Seminar: Play Therapy

Oh, every child just once in their life should have this chance to spill themselves out all over without a
“Don’t you dare! Don’t you dare! Don’t you dare!” Jerry, age 7

No. I don’t have to break that window. I don’t have to go on acting like I always have. I don’t have to
do everything just because I get the idea to do it. I don’t have to hit people just because I feel like
hittin’ ‘em. I guess it’s because I didn’t know before I could just feel mad and in a while it would go
away—the bein’ mad—and I would be happy again. I can change. I don’t have to stay the same old
way always because I can be different. Because now I can feel my feelings! Harold, age 8

Jerry and Harold were clients of Virginia Axline, a leading figure in the world of play therapy (Axline,
1979, p. 520). These children entered therapy because of behavior problems and an inability to
express their emotions in appropriate ways. Perhaps better than anyone, Jerry and Harold portray the
true experience of play therapy as an opportunity to take control of the emotions that can sometimes
run rampant.

Play has many benefits in life, regardless of age. Play is fun, educational, creative, and stress relieving
and encourages positive social interactions and communication. When playing, children learn to
tolerate frustration, regulate their emotions, and excel at a task that is innate. Children can practice
new skills in a way that makes sense to them, without the structured confines of “the real world” or
the need to use verbal language. There are no mistakes too big to overcome through play, and no
challenges too tricky to attempt. Play gives children a chance to master their worlds as they create,
develop, and maintain their own senses of self. Children use play to communicate when they do not
have the words to share their needs and look to adults to understand their language. As Landreth
(2002a) aptly pointed out, play is a child’s language and toys are the words.

A BRIEF HISTORY OF PLAY THERAPY

Sigmund Freud, through his work with Little Hans, first brought the idea of therapeutic play into the
practice of psychotherapy (Freud, 1909). Freud wrote that play serves three main functions:

promotion of freer self-expression (especially of instincts considered taboo), wish fulfillment, and
mastery of traumatic events.


To master traumatic events through play, a child reenacts the event with a sense of power and
control of the situation. This allows the child to bring repressed memories to consciousness and


relive them while appropriately releasing affect.

Termed abreaction, this process is different from catharsis because abreaction includes the
reliving and mastering of the experience itself rather than the simple release of affect (Freud,


1892, as cited in Erwin, 2001).

Some theorists define catharsis in terms of a hydraulic theory of built-up negative energy that
quickly discharges, more recent authors suggest that negative emotions are often brought out and


released slowly as a child gradually assimilates the experience through repetitive play (Pulaski,
1974)

Melanie Klein continued the idea of using play for child therapy in a psychoanalytic framework. In
particular, she believed that play allowed unconscious material to surface, and the therapist could
then interpret the repressed wishes and conflicts to help the child understand his or her problems and
needs.

Klein agreed with the gradual approach to understanding and assimilating negative experiences as
well as the need to relive and master such experiences through play (Klein, 1955).


Klein worked with younger children than traditional psychoanalysts would see.
One technique that Klein (1955) pioneered involved the use of miniatures. When children play with


miniature toys, they often feel a sense of control over these objects as the representation of real-


world objects or people.

Margaret Lowenfeld took this idea further and developed the World Technique. This technique
involves a sand tray and access to water and miniature objects that represent larger scale items.

Sandplay therapists typically have a wide selection of miniatures available, for example, people,
animals, buildings, landscape items, methods of transportation, archetypes, and supernatural


beings.
In the World Technique, children are given the opportunity to create an imaginary world in which
they can express whatever they desire. Children may develop realistic or fantastic worlds, peaceful


or aggressive worlds, orderly or chaotic worlds (Lowenfeld, 1939). These sand trays are
considered to be expressions of predominantly unconscious material and utilized as such in
therapy.

Another psychoanalyst who used play therapeutically was Anna Freud (1946). She helped to bring
child therapy, particularly child analysis, into a more widely used arena.

She believed play was important because it enabled the therapist to establish a therapeutic
alliance with the child. Similarly, recent research has suggested that a strong therapeutic


relationship is necessary for effective therapy.

In the middle of the 20th century, Virginia Axline brought a more humanistic, person-centered
approach to child and play therapy. In particular, Axline (1947) espoused the belief that the necessary
conditions for therapeutic change were unconditional positive regard, empathic understanding, and
authenticity. She also stated that children are better able to express their thoughts, feelings, and
wishes through play than with words.

