Play therapy practices among elementary school counselors.

This study surveyed elementary school counselors who were members of the American School Counselor Association regarding play therapy practices in the schools. Participants (N = 381) were surveyed regarding their training in play therapy, their use of play therapy, their belief system regarding play therapy, and their perceived limitations to the use of play therapy in the schools. Although school counselors appear to believe in the utility of play therapy in the schools, certain barriers were found to exist that were detrimental to its implementation. Counselors identified lack of time available with students and lack of training in play therapy as the primary limitations to its use in the schools.

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Recent literature encourages the use of play therapy as a counseling medium for elementary school counselors (Baker & Gerler, 2004; Newsome & Gladding, 2003; Schmidt, 2003; White & Flynt, 1999). In addition, play therapy helps school counselors in the implementation of the National Standards developed by the American School Counselor Association (ASCA). These standards guide counselors to help students "acquire the attitudes, knowledge and interpersonal skills to help them understand and respect self and others" (ASCA, 2003, p. 2). When responsive services are required of the elementary school counselor, play therapy appears to be one of the developmentally appropriate methods of intervention.

Responsive services address the immediate concerns of students. Individual counseling and group counseling are integral to responsive services. Counselors use these remedial interventions with students who have difficulty making healthy choices and for those who need assistance in coping with difficult situations (Cobia & Henderson, 2003). In the elementary school, responsive services cover a broad range of interventions, from providing counseling groups for children of divorce to assist with their emotional struggles, to offering individual counseling for an abused child not functioning in school, to providing crisis intervention for a child who has lost control. Play therapy can be a way to help elementary school students deal with these issues.

RATIONALE FOR PLAY THERAPY

The use of play therapy is based on a developmental understanding of children. Piaget's (1962) theory of cognitive development recognizes the differences between the way that children understand and process information and the way that adults function. Most children at the elementary level function at two stages: the "Preoperational Stage" (2-7 years) and the "Concrete Operations Stage" (8-11 years). These stages are approximately identified with chronological ages but there are significant variations among children.

At the Preoperational Stage, a child is acquiring the skill of language in which symbols are used to mentally represent objects. Also, in this stage, a child's thinking is rigid and limited to how things appear at the time. This is the stage of magical thinking in which children create implausible explanations for things that they do not understand. Regarding play, a child's play behaviors become increasingly imaginary and fantasy driven. The play, however, will increase in complexity from make-believe play to encompassing emerging cognitive patterns. Internally, the child is improving understanding and knowledge, but externally, the child lacks the ability to communicate this enhanced way of processing within the world. Play is one of the primary ways in which a child can communicate this internal awareness of self and others.

During the Concrete Operations Stage, the child grows in personal ability to reason logically and organize thoughts coherently. Children are able to manipulate ideas and accept logical societal rules. However, they can only think about actual physical objects. They are limited in their ability to engage in abstract reasoning. In this stage, children are unable to express certain complicated emotions, such as guilt or resentment, because of the need for abstract thought to understand such emotions. For those children operating in the Concrete Operations Stage, play helps to bridge the gap between concrete experience and abstract thought.

Building on a developmental understanding of children, Axline (1969) and Landreth (2002) both identified basic principles that guide the therapist in play therapy. These basic principles are consistent with a child-centered philosophy of working with children (Landreth). They include, but are not limited to, the following:

1. Children's natural language is play. Play is a developmentally appropriate way that children express themselves.

2. Children have an inherent tendency toward growth and maturity.

3. Children are themselves capable of positive self-direction. Children possess the capacity to act responsibly.

In summary, play is an important medium for children for several reasons. Play is a natural language from which children express themselves (Landreth, 2002). Developmentally, play bridges the gap between concrete experience and abstract thought. Play offers children the opportunity to organize their real-life experiences that are often complicated and abstract in nature. Children gain a sense of control through play and also learn coping skills. Play therapy utilizes this understanding of children by offering children a therapeutic environment for their play. Play therapy is defined as a dynamic interpersonal relationship between a child and a therapist. The therapist, trained in play therapy procedures, provides selected play materials and facilitates the development of a safe relationship for the child to fully express and explore self. This process occurs through the child's natural medium of expression, play (Landreth).

