Play Therapy For Children With Trauma

Play therapy aims to create a positive environment while providing play and recreation for children and young people facing any situation in life. This therapy can help in coping with difficult situations and communicating their fears or anxieties. It can also help in distracting young people before surgical procedures. 

Overview of play therapy

Playtime is essential for the healthy development of children. So, play therapy has special significance in treating children who have faced some trauma. This therapy can be very helpful in children who are going through a transition period, such as the loss of a parent or death in the family, children with behavioural problems or children who find it difficult to manage their feelings or children with autism.

It is not easy for children to express their feelings or concerns verbally. Play is the medium through which children can express their feelings or concerns. During play therapy, a certified therapist will use the therapeutic powers of play to treat any trauma or achieve optimal growth. Toys are treated like words and the child is able to express their feelings. There are three categories of toys used in this therapy. They are:

1. Real-life toys: These can include toys like matchbox cars, dollhouses, boats, planes, toy kitchens, play money, cash registers, etc. These toys target shy or introverted children and don't require a much-limited setting.
2. Aggressive toys: These can include toys like handcuffs, ropes, toy guns, superhero figures, plastic armour, darts, etc. These toys help in releasing anger or hostility through destruction. They require more limited settings, such as smashing, throwing or knocking them down, depending on the therapist's judgment.
3. Creative expression toys: These can include toys like Play-Doh, scissors, legos, felt boards, paper, crayons, blocks etc. These toys bring out the creativity in children. As they can also be messy, these also need some limit setting to prevent damage to other areas. 

Assessment is done to evaluate target behaviour. There can be questionnaires prepared for parents and teachers to help them understand the reasons for trauma. The therapist can choose some art and craft activities, too, depending on the child's interests and needs.¹,²  

Understanding trauma in children

Trauma in childhood can have a long-lasting impact on children and can hinder their healthy growth. Childhood trauma can be due to vehicle accidents, bullying, exposure to terrorism or war, physical abuse, mental abuse, sexual abuse, domestic violence or community violence. These incidents can lead to post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS).

Childhood trauma has been shown to impact brain development regarding emotional, behavioural and cognitive functions. Children who experienced trauma have a reduced production of serotonin, a hormone which influences learning and memory, and regulates body temperature,  hunger, sleep and sexual behaviour. Low levels of serotonin may give rise to mental health issues such as anxiety, depression or borderline personality disorder. Childhood trauma negatively impacts the production of oxytocin, a hormone which plays a big role in childbirth and lactation after childbirth, emotional attachment and sexual behaviour. Girls who have been abused have lower levels of oxytocin which could result in difficulty in forming relationships or attachments in later life.³

Types of play therapy

Play therapy is a type of psychotherapy for children who have faced some form of ill-treatment in life. Psychotherapy refers to treatment for mental health issues. There are a variety of psychotherapy available depending on the patient’s requirements. In the same way, play therapists can customise the therapy based on the needs and situations of the child.

Types of play therapy are:

• Adler’s therapy: Adler’s therapy is beneficial for children on the autism spectrum, attention deficit hyperactivity disorder (ADHD) or learning difficulties. The therapist plays an active role by directing the play. They aim to meet children’s needs by giving them a feeling of control. The therapist tries to build an equal relationship with the child by exploring their thoughts and feelings. This provides an opportunity to educate them about healthy ways of expressing emotions.
• Children-centred play: In child-centred play or non-directional play, the child is the active participant and directs the session. The relationship between the therapist and the child promotes positivity.
• Cognitive behavioural play therapy (CBPT): In cognitive behavioural play therapy, the therapist introduces new adaptive ways in which children can handle difficult situations in life. In group therapy, a group of children with behavioural or mental troubles play together in the presence of a therapist.
• Family play therapy: In this type of psychotherapy, the parents also engage with the therapist to treat the child.¹

Benefits of play therapy 

Play therapy can vary depending on the requirements of the child. It can be at home, school or a therapist's office. Sessions can be done as one-to-one interaction with a therapist, group therapy with a group of kids or even parent-child interaction. 

Some of the benefits of play therapy are:

• Communication skills: Play therapy involves learning about societal norms and helps the kids improve their ability to express themselves and actively listen to others
• Trauma support: Play therapy helps in processing the trauma by re-enacting the disturbing situation and exploring it in a controlled, therapeutic setting. It helps the children to confront and cope with their fears.
• Behavioural issues: Play therapy helps improve behavioural issues by teaching the kids effective ways to express their feelings. 
• Problem-solving skills: Play therapy helps the children healthily resolve conflicts through role play. 
• Expressing emotions: Play therapy teaches the kids to express their feelings of anger, fear or sadness in a healthy way. 

Play therapy is beneficial as it helps foster healthy interactions between parents and children. Parenting is a challenging task, and the challenges increase if the child is suffering from autism, ADHD or has experienced any traumatic event. Play-based interactions create perfect opportunities to set rules and limitations around. As a result, children start to communicate their needs and behave better. Parents learn how to read their child’s needs, becoming less strict and harsh. These parent-child interactions should be practised frequently, and interventions should be tried at appropriate intervals. All changes, positive or negative, should be noted. If interventions don't seem to be working, the therapist should decide to continue or stop them. Another advantage is that these play interactions can be done in a shopping centre, at school, or at home.⁴

Children who have faced sexual abuse show fewer symptoms of post-traumatic stress after therapy. Several studies have been conducted to shed light on the benefits of play therapy. The majority of them are consistent with positive outcomes for abused children.⁵

Challenges

Play therapy is beneficial not only for children but also for teens and adults. However, this field of science faces challenges as well. A lot of research still needs to be done on the efficiency of therapy as well as the interventions used. Another challenge is the need for more trained professionals globally. Not all countries pay significant attention to this therapeutic area, and there is a need for professional training. Other challenges faced are lack of infrastructure, time constraints, lack of funding and unavailability of appropriate toys.⁶

Conclusion

Play therapy is a form of psychotherapy which aims at treating behavioural and emotional issues. It can be given to kids, teens, and adults. The duration of the session and materials used vary as per the patient’s requirements. In kids, play therapy can be used to help kids with autism, ADHD or who have faced some trauma in their life. The interactions can be with the therapist alone, with the parents or with a group of children facing similar issues. 

Play therapy helps improve behaviour skills, problem-solving skills, trauma support, communication, and the ability to express emotions healthily.