Healing troubled children through play therapy

Whether its bullying or divorcing parents, where do children turn when they’re experiencing psychological difficulties? Play therapist Tim Hydari explains healing troubled children through Play Therapy.

Picture this. You’re struggling with a problem but your loved ones can’t understand what’s bothering you. Maybe you can’t explain it clearly, as mental and emotional states can be hard to pinpoint. So you seek professional help. You look for a counselor, a psychotherapist, psychologist or psychiatrist and during your first session with this person, you nervously describe yourself, your life, and the difficulties you are facing. You hope that this information will be received without judgment and that it will be professionally analysed and reflected back. Now imagine the same scenario but with one modification. You are not an educated, experienced and articulate adult. You are instead a child who is still developing physically, emotionally, intellectually and spiritually. Suddenly this scenario, aimed at facilitating healing is counterproductive. This is because most young children don’t have the cognitive skills necessary to verbalise their thoughts and feelings and therefore their inner world. So it begs the question, where do children turn when they’re experiencing psychological difficulties? Anxiety, attention deficit, disruptive behaviour, developmental delay and persistent feelings of sadness are just some of the mental health problems that 20 per cent of children worldwide suffer from, according to The World Health Organisation. Some of the stressors that lead to mental health concerns include (but are not limited to) peer problems, bullying, struggling with schoolwork, death in the family, illness of a parent, family financial problems, parents’ separation or divorce and natural disasters.


Thankfully, there is hope for troubled children. An effective treatment option continues to develop worldwide and is now available in the UAE. Called Play Therapy, the treatment is an interpersonal, non-invasive and non-judgmental psychotherapeutic method that builds on the normal communicative and learning processes of children. The aim is to alleviate a child’s mild, moderate and severe psychological difficulties whilst preventing the opportunity for new ones to form. The field has roots stemming back almost a century. Luminaries such as Anna Freud, Melanie Klein, Margaret Lowenfeld, Virginia Axline, Violet Oaklander, Carl Moustakas and Gary Landreth have all significantly contributed to its growth as a viable and worthwhile treatment modality in Europe and North America. More recently Play Therapy United Kingdom (PTUK), an organisation aimed at furthering good practice of therapeutic work with children as well as improving children’s emotional literacy and alleviating their behaviour and mental health problems, has worked with the Professional Standards Authority (PSA), to have play therapy registered as an accredited and essential health and social care occupation. While there are other treatment methods available to children struggling with mental health issues, play therapy is now accepted and understood internationally as an effective and crucial mental health intervention choice for children. Recent studies, including a meta-analysis of 94 research studies, have proven its clinical effectiveness and efficacy across modalities, settings, age and gender. This is largely because play is the natural world of the child and it is through play that children learn about themselves, others and their environment.


To understand play therapy we need to be clear about the concept of play. Play is a child’s natural form of exploration and communication. The Office of the United Nations High Commissioner for Human Rights has identified play as a right for all children to achieve optimum development. The American Academy of Pediatrics identified its significance in a child’s overall wellbeing. Some examples are motor play (integrating muscles, nerves and brain functions), social play (reciprocity, cooperation and sharing), constructive play (controlling and mastering their environment), fantasy play (flexible thinking) and games with rules (social contracts). However children experiencing psychological difficulties tend to limit themselves or completely eliminate certain types of play, usually to the detriment of their development, or engage in solely egocentric or even antisocial forms of it. It is a play therapist’s role to watch for patterns and themes in children’s play so as to create responses that produce therapeutic movement. Play also provides children with a safe psychological distance from which to address their problems. Why is it that occupational therapists, speech therapists, physical therapists and other human service providers use therapeutic play with toys and games to facilitate treatment goals? This is because children, in a non-threatening environment, are more willing to engage in the therapeutic process and express their thoughts and feelings, as well as assimilate information and ideas, without fear of being judged. Essentially this engagement helps the therapist avoid fighting an uphill battle.


