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ESTAYAN, Maiko Kimberly

GARCIA, Princess Grace
REFANI, Maryam Remae

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 childs 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 childs 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
In the 1940s, 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 beings 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 childs 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 Axlines original
formulations and devised differing models integrating elements of systemic family therapy,
narrative therapy, solution focused therapy and cognitive behavioural therapy.
Play Therapy is a form of counseling or therapy that utilizes play to help children communicate
their psychosocial challenges. The overall goal is to help children move towards better social
integration, growth, and development.
It can also be used as a diagnostic tool to help make or confirm a diagnosis. A play therapist
observes a child playing with toys (playhouses, pets, dolls, etc.) to determine the cause of the
behavior of concern. The objects and patterns of play, as well as the willingness to interact with
the therapist, can be used to understand the underlying rationale for behavior both inside and
outside the session.
It is generally used with children aged 3 through 12 and provides a way for them to express
their experiences and feelings through a natural, self-guided, self-healing process.

Today play therapy refers to a large number of treatment methods, all applying the therapeutic
benefits of play
Play therapy differs from regular play in that the therapist helps children to address and resolve
their problems through structured or semi-structured play.
Play therapy builds on the natural way that children learn about themselves and their
relationships in the world around them.
Through play therapy, children learn to communicate with others, express feelings, modify
behavior, develop problem-solving skills, and learn a variety of ways of relating to others.
Play provides a safe psychological distance from their problems and allows expression of
thoughts and feelings appropriate to their development.


employed with children aged 3 through 11
is a specialized treatment in which therapists watch kids playing and use what they
observe to help them deal with emotional, mental, or behavioral issues. There are several
different types of play therapy for children, including child-based, family-based, and
group-based therapy. All three can be done with different levels of therapist participation.
Sessions can include a range of activities, which are usually chosen based on the child's
age and preferences.


allows the child to direct the play

is a non-intrusive method in which children are encouraged to work toward their own
solutions to problems through play
often classified as a psychodynamic therapy

may be used to help with behavioral problems


the therapist plays a bigger role and encourages the child to engage in specific activities
seen as a Cognitive Behavioral Therapy (CBT), focusing on behavior and conscious
is often used with trauma victims


a therapist and a child work alone
often used if there is a concern about the parents or abuse in the family, but can also be
done simply to make the child feel more comfortable
can be used to treat behavioral problems, anxiety, Attention Deficit Disorder (ADD) and
Attention Deficit Hyperactivity Disorder (ADHD), Post Traumatic Stress Disorder
(PTSD), autism, and the effects of abuse
includes the participation of the child's father, mother, siblings, or other family members
often used when children experience severe separation anxiety or when certain kinds of
abuse are possible
therapist may not always be directly involved
but almost always watches them and discusses the positive and negative points with the
parents afterwards
Classic filial therapy focuses on four main areas structuring, empathic listening,
child-centered imaginary play, and limit-setting but each session is typically tailored
to the family's specific needs.

a large group of children plays together while the therapist watches and sometimes
to help build better social skills and self-esteem
can also help therapists to treat individual children by letting them observe how the child
interacts with others
used when a child would feel too intimidated to work with a therapist alone


Often children have difficulty verbalizing their feelings when directly questioned, either
because they are guarded or they do not connect with those feelings they find most threatening.
When involved in playing a game, childrens defenses are reduced, and they are more likely to
talk about their feelings. The Feeling Word Game (by Heidi Kaduson; for details, see Kaduson &
Schaefer, 1997, pp. 1921) allows children to communicate their feelings in an enjoyable,
nonthreatening manner.
The therapist sits with the child and introduces the activity to the child by saying, We are
going to play a game called the Feeling Word Game. First, I want you to tell me the names of
some feelings that a boy or girl who is [age of the child] years old has. The therapist writes each
of the childs feeling words on a separate piece of paper. If the child cannot read, the therapist
should also draw a face representing the feeling. If the child does not provide the names of all of
the feelings required to explore the presenting problem, the therapist should suggest it. Once all
of the feelings are written on individual pieces of paper, the therapist lines them up in front of the
child and says, Here are all of the feeling words. I have in my hand a tin of feelings [poker
chips]. I am going to tell a story first, and then I will put down the feelings on these words. The
therapist tells a story about himself or herself, being sure to devise a story that includes both

