Creative Play Therapy Interventions

for Children and Families

By Liana Lowenstein, MSW, CPT-S

When children are referred for therapy, they typically feel anxious and are
reluctant to talk directly about their thoughts and feelings. But activities that are
creative and play-based can engage children and help them to safely express
themselves. The purpose of this article is to provide therapists with creative
interventions to engage, assess and treat children, youth and families.
The interventions presented in this article aim to capture and sustain childrens
interest and motivation in therapy, while helping them express themselves within
the context of a safe therapeutic environment. In using these interventions, the
following guidelines should be considered:

Have a strong theoretical foundation: Therapists should be well grounded in

their theoretical orientation before using any activities in therapy sessions.
Interventions should not be used indiscriminately or in a manner that ignores
clinical theory. The activities in this article can be integrated into any theoretical
orientation that uses a directive play therapy approach.

Build and maintain a positive therapeutic rapport: Regardless of the activity

being used, the therapist-client relationship is central to the clients realization of
treatment goals. Because the rapport that develops between therapist and client
forms the foundation for therapeutic success, the therapist must create an
atmosphere of safety in which the client is made to feel accepted, understood
and respected.

Use interventions that are appropriate for each client: Consider the childs
developmental capacities to ensure that the selected activity is appropriate.
Select activities that fit the clients treatment goals. Pacing is also important.
Consider the clients level of engagement in therapy and degree of
defensiveness before implementing activities that are more emotionally intense.

Introduce, process and bring closure to each activity: When implementing an

activity, first consider how it will be introduced to the client. The therapists
enthusiasm, creativity and overall style are key factors in determining whether
the client will become interested and engaged in the activity. The purpose of the
activity should be outlined and the instructions clearly explained. Interventions
should be carefully processed and used as a point of departure for further
exploration. When the activity has been completed and sufficiently processed,
the therapist should bring closure to the activity.
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Interventions
Pin the tail on the Donkey (Adapted from Lowenstein, 1999)
Purchase a Pin the Tail on the Donkey Game (available at toy or party stores)
and cover any reference to "Happy Birthday" on the game. Tape the game to a
smooth wall at a height that all the children in the group can reach. Write
questions on index cards, such as: (1) What's your favorite movie? (2) Whats
one of your favorite toys? (3) Whats something that makes you happy?

Describe the game as follows: One person is chosen to go first. This player is
given a cardboard tail with a piece of tape attached to it (the game should come
with these tails.) The player closes his or her eyes, the leader spins the player
around twice, and faces the player toward the Donkey Game. The player walks
up to the game and sticks the tail onto the picture. The tail must be taped to the
first place it touches. If a player misses the tail on the picture, then that player
must pick a question card from the stack of index cards and answer the question
(the leader can read the question aloud to the group). Once that player answers
the question, the other group members have a turn to answer the same question.
If the player gets the tail on the donkey, then instead of drawing a question card,
that player gets to hand out treats from the treat bag to all the players. The next
player then has a turn, and so on, until all the group members have had a turn.
The game continues until all of the questions have been answered.

During the activity, there is ample opportunity to gather assessment information,

observe group dynamics, and enhance peer interaction skills.

Can You Kazoo? (Chalker, 2010)

The therapist and child each choose a kazoo. The therapist hums a rhythm or
tune on one kazoo and the child tries to repeat it. If the child repeats it correctly,
he/she chooses a treat or sticker. Then the client hums a rhythm or tune on
his/her kazoo. The therapist repeats it correctly and chooses a treat or sticker.
The therapist starts out with simple rhythms and increases the complexity as the
child becomes more adept at repeating them. The therapist sets a number of
turns for each person or lets the child decide when to end the game.

Children are often shy or anxious and have difficulty interacting with the therapist.
This activity engages the child and helps build a playful and trusting relationship
without requiring the child to talk. The added incentive of choosing a reward
encourages the childs interest in the game.

