Why Play Therapy is Really, Really Stupid

Play therapists believe the way to help a child is through accessing their “inner world” via play.  They get on the floor and play board games with the children, play in sandboxes and dollhouses, have the kids do drawings and make other forms of art work, and engage and interact with children.

Now, I think playing with children is quite important. I love playing with children.  However, I think having parents sit in my waiting room while I engage their child in a game is vainly wrong.  Who am I to think that one hour a week with me, even if I am the greatest child therapist in the world, is going to create a change in the child who is with their parents for the other 167 hours of the week? 

All behavior must be viewed and understood in context.  Allow me to repeat myself:  All behavior must be viewed and understood in context.  A child’s context consists of their home, their siblings, their friends, their school, their parents and anyone else with whom they have significant contact (nannies, grandparents, aunts, etc.)

Now, play therapy is useful, if you are working with orphans.  You need to get into their heads to understand their issues (which usually consist of “Why am I in an orphanage?”, “How am I doing in this orphanage?” and, “How can I get out of this orphanage?”).  If there are no parents with whom to interact, then let the play therapy begin. 

And, play therapy may be useful for one or two sessions as a way to engage the child more fully into the family therapy.  Or, it is one way to help understand the child and how he or she fits or doesn’t “fit” with the rest of his or her family.

My strong belief is:  To help children, the modality of choice is family therapy.

Family therapy is difficult for parents.  We don’t usually sit around and discuss what you did right…the focus tends to be on changing interactions that don’t work well for your family.

Some Examples of Problems That Can Be Resolved with Family Therapy

The problems can be quite different, yet, research shows most problems with children can be resolved via family-based interventions.

School Avoidance:  Family therapy should be utilized to make the little student go to school.  The cure for school avoidance is school attendance.  And that means tomorrow, not next week.

Depression in children:  Family therapy should be utilized to help engage the child in activities that do not serve the depression well, like, exercise, joining clubs, playing with others, getting some excitement going about learning a new skill, etc.  Note:  Drug companies don’t agree, but, I think true depression in children is fairly uncommon.  Depression can occur for periods of time in children, but, children are remarkably resilient.  Drugs may be indicated for a child, but, again, only after other therapies have failed.  To treat a child with drugs as the first attempt at treatment is wrong.  And, to medicate a child without therapy is wrong.  Let me say this again:  To medicate a child without therapy is wrong.

HOT DIAGNOSIS ALERT:  Attention, consumers of mental health services, there is new diagnosis being highly-touted and advertised by the pharmaceutical industry.  That hot, hip diagnosis is Bipolar Disorder in your child.  DO NOT BE GULLIBLE.  There are some Bipolar Children out there, like, maybe, four in all of Georgia.  If somebody told you your child is Bipolar, please get a second opinion.  If your kid is sad sometimes, and really angry at other times:  It means he or she has feelings, not a Bipolar Disorder.

Social difficulties:  Family therapy should be utilized to help engage the child in activities that enable shy, socially awkward or isolate children to be with other children.  The cure for social difficulties is to get a child to be more social…not to play Candyland with his or her therapist.  And, our playing with sand figures won’t help his or her social issues, either.

Anxiety in children:  Family therapy should be utilized to help decrease anxiety in children.  I am now going to say something really hard for parents to hear:  I have never treated an anxious child who did not have at least one anxious parent.  This is really important, so, I will say it twice:  I have never treated a child for anxiety who did not have at least one anxious parent.  A family pattern of anxiety is a gift that keeps on giving and giving and giving….

Acting out” behaviors in children:  Family therapy should be utilized to help decrease the “acting out” types of behaviors.  These behaviors include:  attention deficit types of behaviors, impulsivity, anger and angry outbursts, distractibility, overt defiance at home or school, minor criminal behaviors, destructiveness, threatening acts, violence, etc.  I can get on the floor and play with clay and figure out why Johnny is smashing dishes during dinner, or, we can work as a family to end this “Pathological Plate Smashing Disorder” right away. 

Does family therapy always work on these acting-out behaviors?  No.  Sometimes, families just wait too long to get help.  I can’t count the number of times I have had families say to me, “I wish we did this when Junior was seven years old, instead of now.”

Does family therapy usually work for these behaviors?  Yes. 

Does individual therapy for a child often go “hand in hand” with the family therapy?  Yes.

Is individual therapy ever appropriate?  I feel individual therapy is very appropriate when the entire system is also being “worked on.”  Individual therapy for a child (including Play Therapy) is great, as long as the contextual issues are being addressed clearly and directly.  My experience is that if the entire family is dealing directly with the issues, then there is often no real need for individual child therapy.

Beware:  I have worked at places that proclaim to do family therapy, yet, do hardly any family therapy at all.  They meet with the parents for a few minutes (or, usually, with the mother because the father is at work), then meet with the child for a half hour, then finish up by meeting with the mother again.  Sometimes, if these “family therapists” are feeling particularly bold that day, they finish up with the mother and the child together (!!) in the same room for a few minutes.  This is not family therapy.  This is dangerous because it can create the illusion that the parents have truly attempted to address their issues.

To close:  I believe that children can be compared to “gas” as it was described in one my daughter’s middle school Physics textbook:

A gas has no definite volume or definite shape.  A gas always takes both the volume and the shape of any container into which it is placed.

I can go on, but, my point is simple:  You are the most important agent of change for your child or teenager.  There are 168 hours in week.  One hour per week of trying to better understand what a child is experiencing is not going to help if a child’s context doesn’t allow or create change.

Please allow me to repeat myself:  One hour per week of trying to better understand what a child is experiencing is not going to help if a child’s context doesn’t allow or create change.


Sincere Apology Section:

Pre-emptive Apology and Disclaimer:  This article has angered some Play Therapists.  Sorry.  The above is just my opinion.  I am sure play therapy, by itself, has helped dozens of children over the last fifty years.

No, Really, Here Is the Truth:  I guess I am not all that sorry about this article.  I truly believe that individually treating children usually doesn’t help children, and, in fact, often prevents children from getting the help they need.  And, in no way did I mean to insult orphans, either.