positive and negative feelings. At the completion of the story, the therapist places poker chips on
each appropriate feeling. The amount on each should vary, thereby showing the child that a
person can have more than one feeling at the same time, as well as different amounts of each
feeling. Next, the therapist tells a nonthreatening story about the child, allowing for both positive
and negative feelings. The child is given the tin of feelings and told to put down what she or he
might feel under those circumstances. The child then tells the next story for the therapist to put
down his or her feelings. This continues until the major issues of the presenting problem are
The Feeling Word Game can be successfully used with all children, including those with
conduct problems, attention-deficit/ hyperactivity disorder (ADHD), or anxiety problems. This
technique is a fun and nonthreatening way for therapists to discuss and question issues that are
generally too intimidating for the child to communicate about directly.
Color-Your-Life (OConnor, 1983) provides children with a nonthreatening, concrete
method of understanding and discussing various affective states. It is critical for children to
develop certain skills to successfully manage their affect. Specifically, children need to develop
an awareness of numerous affective states, the ability to relate those states to their environmental
events, and the skill to verbally express these feelings in an appropriate manner.
The therapist begins by asking the child to create various color feeling pairs. For
Therapist: Can you tell me what feeling might go with the color red?
Child: I dont know.
Therapist: Think of a time when people scrunch up their faces and get very red.
Child: Oh, when they get mad!
Therapist: Good job. Many people think that the color red matches being angry.

This type of verbal interplay would occur for each colorfeeling pair as follows: red
angry, purplerage, bluesad, blackvery sad, greenjealous, brownbored, graylonesome,
yellowhappy, orangeexcited. The therapist should make sure that the child describes each
feeling in as concrete terms as possible. After the colorfeeling pairs are established, the child is
provided with a blank paper and told to fill the paper with the colors to show the feelings that
they have had throughout their lives. The child may complete the drawing in whatever way she
or he chooses, using geometric shapes, designs, and so forth. Once the child clearly understands
the task, the therapist limits his or her talking and encourages the childs discussion of the
picture. The focus of the discussion might be on various life events or on the relative quantity of
the assorted colors. If the technique is used with a group, the children will often naturally
compare drawings, and a lively conversation will ensue.
Color-Your-Life is suitable for all children between 6 and 12 years of age. The basic
requirement is that the children are able to recognize and name colors as well as various affective
states. The technique can be used in an individual or a group format. It is helpful to use the
technique at several points throughout the therapy in order to examine what change has occurred.
The technique can be altered to have the children discuss, in a nonthreatening way, their feelings
over the past week or during a particularly stressful time in their lives (e.g., death of a family
member, divorce, move, etc.)
It is crucial to help children understand what anger is and how to release it appropriately.
Balloons of Anger (by Tammy Horn; see Kaduson & Schaefer, 1997, pp. 250253) is an
enjoyable, effective technique that provides children with a visual picture of anger and the
impact that it can have upon them and their environment. It allows the children to see how anger
can build up inside of them and how, if it is not released slowly and safely, anger can explode
and hurt themselves or others.

