Play Therapy: You Don’t
Have To Talk To Be Heard
Developed by
Shanika Fridhandler, M.Sc., Prov. Psych.
with
Lindsay Hope-Ross, M.Sc., R. Psych.
Healthy Minds/Healthy Children Outreach
"Play is the highest expression
of human development in childhood,
for it alone is the free expression
of what is in a child's soul.”
- Friedrich Froebel
Creator of Kindergarten
Outline
¾Why Play?
¾The Power of Play
ƒ Typical Versus Atypical Play
ƒ Play As Communication
ƒ Play As “Self” Developer
ƒ Play As Reparation Facilitator
¾Play Therapy: Entering Another’s
World
ƒ Building Blocks of Play Therapy
1
Outline
ƒ Entering the Play
ƒ Child-Led Play
¾Play Therapy
Approaches
ƒ Non-Directive
ƒ Directive
¾Play Therapy Dimensions Model
¾Play Therapy Tools
¾Play Therapy Process
Outline
¾Special Considerations
ƒ First Session
ƒ Therapeutic LimitSetting
ƒ Aggression
ƒ Sexualized Content
¾References and
Resources
¾Contact Information
Why Play?
¾ Play is universal and is one
of the earliest emerging
forms of human
communication.
¾ Play is children’s language
and toys are the words they
use to express themselves.
¾ Play is enjoyable and
spontaneous.
¾ Play is how children learn
and explore their world.
2
Why Play?
¾ Play is how children come to
understand their life
experiences.
¾ Play is how children express
their feelings, perceptions,
and reactions.
¾ Play is a natural self-healing
process.
To enter into a child’s world,
one must enter the world of
play.
The Power of Play
“Play can miniaturize a part of the complex world
children experience, reduce it to understandable
dimensions, manipulate it, and help them
understand how it works.”
- Jerome Singer
American Psychologist
Typical Versus Atypical Play
¾Typical Child’s Play
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Light-hearted
Free and spontaneous
Enjoyable and fun
Voluntary
Not necessarily goal-directed
Often chat through out
Explore the whole space available
Often use a large variety of toys
Aggressive play clearly expressed as such, and is
contained
3
Typical Versus Atypical Play
¾Atypical Play
ƒ Serious, heavy, or depressing
themes
ƒ Cautious, deliberate actions or
ƒ Chaotic, compulsive, driven, and
intense behaviour
ƒ Repetitive
ƒ Signs of dissociation, freezing,
and/or pivoting
ƒ Often a mismatch between content
and emotion
ƒ May be completely silent or nonstop questions/conversation
ƒ Aggressive play often destructive
and poorly contained
Play as Communication
Why play works as language:
¾ Experiences that occurred before a
child was able to speak are coded in
nonverbal memory.
¾ Due to their cognitive level of
development, children’s feelings,
thoughts, and reactions are often not
accessible verbally.
¾ Traumatic memory is stored differently
than the memory of non-traumatic
experiences, and is often fragmented
and/or compartmentalized, only one
part of which may be stored in verbal
memory.
¾ Some experiences are too distressing to
talk about directly.
Play as Communication
" You can discover more about a person
in an hour of play
than in a year of conversation.”
- Plato
Greek philosopher
427-347 BCE
4
Play as “Self” Developer
Through their play, children:
• learn how the world works, including developing and
practicing life, social, problem-solving, conflict resolution,
and other skills
¾ “try on” roles that they will need for adulthood
¾ make sense of the complex world around them
¾ develop a sense of “self”
Play As Reparation Facilitator
Through play, children are able
to:
¾ gain understanding of life
events,
¾ gain control and mastery over
things that are or were
overwhelming and out of their
control in real life (for
example, natural disasters,
trauma, divorce, and so on)
¾ resolve their situations in
ways that they want (that is,
they can change what
happens or the ending)
¾ feel empowered
Play As Reparation Facilitator
Through play, children are
able to:
¾ “play out” their feelings,
experiences, and problems, just
as adults “talk out” their feelings,
problems, and so on
¾ symbolically revisit distressing or
confusing experiences, feelings,
conflicts, impulses, and
relationships, within a safe,
nurturing environment and,
thereby, be provided a degree of
protection and emotional
distance from directly
acknowledging or confronting
these.
