Play Therapy: A Powerful Tool for Mental Health

Once upon a time, there was a little girl named Emily. She was a sweet and playful seven-year-old, but something was bothering her. Emily had been experiencing symptoms of post-traumatic stress disorder, making it difficult for her to sleep and behave normally. That’s when her parents decided to take her to a psychotherapist named John, who specialized in dealing with child abuse cases.

As the little girl walked into the psychotherapist’s office, her eyes darted around the room nervously. She clutched her backpack tightly and took small, hesitant steps. It was her first time seeing a therapist, and she wasn’t sure what to expect.

John had set up his room with toys and games, hoping to create a comfortable and welcoming environment. However, Emily’s reaction to a little red pickup truck caught John off guard. She seemed terrified of the toy and even hid under a chair in John’s office when she saw it.

As John dug deeper into Emily’s past, he discovered that her parents had a physical conflict in front of a red pickup truck, which traumatized Emily. John knew he had to get creative with Emily to help her overcome her fears. Using play therapy, John began a game of Hide and Seek with the red truck, hiding it in different places for Emily to find.

In one session, John asked Emily to pick up the truck, but she couldn’t even touch it. It was a gradual process, but eventually, Emily could pick up the car with John’s gentle encouragement. John knew that he had helped Emily process her feelings of trauma around the red truck using a mild form of exposure therapy.

Through play therapy, John was able to help Emily overcome her fears and regain her confidence. He understood that children need a safe and comfortable space to express themselves, and that’s exactly what he provided. Emily’s parents may not have been present during her therapy sessions, but John knew they would be essential to Emily’s healing process. And with John’s help, Emily overcame her trauma and returned to being the happy and playful little girl she once was.

Please tell us a little about your background and how you became a psychotherapist specializing in play therapy.

I began psychotherapy in my mid-30s. First, my therapist had me draw on the floor with crayons. Before that, I tried to get in touch with my issues by writing poetry, but it wasn’t helping.

I come from an atypical family with a dad who was 31 years older than my mother. My mother had been informally adopted by her grandmother and had no connection with her biological mother. I was the third of four siblings, and my mother’s excessive anger and other coping mechanisms led to many conflicts in my childhood. In addition, my dad was a workaholic, so he was out of the house most of the time. I went to college and got a degree in journalism and advertising, but I didn’t feel connected to it. I then went to some 12-step meetings with my sister, and that’s when I became more aware of what was happening in my family. I then got into more expressive play therapy and drawing.

Photography became an extension of my play therapy. So I enjoy using photography as a therapy tool. I also use other expressive therapies, like creating artwork by grinding junk mail to recycle the paper and making a collage or assemblage of personal ephemera. I’m also working on a memoir.

Do you mind talking about your first camera?

When I started taking pictures, my digital camera was just a cheap plastic toy I received as a gift with my laptop purchase in 1999. Even though the picture quality was inferior and pixelated, it was a great way to express me and learn how to take photos. I quickly realized that the more I practiced, the better I became at capturing a more satisfying shot.

Can you share your experience of changing careers in your mid-30s? How challenging was this career change for you?

I always had doubts about the advertising industry, and my job interviews with big corporations in Manhattan only reinforced those concerns. The lack of ethics and willingness to sell anything to anyone, even cigarettes to young people, didn’t sit right with me. So, I decided to explore counseling as a career and went back to school.

It was a complete shift for me, and I finally had a sense of direction and motivation. I was the best student I had ever been, and I thoroughly enjoyed studying theories and practicing the skills necessary to become a great therapist. So, while it was a challenging transition, it was also gratifying.

How did you become interested in play therapy?

First, it was my expressive therapy using drawing. Play therapy was very similar to it. Then my Internship experience gave me more information about how children process emotions and knowledge. I started learning how important it was to identify and describe feelings to process them, pushing me to deal more with parenting and children. Then I got into a mental health agency funded by the county, and they were playing therapy. So my office was filled with toys. It had a large sand tray. It had all these beautiful things that children could do now that were wonderful, and I learned a lot.

