then I scoop her up in my arms, flip her upside down, and gently shake the crankies away. Neither of my girls can resist it — and the one who wasn’t being grouchy usually wants a good shaking, too!
One day our two-year-old was angry about not being able to go to the zoo. Instead of trying to explain that it was too hot for the animals to be out, and we would all be cranky and disappointed, I said, “I wish we had a zoo in our backyard. Wouldn’t that be so cool? What animals would you like to have in a backyard zoo? Oh, yes, definitely crocodiles. How about giraffes? Yes, and hippos, too! Hey, let’s draw a picture of our backyard zoo!” Creating a fantasy smoothes over feelings of frustration and disappointment that are often the source of unpleasant behaviors.
[The Parents’ Guide to Art Therapy Techniques & Projects]
Play therapy is a type of therapy that, as the name suggests, involves playing.
It has been around for a long time, even in an academic context.
Recently, play therapy has been refined and targeted to a variety of different disorders, from autism spectrum disorder (ASD) to attention-deficit hyperactivity disorder (ADHD). Play therapy has also been used in normal functioning children and adults to great effect.
This article will explore what play therapy is and some of its benefits, as well as how to become a play therapist if it is something that interests you.
Before you read on, we thought you might like to download our 3 Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
What is Play Therapy? A Definition
Play therapy is a type of therapy that has been around in psychiatry since the 1930s and may have been around for hundreds or even thousands of years before then. Academics in the 1930s felt the value of play therapy was
“that the child revealed far more of himself when talking about things he liked to do, his favorite toys, his pets, his friends, etc., than when he was face to face with a psychiatrist who questioned him first about his troubles”
This belief still drives much of play therapy today.
Nowadays, play therapy is defined by the Association for Play Therapy (APT) 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).
They also define it in a simpler way by saying
“child play therapy is a way of being with the child that honors their unique developmental level and looks for ways of helping in the “language” of the child – play”.
Based on these definitions, it is clear that the APT considers the healthy development of a child to be the primary goal of play therapy.
According to the British Association of Play Therapists (BAPT), play therapy lets children sort through complicated feelings and “use play to communicate at their own level and at their own pace, without feeling interrogated or threatened” (British Association of Play Therapists).
This is a key aspect of play therapy since traditional therapy can often feel intimidating for children (and adults as well), which does not necessarily lead to a conducive environment for self-expression. BAPT’s definition also underscores an important aspect of play therapy, which is the idea that the client can feel in control of how much they reveal about themselves.
To sum up, play therapy is a type of therapy where therapists allow clients (who are often but not always children) to play during sessions, rather than simply sitting with clients and asking them questions about their problems.
Play therapy can be nondirective, as in the case of allowing a client to play with sand to relieve stress, or directive, as in the case of having a client tell a story about a family using puppets to learn more about the client’s family dynamics.
Play therapy can also be adapted to the client, as very young children play in different ways than adolescents and adults. The idea of play therapy is to let clients settle into a more comfortable situation where they are more willing to express themselves than they would be in a traditional therapy session.
50+ Play Therapy Techniques, Activities, and Interventions
Just as there are many different ways that children play, so are there many different types of play therapy.
For example, according to Allen & Hoskowitz (2017), there is:
- nondirective play therapy
- puppets/dollhouse/other toys for the purpose of pretend play
- interpret play for emotional content
- directive play therapy
- interpret drawings for emotional content
- drawing/painting for the purpose of emotional expression (Allen & Hoskowitz, 2017).
There is also Parent-Child Interaction Therapy (PCIT), which, as the name suggests, involves the parent (Zlomke et al., 2017). If you want to see the variety of play therapy techniques that are put into practice around the world, though, the book Essential Play Therapy Techniques (Schaeffer & Cangelosi, 2016) is a must-read.
The book details 58 different play therapy techniques. For people who do not have time to read through the book, take a look at the table of contents, grouped by type of play therapy.
Below, you will find examples that have been pulled from various parts of the book (as well as other sources).
Toy and Object Play Techniques
For example, in a group therapy session, a therapist might have a group take turns throwing a ball around, and anytime someone catches the ball they have to say something that makes them happy. (Hudak, 2000)
Plush Doll Play
For example, the therapist might present the client with a few stuffed animals (or ask the client to bring their own) to help comfort the child during a therapy session. (Schaeffer & Cangelosi, 2016)
For example, a client who has just undergone a stressful medical procedure might do a play examination on one of their stuffed animals, so they can feel a sense of control.
Alternatively, the client may re-enact or roleplay hospital procedures in such a way that they have fun “doctoring” the therapist (Froehlich, 1984).
Baby Doll Play
For example, a therapist might use a baby doll to model positive, nurturing behaviors for the client, or might let the client play with the doll to see what the client’s instincts are. If the client starts mistreating the doll, it is possible that the client is being mistreated by their own parents (though of course, it does not necessarily mean that; Ater, 2001).
Baby Bottle Play
This form of play can be valuable for exploring different familial roles through symbolic play, such as the role of the carer.
An example is if the client were to fill up and offer the therapist a bottle as an act of nurturing (Ryan & Wilson, 1995). This act may then facilitate discussion about the client’s own experiences of caring and being cared for.
