The Process of Play Therapy

At the heart of play therapy is not a technique or a set of activities — it is a relationship. As Garry Landreth describes in The Art of the Relationship, the process of play therapy rests on the connection formed between the therapist and the child. It is not something that is achieved or accomplished in a single session. Rather, it unfolds through shared interactions, facilitated by genuine caring and total acceptance, in which the child is given permission to expand their sense of self.

How the process unfolds

Drawing on the work of Clark Moustakas (1955), Landreth outlines five stages that characterise the developing play therapy process, each reflecting a shift in how the child expresses their inner world through play.

In the early stages, children often express negative feelings directly — a child who cannot tolerate mess, who is hostile toward the room, the toys, or the therapist. This is followed by ambivalent feelings, where anxiety and hostility sit alongside one another. A child might throw a toy aside saying “I don’t like this,” then pick up another and say “but I like this” — holding contradictory feelings at the same time.

As the process continues, feelings become more focused and direct, often expressed toward significant people in the child’s life. A child may line up figures representing family members and act out strong reactions toward them — a way of processing experiences that feel too big to say aloud.

The fourth stage brings ambivalence with both positive and negative feelings toward parents, siblings, and others — a sign that the child is beginning to hold complexity, rather than operating in extremes.

By the fifth and final stage, the child’s play reflects clarity and separation, with positive attitudes beginning to predominate. The difficult feelings have not disappeared, but they are no longer overwhelming.

What makes this possible

Arriving at this fifth stage is not simply a matter of time. It is the direct result of the therapeutic relationship — one built on understanding, acceptance, and care. Within that relationship, the child feels safe enough to become who they are capable of being. The therapist’s acceptance of the child’s unique self is gradually internalised, and the child begins to appreciate their own uniqueness. This, as Landreth describes, is the beginning of self-knowledge.

References

Moustakas, C. (1955). Emotional adjustment and the play therapy process. Journal of Genetic Psychology, 86, 79–99.

Landreth, G. L. (2024). Play Therapy: The Art of the Relationship (4rt ed.). Routledge.