sand tray therapyBy Wendy Winograd, DSM

Sometimes I get questions from teachers and parents about the value of play therapy. Why, they ask, should students who are behaving badly in the classroom be rewarded by getting to come to my office to play?  How will playing with my child improve her behavior?

Most psychotherapists would agree that a child’s inability to play or to engage only in rigid or stereotyped play is an indicator of psychopathology. But how does play in child therapy really work? Is the play in play therapy the totality of the work or must we interpret or make some symbolic understanding of the play in order for a child to heal? In adolescent and adult therapy, how is play associated with transformation and healing of the self?

Play therapists, ourselves, wrestle with the question of how exactly play helps. Does simply playing with a child result in healing of trauma or allow stalled development to proceed? Some would say yes.  Playing, which may seem simple but really is not so simple at all, allows for the expression of inner conflict or the working out of feelings that have resulted from trauma. Playing may create openings where new ideas about the self–new life–can grow, openings like cracks in the sidewalk through which a flower might peek.

Then why, one might ask, would a child need a therapist? Why not just play? Melanie Klein may have been the first child therapist who utilized play as a tool to access the inner life of a child. Trained in classical psychoanalysis, Klein believed that the curative factor was the interpretation. With adults, the analyst listened for unconscious conflict in the free associations of the patient and then interpreted such conflicts to the patient. The goal was to bring unconscious material into conscious awareness where it could be under the patient’s control and thereby resolved. For children, Klein reasoned, the analyst would observe the play–a child’s free association–and interpret the meaning of the play to the children.

Some child analysts still believe that the play must be in some way interpreted to the child. Some interpret the play to the child’s parents, in an effort to help the parents understand their child’s inner life, thereby making it possible for them to be more effective in parenting. Even play therapists who do not explicitly interpret the play to the child or the parents are implicitly holding in mind the child’s inner thoughts, desires, intentions, wishes, and fears as they observe them in the child’s play.

In a session early in the therapeutic treatment, an 8 year old girl created two scenes in the sandtray. In one, an adult was offering a child an ice cream cone, decorated with rainbow sprinkles. In the second, a dog was considering whether or not to eat a mushroom, one that might be poison. I commented on the theme of safety and danger and asked the child he she was wondering if I was going to be like ice cream–safe and delicious–or like poisonous mushrooms. The play can reflect unconscious or conscious feelings about a child’s daily life at home or at school, and it can also reflect fears and wishes about the therapy itself.

A 4 year old child who had recently lost his grandparent spent the good part of a session burying and unburying superhero figures in my sandtray. I could have observed to him that he was wondering what has happened to his grandfather. I may even have wondered if he felt somehow complicit in his grandfather’s death. Had he been angry before his grandfather died? Why the superheroes? Was his grandfather a superhero to him? What could it mean that a superhero died? Was he afraid? Was he angry? Was he sad? Was he worried about his dad? What could this loss have meant to a 4 year old? I could have said these things to the child. I could have said them to his parents. In this case I chose simply to keep them in mind, effectively holding the child’s mind in my mind as he, through play, attempted to work out his confusion about death and burial.

And the very act of holding the child in mind can be therapeutic itself.