The use of play in therapy was first elucidated by the pioneers of Child Psychotherapy. Anna Freud (1928, 1964, 1965), Margaret Lowenfeld (1935, 1970) and Melanie Klein (1961, 1987) posited the theoretical premise for the use of play, for example, Klein (1961, 1987) stipulated that a child’s spontaneous play was a substitute for the free association used within adult psychoanalysis.
Theories and practice surrounding play differ within each Child Psychotherapy tradition. However, each tradition is connected by the central proposition that play transmits and communicates the child’s unconscious experiences, desires, thoughts and emotions.
Play Therapy has emerged from elements of Child Psychotherapy with the specific theoretical foundations emerging from the Humanistic Psychology tradition and Attachment theory.
In the 1940’s, Carl Rogers (1951, 1955) established a new model of psychotherapy – client centred therapy (later termed person centred therapy). This new tradition was born as a protest against the diagnostic, prescriptive perspectives of that time. Emphasis was placed upon a relationship between therapist and client based upon genuineness, acceptance and trust. As such, the person centred approach posited a new and original theoretical perspective of personality structure, psychological health, acquisition of psychological difficulty and the change process within therapy.
Largely influenced by this person centred approach, Axline (1969, 1971) developed a new therapeutic approach for working with children – non directive Play Therapy.
Utilising the person centred theoretical foundations, Axline devised a clear and succinct Play Therapy theory and method. Her account of how she worked with a young boy called Dibs is well known (Dibs: In Search of Self, 1964).
Axline described in great detail how she worked with Dibs and how he was able to heal himself over a period of time. She said “No-one ever knows as much about a human being’s inner world as the individual himself. Responsible freedom grows and develops from inside the person”. Her eight principles of the therapeutic relationship inform the work of many Play Therapists.
Clark Moustakas describes his work as being concerned with the kind of relationship needed to make therapy a growth experience. His stages start with the child’s feelings being generally negative and as they are expressed, they become less intense, the end results tend to be the emergence of more positive feelings and more balanced relationships.
For over 50 years, Play Therapy has been practiced and researched within America. This has been led by many Play Therapists, including Moustakas (1953, 1966, 1973, 1981, 1992), Schaefer (1976, 1986, 1993) and Landreth (1991,2002) who have progressed Axline’s original formulations and devised differing models integrating elements of systemic family therapy, narrative therapy, solution focused therapy and cognitive behavioural therapy.
In Britain, Play Therapy started to emerge as a new and differing tradition in the 1980’s. Initially the Children’s Hour Trust taught professionals the basic techniques of Axline’s Play Therapy used in a multitude of settings. In parallel, two Dramatherapists started using Play Therapy methods to inform their Dramatherapy practice with children. Sue Jennings (1994) and Ann Cattanach (1993, 1994, 1998) integrated elements of non directive Play Therapy to formulate a British Play Therapy movement. In 1990, the Institute of Dramatherapy started to offer a Certificate and Diploma in Play Therapy.
In 1992, the British Association of Play Therapists (BAPT) was started by a group of professionals studying at the Institute of Dramatherapy. Since then, BAPT has developed the British Play Therapy movement and now accredits a number of training courses in the UK including the Masters level programmes currently running at the University of Roehampton(London) and University of Glamorgan (Wales).
British Play Therapy is currently defined as:
“Play Therapy is the dynamic process between child and Play Therapist in which the child explores at his or her own pace and with his or her own agenda those issues, past and current, conscious and unconscious, that are affecting the child’s life in the present. The child’s inner resources are enabled by the therapeutic alliance to bring about growth and change. Play Therapy is child-centred, in which play is the primary medium and speech is the secondary medium.”
Theoretical Basis of Play Therapy
Play Therapy emphasises the client as trustworthy. Play Therapy is based upon three critical theoretical principles:
Actualisation – Humans are motivated by an innate tendency to develop constructive and healthy capacities. This tendency is to actualise each person’s inner potentials, including aspects of creativity, curiosity and the desire to become more effective and autonomous.
The Need for Positive Regard – All people require warmth, respect and acceptance from others, especially from ‘significant others’. As children grow and develop, this need for positive regard transforms into a secondary, learned need for positive self regard.
Play as Communication – Children use play as their primary medium of communication. Play is a format for transmitting children’s emotions, thoughts, values and perceptions. It is a medium that is primarily creative.
Research in Play Therapy
From 1942 to the present, Play Therapy research has been conducted to investigate a range of issues, including clinical effectiveness, parental involvement and the analysis of specific techniques. To illustrate the body of Play Therapy Research, four research studies are summarised as follows:
Kot (1995) investigated the effectiveness of non-directive Play Therapy with child witnesses of domestic violence. Outcome measures were compared against a control group and evaluated using the Joseph Pre-School and Primary Self-Concept Screening Test, Child Behaviour Check List and Children’s Play Sessions Behaviour Rating Scale.
Children in the treatment group were found to have significantly reduced externalising behaviour problems and significant reduction in their total behaviour problems. This study used a total of 20 subjects with ages ranging from 3 years to 10 years.
Springer et al (1992) investigated the effectiveness of Play Therapy and Art Therapy with children identified as having one parent suffering from alcohol or drug dependency. A total of 132 subjects were used with ages ranging from 7 years to 17 years. Results indicated subjects within the treatment groups experienced significant improvements in depression, hyperactivity and disruptive behaviour (identified by Child Behaviour Check List).
Dogra and Veeraraghavan (1994) found that children diagnosed with aggressive conduct disorder who received 16 sessions of non-directive Play Therapy sessions and Parental Counselling sessions showed significant differences in their behaviours. According to the Picture-Frustration Test and Child behaviour Rating Scale, the treatment group showed a significant positive change to self, home, school, social, physical and personality on adjustment. Aggression in the experimental group was also reduced in fighting, bullying, violence against adults, obedience and temper tantrums. This study used a total of 20 subjects with ages ranging from 8 years to 12 years.
Ray et al (2001) completed a meta-analysis of 94 research studies investigating the clinical effectiveness of Play Therapy. The 94 studies measured the effects of Play Therapy conducted by mental health professionals in America and contained 3263 subjects (mean age=7.1 years).
Experimental design was used for each of the 94 studies.
The 94 studies investigated the effectiveness of Play Therapy with different client groups. A total of 20 client groups were investigated, including difficulties such as Conduct Disorder, Anxiety/Fear, Speech and Language Difficulties, Depression, Sexual Abuse and Post Traumatic Stress Disorder. The results of the meta-analysis conducted by Ray et al (2001) revealed a large effect size (d=.80). The authors concluded that Play Therapy is an effective intervention for a broad range of children’s difficulties.
Further to the above studies, many research studies have been conducted in Britain. Currently, the majority of research has undertaken qualitative analyses of Play Therapy sessions and aim to elucidate the specific processes involved in enabling children to make sense of difficult life experiences through the Play Therapy process.
In recent years, the number of Masters and PhD students investigating Play Therapy has significantly increased. Three of the four validated University training courses also offer Masters and PhD research programmes.
Research References
Dogra, A., & Veeraraghavan, V. (1994). A study of psychological intervention of children with aggressive conduct disorder. Ind. Journal of Clinical Psychology, 21, p. 28-32.
Kot, S. (1995). Intensive play therapy with child witnesses of domestic violence. Unpublished dissertation, University of North Texas, Denton, TX.
Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001). The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10(1), p. 85-108.
Springer, J.F., Phillips, J., Phillips, L., Cannady, L., and Kerst-Harris, E. (1992). CODA: A creative therapy program for children in families affected by abuse of alcohol or other drugs. Journal of Community Psychology, p. 55-74.