This article reports a systematic review of the effectiveness of individual child play therapy with children aged 4–12 on several different presenting concerns. From over 5,000 citations, 180 studies were reviewed in detail and 17 met the inclusion criteria. A wide range of results on different concerns were revealed, with effect sizes ranging from d ¼ –0.04 to g ¼ 3.63, though most ranged from .35 to .80. Across most concerns, play therapy was affirmed as an empirically supported therapy.
Review of the Literature: Prior Studies on Play Therapy
As early as 1953, Lebo questioned the lack of research documenting the effectiveness of play therapy. Phillips (1985) also challenged the effectiveness of play therapy, noting the small samples sizes utilized and the omission of control or comparison groups in published studies. Carroll (2000) argued that research assessing the effectiveness of play therapy is needed in social work. LeBlanc and Ritchie (2001) completed a metaanalysis of play therapy outcomes with children with a mean age of 7.8 years, reporting overall a 0.66 standard deviation (SD) improvement. LeBlanc and Ritchie also found that parent involvement was linked to better outcomes, as was longer duration play therapy with the child. Bratton, Ray, Rhine, and Jones (2005) completed another meta-analysis of play therapy outcomes. They included 93 studies with children of a mean age of 7 years, reporting overall 0.80 SD improvement. Bratton and colleagues further reported that humanistic and nondirective play therapies had better results (d ¼ 0.93) than did behavioral approaches (d ¼ 0.73) and that involvement of parents was linked to better outcomes. Further, they reported that “play therapy appeared equally effective across age, gender, and presenting issue” (p. 376). These early reviews found play therapy to be quite effective. Later, Ray, Armstrong, Balkin, and Jayne (2015) published a review and meta-analysis of 23 CCPT studies provided in elementary schools. They report smaller but statistically significant effects, ranging from d ¼ 0.34 for externalizing problems, 0.21 for internalizing problems, and 0.34 for total problems. Lin and Bratton (2015) completed another meta-analysis of 52 controlled studies completed from 1995 to 2010. They report an overall effect size of d ¼ 0.47 for CCPT, as well as “statistically significant relationships between effect size and ... child’s age, child’s ethnicity, caregiver involvement, treatment integrity, publication status, and presenting issue” (p. 45). CCPT appeared effective but with smaller effect sizes than had been previously reported. No 95% confidence intervals (CI) were reported. These publications, however, mixed several different models and modalities of play therapy. From a methodological perspective, Bratton and Swan (2017) reviewed 26 studies including both individual and group CCPT, filial therapy, group sandtray therapy, and Adlerian play therapy. Experimental, quasi-experimental, and one group pre– post designs were included. Twelve studies included active treatment comparisons while 14 employed wait-list controls; with a mean of 42 participants per study. Manualized treatment approaches were few but appeared in some recent studies. Bratton and Swan argue that play therapy is an empirically supported treatment (EST) or research-supported treatment (RST), demonstrating effectiveness with diverse populations and in a variety of real-world settings. However, they did not perform a meta-analysis of the studies they summarized due to variation in outcomes studied nor did they provide 95% CI for their effect size results.