APPLICATIONS OF PLAY THERAPY

Play therapy clients can be infants/toddlers (Schaefer, Kelly-Zion, McCormick, & Ohnogi, 2008),
preschoolers (Schaefer, 2010), or elementary and high school students (Gallo-Lopez & Schaefer,
2005). Clients can come from many socioeconomic backgrounds, including those who are homeless
(Baggerly & Jenkins, 2009). Play therapy can also be utilized with adult and elderly clients (Schaefer,
2003). While play therapy with adolescents and adults is continuing to gain popularity, most current
therapeutic interactions are with children ages 3 to 12.

Play therapy is a modality that can be truly flexible in its location. The space can be an outpatient
clinic or office setting, a school (e.g., Ray, Henson, Schottelkorb, Brown, & Muro, 2008), a home, the
scene of a disaster (e.g., Dripchak, 2007), a hospital bed (e.g., Li & Lopez, 2008), or a playground.
Play therapy can take place in a fully stocked playroom or with materials pulled out of a suitcase.

 Play therapy is limited only by the extent of the therapist’s flexibility and creativity.

THE PLAYROOM AND SUGGESTED MATERIALS

Landreth (2002a) has described ideal features of a playroom to be used for individual therapy
sessions. He suggests

1. 150 to 200 square feet of space;

2. easily cleaned materials, furniture, and floors;
3. shelves for toys and cabinets for extra supplies;
4. a sink with running cold water;
5. child- and adult-sized furniture;
6. a desk or table for artwork;
7. a marker or chalk board; and
8. an attached bathroom.

In terms of play materials, the selection of toys and other items to be included certainly varies,
depending on the therapist’s theoretical orientation, personal ideas and values, and budget/space
issues. There is a selection of basic items that are consistently useful. These include the following:
1. animal families,
2. baby doll (with bottle),
3. dishes/plastic silverware,
4. doll families,
5. doll house or box with furniture,
6. puppets, toy soldiers,
7. blocks and other building materials,
8. clay
9. art supplies (markers, crayons, large paper, tape, blunt scissors),
10. small pounding hammer,
11. two telephones or cell phones,
12. doctor’s kit,
13. small soft ball, playing cards,
14. small box with lid, and
15. transportation toys (cars, airplane, ambulance, etc.).
16. masks,
17. mirrors,
18. rope,
19. dinosaurs,
20. plastic tools,
21. cardboard bricks,
22. books,
23. board games,
24. a magic wand,
25. dress-up clothes, and a
26. sand tray and
27. miniatures can also be beneficial.

Another useful feature of a playroom is separation of space. This might be achieved by variations in
floor coverings, such as vinyl flooring near water or sand areas and carpets/area rugs in other spaces.
Most play therapists like to separate materials by function to include a designated area for dollhouse
play, another for sand trays, a third for puppets, and so on.

A general rule is that every item in the playroom should serve a therapeutic purpose. So, one should
carefully select rather than haphazardly collect the play materials. Also, toys or games that are easily
broken or expensive and games that are very complicated should be avoided (Kottman, 2001).

HOW TO BEGIN AND END A SESSION

For the child, initial sessions often include an introduction to the play space and therapeutic process.
Both should be given at the child’s developmental level and with appropriate amounts of information.
Younger children are often happy to hear that the playroom is a space for them to play in many ways,
while older children can understand more about the process. The amount of information given to a
child is also dependent on the theoretical orientation of the therapist. For example, Theraplay
therapists would likely provide very little introduction for the child, while other therapists might
explain the reason the child is being brought for therapy, what is going to happen in session, and
meeting times. Children use the initial session to explore not only the play space but the therapist as
well. Play therapists should generally allow the child to explore at his or her own pace and not give
suggestions about which materials to use. During the first session, therapists should focus on
developing rapport by creating a warm, comforting, safe environment for the child. When ending a
session, play therapists must decide whether a child will help pick up the toys or not. This is a
personal and theoretically oriented decision. Nondirective therapists such as Virginia Axline would not
encourage children to pick up the playroom. Instead, they gave a warning 5 minutes before the end of
session so that the child can mentally prepare to leave. For most children, announcing when 5
minutes remain is sufficient. Some children require more time to put themselves back together
mentally and would benefit from a 10-minute warning followed by a 5-minute warning. This is
something that is often dependent on the child’s age and level of functioning

LIMIT SETTING IN PLAY THERAPY

Although limits on a child’s behavior in the playroom are generally kept to a minimum, they are
needed on occasion for two main reasons:

to ensure the physical safety of the child and the therapist and
to prevent the destruction of the play materials and the playroom.



