Critical Reviews of Play Therapy

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Hi all,

I'm in an adult-oriented program, and have no exposure to literature on efficacious treatments for childhood problems.

I'm wondering if anyone in a research-oriented program knows how efficacious Play Therapy is, notably for internalizing symptoms in small children (e.g., 5-8)? The few metas I read concluded that play therapy appeared to be as effective as non-play therapies in treating children experiencing emotional difficulties.

I'm skeptical because the general description of play therapy is, "A play therapist observes a client playing with toys (play-houses, pets, dolls, etc.) to determine the cause of the disturbed behavior." That sounds heavily subjective, much like inkblot tests. I understand that cognitive capacity is limited at age six, and that restricts the child's ability to articulate feelings and problems, but there must be something more objective available for anxiety and depression?

Can anyone shed any light onto this?

Thanks in advance!

I'd be interested in any takes people have on it's efficacy as well, but my understanding from all I've read is that it's considered to be empirically supported, but I'm not sure how strong the support is. It may be a little murky at times because play therapy can come in many forms. For example I have a professor who engages in medical play with children at a hospital. It gets them used to doctors, surgical masks, needles, etc. and is (according to her) extremely effective for dealing with that type of anxiety. That's sort of a more CBT based approach to play therapy though, and it's very different then just looking at the ways in which a child has her dolls relate to each other when she plays with them.

Overall it can be subjective, although that's true of many forms of therapy. But I'd say that it's much less subjective to make judgements based on, for example, the fact that a child is continually acting out scenes of violence with her dolls, then the fact that someone saw a lot of flowers in an inkblot.

Originally Posted by Sobe203

Hi all,

I'm in an adult-oriented program, and have no exposure to literature on efficacious treatments for childhood problems.

I'm wondering if anyone in a research-oriented program knows how efficacious Play Therapy is, notably for internalizing symptoms in small children (e.g., 5-8)? The few metas I read concluded that play therapy appeared to be as effective as non-play therapies in treating children experiencing emotional difficulties.

I'm skeptical because the general description of play therapy is, "A play therapist observes a client playing with toys (play-houses, pets, dolls, etc.) to determine the cause of the disturbed behavior." That sounds heavily subjective, much like inkblot tests. I understand that cognitive capacity is limited at age six, and that restricts the child's ability to articulate feelings and problems, but there must be something more objective available for anxiety and depression?

Can anyone shed any light onto this?

Thanks in advance!

I'm going to speak about play therapy- but a side note is that I only have co-workers who use it, as I don't work with children.

The play therapists that I practice with don't just watch kids playing and interpret their behavior. They use play as a format to communicate with the child. For example, they will make up games to talk about how to de-escalate anger, or how to tell mom there's a problem. Or, they will use a game or dolls to talk about what they are feeling, what made them sad, and what to do, etc. In that sense, it is not at all interpretive- its just using play to help articulate things that the child may not on their own be able to articulate. Does that make sense?

Similarly, the Rorschach is the same way. No one card is taken and used in isolation and interpreted... "oh, this person had an explosion in a picture, they must be bottling up emotions..." Instead, its looking at themes and the whole- especially in combination with other measures (sometimes objective personality, sometimes mood related measures...) to put an overall picture together.

Does that make sense?

It just like an adult art therapist using art with a client to help them articulate something they may not have felt able to say in words...

Originally Posted by ClinPsychEnthus

The play therapists that I practice with don't just watch kids playing and interpret their behavior. They use play as a format to communicate with the child. For example, they will make up games to talk about how to de-escalate anger, or how to tell mom there's a problem. Or, they will use a game or dolls to talk about what they are feeling, what made them sad, and what to do, etc. In that sense, it is not at all interpretive- its just using play to help articulate things that the child may not on their own be able to articulate. Does that make sense?

That is exactly how I have seen play therapy used at my clinic as well. I have also seen children groups run where the first 15-20 minutes is spent practicing/learning a skill (such as anger de-escalation) then they kids play for the rest of the time, with the therapists chiming in like coaches when there is a chance for the child to use the technique in vivo.

That's not to say that sometimes interpretation isn't appropriate. I have done a little work with kids and I found that if you have dolls/people-like toys around with kids who have suffered sexual abuse you'll know it pretty quickly by how they play, how they position the dolls, etc.

In my M.Ed. program there were two main texts which might help, Play Therapy: Basics and Beyond by Terry Kottman, and The Creative Arts in Counseling by Samuel Gladding (it had a decent chapter on play therapy, among other techniques). If I remember these texts cited sources pretty frequently, so if you could find them you could look through their references sections. I don't have them anymore or I would just message you the references.

I would be careful drawing comparisons to the use of art/art therapy with adults, which actually has very weak support (at least last I checked). I avoid working with children, so am not familiar with play therapy though what little I do know seems to suggest that is at least efficacious in research (though perhaps moreso than other therapies, I would have concerns about whether that will translate to how people actually implement it in day-to-day practice).

Thanks for explaining Play Therapy in greater depth! I'd heard from a few Ph.D.-level clinicians that Play Therapy is ineffective, notably for treating ADHD, so I was surprised when I began finding so much empirical support for it.

Ollie - You are correct - I am sure everyone implements it differently.

I'd never stand by the Rorschach, though - Poor inter-rater reliability for one, and many scoring systems, which likely means poor validity.

Well just because play therapy is effective in general doesn't necesarily mean that it's effective for treating ADHD. That's a lot different then just having externalizing/internalizing symptoms. I'm not at all up on that area of research.

There are board games that try to teach children to be less impulsive and to stop and think. I usually think of them as being more akin to manualized CBT treatments then to play therapy, but again the line may be a little blurry. I could imagine them being useful for some symptoms of hyperactive type ADHD. I'm not sure how evidence based games like that are though, although they are certainly popular.

As a final note on play therapy, sometimes it is your only real option. I've done mandated counseling with 3 year old children with a variety of issues, and I'm not sure what other form of therapy I could possibly use there. Many have very limited language even by the standards of a 3 year old.

Originally Posted by Sobe203

Thanks for explaining Play Therapy in greater depth! I'd heard from a few Ph.D.-level clinicians that Play Therapy is ineffective, notably for treating ADHD, so I was surprised when I began finding so much empirical support for it.