Heidi Gerard Kaduson (editor), Dr. Charles E. Schaefer PhD (editor) - Play Therapy With Children_ Modalities for Change-American Psychological Association (2020)

Therapeutic Extended Reality  •  243

others (Bodrova & Leong, 2015). These characteristics are consistent with the
desired outcomes of play therapy: (a) development of responsible behaviors
and successful strategies to negotiate barriers that cause anxiety and depres-
sion (Shen, 2002); (b) creation of new solutions to problems, promoting
greater self-esteem and locus of control (Post, 1999); (c) respect and accep-
tance of self and others (Fall et al., 1999); and (d) development of social and
relational skills (Webster-Stratton & Reid, 2009).

Because the framework for development of therapeutic XR arose from play
that can be therapeutic, it is important to distinguish that therapeutic play
and play therapy are very different. Therapeutic play is defined as a frame-
work of activities centered on play that take into account the cognitive and
developmental state of the child to further develop the child’s emotional and
physical well-being (Koukourikos et al., 2015). This framework is often imple-
mented in hospitals to promote recovery. In contrast, play therapy is a psycho-
therapeutic approach used with children to freely explore and express aspects
of their lives and emotions through play. Play therapy has been proven helpful
in work with children to alleviate anxiety, depression, grief, and anger, among
other emotions. Although there may be some overlap between play therapy and
therapeutic play, their distinctions become important when one is consideri­ng
implementation of the techniques associated with each.

Cost-effective XR technologies for therapeutic purposes have only recently
become available; historically, therapeutic (t), XR technologies (i.e., tVR,
tAR, tMR) conceptually have arisen from the modification of frameworks
associated with serious games and serious educational games (SEGs; Lamb,
Etopio, & Lamb, 2018) and have only recently begun to be redeveloped as a
tool for play therapy.

Therapeutic XR has its roots in predecessor technologies such as serious
games, SEGs, and simulations. Serious games are electronic or computer-based
games that were designed not for commercial purposes but for training users
in a specific skill set. For example, the U.S. military has been the leader in
serious games, using them to train soldiers on combat missions that could not be
replicated completely in training in the physical world. SEGs are juxtaposed
with serious games in that they target the development of disciplinary content
knowledge using specific pedagogical approaches as opposed to specific skills.
SEGs allow teachers and students to connect real-world scenarios with
common school content. A simulation, by our definition, has duel character­
istics of a serious game and a SEG but does not keep a score or have an
economy, so in essence there is no endpoint and determination of completion
that is easily identified. Therapeutic XR environments allow the development
of skills, strategy, and content understanding through specific therapeutic

244  •  Lamb and Etopio

approaches (Lamb & Etopio, 2019a, 2019c). As technology integration in
therapeutic settings increases, more attention has been and will continue
to be placed on the components of therapeutic XR that can supply greater
realism, fluidity, and immersion with extensive environmental control. The
increased realism and functionality associated with therapeutic XR situate
it as an up-and-coming tool for use in therapeutic sessions.

The four overarching elements of therapeutic XR that allow its wide appli-
cation in play therapy approaches have been outlined by Lamb (2015) and
Tabak et al. (2017). These elements are (a) familiarity with the environ-
ment and activities (i.e., immersion), (b) distracting elements and graded
exposure to stressors (i.e., interactivity), (c) graduated activity (i.e., visual-
ization), and (d) provision of feedback and/or requested input from user
(fluidity). Visualization, fluidity, interactivity, and immersion form the basis
of treatment enhancements in therapeutic XR and are the foundations for
its environments.

THERAPEUTIC BENEFITS

Many components of therapeutic XR inherently lend themselves to aspects of
therapeutic factors related to play (Schaefer & Drewes, 2011). Integration of
the therapeutic factors is inherent in the nature of constructed environments
(e.g., therapeutic XR). One of the critical factors that links therapeutic XR
play to effective therapeutic approaches is the increased level of engagement
and the opportunity for children to practice and facilitate communication,
foster emotional well-being, improve personal strengths, and develop social
relationship skills. In many XR environments it is possible to have interactive
characters in the same environment, which can promote greater self-expression
and empathy. Therapeutic XR further links to play therapy approaches in the
sense that the child will engage with therapeutic XR in therapeutic settings
because, for some children, this may be a more enjoyable option than others
offered by the therapist. Children at all age levels already interact with tech-
nologies and electronic games for both educational and noneducational
purposes. Therapeutic XR environments allow direct and indirect learning by
means of play narratives and interactive fantasy play. For many children, play
using a board game or nonvirtual materials is unfamiliar and does not allow
the levels of interaction and fantasy available in therapeutic XR environments
(Plowman & McPake, 2013).

In addition to the potential positive aspects of therapeutic XR for children,
therapeutic XR provides the opportunity for a therapist to tactfully observe,
record, measure, and assess the child’s abilities to engage in multiple processes

Therapeutic Extended Reality  •  245

through “stealth assessment,” an approach in which the assessment of prog-
ress is embedded within the activities in the digital environment (DiCerbo
et al., 2017). For example, a child in a therapeutic XR environment may have to
use strategies that help promote self-regulation, empathy, or stress manage-
ment as they were discussed and practiced in prior therapeutic sessions. The
use of these strategies in therapeutic XR may occur as a part of the normal
functioning of the therapeutic XR environment when a child is interacting
with a digital character. Therapeutic XR allows the child to use these strate-
gies in a simulated authentic environment that approximates real life. Stealth
assessment is thought to provide a more reliable and valid measurement of a
child’s actions so the therapist can make therapeutic decisions about the
actions the child takes. Some abilities that can be readily examined using thera­
peutic XR are creative problem solving, social competence, empathy, stress
management and inoculation, and self-expression (Didehbani et al., 2016).

In addition to cognitive and emotional skills practice, therapeutic XR can
be used to promote prosocial practices that will benefit the child. Therapeutic
XR provides the therapist with a view of the child’s ability to cooperate and
coordinate activities within themselves and others, thereby promoting moral
and psychological development through play. This is advantageous because
play is regarded as the most effective setting in which to assess cognitive,
social, and behavioral characteristics for children in a controlled environment
(Knell & Dasari, 2016).

As this form of technology continues to develop, therapeutic XR will
provide greater opportunities to work with children through play because of
the immersive nature, interactivity, and customizability of the environments
(i.e., the broad interactivity and the realism of action). Computer-based
therapeutic XR environments will allow children and clinicians to examine
phenomena at multiple levels, with transitions occurring as needed by the
clinician and child to promote therapy (Lamb & Etopio, 2019c). An important
feature of therapeutic XR that separates it from other therapeutic technol-
ogies is real-time interactivity in three-dimensional environments. Put more
specifically, a therapeutic XR system is responsive to gestures and user inputs
with relatively little lag in environmental changes, which helps augment
activities such as block play, balloon play, and sensory play during play therapy
sessions. Interactivity, control, and therapeutic XR’s ability to respond to
gesture promotes the sensation of immersion by responding to user actions
on a screen, allowing for greater self-expression than with other technologies,
which may rely only on a flat monitor. This allows users not only to visually
interact with objects but also to manipulate graphic objects; that is, the client
is able to touch and feel the objects using auditory, haptic, and tactile inputs
(Jafari et al., 2016). Accordingly, clients using therapeutic XR feel and interact

246  •  Lamb and Etopio

with objects while more of their senses are fully engaged in the experiences.
To a degree, users often “forget” they are in a virtual world and in a therapeutic
setting; this increases the therapist’s ability to understand the child’s world
and how they behave. As confidence and mastery are gained, skills practiced
in therapeutic XR may be transferred into real-life settings.