Toy Telephone Play
For example, the client and the therapist might each have a toy phone, and the therapist can ask therapy-related questions on the phone. The client might be more comfortable indirectly answering questions like this, and if they feel uncomfortable they can just hang up.
This indirect form of communication has been shown, in particular, to help children struggling with elective mutism (Rosenberg & Linblad, 1978).
Magic Wand Play
For example, the therapist might give the client a magic wand and tell them they can make three wishes. At least one of the wishes is likely to relate to a real-life problem the client has.
This play technique is effective for helping clients to safely verbalize their wishes or goals, as well as aspects of their environments (e.g., at school or in their home) that may be troubling them (Kaduson & Schaefer, 2003).
For example, the therapist might simply let the client run around blowing bubbles and popping them for stress relief reasons or to help a child bond with other children in a group session (Schaeffer & Cangelosi, 2016).
For example, the therapist might construct a wall of building blocks and allow the client to throw a ball to knock the blocks down. This can help the client release anger.
A variation of this technique, developed by psychologist Robert Resnick (2002), can support a pair of clients in strengthening their communication and listening skills. Both clients have an identical set of blocks and are concealed from view of each other.
Each then takes turns building a construction out of their blocks, while verbally directing the other person to build an identical construction.
For example, the therapist might ask a group of children in a group session to keep a balloon up in the air for as long as possible, to foster bonding, and to break the ice in a group session (Schaeffer & Cangelosi, 2016).
Tearing Pages Play
For example, the therapist might give the client a phone book, and ask them to tear pages out of the book, crumple them up, and throw them into a trash can. This can help the client understand how to “throw away” angry feelings (Schaeffer & Cangelosi, 2016).
For example, the therapist might let the client play with shaving cream by spreading it around, sculpting it, and even pretend shaving, so the client can creatively express themselves and feel more relaxed and in control (Greenburg, 2003).
Metaphors and Storytelling Techniques
Concrete Play Metaphors
For example, a therapist might present dozens of toys to the client, then ask them to pick out toys that represent family members. This can help the therapist see what the client thinks and feels about their family members (Schaeffer & Cangelosi, 2016).
For example, a therapist might give a client a turtle puppet, and explain that when the turtle is upset about something it stops, goes into its shell, closes its eyes, and takes three deep breaths. The client can then play out this process with the turtle puppet, and this can help the client learn anger-management techniques (Schneider & Robin, 1974).
For example, the client might be presented with an “emotion thermometer” showing a range of emotions from 0 (with a smiling face) to 10 (with a frowning face) and asked to list events that make them feel like they are on different points on the thermometer. This might sound like, “What types of things make you feel like a smiling face? What about a frowning face? What about a medium face?”
It has been shown that children who are taught to monitor and regulate their emotions using this technique are likely to engage in fewer aggressive and disruptive behaviors and display improved behavior in the classroom (Wyman et al., 2010)
Developed by child psychiatrist Richard Gardner (1971), this technique involves the telling of stories by both the client and the therapist. In this, the client (usually a child aged 8-14) is invited to tell a made-up story using fictional characters.
At the end of the story, the child is asked to explain the lesson or moral of the story, and then the therapist re-tells the story using the same characters but offering more adaptive solutions to the conflicts faced by the characters.
To illustrate, imagine a child patient was to tell a story about two children fighting over a toy. If the child’s resolution to the story involved one child using force to take the toy, the therapist’s adaptive version of the story may depict the two children reaching an agreement to take turns and share the toy.
For example, the client and therapist might work together to create a character that represents one of the client’s problems, such as a dragon that represents the client’s fear.
The therapist can then ask questions about the problem without directly addressing the client’s fear, by externalizing the problem to the dragon (Schaeffer & Cangelosi, 2016).
For example, the therapist might find a story or book that involves a problem similar to the client’s problem, and that provides a solution to this problem (Schaeffer & Cangelosi, 2016).
While reading this story with the client, the therapist might ask questions relating the story to the client’s life, such as, “Have you ever felt this way?”.
For example, the therapist and client might role-play a situation the client is anxious about, such as the first day of school, so that the child can work out what they feel anxious about and possibly realize they do not need to be anxious at all (Schaeffer & Cangelosi, 2016).
For example, the therapist and client might pretend that the client is being crowned the new king or queen of a land. The therapist can then ask what the new king or queen wants to do with their power, to figure out what the client likes and dislikes (Marcus, 1966).
For example, the therapist might ask the client to make two collages (masks) out of magazines. One mask (the “outside mask”) is how they think the world sees them, and one mask (the “inside mask”) is how they see themselves. This can reveal a lot about how the client thinks of themselves and the world (Schaeffer & Cangelosi, 2016).
For example, the therapist might ask the client to draw a superhero with superpowers that the client would like to have. The therapist can then help the client figure out how their personal strengths can be as useful as these superpowers (Rubin & Livesay, 2006).
Puppets are frequently used tools in play therapy, which can be employed in a variety of ways (see Drewes & Schaefer, 2018). One popular technique is called the Family Puppet Interview. When facilitating this form of play, the therapist will present the client and the client’s family with dozens of puppets, then ask the client and the client’s family to each choose a puppet to represent them.
The client and the client’s family then tell a story using the puppets, and the therapist interviews each family member about the story then discusses the story with the whole group. This can reveal certain family dynamics that the client is unable or unwilling to directly discuss with the therapist (Irwin & Malloy, 1975).
