Early Childhood Education
For decades, therapists have asserted that play therapy is the most effective medium for conducting therapy with children (Freiberg, 1965; Sandler, Kennedy, and Tyson, 1980). Play therapy is defined as “a play experience that is therapeutic because it provides a secure relationship between the child and the adult, so that the child has the freedom and room to state himself in his own terms, exactly as he is at that moment in his own way and in his own time” (Axline, 1950, p. 68). A more outcome-oriented interpretation of play therapy aims for symptom resolution and adaptive stability.
Play therapy originated in the psychoanalytic tradition as a method used to delve into the unconscious mind of children. Play was first used in therapy by Sigmund Freud in the early 1900s as a technique to understand children’s unconscious fears. Free association, a technique used to explore the unconscious mind in psychoanalytic therapy with adults, was seen as an unsatisfactory tool for use with children. Psychoanalysts and child therapists began to use play in various ways in their therapeutic work with children (Dorfman, 1951). Dorfman describes Anna Freud’s use of play in therapy with children as a means to create an attachment between the analyst and the child, rather than as a central tool in therapy. Play allowed the child to develop a positive attachment to the therapist, thereby permitting actual therapy to occur. Some psychoanalysts saw children’s play as analogous to free association. Similarly, child therapists who focused on a client- centered approach to therapy saw play as a central component of therapy. Play was considered a comfortable means of communication that allowed children to express themselves.
Amster (1943) identified six therapeutic uses of play: (1) play can be used for diagnostic understanding of children; (2) play can be used to establish a working relationship; (3) play can be used to restructure childrens negative functioning in daily life and defenses against anxiety; (4) play can be used to help children verbalize certain conscious material and the associated feelings; (5) play can be used to help children act out unconscious material and to relieve the accompanying tension; and (6) play can be used to develop children’s play interests, which can carry over into daily life and which will enhance prognosis for future functioning.
As play became a more integral part of therapy with children, it became clear that play was the natural language of children. Because language development tends to be a slower process than cognitive development, as children engage in play during therapy, they are communicating information that they may not otherwise be able to express. Play in therapy is based on this developmental understanding that children do not understand or process information the same way as adults.
Numerous types of play therapy have emerged over the years. The major types of play therapy include Psychoanalytic, Directive, Nondirective, Release, Behavioral, Cognitive-Behavioral, Relational, Group, and Sand Tray.
Psychoanalytic Play Therapy was founded by Sigmund Freud, furthered by H. von Hug-Hellmuth, and formally structured by Melanie Klein. Play serves three primary functions in psychoanalytic play therapy sessions: (1) it allows a relationship to establish between therapist and child; (2) it allows the therapist insight into the child achieved through therapist interpretation of past experiences and memories and finally, (3) it serves as the medium for communication between child and therapist. Psychoanalytic play therapy occurs when the child is allowed to play with what he/she chooses, while the therapist interprets his or her preconscious and unconscious meanings out loud to the child—a technique labeled as “free association” (Klein, 1955).
Directive Play Therapy entails a series of therapist-structured situations specific to the child’s current difficulties. In this type of therapy, the therapist is in charge of “setting up” the theme and content of play that will occur in the session. These structured situations are the vehicle to encourage the independent free play of the child, centered on the presenting difficulty (Hambridge, 1955).
Nondirective Play Therapy was pioneered by Virginia Axline, and allows the child to decide what to do in a session (within safe boundaries). Perhaps the most important aspect of nondirective play therapy is that the therapist must develop a warm and friendly relationship with the child. Child-centered, non-directive play therapy is based on Carl Rogers’ philosophy of personality development and is based on the principle that “all individuals, including children, have the innate human capacity to strive toward growth and maturity if provided nurturing conditions” (Guerney, 2001).
Release Play Therapy is designed to allow children to act out their individual fears and concerns in a safe environment. Release therapy generates success by treating the child by utilizing his or her own methods of treating himself or herself (i.e., allowing the child to act out feelings of aggression through dolls, clay, etc.). The role of therapist may be minimal, with little interpretation or guidance from the therapist.