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Play Therapy: Entering Another’s World
“The playing adult steps sideward into
another reality;
the playing child advances forward to
new stages of mastery.”
- Erik H. Erikson
American Psychoanalyst
1902-1994
Building Blocks of Play Therapy
The therapeutic conditions
necessary for growth and
healing (Landreth, 2002).
include:
¾ focus on the child, rather than
on the problem; that is, giving
complete and undivided
attention to the child
¾ genuineness
¾ unconditional acceptance (note:
this means unconditional
acceptance of the child, not
necessarily of all behaviours)
Building Blocks of Play Therapy
¾sensitive understanding
¾safety and
permissiveness in the
relationship
¾patience, thereby allowing
the therapeutic process to
unfold naturally
¾trust in the child’s natural
tendency toward growth
and self-actualization
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Entering the Play
¾ Rather than being a playmate, the therapist acts
as a participant – observer.
¾ Play, itself, does not necessarily produce
change. It is the therapist’s utilization and
interpretation of the symbolism embedded in the
play are extremely important in facilitating
change.
Child-Led Play Therapy
Play Therapy is based upon
the premise that the child
will lead the therapist where
the child needs to go. Basic
tenants of child-led play
include:
¾ be at the child’s level
¾ let your nose follow your
toes (face the child)
¾ have the child catch you
smiling and focusing on
her/him
¾ follow the child’s lead
Child-Led Play Therapy
¾ take off your “teacher’s hat”
¾ unobtrusively comment on themes and feelings
in the play
Child-led play can be taught to parents/caregivers
to:
¾ build the bond between
parent/caregiver and child
¾ foster healthy, normal child
development
¾ remind a child that she/he is
cared for, special, and worthwhile
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Child-Led Play Therapy
“Enter the children’s play and you will
find the place where their minds,
hearts, and souls meet.”
- Virginia Axline (1911-1988)
Founder of Non-Directive
Play Therapy
Play Therapy Approaches
Non-Directive Play Therapy
¾ Founded by Virginia Axline in
the mid-twentieth century
¾ Axline's Basic Principles of
Non-Directive Play Therapy include:
ƒ The therapist must develop a warm and friendly
relationship with the child.
ƒ The therapist accepts the child as she or he is.
ƒ The therapist establishes a feeling of
permission in the relationship so that the child
feels free to express his or her feelings
completely.
Non-Directive Play Therapy
ƒ The therapist Is alert to recognize the feelings the child is
expressing and reflects these feelings back in such a manner
that the child gains insight into his/her behaviour.
ƒ The therapist maintains a deep respect for the child’s ability
to solve his/her problems and gives the child the opportunity
to do so. The responsibility to make choices and to institute
change is the child’s.
ƒ The therapist does not attempt to direct the child’s actions or
conversations in any manner. The child leads the way, the
therapist follows.
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Non-Directive Play Therapy
• The therapist does not hurry the
therapy along. It is a gradual
process and must be recognized
as such by the therapist.
• The therapist only establishes
those limitations necessary to
anchor the therapy to the world of
reality and to make the child
aware of his/her responsibility in
the relationship
(http://www.playtherapy.org.uk/Ab
outPlayTherapy/AxlinePrinciples.h
tm).
Non-Directive Play Therapy
Non-Directive Play Therapy:
¾forms the foundation of all play
therapy
¾is also called “child-centred”
play therapy, based on Carl
Rogers client-centred therapy
¾the child completely directs the
play. The therapist is nonintrusive and follows the child’s
lead
Non-Directive Play Therapy
¾the therapist observes
the play and verbally
tracks what child is
doing (similar to play-byplay reporting)
¾the therapist provides
the space and means
for the child to express
him/herself and play-out
his/her experiences
¾is particularly useful in
the assessment phase
of therapy
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Non-Directive Play Therapy
Tenets for Relating to Children (Landreth, 2002; p.
54) :
1.
2.
3.
4.
Children are not miniature adults.
Children are people.
Children are unique and worthy of respect.
Children are resilient.
Non-Directive Play Therapy
5.
Children have an inherent tendency toward growth and
maturity.
6. Children are capable of positive self-direction.
7. Children’s natural language is play.
8. Children have a right to remain silent.
9. Children will take the therapeutic experience to where
they need to be.