THE USE OF PLAY THERAPY IN SCHOOLS

When elementary school counselors have a solid developmental understanding of children, play therapy might be one counseling intervention that they use with their students. Landreth (2002) has promoted the use of play therapy in schools by explaining that its objective is to help children get ready to profit from what teachers have to offer. Play therapy is an approach that may help school counselors to effectively assist children in their developmental growth.

In a meta-analysis of play therapy outcome research, Ray, Bratton, Rhine, and Jones (2001) found that play therapy was an effective treatment for children's problems. Treatment groups receiving play therapy performed .80 standard deviations better than nontreatment groups. This is considered to be in the large effect size category (Cohen, 1977). This research included 94 studies spanning 6 decades, with 36 of the studies conducted in school settings. Fall, Balvanz, Johnson, and Nelson (1999) compared 31 children, who received six play therapy sessions facilitated by school counselors, to 31 children in a control group not receiving services. They found that self-efficacy was significantly increased for those children participating in play therapy. Additionally, Johnson, McLeod, and Fall (1997) and Post (1999) investigated the effectiveness of play therapy in schools. Both studies found that play therapy had a positive impact on student participants as compared to nonparticipants.

PURPOSE OF THIS STUDY

Play therapy appears to be a developmentally appropriate and effective means of counseling for elementary school students. However, to date, there has been little research conducted on the use and practice of play therapy by elementary school counselors. Because of this lack of knowledge, the authors surveyed elementary school counselors on such issues as training in and use of play therapy. The following research questions were posed:

1. What is the relationship between counselors' level of play therapy training and the use of play therapy in the schools?

2. What is the relationship between counselors' beliefs about play therapy and the use of play therapy in the schools?

3. What is the relationship between counselors' perceived barriers to using play therapy in the schools and the use of play therapy in the schools?

METHOD

Participants

Participants in this study were 381 ASCA members employed as elementary school counselors. Counselors from all states except Alaska were represented in addition to counselors located in Germany, Austria, Korea, and Puerto Rico. The sample consisted of 348 females (91.6%) and 32 males (8.4%), with a mean age of 47 years (SD = 11; range = 25-73). Degrees held by respondents included 355 (93.2%) master's degrees, 15 (3.9%) doctoral degrees, and 2 (.5%) bachelor's degrees. Participants' mean number of years of experience in school counseling was 8.85 (SD = 7; range = 1-35). Participants' school locations consisted of 180 (48.8%) suburban, 114 (31.1%) rural, and 74 (20.2%) urban schools. Participants' membership in other professional organizations included 167 (43.9%) in American Counseling Association, 28 (7.4%) in Association for Play Therapy, 10 (2.6%) in American Psychological Association, and 2 (.5%) in National Association for Social Workers. One hundred and forty (36.8%) participants reported membership in other professional organizations that largely included state and local associations.

Instrument

A survey was developed based upon Axline's (1969) underlying beliefs about children when implementing person-centered play therapy and McLeod's (2000) research on the use of play therapy in public schools. The survey included demographic questions including gender, birth year, highest degree earned, years as a school counselor, location of the school (rural, suburban, or urban), number of students served, number of university-level courses in play therapy, number of workshops in play therapy, years of practical experience in play therapy, and membership in professional organizations. Participants then responded to some statements addressing beliefs regarding children using the following 5-point scale: 1 = strongly agree, 2 = agree, 3 = no opinion, 4 = disagree, 5 = strongly disagree. The three statements were the following: (a) Children have an inherent tendency toward growth and maturity. (b) Children's natural language is play. (c) Children are themselves capable of positive self-direction.