Therapeutic XR technologies have intrinsic properties that activate thoughts
and emotions that help engage direct and indirect teaching, meaningful
learning, discussion, and problem solving (Lamb & Firestone, 2017). Through
repetitive play and reenactment children can relieve stress and gain mastery
over and resolve traumas. Increases in environmental control can promote
changes in thinking and behavior and increase positive emotion and asso-
ciations. In follow-up discussions, participants in therapeutic XR research
have cited realism and its resultant empathy as a key factor in their feeling of
immersion and engagement in the sessions (van Loon et al., 2018). Neuro­
imaging and psychophysiological studies also have confirmed that the
perceived realism and interactivity found in therapeutic XR environments
triggers responses from people in therapeutic XR environments that are
similar to those experienced n the real world (Lamb & Firestone, 2017).

Most recent therapeutic XR work has used three-dimensional video from
the real world in ultra high resolution, creating ultrarealistic content. Infusion
of digital content and information into virtual environments enhances the
experience, making it nearly indistinguishable from reality and more likely
that users will transfer skills learned in therapeutic XR to the real world. For
example, a fully scaled environment in therapeutic XR, such as a forest with
trees or rocks that are of photo quality, allows the user to walk around, see the
size of the trees, touch animals and plants, and experience the responses. Such
experiences allow them to engage in activities such as social scripting, environ-
mental control, and exploration in safe, low-risk environments. Thus, thera-
peutic XR technology engages children and adults in an immersive context
through authentic experiences while still providing a large degree of environ-
mental control by the practitioner and user.

CORE TECHNIQUES

In developing play therapy–based approaches using therapeutic XR it is
important to remember that traditional aspects of play therapy, such as rela-
tionship building between the therapist and child, home contingencies,
drawing, and other forms of creative ventilation (i.e., the free and full expres-
sion of feelings and emotions using creative outlets), are important and are
not replaced by therapeutic XR. In many ways, therapeutic XR in play therapy is
a tool to enhance and augment these and other play-based approaches. When



248  •  Lamb and Etopio

A therapist may initially consider using a less realistic environment, meaning
one that is less complex and less real-world like. The intent is to use an envi-
ronment with fewer interactions and less realism to promote comfort, attach-
ment to characters, and increase the opportunities to apply specific strategies
and approaches. As the child gains understanding and practice, the thera­
pist may slowly use more and more realistic environments. The use of less
realistic environments promotes play and greater fantasy. Many environments
are available at no cost with the caveat that they are often just settings, not
specific to therapy, with objects for interaction. For example, an extremely
realistic forest setting is available in one XR program, A Walk in the Woods
(Brightdawn Entertainment, 2020), with some areas that allow a person to
virtually climb a tree, pick flowers, or choose a specific walking path. The
number of people who may simultaneously engage in the same therapeutic
XR environment currently is limited to two to three people. Simultaneous
immersion by multiple people (i.e., the therapist and child in the same envi-
ronment) can be leveraged, allowing the therapist to see how the child is
behaving without the therapist being seen in the environment. The thera-
pist and child can both wear separate therapeutic XR goggles, with the child
being able to interact with the environment and the therapist just being able
to see the activities in which the child is engaging. This can more directly
allow the therapist to experience the child’s world while the child is in the
therapeutic XR environment.

Use of therapeutic XR has occurred in educational and counseling contexts
with children as young as age 4 years, at a maximum of 10 minutes per session,
with rest periods of 30 minutes and a maximum of two sessions per day.
In both contexts, the young child is exposed to experiences that may not be
available in the real world. For example, in one educational context children
were placed in an undersea environment and allowed to interact with jellyfish
and sea turtles (Lamb et al., 2019; Lamb & Etopio, 2019b). In a counseling
context, a child who was refusing to attend school because of anxiety was
able to virtually walk through the actual school before the first day of school
(Adjorlu et al., 2018). This points to the potential of therapeutic XR to be used
with younger children. However, given the time limitations it is important to
ensure that multiple activities in and outside of the therapeutic XR environ-
ment are planned for each session. The amount of time for each session and
rest between sessions increases and decreases, respectively, up to a maximum
of 1 hour for adults per session. At present there is little research on the topic
of the number of hours of therapeutic XR with which a child can engage, but
research is currently ongoing.

Therapeutic XR is thought to have considerable potential for therapeutic
approaches, especially its effectiveness regarding cognitive retraining (Bashiri

Therapeutic Extended Reality  •  249

et al., 2017), feedback (Laver et al., 2015), interest (Tussyadiah et al., 2018),
emotion regulation (Rodríguez et al., 2015), self-regulation, and mindfulness.

Therapeutic XR should not be thought of as a separate technique unto itself
but as a tool to augment existing therapies; one example of this is therapeutic
XR–enhanced dialectical behavior therapy. Although there are many benefits
associated with therapeutic XR, some potential aspects of it, such as XR-based
motion sickness or simulation sickness, may affect clients. It is important
that potential side effects be explained clearly to the child’s guardian and
that he or she sign an informed-consent form before treatment proceeds. For
more information about side effects, please contact the authors of this chapter.
Therapeutic XR simulation sickness occurs when there is a disconnect between
a person’s movement in the virtual environment and the person’s perceived
motion in real life (i.e., a mismatch between the visual and the vestibular
systems; Ng et al., 2019). A person experiencing simulation sickness may
show symptoms of general discomfort, headache, disorientation, or dysphoric
events that reduce immersion and enjoyment. Simulation sickness is not
a serious condition or concern and occurs in only a small percentage of the
population. The discomfort and symptoms generally resolve with the removal
of the VR headset. Reduction or prevention of simulation sickness may be
achieved by the following means:

• Clear a sufficiently large area and set up the therapeutic XR system in
accordance with manufacturer recommendations.

• Demonstrate the boundaries to the client.
• Familiarize the client with the therapeutic XR equipment prior to use.
• Stop use of the headset when there are performance problems (i.e., frame

rate reductions or skipping).
• Use the headset sitting if possible.
• Use gradual acclimation and increase headset usage slowly.
• Rest between sessions or whenever a client feels the need to do so.

Always provide supervision when a person is in a therapeutic XR environ-
ment. If comfortable, the operator (the person outside of the headset) should
be within about 1.5 arms’ lengths of the client.

