Play therapy in children with autism: Its role, implications, and limitations

Table 1 Stages of play therapy

Stage order	First	Second	Third	Fouth
Name of stage	Initiation phase or exploratory stage	Resistance phase, negative reaction, aggressive stage	Growing phase, or work phase	Termination phase
Duration	Initial 4-6 sessions	Few sessions to a few months	The longest phase	Gradual decrease the number of sessions to every other week or once a month to see if the child can maintain the progress with less support
Aim	The child gets to know the room, the therapist, and the toys, learn the roles of each participant and what is expected from him and develops a bond with the therapist	To help the child confront his maladaptive behavior, helps the child to express his emotions and learn how to communicate his feeling in his body in an acceptable way to society, and start accepting the new changes	To start learning, healing, stepping out of the child's comfort zone and making changes with an improvement of self-esteem, behaviors, communication, and overall outlook on life	To gradually withdraw the play therapy when the child reaches behavioral and emotional function stability in different situations
Counselor role	Acknowledge the child's presence and let the child be aware of his presence	The counselor confronts the child with his maladaptive habits and pushes him to decide to put in the work or keep fighting because it feels difficult	To help the child better address and understand his difficulties, how to best overcome these difficulties, and how to live happier and playful life by utilizing practical coping skills with little prompting, demonstrate self-regulation, and build resiliency and flexibility with change	To ensure that the child is consistently demonstrating his new skills with ease, and that behavioral and emotional needs have stabilized in multiple environments
	They are building a trusting relationship and fostering a safe environment for the child to express himself freely
				To support what the child achieved during the few appointments the child does
Parents Role	The parents may attend the first session to support and encourage him till he is used to the therapist	They can support and encourage the child to give the treatment a chance to begin working	They should practice empathy and remain consistent with their expectations. They should support the child emotionally and remind him of his new skill set	They should compensate for the decreasing number of appointments by building a bridge of trust with their child
Child status	The child explores the playroom and the toys. He may have a desire to touch and try out everything he sees to gain an awareness of what is available to him. He also could be hesitant and uncertain about his role in the playroom and look to the therapist to take the lead. He needs to know what to do and what not to do	The child shifts from the comfortable to the uncomfortable zone with a loss of familiarity and starts the change. The child may no longer want to attend therapy	The child will achieve significant advances. However, he may have regression into some of their pre-existing problem, behaviors, or symptoms. This regression may frustrate both child and parents	The child feels this stage is difficult as the secure relationship he had developed with his therapist will start to change with fewer appointments. He feels as if he is being punished for making positive changes