Guidelines for Referring Children Based on the Observation of Play

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 adult standpoint. 

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. If, for instance, a child has brought up the theme of matricide in his make-believe play once of 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 real. 

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 emotional distress. 

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. 

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