Communicating through puppets has also been shown to help clients struggling with elective mutism (Rosenberg & Lindblad, 1978).
Creative Arts Techniques
Color Your Life
For example, the therapist and client might work together to figure out which colors represent which feelings (such as blue for sad, red for angry, yellow for happy, etc.).
The therapist can then ask the client to draw a timeline of their life, using the colors to represent feelings. The therapist can also ask the client to draw different aspects of their life, such as school or sports (O’Connor, 1983).
For example, the therapist might give the client a ball of clay and let them do whatever they want with it. Unstructured clay play has been shown to be effective for relieving stress (Kimport & Robbins, 2012), but it can also be used to encourage clients to sculpt things that are important to them or troubling them that they can talk about with the therapist.
Free drawing is a widely used play therapy technique that serves a range of functions (Golomb, 1992). It can help therapists develop a rapport with new clients, encourage clients to express their emotions, and reveal unconscious disturbances that spark discussion.
For example, the therapist might simply give the client paper and some crayons (or any drawing materials) and ask them to draw a picture. The therapist can then ask open-ended questions about the picture once it is complete.
For example, the therapist might ask the client to draw a traumatic experience in the client’s past, such as an earthquake. Research has shown that the act of then crumpling up the paper and throwing it away can invoke a sense of control over the traumatic event and be therapeutic for the client (Pynoos & Eth, 1986).
For example, the therapist might give the client a mandala template and ask the client to color it in. The client can then make their own mandala and color in it if they wish.
This activity can help foster creativity and relaxation (Schaeffer & Cangelosi, 2016).
For example, the therapist might ask the client to draw a picture (nondirected) every session. After the picture is drawn, the therapist and client can talk about it, with the therapist not taking notes so it is clear they are present. These drawings over time might show the client’s state of mind as the therapy process progresses (Schaeffer & Cangelosi, 2016).
For example, the therapist might ask the client to collage a nightmare they have been having on the inside and outside of the box. The client can then play with the box to become less scared of it.
Collages can be a great medium of expression for clients who don’t consider themselves artistic and perhaps shy away from painting or drawing (Schaeffer & Cangelosi, 2016).
Similar to free drawings, the therapist might ask the client to finger paint whatever they want, after which the therapist can ask the client to tell a story about the painting (Schaeffer & Cangelosi, 2016).
For example, the therapist might have a client simply play with a hula hoop, so that they focus and relax, which might put them in a better state of mind for a therapy session. This technique can also help clients to integrate facets of the mind and body (Krueger & Schofield, 1986).
Draw a Family
For example, the therapist might ask the client to draw a picture of their family. Once the picture is drawn, the therapist can ask which drawing is which member of the client’s family and discuss whatever the client wants to discuss about the drawing.
The ways various family members are drawn can be revealing and has particularly been shown to help elucidate clients’ experiences of a blended family environment (Berger, 1995).
Similar to the Draw a Family technique, the therapist might ask the client to use clay to sculpt their family members, including the client themselves. Once each family member has a clay figure, the therapist might ask the client to place them in relationship to each other, which can show the therapist how close or far from each family member the client feels themselves to be.
For example, the therapist might present the client with a number of toy instruments and simply ask the client to make up a song or play along with another song. This can help the client express themselves, build self-esteem, and improve the therapist-client relationship (Moreno, 1985).
Imagery and Fantasy Techniques
For example, a therapist might ask the client about a nightmare they have been having, then explain to the client that nightmares are like movies, and tell the client that they can change the nightmare if they do not like it.
The therapist can then work with the client to figure out a happier ending for a nightmare, in an attempt to retrain the client’s brain to feel more control (Kaduson & Schaefer, 2003).
The World Technique
For example, the therapist might give the client a tray half-filled with sand, and dozens of toys, including people, fantasy figures, and scenery. The therapist then allows the client to build their own world without providing any guidance or judgment. The therapist then asks the client questions about the world, still without providing any guidance.
The idea is that the world the client builds might involve themes the client deals with in real life so that the world can be an opportunity to work through some of these issues (Hutton, 2004).
For example, the therapist might give the client a dollhouse and some dolls representing their family members. The therapist can then ask the client to model four different everyday scenarios in their real house: bedtime, dinnertime, playtime, and clean up time, to figure out more of the client’s family dynamics (Warren et al., 1996).
Adaptive Doll Play
For example, the therapist might give the client a few dolls to represent themselves and their family members and ask them to play out a scenario that is similar to a real problem the client is having. The therapist can then help the client figure out ways the client can respond to these scenarios so that they have more positive outcomes.
Evidencing the efficacy of this play technique, one case study found that adaptive doll play reduced clinging behaviors, crying, and children’s requests to call home while at school (Danger, 2003).
Rosebush Fantasy Technique
In this technique, the therapist asks the client to close their eyes, imagine that they are a rosebush, and describe this rosebush, including where it is, who cares for it, and any roots, thorns, or flowers it might have.
The client can then draw the rosebush and tell its story to the therapist, at which point the therapist can ask which parts of the rosebush and its story the client identifies with. This metaphor of the rosebush can facilitate communication of the client’s needs, feelings, and experiences (Stevens, 1971).
Family Relations Technique
For example, the therapist might put a number of mailboxes in front of the client, one for each family member and one for “Mr. Nobody”.
