Article
The Role of Play Themes
in Non-directive Play Therapy
Clinical Child Psychology
and Psychiatry
1­–16
© The Author(s) 2011
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DOI: 10.1177/1359104511414265
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Virginia Ryan1 and Andrew Edge2
Abstract
Describing the processes underlying play therapy is important for evidence based practice in child
therapy. Employing play themes to describe children’s play session contents is in widespread use
by practitioners, but an adequate classification of these themes for non-directive play therapy
practice has not yet been established. This article sets out to fill this gap by first describing how
themes can be distinguished and distilled from the contents of play therapy contents. Second, a
classification of main themes and sub-themes with exemplars to illustrate these concepts which
is compatible with non-directive play therapy practice is set out. Finally a pilot project with
experienced play therapists to test this classification in practice is suggested, along with the
research questions that will need to be investigated in the shorter and longer terms.
Keywords
child centered play therapy, evidence based practice, non-directive play therapy, play themes,
play themes classification
This article will set out a working classification scheme for play themes for one well established
method of therapy, non-directive play therapy (NDPT). First, the rationale and background for this
classification will be discussed; then it will set out the ways child centered, non-directive play
therapists often use themes in their practice. Next the article will outline one way of classifying
themes; this classification is based on the emotional contents of children’s play and their interactions with their therapists. Finally, the article will discuss ways in which this theoretical framework
for themes can be evaluated, refined, and applied to play therapy research, training and practice.
The article has two goals: first, it aims to be immediately relevant to play therapists’ practice; and
second, it aims to contribute to current goals for play therapy of evidence-based practice in psychology (APA Task Force, 2006) by more fully specifying the contents of children’s play sessions,
which is required for a full specification of the change processes in NDPT.
1Ryan
Children’s Services, Hull, UK
Family Therapist for Milton Keynes NHS Specialist Child & Adolescent Mental Health Service, UK
2Consultant
Corresponding author:
Andrew Edge, Consultant Family Therapist, MK Specialist CAMHS, Eaglestone Health Centre, The Hospital Campus,
The Hospital Campus, Standing Way, Milton Keynes, MK6 5AZ, UK.
Email: [email protected]
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Clinical Child Psychology and Psychiatry
Background and Rationale
The identification of “themes” in children’s therapy is in widespread use by play therapy practitioners (e.g. Benedict & Mongoven, 1997; Homberg, Benedict & Hynan, 1998; Sloves & Peterlin,
1994; West, 1996; Wilson & Ryan, 2005). Therapists are trained to consolidate the contents of
children’s therapy sessions into broader categories, or themes. These themes are intended to capture the main issues children express in their therapy. It is also widely assumed that when therapy
is successful, play themes change towards more positive, developmentally typical ones (Wilson &
Ryan, 2005). This article’s main assumption is that the process of theme building in play therapy is
one of ‘co-construction’ (Burr,1995; Dallos & Draper, 2005; Shotter, 1993). That is, theme building is a dynamic process, dependent upon children’s activities with their therapists in sessions and
therapists’ actions with specific children. The process of theme building is also assumed to be
influenced by the emphasis therapists give to different theoretical and practice frameworks, which
in turn can be changed by their perceptions of what children emphasize in their play, thus influencing how therapists formulate “themes” in the future.
Employing themes in child therapy originally developed within psychodynamic child therapy,
with themes seen as reflecting children’s underlying, psychodynamic issues (Sloves & Peterlin,
1984). Psychodynamic psychotherapy still tends, following Freud and Klein (Freud, 1927, 1958;
Klein, 1923, 1926), to value children’s conscious interpretations and verbal insights as indicators
of progress (Blake, 2008; Slade, 1994). In contrast, for NDPT children are assumed to be engaged
actively in their play experiences during therapy and the aim is not to help them have insight into
their own themes directly. NDPT practice emphasizes relationships and play experiences as leading to emotional well being in and of themselves, without children necessarily displaying conscious understanding of these processes through verbalization (Wilson & Ryan, 2005).
Within the non-directive or child-centered play therapy literature, the process of co-constructing
themes and their use in non-directive practice has not been set out fully as yet. This deficit may be
partly due to the difficulty inherent in any categorization that attempts to capture the sometimes
subtle and unclear expressions of underlying emotional issues children may communicate during
their play therapy (May, 2008). Instead writers have discussed the broad aims of therapy with children (Axline, 1969; Landreth, 2002) and there has been more emphasis on the general emotional
issues children encounter (Wilson & Ryan, 2005). These discussions have not included details of
the types of themes that often seem to develop within non-directive play therapy. This article therefore seems overdue. It will explore in more depth the uses of themes within non-directive play
therapy from the perspective of non-directive play therapy practice as it was taught in the UK at the
University of York’s training program in non-directive play therapy, which was accredited by the
British Association of Play Therapists (BAPT). Students were trained in the same skills base from
year to year, founded on a person centered framework of therapy (Rogers, 1951, 1957). The uses
of themes and theme construction in this article will be examined from this person-centered stance,
developed by the authors in training play therapists and from their own practice experiences.
