Play Therapy Sessions Research Articles

Effectiveness of Play Therapy Programme in Promoting Early Child Development of under-5 Children visiting Tertiary Care Hospital in Rural Settings: Study Protocol of a Randomized Controlled Trial.

Background Good care and conscious, mindful parenting are the essential requirements of the early childhood period. Good care in early childhood consists of mindful handling of children’s needs like hunger, care in sickness, socio-emotional needs, safety, love and affection. Good care promotes children’s development and provides a favourable environment for learning. It’s a well-known fact that hospitalization is a stressful situation for child of any age. Play is an integral part of early childhood period which is virtually restricted in hospital settings. This study will try to explore the effectiveness of play therapy delivered in hospital settings, on early child development. Methods This will be a randomized control trial conducted in the Paediatrics department of a tertiary care hospital in Wardha, India. The sample size will be 360 children, 180 each in intervention and control arm. The hospitalized children from intervention arm will receive customized Play Therapy sessions from trained research assistants and will be followed up at scheduled home visits for one year from the date of enrolment. All children will be assessed for changes in cognitive, motor and socio-emotional development scores. The differences in development scores between intervention and control groups will be compared and effect sizes of changes will be calculated. Discussion Implementation of play stimulation activities have been reported as useful strategies for promoting child development and good recovery during hospitalization. This trial will attempt to explore the effectiveness of play therapy on changes in child development scores of children from intervention group compared to the control group. The customized play therapy program will be adapted to paediatric inpatient settings, and attempts will be made to improve the Play Therapy kit for hospitalized children. Registration Clinical Trial Registry of India Registration No.: C.T.R.I./2022/03/041355, dated 24/03/2022. Protocol Version: v6 Dated 04/10/2024.

The Effect of Play-Based Occupational Therapy on Playfulness and Social Play of Children with Autism Spectrum Disorder: A Systematic Review

ABSTRACT Since play is the main occupation of children, occupational therapists often use play as an approach to improve playfulness. However, for children with autism spectrum disorder (ASD), there is some uncertainty as to whether playfulness and social play can be improved through play-based interventions. To determine the effect of play-based occupational therapy on playfulness and social play of children with ASD, PubMed, EBSCOhost, OT seeker, Scopus, Sabinet, Cochrane, and ProQuest were searched. Rayyan was used to sort studies and extract data, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the 12 eligible studies was reviewed using the Joanna Briggs Institute (JBI) checklist tool and data were synthesized using meta-analysis techniques. This review found moderate to strong evidence for 11 of the 12 studies, that play programmes, with a combination of guided and free play, individual, and group therapy sessions, effectively promoted playfulness and social play.

Effectiveness of cognitive-behavioral group play therapy on anxiety-based school refusal and behavioral problems in elementary school boys: a preliminary randomized controlled trial

This study aimed to examine the effectiveness of cognitive-behavioral group play therapy on anxiety-based school refusal and behavioral issues in elementary school boys. A randomized controlled trial design (pretest-posttest with a control group) was utilized. Thirty elementary school boys with school refusal issues were randomly assigned to intervention (n = 15) and control (n = 15) groups. The intervention group received ten sessions of cognitive-behavioral group play therapy. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) questionnaire and Rutter's Children's Behavior Questionnaire were used as assessment tools. Mean scores for anxiety-based school refusal and behavioral problems in the intervention group showed a significant decrease (p < 0.001). Cognitive-behavioral group play therapy is a practical approach to reducing anxiety levels and behavior problems in children with anxiety-based school refusal in primary school grades.

I'm Great! I'm no good….: A case illustration of drama therapeutic work with a male offender of domestic violence in a forensic outpatient setting.

