Play Therapy: Helping Children Heal Through Play

A seven-year-old sits in a room full of toys. She picks up two puppets and begins an elaborate story where a small animal is being chased by a larger one. “You can’t catch me! You can’t hurt me!” the small puppet says. The therapist watches, occasionally reflecting what she sees. The child plays out her story over and over, and each time, the small puppet becomes a little braver, a little more capable. Something is shifting.

This is play therapy—an approach that meets children where they are developmentally, using their natural language of play to help them process difficult experiences, express emotions they can’t yet articulate, and develop healthier ways of being in the world.

What Is Play Therapy?

Play therapy is a therapeutic approach primarily used with children that utilizes play as the medium for expression, communication, and healing. Rather than talking about problems (which is difficult for most children), children act out their inner world through play.

Why Play?

For children, play is:

The Primary Language:
Young children don’t have the vocabulary or abstract thinking to discuss emotions directly. Play is how they naturally communicate.

How They Process:
Children work through experiences by playing them out. This is why a child might play “doctor” after a medical procedure or “school” to master classroom challenges.

Developmentally Appropriate:
Talk therapy requires cognitive abilities that children are still developing. Play matches their developmental stage.

Safe:
Play provides distance from difficult topics. A child can explore scary themes through toys without directly confronting overwhelming feelings.

The Theory Behind Play Therapy

Self-Healing Capacity:
Children have an innate drive toward growth and health. Given the right conditions, they can work through difficulties.

Symbolic Expression:
Through play, children express symbolically what they can’t express directly. A puppet becoming brave might represent the child’s own growing courage.

Emotional Processing:
Playing through experiences helps children make sense of what happened and master overwhelming emotions.

Relationship Healing:
The therapeutic relationship itself—being accepted, understood, and valued—is healing.

Types of Play Therapy

Child-Centered Play Therapy

Based On:
Carl Rogers’ person-centered approach, developed for children by Virginia Axline and Garry Landreth.

Key Features:
– Non-directive (the child leads)
– The therapist follows the child’s play
– Emphasis on the therapeutic relationship
– Trust in the child’s self-healing capacity

The Therapist’s Role:
– Creates a safe, accepting environment
– Reflects the child’s feelings and play
– Sets necessary limits
– Doesn’t interpret or direct

Example:
The therapist might say, “You decided to put the baby in the corner all by itself. It looks lonely over there.” Rather than asking why or suggesting what to do, the therapist reflects what’s happening, allowing the child to lead.

Directive Play Therapy

Key Features:
– Therapist guides the play more actively
– May introduce specific activities or themes
– Uses play to address specific issues
– More structured than non-directive approaches

When Used:
– When specific skills need teaching
– When trauma processing needs facilitation
– When time-limited treatment is needed
– When specific behavioral goals exist

Cognitive-Behavioral Play Therapy

Key Features:
– Integrates CBT principles with play
– Uses play to teach coping skills
– May include psychoeducation through play
– More directive and goal-oriented

Techniques:
– Using games to teach problem-solving
– Puppet shows about managing emotions
– Stories that model coping strategies
– Activities that address specific thoughts and behaviors

Filial Therapy

Key Features:
– Parents are trained to conduct play sessions
– Strengthens parent-child relationship
– Parents learn to respond therapeutically
– Conducted at home after training

Process:
Parents receive training from a therapist and then conduct weekly play sessions with their child, using child-centered play therapy principles.

Theraplay

Key Features:
– Focuses on attachment relationships
– Parent directly involved in sessions
– Structured, playful activities
– Emphasis on nurturing and connection

Goals:
Strengthening attachment, building connection, and healing relationship wounds.

Sandtray Therapy

Key Features:
– Uses miniature figures in a sand tray
– Child creates scenes or worlds
– Expresses inner experience through creation
– Can be directive or non-directive

Process:
The child selects from many miniature objects and arranges them in the sand, creating a representation of their inner world or specific experiences.

What Play Therapy Helps

Common Concerns Addressed

Emotional Issues:
– Anxiety and fears
– Depression and sadness
– Anger and aggression
– Low self-esteem
– Emotional dysregulation

Behavioral Issues:
– Oppositional behavior
– Acting out
– Social difficulties
– School problems
– Adjustment issues

Traumatic Experiences:
– Abuse or neglect
– Domestic violence exposure
– Loss and grief
– Medical trauma
– Accidents
– Divorce or family changes

Developmental Concerns:
– Attachment difficulties
– Developmental delays
– Autism spectrum (modified approaches)
– ADHD (adjunctive treatment)

Who Benefits Most

Play therapy is typically used with children ages 3-12, though it can be adapted for:

• Younger children (with modifications)
• Adolescents (with more age-appropriate activities)
• Children with developmental delays
• Non-verbal children

The Playroom

Environment

A play therapy room typically includes:

Categories of Toys:

Real-Life Toys:
– Dollhouse and family figures
– Kitchen sets and food
– Medical kits
– School supplies
– Vehicles

Aggressive-Release Toys:
– Bop bags or punching pillows
– Toy soldiers or weapons
– Aggressive animal figures
– Handcuffs or rope

Creative Expression:
– Art supplies (paint, clay, markers)
– Sand and water
– Building blocks
– Dress-up clothes
– Musical instruments

