Eleanor Vann

Dr. Sloan Bruan Lorenzini

Welcome to the Sloan Continuing Education podcast. I'm Dr. Sloan Bruan Lorenzini, and today I'm joined by Eleanor Vann — registered play therapist, approved clinical supervisor, and someone who has spent over two decades helping children communicate what words alone can't reach. Eleanor, thank you for making time to sit down with us.

Eleanor Vann

Thank you, Sarah. It's always a pleasure to talk about this work, especially with an audience of clinicians who are looking to deepen their understanding of child-centered modalities. I'm glad to be here.

Dr. Sloan Bruan Lorenzini

Let's start with something fundamental. A lot of clinicians come out of their graduate programs trained primarily in talk-based therapies. When they get a referral for a five- or six-year-old, there's often a moment of hesitation. Why does traditional talk therapy fall short with young children?

Eleanor Vann

It comes down to neurodevelopment. Children under roughly age ten or eleven haven't fully developed the capacity for abstract reasoning or the expressive vocabulary to narrate their internal experience the way an adult can in a session. When we ask a young child "How did that make you feel?" we're essentially asking them to perform a cognitive task their prefrontal cortex isn't wired for yet. Play is their native language. It's how they externalize internal states, rehearse relational patterns, and process events that overwhelm their coping resources. So when we meet them in play, we're not dumbing therapy down — we're actually using the most developmentally appropriate and neurologically congruent medium available.

Dr. Sloan Bruan Lorenzini

That's a useful reframe. So once a clinician decides to work within a play therapy framework, the physical environment matters enormously. You've written and presented extensively on intentional toy selection. Walk us through how you think about setting up a playroom.

Eleanor Vann

The playroom is your clinical instrument, so every object in it should earn its place. I organize materials into broad categories: real-life or nurturing toys — a dollhouse, kitchen set, baby dolls — for relational themes; aggressive or expressive toys — a bop bag, foam swords, toy soldiers — for externalizing anger and working through power dynamics; and creative or unstructured materials — sand, water, clay, paint — for open-ended symbolic expression. What you leave out matters as much as what you include. Too many options create noise. I tell supervisees to aim for a curated palette, not a toy store. Each item should invite a type of expression. If you can't articulate what therapeutic function a toy serves, it probably doesn't belong in the room.

Dr. Sloan Bruan Lorenzini

That's a helpful framework. Now, one of the bigger conceptual divides in the field is the question of directive versus non-directive approaches. Can you unpack that distinction and how you navigate it clinically?

Eleanor Vann

Absolutely. In a non-directive or child-centered approach, which traces back to Virginia Axline's work, the therapist follows the child's lead entirely. You reflect, you track behavior, you facilitate emotional labeling, but you don't steer the content. The premise is that children have an innate drive toward healing when the therapeutic conditions are right. In directive play therapy, the clinician introduces specific activities, metaphors, or games designed to target identified treatment goals — say, a feelings card game to build emotional literacy, or a structured puppet scenario to rehearse social skills. In practice, most experienced play therapists operate on a continuum. I tend to begin non-directively to build rapport and let the child's themes emerge organically, then introduce more directive elements as the therapeutic relationship solidifies and I have a clearer clinical picture. The danger is being directive too early — you end up imposing your agenda on the child's process, which can shut down the very communication channel you're trying to open.

Dr. Sloan Bruan Lorenzini

That brings us to interpretation, which I think is one of the more nuanced clinical skills in this modality. When a child plays the same scenario over and over, or certain symbols keep appearing, how do you read that?

Eleanor Vann

Repetition in play is one of the most clinically significant signals we can observe. When a child replays a scenario — say, repeatedly burying a figure in the sand and digging it up — they're working through something that hasn't been resolved. I look at three dimensions: themes, which are the broad narratives — power and helplessness, nurturing and neglect, safety and danger; repetition, which tells me the child's nervous system is still trying to master or integrate that experience; and symbolic content, which is the specific objects and characters chosen and how they interact. A child who consistently makes the small animal figure rescue the larger ones may be processing a parentified role at home. But I hold these interpretations loosely. The goal isn't to decode the play like a cipher — it's to stay attuned to the emotional undercurrent and reflect it in a way the child can metabolize. I might say, "That little dog keeps having to be very brave," rather than, "I think you feel like you have to take care of your parents." The first stays within the metaphor. The second breaks it, and often breaks trust along with it.