Treating perpetrators of aggressive behavior, like verbal aggression, intimidation, and bullying behavior resulting in aggressive incidents with others, is difficult. This group is often diagnosed with personality disorders and when legal measures applied, they are more often treated in a forensic setting for their problems. This article presents the case of a 54-year-old man, diagnosed with Borderline personality disorder, narcissistic and antisocial traits, mild depressive symptoms, and loss and grief, who has voluntarily had treatment in a forensic outpatient center to reduce aggression and change destructive patterns in relationships. Hating, judging, and self-defeating were the main reasons why the patient found himself ending up in the same situation repeatedly. The client received individual drama therapy sessions. The drama therapeutic approach included schema therapeutic elements, such as schema mode work with cards, as well as roleplay, imagery (with rescripting), improvisation, and psycho drama elements. As a result of drama therapy, the client reported less (active) aggression, less aggression in his relationships (partners/children/friends), but also an increased level of loneliness, and mild depressive symptoms. The client was more in touch with his vulnerability and was able to behave in a more adequate healthy way in relationships. Although self-esteem was still building up, there was a decrease of aggression and less conflict-seeking behavior as a result. Risk assessment tools (FARE-2& HONOS) and Schema therapy scales (YSQ and SMI) were used pre- and posttreatment confirming the improvements. This case promotes the use of dramatherapy in forensic outpatient care to be valuable in lowering risk recidivism and changing deeply rooted behavioral patterns.

Cognitive Behavioral Play Therapy in the Sand

This article describes the application of sand therapy to Cognitive Behavioral Play Therapy (CBPT). An overview of CBPT is provided to consider how foundational theoretical aspects are applied to sand therapy. Case examples give the reader insight into how CBPT sand therapy may be used within a play therapy session. Case examples include both directive and non-directive prompts to demonstrate using either or both at appropriate times within a session. These are chosen through collaboration between client and therapist and are tied to treatment goals. Aspects of CBPT, including role play, CBT-focused facilitative responses, and psychoeducation, are also incorporated into the sandtray process.

The relational change mechanisms of child‐centered play therapy with children exposed to adverse childhood experiences

AbstractThe researchers examined the relational mechanisms and coregulatory change mechanisms of child‐centered play therapy (CCPT) with children (ages 5–8) who endured multiple adverse childhood experiences (ACEs). The researchers computed surrogate synchrony analyses to measure heart rate synchrony between counselor and child participants during CCPT treatment. Child participants received between 10 and 14 CCPT sessions in the elementary school setting. Participants and counselor wore Empatica© E4 wristbands during sessions to collect heart rate data continuously during play therapy sessions. The researchers found consistent, large child‐counselor heart rate synchrony levels across play therapy sessions. The researchers discuss the implications of this research for counselors and play therapists working with children impacted by ACEs.

Comparing the Effectiveness of Cognitive-Behavioral Play Therapy and Resilience-Based Play Therapy on Anxiety, Executive Functioning Behaviors, and Emotional Expression in 6 to 8-Year-Old Children Undergoing Dental Treatment

Objective: This study aimed to compare the effectiveness of cognitive-behavioral play therapy and resilience-based play therapy on anxiety, executive functioning behaviors, and emotional expression in children aged 6 to 8 years undergoing dental treatment. Methods: The current research was a quasi-experimental study with a pre-test, post-test design, including a control group and a two-month follow-up period. All children aged 6 to 8 visiting specialty dental clinics in Isfahan during the first six months of 2021 constituted the research population. Forty-five children were selected using purposive sampling based on inclusion criteria and were randomly assigned to three equal groups of fifteen. Data collection was carried out using the Revised Children's Anxiety Scale - Short Form (Ahlen et al., 2018), the Emotion Expression Questionnaire - Child Form (Penza-Clyve &amp; Zeman, 2002), and the Executive Functioning Questionnaire (Gioia et al., 2000). Cognitive-behavioral play therapy sessions were conducted based on the protocol by Hall, Kaduson, and Schaefer (2002), and resilience-based play therapy sessions followed the protocol by Nikneshan et al. (2019), each lasting for eight weekly sessions of 60 minutes. However, the control group did not receive these interventions. Data analysis was performed using descriptive statistics and mixed ANOVA with SPSS software, version 26. Findings: Results indicated that the mean scores of executive functioning behaviors and their dimensions significantly improved in the experimental groups at post-test compared to the control group, and these improvements remained stable at follow-up (p &lt; 0.05). Moreover, therapeutic interventions (both cognitive-behavioral and resilience-based play therapy) significantly improved scores on anxiety and emotional expressiveness compared to the control group. Additionally, post hoc Bonferroni tests showed that cognitive-behavioral play therapy was more effective than resilience-based play therapy in reducing anxiety scores and increasing skills in emotional expression and executive functioning in children undergoing dental treatment (p &lt; 0.05). Conclusion: These findings further clarify the role of play therapy in children undergoing dental treatment and highlight the necessity of using therapeutic approaches derived from the cognitive-behavioral model to modulate symptoms in these children.

