The Research Evidence for Play Therapy: What the Studies Show

Play therapy is not simply a child-friendly way of working. It is a therapeutic approach with robust theoretical underpinning, extensive training and a substantial and growing evidence base.

Playful, creative communication is a natural and direct route to engaging with children, and one that makes sense to them. It uses a natural, vibrant and flexible means of expression — one that is widely accepted as an evidence-supported intervention for children with a broad range of emotional needs.

For parents, commissioners, and referrers wanting to understand whether and how play therapy works, this page summarises what the research shows, what it does not yet show, and why that matters when choosing support for a child.

What the Research Demonstrates

The most comprehensive evidence comes from meta-analyses — studies that aggregate the results of many individual trials to identify patterns across the field. The landmark meta-analysis by Bratton, Ray, Rhine, and Jones (2005), published in the International Journal of Play Therapy, examined 93 controlled outcome studies involving over 3,000 children. The analysis found consistent positive effects for play therapy across a wide range of presenting problems, including anxiety, trauma, behavioural difficulties, and social functioning.

An earlier meta-analysis by LeBlanc and Ritchie (2001) similarly found significant positive effects across the studies examined, and identified two key predictors of outcome: parental involvement in the therapeutic process, and a longer duration of treatment. These findings have directly informed how play therapy is structured and delivered in UK practice, including by PTUK-registered therapists.

Both meta-analyses found effect sizes that compare favourably with those reported for other psychological therapies for children. This matters for commissioning decisions and referral pathways: play therapy is not a marginal or last-resort alternative — it is a mainstream, evidence-supported intervention with outcomes comparable to established approaches.

A Growing Real-World Evidence Base

While meta-analyses remain the highest level of evidence for assessing overall effectiveness, more recent research has begun to examine outcomes from large-scale routine clinical practice. This is important because it helps answer a different question: not simply whether play therapy can work under research conditions, but whether it produces measurable benefits when delivered in everyday practice across schools, community settings, and private services.

A major update to the Clinical Evidence Base for Play Therapy, published in 2025 in the International Journal of Play and Creative Arts Therapies, analysed outcome data from more than 61,000 play therapy clients and over 36,000 completed Strengths and Difficulties Questionnaire (SDQ) outcome reports. The dataset represents one of the largest collections of routine play therapy outcome data currently available and provides insight into both client characteristics and therapeutic outcomes.

The data show that play therapy is being used with a wide range of presenting difficulties. The most common referral concerns included generalised anxiety, low confidence and self-esteem, anger and behavioural difficulties, social relationship difficulties, autism spectrum conditions, separation anxiety, experiences of domestic violence, bereavement, and adjustment difficulties. Anxiety-related presentations were particularly prominent, reflecting broader trends seen across child mental health services.

The profile of children accessing services is also noteworthy. Most referrals were for children aged between four and twelve years, the age range for which play therapy is most commonly practised, although referrals also included younger children, adolescents, and a smaller number of adults receiving related therapeutic approaches.

The 2025 analysis examined changes in SDQ scores before and after therapy. The SDQ is one of the most widely used measures of children’s emotional and behavioural functioning in the UK and is routinely used across education, health, and mental health settings.

Across more than 36,000 outcome reports, both parents and referrers reported statistically significant improvements following play therapy. Improvements were observed not only in children who entered therapy with elevated levels of emotional or behavioural difficulty, but also among children who began treatment within the average range of functioning. Importantly, the size of these improvements was classified as large according to conventional statistical standards.

When outcomes were analysed by change category, approximately three-quarters of children showed positive change according to both parent and referrer reports. Around 73–74% were classified as having improved, while only a small minority showed no change. A further group showed deterioration, a finding that is important because it demonstrates that the researchers reported outcomes transparently rather than assuming universal success.

The consistency between parent and referrer ratings is particularly significant. One common challenge in child mental health research is that different adults often perceive children’s difficulties differently. The fact that parents and professionals reported broadly similar patterns of improvement strengthens confidence that the observed changes are meaningful rather than simply reflecting the perspective of one group of observers.

