Play Therapy Generally Speaking, Play

Play Therapy

Generally speaking, play therapy is a way to allow children from preschool age to just prior to adolescence, roughly age 2-12, to express themselves about issues, feelings, or emotions through differing types of play. Because it is systematic and a way to use a guided approach to reach the inner issues of a child, it is often used in situations in which children are incapable, or unable, to express themselves in any way. Often, too, it is used as one tool of diagnosis; for example, a therapist might observe a child playing with toys to determine the cause of the behavior -- the objects, patterns, and personification shown and the way the child interacts with the characters in play, often lead to a deeper understanding of underlying issues facing that child (Landreth, 2002).

The psychodynamic theory holds that cognitive change may often result by exploring interpersonal relationships with both animate (humans and pets) and inanimate objects (play items). A child examines and explores their imagination through these inanimate objects, and children will often engage in play behavior in order to work through their inner anxieties. It can be seen as a self-help mechanism if the child is allowed unstructured or free play. From a development point-of-view, play is essential to build cognitive resources, self-reliance, and of course, acculturation (Drewes, 2009).

Even a brief review of the literature finds that play therapy is quite effective as a counseling model for children and adolescents. Having its documented origins in Ancient Greece, it has moved through time to the point where it is now an accepted and well-researched form of therapy. For instance, children who were in the midst of divorcing parents acted out less, were less angry and morose, and more likely to accept change in their lives when given the chance to work through some of their issues through play therapy (Burroughs, Wagner, and Johnson, 1997). Play and art therapy (also considered a type of play), when combined, can also be quite robust in decreasing aggressive behaviors, especially in children that are the victims of abusive or substance-abuse homes (Springer, Phillips, Cannady, and Kerst-Harris, 1992). and, since 1990, there has been an increased effort to implement well-designed and controlled play therapy studies. Two particular studies show conclusive evidence that play therapy has a significant role in improving emotional coping skills, decreasing aggressive or non-responsive behaviors, and allowing children to open up with the therapist (LeBlanc and Ritchie, 2001; Ray, Bratton, Rhine, and Jones, 2001).

Current Research -- Play is clearly an important part of a child's life -- it is voluntary, institual, and normally associated with pleasure, enjoyment, and a positive outcome. It may consist of imaginary interpersonal relationships, building images from inanimate objects, and is a key factor in the way children develop, socialize, and aquire culture. Play, in fact, is so important to the human psyche that as children age it becomes more and more structured and organized, we call it games or sports. However, for decades, modern psychologists have debated how effective play therapy intervention actual is -- and whether structured play thereapy treatment is a viable option within the contemporary therapists' toolbox (Ray, et.al, 376). Since play therapy is typically used to treat children's emotional and behavioral problems, it is important to find out which techniques are efficatious, which are marginal, and which seem to have little or no effect at all.

Piaget notes that most children below the age of 11 or 12 lack a developed capacity for abstract thought, which is necessary for meaninful verbal expression, and to understand complex and disparate issues, motives, and feelings. Unlike adults, then, children are more likely to communicate not through words -- they lack the vocabulary to actually express what they are thinking, but through the world of the immagination, or play (Piaget, 1999). Thus, in play therapy, the actual play takes the place of vocabulary and is the vehicle for "communication between the child and the therapist on the assumption that children will use play materials to directly or symbolically act out feelings, thoughts, and experiences that they are not able to meaningfully express through words" (Bratton, et.al., 376).

Still, many scholars believe that, despite the increase in studies, a body of credible scientific evidence does not yet exist that will completely validate play therapy as the option in child-based treatment. Children facing medical procedures, however, do show a reasonably solid foundation for play therapy interventions, and enough studies have been done since the late 1970s that provide robust data suggesting that actual play therapy as opposed to nondirective, or diversionary play, has the same effect. Even children subjected to puppet show or other outside interventions showed considerably less anxiety regarding upcoming medical procedures than a control group (Phillips, 2010).

In contrast, another scholarly cadre believes that enough evidence is already in to provide proof of efficacy in play therapy. They not that evidenced-based treatment standards are the current criteria for measuring effectiveness of research. Certainly some earlier studies involving play therapy were a bit too subjective, and clearly, it is important that all play therapy research, like any professional research, should follow established methodological standards for determining efficacy. However, the distinction is that Phillips (2010) does not believe that has been done, while Baggerly and Bratton believe that not only has steady progress been made, but evidence-based standards actually prove the efficacy of play therapy ((Baggerly and Bratton, 2010).

As a therapeutic option, the field of play therapy grew rapidly during the 1980s and 1990s as therapists began basing their professional views on data from their own interactions with children. The issue, however, is that there is not simply one defined play therapy -- nor should there be. The basic idea is not debated, "to help children prevent or resolve psychosocial difficulties and achieve optimal growth and development" (Association of Play Therapy, 2001). The issue, though, resides in the very robustness of the therapeutical model -- that each child is unique, has unique issues, and a unique style of play and imagination. Therefore, unlike gestalt, cognitive, or other therapeutical models, play therapy cannot be boxed into a standard set of methodological dicta (Bratton, 378).

Phillips argues, though, that it is just this paucity of credible evidence in like-studies that makes the idea of play therapy suspect in a broad generalized paradigm. He cites evidence that compares samples done over a 10-year longitudinal study that compared a 12 session, cognitive-behavioral, group intervention with a similar session of group-dynamic/client centered play therapy. These children all had sexual acting out and problem behaviors. At the end of the initial treatment, both groups reported a significant reduction in behaviors with similar findings moving forth to the 1-2-year mark. However, "in a recent 10-year follow up using the entire sample and public-sector databases, [researchers] found that children from both treatment groups were no more likely than individuals in the general population to perpetrate any sexual abuse or other sexual offenses as adolescents or young adults"(Phillips, 17).

Thinking about this logically, though, it does not seem that we are comparing apples with Phillips' notion that a 10-year follow up on sexual deviance proves anything about the previous study. The children were not in therapy for sexual abuse or deviance, and although early issues of sexual problems may indicate a national propensity to develop these behaviors, the follow up study was not measuring the same things as the initial study. In fact, that the play therapy intervention worked as well as, or better, or was simply effective in reducing the unwanted behaviors says that it was effective within the context of that particular study group.

Phillips also does not include several prominent studies that were done since 2002 in his review, yet asks the question of the scholarly community, "Are there areas of play therapy that might legitimately warrant the appellation of 'evidence-based'… requirements?" Enthusiastically, the answer appears to be yes, that has already been done and that effective treatments are shown by at least two statistically validated studies that play therapy treatment "is superior… to a waiting-list control group or equivalent to an established treatment or a small series of single-case design experiments" (Baggerly, 28).

It is, however, true that a number of earlier studies from the 1960s to late 1970s were done without adequate sample sizes, but pointed to more qualitative issues. These studies, though, were still important in that they formed the very basis for significant questions that needed attention in the field. It was, and is, possible to extrapolate robust data from many of these studies if one considers that the real issues of play therapy may be broken down into three component parts, with the center part having variation in application, but not in theory: 1) a population at risk in some way that needs therapeutic intervention; 2) the introduction of a model of therapy that allows this population a way to express itself in a manner that leads to a positive outcome, and; 3) answers to the basic question -- was the therapeutic application given in number 2 effective or not -- the measurement is relatively simple; is the patient healthier? (Bratton, 384-7).