Play is the work of childhood, so what exactly are we doing when we use it in therapy? This episode separates play, the verb, from playfulness, the attitude, and gets honest about the vulnerability of being an adult on the floor making dinosaur noises while parents watch. The throughline: when in doubt, let play win, because it reveals the wisdom of the child’s own system.
Following on from following the child’s lead and the just right challenge, we wanted to pin down play with a bit of precision. Tracy explains why playfulness earned its own shelf in STEPPSI, drawing on the play research of Anita Bundy and Diane Parham and the social-affective neuroscience of Jaak Panksepp. Then we get personal: Michelle’s journey from a Sydney boardroom and heels to shoeless on the mat in a hammock swing, and Cory’s path straight into paediatrics leaning on a naturally playful family, both circling the same vulnerability of being watched while you play.
The heart of it is the toggle between playfulness and play, the being and the doing, and how easily we slide into a teachery mode that can either help a child or shut their exploration down, depending on the child. Cory tells a wonderfully relatable dinosaur-and-fireball story about wanting to drill a vestibular target and finally letting the agenda go, only to watch the very skill he was chasing emerge in the play a week later. We finish in polyvagal territory: blended ventral-sympathetic states, chaos and rigidity as the banks of the river, and Tracy’s grandchildren showing how a two-year-old ballerina can be a powerful vagal brake on her rough-and-tumble big brother.
Lightly edited for readability. Speaker labels and chapter markers match the published episode.
Lightly edited for readability. Speaker labels and chapter markers match the published episode.
Cory: We wanted to explore play, because we’d just been talking about following a child’s lead and evincing an adaptive response, and so much of that, because we work with children whose primary occupation is play. We want to be across it and figure it out in a precise therapeutic sense. We’re trying to disentangle the thing where we’re just a playful person, from the elements of this we can work on in our therapeutic toolkit. These are terms we use very frequently, and we’re coming at precision around them. Tracy has playfulness set out in STEPPSI as a particular element we can think about when we’re clinically reasoning. Tracy, would it be useful to voice why that landed on its own shelf and how that came about?
Tracy: Sure. When we first did STEPPSI, Sharon Trunnell, Julie Wilbarger and I put it together back in the 1990s, around 1997 to 98, and we taught it a lot and presented it at AOTA. It used to have one P, because play and playfulness were inferred in it, held in a couple of places intentionally. Because it’s a sensory integrative approach, and Ayres always said play was an essential ingredient of doing the work of sensory integration, it was almost a background beat: of course this is a play-based approach. In STEPPSI, play could have been coded as the interactional element, what’s happening in the relationship, or in the T of task. But after we developed it, there’s been such a beautiful emphasis on studying play and playfulness across disciplines, and in occupational therapy it’s looked at in a rich way. Anita Bundy and Diane Parham come to mind, among many others. Anita developed the Test of Playfulness. And the intersection I’m always interested in is how a brain-science view of play informs us. So it made sense, as that literature unfolded, to pull play out and add it as its own element in STEPPSI, so it’s foreground rather than background. It brings up the difference between play and playfulness, which is worth thinking about. But for both of you, becoming a paediatric OT, was play natural, or something you had to reinvigorate? Talk about your journey of becoming a player.
Tracy: The work of Jaak Panksepp, in his social-affective neuroscience, talks a lot about play, and that’s a really important intersection. And then the theory approaches we thread together around play, Floortime, relationship, interpersonal neurobiology, attachment, and the enriched experiences it takes to foster development, all have connections to play and playfulness. So it made sense, as that literature unfolded, to pull it out and add it as an element in STEPPSI, so it wasn’t so much in the background beat but more foreground. That brings up the question of the differences between play and playfulness, which is important for us to think about.
