Play therapy is a form of child therapy in which play is the main way a child communicates and works through feelings, with a trained therapist guiding the process. Young children often cannot explain what is wrong in words. The American Academy of Child and Adolescent Psychiatry (AACAP) says playing, drawing, building and pretending, as well as talking, are important ways for children to share feelings.
Part of our guide: A Parent’s Guide to Child and Teen Mental Health
It may be a good fit for some young children, and the research supporting it is real but more limited than for behavioral and cognitive behavioral therapies. It helps to know how it works, and how it compares, before you decide.
If your child talks about suicide or self-harm, or you think they are in danger, call or text 988 (988 Suicide & Crisis Lifeline), call 911, or go to the nearest ER. Play therapy is not a crisis service.
How play therapy works
A 2023 published case series describes play therapy as using play and creative activities to help children express their thoughts and emotions. The therapist creates a safe, supportive setting in which children can communicate experiences and feelings and learn new coping strategies. The practice's play therapy page adds that the therapist tracks emotional shifts, themes and responses along the way.
A child who keeps acting out a scene in which a doll gets lost, for example, may be showing something about worry or separation. A skilled therapist treats that as one piece of information, and tests it against what parents and others report.
Child-led and more structured styles
| Style | What it looks like |
|---|---|
| Child-centered (non-directive) | The child leads the play. The therapist listens, reflects and offers warmth and acceptance. |
| Cognitive-behavioral play therapy | More structured. The adult brings CBT ideas into the play. |
Many therapists adjust their approach to the child. Ask which style your child's therapist uses, and why.
What happens in a session
Sessions take place in a space with toys, art supplies, puppets, figures or games. At Mind Body Seven, the play therapy page explains that the work is structured and guided by the therapist, and that children are not left alone to "just play." For older children, sessions may include storytelling, games or more talking.
From a child's point of view, it may mostly feel like playing with a kind adult. That is part of how it works. Your child does not need to know they are "working on" anything, although you should still be honest about why they are going. See how to talk to your child about starting therapy.
Where parents fit in
The CDC says engaging parents and caregivers in treatment is important for children at all ages, and that it is common for therapy with young children to include them directly. The practice's play therapy page describes regular caregiver check-ins about themes, behavior changes and strategies for home, with feedback focused on patterns and needs rather than specific play details. Your child's therapist can explain what you can expect to hear, and how you will be kept informed.
Who it may help
The practice's page says play therapy is most commonly used from early childhood through pre-adolescence, and that developmental stage and language ability matter more than age alone. Published descriptions list behavioral issues, anxiety, depression, trauma and relationship difficulties among the concerns it is used for.
The same page says it may not suit situations with active safety concerns, ongoing abuse or severe neglect, or an acute psychiatric crisis, where other kinds of care should come first.
What the research shows
This is where honest detail helps. A 2023 review of reviews in Clinical Child and Family Psychology Review looked at treatments for young children's mental health (ages 4 to 9). It reported:
- Overall quality: studies on play therapy were rated very low to low/moderate in quality.
- Symptoms overall: two meta-analyses reported small to large effects on mental health outcomes, and the review says play therapy consistently led to improvements in internalizing and externalizing symptoms.
- Behavior: one moderate-quality meta-analysis found child-centered play therapy reduced externalizing and overall problem behaviors, with medium effects.
- Trauma and hard experiences: findings are mixed. One moderate-quality review called it promising for children who experienced adversity, while a low-quality review found very few differences between treatment and control groups and concluded there is limited evidence to recommend it for children who have experienced trauma.
- Self-regulation: a meta-analysis of single-case studies reported it was not effective for improving self-regulation skills.
- ADHD: play-based interventions delivered by occupational therapists in schools could not yet be considered evidence-based for ADHD.
By comparison, the same review found substantial evidence for behavioral and cognitive behavioral interventions and only limited emerging evidence for other approaches. Critics cited in the 2023 case series also point to a lack of standardization and of large, well-designed studies.
So play therapy may help some children, especially with behavior concerns, but it is usually fair to ask whether a better-studied option should come first or alongside it. A good therapist should welcome that question.
How it compares with other options
| Approach | Main idea | Parent role | Evidence note |
|---|---|---|---|
| Play therapy | Child expresses and works through feelings using play | Regular check-ins; varies by therapist | Very low to low/moderate quality; some positive findings |
| Parent training in behavior management | Parents learn skills that strengthen the relationship and shift behavior at home | Central | The CDC lists it as one type of behavior therapy and says it works well for disruptive behavior disorders |
| Cognitive behavioral therapy (CBT) | Child learns skills for thoughts, feelings and actions, adapted to age | Varies; often involved | Substantial evidence in the review of reviews |
| Family therapy | Works on patterns and communication across the family | Direct participant | Depends on the problem being treated |
The CDC also says different therapies seem to work well for different types of problems, and that therapy is most effective if it fits the needs of the specific child and family. These approaches can also be combined. If you are comparing formats, the article on family or individual therapy for your child may help.
How to decide
Play therapy may be worth considering if your child:
- Is young, or has trouble putting feelings into words
- Shuts down when asked direct questions
- Has been through a stressful change and is showing it through play or behavior
Ask about alternatives or additions if:
- The main concern is a specific behavior problem at home, where parent training may be central
- Your child has an anxiety disorder or OCD, where the same review found substantial evidence for cognitive behavioral approaches
- Your child is suspected of having ADHD, where an evaluation and other treatments may be more relevant
- There are safety concerns, which need immediate attention
Questions to ask a play therapist
- What training do you have in play therapy and child development?
- What is the goal for my child, and how will we know if it is working?
- Which style do you use? Are there other treatments you would consider instead?
- How often will we meet as parents, and what will you share with us?
- What can we do at home between sessions?
- When would you change course or suggest something else?
AACAP also suggests asking why psychotherapy is being recommended, what results to expect, how long it may last, and how soon you might see changes. The length of therapy depends on the complexity and severity of the problems, and the practice's page says there is no fixed timeline.
How to tell if it is helping
Look for changes over weeks and months in daily life: fewer or shorter meltdowns, easier bedtimes, more words for feelings. Raise it with the therapist if nothing has shifted after a reasonable period or if your child strongly dislikes going. AACAP notes that therapy goals may be specific, such as a change in behavior or improved relations with friends or family, so agree on what those are early on. The article on behavior as communication in kids can help you spot what to track.
At Mind Body Seven, Dr. Linda Perez-Puelles, PsyD is listed for play therapy. The play therapy page and the child and adolescent psychiatry and therapy page have more on how care works here, and costs are covered on the fees and insurance page.
FAQs
What age is play therapy for?
It is most commonly used from early childhood through pre-adolescence. Developmental stage and language ability matter too, so ask the therapist whether it suits your child.
Is my child just playing?
It can look that way, and that is partly the point. A trained therapist guides the session, observes patterns and responds with a purpose in mind.
Will I find out what my child did in session?
Usually you hear about themes, progress and what to try at home, more than a play-by-play. Ask the therapist how they will keep you informed.
Is play therapy evidence-based?
There is some supporting research, especially for behavior concerns, though a 2023 review rated the studies very low to low/moderate in quality. Behavioral and cognitive behavioral therapies have stronger evidence overall.