The East Carolina University Neurocognition Science Laboratory can pro-
vide a sample protocol for therapeutic XR use.1 The protocol provides an
overview of suggested rest and usage times for therapeutic XR along with
daily maximum usage time recommendations. If maximum usage times are
reached, participants should not use therapeutic XR headsets or similar devices
for 24 hours. For example, the maximum time a 9-year-old is recommended

1 To obtain a copy of the protocols, please use the contact email [email protected].

250  •  Lamb and Etopio

to use the headset is 25 minutes, with a 45-minute rest and then no use of
therapeutic XR or other such devices for 24 hours. “Rest” in this context
means complete removal of the headset from the person’s head and face and
a change to a nontherapeutic XR–based activity. Upon session completion,
the therapist should remove the headset and debrief the client to ensure they
are well. If the person does not indicate any problems, rest can consist of
low-demand activities as tolerated without the therapeutic XR headset (e.g.,
mindfulness-based cognitive therapy, games, or guided imagery).

CLINICAL APPLICATIONS

Therapeutic XR has been found to be an important tool for play therapy
and in other therapeutic activities when used with specific approaches for
development of self-expression, social competency, and moral development
(Barajas et al., 2017; García-Vergara et al., 2014; Riva, 2005). In addition,
it allows therapists to experience firsthand the strategies and approaches
a child may use to self-regulate or manage stress. For example, if a child was
referred for aggression, then the therapist may have an opportunity to expe-
rience the aggression as the child bangs or breaks items in the therapeutic
XR environment without harm to themselves or the child. The therapist can
also help the child learn self-regulation by responding with appropriate strat-
egies. Furthermore, therapeutic XR–enhanced distraction therapy has been
found to outperform standard pharmacotherapy in the treatment of anxiety
and hyperactivity (Pourmand et al., 2017). Distraction therapy is the process of
developing specific strategies to divert or shift attention from a current nega-
tive thought process to a neutral or positive thought process. This approach
is the underpinning of multiple play therapy–based techniques and promotes
the child’s ability child to engage in creative problem solving and stress
inoculation from anxiety, trauma, or depression (Millett & Gooding, 2017;
Parsons, 2015). This occurs through completion of activities in the therapeutic
XR environment in which the child practices and is assessed in their ability
to show multiple emotional and unconscious behaviors (e.g., resiliency, self-
esteem, and more general psychological development) through play (Tabak
et al., 2017). For example, Tabak et al. (2017) found that in these environ-
ments, children had to pick fruits and vegetables or clean up their room, all
in a specific sequence, helping them build self-control. Their results indicated
a relatively wide acceptance of the therapeutic XR environment by the child.
Children can also engage in role play, free drawing and building in three
dimensions, moving and dancing, and even bubble play.

Therapeutic Extended Reality  •  251

CASE ILLUSTRATION

This case illustration shows how therapeutic XR–based technology was a key
component in the success of K,2 a 10-year-old boy referred for hyperactivity
and distractibility in the classroom. Reviews of diagnostic visits by K pro-
vided evidence of intact perceptual systems and an understanding of concep-
tual ideas but also the presence of a parent who has provided rigid prescribed
scheduling and significant control of K’s real-world environments as long as
K could recall. K did not demonstrate other clinically significant symptoms.
Many of K’s sessions, when the mother brought him, were spent immersed
in a simulation of tropical forest with wide-open areas to explore. The
simulation included animals, rivers, trees, caves, and cliffs. It is important
to understand that this environment has multiple components that lend
themselves to play therapy techniques. These include toy and object play,
storytelling, role playing, and other creative techniques. Throughout this
process it was necessary for the therapist to coordinate the play therapy tech-
niques with available therapeutic XR content. The open and interactive nature
of these environments allowed K to interact and maneuver through the
available activities at his planning. These aspects of the technology allowed
K to explore his surroundings in low-risk environments with large amounts of
environmental control.

K was initially trained in the use of the VR controls by means of a small
virtual robot avatar contained inside of the VR environment. The robot taught
K skills such as how to grasp objects, how to interact with the environment,
how to walk and move around the environment, and how to cooperate with
it to accomplish tasks such as building a structure or moving large objects.
The robot also responded with emotional cues when it was struck or some-
thing fell on it. One aspect to note is that the therapeutic XR system allows
full movement with cues demarcating boundaries, thereby promoting explo-
ration and self-determination. During the initial immersive experiences in
the environment, K exhibited aggressive exploratory behaviors and a lack of
inhibition in exploring areas such as the cave and river components. Lack
of self-regulation caused K to approach exploration with a lack of concern
and understanding of consequences, resulting in repetition of mistakes and
frustration.

During the therapeutic XR sessions K would often run through the XR
environment and discuss how the number of interactive elements in the
environment overwhelmed him. During this time he became frustrated and

2 Identifying information has been changed to ensure the case study materials are
anonymous.

252  •  Lamb and Etopio

was unclear regarding how to express his frustration. Over time, and with
assistance from his therapist through storytelling and emotion identification,
K was more able to apply learned strategies, such as mindfulness, along with
more indirectly learned approaches, such as cooperation (in this case with the
robot avatar, which was required to open new areas within the environment
for exploration). The discussions before, during, and after the VR sessions
often focused on how K felt, how he could use strategies to approach activi-
ties that overwhelmed him, and how to handle events when the environment
contained several new items and disrupted his initial plans.

In each of the environments, K needed to continually reason, make use of
learned strategies, cooperate with others in the execution of tasks, express
plans, engage with unknowns, regulate his aggressive responses, and use
socially acceptable responses and appropriate releases of aggression. After
several sessions over a period of 6 months, K came to understand the virtual
environment, learned to generalize the thoughts of how he felt to thoughts
of how another person might feel, and became more aware of how others
may respond to his actions. Ultimately, K was able to move from specific
self-referencing of his actions and responses to assessing the impact of his
activities in a multiperson interactive environment. Over time, K’s impulsive-
ness and need to act in an effort for stimulus slowly diminished, and he began
to function more easily in both the VR environment and the real world.

EMPIRICAL SUPPORT

Multiple studies have illustrated the effectiveness of therapeutic XR technolo-
gies for the treatment of social anxiety (Bouchard et al., 2017), impulse control
difficulties (Smeijers & Koole, 2019), trauma (Beidel et al., 2019), and related
conditions. We examined multiple studies (N = 233, K = 6) to assess the
relative effectiveness of therapeutic XR as an augmentative therapeutic tool.
An analysis of the effects illustrated a medium overall effect, indicating that
therapeutic XR technologies are more effective as an augmentative tool than
individual approaches alone. This result is limited by the lack of examina-
tion of moderators of the effect. An example from a study conducted by the
authors and a colleague illustrates the effectiveness of therapeutic XR augmen-
tation in therapy (Lamb, Etopio, & Lamb, 2018; see Figure 15.3).

In examining the multiple findings from the research, we noted that thera-
peutic XR–based therapies, compared with time-delayed groups, are superior
to comparison conditions in regard to the reduction of symptoms. This finding
is consistent with those of other studies (i.e., Kampmann et al., 2016; Opri¸s
et al., 2012). Examinations of therapeutic XR–enhanced treatments and



254  •  Lamb and Etopio

future research should evaluate the effects of therapeutic XR exposure as a
part of other play therapy techniques. Such interventions, possibly delivered
through inexpensive mobile phone applications and using inexpensive thera-
peutic XR hardware, perhaps through teletherapy, will provide an option to
people who may not have the ability to purchase this equipment.

