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Neuroscience research has provided support for the potential of play therapy to create new neural pathways. Recent studies also have identified the impact of mirror neurons and oxytocin on the therapeutic relationship. Using the metaphor of magic, we discuss how magicians take advantage of these neurological processes to trick audiences and contrast how play therapists use similar dynamics to enhance neuroplasticity. Whereas magicians rely on techniques that narrow or misdirect attention to create their illusions, the magic of play therapy is a powerful and developmentally appropriate method of directing attention to the child’s environment, expanding awareness and transforming children and adolescents.
Neuroscience and the Magic of Play Therapy
Anne L. Stewart
James Madison University
Thomas A. Field
City University of Seattle
Lennis G. Echterling
James Madison University
Neuroscience research has provided support for the potential of play therapy to create
new neural pathways. Recent studies also have identified the impact of mirror neurons
and oxytocin on the therapeutic relationship. Using the metaphor of magic, we discuss
how magicians take advantage of these neurological processes to trick audiences and
contrast how play therapists use similar dynamics to enhance neuroplasticity. Whereas
magicians rely on techniques that narrow or misdirect attention to create their illusions,
the magic of play therapy is a powerful and developmentally appropriate method of
directing attention to the child’s environment, expanding awareness and transforming
children and adolescents.
Keywords: neuroscience, play therapy, attention, magic
Magicians are entertainers whose tricks
amuse and mystify their audiences. Researchers
have discovered that these illusions involve ex-
ploiting neurological processes by taking ad-
vantage of mirror neurons and oxytocin. In fact,
magicians practice both sleight of hand and
sleight of mind (Macknik & Martinez-Conde,
2010;Macknik et al., 2008). Whereas magi-
cians are tricksters, play therapists are commit-
ted to authenticity and transparency—no gim-
micks, no deceptions. Nevertheless, magicians
and play therapists have a great deal in com-
mon. They both are professionals who are ded-
icated to honing their skills, gifted in quickly
developing rapport, and talented in creating
transformative experiences. In this article, we
discuss the neurological principles that both
magicians and play therapists apply to their
work. We summarize the neuroscience findings
that relate to both, and describe how play ther-
apists, using the healing powers of play, pro-
mote the neuroplasticity of their clients. A clin-
ical vignette is provided to illustrate how
neuroscience knowledge can help therapists to
explain and parents to understand the magic of
play therapy.
Neuroscience Principles of Magic
Neuroscientists have demonstrated that the
fundamental principle of magicians is to direct
the attention of others (Macknik & Martinez-
Conde, 2010). They artfully manage attention
and use the shortcomings of human awareness
by a variety of sensory capture processes, such
as framing, top-down attention, bottom-up at-
tention and change blindness.
Framing is a common strategy that magicians
use to localize the audience’s attention, and, in
the process, divert it from noticing a surrepti-
tious action. Patter is one framing technique that
holds the spectators’ interest with ongoing com-
mentary and jokes while the magician is busy
with illusive maneuvers. Magicians also can
immediately narrow our frames by displaying,
with a flourish, a deck of cards to the audience
in one hand. Having captured the spectators’
attentional spotlight, they can secretly palm a
card in the other.
Anne L. Stewart, Department of Graduate Psychology,
James Madison University; Thomas A. Field, Division of
Arts and Sciences, City University of Seattle; Lennis G.
Echterling, Department of Graduate Psychology, James
Madison University.
Correspondence concerning this article should be ad-
dressed to Anne L. Stewart, Department of Graduate
Psychology, 70 Alumnae Drive, MSC 7401, James Mad-
ison University, Harrisonburg, VA 22807. E-mail:
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
International Journal of Play Therapy © 2016 Association for Play Therapy
2016, Vol. 25, No. 1, 4–13 1555-6824/16/$12.00
Top-down attention is a voluntary process in
which one chooses to focus the awareness spot-
light on a particular stimulus. Neuroscientists
have identified the frontal lobe as the origin of
this executive function, which is then mediated
through the basal ganglia (Buschman & Miller,
2007). An example of manipulating attention
through top-down processing is when a magi-
cian merely instructs the audience to observe
carefully an object that a volunteer is holding,
while carrying out a secret action behind the
volunteer’s back.
Bottom-up attention is a rapid and automatic
form of selective filtering that is evoked invol-
untarily by emotional arousal (Connor, Egeth,
& Yantis, 2004). Neuroscientists have identified
the origin of this processing in the brainstem,
parietal, and temporal cortices, so the direction
is upward. One way in which a magician con-
trols this ascending sensory system is by sud-
denly producing an unexpected spectacle, such
as a flying dove or oversized bouquet. Involun-
tarily and automatically, the spectators’ gaze
and attention will focus on the unanticipated
action, giving the magician a few unattended
seconds to carry out the mechanisms involved
in the next trick.
Another important perception principle that
magicians rely on to trick the audience is
change blindness, the well-documented failure
to notice significant transformations that take
place right before our eyes (Levin, 2012). Neu-
roscientists recognize that change blindness
happens because, contrary to popular myth,
multitasking is impossible. Instead, individuals
are actually switching their attention, however
briefly, from one task to another.
