Healing through play: How does play therapy work?

Play therapy can help children explore their emotional issues and cope better
Healing through play: How does play therapy work?

As adults, when we have emotional issues or mental health problems, we are often able to recognize that something is out of sorts; sometimes, we are even able to share our emotions with others. But with children – particularly those who are very young – this may not be possible. Some children may be unable to express themselves verbally, some may be shy, and some others may not be very comfortable with sharing their problems. It is then more effective to use play, a medium that comes very naturally to the child, to explore their issues.

Play therapy is a form of psychotherapy that uses play to help children deal with emotional and mental health issues. By using play as the medium, children are able to explore their feelings and share them with the therapist or the parents.

Even as adults, we sometimes find it difficult to talk about how we feel. And children may find it more difficult to articulate this. Play is a very natural way in which a child explores the world, and find solutions to everyday problems. Just playing can also be cathartic for the child. By 'playing out' life experiences and exploring feelings through play, children can create a safe distance from their issues so that they can understand and come to terms with them, without feeling judged or being forced to change. In play therapy the emphasis is on the child and what is best for them. The therapy is child led, giving the child autonomy to take control back over their life and resolve whatever is causing distress to them, at their own pace, and through a medium which is comfortable, natural and familiar.

Lucy Bowen, Executive Director,  National Association for Play Therapy India

Play helps the therapist understand the child’s needs through a non-directive approach. Play therapy may also be used in addition to other forms of psychological assessment. Sometimes, the therapist may also use art along with play to uncover the child's emotions. Play therapy can be used to help children aged three and over.

Why play?

Most hospital and clinical settings are designed for adults. The therapist sits across the client, usually in an office set up, and asks questions that direct the conversation towards expression of the client’s problems and needs. This format may not work very well with children, who may be intimidated by the setting, and are unwilling or unable to express their emotions. 

Play therapy helps by:

  1. Creating a space that the child feels comfortable in: a room with different types of toys and play aid. The aids may include toys (for instance, a dollhouse with dolls depicting parents, grandparents and children, stuffed animals, puppets, or other toys) as well as art and craft material (paper, pens, colors, paints, and other stationery) through which the child can express themselves. The child is free to move around, explore the space and engage in any activity that they are interested in.

  2. Allowing the child's preferences and needs dictate the course of the therapy, rather than the expert's pre-determined ideas of how the therapy should progress. 

What happens during a play therapy session?

Each play therapy session lasts anywhere between 45 minutes to an hour.

During a play therapy session, the child is taken to the playroom, and asked to explore some toys that are age-appropriate. When the child is allowed spontaneous expression through play, they may pick up toys that indicate their emotional states, or draw something to share their challenges. Children from families which have conflict may draw the picture of a happy family; children who have conduct problems may pick up a gun to shoot a doll, or mimic other acts of violence using the toys provided.

The therapist observes the child play with the toys and writes down their interpretations. (In some clinical set-ups, there may be a one-way mirror that helps the therapist observe the child at play. This can be particularly useful when the child shows discomfort at being observed.) Sometimes, the child may be given a prompt or asked to perform a certain activity. At the end of the session, or after every few sessions, the therapist may speak to the child or the family to get a better understanding of the child’s expression.

Sometimes, the therapist may choose to do a group therapy session based on the child’s needs. Group therapy could involve the child playing with other children of a similar age, or with their own family.

The therapist will always follows certain guidelines during the course of the therapeutic relationship: these guidelines focus on acceptance of the child as they are, maintaining respect for the child’s ability to solve their own problems and letting the child lead the way.

This relationship establishes the trust between the therapist and child, and gives the child safety to explore and express any underlying issues. The therapist's role is not to judge or over-interpret, but rather reflect on what we see and experience with the child. The most important thing is the child's feeling of trust and safety, creating and facilitating their potential to explore themselves and bring about change - the child's process and internal healing or resolution of problems is more important than the therapist's interpretation of the play. Through their play, and with the help of their therapist, children can come to terms with confusing feelings and have a better understanding of who they are and the world around them

Lucy Bowen, Executive Director,  National Association for Play Therapy India

How does play help the therapist understand the child’s problems?

A play therapist is trained to observe the child’s behavior during the play sessions, explore issues with the child, make a diagnosis and construct activities that can help the child heal. Children naturally communicate their emotions and challenges through play, and the therapist is able to pick up on them.

  • A seven-year-old girl who had gone through sexual abuse was unable to verbalize her feelings. In the playroom, she picked up a rag doll and took off its clothes. The therapist explored this issue by gently having a conversation with her. The child eventually shared, “Uncle did this to me.” That was the first time she had ever spoken about this experience.

  • A five-year-old boy began playing with the dollhouse family at the beginning of the session. The therapist observed him picking up the baby doll and burying it in the sandpit, while putting the rest of the dolls (mother, father, son, and grandparents) together in the dollhouse. When the therapist asked the boy if he was hiding the baby doll, he responded, “This is my younger sister. Because of her, my mother hits me and doesn’t pay attention to me.” The therapist was able to understand this as a case of sibling rivalry and help the child come to terms with it.

(These narratives have been created with the help of mental health experts by taking into consideration symptoms and accounts from a cross-section of patients.)

The therapist may also speak to parents and family about their observations to understand more about the child’s issue. How often does the child exhibit this particular behavior? Do they behave like this in general across situations, or are there specific situations where this issue becomes more prominent? Using this information, the therapist can make a diagnosis and help the child cope.

What kind of problems is play therapy effective for?

Play therapy can be used to treat children with several kinds of problems. It is particularly effective for children who have:

  • Experienced physical or emotional trauma

  • Experienced physical, emotional or sexual abuse

  • Witnessed conflict or have been bullied

  • Been severely punished by teachers or authority figures

  • Witnessed armed conflicts or natural calamities

  • Been displaying behavior or conduct issues

  • Experienced significant life changes (loss of parents, parents’ divorce or separation from family)

  • Had trouble reaching developmental milestones

  • Issues with anxiety or sadness

  • Trouble coping with their immediate environment

Sometimes play therapy may also be used to asses how effective pharmacological or therapy has been with a particular child. The therapist will be able to pick up indicators from play sessions before and after treatment and compare them to understand how much the child has benefited.

It's crucial to remember that not all children undergoing problems may benefit from play therapy. The therapist makes an assessment of the child’s situation; if the child is too aggressive or hyperactive, they may require immediate intervention before this form of therapy is introduced to them.

Dr John Vijaysagar, associate professor, child and adolescent psychiatry unit, NIMHANS.

.Where is a play therapy session held?Play therapy sessions are held in playrooms, where a special environment is created to make the child feel comfortable and safe enough to express themselves. The playroom is equipped with different kinds of toys and play aids. There may be several sets of toys and games that are appropriate for different ages. Some playrooms also have one-way mirrors that enable the therapist to observe the child at play without being intrusive.

How does play therapy help the child?

Play therapy gives the child catharsis, and gives them insight into their own issues. By allowing the child the freedom to express what they’re going through, play therapy can help the child to:

  • Learn basic or advanced motor skills

  • Learn decision-making and problem-solving skills

  • Learn social skills

  • Release excess energy

  • Understand their emotions and their problems

  • Gain more confidence through self-expression

  • Enhance their imagination and creativity

Is the family involved?

Most play therapy sessions happen with the therapist and the child; or with other children, in case of group therapy. The parent may be trained to play with the child at home, or given play assignments. They may also be coached about how to interact with the child.

Sometimes, the therapist may ask the parents to attend a special family therapy or group therapy session to help enhance their understanding of their child, and ensure better rapport within the family. This is known as filial therapy.

Who can I approach for a play therapy session?

Any mental health professional (psychiatrist, psychologist or psychiatric social worker) who has had special training in play therapy can conduct a play therapy session. The therapist may work independently, or work with a hospital or institution. When you are looking for a therapist, remember to check:

  • Are they a qualified therapist?

  • Do they have experience working with children, and for extended periods of time?

It’s also important to consider how comfortable you and your child feel with the therapist, as you may be working with them for a few weeks or months.

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