CYC-Online 53 JUNE 2003
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Therapeutic application of play

Don Pazaratz

Abstract: Play offers children and adolescents an opportunity for creativity and psychological development. Play reveals the developmental strengths and maturity of the youth as well as pointing to the youth’s vulnerabilities. Play occurs with the youth acting upon an object or interacting in a game. It stimulates the child's imagination as the youth controls the object. Make-believe is one of the most sustaining elements of play. Interactive play and games can give youth a sense of mastery over their environment, provide an emotional outlet, help stimulate cognitive development, and provide opportunities for friendships and leisure activities. This paper examines play from a therapeutic perspective, in a residential treatment program for disturbed youth.

Dynamics of play
Roopnaire, Johnson, and Hooper (1994) demonstrate that in every culture play is a dominant activity for all children. Play is an important mode for the culture’s transmission and is seen as an indicator and reflection of child development. Play in all societies is seen as important for good mental health and is achieved in a cultural context. Greenberg, Rice, and Elliott (1993) suggest that human beings have a biological tendency to symbolize and to give meaning in order to comprehend the world around them. Cavell (1993) holds the view that there is no thought and, thus, no meaning without language. But emotions are part of a complex organismic system combining cognitive and affective processes in which sensations and cognitions blend together to create meaning. Emotions are motivating factors that pull us or push us toward different directions. They are essential in creating meaning and in organizing one’s experience. Play assists youth in this endeavour as it is used as a symbol for language, behaviour, themes and meaning.

Is it possible to comprehend play from an intellectual point of view? Is it an essential medium of life or a condition? Can we treat it philosophically? Play is primarily and ultimately an experience that can be enjoyed physically, emotionally, and intellectually. For those engaging or participating, play is not dependent on an explanation. For them an explanation wastes time and energy and is never to the point. All you get from an explanation is a particular point of view. By engaging in play, everything in the experience will make it as thoroughly comprehensible as it is capable of being made. One need not go further in order to understand. Play is found in everyday life. It is preeminently self-satisfying, continuously available, and highly practical. It appeals to, and directly enhances, life. The symbolism of play is the element of pretend and the use of the imagination. It promotes the ordinary course of living even though (for adults) we have been taught a falsehood: that it interferes with and is disturbing to others.

The reason it is so rewarding to children and those adults who allow themselves to be at play is that it helps to distract us and to free our minds from all possible entanglements and attachments such as words, ideas, and desires that form the pressures of life. Play is a freedom, a spontaneity, a delight, a sense of discourse. Understanding of play can be conceived in a playful, creative way. We can also play at thinking and think playfully. All these features are found in a phenomenological/hermeneutical endeavour and we can feel satisfaction contemplating or anticipating play.

Modell (1993) contends the self is fundamentally paradoxical, being both dependent and autonomous. There is a strong philosophical notion that the mind is inherently social and this includes explanations of actions such as play. For Smith & Nylund (1997), play can bridge the gap between seemingly disparate worlds of adults and children. The value of play within a family, according to Schaefer & Cangelosi (1993), is that it encourages parents to interact with their children. Narrative and collaborate relationships can evolve during play. Locke (1993) describes how the capacity for dialogue is co-created in the play and playfulness of the mother/infant relationship.

Therapeutic aspects of play
Emotionally disturbed youth are unable to accurately observe and interpret interactions and communications occurring around them (Pazaratz, 1993). During spontaneous play, activities, games, and play therapy youth show who they are and how they deal with others. Play is not only a symbolic vehicle to attempt to gain an understanding of the child's inner and outer worlds and how he/she relates or does not relate, but becomes, according to Gil (1993), the medium through which enhanced communication, understanding, and emotional relatedness between family members or therapist/ client can be achieved. Through play the circumstance of each child is revealed both verbally and nonverbally. For Wilson and Ryan (1992) this provides the context for a detailed analysis of the practical and emotional challenges faced by the therapist.