Early non-directive play therapy research described general themes; for example Moustakas
and colleagues’ process research classified six stages of play therapy, with children moving from
undifferentiated expressions of their emotions to clearly defined, mostly positive emotions in line
with reality (Moustakas, 1955; Moustakas and Scholock, 1955, cited in Guerney, 1984). Guerney’s
own research found that children’s behavior during non-directive play therapy altered from more
aggressive to regressive and finally more reality-oriented play during the course of therapy
(Guerney, 1984). From a directive perspective, Benedict and colleagues’ research, mentioned
above, specified more detailed themes based on children’s behaviors during play therapy. They
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developed a list of play themes derived from sessions with young, pre-school children, who were
described as having “attachment disturbances”. Their approach, referred to as Thematic Play
Therapy (TPT), is described as influenced by object relations and attachment theories. It posits five
main, predetermined themes (e.g. safety, loss, anger, nurturance, and constancy) and thirty-two
sub-themes. Therapists direct children’s play based on themes from a predetermined list. These
themes are then analyzed for their presence in a particular child’s play.
This directive approach to understanding themes seems of limited use for non-directive play
therapy for several reasons. First TPT is based on pre-school children’s behaviors and does not
include later development. Secondly, Benedict and colleagues’ themes and subthemes are derived
from children’s play which is directed by their therapists, unlike the non-directive method of play
therapy. Children’s themes are always selected by their therapists from a predetermined list. Finally,
the TPT approach primarily seems to classify children’s observed behavior in a predetermined
way. For example, play where characters in danger are rescued would always result in the play
theme of “rescuing” (Holmberg, Benedict & Hynan, 1998). This approach therefore is prescriptive,
and does not give non-directive practitioners’ a way to understand the highly personal, individual
emotional concerns of children which seem to be communicated by their behavior during their play
therapy sessions.
In this article a different premise will be adopted; themes are viewed as abstractions not only
from behavior, but more importantly, represent significant, underlying, emotional issues that
children then express spontaneously in their play therapy. Themes in the following discussion
therefore are viewed as a shorthand way of understanding and discussing the therapeutic issues
children express for themselves. Themes are defined as the inferences made about these important emotional issues by the children’s non-directive play therapists. As mentioned above, Wilson
& Ryan (2005) have already set out the main themes they see as often arising within children’s
overall emotional development. Their framework is based on specific aspects of a variety of
approaches, including those of Erikson, Piaget, and Bowlby (Piaget, 1952,1962,1965, 1967;
Bowlby, 1980), all of whom base their theorizing on organismic premises, and will be used again
here. These organismic premises are in turn generally compatible with broader theories of emotions which adopt a psycho-evolutionary stance (e.g. Izard, 1979; Tompkins, 1962; Plutchik,
1980 cited in Greenberg and Safran, 1990), in which emotions are viewed as biologically adaptive
and have a vital role in survival. This article assumes, following Sroufe (1997), that clear, specific
emotions are developed by infants, in relationship with others, by one year of age, as they become
able to behave intentionally, to recall earlier experiences and to anticipate events. Their responses
therefore are genuine emotions in response to specific events, with joy, anger, fear, sadness,
surprise and interest all becoming possible. These basic emotions are assumed to be present
within the classification system we present later.
How themes can be created in non-directive play therapy practice
Themes within NDPT sessions with children and young people are defined here as inferences made
by play therapists about children’s main emotional issues. These inferences are made by therapists
based on children’s patterns of play with materials and/or their patterns of interaction with their
therapists, including both verbal and non-verbal interactions. In NDPT children’s play and interactions with their therapists are child-led (Axline, 1947/1989; Dorfman, 1951; Guerney, 1984;
Landreth, 2002; West, 1996; Wilson & Ryan, 2005). The themes therapists derive from play therapy sessions are based upon these spontaneous, child-led experiences. Therefore, unlike TPT,
therapists do not have a fixed list of predetermined theme categories; instead, themes develop from
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Clinical Child Psychology and Psychiatry
the unique properties of each play therapy session and therapists’ understanding of them. Some
themes may seem self-evident to therapists, while others may be elusive and incomplete, and
therefore difficult for therapists to classify.
In addition to these child-led experiences, therapists also use their own personal, cognitive and
emotional processes in determining themes. UK non-directive play therapists are trained in a
variety of ways, including undertaking personal therapy, being self-reflecting and distinguishing
their own personal emotional reactions to play therapy contents from those arising within their
relationships with children (Ryan & Courtney, 2009). Therefore therapists also base their judgments of what themes are important on their own personal emotional responses to children’s play
with materials and interactions with them during sessions. NDPT therapists are trained to follow
children’s leads and focus on issues important to children. When NDPT is practiced skillfully,
themes are assumed to be minimally influenced by therapists’ own self interested agendas.
During the therapy sessions themselves, especially during early sessions before therapists are
familiar with the children they are working with, children’s play and/or social interactions often
seem to be experienced as a whole by therapists. It is usually only when therapists think about the
contents of early play therapy sessions after sessions that these experiences are abstracted into
themes. Play therapists then use these “themes” as shorthand for experiences that they assume
demonstrate emotional patterns and unique meanings for the children themselves. Themes therefore always are inferences, not “facts”. They are used by therapists as working hypotheses of the
emotional issues that seem important for children. It follows therefore that therapists’ hypotheses
of what themes are important in therapy can be further strengthened or weakened by subsequent
play sequences and interactions with children within sessions.