Neurobiological mechanisms are also used
by magicians as they create an atmosphere of
wonder and surprise. A great deal of exciting
research has found the neuropeptide oxytocin to
increase interpersonal trust (Bartz, Zaki, Bolger,
& Ochsner, 2011). Studies have demonstrated
that oxytocin levels quickly rise when individ-
uals laugh together, display affection, and show
empathy (Feldman, 2012). Magicians rely on
humor and affability to establish rapport and
trigger the release of oxytocin. Consequently,
the higher levels of trust increase the suscepti-
bility of the spectators to being misled during
the performance.
Mirror neurons are present throughout the
human brain and are considered the building
blocks of empathy (Iacoboni, 2012). Our mirror
neurons enable us to imitate the actions of oth-
ers and understand their intentions. However,
they also allow us to be easily bluffed by the
decoys of magicians. A skilled magician con-
stantly makes use of seemingly innocent actions
to hide ulterior moves.
The Neuroscience and Magic of
Play Therapy
Play therapists can also rely on neuroscience
to create a sense of magic, without trickery, in
their work with children. Play is an emotionally
engaging and creative experience that increases
levels of oxytocin. As noted earlier, this hor-
mone enhances feelings of emotional well-
being and trust, thus supporting the creation of
a therapeutic relationship between the child and
play therapist. Mirror neurons are also activated
in play, helping the therapist accurately read
and connect with the child’s emotional state.
Cozolino (2010) proposed a bio-behavioral
view of therapy as a specialized type of en-
riched environment and asserted that “psycho-
therapy is a means of creating or restoring co-
ordination among various neural networks” (p.
25). He argued that therapists can use their
knowledge of neuroscience to design interven-
tions that support the creation of new neural
pathways, in other words, to promote neuro-
plasticity (Cozolino, 2010).
Promoting Neuroplasticity
Cozolino (2010) has identified four factors of
therapy that enhance neuroplasticity. First, the
empathic attunement of a therapeutic alliance
provides the optimal chemical environment for
creating new neural pathways. The importance
of a strong alliance comprised of goals, tasks
and bonds, which has been supported in numer-
ous studies and typically accounts for 30% of
the variance in child, adolescent, and adult psy-
chotherapy outcome research, now has support
from the field of neuroscience (Lambert & Bar-
ley, 2001;Shirk, Karver, & Brown, 2011). Sec-
ond, a certain level of emotional arousal is ideal
for consolidation and integration of neural path-
ways. The context of client-directed play may
permit the child to determine her personal
“sweet spot” for promoting neuroplasticity.
Millions of neurons are firing in both the child’s
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and the therapist’s brains as they engage in the
emotionally and physically enriched playroom
environment. The integration of affect and cog-
nition is the third therapeutic factor. In the play-
room, the child and therapist collaboratively
create conditions where the brain has an optimal
amount of arousal, setting the stage for change
and learning to take place. Complex, elegant
neural patterns emerge when clients engage in
practices that are both expressive and mindful
(Siegel, 2007). Finally, play therapy involves
co-constructing wordless narratives of self-
awareness and transformation. Play has the es-
sential characteristic of honoring the child’s
emotional world and private logic while simul-
taneously providing the conditions to author a
healthier, more adaptive narrative. These four
factors not only promote neuroplasticity, but
also they allow the play therapist to use the
same neurological processes that magicians rely
on to perform tricks. However, in the hands of
play therapists, these same processes can en-
hance relational connectedness, deepen con-
sciousness, and promote conditions for change.
Enhancing Attention and
Expanding Awareness
The findings of neuroscience support the cen-
trality of attention, awareness, and conscious-
ness in the dynamics of successful play therapy.
In contrast to the magician who uses a gimmick
to narrow or misdirect attention, the effective
therapist helps to expand awareness. The pro-
cesses that exist beneath conscious awareness
are vitally responsible for a child’s fundamental
way of being, sense of self, and worldview
(Lux, 2010). However, because such aspects of
functioning are unconscious, they are outside
the range of deliberate cognitive analysis. Nev-
ertheless, they are reachable through the
“magic” of the interpersonal encounter that
takes place in the play therapy relationship.
Building on the transformative power of the
therapeutic alliance, play therapists can rely on
the processes of framing and reframing, top-
down attention, and bottom-up attention to ex-
pand the client’s awareness.
Magicians often lull audiences into false
senses of security through small talk and dis-
cussion while performing the magic trick. In
contrast, play therapy provides a unique frame-
work for the child to explore life circumstances
by establishing security through a safe interper-
sonal haven. The empathic, resonating thera-
peutic relationship provides an unspoken re-
framing of the child’s windows of awareness. In
the safety of the therapeutic relationship, the
child can express and encounter worries, hopes,
fears, anger, and joy. By engaging in play ac-
tivities, therapists rely on the principle of top-
down attention to enable children to focus their
awareness on previously unacknowledged per-
sonal strengths, emerging competencies and un-
explored emotional terrain. Simple, well-timed
tracking statements, comments that acknowl-
edge the child’s decision-making and creative
capacities, and meaningful reflections are op-
portunities for children to see themselves in
different, more positive ways. The play thera-
pist can also facilitate a bottom-up process,
which is rapid and automatic, by several tech-
niques that capture the client’s attention and
arouse emotion. The client’s body language,
tone of voice, and facial expressions are often
outside of awareness. Therefore, one play ther-
apy strategy is to use immediacy by tracking the
behavior and feeling state of the child, making
evident both actions and affect. Another strat-
egy is to honor the child’s transderivational
searches (Erickson, Rossi, & Rossi, 1976)—
those mindful, introspective pauses during
which children may tilt their heads and defocus
their eyes as they explore their inner experience.