The therapeutic approach emphasizes relationship building through the release and support of emotions, nurturance, and warmth. Externalization of problems is one important feature of clinical technique. Clients are encouraged to discuss, objectify, or personify their problems. Freeman, Epston, and Lobovitz (1997) believe even young children can externalize and let go of problems. Opportunities for assisting youth to deal with problems and to gain some control over their lives occur when the children are disentangled from the problem. When the client personifies the problem, the problem is shown as influencing the client but is not part of the client’s identity. This requires the youth to move (intellectually) from a blaming perspective to developing a therapeutic alliance against the problem. But it is hard for children to know who they are or who to trust because they are really defined by adults and limited by their role in families. Play helps the youth to develop intimacy and encourages self-acceptance: recognizing relationships for what they are and letting them be. Therapeutic play encourages self-expression and teaches youth to develop intimate relations rather than seeking love and approval (Ricketts & Gochros, 1987).

For Broomfield (1992), play therapy is indicated for children with such problems as autism, poor impulse control, anxiety, attention deficit, and experience of sexual abuse. According to Schaefer and Cangelosi (1993), structured play with familiar toys can be used to deal with a variety of problems. But structured play primarily meets the needs of the therapist. Therefore, play therapy is acknowledged to be only one among several valuable therapeutic approaches. For Allen (1988) play therapy, like art and drama, enables the therapist to enter the child's world and, through support and sensitive probing, empower the child to grow. Selekman (1997) describes how children's games, literature, art, and experimental exercises capitalize on the natural activity of children, helping therapists to understand the youth emotionally and to make working with children and families hopeful and fun. Linech (1993) agrees that therapy with children should utilize their natural inclination to fantasize and imagine. For Solnit, Cohen, and Neubauer (1993), play serves to resolve problems and conflicts while it furthers development. It becomes an important vehicle for the therapist in understanding emotions and bringing about emotional change. For Pazaratz (1997) the changing interactions, dialogue, and symbols that emerge in the context of the therapeutic relationship are seen as evidence of this growth. Consequently, the role of the therapist is to help the youth to construct reality, to promote the idea of the self as ever emerging, and to stimulate the potential for growth.

Residential treatment
Residential treatment facilities attempt to create an environment and system that provides for the psychological and physical needs of emotionally disturbed youth through stability, attachments, and freedom from fear. Activities are an integral part of treatment and relate to the targeted goals for change, skills to be learned, and directions for growth. Treatment aims to teach youth to face and deal with life’s unpleasant aspects: pain, rejection, fears, anxieties, denials, abuses. In residential treatment facilities, play and activities are critical techniques in the therapeutic management of disturbed youth. Play helps the youth to address and to heal the wounds of life they bring into residence and to deal with the ontological question, the emerging self.

In residential treatment an activity is that part of the program in which youth engage with each other or adults in programs emphasizing group and social interaction. Activities provide a learning situation for the mastery of skills in group situations and a release of emotions, and help to develop new roles and social skills. Activities offer growth and pleasurable experiences of normal life to youth who have a history of being loners, scapegoats, ostracized by peers, or fighters. Play helps youth with emotional and social functioning. Play helps youth to deal with stress, to deal with the inner self, and to establish personal boundaries. Play helps the worker to develop interactional patterns with youth. Workers, according to Gergen (1991), should give up their conventional belief in selthood and individuality and immerse themselves fully in the complexities of relationships. This requires the worker to focus on listening, interpreting, and committing to the development of the relationship.

Structured play (activities)
According to Willats (1997) description precedes explanation when analyzing a youth’s psychosocial level of functioning.

It was a warm summer evening and the playground offered plenty of space for a softball game. Just before the game started, the sentiment was unanimous: the situation was unfair and we shouldn’t proceed with the game. The kids from the other group home, our arch rivals (Haydon House II), were bigger and older, their staff were better than our staff, and we didn’t stand a chance.

"But you guys didn’t complain when it was the other way round and you were bigger and older. So they've got some new kids. It don’t mean nothing. They ain’t a team like we are."

"Oh go on, Don, you know we can’t win," piped up Roy.

"But they ain’t gonna have more fun than we will," I prophesized. “Even if they do win."

"Yeah, it'll be real fun losing," replied James.

I can see from our rivals' behaviour that they understand the game and that we are playing it together. They represent the Blue Jays, and our team represents their nemesis, the Tigers. DiNicola (1997) states that play allows the therapist to analyze the child's own fantasies and to glimpse the child's own perception of reality. The youth and staff in our group homes have staged this scene and acted it out so many times that it is almost ritualistic and yet each time more novel. Some of the residents who only last winter were little guys have grown and become more skillful and quick. They understand the real purpose of play, to let it flow naturally. There is nothing extraordinary or mysterious about this ball game.

