What can Play Therapy offer?
You might be wondering, what is play therapy? Well, let's start with play itself. The act of playing is inherent to children and essential for their development. Play aids children to regulate their emotional responses to disturbances and reduces stress levels. While playing, children can strengthen life skills, leadership, negotiation, and social skills. Playing requires children to make observations, choices, ask and answer questions, broadening their imagination and creativity.
Play therapy is based upon the fact that play is children’s natural medium of expression. Trained therapists use ‘playtime’ as a way to observe and gain insight into children’s problems. They can then assist the child in exploring his/her repressed emotions and tackle unresolved trauma. Play therapy can be directive (therapist determines the choice of activity, issue in treatment, and goal of the session), non-directive (the child determines the choice of activity; less-structured) or a mixture of both.
Some of the different play therapy techniques are (Green & Drewes, 2013; Ray et al., 2013) :
Doll play and action figures
Dance and movement
Painting and drawing
Effectiveness of Play Therapy
A meta-analysis and systematic review conducted on 23 studies examining the effectiveness of child-centred play therapy (CCPT) in elementary school provided promising evidence in support for the use of CCPT in schools (Ray et al., 2014). More specifically, research has established the robustness of play therapy in healing childrens’ attachment trauma of divorced parents (Chen et al., 2021), improving academic achievement (Blanco & Ray, 2011; Perryman et al., 2020) and treating disorders such as ADHD (Barzegary & Zamini, 2011; Ray et al., 2007) and Autism (Josefi & Ryan, 2004; Kenny & Winick, 2000).
Neuroscience of Play Therapy
The lower-level structures of our brain are essential for life support functions, such as homeostasis. These functions tend to get disorganised and disrupted by trauma, producing somatic symptomatology (Gaskill, 2019). Until we can restabilize these regions, our higher-level brain functions (such as our cortex) is usually impeded, portending poor academic performance. Henceforth, treatment of regulatory functions must precede cognitive functioning. Therefore, since the lower-level regions of the brain lack logical and rational thought, movement based therapy and somatosensory activities are recommended as a therapeutic approach (Gaskill, 2019).
In play therapy, children are able to engage their lower-level brain areas whilst playing with sand, making art or dancing. Therapeutic play mediums supply children with repetitive somatic experiences, also known as bottom-up therapy, which is neurologically critical to their treatment process. Neuroscience suggests that trauma heals from bottom-up and it is essential for treatment to engage our body, mind and brain (Van Der Kolk, 2014; Grabbe & Miller-Karas, 2017).
Trauma is often associated with a lack of control, predictability, increased chaos and the absence of positive consistent experiences (Blaustein & Kinniburgh, 2010). Our lower-brain areas require a routine to develop their regulatory capacity. Predictability is essential for making a child feel secure and safe. Therefore, it is of utmost importance that play therapists promote and maintain structure and predictability. This is achieved by keeping the therapy room organised, following a routine in the therapy session, and honouring the child. By doing so, the therapist can build a safe therapeutic alliance and environment with the child. Repetition of rituals informs the client that unity and connection are constant in their therapeutic relationship (Gaskill & Perry, 2017). Moreover, neuroscience supports the use of boundaries, limit setting, esteem building and positive relational experiences within play therapy (Kinniburgh et al., 2005).
Additionally, neuroscience literature has revealed the possibility of play therapy to create new neural pathways, enhance neuroplasticity and the impact of oxytocin on the therapeutic relationship (Stewart et al., 2016). The act of playing is a creative and emotionally engaging experience that increases levels of oxytocin. The hormone oxytocin is also known as the “love hormone”, which increases feelings of trust and emotional well-being, therefore supporting the therapeutic alliance between the therapist and child. During play, mirror neurons are activated, aiding the therapist to read and connect with the child’s emotional state. Cozolino (2010) suggested a biological-behavioural perspective of therapy as an enriched environment where “psychotherapy is a means of creating or restoring coordination among various neural networks” previously impaired or underdeveloped.
Whilst it is evident that play therapy has been found to be an impactful treatment option for children in diverse settings with various difficulties, we must acknowledge that the design of research may not be without limitations. Undeniably, play therapy practice and theory will continue to evolve with new scientific evidence. We hope that future research will provide us with a holistic understanding of somatic versus cognitive treatment options and the child’s perspective of the therapeutic process.
Barzegary, L., & Zamini, S. (2011). The Effect of Play Therapy on Children with ADHD. Procedia - Social And Behavioral Sciences, 30, 2216-2218.
Blanco, P., & Ray, D. (2011). Play therapy in elementary schools: A best practice for improving academic achievement. Journal Of Counseling & Development, 89(2), 235-243. doi: 10.1002/j.1556-6678.2011.tb00083.x
Blaustein, M. E., & Kinniburgh, K. M. (2010). Trauma experience integration. Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency (2nd ed., pp. 55-64). New York, NY: Guilford Press.
Chen, S., Roller, K., & Kottman, T. (2021). Adlerian family play therapy: Healing the attachment trauma of divorce. International Journal of Play Therapy, 30(1), 28-39.
Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain (2nd ed.). New York, NY: Norton.
Gaskill, R. L., & Perry, B. D. (2017). The neurobiological power of play: Using the neurosequential model of therapeutics to guide play in the healing process. In C. A. Malchiodi & D. A. Crenshaw (Eds.), Creative arts and play therapy for attachment problems (pp. 178-196). New York, NY: Guilford Press.
Grabbe, L., & Miller-Karas, E. (2017). The trauma resiliency model: A “bottom-up” intervention for trauma psychotherapy. Journal of The American Psychiatric Nurses Association, 24(1), 76-84.
Green, E., & Drewes, A. (2013). Integrating expressive arts and play therapy. John Hoboken, New Jersey. Wiley & Sons, Inc.
Josefi, O., & Ryan, V. (2004). Non-Directive play therapy for young children with autism: A case study. Clinical Child Psychology and Psychiatry, 9(4), 533-551.
Kenny, M., & Winick, C. (2000). An integrative approach to play therapy with an autistic girl. International Journal of Play Therapy, 9(1), 11-33.
Kinniburgh, K. J., Blaustein, M. E., Spinazzola, J., & van der Kolk, B. A. (2005). Attachment, self-regulation, and competency: A comprehensive intervention framework for children with complex trauma. Psychiatric Annals, 35, 424-430.
Perryman, K., Robinson, S., Bowers, L., & Massengale, B. (2020). Child-centered play therapy and academic achievement: A prevention-based model. International Journal Of Play Therapy, 29(2), 104-117. doi: 10.1037/pla0000117
Ray, D., Armstrong, S., Balkin, R., & Jayne, K. (2014). Child-Centered play therapy in the schools: Review and meta-analysis. Psychology In The Schools, 52(2), 107-123.
Ray, D., Lee, K., Meany-Walen, K., Carlson, S., Carnes-Holt, K., & Ware, J. (2013). Use of toys in child-centered play therapy. International Journal Of Play Therapy, 22(1), 43-57.
Ray, D., Schottelkorb, A., & Tsai, M. (2007). Play therapy with children exhibiting symptoms of attention deficit hyperactivity disorder. International Journal of Play Therapy, 16(2), 95-111.
Stewart, A., Field, T., & Echterling, L. (2016). Neuroscience and the magic of play therapy. International Journal of Play Therapy, 25(1), 4-13.
Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY. Penguin Putnam Inc