Therapy with Kids: What Makes an Activity Therapeutic?

I have noticed that many play therapy activities involve games developed in the 1970s and 80s. Additionally, a lot of the pushback against telehealth with kids has been that screen-time activities are not sufficiently “therapeutic.” This makes me think of how people initially thought card games would be the death of family time, since people would play the game instead of having conversations with each other, and yet games like Uno and Go Fish make great therapy activities, both in person and online.

Photo by Daniel Eliashevsky on

It reminds me of that quote from Socrates: “The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants.” People have been lamenting about “kids these days” for more than 2400 years.

That’s why, if a child asks if they can try an activity in session, I never say “No” on the grounds that the activity is not therapeutic because, in fact, I just have yet to figure out how to make the activity therapeutic. In February of 2020, I never would have considered using Minecraft in a therapy session, and now there are webinars detailing how to make the activity therapeutic and fit with a child’s treatment plan, including this free one!

Many of the telehealth activities I have been using were suggested by children. When I transitioned to working from home in March 2020, I was very honest with my clients that we would be “learning together” what works best for their sessions now that we were online. I decided that I would try anything they suggested, as long as it was safe and could be done in a HIPAA-compliant way.

If you think about it, children don’t get control over much in their lives. Adults decide where they live, what school they will go to, how they spend their weekends, and so on. Even if kids get a say in what’s for dinner or what outfit they will wear, choices are limited based on what adults provide. This means that giving kids a level of control in their therapy sessions is a powerful thing.

Since therapy is all about relationship, the rapport established by giving children a voice in their sessions is therapeutic in itself. Of course, it’s always best if an activity builds rapport and emphasizes another component of the child’s treatment plan.

When a client requests an activity that is not therapeutic in an obvious way, ask yourself:

  1. Why does my client enjoy this activity? Does it help them feel calm or relax them? Does it let them act out big feelings in a safe way? Does it present a challenge they are able to overcome?
  2. How does the activity parallel to the child’s life? Are there similarities to something they have experienced?
  3. What emotions come up for the child as they do the activity? How can those emotions then be processed and addressed in the therapy setting?

These questions are just a starting point, but approaching any activity through a lens of curiosity and creativity can expand your options for therapy sessions infinitely. How could this approach change your approach to therapy with kids?

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.

%d bloggers like this: