Play Therapy

Play therapy incorporates the child’s physical abilities, cognitive functioning levels and emotional needs in a safe, supportive environment. It is a therapeutic and psychological intervention that uses play to help children with Cerebral Palsy develop a better sense of inclusion using both directed and non-directed play. It builds self-confidence, interaction, and sense of self. Playing is the activity that brings the most joy into the young lives of children; play therapy capitalizes on that interest to help a child function.

What is play therapy?

Playing is the activity that brings the most joy into the young lives of children. It’s an activity that allows children to build self-confidence, interact with other children, and learn about him or herself. It’s an experience that exemplifies what it means to be a child; and one that no young person should be excluded from.

Yet for children with Cerebral Palsy, playing can represent some very real obstacles. Although children have an instinct to play, children with physical and cognitive difficulties often have a difficult time acting on those impulses. But that’s where a play therapist steps in.

Play therapy is an innovative process that provides children with the skills they need to have fun and build valuable connections. Play therapy allows a child to have experiences that are fun, emotionally freeing, and universal to childhood.

Play therapy is a therapeutic and psychological intervention that uses play to help children with Cerebral Palsy develop a better sense of inclusion using both directed and non-directed play. This allows children to not only learn how to interact with others and develop relationships, it also provides physical strategies children can use to perform. Play therapy incorporates the child’s physical abilities, cognitive functioning levels and emotional needs in a safe, supportive environment.

What are the benefits of play therapy?

Play therapy helps children with Cerebral Palsy express themselves. It sounds simple because the capacity for play is hardwired in a child’s brain, but in actuality, learning to play can be challenging for some children.

Play with purpose has also been a proven method for mental health professionals – and parents and caregivers – to learn more about how a child interacts within their environment and what their self-concept is. Therapy gives children a voice they might not be able to express in words, and therefore, provides valuable insight into a child’s emotional state.

For instance, if a child is asked to draw a picture of their family, and they draws themselves apart from the rest of the family, the child may feel isolated and without the words to express their feelings. When discovered, the therapist and family improve the child’s situation through play therapy.

But play therapy’s benefits are more far more comprehensive, and include:

• Increased self-confidence
• Improved decision-making
• Improved feeling of control over their environment
• Enabled adaptive play
• Resolution of emotional barriers
• Reduced feelings of anxiety, depression and anger
• Developed cognitive problem-solving
• Increased autonomy
• Increased relaxation
• Increased learning
• Improved self-expression
• Decreased feelings of separateness

For the family of a child with Cerebral Palsy, there are also benefits. Parents and siblings are encouraged to participate in therapeutic play so the entire family can learn to play and interact with the child in a way that delivers enjoyment and bonding.

When is play therapy advised?

Play therapy is typically recommended when the child is a toddler; often, a child can be as young as 2 years old when therapy begins. Play therapy is often performed when the child is young, but is not uncommon in early adolescence when peer pressure and acceptance is crucial.

The earlier play therapy is advised, the sooner a child can begin benefitting from what is learned. Early interventions also greatly increase the likelihood that the child will implement learned behavior into their interactions with other children throughout their various developmental stages. This promotes relationship development, peer connectivity, and feelings of inclusion and acceptance.

How is play therapy performed?

Play therapists employ several techniques to treat children who, either physically or cognitively, are experiencing difficulty playing. Many of the techniques are rooted in psychotherapy and psychology. Some are meant to ensure a child adapts to physical impairments by using step-by-step processes, modified processes, adaptive equipment or assistive technology.

The act of playing in and of itself is often therapeutic to children. Activities such as playing games, drawing or stringing beads helps children develop flexibility and dexterity while experiencing control over their environment. Interacting with other children, or an animal, can help a child socialize; thereby eliminating feelings of isolation.

There are three forms of play therapy:

• Non-directed play occurs when a child is encouraged to pursue any play he or she desires. This gives a therapist a snapshot of how a child feels, and what issues may be preventing the child from fully expressing him or herself in other situations.
• Directed play occurs when the therapist determines how play will proceed.
• Prescribed play is when a therapist teaches a child adapted methods of play.

Play therapy may be conducted on a one-on-one basis between the therapist and the child, or in a group – or both. Additionally, play therapy encompasses many types of play, from physical activities that require movement, to using toys in groups or alone, to passive activities like listening to a story.

