Play Therapy: What Is It and How Does It Work?

The moments when we feel most alive and energized often coincide with times of play (Price, 2022).

“Play by its nature is a creative, spontaneous, and often pleasurable activity” (Meersand & Gilmore, 2017, p. 19). As a therapy, it is a psychoanalytically derived treatment that requires skills, knowledge, and resources from the therapist.

When working with children, play therapy can break down barriers and improve relationship building, creating a safe and motivating environment for a better treatment outcome.

This article defines play therapy, introduces several theories, and explores how it benefits both young and older clients.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises 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

“As an organically emerging capacity, play represents a natural mode of self-expression and an ideal medium for communicating and building relationships with children between ages 3 and 8 or so” (Meersand & Gilmore, 2017, p. 18).

Play and other symbolic functions emerge during the early phases of child development, including narrative language and mentalization. It involves “transforming passive experience into active mastery; modulating intense affects; making meaning of emotionally laden events; trying on others’ perspectives; and sampling roles and identifications” (Meersand & Gilmore, 2017, p. 437).

Early on, psychoanalysts were quick to recognize play as an opportunity to drive wish fulfillment, assimilate reality, and master developmental anxieties (Meersand & Gilmore, 2017).

More recently, research has seen play therapy as a powerful tool in treating children, offering a medium for communication, relationship building, and therapeutic action.

Rather than more formal approaches, such as exploratory skill practice, play engages the intentional projection of the child’s mental representation onto reality while remaining aware that it is a pretense.

When play therapists refer to “pretend play” (including fantasy, imaginative, dramatic, and make-believe), they are typically describing circumstances that (Meersand & Gilmore, 2017):

• Uniquely combine physical action with mental fantasy or role-play
• Have an inherent “behaving as-if” quality
• Engage and immerse children fully despite awareness that it is pretend
• Create an environment that is inherently safe and nonconsequential

Contemporary psychodynamic theories also see play therapy as encompassing the following defining elements (Meersand & Gilmore, 2017):

• Play therapy offers a window into age-relevant anxieties and fantasies and is powerful for communication, assessment, and treatment, especially in younger children.
• Play therapy incorporates information from various fields and recognizes the importance of biological factors, attachment relationships, and cultural influences for the child.

As such, play therapy is recognized as a development-appropriate language for working with children and serves to promote the relationship between therapist and client as a primary healing factor for children experiencing contextual, developmental, and internal difficulties (Crenshaw & Stewart, 2014).

Play also has the potential to help children learn and develop many life-affirming and enhancing skills, including coping. “In play therapy, the play becomes transformative in providing a new perspective on the self and/or the environment, which is at the heart of resilience as a therapeutic power of play” (Crenshaw et al., 2015, p. 33).

What is Theraplay®?

Play can be particularly valuable in helping young trauma survivors (Crenshaw & Stewart, 2014).

While sometimes confused with play therapy, Theraplay® is more adult directed, with activities tailored to the child’s current emotional level rather than their chronological age (Attachment and Trauma Network, 2020). “The focus of treatment is the parent–child relationship itself” (Crenshaw & Stewart, 2014, p. 141).

One of its goals is for the parent to learn to respond to their child’s (sometimes confusing) signals; foster an increased sense of safety, security, and shared meaning; and create stronger connections while attuning to their client’s needs.

Typical treatment duration is 30–40 minutes once a week and can last for between 18 and 20 sessions.

Over the course of the treatment, the parent is encouraged to begin taking control of the play from the therapist and, as a result, develop stronger internal family bonds (Attachment and Trauma Network, 2020).

4 Common Play Therapy Theories

Play therapy continues to evolve and develop with innovative thinkers and inspiring leaders driving theories and models for use with children, adolescents, and adults in therapeutic treatment (Crenshaw & Stewart, 2014).

Four common play therapy theories include:

Child-centered play therapy

Like other play therapies, child-centered play therapy recognizes play as a developmentally appropriate language for treating children.

However, it differs in that its focus is on “the relationship and environment as sources to health and functioning,” with the therapist understanding and accepting the child’s world, their receptivity to treatment, and potential to move “toward self-enhancing ways of being” (Crenshaw & Stewart, 2014, p. 3).

In line with person-centered therapy:

• The client’s perceptual field is seen as their “reality.”
• The client strives toward independence, maturity, and self-enhancement.
• The client behaves in a way that is consistent with their self-concept.
• The client operates as an organized whole.

Ultimately, when a child is given a warm, welcoming environment and a genuine relationship, they can feel comfortable expressing themselves and determine their direction for therapeutic change (Crenshaw & Stewart, 2014).