An important lesson was my reactions and emotional responses to the children that I needed to pay attention to, which I should have done better. I was playing games with them and using techniques and things like that. Still, I had a good trainer, a woman who helped me to understand that my emotional response or visual reactions to the children was important information. I needed to pay attention to that. That helped me a lot to understand what a child needs and what a child doesn’t. Once in a while, I will have a child who won’t do play therapy, which was a meaningful experience.

I had a little boy who was about seven or eight years old again, and he was referred to our agency because he had lost his parents and his grandmother was raising him. His grandmother had a dog and gave him the responsibility of taking care of the dog. Now, what happened was that he was ready to have him as a pet, but he wasn’t mature enough to fully take care of the dog, and the dog died.

The grandmother refused to feed the dog and blamed the child for not taking care of his dog. So he was referred to our agency because of that situation. When he came into my office, he barely looked at me. He hated being in my office. He did not want to be there for one minute. When I asked him if he would like to play something, a game, anything, he looked at me like I had three heads or if he wanted to throw up. He just hated to be in my office.

That puts me in a dilemma. I didn’t know what to do. So I had to go to my supervisor, and I brought it to a group consultation. I said what do I do? This child doesn’t want to interact with me. He hates being in my office, and the feedback I got was that this child didn’t wish to contact me. So that was very important for me.

What, according to you, are the significant differences between traditional talk therapy and play therapy?

Talk therapy is a more sophisticated approach to therapy, but it can be difficult for children to articulate their thoughts and feelings. When I ask them how they’re doing or feeling, they often respond with “I don’t know.” So, to help them open up, I play games like the “UN-Game” or the gratitude list game. These games help them feel more comfortable, and they can express themselves in a non-threatening way. We exchange ideas and develop a trusting relationship, which is essential for therapy to be successful. These games also help them shift their focus from negative thoughts or feelings to positive ones, which can be helpful for anxiety or depression.

Can you tell me about some of the challenges you’ve faced throughout your career and how you’ve handled them?

One of the biggest challenges I faced was burnout when I worked at an agency funded by the county. The hours were brutal, but it wasn’t just the long hours that made it difficult. Working with abused and neglected children was emotionally challenging because these innocent children have been through so much. Sometimes, it was hard to be around them for long periods and listen to their stories repeatedly, risking secondary trauma. So, I had to learn to set boundaries, which wasn’t easy. However, I also wanted to be an effective therapist, so I often went home and did more research, even though I already worked 50 to 60 hours weekly.

Unfortunately, most of my time was spent doing paperwork because we had to document everything to get funded. It was frustrating because I felt like I was doing more paperwork than actual therapy, so I decided to leave that Community Mental Health Agency. I started doing more private practice work in a group, and that’s when I realized how important it is to set boundaries. When I came home, I had to leave most of my work at the office and not bring it home. I had to learn how not to be a super therapist all the time and take care of myself too.

I spend a lot of personal time doing things that make me happy. It helps me relax and unwind when I’m not at work, and I’m more productive and focused in the office. I was a workaholic like my dad and never took a vacation, but I realized that I became a better therapist when I was happy and healthy.

What do you do with a child who doesn’t want to have any contact?

As a therapist, I faced the difficult situation of engaging a child who didn’t want to have any contact. I approached it as an intellectual challenge and thought about parenting strategies. Then, I remembered a technique called Planned Ignoring, where a parent gives the child something to do and occupies them. I decided to try this technique by pretending to ignore the child in my office.

At first, it was difficult for me to ignore him as it went against my nature. However, he started to engage with me on his terms after a while. I learned that giving the child space and allowing them to have control can help in situations like this. I realized that offering things to the child could have been more helpful as he would reject them. So, I learned a lot about dealing with children who don’t want to engage and giving them the space to come to me on their terms, not mine.

