Play Therapy

Definition, why it works, necessary materials, research basis, applications, benefits, techniques, links with social work, suggestions for practice.

Three sections follow:

1. Background Material that provides the context for the topic

2. Suggestions for Practice

3. A list of References

Feedback welcome!

Background Material

What is Play Therapy?

For children in particular, play is a natural medium for self-expression (Billett, 2025).  Play therapy is a form of psychotherapy in which play is used as a means of helping children (or adults) express or communicate their feelings.  Play therapy differs from regular play in that the therapist helps the person address and resolve their own problems. Play provides a safe psychological distance from these problems and allows expression of thoughts and feelings appropriate to the person’s development. (Seyderhelm, 2020).  Play therapy doesn’t necessarily replace medications or any other necessary treatments. Play therapy can be used alone or alongside other therapies (Pietrangelo, 2019).

The benchmark for success is when the presenting problem either reduces significantly or disappears completely. For example, a person who is having regular meltdowns learns how to express their discomfort in a way that doesn’t get them into trouble. This might mean that a child who can’t settle in the classroom, will eventually be able to get through their lessons without shouting out or standing up (Seyderhelm, 2020).  In play therapy toys are like the person’s words, through which the person is encouraged to explore feelings, to understand and accept them and then process them using their innate imagination. This unique form of therapy is mainly used for children but can also be used for adults (Koukourikos et al., 2021).

How Does Play Therapy Work?

Play is at the heart of childhood. It is a dynamic process that enables children to express themselves in their own ways, to get in touch with other children, to become socialized. In contrast to adults, it is not an easy task for the children to verbally express their thoughts, their problems, their questions. They can resort to play to express their concerns, their fears, their desires and to communicate with their environment. They can develop their imagination through play. They are also guided to new ways of viewing everyday life. Play is a basic part of children development, and it is as important as the maternal hug (Koukourikos et al., 2021).

Play therapy is an alternative to talking through problems, something most adults can manage, but many children cannot (Billett, 2025).  Play breaks down barriers between the practitioner and the child.  Play therapy taps into children’s natural way of understanding the world. Through play, they can act out scenarios that mirror their real-life experiences, fears, and desires. Whether it’s through dolls, art, role-playing or another play medium, play provides children with the opportunity to process their feelings in a non-threatening way (Ingham, 2025).

Toys and Materials

Children use toys and materials to (a) express emotions; (b) learn new coping skills; (c) increase self-esteem; (d) recognize and develop responsibility; (e) improve decision making skills; and (e) increase self-control.  The selection of toys and materials will vary depending on the counsellor’s theoretical orientation, personal ideas and values, space, and budget.  Toys suitable for play therapy can be divided into categories such as the following:

Family/Nurturing	Scary	Aggressive	Expressive	Pretend/Fantasy
Baby doll Dollhouse Baby clothes Baby bottles Cradle People puppets Animal families	Plastic snakes Toy rats Plastic monsters	Bobo or bop bag Small pillows	Easel and paints Watercolour paints Crayons Markers Coloured pencils Newsprint Sequins	Doctor kit Human figure puppets Animal puppets Blocks Magic wand Pieces of fabric
Small rocking chair Soft blanket Families of dolls Stuffed toys Pots,pans Dishes, silverware	Dinosaurs Dragons Sharks Insects	Soldiers Military vehicles Foam rubber bats	Play dough Pencils Glue Scissors Tape Stickers Pipe cleaners	Big pillows Iron & board 2 Telephones Animals: zoo & farm Puppet theatre Knights & castles
Sand in sand box/tray Kitchen appliances (wooden or plastic) Empty food containers Family miniatures	Alligator Puppets of dangerous animals	Weapons (rubber) Handcuffs Plastic shield	Needles and thread Beads Construction paper Poster board Butcher paper Magazines Paper bags Sock puppets	Hats & purses Dress up clothes Costumes Fantasy puppets Toy vehicles & cars

While the above list is quite extensive, the authors (Leggett & Boswell, 2016) also suggest a limited list of play materials: crayons, newsprint, blunt scissors, clay, popsicle sticks, tape, baby bottle, doll, plastic dishes and cups, doll family, doll house and furniture, face mask, rubber knife, dart gun, handcuffs, toy soldiers, car, airplane, puppets, two telephones, rope, and costume jewellery.