Typically, play therapists do not state the limits in advance but only as the need arises. Thus, a play
therapist might begin a session by saying to the child:

“You can play with whatever you like in here! If there is anything you can’t do, I’ll let you know.”

In stating a limit, the noted play therapist Haim Ginott (1959) recommended the following four-step
procedure.

First, help the child express his or her feelings or wishes underlying the misbehavior (“You’re
angry at me because you can’t take the toy home”).


Next, clearly and firmly state the limit (I’m not for hitting!”).
Third, try to point out an acceptable alternative to the inappropriate behavior (“You can pound this


clay to get your anger out”).



 Finally, enforce the limit as needed (“We have to end the play now because you still want to hit”).

This procedure avoids the extremes of being too harsh or too soft in teaching children responsible
behavior. Limits are most often set on acts of physical aggression (either to therapist or materials),
unsafe behaviors, and socially unacceptable behaviors (including inappropriate displays of affection;
Landreth, 2002b). Limits should also be set when a child tries to take a toy from the playroom, as well
as when engaging in disruptive behaviors such as continuing to play past the end of session or trying
to leave early (Landreth, 2002b). Limits are often initially uncomfortable for play therapists to apply,
but one can become skilled at it with practice and patience.

STAGES OF PLAY THERAPY

1. RAPPORT BUILDING: The therapist is still gathering information about the child and his or her
experiences, and the child is learning about the play space and process of therapy. Depending on
the therapeutic orientation, these play sessions are typically supportive in nature and allow the
child time to feel safe and comfortable in the play sessions.
2. WORKING THROUGH: This is the lengthiest of the three stages and is where much of the
therapeutic change occurs. In this stage the therapist selects and applies the most appropriate
change agent(s) inherent in play (e.g., abreaction, storytelling, a therapeutic relationship)
a. During the working-through stage, play themes often becoming apparent and offer a
window into the child’s inner world. Play themes are those topics that reappear across play
sessions.
b. They may stem from unmet needs/desires, unresolved confl icts, or diffi culties the child is
trying to master or is struggling to understand. Some examples of common play themes are
aggression, attachment, competition, control, cooperation, traumatic events, death/grief,
fears, fi xing something that is broken/damaged, gender, good versus evil, identity, limit
testing, mastery of developmental tasks, need for approval or nurturance, power, problem
solving, regression, replay of real-life situations, school, sexuality, social rules, transitions,
vulnerability, and win/lose situations. The therapeutic use of these themes will depend on
the theoretical orientation of the therapist.
3. TERMINATION: The therapist and child have used the therapeutic process to ameliorate or
resolve the presenting problem(s). The termination stage is intended to allow the child and family
 to take ownership of the changes that have occurred and to prepare the way to ongoing
improvement

CHARACTERISTICS OF EFFECTIVE PLAY THERAPISTS

A review of the play therapy training literature suggests that there are personal characteristics such as patience, flexibility, and
love of children that all therapists need to work with children. In regard to the characteristics of a “good” play therapist,

Harris and Landreth (2001) outlined eight of the most essential characteristics of child-centered play therapists. This list includes
genuine interest, unconditional acceptance, and sensitivity to the child. Their list also includes the ability to create a sense of
safety, to trust a child to lead the course of therapy in a gradual and natural manner, and to honestly believe that a child is
capable of solving his or her problems while setting the few necessary limits needed to help a child in this process.

