It at the phase where abstract thinking


was Plato that had once said “You can discover more about a person in an hour
of play that in a year of conversation.” However, it is not possible to apply
this concept when working with adults but it does for children. After all, children
are at the phase where abstract thinking and concept about the world are not
developed until adolescent years. However, it is known that play is one of the
ways children can not only learn to explore the world but also express  their feelings and emotions when verbal
communications are difficult or not fully developed. In addition, it is
important to mention that play is universal for children, but it also depends
on what culture on how children play. Since play is universal and is beneficial
for children, some have applied play into practice called play therapy. Play therapy is used for many different interventions
such as disruptive behavior disorder, social anxiety, ADHD, emotional
disturbances; grieving, divorce, etc. Even though play therapy has made
positive results, there have been arguments that play therapy does not have
enough empirical evidence to support its findings, and questions about its
effectiveness for future research. However, there have been large numbers of
research that reveals statistical significant and proven effectiveness. Thus,
in this paper, it is critical to describe each play therapy and analysis it
effectiveness, and explain why it is important to recognize play therapy as
effective for practice.

 Play therapy (PT) is a specialized field of
practice that utilizes play to help clients who are unable to communicate and
express their emotions verbally. Clients are typically children. More
specifically, play therapy is a standardize practice using the theoretical
model to implement interpersonal skills from trained play therapist and
utilizes play as a therapeutic method to help clients to resolve psychological
problems and achieve optimal growth and development (Getz, 2011). Historically,
Sigmund Freud was the first child therapist to study children by observing them
during play time. Also, even though Hermine Hug-Hellmuth was the first
therapist to utilize play in child therapy, Anna Freud and Melanie Klein were
the first to successfully create the foundation of play therapy in the 18th
century (Landreth, 2012). The main reason why Hermine and other therapists
failed to create play therapy was because they have failed to formulate a
specific approach that was meant for children (Landreth, 2012).

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therapy can be used as an educational tool, an alternative for verbal skills
(Chienkesh, 2013), help with behavioral problems, emotional problems,
psychological problems and so on. There are also different types of play
therapy that has been use for different treatment. For instance, parent-child
interaction therapy (PCIT), child-center play therapy (CCPT), and group play or
group active play therapy (GAPT). The PCIT “is a behavioral, parent-training
program that incorporates both operant learning and play therapy techniques to
treat child disruptive behavior problems” (Nieter, p. 490). The CCPT is based
on Carl Roger’s person-center theory, the idea is that children are free explore
the world, seek new experienced, and grow through unconditionally positive relationship
(Ojiambo, p. 356). “The GAPT is a developmentally responsive counseling
intervention for preadolescents (10-12 years old) that is grounded in CCPT
principles and procedures” (Ojiambo, 2013).

determine whether play therapy is an effective psychotherapeutic practice, it
is vital to analyze a meta-analytical review. In 2014, Yung-Wei Lin and Sue Bratton
collected 52 outcome studies that did research on CCPT to examine the overall
effectiveness as a clinical intervention (Lin, 2014). The studies were examined
from 1995 to 2010. To avoid potential publication bias, they have included
unpublished works in the analysis. Each of the outcome studies have to fall
under the criteria to in order to be considered for the analysis: “the use of
CCPT or directive play therapy methods in treatment, the use of control or
comparison repeated-measure design, the use of quantitative psychometric
assessment, and clear reporting of effective size or sufficient information for
calculating effect size” (Lin, p.47). To find which outcome studies meet the
criteria, the researcher assistants were assigned to four studies each week for
coding, after the assistants completed their training for coding. Afterwards, each
of the studied was divided to independent variables (the individual characteristics
of each study) and dependent variable (the effect size of the CCPT treatment in
each study) (Lin, p.47). The meta-analysis showed that children who
participated in the CCPT intervention showed improvements from the
pre/post-test by approximately half than those who did not receive treatment
(Lin, 2014).

there were major two limitations that might have affected the results in this
analysis; “low number of studies in specific categories of the study
characteristics, and missing information’s in some studies” (Lin, p. 54). To
clarify, during the analysis, there were some studies that had to be combined
because the number of studies was too low for coding; which cause discrepancy for
computing results. For instance, for the child’s ethnicity such as African
American, Asian, Hispanic or Latino studies had to be combined in the
non-Caucasian category for coding because there were less than five studies for
each of them (Lin, p.54). In addition, some of the studies that were used for
analysis were lacking some important information which can affect the integrity
of the result.

