Play Therapy: How It Works, Cost, & What to Expect

What Is Play Therapy?

In some situations, clients who are in therapy may have a difficult time expressing their concerns. Play therapy gives clients the opportunity to explore their thoughts in a non intimidating way. Because children are normally comfortable playing, play therapy is often an approach used in child counseling; however, trained mental health providers (e.g., counselors, psychologists, or social workers) can engage clients at any age through the therapeutic process of play.

Many therapists use toys and other child friendly items to interact with children during sessions, but true play therapy requires specialized training and is not just an integration of toys and play. The Association for Play Therapy (APT) calls it a systemic therapeutic approach to helping clients process their thoughts in a safe environment.¹

How Is Play Therapy Different From Regular Play?

Play therapy differs from regular play in that the client is working with a mental health provider who helps them process their thoughts and emotions through play. Play is a child’s natural method of communication and self exploration. When a child is being treated through play therapy, parents/caregivers are often included to support the therapeutic process.²

When Is Play Therapy Used?

Effective interventions in play therapy address concerns and healing related to childhood trauma and PTSD or other adverse experiences, such as parental incarceration, loss of a parent due to death, childhood abuse, living with a parent with mental illness, or living with a parent who suffers from addiction.³ Play therapy also helps children who may have a challenging time articulating their thoughts and emotions.

Situations where children may need help identifying how to express themselves include school settings and new environments. Play therapy could also help children who deal with bullying or have difficulty focusing, who struggle with anxiety or depression, or who have concerns related to coping with emotions, and other life stressors that are out of their control.

Play Therapy For Adults

Although play therapy is often discussed in the context of children, there are situations where adults could benefit from the process, including grief, loss, and dementia.

Situations where play therapy could be used for adults are:

• Adults with dementia
• Adults who are dealing with grief and loss
• Adults who may have developmental delays
• Adults who are elderly

Types of Play Therapy

There are two distinct approaches to play therapy. Both approaches are effective in treating a wide range of childhood concerns and conditions, and as in all therapeutic approaches, are both founded upon a strong therapeutic relationship.

• Directive play therapy: The therapist will carefully select toys and initiate play scenarios with the intention of guiding the discussion toward a specific, predetermined topic.
• Non-directive play therapy: The child takes the lead and reveals what is troubling them to the therapist through play organically, without intervention from the therapist.

Play Therapy Techniques

Therapists who utilize play therapy implement various strategies, some of which are similar to other strategies in different kinds of counseling. The main difference in play therapy is that play is the underlying theme. Specific techniques include arts and crafts, playing with dolls, and using other figurines.

Here are several possible play therapy activities a therapist might use:

• Art: Specific art materials like crayons, paper, markers, and paint can be used to help clients express themselves
• Reading: Books may help clients relate and bring normalcy to difficult situations
• Playing with dolls: Figurines, dolls, puppets, and action figures can assist clients in the play therapy process
• Journaling: This activity can help clients express their thoughts
• Toy play: Toys in general can be used to help clients process their thoughts, feelings, and concerns
• Story-telling: Uses metaphors and stories to address therapy goals, impart important lessons and teach skills
• Playing games: Therapy games often include themes based around emotion identification and expression, and may also address other client goals, like building frustration tolerance or building social skills
• Sand tray: Uses a tray of sand and small objects and figurines to invite the child to share their world with the therapist, without having to use words
• Role-playing: Acting out imaginary or real situations with the therapist in order to process experiences, build skills and practice problem solving

What’s the Goal of Play Therapy?

In play therapy, treatment goals are established in an initial assessment with the therapist; goals will vary depending on the client’s unique needs. If the client is a minor, the parent/caregiver is crucial to help the therapist gather information for the treatment plan. Throughout the entirety of the therapeutic process, goals can change depending on the client’s needs.

What Are the Benefits of Play Therapy?

Play therapy is a developmentally-appropriate and effective treatment for children. It allows children to communicate through imagination and displacement in the safety of the therapeutic space. Through the therapist’s careful intervention, children can have a corrective experience with lasting positive impacts.¹⁶

• Helps with skill building for neurodivergent children: Play therapy has been shown to be effective in helping neurodivergent children improve social skills, emotional expression and regulation.¹⁷
• Reduces disruptions in learning for children with ADHD: Research shows that play therapy reduces the symptoms of ADHD, improving social skills, attention and impulse control.¹⁸
• Helps children process trauma: Research shows that play therapy is an effective treatment for children who have experienced Adverse Childhood Experiences (ACEs) to mitigate the risk of future complex trauma¹⁹
• Reduces OCD symptoms: Incorporating a manualized treatment for OCD into play therapy can be an effective approach in reducing symptoms of OCD in childhood.²⁰
• Helps with communication and other skills in adults with developmental disabilities: Play therapy can help adults with developmental disabilities overcome behavioral and emotional difficulties, improve self-expression, self-efficacy and emotional well-being.²¹
• Boosts mental health for older adults: For older adults, play therapy has been shown to increase socialization, improve self-esteem and reduced symptoms of depression.²²
• Reduces symptoms of ODD in children: One study showed play therapy to be effective in both individual and group settings in reducing symptoms of Oppositional Defiant Disorder (ODD) in children, even two months after treatment, suggesting positive long-lasting impacts²³

3 Examples of Play Therapy

Play therapy can be used in an array of situations based on the clients’ needs and the therapists’ expertise.

Here are three play therapy examples:

1. Play Therapy for Children to Support Academic Achievement

For school-age children, the effects of stress often manifest in their grades, behaviors, or other academic outcomes. It can be difficult for them to express what’s causing them stress within the academic environment. Early detection of children who may be at-risk of academic obstacles is important, as is putting resources in place to support them.⁴ Play therapy provides a safe space to explore stressors related to academic achievement.

