Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to their developmental and mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.
Play therapy is extensively acknowledged by specialists as an effective intervention in complementing children's personal and inter-personal development. Play and play therapy are generally employed with children aged six months through late adolescence and young adulthood. They provide contained ways to express experiences and feelings through an imaginative self-expressive process in the context of a trusted relationship with a care giver or therapist. As children's and young people's experiences and knowledge are typically communicated through play, it is an essential vehicle for personality and social development.
In recent years, play therapists in the Western Hemisphere, as a body of health professionals, are usually members or affiliates of professional training institutions and tend to be subject to codes of ethical practice.
Play as therapy
Jean Piaget emphasised play as an essential expression of children's feelings, especially because they do not know how to communicate their feelings with words. Play helps a child develop a sense of true self and a mastery over their innate abilities, resulting in a sense of worth and aptitude. Play contributes to the advancement of creative thinking, and provides a way for children to release strong emotions. During play, children are driven to meet the essential need of exploring and affecting their environment, and may play out challenging life experiences by re-engineering them, thereby discharging emotional states, with the potential of integrating every experience back into stability and gaining a greater sense of mastery.
Overview
Play therapy is a form of psychotherapy which uses play as the main mode of communication, especially with children and people whose speech capacity may be compromised, to determine and overcome psychosocial challenges. It is aimed at helping patients towards better growth and development, social integration, decreased aggression, emotional modulation, social skill development, empathy, and trauma resolution. Play therapy also assists with sensorimotor development and coping skills.
Play therapy is an effective technique for therapy, regardless of age, gender, or nature of the problem. When children do not know how to communicate their problems, they act out, which may look like misbehaviour in school, with friends or at home. Play therapy seeks to provide a way children can cope with difficult emotions and helps them find healthier solutions and coping mechanisms.
Diagnostic tool
Play therapy can also be used as a tool for diagnosis. A play therapist observes a client playing with toys (play-houses, soft toys, dolls, etc.) to determine the cause of the disturbed behaviour. The objects and patterns of play, as well as the willingness to interact with the therapist, can be used to understand the underlying rationale for behaviour both inside and outside of therapy sessions. Caution, however, should be taken when using play therapy for assessment and/or diagnostic purposes.
According to the psychodynamic view, people (especially children) will engage in play behaviour to work through their interior anxieties. According to this viewpoint, play therapy can be used as a self-regulating mechanism, as long as children are allowed time for free or unstructured play. However, some forms of therapy depart from non-directiveness in fantasy play, and introduce varying amounts of direction, during the therapy session.
An example of a more directive approach to play therapy, for example, can entail the use of a type of desensitisation or relearning therapy, to change troubling behaviours, either systematically or through a less structured approach. The hope is that through the language of symbolic play, such desensitisation may take place, as a natural part of the therapeutic experience, and lead to positive treatment outcomes.
Origins
Children's play has been recorded in artefacts at least since antiquity. In eighteenth-century Europe, Rousseau wrote in his book Emile about the importance of observing play as a way to learn about and understand children.Rousseau, Jean-Jacques. Emile, or On Education. Trans. Allan Bloom. New York: Basic Books, 1979.
From education to therapeutics
During the 19th century, European educationalists began to address play as an integral part of childhood education. They include Friedrich Fröbel,Fröbel, Friedrich (1900) The Student's Froebel: adapted from "Die Erziehung der Menschheit" of F. Froebel, by William H. Herford. 2 vols. London: Isbister, 1900–01. pt. 1. Theory of education – pt. 2. Practice of education (Substantially a translation of Froebel's work, with editorial comments and annotations) Rudolf Steiner,Steiner, R.The Education of the Child, (1907) Maria Montessori, L. S. Vygotsky, Margaret Lowenfeld, and Hans Zulliger.Heilende Kräfte im kindlichen Spiel. First edition 1952; 8th edition: Klotz Verlag (publisher), Eschborn 2007, (in German).