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Index

A clay play therapy for, 177, 184, 187
defined, 132
Abreaction doll play for reducing, 25, 27, 33
in dramatic play therapy, 143 expressive arts for reducing, 57
in puppet play therapy, 112 guided imagery for reducing, 132, 134
in sandtray therapy, 12 stories addressing, 101–102
in sensory play therapy, 164 symptoms of, 132–133
therapeutic XR for, 248
Abuse, 86–87, 102–103. See also Anxiety disorders. See Internalizing
Sexual abuse
disorders
Adaptations, in bibliotherapy, 82 Approved Providers of Play Therapy
ADHD. See Attention-deficit/hyperactivity
Continuing Education, 6
disorder AR. See Augmented reality
Adjustment disorders, 18–20. See also Armstrong, S. A., 21
Art, effects of, 57, 66
Stress “The Art of Becoming an Original Writer
Adlerian play therapy, 40, 96, 109, 212
Adolescents, bibliotherapy with, 89–90 in Three Days” (Börne), 94
Adoption, 33 Art therapy, 55–56, 76, 80, 126. See also
Aggression, 33, 102–103, 250. See also
Drawing, in play therapy
Externalizing disorders ASD. See Autism spectrum disorder
American Library Association, 77 Assessment batteries, dollplay in, 28
Anatomical dolls, 29, 30, 33–34 Association for Play Therapy, 4, 6
Andersen, Hans Christian, 94 Association of Hospital and Institution
Andrew’s Angry Words (Lachner), 88
Anger Libraries, 77
Attachment
case illustration, 102–103, 218–220,
234–236 clay play therapy to improve, 180
defined, 184
games to accept, 213 and doll play, 31, 33
games to regulate, 217 guided imagery to create secure, 128
Anh’s Anger (Silver), 88 insecure, 184
Animal characters, 83, 110 music and movement therapies to
Animals game (guided imagery), 129–130
Anschutz, D. J., 33 improve, 194
Anxiety and sandtray therapy, 11
board games for reducing, 215–216 sensory play therapy to improve, 161
case illustration, 66–71, 117–120,
 259
234–236

260 • Index

stories in play therapy to address, core techniques, 80–85
101–102 defined, 77, 94–95
developmental, 77
theory of, 137, 158 empirical support for, 89–90
Attachment Doll Play Assessment, 28 history of, 76–77
Attachment Story Completion Task, 28 therapeutic benefits, 78–80
Attention-deficit/hyperactivity disorder Block play, 39–50
about, 39–41
(ADHD), 65–66, 232, 234, 237. case illustration, 47–49
See also Externalizing disorders clinical applications, 45–47
Attunement, 194 core techniques, 43–45
Augmented reality (AR), 241, 242. See also empirical support for, 49–50
Therapeutic extended reality (XR) therapeutic benefits, 41–43
Autism spectrum disorder (ASD) Board games, in play therapy, 209–222
about, 66 about, 209–210
block play for children with, 46 case illustration, 218–220
case illustration, 170–172 clinical applications, 215–218
electronic game play for children with, core strategies and techniques, 211–215
226, 232, 236–237 empirical support for, 221–222
sandtray therapy for children with, 18 therapeutic benefits, 210–211
sensory play therapy for children with, Bodrova, E., 42
170 Body Mirrors, 199
Autonomy, 212 Body stories, 200
Avatars, 227 Books, 80–81, 83–84. See also
Awareness, of feelings, 112. See also
Emotional wellness, fostering Bibliotherapy
Axline, V. A., 57, 94, 100, 162 Börne, L., 94
Bowls, freeze dance with, 145
B BPI (Berkeley Puppet Interview), 120
Brain. See also specific structures, e.g.
Badenoch, B., 17
Bagiati, A., 42 Limbic system
Balamoutsou, S., 94 activation of, in sensory play therapy, 172
Barrows, P., 117 development of, 172, 232–234
BASIC Ph Six Part Story Making method, effects of trauma on, 180
and memory, 162
101 neural networks of, 232–234
Bay-Hinitz, A. K., 221–222 synchronization of brain waves, 103
Beat the Clock, 44 Bratton, S. C., 21
Beautiful Oops! (Saltzberg), 80 Breathing, diaphragmatic, 130
Beebe, B., 201 Breath of the Wild, 234
Behavioral difficulties, treatment for, 41, Brick play. See Block play
Broca’s area, deactivation of, 12
172–173 Brody, V. A., 158
Behavioral rehearsal, 112 Bubble play, 250
Bells, freeze dance with, 145 Build a Dance technique, 199, 201
Bender, L., 108 Build a Song technique, 195, 198
Bennett, M. M., 136, 161–162 Bullying, 230
Berkeley Puppet Interview (BPI), 120
Bettelheim, B., 97, 102 C
Bibliotherapy, 75–90
Candy Land, 213–214, 216–218
about, 75–76 Caregivers, involvement in bibliotherapy
case illustration, 88–89
and children’s literature history, 77–78 by, 82
clinical, 77
clinical applications, 85–88

Index • 261

Carlson-Sabelli, L., 116 clinical applications, 183–185
Carter. R. B., 117 core techniques, 180–183
Cartright, S., 40 empirical support for, 187–188
Case illustrations therapeutic benefits, 178–180
Clayworks in Art Therapy (Henley), 183
bibliotherapy, 88–89 Cleanup, sandtray, 17
block play, 47–49 Clinical applications
board games in play therapy, 218–220 bibliotherapy, 85–88
clay play therapy, 185–187 block play, 45–47
doll play, 31–32 board games in play therapy, 215–218
dramatic play therapy, 148–154 clay play therapy, 183–185
drawing in play therapy, 66–71 doll play, 30–31
electronic game play therapy, 234–236 dramatic play therapy, 147–148
guided imagery, 134–136 drawing in play therapy, 64–66
music and movement therapies, 202–203 extended reality, 250
puppet play therapy, 117–120 guided imagery, 132–134
sandtray therapy, 18–20 music and movement therapies, 201–202
sensory play therapy, 170–172 puppet play therapy, 116–117
stories in play therapy, 102–103 sandtray therapy, 18
therapeutic extended reality, 251–252 sensory play therapy, 169–170
Cassidy, S., 143 stories in play therapy, 101–102
Caswell Ellis, Alexander, 26 Clinical assessment
CAT (clay art therapy), 188 doll play in, 26, 28
Catharsis extended reality in, 244–245
in bibliotherapy, 79 for sandtray therapy, 18
from block play, 45–46 Clinical bibliotherapy, 77
in clay play therapy, 179–180 Cocreated stories, 96, 101
defined, 79 Cognitive strategies, 232
in dramatic play therapy, 143 Communication facilitation
from drawing in play therapy, 56–57 bibliotherapy for, 78–79
in puppet play therapy, 111 electronic game play for, 226, 232
in sensory play therapy, 163 with games, 210
from stories in play therapy, 99 with play, 4
Cattanach, A., 94 sounded, 191–192
Cave Drawing technique, 62–64 Conduct disorder. See Externalizing
Cave Fantasy, 131
Chan, A., 232–233 disorders
Charades, 146 Consonant play, 165–166
Checkers, 218 Contact, importance of, 172
Chess boards, 218 Convergent thinking, 42
Child Life hospital departments, 30, 32 Cooking Breathing Game, 130
Children’s literature, history of, 77–78 Cool-down session, 146, 152
A Child’s First Book of Play Therapy Cooperation and resistance play, 164
Coordination disorders, 170
(Nemiroff & Annunziata), 82 Coping skills, 211, 216–217
Choi, S., 188 Coronavirus (COVID-19), 133, 141
Choose a Puppet technique, 113–115 Costumes, 200
Chutes and Ladders, 214–216, 219 Counterconditioning of fears, 27, 99–100
Classical period, 55 Creative movement, 200
Clay art therapy (CAT), 188 Crenshaw, D. A., 13, 109, 204
Clay Field, 180 Culture(s)
Clay play therapy, 177–189
and bibliotherapy book selection, 84
about, 177–178 game modification based on, 214
case illustration, 185–187