The therapist then gives the client “mail”, which consists of strips of paper that read things like “loves me”, “hates me”, “protects me”, “hurts me”, and asks the client to put these pieces of mail in each appropriate mailbox (so if the client thinks their dad loves them, they would put a “loves me” paper in their dad’s mailbox).
This can help the therapist further understand family dynamics (Schaeffer & Cangelosi, 2016).
For example, the therapist might give the client a set of Guatemalan worry dolls or help the client make their own. The therapist can then ask the client to assign a worry to each of these dolls, put the dolls in a box, and leave the dolls in the therapist’s office so that the dolls can worry about the client’s issues instead of the client having to worry about them.
In future sessions, the therapist can bring these dolls out one-by-one to discuss these worries and how the client is dealing with them (Schaeffer & Cangelosi, 2016).
Tea Party Play
For example, the therapist might throw a tea party celebration for the client, to commemorate progress the client is making during therapy sessions or achievements the client has reached outside of therapy. This positive reinforcement can help raise the client’s level of self-esteem and strengthen the relationship between the therapist and the client.
Tea parties can also be a mode to explore themes such as nurturance and reciprocity (e.g., ensuring to pour tea for everyone around the table; Ryan & Wilson, 1995).
Game Play Techniques
For example, the therapist and client might play “The Talking, Feeling, and Doing Game”.
A turn of the game might look like this: the client draws a card that says “Make believe that something is happening that is scary. What is happening?” and if the client does what the card says, they get a chip.
During the game, the therapist can see how the client reacts in certain situations and advise them on how to react in these situations (Gardner, 1973).
Find more communication games and activities here.
For example, the therapist and client might play “Simon Says”, where the client has to do what the therapist says (such as jumping on one foot), but only if the therapist started their sentence with “Simon says…”. This can promote paying attention and self-control, as the client has to pay attention to what the therapist is saying and only do what the therapist says in certain situations (Schaeffer & Cangelosi, 2016).
For example, the therapist might simply play a familiar strategy game with the client, such as chess, checkers, or pick up sticks. This can help the client focus and feel happier, as well as foster a bond between the client and therapist. These games can be especially useful during early therapy sessions if the client is uncomfortable with the therapist or the idea of therapy itself.
These games may help a client feel a sense of control and mastery or strengthen impulse control and self-regulation in their efforts to master the game. The chess pieces may also be seen as embodying parental symbols and, therefore, help spark conversation regarding family members (Fried, 1992).
For example, the therapist might play a cooperative game with the client, such as a game like Max the Cat, where players have to help a mouse, bird, and chipmunk get home before Max the cat eats them.
Playing cooperative games like this can help the therapist-client relationship or the client’s relationship with family members who are also participating in therapy. It can also help the client build social skills, especially if they have trouble working together with their peers (Guttentag & Alex, 1997).
For example, the therapist might play a game with the client that is mostly determined by chance, such as the board game Candy Land or the card games War and Go Fish. Like the other types of games mentioned above, these games are familiar and can help the client ease into a therapy session, as well as help the client build a relationship with their therapist.
Since these games are mostly determined by chance, they also offer the client an opportunity to cope with unexpected losses that they could not have avoided and give therapists the opportunity to walk the client through these situations (Schaeffer & Cangelosi, 2016).
For example, the therapist might close their eyes and draw a random squiggle on a piece of paper, then ask the client if the squiggle looks like anything or makes them think of anything. The client can then draw their own squiggle and ask the therapist if they think it looks like anything.
The therapist and client take turns drawing random squiggles for each other to see if they can find anything in the squiggles. This game can help the client feel more comfortable in a therapy session, and can also work as a sort of Rorschach test for the therapist to find out more about how the client thinks.
For example, a therapist might help a client work through their fear of the dark by desensitizing them to darkness.
This might be accomplished by having the client and their parents play fun games at night in a gradually darker room so that by the end the client is still having fun despite being in the dark. This can show the client that there is nothing to be afraid of (Kelley, 1976).
For example, the therapist and client might take turns trying to make each other laugh in any way they can (without touching each other). The client’s parents can also play a tickling game with the client for the sole purpose of making the client laugh.
Laughter causes lower levels of stress and can improve relationships (Puder, 1998), so either of these options are useful since an improved parent-child relationship and an improved client-therapist relationship are both beneficial.
Stress Inoculation Play
For example, the therapist might have the client play out a future stress-causing situation, such as an upcoming class presentation. The client can use toys to work out what might happen during the presentation, and the client might realize that the situation is not as scary as it first seemed.
The therapist can also offer coping strategies for the client based on the client’s fears about the presentation (Schaefer & Drewes, 2013).
For example, the therapist might recreate a stressful event for the client, such as a car accident, using toys in the playroom. The client can then freely play with the toys in a non-directed manner. This reenactment may help the client to gain a sense of control over the situation and let go of lingering feelings of trauma and fear through a process of desensitization.
It may also allow the therapist to strengthen their understanding of personal meanings associated with the trauma as it is acted out in the form of a narrative (Schaefer & Drewes, 2013). According to Schaeffer and Cangelosi (2016), these reenactments often need to happen multiple times over multiple sessions for optimal results.
