What Is Play Therapy?

Play therapy was developed early in the 20^th century as a way for psychiatrists, psychotherapists, teachers and other childcare professionals to help young children positively and productively handle a wide range of emotional and psychological challenges. The underlying premise of play therapy is to meet children at their own level, where they are most comfortable: in the world of play. Play therapy has been developed by hundreds of therapists over the past 60 years, but  Virginia Axline and Violet Solomon Oaklander are widely considered to be its most influential innovators.  In 2008, the British Association of Play Therapists defined play therapy as:

“The dynamic process […] in which the child explores at his or her own pace and with his or her own agenda to those issues, past and current, conscious and unconscious, that are affecting the child’s life in the present.”

 While older children, adolescents, and adults can engage in abstract conversations about difficult things that are going on in their lives, younger children are often unwilling and/or unable to discuss challenging issues. Play therapy creates a unique situation in which young children and a therapist, counselor or parent can explore a child’s inner life in a way that is safe and healthy.

Recently, however, therapists have developed a modified version of play therapy for adolescents with a history of complex trauma. This new approach to play therapy for adolescents is called trauma-informed play therapy. Adolescents who experience complex trauma during childhood can benefit from play therapy for some of the same reasons young children can: their inability to identify and discuss complex emotions makes play an ideal forum for exploring their trauma in a safe and supportive environment.

In this article, we’ll discuss traditional play therapy for young children as well as trauma-informed play therapy for adolescents.

Who Benefits from Play Therapy?

Play therapy is most often recommended for children ages 2-8. In some cases, play therapy is used for children ages 9-12. Play therapy is a proven effective therapeutic approach for children who show symptoms of:

• Anxiety, stress, or phobia
• Depressive disorders
• Defiance-type disorders
• Attentional disorders, with or without hyperactivity

Play therapy also helps children who:

• Have trouble making friends
• Display bullying behavior
• Experience the loss of a loved one
• Experience trauma
• Have problems with sleep or nightmares
• Show an aversion to play

The universality of play for humans allows play therapists to adapt their techniques to the specific needs of each child, the challenges they face, and the psychological, emotional, and behavioral skills they need to develop to manage their symptoms and process early trauma.

Types of Play Therapy: Young Children

During play therapy, an adult (therapist, counselor, or parent) uses a combination of interactive play and conversation to get an idea of what is going on in the life of the child. The adults pay special attention to the mood, tone, and types of play a child gravitates toward, the characters and roles a child likes to inhabit, and the types of stories a child likes to act out. Through close observation, the adult pieces together the inner life of the child. There are three primary modes of play therapy:

• Directive Play Therapy: In this type of play therapy, the therapist leads the way and makes his or her assessment based on the child’s level of engagement with games they initiate. The therapist will then introduce games, characters or play scenarios he or she thinks will be helpful to the child.
• Non-Directive Play Therapy: In this type of play therapy, the child leads the way. The job of the therapist is to follow, keep the play grounded in reality and create a safe, nurturing environment that encourages free communication and self-expression. The therapist does not guide or push the child in any particular direction and always gives the child the opportunity to solve problems and initiate change.
• Blended Play Therapy: Blended play therapy is a combination of the Directive and Non-Directive play therapy. In a blended session, a therapist might follow the child for a period of time in order to learn, discover, and formulate a therapeutic approach for the child. Then they switch roles and initiate games and activities based on previous observations.

Trauma-Informed Play Therapy: Adolescents

Compared to play therapy for young children and pre-adolescents, play therapy for adolescents is relatively new. It’s also specific to teens who have experienced complex trauma. In the paper “Treating Complex Trauma in Adolescents: A Phase-Based, Integrative Approach for Play Therapists,” authors Eric Green and Amie C. Myrick outline the effects of complex trauma on adolescents and describe the system of play-based therapy they developed to help this population process the emotions related to trauma.