How do you assess a child’s readiness for play therapy or determine the appropriate level of structure and guidance you provide?

As a play therapist, I often assess a child’s readiness for therapy and determine the appropriate level of structure and guidance based on the initial assessment. During this assessment, I ask the parent questions about the child’s behaviors, family and medical history, and any issues they are experiencing. They usually know their child best, so I listen to what they say. Sometimes, the parent will bring reports from the child’s school, which can also be helpful.

Next, I give them a simple puzzle or toy to see how the child interacts. For example, some children may not want to play with puzzles and prefer talking, while others may prefer playing with Legos or Toy Soldiers. Some children may not want to play more competitive games or games that require more intellectual power, like memory card games. These children may get frustrated when they can’t figure it out. In such cases, we start with more independent play, like blocks or drawing with crayons, before moving on to more challenging activities. It usually takes a session or two to figure out where the child is; from there, we can determine the appropriate level of structure and guidance needed for the therapy.

How do you use play therapy to address special needs such as autism or ADHD? Is play therapy effective in these cases?

As someone who works with children diagnosed with ADHD or Autism, I often get asked if play therapy is effective for them. Play therapy is an excellent way to address their social issues and help them feel accepted. Through play, we can interact without requiring a lot of intellectual or social skills, and it’s an opportunity to develop these skills as well. For example, I might start with a simple game or doing little puzzles and then narrate their emotions to help them identify and describe their feelings as they navigate the activity.

This is a crucial step in assisting them in interacting socially and building relationships with other children. I’ve found that some neurodivergent children have difficulty making friends outside of my office because they may look or act differently. However, I have seen great success with online interactive games like Minecraft or Roblox. These games allow children to practice social skills superficially, which can help them transition to in-person interactions. During the pandemic, I have had to adapt to using technology for more in-person activities, but it has been a valuable learning experience.

Is Play Therapy only for children, or can adults also use it?

Play Therapy can be beneficial for adults as well. Although the techniques may be more adult-like, we can still incorporate games such as the gratitude list game to help shift their focus from negativity, for example, to gratitude. It’s a form of expressive therapy. For example, I recently worked with a man struggling with severe anxiety in his marriage. We played the gratitude list game, and although it took him some time and effort, he eventually found relief from his negative thoughts. It’s a great way to practice a new skill and shift the focus of one’s thinking.

How do you approach cultural sensitivity and competence in play therapy and adapt your methods to serve diverse clients best?

I primarily work with middle-class white clients in the suburbs but encounter individuals from different cultural backgrounds. For example, when I worked with a man from Saudi Arabia in grad school, I realized that my cultural references were not universal and had to adapt my approach. Instead of using connections from my culture, I had to be more creative and open-minded to understand his perspective. I learned to listen and adapt as I do with the children I work with. However, it can be challenging to adapt to the needs of diverse communities, such as those with autism or ADHD, whose needs are constantly evolving.

At first, I struggled to understand why they identified as autistic, but I learned to respect their identity and adapt my approach to better meet their needs. Sometimes, I even refer clients to someone who is a better fit for their needs, such as referring a client from the LGBTQ community to someone within that community. It is essential to acknowledge that I don’t have all the answers and to be humble enough to refer clients to someone who can better serve them.

How do you involve parents in the Play Therapy process when addressing behavior issues in their children?

As a Play Therapist, involving parents in therapy is crucial when addressing their child’s behavior issues. I play games with the family, such as throwing a ball. This allows me to observe the interactions between the parent and child and provide feedback. For example, if a parent is not interacting enough, I suggest they step in to assist their child. On the other hand, if a parent is intervening too much, they back off to let the child figure things out on their own. Playing games together is a great way to involve parents in therapy and help them better understand their child’s behavior.

What has been your experience working with non-offending parents in cases of child abuse and neglect?

