PLAY · BIRTH THROUGH HIGH SCHOOL
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Do this, not that! Play therapy edition
These simple swaps in your therapy may help you address social/emotional needs and communication, all at once.
November 8, 2021
This recent review delved into the meaning of play and the potentially problematic ways that play is used in the therapy world. There are still many questions surrounding how we can ethically use play in our interventions. Maybe the field of play therapy can help us out?
“Play therapy allows for an opportunity to develop a relationship with the child and conduct intervention sessions in such a way that honors the child for who he or she is and to be with the child, accepting of who he or she is...”
– Loeb et al., 2021
Play therapists are mental health workers who have specialized skills in the use of play to elicit and reflect on feelings, to work out problems, and to develop a relationship with the child. There is substantial evidence that play therapy can decrease challenging behaviors and improve self-efficacy. In this collaboration, Loeb et al. developed a hybrid play-language intervention that gives us many many concrete suggestions for how to infuse play therapy into our sessions, especially for those kids who may need a little additional social/emotional support.
This study included a small but diverse group of preschoolers with developmental language disorder (presenting with concerns like poor intelligibility, short utterances, reduced vocabulary) and “behavioral problems” such as emotional reactivity, oppositional defiance, attention problems, aggressive behaviors, and anxiety. In this intervention, clinicians swapped some “traditional” therapy strategies for more play therapy-oriented approaches:
“You worked hard on that.”
“You’re happy right now”
“You seem happy when you are coloring”
“Can you find the brown cat?”
“I notice you picked up the dog”
|Talking continuously||Waiting and allowing for silence|
|Trying to elicit specific actions or utterances from the child||Attending to the child unconditionally without directing or judging|
“What do you want to do now?”
|Keeping questions to a minimum|
Expanding & Recasting
“The doll is so silly!”
Having a “do” attitude
“First we’ll do playdough, then we’ll…”
Having a “be with” attitude
“I am here, I see you, I understand, I care”
Depending on how you were trained or your own personal style of therapy these ideas may represent somewhat of a mindset shift for you. For example, the only limit was that the children could not harm themselves or the clinician. This means that when a child was pouring sand from the sand table onto the floor, they were allowed to do so. I know, the type-A SLP inside of you is screaming. But remember, the purpose is to allow the child to explore and communicate their feelings, not necessarily to learn the rules of a preschool classroom.
After eight sessions over a two-week period, a majority of children demonstrated improved intelligibility, increased number of different words, and more complete and intelligible utterances, this last of which the authors suggest could be due to the children gaining confidence and feeling heard and understood. The children also showed significant improvements in challenging behaviors, with some moving from “clinically significant” to “normal” as measured by the Child Behavior Checklist. Of course, this was a small pilot study with no control group, so more research is needed, but you can’t deny that these “swaps” may create a more engaging experience for children experiencing social/emotional difficulties.