Supporting children's mental health and wellbeing
Supporting children's mental health and wellbeing

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Supporting children's mental health and wellbeing

3.1 Play therapy in action

Children often find it easier to talk while they are playing. In a play-based therapy a practitioner uses a range of toys, books or other activities as a way of encouraging children to communicate their feelings and thoughts. The therapist will listen and observe the child during a play therapy session. In Session 5 you examined the importance of listening to children, the points covered included:

  • the importance of listening to the ‘whole child’, not just what they say verbally
  • keeping the child at the centre of the listening process
  • allowing the child to take the lead
  • how listening was related to the processes of attachment and attunement.

Attunement can be perceived as the art of reading body language, reading what the child is doing in their attempt to communicate with us. As adults, we need to feel open to what children are saying, demonstrating and expressing. Then we can affirm what they have said by repeating their expressions and body language so that we are ‘in tune’ with what they want us to see, rather than what we think we want for or from them.

Activity 2 Counselling children through play therapy

Timing: Allow about 20 minutes

As you listen to Christine (who is a play therapist) in the following video clips, consider how she is explaining the art of listening to children and how she allows the child to take the lead in the counselling process.

You might want to watch all the video clips at once or just dip into each as and when you want to.

Download this video clip.Video player: Video 1
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Transcript: Video 1

CHRISTINE
So partly intuitively, partly through the training, I've always wondered about the child and felt that whatever a child brings and whatever behaviour they show to us as adults, there is a reason for that. So I've always been very curious about that.
So in fact, any approach, or every approach, I have with a child or with a young person is, tell me about you. What's it like? I want to understand. What's it like to be you?
Because that's different for every single one, and we mustn't assume because of the experiences that I have had that the child will have the same experiences. Quite the opposite. So I'm always very, very mindful of that. And it really doesn't matter how old the child is. That applies to the 18-month-old toddler to the 18-year-old who is just leaving home.
Mostly, when children are able to communicate with us verbally, we obviously then use emotional words. And I check the children have the same understanding of that, or at least I'm curious of what their understanding of a word, an emotional word, is. With younger ones, it's more about watching and observing their reactions and their interactions with other people.
What I always feel and go to real length to explain to young people is when I first meet them here in this room is that I'm different to a teacher or a doctor. I'm not here to fix anything. I haven't got a magic wand. But I can be another adult who will listen to them and who will be alongside them.
I bear in mind that a child is always referred to me by an adult. So that's always sort of this-- I'm wondering, do you actually want to be here? Do you know what's going to happen here?
So explaining to a young person-- and I'll call a young person or child, whichever way is appropriate to them-- that I haven't got an answer, and I'm not a teacher who has to write a report, or I'm not a doctor who's going to give medication and medicines. But I'm going to make every effort, and I'll try my best, to help them become a little bit of an expert on themselves so that they can understand what makes them angry, why they're angry, what makes them frustrated or anxious. So that's how I explain to a young person what my role is and how it is different from the adults that they may have in their lives.
End transcript: Video 1
Video 1
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Transcript: Video 2

CHRISTINE
When I start working with a child-- I always use the word working with a smile in my head, because I don't feel it is work because very often I just am with a child. I just spend time with them. And we play, and we talk, and we explore things.
The guiding principle for me is the acronym PACE. P for playfulness, A for acceptance, C for curiosity, and E for empathy. Not necessarily in that order, but somehow in the session those four words always stay in my head.
So if I go with acceptance, no matter what the child decides and says, it's right for them because it's their truth. Empathy is actually quite a loaded word, but I think of that more as being attuned to a child. So I can really observe the nuances in their reactions sometimes when they don't say anything or do anything. That's communication. And I need to be and feel I can be attuned to them.
And we also know that playing and playfulness is actually a child's work. So it's important that they have things in the room where they can play. And to build that initial relationship with the child, I play with them. As much as I observe them, I am very aware that a child of even a very young age observes me.
They need to come away with a sense of, oh, this is a trustworthy adult. Not that they'll have that cognitive ability to come to that conclusion, but their sense is she's a nice lady. She's a good person. That's what I want to be for them. And I'm aware that a very young child will also go out of this room at the end with a sense of who is this person.
And the curiosity, that's become my language with them. I wonder what it feels like. I'm curious. So there isn't, I think you feel happy, I think you feel cross. I'm wondering. And that opens up that communication with the child to show me, tell me. And I observe. So that, I think, sets me as a counsellor apart from any other professional that a young person has in their lives.
End transcript: Video 2
Video 2
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Transcript: Video 3