Clay with children who have lost or fear losing a loved one: The play therapist’s observations of some clients

The creative use of clay in play therapy sessions encourages the expression of emotions, such as anger, sadness, fear and worry. It assists the child in different emotional areas and enhances client-therapist relationship. The therapist’s observations and understanding of the therapeutic use of clay in play therapy sessions with three children who had lost or feared losing someone in their family are exposed. The therapist concluded that clay was used by the children as a media to experience protection, containment, as well as release emotions that were making them angry and sad. It was a way that they found to work out their feelings and thoughts related to their loss or the fear of losing a loved one.

The effectiveness of child-centered play therapy on behavior problems of children

This study aims to examine Child-Centered Play Therapy's effect on reducing behavioral problems in five- and six-year-old children living in Istanbul. The study was conducted with 20 children from socio-economically disadvantaged families. Families applied for support to a play therapy room established in a primary school. A pre-test and post-test control group design is used. Child-Centered Play Therapy sessions were implemented in the experimental group for eight weeks as individual sessions. Data due to the children's behavior problems were collected from parents via the “Social Competence and Behavior Evaluation-30 Scale” and the family pre-interview form. Mann Whitney-U Test and Wilcoxon Test analyzed data. Results of the experimental group (ingroup analyses) show a significant difference between pre-test and post-test scores of social competence, anger aggression, and anxiety withdrawal subscales, as hypothesized. However, analyses of between groups’ post-test comparisons show significant differences only in the social competence subscale. Between groups, post-test scores, comparisons of anger-aggression, and anxiety withdrawal subscales showed no significant differences. The results are discussed; additionally, observations of the researcher as a play therapist are presented.

Evaluation of a person‐centred psychotherapy programme for children with developmental disabilities and parents in disadvantaged families

AbstractBackgroundThe needs of parents of children with developmental disabilities (DD) in disadvantaged families are frequently unmet by service providers. This service gap likely diminishes the therapeutic gains of children's treatment. Catering to the psychological needs of both children and parents is important. The present study evaluates the effectiveness of a person‐centred psychotherapy programme for children with DD and parents in disadvantaged families in reducing parenting stress and promoting positive children's behaviours.MethodFifteen parent–child dyads participated in a person‐centred psychotherapy programme consisting of eight 1‐hr child‐centred play therapy (CCPT) sessions and four 1‐hr person‐centred therapy (PCT) sessions. The parents completed a quantitative questionnaire before and after the programme.ResultsThe results indicated a significant reduction in children's conduct problems, with a large effect size, and in the levels of parental distress, parent–child dysfunctional interaction and difficulty in controlling their child's behaviours, with large effect sizes after the interventions.ConclusionsThis study provides positive evidence for the effectiveness of the person‐centred intervention programme. The results imply that individual humanistic therapy sessions are essential and effective to cater to parents' needs. Service providers can provide PCT to parents when delivering child services.

Adlerian Applications of Sandtray Play Therapy

Abstract Adlerian applications of sandtray play therapy is one strategy used by play therapists who practice Adlerian play therapy. Adlerians use a plethora of different kinds of sand trays: spontaneous, non-directed, semi-directed, directed, quasi-directed, therapist-created, and co-created trays with child, adolescents, and adult clients, as well as with families and in parent and teacher consultation. While there is a general guideline of 7 steps in Adlerian sand tray play therapy sessions, therapists can use their own creativity and flexibility to adjust this process based on the needs of individual clients and their treatment plan for working with them. Adlerian play therapists use sandtray therapy in all four phases of therapy: building the relationship, exploring clients' lifestyles, helping clients gain insight into their lifestyles, and reorienting/re-educating clients by facilitating changes in behavior, emotions, and cognitions.

