What is Play Therapy?
[Parts of this section are adapted from VanFleet, 1998, A Parent's Guide to Filial Therapy.  Printed in VandeCreek, Knapp, & Jackson (Eds.), Innovations in Clinical Practice:  A Source Book (vol. 16).  Sarasota, FL:  Professional Resource Press, PO Box 15560, Sarasota, FL 34277.]

You may have heard about play therapy in several different ways.  Perhaps you simply came upon this website as you were exploring the internet.  Perhaps you heard or read about it.  Perhaps someone has suggested that your child receive play therapy.  So what is it anyway?

Play therapy is a type of mental health, educational, or developmental intervention that is designed to help children grow up as happy and well-adjusted as possible.  It involves the use of play to communicate with children and to help children learn to solve problems and change their negative behaviors.  Sometimes it involves the entire family.

At first, you might wonder why anyone would suggest play as a way to overcome children's problems.  Here's why play therapy is often recommended for children:  Play is the primary way that children...

• learn about the world
• understand how different things work
• express their thoughts and feelings
• develop their physical skills
• develop their mental skills
• develop effective social skills and bonds.

As children grow, their use of language becomes more sophisticated, but throughout childhood, they usually express much more of themselves in their play.  We can understand our children better if we understand their play.  By watching children play we often learn more about their thoughts, feelings, motivations, and struggles than by talking with them!  Play has been called the "language of childhood," so if we re-learn that language, it can help us build even stronger relationships with our children.  Play is not something trivial; on the contrary, it is one of the most critical elements of healthy child development!

Perhaps you've seen some of the nature programs on television that show animal babies playing with each other or with their mothers as they develop their hunting and survival skills.  Scientists generally agree that play fosters healthy development of young and adult animals alike.  A long-term study of animal play in the wild reported in National Geographic (December 1994) suggests that play is a "rehearsal for the challenges and ambiguities of life."  This leads to greater strength, increased physical and mental skills, improved judgment, greater security, and stronger social bonds, characteristics that contribute to success as the animal grows.

The same is true for human children and adults.  Playfulness and humor are closely related to mental health, intellectual development, creativity and problem-solving, and even productivity on the job!  Although we sometimes think of play as trivial, in actuality it is one of the strongest supports for coping, learning, good adjustment, and productive activity!  I have spent some of my work life in manufacturing companies where the work is hard and the physical environment (& sometimes the overall climate) is very unpleasant.  I have always been impressed with the way that people use humor and playfulness to cope with some of the most difficult and oppressive situations.  I've seen the same thing in medical environments where people are coping with serious illness or in traumatic situations where people have lost all their possessions. Humor and play help us get through tough times.

How is play therapeutic?
Play therapy creates a safe atmosphere where children can express themselves, try new things, learn more about how the world works, learn about social rules and restrictions, and work through their problems.  Play therapy gives children an opportunity to explore and open up more than usual.

When we, as adults, encounter a tough problem, we often think about it for a while, look at it from different angles, determine our options, and sometimes talk about it with someone we trust.  When things go wrong for us, we might mentally review what happened and think about how we might handle the situation in the future.  During play therapy, children do these same things using their imaginations.  Play therapy provides the tools (toys and activities) and the atmosphere to help children express themselves, work on their problems, "try on" different solutions, and learn more effective coping methods.

What happens in play therapy?
 Actually there are many different types of play therapy, so what happens in a session can be quite varied.  The common aspects are that the therapist holding the session will know how to systematically use play or playful activities to communicate with the child.  (See the article on this website about how to select a play therapist.)  The specific activities will differ.  Here are some of the things that might happen.

Sometimes therapists take children into a playroom that has a wide range of carefully selected toys.  The toys are chosen because they help children express a variety of feelings and problems.  The therapist allows the child to select the toys and the ways that they want to play with them.  The therapist pays extremely close attention to the child's actions and feelings, sometimes engages in imaginary play with the child, and sets limits if the child's behavior gets "out of line."  In this type of play therapy, called child-centered play therapy, the child's problems or issues usually come out naturally in their play.  For example, a girl whose mom had kidney failure and needed a transplant eventually made a small kidney out of modeling clay and performed an imaginary  "transplant" on a stuffed animal in a play session.  Over the course of several sessions it became clear that the girl was quite worried about her mom, wanted to help her mom get better, and was playing in a way so that she (the child) wouldn't feel so helpless.  Shortly after these sessions, she began to talk more openly with her mom about the upcoming surgery and her fears.  Part of the therapist's training involves knowing how to interpret the meaning of children's play.  This can help the therapist discuss the "root causes" of the problems with the parents and come up with possible strategies that are more likely to work.

Other times in play therapy, the therapist might decide to do a specific type of activity with a child because it will teach the child a skill they need to learn or will help the child understand things better.  For example, if a child has trouble getting along with other children, the therapist might use group play therapy (with the parents' permission) to help the child learn better social skills.  The therapist might have the group play a game together while helping the children learn about sharing, taking turns, winning and losing gracefully, showing interest in others, keeping focused on a task, and so on.  Using the game holds the children's interest more than something more serious would and actually helps them practice and develop these different social skills more readily.

Other types of play therapy involve the entire family.  This involvement can take different forms.  Other articles within these Parents’ Pages include information on types of family play therapy.

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Strengthening parent-child relationships through play: 
Filial Therapy
[Parts of this section are adapted from VanFleet, 1998, A Parent's Guide to Filial Therapy.  Printed in VandeCreek, Knapp, & Jackson (Eds.), Innovations in Clinical Practice:  A Source Book (vol. 16).  Sarasota, FL:  Professional Resource Press, PO Box 15560, Sarasota, FL 34277.]

More and more, people are realizing the power of play and humor in promoting positive relationships and mental health.  The family that makes time to play together is likely to be stronger and happier!  There is a family intervention that is designed to strengthen families through the use of play.  It is called filial therapy, and it can be used by families who have few or no real problems but who wish to strengthen their relationships, or it can be used by therapists working with families who are experiencing difficulties.  In filial therapy the parents are true partners with the therapist in bringing about positive changes in their family's life.

In many types of play therapy, the therapist holds play sessions directly with the child and meets with the parents separately to discuss other issues.  In filial therapy, under the therapist's guidance, the parents learn to conduct a special type of play session with their own children.  The parents are considered true partners in the entire therapeutic process.  There are several advantages to parents being the ones to conduct the play sessions with their own children:

• Parents have an intimate relationship with their children and already know their children better than a therapist would.
• Parents are very capable of learning to conduct these special play sessions.
• Parents are the most important people in their children's lives.  This method of strengthening the family capitalizes on this fact, and children need not develop a whole new relationship with a therapist.
• When parents are involved in play therapy as they are in filial therapy, the changes are usually positive and long-lasting.
• When involved in filial therapy, parents usually learn how to understand their children better through their play.  This understanding can help parents as they make childrearing decisions.

Filial therapy strengthens the parent-child relationship directly, and everyone in the family benefits.
Usually children and parents alike really enjoy their special play sessions together, and using play to help children with their feelings and problems can make the change process easier for everyone.

This approach is more efficient.  As parents learn to do this, they can eventually hold these play sessions at home.  The therapist teaches and guides the parents, but eventually they hold these play sessions independently, ultimately reducing the number of therapy sessions needed.

This type of family-oriented play therapy is relatively short-term, but it does require some commitment and work on the part of the parents.  Most parents report that this effort is well-worth-it in terms of the positive outcomes they've experienced.

Filial therapy has been around quite awhile--since the early 60s, in fact, when Drs. Bernard & Louise Guerney developed it--but it has really been growing in popularity among parents and therapists during recent years.  The primary reason for this is that it works.  There has been a great deal of research and clinical experience with filial therapy done over the past 40 years, and those studies show that it consistently helps reduce children's problem behaviors, helps parents feel less stressed and more confident, and improves the understanding parents have for their children. (The term “filial therapy” comes from the Latin words meaning “son” or “daughter” and essentially refers to the parent-child relationship.)

This educationally-oriented approach to strengthening parent-child relationships truly empowers families.  If you have questions about it, just ask your therapist or e-mail us!

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What makes strong families?

In 1985, Nick Stinnett and John DeFrain published the results of an extensive research project designed to learn more about the characteristics that were associated with strong families (Secrets of Strong Families, NY: Berkley Books). They identified 3000 strong families throughout the United States and conducted extensive interviews with family members.  The families represented a true cross-section of the population on many dimensions.  After careful analysis, they determined there were six primary features that strong families have in common:

Commitment
Family members were committed to their relationships and to helping each member grow as an individual.

Appreciation
Family members frequently told and showed each other that they appreciated each other, and they were able to be specific about the things they expressed

Communication
These families used good communication skills and they communicated frequently with each other.

Fun Time Together
Strong families made time together a priority, and some of that time was spent doing enjoyable, fun things.

Spiritual Wellness
Whether it was involvement in their own respective religious groups or involvement in inspirational activities such as deep appreciation of nature or music, strong families reported that their spirituality helped them keep perspective on the day-to-day stresses.

Coping Ability
When these families encountered tough times, they found a way to pull together and support each other rather than being fragmented by crises.

Many children and families are resilient, but in these complex times, sometimes they need a little assistance in overcoming the obstacles in their lives.  One play therapy approach that is designed to strengthen family relationships directly addresses most of the six characteristics listed above.  Filial therapy, in which therapists train and supervise parents as they conduct special child-centered play sessions with their own children, has been shown in 40 years of research and clinical experience to be highly effective in bringing about long-lasting positive change for children and parents alike.  It can be used individually or in group formats, for prevention or intervention with serious problems.  Families who have participated in filial therapy often continue their special play sessions long after formal therapy ends, reporting that both children and parents truly enjoy them!

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How parents can help children through traumatic events

Too often our world is shaken by traumatic events such as natural disasters (e.g., tornadoes, hurricanes, earthquakes, tsunamis, floods), war, school and community violence, acts of terrorism, accidents, housefires, life-threatening illness, separations, loss of a pet, kidnappings, and so on. Such events can leave all of us feeling helpless, and children may be particularly reactive to events that make them feel unsafe. Children who are directly exposed to such events can become traumatized, and the emotional impact of trauma can last a very long time if it goes unnoticed. Some children are exposed to trauma indirectly through sensationalized or repetitive newscasts or by hearing and seeing others‘ emotional reactions, and there's evidence that children can be traumatized by this indirect contact with trauma as well. It's important that parents have information about trauma, its impact on children, and how to help their children understand and cope with these events.

When something traumatic occurs, it's important to give children an honest but simple explanation of what happened. They are bound to hear about it through television, schoolmates, or overheard adult conversations, so it's best if their parents or primary caregivers play an active role in helping them understand the event. It's also important to reassure children that you, their parents, will do everything you can to keep them safe. Some children blame themselves when bad things happen, so parents need to tell them firmly that it's not their fault.

Caregivers should limit children's exposure to newscasts about traumatic events. Broadcasts are geared toward adults, and children may not have the reasoning abilities or coping mechanisms to deal with repeated views of people crying, buildings on fire, and so on. Although children's programs often portray violence, the emotional tone of the news conveys its "reality" and children and adolescents can become extremely frightened, whether or not they show it. You need not restrict their exposure entirely, but screen carefully what they do see!

Children who are roughly 3 to 12 years of age, given the opportunity, will often play out scenes from a traumatic event. Sometimes older children will, too. For example, following a car accident, parents might see their children playing out car crashes and rescues with their toys. When parents see this, they might worry that it's damaging somehow for the child to play out the traumatic situation. Actually, it's often just the opposite: it can help the child cope better. Just as we adults need to talk with others after experiencing something frightening, sad, or devastating, children need to play through their feelings and reactions to the trauma. It can be very beneficial if parents allow their children to play this way while showing acceptance of the child's feelings. To stop such play can cut off the child's primary means of coping. Of course, children should be distracted to some other activity if they are playing in ways that are actually dangerous to themselves or others, or if the child is becoming obviously upset by the play. If a child constantly plays out the traumatic event and seems unable to think about anything else, then limits should be set on the amount of time spent playing out the traumatic events. (If children’s play appears to be upsetting the child further or if they seem “obsessed” with their trauma play, parents should consider a consult with a mental health professional, as these behaviors might signal that the child is already traumatized. If children’s play appears robotic and the child seems “not there” while playing, a consult is warranted as well.)

It’s important to permit children to talk about their reactions to a traumatic event when they want to. Although such conversations can be difficult, especially if we're experiencing our own reactions to the trauma, they do help all of us in the long run. One of the worst things we can do is say to our children, "Don't play that way." or "Don't talk about it--it's over--let's get on with things." Denial of the child's reactions can lead to larger problems later. While it’s important to let children express themselves, including their feelings of anger, sadness, or helplessness, it’s also important to help them focus on the positive aspects of trauma situations.   In the wake of many disasters, there are many amazing, touching stories of selfless acts, heroic deeds, and the very best of human caring coming from the most horrible of conditions.  Although we see some of the worst of humanity after traumatic events, we also see vastly more of the very best.  It's important for our children to hear about them because it adds to children‘s sense of security, connections to other people, and hope for the future.

