Understanding Play Therapy & Parent-Child Interaction Therapy: A Guide for Parents
How does play therapy work for kids?
Seeking mental health support can feel overwhelming and confusing. There are hundreds of providers using different modalities, or approaches to treatment, making it difficult to decipher who and what approach is best for you, your family, and your child’s needs. Families considering play therapy in Charlotte, NC, as a treatment option for their child experiencing emotional or behavioral challenges may question why and how the modality works. A prominent contributor and key figure in child-centered play therapy, Gary Landreth (2023) states it best: “Fish swim, birds fly, and children play.”
Children do not always have the vocabulary or specific words to depict their emotions, experiences, and needs. Unlike adults, who process trauma, anxiety, grief, frustration, and life changes through talking, children use play as their primary communication method. Play therapy best aligns with a child’s developmental needs, granting them the space to process in a way that feels most natural to them. Parent-involved approaches such as Child-Parent Relationship Training (CPRT) and Parent-Child Interaction Therapy (PCIT) can strengthen caregivers' connection and reduce stress with their child by teaching practical skills to respond to emotional and behavioral needs. While both approaches involve supporting children and their families, play therapy and parent-involved approaches are different in their functioning. Understanding how these approaches operate can help parents make an informed decision about what type of therapy would best fit their family and child’s needs.
What is evidence-based play therapy for children in Charlotte, NC?
Evidence-based play therapy for children in Charlotte, NC, involves more than simply providing toys and a space to play during a counseling session. Play therapy is an intentional, evidence-supported therapeutic approach in which a trained mental health professional engages a child through play and the therapeutic relationship to help children explore their emotions, experiences, behavior patterns, and relationships using the child’s preferred communication method: play.
One well-researched and documented approach is Child-Centered Play Therapy (CCPT). CCPT was derived from the nondirective work of Virginia Axline and further developed by Garry Landreth. Axline (1947) adopted person-centered principles to her work with children and established 8 competencies for nondirectional play therapy: accepting the child for who they are, reflecting feelings, warm therapeutic relationship, developing a safe atmosphere for the child to express emotion, child-led sessions, respecting the child's capacity to problem-solve, establishing limits only when necessary, and avoidance of placing pressure on the child to accelerate the therapeutic process.
These principles established by Axline and advanced by Landreth remain highly relevant to the current literature and practice of CCPT. A 2015 meta-analysis assessed 52 CCPT controlled outcome studies and found a statistically significant, moderate overall treatment effect (Lin & Bratton). Rather than directing the session or asking a long list of questions, the therapist follows the child’s lead. The child gets to choose what and how they want to play, and the therapist tracks and reflects the emotions, decision-making, and experiences the child is replicating in their play. Through the therapist’s “backseat role” and reflections, the child gains confidence and begins to build stronger emotional awareness and self-regulation control. Landreth (2023) emphasizes that the therapeutic relationship is key to healing in CCPT.
It is important to note that emotional distress in children does not always look the same as emotional distress in adults. A child experiencing anxiety may not say “I feel anxious.” Instead, parents may notice:
Frequent reassurance-seeking behaviors
Difficulty separating from a caregiver
Perfectionism
Changes in sleep patterns
Becoming unusually quiet or withdrawn
Irritability or increased emotional outbursts
Physical complaints such as stomachaches or headaches
Play provides children with another way to communicate what may be difficult to explain with words. Thus, play therapy is a way for children to make their internal world external (Landreth, 2023).
What actually happens during a play therapy session?
Imagine asking a four-year-old, “What thoughts are contributing to your fear of separation? What coping strategies could you use to self-soothe?” Responses from the child may look like blank stares, shrugging, topic changes, or an “I do not know.” Parents may notice their child struggling with separation anxiety and must recognize the child’s limited developmental language and self-awareness required to answer those questions. The same child may be able to portray their answers through storytelling with animals, drawing a picture, building and knocking down a tower, or creating a battle scene with army figurines.