자폐스펙트럼장애(ASD) 아동의 놀이치료에서 놀이성 변화과정에 대한 질적사례연구 : 플로어타임 중재를 중심으로

This is a descriptive case study that explores the process of change in playfulness of children with Autism Spectrum Disorder (ASD) during play therapy. This study recruited one child with ASD and included two sessions of pre-developmental evaluation and play evaluation, seven sessions of play therapy intervention, and one session of post-play evaluation. This study analyzed the quantitative and qualitative data to comprehensively understand the process of change in playfulness of the participant. Quantitative data was collected by a group of raters who measured the playfulness in each play therapy session. Qualitative data was collected by analyzing video transcripts of evaluation and play therapy sessions. The results indicate that at the end of the intervention, the total score and the sub-factors of the participant maintained improved scores compared to the first session. In the qualitative analysis, 303 meaning units were derived and classified into 13 sub categories and 5 core categories. The core categories include ‘You exist but not exist’, ‘You exist’, ‘I want’, ‘You and me’, and ‘You and me play’.

Comparison of the Effectiveness of Cognitive-Behavioral Play Therapy and Resilience-Based Play Therapy on Anxiety in Children Aged 6 to 8 Undergoing Dental Treatment

Objective: This study aimed to compare the effectiveness of cognitive-behavioral play therapy and resilience-based play therapy on anxiety in children aged 6 to 8 undergoing dental treatment. Materials and Methods: The present study was a quasi-experimental design with pre-test, post-test, and control group with a follow-up period. The study population included all children aged 6 to 8 who visited dental clinics in Isfahan in the first half of the year 2022, from which 45 children were selected through purposive sampling according to the entry criteria and randomly assigned to three equal groups of 15. Data collection was performed using the Spence Children's Anxiety Scale - Short Form (Ahlen et al., 2018). The cognitive-behavioral play therapy sessions were based on the protocol of Hall, Kaduson, and Schaefer (2002), and the resilience-based play therapy sessions were based on the protocol of Nick Nashan and colleagues (2019), conducted over 8 sessions (one session per week) each lasting 60 minutes for the experimental groups, but not for the control group. Data analysis was conducted using descriptive statistics and mixed ANOVA with SPSS-26 software. Findings: The results showed that therapeutic interventions (cognitive-behavioral and resilience-based play therapy) were significantly more effective than the control group in improving anxiety scores (P&lt;0.001) and emotional expressiveness (P&lt;0.001). Furthermore, the results indicated that cognitive-behavioral play therapy had a greater effect on reducing anxiety scores in children undergoing dental treatment compared to resilience-based play therapy (P&lt;0.05). Conclusion: These findings further highlight the role of play therapy in children undergoing dental treatment and the necessity of utilizing therapeutic approaches derived from the cognitive-behavioral approach to moderate these children's symptoms.

Episodic Experiences of Child Physical Abuse, Early Relational Trauma and Post-Traumatic Play: Theoretical Considerations and Clinical Illustrations.

Through symbolic and make-believe play, children can give meaning to their emotional experiences. For children who have experienced trauma, play provides the means to transform their past and tame the intrusive images and feelings associated with it. The quality of parent-child interactions plays a vital role in the development of mental representational capacity, which is essential for children's ability to engage in symbolic play. However, in child maltreatment situations, the unpredictability and insecurity of the parent-child relationship can have a profound impact on children's ability to play. This article aims to explore how the post-traumatic play of children who have suffered from episodic experiences of physical abuse differs from that of children who have experienced early relational traumas (ERT) resulting from chronic exposure to maltreatment and neglect. A theoretical and clinical analysis of the first play therapy session of a child who lived episodic experiences of physical abuse and that of a child who was exposed to ERT is presented. This analysis is informed by the Children's Play Therapy Instrument and the theories proposed by Chazan and Cohen inJournal of Child Psychotherapy, 36(2), 133-151(2010), and Romano inLe Journal Des Psychologues, 279, 57-61 (2010). The nature of the relationship between children and their primary caregivers and the child-therapist relationship are also discussed. ERT appear to compromise the development of diverse abilities in children. Among them, access to the world of mental representations, which depends to a large extent on the presence of mindful and attentive parents, and their ability to capture and respond contingently to the playful proposals of children.

