'So what are they going to do, play?' It's one of the questions I hear most often at a first meeting with a family, even when they don't quite dare to ask it out loud. They've come because their son has been sleeping badly for weeks, because the tantrums get a little longer every day, or because their daughter has gone quiet since her grandmother died and won't talk about it. And the answer they get is a room full of toys.
The doubt makes sense. But for a child, playing is the most natural way to show what's going on inside, and using it in therapy rests on solid ground. In this article I explain what play therapy is, what actually happens in a session, which children it can help and where parents fit in.
What play therapy is
Play therapy is a psychological treatment for children in which play does the job that words do in adult therapy. Instead of sitting a child down in front of an adult and asking them to explain what's bothering them, we offer a safe space with carefully chosen materials where they can express it through play, at their own pace and without feeling interrogated. The American Psychological Association includes it in its dictionary of psychology, and the British Association of Play Therapists (BAPT) explains that it helps children make sense of muddled feelings and upsetting events they haven't had the chance to sort out.
It isn't a fad. By the 1920s some psychoanalysts were already watching how children played in order to understand them, and in 1947 the American psychologist Virginia Axline published 'Play Therapy', the book that shaped non-directive play therapy. Today it's known as child-centred play therapy, and it's still the basis of many current approaches.
Why play is children's language
A six-year-old is unlikely to tell you: 'Since my parents started splitting up I feel insecure, and I'm scared that one day they'll stop loving me.' What they can do is set up a dolls' house where the doll family lives split between two homes, or make a little animal get lost again and again without anyone coming to look for it. Adults put names to their feelings by talking. Children, for many years, do it by playing, because the ability to explain emotions in words develops slowly and play gets there much earlier.
Play also gives a protective distance. It's far easier to make a lion speak who is afraid of being left alone than to say 'I'm afraid of being left alone.' Through the characters, a child can get close to what hurts without being overwhelmed, try out different endings and, often for the first time, feel some control over a situation they can't control at all in real life.
The importance of play goes beyond the therapy room. In a 2018 report, the American Academy of Pediatrics stressed that play is not frivolous. It helps build the brain and executive function, the skills that let us pursue a goal without getting distracted, and when a child is facing adversity it matters even more. The report even encouraged paediatricians to 'prescribe play' at check-ups.
What happens in a play therapy session
A session lasts 45 to 60 minutes and, whenever possible, takes place on the same day of the week, at the same time, in the same room, with the same materials. That regularity helps the child trust the space and the person with them, and without that trust play stays on the surface.
What's in a play therapy room
The materials aren't chosen at random. Many rooms follow the classification of play therapist Garry Landreth, who groups toys into three families:
- Real-life toys: a dolls' house, a family of dolls, a toy kitchen, cars, a doctor's kit. They help children act out what happens at home, at school or in hospital.
- Toys for letting feelings out: foam swords, cushions, wrestler figures or fierce animals. They let children express anger or fear without hurting anyone.
- Creative materials: modelling clay, paint, puppets, dressing-up clothes and, often, a sand tray with miniature figures.
Some parents are surprised to find a sword or a dragon in the room. It makes sense, because anger also needs a place where it can be played out and understood.
What the therapist does during the session
From the outside it can look as if the therapist is just watching, but a lot is going on. The therapist follows the play, puts words to what the child seems to feel ('this horse is really angry') and notices which themes keep coming back and how they change from week to week. There are also clear limits: almost any game is allowed in the room, but nobody can be hurt, the child included, and things can't be broken on purpose. Far from stopping the play, these limits are what make it safe.
Types of play therapy
There isn't just one way to do play therapy. Approaches differ mainly in who takes the lead:
- Non-directive or child-centred: the child chooses what to play and how. The therapist follows, without steering the play or filling the session with questions. This is the reference approach in the field.
- Directive: the therapist suggests games with a specific aim, such as learning to calm down, practising social skills or getting ready for a situation that feels scary. Cognitive-behavioural play therapy is one example.
- With parents in the room: some models have parents and children play together, because the bond between them is exactly what needs strengthening. Theraplay and filial therapy are two examples.
In practice, most of us combine approaches depending on the child's age, the problem and the stage of the process.
The sand tray
One of the resources that surprises families most is the sand tray: a tray of sand, painted blue inside, and a collection of miniature figures (people, animals, houses, trees, bridges, monsters). The child builds scenes, little worlds, and the way they set them up and change them over the weeks says a lot about what they're going through. The therapist doesn't interpret the scene for the child. Instead, the therapist stays alongside and, if the child wants to, they talk about it.
Which children it can help
Play therapy is used with children going through very different situations. Some of the most common are:
- Anxiety and fears that get in the way of everyday life: of the dark, of being apart from their parents, of going to school. If you'd like to read more, there's a guide on childhood anxiety.
- Loss and grief, such as the death of a grandparent or a pet. Children grieve in bursts and often through play, as I explain in the article on childhood grief.
- Changes and tension at home: a separation, a new baby, a house move or family conflicts that drag on.
- Tantrums, anger and behaviour problems that go beyond what you'd expect for their age.