262 • Index

guided imagery with sensitivity to, 136 Doll play, 25–34
and miniature selection for sandtray about, 25–26
with bibliotherapy, 76, 84–85
therapy, 15 case illustration, 31–32
music and movement therapies across, clinical applications, 30–31
core techniques, 27–30
195–201 empirical support for, 32–34
play therapy across, 5 therapeutic benefits, 26–27

D Dolls, 25, 29, 30, 33–34
Domestic violence, 30
Damasio, A., 179 Dracco story, 98–99
Dance. See Music and movement Drama therapy, defined, 144
Dramatic play therapy, 141–154
therapies
Davis, N., 93 about, 141–142
Dear Bear (Harrison), 79 case illustrations, 148–154
Default mode network (DMN), 232–234, clinical applications, 147–148
core techniques, 144–147
237 empirical support for, 154
Delaney, Sadie Peterson, 76 and parent–child relational play, 165
Dementia, 25 therapeutic benefits, 142–144
de Mille, Richard, 129 Drawing, in play therapy, 55–72
Depression, 109–110. See also about, 55–56
with bibliotherapy, 85
Internalizing disorders case illustration, 66–71
Desmond, K. J., 116–117 clinical applications, 64–66
Desoille, Robert, 126 core techniques, 58–64
Developmental bibliotherapy, 77 directive approach to, 60–64
Developmental interpersonal trauma, 95 empirical support for, 71–72
Developmental level, consideration of, nondirective approach to, 58–60
therapeutic benefits, 56–58
212 and therapeutic XR, 250
Developmental play therapy, 158–160 Drewes, A. A., 4, 58, 78, 110, 111, 117,
Developmental transformations (DvT),
127, 143, 178, 194, 210
146–147, 152 Drums, 145, 199–200
Dialectical behavior therapy, 249, 253 DvT (developmental transformations),
Diaphragmatic breathing, 130
Digital technology, for guided imagery, 146–147, 152
Dynamic play, stagnant, 65
133 Dynamic play therapy, 159
Directive approach
E
block play, 44
drawing, 60–64 East Carolina University, 249
puppet play, 113–115 Eating disorders, 170
sandtray therapy, 16 Eberts, S., 136, 161–162
Direct teaching Echo play, 165–166
guided imagery for, 128 Echterling, L. G., 12, 128
with music and movement, 195 Ecosystemic play therapy, 40
in puppet play therapy, 111 Edible clays, 181
stories facilitating, 97 Educational settings
Disasters, human-made, 45–46
Disciplinary problems, at school, 217–218 bibliotherapy in, 77
Distraction therapy, 250 block play in, 40
Divergent thinking, 42 play therapy in, 71–72
DMN (default mode network), 232–234,

237
Documentation, session, 17
Dollhouses, 29

Index • 263

puppet play in, 108 Externalizing disorders, 18, 85–86
therapeutic XR in, 248 External support, from therapeutic stories,
Egalitarianism, 17
Egg Drawing technique, 62–64 98
Ego-resilience, 188 Eyes closed, scribbling with, 59
Elbrecht, C., 180
Electronic game play therapy, 225–237 F
about, 225
case illustration, 234–236 Family Band, 147, 148–154
core techniques, 228–234 Family dynamic assessment, 112
empirical support for, 236–237 Family play therapy, 46–47
therapeutic benefits, 225–228 Family Puppet Interview (FPI), 112,
Elimination disorders, 170
Elliot (Pearson), 86 115–116
Emery, M., 66 Family sculpture technique, 182–183
Emotional release, 42, 179–180 Family system, doll play to determine
Emotional wellness, fostering
bibliotherapy for, 79, 87–88 relationships within, 31
in block play (case illustration), 47–49 Fantasy characters, puppets as, 110
with board games, 216–217 Far Apart, Close in Heart (Birtha), 86
dramatic play therapy for, 154 Fear, addressing, 79, 88–89, 101–102.
in electronic game play, 231
play and, 4 See also Counterconditioning of fears
Emotion cards, charades with, 146 Fearn, M., 169
Empathy, 27, 103, 163 Feelings, awareness of, 112. See also
Empirical support
bibliotherapy, 89–90 Emotional wellness, fostering
block play, 49–50 Fictional books, 83
board games in play therapy, 221–222 Fidget toys, 168
clay play therapy, 187–188 Fine body movements, 164
doll play, 32–34 Finnerty, K., 221
dramatic play therapy, 154 Flahive, M. W., 20–21
drawing in play therapy, 71–72 Food intake, 33
electronic game play therapy, 236–237 Forensic interviews, 29
extended reality, 252–253 FPI (Family Puppet Interview), 112, 115–116
guided imagery, 136–137 Free play
music and movement therapies,
in clay play therapy, 181–182
203–204 with dolls, 29
puppet play therapy, 120–121 with electronic games, 234
sandtray therapy, 20–21 Freeze dance, for dramatic play warm-up,
sensory play therapy, 172–173
stories in play therapy, 103 145
Emunah, Renée, 141–143 Freud, Sigmund, 55, 94, 126
Encopresis, 67–71 Full-body physical activities, 164
Engels, R. C. M. E., 33
Enns, C. Z., 129 G
Ethical assessment, 18
Evangelou, D., 42 Game play, defined, 209. See also Board
Executive functioning, 49–50, 136 games, in play therapy
Explicit memory, 162
Extended reality (XR). See Therapeutic Games
board. See Board games, in play therapy
extended reality (XR) educational, 243–244
electronic. See Electronic game play
therapy
two-player, 231

