“Therapy that feels like play” can sound like something written by a marketing department. That’s a fair suspicion and it deserves a proper answer, so every claim in this article links to the research behind it, and you’re welcome to go past our summary and read any of it yourself.
First, what we mean by play therapy
Two related things live under this name. Play therapy in the formal sense, often child-centred play therapy, is a counselling approach where a trained therapist uses play as the child’s natural language for working through feelings and experiences. Play-based occupational therapy, which is what we deliver, uses play as the engine for building everyday skills: the game is chosen so that the climbing, threading or pretending is doing the therapeutic work. The research below covers both, because they rest on the same foundation. Play is not a break from a child’s development; it’s how development happens.
The paediatricians’ case for play
The American Academy of Pediatrics has published two major clinical reports on this. Ginsburg (2007) set out the evidence that play drives cognitive, physical, social and emotional development, and warned that children’s lives were tilting toward scheduled enrichment at free play’s expense. Yogman and colleagues (2018) went further into the neuroscience: play builds brain structure and function, develops executive function (the planning, focusing and self-control skills that predict how school goes), and buffers the effects of stress. Their recommendation was that doctors literally write a prescription for play at check-ups.
That’s the context for everything an OT does through play. When a session looks like a game, it’s running on the machinery those reports describe.
What the clinical trials show
Play therapy is one of the better-studied child interventions, and the evidence has been pulled together in several large reviews.
Bratton, Ray, Rhine and Jones (2005) combined 93 controlled studies and found an overall treatment effect of 0.8 standard deviations. That’s a large effect, in the same territory as well-established psychotherapies, and it held across ages, genders and presenting concerns.
Lin and Bratton (2015) took a stricter look at 52 controlled studies of child-centred approaches and found a statistically significant moderate effect, with stronger results when caregivers were involved in the therapy.
Ray, Armstrong, Balkin and Jayne (2015) reviewed 23 studies of play therapy delivered in schools and found significant improvements across acting-out behaviour, worrying and withdrawal, self-belief, and academic outcomes.
A note on the word “moderate”: it isn’t faint praise. It’s the replicated middle of the evidence, measured against doing nothing or doing something else.
The Australian research on learning to play
Some children need support to build play itself, particularly pretend play, which is where language, ideas and social understanding get their early workout. The Learn to Play program, developed by occupational therapist Professor Karen Stagnitti at Deakin University, teaches those pretend-play skills directly. O’Connor and Stagnitti (2011) compared six months of this play intervention against traditional classroom activities for children at a specialist school. The children in the play group made gains in language and social skills, and became less disruptive with their peers. Teach the play, in other words, and the language and friendships follow.
Why parents are part of the picture
One finding turns up again and again: play therapy works best when the adults who matter are involved. In the largest review, approaches that included parents produced the biggest effects of all. A therapist gets one hour a week and you get the other 167, which is why we’d rather coach you than impress you, and why parent capacity building is a service in its own right rather than an afterthought.
What this looks like in a session
Behind every game in a play-based session there’s a goal you helped set. Pushing playdough that’s building up the hands for pencil work. A dress-up box that’s practising getting dressed. A turn-taking game that’s about keeping friendships going at lunchtime. Your child gets to be a kid, and the skills are built along the way.
The research mentioned here
- Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119(1), 182-191.
- Yogman, M., Garner, A., Hutchinson, J., Hirsh-Pasek, K., & Golinkoff, R. M. (2018). The power of play: A pediatric role in enhancing development in young children. Pediatrics, 142(3), e20182058.
- Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 376-390.
- Lin, Y.-W., & Bratton, S. C. (2015). A meta-analytic review of child-centered play therapy approaches. Journal of Counseling & Development, 93(1), 45-58.
- Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107-123.
- O’Connor, C., & Stagnitti, K. (2011). Play, behaviour, language and social skills: The comparison of a play and a non-play intervention within a specialist school setting. Research in Developmental Disabilities, 32(3), 1205-1211.
If you’d like to talk about what play-based therapy could look like for your child, our play therapy guide explains how we put this research into practice. We see families across Melbourne’s inner north west, so get in touch.