Play Therapy Explained

Play therapy is a psychological treatment for children. Play, not talking, carries the work of the session. It is not one method. Several approaches share the name, and they differ in theory, in how far the therapist leads, and in how much research stands behind them.

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What play therapy is

The Australian Psychological Society lists play therapy among evidence-based psychological interventions. It describes the method as using play to engage children in therapy in language and context suited to their age¹. Two things follow from that. It is psychological treatment, not something beside it. And the medium is picked to fit the child, not adult habit.

Play in a therapy room is not play at home. The room, the materials and the therapist's responses are chosen for a purpose. The therapist is trained to read what the play is doing. Landreth, whose book is the standard text in the field, writes that in play therapy the toys work like the child's words and the play works like the child's language².

The phrase covers several approaches. Anyone offering play therapy is offering one of them. The difference between them matters more than the label does, and this page keeps returning to that.

Why play instead of talking

The obvious objection is fair. If therapy works by talking, why would playing do the same job for a child who can already speak?

The answer is developmental. A child may have lived through something they cannot yet put into words. Sometimes the words are not there. Sometimes saying it plainly is too much. Play lets them set it out anyway. Landreth cites Piaget, who argued in 1962 that play bridges the gap between concrete experience and abstract thought³.

Symbols also put distance between the child and the material. A frightening event can be handled as something happening to a doll. It can be handled again the next week. The child never has to name it as their own.

Kaplan and Sadock write on treating children who have been maltreated. They note that some children need play, artistic or other projective techniques to reach material that ordinary conversation does not⁴. So the play is not a warm-up to the real work. It is where the work happens.

Where the approach came from

Play therapy has a traceable history. Knowing it explains why two practitioners can describe the same work so differently.

The first published case describing the therapeutic use of play was Freud's report in 1909 on Little Hans, a 5-year-old boy with a phobia⁵. The method then grew up inside child analysis. Klein treated a child's play activities as being as motivationally determined as the free associations of adults, and interpreted them on that basis⁶. Anna Freud used play differently. For her it built the child's attachment to the therapist first, before any interpretation.

A second tradition came out of client-centred work. It moved the other way, away from interpreting and towards following. Writing in 1951, Dorfman reports early process research, based on four cases, in which 75 per cent of therapist responses fell into the nondirective category⁷.

Both are still practised today.

The two main traditions

Searches for types of play therapy turn up brand names: child-centred, directive, filial, Theraplay, sandtray. The list is less useful than the division underneath it.

The interpretive tradition. The therapist watches the play for meaning. At some point that meaning is put into words for the child. This is the line running from Klein's work with young children.

The non-directive tradition. Here the therapist follows rather than leads. Change is expected to come from the relationship and from the child's own direction, not from insight an adult supplies. Landreth describes the aim as a feeling of permissiveness, where allowing the child to make choices is what creates it⁸. Landreth describes warm caring and acceptance as receptiveness to the child's experiential world, which lets the child learn the therapist can be trusted⁹.

Named approaches sit inside those two, or borrow from both. This page does not summarise each variant, because the sources behind it will not carry a claim-by-claim account of every one. Ask a practitioner which tradition they work in. That tells you more than the brand name does.

What a session involves

Sessions are more structured than they look.

The room is set up in advance. In Landreth's account of the playroom, materials are selected to serve six functions, among them reality testing of limits, the development of self-understanding and the development of self-control¹⁰. Sand, puppets, dolls and paint are there for what a child can do with them. Not because children like them.

The therapist's attention is the other half. Landreth describes a session as 45 minutes of the therapist's complete and undivided attention¹¹. Few children get that anywhere else.

Parents are normally seen too, though usually apart from the child's session. Dorfman records that a child rarely refers themselves for therapy, and is usually in the playroom because they have displeased or worried some adult¹². The adults who brought the child are part of the picture from the start. A therapist who never speaks to them is working with half the information.

What the evidence shows, and where it is thin

An honest page has to slow down here.

There is controlled research, and some of it is good. A handbook published by the American Psychological Association reviews that literature. Garza and Bratton found in 2005 that among 29 Latino/a children with behaviour problems, those given 15 sessions of child-centred play therapy showed significantly greater decreases in externalising behaviour than a comparison group¹³. Similar findings repeat across other samples of children referred for behaviour adults find difficult.

Three limits are worth holding onto.

• The strongest findings concern behaviour, especially the outward, disruptive kind. They are not findings about school performance, and this page claims none.
• Samples are often small. A study of 29 children is a real result. It is not a large one.
• The evidence attaches to particular approaches studied under supervision, most often child-centred play therapy. It does not transfer automatically to whatever a given practitioner means by the phrase.

For some presentations, better-tested options exist. The National Child Traumatic Stress Network reports 25 randomised controlled trials of trauma-focused cognitive behavioural therapy, with children's PTSD and related difficulties improving in 8 to 25 sessions¹⁴. A therapist who can say why play therapy suits your child, rather than that it is what they offer, is telling you something worth hearing.

Who it suits, and who it does not

Play therapy is usually offered to children old enough to play symbolically and not yet ready to use talking therapy well. They are often brought after a loss or a family change. Sometimes they are aggressive, or withdrawn. Sometimes something is wrong and nobody can get them to explain it.