Dr. Sloan Bruan Lorenzini

Beautifully put. Let's talk about sand tray specifically, because it's become a go-to modality for trauma work with children. What makes it particularly effective, and what should clinicians be mindful of when using it?

Eleanor Vann

Sand tray gives children a contained, three-dimensional space to externalize their inner world without requiring verbal narrative. That containment piece is critical in trauma work — the tray has edges, which psychologically communicates that the experience has boundaries, that it can be held. Children who are flooded by traumatic memory often can't organize it verbally, but they can place figures in the sand and begin to create spatial and relational structure around what happened. I've seen children build entire trauma narratives in the tray over multiple sessions that they couldn't access through conversation at all. The clinical caution is titration. Sand tray can be powerfully evocative, and a child can move into traumatic material faster than their window of tolerance allows. I always co-regulate during sand tray work — watching for physiological signs of dysregulation, pacing the session, and making sure we have adequate time for grounding before the session ends. You never want a child walking out of your office still activated.

Dr. Sloan Bruan Lorenzini

That's a critical clinical consideration. Now, let's shift to the other side of the therapeutic relationship — the parents. One of the biggest challenges I hear from play therapists is translating what happens in session into something parents can understand and engage with. How do you handle parent consultation?

Eleanor Vann

This is one of the most underappreciated aspects of play therapy practice. Parents come in wanting progress reports — "Is she getting better? What did she say about the divorce?" — and what we have to offer is often more abstract. I frame it early: "In play therapy, progress doesn't always look like what you'd expect. Your child may not come out and narrate what happened. What you'll start to see are shifts in behavior, regulation, and relational patterns at home." I give parents concrete behavioral markers to watch for — fewer meltdowns, more flexible thinking, improved sleep, a willingness to separate at drop-off. I also use parent consultation sessions to teach reflective language. If a parent can learn to say "You seem really frustrated right now" instead of "Stop crying," they become an extension of the therapeutic work. I see my job as building the parent's capacity to be the child's primary healing relationship, not positioning myself as the only person who understands their child.

Dr. Sloan Bruan Lorenzini

That's a really important clinical posture — empowering the parent system rather than creating dependency on the therapist. I want to ask about scope of practice, because I think it's something we don't discuss openly enough.

Eleanor Vann

Completely agree. Play therapy is a powerful modality, but it isn't a universal intervention, and I think ethical practice requires us to be honest about its limits. If I'm working with a child presenting with severe behavioral dysregulation that isn't shifting over a reasonable course of treatment, I'm going to consider whether there's an unidentified neurodevelopmental issue — ADHD, autism spectrum, a sensory processing disorder — that needs a different kind of evaluation and support. If a child is actively in danger, play therapy alone isn't sufficient; we need systems-level intervention — child protective services, school safety planning, coordination with a prescriber if there's a psychiatric crisis. I also refer out when the family system is the primary driver of the child's distress and the parents aren't willing to engage in their own therapeutic work. You can do beautiful work with a child in the playroom, but if they go home to the same toxic dynamics every night, you're swimming upstream. Knowing when to bring in a family therapist, a neuropsychologist, or a psychiatrist isn't a sign of failure — it's good clinical judgment.

Dr. Sloan Bruan Lorenzini

Eleanor, this has been an incredibly rich conversation. Before we close, is there a final thought you'd like to leave with our listeners?

Eleanor Vann

I would just encourage clinicians to trust the process and trust the child. Play therapy asks us to slow down, tolerate ambiguity, and resist the pull to make things cognitive and explicit before the child is ready. If you can sit in that space — genuinely present, attuned, and non-anxious — the therapeutic work will unfold. Children are remarkably resourceful when we give them the conditions to access their own resilience.

Dr. Sloan Bruan Lorenzini

That is a wonderful note to end on. Eleanor Vann, thank you so much for sharing your expertise with our community. For our listeners, this episode counts toward your continuing education requirements — check the course page for details on earning credit.

Eleanor Vann

Thank you, Sarah. It was a genuine pleasure.

Dr. Sloan Bruan Lorenzini

And that wraps our session for today. Thank you for listening, and we'll see you next time on the Sloan CE podcast.