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Child’s Play: How Play Therapy Works

Child’s Play: How Play Therapy Works

Kids can’t always put their feelings into words.

By Tomás Casado-Frankel, LMFT

I am frequently confronted with parents’ concerns regarding the effectiveness of play therapy as a form of treatment. They say, “But it’s just play!”

Play therapy is not just play. The treatment might be fun for the young patient—yes—but there is a lot that’s being expressed and understood. Play therapy is meaningful!

Young children communicate through play. Pretend play allows children to assume the control they so rarely experience living in a world run by adults. They are free to express their emotional experience—what it feels like to be them. With access to this internal realm, I, as a play therapist, can help the child discover alternative ways of coping with their worries.

Play Reveals the Child’s Internal Emotional World

Consider a 6-year-old boy who has repeatedly witnessed domestic violence and is acting out aggressively at school—he’s been labeled a bully. He walks into a session with an entourage of miniature cars—a bag full of treasure—and in the bat of an eye, turns the room into a battlefield with a dollhouse under siege.

Play and reality are not that different.

At first glance, this boy may appear to be an aggressive child acting out anger in his play, but to the therapist, he is revealing a world of pain. The child brings his fearful and vulnerable self into the session by assigning me the role of victim. In this role, I must repeatedly attempt to defend my family from bad guys in an unpredictable dollhouse home—I feel what it feels like to be him in his home, one in which he is repeatedly under siege.

“Get ready the bad guys are coming closer!” he whispers right before beginning an attack. A toy police car I dispatch is unable to stop them. Then I’m informed that even the good guys in the house have turned bad. My friends in the dollhouse are no longer to be trusted, and I’m forced to put up with an onslaught through every door and window. I get the feeling that no matter how much I fight, I’m stuck. There is not much I can do.

I experience the helplessness he has to tolerate every day. The anger in his play, like that expressed at school, is likely his reaction to underlying feelings of pain and fear. Feelings too overwhelming for him to put into words—in play he is able to express that for which he cannot find language.

Or think of an 8-year-old girl whose anxiety is so intense it practically renders her mute. Her symptoms have taken hold of her body too. She has a hard time moving her bowels and difficulty swallowing.

Attempts to use words during our first session are futile, but as soon as she pulls out the dollhouse, she gives the characters a voice. Toy parents are straddled over a small airplane and suddenly disappear to a hidden corner of the room. The children in the dollhouse are all alone.

The family history reveals the mother had frightening medical complications after the last sibling’s birth, and the father had an unnerving immigration experience. This child has been terrified of losing them. Her play puts feelings into visible action.

Play Therapy Offers Alternatives

For the boy in the first vignette, being aggressive at school might feel like the only way my young patient feels he can avoid being a victim. But disconnected from his vulnerable feelings of victimhood, he will not have the opportunity to address the pain of his home life. The therapist understands this and works to bring those parts together in the play.

I pull out my loyal toy-musketeer, and right in the midst of the most gruesome of the child’s bad-guy attacks, my swordsman yells out: “No bad guys allowed! Get outta here bad guys!!!” And something happens. I’m speaking for the part of him that longs for calm and security. Though the characters are seemingly angry, they are expressing a wish to protect themselves—we’ve found a safe enough way to address my patient’s vulnerability.

The child says, “I really really like it when you say that! I don’t know why, but I reeeaally like it!! Say it again!” So I do. Or I should say the musketeer does, “No bad guys allowed!”

On the other hand, the girl patient has me searching for my missing parents. As the little girl, I ask, “When are they coming back?!” Her figure says, “I don’t know!” I exclaim, “But I’m worried! I want my parents back now!” The therapist finds words for the hidden feeling.

Play Therapy is Deeply Reparative

The message for the little girl is this: it’s OK to address unspeakable fears. Adults can be here to help you process and understand them.

She has started skipping down the hall before and after sessions. Body ailments have started to dissipate too. It’s not so hard to relax in the bathroom when the world is not as scary, and one feels understood.

The message for the boy however is this: one need not attack to be safe—he can defend himself with words. He can assert authority without overt aggression. Fighting in school might not always be necessary in order to feel less vulnerable. There might be a way to protect oneself without attacking first.

Play therapy helps children work through difficult emotions. It helps them feel heard and seen, and for children such as I’ve described, it often manifests in improved behavior at school or a reduction of overwhelming anxiety. Working through the threads of the underlying feelings in play therapy can be deeply reparative.

Tomás Casado-Frankel, LMFT, is a licensed marriage and family therapist in private practice in Brooklyn and Manhattan.

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