The key to the selection and use of toys and materials in play therapy is client need. Thought and deliberation on the focus of the therapy and what each session should provide for the client should dictate choice of materials. If the focus is for the client to identify an object in the playroom that represents his/her problem then toys and materials from varied categories must be available (Leggett & Boswell, 2016).

Research

Play therapy as a form of intervention for children has attracted the interest of many researchers, who have highlighted the value and effectiveness of this method.  Studies have demonstrated its effectiveness in children:

• Improving expressive and perceptual skills related to speech

• Significantly reduced the stress of both teachers and students

• Reduction in anxiety symptoms and overall decrease in behavioural difficulties

• Enhancing of children’s social-emotional skills and, in particular, communication and problem-solving skills

• Reduction of disobedience in children

• For children in hospitals, a reduction in concerns and fears both preoperatively and post operatively

• Assistance with communication in family therapy (Koukourikos et al., 2021).

When Play Therapy Can Be Used

Although people of all ages can benefit from play therapy, it’s typically used with children between the ages of 3 and 12. Play therapy may be helpful in a variety of circumstances, such as:

• facing medical procedures, chronic illness, or palliative care

• developmental delay or learning disabilities

• problem behaviors in school

• aggressive or angry behavior

• family issues, like divorce, separation, or death of a close family member

• natural disasters or traumatic events

• domestic violence, abuse, or neglect

• anxiety, depression, grief

• eating and toileting disorders

• attention deficit hyperactivity disorder (ADHD)

• autism spectrum disorder (ASD) (Koukourikos et al., 2021; Pietrangelo, 2019).

Trauma-informed play therapy is a powerful therapeutic approach that offers children a safe space to process and heal from trauma. Play therapy plays a critical role in helping children recover and regain a sense of safety and control.  Trauma-informed play therapy helps children heal by:

• Building trust and safety in a controlled, supportive setting

• Allowing children to express emotions—anger fear, sadness or confusion—through play without the pressure of putting complex emotions into words.

• Restoring a sense of control by allowing children to make choices and engage in activities they control, thus regaining autonomy.

• Healing through creativity through art, storytelling, role-playing and other creative outlets, allowing children to ‘rewrite’ the narrative of their trauma.

• Enhancing emotional regulation as children use role-playing and dramatic play to identify emotions, express them constructively and manage them in real-life situations (Bradford, 2017).

While there is substantial and growing evidence for the efficacy of play therapy, play therapy may not be suitable or necessarily the best form of assessment and intervention for all children or presenting issues. A thorough parent or carer assessment prior to working with children is essential to determine how best to understand and work with a child, if at all. In some families where children are displaying challenging affect or behaviour, the optimal intervention can involve working primarily with parents. When children are deemed to be at risk of harm, safety planning and relevant child protection notification to the appropriate authority takes precedence. Where children are showing symptoms of obsessive-compulsive disorder, the research literature suggests behavioural interventions should be used in the first instance (Short, 2015).

Benefits of Play Therapy

Some of the potential benefits of play therapy are:

• taking more responsibility for certain behaviors

• developing coping strategies and creative problem-solving skills

• self-respect

• empathy and respect for others

• alleviation of anxiety

• learning to fully experience and express feelings

• stronger social skills

• stronger family relationships

Play therapy can also encourage use of language or improve fine and gross motor skills (Pietrangelo, 2019).

Therapeutic powers of play (Hartwig, 2021; Dean & Goldingay, 2023)

Facilitates communication

1. Self-expression:  Play is a child’s natural language.  Thoughts and feelings are expressed through play. 

2. Access to the unconscious: Unconscious thoughts and feelings are accessed through play.  Sensations and experiences are played out to externalise and express internal thoughts, feelings and desires.

3. Direct teaching: Learning through play can be fun.   Playful approaches foster learning engagement. Active and playful participation enhances the learning experience.

4. Indirect teaching: Playing in the metaphor facilitates meaning making.  Narrative play optimises ‘knowing’.

Fosters emotional wellness

1. Catharsis: healing, releasing, freeing emotions through play.

2. Abreaction: re-create, re-direct, re-experience

3. Positive emotions: fun, joy, ha…ha…ha!!!, silly, satisfied, sigh

4. Counter conditioning fears: relax, replay, de-sensitise

5. Stress inoculation: show, practise, play it away.  Seeing and doing as preparation.

6. Stress management: Coping and caring for self and for others.

Enhances social relationships

1. Therapeutic relationship: Wired to socially connect. Trust, safety and acceptance.

2. Attachment: Bonding, affection and connection that crosses the lifespan.

3. Social competence: social skills (empathy, cooperation and mutual fun).  Role play in a social context.

4. Empathy: Theory of mind.  Attunement to and understanding of others’ experiences.

Increases personal strengths

1. Creative problem solving:  Scenarios can be practised and problems solved through play.  Pretend play allows for creativity, flexibility and divergent thinking.

