Cultural Considerations for Play-Based Therapy

SLP Considerations for Play-Based Therapy

Over the last few years, studies have mentioned the need for Speech-language pathologists to practice cultural competence when working with children from different cultures. This concept emphasizes the importance of culture, cross-cultural relations, and dynamics to provide services that meet specific cultural needs (Verdon et al., 2015). As clinicians, services must be independent of a one size fits all model. The problem with this practice is the tendency to exclude secondary cultures, only focusing on the dominant culture, and failing to acknowledge the essence of the child's cultural background (Verdon et al., 2015). 

Through play, a child explores their world and thoughts while feeling safe in their environment (Loeb et al., 2021). Using elements from play therapy inside speech therapy sessions has been introduced previously. History has documented that speech-language pathologists have been using toys and other elements to improve communication skills (Loeb et al., 2021). The collaboration and dialogue between all parties involved in a child's intervention, such as teachers, parents, and clinicians, is necessary to identify goals that will maximize the child's culture (Verdon et al., 2015). 

Part of speech therapy success is the parent-child interaction during the intervention and the extent to which parents engage in the process. Parents' reaction to therapy demands is critical and must be considered (Levickis et al., 2020). Speech-language pathologists are responsible for recognizing their biases around cultural differences and how they will impact their ability to provide services. For this reason, cultural considerations and competency are an opportunity to align with the client's expectations (Baylor University, 2019).  

Multiple factors mediate children's play, such as cultural goals of development, cultural values, and definitions of play. Each of these factors will indicate the type and nature of play, the spaces provided to play and the toys available, and the amount of adult support and encouragement given to the child. Professionals must develop positive attitudes towards diversity in play while at the same time contributing to multicultural perspectives in play (Sanagavarapu & Wong, 2008).  

This webpage aims to help readers become aware of the dominant US views about play and play-based therapy in hopes of collaborating with families in integrating the value systems of both cultures to provide culturally competent and efficacious practices in early intervention.

Fundamentals of Play-Based Therapy

Play-based therapy is grounded in various theoretical models, including psychoanalytic, child-centered, cognitive-behavioral, prescriptive, and family play therapy (Nash & Schaefer, 2012). Underlying these theoretic models is the idea that active forces embedded in play can are utilized to help children overcome their unique developmental challenges. Nash & Schaefer (2012) listed eight broad categories that encompass the therapeutic powers of play: communication, emotional regulation, relationship enhancement, moral judgment, stress management, ego-boosting, preparation for life, and self-actualization.

Much of the research on play-based therapy is grounded in the educational fields of psychology and child development. Within the context of early intervention, the field of speech-language pathology relies heavily on this research to support their practice of providing communication therapy in the child's natural environments. Naturally and innately, children play. Within this context, speech therapists work in early intervention with children with communication challenges and their families. As stated by Nash and Schaefer (2012), play creates a familiar setting where children can practice new skills in a way that makes sense to them. Additionally, children communicate through play. Children with communication challenges often rely on play to communicate their needs and wants with others (Nash & Schaefer, 2012).

Play Development Common in Western Cultures

Around age two, play moves from predominantly exploratory and object-dominated to symbolic and pretend (Cote & Bornstein, 2009). The development of pretend play is considered a significant milestone in the United States and most Anglo cultures and is considered the precursor to language development (Tamis-LeMonda & Bornstein, 1990). Many middle-class parents believe that participating with their children in pretend play enhances cognitive and language development (Rogoff, 2003).

Multicultural Play Behavior

Clinicians must consider the underlying values that may result in different forms of play. We must be mindful of culture when working with clients from various backgrounds, as these cultural values can shape play. The following points illustrate differences among cultural views about play, and they follow by examples of specific cultural variations to highlight further the importance of each domain (Maschinot, 2008):

1. Play plots focused on everyday activities for the child, such as family dynamics, may yield more child involvement. 

   • Children of Korean heritage participate in play that involves more familial focus compared to Anglo-American children, whose pretend play involves adventure and fantasy.

   • Korean culture is more rooted in collectivism which may impact pretend play behavior as children may not express creativity outwardly.

2. Culture must be considered when assessing social effects, as cultural values impact social interaction. 

   • Korean-American children are less outward with their feelings in play than Anglo-American children, which may be misinterpreted as an adverse effect. 

3. Parent involvement is shaped by culture.

   • Puerto Rican mothers tend to be more involved in their child's play; mothers initiate play by presenting toys to entice their children and then engage them in social play, such as turn-taking. 