Michelle: I had a really varied career before paediatrics. I used to work in Sydney, in a head office on Sussex Street, so I wore heels and a suit, took the ferry through the CBD with my piccolo and my briefcase. Then I moved to Orange and was part of a project team looking at clinical governance, so I got rid of the heels but kept the suit. The first time I met with Sarah, we sat on the ground and she took her shoes off, and I was like, what are you doing, is this okay? I felt very exposed. I’d gone from boardroom to on the ground with my shoes off, wearing tops that didn’t show my breasts, and low-rise was in at the time, so I had to modify to high-rise. There were adaptations I had to make in my dress and my head space to squat on mats. One of the first things she showed me was the hammock swing, getting in, doing linear movement, pulling on the rope and climbing up. Getting our OTs onto the equipment and learning to use it is one of the first things we do, and Sarah did it to me. It was a culture shock, and once I got over it, my body felt good, we laughed, and I felt the joy of it. I had young kids of my own and played on the ground in parks, but not publicly or with my professional hat on. So it felt like a coming home, integrating different parts of myself. The first few times I was very conscious, adults watching while you’re roaring and ball-wrestling on the ground, but I have no filter now, and you can’t either, because you can’t be truly present with the child and worry about whether your roar is loud enough or whether you look like a bear. That was a journey, but I love it, and it’s the greatest joy, it keeps me young.
Cory: I came to this very differently. I went straight into paediatrics, not even intentionally, I just needed a job, and that’s the one I had. I was very untethered in that first job, with nothing to my knowledge but my playfulness. I was fresh, didn’t have much mentoring, wasn’t watching other clinicians, I was just lucky I could relate to kids instantly. I’m very lucky to have a playful family, my dad and mum are both very playful, so being playful didn’t feel like a stretch, which I know isn’t the case for many people. What I did struggle with, like you, Michelle, was being watched, because play is very vulnerable. You can’t hide yourself, you have to be authentic to be playful. Initially it was embarrassing, someone fully watching me with these dolls, the child wanting the dolls to cry, and you have to embody it. To embody it you have to feel sure in how you’re coming to the interaction, so you don’t second-guess yourself, because then you can’t connect with the child in the moment. Now I have none of that. It’s getting used to the discomfort, and seeing the therapeutic benefit reassures you to keep going. Parents love watching it, they get joy and release from seeing you so comfortable, a kind of permission to let go.
Michelle: Tracy, what’s your experience, given you’ve had the academic, research and leadership side too? How does play feel for you?
Tracy: This is a memory that just came to me listening to you both. When I was first becoming an OT, our uni did a level-one fieldwork, a short one-week placement, and then a level-two. My first level-one was adult rehabilitation, a serious, medically oriented environment with significant injuries, a steep learning curve, and we wore white coats back then, so it felt very serious. My next one was at a regional centre, which hardly exist anymore, a residential state placement where kids with many layers of difficulty went to live. A lot of these kids were really struggling with ambulation and eating. I’d been around kids with different needs, but never eighty kids all struggling like that. I was certain I wanted to be a paediatric OT, but you show up trying to be the professional student. I was observing this OT, whom I still know, very gentle and loving but a little procedural, I’d say now. After a day or two it was my turn. I felt an inner need to connect with this little girl in a more playful way. It was almost range of motion, but when I added some rhythm and sound, she connected differently and allowed me in, and the therapist looked at me like, what are you doing? I felt so vulnerable. But I could hear Ellie Gilfoyle in my head asking, what does it really mean to have purposeful activity? In that moment, play was the solution: the thing that had to happen to this child for her physical wellness didn’t have to happen to her, it could happen with her. Afterwards I felt vulnerable and full of questions, and when I went back to uni and explained it to my mentor, she said, yes, you’re doing the right thing, which was affirming. So many times since, I’ve encountered this space of doing-to versus being-with. Play and playfulness are a space of authentic connection, and can create meaning even in something as perfunctory as range of motion.
Cory: Now my questions are different. The parent’s probably wondering what on earth I’m doing, but because my clinical reasoning is so much more robust, I feel comfortable even when I don’t know exactly what’s happening, and I can help the parent understand the value in it. Being able to explain what I’m addressing in the play, and why it matters, has relieved my self-consciousness.