2. Play Therapy for Children Exposed to Traumatic Events

Many children and adolescents suffer from the effects of experiencing a traumatic event. When one refers to Adverse Childhood Experiences (ACEs), they’re normally talking about the loss of a parent/caregiver; loss of a loved one due to incarceration; having a parent/caregiver with a mental illness; being abused; or having parents who separate/divorce.⁵ Children can explore these difficult situations through play therapy.

3. Utilizing Play Therapy With Children Exhibiting Behavior Concerns

Childhood behavioral problems continue to increase in the United States. This could be because children don’t always have the words to express themselves; those unexpressed feelings show up in behaviors that could impact them at home, school, and in their communities.⁶ Play therapy helps children process their thoughts and feelings.

This non-directed intervention uses toys and means of play to meet children where they are developmentally, which is the key to play therapy.² It provides a safe, supportive space with a trusted adult to practice healthy ways of coping with emotions.

Cost of Play Therapy

The price range for a typical counseling session ranges from $100 – $250 per session. Initial assessments, however, can range from $250 – $400. Cost varies based on geographical location, expertise, etc. Mental health services are typically covered by health insurance; when scheduling an appointment, clarify that they accept yours. If they don’t accept your insurance, note that some do offer sliding scale fees to offset costs.

How to Find a Play Therapist

To access professional mental health treatment, contact your child’s primary care physician (PCP) and ask if they’re aware of a registered play therapist. You could also speak with friends, colleagues, or loved ones who have firsthand experience with mental health concerns and diagnoses. Contact your insurance company to learn more about coverage in your area and check their list for registered play therapists. It can also be helpful to search an online therapist directory for therapists specializing in play therapy.

Who Is Able to Offer Play Therapy?

According to the Association for Play Therapy, play therapists are licensed mental health professionals who have extensive training in play therapy and are registered as play therapists.¹ Visit the APT website for information on registered play therapists in your area.

What to Look For in a Play Therapist

Choosing a therapist who fits you and your child’s needs is important, so it’s imperative to do research on the therapists in your geographical location. Explore what credentials they possess and how they will address the concerns you’re seeking treatment for.

Here are six key considerations when choosing a play therapist:

1. Is the therapist a registered play therapist with the APT?
2. What experience does the therapist have with your area of concern (i.e.,. anxiety, trauma, depression)?
3. Is the therapist accepting new clients?
4. Does the therapist accept your insurance? If not, is there a sliding fee scale?
5. Does the therapist have availability on days that work for you?
6. What therapeutic techniques do they use in play therapy with clients?

What to Expect at Your First Appointment

During the first therapy appointment, expect to provide information on the concerns that brought you in. At this point, the therapist is trying to get to know you. Sharing information and being open to telling them pertinent information is important. During this time, the therapist will also likely discuss the therapeutic process and their ethical standards. This is a good time to ask questions.

Is Play Therapy Effective?

Therapists have integrated play into their sessions for years; however, there is limited research discussing its effectiveness. One analytic review looked at 93 controlled outcome studies to assess the overall effectiveness of play therapy. In general, it showed that play therapy is beneficial to addressing children’s developmental needs.

Outcomes from the analytic review show the following:⁷

• Play therapy can have a major impact on children’s behavior, social and emotional well-being, and personality overall
• Parent involvement throughout the treatment process can be beneficial to therapeutic outcomes
• To see the desired outcome, the number of play therapy sessions may be higher than regular therapy

How Is Play Therapy Different Than Other Types of Therapy for Children?

Mental health treatment for children varies based on their needs, overall developmental level, and ability to express their concerns within a therapeutic setting. Quite often, when people think of therapy, they imagine going into an office and talking to a therapist; however, when thinking about effective ways to get a person to open up and process their feelings, different modals – such as play therapy – should be considered.

Here are a few therapeutic approaches and how they differ from play therapy:

Play Therapy vs. Cognitive Behavior Therapy

In cognitive behavior therapy (CBT) for children, the therapist focuses on identifying, understanding, and changing the client’s thought and behavioral patterns.^8,9 Similarly, play therapy allows clients to open up and share their thoughts; however, this is done using toys, role plays, and other materials. The mental health providers observe the child’s play and look for better ways to help them cope with their challenges.

Play Therapy vs. Family Therapy

Marriage and family therapists strategize to help families dealing with various situations to enhance communication, work on relationships, and promote wellness in family therapy sessions. Integrating parents into play therapy is an important factor in effective outcomes.⁷ Family can also be included if the therapist identifies beneficial strategies.

Play Therapy vs. Trauma-Focused CBT

Trauma-focused CBT (TF-CBT) is an evidence-based practice for children and adolescents who have symptoms related to trauma. It combines psychoeducation and cognitive techniques to teach children and parents/caregivers how to express themselves, learn cognitive coping skills, deal with stressors, develop relaxation skills,and manage behaviors.¹⁰ Some of these same factors could be explored throughout play therapy if the therapist is aware of the trauma.

History of Play Therapy

Integrating play into therapy has been a key component of treatment for many years. Since the early 1900’s, Sigmund Freud documented integrating play into sessions with children. Psychoanalyst Melanie Klein has also been noted to use play in therapy in the early 1900’s.^11,12 Eventually, APT was established in 1982.¹ It promotes best practices, skills, and credentialed registered play therapists throughout the country.

Recently, more research studies have reviewed and assessed outcomes of play therapy.^13,14,15 Although play therapy is not new, additional research should continue to document the outcomes of play therapy.