Axline's (1947) early work recognized a child’s ability to use play to express experiences and feelings within the safety of a therapeutic relationship. Landreth (2023) further expanded on Axline’s work in CCPT and emphasized understanding the child’s world or perspective, rather than requiring the child to communicate through adult conversations. A trained play therapist can enter the child’s world and look for recurring patterns or themes depicted through the child’s play. These patterns or themes can inform the therapist's understanding of the child’s emotions, relationships, choices, and experiences.
This does not mean that every toy the child picks up, or action the child takes, has a hidden meaning or agenda. A play therapist’s role is to create a consistent relationship in a safe environment in which the child feels empowered to experiment, make choices, solve problems, encounter appropriate limits, and develop a stronger self-awareness of themself and others. For children who have difficulty finding the “right” words, play can provide an alternative pathway to therapy.
What parents might notice at play therapy in Charlotte, NC
Parents may ask themselves or the therapist, “My child just plays during the session. How is that actually helping and different from playing at home?” This is a very understandable and valid question. Everyday play is a healthy and fundamental part of childhood. Children use play at home to have fun, explore their imagination, practice new skills, and build relationships.
CCPT is different not only in setting, but in purpose. CCPT occurs within an intentionally developed therapeutic relationship and is guided by clinical principles and individualized treatment plans. The playroom where CCPT takes place is an intentionally curated environment featuring toys and creative materials for a child to manipulate and express themselves. A play therapist is not simply a spectator of the child’s play or seeking to entertain the child. A play therapist is trained to respond with intentionality to the child’s emotions, choices, behaviors, and play while creating an environment characterized by empathy, consistency, acceptance, and appropriate therapeutic limits (Landreth, 2023).
For example, imagine a child growing frustrated while trying to master the “perfect” tower. At home, a caring adult may offer assistance and show the child how to make the tower stand. In CCPT, the therapist may respond differently through reflection of the child’s experience. The play therapist may state, “You really want that to work” or “You are frustrated it keeps falling.” The play therapist is not ignoring the child or refusing to help. Instead, the therapist is giving the child space to experience the feeling, make a decision about what to do next, and recognize their own capacity for problem solving.
From an outside perspective, therapeutic play can look vastly different from traditional talk therapy. The important distinction is the clinical intention behind the play taking place. Depending on the child’s concerns and treatment goals, parents may begin noticing changes in their child’s ability to:
Cope with frustration
Develop confidence
Regulate strong emotions
Make decisions
Respond to limit setting
Connect more effectively with caregivers
Recognize and communicate emotions
Landreth’s relationship-focused model prioritizes an environment where children experience unconditional acceptance while learning responsibility through appropriate therapeutic limit setting (2023). The balance between freedom and structure within the playroom provides children with opportunities to experiment with decision-making and experience themselves as a capable individual. Similar to traditional talk therapy, progress or growth in CCPT is not always linear and immediate.
Developing trust between child and play therapist takes time and precedent before addressing emotional themes and behavioral changes. Caregiver involvement is an important part of the treatment process. Caregivers may participate in consultations without the child present to discuss concerns, progress, patterns at home, parenting strategies, and other methods to support their child outside of the counseling space.
What is PCIT therapy and how does it work?
Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment that directly involves the child and parent. PCIT was created to address disruptive and externalizing behaviors in young children while strengthening the caregiver-child relationship. Traditional PCIT incorporates two phases: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI).
During Child-Directed Interaction, caregivers learn CCPT skills to increase positive child-parent interactions, reinforce appropriate behavior, and strengthen connection. Parents practice following their child’s lead during play while using specific skills that communicate attention, warmth, and encouragement. During phase two, Parent-Directed Interaction, parents or caregivers learn strategies for giving clear instructions, setting limits, and responding with consistency.
The primary component that sets PCIT apart from other parent counseling modalities is that PCIT is live, real-time coaching. The therapist observes the child and caregiver in real-time and provides feedback while the caregiver practices CCPT skills in a controlled environment. The therapist is able to notice and address gaps in caregiver CCPT skill implementation, instead of only hearing about how the intervention went at home. This allows the therapist to be more specific and provide tailored advice based on the observed interactions between parent and child.