EFFECTIVENESS OF PLAY THERAPY

A compilation of previous, well-designed play therapy research is presented in the book Empirically Based Play Interventions for
Children (Reddy, Files-Hall, & Schaefer, 2005). In addition, there are several promising meta-analytic studies on the effectiveness
of play interventions. In a review of 42 published and unpublished studies, including dissertations, LeBlanc and Ritchie (2001)
found the average effect size of play therapy outcomes to be 0.66 using a meta-analytic approach. This is a medium to large
effect size (Cohen, 1977) and indicates statistically significant improvement in the children (LeBlanc & Ritchie). Previous meta-
analytic studies of non-play-based therapeutic interactions with adults and children reported mean effect sizes of 0.68 (Smith &
Glass, 1977) and 0.71 (Casey & Berman, 1985), respectively. In Casey and Berman’s study, when play-based interventions were
examined separate from non-play-based therapies, a mean effect size of 0.65 was found. These results suggest that
interventions utilizing play therapy are as effective as talk-based therapies. Bratton and colleagues (2005) recently performed a
more comprehensive metaanalysis of play therapy interventions. Like LeBlanc and Ritchie (2001), Bratton and her colleagues
analyzed only studies that included play therapy interventions as opposed to previous analyses that included traditional talk-
based psychotherapies. These researchers identifi ed 93 studies of play therapy by using the defi nition of play therapy that was
determined by the Association for Play Therapy. They found a large mean effect size of 0.80 (Bratton et al., 2005). These meta-
analytic investigations also shed light on specifi c treatment and participant characteristics that led to improvements noted in
the children. In particular, Play Therapy 11 these meta-analyses highlighted the importance of including parents in children’s
treatment. When parents were trained to act as cotherapists, higher effect sizes were seen across studies (Bratton et al., 2005;
LeBlanc & Ritchie, 2001). Filial and parentchild interaction therapies often include parents in an effort to improve interactions
between parents and children as well as teach parents skills that can be used after therapy has ended. Also, both studies
suggested that having 30 to 35 sessions of play therapy was the optimal number for identifying positive changes on outcome
measures (Bratton et al., 2005; LeBlanc & Ritchie, 2001).

1. PSYCHOANALYTIC APPROACH TO PLAY THERAPY

 1st account of play therapy was published by psychoanalysts- Heg hellmuth in 1921
 Freud said: “every child at play behaves like a creative writer, in that he creates a world of his own, or, rather, re-
arranges the things of his world in a new way which pleases him” (pp. 141–154”
 Freud noted that play also entails a “revolt against passivity and a preference for the active role” (Freud, 1931, p.
264)

Early child analysts viewed play as a route into the unconscious minds of children. They recognised play as a medium to treat
children who had difficulties that represented neurosis. Since children were unable to make use of the traditional form of
therapy, like lying on the couch and free association, they looked for avenues that allowed the following:

1. A setting that allowed children to relax and loosen the ego’s control over the entry of psychically dangerous, confl
ictual material into consciousness.
2. As in dreams, a medium where this material would be admitted to consciousness in a symbolic, disguised form (in
order to minimize the anxiety that would accompany it if its actual meaning were recognized).
3. A setting that was congruent with children’s developmental level, in which their wishes, fears, and needs would be
expressed naturally.
 4. A setting that would permit the analyst to observe, interpret, and engage children therapeutically

Indeed, Waelder (1932), a member of Freud’s inner circle, stated that play

1. Serves to develop a sense of mastery

2. Allows for wish fulfillment

3. Permits the assimilation of overpowering experiences

4. Transforms experience of the individual from passivity to activity

5. Is a vehicle for temporarily moving away from demands of reality and the superego

6. Is a route for fantasizing about real objects (i.e., internalized representation of important people)

One metaphor for psychoanalysis in general was that of archaeology, which also captured the imagination of scientists and the
lay public alike at the time. Artifacts of earlier and more “primitive” cultures were unearthed only after painstaking efforts at
locating where valuable remains might lie buried. Great care and skill was needed by archaeologists to retrieve and piece
together the fragments once they were found. Just as in archaeology, the deeper one dug, the artifacts that were recovered
were more ancient and “basic”. As in archaeology, the older the fragment, the more basic and fundamental was this material to
the development of the patient’s psyche, and thus would shed light on the nature of the roots of the patient’s conflicts.

Through play, early analysts recognized that its form and content held great symbolic meaning and permitted expression of early
conflicts. Flagbearer- Melanie Klein

Klein (1955) viewed play as the equivalent of free association in analysis with adults. She asserted that play, along with other
elements of children’s behavior, are means of expressing what adults express through words. Child analysis, therefore, required
the interpretation of ‘‘phantasies, feelings, anxieties, and expressions by play’’ (Klein, 1955, p. 124)\

 Free Association through Play: Melanie Klein (1932) viewed a child's spontaneous play as equivalent to adult free
association, allowing access to unconscious processes.

