Stop Guessing: 3 Indicators Play Therapy is Working

Learn three key indicators of play therapy progress and how your theoretical framework can help you make clinical decisions with confidence.

How to recognize meaningful progress in the playroom, understand what your client’s play is telling you, and make clinical decisions with more confidence

One of the questions I hear from play therapists all the time is:

How do I know if play therapy is actually working?

Maybe your client comes into the playroom week after week and plays. You’re noticing things happening in the session, but you’re not quite sure what they mean.

Is this therapeutic?

Are they making progress?

Should I be doing something differently?

And then, of course, parents want to know too.

“How is my child doing?”

That can be a difficult question to answer when you aren't sure what indicators you should be looking for.

This is especially challenging in play therapy because we aren't necessarily sitting across from our clients asking them how they think therapy is going or how close they feel to meeting their treatment goals.

The younger the child, the less likely we are to get useful information that way.

Instead, we have to know what to look for in the play therapy process.

And knowing what to look for doesn't just help you determine whether your client is making progress. It also helps you determine when your client may eventually be ready for termination.

You can't confidently know when therapy is complete if you haven't been able to recognize progress along the way.

Why Progress in Play Therapy Can Be Hard to Measure

One of the biggest reasons play therapists struggle to recognize progress is that they're not always using a framework to make sense of what's happening.

When you don't have a framework, it's easy to start looking for whatever evidence you can find.

You might look primarily at behavior.

And behavior matters. I look at behavior too.

But behavior is only one piece of the picture.

Sometimes you'll begin seeing changes inside the playroom before those changes show up at home, at school, or in the child's relationships.

The opposite can happen too. You might see a quick improvement in behavior while the deeper issue driving that behavior hasn't fully healed.

If we only look at whether the child is "behaving better," we can miss important information about what's actually happening therapeutically.

Another thing I see happen is what I call the spaghetti-against-the-wall approach.

You aren't sure whether therapy is working, so you start second-guessing yourself.

Maybe I need another activity.

Maybe I need to be more directive.

Maybe I need a new intervention.

Before long, you're searching the internet for activities and trying one thing after another because you don't have clear indicators telling you where your client is in the therapeutic process.

And then there is another indicator therapists sometimes rely on:

Can I get the child to talk about it?

This is where we have to remember that play is the child's language.

If we're using games, toys, or art primarily as a way to get a child to verbally process what's happening, we may still be operating from a traditional talk therapy mindset rather than truly using play as the vehicle for therapeutic change.

There are play therapy models where verbal processing is part of the model. But a child's ability or willingness to talk about something isn't the only way to know that healing is happening.

So what should we be looking for?

Your Play Therapy Model Is Your GPS

Before I get into the three indicators, there's an important piece we need to talk about.

Your play therapy model is your GPS.

It helps you know what to do, when to do it, and how to do it.

Most importantly for this conversation, your model helps you understand what you should expect during the different stages of therapy.

What happens during the early stages of treatment will look different from what happens later.

Your role may change.

What the child does may change.

What you're looking for may change.

And how you make sense of those changes should be influenced by the theoretical model you're using.

This is true even if you use an integrative approach.

I consider myself integrative. I love Child-Centered Play Therapy, and I also integrate other theoretical models. But when I'm using Child-Centered Play Therapy, I'm grounding my clinical decision-making in that framework. When I'm integrating models, I'm thinking about the frameworks I'm integrating and how those models understand progress.

Without that theoretical anchor, it's much easier to feel lost and start second-guessing yourself.

And even after almost 35 years in the child and adolescent mental health field, I still get stuck sometimes.

Clients are complex.

Real clients don't always show up exactly the way they did in the training.

When I'm unsure, I go back to my framework.

That's what anchors my clinical decision-making.

Within that framework, there are three broad areas I look at that can give us valuable information about whether progress is happening.

Indicator #1: Changes in the Therapeutic Relationship

The first place to look is the therapeutic relationship.

Think about how a child initially enters your playroom.

Maybe they're hesitant.

They look around but don't really settle into sustained play.

Maybe they ask a lot of questions because they're trying to figure out the rules and expectations.

Maybe they play, but they don't invite you into their play.

Or they barely interact with you at all.

Then, several sessions later, something starts to shift.

They're engaging with you more.

Their play becomes more sustained.

They're letting you see what they're doing.

Maybe they're even starting to test limits.

And sometimes what looks a little more chaotic can actually represent progress.

The child who barely acknowledged you during the first few sessions might suddenly decide that you're going to participate in a very rambunctious sword fight in which you're killed, brought back to life, and promptly killed again.

That is different.

Something has changed in the relationship.

They're showing you more.

They're allowing you into their world.

They're beginning to experience the playroom—and you—as safe enough for greater vulnerability.

Children can't engage in deeper healing until they experience enough safety to do so. That requires trust.

So don't overlook changes in how your client relates to you simply because they don't look like the behavioral changes parents are hoping to see yet.

Those relational shifts can give you important clues about what's happening underneath.

Indicator #2: Changes in Play Themes

The second area I pay close attention to is play themes.