The batter has his hands gripped tightly around the bat handle and the bat cocked over his shoulder. I hear the heckling from the other side. I raise my hand and the ball. All the while the batter is carefully watching me, looking for clues. As I release the ball, I watch him and the ball’s flight. He swings the bat. He has a hit. I see the intensity on his face as he runs to first. It is almost audible. If he were being vocal he would be cheering. He is at play.

He is living a good deal of pleasure. No wordy discussion is necessary, nor any explanation. There is no need for explaining; his play says it all. If play is at all conceivable he has indeed taken hold of it.

But is play the same for a youngster as for the worker? I think the idea of play for a worker is to allow activities to flow. Even when there is no creative originality there is still play. And when we do not agree upon the appropriateness of it, it is not false, we are merely at cross purposes. Both youth and workers know play fully by experiencing it and by reflecting upon themselves during the experience. Activities create situations that provide an outlet for expression of feelings, create excitement, and help in the development of the youth’s physical well being.

Being practical and directly to the point, play (the ball game) was not for me (or the youths), a waste of time, nor do I really feel that words are wasted in explanation. I can see that there was nothing circumvolutory in the game; our actions occurred or came about spontaneously and without a moment’s delay. Even though our team took a drubbing (as prophesized) the game motivated our team members to engage in an activity (task) and they were entertained until its completion. Undeniably, structured activities have an educative value, incorporating life skills learning and the development of self-satisfying interests and talents. It was agreed this was a fun way to spend a summer’s evening. Hopefully staff taught residents to focus on previously unimportant aspects “to have fun and not to worry about performance or outcome.

Unstructured (non-directive) play
According to Ryan and Wilson (1996) non-directive play provides the context in which the youth feels safe enough to explore past trauma. Understanding occurs with the use of reflective comments or role playing by the therapist.

"The other kids call him “Fast Eddie." Eddie’s mother says, “He’s just like his dad. He doesn’t listen and is easily distracted. They should both be at Haydon." Eddie is fourteen years old, small for his age. Some staff believe Eddie’s small size is a direct result of the years of being on Ritalin prior to coming to Haydon. Even though he is not now on any medication, staff believe the drug drastically impeded his maturation and growth. Greenspan and Solomon (1993) cite delays in emotional development as the underlying reason for children's difficulties. But Eddie is neither less bright, nor any more problematic than any of the other youth at the group home. Maybe a bit more active. He likes staff. He sees them as fun. They keep his environment safe and provide for his physical well-being. He always asks questions. Which staff are on today? What are we doing for activities? When can I go home next? Can I have a paid chore? How come the other kids can do it? etc. Eddie can be exhausting because he is an incessant talker, has a flight of ideas, and is often unable to remain still. Eddie can be superficially polite and endearing, but when frustrated he can explode with anger and a barrage of cursing. In our Day Treatment Program Eddie is off task more often than not.

As I drive up to the group home “Fast Eddie" spots me. He is supposed to be on a yard chore, but he isn’t doing much of anything. “Hi, Don," he yells as I walk toward the back door of the building.

"Oh Eddie, look at that," I yell, pretending to see an object on the ground and pointing. The excitement in my voice piques his curiosity and he cries out, “What is it, Don?"

"I can’t believe it, Eddie," I yell back and I bend over, pretending to pick an object from the ground.

"What, Don, what did you find?" asks Eddie, pleading.

I open my hand partially, pretending to look at the object and say, “1 can’t believe I found this. Eddie, you were here all day. You could have found it, but you didn’t. I did. It’s mine. Wow!"

"What is it, Don?" demands Eddie, sounding desperate. “Show me.'

"No, I can’t," I say flatly. “It’s too valuable," I shout, “you'll want it." As Eddie moves toward me, I close my hand, move it in the air and holler, “No, Eddie, you can’t have it! No! No!" and I run off, in the opposite direction, but not too quickly because I want Eddie to chase me. And he does. All the while he’s yelling, “Let me see it, Don, please." “No," I yell, “you won’t give it back." He follows me down the street, yelling to me, “I will give it back! I promise, Don!" I circle a giant oak, turn, and see Eddie has slowed down. “Well, maybe I'll show you, Eddie," and his face lights up. As he approaches me, “I won’t take it," he says reassuringly, “I promise."

