Play therapy: what it is, techniques and how to use it in practice

A six-year-old walks into your consulting room for the first time. He ignores the chair you offer, heads straight for the doll's house, puts the smallest figure under a bed and turns all the others to face the wall. Then he goes out to the corridor to find his mum. He hasn't said a single sentence about what is going on, and yet he has told you quite a lot. Play therapy starts from that simple observation: at that age hardly anyone can explain in words what they feel, but they can play it.

This guide is written for psychologists who see children in private practice or are starting to. It covers what play therapy is, when it makes sense and when it doesn't, the main approaches, the techniques used most often, how to set up a playroom without spending a fortune, how to set limits, what role parents play and what to record so the process doesn't depend on your memory.

What play therapy is

Play therapy is a form of child psychotherapy in which play is the main means of communication between the child and the therapist. The APA Dictionary of Psychology describes it as the use of play activities and materials (clay, water, blocks, dolls, puppets, finger paint) in child psychotherapy, on the basis that these activities mirror the child's emotional life and let them play out feelings and problems in action rather than words.

The British Association of Play Therapists (BAPT) adds a useful nuance: the child explores, at their own pace and with their own agenda, the issues that are affecting them, and the relationship with the therapist is what allows them to use their own resources to change. Play comes first; words come second.

It is worth being clear from the start about what it isn't. It isn't playing with a child so they relax before "the serious part", nor a leisure activity with a friendly adult. There is a theoretical model behind it, a stable frame, goals agreed with the family and a trained professional who observes, responds and keeps records. It is used mostly between the ages of 3 and 11 or 12, although many of its techniques adapt well to preteens.

What play therapy helps with (and what it doesn't)

Play therapy is often indicated in situations like these:

• Fears, excessive worry and separation anxiety.
• Intense tantrums, aggression or difficulty managing anger.
• Changes that overwhelm the child: parents separating, moving house, a new sibling, a new school.
• Grief after the death of a relative or a pet.
• Difficult or traumatic experiences, as part of a wider plan.
• Problems getting on with other children, shyness that limits daily life, or low self-esteem.
• Chronic illness, hospital stays or medical procedures that need preparing for and working through.

Meta-analyses from the last two decades find positive effects, moderate to large depending on the study, and clearer when parents take an active part in the process. That doesn't make it the answer to everything. Severe conduct problems respond better to parent training programmes such as parent-child interaction therapy (PCIT). Trauma with intense symptoms has treatments with stronger evidence, such as trauma-focused cognitive behavioural therapy (TF-CBT), which also uses play as a vehicle. And for the core features of autism, play therapy doesn't replace specific developmental interventions, even though it can help with anxiety or emotional regulation. Often the best decision is to combine approaches.

Why it works: play as a language

Three ideas help you understand what happens in the room and explain it to parents without jargon.

Symbolic distance. Talking about what scares you in the first person is hard at any age. If the dinosaur gets lost in the forest or the bear family moves house, there is a layer of protection: the child can get as close to the subject as they can bear and back away when they need to, without having to admit anything.

Mastery through repetition. A child who has lived through something they couldn't control tends to play it over and over, and each time they can change the ending, move from victim to hero or rehearse new responses. Watch out here: when the play repeats rigidly, without variation and with growing distress, it may be stuck post-traumatic play, which needs a more directive intervention.

The relationship. An adult who watches without judging, who puts into words what the child feels and who keeps the same limits every week is, in itself, a corrective experience for many children. A good part of the change happens there.

Approaches to play therapy

There isn't one single play therapy but a family of approaches that share the medium and differ in how much the therapist leads and what role they give the family. The field has grown a great deal since the early work of Hermine Hug-Hellmuth, Melanie Klein and Anna Freud, who were already using play in child analysis.

Non-directive or child-centred play therapy

It began with Virginia Axline, who in 1947 set out eight basic principles inspired by Carl Rogers: accept the child as they are, create a permissive climate, recognise and reflect their feelings, trust their ability to solve their problems, let them lead the play, don't hurry the process and set only the limits needed to anchor therapy in reality. Garry Landreth later developed the child-centred play therapy model, which is probably the most researched. The therapist doesn't suggest games or interpret: they accompany, describe and reflect.

Directive and cognitive behavioural play therapy

In directive approaches the therapist chooses the materials and suggests activities with a specific goal: naming emotions, practising problem-solving, gradual exposure to what the child fears or rehearsing social skills. The cognitive behavioural play therapy described by Susan Knell brings in techniques such as modelling with puppets, reinforcement or age-appropriate work on thoughts. It works well when the problem is clearly defined and the child needs to learn something new, not only to express themselves.

Filial therapy: parents as agents of change

In the 1960s Bernard and Louise Guerney proposed training parents to run special play sessions at home themselves, supervised by the therapist. Landreth and Bratton's ten-session model (CPRT) is its most structured version. It is especially useful when the parent-child relationship has deteriorated and when the family can't sustain a weekly session in your practice for months.

Sandtray, Theraplay and other variants

Sandplay, which Dora Kalff developed from Margaret Lowenfeld's world technique, invites the child to build scenes with miniatures in a tray of sand. Theraplay, created by Ann Jernberg, is a structured, attachment-based approach that works on the relationship through physical games between parents and child. In hospitals, therapeutic play is also used to prepare children for tests and procedures. Each of these calls for specific training: owning a sand tray doesn't turn a session into sandplay therapy.

Play therapy techniques used in practice

Whatever the approach, there is a repertoire of responses and resources that turns up in almost every playroom. These are the ones used most in play therapy:

The most underrated technique is the simplest one: describing out loud what the child is doing without adding judgement. Many children have never had an adult pay attention to their play without correcting it, and that alone changes the quality of the relationship within a few sessions.