Nurturing Toys:
– Baby dolls and bottles
– Soft animals
– Blankets
– Play food

Scary/Powerful Toys:
– Dinosaurs and monsters
– Superhero figures
– Snakes and spiders
– Handcuffs

Why These Toys

The selection allows children to:

• Reenact real-life experiences
• Express aggression safely
• Explore nurturing and being nurtured
• Create and express themselves
• Work through fears
• Feel powerful when feeling powerless

What Happens in Play Therapy

Initial Sessions

Orientation:
– Child and parent meet the therapist
– The playroom is introduced
– Basic rules are explained
– Relationship building begins

Assessment:
– Observation of how the child plays
– Understanding the child’s world
– Identifying themes and concerns
– Building rapport

Ongoing Sessions

Structure:
– Sessions typically 30-50 minutes
– Usually weekly
– Begins with greeting and transition
– Child leads the play
– Ends with transition out

The Therapist’s Approach:
– Follows the child’s lead
– Reflects feelings and themes
– Provides unconditional acceptance
– Sets necessary limits (safety, time)
– Notes patterns and progress

Stages of Play Therapy

Beginning Stage:
– Building relationship and trust
– Testing the environment and therapist
– Exploring the playroom
– Beginning to feel safe

Working Stage:
– Deeper play emerges
– Trauma or conflicts may be expressed
– Emotional processing occurs
– Themes are worked through
– Progress becomes visible

Ending Stage:
– Termination is prepared for
– Gains are consolidated
– Independence is supported
– Skills are reinforced

The Therapist’s Responses

Tracking

Describing what the child is doing:

“You’re putting all the animals together in one area.”

Reflecting Feelings

Naming emotions observed in the play:

“The baby seems really scared right now.”

Reflecting Content

Restating themes or meanings:

“In your story, the little one had to take care of everyone all by itself.”

Limit Setting

When necessary for safety:

“I know you’re really angry. The rule is you can hit the pillow, not me.”

Returning Responsibility

Supporting the child’s autonomy:

“You can decide where that should go.”

The Parent’s Role

Information Sharing

Parents provide crucial information about:

• The child’s history
• Current concerns
• Home and school functioning
• Changes and stressors

Updates and Progress

Regular parent meetings include:

• General progress updates (without sharing play details)
• Themes being addressed
• Suggestions for home support
• Discussion of any concerns

Confidentiality Considerations

• Play content generally remains private
• Child needs safe space to express freely
• Parents receive updates without specific details
• Safety concerns are always shared

Home Support

Parents can help by:

• Providing consistent routines
• Allowing emotional expression
• Using reflective listening
• Avoiding quizzing about sessions
• Following therapist recommendations

How Long Does Play Therapy Take?

Factors Affecting Duration

• Nature and severity of concerns
• Child’s resources and support system
• Consistency of attendance
• Home environment stability
• How quickly trust develops

Typical Timeframes

• Short-term: 12-20 sessions
• Moderate concerns: 20-40 sessions
• Complex trauma: May be longer
• Some children need ongoing support

Progress Indicators

• Changes in play themes
• Improved emotional regulation
• Better behavior at home or school
• Reduced symptoms
• Improved relationships

Evidence and Effectiveness

Research Support

Play therapy has research support for:

• Reducing anxiety and depression symptoms
• Improving behavioral problems
• Helping children process trauma
• Improving self-concept
• Enhancing emotional regulation
• Strengthening parent-child relationships

Meta-Analyses

Research reviews find:

• Moderate to large positive effects
• Benefits across various problems
• Effectiveness across age ranges
• Particularly strong for trauma and emotional concerns

When Play Therapy May Not Be Enough

Additional Supports Sometimes Needed

• Family therapy for relationship issues
• Parent training for behavioral concerns
• School consultation for academic problems
• Psychiatric evaluation for medication consideration
• Coordination with other providers

When to Consider Other Approaches

• Child is significantly older and prefers talk
• Issues require more directive intervention
• Primary problem is behavioral (may need parent training focus)
• Child isn’t engaging in play meaningfully

Finding a Play Therapist

Credentials to Look For

Registered Play Therapist (RPT):
– 150 hours of play therapy training
– Supervised play therapy experience
– Master’s or doctoral degree
– National certification

Registered Play Therapist-Supervisor (RPT-S):
– Additional experience and training
– Can supervise other play therapists

Questions to Ask

• What is your training in play therapy?
• What approach do you use?
• How do you involve parents?
• How do you measure progress?
• What is your experience with my child’s concerns?

Red Flags

• No specific play therapy training
• Unwillingness to meet with parents
• Pushing child to talk rather than play
• Lack of appropriate playroom
• Not child-friendly environment

Moving Forward

Children speak through play. When they’re struggling, they may not be able to tell you what’s wrong, but they can show you—if given the space and tools to do so.

Play therapy provides that space. A skilled therapist, appropriate toys, unconditional acceptance, and time create conditions where children can work through what words can’t express. The puppet becomes brave. The dollhouse family finds resolution. The sandtray world moves toward safety. And through this symbolic work, real healing occurs.

If your child is struggling, play therapy offers help that meets them where they are. In the language they already speak, with the process that comes naturally to them, healing becomes possible.

This article is for educational purposes only and is not a substitute for professional mental health treatment. If you’re struggling, please reach out to a qualified mental health provider. Arise Counseling Services offers compassionate, professional support for individuals and families throughout Pennsylvania.