"No, you can’t," I yell and I race past him. “It’s mine, I found it, you could have, but you didn't," and the chase is resumed. I’m tired. I can feel my lungs. He’s fourteen and I’m not. But I can’t let him quit, so I keep running all over the place and finally he stops.

Later he catches up with me. I’m on the sofa in the staff office. “Don, can I please see that thing now?" he pleads.

"Oh, Eddie, I dropped it out there some place while you were chasing me. I have an idea of where it is. I’m too busy to look for it now, maybe later or tomorrow. But can you tell me why you've been on extra chores for a whole week?"

Although this spontaneous activity does not take the place of talking about feelings or looking at behaviours, sometimes when emotionally disturbed youth are stuck in a negative acting out cycle, talking may trigger some further acting out. The worker should aim to restore feelings of safety and the ability to trust. Putting fun and play into their daily routine helps the youth to live in the moment and not to brood about injustices and delays in gratification. Workers at Haydon are encouraged to develop their own repertoire of counselling skills and techniques. For Pazaratz (1996), once the staff/youth dialogue has opened up and the youth can contemplate the nature of the relationship, counselling can then be resumed along with active directive interventions. Likewise, in the theory of the mind, Steerneman (1994) refers to the child's ability to ascribe thoughts, feelings, ideas, and intentions to others and use this ability to anticipate the behaviour of others. Games help the individual to give meaning to social behaviour and to engage in socially competent behaviours. In this spontaneous play Eddie was aware of the real conditions of the game. He did not get his own way. This was symbolically expressed through the chase.

Playfulness in treatment fosters emotional connectedness, overcomes delays and defects, and helps to deal with issues. Once Eddie was receptive to giving up control to me as an authority figure, I was then able to ask him to look at his recent behaviours. Did he make progress toward resolution of issues with other staff? I monitored his reinforcement/level chart and in about two weeks' time, when he slid into his old habits, I accidentally on purpose find the valued object again, outside on the street, and the chase is back on. Eddie will be it for a while until I can think of a variation of this game.

To be original in my approach to Eddie and in the use of therapeutic play, I must be on guard not to be carried away by outward signs of disapproval or believe that as an adult l'm above playing. While we interact, I really desire, primarily, to share in the fun. It would be difficult and misleading to believe, as a therapist, that I comprehend each client literally and logically. Good youth workers have explored their own past and can understand or locate “their child" in their own fun and experiences. The whole person of the worker, not just the clinical side, informs any therapeutic activity.

Eddie calls staff he likes his favourite staff, and when he is questioned about his meaning he states, “You’re fun." A youth’s answers to direct questions are pointers by which a worker may understand some of the youth’s meaning. But I must remember that “fun" and play under no circumstance can be changed into life itself. Danger always lurks where the intellect slyly creeps in and we take the index for the experience itself. Fantasy and imagination as aspects of humanness form the wellspring of self-expression, self-love, and emotional growth. I wanted Eddie to move from a perceptual experience to self-reflection and to develop an understanding of me (and other workers) and my emotions and motives (as in the theory of the mind). Therapeutic play enables the youth and the worker to relate to the activity (game) and to one another. It is a means of developing other relatedness (relationships) and does not rely upon verbal self-expression. It underlines the importance of the relationship and its components including trust, boundaries, and transference.

Acting out as play
Acting out is the way in which disturbed adolescents deal with emotions. Sometimes acting out can be playful, other times it is malicious, intent on retaliation or merely meant to spoil an activity for others.

The basketball game ended with the bell. The players were lined up by the door and waited for me until I locked up the equipment in the next room. Upon my return to the gym, Robert, a tall, lanky twelve-year-old, was hanging from one of the basketball hoops.

"Robert, get down," I said.

"I wasn’t up there, Don" he replied immediately upon landing to the floor.

"Robert, what are you talking about?"

"I wasn’t up there" he said innocently.

"Don’t be silly. You were hanging from the hoop and you jumped down when I told you to get down."