The difference between play and play therapy is the presence of a therapist. During a play therapy session, the therapist is able to analytically deliberate on what is verbally, non-verbally and symbolically occurring in the child’s play and creative activities whilst facilitating an environment for healing through the implementation of psychotherapeutic principles. Toys, for example, allow for creative and emotional expression, testing of limits, and role-playing reality and play therapists have a sound theoretical rationale for selecting and placing toys and material in the Play Therapy playroom. This symbolic play allows children to express the unmanageable in manageable ways. Play therapists watch for patterns and themes in children’s play so as to create responses that produce therapeutic movement. So in a way the therapist is facilitating a supportive environment for communication.

As mental health professionals, play therapists are specifically trained to use children’s play as the basis of therapeutic interaction, strategically using it to help children express what’s troubling them. Play Therapists attempt to facilitate a healing environment by drawing out the therapeutic powers of play through the adoption of particular therapy principles and the use of unstructured and structured games and activities. One of the therapeutic powers of play which are accessed include catharsis, a purging of undesired or stuck feelings. When a child has experienced a stressful or traumatic event, the trauma often remains stuck in the nonverbal parts of the brain (the amygdala, thalamus, hypocampus, or brain stem). However the ability to think through and process these events takes place in the frontal lobes. So how does a child move the trauma from a place where it is doing more harm, to a place where it can be resolved? Essentially the treatment needs to incorporate the sensations and actions that have become stuck. Playing out the event assists the brain in moving the memory from the non-verbal parts to the frontal lobes and therefore giving the child an opportunity to process, organise and integrate the traumatic sensations and actions.


There are many other therapeutic powers of play, including but not limited to attachment formation (forming a trusting, accepting, respectful, reliable and consistent relationship with an adult role model), abreaction (playing out and resolving through play, past traumatic experiences), wish fulfilment (expressing desires possibly unacceptable or unattainable in a non-judgmental and safe environment), and mastery of thoughts, feelings and fears (usually through the use of metaphor). For the therapeutic powers to be safely and fully accessed, a play therapist will apply principles to facilitate healing. At the same time, toys allow for creative and emotional expression, testing of limits, and role-playing reality and Play Therapists have a sound theoretical rationale for selecting and placing toys and material in the Play Therapy playroom. Play Therapy International (PTI), an affiliate of PTUK, has a prescribed toolkit, which includes sand, art, clay, music, storytelling, puppets, creative visualisation and drama. Children benefitting from play therapy typically range from age three through to 13, however adolescents and adults can benefit as well, mainly from the creative arts aspect of play therapy. Whilst some interventions have lasted for six weeks, with one or two sessions a week, others have gone on for as long as six months to a year. The length very much depends on the child and the severity of the difficulty he or she is facing and is therefore decided by the therapist on a case-by-case basis. Importantly, outcomes of the process are measured through the collection of qualitative and quantitative data at the beginning, middle and end of the intervention. Remember that, by the age of around three, children are able to imbue symbolic meaning onto their play, which reveals that while the toys they use are like their words, the play itself acts as their language. Your child might be communicating his or her inner world to you right now and if there is a problem it is essential you begin to listen so that you can seek out appropriate help. The best way to listen is to play. What is your child telling you today?


Play therapy has helped children: • Become more responsible for their behaviours; • Develop safer, more adaptive and more successful coping strategies; • Develop new and creative solutions to problems; • Change the way they think about, feel toward and resolve concerns; • Improve their social skills; • Develop respect and acceptance of self and others; • Learn to experience and express emotion; • Cultivate empathy and respect for others; • Develop self-efficacy and thus a better assuredness about their abilities; • Enhance cognitive development through the removal of dysfunctional thinking.

An accredited Play Therapist and Trainee Supervisor, Tim Hydari trained with the Academy of Play and Child Psychotherapy (APAC), he has a postgraduate Diploma in Practice Based Play Therapy and a Masters degree in Developmental and Therapeutic Play. He is a member of Play Therapy International (PTI) and the Association of Therapeutic Playwork. Tim’s aim is to enlighten, empower and heal children, parents and families. To enquire about Play Therapy, contact Tim through Breath and Health Alternative Medical Centre in Dubai, UAE on +971 (0)4 348 9940.


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