Play is the child’s language and toys are their words

Garry Landreth   
 

Play therapy hasn't always been taken seriously in academic and clinical settings. After all, it has play in its name. However, those who regularly use it in their clinical work and/or are trained as registered play therapists fully understand its healing power. I have always been attracted to play as a natural medium for self-expression in which the child can address and work through complex and often painful feelings, conflicts, and experiences in a place of safety and security, free of judgement and pressure. I have been particularly drawn to the non-directive approach to play therapy pioneered by Virginia Axline and later Garry Landreth, which relies on building a trusting therapeutic relationship with the therapist and letting the child lead the play without adult direction.
 

Jasmin

Four-year-old Jasmin* was referred for play therapy to the children’s hospital outpatient clinic in Dubai, United Arab Emirates where I work. She was struggling with severe anxiety and was unable to tolerate being around other people, including family members. She experienced panic attacks if someone spoke to her and was unable to play in crowded areas. Jasmin’s mother was deeply concerned that, because her daughter had missed her chance to start school, she would not be able to live a normal life or have friends.

I gathered from her history that Jasmin’s life journey had begun in the shadow of severe separation anxiety. Her parents were immigrants from a neighboring Arab nation and had extended family living nearby, ultimately settling down in Dubai where Jasmin was born. Jasmin experienced many medical complications directly after her birth: she spent almost four months in the neonatal intensive care unit (NICU), with only one day out of 100 with skin-to-skin contact. Jasmin’s mother became highly protective of her fragile infant daughter, shielding her from other people and giving her anything she wanted. This was likely related to guilt from the experience that they shared ever since Jasmin’s birth.

In our earliest play therapy session, Jasmin’s mother was fearful and pessimistic that her daughter could be helped to overcome her — or perhaps I should say “their” anxiety and fears. Jasmin arrived for that session crying, screaming, and saying she wanted to go home while hiding her face and clutching her mother in intense fear. She did not accept any direct communication from me.

In the coming weeks I maintained a consistency in my quiet and patient presence, with hopes of reducing Jasmin’s fear and providing a predictable environment for her. Eventually her crying stopped, and Jasmin seemed more comfortable in my presence, showing a burgeoning interest in some of the toys and materials in the playroom. Perhaps the seeds of trust were being sown.

In the following five to ten sessions, she once again began hiding her face and regressed to avoiding any direct speech on my part, instead choosing to hold on to her mother. I’m not sure what changed this early course of “progress” for the better, but after a few more sessions in which I was consistent, respectful of her need to withdraw, and validating in small verbal and non-verbal ways, Jasmin once again shared eye contact with me. However, she continued to only communicate non-verbally despite this progress.

After a few dozen sessions — which may seem like a lot to those who have not relied exclusively on a non-directive approach — there was a breakthrough. Jasmin spoke! She seemed to slowly accept my presence, engaged in play, grew more visibly comfortable in our relationship. From that session onwards, she laughed, giggled, asked me to draw, commented on my drawings, and shared her toys with me. She began speaking openly about her thoughts and feelings, and at one point, even gave me a high five! Yet, while these were indeed huge steps for Jasmin, she was still speaking only through her mother, telling her what she wanted to play instead of asking me directly. It’s important to note that during the initial sessions, Jasmin used the sand tray to explore and express her thoughts and feelings.

My Play Therapy Room


Puppets


Musical Instruments

As our time together went on, Jasmin slowly solidified her confidence, using puppets to speak for her so that she might maintain a safe distance from her problems. Similarly, she became increasingly comfortable using the creative arts materials, paint, and messy play to work through the difficult feelings she was experiencing, mostly around fear. After four months of attending play therapy, Jasmin felt safe enough to physically separate from her mother and join me unaccompanied. She was testing the limits of her coping skills and taking a brave step towards a new level of security and developmentally appropriate autonomy. Towards the very end of our work together, Jasmin used the baby doll to role play the nurturing mother, while also addressing her feelings around friendships through parallel enactments of shared play in the playground/school yard.  

Jasmin now attends our sessions and often proclaims that she is the teacher, stating that “it is now time for a music lesson!” She plays the instruments, sings, dances, and performs with confidence. It has been such an incredible transformation! At the beginning of this journey, Jasmin’s mother did not think it was possible for her daughter to change or live a normal life. But with the right environment, trust in the process, and using play as a medium to bring us together, alongside clear communication and teamwork between the parent and child, such seemingly unattainable goals became achievable. 

 Testimonial

Jasmin’s mother wanted me to share some words about her experience of play therapy:

“Play therapy simply took me out of the darkness into the light. At the beginning of the journey, I was not completely sure that I would reach my goal and that my only daughter would be like the rest of the children. But I had faith in Allah that made me take the risk. In my first meeting, I saw everything that was said like a dream that was difficult to achieve. The therapist told me that in a year from now, Jasmin will be in school. I muttered to myself ‘just a dream. Allah, please help me to achieve it.’ My child was diagnosed with severe anxiety.

The next day, the journey began with the therapist, Gemma. When I looked into her eyes, my eyes filled with tears. I waited for her to confirm what the doctor had said; that the diagnosis was anxiety and not something else. Gemma greeted me with a smile that gave me hope that my daughter would be cured of that anxiety. Every day while she was assuring me that we would arrive at that goal, my patience was tested.

On our daily trip for the whole year, I saw the light coming from a small gap, and that gap started to widen more, and I saw that light growing stronger. It was a challenge getting to the sessions every day at nine in the morning, on time and in the same chair awaiting victory.

I believed in play therapy. I stuck to it, as a child clings to her mother, and I held onto it with all my strength. Gemma's whispers of confidence never left me. Her support, clarification and understanding were so important. While she was treating my child, she did not realize that she was doing so in a very culturally sensitive and experienced manner, embracing the mother and child together.

Yes, there were many challenges, with those many moments of Jasmin closing her eyes and crying when she saw Gemma (therapist), ending with her running towards Gemma. Yes, it's play therapy but don't underestimate the word. It’s a new hope for every child who is suffering.

And now, after a year, I am looking at the end, exactly as they promised me. My child is now entering her first school year. It is an amazing treatment that is not based on the use of chemical medicines, especially with such young flowers.”   

*Names have been changed for anonymity  


File under: The Art of Psychotherapy, Child & Adolescent Therapy