Garland, E. L., 99
Gascoyne, S., 158
Gaskill, R. L., 40, 163

264 • Index

Gender, 33, 84 I
Gersie, A., 94
Gil, E., 115–116 I Feel Better Now! program, 90
Ginott, H. G., 162 I’m Happy Sad Together (Britain), 88
Giraffes Can t Dance (Andreae), 87 Immersive environments, 242
Gondor, E. I., 72 Implicit memory, 162
Green, John, 75 Indirect teaching
Grief and loss, addressing
in bibliotherapy, 79
with bibliotherapy, 87 with doll play, 27
case illustration, 185–187 guided imagery for, 128
with clay play therapy, 183–184 with music and movement, 195
with puppet play therapy, 117 stories facilitating, 97
Gross body movements, 146, 164 Induction phase (guided imagery), 131
Grotberg, E. H., 98 Initial session, preparation for, 82
Group settings In My Heart (Witek), 87
for ADHD treatment, 66 Insecure attachment, 184
dramatic play therapy in, 147–148 Interactivity, real-time, 245
music and movement therapies in, Internalizing disorders, 18, 86
Interpersonal trauma, 30
200–201 Introduction, of therapy, 16, 197
puppets use in, 108 Irwin, E. C., 110, 115
Guatemalan worry dolls, 29 It’s Hard to Be a Verb (Cook), 85
Guided imagery, 125–137
about, 125–126 J
case illustration, 134–136
clinical applications, 132–134 Jang, H., 188
core techniques, 129–132 Jenga, 44
empirical support for, 136–137 Jennings, S., 94, 159
for Rosebush drawing, 60–61 Jessie, 87
therapeutic benefits, 127–128 Johnson, David Read, 146
Guided teaching techniques, 44 Johnston, S. S. M., 117
Jones, E., 76, 94
H Jones, P., 141, 143–144
Jung, C. G., 9, 14, 16, 21
Haen, C., 145
Hall, Granville Stanley, 26 K
Hanline, M. F., 40
Harold and the Purple Crayon (Johnson), Kaduson, Heidi, 44, 133, 221, 236–237
Kalff, Dora, 11, 16
84 Kelly, J. E., 109
Hartwig, E. K., 108–109, 111 Kestly, T. A., 17, 21, 41, 46
Hasbro, 44 The Kid Trapper (Cook), 86
Hector’s Favorite Place (Rooks), 88 Kimport, E. R., 187–188
Henley, D., 183 Kinesthetics, 11, 14, 84
Herman, Judith, 64 Kottman, T., 40
Ho, R. T. H., 188 Kretschmer, Ernst, 126
Homeyer, L. E., 10, 14–15, 17–18 Kwiatkowska, Hanna, 55
Hospital settings, puppet use in, 108
Huebner, Dawn, 85 L
Hull, K., 226
Human contact, importance of, 172 Lahad, M., 93, 94
Human-made disasters, 45–46 Lamb, R., 244
Hynes, Arleen McCarty, 77 Landreth, G. L., 40, 41, 56
Hyperactivity, 251–252

Index • 265

Landreth, Garry, 83 Miniaturization, 27
Language skills, 12–13, 40 Mirroring
La Roche, M. J., 136–137
Latino community, 137 in clay play therapy, 182
The Legend of Zelda, 234, 237 as dramatic play warm-up, 145
Leggett, E. S., 114 in music and movement therapies, 195,
LEGO-based therapy, 40–41, 46, 47–49
LEGO bricks, 40–41 199
LEGO Education company, 44 in sensory play therapy, 166
LEGO Movie 2 Movie Maker, 227–228, 234 yoga ball toss with, 145
LEGO Serious Play methodology, 41, 46 Mister Rogers’ Neighborhood (television
Lemon Squeezies, 134
Leong, D. J., 42 show), 107
Lerman, Liz, 199 Mixed reality (MR), 241. See also
Leuner, Hanscarl, 126
Levy, A. J., 128 Therapeutic extended reality (XR)
Library War Services, 76 Model Magic, 181
Lifetimes (Mellonie & Ingpen), 87 Moheb, N., 187
Limbic system, 12 Moral development, 27
Literacy skill, 40 Morgenstern, E., 95
Loneliness. See Internalizing disorders Mother–child interactions, 33
Loomis, E. A., 209 Movement(s). See also Music and
Loss, addressing. See Grief and loss,
movement therapies
addressing creative, 200
Lowenfeld, Margaret, 10–11, 13 fine, 164
Lowenstein, L., 130, 213, 217 gross, 146, 164
importance of, 191
M MR (mixed reality), 241. See also

MacArthur Story Stem Battery, 28 Therapeutic extended reality (XR)
Main imagery experience phase (guided Musical Instruments, 199–200
Music and movement therapies, 191–204
imagery), 131
Make friends with clay technique, 182 about, 191–192
Malchiodi, C. A., 55–56, 58–59, 63, 65–66, attunement through, 194
basic components, 193–194
72 case illustration, 202–203
Malloy, E. S., 115 clinical applications, 201–202
Mathematical development, 39–40 core techniques, 195–201
McLeod, J., 94 empirical support for, 203–204
McNiff, S., 142 history of therapy involving, 192–193
Meany-Walen, K. K., 40, 109 therapeutic benefits, 194–195
Measelle, J. R., 120 and therapeutic XR, 250
Medical procedures, preparation for, 28–32 unconscious feelings/motivations and,
Memory, 162
Messy play, 168–169 192
Metaphors, use of, 178–179, 194, 228–229 Mutism, selective, 184
Meta-storying, defined, 95 Mutual storytelling technique, 96
Military training, serious games for, 243 My Cold Plum Lemon Pie Bluesy Mood
Mimicry, 165–166. See also Mirroring
Mindfulness, 130–131 (Brown), 87–88
MindLight, 231 My Mouth Is a Volcano (Cook), 80
Minecraft, 226, 230, 234, 237
Miniatures, 14–16, 214 N

Nan, J. K. M., 188
Narrative, defined, 94
Narrative doll play, 28
Narrative Drawings, 61–62, 65
Narrative play therapy, defined, 94