Dramatherapy for children and adolescents with autism spectrum disorder: A systematic integrative review

Dramatherapy is a form of psychotherapy practised by qualified and clinically trained dramatherapists and entails the intentional use of drama and theatre-arts creative processes such as storytelling, role-playing, movement, dramatisation and improvisation to promote therapeutic change, adaptation or self-development. Dramatherapists and researchers have contributed to the development and appreciation of dramatherapy for supporting children and adolescents with an Autism Spectrum Disorder (ASD) diagnosis, who tend to experience mild to severe challenges in interacting and communicating with others as well as processing social-emotional experiences. However, there is limited empirical research in this field. The present study adopted an integrative approach to systematically review the published research on the effects of dramatherapy sessions for children and adolescents with ASD, aged under 19 years; aiming at offering an in-depth and holistic understanding of the impact on emotional, psychological and social domains. Nine research studies utilising different research designs, namely six qualitative studies, two quantitative studies and one mixed methods were identified and integrated in this systematic review. A textual narrative approach was employed to synthesise the findings which suggested that dramatherapy can support children and adolescents with ASD by fostering behavioural, expressive and social skills and promoting emotional well-being through the use of various art forms and techniques. Methodological issues concerning the transparency of the research process were identified. In addition, the need for a formalised approach to exploring and evaluating the impact was recognised.

The Effectiveness of Play Therapy Studies on Behavioural Disorders in Children in Iran

Introduction: This study aimed to meta-analyze the influential play therapy studies on behavioural disorders in children in Iran. Method: The analysis of the present research method uses internal and external databases to find and collect all research reports. The sample used included 22 studies conducted from 1997 to 2013, including 637 subjects. The data from these 22 studies were meta-analyzed by the standardized effect size difference method or Cohen d for the fixed effects model. All statistical operations were performed using the second edition of comprehensive meta-analysis software. Results: The results showed that the average effect size of the studies is 0/434 for the fixed effects model and 0/477 for the random effects, both of which are significant. Because the effect sizes were heterogeneous, moderators were searched. The results showed no significant difference between the effect size of the studied studies according to the research design and the gender of the subjects. However, there was a substantial difference between the effect of studies on the effectiveness of play therapy on children's behavioural disorders according to the subject's age, the type of independent variable and the number of play therapy sessions. Conclusion: Holding play therapy sessions ultimately and in multiple sessions and at a young age can improve more behavioural disorders in children.

Dramatherapy online: Here, there, and Black everywhere

This article highlights the necessary narratives and voice of a Black male dramatherapist working with unaccompanied/separated children and adolescents accessing dramatherapy online as a viable extension of dramatherapy practice. It explores the metaphor of a cyborg in relation to the dramatherapist, examining how feelings of distance may be magnified through the screen, yet offer the opportunity to co-create new connections and relationships. Holding dramatherapy sessions online challenges boundaries and space-holding, as online therapy does not include a shared physical room or container in the same way as traditional place-based dramatherapy. Remote access to therapy is enabled by technology when access to shared physical spaces is compromised. This research uses a phenomenological and naturalist retrospective analysis of voice, language and agency and aims to cultivate a philosophical repertoire to conceptualise and identify themes present in my experience of online dramatherapy.