CCPT was further supported by another research conducted in Uganda in Eastern
Asian on group active therapy. This study was initially conducted due to the
staggering increase number of preadolescents (10-12 years old) displacing into
the orphanage from civil war outbreaks and HIV/AIDS epidemics (Ojiambo, p.
355). In addition, due to the increase number of orphans, there was a sever
lack in specialize counselors and mental health services; therefore the
preadolescents were at high risk for developing mental and emotional problems.
The purpose of this study was to “was to identify an effective intervention
that was responsive to the needs of a growing population of displaced Ugandan teens
living in orphanages” and determined what method can reduce internal and
external problems in children, GAPT or reading mentor (RM) (Ojiambo, p. 357). The
pre/post-test from the teens, teachers, and house mothers, showed that there
was a 10-point average decrease in behavioral problem with students who were in
GAPT than student who was in RM; which showed minimal changes. The results
confirmed that the GAPT revealed statistically significant decrease in
internalizing and externalizing problems with students than those who were
receiving RM (Ojiambo, p.360).  

there were also limitations that also could affected the results. For example,
since the sample was collected in one general location generalization is very
limited. There was also an issues involving confidentiality about the group
processes. To clarify, in a group process sometime group leaders cannot control
comments about the treatment that the group members shared with either their
teacher or their housemothers. Since the teachers and housemothers provided the
necessary data for the experiment, there was a potential bias in desirability.
Lastly, the biggest limitation was the extreme involvement with the author,
Ojiambo, to conduct the research; which leads to experimental bias (2014, p.
362). However, Ojiambo emphasized that there methods, results, and limitations
were very similar to those who conducted the same research in the United

Another study wanted to determine not only if PCIT was effective
but also transportable to a community base setting (Nieter, 2013). The reason
for this experiment was to fulfill the need to provide an evidence-base
community services within agencies in order to bring the best practice for
lower income families (Nieter, p.409). The researcher targeted families with
low socioeconomic status whose children have disruptive behavioral problems and
maltreatment. The families were recruited by self-references or CPS references
(Nieter, 2013). It was hypothesized that the parents/caregivers that
participated and completed in the PCIT program would report a decrease in the
child’s disruptive behaviors during sessions and decrease in parental stress
(Nieter, p. 491). The study revealed that that for those who participated and
completed the program showed significant decrease in child disruptive behaviors
and significant increase in “parent prosocial behavior” (Nieter, p.496)

They were able to support the hypothesis; however, there was one
major factor that could affect the results. In the article it explained the
method for collecting the data, to ensure completion they provided services such
as childcare, transportation, and free dinner; and offered coupon to
restaurants for parents who completed additional assignments from the session.
Even though it was claimed to remove treatment barriers, this is also a
potential factor that could affect the results. In addition, there were some
participants that were unable to complete the program.

There was a similar research conducted in Iran, but conducted its
program in a short session to support its effectiveness. The purpose of the
research was to “examine the impact of group play therapy on self-awareness,
self-regulation, social interaction, empathy, and adoptability of pre-school
children in Tehran, Iran” (Chinekesh, p.164). The program was a three week
session with 372 participants in two groups (case group and control group).
Then use the BUSSE-SR which measures all the socio-emotional categories.
Chinekesh found that there was a significant improvement from the pre/post-test
from the case group than the control group. However, one potential limitation
from this research was no follow-up to determine if the behavior that was
improved still maintained.   

It is important to recognize that play therapy is effective
practice in order to expand its practice to other methods; like creating a
play-base therapy for an evaluation in the clinical field. In a reoccurring
study, Jager replicated his previous research on the use of play-base
evaluation method to understand children’s perspective about therapy (2013). However,
overall purpose of this study was threefold: to record the children’s views
of play therapy; to explore the use of play-based evaluations as new methods to
gain children’s views; and to explore therapeutic interactions observed during
play-based evaluations from an attachment perspective” (Jager, 2013).

The techniques that were used for the research were ‘The Expert
Show’ and ‘The Miniature Play Room’ (Jager, p.413). ‘The Expert Show’ was a
role play method where the child plays the host of a news broadcast, and the
play therapist acts as the callers to ask the child questions related to common
childhood issues, and ask for advises (2013).The purpose of this technique was
for the therapists encourage the child to share his/her feelings and
experiences about the therapy (Jager, 2013). In ‘Miniature Play Room’ the
“child is provided with Play Mobil figures with which to choose a child protagonist
and adult figures to represent the play therapist and any other adult they
choose” (Jager, 2013). Qualified play therapists recruited
children for the research, and video document the sessions for the last two and
a half years. Once the therapists completed the sessions, they submit the
videos to the author for data collects. Then the author thoroughly watches each
session from body language to verbal cues.

There were some limitations to this research. For instance,
involving the author to participate in data collecting was a potential
experimental bias which could also affect the integrity of the results. Also,
since the therapists sent their video documents, it did not describe how it was
sent and how long they would hold the information and if the information would
be destroyed; and there was no explanation about resolving a potential issue on
tampering. This could affect the result greatly if the videos were lost or tampered.

Overall, in order to support that play therapy was an effective
practice is was important to analysis each of the studies’ results and
limitations, and to express why it was essential to recognize play therapy as
such. As previously described, there are many research and studies that have
confirmed their findings about play therapy but it was important to also
understand each of its limitations in order to conduct the next research to
eliminate each of the barriers. However, despite their limitations, they are
still recognized as effective works.  It
is important to recognize their effectiveness in order to apply the practice in
other forms of methods or potentially create a new method.