Therapy · Children aged 3 to 12

Play therapy for children: when words are not enough

Children rarely tell us what is wrong. They show it in their play. In play therapy, the child psychologist uses play as the child's language, so the child can work through difficult experiences, understand their feelings, actions and consequences, and find new ways of relating to themselves and the world around them. Play therapy is used, for example, for anxiety, acting-out behaviour and bullying, and to build self-confidence.

Authorised child psychologists · Typically ages 3 to 12 · No referral needed

What is it?

Play therapy is psychological treatment for children in which play is the primary language and conversation the secondary one. Adults work through problems by talking about them. Children work through them by playing them out. In the playroom, a child can show what they cannot explain, whether that is a divorce, a death in the family, anxiety, bullying or a feeling that everything is difficult.

The method has its roots in the child psychoanalysis of Anna Freud and Melanie Klein and was developed further from the 1940s by the American psychologist Virginia Axline, who founded child-centred play therapy. The psychologist follows the child, accepts the child as they are, and sets only the limits needed to keep things safe. In Denmark, play therapy was introduced by Bodil Farup. Today there are both non-directive forms, where the child chooses the play, and structured forms, where the psychologist shapes the play around what the child needs to practise.

In Denmark, play therapist is not a protected title. Psychologist is. At EGOLAB, play therapy is provided by authorised psychologists experienced in working with children, and the play is always part of an overall psychological assessment of the child's development, the family's situation and everyday life at nursery or school.

Who is it for?

Play therapy suits children aged roughly 3 to 12 best. The youngest do not yet have the words to describe what they feel, and many school-age children have the words but rarely use them about what hurts. Teenagers usually prefer talking, sometimes combined with creative methods.

Typical reasons to seek play therapy are anxiety and worry, grief after a death or illness in the family, divorce and new family patterns, frightening experiences, bullying, angry outbursts and acting-out behaviour, withdrawal or low self-esteem. Play therapy is also used to support children with autism or ADHD when feelings and conflicts are hard to regulate, and in cases of school refusal, where anxiety often lies behind.

Play therapy is one of several options with our child psychologists. In the initial session we assess together with you whether play therapy, parent counselling or sessions with the child is the right way forward, and whether an assessment is needed first.

Play therapy requires that the child feels safe enough to play, and that the adults around the child support the process. Play therapy is therefore rarely the right first step in the following situations:

• The child is still in a harmful situation. If bullying at school continues, or the child lives with violence, abuse or serious neglect, safety has to come first. Therapy cannot protect a child, and a child who is rightly on guard cannot use what they practise in the playroom. Here we begin with the parents and the school, and where necessary with the municipality.
• A parent works against the treatment. The effect depends on the parents' participation. If a parent cancels sessions, talks the treatment down in front of the child or will not attend the parent sessions, parent counselling or family therapy is usually a better place to start. Where custody is shared, we ask for consent from both parents, and in an entrenched conflict over the child, therapy can deepen the conflict rather than help the child.
• The child needs something else first. In an acute crisis, with suicidal thoughts or a suspected serious mental illness, the child must be assessed by a doctor or child psychiatry before play therapy comes into the picture. If the picture is unclear, a psychological assessment often gives a better basis for choosing treatment.
• The child has outgrown play. From around the age of 12, most prefer talking, sometimes with creative elements.

In the initial parent session we assess together whether play therapy is the right help right now, or whether something else should come first. The goal stays the same. It is the order that may change.

The research

Play therapy is one tool in the psychologist's toolbox for working with children. There is, of course, no guarantee that it will work for your child and family. The research on the method is encouraging, though, especially when parents take part.

Its effect has been studied in controlled trials for more than 60 years. The largest meta-analysis (Bratton et al., 2005) pooled 93 studies and found a large overall effect. A later analysis of 52 studies of child-centred play therapy (Lin and Bratton, 2015) found a moderate effect. A review of 23 randomised trials carried out in schools (Ray et al., 2015) showed effects on acting-out behaviour, internal difficulties such as anxiety and sadness, children's belief in their own abilities and academic problems.

Two findings recur across the analyses. The effect is greatest when parents take an active part, and the method works across age, gender and type of problem. That is why we count the parent sessions as part of the treatment itself.

In practice, this means that you take part in the initial parent session and in the regular follow-ups along the way, where we share what your child is working on in play and agree on what you can do at home. That might be short periods of play on your child's terms, a consistent way of talking about feelings, or agreements with school or nursery. We also ask you to keep the rhythm of the sessions and to avoid questioning your child after a session. The child needs to know that the playroom is their own, and that you are behind them.

Along the way we assess whether play therapy is still the right path, or whether the family is better helped by parent counselling, sessions or a combination.

Good to know

Everything your child plays and says is covered by the psychologist's duty of confidentiality. As parents, you do not get a report of every session. You get an understanding of what your child is working on, and concrete advice on how to support them at home. Where the line is drawn is agreed with you from the start, and your child knows what will be shared.

You do not need a referral from your GP to start. Sessions are charged at our standard hourly rates, and some health insurance policies cover psychological help for children. Check with your insurer before you begin.