At such moments, the play therapist can allow
time for the child to access unconscious pro-
cesses through expressive and symbolic play.
Overcoming Change Blindness
In change blindness experiments, one person
or object is often switched with another, outside
of the viewer’s conscious awareness. The fun-
damental lesson of the change blindness studies
is that to truly see, we must pay careful atten-
tion. Gradual changes, which are typical in play
therapy, can be especially difficult to notice.
The process usually takes place imperceptibly
when children experience more satisfying inter-
actions, an expanded range of emotions, and
enhanced regulation. Nevertheless, when they
turn their focus from inadequacy to compe-
tency, from victimization to resilience, and
from agony to hope, they change in heart, mind
and brain.
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Researchers have found communication and
collaboration can overcome change blindness
(Tollner-Burngasser, Riley, & Nelson, 2010).
The therapist has a unique opportunity and re-
sponsibility to bear witness to the process of a
new person gradually appearing from the for-
mer self—much the same way that the change
blindness experiments switch one person for
another. Frequently, the therapist can track
change by combining a there-and-then recollec-
tion with a here-and-now observation. For ex-
ample, the therapist might say, “You know,
back when we started working together, you
looked really sad. Now, I see you smiling as you
draw this picture.”
Using Oxytocin for Enhancing
Therapeutic Trust
Magicians rarely rely on interpersonal trust
from their audience to perform tricks. In play
therapy, the relationship between therapist and
client is characterized by unconditional positive
regard and genuineness (Landreth, 2012),
whereby both the therapist and the child estab-
lish a trusting therapeutic bond. Numerous
studies indicate that oxytocin plays a key role
in social behavior and social understanding.
Oxytocin secretion is typically correlated
with increased trust, reduced fear, and im-
proved emotional recognition. Because of the
lessening of the fearful effects produced by
the amygdala, the child will be able to address
previously threatening aspects of trauma or
loss. Formerly automatic defensive responses
will be relaxed so that maladaptive somatic
markers can be unlearned and new patterns of
engagement, responding and problem-solving
can be tried. As James (1996) stated, “In the
safe disguise of play, (the child) can balance
power, reward himself or herself with fabulous
riches, vanquish those who do not do his or her
bidding, and devour his or her enemies” (p 163).
Symbolic play in the context of a caring rela-
tionship provides safe opportunities for the
child to practice creative exploration, reenact-
ment, and rehearsal for dealing with challenging
emotions, people and events.
Using Mirror Neurons for
Empathic Attunement
An attuned play therapist, who seeks to un-
derstand what it is like to experience oneself
and the world as the child does, achieves this
understanding by attending to information re-
ceived from his or her own mirror neuron sys-
tem. This understanding is first an implicit sen-
sation that emerges as an intuition. The therapist
then feels the child’s emotion. In return, this
magical moment of connection can help the
child to feel truly felt. Such an exchange of
emotional contagion is the heart of the thera-
peutic encounter.
Neurologists have discovered how the simple
act of making eye contact is another example of
how hard-wired humans are for connecting with
others. A magician uses eye contact to distract
and deceive, but a play therapist uses it to attune
with the child and create a therapeutic alliance.
This interpersonal fusing of experience involves
the right hemisphere of the play therapist’s
brain connecting implicitly to the child’s right
hemisphere (Schore, 2012). This reciprocal
connection on an unconscious level allows for a
mutual communication that creates relational
magic. A magic performance can leave a spec-
tator mystified, but the real magic of play ther-
apy is that it can leave a child transformed.
Play Therapy as a Developmentally
Appropriate Method
For many children, magic tricks are a popular
form of play, in part because unexpected events
spotlight attention and interest and because
many children respond more to nonverbal sig-
nals than verbal discussion. Play therapy has
been established as a developmentally appropri-
ate intervention for young children and preado-
lescents, in contrast to the traditional counseling
approach of talk therapy (Goodman, Reed, &
Athey-Lloyd, 2015). Studies of brain functions
and development provide an additional evi-
dence base to help explain why talk therapy is
less appropriate during early developmental pe-
riods. The prefrontal cortex is the one of the last
brain regions to fully develop (Field, Beeson, &
Jones, 2015), usually not until a person is in his
or her mid-20s. The ability for executive func-
tioning, also known as planned behavior or or-
ganizational ability, is still “under construction”
earlier in life. Furthermore, the capacity for
metacognition, also known as “thinking about
thinking,” is continuing to develop in child-
hood. The ability to hold and reflect on complex
perspectives is considered a foundational ability
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for psychological mindedness, mindsight, or in-
sight into a person’s own mentalization and
motives (Fonagy & Target, 2002).
Talk therapy is a modality that relies on the
capacity for insight, self-awareness, the ability
to express oneself through language in addition
to nonverbal communication, and the ability to
sit in a chair for an extended period of time.