Three questions then addressed the use of play therapy, including (a) the number of hours spent engaged in counseling with students, (b) personal identification as a play therapist, and (c) the hours per week spent in play therapy with students. Participants then were asked to rate the effectiveness of play therapy for elementary school counseling on a 5-point Likert scale. The final section of the survey addressed factors that might limit the use of play therapy, including the following: lack of facilities or space at the school, lack of supplies in the school, lack of administrative support, lack of time available with students, lack of training/education in play therapy, or disbelief in play therapy effectiveness. At the conclusion of the survey, participants were provided an opportunity to write any comments regarding limitations to the use of play therapy. The survey was pilot-tested via administration to a sample of local master's-level school counselors in order to clarify any ambiguous items.

Procedures

ASCA provided the researchers with 2,000 names randomly selected from its elementary school counseling membership. The researchers randomly selected 800 participants from this sample to participate in the survey. Gall, Borg, and Gall (1996) and Rea and Parker (1997) both cited low response rates as a major limitation of mail surveys. In efforts to improve the return rate of this survey, respondents were entered in a drawing for a DVD player.

The 800 individuals in the sample initially were precontacted via e-mail to inform them of the study and that the surveys would be arriving via mail. Surveys then were sent with a cover letter and a postage-paid return envelope. A total of 330 surveys were returned within 28 days of the initial mailing. After 28 days, a follow-up notification was submitted via e-mail to those who had not responded. This follow-up included an electronic version of the survey that could be returned via e-mail. After this follow-up, 7 surveys were retrieved via e-mail and 44 surveys were retrieved via the postal service. Data collection ended on the 60th day after the initial mailing. The final return consisted of 381 surveys representing a 48% return rate. All 381 surveys were included in the final sample for this study.

RESULTS

Training and Use of Play Therapy

When participants were asked how much training in play therapy they had received, 67% indicated that they had not taken a university-level play therapy course. About 21% of participants indicated that they had taken one university play therapy course and 12% reported that they had taken two or more play therapy courses. As shown in Table 1, the level of training in play therapy was significantly related to its use in elementary schools. Mantel-Haenszel chi-square tests revealed that the relationship between formal training in play therapy and use of play therapy was significant, [chi square] (N= 300) = 11.56, p = .0007.

The majority of the respondents, 62%, indicated that they used play therapy 3 hours or less per week in their schools. Another 19% indicated that they used play therapy 4 to 6 hours a week. Apparently one of the factors related to the use of play therapy is the number of hours participants spent counseling students in general. About 93% of participants who indicated that they counseled students 5 hours or less per week reported that they used play therapy 3 hours or less per week. By contrast, about 38% of the participants who counseled students 6 hours or more per week used play therapy 4 hours or more per week.

Child-Centered Beliefs and Use of Play Therapy

Ninety-four percent of respondents strongly agreed or agreed that children have an inherent tendency toward growth and maturity. About 97% of the participants strongly agreed or agreed that children's natural language is play. Also, 78% of the participants strongly agreed or agreed that children are capable of positive self-direction. Even though the vast majority of participants indicated that they held beliefs about children that are consistent with child-centered play therapy, the only belief that was significantly related to the use of play therapy was the principle that the natural language of children is play, as indicated by Table 1, [chi square] (N= 376) = 11.92, p = .0006.

Barriers to the Use of Play Therapy

Chi-square tests were used to analyze the relationship between various barriers in schools and the use of play therapy. The belief that play therapy is ineffective was listed as a barrier by fewer than 2% of participants. Participants did indicate that a lack of time and training were the most important factors that limited their use of play therapy in elementary schools. Even though 70% of participants reported that a lack of time limited their use of play therapy in schools, the relationship between a lack of time and the number of hours using play therapy was not statistically significant. However, the relationship between a lack of training and the number of hours using play therapy was statistically significant, [chi square] (N = 376) = 14.19, p = .0002. Results from additionally listed survey barriers did not reach statistical significance. These included lack of facilities or space, lack of supplies, lack of administrative support, and time consumed with noncounseling duties.

DISCUSSION

Despite the increasing support for using play therapy in elementary schools (Baker & Gerler, 2004; Newsome & Gladding, 2003; Schmidt, 2003; White & Flynt, 1999), researchers have not investigated the level of implementation of play therapy by elementary school counselors. The present study explored the practices of elementary school counselors concerning play therapy. In addition, this study surveyed the beliefs that counselors hold regarding the effectiveness of play therapy and the philosophy of child-centered play therapy.

