child clinical psychology and play therapy

Clinical psychology includes the scientific study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries clinical psychology is a regulated mental health profession.

Clinical psychology may be confused with psychiatry, which generally has similar goals (e.g. the alleviation of mental distress), but is unique in that psychiatrists are physicians with medical degrees. As such, they tend to focus on medication-based solutions, although some also provide psychotherapeutic services as well. In practice, clinical psychologists often work in multidisciplinary teams with other professionals such as psychiatrists, occupational therapists, and social workers to bring a multimodal approach to complex patient problems.

Child experts agree that significant childhood problems—including poor bonding with parents—shape future adult work and social relationships if not treated. “Children who don't get the attention they need in the early developmental years may have a limited capacity for intimate attachments, or an inability to commit or empathize as adults,” notes Dr. Ana Badini, a psychotherapist who has treated adults and children for over 18 years.

Therapy can help children resolve current problems, as well as provide tools to cope with life challenges later on.

Child Counseling

Counseling for children is a tough process for many parents. Some feel their child doesn’t need it and choose to overlook potential problems, while others feel their child will be stigmatized for undergoing therapy.

There is also a common belief that children are resilient enough to simply “bounce back” from traumatic events or emotional issues, but this belief is dangerous. Children are often the most vulnerable to damage from trauma because they don’t fully understand what they’re going through. Child counseling gives them an opportunity to explore the issue in a safe environment with a professional who is trained to guide them through the healing process.

Types of Child Counseling

There are many types of therapy geared specifically to children. Just a few of these include:

  • Child custody counseling. When parents go through divorce, they may not always be aware of the impact a custody agreement will have on their child. A child custody therapist can help a child better understand the situation and can help parents better understand what their child may be feeling.
  • Child abuse counseling. Sadly, abuse is one of the most common reasons parents seek out child counselors. The emotional damage caused by child abuse is traumatic both for children and their parents, making specialized therapy even more important in everyone’s recovery process.
  • Bullying counseling. It’s difficult for many children to cope with bullying, and even if parents put a stop to the problem, they may not be able to undo the emotional damage their child has experienced. School counseling is often available for issues of bullying and harassment, but many other independent therapists are also available with specialized training in this area.

Benefits of Child Counseling

Children often don’t know how to express their emotions properly, and it usually takes them longer to adjust to major life changes. Though they are good at hiding their struggle, warning signs of a child in crisis can include mood swings, misbehaving in school or at home, and depression or withdrawal from daily life.

Talking to a counselor can help children vocalize their problems and get to the root of the feelings that they don’t understand, yet are causing their sadness and anxiety. It can also help control or prevent many of the symptoms listed above.

§  Finally, the process can also help parents better understand what their child is going through without feeling pressured to solve the problem or guilty because they believe themselves to be the cause. Though such counseling is primarily for the benefit of the child, it often acts as a form of family counseling, bringing all members Lydia was diagnosed with bone cancer after her eighth birthday. After enduring three years of cancer treatments, she is sad that her classmates avoid her, fearing that her cancer was contagious.

§  Paul is six years old, and he became very withdrawn after his parents separated. Struggling with a learning disability, he seldom speaks, but expresses his feelings through vivid crayon pictures.

§  At age nine, Danny complains that he can’t get rid of “bad thoughts” in his head. Every night, he compulsively counts all his toys before going to sleep.

These children are grappling with emotional pain and hardships at very early ages. Unfortunately, they are not alone—thousands of children face complex life issues that often stem from fractured, dysfunctional family structures and a fast-moving, technological society.

When Does a Child Need a Therapist?

According to the American Academy of Child and Adolescent Psychiatry, there are warning signs that indicate that your child is having difficulty, and may benefit from a psychiatric evaluation. Some of these signs are:

  • Changes in school performance, such as dropping grades, missed homework, and skipping school
  • Excessive worry or anxiety
  • Loss of interest in usual activities
  • Change in sleeping habits or frequent nightmares
  • Mood changes, including temper tantrums, depression, anger, and aggression
  • Dangerous and/or illegal behavior, including:
    • Use of alcohol, cigarettes, or drugs
    • Inappropriate sexual behavior
    • Vandalism
    • Theft
    • Fighting

Sometimes, the symptoms are vague. “Often a parent brings a child to therapy because he/she knows there is a problem, but is not sure what it is,” says Lorenzo Colon-Monroe, Director of the Den for Grieving Kids in Connecticut. “The minute you notice a change, sit down with your child and talk. If you need more help, it's never too early to start therapy.”