These abilities are at a different stage of devel-
opment in young children, who often commu-
nicate nonverbally and kinesthetically (Kestly,
2014). In other words, children communicate
through play. Because it is believed that 60% of
communication is nonverbal (Burgoon, 1985),
even adults primarily interact nonlinguistically
with each other. Neuroscience can also be used
to help explain how play therapy works to
adults who are themselves participating in play
therapy as an intervention.
Especially relevant for our work is that play
is an excellent vehicle for promoting children’s
emotional development and affective regulation
(Andrews, 2012). Researchers and theorists
have long proposed that play affords the child
an optimal level of arousal (and satisfaction) by
providing activity that is not too challenging or
too easy (Andrews, 2012;Bruner, 1986;Csik-
szentmihaly, 2002;Vygotsky, 1935/1978).
Bruner hypothesized that play has the ability to
reduce stress and allow the child to be in con-
trol, which, interestingly, supports the child’s
engagement in increasingly complex activities.
Symbolic play, also known as pretend play, is
considered essential to a person’s social, cogni-
tive, emotional, and physical development (Lil-
lard et al., 2013). The pioneer of psychoanalysis
Sigmund Freud postulated that all play releases
internal tension; the empirical research seems to
suggest that symbolic play may have a causal
impact on reasoning, language, narrative, and
emotional regulation, though further research is
needed (Lillard et al., 2013). Fiorelli and Russ
(2012) found that affect or emotional themes in
play related to positive mood in daily life and
that imagination and organization in play re-
lated to coping ability.
Using Neuroscience to Explain the Process
of Play Therapy
In practice, it is common for parents, teach-
ers, physicians, and other care providers of chil-
dren receiving play therapy to ask about what
the clinician is doing and to wonder how play
therapy can be healing. These questions can be
disconcerting if the practitioners have not won-
dered deeply about their role and considered
how play therapy facilitates growth and change.
In contrast to magicians who intentionally avoid
revealing the “secrets” of their trade, play ther-
apists can use neuroscience concepts to provide
information to parents about child development
and expected responses to play interventions
(Fine & Sung, 2014). We believe it is crucial for
play therapists to share the robust research base
regarding the importance of play for all aspects
of development, including cognitive, language,
social, and motor domains with the parents and
community providers. Two meta-analyses have
provided support for the effectiveness of play
therapy for children with externalizing and in-
ternalizing behavior problems (Bratton, Ray,
Rhine, & Jones, 2005;Leblanc & Ritchie,
2001). Referencing these and other articles to
advocate for the use of play therapy is recom-
mended practice for clinicians. We encourage
practitioners to use the information in the article
to reflect on how to respond and offer some
ideas from our own clinical experience. In ad-
dition to providing information about the role of
play for healthy, positive developmental out-
comes, here are topics we typically share to
convey the neuroscientific basis of play therapy.
Play is the child’s language and the brain’s
language. Play is evolutionarily adaptive.
Across cultures, play provides developmentally
appropriate opportunities for attuned interper-
sonal interactions—interactions that actually
shape and reshape brain circuits. These circuits
lay the foundation for later developmental out-
comes, from academic performance to mental
health and interpersonal skills (Cozolino, 2010;
Siegel, 2007). Gradually, one playful, respon-
sive interaction at a time, a secure attachment
pattern is created, an artifact of the neural con-
nections. Renowned neuroscience researcher
and clinician Bruce Perry has avowed that a safe
relationship is our most powerful neurobiolog-
ical intervention (Perry, 2006).
Hurt and healing happen in relationships.
Play facilitates the creation of a strong and
trusting therapeutic alliance with the child, re-
sulting in a secure, corrective relationship.
Leaders in the field of interpersonal neurobiol-
ogy have written about the importance of the
therapist’s ability to attune to the inner world of
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
the client (Schore, 2012;Siegel, 2010). Em-
pathic attunement is reflected in interpersonal
child-directed play when the therapist contin-
gently and sensitively responds to the child’s
play by offering supportive comments, express-
ing interest verbally and nonverbally, convey-
ing warmth, and setting limits when needed.
When the therapist tracks the nonverbal behav-
ior, verbal behavior, and feeling state of the
client, they demonstrate resonance which in-
creases oxytocin and supports social bonding
(Badenoch, 2011).
Play regulates emotions. Researchers
have compelling evidence about the disruptive
impact of emotionally overwhelming events on
the functioning of our brain and body. Chronic
stress and trauma can result in a brain trained to
exist in a state of hyperarousal. In such a state,
children cannot concentrate and become easily
frustrated, more impulsive, and moody. Their
sleeping and eating patterns may become irreg-
ular. In the context of play-based interventions,
the child benefits from the therapist’s healthy
emotional regulation through mirroring, helping
to calm the child’s overactive nervous system.
When the therapist models a calming presence,
mirror neurons connect the two intersubjective
experiences of therapist and client, granting the
client greater capacity for self-regulation in a
similar way to how a baby’s heart rhythm
adapts to the rhythm of the attachment figure
when held (Badenoch, 2008). The therapist’s
rate of breathing may even synchronize with the
child’s at those times. With repeated exposure
to such self-regulation and acceptance of emo-
tion, children can use the safety of the therapeu-
tic relationship to approach rather than avoid
difficult emotional states, revisit hurtful experi-
ences, and develop more adaptive coping re-
sponses (Perry, 2006;Siegel, 2010). However,
it is crucial that therapists conduct a thorough
developmental trauma assessment to design tar-
geted interventions that can address symptoms
deriving from different brain regions (Gaskill,
Clinical Vignette of Neuroscience Principles
in Play Therapy
The following clinical vignette is provided to
illustrate how to use neuroscience-informed
play therapy techniques and provide neurosci-
ence-informed psychoeducation to parents
when working with families of children receiv-
ing play therapy.
