Dear Patti,
Our daughter Bailey just turned 4. She’s bright, funny, good-natured and a joy to be around. Nine months ago we enrolled her at an excellent preschool but, for some reason, she’s withdrawn, plays very little with other children and even wets her pants. We’re confused because she’s not like that at home or when playing with her cousins.
 
The school gave us a list of child counselors and is recommending play therapy. Bailey’s pediatrician said she’s physically healthy and will probably outgrow this behavior, but he also thinks child therapy might be a good idea. 
 
I believe in psychotherapy but know almost nothing about play therapy. We’ll do anything to help Bailey, but it seems like we’d be spending a lot of money just to have a counselor play with her. Could you explain how the process works?
—Helga

Dear Helga,
I can understand how play therapy might seem like nothing more than “playing” but, in fact, important psychological work takes place during this form of psychotherapeutic treatment. Play is a child’s natural form of communication. Accordingly, therapy modalities that encourage expression through playtime activities help address such behaviors as acting-out aggression (hitting, biting, teasing), the inability to sit still or concentrate, and — like Bailey — symptoms of withdrawal brought about by fear, pressure and/or separation anxiety. Play therapy is also helpful after a child has been exposed to a traumatic event such as illness or the divorce of parents, as well as new transitions, like starting school or adjusting to a new sibling.
 
Whatever the core of Bailey’s problem, the play therapy process will provide her with a developmentally appropriate way of accessing her feelings so that therapeutic healing can occur. In this environment, various toys, such as puppets, dolls, paints, clay, paper, crayons and dress-up clothes, are set out. 
 
A shallow tray filled with sand is another common tool in play therapy and invites a child to use small representational people, animals, cars, etc., to create her own imaginative worlds. Through sand therapy, guided imagery, storytelling, fantasy and drawing, Bailey will be able to fantasize, mirroring her life experience and expressing her inner feelings.
 
Although every child comes into play therapy with issues particular to his or her situation, play therapy generally has three stages. Initially, Bailey may feel anxious and appear immobilized because of diffused or undifferentiated feelings about what’s happening.
 
As she starts to feel safer with her therapist, she’ll enter the second stage where her emotional focus will become more specific insofar as individuals and situations. For example, Bailey might express being afraid of being around two boys when they’re by the slide because they once pushed her when she was there. In the third stage, feelings of ambivalence will be expressed through both positive and negative feelings. Bailey, for instance, might express being afraid of being around the two boys by the slide, but actually saying that she likes playing with Brittany. Unlike the first stage of being afraid of all children, she has narrowed her anxiety down to specifics.
 
A major goal of this imaginative play is to allow her to understand her inner world, which will ultimately help her become more secure at school and other social situations. It’s a therapist’s responsibility to create a place for your daughter where her feelings and perceptions are fully accepted. By exhibiting genuine empathy toward Bailey — especially in her emotionally vulnerable state — a positive therapeutic alliance can be developed between them. Once Bailey realizes that her feelings can be freely expressed, better understood and accepted, she’ll gain a stronger sense of self-worth and confidence.  The therapist’s role is to be supportive and sensitive to what Bailey is feeling and respect her for who she truly is rather than who she will be or should be.  Play therapy will also give her the chance to explore age-appropriate behavioral strategies and learn how to communicate more effectively.