Butterflies in My Stomach (Lowenstein, 1999)

The therapist introduces the activity by pointing out that everyone has problems
and worries. Different ways the body reacts to stress are outlined. For example,
when people are scared, their heart might pound faster, or when they are sad
and about to cry, they might feel like they have a lump in their throat.
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The therapist then asks the client if he or she has ever heard of the expression I
have butterflies in my stomach. If the client is unfamiliar with the expression, the
therapist offers an explanation, such as, When you are worried or nervous about
something, your stomach might feel funny or jittery, as if you have butterflies in
your stomach. You dont really have butterflies in your stomach; it just feels like
you do.

Next, the child lies down on a large sheet of banner paper, while the therapist
outlines the childs body. (Alternatively, the child can draw a body outline.) Then
the therapist gives the child assorted sizes of paper butterflies (see Lowenstein,
1999, p. 11). The child writes his or her worries on the paper butterflies. Bigger
worries are written on the larger butterflies, smaller worries on the smaller ones.
If the child is reluctant to identify worries, the therapist can give prompts, such as,
Write about a worry you have at school, Write about a worry you have about
your family and Write about a worry you have with other kids. The butterflies
are then glued onto the childs body outline, inside the stomach. As the child
identifies each worry, the therapist can facilitate further discussion by asking
open-ended questions, such as, Tell me more about this worry. At the end of
the exercise, the child can color the butterflies and decorate the body outline.

This activity facilitates self-awareness and open communication. It is a useful

assessment tool applicable to a wide variety of client populations. This is a
particularly useful activity with children who have a multitude of presenting
problems, as it enables them to communicate to the therapist which problems are
most pressing and need priority in treatment.

The Way I Want It to Be (Lowenstein, 2002)

The client draws two pictures, the first on a sheet of paper titled The Way My
Life Is and the second on a sheet of paper titled The Way I Want It to Be. The
client then discusses the two pictures. The therapist can ask the following
process questions:

How did you feel during the drawing activity?

How are you going to get from the way it is to the way you want it to be?
What do you need to do differently to get to the way you want it to be?
How might therapy help you get to where you want to be?
How will you feel when you get to where you want to be?

A variation for family therapy is to have the family draw two pictures. The first is
titled The Way It Is in Our Family. The second is titled The Way We Want It to
Be in Our Family. The therapist processes the activity as described above, but
the questions are reworded to suit a family session:

How did each person in the family feel during the drawing activity?
What does each member of the family need to do differently to help your family
get to the way you want it to be?
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How might therapy help your family get to where you want to be?
How will it feel to get your family where you want it to be?

Incorporating art activities into family sessions provides a medium to engage all
family members. While the content of the family drawings provides valuable
diagnostic information, the therapist should also focus on the family dynamics
that emerge during the exercise, including interaction styles, issues of power and
control, roles and dysfunctional patterns.

Paper Dolls (Adapted from Crisci, Lay, and Lowenstein, 1997)

Introduce the activity by stating, We are going to do an activity about the
important people in your life, and how you feel about them. The child makes a
string of eight paper dolls (for instructions refer to Crisci, Lay, & Lowenstein,
1997, page 29).

The child uses the paper dolls to complete the activity as follows: "Label each
doll by writing the names of the people who are important to you. Include
yourself, each person in your family, and other people who are important either
because you feel close with them or because they have hurt or upset you. For
example, you may want to include certain relatives, someone who hurt you, your
teacher, a best friend, baby-sitter, foster parent, therapist, or pet. Next, you are
going to put stickers on the paper dolls to show how you feel about these people.
Put a happy face sticker on anyone who feels happy, and explain why they feel
happy. Put a red dot sticker on anyone who feels angry and explain who they are
angry at and why they feel angry. Put a black dot sticker on anyone who is mean
or bad and explain why they are mean or bad. Put a star sticker on anyone who
helps you and explain what they do to help you." As a closing activity, the child
can make a sticker book to take home.

The paper dolls and stickers are used to engage children and to help them
express thoughts and feelings regarding family and community relationships.

