Play therapy


Play therapy as defined by the Association for Play Therapy is “the systematic use of a theoretical model to establish an interpersonal process wherein trained Play Therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development."

Therapeutic play is widely recognized as a highly effective method of communicating with children and helps them learn and work through experiences in a way that no other method does. 

Background and development of play therapy

Play therapy has its foundations in early child psychotherapy. Anna Freud, Margaret Lowenfeld, and Melanie Klein first recognized the theoretical premise in support of play as therapy. Initially, play therapy developed from the use of attachment and humanistic theories, but with the rise of Carl Rogers’ client-centered therapy, non-directive play therapy was developed.   

Play therapy was recognized as effective for children because play is such a vital part of a child’s ability to communicate. Children use play to express emotions, thoughts, perceptions, and values, and through this, significant work can be done. 

Since the 1940s, play therapy has been researched to establish effectiveness across many mental and behavioral health disorders and has been found to be effective at helping with: 
  • Anxiety and phobias
  • Tantrums or behavior problems, including aggression
  • Grief and loss
  • Trauma
  • Social skills difficulties
  • Problems in family relationships
  • Coping with big life changes, like divorce or a recent move

Setting for play therapy

Play therapy can be conducted in a variety of settings. Of course, the standard setting is the therapy room or office, which is set up specifically for play therapy. There would be a myriad of toy choices, child-sized furniture, places to draw, like chalkboards or whiteboards, and game choices. 

However, play therapy can be conducted in many other places. Some children may prefer to talk in an outdoor setting, drawing with chalk on the sidewalk or playing basketball while talking. Some children may be seen at school and work with a play therapist who brings a travel kit of tools with them. Others may be seen in the home due to travel or time obligations or due to the need to also work with the parents in a comfortable setting. 

With play therapy, the emphasis much of the time is on the child leading the way, so the setting is less of a strict guideline than in other modalities of therapy. The principles and techniques are the more focused aspects of play therapy. 

Therapy techniques

The techniques for play therapy are as varied as the children themselves. Child-directed play therapy allows the child to be the guide, and the therapist joins in with the child as they play in order to understand and facilitate healthier play and further learning through play. If the play is therapist directed, then the therapist will choose an activity that the child enjoys and guide the play to the topic that the therapist is trying to learn about or work on with the child. Approaches to play may include art, fantasy play, sensorimotor play, and the use of games.

These may also involve: 
  • Storytelling 
  • Role-playing 
  • Puppet, doll, or mask play
  • Water or sand tray work 
  • Music or artwork 
  • Imagination or visualization

The goal is to learn the child’s symbols and schema and use those to develop insight and then emotional development in a low-stress way that the child will enjoy and internalize. 

Tools for therapy
There are some standard toy suggestions available, though this is by no means an exhaustive list:

For play-centered around real-life problems and expression have on hand:

  • Matchbox cars 
  • Generic dolls (including multi-racial options)
  • Dollhouse
  • Cash register and money
  • Boats and planes
  • A toy kitchen with utensils, dishes, and food

When working on aggressive play, you may need things like: 

  • Toy guns
  • Nerf darts and guns 
  • Toy swords and armor
  • Handcuffs and ropes
  • GI Joes and Superhero figures

When working with a child through creative expression, these tools may be helpful: 

  • Play-Doh
  • Kinetic sand
  • Scissors
  • Paper
  • Crayons, markers, and pencils 
  • Blocks or Legos
  • Puppets
  • Felt boards 
Who can benefit from play therapy?

While play therapy has benefits that extend across the lifespan and some play therapists work with all ages, most registered play therapists specialize in working with children. The majority of children in play therapy are between 3 and 12 years of age. This age range has been found to benefit most when play therapy is the focus due to a number of reasons, but limited communication and ability to verbally express themselves are two of the strongest arguments for focusing on therapy through play. 

If a child has an interest in toys, make-believe, and imaginative play, it’s a good indicator that they could benefit from play therapy. Children with many different mental and behavioral health conditions can benefit. 

