Play Diagnosis 

A psychodynamic orientation

Case 1: Dialogue between the psychologist and the seven-year-old patient

Dr. Isilay: Do you think it would be fun to build a house with these toys right here? Child A: Yes

Dr. Isilay: Okay so you can make the house with these, and use the little animals to put them in house

Child A: Okay

Dr. Isilay: Now, tell me about these characters in the house

Child A: This is the mum, this is the dad, this is the son and this is their daughter.

Dr. Isilay: What do these people in the house?

Child A: The mum makes food, the dad watches TV, and the children play”

Case 2: Dialogue between the intern (Me) and the 4-year-old patient

Intern: What is this animal here called? (Showing a lion toy)

Child B: Animal here called

Intern: Can you tell me his name?

Child B: Can you?

Intern: How about you point to the animal’s friends from the toys in the room? Which animal does he like?

Child B: Like, friend animal

These are two small extracts I wrote down in my internship diary, from the time when I worked with a child psychologist as an intern. At first, I want to briefly discuss the potential uses of play as a psychological measurement tool, aiding in the diagnosis of children and thereafter elaborate on the two cases I mentioned above.

Play therapy and play used for diagnostic purposes are both psychoanalytic approaches. Child psychoanalysts think about play as a window into the inner life of the child; different types of play activities representing the child’s mind and the child’s mind being accessible to expression. Observations of play activities can include things like tracking specific behavior for example examining the frequency with which an item is used by the child; defining categories of carrying complexity like household scenes (this was used in the first case I will describe later on), and etc. The observation of actions and language during play can provide psychologists with important information about sources of anxiety and attendant defensive activities.

The first case I wrote about is a dialogue, which takes place between the psychologist I worked with and a seven-year-old kid who was brought to the clinic because he was showing signs of conduct disorder and his parents were concerned. To get an understanding of this child’s inner world and the rationale behind his violent behavior, the psychologist decided to go with play therapy. Although, I had no training in play therapy, I could easily understand from this dialogue that there were issues in the household, due to a lack of social interaction between the members of the family. When the psychologist was interviewing the patient’s mother, we found out that they were getting a divorce and things were in an unstable situation. Through this play session, the psychologist and I got a brief understanding of the child’s perception of self and perception of family. After the play session and the interview with the mother, we discussed how the violent behavior was a way for this child to get attention from his parents who were too busy being involved in their own relationship. Thus, the play diagnosis was a way to understand why the child was behaving the way he was. I felt like the play activity was more useful than the application of objective tests, because he was very hyperactive and easily bore, thus it was impossible to get him to sit down and ask questions.

Now, the second case is based on a dialogue between a four-year-old child with communication problems and I. It is possible even for someone with no background in psychology to understand that there are some big communication concerns here. When the psychiatrist was interviewing the parents to learn more about when this problem started, and general information related to the cognitive development of the child, I was asked to go in the playroom and to keep the child busy with games. The striking thing about this kid was that he never responded to my questions, and he kept on repeating what I was saying; when he responded back, he only replied with the words I used from my sentences.

In this context play therapy was used as a tool for diagnosis- a psychological test. I observed the child play with different toys and tried to use these toys to communicate with him; however, in this play session, which took about an hour and a half, I failed in each attempt I made. The child’s developmental status was being expressed through the play activities I came up with. After the psychiatrist joined our play session, she diagnosed him with the social communication disorder.

Was the information obtained from this play sufficient enough to diagnose this child with a disorder? According to other psychological tests that were applied to this patient, the diagnosis was indeed accurate. The communication issues the child had in the play session resembled the communication issues he had in his daily life with parents and these issues fit the DSM-IV-TR criteria. This experience has shown me that observation of play activities emerging in the psychologist room have a central role in the diagnosis and psychotherapeutic treatment of young children.

After this direct experience, I came to the realization that play was a valuable psychological test for detecting abnormal behavior and conflict in the child’s inner world. I also feel like with small children using play as a psychological test rather than objective measures allows the psychologist to form a stronger bond with the child. However, it is important to mention that these are very subjective measures. One needs good intuition and years of skills to diagnose children through play activity. The psychologist I worked with studied psychoanalysis for ten years and joined multiple workshops in play therapy. Thus, for those who are less experienced it would make diagnosis more reliable and valid if play was combined with other objective test measures.