10. Children’s growth cannot be speeded up.
Play Therapy Approaches
Directive Play Therapy
¾ directive techniques may be
used in addition to nondirective methods as a way
of being with a child
¾ the therapist participates in
and/or directs (at times) the
play
¾ the therapist actively
interprets the child’s play,
making the symbolism
explicit
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Directive Play Therapy
¾ when appropriate, the therapist introduces
therapeutic activities, such as games, art,
play themes, psycho-educational
discussions, therapeutic books,
externalization activities, and so on
Play Therapy Dimensions Model
The Play Therapy Dimensions Model
¾ developed by Ken Gardner and Lorri
Yasenik, founders of the Rocky Mountain
Play Therapy Institute in Calgary, Alberta
¾ the model postulates two primary dimensions to
the therapy process:
ƒ directiveness (the degree of immersion and
level of interpretation used by the play
therapist), and
ƒ consciousness (as represented in the child’s
play)
Play Therapy Dimensions Model
¾ depending on the specific case and the
therapist’s theoretical orientation, a clinician may
work primarily in one of four quadrants, or may
move across quadrants (this movement may
occur across sessions or within one session)
¾ the quadrants are:
ƒ Active Utilization
ƒ Open Discussion and
Exploration
ƒ Non-Intrusive Responding
ƒ Co-Facilitation
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Four Quadrants
Consciousness
Active Utilization
Open Discussion
and Exploration
Non-Directiveness
Directiveness
Non-Intrusive
Responding
Co-Facilitation
Unconsciousness
Play Therapy Dimensions Model
Quadrant 1. Active Utilization
¾ Conscious/Non-Directive
ƒ the therapist makes
interpretive comments, such
as making a connection
between the play and what
has occurred in real life
ƒ the therapist brings a theme of the child’s play out
into the open, but without interrupting the play
ƒ the therapist triggers conscious responses from
child
Play Therapy Dimensions Model
Quadrant 2. Open Discussion and Exploration
¾ Conscious/Directive
ƒ the therapist initiates and structures an activity that
is directly related to the child’s presenting problem
ƒ the therapist uses a developmentally appropriate,
cognitive play therapy approach
ƒ the therapist provides conscious processing of the
play and psycho-education to the child using
therapeutic board games,
role-playing, externalization
activities, and so on
ƒ this approach works well for
anxiety and other issues requiring
skill development
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Play Therapy Dimensions Model
Quadrant 3. Non-Intrusive Responding
¾ Unconscious/Non-Directive
ƒ for example, Virginia Axline’s and Garry Landreth’s nondirective play therapy methods
ƒ the child initiates and directs the play
ƒ the therapist follows the child’s lead
ƒ the therapist provides verbal tracking
of the child’s play, with reflection of
feelings
ƒ the therapist may or may not join in
the play when invited by the child
ƒ when the therapist joins the play, she/he still asks for
complete direction from the child (for example, in a stage
whisper, “and then what does she say?”)
Play Therapy Dimensions Model
Quadrant 4. Co-Facilitation
¾ Unconscious/Directive
ƒ initially the child directs the play
ƒ following an invitation from the child, the therapist enters
the play
ƒ the therapist “stays in the play” and tests hypotheses or
elaborates the play by inserting comments, actions, or
subtle interpretations
ƒ this may be used to interrupt compulsive repetition,
incomplete, or circular play segments (such as when play
becomes “stuck”)
ƒ the therapist does not directly discuss or interpret the play
ƒ the therapy works by shifting the play at an unconscious
level (for example, when chaos shifts to more organization
or when a new character is added as a “helper” to solve a
problem or save the victim)
Play Therapy Tools
Toys and materials commonly
used in play therapy include:
¾ baby doll
¾ baby toys
¾ nurturance toys such as a bottle,
blanket, rocking chair, doll bed,
stroller
¾ kitchen equipment
¾ play food
¾ dishes and utensils
¾ telephones
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Play Therapy Tools
¾ play money
¾ cash register
¾ tool set
¾ dress-up clothes
¾ family of bendable
dollhouse figurines