The natural tendency of children to play out the things that are happening around them is their way of trying to understand. Because they are PLAYING, it feels safer to them, and this is very important. Too much TALKING about scary events can actually scare children more. Some talking is important to give children some basic information and to answer their questions, but it is through their play that children, especially those under 12, have a real opportunity to understand what is going on. Throughout the world, children in war zones are seen “playing war.” Children play doctor or medical scenes when they or someone in their family has been ill or hospitalized. Aid workers noticed that children directly affected by the Oklahoma City Bombing were playing with small plastic dogs sniffing around in piles of blocks, much as real dogs were used to find survivors in the actual rubble. After September 11, children throughout the world were reported to be playing scenes of planes hitting buildings, firefighters and rescue, buildings crashing down, and even funeral themes. A boy in the U.K. played scenes of police officers arresting “bad guys” after the terrorist bombing of the London Underground. A girl from New Orleans who had been moved to a shelter after Hurricane Katrina involved several other children in play where she was the “Mama Alligator” who was trying to save her babies (the other children) from the “Cane” (hurricane).

Long after a traumatic event has occurred, parents should remain alert to any signs of trauma in their children. When children are traumatized, the effects may occur much later than expected. Sometimes traumatized children look quite "normal" on the surface after the event, and then experience post-traumatic symptoms weeks, months, or even years later. It’s fine for parents to ask their children what they’re thinking and feeling about the event from time to time, and then really listen to what they say. On the other hand, it's best not to "bombard" children with questions about how they're feeling or to hold lengthy discussions with them, as this might actually raise the children's anxiety levels. It's good for parents to share their own feelings of fear, sadness, anger about an event because it helps children see that these reactions are normal and can provide good coping models. (A caution, though: be sure that you share your feelings simply and don't elaborate to a point that could frighten the child further. Always reassure them that you'll keep them safe.)

One of the most beneficial things for children after a traumatic event is for their day-to-day environment to return to "normal" as quickly as possible. Getting back to some sort of daily "routine" can help kids feel safer and keep the traumatic event from becoming the only focus of their lives. This can be challenging following some disasters, but working toward as normal an environment as possible under the circumstances can help. Parents can help children find a balance between playing/talking about the event and doing daily tasks and other types of activities.

When trauma has been caused by humans, as in terrorism, it is important for children and adults alike to remember that we gain strength from our human connections and that most people are good. Broad, angry statements about other ethnic groups can add to children’s sense of insecurity and promote prejudice and uninformed backlash effects. People throughout the world have struggled for a long time with our “differences,” and that struggle continues. Acts of terror are intended to divide us, and we can resist this and help our children feel much safer by teaching them that these bad deeds are the work of individuals (or small groups of individuals) and not of any broad ethnic, racial, religious, or other group.

Many children are quite resilient when dealing with traumatic events, but it's good for parents to know what to look for when their child might be struggling. Here are some signs that your child might be experiencing post-traumatic problems:

• anxious, "edgy", nervous, agitated
• difficulty concentrating
• refuses to go to school; difficulty with schoolwork
• becomes angry quickly
• aggressive, either verbally or physically
• nightmares, or repetitive nightmares
• won't sleep in his/her own bed; sleeps on floor or wants to sleep with parents
• easily startled by noises or situations similar to the traumatic event
• reverts to "younger-age" behaviors like bedwetting, nail biting, thumbsucking
• won't talk about what happened
• talks excessively about what happened
• becomes very dependent--clings to parents or other caretakers; fears separations
• problems with friendships and siblings--seems aloof or argues
• seems "different" than he/she did before; personality seems a bit different

Although these signs might be related to other things, if the signs persist, are intense, are different following the trauma, or if several occur for your child, it could be a sign of a traumatic reaction. If you or your children experience continuing distress that interferes with your day-to-day work, school, and family life, you might consider consulting with a therapist.  The sooner a post-traumatic reaction is determined and treated, the better the outcome is likely to be for the child (or adults, too). A qualified mental health professional can help the child and the parents.

