Introduction

Social play is a fundamental activity for children, integral to their development of social skills such as making friends, interacting with others, waiting, and taking turns. Despite its importance, many children face challenges in these areas. According to Lynch and Simpson, "Social skills are behaviours that promote positive interaction with others and the environment.".¹ Deficits in social skills can occur at any stage of development and are unlikely to improve spontaneously, as impaired social skills hinder interactions with others. Improving social skills is often a critical focus in therapeutic settings, particularly when addressing various psychological disorders. The COVID-19 pandemic highlighted the importance of social skills, as public health measures like social distancing and lockdowns drastically reduced children's opportunities for face-to-face interactions, potentially leading to increased social skill deficits.² This was especially true for preschool children, who missed critical periods of social development due to the pandemic. This article will discuss play therapy and how interventions can enhance and improve children’s social skills.

What is play therapy?

Play therapy is a person-centred treatment for children aged 3 to 12 years old. Play therapy involves structured play led by a trained therapist, who creates a safe and supportive environment. This enables children to express their emotions, thoughts, and experiences at their own developmental level and pace. lay therapy is based on the idea that play is the most natural way for a child to express themselves, instead of verbal expression. Play therapy involves a broad assortment of toys and creative materials, such as dolls, art equipment, sand trays, and building blocks.

There are two primary approaches to play therapy:

• Non-directive “child-centred” play therapy: where the therapist may participate in play, but the child is allowed to play without guidance or interruption. This is based on the assumption that, when provided with the necessary conditions, the child will heal themselves
• Directive play therapy: where the therapist actively facilitates play and may introduce the child to particular toys or activities to address specific behaviours

The eight basic principles of child-centered play therapy outlined by Axline (1947) are:³

1. The therapist must develop a warm, friendly relationship with the child
2. The child is accepted unconditionally
3. The relationship should be permissive, allowing the child to feel free to express themselves
4. The therapist recognizes and reflects the child's feelings to foster understanding
5. The therapist respects the child’s ability to solve their own problems, offering opportunities for the child to take responsibility for their actions
6. The therapist does not direct the child's actions or conversations but lets the child lead
7. The therapist acknowledges the gradual nature of the therapeutic process and avoids rushing
8. The therapist establishes only necessary limitations to connect the therapy experience with reality

Techniques in play therapy

Play allows children to express their emotions as they occur, openly discuss them, and then learn how to control or release them appropriately. It allows therapists to enter and experience the child's world. This enables children to relive past experiences and associated emotions during play. For instance, if a child is referred to therapy for aggressive behaviour, the therapist can observe this aggression during play, for instance when a child attempts to break toys or shoot darts, which also allows for the teaching of self-control through structured therapeutic boundaries.

Games are one of the main communication tools used in play therapy. Children express their feelings, thoughts, and experiences through play, either directly or symbolically, which they might not be able to convey through words alone. This method helps bridge the gap between their experiences and understanding, offering them a way to gain insight, learn, solve problems, cope, and gain mastery over their emotions.

 Other play therapy interventions include：

• Role-playing games 
• Sand tray therapy 
• Art therapy
• Therapeutic storytelling
• Puppet play
• Cooperative games 

How play therapy facilitates social skills

Play therapy can form part of social skills training. Social skills are essential for children to interact effectively with their peers and adults. 

Common dimensions of social skills interventions for children include:

• Peer relationship skills: these skills involve pro-social behaviors such as playing cooperatively, giving compliments, initiating playdates, and displaying sportsmanship
• Self-management skills: these include accepting criticism and controlling one's temper
• Academic skills: important in academic settings, these skills involve listening to and following teachers' instructions and ignoring distractions from peers
• Compliance skills: these skills focus on obeying rules and following directions
• Assertion skills: these skills involve standing up for oneself and communicating needs effectively

Social skills training can be a primary focus of interventions or part of broader therapeutic or educational strategies, such as parent training and emotional coaching. For older children and adolescents, interventions often target more complex behaviours, such as joining groups, managing challenging aspects of communication and interpersonal problem-solving.⁴

This has been proven to be successful; a 2010 study investigating a play-based intervention (based on the 'Learn to Play' program) showed that children aged 5–8 years participating in play interventions exhibited significant improvements in play skills, decreased social disruptions, and better peer interactions compared to those in traditional classroom settings.⁵ Both groups saw improvements in language skills and goal achievement rates, endorsing the use of play interventions to enhance children's play, behaviour, language, and social skills.

Play interventions for children with intellectual disability

Intellectual disability is a common neurodevelopmental disorder that can significantly impair a child's social interactions, skills, and overall quality of life. Play therapy has proven to be an effective method to enhance social skills in children with intellectual disabilities. It includes strategies like group play therapy, which can improve social capabilities such as leadership, and cognitive-behavioral play therapy, which has been used for decades to foster social relationships and skills.

In play therapy interventions for children with developmental delays and disabilities, the following training can be effectively implemented:

Communication skills training

Effective communication is fundamental to appropriate and reinforcing social interactions and is a crucial component of nearly all social skills interventions. Many types of social skills interventions are described as enhancing communication, such as building confidence, initiating interactions, and resolving conflicts. Conversational skills are essential for initiating and maintaining mutually reinforcing dialogues and developing and maintaining close interpersonal relationships. Communication training has shown positive outcomes across various groups, including autistic individuals and those with social anxiety, communicative disorders or language impairments, and psychiatric disorders.

Social problem-solving skills training

Most social skills interventions focus on enhancing the use of observable behaviors in social contexts to improve social competence. In contrast, social problem-solving training is a cognitive behavioural strategy where the individual (or group) “identifies or discovers effective methods for dealing with problems encountered in everyday life."⁶ This approach is suitable for young children with social anxiety or aggressive behaviour, and autistic adolescents. 

Summary

Play therapy is an invaluable tool for enhancing social skills among children, especially those facing challenges with traditional developmental milestones. By leveraging structured play in a therapeutic setting, play therapy facilitates expression and processing of emotions, fostering significant improvements in communication, problem-solving, and interpersonal interactions. This approach not only supports children with typical development but is also effective for those with developmental delays and disabilities. Through techniques such as role-playing, cooperative games, and cognitive-behavioral interventions, play therapy offers a dynamic and supportive environment where children can learn and grow socially and emotionally.