CHRISTINE
So when a child or young person first comes to the room to meet me, it's with the parent. I invite the parent. I really would like-- I like the parents to be in the room first because that's when I tell them about the confidentiality and the permission.
I want parents to give, very, very explicitly, permission to the child to bring anything they want into this room and that I won't feed back to anyone. I won't share what the child says. And the parents need to be comfortable with this, and I want the child to hear the parents say that.
In many cases, the first session is also about getting a little bit of the backstory, what brings them here. And again, I do this very deliberately, with the parent and the child in the room. Although, I may brief the parent to be mindful of the child's feelings, and if there was anything in more depth that we should discuss that I would invite them to do that either by email or by phone or in a separate meeting.
So that gives the child the sense of I am the one who matters. Because that's-- I go to great lengths to explain that this is the child's time and this is about them, as I have this in my head-- I want the child to feel empowered.
You know, a lot of the time, the reason for children being brought to counselling is because either they've become a problem in the family or they're the naughty ones. They're the difficult ones. And of course, that's how they might present, but for me, it's why? What lies behind that? And how can a five-year-old or a six-year-old really be the problem in the family? So I want to-- I have that in my head. I have that in what I focus about when I see them.
Very often, then, and depending on how confident the child is, I will invite them to stay with me on their own for 10 minutes. I'll invite parents to go out of the room to sign that form that we all need to have signed, and then I'll just check in with the child. Are they feeling comfortable with me? I'll explore the room with them. I'll take them on a little tour of the room. But I get a sense, then, are they actually happy to stay here and are they comfortable?
So that's the first phase. We then agree with the parents that the contract, if you like, is with the child in terms of what we talk about, and what we do is ours. But it's obviously the parent who has to agree to bring them on a regular basis and to make payment and all the kind of-- that side of thing. That's their job, and the child's and my role is kind of a three-way contract.
End transcript: Video 3
Video 3
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Transcript: Video 4

CHRISTINE
The way I section the counselling is in three phases. The assessment phase and the initial phase is when I meet with a parent to get the backstory and to explain what I can offer. The middle phase is then about the actual work with the child. So the child, for example, who is angry, we look at how we understand that anger a little bit better and how we can express it safely.
So that's the actual work we do. It may not be explicit. You were angry, you need to do point 1, 2, or 3. It's through the process of spending time with the child and getting them to explore their reactions. And that's by playing games. How do they feel about winning? How do they feel about losing? That's the middle phase.
That takes as long as it takes. There is no limited or prescribed amount of time. But as is always the case with counselling and therapy, we need to be mindful towards ending therapy. It's bittersweet for us as counsellors because we build a relationship with the young people. But I'm also very aware that when it comes to that third phase, towards ending, beyond therapy, then that the child has become more able to understand themselves better.
I like to feel, and I use the expression sometimes quite deliberately, that the child has become an expert on themselves a little bit more. It's always a lifelong thing. But when I feel, or when together we feel the child has got some tools and strategies that they can apply outside of the room, then we work towards the ending.
End transcript: Video 4
Video 4
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Transcript: Video 5

CHRISTINE
The room is set up on the face of it when you first walk in, I guess, it's just a bit cluttered, if you like. But there is method in that madness, because obviously a lot of thought has gone into what would help a child first of all feel comfortable and relaxed. And as I said earlier, playing is part of a child's world.
And so I very deliberately have a variety of things in the room. One easy way of describing that perhaps is that I was very mindful of the senses. So I want children to be able to experience and explore through a variety of media. So some child might be very tactile, so there are things in the room that they can really handle and play.
So there's Play-Doh, there's sand. It's on the line of children being able to feel something in their hands. There are also some materials in the room where it allows the child to express themselves through art, either by using paints or the whiteboard. Sometimes, children really like to doodle and to draw.
And together, we can then explore what that means, what they're trying to tell me or themselves. Sometimes, they discover things for themselves. It's about that, too. There are other things in the room where we perhaps go more into the sense of relational games and activities.
Those games can be really quite fun. We laugh. We are noisy. We express our frustrations. And it's something where we can be quite competitive, even. But it is something where we are together.
End transcript: Video 5
Video 5
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Transcript: Video 6