Overall, participants demonstrated strong support for play therapy in elementary schools. More than 73% of respondents indicated that they believed that play therapy is an effective or highly effective tool for elementary school counselors, even though most participants had not been trained in play therapy. Only 1.6% identified the ineffectiveness of play therapy as a limiting factor to its use in schools.

The belief in the effectiveness of play therapy could possibly be tied to basic beliefs about children. These basic principles are integral to the child-centered play therapy philosophy. Such beliefs were included in the survey so that researchers could investigate the relationship between barriers to play therapy and basic beliefs about children. Although more than 53% of participants had never been formally trained in play therapy, and another 20% declined to answer this question (possibly indicating that more than 73% of participants had never received formal training), the participants appeared to embrace several of these core beliefs. On the whole, it appeared that participants held beliefs that are consistent or somewhat consistent with child-centered play therapy. Counselors' beliefs in the strength of play and children's capabilities could explain their belief that play therapy is an effective medium for the elementary school counselor.

Results indicated that the majority of the surveyed elementary school counselors maintained a positive impression regarding the use of play therapy. In addition, their belief systems seemed aligned, or at least not opposed, to the belief system of child-centered play therapy. On the final question of the survey, counselors identified specific factors that limited their use of play therapy in the schools. The counselors recognized that their lack of time available to spend with counseling students and their lack of training were the main barriers to using play therapy. It is not surprising that counselors identified their lack of time to counsel students as their primary limitation to using play therapy. Counselors have becoming increasingly responsible for other duties in the schools, including testing and administrative tasks. This may limit their ability to provide any responsive services, including play therapy.

Results also reflected the positive effect of receiving training, because the amount of training that one received seemed to dictate the level at which one saw play therapy as effective. The researchers were most concerned with the finding that counselors identified a lack of training in play therapy as their second highest barrier to the use of play therapy. Close to 63% indicated a lack of training as a limitation. This finding was consistent with the previous finding that very few school counselors have actually received formal training in play therapy. In fact, several returned surveys included requests for training or training materials from the researchers. Participants in the survey appeared to hold play therapy in high regard and desired training in the use of play therapy.

One surprising finding regarding the specific limitations to play therapy in the schools was that counselors did not largely identify administrator support as a problem. The counselors seemed to be much more impaired by job duties, training, and facilities/materials than opposition from administrators. This seems to bode well for future implementation of play therapy in elementary schools. Ostensibly, if the counselor could concentrate on counseling duties and receive training, administrators would be in support of play therapy.

LIMITATIONS AND FUTURE RESEARCH

This study was encumbered by several research limitations. Although ASCA provided a randomized sample of elementary school counselors and an additional random sample was taken from the original sample, participants may not fully represent elementary school counselors. ASCA membership does not represent all elementary school counselors. It may be that there are differences in those professionals who choose to join their professional associations and those who are not affiliated with such organizations.

Possible future studies on the use of play therapy in the schools seem warranted. A future study might involve surveying school counselors who practice play therapy on the specifics of how they deliver play therapy in their schools. Research also is needed on how counselors make play therapy work in their schools. In addition, more information on what type of training is available to school counselors and what specific areas are severely lacking in training availability would be useful. As identified by Ray et al. (2001), researchers need to continue investigating the effects of play therapy in schools. The more we can demonstrate the effectiveness of play therapy, the more likely school counselors will be able to break down the identified barriers to play therapy.

CONCLUSION

The findings of the present study describe current play therapy practices of elementary school counselors. Although school counselors who participated in this study appeared to believe in the utility of play therapy in schools, certain barriers were identified that may limit its implementation. Lack of time available to work directly with students and lack of training in play therapy were the primary limitations identified in this study. These findings indicate that many elementary school counselors believe that play therapy is a developmentally appropriate way to provide counseling to young children. This study supports the need to address the barriers identified and to provide more pre-service training to future school counselors.

