What Is Play Therapy? Who It Helps and How Sessions Work

What is play therapy, which children is it for and how do sessions work? Read about how child-centred play therapy works and the role parents play.

Play therapy is a psychotherapy approach that allows children to express their feelings, the difficulties they are going through and their inner world through play, their natural language. Adults can describe their distress in words; for children, this is often not possible. A child may not be able to say, "I get really scared when Mum and Dad argue", but they may stir up a storm in the dolls' house. In this article, we look at what play therapy is, which children it is used with, how sessions go, the role of parents in the process, and answers to frequently asked questions.

What Is Play Therapy?

As many theorists concerned with child development have stressed, play is the child's language and toys are their words. Play therapy starts from this idea: while playing in a specially prepared playroom with a trained therapist, the child expresses their feelings, reworks their experiences and develops new ways of coping.

This approach is not the same as "playing with a child". The therapist does not watch the play at random; they carefully follow what the child repeats in play, which feelings they express and which themes come to the fore, and respond in a way that helps the child become aware of their feelings. The toys in the playroom are also chosen with care: family figures, animals, puppets, vehicles, a sand tray, art materials, play dough, kitchen items and materials with which the child can express their anger safely are some of them.

Child-centred play therapy

There are different approaches within this field. One of the most common is child-centred play therapy. In this approach the child directs the play themselves; they decide what to play, how to play it and how the therapist will join in. The therapist accompanies the child with an accepting, non-judgemental and understanding attitude. Within this safe relationship, the child experiences expressing themselves, regulating their feelings and making their own decisions.

At the heart of the child-centred approach lies the belief that every child, when the right conditions are provided, can activate their own capacity for healing and growth. That said, there are also some limits in the playroom: the child is not allowed to harm themselves, the therapist or the room. These limits offer the child a safe structure.

Directive approaches

In some cases, the therapist may suggest more structured games, stories or activities in order to work on a particular problem. For example, games that teach relaxation skills may be used with a child experiencing anxiety, or emotion-recognition activities with a child experiencing anger. Approaches such as cognitive behavioural play therapy combine play with structured techniques.

Which Children Is Play Therapy Used With?

This therapy method is generally used with children between 3 and 12 years old. However, this limit is not fixed; play-based work can also be done with younger or older children, depending on the child's developmental level.

Situations in which the therapy is often used include:

• Anxiety and fears: Separation anxiety, fear of the dark, school fears, intense worries
• Behaviour problems: Tantrums, aggression, difficulty following rules. We covered this subject in detail in our article on tantrums in children.
• Changes within the family: Divorce, the birth of a new sibling, moving house, a parent's long absence
• Loss and grief: The loss of a loved one or a pet
• Traumatic experiences: Accidents, hospital experiences, natural disasters such as earthquakes
• Emotional difficulties: Withdrawal, unhappiness, low self-esteem
• Physical symptoms: Stomach ache with a psychological cause, bed-wetting, sleep problems
• Social difficulties: Difficulty making friends, shyness, conflict with peers
• Adjustment problems: Difficulties when starting school or nursery

In Turkey, the 6 February 2023 earthquakes caused many children to experience loss, displacement and uncertainty. After such severe experiences, children often re-enact what they have been through in play; for example, they may knock down toy houses and rebuild them again and again. Therapeutic play can help this repeated play take on meaning in a safe setting and help the child process their experience.

Why Do Children Express Themselves Through Play?

Children's ability to think abstractly and to describe their feelings in words is still developing. Forming sentences such as "I feel worthless" or "Since Dad lost his job, the tension at home scares me" is very hard for a child. Yet the same child can show what they are going through in play with surprising clarity.

Play also lets the child put a safe distance between themselves and the experience they have been through. Rather than telling a frightening event directly, it is much easier to play it out as something that happened to a teddy bear. This distance allows the child to face difficult feelings without being overwhelmed. Having control in play helps the child gain a sense of power and competence even in situations where they feel helpless in real life.

Imagine a five-year-old child whose parents have recently separated and who, in sessions, keeps setting up two separate toy houses and moving a small figure between them. Sometimes the figure gets lost on the way, and sometimes the doors of both houses stay shut. The child does not tell this in words; but the play clearly shows their feelings of being caught between two homes, of being lost and of not knowing who will welcome them. By naming these feelings, the therapist helps the child feel understood.

How Do Play Therapy Sessions Go?

The therapy process generally consists of several stages.

Parent meeting

The process most often begins with a preliminary meeting with the parents. In this meeting, the child's developmental history, when the complaints began, the family structure, the situation at school and the parents' observations are discussed. This meeting is important for getting to know the child and setting the goals of the process.

Meeting the child and assessment

In the first sessions, the child gets to know the playroom and the therapist. Some children dive straight into play while others may be hesitant; both are natural. The therapist builds a relationship of trust without pushing the child, keeping to the child's pace. At this stage, observation and, where needed, drawing work and play-based assessment tools may be used.

Therapy sessions

Sessions generally take place once a week and last about 40-50 minutes. Each week the child meets the same room, the same therapist and similar toys. This continuity and predictability supports the child's sense of trust.

