How Play Reduces Anxiety

Playtime Principles for Therapy with Kids and Their Parents

Lawrence Cohen

Q: Parents of young, anxious children are often unsure of how to prepare them for a potentially upsetting event. Beyond empathizing with these parents, what tools can I give them to handle these situations?

A: I used to feel a bit helpless when parents asked me how they should tell young children—especially anxious ones—about an upcoming event that may difficult for them. Often attempts to prepare these children in advance for the event, such a doctor’s visit, just lead to prolonged agitation. But not preparing them runs the risk of delivering a shock that’s hard to recover from. Fortunately, a powerful session with a mother and daughter clarified the principles that would come to guide my approach.

Shoshana, the custodial parent of four-year-old Becca, was in the early stages of a contentious separation from her husband, following years of tension in which their different parenting styles were a continual source of conflict. Shoshana had agreed to overnight visits for Becca, but came to me for help because whenever she told Becca about an upcoming visit, Becca would start showing signs of anxiety, becoming clingy at home with her mother and hoarding toys at school, later saying she was just borrowing them.

Before our first session, I asked Shoshana if she and Becca talked openly about the difficulties with clinging and “borrowing” toys. If they hadn’t, I’d have suggested that Shoshana gently broach the topic as something the three of us could talk about and play some games about. But Shoshana told me that they’d had several conversations about these behaviors, so I felt comfortable bringing them immediately into what I refer to as the play zone, where young children can address difficulties more effectively.

To begin, I picked up a toy and said to Becca in an exaggerated manner, “I’m going to borrow this. Hmm, maybe I’ll put it in my pocket.” Becca promptly came over to take the toy away from me. I pretended to cry and then “borrowed” a different toy. My guidelines for this kind of play are first to lead by introducing a theme or issue, and then to follow wherever the child takes the game. Becca laughed a lot as she took away my “treasures,” while I fake-cried and faked a tantrum.

After a few turns of this game, instead of scurrying off, Becca stayed close to me after she’d taken the toy back. I took this as my cue to introduce the clinginess theme, which I did by asking Shoshana if I could “borrow” Becca, just for a bit. Becca whispered to her mother, “Is he really going to keep me?” Shoshana said that no, it was just a game. I added my reassurance that Becca could leave at any time. Hearing this, Becca stepped close enough for me to catch her in my arms, and was wholly engaged as she focused on escaping from my gentle grasp. Now that the themes of clinginess and hoarding were both in the play zone, I watched closely to make sure Becca was enjoying this game, because the therapeutic play zone requires the same elements of joy and flow as free play.

“You’ll never ever get away from me,” I bragged. “It may get messy when I make soup, but I’ll never let you go!” She giggled and squirmed away, then let me pull her back again. Becca leaned into me as I elaborated on the theme of safety that I assumed was underneath the clinging, saying, “I need you to stay right here next to me, that’s the only way I’ll be safe!” If she’d seemed distressed in any way by this game, I’d have returned to hoarding her toys and increased the silliness quotient.

It can be a new experience for an anxious child to have someone cling to them, and after a few minutes of relishing the role reversal, Becca began to pull away. I let her go, of course, but ramped up my pretend neediness. Becca kept the game going by staying in range for me to pull her back every time. She laughed harder and harder as we repeated the game. When it seemed too easy for Becca to get away, I made her work a little harder before I let go, but she always prevailed and escaped. As she laughed, she seemed to release some of the tension that had built up about separation from her mother.

I told Shoshana that I’d deliberately activated the emotions underlying Becca’s new behaviors—hoarding toys and clinging. I achieved this activation first by mentioning these troublesome behaviors in a light way, and then by bringing them into play. The specific type of play was role reversal, where I played the anxious and needy one. Once these feelings and their related memories and upsets had been activated, the rambunctious play relieved the tension.

Deliberate Playful Activation

My work with Becca and Shoshana led me to a new perspective on preparing children for anxiety-inducing events. I realized that advance-preparation conversations probably activated the same strong feelings in Becca as our playtime did, but without any release of tension. The conversations were just too serious, and they couldn’t contain the tension that both mother and daughter felt about the custody arrangements. In fact, discussions designed to prepare Becca for visits with her father probably increased the tension, instead of decreasing it. The contrast was clear: play about hoarding and clinging provided Becca the opportunity for the deliberate activation to be therapeutic, while serious conversation activated the feelings without release, resulting in agitation and dread.

With this idea in mind, I suggested that Shoshana might bring up the topic of overnights when she herself could be more playful and lighthearted. If this emotionally loaded topic could be introduced into the play zone, Becca could use play to heal from her past upsets and prepare for upcoming transitions. But Shoshana was skeptical about this idea, insisting that she couldn’t be lighthearted about such a painful subject.

So I offered a different suggestion. “What if you bring a specific aspect of the separation into the play zone, one that isn’t too difficult or overwhelming for you?” I picked up a baby doll to demonstrate. “Hello, Becca,” I had the doll say. “Goodbye, Becca. Hello. Oh I missed you so much. Wah wah wah. Did you miss me too? Hello, goodbye, hello again, goodbye again.” As I played this simple game with the doll, I faced it toward Becca and then turned it away from her, acting out the dance of connection, disconnection, and reconnection. I love this game, because a child can experience 20 or 30 playful hellos and goodbyes in quick succession. This activates feelings about separation in a safe and fun way, which can allow for tension release and powerful healing.

Finally, I recommended lots of playful roughhousing for Shoshana and Becca. Pillow fights, silly dancing, and wild wrestling are great ways to rebuild confidence and a sense of power when a child feels that important things in her life aren’t under her control.

When parents or therapists use play in this manner, the result isn’t always entirely filled with laughter and silliness. Sometimes children respond to a lighthearted approach with sorrowful tears, indignant rage, or both at once. This overflow of painful feeling can happen right away, or can occur as an unwelcome surprise at the end of a joyful playtime. I make sure parents understand that this is perfectly normal. It just means that the safety and connection of play has activated a strong flow of emotion. At these moments, children need empathy and comfort for their tears and tantrums. While similar to a dreaded meltdown, there’s more of a healing quality to this release of feelings. When the wave of feeling recedes, play can resume.


This blog is excerpted from "Playing with Anxiety," by Lawrence Cohen. The full version is available in the July/August 2017 issue, Left to Our Own Devices: Is It Time for Therapists to Be Concerned?

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Photo © Dreamstime

Topic: Anxiety/Depression | Children/Adolescents

Tags: 2017 | adolescence | Anxiety | anxiety attacks | anxiety in children | anxiety relief | anxiety treatment | Children | Children & Adolescents | kids | Parenting | parenting techniques | play | playfulness | raising kids | role-playing

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