Play therapy can be very effective with traumatized children. The play gives them some "distance" from which to explore and deal with their feelings. Even teens and adults can benefit from treatments which involve play and art or other expressive interventions. Words can fail us when we experience intensely frightening events, and other means of expressing ourselves become necessary. Sometimes family play interventions can be very helpful. If you have questions or concerns about your child, contact a local mental health professional. Make sure that he or she has experience with trauma, and having a background in play therapy can be a big plus.

Information on finding play therapists who specialize in children is listed on another page of these Parents' Pages, and your local and state psychological, social work, mental health counseling, crisis, medical, or school counseling associations or professionals can make referrals to adult therapists.

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Finding a play therapist

I sometimes receive emails from parents looking for a play therapist for their children.  This segment discusses ways to find a play therapist.  Credentials, finding a play therapist in your geographic area, and determining if a play therapist might be a good "match" are discussed separately.

Credentials
Many play therapists are also licensed in another mental health field, such as psychology, social work, counseling, and so on.  Licenses in the United States are determined on a state-by-state basis, although many require passing a national examination.  Internationally, credentialing processes are determined on a country-by-country basis.

Generally speaking, licenses usually permit a  professional to practice independently.  Mental health counselors without licenses usually practice under the direct supervision of a licensed professional or within an agency.  In general, it's desirable to find someone with a license or someone who is regularly supervised by a licensed professional.

There is another credential that play therapists in the United States can achieve called the Registered Play Therapist (RPT).  This credential is provided through the Association for Play Therapy.  It requires the play therapist to have at least a master's degree and license in a mental health field, to complete a substantial amount of play therapy training, to have extensive clinical experience, and to have received play therapy supervision.  Registered Play Therapist-Supervisors (RPT-S) must be licensed, have had supervisory training, and have achieved even more experience in play therapy.  If you'd like to know more details about the requirements for becoming an RPT or RPT-S, visit the website for the Association for Play Therapy, then click on Registration. Other countries may have their own forms of credentialing for play therapists, but this is a relatively new development in the field overall. For example, in the United Kingdom, Qualified Play Therapists have undergone extensive training and supervision specifically in play therapy (for more information on this visit The British Association of Play Therapists).

There are also specialty credentials in play therapy.  Because there are many different types of play therapy, some therapists concentrate their training in one area to become more proficient.  These credentials are called different things.  For example, the Family Enhancement and Play Therapy Center offers a credential called a Certified Filial Therapist.  This is awarded to individuals who have achieved advanced levels of training and experience, and competence in filial (parent-child) therapy (see description in the article in our Parents’ Pages).  If you have questions about one of these specialty credentials, ask the potential therapist to share the requirements for that credential with you.

Some of these play therapy credentials have been developed only within the past decade or so.  If you can't find a play therapist in your area with an RPT or RPT-S, look for one who is working toward becoming an RPT.  There are many fine play therapists who are currently in this category.

Finding a Play Therapist in Your Area
In the United States, the Association for Play Therapy maintains a directory of its members, approved RPTs, and RPT-Ss.  Most states (in the U.S.) have their own branch of APT.  Your local branch would be a good source of information about play therapists in your area.  Visit the Association for Play Therapy site (click on Find a Play Therapist), or call them at 559-294-2128 (in California), ask for the name of the contact person for your local branch, and contact that person.

Determining if a Play Therapist is a "Good Match"
Once you obtain the name of a potential play therapist or two, feel free to call them and ask a few questions.  It's fine to inquire about their credentials, what type(s) of play therapy they do, and what types of problems they typically handle.  Ask them to explain anything you don't fully understand.  A quality therapist won't mind answering these types of questions.

It's important that you feel comfortable with the therapist you choose.  Although details about play sessions are usually kept confidential so children feel free to express themselves fully, your play therapist should keep you informed about general issues and progress, and work with you to handle various parenting questions that arise.  If Filial Therapy, described above, is appropriate for you and your child, you would be an integral part of the sessions.  If you are uncomfortable with your play therapist for any reason, it's best to raise your concerns with your therapist directly before deciding to switch to someone else.  Sometimes simple misunderstandings can easily be resolved with some open communication.

The key is that you trust the competence of your play therapist, that your child likes the therapist, and that you develop a collaborative relationship with your therapist.  Play therapy and filial therapy can be very rewarding and useful experiences for children and parents.  Although I can't guarantee that these ideas will work for you, I hope this helps you find a good play therapist near you!

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