By Suzanne C. Doherty, Ph.D.

Jesse was five when he lost his mother, grandmother, and little sister in a car accident. Jesse’s lack of emotional reaction to the loss of his family was chilling. An observer might conclude that Jesse was strangely undisturbed by this event. The truth is that Jesse did not have the words available to him that could begin to describe his pain. When invited to play, however, Jesse began a repetitive, ritualistic enactment of the overwhelming sense of destruction of his world. Allowing him his natural “language” facilitated the process of grief and healing.

Children are specialists in play. When their cognitive and verbal abilities fail or are insufficiently developed, they naturally communicate through play and can achieve resolution and healing through the emotional experience elicited in play therapy.

Critical to play therapy is the fundamental belief that children are driven to whatever issue is unique to them and that they communicate that issue through the play experience. The therapist must believe that the child knows what his/her issue is and must be willing to enter into the child’s experience. This means leaving adult conceptions/agendas behind and turning one’s ear to the child’s metaphorical mode of expression.

During the first phase of treatment—developing the therapeutic relationship—I work carefully to build trust between us. The child must experience me as predictable, safe, and accepting. I am respectful of a child’s need for boundaries—sometimes directly expressed: “I’m gonna play over here, you stay over there;” sometimes, metaphorically: Alex stuffs a toy gun into each pocket, slips a plastic knife in his sock, and a sword in his belt before he selects play materials.

Once a child feels comfortable, the treatment process moves into the exploratory stage. The child begins to invite me into her more private experience by using unstructured materials—doll house, clay, fantasy objects—and by eventually drawing me into direct participation in her world. At this point I begin to make observations about what seems to be happening: “There sure is a lot of yelling going on in this house!” “That blue car keeps crashing into the red one.” I see you are shooting the gun at all the animals.” I also begin to test out hypotheses of emotional meaning in the play content: “This little kitten must sure feel scared when the lion roars at it.” “I guess this boy feels really sad when his dad leaves him like that.” “Wow! That is one angry dragon!”

As the process moves toward the therapeutic growth stage, play becomes more intensely focused on the issue that is primary to the child at that moment. I begin to identify behavioral patterns within the play therapy session and to pair affect and motivation with the observed patterns.

If, for example, I am playing “patient” to the child’s “doctor” I may verbalize within the context of the role he has defined for me some of the emotional themes I’ve heard him express in his play. Other times I may make a more direct connection for the child: I’ve noticed that when you feel scared you like to throw the doll furniture, use that sword, and boss me around.”

Once a child has played out her issue in all its variations, she moves naturally toward the resolution, or problem solving, phase of play therapy. I might introduce alternate ways of thinking about things within the child’s own play scheme and use my given role to act out different ways to respond to life situations. Instead of killing off all the monsters, for example, I may help a child explore ways to tame the monsters.

The final phase of the treatment process is, like any other therapy, the time to prepare for ending. The child often spontaneously “reviews” the therapy process in the content of the next few sessions. The theme that predominates in any therapeutic metaphor that I might create at this time is one of empowerment.

My hope is that the children who have brought their pain to me and shared experiences in the most profound way will have played their way to a new level of understanding of themselves in relation to their own developmental processes and to the events in their lives. Through play I hope they will have learned appropriate expression of their feelings and where possible, develop good coping and problem solving skills. Most important, I hope that through their play, children come to a better recognition and appreciation of their unique strengths so that they might plunge ahead into life confident in their abilities to mater their experience.