The importance of taking play seriously 

Fiona Peters, head of clinical services at Think Therapy 1st, discusses the benefits of implementing play in occupational therapy and how this approach can enhance therapeutic outcomes for children and adults. 

The Royal College of Occupational Therapists (RCOT) recently introduced new guidelines around the role of play in occupational therapy and the need to incorporate this into assessments of children and young people.

The importance of play when it comes to children and young people’s development is widely acknowledged. But there is also a rich evidence base showing that creative activities can unlock therapeutic potential, engaging young people effectively and building trust.

Writing in the introduction to the new RCOT guidelines, Dr Nina Kolehmainen, describes play as an ‘essential domain of childhood’.

“Put very simply, a child playing is a child who is well, happy, included and participating in their community and society,” she writes.

“A child who can play has hope – to grow, to develop, to heal, to connect with others. As the guideline states, play is a fundamental right for all children, and as occupational therapists we must take play, as a therapy outcome, seriously.”

Play is something that Fiona Peters and her team at Think Therapy 1st have been taking seriously for some time. 

They have seen first hand how being more creative within therapy sessions can encourage collaboration between the child and therapist, improve the child’s engagement, and ultimately help them reach their own goals. 

Giving the child the autonomy to decide on the goals that matter to them—rather than those which a professional might identify from a therapeutic perspective— is a fundamental part of the process.

“We work on getting the child to identify what is the most significant problem for them, because it's really important that they've got some power in that situation,” Fiona explains.

“I revise those goals with them as we go along and we try to find activities that would help them to reach them. It's often about concentration, attention and then exercise tolerance, finding activities that they are motivated by that would encourage them to engage with that process.”

She adds: “It’s more of an opportunity to be collaborative. This plays out in their outcomes, because they're part of the process.”

What do we mean by play?

One of the joys of play is that it isn’t prescriptive. It could be taking the young person to a cafe and treating them like an adult, Fiona explains, or creating an assault course in the garden at home. 

“We encourage people to just use their own innate creativity,” she says. 

“It doesn't have to be something that costs a lot of money. 

“Sometimes the sessions do have to be really targeted towards the needs that you've identified for that individual, but very often, it's quite nice for them to be treated like everybody else.”

The list of activities which have been facilitated by Fiona and her team is extensive; from outdoor activities and charity events, to creating a TikTok dance video and putting together their own family story book. 

One activity that has proven to be a particular success though, is Geocaching. This provides meaningful opportunities for children and young people to address the cognitive, physical and social impacts on functioning of accident, injury or disability.  

It allows them to work on developing a number of skills at the same time, including attention span, navigating spaces, following instructions, community interaction, physical activity and exercise tolerance.

“For someone with a brain injury or learning disability, they're having to engage with the wider community, to pay focused attention to something in order to get to what they're motivated to get towards, they're having to navigate spaces with other people that they might not get much freedom to do, and they’ll often cover extended distances,” says Fiona.

“It’s very motivating for everybody. It’s like stealth by therapy, within an activity.”

Another favourite is what Fiona calls ‘Emotions Jenga’, which encourages children to identify, talk about and understand their feelings better. 

“I’m surprised how much benefit kids get out of that, they will always ask what the word means, she continues.

“A lot of kids get angry and then identify themselves as an angry person, but I like to explore all the dimensions of feelings that are behind anger, like frustration, feelings of worthlessness and then working on making them feel better about that. 

“It’s a strengths-based approach to helping people identify for themselves what the issues are in themselves in their families and being able to take it forward.”

Fiona emphasises that it’s not necessarily the activity itself that is of importance, as the opportunity to show the person’s family or friends that this play is something they can replicate outside of the therapy session. 

“When you break it down to the family and to the friends, they realise that it doesn’t have to be so prescriptive and medically-based,” she says. 

“It’s not something that can only be led by professionals, the activity and the benefits of that activity are available for them to help their loved one.”

Benefits of play at any age 

Fiona and her team place a great deal of value on incorporating play into therapy with children and young people, but it doesn’t stop there. This creative approach to therapy can be hugely beneficial at any age.  

“It’s important to consider that, although children learn and develop through play, as adults we do  it through trial and error and actually, that's still experimentation and play,” she says.

“It’s about building therapeutic relationships based on unconditional positive regard and I feel like that's important with whoever you work with. Play is a part of how we carry out the interventions, but it's also present in the playfulness within the delivery of interventions with every client, children, young people, and adults.”

Fiona adds: “By embracing this approach, therapists can better address their client’s needs and provide them with tools for ongoing success.”