Michelle: Some of that comes down to the parents’ perception of the value of play and those gentle, attuned interactions, versus, when are you going to do the procedure, when are you going to start working, Michelle? I just started with a new family, and we’d missed the intro conversation, going straight from assessment to intervention. I caught up that afternoon and apologised that I hadn’t explained what was coming before they saw it in action. They said, we trust you, Michelle, we see what you’re doing, he’s doing things with you we cannot get him to do. It was lovely, and a bit gritty, he has vestibular and somatosensory discrimination issues bumping into modulation, so I was bumping the edges. That family are intuitive people who value play and the gentle attuned approach. Other families really value the procedures, the doing, let’s educate our child, a more behavioural or top-down teaching approach, and for them the value of play isn’t as obvious, so they have a harder time seeing what we’re doing.
Tracy: It brings up something we do in STEPPSI that I don’t know I’ve read elsewhere. Play is both a means and an ends. It’s the methodology, but in clinical reasoning you’re constantly toggling between thinking about the goal and the not-goal. From the research, the skilfulness is in some ways the secondary outcome of play, and the primary thing is the whole of the child, the enrichment, the almost intangible benefit, because to be a player is part of what it means to be human, entwined with our essence, especially in developing children.
Tracy: So what STEPPSI helps you with, in moments of uncertainty, is to pause and ask, am I working more on the means or the ends of play, and how can I deepen my understanding of that work? We use this idea of zooming in and zooming out as shorthand for clinical reasoning, and play and playfulness require constant zooming in and out, while releasing your attachment to what it is. That’s a tricky space to work in.
Michelle: Totally. One of my key learnings studying DIR was being with, and watching, waiting and wondering with the child. I could do that for a while, but my own individual differences would have me thinking, I’m bored now, how can I get you to move on. I videoed myself, as you have to, and I’d be saying, don’t move the game on, Michelle, let this happen, but keep playful. To maintain being present, I started teaching: oh, the green car’s going up the ramp, vroom, down, down. That was me filling my own need to do something for the end, to get some skills in while we play. If it’s slower than my preference, I get worried about the end, and I get teachery, let’s do colours, up, down, below. That’s my own impatience.
Tracy: It’s a natural thing that happens to everyone, especially adults, this shift from playfulness into play. In some ways playfulness is more of an attitude, and play is more of a verb, an action, a task, a doing, versus the being part, which is the playfulness. Anita Bundy has elements that define playfulness, and we’ll post that in the show notes. What’s interesting is to notice when you toggle between playfulness and play, and to hang in that toggling with a child to learn the difference. Often when we take the agenda to turn it into play, it becomes that teachery space, not teachery in a pejorative way, just an option in our interactional style to shift into more task-structuring of the play. But as soon as we do, we take away the freedom of the child’s exploration. For some kids that promotes play; for others it reduces it, depending on their individual differences. It shifts you from outcomes related to regulatory capacity or higher-level praxis and skill, to outcomes related to social interaction, and then there’s the higher level of just being a whole person that develops in the context of play. There’s an artfulness in shifting between those places. Neither is better in a moment, there’s a decision to be made.
Cory: I can demonstrate this from last week, with a kiddo at daycare. Am I going to show up and embody playfulness to facilitate his sustained engagement, his language, his working memory around staying with an idea, or am I going to address the clear vestibular discrimination issues, which are humongous, that I really feel I need to get precision into? For context: in the sandpit, observing him, he’s overwhelmed by any social assertiveness from peers. A peer sets an idea, and from his body language he doesn’t want to do it, he pulls into himself, but he has no capacity to problem-solve or assert himself, so he gently moves on to something else. And daycare is busy, you’re never far from another kid joining, especially with the enticing OT there. I don’t think he gets many nicely attuned, enjoyable social play experiences, so a lot of his play looks repetitive, structured, solo building. But he’s a caring, connected, beautiful kid when the situation allows. Every time I show up he processes me, makes space for me to sit beside him, he’s able and wants to connect. But I don’t think he gets many attuned interactions building his trickier capacities: language, processing speed, body awareness, staying with one idea.