First, the child blows up a balloon, and then the therapist helps tie it. Second, the therapist
explains that the balloon represents the body, and that the air inside the balloon represents anger.
The therapist asks the child, Can air get in or out of the balloon? What would happen if this
anger (air) was stuck inside of you? Would there be room to think clearly? Third, the therapist
tells the child to stomp on the balloon until it explodes and all of the anger (air) comes out.
Fourth, the therapist explains that if the balloon were a person, the explosion of the balloon
would be like an aggressive act (e.g., hitting a person or object). The therapist asks the child if
this seems like a safe way to release anger. Next, the child blows up another balloon, but instead
of tying it, the child pinches the end closed. The therapist tells the child to slowly release some of
the air and then pinch it closed again. (The child will love the noise that the air makes as it
slowly seeps out.) The therapist asks the child, Is the balloon smaller? Did the balloon
explode? Did the balloon and the people around the balloon stay safe when the anger was
released? Does this seem like a safer way to let the anger out? At the end of the activity, the
therapist again explains that the balloon represented anger. By talking about what makes us
angry and by finding ways to release the anger appropriately, the anger comes out slowly and
safely. The therapist reminds the child that if he or she allows anger to build up inside, it can
grow and explode and possibly harm the child or someone else. The therapist then discusses
various angermanagement techniques.
Balloons of Anger is effective for aggressive children who have difficulty controlling
their anger and for withdrawn children who internalize their anger instead of expressing it. This
technique can be used in an individual or a group format. Bottle Rockets, by Neil Cabe (see
Kaduson & Schaefer, 2001, pp. 282284), is a variation of this technique that uses exploding
canisters to demonstrate what occurs when anger is not released slowly and safely.
Beat the Clock (by Heidi Kaduson; see Kaduson & Schaefer, 1997, pp. 139141) was
designed to increase childrens self control and impulse control. The goal of this game is for the
child to resist distraction, remaining on task and focused for a specified period of time. When the
child successfully completes this task, she or he receives poker chips, which can be cashed in for

a prize. When the child is successful at the game, the child is filled with a sense of competence
and accomplishment.
The therapist introduces the activity to the child by saying, We are going to play the
game Beat the Clock. First I will give you 10 poker chips. Here are some blocks. I am going to
set the timer for 10 minutes. During that time, you are to build a tower with the blocks and not be
distracted by anything around you. If you look up from your activity, you will pay me one chip.
Each time you get distracted, ask me a question, or do anything except build the tower you will
have to pay me one chip. Do not stop building until you hear the timer go off. If you are able to
stay on task for the entire 10 minutes, then I will give you another 10 chips. After you have 50
chips, you can pick anything you want from the Treasure Box [a box of inexpensive toys
purchased in advance]. On your mark, get set, go. The therapist remains quiet for the first few
minutes and then creates some distractions. The goal of the activity is to get the child to stay on
task no matter what is happening in or out of the room. The child will be very motivated to earn
the 50 chips and pick a prize. The therapist should increase the time by 5 min each time a 50chip prize is attained. Eventually, many children are able to stay on task for the entire session.
Beat the Clock can be used in an individual or a small group format. This technique is
useful for any child who has impulsecontrol problems (e.g., children with ADHD). Swanson and
Casarjian (2001) described a comparable version of Beat the Clock in which the child is engaged
in school-based activities. Common techniques that have a similar goal include Statue (i.e., the
child is to remain motionless) and Make Me Laugh (i.e., the therapist tries to make the child
laugh and vice versa).
Children often worry about numerous things that they keep bottled up inside. These
worries may be the root of some of their presenting problems, such as fears, peer conflict, temper
tantrums, and separation anxiety. Worry Can (by Debbie S. Jones; see Kaduson & Schaefer,

1997, pp. 254256) is an effective method for helping children to identify and then discuss their
worries with an adult and/or other children.
First, the therapist cuts a strip of paper large enough to completely cover the can. The
therapist then asks the child to draw or write scary things on one side of the paper strip and to
color it with markers. Next, the strip is glued to the can, and the lid is put on the can. A slot large
enough for a slip of paper to fit through is cut in the top of the can. The child is instructed to
write down his or her worries on separate pieces of paper and then to place the strips of paper
into the can. The child should then share some worries with the therapist or with other children if
the activity is conducted in a group.
Worry Can may be used in an individual or a group format. It can be adapted to be used
as an Anger Can or as a Sad Can. A variation of this technique is The Garbage Bag Technique
(by Heidi Kaduson; see Kaduson & Schaefer, 2001, pp. 37). Two brown sandwich bags may be
used as garbage bagsone for garbage from home and one for garbage from school. The child is
instructed to decorate the garbage bags and then place three strips of paper, each with a separate
problem, in each bag. The following session, the child picks out a piece of garbage to play out in
miniatures or in role-playing. Often children will develop their own solutions to their problems.
If this does not occur, the therapist should be directive and intervene with suggestions in the
context of the play. The therapist needs to keep the play in the third person so as to allow the
child to maintain enough distance from the problem in order to solve it.


Children will play out their feelings and needs in a manner or process of expression that
is similar to that for adults. Although the dynamics of expression and the vehicle for
communication are different for children, the expressions (fear, satisfaction, anger, happiness,

frustration, contentment) are similar to those of adults. Children may have considerable difficulty
trying to tell what they feel or how their experiences have affected them.
If permitted, however, in the presence of a caring, sensitive, and empathetic adult, they
will reveal inner feelingsthrough the toys and materials they choose, what they do with and to the
materials, and the stories they act out. The play therapy process can be viewed as a relationship
between the therapist and the child in which the child utilizes play to explore his or her personal
world and also to make contact with the therapist in a way that is safe for the child. Play therapy
provides an opportunity for children to live out, during play, experiences and associated feelings.
This process allows the therapist to experience, in a personal and interactive way, the inner
dimensions of the childs world. This therapeutic relationship is what provides dynamic growth
and healing for the child. Because the childs world is a world of action and activity, play therapy
provides the therapist with an opportunity to enter the childs world. The child is not restricted to
discussing what happened; rather, the child lives out at the moment of play the past experience
and associated feelings. If the reason the child was referred to the therapist is aggressive
behavior, the medium of play gives the therapist an opportunity to experience the aggression
firsthand as the child bangs on the Bobo or attempts to shoot the therapist with a gun and also to
help the child learn self-control by responding with appropriate therapeutic limit-setting
Without the presence of play materials, the therapist could only talk with the child about
the aggressive behavior the child exhibited yesterday or last week. In play therapy, whatever the
reason for referral, the therapist has the opportunity to experience and actively deal with that
problem in the immediacy of the childs experiencing. Axline (1947) viewed this process as one
in which the child plays out feelings, bringing them to the surface, getting them out in the open,
facing them, and either learning to control them or abandon them.

The establishment of dynamic Ethical Principles for Play Therapists work related
conduct requires both a personal commitment and acceptance of responsibility to act ethically
and to encourage ethical behaviour by students, supervisors, supervisees, employees, colleagues
and associates.
These Ethical Principles are intended to guide and inspire Play Therapists towards
achieving the highest ideals of the profession. Ethical Principles, as opposed to Standards or
Codes, do not represent obligations in their own right. However, all Play Therapists are obliged
to consider their practice with direct reference to each of these Ethical Principles.
These Principles are aspirational in nature, but are considered good ethical practice for a
Play Therapist. Play Therapists need to be motivated, concerned and directed towards good
ethical practice. They are required to take responsibility to maintain these standards and Play
Therapists should always accept responsibility for their professional behaviour and actions. Play
Therapists are concerned about the ethical compliance of their own practice and their colleagues
professional conduct. When ethical conflicts occur, Play Therapists attempt to resolve these
conflicts in a responsible manner. Play Therapists are also aware of their professional
responsibilities towards their clients, society and to the communities in which they work.
Play Therapists strive to benefit those with whom they work, acting in their best interests
and always working within their limits of competence, training, experience and supervision. This
principle involves an obligation to use regular and on-going supervision to enhance the quality of
service provision and to commit to enhancing practice by continuing professional development.
An obligation of the Play Therapist is to act in the best interests of clients and this is the
paramount consideration for Play Therapists since clients are generally non-autonomous and
dependent on significant others. Ensuring that the clients best interests are met requires
monitoring of practice and outcomes and accordingly BAPT has set down standards for
supervision which all members of BAPT should follow.

Play Therapists are committed to not harming those with whom they work. Because Play
Therapists professional judgements and actions may affect the lives of others, they are aware,
concerned and committed to guard against personal, financial, social, organisational, emotional,
sexual or political factors that may lead to a misuse of their influence or exploitation of those
with whom they work. This may involve not providing services when unfit to do so due to
personal impairment, including illness, personal circumstances or intoxication. Play Therapists
have a responsibility to challenge the incompetence or malpractice of others and to contribute in
investigations or adjudications concerning the professional practice and/or actions of others.
Play Therapists establish relationships of trust with those with whom they work. Play
Therapists honour and act in accordance with the trust placed in them. This principle obliges
Play Therapists to maintain confidentiality and restrict disclosures of confidential information to
a standard appropriate to their workplace and legal requirements.
Play Therapists recognise that fairness and justice is an entitlement for all persons. This
obliges Play Therapists to ensure that all persons have fair and equal access to and benefit from
the contributions of Play Therapy and to equal quality in the services being conducted and
offered by Play Therapists. Play Therapists exercise judgement and care to ensure that their
potential biases, levels of competence and limitations of their training and experience do not
directly or indirectly lead to unjust practices.
Play Therapists respect the dignity and worth of all people and the rights to privacy,
confidentiality and autonomy. Play Therapists who respect the autonomy of those with whom
they work ensure accuracy of advertising and delineation of service information. Play Therapists
seek freely the informed consent of those legally responsible for clients and, where possible,
assent from clients, engage in clear and explicit contracts, including confidentiality requirements
and inform those involved of any foreseeable conflicts of interest. Play Therapists are aware that

special safeguards may be necessary to protect the rights and welfare of clients who are nonautonomous and dependent on significant others.
Play Therapists respect the needs of individuals, including emotional, psychological,
social, financial, educational, health and familial needs. Play Therapists who respect peoples
needs and relationships are aware that clients may be dependent upon significant others and that
autonomous decision making may not be possible. Play Therapists respect the clients
relationships and ensure that, where possible, those in significant relationships to the client are
included in the decision making processes.
Play Therapists apply all of these principles to themselves. This involves a respect for the
Play Therapists own knowledge, needs and development. This includes accessing opportunities
for personal and professional development. There is a responsibility to use supervision for
development and to seek training for continuing professional development.(see BAPTs
Continuing Professional Development documents) Ensuring Play Therapists are appropriately
safeguarded by insurance is also a requirement for this principle.
David, a 7-year-old, and his older brother Mark, an 11-year-old, were referred to the
community mental health agency where I completed my clinical training. They had both been
sexually abused. The abuse was discovered when David and Marks biological father was
arrested for indecent exposure in the community and subsequently admitted to sexually abusing
both children. Mark reported that his father showed him pornography, masturbated in front of
him, fondled him, and attempted to anally penetrate him. David remained silent about what
happened to him. Mary, the boys mother, came alone initially to the center for an intake session.
During the intake, she described David as a quiet child who liked to be alone. Mary
observed that after the sexual abuse was disclosed, David seemed even more quiet and
withdrawn. Davids teacher also commented to Mary that she noticed this shift in his affect and
that he was less verbal and more subdued within the classroom. Furthermore, Mary expressed
concern about the fact that David was watching her come out of the shower and was kissing his
youngest sister on the lips. After the intake was complete, both boys were assigned to separate
therapists who began a nondirective developmental assessment with each child. The nondirective

developmental assessments were conducted in play therapy rooms. As in child-centered play