2. Resiliency: Play can give insight into a child’s strengths, coping strategies and preparedness for future challenges.

3. Moral development: Play meets the child where they are developmentally, and through a playful relationship the exploration of a social conscience can occur.

4. Accelerated psychological development:  Zone of proximal development.  Play can promote growth in children’s social, emotional and neurological development.

5. Self-regulation.  Window of tolerance.  Play fosters the mastery of physical and emotional regulation.

6. Self-esteem.  In play the child can discover their whole self.  The therapeutic skills used in Play Therapy recreate optimal conditions for developing self-esteem (Hartwig, 2021; Dean & Goldingay, 2023).

Play Therapy Techniques

The therapist may use a variety of play-based techniques, such as:

• Sand Tray Therapy: Using a tray of sand and miniatures to create scenes that represent the child’s experiences and feelings.

• Board Games and Card Games: This can a great way to assist children to increase distress tolerance, especially those who struggle with the emotions associated with losing. These games can also be used as positive spaces to build and reinforce social skills.

• Creative Art: Drawing or painting to express emotions that might be too hard to put into words.

• Role-playing or Puppetry: Using dolls, puppets, or action figures to act out social situations or issues the child is facing.

• Storytelling: Encouraging the child to create stories or scenarios that reflect their experiences (Ingham, 2025).

As the child plays, the therapist will typically silently observe, making mental notes about the child’s behaviours, tone, or actions. For example:

• Themes: Is the child building a fortress, suggesting a need for security? Are they acting out aggressive behaviour, which could indicate anger or frustration?

• Repetition: If the child keeps repeating certain actions, it may signal an emotional preoccupation or an unresolved issue they are working through.

• Body Language: The child’s posture or facial expressions can indicate how they’re feeling while engaging with the toys or materials (Pietrangelo, 2019; PTI, 2019).

At times, the therapist might gently engage by asking questions or offering comments, not to direct the play, but to encourage more exploration. For example: "I see you’re making a big tower. What’s happening with the tower now?" This gives the child a chance to express themselves further.  Over time, the therapist can help the child process difficult emotions, explore solutions to problems, and develop healthier coping strategies (Ingham, 2025).

Sessions typically last 30 45 minutes to an hour and are held once a week or so in an environment where the child feels safe and where there are few limitations. The number of sessions needed depends on the child and how well they respond to therapy. Therapy can take place individually or in groups (Pietrangelo, 2019; PTI, 2019).

Play therapy can be directive or nondirective. In the directive approach, the therapist will take the lead by specifying the toys or games that will be used in the session. The therapist will guide the play with a specific goal in mind.  The nondirective approach is less structured. The child is able to choose toys and games as they see fit. They’re free to play in their own way with few instructions or interruptions. The therapist will observe closely and participate as appropriate (Pietrangelo, 2019).

Play Therapy for Adults

Play isn’t just for children, and neither is play therapy. Teenagers and adults can also have a difficult time expressing their innermost feelings in words. Adults who may benefit from play therapy include those affected by:

• intellectual disabilities

• dementia

• chronic illness, palliative care, and hospice care

• substance use

• trauma and physical abuse

• anger management issues

• post-traumatic stress disorder (PTSD)

• unresolved childhood issues

When working with adults, a therapist may use dramatic role-playing or sand-tray therapy to help the person get in touch with feelings that are hard to talk about. These therapies can help the person work on strategies for dealing with particular scenarios.  The very act of playing, whether it’s games, arts and crafts, or music and dance, can help the person relax and unwind from the stresses of everyday life.

Art therapy, music therapy, and movement can help reveal hidden traumas and promote healing. Under the guidance of an experienced therapist, play can be a valuable tool in getting people to where they want to be.  Play therapy for adults may be used as a complement to other types of therapy and medications (Pietrangelo, 2019).