Cory: So we’re playing in the sandpit, and in front of my eyes his right eye is wandering in and out of alignment. I know that needs addressing, I need to get him some input to pull that eye back so he can perceive his world visually and find the stop in his own body, vestibularly find himself in time and space, which is hard for him if I move out of his close space. Thinking of Patti Oetter and Eileen Richter’s progression of space, I’m in mother space, maybe two to three metres, to get him to place me in space with him. It’s all related to his vestibular discrimination and somatosensory issues. We’re playing a game I’ve playfully followed his lead on, with dinosaurs, and he wants the dinosaur to shoot a fireball. I’m really attuned at this point, and then I think, I need to get you to move, to do some head rotation, something vestibular. So I say, the dinosaur won’t fire up unless we power him up, which was way too complicated and abstract for him. I’m trying to get him to do basic robot zaps from the Astronaut Training protocol, standing back to back, feet planted, rotating to tap each other’s fingers, or just passing the dinosaur around. It was never going to fly. He had no midline orientation, no other kid to demonstrate, and every time we tried to stand back to back, he’d turn his whole body to face me to pass me the dinosaur, facing my back, and I’m going, no, your feet have to glue to the floor.
Michelle: Here, let me stuff up this play just a little bit more for you, honey. Let me get in the road.
Cory: Exactly. This is not useful right now, just stop, let it go. Let go of the agenda to address the somatosensory and vestibular stuff, there’ll be other opportunities. So I let go, and we kept playing. I said, oh man, this isn’t the way to power up the dinosaur, is it, what do you think we should do? He said, let’s just do this, and I said, sounds great. The urge to hit that tricky system was so strong, it’s hard to dance that dance. Then this week, he was playing the dinosaur game again, and he decided they needed a ramp, the car was out of battery, and he was going to go call Battery World, which is really complicated for his language. I said, that sounds great, we need a battery. He moved away from me in space, further away, and I made myself stay put, don’t follow him, see if he can sustain the idea and come back, can he hold that goal. He went around the corner, fully out of sight, and it was taking a while, and I’m wondering, is he inhibiting all the other toys he can see, or just picking them up and losing the idea, because normally he’d move into a different space and completely lose the concept.
Michelle: Cory, he’s probably thinking that about you, we were just doing fireballs and you wrecked it, Cory really needs to improve her play skills.
Cory: He was sweet, just following along, okay, do what, I guess, but it wasn’t conducted for him at all. Anyway, it was taking him a while and I couldn’t see him, and I was trying hard not to follow, so I called out, oh man, I really hope they have a battery, we really need one over here. He goes, I’m hurrying, I’m hurrying. Then he comes back with sea creatures and a battery. I saw the sea creatures and thought, oh no, it’s a new idea, not the battery, he just wants to play sea creatures now, which is what he’d normally do. But he says, I have some sea creature friends, with the dinosaur and the battery. That was exciting, because it reflects his improving skill in the exact thing I’d been trying to drill, and I got it in play, rather than getting bogged down in the not-really-attuned activity I’d been trying to force.
Tracy: So good, such a relatable story, the whole struggle of it. Suspending clinical reasoning and letting play be the winner is often the very best solution, because it reveals the wisdom of the child’s own system and it’s authentically aligned with all our theory bases. Sometimes we get greedy.