Scavenger Hunt (Lowenstein, 2006)

This intervention is most appropriate for group settings, but it can be adapted for
individual or family sessions as well. The therapist develops a list of scavenger
hunt items for group members to create or collect. Modify the list depending on
the ages of the clients and the issues to be addressed in the session. For
example, scavenger hunt items for a group of children dealing with divorce might
include:

Definition of divorce
Outline of a hand
Five feelings children might have when parents divorce
Two people with the same shoe size
Words of advice to help children who feel the divorce was their fault
A group of children holding hands and singing a song aloud
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The activity is explained as follows: You will be divided into two teams. Each
team will get a list of scavenger hunt items to create or collect. You will have 15
minutes to create or collect as many items on the list as you can. The team that
collects the most items from the list wins.

A group leader should be assigned to each group to assist with reading and
writing and to facilitate appropriate group interaction. This intervention promotes
open communication, expression of feelings and problem solving. Likewise, it
encourages open dialogue among group members and facilitates group
cohesion.

Its My Life CD (Adapted from Smith, 2008)

Begin by exploring the clients musical taste and favorite musicians, bands, and
CDs. Present the client with the empty jewel case and explain that she/he will be
designing her/his own CD. This will include the CD title, a cover design, and a
playlist. The CD theme can be as vague as This CD will be about your life, or
more specific, such as focusing on a specific treatment issue (i.e., anger, grief,
and so on). Clients can create fictitious song titles for their playlist or select real
songs that have meaning for them, or a combination of the two. Many
adolescents are immersed in the world of music. This connection to music is a
great way to begin to establish a relationship with teen clients in a non-
threatening manner. The information gathered from this project can be used as a
springboard for further discussions and activities.

Feel Better Bag (Lowenstein, 2006)

Encouraging self-care and teaching healthy coping strategies is an important
goal for most clients. The Feel Better Bag is used as a tool to facilitate self-care.
The child is provided with a bag and fills it with self-care items such as: a stress
ball, dream-catcher, picture of a proud moment, etc. The practitioner and child
can come up with additional self-care items for the Feel Better Bag or obtain
ideas from the book, Creative Interventions for Bereaved Children (Lowenstein,
2006). The child takes the bag home and is encouraged to use the self-care
items during times of need.

Conclusion
Children will more readily embrace therapy if it is engaging, innovative and
immersed in play. The games, art, and music activities in this article are designed
to appeal to children so that a positive therapy experience results. Using these
and other creative activities, therapists can break through the resistive barrier,
engage children in therapy and have successful treatment outcomes.

References
Chalker, D. (2010). Can You Kazoo?. In Assessment and Treatment Activities for
Children, Adolescents, and Families VOLUME TWO: Practitioners Share Their
Most Effective Techniques, ed. L. Lowenstein. Toronto: Champion Press.
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Crisci, G., Lay, M., Lowenstein, L. (1997). Paper Dolls and Paper Airplanes:
Therapeutic Exercises for Sexually Traumatized Children. Indianapolis:
Kidsrights.

Lowenstein, L. (1999). Creative Interventions for Troubled Children & Youth.

Toronto: Champion Press.

Lowenstein, L. (2002). More Creative Interventions for Troubled Children &

Youth. Toronto: Champion Press.

Lowenstein, L. (2006). Creative Interventions for Bereaved Children. Toronto:

Champion Press.

Lowenstein, L. (2006). Creative Interventions for Children of Divorce. Toronto:

Champion Press.

Smith, J. (2008). Its My Life CD. In Assessment and Treatment Activities for
Children, Adolescents, and Families: Practitioners Share Their Most Effective
Techniques, ed. L. Lowenstein. Toronto: Champion Press.

About the Author

Liana Lowenstein, MSW, CPT-S, maintains a private practice in Toronto, provides clinical
supervision and consultation to mental health professionals and lectures internationally on
childhood trauma and play therapy. The activities described in this article were adapted from her
books, Creative Interventions for Troubled Children and Youth (1999), More Creative
Interventions for Troubled Children and Youth (2002), Creative Interventions for Bereaved
Children (2006), Creative Interventions for Children of Divorce (2006). For more information, go to
www.lianalowenstein.com.

Learn more innovative play therapy techniques

at Liana Lowensteins workshop on March 20

Liana Lowenstein