Michael is a 6-year old African American
boy in kindergarten. His parents state that they
brought him to therapy at the suggestion of the
school counselor.
Since returning from winter
break, Michael has had difficulty following di-
rections, sitting still, and maintaining appropri-
ate boundaries with his fellow students. Most
notably, he has had episodes of sobbing and
shutting down when he makes errors in his
work. After obtaining a release of information
for the school from the parents, Michael’s class-
room teacher validates this information and
adds that she is concerned Michael may be
displaying hyperactive behavior. Later scores
on a screening inventory for hyperactivity are
nonconclusive; though the classroom teacher
rated Michael within the clinical range, neither
parent rated Michael’s hyperactivity as clini-
cally significant at home. Michael’s parents di-
vorced several years ago, and Michael alter-
nates weeks with his parents. Transitions
between households are reportedly the most dif-
ficult day of the week for Michael. It is men-
tioned in passing that Michael has been playing
with a dollhouse at school that he found in the
After both parents give consent, play therapy
is initiated with Michael. The playroom is
equipped with real-life toys (e.g., doll families,
dollhouse, vehicles, phones), aggressive toys
(e.g., soldiers, aggressive animal puppets, hand-
cuffs), and creative expression materials (e.g.,
crayons, paint, paper, clay, sand). During the
initial session, Michael engages briefly in ex-
ploratory play and then concentrates his atten-
tion on the dollhouse. It is interesting to note
that this dollhouse is one with detachable
rooms, allowing the child to create several dif-
ferent configurations. Michael constructs a sin-
gle dwelling, selects furnishings for the room,
and invites the therapist to join him in cooper-
ative play. He plays out everyday routines, with
no disruptive events, using two African Amer-
ican family figures. By the third session, Mi-
chael begins constructing more complex, cre-
ative, and somewhat fragile houses, prone to
collapsing abruptly. A notable theme emerges
Identifying information was modified to preserve client
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
in his play, of setting up stations around the
room where the action of the play occurs. When
Michael transitions from one station to another,
he displays agitated behavior such as trying to
throw objects and smash toys. Initially, Michael
has difficulty regulating his emotions and inhib-
iting his actions as the therapist used the ACT
model (Landreth, 2012) to maintain the psycho-
logical safety of the playroom. However, after
two sessions he expresses his agitation in ways
that conform to the set limits.
Midway through
the therapy, the therapist’s office is abruptly
moved to another room in the building. Not
surprisingly, Michael’s first session in the new
office is marked by agitated behavior and sig-
nificant struggle to follow the rules of the play-
After approximately 10 sessions, the parents
and teacher both report that Michael’s behavior
at school and at home has drastically improved.
Michael is focusing better, and able to cope
when he makes mistakes in his schoolwork. He
looks forward to his therapy sessions each week
and has established a trusting relationship with
his therapist. At one point in therapy, Michael
draws his therapist a portrait, writing that the
therapist is “special.” At the therapist’s sugges-
tion, the parents move to biweekly transitions
between households to reduce the frequency of
transitions. This appears to be well received by
To prepare for filial therapy, one parent at a
time joins the play therapy session at Michael’s
assent, to see how to support Michael’s play in
his home environment. They initially try to limit
Michael’s play, for example, by reorganizing
the house structure so that it does not collapse.
However, they are open to learning an alterna-
tive way to interact. The therapist explains that
play therapy may seem like a strange activity to
a parent because the child is allowed to lead the
play and has limited rules for play behavior
compared with those of the home environment.
At one point, a parent becomes worried about a
theme in Michael’s play, which seems to indi-
cate that Michael is taking responsibility for
events that are outside of his control (i.e., pa-
rental divorce). In response, the therapist re-
views Piaget’s (1954) observations that young
children engage in magico-phenomenalistic
causality, believing that their own desires and
actions, through some mysterious and powerful
process, are the primary causes of events in
their lives. In response to this psychoeducation,
the parents are active participants in the therapy,
successfully cooperating and learning the prin-
ciples of child-centered play therapy and corre-
sponding facilitative techniques (Landreth &
Bratton, 2006). Gradually, the parents become
more attuned at following Michael’s lead, ver-
bally tracking his behavior, and allowing his
structures to smash and collapse on the ground.
During the course of play therapy, both par-
ents inquire about how and why play therapy
appears to be successful with Michael, exclaim-
ing: “It’s having such a magical effect on him.”