What Happens Inside the Therapist's Office

The most common therapeutic approach for children ages 4-11 is play therapy. In play therapy, children use dolls, art, and games to express their thoughts, experiences, feelings, and conflicts to the therapist. The therapist may observe and/or interact with the child during play, using talk or play objects to communicate.

Depending on the child's verbal abilities and maturity, talk therapy or cognitive-behavioral methods may be used with children aged 12 and older.

Before the First Session

If you've decided on child therapy, Colon-Monroe suggests that you prepare your child before the initial session. “If they don't understand why they're here, children may be fearful, anxious, or may interpret therapy as punishment,” he says. “This interferes with the initial bonding process, and can adversely affect the process.” When talking to young children, he suggests you explain that a therapist is a “talk doctor” with “no needles,” and emphasize to the child that they are free to tell the therapist any problems. Badini also suggests that parents present the therapy as “teamwork”— something that “we” are going to do together to help “us.”


If a Child Needs Medication

Certain psychological or behavioral disorders may be treated with medication as an adjunct to other types of therapy. Some conditions treated with medication include:

  • Anxiety
  • Attention deficit hyperactivity disorder (ADHD)
  • Obsessive compulsive disorder (OCD)
  • Bipolar (manic-depressive) disorder
  • Psychosis
  • Severe aggression

Although medication can help reduce or eliminate symptoms, it should not be prescribed lightly. All psychiatric medication should be prescribed by a physician experienced in treating psychiatric problems in children and adolescents, and the course of treatment should be monitored very closely by both parent and physician. If medication is recommended for your child, discuss all ramifications of the treatment with your doctor.

Counseling benefits divorced children can recieve from group counseling include things like a sence of belonging, a sence that their problems are shared with their peers and the development of positive coping skills. To get the most benefits from group therapy the right form of this therapy needs to be found. For example, while teens may benefit from peer group therapy, younger kids may benefit more from family group therapy.

In addition to group therapy options, counseling benefits divorced children can acquire can also be gained through individual counseling. Individual counseling sessions work well for young kids, teens and even for adult children of divorce. The benefits here will focus on emotional release, the development of coping skills and the ability to deal with stress.

In order to get the most out of a counseling program several factors have to be met. First of all the right counseling setting has to be selected, either group or individual. Next the right approach to the counseling experience needs to be offered by the counselor. Finally, the right match between your child and a counselor needs to be sought. When all of these things work, magic can happen.

Why Therapy? 

Unresolved problems or disorders can impede a child’s development or trigger emotional states that cause trauma for the child, the parents, and the family. The effects may be long lasting.

Child experts agree that significant childhood problems—including poor bonding with parents—shape future adult work and social relationships if not treated. “Children who don’t get the attention they need in the early developmental years may have a limited capacity for intimate attachments, or an inability to commit or empathize as adults,” notes Dr. Ana Badini, a psychotherapist who has treated adults and children for over 18 years.

Therapy can help children resolve current problems, as well as provide tools to cope with life challenges later on.

Child counselling aims to help children cope better with their emotions, understand problems, develop necessary coping skills and make positive choices. During counselling children are encouraged to explore and express their feelings through one of many media depending on the child’s individual preference e.g. talking, artwork, telling stories, drama or play.

Child counselling is helpful to:

·         Children who find it difficult to acquire social skills.

·         Children who have experienced loss through family breakdown or bereavement.

·         Children who have experienced abuse.

·         Children with low self esteem, anxiety or depression.

·         Children whose behaviours are potentially life threatening.

I think its very important to have clinical child psychology to resolve conflicts of child such as the effect of divorce on children.

Unresolved problems or disorders can impede a child’s development or trigger emotional states that cause trauma for the child, the parents, and the family. The effects may be long lasting.

Child counselling aims to help children cope better with their emotions, understand problems, develop necessary coping skills and make positive choices. During counselling children are encouraged to explore and express their feelings through one of many media depending on the child’s individual preference e.g. talking, artwork, telling stories, drama.