I find the topic of non-offending parents in child abuse and neglect cases very interesting. As a therapist, I have worked with many individuals who have been part of a family where there has been severe abuse, whether it is physical or sexual. Non-offending parents did not commit the abusive act but allowed it to happen. It can be tough to understand why they needed therapy when they did not achieve the abuse themselves. However, treatment is often court-ordered to help them understand their role in the situation and the impact of their actions, or lack thereof, on their children.

In my experience, non-offending parents often have difficulty understanding what they did wrong. It’s more of an act of omission rather than a commission. They may not have physically committed the abuse, but they did not intervene or stop the abuse from happening. Instead, they may have ignored or avoided it, ultimately worsening the situation. Through therapy, I aim to help them understand that what they did NOT do is essential. I often find that these parents have deeper issues to address, such as depression or anxiety, due to their involvement with an offender. They often come from backgrounds where they have not dealt with or processed their issues. Therefore, they are usually referred to individual therapy to address their more profound matters.

Can you describe what the healing or coping process typically looks like for cases like these?

A group setting can be very beneficial for individuals to connect and share their thoughts and emotions about the situation they are going through. It can be challenging for those who have experienced abuse, and having the support of others who understand what they are going through can be a tremendous help. Nowadays, with the accessibility of support groups through the internet and video sessions, it’s easier for people to find the support they need. Various groups on social media are available for different issues, and individuals need to find the one best suited for them.

How do you address the intersectionality of identities such as race, gender, sexual orientation, and counseling?

It can be challenging to address these sensitive issues as they often do not come up immediately in therapy sessions. However, I have had a few clients who have shared their experiences with me. For example, I had a young boy who came from a divorced family and had a trans-sister. His biological father was not accepting of his sister’s transition, and the boy had witnessed physical violence between them. Through therapy, we could discuss and work through his emotions about his sister’s situation and his father’s lack of acceptance. Another client, a 14-year-old boy, shared with me that he believed he was gay. He was hesitant to discuss this with his conservative Christian parents and decided to stop therapy for the time being. I respected his decision and felt honored that he trusted me enough to share his feelings. These situations can be delicate and require a lot of care and sensitivity, but creating a safe space for clients to discuss and process these issues is crucial.

How do you see the counseling field for LGBT individuals who have engaged in child abuse or maltreatment evolving in the future?

As a counselor, I understand that the question regarding the future of counseling for LGBT individuals who have engaged in child abuse or maltreatment is complex. It is essential to recognize that multiple issues are at play here, including the abuse and the person’s sexuality. To effectively address these issues, it is necessary to take a dual diagnosis approach, similar to working with someone with both an alcohol problem and a mental health issue.

When dealing with these situations, addressing the most pressing issue is crucial. For instance, if the person is struggling with alcohol or drug abuse, that issue needs to be addressed before diving into the more emotionally charged issues surrounding their abuse or maltreatment. It is also essential to ensure that the person is healthy enough to engage in the more profound work of therapy. Sometimes, individuals must complete rehab or attend support groups like Alcoholics Anonymous before getting ready for treatment.

About John Moyer

John is a licensed professional counselor and a member of the American Counseling Association and the National Certified Counselor. He specializes in abuse and neglect, misattributed parentage, and NPE issues for children and adults.

In addition to his work as a psychotherapist, he is also a photographer and has had his work published in several magazines and documentaries. John is the author of a graduate-level urban revitalization textbook, including one of his photos.

He has experience offering LGBTQIA-affirming, non-recidivism-focused counseling for people who have engaged in child abuse/maltreatment. John holds a Master’s degree in Psychology in Education from the University of Pittsburgh, where he was a member of the Chi Alpha Omega society with unique distinction. He also holds a Bachelor’s degree in Journalism/Advertising from the University of Wisconsin-Madison.

John has worked as a therapist and mobile therapist supervisor for several organizations, including Family Resources of PA and Pittsburgh Mercy. He is currently in private practice at New Directions Counseling Services in Pittsburgh, where he provides psychotherapy for various issues.

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