therapy, the child leads the process. For instance, some children may choose to talk, to talk and
play, or just to play.
The therapist observes the childs play, play themes, 8 affect, behaviors, verbal
statements, and the familys interactions and draws diagnostic inferences from this data. The
objectives of this process were to assess the boys general developmental status, the presence of
clinically significant symptomatology, the level of traumatic impact, and the familys functioning
and ability to appropriately support the childs adjustment after being sexually abused. Based on
the assessment, David was diagnosed with Post Traumatic Stress Disorder and individual therapy
was recommended. I was assigned to be Davids therapist. Davids entry into therapy did not
flow smoothly. I was in contact with Mary for two months before she brought David in for his
first appointment with me. During this time period, I spoke with Mary many times by phone and
scheduled several sessions with David. However, Mary did not keep any of the appointments.
When I spoke to her after a missed appointment, she usually said she had forgotten and once
mentioned she felt depressed. In the meantime, an in-home worker was assigned to the family
because Mary was having a difficult time bringing David and Mark to therapy and there was a
high level of chaos at their home. The in-home worker often transported David to later therapy
sessions. Subsequently, I met with David for 36 sessions of child-centered play therapy over the
course of 10 months.

John was an 8 year old boy diagnosed with Type 1 diabetes, a chronic disorder caused by
a lack of insulin secretion from the pancreas. Treatment involves insulin injections, exercise and
regulation of stress and diet. John's parents thought that he had adjusted to the diabetes as he
complied well with the diabetic routine of insulin injections. However, they reported that John
had recently become challenging when asked to complete homework and chores or comply with
rules. John completed 12 sessions of individual play therapy.
In initial sessions, John played out battles between soldiers in the sand box. This was
followed by battle scenes between soldiers on one side of the sand box and plastic food items on
the other. In middle sessions, John set up hospital scenes with battles between medical personnel
and patients. Later, one particular patient began to win the battles. In final sessions, John did not
play out battles, but painted pictures, played with family figures and talked about his favourite
TV programmes.
While John's parents did not think that his behaviour was related to his medical condition,
it was clear from the battles' in John's play that he had strong feelings of anger towards the
restrictions that his medical condition had on his life. Through play, John was able to express his
feelings in an age-appropriate way in an environment of safety and trust. John developed an in

increased understanding and sense of control over his feelings, preventing future negative
expressions of these feelings. John's behaviour at home became less challenging and he became
more became more co-operative with homework, chores and rules.

Cloe was a 5 year old girl, in reception year at school referred to me for play therapy due
to her increased emotionality and withdrawal in response to a disruptive home situation. Cloe
and her half sister until recently had lived with their mother however both children's fathers were
fighting for custody of their daughters. At the point of referral Cloe's half sister had moved out of
home to live with her father while Cloe remained living with their mother...

During her ten play therapy sessions Cloe played out her muddles and fears
metaphorically, using figurines, sand and water. Within the safety of the playroom Cloe
developed her story of three chameleons who lived in a river. One chameleon in particular feared
the threat of the crab, who continuously tried to pull the other chameleons out of the river. Cloe
told me how the chameleon could not sleep at night for she had to keep watch over her friends;
she was tired and scared.
Week after week Cloe played her story, expressing and exploring her inner world at her
own pace. I sat quietly besides her, touched by her vulnerability and perseverance. I
gently reflected the emotions surrounding the characters and expressed my empathy for the
struggle the chameleons faced. I 'wondered' aloud about the needs of her characters. Gradually
Cloe discovered the needs of the chameleons, ways to make them feel safe and unmuddled. As
Cloe began to transfer these ideas and coping strategies into her own world, her story
The chameleons were nourished and cared for they spent entire sessions eating special
vitamins until, one day, the chameleon who had been tired and afraid was no longer so. She felt
safe in the knowledge that she knew where her friends were when they were not in the river and
in her knowledge that they would returnand finally Cloe too, felt safer and at peace in her