How does Play Therapy work?

By Joseph Sacks, LCSW

Many parents wonder, “How does Play Therapy work?”

How can just playing with my child heal serious, real behavior problems and emotional issues?

What exactly happens in the Playroom?

The answer is, many amazing things happen! Play Therapy is a medical treatment carried out by a specially trained professional that has the power to literally cure emotional disorders and behavior problems. How? There are many important ways.

Play Therapy creates conscious awareness of emotional life, processes troublesome feelings, celebrates healthy expression of desires, develops the power of decision and executive functioning, develops self-determination, raises self-esteem, builds self-confidence and creates self-respect. It models self-acceptance, reduces self-criticism, teaches children to accept limits, teaches children to evaluate themselves positively, processes traumas and stressful events, teaches responsibility and perseverance and motivates the child to come to therapy. In the Playroom I bestow so much kindness on the child, that he or she learns from my model and develops a healthy attitude of kindness and generosity towards himself! All of the above raises a child’s happiness level so much, that most behavioral and emotional issues are completely resolved, and usually within a few months!

How does Play Therapy work? Let’s examine the above wonderful items in detail.

Gaining conscious awareness of emotions

Feelings are one of the most important and under-appreciated aspects of mental and even physical health. A person needs to be aware of what he’s doing in order to be successful, and similarly, a child needs to be aware of exactly he’s feeling about everything in order to be healthy and to function properly. Feelings need to flow freely through the executive command center of the conscious mind. Then the child can process, manipulate and decide what to do with them. But often because of certain stressors, children’s feelings are repressed or blocked off, and they have learned the unhealthy habit of not accepting them and pushing them down, or being ashamed of their natural emotions. This can create all sorts of problems, such as anger issues, depression, anxiety, tantrums, ADHD, defiance and others.

However in the Playroom the child regularly gains a conscious awareness of his feelings. This is accomplished through the curious Play Therapy technique called tracking. That is, I reflect verbally back to the child every feeling he expresses or I see him experience, as well as desire or need he realizes, and every decision taken. Such as, “Oh you fixed it, that makes you happy!” “Ooh, you’re angry now,” and “It feels frustrating when you can’t get it in.” Having his feelings constantly reflected back to him verbally in the moment he is feeling them teaches him to pay attention to those feelings, and the fact that I even celebrate the experience of each feeling with him teaches him to appreciate and value his feelings for the wonderful element of his self that they are. All this gets him into the habit of letting his feelings flow through his executive functioning center, his mind. So he learns to act by taking his feelings into consideration, and thereby makes decisions that respect and honor his own important emotional life.

Processing troublesome feelings

In addition, this tracking and awareness of feelings helps the child to process and resolve those feelings that have been causing him problems at school or at home, such as repressed anger, shame, frustration, fear, or powerlessness. Once he gains awareness of let’s say, his anger, in the playroom, and expresses it through symbolic play, it gets processed and its intensity fades, and over a few sessions that anger becomes only a memory and slips into the past, where it no longer causes outbursts or aggression. Shame is reduced by counteracting it by helping the child view himself in a positive way. When I reflect back each accomplishment in a non-evaluative, non-judgemental way, the child is led to the logical conclusion that he is indeed a decent, worthwhile person, and his shame is reduced.

Honoring desires

Desires are also closely related to feelings. Let’s say a child wants a drink, that’s a desire but it’s also a feeling of thirst. Therefore in the Playroom, I celebrate, honor and respect each and every desire that the child demonstrates. For example, when he picks up a toy to examine it and consider playing with it, this is an important event in the child’s world. He is realizing his desire to establish a temporary ownership over an attractive item. So I celebrate this accomplishment with a hearty, “Oh you got that!” This simple, emotionally charged statement teaches the child to respect and honor his own desires! Thus he learns, “My needs, wants and feelings are important. People need to respect them.” A Play Therapy session is a constant stream of desires realized and celebrated, and accomplishments earned. As the child learns to respect his desires, he learns to respect his emotional life as well, which gives him the power to control his behavior.

To find out more about how Play Therapy helps a child's emotional health, click here.

Play Therapy develops the power of decision

Making decisions is an important skill that children, over time, need to work on. In the Playroom, I don’t direct the child what to do, he or she makes all of his own decisions, and I follow him, demonstrating great respect for every decision taken, as this is an important event in the child developing self-determination. In addition, I celebrate each decision with an enthusiastic statement like, “Oh you’ve decided to put that over there!” and, “You don’t want to do that anymore, it looks like you’ve decided you want to blow up some balloons!” This celebration in the interpersonal venue gives the child great pleasure and satisfaction, and the child associates that good feeling with the decision itself, and is thus encouraged to make more healthy decisions. He learns that deciding to do things is an exciting and important part of his developing self, and this strengthens his executive functioning. For children with ADHD this is particularly helpful, as it helps them develop the power to focus on their work. Learning to make decisions successfully empowers children and it develops self-confidence.

To find out more about How Play Therapy helps for child ADHD, click here.

Developing self-determination

Play Therapy puts the child in control. He directs all the action and the adult follows him. He becomes the boss of an entire institution, his weekly Play Therapy session. This gives him an exhilarating sense of control over his own life and destiny, which satisfies him so much and gives him such an experience of self-determination, that later he doesn’t mind so much being told what to do by his parents outside of the session! In this way tantrums and defiance are greatly reduced, and the child learns that he or she is somebody important, too.

To find out more about how Play Therapy reduces tantrums, click here.