The Effectiveness of Play Therapy on Anxiety and Specific Learning Disorders of Elementary-School Students in Isfahan, Iran

Background: Anxiety and specific learning disorders (SLDs) are two problems faced by some elementary-school students, resolving of which is a challenge for elementary teachers. The present study aimed to investigate the effectiveness of play therapy on anxiety and specific learning disorders of elementary-school students. Methods: The research method was quasi-experimental with pre-test post-test design and control group. The statistical population comprised of all the male elementary-school students aged 9-10 years in Isfahan, Iran, in 2020. Using convenience sampling, we selected 30 students and randomly divided them into experimental and control groups (n= 15 per group). The experimental group underwent nine sessions of play therapy (two 30-minute sessions per week), while the control group received no intervention. The research instruments included Spence Children's Anxiety Scale (SCAS) and the Colorado Learning Difficulties Questionnaire (CLDQ). First, both groups completed the pre-test questionnaires, and the intervention program was evaluated in the last training session. As the children could not complete the questionnaires, their parents were asked to collaborate with the research. Analysis of covariance (ANCOVA) was performed in SPSS software version 22.0 to analyze the data. Results: The mean ± standard deviation (SD) of the post-test scores of anxiety and specific learning disorders were 64.73±1.30 and 41.73±3.06 in the experimental group and 71.64±1.80 and 49.73±3.33 in the control groups. The results showed that play therapy was effective in reducing the anxiety of elementary-school students in Isfahan. It was also highly effective in alleviating their SLD-related problems (P= 0.001). Conclusions: Based on the results, the play therapy intervention can reduce anxiety and ameliorate the SLD problems of elementary-school students.

The effect of non‐directive play therapy on reduction of anxiety disorders in young children

AbstractBackgroundThere is strong evidence that non‐directive play therapy, which is also known as child‐centred play, may be useful in reducing anxiety in young children. Non‐directive play is an approach to playing where the child is given ultimate freedom rather than a practitioner impressing ideas on them.ObjectivesThe purpose of this study was to evaluate the efficacy of non‐directive play therapy for anxiety reduction in children.MethodsFor this purpose, 20 elementary students who had been diagnosed as anxious according to the Spence Children's Anxiety Scale (SCAS) were selected through random sampling and were divided into an experimental group and control group. The experimental group participated in 10 sessions of play therapy, and after finishing the sessions, the SCAS questionnaire was implemented again as a post‐test. Analysis of covariance was used to analyse the data.ResultsThe results of the study showed that scores on the anxiety scale reduced significantly in the experimental group.ConclusionsNon‐directive play therapy was useful in reducing children's anxiety, so it may be implicated as an education plan for problematic parent–child relationships. However, more studies are needed to support these results.

Development of the child\u2019s ego strength scale: an observation-based assessment of the board game behaviors in play therapy in Korea

BackgroundThe purpose of this study was to develop a scale for assessing children’s ego strength through the observation of children playing board games in a therapeutic setting. Because ego strength is an index of psychosocial health, it is important to assess ego strength in childhood. In particular, children aged 7 to 9 exhibit their ego-strength characteristics in a situation challenged by self-competence due to their latency period. Therapists can identify such ego strength through game behaviors of children aged 7 to 9 in the play therapy setting. Thus, it is needed to develop a scale by selecting game play behaviors that grasp ego-strength.MethodData were collected from 127 play therapists and play therapist-supervisors, who observed 468 play therapy sessions and 55 children aged 7–9 who received play therapy in Korea. The scale was created through content validity verification, factor analysis and verification of criterion-related validity.ResultsWe generated a Child’s Ego Strength Scale (CESS) consisting of five sub-factors (Coping Strategy, Cognitive Strategy, Ego Restriction, Interpersonal Functioning, Frustration Tolerance) through exploratory factor analysis. The scale met the goodness of fit criteria in a confirmatory factor analysis. The analysis of therapy sessions of children with strong and weak ego strength, as identified by play therapists, showed a significant difference between the two groups in all five sub-variables. There was a significant correlation between the CESS scores and scores of ego strength-related variables of the Rorschach scale, indicating good criterion-related validity.ConclusionThe CESS appears to be a practical method for the assessment of ego strength in the field of child counseling.