What These Findings Mean in Practice

In addition to the controlled studies and meta-analyses that have shaped the profession, more recent large-scale clinical outcome data analysis provides further evidence that play therapy produces meaningful improvements in children’s emotional and behavioural wellbeing under real-world practice conditions.

These results come from the practice of many play therapists, with many children, in many clinical settings. This is important because it means the effects are not dependent on a single practitioner or an unusual set of circumstances — they are consistent enough to show up when hundreds of different studies, with many different children and therapists, are combined and analysed together.

The evidence is strongest for child-centred, integrative and humanistic play therapy approaches, which form the foundation of much UK practice. It is also growing for specific modalities including filial therapy, Theraplay, and sandplay therapy, each of which has its own developing evidence base alongside the broader play therapy literature.

Parental Involvement: A Key Predictor of Outcomes

One of the most consistent findings across the research is the positive effect of parental involvement on outcomes. Children whose parents or carers are actively engaged in the therapeutic process — whether through regular review meetings, filial therapy, or structured guidance from the therapist — show better outcomes than children whose therapy takes place in isolation from the family.

This finding has important practical implications. PTUK-registered therapists are trained to work collaboratively with families, not only with the individual child. The research also points to the value of filial therapy as an approach in its own right: by working directly with the parent-child relationship, it addresses the child’s difficulties in the context where they matter most and where change is most likely to be maintained.

For parents who ask why they are expected to be involved in their child’s therapy, rather than simply dropping the child off for sessions, the research provides a clear answer: their involvement is not a courtesy — it is a significant predictor of whether their child benefits from the work.

PTUK therapists explain to parents that their role is of central importance to the therapy, as is their support of their child attending therapy. It is explained that although their child may choose to keep what they do in their sessions private, this is not a cause for concern and may be because the child does not yet have the words to explain it to them. Parents are told that the play therapist will keep the exact details of what happens in the sessions confidential, but can share with parents the general themes of the play and talk to them about patterns they notice or topics that come up, so that the parent can understand better and help their child at home. It is also explained that, just as it helps not to ask for details about their sessions from your child, it helps not to ask them to behave in a certain way when they are there. The play therapist does not expect or need “good” behaviour in the sessions. Instead, the therapist hopes that each child comes to trust that they can express themselves freely, without judgement, in their sessions. Our therapists are trained to understand and manage all types of behaviour, and to recognise and work with the reasons behind it.

Duration of Treatment

The LeBlanc and Ritchie (2001) analysis found that outcomes improved with longer treatment duration. Short-term therapy can produce positive change, but more complex or entrenched difficulties typically benefit from sustained work over time. This is relevant for commissioners and referrers who may be considering time-limited models — the evidence suggests that truncating treatment below what a child needs is likely to reduce effectiveness, not just the depth of change.

The PTUK 2025 research paper reported the average number of sessions children attended was sixteen, a figure that has remained remarkably stable across successive analyses. Children presenting with higher levels of need at referral tended to receive slightly more sessions, averaging eighteen.

PTUK-registered therapists discuss realistic timeframes with families from the outset and review progress at agreed intervals. The goal is not to extend therapy unnecessarily, but to ensure that sufficient time is allocated for meaningful and lasting change. Brief intervention and longer-term work both have roles depending on the child’s presentation and the nature of their difficulties.

The Limits of the Evidence Base

Research on play therapy faces methodological challenges familiar to all psychological therapies with children: difficulty establishing suitable control conditions, variation in how “play therapy” is defined across studies, and the challenge of long-term follow-up. The field continues to develop more rigorous trial designs, but funders and policymakers should understand that the existing evidence base, while substantial, is not without limitations.

