What Is Play-Based Therapy? Helping Children Express, Process, and Build Skills Through Play
QUICK ANSWER:
What is play-based therapy?
Play-based therapy uses games, art, storytelling, imaginative play, and other developmentally appropriate activities to help children communicate, process emotions, and practice new skills.
Children do not always have the words (or the desire) to sit across from an adult and explain exactly what they are feeling. Play gives therapists another way to understand a child’s experience and makes therapeutic concepts easier to explore.
Although sessions may look playful, the activities are chosen intentionally and connected to the child’s treatment goals.
If you ask a child what is making them anxious, they may shrug and say, “I don’t know.”
Five minutes later, while building a world out of blocks or creating characters in a game, they may show you exactly what feeling anxious is like for them.
Children often communicate differently from adults. They may express themselves through stories, movement, drawings, games, humor, or imaginative play before they are able or willing to explain an experience directly.
That is where play-based therapy can help.
Play-based therapy meets children at their developmental level and allows therapy to feel more natural, engaging, and accessible. Instead of expecting a child to talk for an entire session, the therapist incorporates activities that help the child express emotions, understand patterns, and practice new ways of responding.
What Is Play-Based Therapy?
Play-based therapy is an approach that incorporates play and creative activities into psychotherapy.
Depending on the child’s age, interests, needs, and treatment goals, sessions might include:
Board games or card games
Drawing, painting, or crafts
Dolls, figures, or stuffed animals
Building blocks or other construction materials
Storytelling or imaginative play
Movement-based activities
Sensory tools
Therapeutic worksheets or visual activities
Role-playing and practicing real-life situations
These activities are not simply included to entertain the child.
The therapist pays attention to how the child approaches challenges, manages frustration, communicates needs, responds to mistakes, navigates relationships, and makes sense of their experiences.
Play can also create opportunities to teach coping skills in a way that feels concrete and memorable.
Why Use Play in Therapy?
Adults often use conversation to organize their thoughts and make sense of their experiences. Children may not yet have the language, self-awareness, or abstract thinking skills required to do that in the same way.
A child might know that their stomach hurts before school without being able to explain that they are anxious about making a mistake.
They might become angry when a game does not go as expected without understanding that losing brings up feelings of embarrassment or not being good enough.
They may act out a conflict between two characters before they feel ready to talk about a conflict happening in their own family.
Play creates some distance between the child and the problem. Talking about what a character feels can sometimes feel safer than immediately talking about themselves.
It also allows the therapist to make skills more tangible. A child can practice flexible thinking during a game, create a visual plan for handling worries, or role-play how to ask a parent for help.
For many children, play is not separate from the therapeutic work.
Play is how we access the work.
Is Play-Based Therapy Just Playing Games?
No (although it may occasionally look that way from outside the therapy room).
A therapist might use a game to help a child:
Practice handling frustration or disappointment
Notice perfectionistic thinking
Become more comfortable making mistakes
Take turns and read social cues
Improve impulse control
Identify emotions and physical sensations
Practice flexible thinking
Communicate wants and boundaries
Tolerate uncertainty
Strengthen problem-solving skills
For example, a child who becomes extremely upset when they lose a game may be experiencing similar difficulties when they make a mistake at school or feel less successful than a sibling.
Rather than simply correcting the reaction, the therapist can help the child slow down, identify what happened internally, and practice responding differently in real time.
The game creates a natural opportunity to observe and work through the pattern together.
What Happens During Play-Based Therapy?
There is no single script for a play-based therapy session.
Some sessions may be more child-led, allowing the child to choose how they would like to engage. Other sessions may be more structured, with the therapist selecting an activity connected to a particular goal.
A session might include:
Drawing what anxiety looks or feels like
Creating characters that represent different emotions
Using a board game to practice coping with mistakes
Building a “worry monster” and identifying what feeds it
Role-playing how to respond to a difficult social situation
Using figurines to explore family or friendship dynamics
Practicing urge-management skills while completing an activity
Making a visual coping plan
Playing a cooperative game to work on communication
Using stories or metaphors to explain how the brain responds to stress
The therapist may talk with the child throughout the activity, but the child is not expected to maintain a face-to-face conversation for the entire session.
The balance between talking and playing will depend on the child.
Is Play-Based Therapy the Same as Play Therapy?
The terms are sometimes used interchangeably, but they can have different meanings.
The Association for Play Therapy defines play therapy as a structured approach in which trained play therapists use the therapeutic powers of play to help clients address psychosocial difficulties and support healthy development.
“Play-based therapy” is often used more broadly to describe psychotherapy that incorporates games, creative activities, storytelling, movement, or other playful interventions.
A therapist may integrate play-based techniques alongside approaches such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Exposure and Response Prevention (ERP), Habit Reversal Training (HRT), or other evidence-based treatments.
For example, a child receiving ERP for OCD might create a fear ladder using drawings or complete exposures through a game. A child working on hair pulling might become an “eyelash detective” and use visual activities to identify triggers and practice competing responses.
The play helps make the treatment more developmentally appropriate without replacing the clinical goals behind it.
What Can Play-Based Therapy Help With?
Play-based interventions can be used to support children experiencing concerns such as:
Anxiety and excessive worry
OCD and related disorders
ADHD and impulsivity
Emotional regulation difficulties
Perfectionism
Low self-esteem
Family changes or transitions
Friendship or social difficulties
Grief and loss
Trauma or stressful experiences
Body-focused repetitive behaviors
Difficulty identifying or communicating emotions
The specific activities used should reflect the child’s needs rather than assuming that every child benefits from the same type of play.
One child may express themselves easily through art. Another may dislike drawing but become completely engaged in a strategy game. Another may prefer movement, storytelling, sensory activities, or simply talking while their hands are occupied.