Child clinical psychology may have better outcomes for a healthy future for a child.



What are the techniques employed in play therapy?


Play Therapy


Play therapy is based upon the fact that play is the child’s natural medium of self-expression. It is an opportunity which is given to the child to “play out” his feelings and problems just as, in certain types of adult therapy, an individual “talks out” his difficulties. These children range in ages 4 to 12.


Play therapy may be directive in form that is the therapist may assume responsibility for guidance and interpretation, or it may be non directive: the therapist may leave responsibility and direction to the child.

Play therapy refers to a method of psychotherapy with children in which a therapist uses a child's fantasies and the symbolic meanings of his or her play as a medium for understanding and communication with the child. Because children's language development lags behind their cognitive development, they communicate their awareness of what is happening in their world through their play

Because the child's world is a world of action and activity, play therapy provides the psychologist in elementary-school settings with an opportunity to enter the child's world. In the play therapy relationship, toys are like the child's words and play is the child's language. Therefore, children play out their problems, experiences, concerns, and feelings in a manner that is similar to the process of talk therapy.

Directive vs. Non Directive Approaches


There is an ongoing debate in the play therapy field over which approach is “better” – non-directive or directive.  There are two issues of concern.  First, there is not one right way to proceed in our work with children.  Contrary to the dogmatic views of some theorists in the field, many approaches work with children.  Second, it is highly questionable that there is really any such thing as non-directive therapy.  The term “non-directive” is a misnomer.

A therapist should be fairly non-directive in the therapeutic process, often quite directive with regard to the methods used in a session, and as non directive as possible with regard to the interpretation of the material which arises during a session, and quite directive in the issues of safety and best interests of the child.

Therapists who call themselves non-directive or client-centered are often only non-directive in terms of what they do in a session.  They suddenly become very directive in interpreting and analyzing the client’s inner world and reflecting back to the child.


The goals of play therapy are to help the child with the anxiety/conflicts/symptoms that precipitated the referral to the therapist and to work with the child and family to remove any obstacles that threaten to interfere with the child's future optimal development. In the play therapy sessions techniques for engaging and communicating therapeutically with children are demonstrated as well as strategies for working with children of various ages. The purpose of employing techniques (and play materials) in play therapy is to enhance communication with the young child. The techniques must be considered as tools in the complicated process of engaging, assessing, and treating the child through play therapy.



Hanney and Kozlowska,(2002) emphasized that preschool children who are confronted with stressful situations or memories experience a physiological response of hyperarousal, which undermines their ability to utilize their developing cognitive capacity. Physiological responses of overwhelming anxiety, fear, and distraction may make many children unable to participate in family-therapy sessions because they are unable to access these traumatic memories and to verbalize their feelings.


For example a seven year old boy, in the middle of the play therapy session cried out spontaneously, “ Oh, every child just once in his life should gave a chance to spill out all over without a “Don’t you dare! Don’t you dare! Don’t you dare!” That was his way of defining his play therapy experience at the moment.


For example, a first-grade student in the sensory-motor stage may not be able to properly express that he is sad about his parents' divorce. Instead, he may demonstrate his egocentric thinking by stating his wish for his parents to attend his baseball game so that they can see how much fun they can have as a family. Another child may not even able to verbalize her emotion; instead, she may pull out pieces of her hair to display the intensity of her anguish over her parents' divorce (Myers, Shoffner, & Briggs, 2002).


The therapist realizes that non directive therapy is not a panacea. She admits that, like all things it too has its limitations, but accumulating experiences indicates that the implications of this type of therapy are a challenge and an inspiration to those who are concerned with the problems of adjustment

When a child comes for play therapy it is usually because some adult has either brought him or sent him to the clinic for treatment. He enters into his unique experience just as he enters all new experiences either with enthusiasm, fear, caution, resistance or any other manner that is typical of the way he reacts to new situations The initial contact is of great importance for the success of the therapy.

It is during this contact that the stage is set so to speak. The structuring is demonstrated to the child not merely by words, but by the relationship that is established between the therapist and the child.