Current research strongly supports PCIT for childhood behavioral concerns. Thomas et. al. (2017) conducted a meta-analysis of 23 studies involving 1,144 participants. The research proved that PCIT significantly reduced children’s externalizing behavior compared to control conditions. In addition, researchers found reductions in overall parent/caregiver stress and improved children’s compliance with caregivers' requests.
How can therapy help parents bond with an anxious or behavioral child?
Therapy for parents building bonds when a child has anxiety and behavioral problems can be a particularly valuable experience because children’s emotions, behaviors, and caregiver relationships often influence one another. A parent’s natural instinct is to protect, so when a child is anxious, a parent might try to provide repeated reassurance, quickly intervene, or allow avoidance of a feared situation in an effort to keep their child from experiencing distress. When a child is struggling behaviorally, parents might find themselves negotiating, repeating directions, raising their voice, or trying multiple consequences in the hope that one will be the “right fix.”
These reactions are understandable. Parenting a child who is anxious, frequently facing dysregulation, or overwhelm can be exhausting. Parent-involved therapy can help primary caregivers better understand what may be contributing to their child’s behavior while developing practical strategies for responding meaningfully and effectively.
PCIT was initially developed to support caregivers and children struggling with disruptive behaviors. Current research also suggests that PCIT is effective in reducing childhood anxiety. The key is teaching caregivers to first stop and ask why a behavior is occurring. Behavior is communication, which provides information. Effective treatment begins by understanding the child and family rather than focusing only on eliminating unwanted behavior.
My approach to working with children and families
In my work with children and families, I use developmentally appropriate approaches that recognize the strengths of the child and foster emotional and physical safety needed for self-exploration and growth. I provide child-centered play therapy (CCPT), child-parent relationship training (CPRT), and parent-child interaction therapy (PCIT) for children, adolescents, and caregivers. I am working towards a Registered Play Therapist credential by undergoing continued education and supervision by a Registered Play Therapist Supervisor (RPT-S).
My approach to play therapy is informed by the child-centered focus established by Axline and further developed by Landreth. I practice under the belief that children need a therapeutic relationship in which they can experience acceptance, empathy, appropriate limits, respect for their capacity to grow, and emotional safety (Axline, 1947; Landreth, 2023). In addition, I consider the child’s world, or their interpretation of it, their truth.
Caregivers are also an important part of the therapeutic process. During CCPT, I interact with the child for only one hour once a week or bi-weekly. Therefore, I believe in working as a team with caregivers to best support the child's needs. Parents may benefit from learning practical tools they can implement with their child to build stronger relationships and gain clearer insight into what their child’s behavior may be communicating. Therapy is not about creating a “perfect child” or “perfect parent”. It is about the pursuit of growth, self-awareness, and empathy for oneself and others.
Helping children feel safe, understood, and connected
Parents or caregivers do not have to wait until their child can perfectly explain what is happening before reaching out for support. Parents and caregivers do not need to wait for their stress levels and child's behavior to escalate to a 10/10. If you have noticed changes in your child’s emotions, relationships, confidence, behavior, or ability to cope with life's many challenges, therapy can provide a safe space for your child to reflect, process, and grow.
If you are interested in learning more about CCPT, PCIT, CPRT, or other evidence-based, trauma-informed approaches and whether one of these approaches is right for your child and family, I welcome you to reach out to learn more about child therapy near South Charlotte.
References
Axline, V. M. (1947). Play therapy: The inner dynamics of childhood. Houghton Mifflin.
Landreth, G. L. (2023). Play therapy: The art of the relationship (4th ed.). Routledge.
Lin, Y.-W., & Bratton, S. C. (2015). A meta-analytic review of child-centered play therapy approaches. Journal of Counseling & Development, 93(1), 45–58. https://doi.org/10.1002/j.1556-6676.2015.00180.x
Stulmaker, H. L., & Ray, D. C. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127–133. https://doi.org/10.1016/j.childyouth.2015.08.005
Thomas, R., Abell, B., Webb, H. J., Avdagic, E., & Zimmer-Gembeck, M. J. (2017). Parent-child interaction therapy: A meta-analysis. Pediatrics, 140(3), Article e20170352. https://doi.org/10.1542/peds.2017-0352
