BAPT: Quality Assurance for Play Therapy

What is Play Therapy?

Play Therapy is an effective therapy that helps children modify their behaviours, clarify their self-concept and build healthy relationships. In Play Therapy, children enter into a dynamic relationship with the therapist that enables them to express, explore and make sense of their difficult and painful experiences. Play Therapy helps children find healthier ways of communicating, develop fulfilling relationships, increase resiliency and facilitate emotional literacy.

Children use play as a form of communication. So often children referred to Play Therapy do not have the words to describe their thoughts, feelings and perceptions of their internal and external world.

What do Play Therapists do?

Play therapists work with children aged between three and eleven years of age, and occasionally adolescents, suffering from a range of psychological difficulties and complex life experiences. Psychological difficulties include depression, anxiety, aggression, learning difficulties and ADHD. Difficult life experiences include abuse, grief, family breakdown, domestic violence and trauma. A professionally trained play therapist helps a child to increase insight, to decrease internal conflict and to increase resiliency, coping and emotional literacy. Play therapists work closely with the child's parents/carers throughout the play therapy intervention and occasionally undertake parent-child relationship interventions.

A Brief History of Play Therapy

The use of play in therapy was first elucidated by the pioneers of Child Psychotherapy. Anna Freud (1928, 1964, 1965), Margaret Lowenfeld (1935, 1970) and Melanie Klein (1961, 1987) posited the theoretical premise for the use of play, for example, Klein (1961, 1987) stipulated that a child's spontaneous play was a substitute for the free association used within adult psychoanalysis.

Theories and practice surrounding play differ within each Child Psychotherapy tradition. However, each tradition is connected by the central proposition that play transmits and communicates the child's experiences, desires, thoughts and emotions.

With the migration of the early Child Psychotherapists to Britain in the 1930s, Child Psychotherapy has grown and developed as a strongly European tradition. Whilst Play Therapy has emerged from elements of Child Psychotherapy, the specific theoretical foundations emerged from the Humanistic Psychology tradition.

In the 1940s, Carl Rogers (1951, 1955) established a new model of psychotherapy - client centred therapy (later termed person centred therapy). This new tradition was born as a protest against the diagnostic, prescriptive perspectives of that time. Emphasis was placed upon a relationship between therapist and client based upon genuineness, acceptance and trust. As such, the person centred approach posited a new and original theoretical perspective of personality structure, psychological health, acquisition of psychological difficulty and the change process within therapy.

Largely influenced by this person centred approach, Axline (1969, 1971) developed a new therapeutic approach for working with children - non directive Play Therapy. Utilising the person centred theoretical foundations, Axline devised a clear and succinct Play Therapy theory and method.

For over 50 years, Play Therapy has been practised and researched within America. This has been led by many Play Therapists, including Moustakas (1953, 1966, 1973, 1981, 1992) and Schaefer (1976, 1986, 1993), who have progressed Axline's original formulations and devised differing models integrating elements of systemic family therapy, narrative therapy, solution focused therapy and cognitive behavioural therapy.

In Britain, Play Therapy started to emerge as a new and differing tradition in the 1980's. Initially the Children's Hour Trust taught professionals the basic techniques of Axline's Play Therapy used in a multitude of settings. In parallel, two Dramatherapists started using Play Therapy methods to inform their Dramatherapy practice with children. Sue Jennings (1994) and Ann Cattanach (1993, 1994, 1998) integrated elements of non directive Play Therapy to formulate a British Play Therapy movement. In 1990, the Institute of Dramatherapy started to offer a Certificate and Diploma in Play Therapy.

In 1992, the British Association of Play Therapists (BAPT) was started by a group of professionals studying at the Institute of Dramatherapy. Over the last nineteen years, BAPT has developed the British Play Therapy movement and currently validates Masters level training courses at the University of Roehampton (London / Surrey)and the University of Glamorgan (Wales). The training courses are founded upon a non-directive Play Therapy approach (informed by Axline's theory and methods).

Play Therapy is currently defined by BAPT as:

'...the dynamic process between child and Play Therapist in which the child explores at his or her own pace and with his or her own agenda those issues, past and current, conscious and unconscious, that are affecting the child's life in the present. The child's inner resources are enabled by the therapeutic alliance to bring about growth and change. Play Therapy is child-centred, in which play is the primary medium and speech is the secondary medium.'

Play Therapy Standards

Regulating practice and conduct is a key element to the work of the British Association of Play Therapists (BAPT).

Registered Play Therapists agree to abide by the Ethical Basis for Good Practice in Play Therapy as a condition of their registration. The Ethical Basis for Good Practice in Play Therapy is the benchmark of good practice for all BAPT registered Play Therapists. Clinical supervision from an experienced Play Therapist is a BAPT requirement for good practice. Play Therapists who breach the codes of practice could be removed from the register through the complaints procedure.

Play Therapy Career Case Studies

Julie - A Play Therapist in the NHS
Simon - A Play Therapist in Social Services
Sonnhild - A Play Therapist in Education
Kath - An Independent Play Therapist
Mary - a Play Therapist in an Assessment and Treatment Facility

Theoretical Foundations in Play Therapy

Play Therapy shares Person Centred Therapy's emphasis upon the client as trustworthy. Play Therapy is based upon three critical theoretical principles:

  • Actualisation - Humans are motivated by an innate tendency to develop constructive and healthy capacities. This tendency is to actualise each person's inner potentials, including aspects of creativity, curiosity and the desire to become more effective and autonomous.

  • The Need for Positive Regard - All people require warmth, respect and acceptance from others, especially from 'significant others'. As children grow and develop, this need for positive regard transforms into a secondary, learned need for positive self regard.