For example, a therapist might create hiding spaces in the playroom so they can play hide-and-seek with the client. This game is an avenue through which the therapist can explore issues such as separation anxiety, loss, or abandonment (Frankiel, 1993). Of course, it may also simply serve as a fun activity the therapist and client can bond over (Schaeffer & Cangelosi, 2016).
For example, the therapist might ask the client if they want to see some magic, show them a magic trick, and then show the client how to do the magic trick themselves. This is a fun activity that can help the bond between the therapist and client. Showing the client how to do the trick themselves can also give the client a feeling of control and mastery, which can raise their levels of self-esteem.
For example, the therapist might decorate their playroom walls with “feeling faces”, or faces that demonstrate different feelings such as happiness or anger. The therapist can then start off the therapy session by asking the client to point to a face that they identify with at the time, which can give the therapy session some direction.
They can also be helpful for clients to show how they are feeling throughout the session without having to use words (Curry & Frazio-Griffith, 2013).
For example, a therapist might create a “suitcase playroom”, which is simply a suitcase filled with the toys and materials necessary for play therapy. This is helpful for play therapists who do not have dedicated playrooms. The play therapist can then open up the suitcase to start each session and pack it up at the end of each session.
This is not only practical for smaller therapy spaces, but also shows the client that the therapist cares for them since they are going out of their way to bring all these toys for the client (Schaeffer & Cangelosi, 2016).
Play Therapy Rituals
For example, a therapist might start every session with the client in the same way, perhaps by saying hello, asking the client to remove their shoes, and then starting the squiggle game.
This predictability can show the client that play therapy is a safe space for them and can raise their levels of self-esteem and feelings of control. Rituals can also take place at the end of each therapy session so that the client knows that every session will end with a free drawing (Schaeffer & Cangelosi, 2016).
Some of these techniques are designed to help children reduce their aggression, while others are meant to be escapist fantasy games. Other techniques on this list involve representational play, where children can detail their problems to the therapist without doing so explicitly.
Some are simply meant to help children pay better attention to aspects of the world around them. This wide variety of techniques underscores how valuable play therapy can be to all sorts of children since there is a technique for just about every type of play a child might prefer.
Useful and Fun Toys For Child-Centered Play Therapy
Child-Centered Play Therapy (CCPT) is a form of play therapy that facilitates a child’s experience of self-direction, integration, and growth (Bratton, Ray, & Landreth, 2008).
In particular, CCPT provides children an opportunity to express positive and negative emotions using toys and different materials of their choice as an indirect way of exploring specific events, beliefs, and feelings. Through this play, the therapist may gain insight into the child’s underlying needs and perceptions and explore suitable responses, both within the playroom and through adjunct services (Bratton, Ray, Edwards, & Landreth, 2009).
Given the centrality of toys in many CCPT approaches and interventions, it is important to have the right tools for the job.
According to the Center for Play Therapy at the University of North Texas, toys for this type of play therapy should be durable, easy to use, and allow for creative expression of a wide range of feelings. These toys can be categorized as “real-life and nurturing” toys, “acting-out, aggressive, scary toys”, and “creative expression and emotional release toys”. Some of the toys they recommend include:
- Representative toys, like dolls, a bendable doll family, doll bed, clothes and accessories, pacifiers, nursing bottles, and doll furniture, hand puppets.
- Toys for a play kitchen or grocery store, like a fridge, a stove, a pitcher, pots and pans, dishes, plastic food, egg cartons, empty fruit and vegetable cans, rags or old towels, play money and cash register.
- Toys for pretend adventures, like toy soldiers and army equipment, toy guns, rubber knives, fireman’s hats and other hats, masks, trucks, cars, airplanes, tractors, boats, zoo and farm animals.
- Toys for creative, non-directed expression, like play-doh, clay, pipe cleaners, paint, paintbrushes, easels, chalk, and construction paper.
The full list from the Center for Play Therapy at the University of North Texas can be viewed here.
Play Therapy and Games for Adults
While play therapy might sound like it is for children (since we usually associate playing with childhood), it is also extremely useful for adults.
According to Schaeffer (2002):
“play is a wholistic experience in that it invites our total being into the process”.
Schaeffer goes on to say that play can raise our self-esteem, nurture stress release and allow insight into things going on in our lives. These are all qualities that are clearly helpful for adults along with children, yet most people still think of play as something for children.
The idea of play therapy for adults is not to force adults to play, but to offer them the opportunity to work through feelings that they do not have the words for. Some types of play therapy which Schaeffer recommends for use with adults include dramatic role-play and sand play.
Play therapy has also been used successfully in a case study involving elderly adults in nursing homes (Ledyard, 1999). This study found that play therapy led to decreased levels of depression and increased levels of self-esteem, among other benefits.
These benefits, of course, would be desirable for any population, furthering the idea that play therapy could be as useful for adults as it is for children. The idea of play therapy for children is that playing is the “language” of children, but this does not mean that adults would not be able to express difficult ideas while playing as well.
Types of Play Therapy for:
Play therapy seems like a natural fit for children with autism spectrum disorder (ASD), especially those with communication issues.
LEGO® therapy is one specific type of therapy that is often used for ASD, and it has been found to be very effective (Lindsay et al., 2017).