Effective therapy follows the child’s cues and interests while remaining connected to meaningful treatment goals.
What Are the Benefits of Play-Based Therapy?
Play-based therapy can make it easier for children to:
Feel comfortable and connected with their therapist
Communicate experiences they cannot easily put into words
Explore emotions with less pressure
Learn therapeutic concepts in concrete ways
Practice skills during the session
Build confidence through manageable challenges
Develop emotional awareness
Increase frustration tolerance
Strengthen problem-solving and flexible thinking
Experience therapy as collaborative rather than intimidating
Play can also help the therapist see a child’s strengths.
A child who struggles to describe themselves may demonstrate creativity, persistence, humor, empathy, leadership, or strong problem-solving abilities during an activity. Therapy can build on those strengths instead of focusing exclusively on what is going wrong.
Does My Child Have to Talk About Their Feelings?
Not immediately, and not for the entire session.
Some children naturally begin sharing while their hands are busy. Others communicate through the choices they make in a story, game, or creative activity. Some need time to develop trust before they are ready to talk about more vulnerable topics.
A therapist may gently invite reflection by asking questions such as:
“What do you think that character is feeling?”
“What did you notice in your body when that happened?”
“Was it hard to keep trying when the game changed?”
“Does this remind you of anything that happens outside of therapy?”
“What helped you get through that moment?”
The goal is not to pressure a child into revealing something.
The goal is to create enough safety, connection, and curiosity for communication to develop naturally.
How Are Parents Involved?
Parent involvement depends on the child’s age, needs, treatment goals, and individual circumstances.
Parents may participate by:
Providing background information and updates
Helping identify patterns outside of therapy
Learning how to respond to anxiety or strong emotions
Practicing strategies with their child at home
Supporting consistent expectations and routines
Attending occasional parent or family sessions
At the same time, children and teens need an appropriate level of privacy in order to build trust with their therapist.
The therapist can help parents understand general themes, treatment goals, and ways to provide support while preserving the child’s therapeutic space. Safety concerns are handled differently and are communicated to parents or caregivers as clinically necessary.
Parent involvement is not about receiving a detailed report of everything the child says or does. It is about helping the adults in the child’s life understand what the child needs and reinforce progress outside of sessions.
Can Play-Based Therapy Be Used With Older Children or Teens?
Yes!
Play-based therapy is not limited to very young children. The activities simply change as children get older.
With tweens and teens, therapy might include:
Conversation-based card games
Creative writing or journaling
Art and visual exercises
Music, media, or character-based discussions
Strategy games
Collaborative problem-solving
Role-playing difficult conversations
Values activities
Interactive worksheets
Humor and age-appropriate metaphors
Some older children and teens find it easier to talk when the conversation is not the only focus of the room.
The goal is never to make therapy feel childish. It is to find ways of engaging that feel natural, respectful, and useful for that particular client.
How Do I Know Whether Play-Based Therapy Is Working?
Progress may show up in different ways.
You might notice that your child:
Recovers from frustration more quickly
Uses words to express needs or emotions
Tries a coping skill without being prompted
Becomes more flexible when plans change
Avoids fewer situations
Seeks reassurance less frequently
Handles mistakes with less distress
Communicates more openly
Shows increased confidence or independence
Experiences fewer disruptions at home, school, or with peers
Progress is not always linear. A child may understand a skill in therapy before they are able to use it consistently during a stressful moment at home.
The therapist, child, and caregivers can continue evaluating what is helping, where the child remains stuck, and whether the treatment plan needs to be adjusted.
Frequently Asked Questions
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No. Play-based and creative interventions can be adapted for school-aged children, tweens, and teens. The therapist should choose activities that feel appropriate for the child’s age, personality, and interests.
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That is completely okay.
Play-based therapy does not require dolls, puppets, or imaginative play. A child may prefer board games, art, puzzles, movement, sensory activities, building, or talking while doing something with their hands.
Therapy should not force a child into a particular type of play.
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Children can enjoy therapy while still doing meaningful work.
The therapist helps connect activities to the child’s goals and gradually builds their ability to reflect on what happens during play. Therapy does not need to feel unpleasant in order to be effective.
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Yes, play-based strategies can make evidence-based anxiety and OCD treatment more understandable and engaging for children.
For example, a therapist might turn exposure practice into a challenge, illustrate the anxiety cycle, create a character for OCD, or use a game to practice tolerating uncertainty. Play supports the treatment rather than replacing approaches such as CBT or ERP.
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Children need developmentally appropriate privacy to form a trusting therapeutic relationship. Parents are typically kept informed about treatment goals, progress, recommendations, and safety concerns without receiving a detailed account of every conversation or activity.
Your therapist should explain confidentiality and parent communication at the beginning of treatment.
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There is no single timeline.
The length of treatment depends on the child’s concerns, goals, developmental needs, family circumstances, and how they respond to therapy. Some children benefit from focused, shorter-term support, while others need more time to build trust and create lasting changes.
Looking for Play-Based Therapy for Your Child?
Your child does not need to be able to sit still, maintain eye contact, or explain all of their feelings perfectly in order to benefit from therapy.
At Temperance Psychotherapy, I use developmentally appropriate, play-based interventions to help children and teens feel more comfortable expressing themselves, understanding their emotions, and practicing new skills.
Play-based strategies may be incorporated alongside CBT, DBT, ERP, HRT, and other therapeutic approaches depending on your child’s individual needs.
I work with children and teens in person in Longwood and Maitland, Florida, as well as virtually throughout Florida.
If you are wondering whether therapy may be a good fit for your child, you can request an appointment or free consultation to get started.
Sources
The information in this article is informed by evidence-based clinical practice and resources from:
