Wellness Methods & Modalities

This article appeared in Issue No. 4 of Reunion, Joyful Heart’s magazine. To read more of this issue online, click here. To get on the mailing list to receive future issues, we welcome you to sign up here.

What does it mean to play? If you are an adult, you might think of playing a game, an instrument or perhaps a role. For most people, play is something we do consciously and within a context. Do you remember, though, what play was like when you were a kid and how easy it was?  

For children, playing is as natural as breathing—it’s a part of who they are and how they communicate. Play is fun and joyful. It provides a way to learn, and it can also promote healing.

As the noted psychologist Jean Piaget said, “Play is a child’s work.” Children learn, process and communicate through playing.

For children who have experienced trauma—from abuse, family problems or social issues—play therapy can be an effective and developmentally-responsive way to cope and recover well-being.

What is Play Therapy?

Play therapy is a form of psychotherapy used mainly with children to facilitate communication and expression of thoughts and feelings through the use of toys and other creative activities. A trained clinician with experience working with children and families can provide this mode of therapy. Through the use of play, a clinician can make observations about the dynamics within the family system. In addition, the manner of play and the toys chosen can provide insight about the child’s behavior both in and out of the session. Play therapy can also help children build trust and a sense of safety in which they can thrive. The participation of parents and caregivers is often encouraged as their involvement helps strengthen the bond between the child and the caregiver.

In the third issue of Reunion, Joyful Heart explored creative expression and how it can help us connect with our inner healing voice that knows how to find our joy and heal. Through creativity, we can communicate “thoughts and feelings that are too big or too difficult to put into words.” Creative expression is a wonderful modality for all ages, but it might not work for children who are nonverbal, disinterested, or lack motor skills. Something more basic and inherent to their being kids can open the door for them: play.

Play is another form of natural expression. It is spontaneous, inventive and joyful. Importantly, it gives children the opportunity to take what is abstract or unmanageable and transform it into real, relatable experiences. Play therapy is used to describe a compilation of techniques that incorporates play in order to provide therapeutic benefits to children. It provides the space and materials for kids to safely deal with feelings, thoughts and experiences, and it is used to help children ages 3-12 years address problems such as trauma, repetitive rituals, regressive behavior  and more.

Trauma can be defined as “an experience that is emotionally painful, distressful or shocking, often resulting in lasting mental and physical effects.” Examples include living through a natural disaster such as Hurricane Irene, witnessing an accident and surviving physical or sexual assault. As we know, trauma can also be caused by more than one incident, and it is also the emotional responses or symptoms to these experiences that threaten a person’s safety, security and control. Trauma is often intimately experienced and can cause physiological and psychological changes that may lead to feeling scared, distressed, upset, anxious and isolated. Unfortunately, children are not immune: statistics show that at least four out of ten American children will experience trauma before they reach adulthood.

Trauma can negatively impact children throughout their lives, from immediate reactions to their mental, physical and emotional development. It is vitally important for children to receive appropriate support so they, too, can find their inner healing voice and so that traumatic symptoms do not become embedded and permanent. Play therapy can support that goal.

Play therapy takes place in a safe environment with a trained therapist. Sessions can be tailored for individuals or a group of children, and selected materials (e.g., dolls, blocks, sand trays, art supplies, puppets, masks or games) are provided for play. Play therapy is child-centered, and contemporary models include both directive and nondirective approaches during which therapists may initiate play-based interventions, provide reflective observations or teach a parent/guardian play therapy techniques that will facilitate bonding with the child. Regardless of the approach, the goal is for children to have the freedom, time and space to make sense of their feelings and work through conflicts.

The Importance of Play

Think about a time when you really had FUN. You could’ve been out with friends, sharing a meal with loved ones, spending time alone listening to your favorite music or something entirely different. Whatever the scenario, what made the experience fun? Often, we have fun when we feel happy and alive, we smile and laugh, and our hearts brim with joy. As adults, we readily relate to having fun… which is exactly what playing is!

The Strong® is an educational institution in Rochester, New York, that is dedicated to all things related to play and even includes the National Museum of Play. Its website highlights the importance of play in happiness, healing and identity: “Play is basic to all of us… When we play, we affirm our values and connect with others… When we look closely at play over time, we find ourselves.”

Indeed, many well-known philosophers and educators throughout history highlighted the value of play. The great philosopher, Plato (~428-347 BCE), shared that ,“You can discover more about a person in an hour of play than in a year of conversation.” Several centuries later, Fred Rogers (aka, Mr. Rogers) said, “Play is often talked about as if it were a relief from serious learning. But for children play is serious learning. Play is really the work of childhood.”