Cognitive‑Behavioral Play Therapy (CBPT)

CBPT “is a part of cognitive-behavioral approaches aimed to dislodge and deactivate maladaptive social behaviors and phobia credited to dysfunctional thoughts and replace them with better ones” (Obiweluozo et al., 2021, p. 2).

While Cognitive-Behavioral Therapy is predominantly verbal and, therefore, less suitable for younger clients, when combined with play, it is possible to use fantasy and make-believe to engage several affective processes, including expressing emotion, emotional regulation, and cognitive integration (Crenshaw & Stewart, 2014).

CBPT engages the client in the following processes:

• Insightful and flexible problem-solving
• Diverse thinking
• Considering alternative coping strategies
• Increasing experience of positive emotions
• Improving emotional awareness and understanding

Family play therapy

Family play therapy has a place in the long history of treatments designed to support and address the wellbeing of the individual and the family as a whole. Family play therapy aims to bring the power of play to families by inviting them to “imagine and participate in creating an alternative vision of what family can be” (Crenshaw & Stewart, 2014, p. 187).

The treatment has the potential to shift mental models and structures and redefine daily life, working with the family as a whole rather than “fixing” the child. As such, the therapist must:

• Have a genuine and deep interest in working with families
• Enjoy the process of family therapy
• Remain comfortable with ambiguity
• Notice small indicators and their implications for larger relational patterns
• Show respect for all family members
• Have high emotional stamina
• Maintain a playful style and a genuine sense of humor

Psychodynamic play therapy

“The psychodynamic therapist sees the reasons for behavior as more complex than what is revealed by observable behavior” (Crenshaw & Stewart, 2014, p. 66). Play can be a helpful tool for examining how children’s feelings lead them toward specific problematic behavior and arise from deeper underlying problems.

Psychodynamic play assumes that:

• Symptoms have meanings.
• Problems arise from unconscious conflicts and failing to assimilate overwhelming experiences and cope with developmental difficulties.
• Children’s play is symbolic.
• Children’s behavior is characterized by transference-based thoughts (in and outside therapy).

Play helps children move to developmentally higher levels of functioning, having previously been halted by trauma or internal conflict.

What Are the Benefits?

Play therapy is recognized as “an effective intervention for children’s problems, one that is uniquely responsive to children’s developmental needs” (Bratton et al., 2005, p. 385).

Research has uncovered wide-ranging benefits from adopting play therapy techniques in the treatment of children’s unique and varied developmental needs (Bratton et al., 2005; Obiweluozo et al., 2021; Helping children, 2019).

• It offers treatment opportunities for children (typically below the age of 11) who lack a fully developed capacity for abstract thought.
• It provides a concrete and accessible means of communication when verbal skills are lacking.
• It offers materials and opportunities to act out feelings, experiences, and thoughts symbolically or directly that they cannot express through words.
• It supports children in bridging the gap between experiences and understanding.
• It provides opportunities for insight, problem-solving, and skill mastery.
• It works through perceived social, behavioral, and cognitive aspects of emotions.
• It encourages children to develop new and creative solutions to problems.
• It helps children develop empathy and respect for others and what they think.
• It helps children learn new social and relational skills.

Why Play Therapy? How Does It Work?

“Unlike adults who communicate naturally through words, children more naturally express themselves through the concrete world of play and activity” (Bratton et al., 2005, p. 376).

Whether it involves straightforward playing with games and toys, role-play, or synergetic play therapy (where the therapeutic power of play is blended with nervous system regulation), play is viewed as a vehicle that supports natural communication between child and therapist (What is synergetic, 2022).

The child plays out thoughts, feelings, and emotions they might not otherwise be able to express meaningfully through their words (West, 2022; Bratton et al., 2005).

As the child acts out their feelings, directly or symbolically, the therapist can gain insight into their emotional state. And playing together offers a safe environment for the child to express how they feel while interacting with the world and those in it and developing coping, problem-solving, and resilience-related skills (West, 2022).

While typically used with children, play therapy is also effective with adolescents and adults in treating anxiety, depression, trauma, and behavioral disorders (West, 2022; Doyle & Magor-Blatch, 2017; Rozenova et al., 2022).

Types of Play Therapy

While many different play therapy theories exist, most treatment styles can be divided into directive or nondirective interventions (Crenshaw & Stewart, 2014).

Directive

Directive interventions typically involve behavioral, cognitive, and directed activities, such as playing board games or solving puzzles, and are often described as nonhumanistic (Bratton et al., 2005).

Such activities are usually task based, structured, and goal oriented rather than open ended, with the therapist taking charge of regulating the pace and intensity of exposure to painful events and emotions, such as grief (Obiweluozo et al., 2021; Crenshaw et al., 2015).