Play Therapy Skills and Social Work

The foundation skills used in play therapy are similar to social work skills, just in a different medium:

• Attunement (being able to track what’s happening for the person; connecting with the person – moods and emotions)

• Empathy (empathetic responding – ‘you did that and you’re feeling really proud’)

• Unconditional positive regard

• Authenticity

• Structuring

• Prizing the person rather than praising them so that the person builds their internal locus of control (belief that the outcomes of their action are the results of their own abilities) rather than feeling judged (positively or negatively) by the therapist.  For example, rather than “that’s a really good job you’ve done there” say “you’ve put so much work into that, you must be really proud” (Dean & Goldingay, 2023).

Eight key principles have been suggested as necessary in play therapy:

1. Development of good communication / relationship,

2. Acceptance of the person as she/he is,

3. Provision of opportunities for the person to express feelings,

4. Awareness of the feelings expressed by the person,

5. Belief that the person has the ability to solve his problems,

6. Non-directional play,

7. No rush for the child,

8. Secure boundaries around the treatment, to maintain contact with reality (Koukourikos et al., 2021).

Legget and Boswell (2026) elaborate on the above by outlining the verbal and non-verbal skills used with all clients in play therapy.

Nonverbal skills

• Leaning Forward. Leaning forward with an open body posture helps the counsellor create a warm and accepting environment for the client.

• Appearing Interested and Relaxed and Comfortable. This can be demonstrated with the counsellor’s body postures, facial expression, and accurate responses.

• Expression and Tone Congruency. The counsellor strives to be congruent with the client’s expression. Matching the affect (e.g. feelings) of the client should appear genuine which would be reflected in the counsellor’s tone.

Verbal skills

• Verbal responses.  The length of responses should be short, succinct, and focus on the client. The frequency of the counsellor’s interactions should match the client, e.g. be slow to respond if the client is quiet.  Silence is a valid response.

• Reflecting content.  The counsellor paraphrases the verbal utterances of the client.

• Reflecting feelings.  Reflecting the client’s affect serves to make the feelings explicit to the client. Both children and adults may avoid the verbal expression of feelings.  Reflecting a client’s feelings leads to: (a) demonstration of the counsellor’s understanding and acceptance; (b) trust and acceptance of client feelings; (c) validation; and (d) creation of empathy.

• Facilitating decision making and creativity.  When the client asks questions or asks for help from the counsellor it is an opportunity to return the responsibility back to the client. The counsellor’s role is to encourage the client to make his/her own decision and to take responsibility for the current concern. Another opportunity to facilitate decision-making is recognizing when a client takes charge of a situation in the counselling session and decides what he/she wants to do or how he/she wants to do it. These occurrences help the client learn to be more autonomous, independent, and more comfortable with his/her own initial ideas.

• Esteem building and encouraging (prizing rather than praising).  These statements recognize when a client achieves something he/she may have struggled with, such as getting the top off of a container. “You didn’t give up, you got it!” At times counselors can struggle between encouraging a client and praising the client. A praise statement encourages the client to perform for the counsellor. This reinforces an external locus of control. “I like the way you built that.” “Your drawing is pretty.” An esteem building statement encourages the client develop an internal locus of control. “You are proud of the way you built that.” “You drew that picture just the way you wanted.” When a client is encouraged to value the effort and work he/she put towards a task, he/she develops an internal source of evaluation. Then, instead of seeking approval from others, the client is able to applaud his/her own effort and accomplishment. 

Accreditation

Play therapy is a recognised and accredited four-year training course.  While it is possible to include some aspects of the play therapy toolkit, such as therapeutic storytelling, drawing, and painting into the social worker’s toolkit, social workers who wish to incorporate play therapy as a major aspect of the support they offer children, or social workers who deal primarily with children, need to acquire knowledge of how to create a therapeutic frame with the child; how to hold and contain the child’s emotional story, how to work with transference and countertransference that arises typically between child and social worker (Seyderhelm, 2020).  These workers should consider gaining accreditation in play therapy from an accredited institution.  Play therapy is not a magic wand which can create change and development in children immediately. Professionals need substantial knowledge, training, supervision, consultation, awareness, personal investment, skills on the issue and should have a belief in children's development (Kilic, 2020).

Suggestions for Practice

Social workers, as part of everyday practice, often have contact with children in distress.  These children may be abused, traumatized, settled in institutional care, experiencing adjustment problems at school, staying in the middle of parents' divorce process, coming to another country as an asylum seeker, driven to crime, having behavioral disorders, being treated in oncology clinics and in many other environments.  It is evident from the above material that working with children can be different to working with adults because of the difficulty children may have in verbalising issues.  Given play therapy is recommended as a very effective method when dealing with the problems and concerns of children, it is an area of practice that social workers should consider adding to their skill set.