It is also important that other sources of information be evaluated by therapists against themes
within play therapy sessions. Information may include observations of the children by their therapists before/after sessions, at school, at home; parent/teacher verbal reports; written documentation, verbalizations by children themselves, and therapists’ evolving knowledge about children
generally. This information may or may not correspond to themes arising within the sessions.
Inferences again are made by therapists when linking together this “outside” information with the
themes arising during play sessions.
How themes can be used in NDPT practice
An important function of themes is to inform non-directive play therapists’ empathic and congruent
responses to children during play therapy sessions. Particularly during the early stages of therapy,
therapists work consciously to understand more about the children they help through video playbacks, writing up and thinking about their clinical notes for each session, receiving supervision,
reading about similar cases and relevant research literature. Their aim, through continually reflecting on relationships and processes, is to become more attuned and more able to anticipate a specific
child’s feelings and reactions on an emotional level during their play therapy sessions. Therapists’
congruent feelings (Ryan & Courtney, 2009; Wilson & Ryan, 2005), which are those feelings arising within each relationship at a specific moment with each child for each therapist, are based on
therapists’ empathy with the children they help. These feelings of empathy and congruence in turn
help therapists to further attune themselves on an emotional level to a child they are seeking to help
(see Ryan and Courtney, 2009).
Another important role for themes in non-directive play therapy practice is that they allow therapists to maintain session confidentiality. For example, by using themes in reviews and other discussions about therapy, it usually is not necessary, or beneficial, to reveal the more intimate details of
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children’s therapy. In NDPT therapists usually check with children and young people on the
possible issues they will discuss during review meetings with parents and other professionals. (See
Ryan & Wilson, 2000; Wilson & Ryan, 2005). The children and young people themselves may
verbally confirm or disconfirm play themes during these discussions, in their play therapy sessions
and their review meetings, (e.g. when they are mature enough and wish to attend such reviews).
For example, ten year old Lucy was reluctant to attend the play therapy review her therapist was
holding with her parents after a further six sessions of NDPT, but wished to hear what her therapist
intended to say. Her therapist accepted Lucy’s feelings and stated that Lucy seemed to feel sad and
lonely at home, but she also was showing that sometimes she felt strong and able to win. Lucy was
positive about this feedback and wanted her therapist to talk with her parents about letting her see
more of her new friend at school. Her therapist’s feedback was based on many occasions during
sessions of Lucy showing these strong negative feelings in her drawings, sand tray arrangements
and conversations, in contrast with Lucy’s new energy and enthusiasm when playing competitive
board games with her therapist. Lucy’s therapist inferred that Lucy’s main play theme during her
recent sessions was competence versus inferiority, an age appropriate theme proposed in the
classification scheme below.
This theme seemed to be further confirmed by Lucy’s comments about her newly felt desire for
friendship, which she was unable to discuss herself with her parents. However Lucy still seemed
to be expressing feelings of mistrust in her parents, which indicated to her therapist that Lucy’s
individual play theme of mistrust continued to be a significant theme for her. Yet Lucy also was
displaying a growing trust in her therapist, with her relational play theme of trust developing as
well. This example, which uses the classification outlined below, shows that inferred themes can
help therapists refine their feedback to children about what they intend to say during review meetings and help therapists to clearly discuss children’s emotional needs during these meetings.
Finally, themes are often used by therapists to review progress made by children during their
play therapy sessions. Progress, defined in NDPT as the general aims children, therapists, and
other interested parties hope children will achieve for themselves as a result of non-directive play
therapy, has been discussed elsewhere (e. g. Landreth, 2002; West, 1996 ; Wilson & Ryan, 2005).
For instance, themes indicating children moving towards more self-confidence, genuine feelings
of competence, and deeper, more satisfying relationships with others, would usually show progress. And themes suggesting strong distrust and distancing from others, chaos and destruction may
be signs of lack of progress or deterioration. Such themes are incorporated within our suggested
classification scheme set out later.
Such themes would not be interpreted literally or uniformly/universally in NDPT. Rather, they
are used as signs of progress or lack of progress by therapists within each child’s individual life,
and their context is needed to understand their meaning for each child. However, often nondirective play therapists seem to notice similar themes with children who are referred for therapy
with similar presenting problems. This article’s position therefore is that there often are similarities in themes and these similarities can be useful for therapists to consider. Non-directive play
therapists are aware that while themes can have the same general meaning for different children
some of the time, themes also may change their meanings at different points in the process of
therapy, even for the same child. For instance a child who hides marbles in the sand might communicate themes of secrecy and distrust in the early stages of therapy during this play, but feelings of competence and pleasure may be conveyed by later, almost identical play. In general
non-directive play therapists try to take a non-deterministic stance with all the children they work
with, and guard themselves against their own biases and preferences when arriving at themes for
each child they meet.
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Clinical Child Psychology and Psychiatry
How themes can be conceptualized in NDPT
It is assumed here that all children’s emotional development can be seen as occurring within the
relationships they have with others, the world they live in, and their own changing sense of self.