In the session, the therapist follows the child's play, reflects their feelings ("This little bear looks really angry right now"), notices the child's efforts and sets limits when necessary. In play, the child begins to find their own solutions, to recognise their feelings and to express them in healthier ways.

Parent meetings and review of the process

Meetings with parents are held at regular intervals. In these meetings, the child's development is assessed, the changes observed at home and at school are discussed, and parents are given suggestions for how they can support the child. However, to protect the child's trust, the details of the games played in sessions are generally not passed on word for word; instead, general themes and progress are shared.

Ending

When a marked improvement is seen in the child's complaints and they are functioning better in daily life, the process is brought to a planned end in a way the child can be prepared for. Rather than an abrupt ending, the child is told a few sessions in advance, and the farewell is treated as a therapeutic experience too.

In the playroom, the child rebuilds the world in a space scaled down to their size; what they learn there is carried beyond the playroom as well.

What Can Parents Do at Home?

The effect of therapy is strengthened when parents support the process. The following steps can be helpful at home:

1. Set aside special play time with your child: A few times a week, however brief, play time away from screens and led by your child strengthens the relationship.
2. Follow the play rather than directing it: Instead of telling your child what to do, join in with their play and watch with interest.
3. Name feelings: Sentences such as "You got really cross when the tower fell down" help the child recognise their feelings.
4. Do not question them about the session: Instead of pressing the child with questions like "What did you do today?" or "What did you say?", show that you are ready to listen if they want to share.
5. Be consistent: Attending sessions regularly is important for the child's sense of trust.
6. Look after your own feelings too: The stress and anxiety a parent experiences can be passed on to the child. Getting support for yourself when needed is also an investment in your child.

When Should You Seek Professional Support?

Every child struggles, gets angry, feels afraid or withdraws from time to time. These are natural parts of development. However, consulting a child mental health professional can be helpful in the following situations:

• If the change in behaviour or mood lasts longer than a few weeks
• If the difficulties are seen at home, at school and in friendships all together
• If the child shows regression in skills they had previously gained (such as bed-wetting or baby talk)
• If a marked change is observed after a loss, trauma or change within the family
• If sleep, eating or physical complaints have become marked
• If the child shows behaviours that harm themselves or others

For more detailed information on when to seek a child psychologist, you can read our article should I take my child to a psychologist. We would like to remind you that these signs do not by themselves amount to a diagnosis and that the assessment needs to be made by a professional. If a developmental or neurological condition is suspected, a child psychiatry assessment may also be needed.

How Is Play Therapy Approached in Therapy?

The child and play therapy process is shaped according to each child's needs. Depending on the child's age, developmental level, the problem they are experiencing and family circumstances, the therapist can choose between child-centred and more structured approaches, or combine them.

Children's drawings can also be an important means of expression in the process. However, drawings are treated not as a diagnostic tool on their own but as a window that helps us understand the child's world, to be considered together with other observations.

Cooperation with parents is an inseparable part of the process. In some cases, parent counselling or sessions that the parent attends together with the child may also be added. The aim is for the skills the child gains in the playroom to be supported at home and at school too.

The length of the process varies according to the nature of the difficulty the child is experiencing, how long it has lasted and family circumstances. In some children marked changes are observed within a few months, while others may need a longer process.

How can you tell if therapy is progressing?

Progress is not always in a straight line. In some children, behaviours may temporarily intensify in the first weeks of therapy; this can be a sign that the child has begun to express feelings they had been holding back. Over time, parents generally notice changes such as:

• A decrease in the frequency or intensity of angry outbursts
• The child expressing their feelings in words more easily
• Improvement in falling asleep and in eating patterns
• Settling in more comfortably at school and in friendships
• Less anxiety and more curiosity about new situations

Changes are also observed in the playroom: chaotic and scattered play may become more orderly, and repeated frightening themes may give way to stories that look for solutions. The therapist shares these observations with you in parent meetings and you plan the next steps of the process together. There may also be periods of regression; holidays, school changes or new sources of stress in the family in particular can cause such fluctuations. These periods are treated as a natural part of the process.

Frequently Asked Questions

Is play therapy just playing?

No. Although from the outside it may look like just play, play therapy is a structured psychotherapy process carried out under the guidance of a trained therapist. The therapist carefully follows the themes, feelings and relationship patterns in the child's play and responds with therapeutic aims.

Do parents take part in the sessions?

Sessions with the child generally take place between the child and the therapist. Separate meetings are held with the parents at regular intervals. In some cases, joint sessions that the parent attends can also be planned, according to the child's needs.

Can play therapy be done online?

Because of the possibilities offered by the playroom and materials, this work is mostly carried out face to face. That said, parent meetings and, for some age groups, structured work can also be carried out online. The most suitable format is decided together according to the child's age and needs.

How should I tell my child they are going to therapy?

It is recommended to give an explanation that is simple, honest and suited to your child's age. For example, saying "You're going to meet someone who knows about talking about feelings and playing; there are lots of toys there" may be enough. It is important to avoid presenting therapy as a punishment or the result of "naughtiness".

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• #child psychology
• #child therapy
• #parenting

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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