(preferably of different races)
¾ dollhouse and furniture
¾ emergency vehicles (police,
ambulance, fire truck)
¾ hospital and medical kit
Play Therapy Tools
¾ animals:
ƒ primitive (dinosaurs,
snakes, alligators, bugs,
spiders)
ƒ wild (jungle [lions, tigers, giraffes, hippos,
elephants, rhinos] and local animals [such as
deer, moose, bears, cougars, coyotes, foxes,
squirrels, rabbits], as well as birds [eagles,
buzzards, owls, song birds])
ƒ water animals (sharks, whales, dolphins, fish,
starfish, octopus, eels, sting rays
ƒ domesticated (dogs, cats, horses, cows, pigs,
goats, ducks, chickens)
Play Therapy Tools
¾ fantasy figures (heroes,
villains, and magical
figures of both genders)
¾ toy soldiers and vehicles
¾ elements of nature (rocks,
stones, trees, flowers,
shells, twigs, bark, moss)
¾ jewel stones or crystals
¾ vehicles (airplanes,
construction, trucks, cars,
boats, train, school bus)
¾ weapons (optional,
depending on personal
preference)
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Play Therapy Tools
¾ sand tray
¾ water tray
¾ art and craft supplies (Play-Doh/clay
and tools, paper [white and coloured
construction], felt pens, crayons,
scissors, coloured pencils, paint,
finger paints, glitter, beads, string,
wool, fabric scraps, collage materials, mask-making
supplies)
¾ musical instruments
¾ puppets and stuffed toys
¾ physical toys (balls, ring toss, dart board, basketball
hoop, floor hockey sticks and ball, skipping rope)
¾ bopping doll
Play Therapy Process
Hypothesis Testing: Both hits and misses provide
important information:
¾ Hits
ƒ Intensifies play
ƒ Elaborates play
ƒ Pauses to process
therapist’s response
ƒ Increases affect
ƒ Accepts/acknowledges
therapist’s response
ƒ Vehemently denies
therapist’s response
ƒ Pivots
¾ Misses (in content or
timing)
ƒ Ignores the therapist
ƒ Corrects the therapist
ƒ Distances her/himself
from the therapist
ƒ Stops playing
ƒ Increase in anxiety
ƒ De-intensifies the play
theme
Play Therapy Process
Play Themes:
Themes in a child’s play may represent:
¾ what the child has experienced or been exposed to
¾ reactions to what was experienced by the child
¾ feelings about what was experienced by the child
¾ what the child wishes, wants, or needs, and/or
¾ the child’s perception of her/himself, others, and/or
the world (Landreth, 2002)
15
Play Therapy Process
What To Watch For:
¾ content of play and symbols
¾ language surrounding play
¾ developmental level of play
¾ presence of regression or pseudo-maturity
¾ repetitive themes
¾ progression of themes/play story
¾ play disruption/pivoting
¾ post-traumatic play, especially when it becomes
“stuck”
¾ affect and its’ intensity
¾ quality and level of interaction with the therapist
Play Therapy Process
¾ be mindful about “over-analyzing” or
“over-interpreting” – sometimes a cigar is
just a cigar!
¾ best to have a balance and to be tentative
in most of your interpretations
¾ remember that you are looking for
patterns that persist over time which are
accompanied by intense or incongruent
emotion and/or are atypical for a child of
that developmental level
¾ at the same time, pay attention to your
“gut instinct” and when you sense a red
flag
¾ it is important to seek supervision and
consultation with colleagues on an ongoing basis
Special Considerations
¾ Meeting with Parents/Caregivers
ƒ Review confidentiality.
Explain that parents/caregivers
have a right to information
concerning their child.
However, therapy is often more
effective when the child feels that
he/she has a certain degree of
privacy. Explain that, with parents’ permission, your
preference is to respect confidentiality with the child as
you would with other clients, but that if there is anything
of concern or that is otherwise important for the parents
to know, you will tell them (and will inform the child of
this as well).
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Special Considerations
¾ obtain background information to the problem, the
child’s full medical and social history, and the parents’
view of the issue
¾ explain the process of play therapy
¾ explain that you would suggest regular meetings with
them to obtain updates, as well as to provide them
with general information about how therapy is
progressing, themes arising in the play, and/or
suggestions for strategies they can implement at
home.
Special Considerations
¾First Session With The Child:
ƒ introduce yourself, tell the child by
what name he/she may call you,
and explain what you do
ƒ describe what sessions will be
like, including limit-setting
ƒ talk about limits to confidentiality
(age-appropriate)
ƒ share with the child your
knowledge of why they are
coming to see you and ask
her/him if there is anything he/she
might like to add
Special Considerations
ƒ introduce the toys, saying
something like, “In here you
can play with any of the toys
in most of the ways that you
want”.
ƒ if the child is extremely shy,
uncomfortable, or reluctant to
play with the toys, the
therapist can choose a toy
with which to start playing and
acknowledge the feeling the
child is exhibiting, for
example, “sometimes its
scary to come to a new place
and meet a new person”.
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Special Considerations
¾ Therapeutic Limit-Setting:
ƒ reasons why children engage in behaviours
that require limit-setting in the playroom:
• they have not been taught otherwise
• it is another way to show therapist what
they have been through
• they are testing whether the therapist will
still want them to come
• they are testing whether or not the
therapist will follow through
• the child wants to find out what the
therapist does when angered; that is, how
safe will I be with the therapist?
Special Considerations
ƒ the goal is to set limits while keeping the therapeutic
relationship intact
ƒ therapy cannot occur without limits
ƒ limits are set only as the need arises
ƒ limits are essential for maintaining the safety of the
child, the therapist, the playroom, and the toys
ƒ establishing limits communicates to a child that you
will keep them safe
Special Considerations
ƒ limits help the child learn selfcontrol
ƒ avoid inducing shame
ƒ first reflect the child’s feeling,
then in a calm, matter-of-fact
and firm manner, state the
limit. For example:
“I can see that you want to
throw that at me, but I am not
for throwing things at. In here
it is not okay for me to get hurt
or for you to get hurt. Instead,
you can throw that block at the
big pillow”.
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Special Considerations
¾ Refusal to Leave the
Playroom:
ƒ can be very challenging and
stressful for both the child and the
therapist
ƒ acknowledge the feeling underlying
the refusal to leave
ƒ offer a fun way to leave the
playroom
ƒ have stickers/candy outside in the
waiting room that they can choose
once they have left the playroom
ƒ allow the child to carry a toy with
him/her, after explaining that they
will need to give it back to you once
he/she gets to the waiting room
Special Considerations
ƒ use a calendar to show the child when she/he
will return for therapy and count how many
sleeps until next visit
ƒ draw a picture together or write a note and give
to this to the child to take with him/her
ƒ with children for whom this is regularly a
challenge,
• set up a ritual/routine for
the end of the session
(such as, cleaning up the
toys, singing a song, having a snack)
Special Considerations
• provide reminders (10 minutes left…5 minutes left…2
minutes left)
• use a timer that the child can be
responsible for setting/turning off
to give her/him some control
ƒ In rare cases, there might be
flat-out refusal to leave and/or acting-out
behaviours (such as “trashing” the playroom)
even after having tried the above strategies. In
these cases, you may have to provide warnings
(for example, count to 3) and, in the worse case
scenario, get the child’s caregiver to remove the
child.
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Special Considerations
¾ Aggression:
ƒ there are varying approaches and degrees of
comfort with allowing aggression and aggressive
toys (guns, knives, swords, grenades, and so
on) in the play
ƒ forms of aggression may include:
• aggression toward the therapist
• aggressive play involving the
therapist
• aggressive play toward babies
and child figures in the play
Special Considerations
ƒ reasons for aggressive
play may include:
• catharsis
• symbolic or actual reenactment of trauma
• displaced anger
ƒ care must be exercised in
order to not allow the play
to retraumatize the child
Special Considerations
¾ Sexualized Play:
ƒ it can be disturbing to see
sexual content in a child’s play
• reasons for sexualized
behaviour may include:
• neglect
• domestic violence
• physical violence
• sexual abuse
• exposure to inappropriate
sexual material
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Special Considerations
ƒ it is okay to express not feeling comfortable when a
child is acting in a sexual manner toward you and it
is important to set limits. Immediately offer
validation and provide messages of safety and
caring. Suggest another means of demonstrating
what it is the child needs to express, for example, “I
don’t feel comfortable doing that, but you can show
me with the toys”.
ƒ offer reparative messages, either within the play or
verbally
Special Considerations
¾ Child Protection Concerns:
When to call Child and Family Services:
ƒ there is a disclosure of neglect or
abuse
ƒ there are repetitive themes in the
play that are concerning and atypical
(such as sexual content, portrayals of
domestic violence, victimization, and so on)
ƒ be prepared to come up against a misconception or a lack
of awareness, in that thematic material occurring in play is
sometimes not taken seriously.
