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Section 18
Play Therapy: The Children's Views

Question 18 | Test | Table of Contents

In the following excerpts from transcripts, therapists are referred to as T. Numbers after the children’s names are their age at interview. The interviewer (myself) is I.

Introduction to play therapy
I inquired why the children believed they had attended play therapy, and their expectations prior to meeting the therapist and seeing the playroom. Five children appeared unclear why they had attended; this may reflect the time lapse, they may have been embarrassed, or they may genuinely not have known. Five children thought they needed help with behavior, and three identified incidents in their past. Two children connected past events with their behavior.

One child supplied additional information beyond that provided by her therapist: she was referred following the death of her grandmother; a subsequent disclosure of sexual abuse became the focus of therapy. However, she told me:

I actually know that it was because I’d stopped eating, cos my nan died and I used to eat her meals – her meals on wheels – and that’s why I thought she died, so I stopped eating.
(Tiffany, 13)

Five children could not recall their expectations preceding therapy. The predominant concern of other children was that it would be boring, or they would be expected to talk:

I thought it was going to be a little room with either a really old man or a really old woman, that asked you questions that you really, really didn’t want to answer, and you did a bit of coloring and drawing and that was it. (Allan, 14)

Many therapists recounted comprehensive introductions which explained the purpose of therapy, and described the playroom. I asked the children what they would tell their peers if one expressed anxiety prior to attending for play therapy themselves. Children’s responses contrasted with the lengthy accounts given by therapists; their basic message was that it was fun, and it helped:

L: I’d say to the person, you’re going to play therapy, take it from me, if you don’t like fun, don’t bother going.
I: Was that the best thing about it?
L: Yea, and explaining my problems. If other people went, I think the whole school should go. (Lewis, 11)

Children were aware of efforts made by carers in taking them to therapy; one understood the need for a change of venue as it simplified traveling for her mother. Another valued time spent with her mother on the bus journey. Attendance for children seen in school or residential units posed no such
problems.

External supports for the children were valued by therapists; secure placements, with loving carers able to contain children when they had difficult feelings, were seen as essential. It was also clear that support given to carers was understood and appreciated by the children. One child was particularly positive about attention given to her family on arrival:

K-A: When she come to get me, in reception, she didn’t just come and get me straight away. She always stopped and asked how Mum was and things, and like played with these two [indicating her sisters] for a bit.
I: And you liked that? You didn’t mind sharing her for a minute?
K-A: No. (Kerrie-Anne, 13)

Therapists appear to have succeeded in keeping their concerns about external difficulties, such as uncertainty over funding or future plans, away from the work with the children, as they made no mention of it.

Relationship between child and therapist
These children were deeply engaged in the therapeutic relationship; they felt warmly towards their therapists, and identified aspects of the therapist’s behaviour or demeanour which were particularly helpful.

Therapist behaviour which facilitated the relationship
The children acknowledged efforts that therapists made to ensure they felt comfortable, both physically and emotionally. Three children specifically mentioned the provision of a drink and biscuits. One child, when asked what he did not like, commented that he would have liked such provisions, but his therapist suggested it would impede their play. There are mixed views about the provision of food (Haworth & Keller 1993), but these children’s opinions are unequivocal: they feel nurtured by it.

Two children valued the provision of a box or folder, containing private materials. They were able to describe, in great detail, the contents of their box, reflecting its importance. One child mentioned being given a present:

B: There was a book called the ‘Big Bag of Worries’ and she gave me that one, and in the book she asked all her parents, and then she asked her grandma and her grandma said ‘Let all your worries out’ and they were little, and they were chucking them out.
I: And how did that make you feel?
B: I liked it, cos she gave me something. (Britney, 11)

The therapist hoped the book would help Britney share her worries, but this was overshadowed by her delight at receiving a present. All the children were appreciative of toys and materials provided for them, irrespective of whether they worked in a fully equipped playroom or in borrowed rooms with portable materials. Seven children identified confidentiality as a vital component of the therapeutic relationship, and a further indication of the therapist’s willingness to help.

One day there was this teacher in year three that I really didn’t like, and I bottled it up for about a year, until I was talking to T. I could like say ‘I don’t like so-and-so teacher’. Cos it was sort of like she wouldn’t say anything. She’d never say anything to anyone else that I, like I said I didn’t like so-and-so teacher, and she wouldn’t go and tell that teacher. (Lewis)

Susie (14) went a step further; she knew that her mother would be upset if Susie talked about her sexual abuse at home, but that the therapist could contain her feelings safely and confidentially. However, children recognized that therapists talk with other adults, and two understood that therapists had a vital role as advocate on their behalf. Jamie and his sister had moved several times before beginning therapy:

I: Before you started play therapy, do you remember what you thought would happen?
J:We would keep moving to different people.
I: What did you think it would be like when you went to see T?
J: I’d think it was going to be good, cos she can listen to what we think, and she can tell the Social Services if we can go to someone permanently, so help us not move around loads. Cos sometimes it got annoying. Cos you’d like unpack your stuff, then pack it up again, then unpacked it, then packed it up again.
I: How do you think T stopped that happening?
J: Cos she told Social Services our feelings, and what sort of place we would like to go to.
I: And that was part of the play therapy? That was part of her job? Or was it something extra that she did?
J: I think it was a bit extra and part of her job. ( Jamie, 12)

A child referred with separation anxiety acknowledged the pivotal role of the therapeutic relationship in his developing ability to separate from his mother:

S: It [play therapy] helped me understand things more better. Like, if my Mum went off, that she would come back; cos she usually went to these meetings, and it used to be that she didn’t come back till nine or ten.
I: Do you know what it was about play therapy that helped you learn that?
S:Well, when I usually went into the room, without my Mum, it felt as though Mum had gone off without me; but I still had somebody to be with. (Simon, 11)

Words children use to describe their therapist
Eight children described their therapist as ‘really kind’, and five as ‘friendly’. Two portrayed them as relaxed and unlikely to become angry or upset:

She’s nice. She’s really kind and everything, and she don’t really get annoyed.Well, she didn’t get knotted, she was really relaxed sort of thing. (Legoman, 12)

Three children liked being teased by the therapist:

She’d say how pretty I looked in my school uniform, how cheerful I was; I lost one of my teeth once and she said, she kept saying ‘Have you been kissing a lot of boys lately?’ and I went ‘No’. (Christina, 11)

Four children extended descriptions of the therapist and thought of them as helpful and understanding. Stephanie highlighted the therapist’s ability to
understand and reflect feelings:

S: She’s quite good at predicting things, like when I went out she said ‘I think you feel very happy’ and I went ‘Yes, you’re
right’.
I: How do you think she does that?
S: I dunno, I think she has some kind of, magic power-thing.
I: And what does this magic power do?
S: Like, makes her think of everything, makes her know everything, like she’s psychic. (Stephanie, 11)

However, although the children were quick to describe their therapists as ‘kind’ and ‘helpful’ they found it more difficult to isolate qualities to illustrate that helpfulness.Two children talked of the therapists being easy to talk to, and another of a willingness to
help with feelings of anger; but most children were unable to develop this discussion.

Children’s awareness of appearance
These children were acutely aware of dress and appearance.

L: She always wears lipstick, sort of reddy-orange. She usually wears trousers. She usually wears [whispers] old stuff.
I:Why do you think she usually wore [whispers] old stuff?
L:Well, I don’t like to say; it’s a bit naughty, rude; sorry, well, I’ll say it, she’s a bit old. Sixties style. She’s really funky. She wears really funky stuff, like leopard skin trousers.Well, I don’t think it was real leopard skin; but I don’t really like stuff that’s fake, like that, cos I really love animals. (Lewis)

Tiffany recalled her therapist appearing one day in a ‘posh suit’, in contrast to her customary informality. This event had occurred six years prior to our discussion (she attended therapy for several years).
- Carroll, Jo; Play Therapy: the Children’s views; Child & Family Social Work; Aug 2002; Vol. 7, Issue 3. p 177-187.

Play Therapy and the Therapeutic Use of Story

- Carlson, Roxanne, Play Therapy and the Therapeutic Use of Story, Canadian Journal of Counselling / Revoie canadienne de counseling /, Vol. 33:3, 1999.

Personal Reflection Exercise #4
The preceding section contained information about the children’s views of play therapy. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Play Therapy via Telemedicine in a Child with Sudden-onset
Emotional Disorder During the COVID-19 Lockdown Period: A Case Report

- Sahoo, S., Sachdeva, D., Yumnam, S., Shah, R., Mehra, A., & Grover, S. (2022). Play Therapy via Telemedicine in a Child with Sudden-onset Emotional Disorder During the COVID-19 Lockdown Period: A Case Report. Innovations in clinical neuroscience, 19(10-12), 40–42.


Peer-Reviewed Journal Article References:
Hiles Howard, A. R., Lindaman, S., Copeland, R., & Cross, D. R. (2018). Theraplay impact on parents and children with autism spectrum disorder: Improvements in affect, joint attention, and social cooperation. International Journal of Play Therapy, 27(1), 56–68.

Swank, J. M., & Smith-Adcock, S. (2018). On-task behavior of children with attention-deficit/hyperactivity disorder: Examining treatment effectiveness of play therapy interventions. International Journal of Play Therapy, 27(4), 187–197.

Van Horne, J. W., Post, P. B., & Phipps, C. B. (2018). Factors related to the use of play therapy among elementary school counselors. International Journal of Play Therapy, 27(3), 125–133.

QUESTION 18
What was identified by the children as a vital component of the therapeutic relationship, and a further indication of the therapist’s willingness to help? To select and enter your answer go to Test.

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