Guidelines for Referral Based upon the Observation of
These guidelines are based upon an extract from Children’s
Imaginative Play published by the Greenwood Publishing Group August 2002. The author Shlomo Ariel PhD is a clinical
psychologist and supervisor of clinical psychology and marital and family
therapy in Israel.
Integrative play diagnosis and play therapy can be carried
out properly only by specially trained professional therapists. However, lay
persons - parents, educators and other carers of children - who are worried
about a child under their care, can include careful observations of the child's
spontaneous play in their sources of information about the child's emotional
condition. It should be stressed that not every aspect of children's play, or,
for that matter, non-play behaviour, that might look to an adult worrying is
really a cause for concern. Perfectly normal young children are often
irrational, irresponsible, and absurd. The make-believe play of well-adjusted
children often includes themes of patricide, matricide, suicide, sadism, and a
whole assortment of ideas that might look way out, bizarre and crazy from an
What in children's play should be a cause for concern then?
In some cases the very lack of such frightening elements. Suppose for instance
that a child has been going through extremely stressful experiences, e.g. death
of a parent, abuse, traumatic divorce or the like. If his or her make believe
play exhibits at that period no trace whatsoever of these experiences but
depicts an ideal, beautiful world without any trouble or difficulties, it would
be reasonable to surmise that this child is not coping with the bad experience
well and perhaps has no way of working through his or her emotional reactions.
In this case it would perhaps be advisable to refer the child to professional
counselling or play therapy.
Another feature of children's play that can be viewed as an
indication for referral to therapy is obsessive, persistent repetition of
certain negative signified contents. For instance, if a child has brought up
the theme of matricide in his make-believe play once or twice, among a variety
other contents, this is not necessarily a cause for concern. But if a child
plays only about matricide, over and over again, for weeks on end, then this
should perhaps be taken as an alarm.
Another sign of possible serious difficulties is what looks
like a persistent loss of the distinction between play and reality. This can
take various forms, e.g. fear of toys, as if they can really do harm, slipping
from play aggression to real aggression toward people, animals or objects and
insisting stubbornly that the imaginary make-believe characters and events are
Parents and other carers are also advised to be watchful of
signs of regression in play. If for instance a six year old child whose
make-believe play used to be highly developed appears to have gone back to the
earliest stage of make-believe play development and remains only there for a
considerable period of time this is perhaps a sign of regression due to
It should be stressed however, that identifying emotional
distress which requires therapy should never be based only on the child's
make-believe play. The functioning of the child in all areas of life should be
taken into account. Make-believe play is only one of a variety of sources of
information that should be considered.
that play therapy can help