ƒ it is important to explain your rationale for being concerned
ƒ in the end, keep in mind that it is your ethical and legal
responsibility to report a concern, regardless of how the
information is handled.
Special Considerations
¾ Termination:
ƒ
ƒ
ƒ
ƒ
•
•
•
•
•
•
provide notice and count down the days on a calendar
process ending with the child
decide together what to do in the last session
ritual is often a helpful way to terminate. Some
suggestions:
have a party with special snack and
decorations
have a tea party
teddy bear
make “You Are Special” rocks
make a treasure box
write therapeutic letters
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References and Resources
Axline, V. (1947). Play therapy. Boston, MA: Houghton
Mifflin Company.
Barnes, M.A. (1996). The healing path with children: An
exploration for parents and professionals. Kingston, ON:
Viktoria, Fermoyle & Berrigan Publishing House.
Crisci, G., Lay, M. & Lowenstein, L. (1997). Paper dolls
and paper airplanes: Therapeutic exercises for sexually
abused children. Charlotte, NC: Kidsrights.
Gil, E. (2006). Helping abused and traumatized children:
Integrating directive and non-directive approaches. New
York: The Guilford Press.
Gil, E. (19940. Play in family therapy. New York, NY: The
Guilford Press.
Gil, E. (1991). The healing power of play: Working with
abused children. New York: The Guilford Press.
References and Resources
Kaduson, H.G., Cangelosi, D. & Schaefer, C. (1997). The
playing cure: Individual play therapy for specific
childhood problems. Northvale, NJ: Jason Aronson Inc.
Landreth, G. (2002). Play therapy: The art of the
relationship, 2nd Ed. New York, NY: Brunner-Routledge.
Landreth, G. (2001). Innovations in play therapy: Issues,
process, and special populations. New York,NY:
Brunner-Routledge.
Lubimiv, G.P. (1994). Wings for our children: Essentials of
becoming a play therapist. Burnstown, ON: The General
Store Publishing House.
Oaklander, V. (1988). Windows to our children. Highland,
NY: The Gestalt Journal Press.
O’Connor, K.J. (2000). The play therapy primer, 2nd Ed.
New York, NY: John Wiley & Sons, Inc.
References and Resources
Schaefer, C. & Kaduson, H. G. (Eds.) (2006).
Contemporary play therapy: Theory, research, and
practice. New York, NY: The Guilford Press.
Schaefer, C. & Kaduson, H. G. (Eds.) (1997). 101 Favorite
play therapy techniques. London: Jason Aronson Inc.
Schaefer, C. & O’Connor, K.J. (1983). Handbook of play
therapy. New York, NY: John Wiley & Sons.
Straus, M.B. (1999). No-Talk therapy for children and
adolescents. New York, NY: W.W. Norton and
Company.
Webb, N.B. (2007). Play therapy with children in crisis:
Individual, group, and family treatment, 3rd Ed. New
York, NY: The Guildford Press.
Yasenik, L. & Gardner, K. (2004). Play therapy dimensions
model: A decision-making guide for therapists. Calgary,
AB: Rocky Mountain Play Therapy Institute.
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References and Resources
¾Play Therapy Association Web Sites:
ƒ www.albertaplaytherapy.ca
ƒ www.cacpt.com
ƒ www.a4pt.org
ƒ www.playtherapy.org
Contact Information
Shanika Fridhandler, M.Sc., Prov. Psych.
Clinical Consultant
Healthy Minds/Healthy Children Outreach
Richmond Road Diagnostic and Treatment Centre
1042 – A, 1820 Richmond Road S.W.
Calgary, AB T2T 5C7
Phone: 403-955-8441
Fax: 403-955-8184
E-mail: [email protected]
Lindsay Hope-Ross, M.Sc., R. Psych.
Clinical Lead
Healthy Minds/Healthy Children Outreach
Richmond Road Diagnostic and Treatment Centre
1047 – 1820 Richmond Road S.W.
Calgary, AB T2T 5C7
Phone: 403-955-8644
Fax: 403-955-8184
E-mail: [email protected]
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