Squiggle game

Domain VIII · Creative & expressive arts therapies · D. W. Winnicott · 1950

What it is

A drawing exchange between clinician and child with no rules. One makes a quick, spontaneous wriggly line, and the other turns it into something. Then the roles reverse, and the two talk about what has appeared. Winnicott, a paediatrician and psychoanalyst, developed it in the 1950s. Wittmann…

Format

• Format. The child is seen individually. The parent is asked to wait in the waiting room, and parents are seen separately or jointly at other points. Winnicott's sessions were about an hour long; the Cécil case describes six one-hour consultations. Materials are paper (Winnicott tore sheets in half…
• Typical number of sessions. Winnicott's own use was one consultation or a few, often with long gaps between them. In the Cécil case, consultations ran from 21 months of age (first with the father alone, then with the mother and child, then with both parents) to follow-ups at 8 and 8½ years.…

Who practises it, and how they are trained or regulated

• Professional frame. The squiggle game has no credential, accrediting body or regulated profession of its own. It is a technique used inside an existing child-mental-health profession. Examples are child and adolescent psychotherapists, play therapists (APT/BAPT/PTUK and national equivalents), art therapists (HCPC-registered in the UK, AATA/ATCB in the US), child psychiatrists, paediatricians and clinical…

Evidence status, as the guide reports it

• Not a diagnostic test. The squiggle game has no norms, no scoring, and no published reliability or validity data that support reading any drawing as a sign of a disorder or of abuse. A systematic review of controlled studies found that no graphic indicator or scoring system in children's projective…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Embarrassment at drawing, in teenagers especially. Fatigue in younger children.
• Repeated returns with no change: think about longer treatment or other services.
• Relief versus shutting down. If the child stops drawing, go back to playing without pressing.
• Compliance that hides a wish to refuse. Watch the child's body language as well as the answer.
• Squiggles that are too suggestive (you are leading) or too complex (the child feels overwhelmed).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.