The real limits are clinical, not practical. Landreth counts short-term play therapy as 10 to 12 sessions or fewer, and says it is not appropriate for every child. He is explicit that children who have experienced prolonged abuse or trauma, and those with severe emotional problems, need longer-term therapy¹⁵.

Pace is its own limit. Landreth notes that children seldom make sudden breakthroughs in play therapy, and that growth is a slow process¹⁶. A parent expecting visible change after three sessions may be disappointed by treatment that is working normally.

On adolescents, be careful. The sources behind this page describe work with children. Whether a play-based approach suits a teenager is a question for the practitioner, and it should be asked directly.

Who counts as a play therapist

Most explainers skip this part. It is the part that changes what you do next.

Play therapy training is added on top of a professional qualification. Landreth lists graduate coursework, workshops and observing experienced play therapists as prerequisites in learning to be a play therapist¹⁷. Supervised practice matters most. In this field supervision is not a formality. It is how the training is done.

Underneath the training sits a registration, and that is what a member of the public can actually check. Take Australia as a worked example. Ahpra describes its main role as protecting the public by making sure that only practitioners who are suitably trained and qualified are registered¹⁸. Psychology Board of Australia states that general registration allows psychologists to work in any area of psychology that falls within their scope of practice¹⁹. Other countries organise this differently, and your register may go by another name entirely.

The practical consequence holds anywhere. Find out which regulated profession the person belongs to, and confirm they are on that register. Then ask separately about their play therapy training. Those are two questions, not one.

Questions worth asking before you book

• Which register are you on, and under what profession?
• What play therapy training did you do, and who supervised it?
• Which tradition do you work in, following the child or interpreting the play?
• Why this approach for my child, rather than another one?
• How will we know whether it is helping, and when would you say it is not?
• How will you involve me, and what will you tell me about the sessions?

A practitioner who welcomes those questions is showing you how they work. You can search for a registered therapist through the TherapyRoute directory.

Frequently asked questions

How long does play therapy last?

There is no fixed course. Play therapy is often short, and a longer course is a clinical decision rather than a delay. Ask at the start how progress will be reviewed.

Will I be involved in my child's sessions?

Usually yes, though not often inside the session itself. Practice varies between therapists. Ask how this one works with parents before you start.

Can it help with school and learning problems?

The controlled research cited here is about behaviour, not academic results. Where school problems follow from distress or difficult behaviour, that is worth discussing. Treat any promise about grades with caution.

Is it suitable for teenagers?

The texts and evidence behind this page concern children. Some practitioners adapt play-based and creative methods for adolescents. Ask about it directly rather than assuming either way.

Is play therapy just supervised playing?

No. The materials are selected to develop self-control and self-understanding¹⁰ among other things. The therapist is trained to read the play. And the work sits inside a recognised psychological treatment.

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References

1. [1] Evidence-based Psychological Interventions in the Treatment of Mental Disorders, 4th edition. Australian Psychological Society. psychology.org.au.
2. [2] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 9 Parents as Partners in Play Therapy (pt 2) (pp 176-183).
3. [3] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 2 The Meaning of Play (pt 2) (pp 38-45).
4. [4] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2): Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017, vols 1+2), 55.2: Child Maltreatment (pt 5) (pp 9775-9780).
5. [5] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 3 History and Development of Play Therap (pt 1) (pp 50-57).
6. [6] Rogers - Client-Centered Therapy (1951): Rogers - Client-Centered Therapy (1951), pages 251-260 (pt 1) (pp 251-258).
7. [7] Rogers - Client-Centered Therapy (1951): Rogers - Client-Centered Therapy (1951), pages 281-290 (pt 1) (pp 281-288).
8. [8] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 11 Beginning the Relationship: The Child’s Time (pt 1) (pp 218-225).
9. [9] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 5 Child-Centered Play Therapy (pt 3) (pp 92-99).
10. [10] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 10 The Playroom and Materials (pt 2) (pp 200-207).
11. [11] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 7 The Play Therapist (pt 1) (pp 132-139).
12. [12] Rogers - Client-Centered Therapy (1951): Rogers - Client-Centered Therapy (1951), pages 271-280 (pt 2) (pp 279-280).
13. [13] Cain, Keenan & Rubin - Humanistic Psychotherapies: Handbook of Research and Practice (2nd ed, 2016, APA): Cain, Keenan & Rubin - Humanistic Psychotherapies: Handbook of Research and Practice (2nd ed, 2016, APA), Chapter 12 Humanistic Psychotherapy With Children (pt 2) (pp 413-420).
14. [14] Trauma-Focused Cognitive Behavioral Therapy | The National Child Traumatic Stress Network. nctsn.org.
15. [15] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 18 Intensive and Short-Term Child-Centered Play Therapy (pt 2) (pp 426-433).
16. [16] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 17 Determining Therapeutic Process and Termination (pt 1) (pp 392-399).
17. [17] Landreth - Play Therapy: The Art of the Relationship (2012): Landreth - Play Therapy: The Art of the Relationship (2012), 8 Supervision and Play Therapy Training (pt 1) (pp 158-165).
18. [18] Australian Health Practitioner Regulation Agency - Register of practitioners. ahpra.gov.au.
19. [19] Psychology Board of Australia - General registration. psychologyboard.gov.au.