Introduction: An Overview of the Field of Play Therapy

Before moving into the new treatment modality of Creative Play Therapy, we want to first begin with a brief overview of the field of play therapy. Most of this will not be new knowledge for those practicing in the field, but for those who are students or beginners, it may help to understand the history of the profession and the effectiveness of it. We also want to explain why it works, offer a few insights from the field of neuroscience, and explain child- centered play therapy. We will draw from this information later in the book. Finally, we will end the introduction with an overview of what to expect in the coming pages of the book.

History of Play Therapy

Play therapy began as a way to provide age and developmentally appropriate therapeutic services to children. In the early years of psychotherapy, lying on a couch and free associating with psychoanalyst was helpful for adults, but professionals quickly realized that children needed something different. Since children naturally played, and views on childhood were changing, play became a bridge to providing psychotherapy to children, including children under the age of six.

In 1911, H. G. Wells, author of The Time Machine and War of the Worlds, published a book of floor games (Wells, 2017). He listed four categories of toys, the kinds of toys played with repeatedly and in many different ways. He suggested that the categories of toys were 1) soldiers (including sailors, railway porters, civilians and lower animals); 2) bricks; 3) boards and planks; and 4) railway trains and rails (along with miscellaneous things like tin ships and Easter eggs). Wells believed these types of games not only kept boys and girls happy (entertainment), but also built a “framework of spacious and inspiring ideas” (p. 53). His book reflected a broader shift that valued play, and play soon became integrated with therapy.

Melanie Klein, a contemporary of the first credited child psychoanalyst Hermine Hug-Hellmuth, first began applying what she later called the psychoanalytic play technique in 1919 with a 5-year-old boy (Klein, 1955). She wrote, "In interpreting not only the child’s words but also his activities with his toys, I applied this basic principle [free association] to the mind of the child, whose play and varied activities, in fact his whole behavior, are means of expressing what the adult expresses predominantly by words” (pp. 223-224).

In the context of history, Wells and Klein voiced an idea about childhood that had finally taken hold in Europe. For about 150 years, the climate had slowly been shifting from seeing children as little adults to appreciating children as fundamentally different from adults. This led to a rise in professional interest in play (Ray, 2011). Conceptualizing children differently opened the door to interventions occurring in childhood to improve their future. This could be done through enriching activities (such as floor games), through prevention, or through therapy for childhood problems to reduce the impact in adulthood.

Over the last hundred years, the methodologies of using play to provide therapy with children have greatly expanded. Now, popular approaches identify with different theories (child-centered, Adlerian, object relations, Jungian, gestalt, reality, and others), different client groups (individual, family, siblings, group), and different settings (therapy offices, schools, homes, hospitals, the outdoors, and more). The body of play therapy research is growing and broadening. We have learned much from tapping into play to help children. Now, it is time to expand that work across the lifespan, drawing on the benefits for children, and applying it to adolescents and adults.

Effectiveness of Play Therapy

Treatment is defined by the American Psychological Association (APA, 2012) as, “any process in which a trained healthcare provider offers assistance based upon his or her professional expertise to a person who has a problem that is defined as related to ‘health’ or ‘wellness’” (p. 1). While many different treatments are effective, effectiveness varies from client to client, disorder to disorder, and helper to helper (Kenney-Noziska et al., 2012), so like all treatments, play therapy is not a magical modality that works with every client every time, but it is a developmental^ responsive and empirically supported treatment (Wheeler & Dillman Taylor, 2016).

Dr. Sue Bratton has compiled summaries of empirical research studies in play therapy at the Evidence Based Child Therapy web site (http://evidence- basedchildtherapy.com). We refer you there for a comprehensive list of play therapy peer-reviewed research. One noteworthy portion is a summary of meta-analytic research (Lin & Bratton, n.d.). A meta-analysis looks at data from a number of independent studies on a subject to determine trends and usually to examine the consistency of treatment. By compiling data from many smaller studies, researchers pool together a larger sample.

Four of these meta-analyses (Bratton et al., 2005; Leblanc & Ritchie, 2001; Lin & Bratton, 2015; Ray et al., 2015) demonstrated robust evidence for the treatment effect of play therapy, with statistically significant effect sizes for behavioral problems, social adjustment, personality concerns, self-concept, anxiety and fear, developmental concerns, and parent/child relationships. They found that play therapy was effective in schools, outpatient clinics, residential settings, and critical-incident settings. It worked with individuals and groups. Many of the research studies included used child-centered play therapy, and those results suggested that CCPT is also a culturally responsive intervention.

In other words, play therapy works. It works for a variety of presenting concerns. It works across various settings. It works with individuals and groups. And it adapts well with clients (and therapists) from different cultural backgrounds. Although debate has raged for decades about whether directive or nondirective approaches are more effective, they are equally effective at producing therapeutic change (Kenney-Noziska et al., 2012).