Understanding Play Therapy: Game Play in the Therapeutic Space
What does playing a game in session have to do with therapy?
The games in Play Therapy playrooms are selected purposefully. Many of the games you may already have at home target social skills, emotional regulation, and concentration. Here are some examples of the games in my playroom and how they build skills during play therapy.
Games in Therapy
Trouble involves moving four pieces around the board at intervals determined by a dice roll. Each piece travels all the way around the board until it is placed in “home.” Several elements of this game involve tolerating frustration when things don’t go your way. For example, other players may land on your piece, sending you all the way back to the start. This can be infuriating and allows the child to process feelings of frustration. The child might say, “That’s not fair!” and angrily cross their arms. I might reply, “Ugh, it feels so unfair and frustrating that you have to move your piece back to the beginning. You really wanted to keep moving it forward.” In this way, I’m not telling the child to feel differently or judging their emotion; I’m validating that I understand where it came from and allowing the child to feel heard. Typically, at this point, the child may grumble a little more and then move their piece back to start, allowing gameplay to continue. The child learns that their frustration is allowed, and that I will make space for it to exist while we continue to play.
Connect Four is a game involving an upright grid where tokens are placed with the goal of connecting four in a row either horizontally, vertically, or diagonally. To be successful, a child must pay attention to both active play (trying to win) and passive play (not letting the therapist win). This means the child must concentrate on multiple tasks at once and make decisions based on which move will allow them to keep working toward making four in a row without the therapist winning first.
UNO is a game in which players take turns playing cards into the center pile. Cards must match in either color, number, or action (skip, +2, reverse). Cards are played until one player has played all their cards. During gameplay, when players no longer have playable cards in their hand, they must draw from the deck. This often requires players to reorganize the cards in their hand to be successful at winning the game. Many children organize their cards differently. Some children like to set up piles on the floor of matching colors or numbers, while others organize cards by color or number in their hand. While it's not necessary to be organized to win UNO, it certainly helps players increase their chances of winning. In this way, UNO aids children in learning organizational skills.
Candy Land is a board game in which players take turns drawing cards with different colors on them to journey from start all the way to Candy Land. Like Trouble, Candy Land involves tolerating potentially upsetting situations, such as getting stuck on a Licorice Square or drawing a Gumdrop card after the child has already passed the gumdrop square, causing them to backtrack. This offers abundant opportunities for children to express and process frustration and anger at the sudden “unfairness” of the game.
Jenga is a game in which players carefully attempt to remove one block at a time from a precarious tower without causing it to collapse. Jenga involves tolerating anxiety, as a child is aware that with each block pulled from the tower, it becomes more likely to collapse. The child must remain steady and focused to successfully pull a block out and continue gameplay. In the event that the tower falls, the child may express frustration, anger, sadness, or disappointment, at which point the therapist may sit with them, allowing their feelings to be heard and processed.
Card matching games focus on memory and concentration. In a matching game, cards are placed face-down in a grid on the floor or table. Each player takes turns picking up two cards, determining whether they are a match, and either replacing them in their respective spots or taking them as a match. The player with the most matches at the end wins the game. Card matching requires children to remember the location of matching cards and focus on the other player’s choices during gameplay. To be successful, a child must remember their own moves and revealed cards, as well as the moves and revealed cards of the therapist.
Finally, all of the above games involve turn-taking, tolerance of feelings, patience, and social skills—all of which are helpful practice for children.
Feelings-Focused Adjustments
Many games can be adjusted to involve more feelings-related discussion and learning. For example, in UNO or Candy Land, each color of card can be assigned to a different feeling. If I drew a red card, perhaps I would have to share something that makes me feel angry. If I drew a blue card, something sad, and so on.
Totika is a Jenga-adjacent game that comes with a deck of question cards asking players to identify their strengths and weaknesses or name the people closest to them for each piece they pull from the tower. This sparks conversation, builds relationship rapport, and has all the aforementioned benefits of playing a Jenga game!
Some versions of games can be modified so that the special spaces on the board mean different things. For example, I have the Bluey version of Trouble, which includes a scooter space, a magic xylophone space, and an asparagus space. Sometimes I modify the meanings of these spaces so that if a child lands on the asparagus space, they name a feeling they had today. A xylophone space could prompt them to name a coping skill.
Rapport Building
One of the fundamental parts of therapy is building a safe and trusting relationship between the child and therapist, called "building rapport." Although gameplay has many benefits for emotional regulation and concentration, it also builds connection. Throughout many of my sessions involving gameplay, I am laughing with my clients. We are smiling and joining in something that makes them feel connected with me, which allows more vulnerability and trust to be built in the therapeutic relationship.