Before we discuss their paper, we’ll offer a brief definition of complex trauma, then describe the impact it can have on adolescent development. The National Child Traumatic Stress Network (2007) defines complex trauma as:

“Both children’s exposure to multiple traumatic events, usually of an invasive, interpersonal nature, and the wide-ranging, long-term impact of this exposure”

Complex trauma can lead to significant impairments in a wide range of critical developmental areas. While each child is different, and each profile of early trauma and its consequences in adolescence follows a unique trajectory, victims of early trauma often develop problems in the following developmental domains:

Complex Trauma: Common Impairments

• Attachments and Relationships. Adolescents who experience trauma as children often have difficulty forming meaningful bonds with others, including family, friends, and teachers.
• Physical Health. Complex trauma can cause dysregulation and impaired development in the immune system and stress response system. Victims of early complex trauma are also at increased risk of risky behavior as adolescents, and developing chronic illnesses or physical conditions as adults.
• Emotional Regulation. Adolescents who experience complex trauma often display unpredictable or volatile emotional reactions to external stressors that may appear minor to the outside observer.
• Emotional Connection. This is similar to the difficulties victims of complex trauma have in forming bonds with others. In this case, the adolescent is not disconnected from others, but rather from themselves and their own emotions. This can result in feelings of being cut off from their own bodies and experience, and may impact learning, behavior, and peer interactions.
• Behavioral Regulation. Victims of complex early trauma, due to impairments in emotional regulation, may also have difficulty controlling impulses. They may display unpredictable, extreme, and oppositional behavioral patterns. These may include high-risk behaviors such as early sexual activity, experimenting with alcohol and drugs, and engaging in illegal activities.
• Cognition. Adolescents with a history of complex trauma may develop problems with rational thinking, problem-solving, risk assessment, and planning. In school, this can affect learning, language development, and high-order reasoning skills.
• Self-Concept and Self-Esteem. Victims of complex early trauma often experience poor self-image, low self-esteem, and overwhelming feelings of shame and guilt that can affect all areas of their lives: physical health, mental health, academic achievement, and social functioning.

These impairments can make adolescence extremely difficult. And if the trauma is not addressed and processed with the help of qualified mental health professionals, these challenges may persist through adulthood.

Play Therapy for Adolescents

Play therapy for adolescents with a history of complex trauma follows the same pattern as non-play therapy for adults with a history of complex trauma: establishing safety, processing trauma, and re-engaging/reconnecting with the world. Adolescent-specific treatment for complex trauma adapts these three phases as follows:

1. Safety and Stabilization. In the adolescent population, this involves:
   • Reducing self-destructive behavior
   • Recognizing and managing symptoms
   • Learning and practicing self-care
   • Establishing a positive relationship with a therapist
   • Coping with emotional pain and life-interrupting impulses
2. Trauma Processing. In the adolescent population, this involves:
   1. Applying self-stabilization skills to the past traumatic event.
   2. Creating a life narrative in order to understand the way trauma affects their lives.
   3. Using non-talk methods to explore trauma, such as:
      • Music
      • Visual Art
      • Drama
      • Sand tray exercises
3. In the adolescent population, this involves:
   1. Development of self-mastery of trauma exposure:
      • The memory of trauma becomes less powerful
   2. Development of self-mastery of emotional states:
      • Emotions become less overwhelming
   3. At this point in treatment, adolescents begin to define their own goals, based on their own wants, needs, and ambitions. Common treatment goals include resolving or exploring:
      • Identity issues
      • Spiritual questions
      • Sexuality
      • Future Plans: i.e. What do I want to do with my life?

Learning the Skills to Help Themselves

As most adults know, children and adolescents are more likely to open up when they’re having fun. They’re also more likely to open up to someone who will share that fun with them. Though the theories behind play therapy can be helpful for parents and teachers, it’s important for the general public to understand that play therapists aren’t just playmates. They’re trained mental health professionals.

In the U.S., play therapists are required to hold a license in a mental health profession and to complete special training in play therapy. The training can be at a graduate school or organization such as The United States Association for Play Therapy.

The games children play reveal volumes about what they’re thinking, feeling, and experiencing. In many cases, their games are mirrors to their lives. The same is true for adolescents. Watch what they do with their unstructured free time, and you’ll probably learn more about them than you will by asking direct questions. The advantage of play therapy for young children is that it speaks to them in a language they understand: the language of blocks, toys, Legos, dress-up, and make believe. The advantage of play therapy for adolescents is that it gives them a condition they crave: freedom. When adults dig down and unlock the secrets of play in both children and adolescents, they begin to understand that games are more than just games. They are, in the words of renowned play therapist Violet Oaklander, “Windows to Our Children.”