The aim of play therapy is to decrease those behavioral and emotional difficulties that interfere significantly with a child's normal functioning. Inherent in this aim is improved communication and understanding between the child and his parents. Less obvious goals include improved verbal expression, ability for self-observation, improved impulse control, more adaptive ways of coping with anxiety and frustration, and improved capacity to trust and to relate to others. In this type of treatment, the therapist uses an understanding of cognitive development and of the different stages of emotional development as well as the conflicts common to these stages when treating the child.

Play therapy is used to treat problems that are interfering with the child's normal development. Such difficulties would be extreme in degree and have been occurring for many months without resolution. Reasons for treatment include, but are not limited to, temper tantrums, aggressive behavior, non-medical problems with bowel or bladder control, difficulties with sleeping or having nightmares, and experiencing worries or fears. This type of treatment is also used with children who have experienced sexual or physical abuse, neglect, the loss of a family

Children communicate their thoughts and feelings through play more naturally than they do through verbal communication. As the child plays, the therapist begins to recognize themes and patterns or ways of using the materials that are important to the child. Over time, the clinician helps the child begin to make meaning out of the play. (S. Villeger)

At times, children in play therapy will also receive other types of treatment. For instance, youngsters who are unable to control their attention, impulses, tendency to react with violence, or who experience severe anxiety may take medication for these symptoms while participating in play therapy. The play therapy would address the child's psychological symptoms. Other situations of dual treatment include children with learning disorders. These youngsters may receive play therapy to alleviate feelings of low self-esteem, excessive worry, helplessness, and incompetency that are related to their learning problems and academic struggles. In addition, they should receive a special type of tutoring called cognitive remediation, which addresses the specific learning issues.

Techniques Employed In Play Therapy


The basic principles which guide the therapeutic contacts are very simple, but they are great in their possibilities when followed sincerely, consistently, and intelligently by the therapist.

 The principles are as follows for the therapist:

The therapist must develop a warm and friendly relationship with the child.

The therapist must accept the child as she or he is.

The therapist must establish a feeling of permissiveness in the relationship so that the child feels free to express his or her feelings completely.

The therapist must be alert to recognize the feelings the child is expressing and reflects those feelings back to him in such a manner that the child gains insight into his/her behaviour.

The therapist must maintain 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.

 The therapist does not attempt to direct the child’s actions or conversations in any manner.  The child leads the way, the therapist follows.

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.




The word structuring is used in this instance to mean the building- up of the relationship according to the foregoing principles so that the child understands the nature of the therapy contacts and is thus able to use them fully. Structuring is not a casual thing, but a carefully planned method of introducing the child to this medium of self- expression which brings with it release of feelings and attendant insight. It is not a verbal explanation of what this is all about, but by establishing the relationship.


The relationship that is created between the therapist and the child is the deciding factor in the success or failure of the therapy. It is not an easy relationship to establish. The therapist must put forth a sincere effort to understand the child and to check constantly her responses against the basic principles and to evaluate her work with The relationship that is created between the therapist and the child is the deciding factor in the success or failure of the therapy. It is not an easy relationship to establish. The therapist must put forth a sincere effort to understand the child and to check constantly her responses against the basic principles and to evaluate her work with each case so that she too grows in her understanding of the dynamics of human behaviour.



Desirable Characteristics of the Playroom


Some desirable characteristics of the playroom have to be present that are suitable so that the child can comfortably play within the room. It is desirable to have a room set aside and furnished for the playroom however, this is not absolutely necessary. They are vast possibilities of utilizing play therapy techniques with a very small budget and space appropriations.


Many psychologists have carried out play therapy in the corner of a regular schoolroom; some in the corner of an unused nursery with the therapist bringing the play materials in a suitcase for each meeting. If money and space are available to furnish a special play therapy room is should have the following list of things:

 The room should be sound proofed if at all possible. There should be a sink in the room with running hot and cold water.

 The windows should be protected by gratings or screens.

 The walls and floors should be protected with a material that is easily cleaned and that will withstand clay, paint, water, and mallet attack.

If the room can be wired for phonographic recordings and provided with a one way screen so that observations can be made without the child being aware of the observer. This equipment should be used only for the furtherance of research and as a teaching aid for student therapists.

 The parents do not need to observe the therapy contacts or listen to the phonographic recordings of the play sessions.


