to make uncomfortable verbal disclosures around harrowing topics to law enforcement and legal representatives, and play therapy can provide a welcome relief from these painful disclosures. It is essential that the play therapist focus on the needs of the youth and base session activities and interventions on the youth’s needs, including needs for nonverbal rather than verbal engagement.
As many unaccompanied children are older adolescents, age- building exercises to manage post-traumatic symptoms as well as to facilitate communication, can be helpful. Books on play therapy intervention resources (e.g., Goodyear-Brown, 2009, 2019).
Educational Recommendations for Providing Play
Therapy with Unaccompanied Immigrant Children In addition to a solid foundation in general play therapy practice, from an understanding of trauma, attachment disruptions, children in crisis, grief and loss, and cultural humility. The book Play Therapy with Children and Adolescents in Crisis (Webb & Terr, 2015), as well as the book Play Therapy and Expressive Arts in a Complex and Dynamic World: Opportunities and Challenges Inside and Outside the Playroom (Cassina et al., 2023), are excellent resources.
International considerations and perspectives in mental health assessment can provide a lens into the youth’s understanding of mental health treatment. Many unaccompanied youth come from cultures where psychotherapy may be unfamiliar (Brown, 2016). The World Health Organization’s Mental Health Atlas (2020), provides information on the availability and range of mental health services in member countries. The United States Department of State provides Country Reports on Human Rights Practices, which can provide therapist in understanding the experiences and needs of the child. The (ICD-11) (2022) provides diagnostic criteria for emotional disorders including post-traumatic stress disorder with an international perspective.
Setting the Stage for Play Therapy: Physical and Emotional Safety
Cassina notes, “Reaching and being in a safe country does not mean feeling safe,” (Cassina, in Cassina et al., 2023, page 53). Cassina and Mochi (2023) provide a detailed framework for attending to children’s overarching and immediate needs for safety and stability before play therapy.
Unaccompanied immigrant children do not have a caregiver with whom they are bonded in their immediate presence. In addition, the experiences where adults suffering from persecution, violence, or other factors in the home country were not able to consistently meet the needs of the child. Professional Counselor Lisa Gaub notes
CLINICAL EDITOR’S COMMENTS: Children immigrating without a primary caregiver
developmentally appropriate play therapy support as
that practitioners should be mindful of their role as an example of a safe adult, as unaccompanied youth may not have had experiences with safe adults in their recent or distant past (Gaub, personal communication, September 17, 2024). Safety can be communicated predictable and compassionate interpersonal style, and sensitivity about and respect for the youth and their history, community, and culture.
In addition to a lack of a caregiver upon arrival in the United States, an unaccompanied child may have had to function as an adult prematurely and live independently prior to immigrating. They may reacclimating to the role of a child. Relationship-building skills and communication skills are critical to the child’s internalization of a sense of safety. Collaboration with family in other locations may also be helpful. Cassina (2023) describes helping parents of a refugee family enhance the structure, predictability, bonding time, and routine foster parents and other supporters of an unaccompanied child.
Cultural Considerations well as beliefs about those countries themselves, with a sensitivity to the realities of countries with fewer resources than the United States. For instance, youth in other countries may be accustomed to working in the family business from an early age, sometimes even in place of formal education, for economic reasons. Some honor in helping the family (Gaub, 2024). Play therapists should seek formal education about the cultural and historical backgrounds of immigrant children, as well as informative relationships with adults with lived experiences of these backgrounds. While building rapport around shared interests such as music is natural and expected, it is important not to impose on the youth as the primary source of information related to their home culture. It is also essential to be educated on micro-aggressions and implicit bias to reduce the risk of assumptions or statements that may make the youth uncomfortable or offended, including inadvertent inclusion of only stereotypical play materials, or unconscious assumptions about a population’s typical family structure or religious beliefs. It can be particularly helpful to have an outside play therapist review one’s toys and materials to assess for cultural or other blind spots that the play therapist may have (Xanthia Johnson, personal communication, 2016).
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