However, for the purpose of identifying themes, it seems useful to conceptualize themes in terms
of whether a theme seems more ‘individual’ or more highly ‘relational’ (Fredman, 2004). Therefore,
while all themes from sessions are created within the relationship between children and their therapists, some themes appear to focus more on a child’s sense of self as an individual, while other
themes appear to primarily focus on their relationships and sense of others. Yet these individual and
relational themes are assumed to always interconnect to varying degrees. While the “individual
play themes” discussed below might be seen as similar to more traditional models of emotional
development which view children as “autonomous” beings (e.g. Erikson, 1977), an important
difference here is that in line with later research (i.e. Stern, 1985), such “autonomy” is viewed as
developing within relationships and from a sense of relatedness (Fredman, 2004).
The “individual play themes” children develop in therapy can be seen primarily as expressions
of their emotional senses of self. By contrast their “relational play themes” (Edge, 2007) can be
seen as connecting more with theories of emotional and social development which stress
the importance of relationships and how feelings and emotional states are created between people, such as attachment theory and social constructionism. It seems important to underline that
these two categories, of “individual” and “relational”, are not assumed to be mutually exclusive.
A theme is always classifiable under both categories, but one category may describe a particular
theme’s character more aptly. Reflecting on themes in such a way may help provide an additional
resource for play therapists and the children they work with, an assumption which merits future
action research on play therapists’ practice, as discussed in the final section.
How themes can be identified in NDPT
This section sets out the main indicators therapists may use, again subject to further research,
during play therapy sessions to alert them to when possible themes are occurring for children.
These suggested markers are based on the authors’ and colleagues’ NDPT practice, and their extensive supervision and training of many play therapists. The first set of potential markers play therapists seem to use in their practice, as set out below, are for those themes we have classified primarily
as “individual play themes” and the second set are those for “relationship themes”.
Themes can be inferred both from contents arising within one session (e.g. patterns of play and
interactions that are repeated within the therapy hour) and across sessions (e.g. a child may continue with a theme from one session to the next or may return to a previous theme after one or more
sessions). NDPT also assumes that there are often several meanings or themes contained or symbolized in one important play segment for children.
Common markers for “individual” play themes arising in play therapy sessions include one or
more of the following occurrences:
•
•
•
•
•
Repeated, similar play with the same materials or toys within a session;
High levels of emotional involvement and intensity in children’s play;
A lengthy amount of time spent on the same activity;
Ideas and emotions that seem similar, even though toys or activities change;
Children verbally remembering previous play activities and/or relating the play with their
therapist to their current/past/future life;
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• Repeated, similar play with the same materials or toys from one play therapy session to the
next (or later session);
• A sudden and intense change of activity, with highly focused play emerging;
• Children verbally remembering with others previous play activities and/or relating the play
to current/past/future life, immediately after a session or at a later date.
Common markers for ‘relational’ themes arising in play therapy sessions include one or more of
the following:
• Children’s primary, continued focus is on their therapist and not on play activities (e.g. a
child asks for personal information from the therapist, such as “where do you live?”);
• Children’s behavior towards their therapists is very intense emotionally (e.g. a child tries to
please his therapist inordinately; or is highly avoidant or dependent; or is strongly challenging of limits);
• Children’s interactions with their therapists are similar, even though the activities and/or
verbal content change;
• Children’s interactions with their therapists are markedly different, even though activities
and verbal content remain similar;
• Therapists’ personal emotional responses to interactions with children during play therapy
are out of the ordinary and unexpected (e.g. more intense or inexplicably bored).
In summary, NDPT therapists create hypotheses about what issues are of most importance for
children primarily from their observations of the emotional similarities and differences within play
sequences and interactions with children during play therapy sessions. However, when therapists
are inferring what the most important issues are for children within their daily lives, and not just
their play sessions, they also may have additional information from various sources, as mentioned
earlier, and may also base their hypotheses on one or more of the following:
• Direct knowledge of a child within other settings (e.g. a home visit, an observation at
school);
• Information from other sources (e.g. parents, other professionals, teachers, etc);
• Their own theoretical orientation and ways of creating meaning;
• Their own knowledge of normal and atypical child development theory and research; and
• Their own experiences with children generally, both in therapy and in everyday life.
A working model for inferring and classifying both individual
and relational play themes
Preliminaries
It is assumed here that “individual” (I) and “relational” (R) themes are most useful for therapists in
understanding children’s worlds when they are linked to explanations and theories of emotional
and social development (e.g. attachment, Erikson’s eight stages, social constructionism, child
development research, maltreatment etc). The classification of themes used in NDPT below reflects
these two types of themes (R and I) and is primarily based on Erikson’s eight stages (see Wilson &
Ryan, 2005 ), current developmental theory and research, attachment concepts (see also Ryan,
2004) and social constructionism (Edge, 2007).