Play materials which have been  used with varying degrees of success include nursing bottles, a doll family, a doll house with furniture, toy soldiers and army equipment, toy animals, playhouse materials, including table, chairs, cot, doll bed, stove, tin dishes, pans, spoons, doll clothes, clothesline, clothespins, and clothes basket.

A didee doll, a large rag doll, puppets, a puppet screen, crayons, clay, finger paints , sand, water, toy guns, pegpounding sets, wooden mallet, paper dolls, little cars, airplanes, a table, an easel, an enamel top table for finger painting and clay work, toy telephone, shelves, basin, small broom, mops, rags, drawing paper, finger painting paper, old newspapers, inexpensive cutting paper, pictures of people, houses, animals and other objects and empty berry baskets to smash.

Checker games have been used with some success but are not the best type of material for expressive play. Likewise mechanical toys are not suggested because the mechanics often get in the way of creative play.


If it is not possible to secure all the suggested materials a beginning can be made by furnishing a doll family and a few pieces in proper scale, including beds, tables and chairs, nursing bottles, clay, toy gun, toy soldiers, a toy car, puppets, a rag baby doll, and a telephone. These materials can be packed in a suitcase and carried about with the therapist.

Floortime Therapy.

 Floortime is a play-based technique which builds on autistic children's own interests or obsessions to develop relationships and social/communication skills.

The Play Project is another therapeutic approach which uses play as a tool for building skills in autistic children. Like Floortime, it builds on children's own interests.

It is possible to be officially credentialed in Floortime therapy through a certification program that includes a wide range of content

Sandtray or Sandbox Therapy is a form of experiential workshop which allows greater exploration of deep emotional issues. Sandplay therapy is suitable for children and adults and allows them to reach a deeper insight into and resolution of a range of issues in their lives such as deep anger, depression, abuse or grief.

Through a safe and supportive process they are able to explore their world using a sandtray and a collection of miniatures. Accessing hidden or previously unexplored areas is often possible using this expressive and creative way of working which does not rely on “talk” therapy.

"Sand Tray participants are invited to create a diorama (a story or miniature world) by arranging toy people, animals, and other items in the sandtray. The therapist evaluates the participant's choice and use of objects to draw various conclusions about the subject's psychological health. This non-invasive method works especially well with those individuals who are young or have trouble comprehending and talking about difficult issues, such as domestic or child abuse, incest, or the death of a family member."

Traditional Play Therapy:

Traditional play therapy is child-centered. The play takes whatever direction the child chooses. The therapist takes on whatever role the child assigns. Rather than teaching or changing behavior directly, traditional play therapy provides a safe environment for the child to act out and release his or her emotional conflicts.

Cognitive-Behavioral Play Therapy:

Cognitive-behavioral play therapy follows the same principles as traditional cognitive-behavioral therapy. It is generally a short-term therapy with the specified goals of changing the child’s automatic thoughts and reactions in order to stop the phobic reaction.

In cognitive-behavioral play therapy, the therapist enters into the play world and gains the acceptance of the child. Once that happens, the therapist begins to gently guide the play. The toys are used to model different reactions and teach the child new ways of thinking.

All playthings should be simple in construction and easy to handle so that the child will not be frustrated by equipment which he cannot manipulate. Moreover, they should be durably constructed, designed to withstand strenuous handling in the playroom. The doll house should be made of light weight wood, with removable and variable partitions and should be furnished with sturdy wooden furniture that can be tossed about, bombed, and even stood upon, and still remain relatively intact. The doll family should be as unbreakable as possible and outfitted with removable clothes. Very satisfactory doll families can be made from pipe cleaners, wrapping the pipe cleaners with cotton and securing it with adhesive tape to give them body. The heads can be made of little cotton stuffed cloth balls. There should be mother, father, brother, and sister, baby and grandparents dolls to equip the child with all possible family symbols. The hand puppets or mitten dolls as they are sometimes called can also be made out of cloth, using cotton stuffed heads and yarn hair. The puppets too should include all possible family characters.


A large sand box serves as an ideal setting in which to place the doll house and family, the toy soldiers, animals, cars and airplanes. Moreover, the sand is an excellent medium for the children’s aggressive play. It can be thrown about with comparative safety. The dolls and other toys can be buried in it. It can be snow, water, burying ground or bombs. It can readily keep pace with the most elastic imagination.  If the sand box is placed flat on the floor and has a seat built part way around it, it is more accessible to children of all sizes than a sand table would be.