Behavioral Play Therapy differs from other forms of play therapy in that the parents directly participate in the session—essentially assuming the role of “therapist.” These therapy sessions occur in a typical play therapy room, with the parent engaging in activities chosen by their child. In these play sessions, operant conditioning is the primary technique used to effect behavioral change. Parent’s administration of immediate and consistent reinforcement of appropriate behavior leads to an increasing frequency of this desired behavior. This also causes gradual extinction of the undesired behavior.
Cognitive-Behavioral Play Therapy is specifically created for preschool and school-aged children, and emphasizes the child’s involvement in treatment by addressing issues of control, mastery, and responsibility for one’s own change in behavior (Knell and Ruma, 1996). Techniques commonly employed in this type of play therapy are modeling, using puppets to demonstrate the behaviors the therapist wants the child to learn, and role playing, in which the puppets practice skills and receive feedback from the therapist.
Relationship Play Therapy was founded by Otto Rank and Carl Rogers and promotes full acceptance of the child as he or she is. The focus is on the importance and strength of the therapeutic relationship between child and therapist (Gil, 1991).
Group Play Therapy is defined by the modality of play; however, the focus of the therapy is on children interacting with each other. This therapy occurs with minimal interaction and guidance from the adult therapist and is based on the assertion children will change negative behavior to obtain acceptance from peers (Ginott, 1975).
Sand Tray Play Therapy was created by Dora Kalff. Sand tray play therapy is modeled after Jungian therapy, in that the sand tray represents the child’s psyche. The child’s placement of objects in the tray and use of symbols is interpreted as the child’s passage through healing (Gil, 1991).
In summary, there are several reasons why play therapy has emerged as an important treatment approach for working with children. As stated previously, play is the natural language of children. Using play in therapy brings the therapist into the child’s world and addresses issues in a language that is comfortable for the child. In a sense, children “play out” their issues or problems the same as adults “talk out” their problems. Developmentally, play is a means through which children are able to use concrete symbols (i.e., toys) to express their inner thoughts. Play therapy gives children the opportunity to exert some control in the therapeutic situation and a safe, supportive environment in which to express themselves.
Further Readings: Amster, F. (1943). Differential uses of play in treatment of young children. American Journal of Orthopsychiatry 13, 62-68; Axline, V. M. (1950). Entering the child’s world via play experiences. Progressive Education 27, 68-75; Dorfman, E. (1951). Play therapy. In C. R. Rogers, ed., Client-centered therapy: Its current practice, implications, and theory. Cambridge, MA: The Riverside Press, pp. 235-278; Freiberg, S. (1965). A comparison of the analytic method in two stages of child analysis. Journal of the American Academy of Child Psychiatry 4, 387-400; Gil, E. (1991). The healing power of play: Working with abused children. New York: The Guilford Press; Ginott, H. G. (1975). Group therapy with children. In G. M. Gazda, ed., Basic approaches to group psychotherapy and group counseling. Springfield, IL: Charles C. Thomas, pp. 327-341; Guerney, L. (2001). Child-centered play therapy. International Journal of Play Therapy 10, 13-31; Hambridge, G. (1955). Structured play therapy. American Journal of Orthopsychiatry 25, 601-617; Klein, M. (1955). Psychoanalytic play technique. American Journal of Orthopsychiatry 25, 223-237; Landreth, G. (2002). Play therapy: The art of the relationship. 2nd ed. New York: Brunner-Routledge; Lebo, D. (1955). The development of play as a form of therapy: From Rousseau to Rogers. Journal of Psychiatry 112, 418-422; Sandler, J., H. Kennedy, and R. Tyson (1980). The technique of child psychoanalyses. Cambridge, MA: Harvard University Press.
Susan M. Swearer, Kelly Brey Love, and Kisha M. Haye