"I wasn’t up there, Don," his voice rising in affirmation of his statement.

This is a typical example of a boldfaced denial by a youth caught acting out. The youth shows neither shame nor lack of sincerity and will escalate the confrontation into a power struggle. For Robert, his inability to gain recognition in the basketball game and any true satisfaction in participation results in his inability to play within and by the rules, and to stop playing (acting out his emotions or retaliation) when the game ends. Play reveals Robert’s internal struggle (anger) that he doesn’t talk about, and the fantasy he has of establishing and winning power struggles.

"Okay, Robert, since you’re not lined up properly, you will be the last one to leave the gym.

"Whatever you say, Don," replies Robert, having to get the last word in. Before Robert leaves with the others, I ask him to think about how important it is to follow instructions, as the issue of defiance and resistance are ongoing concerns. The rules, I tell him, not only apply during the game but also afterwards.

A couple of days later, Robert is sitting on the stairs of the front porch to the group home. “Do you want to toss the football?" I ask. “Sure," he replies.

We are on the street, about fifteen yards apart. He does not have a powerful arm but he is fairly accurate. After about five minutes, he tosses one over my head. As it bounces down the street, I chase after it. Coming back with the ball I say to Robert, “I hope you aren’t going to start that again."

"What’s that, Don?"

"You know, you've done this before. Throw the ball way over my head and enjoy watching me fetch it."

We resume tossing the ball. Within a few moments, he tosses one with all his might down the street. “You can get that one, Robert."

"Forget it!" he says curtly and storms angrily into the house.

Robert has deep anger toward authority figures and tries to set them up when they rely on him to act reasonably.

"Hey, Robert, what’s going on?" I ask when I catch up with him. “You jerk me around while we’re playing ball; I tell you I don’t like it and you get mad at me?"

"I didn’t throw the ball over your head on purpose.

"Well, how come many of your interactions end on a negative note?"

"What do you mean?"

"We’re playing and rather than having fun, you've got to show me up and make me look bad so you can win.'

"I didn’t do nothing!"

I can see from the look in Robert’s eye that he’s conning me. I want to avoid another power struggle. “Remember when you and Doug went fishing with Gord, and Doug got his line tangled in yours?"

"He’s stupid. He threw his line over mine."

"Well, how did you deal with it?"

"I dunno."

"You left your pole there at the creek for Gord to untangle, came back to the residence, and threw all Doug’s clothes and belongings out the window."

"He’s a dummy. He deserves it!"

"But you take the fishing too seriously; you look for reasons to be angry and to get at people."

In Robert we see a youth who experienced trauma in the form of emotional betrayal by parents and family even in play. In his case notes there is an example of his uncle urinating on Robert’s hand while they were ice fishing. This occurred when Robert was passing out beers through a window for his dad and uncle. During play or activities, Robert was often humiliated and laughed at. He scapegoats Doug in the same way, referring to him as a “dummy." I want Robert to recognize his strengths rather than focus on his anger; Mason, Breen, and Whipple (1994) advocate the use of this pragmatic solution-focused approach. The question for me as the worker is, how can I get Robert to contemplate new strategies for problem solving? What specific steps should be used to carry out and develop meaningful activities? “You love fishing and so does Doug. He’s not as clever as you at fishing and so he tries to get close to you, to copy you. Maybe you could show Doug how to fish his own area so he doesn’t crowd your fishing spot. You could direct him with instructions so he doesn’t move in on you and ask me to back up when playing ball."

For Farmer (1990) a youngster’s resistance prevents establishing a constructive relationship with professionals. Play activities can help youth to comprehend and sometimes express the feelings they are unable or unwilling to verbalize. Robert provokes people into fights in social situations because Robert does not know how to fit in, nor does he believe in his own value, thinking that therefore he should not fit in. But when the other person turns on him (Doug blamed Robert for the lines becoming tangled), Robert runs away or will act out in ways so people cannot retaliate (throwing Doug’s belongings out of the window).

About a week later, the president of a local service club had arrived on time, but the photographer was late. He had brought a cheque as a donation for the purchase of sporting equipment. It was agreed that both organizations would benefit from publicizing this generous gift. While we waited in the living room of the group home, two residents (Robert and Doug), arriving back at the residence and seeing me dressed up, were curious and wondered who the visitor was.