Self-esteem, self-confidence and self-respect

The awareness of feelings, desires, making of decisions and development of executive functioning described above greatly increases self-esteem, self-confidence and self-respect. In addition, I treat the child with so much patience, respect and kindness, that the child learns to respect and feel great about himself. The child thinks, “Joseph thinks the things I do are important, therefore I must be important.” Since poor self-esteem fuels misbehavior, all this results in improved behavior.

Modeling self-acceptance

In the Playroom, I don’t try to correct or improve the child or get him to be something he’s not. I completely accept the child where he is and as who he wants to be. In other words, I don’t criticize the child at all. Therefore I model an attitude of acceptance, and the child learns to adopt a non-critical, accepting attitude towards himself, which is one of the definitions of emotional health.

Accepting limits

There are still a few limits in the Playroom, however, such as no hitting the therapist, no purposely breaking toys, no throwing sand out of the sandbox, no leaving early and ending the session on time. However these limits are exercised only on a very limited basis. In other words, the session is such an outpouring of kindness, generosity, freedom and opportunity for the child, that he is so satisfied that he finds the strength to tolerate the limits. This however still gets him into the habit of happily complying with reasonable limits, which he carries with him outside of the session.


In the Playroom I don’t evaluate or judge the child. I don’t say, “Wow what a great job you did,” or “What a beautiful picture you painted,” or, “You’re such a good boy.” That would create other-esteem, because it is a judgement coming from the other. Instead I create true self-esteem by encouraging the child to evaluate himself and draw the logical conclusion from the evidence, which invariably is, “I am a decent and worthy person.” I do this by describing and celebrating what he does, without evaluating or judging, such as, “Yay, you got it in,” and I see a green house and a blue sky in your picture. What do you think of it?” and “You’ve been trying really hard on that for 5 minutes.” This describing just sets forth the objective evidence without any bias, and since the ultimate truth is, any child’s play is just worthy and fine as it is, the child tends to conclude just that, that he is just fine the way he is. That is true self-esteem, because it is esteem coming from the self.

For a fascinating discussion of how celebrating a child's accomplishment is better than praising them, click here.

Processing stress

Children often inevitably have stressors in their life. When an adult has been through stress or trauma, he may speak about it in psychotherapy, going through the stressful event in detail, processing all his feeling and thoughts about it, and having his experience accepted and reflected by an empathetic therapist. That is the natural mechanism for healing from stress, to express and process it in the interpersonal venue.

A young child, however, does not possess the maturity and conceptual ability to discuss his experience in a narrative form for 45 minutes. Instead he expresses and processes his experiences through play. If he is feeling angry he may act out a scene of certain figures aggressively defeating others. Every step of this action is reflected back to him verbally by the therapist, so it accomplishes the same as an adult having his anger validated in talk therapy. If a child has been through stressors and the loss of family conflict, he may play out scenes of characters not getting their way, being disappointed, and losing important things, which symbolically represents him expressing what he has lost. It is not necessary for the therapist to draw an explicit connection from the symbolic play to the exact stressor, it is enough that he reflects the childs’ actions in the same language that the child expressed it, and he will feel heard and validated, and will be able to process his stressors, gain mastery over them and put them into the past.

One child I had emphatically expressed about my Playroom, “It is the only place where I can really play!”

For a fascinating discussion of how Play Therapy helps reduce child anxiety, click here.

Learning perseverance

In the Playroom, if a child asks me for help I will give it to him, but otherwise I do not do things for him that he is capable of doing for himself. That is, I allow him to struggle with challenges, such as figuring out how to work an unfamiliar toy, or opening the lid on a can of clay. This empowers the child. It is important to carefully select the toys to not include anything that is too difficult and frustrating for young children, but include things that are just difficult enough for each child to be successful and gain mastery. Once a toy broke and the child decided she wanted to try and fix it. I saw that it was within her ability and so I let her struggle with it, reflecting back each step and accomplishment along the way, which had the effect of encouraging her. Then she actually succeeded in fixing it, leading her to exclaim, “I know how to fix things!” that was the creation of true self-esteem.

Motivation to come to therapy

If you have tried before, you may have noticed that it can be very difficult to get children to willingly attend talk therapy sessions. They tend to find it boring, as a long conversation with an adult is not very engaging to a child.

However children love coming to my Playroom! Parents report that they eagerly look forward to every session. It’s not just that I have a lot of good toys, it’s that they are so carefully selected to be just the right ones which will capture a child’s heart and facilitate his self-expression and mastery. In addition I believe that children are very happy with the way I treat them, they enjoy our special relationship, it is very meaningful to them. It is very helpful to parents to have a therapist who their child is happy and motivated to go to. They leave the session in a great mood and with improved behavior that lasts. Without consistent attendance, there will be no therapy and no improvement.

To learn more about Child-Centered Play Therapy, click here.

Kindness and generosity

Above all, I behave with extreme kindness, generosity and patience towards children in the Playroom. They thereby learn to adopt an attitude of kindness towards themselves, and that they deserve to be treated well. I always greet them with a big, hearty hello, and this warms and elevates them. They are always happy to see me. It is my greatest joy to help a child!

Feel free to peruse my interesting blog, view my video or download one of my informative free reports at the bottom of this page. If you would like to discuss further the question of “How does Play Therapy work,” you may chat with me in the chat box, or call me directly for a complementary 15-minute consultation at 646-681-1707. I look forward to speaking with you!