Methods for diagnosis and psychotherapies based on play therapy

The Child and Adolescent Psychiatry (BUP) of Sweden uses various methods to aid in the diagnosis or detection of psychiatric needs [1]. One of the methods: the Erica method is developed from a psychotherapeutic play therapy "World Technique" that was established by Margaret Lowenfeld, in the1920’s [2]. The Erica method has been under query for lacking scientific support [3]. As BUP also uses various play therapies the question about the Erica method was expanded to include psychotherapies based on play therapy or world techniques.

We searched studies and systematic reviews to explore the scientific support for diagnosis or psychotherapy based on play therapy or world techniques. We did not find any scientific studies on the reliability of using methods based on play therapy to determine diagnosis. We found one systematic review [4] on play therapy interventions for a number of psychiatric conditions.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.


  • Is there any scientific support for the reliability of methods for diagnosis based on play therapy?
  • Is there any scientific support for the efficacy of psychotherapies based on play therapy?

Table with identified studies

Table 1 Systematic reviews.
Included studies Population/intervention Outcome
Bratton, et al. (2005) [4]
93 controlled outcome studies (published 1953–2000) Children/Play therapies Behavior
Social adjustment
Family functioning/relationships
Authors' conclusion:
The overall meta-analytic results establish that play therapy is a statistically viable intervention. Further analysis revealed that humanistic approaches yielded higher outcomes than non¬humanistic treatments and that filial play therapy conducted by parents produced larger treatment effects than did play therapy conducted by a professional. Although we attempted to glean a clearer understanding of factors that contribute to the effectiveness of play therapy, our attempts were hindered by a lack of specificity in many of the studies. On the basis of data reported in individual studies, play therapy appeared equally effective across gender, age, and presenting issue.

A well-designed research methodology that can be replicated in multiple studies is needed to not only further investigate the overall efficacy of play therapy but also to examine a multitude of treatment factors and their impact on treatment outcome. Only then will play therapists be able to answer questions regarding the most efficient and effective delivery method of play therapy services to their child clients.


For further reading we also added a list of systematic reviews on play therapy for single conditions, or where play therapy is included [5–11].


  1. Dunerfeldt, M., Elmund, A., Söderström, B. (2010). Bedömningsinstrument inom BUP i Stockholm. Utvecklings- och utvärderingsenheten, Barn- och ungdomspsykiatri i Stockholms läns landsting
  2. Sjöberg L. Projektiva test och psykodynamiskt grundade bedömningar otillförlitliga. Läkartidningen 2000;97:56-9.
  3. Nelson KZ. The sandtray technique for Swedish children 1945-1960: Diagnostics, psychotherapy and processes of individualisation. Paedagogica Historica 2011;47:825-40.
  4. Forsbeck Olsson, U. (2006). 2000-talets barn bygger i sandlådan – normering av Ericametoden. Ericastiftelsen/Mareld.
  5. Bratton SC, Ray D, Rhine T, Jones L. The Efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Prof Psychol Res Pr 2005;36:376-90.
  6. Dorsey S, McLaughlin KA, Kerns SEU, Harrison JP, Lambert HK, Briggs EC, Amaya-Jackson L. Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol, 2017;46:303-30.
  7. Gillies D, Maiocchi L, Bhandari AP, Taylor F, Gray C, O'Brien L. (2016). Psychological therapies for children and adolescents exposed to trauma. Cochrane Database Syst Rev, 10, Cd012371. doi:10.1002/14651858.cd012371
  8. Wethington HR, Hahn RA, Fuqua-Whitley DS, Sipe TA, Crosby AE, Johnson RL, Chattopadhyay SK. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. Am J Prev Med 2008;35:287-313.
  9. Allin H, Wathen CN, MacMillan H. Treatment of child neglect: a systematic review. Can J Psychiatry 2005;50:497-504.
  10. Comer JS, Hong N, Poznanski B, Silva K, Wilson M. Evidence base update on the treatment of early childhood anxiety and related problems. J Clin Child Adolesc Psychol 2019;1-15.
  11. St Amand A, Bard DE, Silovsky JF. Meta-analysis of treatment for child sexual behavior problems: practice elements and outcomes. Child Maltreat 2008;13:145-66.
  12. Zhou X, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, Xie P. Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World Psychiatry 2015;14:207-22.
Published: Report no: ut201907 Registration no: SBU 2018/740

Literature search

Project group

Alexandra Snellman, Sally Saad, Jessica Dagerhamn, Sara Fundell and Miriam Entesarian Matsson at SBU.

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