266 • Index

Narrative therapy, 187 Personal strengths, increasing, 4, 80,
Nash, Julie Blundon, 163 226–227
Nash, E., 145
National Institute for Trauma and Loss, 90 Personification technique, 183
National Registry for Evidence-based Photographs, 17
Physical play, 164–165
Programs and Practices, 172 Piaget, J., 107
Natural disasters, 45–46 Pitre, N., 120
Naumburg, Margaret, 55 Plasticine, 181
NDP (Neuro-Dramatic-Play), 159–160 Play
Neural entrainment, 103
Neurocognition Science Laboratory consonant, 165–166
cooperation and resistance, 164
(East Carolina University), 249 defined, 3
Neurodevelopmental disorders, 46, 232 echo, 165–166
Neuro-Dramatic-Play (NDP), 159–160 essential components of, 242
Neuroprotection, 237 free. See Free play
Newman, E., 109 messy, 168–169
Nez, D., 179 outdoor, 169
Nims, D. R., 109 parent–child relational, 165–167
Nondirective approach physical, 164–165
pretend, 162–163
drawing, 58–60 rhythmic, 165
puppet play, 113 rough-and-tumble, 163
sandtray therapy, 16 therapeutic, 243
Nondominant hand, scribbling with, 59 therapeutic powers of, 3–4, 57
Not in Room 204 (Riggs), 86 unstructured, 44–45
Nurturing touch, 158 Play-Doh, 181, 187
PlayMancer, 231
O Play Story, 100–101
PLAY system, 164
Oaklander, Violet, 126, 128, 131, 177, Play therapists, training for, 6
179, 182 Play therapy
about, 4–6
Object constancy, 180 defined, 4, 243
Obsessive-compulsive disorder (OCD), desired outcomes of, 243
in educational settings, 71–72
134–136, 184 sensory play in, 159
O’Connor, K., 40 Please Tell! (Jessie), 87
Once Upon a Time . . . Therapeutic Stories Pokemon, 237
Pomeroy, Elizabeth, 76
That Teach & Heal (Davis), 82 Positive emotions, 160
Openness to Experience, 234 Positive reinforcement, 161
Opinions About Mental Illness Scale, 120 Post drawing interviews (PDI), 63–64
Opposites technique, 197–198 Posttraumatic stress disorder (PTSD), 30,
Oppositional defiant disorder. See
61, 66–71. See also Stress
Externalizing disorders Prefrontal cortex, 12
Outcome research. See Empirical support Prendiville, E., 160
Outdoor play, 169 Pretend play, 162–163
Problem solving, promoting
P
with block play, 42
Pacing, 45 with electronic game play, 226–227
Pain management, 136 in puppet play therapy, 112
Panksepp, J., 160 in sensory play therapy, 162–163
Parental caregiving, 33 stories in play therapy for, 97–98
Parent–child relational play, 165–167
People, puppets representing, 110
Perry, B. D., 40

Index • 267

Processing phase (guided imagery), 132 Rest, in therapeutic XR, 250
Props, in music and movement therapies, Return phase (guided imagery), 131–132
Rewriting stories, with clients, 82
199–200 Reycraft, J., 217
Psychoeducation, 79 Reynolds, A., 146
Psychological development, 162 Reznick, C., 130–131
Psychosis, 18 Rhythmic play, 165
Puppet play therapy, 107–121 Rhythm instruments, 199–200
Ringoot, A. P., 121
about, 107–108 Robbins, S. J., 187–188
with bibliotherapy, 76, 84–85 Roberts, J. M., 209
case illustration, 117–120 Roberts, T., 172
clinical applications, 116–117 Roblox, 237
core techniques, 112–116 Rogers, D. L., 40
curating puppets for, 110 Role play, 95, 109, 143, 250
empirical support for, 120–121 The Rosebush approach, 60–61
historical roots and settings, 108 Rough-and-tumble play, 163
and sensory play therapy, 162 Rubin, Rhea, 77
theoretical applications, 108–110 Rush, Benjamin, 76
therapeutic benefits, 111–112 Ryan, K., 173
Puppet Play Therapy (Schaefer & Drewes),
S
111
Put Your Mother on the Ceiling (de Mille), Safety, feeling of
in dramatic play therapy, 143
129 from sandtray therapy, 11, 13, 16
from sensory play therapy, 160
Q in therapeutic relationship, 57

Question stems, for doll play, 28 Sand, selection of, 14
Sandplay therapy, 10
R Sandtrays, 14, 16, 17
Sandtray therapy, 9–22
Racial identity, 26, 79
Rahmani, P., 187 about, 9–11, 22
Rapport building, puppet play for, 112 with bibliotherapy, 76, 85
Ray, D., 20–21 case illustration, 18–20, 89
Reading level, 212 client introduction to, 16
Real-time interactivity, 245 clinical applications, 18
Recorded music, 196 empirical support for, 20–21
Regulatory play, 168 with guided imagery, 126
Reid, S. E., 210 protocol, 15–17
Rejection, dealing with, 230 for storytelling, 97
Relaxation phase (guided imagery), therapeutic benefits, 11–13
tools, 13–15
130–131 virtual, 231
Relaxation techniques, 125, 130 Sargent, H., 26
Renter, S. G., 214 Scarves, 199–200
Repeat a Gesture, 198 Schaefer, Charles, 4, 49, 58, 78, 111, 127,
Repeat a Phrase technique, 198
Resilience, domains of, 98 143, 178, 194, 210
Resiliency, promoting Scribbles approach, 58
Scribbling techniques, 59
in bibliotherapy, 80 Secure attachment, 180
case illustration, 47 SEGs (serious educational games), 243–244
in clay play therapy, 188 Selected Toy process, 114
with electronic game play, 226–227
stories in play therapy for, 97–98
Resistance, overcoming, 12

268 • Index SFPT. See Solution-focused play therapy
Shen, Y. -P., 21
Selective mutism, 184 Sherwood, P., 177
Self-esteem, increasing Shrodes, Carolyn, 77
Sickness, simulation, 249
in bibliotherapy, 87 Siculus, Diodorus, 76
in clay play therapy, 185 Siegel, D. J., 232–233
in dramatic play therapy, 143 Silly Putty, 181
in sensory play therapy, 161–162 Simon Says, 165, 171
stories in play therapy for, 98 Simulations, 243
Self-expression, enhancing Simulation sickness, 249
with block play, 41–42 Singing, 193. See also Music and
in clay play therapy, 178–179
with doll play, 26 movement therapies
with drawing, 56–57 Skills development
with guided imagery, 127–128
with music and movement, 195 language, 12–13, 40
in puppet play therapy, 111 literacy, 40
in sandtray therapy, 11 for play therapists, 6
stories in play therapy for, 97 social. See Social skills, developing
in times of despair, 141 Smash technique, 183
Self-regulation, promoting Smith, C. W., 214
with block play, 42–43 Social–emotional learning, 218
defined, 42 Social relationships, enhancing
with doll play, 27 in bibliotherapy, 79–80
with music and movement, 195 case illustration, 88–89
in sensory play therapy, 161 with electronic game play, 226
stories in play therapy for, 98–99 with play, 4, 57
Self-representation, 227–228 Social skills, developing
Self-sculpting technique, 183 in bibliotherapy, 86
Sensory materials, 168 with block play, 43, 46
Sensory play with doll play, 27
defined, 158–159 in dramatic play therapy, 154
interactive, 167 games for, 210–211
Sensory play therapy, 157–173 with music and movement, 203–204
case illustration, 170–172 in sensory play therapy, 163
clinical applications, 169–170 with therapeutic extended reality, 245
core techniques, 164–169 Sock Puppets Complete, 227
defined, 157–158 Soft-failure environment, 247
empirical support for, 172–173 Solution-focused play therapy (SFPT),
historical roots of, 158–160
therapeutic benefits, 160–164 109, 114, 117–120
Sensory processing challenges, 18 Some Secrets Hurt (Garner), 86
Serial Drawings, 59–60, 65 Sori, C. F., 110, 116
Serious educational games (SEGs), Sorry! (board game), 217–219
Soul-making, 14
243–244 Sounded communication, 191–192
Sesame Street (television show), 107 Sound Mirrors, 199
Session structure Souter-Anderson, L., 178, 184
Spare, G., 21
bibliotherapy, 84–85 Special roles, puppets with, 110
therapeutic XR, 247 Speechless terror, 11
Sexual abuse Squiggle Game (squiggle technique), 62
art therapy for, 71 Steele, M., 33
bibliotherapy for, 86 Stein, M. T., 28
and doll play, 29, 30, 33–34
puppet play therapy for, 117

