Play Therapy: A Premier Treatment for Young Children

For children between the ages of 3 and 8 years, imaginary play represents an ideal modality for communication, relationship building, and therapeutic action, offering unparalleled access to youngsters’ inner world. In play therapy, the clinician seeks to restore developmental progression through joining in the playing state, a natural habitat for young children that involves a temporary suspension of reality and a deep immersion in the fantasy and action of pretending.

From within this shared intermediary zone, the therapist functions as a participant-observer who facilitates emotional expression, elaborates affects, and co-creates meaningful scenarios that elucidate the child’s developmental struggles, perceptions of reality-based events, wishes and worries, relational modes, and self-protective mechanisms.

Imaginary play emerges at around the age of 3 years, in tandem with evolving ego capacities for complex fantasy, narrative language, and theory of mind. The Oedipal period of development, roughly from ages 3 to 6, represents high season for pretend play. Indeed, access to imaginary roles and stories vastly expands the child’s mental resourcefulness during a phase marked by heightened conflictual feelings toward important attachment figures. Pretend play provides an enormously flexible and creative medium for modulating aggressive urges, coping with small daily mortifications, and assuaging unsatisfied longings as the child grapples with augmented social expectations (sharing, waiting is or her turn), jealousy of others’ relationships (and particularly the intimacy between parents), a sense of exclusion from adults’ private lives, intense sexual curiosities, and inevitable feelings of powerlessness.

While in the playing state, the child benefits from the transformation of passive into active experience, mastery of emotionally laden events, the temporary fulfillment of wished-for states, respite from reality-based pressures, organization and modulation of intense affects into coherent narratives, identification and experimentation with desired roles and storylines, and trying out creative solutions to interpersonal dilemmas.

When clinicians use play as a therapeutic modality, they allow themselves to be enlivened by the child’s imaginary fantasies; inevitably, the therapist contributes unconscious elements to the unfolding narratives, but the child’s subtle cues and more overt directions (“You play the ugly stepsister, and I’ll be the beautiful princess!”) guide the evolving themes.

For most children, the passion for play is powerful: often, little is needed to initiate pretense beyond inviting a young child into a room that contains usable objects that lend themselves to symbolic transformation. Through displacement onto play characters and scenarios, children reveal repudiated affects, painful experiences, and conflict-laden wishes. Disowned aspects of the self are often assigned to the therapist who is called upon to animate a jealous sibling, a stumbling reader, or an angry monster. From within these characters, the therapist labels hard-to-tolerate urges, elaborates unwanted self-states, and embellishes affect-laden events, helping the child to grasp, tolerate, reclaim, and reintegrate previously rejected aspects of self-experience. The developmentally normative and organic mode of play facilitates young children’s self-expression without undue self-consciousness or sense of exposure. Accordingly, the therapist’s questions, comments, and interpretive remarks are often made within the play itself, as one play character to another, rather than directly to the child.

Playing with children is exhilarating and engrossing but also uniquely demanding, pushing the therapist beyond the usual comfort zone to tolerate action-filled sessions, contain overwhelming affects, and keep constantly abreast of shifting cultural modes that youngsters use for play and self-expression (for example, media-based references, images, and expressions). Moreover, imaginary play often teeters on the precarious brink of overstimulation as frankly aggressive and sexual material inevitably makes its way into the child’s narratives; such themes are prevalent in children’s fantasies and in their play, as they are in the classic beloved fairytales that have been adored for generations. Developmentally normative hostile urges and fears of punishment contribute to the ubiquity of common play representations such as sadistic, monstrous, and devouring characters.

A clinician’s capacity to accept such roles when assigned by the child, tolerate uncomfortable affects, and make meaning of chaotic and scary scenarios is key to the use of play for therapeutic benefit. ■