LEGO® therapy involves three people: a supplier, a builder, and an engineer, with each person playing a specific role which encourages communication. The specific benefits of LEGO® therapy include improved:
“social interactions, social initiations, adaptive socialization, play, communication skills, social competence, social confidence, ASD-specific behaviours, belonging, family relationships, coping, making new friends, independence, and inter-personal skills”.
Another play therapy intervention being used with children with ASD is Parent-Child Interaction Therapy (PCIT).
PCIT involves a Child-Directed Interaction (CDI), where “parents are taught and coached to ignore negative attention-seeking behaviors; to provide attention for positive behavior; and to refrain from criticism, commands, and questions” and a Parent-Directed Interaction (PDI), where “parents are coached to give clear, direct, and age-appropriate commands and to consistently reinforce child compliance” (Zlomke et al., 2017).
Play therapy has increasingly been used with children who exhibit symptoms of post-traumatic stress disorder (PTSD). One such case involves two children who were traumatized by the effects of Hurricane Katrina in the Southeastern United States in 2005 (Dugan et al., 2009). One of these children showed fear around water, such as during bath time or when thunderstorms would appear, and also refused to sleep by himself.
In his first play therapy sessions, he exhibited themes of control, safety, and aggression. After a few sessions, he started showing nurturing themes in his play, as well as trauma re-creation where he “drowned” characters in the sandbox. By the eighth session, the child was able to enjoy himself at a water park without being scared of the water, and after a few additional sessions, he was able to sleep by himself again.
The success of this play therapy can partially be attributed to the repetitious nature of the play, where the child was able to desensitize himself to the source of his trauma. The child also indicated a higher level of independence, perhaps due to the fact that he could choose how to work through his issues in play therapy.
This type of repetitious play therapy is especially valuable for young children who might not be able to recover as well in a traditional cognitive-behavioral therapy program.
Child-Centered Play Therapy (CCPT) has been found to be effective in treating anxiety in six- to eight-year-old children (Stulmaker & Ray, 2015). Specifically, 12-16 individual half-hour sessions of CCPT over eight weeks reduced self-reported anxiety symptoms in children more than sessions where children just colored with a counselor.
This is promising, since anxiety is “considered one of the most current and pervasive childhood disorders, with a poor prognosis if left untreated”, and traditional methods of treating anxiety do not always work with children (Stulmaker & Ray, 2015).
Cases of childhood anxiety highlight the importance of play therapy. By providing therapy in a lower-pressure environment where even young children can understand what is going on, play therapy can be an invaluable resource for parents and schools. The Stulmaker & Ray study also claims that play therapy can be a preventative factor in childhood anxiety, on top of being an available intervention for existing anxiety.
Play therapy has been increasingly used in cases of attention deficit hyperactivity disorder (ADHD) since one of the challenges that can come with childhood ADHD is difficulty playing with other children (Wilkes-Gillan et al., 2014).
One such study by Wilkes-Gillan et al. in 2014 focused on children who had already undergone a play therapy program with a licensed therapist. In this study, children underwent a seven-week program that involved parent-led home sessions and three clinical therapist-led play therapy sessions.
The study showed evidence of increased prosocial behavior during playtime, especially in the clinical, therapist-led sessions. Parents also reported that seeing their children in the therapist-led sessions helped them lead the parent-led sessions. This study shows that there is a promising future for parent-led play therapy sessions for children who have ADHD.
The Stulmaker & Ray (2015) study shows the value of play therapy in schools, especially since play therapy had a preventative effect on anxiety and worry levels. Another study showed that 26 sessions of Child-Centered Play Therapy (CCPT) led to increased academic achievement long-term in normal functioning first-grade students (Blanco et al., 2017).
Interestingly, these improvements in academic achievement differed from child-to-child, with some improving more in math and others improving more in reading, for example. This indicates that play therapy has individualized effects on each child, which makes sense since the way a child plays is unique to them.
Since one study focused on preventing anxiety symptoms and the other focused on academic achievement in normal functioning children, this indicates that play therapy can be extremely valuable for schools, since it can be applied to all children.
Play therapy is also valuable for schools since it can easily be implemented, as most schools have school psychologists and all children enjoy playing in some way or another. Most importantly, play therapy is effective with extremely young children in a way that other therapies are not (Stulmaker & Ray, 2015).
35 Certification, Degree, and Online Training Options
The Association for Play Therapy (APT) offers three credential options for prospective play therapists:
- Registered Play Therapist (RPT)
- Registered Play Therapist-Supervisor (RPT-S)
- School Based-Registered Play Therapist (SB-RPT)
To earn an RPT, RPT-S, or SB-RPT credential, one must first have a master’s degree or higher in child development, child and adolescent psychotherapy, or a related field. One must also have either 2,000 (RPT and SB-RPT) or 5,000 (RPT-S) hours of supervised clinical experience, as well as 150 hours of specific play therapy instruction from an APT approved provider.
One must also have either 500 (RPT), 600 (SB-RPT), or 1,000 (RPT-S) hours of supervised (by an RPT-S) play therapy-specific experience. At this point, one can apply for RPT or SB-RPT licensing. To become an RPT-S, one must complete six additional hours of supervisor training, so that they can supervise future prospective RPTs.
Finally, whether one chooses to be an RPT, RPT-S, or SB-RPT, 18 hours of continuing education is required every three years.
More information on APT credentialing for play therapy can be found here.