The PTUK 2025 paper provides findings direct from practice and from a database of clinical outcomes which continues to grow. This resource will hopefully be of central importance to the dissemination and publication of play therapy research. Unlike tightly controlled research trials, it is reasonable to suggest high confidence in the conclusions made by the PTUK 2025 paper being replicable in usual practice at large, as they were born from those same circumstances.

Play Therapy UK and Professional Standards

PTUK (Play Therapy UK) is the UK’s professional register for play therapists. Registration with PTUK means a therapist holds a recognised qualification in play therapy, has completed the required supervised practice hours, and is bound by a code of professional ethics. The register is publicly searchable, meaning parents, referrers, and commissioners can verify a practitioner’s credentials directly before making a referral. Importantly, PTUK and its therapists are accredited by the PSA (Professional Standards Authority). The PSA oversees the regulation of healthcare professionals and organisations in the UK. Referrers can look out for this logo alongside the PTUK one.

PTUK works alongside the broader play therapy research community to ensure that practice in the UK remains aligned with the best available evidence. The standards for registration reflect the research findings — including the emphasis on training, supervision, and working collaboratively with families as predictors of good outcomes.

Frequently Asked Questions

Is play therapy evidence-based?

Yes. Play therapy has a substantial research base, including multiple meta-analyses covering hundreds of studies. The weight of evidence supports its effectiveness for a range of childhood difficulties including anxiety, trauma, behavioural problems, and social difficulties. More recently, published practice-based evidence from PTUK has added strength to the evidence base.

How does play therapy compare to CBT for children?

Both Cognitive Behavioural Therapy (CBT) and play therapy have research support. They tend to suit different presentations and different children. CBT requires verbal and cognitive engagement with difficulties and is most effective for children who can reflect on their own thinking and behaviour, make verbal links between the two, and discuss new perspectives with a therapist. Play therapy is more effective for younger children; children who cannot, will not, or are afraid to talk about their difficulties; and children whose presentations involve underlying (long-running or widespread) emotional or relational issues, rather than specific cognitive distortions. For some children, the approaches can complement rather than compete with each other, at different life stages or for different referral reasons.

Does PTUK registration guarantee good outcomes?

Registration with PTUK indicates that a therapist meets established standards of training, clinical supervision, and ethics. It does not guarantee a particular outcome — as with any professional field, outcomes depend on multiple factors including the child’s presentation, the quality of the therapeutic relationship, family and school engagement, and the specific difficulties being addressed. What registration provides is meaningful assurance of professional competence and accountability.

It has consistently been reported by PTUK that their therapist members’ outcomes show the mental health and wellbeing of 72% of children improves following play therapy. This rises to 82% for those children with higher needs at the time of referral.

Can play therapy be used alongside other treatments?

Yes, except for another type of relational therapy or psychotherapy. Play therapy is not designed to replace academic or physical provision. It works well alongside medical, educational, and other non-therapeutic interventions, addressing the emotional and relational dimensions that other approaches may not focus on specifically. Your therapist can discuss how their work fits with any other support your child is receiving and, where appropriate, liaise directly with other professionals involved in your child’s care.

How do I know whether play therapy is working?

Progress in play therapy is not always immediately visible in behaviour outside the session, particularly in the early stages. Your therapist will discuss with you what to look for and will offer regular reviews. PTUK therapists will explain the pre- and post-therapy measures that will be taken from parents, teachers or other professionals who know the child well, and from the children themselves. Goals for the therapy will be discussed before the work begins, and these will be reviewed and measured as the sessions progress. The most meaningful indicators of progress often include a child appearing more settled at home and school, showing more capacity to manage disappointment or frustration, more capacity to focus on work and attend to tasks, more capacity to build and sustain friendships, and more capacity to understand how they are feeling and communicate this to those around them.

Finding a PTUK-Registered Therapist

To find a qualified, registered play therapist, visit the Find a Play Therapist directory at https://playtherapy.org.uk. All therapists listed hold PTUK registration and are subject to the professional and ethical standards outlined on the register.