Is play therapy enough? One of the main premises in play therapy is reaching underlying and not easily accessible emotions, using indirect methods that make children feel more comfortable (www.playtherapy.co.za). This method allows children to begin to open up and express themselves through games. Is expression per se or on its own enough though? Evidence based therapies, such as CBT and others, tend to have clear step by step programs and techniques for eliciting real and permanent change in behaviour and cognitive processing?
According to studies Psychodynamic therapy for children affected by trauma appears to be quite effective. This form of therapy is based largely on the developing and strengthening of relationships in the child’s life and includes the family, particularly the parents in the healing process. “A core aspect of psychodynamic psychotherapies is that the ultimate goal is to promote personality coherence and healthy development rather than to alleviate symptom severity alone” (Foa, Keane, Friedman & Cohen, 2009; 586). This form of therapy appears to be aimed at a more sustainable approach to childhood trauma focusing on long-term mental wellbeing, whereas play therapy appears to be more focused on expression.
From a systemic perspective, when working with children one should always aim to incorporate their parents and family as much as possible, you cannot heal a child in isolation as they are part of a larger system on which they are dependent. To effect real change the system needs to be incorporated (http://ecosystemic-psychology.org.za/). However, when using play therapy the child and therapist work alone, is this really the most effective means of working through trauma? Especially when one considers the fact that a child will spend one hour a week with their therapist playing, and the rest of the week with their family, surely their family should be involved and at least educated as to effective support strategies for their child.
Children have not yet fully developed the ability to articulate what they feel or even why they feel the way they do; “toys are a child’s words and playing is their conversation” (http://pegasus.cc.ucf.edu/~drbryce/Play%20Therapy%20Techniques.pdf). Professionals have to look to the games children play to discover the story a child is trying to tell you. This becomes especially difficult when one is attempting to make an assessment of a child’s safety and it comes down to deciphering what is fantasy and what is reality. The interpretation made by a therapist can have severe and far reaching consequences in the child’s life, even legal cases in instances of suspected abuse, adding pressure to make the correct assessment. Is the analysis of a repetitive pattern of play really sufficient in determining whether or not a child is being abused or is unsafe in their home environment? There are a variety of influences that can inform the games that a child plays including, but not limited to, games learnt from other children, television programs, computer games and the internet. How can we be sure that the story we are being told is rooted in reality?
Generally it seems to be accepted as axiomatic that play therapy is the method of choice to deal with childhood trauma. However, it is fair to say that play therapy actually needs considerably closer, scientific scrutiny, and a sound evidence base, before the widespread use of the modality is justified.