During play therapy, children will learn:

• The benefits of play
• How to have fun
• How to make friends
• How to channel the impulse to play into action
• How to play with and alongside others
• How to thrive in group settings
• How to minimize physical limitations
• How to physically manipulate toys and objects
• How to comply with socially accepted norms of play

Techniques used in play therapy include:

• Talk therapy
• Conversation to engage a child
• Story time involving books that support positive messages
• Animal interaction
• Human interaction with children and peers or adults with authority
• Family time

Play with purpose is often fun. Toys are gripped, operated and manipulated. Creative arts and crafts encourage sharing and openness. Large art projects created with others provide a sense of partnership. Dramatic dance or musical performances involve the senses.

It is easy to understand why children embrace play therapy over other modalities as they often don’t perceive play in a negative light; difficult or a chore.

Where is play therapy performed?

Play therapy can take place in several settings, some of which are therapeutic settings, and others which are informal. Play therapy, especially when it is unstructured, can take place in therapeutic settings, rehabilitation centers, educational environments, community centers, playgrounds, or in a child’s home. Play happens indoors and outdoors.

Play therapy should always take place in areas that are safe – meaning that modifications often need to be made based on a child’s physical and developmental needs.

Who provides play therapy?

Play therapy is provided by degreed, professional play therapists. The path to a career in play therapy, however, is varied. Though play therapists can earn a master’s in play therapy, those who earn the same level of education in fields such as psychology and social work can also pursue certification.

Typically, practicing play therapists study several subjects as part of their education, including:

• Behavioral psychology
• Child or adolescent psychology
• Sociology
• Art
• Human development

Certification also has two paths. To attain certification as a Registered Play Therapist (RPT) or a Registered Play Therapist Supervisor (RPT Supervisor) through the Association of Play Therapy, an applicant must already be a licensed mental health professional (i.e., a social worker must meet licensing requirements outlined in that field).

The requirements for an RPT certification include:

• Certification in the field
• Two years or 2,000 hours of clinical experience
• Completion of 150 hours of play therapy instruction
• Completion of 500 hours in supervised play therapy practice

The requirement for an RPT Supervisor certificate include all of the above, and:

• An additional three years of practice after state licensure
• An additional 500 hours of play therapy practice
• State licensure that allows the applicant to supervise others

Play Therapy International also offers certification. The requirements for PTI certification include:

• A master’s degree in play therapy, mental health, medicine, or education, among others
• Demonstrated coursework in psychology, human development child psychosocial development, family therapy, behavioral disorders, and research and evaluation
• 2,500 hours of clinical practice
• 2,000 hours with children
• Completion of PTI evaluation process
• Completion of 48 hours of continuing education every three years

Visit your state’s medical licensing board for more information.

What happens during play therapy?

Play therapy begins with an assessment of a child’s cognitive, physical and emotional condition, as well as a review of the child’s medical records. Interviews are conducted with the child, caregivers and parents. Early on in the therapy process, a therapist will note activities a child will enjoy, and what forms of play would help develop a child’s unique abilities while incorporating impairment.

A plan of treatment will then be developed that will likely involve solitary play, group play, play with family, focused or directed play, and activities where the child determines how and when play will take place. How often a child will attend play therapy sessions is determined by the child’s needs, as well as insurance provisions.

During therapy, children will learn how to take part in the physical aspects of play by using altered toys, adaptive equipment, and modified techniques, like:

• Soft clay
• Pencils, markers, crayons and paint brushes with a foam grip
• Costumes with Velcro closures
• Large beads and course string
• Sand trays
• Textured toys
• Brightly-colored games
• Simple musical instruments and bells

It is the therapist's responsibility to make sure that play therapy occurs in a safe environment. Therapists coach parents and educators on how they can modify their play spaces to suit a child with Cerebral Palsy.

Methods beyond child-safe measures, that can be used to make a space safe and conducive to play for those with impairment, include:

• Strategically-placed wedge pillows
• Large stuffed animals
• Soft carpet
• Permanently stabilized stationary toys and dollhouses
• Bright lighting
• Safe play surfaces
• Unobstructed travel areas