CHRISTINE
For me, the most important thing in my work with the children is to be with them, to spend time with them where they are not guided, where they are not interrupted, where there isn't an agenda, where there isn't a lesson plan. We can just make it up as we go along and be free with free play, free flow play.
What else is there? Puppets and soft toys, some children really, particularly those who don't want to tell their story directly might feel more comfortable using puppets. So using a puppet to then use them in front of their face and give them a voice.
And sometimes, they talk to me, and I have a puppet. So it's like two puppets interacting. And that's the skill, then, really, and the joy of responding to whatever the child brings.
End transcript: Video 6
Video 6
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Transcript: Video 7

CHRISTINE
If children want to build something, I've got LEGO. And LEGO is something that they really, really love. That means they are really fully engaged with the LEGO, but I go with them. I go out on the floor alongside them, and I then really have a sense I am just in tune with the child.
Not just the LEGO. I invite children to take things off the shelf. There is a curiosity basket, I call it, with all sorts of odd things in there. And I ask, invite the child to bring it down on the floor together on the floor. We empty it, or I watch what the child brings out, and something always develops. And just spending time being together is so important.
So I like the idea of making something for children to be able to have something tangible when they talk about feelings. So using something like this toy works really quite well. So the idea is that a child has a worry. The worry is written on a piece of card.
And then it's put inside that toy's tummy so that it can be eaten and gone. Because very often, feelings stay as thoughts in a child's head, but they haven't got the tools to deal with that. But physically putting it somewhere works really, really well.
End transcript: Video 7
Video 7
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Transcript: Video 8

CHRISTINE
I remember when I was still at school, I persuaded senior management that they allow me to take Sammy to school because he's just such a lovely dog. And they agreed.
And what happened was that a young girl, very sadly, her father had died very suddenly. And she came to my office, and Sammy was in my office. And she just sat by him on the floor and eventually fell asleep with her head on Sammy's shoulder. And she then went home and just felt-- and said to mum how she loved and how that was so, so calming for her to be able to just be allowed and to just lie on Sammy.
So that really is when the idea of wow, Sammy's so good with that started. And I looked into pets are therapy more and using animal-assisted therapy. And so I explored that in more detail.
And what I found was that Sammy-- and not just Sammy. I guess it works with other therapy dogs. A child, for example, who isn't very confident, would speak very quietly, very softly, or not at all to anyone in school or even in the family. But when they were with Sammy, I've discovered that they'd all of a start sudden start talking with them. And we would do things like, well, would you like to give Sammy a treat? But then I could, with that, encourage the child to praise Sammy for sitting nicely and for lying down or giving the paw.
So although I wouldn't use the word "become more assertive" with a child, but that's what happened. The child's voice became louder. The child's voice became stronger and more positive. So because Sammy is this beautiful dog, unconditional love, unconditional, it gave that child that confidence and that boost.
End transcript: Video 8
Video 8
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Transcript: Video 9

CHRISTINE
A really deep observation I found was that a child was more able to identify feelings or states of being in Sammy than in other beings, in human beings, in friends, or family. So Sammy would lie totally relaxed, sleeping, and the child would notice that Sammy is calm, and he's relaxed.
So I could then make the link with, well, what is it like for you to be calm and relaxed? What do you do to be calm and relaxed? And the opposite, when Sammy was excited because he knew there was a treat coming, that liveliness.
So Sammy became this-- or is and continues to be this intermediary between the child and the world, if you like. And it is a real, real lovely way of helping a young person to just discover by observing, to discover their own feelings and their own emotions by observing and describing that of Sammy.
End transcript: Video 9
Video 9
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After watching the video clips, note your responses to the following questions:

  • How would you describe the key aspects of the counsellor’s approach to working with children explained in the videos?
  • In what ways does Christine suggest her role is different from other adults who might be supporting children?
  • What processes were described in each of the three counselling phases Christine mentioned?
  • How did Christine explain the ways in which she uses her therapy dog, Sammy?
  • Which activities demonstrated by the counsellor interested you the most?
  • Why do you think that was?
  • How do you think children would respond to the different activities?
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Discussion

In the video clips you will have noticed how Christine, the counsellor, stresses how she keeps the child at the centre of her focus and is very much guided by what the child chooses to do. Christine’s role is more of a ‘watchful presence’, allowing the child to explore their environment and their feelings and reactions while she ‘actively listens’ to what they can share with her. These processes may well remind you of the role of the adult listening to children in early years’ settings, as you explored in Session 5.

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