Hermine Hug-Hellmuth formalised play as therapy by providing children with toys to express themselves and observed play to analyse them. In 1919, Melanie Klein began to use play as a means of analysing children under the age of six. She believed that a child's play was essentially the same as the free association technique used with adults, and that as such, it provides access to the child's unconscious. Anna Freud (1946, 1965) used play as a means to facilitate an attachment to the therapist and supposedly gain access to the child's psyche.Freud, Anna. The Writings of Anna Freud: 8 Volumes. New York: Indiana University of Pennsylvania Vol. 1. Introduction to Psychoanalysis: Lectures for Child Analysts and Teachers (1922–1935) Vol. 2. Ego and the Mechanisms of Defense (1936); (Revised edition: 1966 (US), 1968 (UK)) Vol. 3. Infants Without Families Reports on the Hampstead Nurseries Vol. 4. Indications for Child Analysis and Other Papers (1945–1956) Vol. 5. Research at the Hampstead Child-Therapy Clinic and Other Papers (1956–1965) Vol. 6. Normality and Pathology in Childhood: Assessments of Development (1965) Vol. 7. Problems of Psychoanalytic Training, Diagnosis, and the Technique of Therapy (1966–1970) Vol. 8. Psychoanalytic Psychology of Normal Development
Arguably the first documented case describing a proto-therapeutic use of play was Sigmund Freud's 1909 work with "Little Hans", a five-year-old child suffering from a horse phobia. Freud saw him once briefly and recommended his father take note of Hans' play to provide observations which might assist the child. The case of "Little Hans" was the first case where a child's difficulty was adduced to emotional factors.
Models
Play therapy can be divided into two basic types: non-directive and directive. Non-directive play therapy is a non-intrusive method in which children are encouraged to play in the expectation that this will alleviate their problems (as perceived by their care-givers and other adults). It is often classified as a psychodynamic therapy. In contrast, directive play therapy includes more structure and guidance from the therapist as children work through their emotional and behavioural difficulties through play. It often contains a behavioural component and the process includes more prompting by the therapist. Both types of play therapy have received at least some empirical support. On average, play therapy treatment groups, when compared to control groups, improve by .8 standard deviations.
Jessie Taft (1933), (Otto Rank's American translator),Taft, Jessie. The dynamics of therapy in a controlled relationship. New York: Macmillan, 1933. and Frederick H. Allen (1934) developed an approach they entitled relationship therapy. In their method, the primary emphasis is placed on the emotional relationship between the therapist and the child, as well as the child's freedom and strength to choose.
Virginia Axline, a child therapist active in the 1950s, applied Carl Rogers' work to children. Rogers had explored the work of the therapist relationship and developed non-directive therapy, later called client-centred therapy. Axline summarised her concept of play therapy in her article, 'Entering the child's world via play experiences', where she described play as a therapeutic experience that allows the child to express themselves in their own way and time. That type of freedom allows adults and children to develop a secure relationship.(Progressive Education, 27, p. 68). Axline also wrote Dibs in Search of Self, which describes a series of play therapy sessions over a period of a year.
Non-directive
Non-directive play therapy may encompass child psychotherapy and unstructured play therapy. It is guided by the notion that if given the chance to speak and play freely in appropriate therapeutic conditions, troubled children and young people will be helped towards resolving their difficulties. Non-directive play therapy is generally regarded as mainly non-intrusive. The hallmark of non-directive play therapy is that it has minimal constraints apart from the frame and thus can be used at any age. These approaches to therapy may originate from child specialists Margaret Lowenfeld, Anna Freud, Donald Winnicott, Michael Fordham, Dora Kalff, or even from adult therapist Carl Rogers' non-directive psychotherapy and his characterisation of "the optimal therapeutic conditions". Virginia Axline adapted Carl Rogers's theories to child therapy in 1946 and is widely considered the founder of this therapy.Kendrick, P., Wilson, K., & Ryan, V. (1992) Play Therapy: A Nondirective Approach for Children and Adolescents. North Yorkshire, UK: Elsevier Science Limited. Different techniques have since been established that fall under the realm of non-directive play therapy, including traditional sandplay therapy, play therapy using provided toys and Winnicott's squiggle and spatula games. Each of these forms is covered briefly below.
Using toys in non-directive play therapy with children is a method used by child psychotherapists and play therapists. These approaches are derived from the way toys were used in Anna Freud's theoretical orientation. The idea behind this method is that children will be better able to express their feelings toward themselves and their environment through play with toys than through verbalisation of their feelings. Through this experience children may be able to achieve catharsis, gain more stability and enjoyment in their emotions, and test their own reality. Popular toys used during therapy are animals, dolls, hand puppets, soft toys, crayons, and cars. Therapists have deemed such objects as more likely to open imaginative play or creative associations, both of which are important in expression.
Sandplay