Index • 269

Stephens, G. J., 103 drawing in play therapy, 58–64
Stewart, A. L., 11, 12, 128 electronic game play therapy, 228–234
Stone, J., 237 extended reality, 246–250
Stories (generally) guided imagery, 129–132
music and movement therapies,
art to facilitate telling of, 71
body, 200 195–201
cocreated, 96, 101 puppet play therapy, 112–116
defined, 94 sandtray therapy, 13–17
rewriting of, 82 sensory play therapy, 164–169
therapeutic life, 96 stories in play therapy, 100–101
Stories, in play therapy, 93–103 Temenos, 14
about, 93–96 Terr, L. C., 34
case illustrations, 102–103 Terror, speechless, 11
clinical applications, 101–102 Theory-based approach to sandtray
core techniques, 100–101
empirical support for, 103 therapy, 10
therapeutic benefits, 96–100 Therapeutic alliance
Storytelling cards, 101
Strengths, personal. See Personal in bibliotherapy, 82
modifying games to promote, 215
strengths puppet play promoting, 109
Stress, 18, 27, 161. See also Posttraumatic Therapeutic bibliotherapy, 77
Therapeutic extended reality (XR),
stress disorder (PTSD)
A Study of Dolls (Hall & Caswell), 26 241–254
Sun Salutations, 200 about, 241–244
Super Smash Bros., 228 case illustration, 251–252
Sutton-Smith, B., 209 clinical applications, 250
Swank, J. M., 211, 213–214, 217 core techniques, 246–250
Symbolism, 178–179, 194 empirical support for, 252–253
therapeutic benefits, 244–246
T Therapeutic factors, defined, 5
Therapeutic life stories, 96
Tabak, M., 244, 250 Therapeutic narratives, 94
Tactile contact, 179 Therapeutic play, 243
Talking, Feeling, and Doing Game, Therapeutic powers of play
about, 4, 210
209–210 and clay play therapy, 178
Tanaka, M., 62 and drawing, 57
Task positive network (TPN), 232–234, and electronic game play, 225
and sandtray therapy, 11–13
237 Therapeutic relationship
Taylor de Faoite, A., 94 drawing to promote, 57
Teaching and safety, 57
sandtray cleanup to promote, 17
direct. See Direct teaching in sensory play therapy, 160
guided techniques, 44 stories that build, 100
indirect. See Indirect teaching Theraplay, 147, 158, 172
Tears of Joy (Behm), 86 Thomsen, A., 41
Techniques Tillman, K., 13
bibliotherapy, 80–85 Totika, 44
block play, 43–45 Tough Boris (Fox), 83
board games in play therapy, 211–215 Toys, 162
clay play therapy, 180–183 TPN (task positive network), 232–234,
defined, 144
doll play, 27–30 237
for dramatic play therapy, 144–147

270 • Index

Trading leadership (warm-up exercise), Verbal skills
145 and drawing, 56–57
and sandtray therapy, 12–13
Training, for play therapists, 6 singing for patients with poor, 201
Transference, 13
Trauma. See also Posttraumatic stress Veterans Administration, 76
Violet (Stehlik), 79, 89
disorder Virtual reality (VR), 241, 242. See also
block play for clients who have
Therapeutic extended reality (XR)
experienced, 45–46 Virtual Sandtray app, 231
case illustration involving, 202–203 Von Gontard, A., 21
developmental interpersonal, 95 Vygotsky, L., 107
doll play for clients who have
W
experienced, 29, 30, 34
drawing to address, 61, 62, 65 Warm-up exercises, 144–145
effects of, on brain, 180 The Way I Feel (Cain), 87
guided imagery to address, 129 The Weather Report, 147
implicit memories associated with, 162 Weinrib, E. L., 17
interpersonal, 30 Welcome to Therapy! (Putt), 82
neurobiological effects of, 12 What to Do When You Worry Too Much
sandtray therapy for clients who have
(Huebner), 83, 85
experienced, 12, 18 Whelan, W. F., 11
speechless terror related to, 11 When Dinosaurs Die (Brown and Brown),
stories to address, 101–102
Treatment plans, 5, 64. See also 87
When Sophie Gets Angry—Really, Really
Techniques
Trouble (board game), 217 Angry (Bang), 88
Two-player games, 231 Wilson, G. R., 222
Winnicott, Donald, 62
U Woltmann, A. G., 108
Words, changing, in bibliotherapy, 82
Unconscious, enhancing access to Working through, in dramatic play
in clay play therapy, 179
with doll play, 26 therapy, 145
in dramatic play therapy, 143 World Alliance of Drama Therapy, 142
with guided imagery, 127 World Technique, 10
in puppet play therapy, 111 World War I, 76
in sandtray therapy, 12 Worry dolls, 29
in sensory play therapy, 162 The Worst Day of My Life (Cook), 85
stories in play therapy for, 97
X
Ungame, 210
Unstructured play, 44–45. See also XR, therapeutic. See Therapeutic extended
reality (XR)
Free play
Unzipping Me From OCD technique, 134 Y
U.S. Substance Abuse and Mental Health
Yoga, 200
Services, 172 Yoga ball toss, with mirroring, 145
Usher, W., 157–158 You Weren’t With Me (Ippen), 86

V Z

Van der Kolk, B. A., 11 Zero (Otoshi), 87
Venue preparation, for sandtray therapy,

15–16
Verbalization, as a defense, 13

About the Editors

Heidi Gerard Kaduson, RPT-S, PhD, specializes in evaluation and interven-
tion services for children with a variety of behavioral, emotional, and learning
problems. She is past president of the Association for Play Therapy and
Director of The Play Therapy Training Institute in Monroe Township, New
Jersey. She has lectured internationally on play therapy, attention-deficit/
hyperactivity disorder, and learning disabilities. Dr. Kaduson has edited
and authored many books on play therapy: Prescriptive Play Therapy:
Tailoring Interventions to Specific Childhood Problems; Contemporary Play
Therapy; Short-Term Play Therapy for Children, Third Edition; 101 Favorite
Play Therapy Techniques; as well as 101 More Favorite Play Therapy Tech-
niques and 101 Favorite Play Therapy Techniques, Volume III. Dr. Kaduson
has trained and supervised thousands of individuals across the world. She
maintains a private practice in child psychotherapy in Monroe Township,
New Jersey.

Charles E. Schaefer, RPT-S, PhD, is professor emeritus of clinical psychology
at Fairleigh Dickinson University in Teaneck, New Jersey. He is cofounder
and director emeritus of the Association for Play Therapy. Dr. Schaefer is
the author/coauthor of more than 100 research articles and author/editor
of more than 70 professional books, including Handbook of Play Therapy,
Second Edition; Foundations of Play Therapy, Second Edition; The Therapeutic
Powers of Play, Second Edition; Essential Play Therapy Techniques: Time-
Tested Approaches; Short-Term Play Therapy, Third Edition; and Play Therapy
for Preschoolers.

271