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Wilson & Ryan, (2005), in presenting the theoretical underpinnings of NDPT, have argued that
the above theoretical frameworks appear highly compatible with NDPT, which emphasizes both
emotional development and relationships in its practice. They argue that Erikson’s theory is useful
for play therapy due to its wide scope, but without its strong, psychosexual underpinnings. The
following classification uses Erikson’s broad conceptualization of emotional/social development
as consisting of opposite polarities with “positive” and “negative” valences, and his assumption
that normal development consists of a preponderance of positive themes and smaller numbers of
negative ones. (These themes, when researched, may later be more usefully formalized as points
along a continuum, with elements of both polarities being present in certain themes.) The classification tables set out at the end of this section give main play themes and specify subthemes within
these main themes, followed by an example from play therapy practice that seems representative
of each theme described. The subthemes are based on those considered “universal” or common
(see Bettelheim, 1991; Fein, 1989; Landreth, 2002; Harper, 1988; Russ, 2004); they are placed
within the main themes as subthemes that seem compatible with Erikson’s main themes. Being
able to move between these different levels of abstraction/meaning may provide an additional
resource for play therapists when they reflect on their practice and help develop their understandings of the children with whom they work, another topic for further research.
The classification does not assume that any of the suggested themes and subthemes are predetermined, but does assume that some themes may be able to be generalized, in keeping with
attachment theory in particular. It also assumes that children and adolescents’ play themes, as
well as being influenced by their life experiences, are influenced by their developmental status
and capacities, with certain themes having resonance at particular ages. Each child and adolescent has a unique life trajectory, yet also follow a similar developmental progression (e.g. Wenar
& Kerig, 2006), with commonalities. It should be noted however that this list of examples will
not be sufficient in itself to understand children’s personal play themes. As noted earlier, within
this classification it is assumed that similar behaviors and interactions can have several, or even
different, thematic meanings in different contexts. Therefore the classification is intended to be
used as a way for practitioners to consider for themselves whether the themes suggested here
seem present in their work, rather than being used rigidly. The themes, while potentially useful
as a practice tool on this theoretical level, also warrant empirical investigation, as discussed in
the last section.
The classification presented here follows Erikson in assuming that each stage of emotional/
social development has precursors to other stages of development within it, but that the main
emotional issue of each stage dominates that period of development for children (Wilson & Ryan,
2005). Typically these emotional issues are assumed to be revisited by children, young people and
adults, both during typical development and more intensively (perhaps) during their therapy. This
revisiting may be independent of a child’s overall developmental level and due to subsequent
emotional difficulties or successes, and unique life experiences. Generally it is assumed that children will have a preponderance of themes relating to their current developmental level when they
are less troubled, an assumption that will again need to be empirically tested.
This assumption of an increase in themes related to children’s current developmental level is
reflected in our proposed classification tables below under “play level”. For example, using this
classification an eight year old boy who played out lying in a cot and being ignored during his
initial play therapy sessions might be seen as exploring a negative theme of “mistrust”, subtheme
“distancing and rejection” with the age level of “infancy”. In contrast during his ending sessions,
he persisted in attempts to model a racing car from clay, an activity which could be classified under
“industry” with the subtheme of “persistence”, an age appropriate, positive theme.
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Proposed classification of themes
The classification below encompasses both childhood and adolescence. Briefly, the most basic
cornerstone of personality and social relationships can be seen as the development of trust and
primary attachment relationships, which begins from birth onwards. This is followed in normal
development by increased complexity in social relationships and individuation, with the emergence of noticeable autonomy or independence in children by approximately 24 months old. By
three to five years of age, children begin to take initiative in their interactions with others, develop
a richer imaginative life, and begin to develop a sense of responsibility towards others. Children
intensify their learning to become productive members of society, developing their own skills and
skills alongside others between their seventh and eleventh years. This is followed by adolescents’
increased interest in the formation of their adult identity and their place in wider society (Erikson,
1977). All of these developmental and emotional issues are used as primary themes within the
classification of play therapy themes below.
Each theme will be described next, including both positive and negative poles and the emotions
that can be seen as expressions of these main themes and accompanying subthemes. While some
of the subthemes rely on clinical experience and judgments about best fit, most of these derive
from child development, child maltreatment, and play therapy research and theory. Descriptions of
the main themes will be followed by a list of the subthemes assumed to be classified within each
of the main positive and negative themes. Tables giving examples from practice to illustrate these
themes and subthemes will then be given.
Trust versus Mistrust
The theme of trust versus mistrust is related to children’s development of attachment within intimate relationships (e g with peers, family, therapist, and authority figures, etc) and is most prominent in very young children who are typically developing. Emotions expected to accompany
themes/subthemes of trust are: joy, curiosity, optimism and hopefulness. Subthemes under this
trust heading which seem to fit include: safety/protection, nurturing, comfort, rescued/saved,
attunement, exploration, rebirth, full, satisfied, having enough, and hopefulness.
However issues of attachment and trust arise throughout development; these emotional issues
can be influenced both positively and negatively by a wide range of experiences. More reparative
experiences for children and adolescents that may be linked to their play themes include: receiving
consistent attentive care giving, improvement of family fortunes, cessation of traumatic experiences and recovery from illness. Negative experiences include: bereavement and separation from
significant attachment figures, trauma and maltreatment, serious illnesses and accidents can all
erode trust and lead to high levels of mistrust. The emotions accompanying mistrust themes/
subthemes may be: sadness, hopelessness, fear, rage, emotional detachment, grief and loss (see
Russ, 2004). Subthemes under the “mistrust” heading that seem to fit include: distancing or rejection
of relationship, chaos, relationship ambivalence, trauma/abuse within primary relationships, death/
destruction/loss of self/others of importance, dying, emptiness, despair, never having enough, and
numbness/lack of affect.