After introductions, Robert and Doug asked a barrage of questions. Mr. Jones stated that he had a donation for our organization and wondered what equipment should be purchased. When they stated new fishing poles, Mr. Jones’s face lit up. This was his favourite pastime. Doug, losing interest in talking about fishing, left quickly, but not Robert. When the photographer arrived he felt the picture should be taken on the front porch with Mr. Jones handing me a cheque for two thousand dollars. First the photographer left the living room followed by Robert, who waited outside the door while Mr. Jones followed. Robert stuck out his foot and tripped Mr. Jones, who stumbled the length of the hall all the time clutching the cheque. As Mr. Jones looked back at Robert, the look on Mr. Jones” face was shock and disbelief. Robert replied angrily, “I should have broke your f–g neck," and quickly stormed out the back door. Grasping for an explanation and an apology I said, “Now you can see how much your donation will help these kids." Mr. Jones' quick smile indicated how badly he wanted to leave.

When I confronted Robert about this behaviour, he first stated that Mr. Jones had stumbled on his own. Then it was Mr. Jones who had run into Robert’s foot. Finally, Robert stated he hadn’t meant “no harm": he was only fooling around. Playing or fooling around for Robert was part of his background where violence perpetrated on him was disguised or masked as something else, such as horseplay or play fighting, or that Robert was being a “suck" and couldn’t take it. But Robert always lost, was often physically hurt, and was always emotionally traumatized as he was scapegoated. His dysfunctional parents had a history of alcoholism and (accidental) child abuse. Robert had also been bullied at school. This resulted in Robert learning to survive and to strike back in a manipulative or passive aggressive manner. “Robert, you knew that Mr. Jones couldn’t get at you so you took advantage of him, hurt him when his guard was lowered and betrayed his friendliness, his trust in you. But ultimately you got at me and the program, by trying to embarrass and humiliate all of us. And then you deny your real purpose and say you were being playful. Sounds a lot like the crap that your parents did and said to you, when you got hurt accidentally but on purpose, don’t you think?"

In describing these interactions with Eddie and Robert, I have tried to demonstrate and discuss the process of therapeutic play. Robert entered treatment having experienced traumatic experiences in his natural family. Eddie had a number of broken relationships and abuses in his past that had left him with attachment difficulties. Both youth faced practical and emotional difficulties fitting into the group home and relating to staff. Through play I attempted to create constructive experiences for each youth, to resume the developmental process interrupted by abuse. During structured play, activities, and games Robert showed who he is and how he has difficulty with others and competition. Play tells the worker the way in which the youth is doing things, and with the use of confrontations and redirection the worker tells the youth the way in which he could be doing things. Activities help to work through painful experiences with familiar and comfortable materials. They effectively illustrate the power of therapeutic relationships. With encouragement and support from staff, the youth gain a sense of mastery over their environment.

In residential treatment, there is often a great deal going on. There can be a lot of commotion and confusion during activities. Not only do staff feel frustrated and overwhelmed but often cannot explain what is happening in spite of theorizing and intellectualizing. When staff scarcely hear the residents speak, staff do not always recognize that residents are acting out, seeking negative attention, or engaged in power struggles. This adds to the noise. Therapeutic play helps the worker develop an alliance as was attempted with Eddie and Robert. Play does not require linguistic or logical abilities, but fosters the development of cognitive traits. Play reveals attachments as it includes the dynamics between individuals and their social context.

Play is partly informed by how we interpret what happens to us and to others. Ultimately, the individual is faced with adapting. Robert attempted mastery through power and control and Eddie through release of energy and supplication. Play is not always a constructive experience for youth, and this is where the counselling comes in. Physical games can have a powerful effect on our bodies, identities, relationships with others, and the way in which some of us approach life. Some youth such as Robert are too serious and depressed, and cannot share even in the fun of play. It is safer for Robert to act out in play situations, enabling him to deal with his psychological and physical abuse and emotional neglect. Robert is the vulnerable child for all occasions.


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This feature: Pazaratz, D. (1998). Therapeutic application of play. Journal of Child and Youth Care. Vol.12 No.3 pp 27-38

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