By the time you and your child make it to our offices for Play Therapy, you have likely been struggling with emotions and behaviors, not to mention family dynamics, for a little while. You are ready for things to feel better in your family, for your child to behave and learn to manage big feelings more easily. Whatever has gotten you to this point, it will take some time, understanding, and intention to realize the cohesion and improved behaviors you desire. There is good news, too! In Play Therapy, we have specialty-trained therapists who have spent another two years minimum beyond their master’s degree and years under supervision to perfect this unique therapy craft that is rooted in evidence-based research. Most of our Play Therapists approach Play Therapy from Child-Centered Play Therapy, at least initially, while others are also expertly trained in Adlerian Play Therapy. This article is influenced by Child-Centered Play Therapy.
Child-Centered Play Therapy is very different from talk therapy, and it can be very easy to mistrust or not completely understand what is happening or how Play Therapy even works. First, your child is playing. Our culture places a high value on achievement, and when children play, it appears on the surface that no learning or change is happening. But what is actually happening is children are learning how their world works in a safe and fun environment. Adults generally like to process thoughts or words with another adult, but children learn to process through play. This is critical to understanding the play therapy process. Second, your child needs to do this on their own, with a trained professional. Play Therapy works best when children can work with a blank slate and no expectations with a few safety rules.
The Play Therapy Process
Often, parents want to know all the details or even be involved in the therapy sessions. They may even want to tell the Play Therapist what to do in sessions. In the Play Therapy process, it is ideal for children to have their own protected space to work on the challenges they need to overcome troublesome behaviors, big emotions, or interpersonal difficulties (including social skills development). Including parents in the process, which consists of listening to their needs and goals, is also critical to the child and family’s success. I generally like to include parents in the process by meeting with them in parent sessions (time with me and the parents without their child). This session is a protected time where the parents gain a deeper understanding of their child’s challenges from a social-emotional perspective and are given practical strategies to handle the child’s challenges to promote change in the family. Occasionally, the Play Therapist will also include family sessions, sibling sessions, or parent-child sessions.
The Play Therapy process can seem quite long, especially when you are ready to see immediate changes! Parents who have a good sense of the Play Therapy process have been noted to have more patience and understanding that their child is working hard, and change will happen. Parents who understand the process, and participate in the process, as requested by the Play Therapist, also experience growth in themselves, and improved interpersonal skills and dynamics in the family. During the Play Therapy Process, your Play Therapist will help you and your child become familiar with Play Therapy.
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- Complete History (Bio-psycho-social)—Your Play Therapist needs to have a comprehensive understanding and history of the presenting concerns, your child’s developmental history, and your family’s history.
- Assessments—Your Play Therapist will conduct several informal and formal assessments to help develop a solid treatment plan and diagnosis, if necessary. This is also important in developing goals for parent sessions, family sessions, sibling sessions, group sessions, and classroom observations.
- Frequency—Your Play Therapist will likely prescribe weekly Play Therapy sessions and monthly parent sessions. Frequency is an important part of the process for children. It helps them know that the work they are doing is important, and consistency conveys predictability and trustworthiness. It can be hard for the process to be done less frequently, and it can be detrimental to the psychological process of the child in the therapeutic process.
- Check-Ins—Your Play Therapist will likely want to know how your child is doing between sessions. These check-ins are geared toward information-sharing, not tattle-telling. It is important to protect the therapeutic relationship and provide information necessary to understand how the child is experiencing their world between sessions, including emotional, behavioral, social skills, and communication.
- Parent sessions—Your Play Therapist will provide you with a tentative frequency for parent sessions to support you and your child throughout the Play Therapy process.
Phases of Play Therapy
The Play Therapy Process includes 4 phases:
- Exploratory
- Resistance
- Work
- Termination
The amount of sessions in each phase can vary. You can learn more about what to expect in each phase below.
Exploratory Phase (4-8 Sessions)
The first 4-8 sessions are considered the exploratory phase. This phase is the most critical stage in your child’s mental health journey since it lays the foundation for the child’s work to occur. The focus is on building a trusting therapeutic relationship to foster an accepting and emotionally and physically safe environment in which your child can express themselves freely.
In this phase, the child and parent:
- Learn what to expect in each session
- Develop a therapeutic relationship with the Play Therapist
- Understand the roles of the therapist, the child, and the parent
- Understand the therapeutic process, the toys of the room, and any techniques used in the process
- Understand the rules of the room (limits of safety)
Children have a wide range of responses to the therapeutic process. Some children are excited to explore the playroom and the toys, some are timid and test the relationship before exploring the toys, and some children may even be hesitant to participate and either resist or want the therapist to lead the process. In Play Therapy, Play Therapists generally pay close attention to the child’s needs and lead in the playroom.
Parents generally feel cautious and excited during this phase. I like to prepare the parents with what to expect with this Play Therapy Information Sheet so they know how to prepare the children for the Play Therapy process. Parents are excited to begin seeing improvement but also cautious about whether the Play Therapy process will work. I tell my parents that if we work well together and they trust the process and their child, we will get to their desired goal. But, it takes all of us working together for the good of the child and the treatment goals.
Resistance Phase (6-20+ Sessions)
Now that we are past the Exploratory Phase, we should have a solid foundation to work from to allow the root of the issue that is causing the behavioral and/or emotional symptoms to be present. In the Resistance Phase, we see a shift from excitement and “newness” of the relationship to some angst, where the child is now confronting the issues in the play. They are starting to exhibit maladaptive behaviors, intense emotions, disruptive patterns, and so on. Your child may feel uncomfortable during this stage and may not even want to come to therapy. Parents, continuing the course, trusting the process, and outlasting this extinction burst, will bring you reward. Every child goes through therapy at their own pace, but the phases are all the same. Every child with every symptom goes through every phase to shift from pleasant to uncomfortable to change. The loss of the familiar (or the normal) causes such an adverse reaction. Parents, remember, you have a specialty trained Play Therapist along your side for this journey. We can do these hard things together!
In this phase:
- Children will exhibit heightened emotional self-expression and may need to be in control more often
- Children may make more mistakes as they learn new skills
- Children may regress with behaviors they have previously mastered
- Parents will experience a heightened sense of frustration – sometimes expressing that this is not working. Stay the course! Your child must go through this as a part of the developmental mastery process, which is generally short-lived.
- Parents who trust their children in the process show respect for their personal growth. This is an important time to show your support and care for your child.
One thing to always remember, or ask yourself, when children are exhibiting emotional self-expression, are they hungry or tired or have another physical need that needs met?
Work Phase (12-32+ Sessions)
The Work Phase is generally the longest stage in the Play Therapy Process. You will notice your child learning, healing, trying new things, managing feelings more efficiently, and telling you what they want or need more regularly. You will notice an improvement in their self-esteem and overall well-being, including their relationships with siblings, within the family, and with their friends. You will also see some small moments of setbacks, which can be very confusing for parents. It is normal to expect this to happen, as their brain is rewiring its neural connections and building strong neural pathways that will become the go-to for emotional and behavioral reactions and responses to stimuli.
Parents, this is a critical part of your work in the Play Therapy process. This is where your skills learned in parent sessions, consistent empathy, consistency with expectations, and positive reinforcement of new behavioral patterns will block off those old behavioral and interactional patterns. This is the phase that may last the longest, and it is important to remember that your child and you will make mistakes. Learning from these mistakes will be key to resiliency and change.
Termination Phase (24-40+ Sessions)
As you might guess, the termination phase is the last phase of the Play Therapy process. This phase begins when the Play Therapist, the parents, and the child notice that the child is consistently demonstrating new skills and communication patterns with ease. We will also see that the child’s behavioral and emotional expressions have stabilized in all environments. In this phase, we will decrease the number of sessions from weekly to bi-weekly and then move to monthly sessions when we are confident the child can maintain progress with less support. Parent sessions will also become less frequent, as parents have been working hard to maintain their new skill sets and understand their child’s emotional and behavioral needs more deeply.
As you might imagine, this will also be a difficult phase for your child. They have spent time with the Play Therapist weekly, and a strong, secure relationship has developed. You and your child’s Play Therapist will want to establish a plan to ensure this new loss is met with accomplishment and celebration! Children can see termination as a punishment for achieving their goals, and with great care and intention, the Play Therapist and parents can help the child realize the process was healthy and positive. After the termination is complete, parents can expect to see some minor regressions, but your child has been equipped with the skills and has now realized their efficacy in managing their needs, emotions, and communication in a healthier way. They have realized their goodness and strength inside.
Resources:
- Play Therapy Information Sheet
- Landreth, Garry (2002). Play Therapy: The Art of the Relationship: Second Edition. New York, NY: Brunner-Routledge.
- https://www.a4pt.org/general/custom.asp?page=ParentsStagesofThera