- Difficult or traumatic experiences, such as an accident, a hospital stay or witnessing violence.
- Extreme shyness or trouble relating to others, including children who don't speak outside the home, as happens in selective mutism.
- Low self-esteem or problems at school that affect how they see themselves.
BAPT adds a point worth keeping in mind. Because play therapy can stir up deep feelings, the child needs stable enough adults around them to hold them through the process. If the family is in the middle of a big change, such as moving house, changing school or changing carers, it's sometimes better to wait a little or to start by working with the parents.
What age play therapy is for
It's mostly used with children aged roughly 3 to 12. With the youngest, at 3 or 4, play is almost the only way in, and work with the parents carries a lot of weight. By 8 or 9, children can talk more about what's happening to them, and sessions mix board games, drawings or stories with moments of conversation. With preteens play becomes more structured, but it's still useful, because a card game can open conversations that would never happen face to face. Before age 3, the usual approach is to work mainly with the family.
Does it work? What the research says
Play therapy has more research behind it than many people think. A review of 93 controlled studies (Bratton and colleagues, 2005) concluded that it's effective, with better results for humanistic approaches and when parents were involved. A later analysis of 52 studies of child-centred play therapy published between 1995 and 2010 (Lin and Bratton, 2015) found a moderate effect.
That doesn't mean it works for everything or that it should always come first. For some difficulties there are treatments with more research behind them. With childhood trauma, for example, trauma-focused cognitive behavioural therapy has the strongest support. That's why, in practice, play is usually combined with other tools, and the choice depends on the child.
Play therapy is not 'just playing'
You can play a lot with your child at home, and it's one of the best things you can do for them. But it isn't the same as play therapy. BAPT distinguishes between therapeutic play, which any adult caring for a child can offer, and play therapy proper, delivered by a trained professional with a theoretical framework and a structured process. The difference lies in how the play is read: knowing what it might mean when a child always buries the same figure in the sand, when to let a game run and when to set a limit, and how to connect what happens in the room with everyday life.
The role of parents
Even though the sessions are with the child, the family is central to the process. It usually starts with a meeting with the parents, without the child, to understand what's happening, since when, and what the child's life is like. After that there are regular review meetings to tell the parents how things are going, which themes are coming up and how they can support the child at home.
One thing parents sometimes find hard is that the therapist won't report every detail of what the child does in the room. Themes and progress are shared, but the specific content of the play belongs to the child, and that confidentiality is what lets them play freely. For the same reason, it's better not to question them when they come out ('What did you do? What did you talk about?'). If they want to talk about it, they will. There's one clear exception: if there's any risk to the child or to someone else, the family will be told straight away.
It also helps to know that, for a few weeks, the child may be more sensitive or more intense outside the sessions, and may even take steps backwards, such as asking to sleep in your bed again. That doesn't mean therapy is going badly; it's often a sign that things are shifting. Mention it at the review meetings.
How to tell your child they're going to play therapy
Tell them the truth, in simple words and without drama. For example: 'We're going to see a psychologist. It's someone who helps children when something is worrying them or making them feel bad, and there are lots of toys in the room.' Avoid presenting it as a punishment ('if you don't behave, I'll take you to the psychologist') or as a secret nobody can know about. There are also picture books written for this moment, such as 'A Child's First Book About Play Therapy' by Marc A. Nemiroff and Jane Annunziata.
How long play therapy lasts
It depends on the child, the difficulty and how long it has been going on. When the problem is specific and recent, the process can be short, a few months. When there are difficult experiences in the background or several difficulties at once, it tends to take longer. Goals are set at the start and reviewed regularly with the family. Change doesn't happen overnight. First the child needs to feel safe in the room and with the therapist, and from there play starts to do its work.
When to seek help
You don't need to wait until things are serious. It's worth asking for an assessment if your son or daughter:
- Has been sad, irritable or fearful in new ways for weeks.
- Has more and more tantrums or aggressive outbursts and you don't know how to stop them.
- Has gone back to things they had outgrown, such as wetting the bed or talking like a baby.
- Is sleeping or eating much worse, or often complains of tummy aches or headaches with no medical cause.
- Has been through a loss, a separation or a frightening event and isn't getting over it.
- Plays the same game over and over, always with the same distressing ending.
- Is struggling at school, according to the teachers, or refuses to go.
Many parents put off asking for help because they're afraid of being blamed for what's happening to their child. Feeling responsible is part of caring for someone. And wanting to understand what's going on is already a way of helping.
Play therapy in Igualada
At my practice in Igualada I use play therapy with boys and girls, combining free play, the sand tray and more structured activities depending on what each child needs. Before we start I meet with the family, and during the process we hold review meetings so you know how things are going and how you can help at home. Play sessions take place at the practice, because the room and the materials are part of the work; follow-up meetings with parents can also be held online if that suits you better. I work in Spanish and Catalan, as a health psychologist. You'll find more information on the child therapy page and on the page about in-person sessions in Igualada.
If your child hasn't been doing well for a while and you don't know where to start, get in touch. In a first conversation, with no obligation, we'll look at whether play therapy is what they need or whether there's a better way to help.