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“Let’s Play!”: The Use of Play Therapy in Child Healthcare

James Belarde//

“To truly laugh, you must be able to take your pain, and play with it.” -Charlie Chaplin

Children are the definition of potential. While having dinner on a first date at a vegetarian restaurant, the conversation turned to my gross undereducation in the field of vegetables and an abhorrent overeducation in the field of chocolate milkshakes and lava cakes. I jokingly attributed this to never advancing beyond a 5-year old’s natural palette, but my date disagreed. “Kids aren’t picky,” she replied, before quickly adding, “Picky isn’t a thing.”

After I finished laughing at this humorous rebuke of my ridiculous diet philosophy, the idea’s broader truth stayed with me. She meant that children develop their palette based on the foods and opinions about foods they experience in life. There are no inherent “picky” tendencies. And indeed, this is a recurring theme in child development. Research shows babies distinguish different speech sounds from languages around the world early on, but gradually lose this ability for sound distinctions that don’t exist in their native languages.1 Studies suggest a similar pattern with facial discrimination. Babies initially differentiate between facial expressions of all races equally well but become much better at discriminating faces of the predominant race they’re exposed to as they age.2 A child’s worldview is a summation of the experiences and lessons they acquire in development.

Unfortunately, some defining experiences have a negative impact on one’s worldview. Children are not immune to depression, anxiety, and other psychological problems caused by difficult life events and painful trauma. If left unaddressed, these can create significant obstacles for a child’s development. A method for identifying and easing this mental stress in children would be invaluable. In my previous article, I discussed how a child’s evolving sense of humor could provide insight into their underlying cognitive development. But can this ability to intuit the inner psyche of children through their recreation provide a therapeutic benefit? Many child psychologists think so, and this is where the method of play therapy comes into, um…play.

Play is an important part of any child’s life. So much so that UNICEF included it in their widely-supported Convention on the Rights of the Child (a treaty ratified by every member of the United Nations except the United States). Article 31 of this document states, “Children have the right to relax and play, and to join in a wide range of cultural, artistic and other recreational activities.”3 Play therapy is founded on the related belief that play is a vital form of communication for children. Child psychiatrist Dr. Christine Anzieu-Premmereur writes, “When they can play, they show what has happened to them, what they felt about it, what they want, and what they need.”4 This is especially so for younger children lacking the verbal expertise necessary to clearly communicate their internal mental states. For these kids, how they play is much more informative. Rather than interpreting the things a patient says, child psychologists interpret what a patient does during observed recreation. Toys and games stand in for words and discussion.

One of the more standardized examples of this approach is the sandplay method. Initially developed by pediatrician Margaret Lowenfield in 1929 and further refined by Swiss Jungian psychologist Dora Kalff five decades later, sandplay began as a tool for children to resolve early trauma experiences.5 The idea was that it allowed for a healing expression of unconscious thoughts.

An example of sandplay therapy. Wikimedia Commons

Though there are many variations, the basic technique is always the same. Children are given two trays, both about four square feet in size, one filled with dry sand and one with wet sand. The trays are also usually painted blue to mimic water when the sand is pushed away. The child is encouraged to play with these and create an environment using an assortment of miniature figurines that can include animals, people, buildings, trees, vehicles, and more. The therapist observes this process, offering support and occasional comments or questions.

The goals of this sandplay are numerous and depend on the specific variation used. But by having a safe space in which they can express themselves and solve problems that arise during play, children experience a feeling of empowerment and control. This alone can be a relief when mental stress and trauma intensify feelings of powerlessness that naturally accompany the vulnerability of youth. The therapist can provide additional benefit by identifying trends in the child’s play that suggest strategies for intervention, by allowing the child to openly explain their approach to the sandplay, or by engaging in more traditional talk therapy using the activity as a starting point for discussion. Interestingly, sandplay can be adapted for use as a family therapy as well. When inviting parents and children to play together, a therapist provides an opportunity for families to reflect on how they work as a team and develop healthier cooperative behaviors. (I shudder imagining the number of sand civilizations that would have been decimated by my younger brother and I as we worked out our own childhood disputes!)

Of course, sandplay is just one of the many methods play therapists have at their disposal. Other techniques utilize diverse recreational tools including puppets, dolls, visual arts, puzzles, and board games, to name a few. Dramatic approaches involving role-play and make-believe can also be of great benefit to both children and their parents, who are often invited to participate.5 Any activity that encourages a child’s creative, free expression of their psyche has therapeutic potential.

As children get older and develop greater mastery over language, their use of wordplay and jokes contribute a new dimension to this approach. In this case, their playful humor can be both an indicator of psychological stress and a way of overcoming it. Dr. Anzieu-Premmereur writes about Peter, a patient that had been abused by a babysitter who would try to force-feed him.4 Around the age of five, Peter began telling jokes that made him laugh endlessly, and Dr. Anzieu-Premmereur noticed many of these jokes related closely to his experiences. For example, “What did the teddy bear say when he was offered dessert? No thanks, I’m stuffed!” But these jokes weren’t just communicating an earlier trauma. They were his way of achieving mastery over it. The joy the jokes provided were a type of victory over his former pain.

Given everything children endure as they learn to navigate a wholly new world with strange cultural expectations, it’s no surprise (and more importantly, no failure) that they often face serious psychological struggles during development. But with guidance and healthy coping mechanisms, kids can overcome these hurdles. Toward this end, play therapy is a powerful tool that facilitates well-adjusted mental health throughout childhood. But its usefulness doesn’t stop there. Adults benefit from similar therapeutic approaches, and those who don’t make enough time for play can become mentally distraught.5 So, remember to take a page out of a children’s book and be playfully silly from time to time. After all, just as kids aren’t born picky, adults aren’t born dull.

Featured image from golso via Pixabay.


  1. Werker, J. F., and Tees, R. C. “Cross-language speech perception: Evidence for perceptual reorganization during the first year of life.” Infant Behavior and Development. 1984; 7(1):49-63.
  2. Mayer, Amy. “How Babies See Race.” Scientific American, 1 Sept. 2012, Accessed on 7 Dec. 2018
  3. “A summary of the rights under the Convention on the Rights of the Child.” UNICEF, Accessed on 3 Dec. 2018
  4. Anzieu-Premmereur, Christine. “The Development of a Sense of Humor in a Young Child During Psychoanalysis.” Journal of Infant, Child & Adolescent Psychotherapy. 2009; 8:137-144.
  5. Gladding, Samuel T. “Chapter 8: Play and Humor in Counseling.” The Creative Arts in Counseling. Alexandria: American Counseling Association, 2011. 155-179.
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