Play gives children a way to better understand themselves and the world in which they live: it provides them with a natural expression through which their internal light shines brighter. Taking it a step further, Peter Gray, a Boston College developmental psychologist, posits the role of play in the evolution of humans and our cooperative society in an American Journal of Play (Spring 2009) essay. He theorizes that the play of our ancestors’ children promoted an adult culture that included an “egalitarian attitude, intense sharing and relative peacefulness for which hunter-gatherers are justly famous and upon which they depended for survival.” Through play therapy, individuals are able to reconnect with sharing and interacting in a non-competitive environment that promotes cooperation and free expression reminiscent of earlier forms of play at its purest level. When humans play, they are better able to decrease aggressive tendencies and become more cooperative and connected beings. The kind of play Gray describes is “free play” that is nondirective, not organized, mixed-age and non-competitive. It is also different from playing video games, watching TV and playing organized sports—all forms of play that are goal-directed or may lack full engagement with others. Within this context, we can see the importance of play for a healthy society in which people are concerned for and connected with each other. We can also see why play therapy is a therapeutic outgrowth of this natural expression.

Why Play Therapy?

We know that playing is fun and brings laughter and light. Play therapy also has proven therapeutic benefits. Dr. Richard Gaskill, noted expert in play therapy at the Sumner Mental Health Center in Wichita, Kansas, explains the importance of play:

Play is a universal activity of children as well as a healthy, productive activity for adults. Studies on play have shown that all primates and most mammals play. Even birds play… Play enlightens us, invigorates us and informs us, often drawing us closer to each other.

The first documented use of play therapy was in the early 1900s, and its efficacy has been well-researched. In August 2011, Play Therapy United Kingdom, also known as the UK Society for Play and Creative Arts Therapies, Limited, published a study entitled “An Effective Way of Promoting Children’s Wellbeing and Alleviating Emotional, Behavioral and Mental Health Problems—The Latest Research,” which found:

• Play therapy resulted in improvements for 83% of children with severe problems and 74% of children with slight to moderate problems
• Play therapy is effective for 80% of children at six years of age and for 71% of children at 12 years

A meta-analysis of 93 outcome studies also examined the efficacy of play therapy, and the results were published in Professional Psychology: Research and Practice (2005, Vol. 36, No. 4). This review found that play therapy is an effective psychological intervention for children: kids who receive play therapy function better than those who do not, and play therapy was found to work equally well for girls and boys, across age, in various settings and for different issues. This review also found that play therapy is more effective with a greater number (up to 35) of sessions, if parents/guardians are fully involved and trained using a well-developed protocol, and when utilizing a humanistic-nondirective play therapy approach that is centered on the child’s uniqueness, potential and growth.

Application of Play and Play Therapy

A trained clinician will often use diverse tools to facilitate play within a therapeutic session. The materials used depend on the topic or area the clinician would like to explore with the child. For example, if he or she is having difficulty talking about a traumatic event, the clinician may ask the child to draw their thoughts or feelings. The final art project may shed light about specific events or inner turmoil the child may be experiencing. Other forms of play include sandplay, dollhouse play, role play and puppetry. The most beneficial types of play therapy are those in which children can externalize their feelings in a non-judgmental environment.

While we have focused here on the use of play therapy for children who have experienced abuse and trauma, it can also be applied to other family members, including adults and health/healing practitioners, as well as in organizations. As adults, we learn, reflect and process information through multiple modalities. While talk therapy remains the most common service provided for adults, this leaves out large portions of the population who process information better through artistic, experiential means. The basic premise is to allow oneself to play, reflect and integrate what is learned and experienced.

How do we initiate play? Perhaps the easiest way is to have some play kit items handy. You may not have a therapeutic sand tray available, but you can put on some upbeat music for singing and dancing and bring out a few colorful pens to doodle and draw. Play is what you make of it, and it can take many forms: being silly, playing a game or with something tangible, unfolding your own myth (please see p. 36) or merely giving yourself space to breathe and enjoy the present moment. It is also easy: give yourself permission to play and enjoy bringing fun into your daily life.

While play therapy is a service provided by a trained clinician, there are many ways each of us can increase play in our lives and the lives of our children in order to connect, relax and release stress. There may be more value in these experiences then we ever imagined.

When was the last time you doodled on a page as a way to soothe yourself and maintain your focus? Consider the joy you experience when listening to a well-told story. Perhaps there is inherent value in being free to engage in an activity that does not require a directed outcome. Think about how we may tap on the table to create rhythm and how that may connect with the flow of thoughts in our mind. Our very beings are interactive and playful when given the space and safety to express these sides of ourselves. Einstein said, “I often think in terms of music.” Maybe he was onto something!

More Information about Play Therapy

The National Child Traumatic Stress Network provides resources for parents and professionals on childhood trauma and how to access mental health services. Please visit: www.nctsn.org for more information.

Play Therapy International (PTI) promotes play therapy around the world and its website contains a wealth of information about this treatment modality. Learn more about PTI and play therapy at www.playtherapy.org or (559) 294-2128.

The Association for Play Therapy (APT) is a national professional association that “promotes the value of play, play therapy, and credentialed play therapists” through public awareness, educational and training programs and promotion of effective play therapy services.

“Play Therapy Works!” is a short APT video that introduces play therapy and how it works. You can find it at the APT website under “About APT” at www.a4pt.org.

You can also go to YouTube.com and search for “Play Therapy Works!” 

To find a play therapy practitioner, visit APT’s website at www.a4pt.org and click on “Search Directories” and “Find Play Therapists.”