The therapist provides the following explana-
tion: As with all children, Michael’s ability to
use executive functioning (associated with fron-
tal lobes) to consistently direct his behavior and
help modulate his emotions is not fully devel-
oped. He is more likely to communicate through
play, body movement, and nonverbal expres-
sion than through spoken language. When he
first came to therapy, Michael was struggling
with adjusting to transitions, most notably his
return to school after winter break. He also
struggled on the day when he transitioned be-
tween parents during the week. Through play,
Michael has expressed his difficulties with tran-
sitions while the therapist has demonstrated
nonjudgmental acceptance of this experience
through empathically verbally tracking Mi-
chael’s play behavior and setting therapeutic
limits. A strong bond has developed between
Michael and his therapist, who has helped Mi-
chael with self-regulation when transitions oc-
cur in his play through being a soothing pres-
ence. Through mirror neurons, Michael has
attuned to the therapist’s internal calm during
transitional moments. As a result, Michael has
displayed less difficulty with transitions at both
school and home. Play therapy provides Mi-
chael with the environment to work through his
issues using the tools and skills that come most
naturally to him: nonverbal communication and
creative self-expression. Both parents were
thankful for this explanation, which made log-
ical sense to them.
As Michael’s treatment begins to reach a
close, the therapist explains to the parents that
ACT stands for Acknowledge the feeling, Communi-
cate the limit, and Target an acceptable action (Landreth,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
future transitions will be a challenge for Mi-
chael, and they can help Michael prepare for
future transitions by discussing them and even
playing them out ahead of time. As expected,
Michael’s 18th and final session is a struggle for
Michael, even though the therapist provided a
countdown calendar for 3 consecutive weeks,
illustrating that therapy would be ending. Agi-
tated at various times during the session, Mi-
chael has difficulty remaining on task, transi-
tioning frequently from station to station. He
rebuffs the therapist’s suggestion of a closing
activity (create a book of drawings Michael had
made throughout the therapy experience). At
the end of the session, Michael seems hesitant
to say goodbye to the therapist and paces the
room. Yet even in the storm of his emotional
turmoil, Michael manages to ask the therapist,
“Why can’t I keep coming?” The therapist re-
flects in an age-appropriate and understanding
tone that Michael wants to continue coming to
therapy and finds change to be stressful and
difficult. The therapist adds that even when Mi-
chael is upset, he has learned to communicate
with the therapist about his wants and needs. To
the therapist, his teacher, and his parents, this
means that Michael is better able to cope with
change at school and home, and hence it is time
to take a break. After learning that he is wel-
come back anytime, Michael seems to accept
this explanation. After giving the therapist a
high-five, Michael leaves the session with his
The therapist asks both parents to attend one
more final session without Michael present, to
review their son’s progress and explain what
occurred in the previous session. The therapist
explains that tolerating significant transitions
will take time and practice for Michael, as the
brain needs repeated exposure to smooth and
low-stress transitions before implicit memories
can be formed which will assist Michael to
approach transitions with less fear and anguish.
Through repetition, positive coping behavior
can become overlearned, automatic, and in-
grained as new neural pathways are developed.
The therapist uses the example of how learning
to ride a bike, drive a car, or play a musical
instrument requires repetitive practice before
fluency and mastery develop. Consistent with
their learning in filial therapy, the therapist re-
views with the parents how reflective listening
can be used to validate their son’s internal state
when he is stressed through verbal tracking of
his nonverbal behavior and verbal reflecting of
content, feeling, and meaning. This grants Mi-
chael the opportunity to rely on his parents to
support his regulation as he develops his ability
to express his emotions appropriately. Over
time this will result in Michael self-regulating
his emotions more successfully when faced
with transitions and change. An excellent op-
portunity to practice appropriate emotional ex-
pression and self-regulation during transitions is
Michael’s transition between households every
2 weeks. Both parents engage in role-playing
how to empathically respond to their child’s
verbal and nonverbal behavior during transition
days by verbally tracking the therapist’s simu-
lation of Michael’s nonverbal behavior and ver-
bal speech. In addition, they create a routine for
the transition and illustrate a description of the
steps with family and home photos. The thera-
pist also suggests that the impending summer
break from school and return to school in the
fall are also both excellent practice opportuni-
ties for Michael. By the conclusion of the ses-
sion, both parents report a greater understanding
of their son’s behavior during the final session,
and feel prepared to face future challenges with
The professional code of magicians prohibits
performers from revealing how they create the
illusions that trick audiences. Play therapists, on
the other hand, are committed to authenticity
and transparency with their clients. Not only
does the recent research in neuroscience support
the efficacy of play therapy, the findings also
offer a rationale for explaining the “magic” of
its power to parents and allied professionals. In
contrast to magicians, play therapists do not
portray themselves as possessing hidden or spe-
cial powers. We do not have a “bag of tricks.”
Rather, the neuroscience evidence suggests that
it is more appropriate to explain that play ther-
apists have a “tool kit” of practices for promot-
ing lasting and meaningful change.
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Received August 28, 2015
Accepted November 3, 2015
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... Computers facilitate the instructor's ability to customize instruction and monitor progress. In addition to offering various visual and auditory exercises, the program automatically A becomes more difficult as the client advances [21], continually guiding subjects to develop their cognitive abilities to their fullest potential. Many clinical disorders are characterized by poor attention and self-control. ...