The play therapy room: materials and layout

You don't need a huge room or expensive toys. Landreth groups materials into three categories that are still a good guide to what to buy:

• Real-life toys: a doll's house with a family, a toy kitchen, cars and an ambulance, a phone, play money, a doctor's kit.
• Toys for expressing aggression: wild animals, soldiers, an inflatable punch bag, cushions. Toy weapons are a decision about your frame: some professionals include them and others don't, and it should be a considered decision rather than an accident.
• Creative materials: clay or play dough, paints, large paper, blocks, sand, fabric and simple dressing-up clothes.

Stability matters more than quantity: the same objects, in the same place, session after session. The child needs to know the room is predictable in order to allow themselves the unpredictable inside the play. If you share an office with adult clients, one or two boxes of basic materials that are always set out and packed away the same way do the job. Electronic toys and screens tend to take away more than they add.

Setting limits in play therapy

Permissiveness doesn't mean there are no rules. Limits protect the child, the therapist and the room, and they mark the end of the session. Landreth proposes a three-step approach that works even with very dysregulated children:

1. Acknowledge the feeling: "You're really angry with me."
2. Communicate the limit: "But I'm not for hitting."
3. Target an alternative: "You can hit the cushion or the punch bag."

How a course of play therapy is structured

The first meeting, without the child

Almost every process starts with one or two meetings with the parents alone: the reason for referral, developmental history, family situation, school, what they have already tried and what they hope for. It is also the moment to explain how play therapy works, what will be shared with them and what won't, and to sign the informed consent.

Sessions with the child

The usual pattern is weekly sessions of 45 to 50 minutes, on the same day, at the same time and in the same room. Consistency is part of the treatment. A few minutes before the end you signal it ("we've got five minutes left") so the child can wind the play down without feeling cut off. There is no fixed number of sessions: many therapists review the process with the family around the tenth or twelfth and decide together whether to continue, space sessions out or change strategy.

Ending

The ending is prepared well ahead, announced several sessions in advance. For a child who has built a secure bond with the therapist, an abrupt goodbye can repeat exactly the experience that brought them to therapy.

Working with parents in play therapy

Parents aren't spectators. A session with them every three to five sessions with the child lets you share progress, hear how things are going at home and at school, and adjust guidance. What the child plays in the room isn't reported in detail: you share the themes that come up and the changes you see, and the child should know that this is how it works. The children's version of the UN Convention on the Rights of the Child puts both sides of this plainly: every child has the right to play, and adults should listen to their views and take them seriously.

Consent deserves particular care. When parents are separated, the prudent approach is to inform both and have both consent before you start, unless a court order says otherwise. The details depend on where you practise, so check your professional body's code of ethics and the law that applies to you; most professional bodies offer ethics advice for specific cases.

If you want to go deeper into framing the work with the family at different ages, the articles on attachment theory applied to therapy and on therapy with teenagers cover exactly that transition.

Assessment and record-keeping in play therapy

What to note after each session

A short note written on the same day is worth more than a perfect memory a month later. Five points are usually enough: the themes that came up in the play, the emotional tone, how the relationship with you went, which limits were needed and what changed since the previous session. If you work with a sand tray or drawings, a photo of the final scene (with the family's permission) lets you compare progress at a glance.

Measures before and after

Clinical impressions should be checked against something more objective. Short questionnaires for parents and teachers, such as the SDQ, given at the start and at each review, help you see whether the changes you notice in the room are reaching home and school. The most common signs of progress within sessions are play that is more organised and less repetitive, a wider range of feelings expressed, more tolerance of frustration and a more cooperative relationship.

When play therapy isn't enough

Some situations call for something more or something different: symptoms getting worse despite the work, thoughts of death, self-harm, weight loss, psychotic symptoms or a clear decline at school. In those cases you need to coordinate with paediatrics or child psychiatry and consider specific treatments with stronger evidence for that problem.

Can play therapy be done online?

With caveats. With children from about seven or eight, shared drawing, puppets the child has at home, digital whiteboards and adapted board games work reasonably well. With younger children a direct online session loses a lot, and parent-focused work along the lines of filial therapy, where the therapist coaches and the adult plays, usually works better. There are more practical ideas in the guide to online child psychology.

Running a play therapy practice with My Psico Agenda

My Psico Agenda won't play for you or interpret a sand scene. What it handles is the admin side, which in child work has its own complications: two parents, invoices in one parent's name, consent forms for minors and weekly appointments that can't slip.

• The minor's record holds the child's details and those of the mother and father, each with their ID number, and it is where you choose whose name the invoices go under. In the diary the appointment shows the child's name, and the search finds them by their mother's or father's name too.
• The informed consent form has a clause for minors that fills in from the record. You can write your own wording with placeholders for the child, the mother and the father, and use only the ones you need. You can also send it by link to be signed remotely.
• WhatsApp reminders go out 24 hours before to the phone number in the record, usually a parent's, with buttons to confirm or cancel. You can switch them off for an individual patient.
• In the clinical record you write each session's note in your own words, and in the patient's files you can store the photo of the sand tray, a scanned drawing or the school report, up to 25 MB per file.
• Each appointment can be tagged as "Child Therapy", session packs fit weekly processes, and the family can request or cancel appointments from their patient space, always within your working hours.

If you work mainly with children and want to see how this fits into day-to-day practice, the article on software for child psychologists goes into detail. Individual plans start at €4.99/month + VAT (Semilla plan, with 25 patients, 20 automatic reminders and 20 VeriFactu invoices a month) and go up to €19.99 (Júnior) and €29.99 (Sénior), both with unlimited patients. No lock-in: cancel whenever you like.