   • Anglo-American mothers observe their children self-select toys and watch as they play independently.

4. Analyze and select culturally appropriate materials to elicit interest and child interaction. 

   • Children of Korean heritage participate in play involving structured toys, while Anglo-American children demonstrate more interest in pretend play. Structured tasks (such as puzzles and blocks) may be a more natural play-based approach for this population.

   • Children in poverty are more likely to engage in play that involves printed text when an adult monitors and scaffolds within a play scheme. An approach that combines play with direct teaching can allow children to understand print's importance better while engaging in social play.

The above examples suggest that while Korean-American children may present behaviors that look disordered or delayed (such as decreased positive affect), cultural values should differentiate a deficit from a difference. In the case of the Puerto Rican mothers from the study, a clinician may involve the family in treatment more. For people from other cultures, engaging with their children in this way may feel unnatural. In this case, a more traditional method of clinician-led therapy may be most appropriate.

Cultural Collaboration in Play-Based Therapy

Often in Early Intervention (EI), SLPs will conduct a portion of their assessment in a play context and use it as the backdrop for much of their therapy. Also, a child's play behavior measures cognitive and social development. When working with multicultural families, it is essential to consider parents' expectations of play behavior for their children and how these compare to mainstream expectations. Professionals' concerns regarding play may perplex immigrant families, especially if cultural aspects of their child's play or the parent's participation are interpreted as problematic by clinicians if they are not in alignment with aspects of mainstream play (Cote & Bornstein, 2009). For clinicians working with culturally diverse populations in EI, it is necessary to educate families, when appropriate, regarding mainstream values and the structure of play. Children in EI programs will be exposed to the mainstream structures of play in intervention and will soon be in school. If they are not already, they will be expected to play with children using various play styles (Cote & Bornstein, 2009).

Culturally Responsive Practices

To have the most therapeutic impact, the culturally responsive clinician must understand the play structure most relevant to the family they serve. They must consider and probe parent values and beliefs, such as views of play or familial roles (Hwa-Froelich, 2004). Research, observation, and interview are essential in understanding broad and individual cultural values. These will provide rich information on how best to assess and treat a child and is just the beginning of an ongoing dialogue to facilitate a collaborative relationship between the family and the clinician (Kalyanpur & Harry, 2012).

1. Research the culture 

   • Clinicians will want to prepare themselves by researching the literature before meeting a family to anticipate the values, parent-child interaction, and play behaviors they will encounter. One accessible research method is talking with other professionals or educators that have experience working with the population in consideration. This method allows clinicians to prepare for what they may experience while working with the family and better develop interview questions to elicit more detailed information, creating a complete ethnographic view.

2. Observe the child 

   • Observation of the child should occur in their natural environment with familiar communication partners (Hwa-Froelich, 2004). Clinicians should be open to the idea that the family may differ from anticipated. 

3. Interview the parents

   • A detailed parent interview should be designed with questions tailored to each family and situation. Interview questions should include open-ended and descriptive questions, allowing the family to share their feelings. This form of interview is relevant and vital without constraining their answer by how the question is asked (Kohnert, 2013). 

Questions for culturally diverse families about play

• How do they (the child) typically play? What types of things do they play with?

• Who does your child typically play with? Peers? Siblings? Parents? Other adults? Alone?

• Does your child talk, sing, or make sounds while playing?

• How is play initiated in the household? Does your child seek play opportunities with you or peers?

• What types of things do you and your child play or do together?

• When do you talk with your child the most? When do they talk to you the most?

• Do you think play is important? What type of play do you think is essential? How would you like your child to play?

• What types of play has your child engaged in frequently in the last few weeks? What type of play is done but not frequently?

• Do they play similarly to your other children at the same age?

• Have teachers ever had any concerns about how your child plays or interacts with other children?

• What types of games does your child play? Who do they play games with most frequently?

Sharing of Ideas Between Cultures

While working with culturally and linguistically diverse clients, the clinician must emphasize the family's advantages by participating in multiple cultures. When intervention is structured to include those cultures, clinicians and families can learn from each other without giving up values and expand their possibilities by sharing ideas between cultures. The inclusive intervention also allows us to develop flexible ways of interacting and communicating and appreciate different patterns in our world (Rogoff, 2003).

Student contributors: Elisabeth Baker, Amy Bantle, and Morgan Graham, Spring 2013

Updated by Fall 2022