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Objectives: Attention is one of the cognitive functions that can be enhanced through cognitive rehabilitation. Play therapy is a treatment option for cognitive impairments. This study aims to investigate the use of rehabilitation based on play therapy to increase the attention of medical students. Methods: The present research is a randomized controlled clinical trial. The statistical population included all 162 third-year students of the College of Medicine in 2022 at the University of Baghdad City, Iraq. Using simple random sampling, the statistical population of 70 people was selected and then divided into intervention (n=35) and control (n=35) groups. Play therapy was provided to individuals in the intervention group, while subjects in the control group did not receive any intervention. We used the IVA-2 CPT software, version 2019.1 to assess visual and auditory attention as well as response control performance. The pre-test and post-test stages were separated by a 15-week interval. The data were analyzed via the multivariate covariance analysis in the SPSS software, version 23. The significance level was set at 0.05. Results: The results indicated a statistically significant difference between the intervention group’s mean pre-test and post-test scores (P<0.001); thus, the rehabilitation based on play therapy significantly enhanced attention in the intervention group. Also, the post-test results revealed a statistically significant difference between both groups (P<0.001). Discussion: Rehabilitation based on play therapy is an effective way to increase people’s attention.
... At the same time, he should set boundaries when necessary to ensure an appropriate holding environment. The therapist observes and gains perceptions of the child's problems; then, he can help the child explore his emotions and deal with any unresolved trauma by scaffolding the child and the therapeutic achievement [78]. The therapist uses play to help children redirect unacceptable behaviors, discover and practice new coping mechanisms, and form new functional neuronal circuits and healthier epigenetic mechanisms. ...
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Play is a pleasurable physical or mental activity that enhances the child's skills involving negotiation abilities, problem-solving, manual dexterity, sharing, decision-making, and working in a group. Play affects all the brain's areas, structures, and functions. Children with autism have adaptive behavior, adaptive response, and social interaction limitations. This review explores the different applications of play therapy in helping children with autism disorder. Play is usually significantly impaired in children with autism. Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels. The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development. Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways. It changes their Elbeltagi R et al. Play therapy in children with autism WJCP 2 January 9, 2023 Volume 12 Issue 1 way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words. Play therapy also helps those children to experience feeling out various interaction styles. Every child with autism is unique and responds differently. Therefore, different types of intervention, like play therapy, could fit the differences in children with autism. Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others. This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way. Despite weak evidence, play therapy still has potential benefits for patients and their families.
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Sexual incidents in Indonesia reported by the Data Information Center of the National Child Protection Commission (KPAI) from 2010 to 2014 resulted in 21,869,797 violations against children spread over 34 regions. The uniqueness of child sexual abuse in Indonesia is that it often occurs in places that should provide a sense of security and comfort for teenagers, such as the climate at home, schools and welfare. Sexual crimes against Indonesian teenagers certainly have an impact on the condition of children. For example, a sense of responsibility, self-blame, sexual wilderness images, nightmares, sexual failure, mental problems. The use of play treatment for sexual abuse survivors is one of the tools used to help children alleviate their worries. This survey uses an activity survey approach. The information classification procedure was carried out through the provision of treatment to two victims of juvenile sexual abuse, joint meetings with social experts, awareness of members of the provision of treatment, and changes in the behavior of rice field children. The results showed that the use of play therapy for sexual wilderness survivors with the trash can and storytelling methods could replace the adolescent's language in communicating their emotions. The point is that every child has a different injury experience, each child has a different number of games, and the treatment strategies and game media used adapt to what the child is experiencing, so that with each child it is not the same.Keywords: Play therapy, Child sexual abuse, Garbage bag, Story telling. Abstrak. Kasus kekerasan seksual di Indonesia menurut Pusat Data dan Informasi Komisi Nasional Perlindungan Anak Indonesia (KPAI) dari tahun 2010-2014 memperoleh hasil bahwa sebanyak 21.869.797 kasus pelanggaran hak anak yang tersebar di 34 provinsi. Fenomena kekerasan seksual anak di Indonesia sering terjadi di tempat-tempat yang seharusnya memberikan keamanan dan kenyamanan bagi seorang anak, misalnya lingkungan keluarga, sekolah, kesehatan, dll. Kekerasan seksual pada anak di Indonesia tentunya akan berdampak pada kondisi sang anak. Misalnya, perasaan bersalah atau menyalahkan dirinya sendiri, bayangan kejadian kekerasan seksual, mimpi buruk, disfungsi seksual hingga gangguan psikologis. Penggunaan play therapy untuk korban kekerasan seksual ini menjadi salah satu sarana yang digunakan untuk membantu anak dalam mengatasi masalahnya. Penelitian ini menggunakan pendekatan penelitian action research. Teknik pengumpulan data yang dilakukan melalui pelaksanaan terapi kepada kedua korban kekerasan seksual anak, wawancara bersama dengan pekerja sosial, observasi partisipan terhadap pelaksanaan terapi dan perubahan perilaku anak. Hasil penelitian menunjukkan bahwa penerapan play therapy pada korban kekerasan seksual bisa digunakan menggunakan teknik garbage bag dan story telling sebagai pengganti bahasa anak dalam mengekspresikan perasaan yang dimilikinya. Kesimpulannya adalah setiap anak memiliki pengalaman trauma yang berbeda, begitu juga penanganannya sehingga masing-masing anak memiliki jumlah sesi yang berbeda, dan teknik play therapy serta media yang digunakan akan berbeda dari masing-masing anak karena menyesuaikan dengan kasus yang dialami oleh anak.Kata kunci: Play therapy, Kekerasan seksual anak, Garbage bag, Story telling.
