When adults need to process difficult experiences, they talk. Children process through play — it is their natural language for working through what they've encountered, what they feel, and who they are. Play therapy is a clinical approach that meets children exactly there.
Why children need a different therapeutic approach
Adult therapy relies heavily on verbal articulation: describing experiences, identifying and naming emotions, making connections between thoughts and feelings, and reflecting on patterns. This requires cognitive development that most children haven't fully achieved.
Children under about 10 don't have the abstract reasoning capacity to think about their own thinking (metacognition) or to step back from an experience and analyze it verbally. What they can do — naturally, fluently, and often therapeutically — is enact it. The dollhouse becomes the family; the sand tray becomes the situation; the puppet carries the feelings the child can't say directly.
Play therapy uses this developmental reality as the medium of treatment rather than working around it.
The research base
Play therapy has been studied since the 1940s. A comprehensive meta-analysis by Ray and colleagues (2015) found significant effects across diverse conditions, settings, and populations. More recent research specifically supports play therapy for trauma (where it is often combined with Trauma-Focused CBT), anxiety, ADHD, and behavioral disorders in young children.
The Association for Play Therapy maintains a body of evidence-based practice recommendations, and play therapy is recognized as a legitimate clinical specialty with its own credentialing (Registered Play Therapist, RPT).
Types of play therapy
Nondirective (Child-Centered) Play Therapy follows Carl Rogers' humanistic principles: the therapist provides unconditional positive regard, empathic reflection, and a safe environment, and the child directs the session completely. This approach trusts the child's natural drive toward health and integration.
Directive Play Therapy involves the therapist introducing specific activities, games, or scenarios in service of explicit therapeutic goals. This might include structured trauma narratives, social skills games, role-playing, or expressive arts with specific therapeutic prompts.
Cognitive Behavioral Play Therapy (CBPT) integrates CBT concepts into play-based interventions — particularly helpful for anxiety and behavioral challenges.
Trauma-Focused CBT (TF-CBT) uses play-based components within a structured, evidence-based protocol for children who have experienced abuse, neglect, or traumatic events. It involves both the child and parents. Learn more about trauma-informed care →
Theraplay focuses specifically on the attachment relationship and is used for children with attachment disruptions, foster and adoptive placement challenges, and developmental trauma.
What happens in the room
A well-equipped play therapy room includes:
- Sand tray with miniature figures representing people, animals, buildings, and symbols
- Art supplies (crayons, paint, clay)
- Puppets and stuffed animals
- Dollhouse and figures
- Building materials (blocks, LEGO)
- Games and cards
- Costumes and props
The therapist observes carefully: what the child chooses to engage with, what themes emerge repeatedly, how the child navigates conflict and resolution in play, what emotions arise around different materials. This observation informs the therapist's understanding and responses.
Limits are set calmly and consistently — not as punishment, but as structure that helps children feel safe. Some directive guidance helps children who are stuck, overwhelmed, or needing specific skill-building.
How parents stay involved
Particularly for younger children, parent involvement is critical. Children can't implement change on their own — the adults in their lives are the system through which therapeutic insights become daily reality. Your child's therapist will typically meet with you periodically to share observations, provide psychoeducation, and give you specific strategies to support progress at home.
Parents of children in play therapy should expect to actively participate in the work — not just in drop-off and pickup, but in conversations with the therapist about what you're seeing and in practicing new responses at home.
Getting started in Minnesota
MMHC's children's therapists are trained in play therapy and other evidence-based approaches for children across the Twin Cities. A first appointment begins with a parent interview to gather background before meeting your child. Most major insurance plans accepted.