Autonomy/Independence versus Shame and Doubt
This theme is related to children beginning to develop, through their relationships with others, a
sense of self as a valued individual in their own right. Emotional regulation issues are part of this
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theme, usually most prevalent during the second and third years of typical development, although
like all themes it may be important at other times in the lifecycle. Emotions expected to accompany
the positive theme of autonomy include age appropriate self-efficacy and independence. Subthemes
that appear to fit under this heading include power, mastery, sense of completion, satisfaction.
Those accompanying shame and doubt may include the negative emotions of helplessness, anger
and frustration. Subthemes under this heading can be: control/victimization; weakness/helplessness; limit testing, aggression, over-compliance and high approval seeking, defiance, and dominance/submission.
Initiative versus Guilt
This theme relates to children developing a sense of morality or conscience, with values of “good”
and “bad” in relation to themselves, other people and the cultures in which they live. With initiative, children are interested in trying out new activities and new roles for themselves within social
relationships, as well as beginning to take age-appropriate responsibility for their actions. Typically
this tends to predominate between the fourth and sixth years. Children usually are interested in
exploring adult roles and interests, either in talk or play, often role-playing adult and child characters. Emotions and attitudes expected to accompany the theme of initiative are a sense of purpose
and energy, creativity, beginning awareness of social obligations, and expressiveness of feelings.
Their hopes, wishes and feelings can be expressed through imaginative play and verbalization.
Subthemes in play therapy under this heading can be: ‘goodness’ (e.g. issues regarding spirituality,
morality, prejudice), healing, helping, age appropriate risk taking, social regulation (general compliance with social rules), respect for physical objects and exploration of adult roles. The emotions
and attitudes often accompanying guilt are blaming self and feeling “bad”; confusion of fantasy/
imagined worlds with reality, overdeveloped conscience, and overall inhibition of thoughts, feelings and imaginative play. Subthemes under this heading may include injury/harming self and others, damage of property/objects, noncompliance with social rules, preoccupation with “evil”, over
concern for own safety, sneaking and trickery.
Industry/Competence versus Inferiority
This theme relates to children developing a sense of industry for themselves and with other people.
Usually this theme is a primary focus between the seventh and eleventh years, although as with all
the themes it can be present or revisited at many points in the life cycle. At the positive pole children learn to share interests, solve problems, cooperate and work with others, as well as developing
their own skills in social relationships, academic work and leisure activities. Emotions and attitudes which may accompany competence include persistence and overcoming frustration, feeling
clever, robust and capable. Subthemes under this heading include: friendship, persistence, learning,
enjoying social recognition for skills and accomplishments, pleasure in own achievements, and
interest sharing with peers and adults. At the negative pole of inferiority emotions and attitudes can
include feeling stupid, worthless, unable to learn or accomplish things, unable to work with peers
or adults. Subthemes under this heading include: over conformity to social rules and expectations,
lack of persistence at tasks, preoccupation with winning, alienation of peers and adults, inability to
work cooperatively or ask for help, feelings of low self worth, over compliance, and high approval
seeking.
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Ryan and Edge
Identity versus Role Confusion
This theme primarily relates to young people developing a sense of their own unique identity and
the ways they fit into and commit themselves to wider society, moving beyond family relationships
in a fuller way than during middle childhood. An interest in adult roles and life styles can again
emerge strongly as a typical theme during late adolescence, and may often be seen in conversations
adolescents have with their play therapists. As with other themes, the goals, emphasis, acceptability or even presence of such a process is likely to be culturally specific. Different emotions and
themes seem to be viewed as developmentally “normal” within the particular cultures of the child
and therapist (Edge, 2007). Emotions and attitudes accompanying “identity” may include; reviewing and taking pleasure in remembering childhood experiences, hope for the future, sense of
belonging to societal, cultural, peer and family groups, and working out meaningful values and
aspirations. Subthemes under this heading could include: looking at several aspects of social situations at once from different perspectives, ability to tolerate a range of complex/mixed emotions
simultaneously, identification with chosen peer group, respect for societal values overall and
appropriate challenge, and age appropriate interest in sexuality.
Emotions and attitudes which may accompany “role confusion” include longing for childhood,
despair for the future, low sense of belonging, extreme questioning of values and aspirations of self
and others Subthemes under this heading can include: over identification with delinquent peer
group, pervasive lack of respect for social rules, preoccupation with or lack of interest in sexuality,
over concern about caring for others and not self, cynical mistrust, lack of identification with adult
roles, lack of interest in forming intimate relationships with peers, regression or over maturity.
This section has now set out the assumptions and given descriptions of a working classification
of play themes from children’s and young people’s play therapy. The following three tables show
possible examples from play therapy sessions to illustrate these themes and subthemes. Table 1
gives positive and negative examples of each main theme from different children’s play therapy
sessions. It also shows each child’s chronological age, the developmental level of the example and
whether the theme seemed more highly relational or individual in expression, based on the clinical
judgments of the authors.