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In the use of simulation activity as a learning approach, the debriefing phase is considered as crucial to achieve learning. In debriefing, the participants reflect and discuss what happened in the scenario. Feedback is an important factor, and research shows that there must be certain conditions present to achieve learning from feedback. The facilitator and the structure used impact on these conditions. In this chapter, we will present a new structure for debriefing in simulation based on a study focusing on how the structure affects the facilitator role.
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This chapter provides information for teachers in higher education who are interested in collaborative learning combined with the use of immersive virtual reality (VR). It presents an introduction to VR and experiences from implementing and using VR in training midwifery students on the master’s level and radiography students in anatomy on the bachelor’s level.
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Educational institutions can elevate student perspective and activation so that playful learning is formed by looking for new teaching possibilities. Didactical methods need to provide a safe environment where students can focus on interpersonal interactions with patients while being aware of how their own emotions can influence their situational awareness and decisions. The authors believe that relevant scenarios in a 360-degree video format will be beneficial for nursing students, specifically in preparation for the clinical setting. The potential of 360-degree video in virtual reality (VR) gives the instructor flexibility to create systematic, experiential learning and shapes emotional learning in collaboration with students. 360-Degree video can be seen as a playful way to learn in new situations. Playfulness of this kind can affect teachers and students motivation, as well as the opportunity to promote learning. This field lacks studies exploring the use of 360-degree videos in psychiatric simulation settings. This chapter will provide knowledge about the practical use of 360-degree video in VR, insight into technical potential, as well as challenges. Background information on why this method is suitable for promoting nursing students’ competence in mental health work will be presented. Another function of this chapter is to give an introduction and inspire exploration of 360-degree video in VR in professional education, with particular focus on how this can be used as a tool for nursing students in psychiatric simulation settings, like the VR-SIMI model, which is discussed later in the chapter.
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Palliative care promotes quality of life for seriously ill and dying patients and their loved ones. An ageing population with more complex chronic and life-limiting conditions will increase the demand for competence in the field. Interprofessional cooperation will be a critical factor in achieving this. Such cooperation within the field of nursing is critical because of registered nurses’ (RNs) role and function in patient- and family-centred care. A project focusing on learning interdisciplinary teamwork using simulation as a learning approach was established. Two groups of students participated in the project: one group consisted of 17 nursing associates who were participating in a 2-year part-time study programme in cancer care and palliative care at a vocational college. The second group was made up of 28 RNs, a social worker and learning disability nurses, all postgraduate students taking part in a part-time interdisciplinary programme in palliative care at master’s degree level. Simulation activity is usually conducted with participants physically present, but because of the COVID-19 pandemic situation, this was not possible. A pilot project was conducted where simulation activity was tried out as online learning. RNs and nursing associates (NA) participated, and their cooperation was focused on palliative/end-of-life care. They were all trained clinicians in two different study programmes. In this chapter, we present how simulation activity with participants physically present was transformed into an online learning situation. A brief presentation of students’ and teachers’ reflections on the pedagogical advantages and disadvantages of such a transition is also included.
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Over several years, simulation has become an established teaching method in study programs of nursing and other health disciplines. Simulation exercises have a theoretical foundation in a number of perspectives on how adults acquire knowledge, through experience-based learning, reflection-on-action and reflection-in-action, and an emphasis on the sociocultural context. As part of the learning process of simulation, the opportunity for feedback and feed forward is crucial in the learning process. The individual facilitator is particularly important in this understanding of learning. The role of the facilitator is aimed at guiding the student toward learning with the help of didactic and pedagogical methods. Learning in itself is a process that could be defined as a transformation that is not based on biological maturation. In this chapter, we look closer at the nature of train the trainer courses, what separates a facilitator from a lecturer, the significance of a common language and framework, as well as how the side effects and synergies of the facilitator’s skills might benefit academic staff in nursing and other health education programs.
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Cognitive-behavioral therapy models are evolving to take into account the impact of physiological responses on client distress and the secondary role of conscious cognitions and beliefs in perpetuating distress and dysfunction. This article presents an accessible and practical description of a neuroscience-informed cognitive-behavior therapy model, in the hope that readers will learn how to apply this model in practice.
This book offers a survey of the historical and theoretical development of the filial therapy approach and presents an overview of filial therapy training and then filial therapy processes. The book also includes a transcript of an actual session, answers to common questions raised by parents, children, and therapists, as well as additional resources and research summaries. Additional chapters address filial therapy with special populations, filial therapy in special settings, and perhaps the most useful resource for busy therapists and parents, a chapter covers variations of the 10 session model, to allow for work with individual parents, training via telephone, and time-intensive or time-extended schedules.
Attention can be focused volitionally by “top-down” signals derived from task demands and automatically by “bottom-up” signals from salient stimuli. The frontal and parietal cortices are involved, but their neural activity has not been directly compared. Therefore, we recorded from them simultaneously in monkeys. Prefrontal neurons reflected the target location first during top-down attention, whereas parietal neurons signaled it earlier during bottom-up attention. Synchrony between frontal and parietal areas was stronger in lower frequencies during top-down attention and in higher frequencies during bottom-up attention. This result indicates that top-down and bottom-up signals arise from the frontal and sensory cortex, respectively, and different modes of attention may emphasize synchrony at different frequencies.