The degree of directiveness varies and should remain flexible according to the needs of the client and their treatment environment. The therapist may introduce new characters or variations to the play to help the child move forward and become “unstuck” (Crenshaw et al., 2015).

Nondirective

According to some research, humanistic — or child-centered — nondirective play therapy interventions have produced significantly positive treatment effects beyond directive interventions (Bratton et al., 2005).

After all, there are times when the child does not need the precise direction of the therapist.

Children can often accomplish a great deal through their play, particularly when provided with toys that serve as gentle reminders (particularly in relation to trauma) with no clear direction (Crenshaw et al., 2015).

Who Can Benefit From Play Therapy?

Play therapy benefits diverse populations. While primarily used for treating children, it can be helpful for adolescent and adult populations (Crenshaw & Stewart, 2014).

The following includes a sample of four specific groups that research shows can benefit from play therapy.

Play therapy for adults

Despite its prevalence in treating children, play therapy can offer fascinating benefits to adult populations.

A 2017 systematic review of the research studied its application in rehabilitating adults with adult-acquired brain injury. Play therapy can benefit those who have experienced traumatic brain injury and strokes, helping them improve mobility, balance, and independence, and is rated more enjoyable than traditional treatments (Saywell et al., 2017).

Play therapy also proves a successful treatment in adults experiencing extreme trauma.

Studies suggest it is an effective intervention for helping clients “because play addresses areas of social, emotional, and cognitive development compromised from chronic personal exposure in early childhood” (Olson-Morrison & Hudspeth, 2017, p. 172).

Play therapy for kids

Play therapy is highly valued as a treatment for children, particularly when they lack the verbal skills to share their feelings (Crenshaw & Stewart, 2014).

There are also some more unusual applications.

Cognitive Behavioral Play Therapy has been shown to reduce social anxiety among children with stuttering. The authors of a 2021 study suggest that it is valuable for young people with speech deficits experiencing difficulties in their social relationships, such as withdrawal and low self-esteem (Obiweluozo et al., 2021).

Other research has confirmed the value of play therapy for supporting children experiencing bullying, trauma, divorce, and anxiety (Crenshaw & Stewart, 2014).

Play therapy for autism

Play therapy is a highly effective approach for children and adolescents on the autism spectrum. It is beneficial for (Crenshaw & Stewart, 2014):

• Increasing social skills
• Improving emotional control
• Decreasing negative emotions
• Increasing verbal expression
• Improving verbal activity
• Strengthening relational connections
• Increasing coping skills and adaptability

Some characteristics of being on the autism spectrum can cause challenges in play therapy.

Children with autism may struggle to form close bonds due to deficits in joint attention, which can damage the therapeutic bond and ultimately put a successful treatment outcome at risk. In addition, children may have a particular toy or game they prefer and refuse to play with another. As with other therapies and populations, unconditional positive regard remains vital for success (Crenshaw & Stewart, 2014).

Play therapy for ADHD

“Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed neurobehavioral disorders in children” (Crenshaw & Stewart, 2014, p. 415). Where once it was described in terms of overactive and inattentive behavior, it is now characterized by deficits in executive function and motivation (Crenshaw & Stewart, 2014).

Play therapy in children with ADHD typically involves multiple techniques and has proven successful in helping them learn more adaptive coping skills, through doing rather than being told how to behave.

Well into their adolescent years, those with ADHD can find play therapy a helpful tool to express and relate through play.

Authors of a recent case study reported that cognitive play therapy is highly effective at reducing anxiety and aggression in a child with ADHD who has experienced physical abuse (Hassani et al., 2021).

A Take-Home Message

Play creates moments of energy and insight and opportunities to motivate change.

For children in therapy, it offers a mode of communication that does not rely on verbal skills and provides a safe environment to build a solid therapeutic bond that facilitates a path to a positive treatment outcome.

Research has confirmed play therapy as a powerful tool in treating children, adolescents, and young adults and providing an opportunity for growth in communication, relationship-building skills, and therapeutic action.

Play therapy combines play, role-play, fantasy, and “behaving as-if” to create a nonconsequential environment that can be a window to age-relevant anxieties, concerns, emotional states, and trauma.

Ultimately it is a development-appropriate language for working with children and serves as a potential healing factor for clients experiencing contextual, developmental, and internal difficulties.

Incorporating aspects of play into therapy with any age group — but especially children and young adults — can support clients’ development of life-affirming and life-enhancing skills, such as resilience, problem-solving, emotional awareness, and communication.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.

Ed: Update May 2023