Many of the counselling skills that social workers use in day-to-day practice are used as part of play therapy.  With additional training, social workers will be able to incorporate play therapy approaches, either directive or non-directive, into their practice and further the wellbeing of children.  Furthermore, for adults who find it difficult to express themselves verbally, play therapy using a medium of choice, may enable to person to more easily explore the issues that are troubling him or her.

There is research evidence that play therapy can be effective for a variety of circumstances, adding weight to the expectation that social workers add this approach to their toolkit of strategies:

• facing medical procedures, chronic illness, or palliative care

• developmental delay or learning disabilities

• problem behaviors in school

• aggressive or angry behavior

• family issues, like divorce, separation, or death of a close family member

• natural disasters or traumatic events

• domestic violence, abuse, or neglect

• anxiety, depression, grief

• eating and toileting disorders

• attention deficit hyperactivity disorder (ADHD)

• ·       autism spectrum disorder (ASD) (Koukourikos et al., 2021; Pietrangelo, 2019).

It should be noted that a thorough parent or carer assessment prior to working with children is regarded as essential to determine how best to understand and work with a child, if at all. In some families where children are displaying challenging affect or behaviour, the optimal intervention can involve working primarily with parents. When children are deemed to be at risk of harm, safety planning and relevant child protection notification to the appropriate authority takes precedence. Where children are showing symptoms of obsessive-compulsive disorder, the research literature suggests behavioural interventions should be used in the first instance (Short, 2015).

There are a variety of play therapy techniques mentioned in the background material above.  This suggests that social workers do not need to be adept at all possible techniques.  Some social workers may find techniques that fit their strengths, where they already have some background knowledge and skills, that enable them to use this form of therapy in practice after investigating how this specific approach is used by experienced play therapists.  Board and card games, creative art and storytelling are examples.

References

Billett, B. (2025). The power of play-based therapy.  Social Futures.  https://socialfutures.org.au/the-power-of-play-based-therapy/ 

Bradford, M. (2017). Healing Through Play: Trauma-Informed Play Therapy.  Purple Sky Counselling.  https://www.purpleskycounseling.com/blog/mckenzie-bradford-lcsw-trauma-informed-play-therapy-for-children

Dean, B., & Goldingay, S.  (2023). Play therapy.  AASW webinar.  https://my.aasw.asn.au/s/global-search/Play%20Therapy

Hartwig, E. K (2021). Solution-focused play therapy: A strengths-based clinical approach to play therapy. Routledge.

Ingham, K.  (2025). When play becomes a language: Understanding play therapy for children.  Northside Psychology.  https://northsidepsychology.com.au/when-play-becomes-a-language-understanding-play-therapy-for-children/

Kilic, C. E. (2020). Importance of play therapy in social work practice with children.  Journal of Human Sciences, 17(4), 1137-1148.  doi:10.14687/jhs.v17i4.6083

Koukourikos K, Tsaloglidou A, Tzeha L, Iliadis C, Frantzana A, Katsimbeli A, & Kourkouta L. (2021). An overview of play therapy. Mater Sociomed, 33(4), 293-297. doi: 10.5455/msm.2021.33.293-297

Leggett, J. & Boswell, J. (2016). Directive play therapy.  In E. S. Leggett & J. N. Boswell (Eds.), Directive play therapy: Theories and techniques (pp. 1–15). Springer Publishing Company.

Parker, M., Hollenbaugh, K., Kelly C. (2021). Exploring the impact of child-centered play therapy for children exhibiting behavioral problems: A meta-analysis.  International Journal of Play Therapy, 30(4), 259-271. https://doi.org/10.1037/pla0000128

Pietrangelo, A. (2019). How play therapy treats and benefits children and some adults.   https://www.healthline.com/health/play-therapy

PTI: Play Therapy International.  (2019). How does therapeutic play work?   https://playtherapy.org/about-play-therapy/

Seyderhelm, A. (2020, November 22). Helping children communicate their feelings through ‘play’.  Social Work News.  https://www.mysocialworknews.com/article/helping-children-to-communicate-their-feelings-through-play

Short, J. (2015). Play therapy: Working creatively with children.  InPsych, 37(3).  https://psychology.org.au/inpsych/2015/june