  • Play as Communication - Children use play as their primary medium of communication. Play is a format for transmitting children's emotions, thoughts, values and perceptions. It is a medium that is primarily creative.

Psychological health is defined as a child's ability to achieve a level of psychological freedom that allows a full potential use of their talents, abilities and a movement towards a more complete knowledge of themselves and their experiences. Psychological health is maintained by the self concept remaining congruent with the child's experiences. The child's developing self concept may be enabled by unconditional positive regard from significant others. This in turn develops a positive self concept that is a pre-requisite to psychological health. Psychological health is defined by five factors:

  • Unconditional Positive Self Regard

  • Openness to Experience

  • Trusting Experience

  • Trusting the Self

  • Forming successful interpersonal relationships

In order for a child to move to a position of improved psychological health, Play Therapy utilises specific agents of change. Such agents of change are regarded as the key constituents to the therapeutic process of Play Therapy that induce change. The agents of change in the Play Therapy process include (Dighton, 2001):

  1. Acceptance

  2. Psychological Safety

  3. Congruence

  4. Empathic Understanding

  5. Trust in Therapeutic Process

  6. Trust in Therapist

  7. Continuity

  8. Freedom of Expression

  9. Medium of Expression

  10. Exploration of Symbolic Expression

  11. Multiplicity of Perspective

  12. The Therapeutic Use of Significant Others

Applications of Play Therapy

Play Therapy is increasingly recognised as an effective psychological intervention for children. Although very widely used in America since the Second World War (Play Therapy is the most commonly used psychological intervention for children, with many thousands of US Clinical Psychologists utilising its wide application), it is relatively new to Britain.

Like other therapeutic treatments, Play Therapy may be used with a multitude of childhood difficulties. The vast majority of British based Play Therapy is involved in working around issues of abuse, disability, separation, loss and trauma.

A key strength of Play Therapy is its ability to initiate change for children in transition, especially those in the care of local authorities.

It is important to note that Play Therapy is not Child Psychotherapy. Play Therapy developed from a vastly differing theoretical and philosophical stance and its application and practice are different. Both forms of interventions have particular strengths and BAPT respects the enormous contributions made by Child Psychotherapy. The differences between orientations are often both practical and theoretical, although both share a common motivation to help children in need.

Play Therapy Research

From 1942 to the present, Play Therapy research has been conducted to investigate a range of issues, including clinical effectiveness, parental involvement and the analysis of specific techniques. To illustrate the body of Play Therapy Research, four research studies are summarised as follows:

Kot (1995) investigated the effectiveness of non-directive Play Therapy with child witnesses of domestic violence. Outcome measures were compared against a control group and evaluated using the Joseph Pre-School and Primary Self-Concept Screening Test, Child Behaviour Check List and Children's Play Sessions Behaviour Rating Scale. Children in the treatment group were found to have significantly reduced externalising behaviour problems and significant reduction in their total behaviour problems. This study used a total of 20 subjects with ages ranging from 3 years to 10 years.

Springer et al (1992) investigated the effectiveness of Play Therapy and Art Therapy with children identified as having one parent suffering from alcohol or drug dependency. A total of 132 subjects were used with ages ranging from 7 years to 17 years. Results indicated subjects within the treatment groups experienced significant improvements in depression, hyperactivity and disruptive behaviour (identified by Child Behaviour Check List).

Dogra and Veeraraghavan (1994) found that children diagnosed with aggressive conduct disorder who received 16 sessions of non-directive Play Therapy sessions and Parental Counselling sessions showed significant differences in their behaviours. According to the Picture-Frustration Test and Child behaviour Rating Scale, the treatment group showed a significant positive change to self, home, school, social, physical and personality on adjustment. Aggression in the experimental group was also reduced in fighting, bullying, violence against adults, obedience and temper tantrums. This study used a total of 20 subjects with ages ranging from 8 years to 12 years.

Ray et al (2001) completed a meta-analysis of 94 research studies investigating the clinical effectiveness of Play Therapy. The 94 studies measured the effects of Play Therapy conducted by mental health professionals in America and contained 3263 subjects (mean age=7.1 years). Experimental design was used for each of the 94 studies. The 94 studies investigated the effectiveness of Play Therapy with different client groups. A total of 20 client groups were investigated, including difficulties such as Conduct Disorder, Anxiety/Fear, Speech and Language Difficulties, Depression, Sexual Abuse and Post Traumatic Stress Disorder. The results of the meta-analysis conducted by Ray et al (2001) revealed a large effect size (d=.80). The authors concluded that Play Therapy is an effective intervention for a broad range of children's difficulties.

Further to the above studies, many research studies have been conducted in Britain. Currently, the majority of research has undertaken qualitative analyses of Play Therapy sessions and aim to elucidate the specific processes involved in enabling children to make sense of difficult life experiences through the Play Therapy process. In recent years, the number of Masters and PhD students investigating Play Therapy has significantly increased. Three of the four validated University training courses also offer Masters and PhDs to students.

Play Therapy Its Relevance to 21st Century Needs of Children, Young People and Families - A Research Summary prepared by BAPT - September 2009

Research References

Dogra, A., & Veeraraghavan, V. (1994). A study of psychological intervention of children with aggressive conduct disorder. Ind. Journal of Clinical Psychology, 21, p. 28-32.

Kot, S. (1995). Intensive play therapy with child witnesses of domestic violence. Unpublished dissertation, University of North Texas, Denton, TX.

Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001). The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10(1), p. 85-108.

Springer, J.F., Phillips, J., Phillips, L., Cannady, L., and Kerst-Harris, E. (1992). CODA: A creative therapy program for children in families affected by abuse of alcohol or other drugs. Journal of Community Psychology, p. 55-74.

Further Information

Page last revised Oct 2011