Play therapy examples of emotional issues within each subtheme also have been developed for
pilot research, with some examples presented in Tables 2 and 3. (Other subtheme exemplars are
available on request.)
Next, the practice and research implications for this classification are discussed.
Training and Practice Implications
The themes classification proposed above seems immediately relevant to play therapists’ practice.
This classification provides a fuller working definition and classification of play themes, and a
developmental perspective. It also outlines key assumptions that therapists seem to make when
constructing themes. The classification above therefore may enable therapists to understand and
discuss more concisely the contents of their play therapy sessions, and to evaluate children’s progress against the kinds of themes expressed in therapy sessions. In addition the themes classification may help practitioners more quickly develop additional hypotheses about themes for particular
children.
The classification of themes set out above also can be useful in training practitioners to become
non-directive play therapists. By making comparisons of key experiences they have with children
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Table 1. Main Themes
Theme
Age
Trust
9
Mistrust
7
Autonomy/
Independence
5
Shame and
Doubt
4
Initiative
7
Guilt
9
Industry
8
Inferiority
9
Identity
14
Role Confusion
15
Example
Play Level
Tina a bereaved girl who is upset after playing
out burying a figure in the sand, asks her
therapist to sit nearby and hold her hand. R*
An overly active boy Josh, hides from the
therapist behind the puppet screen for several
minutes and loudly bangs on the floor, screen,
and toys near him with a wooden mallet.** R*
Crystal, previously distressed and tearful after
playing tea parties and asking her therapist to
tidy up, confidently packed everything into its
wicker basket before moving to the art table to
paint. I*
Martin continually asks his therapist which chair
he can sit on, what color of paint he can use,
which toys he can play with. R*
Dean, who in previous play therapy sessions
had deliberately spilled paint on the carpet and
challenged the therapist to ‘make him’ clean it
up, decides to pour paint only on the waterproof
mat and then clean it up before moving on to
another activity. R*
Sonya often takes the role of a child running
away from home with her younger brother.
This time they find a crying baby who has to be
silenced so that their hideout is not found. They
silence the baby, pounding its head until it stops
crying.*** I*
Vishelle, who had been severely neglected,
starts to use the scissors in the playroom after
attending play therapy sessions. She asks her
therapist to help her learn to cut, saying that she
didn’t do cutting out at school because she had
never learned how. R*
Lewis hits himself on the head with a soft mallet,
saying with despair ‘I’m no good’ repeatedly
when he becomes frustrated with a task. I*
Saul discusses with his therapist how he believes
his father’s imprisonment was justified, but it’s
difficult for him all the same because he doesn’t
know what to say to his mates about it and he
does miss his father a lot. R*.
Megan excitedly describes to her therapist her
boyfriend’s latest escape from the police, giving
details of his ensuing episodes of fire setting,
drug taking and stealing. R*
Age appropriate
*Highly ’’Relational’ (R) or highly “Individual” (I) Theme.
**This might also communicate “autonomy vs. shame/doubt” under the subtheme of “anger”.
***This example also may represent subthemes under mistrust (e. g. dying, abuse, and rejection).
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Toddler
Age appropriate
Toddler
Age appropriate
Age appropriate
Preschool
Preschool
Age appropriate
Age appropriate
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Ryan and Edge
Table 2. Trust versus Mistrust Theme, including Subthemes
Theme
Subtheme
Trust
Age
Exemplar
Play Level
9
Tina a bereaved girl who is upset after
playing out burying a figure in the sand,
asks her therapist to sit nearby and hold
her hand. R*
Connor makes sure there is a separate
area for spectators before two cars
begin a high speed road race. I*
A very traumatized and hyper vigilant
boy Alan is able to self sooth by curling
up in a tent with a baby’s feeding bottle
containing orange squash. I*
Susan makes sure a toy cat has a soft
bed and lots of milk, then sings it to
sleep I*
An overly active boy Josh, hides from
the therapist behind the puppet screen
for several minutes and loudly bangs on
the floor, screen, and toys near him with
a wooden mallet.** R*
Bonnie works at the art table in silence,
turning her back to the therapist,
thereby hiding both her face and her
painting. R*
Colin haphazardly puts all the
equipment near the sand into the sand
tray, fills the sink with water and repeats
this process in the sink with all items
in his reach, then tries to take apart
the toy clock, almost breaking it, before
going on to other similar activities I*
David plays an angry Mum who locks
the therapist, in the role of a small child,
in a cellar and then laughs when the
“child” is frightened by the noises of the
“scary” TV program the adults upstairs
are watching R*
age appropriate
Safety or Protection
8
Comfort
7
Nurturing
6
Mistrust
7
Distancing or
Rejection
9
Chaos
4
Trauma and Abuse
within Primary
Relationship
8
age appropriate
Toddler
age appropriate
Toddler
age appropriate
Toddler
age appropriate
*Highly “Relational” (R) or highly “Individual” (I) Theme.
**The same episode can simultaneously hold several thematic layers; this might also communicate the next theme, “autonomy vs. shame/doubt” subtheme of “aggression”.
during their training sessions, trainees should become better able to abstract themes in play
sessions both indirectly when using training videos, and comparing their results with those of other
trainees, and directly when using their own videos and written notes of sessions. Establishing a categorization of themes that is useful for play therapists in practice is an important goal in itself, in
addition to more general research aims discussed next.
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Clinical Child Psychology and Psychiatry
Table 3. Autonomy/Independence versus Shame and Doubt Theme, including Subthemes
Theme
Subtheme
Autonomy/
Independence
Age
Exemplar
Play Level
5
Crystal, previously became distressed
after playing tea parties, and tearfully
asked her therapist to clear away
the items. In her sixth session the
tea party ended and she confidently
packed everything into its wicker
basket before moving to the art table
to paint. I*
Sian wins the scrum in an imaginary
game of rugby and beats successive
tackles to score a try. I*
Demi uses sheets, chairs, boxes and
foam mats to build a sophisticated
freestanding “den” with three
interconnected rooms. I*
Isaac signs with a flourish the
intricate mosaic he has worked on
over two sessions. I*
Martin continually asks his therapist
which chair he can sit on, what
colour of paint he can use, which
toys he can play with.* * R*
Bronwyn plays a cruel teacher who
ignores and then ridicules a single
pupil in front of the whole class. R*
Sean, having successfully opened
several bottles of paint suddenly says
he does not know how to open the
others and asks the therapist to take
over. R*
Demetrius shouts, “I hate you” and
hits the teddy bear repeatedly with a
wooden sword. I*
age appropriate
Power
10
Mastery
9
Sense of
Completion
11
Shame and Doubt
4
Control/
Victimization
9
Weakness or
Helplessness
6
Aggression
7
age appropriate
age appropriate
age appropriate
toddler
age appropriate
Preschool
Preschool
**Example taken from Wilson and Ryan, 2005, Chapter 3.
Future Research
Research to test the classification of themes proposed here is required, as mentioned above. The first
phase in establishing a usable classification scheme for themes in NDPT is testing its reliability and
validity against practice in a pilot research project with experienced non-directive play therapists. A
more comprehensive list of exemplars for use by therapists and researchers alike has been developed
by the authors, in addition to those in Tables 1-3. Experienced non-directive play therapists already
using themes in their analyses can be given these descriptions of how to identify themes and the more
comprehensive list of exemplars under each theme and subtheme which have been developed. (The
list totaling 82 exemplars of themes and subthemes is available for researchers from the authors).
They can be asked to complete a protocol for each non-directive play therapy session conducted with
one child or adolescent from the outset to the end of their intervention. In addition, experienced play
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Ryan and Edge
therapists from other methods of therapy also can pilot this classification in their interventions in
order to test its usefulness across methods of therapy.
Research questions which seem important to investigate include:
1. Is the list complete or will it need revision? Are any new themes or subthemes required?
2. Can practitioners use this categorisation readily in their practice, or is more training/information required?
3. Do play themes correlate with diagnostic categories?
4. To what extent are the play themes applicable to directive play therapy practice?
Once a classification of themes that encompasses the main issues children have in NDPT is established, and practitioners begin using this model in their practice, a far wider range of research questions becomes possible in NDPT. Questions concerning the process of change in children’s sessions,
based on the changes in themes that emerge, can be investigated. General research hypotheses can be
posed, including: (i) that positive themes will predominate over negative ones at the end of therapy,
with the reverse for early sessions; and (ii) that children will reach developmentally appropriate play
themes by the end of their interventions. In addition, different methods of child therapy that are well
specified can be compared with NDPT for children with particular identifying problems. Once the
process of play therapy is clarified, the field will be able to conduct more tightly designed process
outcome studies, which are important for identifying mechanisms of change in therapy (APA Task
Force, 2006). This will bring NDPT further towards one of the main goals of child therapy research,
the goal of identifying “what works for whom” and when (Fongay, P. et al. 2002). In conclusion, this
article has set out a theoretical framework and a working classification scheme for play themes in
NDPT, which aims to have both clinical and research potential. It appears that play therapists have a
valuable role to play in a research program on classifying themes, with both researchers and practitioners having the shared aim of providing more effective play therapy for children, teens and their
families.
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Author biographies
Virginia Ryan is a Child Psychologist and British Association of Play Therapists (BAPT) qualified Play
Therapist/Supervisor and Certified Filial Therapist/Supervisor/Instructor. Her clinical practice concentrates on
play therapy and filial therapy for children and young people, including those referred by local authorities in the
Yorkshire, Lincolnshire and Derbyshire areas, and training/supervision in both methods of therapy. Virginia was
the director of the University of York’s previous postgraduate MA/Diploma in Non-directive Play Therapy.
Andrew Edge is a Consultant Family Therapist for Milton Keynes NHS Specialist Child & Adolescent Mental
Health Service, England. He is a British Association of Play Therapists (BAPT) qualified Play Therapist/
Supervisor and a United Kingdom Council for Psychotherapy qualified Systemic/Family Psychotherapist.
Andrew is a former MA supervisor of the University of York’s postgraduate MA/Diploma in Non-directive Play
therapy.
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