Table 1. Relationship of Training and Child-Centered Beliefs to
Utilization of Play Therapy

                  Utilization of Play Therapy (hours per week)

                  0 to 3 hrs     4 to 6 hrs   7 to 9 hrs

Training in play therapy--courses (n = 300) *

No courses         145 (72%)      25 (12%)       15  (7%)

1 or more           45 (46%)      28 (29%)       11 (11%)

Belief #1: Children have a tendency toward growth and
maturity (n = 376)

Agree              223 (63%)     68  (19%)       30  (8%)

Disagree            13 (62%)      3  (14%)        1  (4%)

Belief #2: Children's natural language is play (n = 376) *

Agree              227 (62%)     70  (19%)       31  (8%)

Disagree             9 (90%)      1  (10%)        0

Belief #3: Children are capable of self-direction (n = 376)

Agree              182 (62%)     56 (19%)        22  (8%)

Disagree            54 (65%)     15 (18%)         9 (11%)

                  Utilization of Play Therapy (hours per week)

                  10 to 12 hrs   13 + hrs        Total

Training in play therapy--courses (n = 300) *

No courses          12  (6%)      5  (2%)          202

1 or more            6  (6%)      8  (8%)           98

Belief #1: Children have a tendency toward growth and
maturity (n = 376)

Agree               20  (6%)     14  (4%)          355

Disagree             2 (10%)     2  (10%)           21

Belief #2: Children's natural language is play (n = 376) *

Agree               22  (6%)     16  (4%)          366

Disagree             0            0                 10

Belief #3: Children are capable of self-direction (n = 376)

Agree               20  (7%)     13  (4%)          293

Disagree             2  (2%)      3  (4%)           83

Note. Mantel-Haenszel chi-square is significant.
* p < .001.

References

American School Counselor Association. (2003). National standards. Retrieved December 7, 2003, from the ASCA Web site, http://www.schoolcounselor.org

Axline, V. (1969). Play therapy. New York: Ballantine.

Baker, S., & Gerler, E. (2004). School counseling for the twenty-first century (4th ed.). Upper Saddle River, NJ: Merrill Prentice Hall.

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Cohen, J. (1977). Statistical power analysis for the behavioral sciences (Rev. ed.). New York: Academic Press.

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Gall, M., Borg, W., & Gall, J. (1996). Education research: An introduction. White Plains, NY: Longman.

Johnson, L., McLeod, E., & Fall, M. (1997). Play therapy with labeled children in the schools. Professional School Counseling, 1, 31-34.

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Piaget, J. (1962). Play, dreams, and imitation in childhood. New York: Routledge.

Post, P. (1999). Impact of child-centered play therapy on the self-esteem, locus of control, and anxiety of at-risk 4th, 5th, and 6th grade students. International. Journal of Play Therapy, 8, 1-18.

Ray, D., Bratton, S., Rhine, T., & Jones, L. (2001).The effectiveness of play therapy: Responding to the critics. International Journal of Play Therapy, 10, 85-108.

Rea, L. M., & Parker, R. A. (1997). Designing and conducting survey research: A comprehensive guide. San Francisco: Jossey-Bass.

Schmidt, J. (2003). Counseling in schools: Essential services and comprehensive programs (4th ed.). Boston: Allyn & Bacon.

White, J., & Flynt, M. (1999). Play groups in elementary school. In D. S. Sweeney & L. E. Homeyer (Eds.), Group play therapy: How to do it, how it works, and whom it's best for (pp. 336-358). San Francisco: Jossey-Bass.

Dee C. Ray is director of the Child and Family Resource Clinic and assistant professor in the Counseling Program, University of North Texas, Denton.

Stephen A. Armstrong is assistant professor in the Department of Counseling, Texas A&M University-Commerce.

E. Scott Warren is a doctoral student in the Counseling Program, University of North Texas.

Richard S. Balkin is assistant professor in the Department of Counseling, Texas A&M University-Commerce. E-mail: [e-mail]