The APT lists 30 approved places to learn about play therapy for credentialing and these can be found by pressing “continue” on this page. Since the APT is in the United States, so are all these centers. They are, however, spread across the country.
According to the British Association of Play Therapists (BAPT), there are three entry requirements to enter a master’s program in play therapy in British Universities:
- A bachelor’s degree in psychology, education, social work, or a related field
- Professional qualification as a teacher, nurse, social worker, occupational therapist, or a related profession
- At least five years of work experience in a relevant field
The BAPT lists three master’s programs that qualify as BAPT-approved training centers. These are offered at Roehampton University, the University of South Wales, and Queen Margaret University in Scotland. All three of these programs include supervised clinical experience, which is necessary for certification.
There are also online options for play therapy training. For example, Capella University offers a graduate certificate in play therapy which is offered completely online, and the faculty chair of this program is a registered RPT-S. The program requires a master’s degree in counseling or psychology. Capella University is an APT-approved provider of play therapy instruction. More information on this program can be found here.
One last online option for play therapy training is from the Rocky Mountain Play Therapy Institute (RMPTI), which is also an APT-approved play therapy instructor. The institute is also an approved instruction provider for the Canadian Association for Child and Play Therapy (CACPT).
The RMPTI offers training programs for prospective play therapists as well as continuing education for current play therapists. More information on this program can be found here.
Play Therapy Jobs and Qualifications
The BAPT offers a collection of job listings on their website, which can be accessed here. These jobs show the variety of settings play therapy can be valuable in, from jobs helping children who have suffered trauma or sexual abuse, to jobs helping teach other play therapists, to school-based jobs. Most of these jobs involve working with children.
The Bureau of Labor Statistics (BLS) does not track play therapists, but it does track recreational therapists, who do recreational activities with injured and disable people to improve their wellbeing. The two jobs are not quite the same, but they are similar in some ways and indicate a similar recognition of the value of play and recreation.
According to the BLS, “employment of recreational therapists is projected to grow 12 percent from 2014 to 2024, faster than the average for all occupations”, with many of these jobs being in nursing homes and adult day care programs.
This BLS data may indicate a similar increase in the need for play therapists in the future. These two sources show that there are many available jobs for play therapists in the present working with children, but that we may start seeing an increased need in the future for play therapists working with adults.
Regardless, the job outlook for play therapists looks promising, and it is hard to imagine that it will go down in the future as the value of play therapy continues to be studied.
5 Play Therapy Books
Some of us like to find books that can take us on deep dives into a subject. If you are one of these people, here are five books that might interest you. From foundational texts on play therapy to more modern, updated collections, and whether you are a prospective play therapist or simply a curious parent, at least one of these books is for you.
1. Play Therapy: The Groundbreaking Book That Has Become a Vital Tool in the Growth and Development of Children – Virginia M. Axline
This classic book on play therapy has informed play therapists for decades. In it, the author overviews several case studies of play therapy throughout the years, with a wide variety of children and a wide variety of issues they were working through.
This is a great option for anyone who wants to read up on the history of play therapy or someone who wants to start to understand what it is all about. It is fairly dated, however, so it is probably best read in conjunction with another, more recent book on play therapy.
Available on Amazon.
2. Play Therapy: A Comprehensive Guide to Theory and Practice (Creative Arts and Play THerapy – David A. Crenshaw, Anne L. Stewart and Stuart Brown
This book is an invaluable resource for play therapists of all specialties, as it is a collection of play therapy exercises as told by experts practicing in the field.
From play therapy for grief to play therapy for autism spectrum disorder (ASD) and even play therapy for children in military families, this book has targeted exercises for any problem a client might come in for.
This book is a great option for any prospective play therapist or any play therapist who wants to expand their practice to other disorders but is not sure where to start.
Available on Amazon.
3. 70 Play Activities for Better Thinking, Self-Regulation, Learning & Behavior – Lynne Kenney and Rebecca Comizio
This book from experienced school psychologists is a great option for play therapists as well as parents, and even for older children themselves.
The book contains worksheets and activities the reader can use to help themselves think better, pay more attention, and make better choices, meaning a child can work through it themselves or with a parent.
Play therapists can also use it to get ideas for their own practice. This book is the best option for parents who want to try out some of play therapy’s ideas with their own children at home.
Available on Amazon.
4. Child-Centered Play Therapy Workbook: A Self-Directed Guide for Professionals – Jodi L. Mullen and June M. Rickli
This is a workbook of all sorts of activities therapists can use in their play therapy sessions.
Along with introducing these exercises, the authors also discuss the value of play therapy and each particular exercise so therapists understand why they are doing a particular exercise.
The book also includes activities for the reader, which will help prospective therapists put themselves in the place of their clients and better understand their needs. This book is a must-read for any therapist who is planning on conducting play therapy sessions in their practice.
Available on Amazon.
5. A Child’s First Book About Play Therapy – Marc A. Nemiroff, Jane Annunziata and Margaret Scott
While Kenney & Comizio’s book is great for older children and parents, this book is targeted directly to four- to seven-year-old children in therapy for the first time.
It explains the reasons someone might talk to a therapist, how a therapy session works, and how play therapy itself works. This option is perfect for any child who is entering play therapy but is unsure why or is feeling nervous about the process.
Available on Amazon.
You can find a list of the best therapy books here.