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Effectiveness of play therapy

A study that looked at the effectiveness of play therapy in 2010 showed that, based on current research, play therapy is highly effective with specific anxiety and Attention Deficit disorders. It showed a good prognosis with problematic behaviors, general anxiety, and fear, and had been shown to improve self-efficacy significantly. At the time, the research was not well established, but play therapy was showing preliminary signs of improvement in children with PTSD, abuse, trauma from natural disasters, chronic illness, cultural struggles, and aggression. 

The Association for Play therapy reports studies have shown that play therapy helps children:
  • Develop responsibility and more successful strategies for getting needs met 
  • Develop new and creative solutions 
  • Improve respect and acceptance for themselves and others
  • Improve their experience and expression of emotion 
  • Develop empathy and respect for other's thoughts and feelings 
  • Improve social and relational skills 
  • Develop self-efficacy

Potential limitations

Play therapy is mainly dependent on the therapist’s skills. It is not manualized like some other modalities are, so the onus is on the therapist to ensure they have the training necessary to work appropriately with each child they take on. This can lead to mixed results if the therapist is still learning or has a blind spot in an area. 

When therapy must be completed on a time crunch or the child has a limited number of therapy sessions due to billing sessions, child-directed play may not be appropriate. If you need to begin work immediately to resolve any issues as efficiently as possible, allowing the child the freedom to direct play therapy may be a hard sell to insurance companies (and sometimes parents). 

Billing for play therapy

Play therapy is simply individual therapy with  ‘tools’ in use, like games, so most therapists bill under regular coding 90837/34/32. At the same time, some others use code 90899 for Other Psychiatric Services or Procedures to report psychiatric services or procedures that do not have a specific code. In the notes, therapists should indicate information referring to specific play therapy techniques used and the client's response to the treatment. 

Some specific insurance companies have their own billing codes to designate specific modalities, including play therapy. Always consult information received upon credentialing with specific insurance boards for best billing practices. 

If used in medical settings such as occupational therapy, G0176 is a valid 2022 HCPCS code for Activity therapy, such as music, dance, art, or play therapies that are not recreational in nature but related to the treatment of a patient’s mental health diagnosis. Sessions must be a minimum of 45 minutes to qualify.

Special training for the therapist

While many therapists use aspects of play therapy with children, there are some recommended guidelines established by professional organizations. Play therapy should be provided by licensed clinical mental health professionals with extensive specialized play therapy education and training, as well as experience supervised by an appropriately credentialed mentor. 

All Registered Play Therapists have a Master’s degree or higher in a mental health specialty as well as a license to practice therapy. In addition, those who become RPTs must complete a minimum of 150 hours of additional coursework on the subject of play therapy and then receive clinical supervision from a senior therapist about their work. RPTs work to improve their understanding of how play can help children with specific mental and behavioral health problems, including behavioral difficulties, grief and loss, ADHD, social skills, anxiety, trauma, and depression. They also learn how to use toys and play materials more intentionally to help guide children in the most productive way possible. 

Training can be found through the Association for Play therapy or look into your local university; many graduate programs offer classes in play therapy that count as training hours and are willing to let therapists participate in them. Before starting, ensure that the course is approved for credit in order to count it as training toward your credentialing. 

Play therapy resources 

The Association for Play Therapy is a national society founded in 1982 to foster the development of play therapy in the mental health field.

They have many resources, including:

For individuals outside of America, Play Therapy International is a wonderful resource for training and information, and there are a variety of play therapy associations for most continents and many countries. 

Mental health professionals in need of a tool to manage their practice should consider Theraplatform, a Web-based EMR portal that offers documentation, practice management, and billing in a user-friendly and straightforward interface. TheraPlatform also includes tools that can be used virtually for sessions or ‘homework assignments,’ including a number of games and drawing options. TheraPlatform, an all-in-one EHR, practice management and teletherapy tool was built for therapists to help them save time on admin tasks. They also offer a 30-day trial with no credit card required. Cancel anytime.

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