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Play therapy can be defined as a cluster of theory-driven treatment modalities used to establish an interpersonal process wherein trained play therapists help clients prevent or resolve psychosocial difficulties, facilitate optimal development, and reestablish the ability to engage in adaptive play behavior. For more than half a century, it has been the most prevalent child mental health therapy in the United States. While play therapy is traditionally implemented with children ages 3 to 12, many play therapy techniques (e.g., tray construction with miniature objects) are also used as therapeutic interventions with teenagers and adults. There is no single play therapy approach; instead, there are several prominent theoretical schools of thought and numerous play therapy techniques. Though play therapy is most often used as an individual therapy, it is also implemented via group play therapy and family play therapy. Often, professional therapists conduct the play therapy, but parents and other care providers can also be taught to perform play therapy. The following play therapy overview includes discussion of the definition of play, the therapeutic use of play, play therapy history, play therapy outcomes, and play therapists' qualifications.

Definition of Play

Although there are multiple definitions of play, it is generally considered to be an activity that is intrinsically motivated, freely chosen, nonliteral, actively engaged in, and pleasurable. In contrast, children with psychological disturbances often exhibit play that is compulsive, impulsive, irrational, and devoid of pleasure. Play has been called the singular central activity of childhood. It occurs in virtually all cultures and circumstances.

Given the prevalence of children's play, it is often seen as integral in human development. Jean Piaget described play as “a process that allows children to mentally digest experiences and situations.” Play is fundamental in children's development of expressive language, communication skills, emotional development, social skills, decision-making skills, and cognitive development. The functions of play have been classified into four categories: biological (learn basic skills, relax and release excess energy, kinesthetic stimulation and exercise), intrapersonal (mastery of situations, mastery of conflicts), interpersonal (develop social skills, separation-individuation), and sociocultural (imitate desired roles).

Therapeutic Use of Play

Play has been described as a form of self-therapy for children. Through play, children have the opportunity to work through conflicts, relieve anxieties, and make sense of their worlds. Consequently, play functions well as a facultative force in children's therapy. A goal of play therapy is to help disturbed children work through their issues, so they can experience pleasurable play again.

Researchers have identified specific qualities of play behavior that facilitate the therapeutic process (i.e., communication, relationship enhancement, creative thinking, overcoming resistance, catharsis, abreaction, role-play, fantasy/visualization, metaphoric teaching, attachment formation, positive emotion, mastering developmental fears, game play) and the accompanying beneficial outcomes (working alliance, understanding, self-esteem, innovative solutions to problems, emotional release, adjustment to trauma, practice/acquiring new behaviors, empathy, fantasy comprehension, insight, attachment, self-actualization, self-esteem, growth and development, socialization).

Play Therapy History

Documentation of psychotherapy with children reaches to the early 1900s. Early records describe Sigmund Freud's work with Little Hans's father in the attempt to alleviate Hans's phobic reaction. Play was first directly applied to children's therapy in 1919 through Hermine Hug-Hellmuth's utilization of play for child assessment and treatment and analysis. Anna Freud began using play in 1928 as a way of building therapeutic alliances and enticing children into the process of analysis, and in 1932 Melanie Klein proposed using play as a substitute for children's verbalizations. These early forms of psychoanalytic play therapy were focused on the attainment of insight through interpretation of the child's play.

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