"Play is the child's language and toys are the child's words." (Landreth, 2002, p. 16)

"In play, the child reveals his deepest anxieties, fantasies, and conflicts through symbolic means."
— Melanie Klein, The Psychoanalysis of Children (1932)

 Symbolic Interpretation: Therapists interpret symbolic play to uncover conflicts, drives, and defenses. Interpretations
aim to make the unconscious conscious (Freud, 1920), particularly focusing on unresolved drives (aggression, sexuality,
envy). Technique: Direct interpretations of the symbolic content during or after the play sequence.

"The child’s anxieties and defenses are accessible through their spontaneous play."
— Anna Freud (1927)

 Transference and Countertransference: The therapist becomes a canvas for projected relational dynamics.

"Transference is the central mechanism of change in analytic therapy."

— Freud (1912)

 Working Through via Play: Children re-enact conflicts, fears, and desires repeatedly, allowing resolution over time
(Freud, 1927).Repeated enactment of conflict-laden themes enables gradual mastery and ego integration (Freud,
1914)

 Therapeutic Holding (Winnicott, 1960): The therapist provides a psychological ‘holding environment’ akin to the
maternal function, allowing regression within safety. Technique: Non-intrusive, steady presence that emotionally
contains anxiety and fragmentation.

"It is a joy to be hidden, but a disaster not to be found."

— D.W. Winnicott (1963)
Insight:
Psychoanalytic play therapy hinges on the belief that “children use play to express and work through internal conflicts that they
cannot articulate verbally” (Bromfield, 2003).

2. Psychodynamic Play Therapy (PDPT): Techniques

"The therapeutic relationship itself becomes the agent of change."

— Safran & Muran (2000)

1. Establishing a Secure Attachment Relationship

 Daniel Stern (1985) emphasized the ‘interpersonal world’ of the child as formative. PDPT therapists prioritize creating
a relationally secure space.

 Technique: Empathic attunement, validating affects, ensuring relational safety.

"The relationship is the therapy."

— Donald Winnicott

2. Clarification over Confrontation

 Unlike PPT’s interpretative stance, PDPT employs gentle clarifications of affect and defenses to enhance insight.

 Technique: Reflective listening, paraphrasing the child’s play or emotional expressions.

3. Affect Regulation Through Play

 Techniques encourage naming and tolerating difficult emotions (anger, shame, envy) within the symbolic space.

 Technique: Naming affect explicitly; bridging between internal experience and external expression.

"Affect regulation is the core of development and therapy alike."

— Schore (2003)

4. Exploring Relational Patterns in the Here-and-Now

 Emphasizes current relational dynamics within the therapy dyad. The child's defenses, attachment needs, and
relational strategies emerge in vivo.

 Technique: Use the child-therapist relationship as a microcosm for external dynamics.

5. Building a Coherent Narrative (Fonagy, 1991)

 Enhances the child’s mentalizing capacity — the ability to understand behavior in terms of internal states.

 Technique: Co-construct stories from play to form coherent, continuous self-narratives.

6. Parental Involvement and Parallel Work

 PDPT often integrates parent guidance, psychoeducation, and family systems thinking.

 Technique: Parent sessions to align home responses with therapeutic goals, reduce intergenerational patterns.

"Parents cannot be left outside the consulting room."

— Anna Freud (1965)

Key Comparison: Techniques in Action

Aspect Psychoanalytic Play Therapy Psychodynamic Play Therapy

Core Focus Unconscious conflict, drives, early trauma Relational patterns, affect regulation, attachment repair

Methodology Interpretation through symbolic play Exploration through relationship and narrative

Therapist Role Neutral, observing transference Engaged, responsive, emotionally attuned

Tools Toys, dreams, fantasy, interpretations Empathic dialogue, narrative play, relational repair

Parental Role Limited direct involvement Integrated, collaborative

Recommended Readings & References

1. Freud, A. (1927). The Ego and the Mechanisms of Defense.

2. Klein, M. (1932). The Psychoanalysis of Children.

3. Winnicott, D. W. (1960). The Theory of the Parent-Infant Relationship.

4. Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect Regulation, Mentalization, and the Development of the
Self.

5. Schore, A. N. (2003). Affect Dysregulation and Disorders of the Self.

6. Safran, J., & Muran, C. (2000). Negotiating the Therapeutic Alliance.

7. Stern, D. (1985). The Interpersonal World of the Infant.