Play therapy in diabetes management

Daniel Sher educates us on the basics of play therapy and how it can help a child to manage their diabetes.

Diabetes is, quite literally, a matter of life and death. The implications for a child diagnosed with this condition are huge! That’s a lot of seriousness for a little human to be taking on board, right? This is where play therapy can help.

Play provides kids with a wonderful medium through which to counteract and cope with all this tiresome seriousness. This sort of work is vital when it comes to helping your little one develop healthy beliefs, emotions and behaviours in relation to their diabetes.

What is play therapy?

Play therapy is an evidence-based counselling intervention. It is based upon scientific knowledge about how child development happens, with particular reference to the importance of play in the context of emotional and mental growth.

More specifically, it seeks to empower a child to express themselves non-verbally and in abstract, rather than concrete ways. In doing so, this type of therapy equips children with a new language with which to express their emotions and experiences.

What happens during a session?

There are many different models and approaches. The most common format for this sort of intervention involves the child meeting regularly with a trained psychotherapist and playing together during session times to build a therapeutic relationship and promote emotional healing.

The child will be encouraged to “play out” conflicts, feelings and experiences which they may not otherwise be ready to verbalise.

Some therapists bring specific games, such as a doll or snakes-and-ladders, that is directly focused on promoting healthy diabetes behaviour. Other therapists might use painting, word games or any number of toys and activities that they have at their disposal.

What does the research say?

Play therapy is a widely-used intervention that psychologists all over the world have used to help children cope with a range of psychological and emotional difficulties. For example, research has found that it can be effective in managing:

• Depression
• Anxiety
• Post-traumatic stress disorder
• Communication difficulties
• Anger outbursts
• Grief and bereavement
• Conduct disorder

Studies^1,2 which systematically analyse the results from existing research (i.e. meta analyses) have consistently found that play therapy has a lot of potential in successfully treating these psychiatric symptoms.

How does play therapy help with diabetes?

To date, the research directly exploring play therapy applied to children with diabetes is sparse. Nonetheless, one study³ published in The International Journal of Play Therapy found that this approach can help young children with Type 1 diabetes to reduce emotional difficulties (including depression and anxiety) related to diabetes.

The researchers also advised that children with diabetes receive preventative play therapy to foster longer-term medical and psychological health.

Furthermore, given the positive impact that this approach can have on children’s cognition, emotional development, problem solving and communication skills generally, there are good reasons to believe that play therapy can significantly help kids with diabetes to cope.

Therapy goals

In my own practice, I use play therapy as a way of helping children with diabetes to:

• Cope with difficult emotions related to a new diagnosis.
• Process the “unfairness” of having this condition.
• Develop healthy communication skills and thus better manage relationships with their family and treating team.
• Increase responsibility and self-respect.
• Regulate and express difficult emotions, such as frustration, grief and anxiety.
• Feel heard and supported.
• Recognise and address diabetes burnout.
• Develop healthier dietary habits to prevent later eating disorders.

Improved self-efficacy

Another benefit is that play therapy can help a child develop their self-efficacy. This refers to a child’s belief in their own ability to successfully manage their condition. Self-efficacy is absolutely vital when it comes to diabetes self-management.

Research⁴ has consistently shown that diabetes patients who have high self-efficacy are more likely to have better glycaemic control. In this way, it can help children with diabetes to feel more in control of their behaviours, habits and overall blood glucose management.

More than just fun and games

Ultimately, play therapy is a safe, enjoyable, empowering and affirming experience. Younger children struggle to express abstract concepts verbally, in the way that adults do. Play therapy is effective because it meets children on their level, drawing on the language of play to help them express their inner world. By providing children with a safe space in which to play therapeutically, we can help them develop healthier relationships toward themselves and their diabetes.

References:

1. Bratton, S., Ray, D., & Rhine, T. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Journal of Professional Psychology Research and Practice, 36(4), 376-390.
2. Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107-123.
3. Jones, E. M., & Landreth, G. (2002). The efficacy of intensive individual play therapy for chronically ill children. International Journal of Play Therapy, 11(1), 117.
4. Beckerle, C. M., & Lavin, M. A. (2013). Association of self-efficacy and self-care with glycemic control in diabetes. Diabetes Spectrum 26(3), 172-178.