Play Therapy: The Art of the Relationship (about the book)
Play Therapy: The Art of the Relationship is a book by Garry L. Landreth which functions as a handbook for any therapist interested in using play therapy with children. The author is a major proponent of play therapy and the founder of the University of North Texas’s Center for Play Therapy.
The book covers Child-Centered Play Therapy and how to introduce it into a practice, up-to-date research on play therapy, as well as legal and ethical issues a therapist must keep in mind when practicing play therapy. Along with tips on working with children, the book also includes tips on working with parents of the children being treated.
This comprehensive volume on play therapy is an excellent option for college courses on play therapy, as well as an excellent option for any therapist who wishes to start using play therapy in their own practice.
Available on Amazon.
Play Therapy Conference
According to the Association for Play Therapy (APT), the Annual Association for Play Therapy International Conference and Exposition is a six-day conference on play therapy attended by about 1,000 therapists and prospective therapists each year.
The conference includes about 60 workshops and about 40 hours of licensed continuing education opportunities. It also serves as a marketplace for play therapists to find new toys, games, and activities to use with their clients.
The conference is an excellent way for play therapists to network and share knowledge with other play therapists, as well as a great way to fulfill continuing education requirements. It is also the best place for vendors to inform play therapists about potential new play therapy tools and games.
To learn more about upcoming conferences, visit the official website or take a look at our dedicated post detailing a range of upcoming positive psychology events.
PDF Resources For Further Exploration
If books are not for you, or if you prefer a bit more information before committing to a book, here are PDFs that might be helpful.
For parents who are unsure how to support their child during play therapy (or parents who are unsure if their child needs play therapy), the Child Guidance Clinic in Singapore has put together this PDF. It is meant to be in brochure form, so the sections are a bit out of order.
That said, there is valuable information for parents here, from how to tell if your child needs play therapy to how to greet your child directly after a play therapy session.
For an off-beat application of play therapy, the Humane Society of Chittenden County has put together this PDF detailing play therapy for your cat! From helping multiple cats get along to help your cat be less stressed, this guide will help you and your cat bond during playtime. While this might seem silly, it might be just what your cat needs.
YouTube Videos About Play Therapy
If you prefer videos to reading, here are some YouTube videos which can tell you more about play therapy. Some are short (under two minutes) and some are long (over 20 minutes), but they are all about play therapy. Pick one and either dive right into a play therapy session or learn more about the practice in a TED Talk.
1. BAPT: Play Therapy In Action
This video, from the British Association of Play Therapists, serves as a quick overview of some scenes that might play out during play therapy sessions. The children in this video are actors, so it is more of an explanatory video than a look into a play therapy session.
This video is an excellent way to see how different children might react to play therapy sessions, as well as a way to see if play therapy might be a good option for someone to try.
2. Play Therapy with Explanation of Techniques
This is an excellent video about play therapy, as it lets the viewer into a play therapy session, stopping along the way to discuss crucial aspects of the therapy session. This is a great video for anyone who is not sure what play therapy should look like or anyone who thinks they understand play therapy but needs a bit more guidance before they feel ready to introduce it into their practice. This video is eight minutes long.
3. Play Therapy Session
This video is another recorded play therapy session, but this one comes in at 22 minutes. The video is not narrated, so it is an opportunity for the viewer to feel like they are sitting in on a complete play therapy session without interruption.
The video is split between a non-directed approach and a directed approach, so the viewer can see what both approaches look like during a play therapy session.
4. Play is the Child’s Language: Play Therapy | Joanne Wicks
This 10-minute TED Talk on play therapy from play therapist Joanne Wicks explains the value of play therapy and the proper ways to conduct a play therapy session. In the video, Wicks explains the ways that a therapist might accidentally sabotage a session, such as by unknowingly directing a session when they want the client to direct the session.
This video is entertaining and informative for play therapists but also serves as a way to teach parents different ways to play with their own children.
5. GroundWork Counseling – Child Therapy | What Is Play Therapy?
This video serves as a very short introduction (coming in under two minutes) to play therapy, some of its techniques, and its value. It is far from comprehensive but can be a great introduction to play therapy for someone who knows absolutely nothing about it.
The video is produced by a counseling center offering their play therapy services, but only the very end is specifically about the center.
A Take-Home Message
Since playing is considered to be the language of children, playing with a child can be a better way to learn about them than sitting down and talking to them about their problems would be. From normal functioning children to children who struggle with anxiety, play therapy is a low-pressure option for children to start increasing their levels of wellbeing.
Children do not get to have all the fun, though, as play therapy is also increasingly being used with adults, even in parallel with more traditional forms of therapy. If you are an adult who feels that play therapy would be a better way to express yourself than talking, or if you have a child who seems most like themselves when they are playing, play therapy might be the perfect option for you.
If you are a prospective play therapist, keep in mind that every child (and adult) likes to play and express themselves in different ways. That said, by being non-judgmental and non-guiding (in nondirected sessions) or clear with your instructions (in directed sessions), it should only be a matter of time before you start to get to know your client in a personal way.
Becoming a certified play therapist is also similar to becoming any type of certified therapist, so achieving your goal of becoming a certified play therapist and helping children and adults figure things out at their own pace is only a matter of dedication and hard work.
We hope you enjoyed reading this article. Don’t forget to download our 3 Positive Psychology Exercises for free.
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