Michelle: We do. Some kids you can partner with more readily, they’ve got more capacity across the domains. But some kids with regulation challenges find the playful state makes it harder to stay regulated. Being with another, being flexible and creative, is a big ventral state, but coming up with more ideas, like Cory’s fireball, can activate us into a blended ventral-sympathetic state, and some kids struggle with that. If we embody their joy, great idea, get the fireball, it can tip them over their edge of regulation, and they’re off without us, jumping off the loft. The opposite is where we bump into rigidity, no, no, Cory, we don’t need a battery, we don’t need a fireball. So with kids who have more capacity, the play still has to be just right in how we reflect their non-verbals and energy, because the wrong ideas can have them on the go, let’s destroy the jungle, suddenly much more activated, pulling us out of that blended ventral mode.
Cory: That makes me reflect on early in my career and my own individual differences. When a kid’s playful and motivated, my nervous system shifts quickly into, yeah, let’s do that, and I’d go into a much higher-level creative idea than the child was ready for. They’d have a basic, simple idea, and I’d lay this and this and this on top of it, way harder, this is before my DIR training. It was a mismatch with their current capacity in play. The intention was to join them and make it more creative, but knowing my profile as a therapist, it’s better to stay where they’re at. And if I push too far, I always hit rigidity in that other profile. That took a long time to figure out.
Tracy: Those edges are Dan Siegel’s river of integration, with chaos and rigidity as the banks. Naming it as chaos or rigidity helps, because you can see, I went beyond where this kiddo can hold the playfulness. In the DIR framework and the FEDCs, it’s interesting how often newer therapists equate play with pretend, very symbolic, turning the block into a building, the animal alive and animated. A lot of our kids aren’t at that level, so their play isn’t there. Learning to play in different ways means asking, where’s the child, what’s their focus, is it about the movement itself, the object interaction, the interpersonal interaction? There’s a lot to unpack. I’m always encouraging therapists to release their attachment to what play has to look like, because that constrains it, makes it rigid, and makes the therapist feel chaotic. Finding that ease of being-with, letting play be the place you go back to, is the flow you’re striving for.
Cory: Michelle, you touched on dancing with the autonomic nervous system in play. More recently I’ve got my head around the blended states in polyvagal theory, having access to more than one state, which makes sense as how the nervous system responds to the environment most adaptively. If I’m playing, I need some sympathetic activation to mobilise energy in the play space, but it’s coupled with the brake of the ventral vagal system, so the activation doesn’t become too much and tip into fear or worry, the chaos side. Tracy, could you explain what’s happening with the blended states and how the sympathetic activation and the ventral vagal brake dance?
Tracy: You explained it really well, actually.
Tracy: Here’s what it brought up for me. I’m a grandma now, and I recently spent a weekend with my grandchildren, four and two, the four-year-old a boy and the two-year-old a girl. They’re learning to play together but have really different energies, and the whole experience is deliciously ventral, bathed in connection and curiosity and shared experience. My grandson has more intense sympathetic blending, he wants rough-and-tumble, to climb on you, to crash and burn things, which is all fine, but at some point it gets too big for my granddaughter, whose way of being is to regroup with a bit of downtime. It’s beautiful to watch: she’ll either start moving really slowly and rhythmically, saying I’m a ballerina, getting very bilateral and rhythmic and dialling the whole thing down, or she gets flat, lies on the floor and goes quiet. And because we’re in ventral play, even though my grandson has big sympathetic energy, his ventral system is available enough to see that change, and he dials down. She has a very powerful vagal brake over him, more than he has over her, because she uses her energy to slow the train down. I imagine she learned it because he was rough-and-tumbling when she was smaller, and she’s also just a bit more of a zen, chill personality, maybe a bit like her Nana. It helps us picture how our autonomic nervous systems are part of our social nervous system, and playfulness is what constructs all of that: the start-and-stop signalling, the rhythm, the cueing, how it all gets integrated. The foundation of regulation is how we draw from those energy sources and match them to the other and to the environment, and it evolves from playfulness itself.
