BROOKINGS – Mental health issues – for adults and children – are on the rise in the United States.

The U.S. Department of Health and Human Services published a study this spring stating the number of children diagnosed with anxiety grew by 29% and the number diagnosed with depression grew by 27% between 2016 and 2020. And that’s just the children diagnosed. Thousands more have undiagnosed mental health issues that are left untreated. 

Additionally, rising mental health issues are coupled by South Dakota’s mental health professional shortage – nearly every county has an inadequate number of mental health professionals.

The South Dakota State University School of Education, Counseling and Human Development’s play therapy program – the Institute for Play Therapy Education – is working to address these challenges.

But what is play therapy? 

“Play therapy is a therapeutic modality for supporting children using play,” said Staci Born, an associate professor, registered play therapist – supervisor and leader of the program’s graduate coursework. 

Children – especially those between the ages of 3 and 12 – may not be able to process their emotions, discuss their personal challenges or communicate effectively with their parents, caregivers, teachers or other adults. Rather than using words, children often express themselves through play. Born said play is a child’s first language and when a child plays, one expresses thoughts and feelings that may otherwise remain unexpressed.

Play therapists are trained to detect a child’s nonverbal cues, helping them understand what emotions or challenges the child may be going through – all through the simple act of playing. This can be done through toys, arts and crafts, puppets, music or even creative dance – the type of play varies on a case-by-case basis. 

“When you add on the skills of being a play therapist, we really focus not only just on what’s verbally said, but also the nonverbal behaviors,” Born said. “Play – while there might be words involved, while kids are acting out a scene or experienced something they are trying to understand – is expressive so it’s using the right side of the brain that doesn’t require language.”

Play therapy can either be directive, nondirective or a blend of both, she said.

“In a nondirective play therapy environment, I’m really following the child’s lead,” Born said. “They’re kind of guiding where play needs to go.”

In the directive stance, Born will have the child work on therapeutic activities or use specific toys. Therapists will often blend both directive and nondirective activities, depending on the child’s treatment goals, she said.

During treatment, Born will narrate the child’s play, taking nonverbal and verbal cues and turning their actions into language. For example, if Born notices a child’s clenched teeth and tense muscles during play, for example, she may describe aloud the tension she is observing in order to support children’s ability to integrate internal physiological states with external behaviors and relationships.

“We’re helping them develop literacy for emotions,” Born said.

Born may help a child deal with emotions through role modeling. For example, if a child is expressing he or she is angry, she will model to the child what she does when she is angry, which might involve taking deep breaths.

“It is very powerful for the child to witness me regulate my anger in those moments. That’s so much more visceral and lived, which gets at the play experience,” Born said. 

Play therapy is often a one-on-one counseling session between the therapist and the child, and parents may often be involved – it really varies on a case-by-case basis. It can also help children with social/emotional, behavioral and developmental disorders, including attention-deficit/hyperactivity disorder and autism spectrum disorder, learn to communicate and interact with others while also developing problem-solving skills.

Other issues that play therapy can help with are bereavement, school refusal, parental separation and traumatic childhood events. 

Born’s path to play therapy

Growing up, Born was surrounded by children because a parent was in early childhood education. 

“My mom always said, ‘kids learn through play, kids learn through play’ so I was drawn to working with children through her,” Born said.

Born took her mother’s words to heart. At Minnesota State University, Mankato, she received undergraduate degrees in Spanish and psychology. While working toward a graduate degree, she began studying with a faculty member – John Seymour – who got her focused on play therapy.

“Dr. Seymour inspired me to teach play therapy,” Born said. “I’ve gotten to create it and, in my eyes, also advance the field of play therapy and education.”

After completing her master’s in mental health and counseling and her doctorate in counselor education and supervision, Born began working at SDSU in 2016 and was met with immediate interest about play therapy. At the time, there were around 10 registered play therapists in the state. Born was asked to offer a class but then was also asked to offer all the requisite courses needed to become a registered play therapist.

“I just spoke to the need,” Born said. “So, I wrote the curriculum to meet the needs of individuals obtaining all of the education and supervision required to become a registered play therapist.”

Two years of classes, including clinical supervision and direct contact play therapy services, are needed to complete the program. Aspiring play therapists require 150 educational hours and 350 hours of supervised clinical experience are required. SDSU is one of the only universities in the country that offer all of the play therapy resources in one unit, within a university.

“What Dr. Born has been able to accomplish since arriving at South Dakota State University just over six years ago is amazing,” said Jay Trenhaile, a School of Education, Counseling and Human Development professor and a member of the South Dakota Board of Counselor Examiners. “Most universities that become nationally recognized have had programs in place and specific play therapy facilities for a number of years prior to that level of recognition.”

In spring 2020, the Association for Play Therapy – the national professional society for the field – approved SDSU’s Institute for Play Therapy Education as an approved center for play therapy education, research and training. SDSU’s program is unique to the region and the first in the state to be approved by the APT. 

In South Dakota, there are now 30 registered play therapists – half of whom came directly from Born’s program. Another 20-25 individuals are working to become a registered play therapist, she said. 

“The work Dr. Born has done will positively impact the mental health of our state’s citizens forever,” Trenhaile added. 

Research efforts

In 2018, Born was awarded a five-year, $2.2 million grant from the Substance Abuse and Mental Health Administration to improve early childhood mental health in South Dakota. Born and Christin Carotta, a fellow assistant professor in the school, are working in partnership with Southeastern Behavioral Health in Sioux Falls and Inter-Lakes Head Start to ensure increased access to mental health services for low-income children, ages 0-5 and their caregivers, in rural areas of South Dakota.

“We’re measuring the progress of children we serve through those grant dollars, because not only is that funding training efforts, but it’s also funding play therapy service delivery in South Dakota,” Born said.

Born also recently finished editing a textbook on play therapy supervision, which should be released later this year. In it, Born devotes a chapter to self-compassion – something she has been exploring with her play therapy students. 

“Self-compassion is kind of self-care on steroids, in my opinion,” Born said. “We can do all these nice things for ourselves but not if we’re hard on ourselves while we’re doing it. For example, if I choose to take a bubble bath to honor my self-care, but while in the tub, I’m criticizing myself for all the things I could be doing, I’m not being very compassionate.” 

Born describes self-compassion as showing ourselves compassion by treating ourselves with kindness and understanding when we experience a personal struggle. After acknowledging our difficult emotions, we can then move into problem-solving and resolution. This mindful attention to our struggles has been shown to tremendously benefit mental health.

Born is beginning to examine the ways in which self-compassion develops. One of the things she has found so far is that more seasoned clinicians have more self-compassion and novice clinicians have less.

“How can we instill more self-compassion in our novice clinicians so they can make it to the seasoned state and perhaps prevent them leaving the field because of their own mental health deterioration?” Born said. “As a play therapy educator, I want to make sure our play therapists are well because they’re part of that system, too.”