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28 Identifiers in Play Therapy that Suggest Sexual Trauma

Themes and behaviors in the playroom are huge indicators of what is going on in a child’s life or their past experiences. There are many general themes that can be seen in play therapy, as discussed in the post 15 Common Themes in Play Therapy.

This post will talk about things that are seen particularly in children that have potentially been sexually abused. That being said, just because a child is showing these things in play therapy does not mean that a child has been sexually abused. You should keep the thought in the back of your head until more evidence appears. This may be sexualized behaviors or the disclosure of abuse.

  • Precarious Hygiene

  • The dark

  • Use of masks, puppets

  • The theme of trickery

The theme of trickery is common in children who have been sexually abused or experienced some form of trauma overall. This may be seen in a character in their play being tricked, the client being tricked, or the therapist being tricked. An example of the theme of trickery is the child sneaking up behind the therapist.

  • The child playing out hide and seek

Hide and seek in play therapy can be exhibited in many forms. This may be the child hiding from the therapist, the child wanting to hide an object from the therapist, or the child wanting the therapist to hide an object. An example of this would be a child hiding an object in the sand tray and asking the therapist to find it.

  • Secrets

This may be seen in the child wanting to keep a secret from the therapist. An example would be the child saying “I have a secret and I don’t want to tell you.”

  • The theme of good vs. evil

The theme of good vs. evil is one that I see quite frequently not only in children who have been sexually abused, but have experienced another form of trauma. An example of good vs. evil in play is when there are “good guys” and “bad guys” fighting against one another.

  • Feeling creeped out

A huge part of play therapy is being present in the moment. In being present, we experience feelings and sensations as a therapist. There may be times you feel uncomfortable or creeped out and just can’t put your finger on why. In addition with conjunction with other indicators, this may be a sign of sexual abuse.

  • Confusion of hurt vs. love

An example of this would be a child playing out a character being hurt and then taken care of. I have experienced this before where I have repeatedly “been hurt” by the child and then “taken care of” by the child.

  • Dissociation

  • Passivity

  • Masturbation

  • Inserting objects

  • Messes

Mess, or some form of chaos, is very typical in children who have been traumatized. An example of this is the child creating artwork using paint and then using their hands to wipe the paint all over the page.

  • Eating poison, dirt, poop, pee, vomit, or people

This is very typical of children who have experienced sexual abuse. This may be combined with the theme of trickery by the child saying “here’s some cake for you to eat,” and once the counselor is pretend eating the child says, “it’s poop!” or “it’s poisonous!.” This represents the child consuming or experiencing something disgusting.

  • Cleansing or washing

Cleansing or washing is typically seen following mess or eating disgusting things. This may represent the child experiencing a repulsive event (i.e. sexual abuse) and wanting to be rid, or cleaned of the abuse. An example of this is a child wanting their hands to be clean following using the sand tray.

  • Toleration of feelings

  • People being back alive or reincarnation

  • Devouring

This is additionally very typical of children who have experienced sexual abuse. Devouring is not typical eating. Think of this as the character or the child scarfing down food. An example of this would be a character eating the sand in the sandtray as fast as they can, never seeming to be satisfied.

  • Toilet breaks

  • Hypervigilence

Hypervigilence, not to be confused with hyperactivity, is something very common in children with trauma histories. Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. An example of this in session is when a child hears a door closing outside of the office, becomes startled and says “what was that?!”

  • Theme of aggression

Aggressive is a very common theme in play therapy overall, but especially common in children with a history of trauma or disruptive behavior. This may be seen through characters fighting one another or the client pretend fighting with the clinician. For example, the child play attacking the therapist with pretend swords.

  • Theme of regression

As stated in 15 Common Themes in Play Therapy, regression is a theme that is common in children with a trauma history that have been parentified, or feel like they have to be a mini parent. These children sometimes feel that they have lost part of their childhood and are therefore recreating it in the playroom. Regression can be observed the in play therapy when a child is using “baby talk,” crawling like a baby, and using a bottle like a baby.

  • Theme of expression

  • Simulating sex or other sexual acts

This is a very obvious indicator of sexual abuse. This would be seen in the play therapy session through the child having dolls engage in intercourse with one another.

  • Theme of nurturance

This is personally one of my favorite themes in play therapy. The theme of nurturance shows that the child is beginning to progress through treatment. In relation to sexual abuse, the child may feel as though their childhood has been taken away from them and therefore needs to be recreated in the playroom. This can be exhibited through a child feeding a baby doll with a bottle.

  • Sexual artwork

This is a very obvious indicator of sexual abuse as well. An example of this is a child drawing genitalia in session.

  • Precarious boundaries

For me personally, is is one of the indicators that really sticks out to me. I always think about potential sexual abuse when children don’t seem to be aware of personal space and boundaries. This could be seen in play therapy through the child attempting to sit on the counselor’s lap.

What other things have you seen in play with children that have been sexually abused? Tell me your experiences in the comments below!

Play On!



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