Michelle: And they’ve found a rhythm. She’s found a strategy, he’s tuning in because his intention is to play and he’s connected with her, so he comes over to see what ballerina princess is resting from. They’re connected enough. I’m working with two boys who aren’t doing that, there’s no pause between them, they both get energised and chaotic and pull away from me, because their energies align and feed each other, and why would they want to stop when it’s awesome and they can move mountains together? So the challenge for the parents and for us co-treating is that we wear the brake for them, and the two of them together mean we have to be more appealing than them whizzing off, which is every parent’s dilemma when kids’ energies align. They’ve got the dance happening, but without the noticing of where the other one’s at, and that’s what our involvement and parent coaching is about.
Cory: We’re talking about the autonomic contribution to start-and-stop signalling. I wondered if we could talk about that as a therapeutic strategy in play, because, Michelle, with your siblings, play is surely the key strategy to support the brake. Without the play, you can’t catch them enough to put the brakes on.
Tracy: Absolutely. The autonomic energies are in a space of activation or deactivation. With my grandkids, the activation and deactivation happen in a co-regulatory way with each other. Sometimes it’s more co-mobilised, like the brothers, who are activated together but neither is the co-regulator, they’re just co-active. Then you need the triad: the environment, the rules, or another to be the co-regulator and help find the down-regulation signal. People often assert a rule, but what we often do in therapy is set a boundary while also joining the kids in the play to help them find the stop signal inherently. Maybe, we’re both going to climb to the top of the ramp, but we can’t jump off at the same time, which creates an automatic turn-taking and a need for the brake, and invokes a lot more body in space, more proprioception. The striatum and motor-planning circuitry have to help you find the start and stop, because the stop-and-go signal is so based in our proprioceptors. So if kids are upregulating, and I need to help them find a stop signal, I can infuse more proprioceptive qualities, plus the social quality of the you-and-me, which creates the context for the boundary, and then the rule can grow out of that, rather than imposing it.
Cory: What comes to mind is climbing up the ramp and saying, I really want to do that but I’ll struggle, can you help me, can you pull me? That’s proprioceptive, and it depends on the child: some say, yeah, I can help you, and some say, get up yourself, I’m just going to keep jumping.
Tracy: It also pulls in the social nervous system, the prosocial cue of help me, of my turn, your turn, which is essential to regulatory capacity. The ventral vagal complex helps us be most attuned to each other, so it’s the social nervous system we want as the fiery partner or the down-regulating, braking partner, and the proprioceptors anchor it.
Michelle: That was our game. There was jostling about who’d go first and who was winning, so we created an activity: get from Danger Island across the lava to safety island. What could we step on to avoid the lava? We brainstormed on the mat: a big heavy barrel, tyres, crash mats, all grounded, last week. You had to hang on, and if you splattered into the lava, you’d reset. They were awesome at it. Yesterday the challenge was to make it aerial, for more vestibular input and activation, keeping the structure that we’re all going to be successful and all get to the island. They chose swings. We came together on a crash mat on Danger Island and cheered each other on, so we got rid of the winning and losing, no team ninja needing to win, we stopped that competition. With more vestibular activation it was awesome, but we were certainly more heightened than when it was heavily proprioceptive and grounded. They climb trees and do amazing stuff, so we wanted more activation in play and to see if we could hold the connection with us. It was awesome playful stuff.
Tracy: I’m so grateful to our OT colleagues doing all this great research in this space, and we’ll share some favourite resources in the show notes. Go forth and play is the thing we hope for everybody.
Michelle: Awesome. Bye.
And that’s a wrap on today’s episode of Spirited Conversations. We hope this sparks something for you, whether it’s a new clinical idea, a fresh perspective, or just the reminder that you are definitely not alone in this work. If this conversation resonated, we would love for you to share it with anyone on their own learning journey. You can find information about the podcast on our website, and you can join us in the courses and communities the Developmental FX team have put together at developmentalfx.org. And if you’re enjoying listening, please subscribe or leave a review, it genuinely helps more people find us. Until next time, keep the conversations spirited!