What Is Play Therapy for Kids? A Parent’s Guide to How It Works

The Association for Play Therapy (APT) defines play therapy as treatment in which trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties. In plain words, children work through emotional and social problems by playing with an adult trained in this work. APT says that adult is a licensed mental health professional with a graduate degree.

At WBMA, our child therapy team uses play therapy with younger children. For them, the play itself carries the conversation. You stay part of the work. Parents help set the goals and learn what to do differently at home, and in filial play therapy they run part of the work themselves. This guide follows the questions parents bring us.

Why Children Play Instead of Talk in Therapy

Therapy helps us make sense of life. Once we have made sense of something, we can approach it differently. When adults go to therapy, they sit down and talk. When kids go to therapy, they play. The University of North Texas Center for Play Therapy puts it simply. Play therapy is to children what counseling is to adults.

The reason has to do with development. Bratton and colleagues led a 2005 review of play therapy research. They write that children lack the cognitive ability to share thoughts and feelings through the abstract means of verbal language. Citing Piaget, they add that most children under 11 have not fully developed abstract thought. Meaningful verbal expression depends on that capacity.

Toys, art and other play give children what those researchers call an age-appropriate and emotionally safe way to express hard experiences. The UNT Center describes play as children’s natural medium of expression. It adds that play helps children express their feelings more easily through toys than through words.

What Is Play Therapy Used For?

APT lists a wide range of concerns for which play therapy has been used, either as the main treatment or alongside other care. The list describes where therapists apply it. It is not proof that play therapy works for each one. APT’s list includes these concerns.

• Anxiety and obsessive-compulsive disorders
• Depression
• Attention deficit hyperactivity disorder (ADHD)
• Autism spectrum
• Oppositional defiant and conduct disorders, and anger management
• Crisis and trauma
• Grief and loss
• Divorce and family breakup

A 2021 review in Materia Socio-Medica adds children going through a transition. It names a divorce, a loss, a move, a new school or a new family member, and our guide to stress management for kids looks at building resilience.

Play gives children some distance from those problems. Rather than talking through their struggles with frustration, they stretch their frustration tolerance week after week. A child builds a clay house and the walls keep caving in, or the Chutes and Ladders board sends them 20 spaces back. Another player gets the Candy Land “Princess Lolly” card the child really, really wanted.

The evidence behind these uses is uneven. In a 2018 trial of 71 school-age children, 16 sessions of child-centered play therapy led to significant gains by parent report, but not by teacher report. For ADHD, a small Taiwanese study of 17 children found better cognitive flexibility after 12 weekly sessions. Cognitive flexibility is one thinking skill rather than a core ADHD symptom, and play therapy does not replace ADHD care.

For trauma, a 2019 review of seven studies found some consistency in gains on internalizing problems and self-concept, with limits in how the studies were run. A 2023 review of play therapy for autistic children called the evidence weak while noting potential benefits for children and families. Play therapy is usually one part of a wider plan, which makes its own effect hard to separate.

In a pilot trial of 23 autistic children, those who had 24 sessions of child-centered play therapy scored lower on the study’s symptom scales than children without it. A sample that small cannot be generalized. Our parent guide to therapy options for autistic children covers other approaches. Within that wider plan, play therapy may help children and families, though the evidence is weak and it is not a cure.

How Does Play Therapy Work?

In the playroom, children express themselves through play. Some choose pretend play, such as storytelling, dress-up and make-believe scenes where they control the story. Others lean toward art, music or movement. Some children do well with sensory play, like fidgets, kinetic sand or a game of catch. Others prefer competitive games where they practice winning and losing.

Small moments carry the work. A child might feel excitement on finding a toy, anger when a crayon breaks, or disappointment when the pretend dinosaur does not get invited to the birthday party. Through symbolic play like this, children get the distance they need to work on real problems. The therapist’s approach shapes those moments.

In nondirective play, which includes child-centered play therapy, the child directs the session. The therapist watches, reflects and accepts the child without conditions. A 2021 review describes the relationship between child and therapist as the key to change in this model. Virginia Axline brought this approach into play therapy in 1947, a step the 2005 Bratton review called perhaps the most significant in the field.

Directive play therapy is more guided. Our therapist might bring in games tied to what the child is facing, such as separation fears. Cognitive-behavioral play therapy, pioneered by Knell, uses play to change how a child thinks and to model more helpful responses. Our therapists do not stick rigidly to one approach. They adapt to each child, sometimes guiding and sometimes stepping back so the child can lead.

A third model brings parents into the playroom role. Filial therapy, first described in 1964 by Bernard Guerney Jr., teaches parents basic child-centered play skills. Parents use them in weekly 30-minute play sessions with their own child, under a trained play therapist’s supervision. WBMA runs a filial play therapy program for parents of children ages 4 to 10, and our guide to filial play therapy explains the method.

The Stages of Play Therapy

Parents often ask about the stages of play therapy. The stages below follow one published model. A 2023 review describes four phases drawn from earlier work. First comes an exploratory stage, when the child explores the playroom, the therapist and the process itself. A resistant phase follows, which can include aggressive play. Some children pass through it in a few sessions, while others need months.

The work phase comes next, and the review calls it the most crucial and usually the longest part of play therapy. The last phase is termination, when sessions are gradually spaced out. The 2023 review focused on autistic children. Read these phases as one published description of how therapy can unfold rather than a universal model.

1. Exploratory

   The child gets to know a new setting, including the playroom, the therapist and the process.

2. Resistant

   Play can turn aggressive for a while, and this phase lasts anywhere from a few sessions to months.

3. Work

   The review calls this phase the most crucial one, and it usually runs the longest.

4. Termination

   Sessions are spaced further apart, step by step, as therapy comes to a close.

Is Play Therapy Evidence-Based?

Play therapy can feel far removed from a caregiver’s concrete worries. “My kid is having daily meltdowns, hits their sibling, and can’t tolerate not getting their way, and you’re spending time with them playing games?” The research gives a qualified yes. Research on play therapy for children goes back decades. Reviews of that research report benefits, though their size varies with the study, setting and parent involvement.

A 2005 review by Bratton and colleagues pooled 93 controlled studies of play therapy published from 1953 to 2000. Against no treatment or a non-play comparison, the overall effect was 0.80 standard deviations, which the authors call large by a common research yardstick. Nondirective approaches averaged 0.92 and directive ones 0.71. The authors urge caution on that gap, since 73 studies were nondirective and only 12 were directive.

The authors also flag a limit. A review is only as strong as the studies it pools, and they kept 93 of about 180 studies they found, dropping many for weak methods. Newer work reports smaller numbers. Lin and Bratton (2015) pooled 52 studies of child-centered play therapy from 1995 to 2010. They estimated an effect of 0.47, which they describe as moderate.

A 2015 review of 23 studies in elementary schools found effects from 0.21 to 0.38 across outcomes. Its authors called the evidence for school use promising to strong. The federal Title IV-E Prevention Services Clearinghouse rates child-centered play therapy as a promising practice. The rating means at least one study rated moderate or high on design showed a favorable effect.

The Clearinghouse numbers also show the limits. Across 12 studies it rated moderate or high quality, with 760 participants, the average effect on behavioral and emotional functioning was 0.05. Only 6 of 30 findings were favorable, and 24 showed no effect. Effects on social functioning (0.32) and school achievement (0.34) were larger, each across 5 studies.

Results look stronger when parents take part. In the 2005 review, studies where trained parents ran filial therapy averaged 1.15, against 0.72 for play therapy by professionals. The two groups of studies were separate, and no head-to-head trial compared them. The Clearinghouse also rates Child-Parent Relationship Therapy, a parent-led version of child-centered play therapy, as a promising practice.

How Play Therapy Differs From Play at Home

You should play at home too. The American Academy of Pediatrics reports that developmentally appropriate play with parents and peers builds social-emotional, cognitive, language and self-regulation skills. Play therapy adds one thing everyday play does not have, a trained therapist in the room. What that therapist does falls into three parts.

• How the therapist responds. Our therapists choose their words, tone, facial expression and body language on purpose, and they know when to stay silent. Even where they sit is a choice. The aim is to help a safe relationship develop between child and therapist.
• What the therapist tracks. Our therapists look for themes. They notice which toys a child picks, how the child plays with them and how the child handles pressure or a hoped-for outcome. APT expects the therapist to stay in regular contact with caregivers to plan treatment and monitor progress.
• What the child is free to try. The playroom is a safe place to test new responses. Take the child who keeps changing the rules and yells at the therapist for not keeping up. The therapist can model not knowing, welcome the child’s full self and still greet the child with a real smile next week.

Whether your child invites the therapist into the play or not, both are okay. Either way, the therapist adds short reflective comments that help children notice what they feel and what they choose. Putting words to play gives children repeated practice in linking language to experience.

Take a child wrestling with power and fair play. When our therapist lets that child cheat at cards week after week, the child can come to see that a win they did not earn feels hollow. The lesson comes from the child’s own experience.

The UNT Center for Play Therapy holds that in child-centered play therapy, the child’s experience of the relationship is what heals most. The center offers this as theory rather than a measured result. Across youth therapy, a 2018 review of 28 studies reported a small to medium link (r = 0.19) between the therapy relationship and outcomes. APT likewise says play therapy works best in a safe relationship.

Play Therapy Ages, From Preschool to the Teen Years

APT describes play therapy as especially suited to children ages 3 through 12, a range it draws from practice texts rather than an outcome study. APT also notes that play therapy methods have been applied to infants and toddlers in recent years. No outcome results come with that report, so a parent of a very young child should ask how the approach would be adapted.

If you worry your child is too old for play, APT states that teenagers and adults have also benefited from play techniques. With older children and teens, our therapists adapt the approach. Play is not always a dollhouse or action figures. It can mean exploring themes through the shows, games and characters a teen identifies with, and pop culture is fair game.

Age on paper does not always match developmental age. A 13-year-old whose impulse control looks like a typical 9-year-old’s may still respond to play-based techniques as the content grows up. Some middle schoolers find value in regressive play, such as board games made for preschoolers. It gives them a break from the stress of growing up while they practice the same basic skills.

When to Consider Play Therapy for Your Child

A checklist cannot diagnose a child. Still, it can show whether a conversation with a clinician makes sense. Several of the items below, such as anxiety, trauma and loss, also appear on APT’s list of uses. Consider asking about play therapy if any of them fit your child.

Some children need more than play therapy. At WBMA, the same team treating your child can also run testing, including ADHD and autism testing, and handle medication questions if they come up. Parents of children ages 4 to 10 can also take a direct role through our filial program, where they learn to lead the play sessions at home.

If you are unsure whether play therapy fits, talk with our child therapy team. Our office is at 5480 Wisconsin Ave., Suite 223, in Chevy Chase, MD, on the DC line. You can contact WBMA to describe what you are seeing at home, from meltdowns to worries, and set up that first conversation.