Play Therapy and the Stages of Counseling

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The decision to begin counseling for yourself or a child can be a very intimidating and challenging one to make. But, now that you have made that decision; what can you expect to happen?

While there is not a one-size-fits-all approach, as everyone’s needs and time frame is individual, there are general stages of the counseling and/or play therapy process. The six stages include:

Diagnostic Interview: This is the first session with your counselor or your child’s counselor (or play therapist). During this session, you will be asked questions about what brought you in to counseling, history of concerns, how you are or your child is currently functioning, and (for children) early development (i.e., any birth complications, meeting developmental milestones, significant life changes, etc.). Depending on the presenting concern and/or severity of symptoms, the therapist may conduct an assessment. This can be as simple as having you complete some rating scales and/or your child completing questionnaires and drawings. It may also be beneficial to complete a more formal psychological or educational evaluation. If this is the case, the therapist will refer you to a psychologist for scheduling. These assessments and evaluations can coincide with the actual counseling sessions.

Introduction: During these first several sessions, you or your child will begin building rapport with the therapist—getting to know him or her, getting comfortable in the space, and learning the counseling or play therapy process. For children, especially those who are shy or anxious, it can be an awkward period of time. Help your child by giving lots of encouragement for them to give counseling a chance, give your child a safe place with you to express his or her worries or concerns, and feel free to discuss worries or concerns with the therapist.

Tentative Acceptance: This stage begins after one to several sessions and is the period when you or your child feels eager to go to counseling. You are noticing some positive changes and are feeling better. Your child is excited about interacting with his or her counselor and looks forward to entering the room (for those in play therapy, your child may even make plans of exactly what he or she wants to play with days ahead!).

Negative Reaction: This period of time is when the work begins and the deeper concerns, emotions, and stories are coming to the surface. During this stage, you (or you and your child) are working to make necessary but sometimes difficult changes, and this is uncomfortable. Attitudes toward these changes can fluctuate between whole-hearted attempts to engage in healthy new behaviors to persistent efforts to retreat back to more comfortable and familiar approaches. Some individuals pass through this stage without any problems; however, others experience their concerns getting worse. In these cases, it is common to resist coming to sessions. For adults, be open with your therapist during this time. For children, provide him or her with support and confidence that the process will help him or her be healthier and happier.

Growing: This stage can start as early as the fourth or fifth session, or it may come after several months. Whenever this stage begins for you or your child, it is the longest and most important stage. It is when individuals learn how to best resolve struggles, cope with stressors, and come to better understand themselves. This time is a period of significant advances and positive strides towards your goals. Despite these strides, there will be periods of setbacks, or the reemergence of those old problem behaviors or symptoms. Whether for you, or for you and your child, these regressions can be incredibly frustrating. Remember to trust the therapy process, rejoice over what you or your child has accomplished, and discuss feelings and concerns with the therapist.

Graduation: The final stage of therapy begins when you and the therapist (or you, your child, and the therapist) are confident that behavioral and emotional functioning are stable enough to maintain what you and/or your child has accomplished. This can be both an exciting and difficult time. While the end of therapy is a sign of success, it is also the ending of the therapeutic relationship. It is important to process any concerns with your therapist. Continue to remind yourself and/or your child of what has been accomplished, the healthier ways of coping that have been learned, and the successes achieved. This period is a time of celebration.

Adapted from the Association of Play Therapy website