Behavioral symptoms include exhibiting an inability to relax, to feel  procrastinating on projects due to feeling overwhelmed by the thought of starting or completing them; and avoiding situations that may be anxiety provoking. Concretely, these may manifest if a play therapist is using a directive or semi-directive approach and the child avoids certain subjects or works aimlessly on a project without making progress. By adjusting therapist way of being and breaking a project into manageable parts, the child can experience small successes and make progress.


Physical symptoms may include feeling tense and reporting body aches, suffering from insomnia or feeling restless while trying to sleep, and experiencing gastro-intestinal problems with digestion, nausea, or diarrhea. The child or parent may directly report the child having a “tummy ache” or s/he may ask to go to the bathroom in session. Or, the child may play out these symptoms through dolls     communication for the parents, both noticing and caring about the child’s well-being, and providing a different way of receiving the child’s reports.


Art techniques, psychodrama, and story-telling are all


powerful techniques that can be utilized with entire families.


It is vital for the therapist to make the child with anxiety feel at ease in therapy to obtain optimal results. A child seeming to be reluctant or anxious in a play therapy session calls for the therapist to be verbal. Landreth (2012) suggested that the therapist not mirror the child’s silence to avoid raising further anxiety. Lund et al.’s (2002) suggestions for helping children feel more comfortable in family therapy paralleled many established play therapy practices, such as establishing clear limits while keeping rules to a minimum, using fewer and simpler words, and using visual aids. More directive play therapists will be comfortable with Lund et al.’s suggestions for asking for the child’s opinions, comments, concerns, thoughts, and feelings. This is extremely important if the child feels s/he does not have a voice at home, because family play therapy can be a place where s/he is heard, through words or toys and activities. Keeping therapy positive by reiterating the child’s strengths rather than his or her weaknesses (Lund et al., 2002) also dovetails nicely with both play and family therapy suggestions.


In sum, child-focused work is the responsibility of all clinicians, and is not just a specialty for some. Art techniques, psychodrama, and story-telling are all powerful techniques that can be utilized with entire families. Play therapists, marriage and family therapists,


20 | PLAYTHERAPY | March 2018 | www.a4pt.org


psychologists, counselors, social workers, and other mental health professionals are encouraged to be creative and to try something new by combining play and family therapies. Using these techniques with families with anxious children will help them recalibrate their thoughts and reactions to the symptoms and will help the child make 


References Borg, J. (2015). Body language: How to read others, detect deceit, and convey the right message. New York, NY: Skyhorse.


de Castro, S., & Guterman, J. T. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital and Family Therapy, 34, 93–106. doi:10.1111/j.1752-0606.2008.00055.x


 childhood ritual, play, and the evolution of symbolic


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Kaslow, N., Broth, M., Smith, C., & Collins, M. (2012). Family-based interventions for child and adolescent disorders. Journal of Marital and Family Therapy, 38, 82-100. doi:10.1111/j.1752-0606.2011.00257.x


Keith, D., & Whitaker, C. (1981). Play therapy: A paradigm for work with families. Journal of Marital and Family Therapy, 7, 243-254. doi:10.1111/j.1752-0606.1981.tb01376.x


Landgarten H. (1987). Family art psychotherapy: A clinical guide and casebook. New York, NY: Brunner/Mazel.


Landreth, G. L. (2012). Play therapy: The art of the relationship (3rd ed.). New York, NY: Brunner Routledge.


Lund, L., Zimmerman, T., & Haddock, S. (2002). The theory, structure, and techniques for the inclusion of children in family therapy: A literature review. Journal of Marital and Family Therapy, 28, 445-454.


Penn, P. (1982). Circular questioning. Family Process, 21, 267–280. doi:10.1111/j.1545 5300.1982.00267.x


Pinsof, W., & Estrada, A. (1995). The effectiveness of family therapies for selected behavioral disorders of childhood. Journal of Marital and Family Therapy, 21, 403-440. doi:10.1111/j.1752-0606.1995. tb00173.x


Willis, A., Walters, L., & Crane, D. (2014). Assessing play based activities, child talk, and single session outcome in family therapy with young children. Journal of Marriage and Family Therapy, 40, 287- 301. doi:10.1111/jmft.12048


ABOUT THE AUTHOR


Eman Tadros, MS, MFT, is a MFC/T PhD student at The University of Akron. Eman is an adjunct professor whose pedagogical philosophy focuses on applying psychological/ counseling theories to real life situations. Her research focuses on parent-child relationships in underserved populations. emantadros@gmail.com


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