If the room is large enough it is desirable to have a stage built into one end of, with an elevation of about eight inches. This should be furnished with child- sized playhouse furniture, which should also meet the standards of durability, thus giving the children the advantage of having a playhouse unit as well as a stage for dramatic offerings. The slight elevation is not absolutely necessary but does have the effect of setting aside the playhouse unit plus it seems to inspire dramatic efforts. The possibilities of psychodramatics seem worthy of further research as a medium for therapy.


The materials should be kept on shelves which are easily accessible to the children. The writer believes that better results are obtained when all play materials are a view and the child can choose his own medium for expression than when the therapist places certain selected materials on the table before the child and then sits quietly by, awaiting the child s non-directed play. However some therapists prefer to use a minimum of materials and have observed interesting results with materials which they have selected for the child.


It is the responsibility of the therapist to keep a constant check on the materials, removing the broken toys and keeping the room in order. If the room is used by several therapists, each one has the added responsibility of seeing that the playroom is left in order so that one child's play effects will not be suggestive to the child that follow him. For example if the sand box is used as a replica of home set up by one subject, it should never be left in a state of chaos for the next play therapy subject. The paints and clay should be kept clean and sanitary. If the paint colours become, smeared they should be freshly mixed. The nursing bottles should be kept sterile. All pictures and clay work should be removed from the playroom at the end of each session so that the room is always free from suggestive use of materials.


Due to the nature of some of the play materials, it is suggested that the child be provided with a coverall to protect his clothes; this may be furnished either by the parent or by the therapist. The child should feel free to use the materials in any way that he desires, within the few limitations that are set up, without being restricted by a fear of soiling his clothes.


Play Therapy for Children with Attention Deficit and Disruptive Behavior Disorders

This focuses on using play therapy with children who are diagnosed with Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders such as Oppositional Defiant Disorder and Impulse Control Disorder NOS. Emphasis will be placed on learning play therapy techniques that target the primary symptoms of these diagnoses. In addition, differential diagnosis and comorbidity will also be addressed. Adjunctive resources and concrete methods for working with parents and school personnel in a manner that assists in the generalization of skills learned through play therapy will also be explored.

ADHD) has been a significant diagnosis for well over a decade. Kaduson and Finnerty (1995) conducted a study with sixty-three children between the ages of eight and twelve. The authors compared three groups of children diagnosed with ADHD using a game (Self-control Game) for one group, biofeedback for another and a control strategic game only in the final group. Results indicated biofeedback was the most effective in improving the child’s self-perception of self-control. All three groups indicated a significant improvement in sociability and attention. Peer play therapy groups combined with art therapy groups, and family play therapy groups combined with art therapy groups, have been shown (Springer, et al., 1992) to improve depression and hyperactivity scores, in both boys and girls, according to the ‘Child Behavior Checklist in children who have at least one parent who is suffering from alcohol or drug dependency. Additionally, aggression and delinquent behaviors significantly decreased in boys. The study included 132 subjects between the ages of seven and seventeen. Over the past two decades there has been a concerted effort to develop and implement well-designed controlled play intervention studies. Two meta-analytic studies have examined the effectiveness of play therapy with children (e.g., LeBlanc & Ritchie 1999; Ray, Bratton, Rhine, & Jones, 2001). LeBlanc and Ritchie’s meta-analysis included 42 experimental studies, dated from 1947 to 1997.

What Does a Play Therapist Do for Children with Autism?

A good play therapist will get down on the floor with your child and truly engage him through the medium of play. For example, the therapist might set out a number of toys that a child finds interesting, and allow her to decide what, if anything, interests her. If she picks up a toy train and runs it back and forth, apparently aimlessly, the therapist might pick up another train and place it in front of the child's train, blocking its path. If the child responds -- verbally or non-verbally -- then a relationship has begun.

If the child doesn't respond, the therapist might look for high-interest, high-energy options to engage the child. Bubble blowing is often successful, as are toys that move, squeak, vibrate, and otherwise do something.

Over time, the therapists will work with the child to build reciprocal skills (sharing, turn-taking), imaginative skills (pretending to feed a toy animal, cook pretend skills) and even abstract thinking skills (putting together puzzles, solving problems). As a child becomes better able to relate to others, additional children may be brought into the group, and more complex social skills are developed.

