BookREVIEW: The Interpersonal Neurobiology of Play

Theresa A. Kestly
2014 W W Norton

Reviewer Mary-Lou Al-Saedy

Neurobiology of playThis book discusses the neurological effects of play on young children, teenagers and adults. The author uses her expert knowledge to explain how the brain/mind develops from birth onwards and what happens when the environment fails to provide a good enough situation for the child to develop normally or when a ‘good enough mother’ is not available. She then suggests a ‘hands on’ therapeutic approach for change. As I work with teenagers and toddlers it is of particular interest to me. I feel supported when I can find theory that will confirm my observations and practice.

The author describes children who repeatedly mis-read situations and are painfully reminded of previous traumatic events, by even the slightest everyday incident. She explains, by micro-examination of play, how hypo- and hyper-arousal occur and how the main care-giver of an infant is so influential in moderating these stimuli, until the child is able to control the feelings for himself. Dr Kestly states: “What fires together, wires together”, this being a gross over-simplification for neurons that are stimulated in traumatic circumstances, wrongly connecting, and then staying fused together. She suggests that through play therapy we can correct this faulty wiring.

It is shown how play can produce new neural pathways that will supersede the damaged synapses. Different methods of play are explored that can allow the development of new neural pathways to take place and the need for the intuitive attunement of the therapist is explained. I particularly enjoyed reading her thoughts on the heart brain and stomach brain and how we should unite them with our head brain. She suggests mindfulness for clients and herself to provide optimal presence and openness in which to be totally non-judgemental. If we relinquish a wish or plan for the client, change can occur.

Dr Kestly is a play therapist whose specialty is in sand tray therapy. She works with children and adults and has developed her own special understanding of the brain. She teaches us that our right brain is the “story teller” and our left brain is the verbal understanding of the story. She tells us that there must be a spiral movement between right and left brain in order to function well. To put this into practice she allows her clients to work in a sand tray, using many objects to tell a story. She then takes an analytical approach to understand what is happening/has happened to produce blocks to development. The problem with analysis of sand tray stories is that the interpretation can be horribly wrong. Dr Kestly does say that we can treat the story as dream work but I feel the interpretations she makes are rather more precise than this. The author is certainly a teacher and she wants to share her knowledge with other therapists so they may emulate her.

Dr Kestly explains the work of Panksepp and several other therapists whose main interests are in the neurological functioning of the brain. She marries these principles with the thoughts of more tried and tested therapists such as Winnicott, Ainsworth and Jung. She also incorporates the thoughts of Jeremy Rifkin to give balance to her arguments. We are given beautiful vignettes of her client work that make the rather dry explanations of neurological findings more palatable. Many diagrams are inserted into the text to clarify what is said. I found some of these diagrams very difficult to follow, but there were others that were extremely helpful. All in all there was a reasonable mix of theory and clinical work, splashes of bright colour among a rather black-and-white background; perhaps this could be seen as playful?

This book is a must for anyone who works with children or young people. Therapists with an adult clientele will benefit from reading it too: our clients were all children once. I wouldn’t want to recommend introducing a sand tray if you haven’t practised on your peers first but the ideas of play and the role it fulfills would be helpful to any therapist.

Primarily the book is for therapists who work with children. It can be used as a text book for teaching students of therapy and there is a section of hand-outs that could be copied and given out to students. It would be very useful to all therapists as play is not always on our agenda, but as one of nature’s developmental tools, perhaps play should be more prominent in the therapy hour. The vignettes are entertaining and we are shown how to put the theory into practice. Parts of the book would entertain you on your commute to work; parts of the book require total silence and deep thought.

Will I be adding a sand tray to my therapy room? Probably, but I will definitely be practicing on my friends first.


Mary-Lou Al-Saedy works in private practice as an integrative psychotherapist. She is also a program manager at Teens and Toddlers, working to prevent young people from becoming NEET (Not in Education, Employment or Training) or improving their interpersonal skills in a nursery setting.


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