We say it all the time:

Play is the language of children.

If that's true, then we need to listen to what they're communicating through that language.

What is happening repeatedly in the child's play?

What are they saying?

What are they doing?

What roles are showing up?

What patterns keep repeating from one session to another?

Those patterns can help us identify the deeper themes the child is navigating.

For example, perhaps early in therapy you're seeing significant aggressive play.

You're handcuffed and thrown in jail over and over again.

There are repeated sword fights.

The child makes food in the play kitchen—but keeps poisoning yours.

Or the baby dolls are repeatedly "bad" or "naughty."

Those patterns give us information.

Then, over time, the themes may begin to shift.

Maybe you're not getting killed off 97 times anymore.

Maybe the kitchen play begins moving from poisoning toward nurturing.

Maybe the baby dolls start being cared for.

Or perhaps you're working with a child whose parents are divorcing. Initially, you see significant aggression. Later, wedding figures begin appearing in the sand tray as the child starts exploring some of the attachment and family changes happening in their life.

That's movement.

Rather than looking at one isolated play therapy session and trying to decide what it means, look at the patterns across sessions.

How are the themes changing?

How does that shift fit within your play therapy model?

What does your theoretical framework tell you should be happening during this stage of treatment?

And remember that progress isn't always linear.

Children can move forward and then regress when something new happens or another layer emerges. They may move back and forth as they work through what they need to heal.

That's why we need to look at themes over time, rather than making clinical decisions based on a single session.

Indicator #3: Changes in Self-Regulation and Agency

The third broad indicator I look for is self-regulation and agency.

I tend to look at this through a neuroscience and attachment lens.

A child's attachment experiences influence beliefs about themselves, other people, and relationships. There can certainly be other factors involved—including neurodiversity—but those internal beliefs can influence how a child responds to what's happening around them.

If a child's internal experience is:

I'm not safe.

or

People are bad.

their nervous system may respond accordingly.

We may see fight, flight, freeze, shutdown, or other internalizing and externalizing behaviors.

As healing begins to happen internally, we can start seeing changes externally.

Maybe the child isn't shutting down as frequently.

Maybe they're not exploding as often.

Perhaps they're better able to tolerate frustration or adapt when something doesn't go the way they expected.

And then there's agency.

Are they beginning to believe:

I can do this.

I am capable.

I can figure something out.

I can ask for what I need.

Imagine a child who enters therapy with significant themes of helplessness.

Their distress tolerance is very low. As soon as something becomes difficult, they turn to you to fix it.

You're the grown-up. You're supposed to make it better.

But over time, something changes.

Instead of immediately asking you to solve the problem, they try.

They tolerate a little more frustration.

They take initiative.

They begin figuring things out themselves.

They seek help when they need it rather than automatically giving the problem to someone else.

From an Adlerian perspective, we might think about courage and capability. Developmentally, we might look at whether the child is increasingly able to accomplish the tasks we would expect at their stage of development.

Those changes matter.

Greater self-regulation, competence, and agency can all be indicators that deeper therapeutic change is occurring.

Progress Is Bigger Than “Is the Behavior Better?”

This is why I don't want us to reduce progress in play therapy to whether the presenting behavior has disappeared.

Behavior matters.

But we want the bigger picture.

I'm looking at the therapeutic relationship.

I'm looking at play themes and how they're changing over time.

I'm looking at self-regulation, competence, and agency.

And I'm looking at all of those things through the lens of the play therapy model I'm using.

That's what takes us from guessing to clinical decision-making.

Because ultimately, we're not just asking:

“Is the child better?”

We're asking:

Where is this child in the therapeutic process, what is their play communicating, and what does my theoretical framework tell me needs to happen next?

That is a very different question.

And it's one that can give you much more confidence when you're deciding what to do next, explaining progress to parents, or determining whether your client may be moving toward successful termination.

You Don't Have to Figure It Out Alone

This question—How do I know if it's working?—comes up all the time when we're staffing cases inside Play Therapy Elevation Circle and Play Therapy Academy.

Because even when you understand your theoretical model, real cases get complicated.

Sometimes you need another set of eyes.

Sometimes you need someone to help you identify the pattern you're missing.

And sometimes you simply need to hear, Yes, I see what you're seeing too.

That's one of the reasons I believe ongoing consultation and community are so important for play therapists.

No matter how long you've been doing this work, you don't have to figure out every moving piece by yourself.

Want Support Making These Clinical Decisions?

If you're tired of second-guessing your clinical decisions, Play Therapy Elevation CIRCLE is a community designed to give play therapists ongoing clinical support.

We staff cases, discuss clinical topics relevant to play therapists, and share ideas and resources so you have a place to work through the complicated parts of this work with other professionals who understand play therapy.

Because one of the things I've seen contribute to second-guessing again and again is trying to provide play therapy in isolation.

There are a lot of moving parts.

You don't have to figure all of them out alone.

Categories: : Case Conceptualization, Community, Play Therapy Academy, Play Therapy Elevation Circle, Play Therapy Model, Podcast, Supervision