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Book Review: Aggression in Play Therapy

How do we handle aggression and anger in children? It is a question that has evaded parents, teachers, and child therapists alike.

Often when faced with aggressive behaviors, caregivers tend to focus solely on those behaviors and miss the important messages — and even adaptive strategies — they confer. Conversely, many fear that by allowing the child to express her frustration, we open the door for future combative behavior.

Yet according to Lisa Dion, one of the most important components in helping a child learn to handle her aggression is a child therapist. In her new book, Aggression in Play Therapy: A Neurobiological Approach for Integrating Intensity, Dion draws on the important underlying neurobiological actors that drive aggression to show how, when we mindfully join with the child and offer them a safe space to express their aggression, we offer them the greatest lesson of all: that in their aggression can also be deep healing.

Dion explains, “We live in a culture that teaches children that aggression is wrong. So much of the education on aggression that children receive at school and in their homes is behavior based. In my opinion, we are missing the child inside the behavior.”

Aggression is a behavior, but it is also an attempt on the part of the child to integrate traumatic memory and sensation — and the consequent activation of the sympathetic nervous system — and find a way to regulate themselves.

However, a child learning to regulate themselves in play therapy requires a therapist who doesn’t avoid intensity in play and instead knows how to be with the experience — and themselves — offering the child a model of self-regulation.

“It is also my opinion that many play therapists don’t understand how to manage the intensity of their own bodies so that they don’t develop signs of compassion fatigue or burnout,” writes Dion.

In many ways, play therapy is the perfect place for aggression to be expressed, and Dion notes that when aggressive urges are suppressed in play therapy, children are often forced to express and explore them outside of the playroom.

She writes, “What we suppress, we eventually express. At minimum, children grow up learning not to understand and trust their instincts and impulses, which over time can lead to a disconnected relationships with their bodies.”

One result can be internalized shame, which creates not just confusion, but relational disconnection.

“I am asking you to make the shift from seeing aggression as bad and needing to ‘do something to’ the child to learning how to be with the child,” writes Dion.

To accomplish this, Dion offers six keys: therapists must become external regulators to help modulate the intensity in the playroom; interventions must encourage children to become mindful of the thoughts, feelings, and sensations in their bodies; therapists must model for children how to stay connected to themselves in the midst of intensity; therapists must be authentic and congruent to promote feelings of safety; boundaries must be set when there is a genuine safety concern; and therapists must create a neuroception of safety if emotional flooding occurs to help children get back into their windows of tolerance.

While many events can initiate a threat response, there is one that is especially insidious. Dion writes, “‘Shoulds’ and ‘unmet expectations’ are perceived as a danger to our sense of self…. The number one thing that will block your ability to facilitate children through their aggression are the messages in your head about what you think you ‘should’ or ‘shouldn’t’ do in the moment.”

Moving toward intense and emotional states is how we develop emotional resiliency. When the therapist can act as an external regulator, by offering mindful awareness, they can help children learn to find their own regulation and stay connected to themselves in the process.

“Becoming a play therapist is not just a commitment to the children we work with but also a commitment to ourselves and our ongoing personal growth,” writes Dion.

Therapists must be willing to feel what is happening in their own bodies without suppressing or becoming consumed by the experience, and they must work through their own fears and past experiences related to aggression.

“If we can’t hold our own discomfort, we will have a hard time holding the child’s,” Dion explains.

By spending time in their own bodies, widening their window of tolerance and offering what is known as a “ventral embrace,” therapists offer a rich interpersonal experience to their clients where their nervous systems flow into and back out of synchrony many times.

By attuning to their bodies, feeling — not thinking — their way through play therapy, increasing their window of tolerance and confronting their own beliefs about aggression, modeling regulation and authenticity, remaining mindfully aware and understanding play therapy as a shared experience, therapists will be able to offer the child a space not just to express and explore aggression, but also find profound growth and transformation.

Aggression in Play Therapy would be helpful for every child therapist. Dion does a brilliant job of integrating mindful awareness, polyvagal theory, and a neurobiological understanding of aggression into a comprehensive, thoughtful, and much needed guide for handling aggression in play therapy.

Aggression in Play Therapy: A Neurobiological Approach for Integrating Intensity

W.W. Norton & Company, November 2018

Hardcover, 288 pages

Book Review: Aggression in Play Therapy

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Claire Nana

Claire Nana is a regular contributor and book reviewer for Psych Central.

APA Reference
Nana, C. (2019). Book Review: Aggression in Play Therapy. Psych Central. Retrieved on November 26, 2020, from
Scientifically Reviewed
Last updated: 3 Feb 2019
Last reviewed: By a member of our scientific advisory board on 3 Feb 2019
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