Many parents find they can do play therapy on their own, using videotapes and books as a guide. Others rely on the experience of trained play therapists. And still others choose to simply bring their children to a play therapist or have the therapist come to their home. In any case, play therapists can provide parents with tools to connect with and have fun with their children on the autism spectrum.


Children sometimes return to therapy for additional sessions when they experience a setback that cannot be easily resolved.

Normal results

Normal results include the significant reduction or disappearance of the main problems for which the child was initially seen. The child should also be functioning adequately at home, in school, with peers and should be able to participate in and enjoy extracurricular activities.

Abnormal results

Sometimes play therapy does not alleviate the child's symptoms. This situation can occur if the child is extremely resistant and refuses to participate in treatment or if the child's ways of coping are so rigidly held that it is not possible for them to learn more adaptive ones.


Play therapy is not an approach based on guess, trial and error, or whims of the play therapist at the moment. Play therapy is a well-thought-out, philosophically conceived, developmentally based, and research-supported approach to helping children cope with and overcome the problems they experience in the process of living their lives. Play therapy has been demonstrated to be an effective therapeutic approach for a variety of children's problems including, but not limited to, the following areas: 

  • abuse and neglect 
  • aggression and acting out 
  • attachment difficulties 
  • autism 
  • burn victims 
  • chronic illness 
  • deaf and physically challenged children 
  • dissociation and schizophrenia 
  • emotionally disturbed children 
  • enuresis and encopresis problems 
  • fear and anxiety 
  • grief 
  • hospitalization 
  • learning disabilities 
  • mentally challenged children 
  • reading difficulties 
  • selective mutism 
  • self-concept and self-esteem 
  • social adjustment problems 
  • speech difficulties 
  • traumatization 
  • withdrawn children 

The popular myth that play therapy requires a long-term commitment for many months is unfounded as is shown in case studies and research reports reported by Landreth, Homeyer, Glover, and Sweeney (1996) in their book, Play Therapy Interventions with Children's Problems

Some examples of problems typically able to be improved and resolved through child play therapy include

Separation or Divorce – Often children are greatly affected by the dissolution of their family unit, occasioned by the separation or divorce of their parents.  These circumstances are sometimes exacerbated by the child being moved frequently from one residence to another or by being placed in the middle of parental discourse.  This can often be extremely difficult for a child who loves both parents and does not comprehend all of the complicated issues surrounding this extraordinary life change. Play therapy will assist children in this situation to acknowledge their concerns and develop strategies to help them manage the inevitable stress of these situations, while simultaneously developing skills that will be relevant and effective throughout their childhood and into their adult lives.

Life Transitions Children often have serious difficulties with transition, whether it be attending a new school, moving to a new neighborhood, a new home or a new city. It is imperative that they are able to pinpoint the root of their stress, and develop methods to recognize, express and cope with their feelings.

Birth/Adoption of a Sibling or Blending of a Family Adding a new member to any family will certainly offset the balance in the family and can also cause children significant stress and anxiety. Children may feel insecure and threatened by the necessity to share attention with the new baby or children. It is imperative that they are able to pinpoint the root of their stress, and develop methods to recognize, express and cope with their feelings.  These skills will help them in the immediacy of the situation, but will also carry forward into their adult lives.

Special Issues Facing Adopted Children  There are often unique issues and challenges which adopted children face, including fears of abandonment, rejection, detachment, and in certain cases, issues associated with being from a different culture, looking and feeling dissimilar from your family, etc. Therapy can help parties address these concerns directly and can help adoptive parents better understand and handle these complex and often very painful issues.

Power Struggles/Temper Tantrums While testing limits is a normal part of childhood, the resulting power struggles can also be a complex and difficult issue for both parents and children. Therapy can help parents better understand a child’s desire and need to feel in control and find ways to relinquish and allow a child to have some control, thus hopefully helping to avoid these difficult situations. Therapy will also provide the tools necessary to effectively manage a tantrum should one occur and help parents manage their own feelings and reactions.

From a play therapy perspective, there is growing support for combining different theoretical models in a clinically grounded, integrated manner to address the needs of children, including those impacted by abuse and trauma (Gil, 2006; Kelly & Odenwalt, 2006; Kenney-Noziska, 2008b).  The emphasis is placed on responding to the child’s needs versus strict allegiance to one theoretical school of thought.  Being responsive to the child and adapting the therapeutic approach according to the child’s needs becomes essential and creates the context from which the therapist operates (Gil, 2006).

As a result, dedicating clinical attention to this area is an important step.  Play-based interventions can assist in this area. 

        For example, the intervention “Ice Breaker” (Kenney-Noziska, 2008a), a modified version of the game Don’t Break the Ice (Milton Bradley), provides a play-based medium for the therapist and child to get acquainted by sharing information about themselves based on the color of the sticker on the underside of the game’s ice cubes.

         Another intervention, “All Tied Up” (Kenney-Noziska, 2008a), highlights the importance of addressing and processing abusive and traumatic events using a large puppet or stuffed animal which is tied up in yarn labeled with symptoms depicted in the therapeutic story “Brave Bart: A Story for Traumatized and Grieving Children” (Sheppard, 1998).  This serves to symbolize the need to address symptoms and issues via treatment to avoid being “all tied up.”  Until these symptoms are explored and addressed, the individual remains “all tied up” with the problems.

Emotional Expression

        One empirically supported component in child mental health is providing skills for emotional identification, processing, & regulation (Saunders, Berliner, & Hanson, 2004).  The literature suggests that people who use words to describe internal states are more flexible & capable of regulating emotions in a more adaptive way (Siegel, 2007).  It is important to note that many verbal children have difficulty with words denoting emotions (Knell, 2009) & adolescents often suffer from a limited feelings vocabulary (Friedberg & McClure, 2002).  Subsequently, activities which are geared toward facilitating emotional expression are essential components of our work. 

        Since many clients avoid discussing distressing emotions, Revealing Your Feelings” (Kenney-Noziska, 2008a) was developed to facilitate emotional expression of “hidden” feelings. The therapist uses the “invisible” marker from the package of Crayola Color Changeable Markers to write various feelings inside shapes (i.e. squares, circles, triangles, etc.). Players take turns coloring a shape with one of the Color Changeable Marker, revealing the feeling word written inside the shape.  Each feeling is discussed and processed.

Feelings Hide-and-Seek” (Kenney-Noziska, 2008a), a therapeutic version of the childhood game hide-and-seek, is another technique to facilitate emotional expression. In this activity, feelings are initially hidden, and through the course of hide-and-seek are found and discussed. Feelings are written on index cards that are hidden at varying levels of difficulty around the room. Players take turns finding the hidden feeling cards and processing a time they experienced the emotion written on the card.

Assessment and Diagnosis

Treatment planning depends on the accurate assessment of the child’s development across areas of functioning and an accurate psychological analysis of the child’s actions during play.

Steward, Farquher, Dicharry, Glick and Martin (1986) describes a group treatment model for young victims of physical/ or sexual abuse that is open ended, allowing new group members to begin at any time in the treatment process. The model utilizes a nondirective play therapy approach identifies treatment length as 8 months to 2 years. This treatment goals focus on both healing the wounds of the past and meeting the child’s emotional needs in the present future.

However a directive approach, with sexually abused children has been endorsed (Salter,1988& Cunningham1995, Cohen,2009) as a means of ensuring that trauma issues are specifically addressed in order to bring about a decrease in symptoms and in the child’s risk of future abuse. Friedrich(1991) advocates a treatment approach that is specific should be sensitive to the child’s needs and should emphasize the interpersonal.


Contemporary play therapy embraces both nondirective as well as directive approaches.  Play therapy is far more than mere “play” and it is essential therapists remain informed of the empirical literature and use information in their practice.  The emphasis is on using empirical information in a manner which informs the play-based interventions utilized in practice.  As therapists accompany children and adolescents on their journey of healing, the incorporation of empirically-informed play therapy interventions into practice may serve to support the therapeutic process. Child centered play therapy focuses on the child. Play-based interventions serve to create a therapeutic process which is developmentally appropriate, engaging, and effective at addressing many clinical issues.  To accomplish this, interventions utilized must be clinically grounded and informed by the literature and research which guides the field to serve the clients. All family members in play therapy interventions are free to work on specific self-identified problems.