Squiggle game · Atlas

1. Introduction

Version followed: D. W. Winnicott's own use of the squiggle game inside the "therapeutic consultation" (first-interview work with children), as set out in Therapeutic Consultations in Child Psychiatry (1971) and his paper(s) on "The Squiggle Game" (dated 1964–68 in the Spanish edition). The Oxford Collected Works vol. 8 chapter is, according to its abstract, an amalgamation of two papers on the game; de Rijke 2023 also cites a reprint in Psychoanalytic Explorations (1989). Winnicott's own texts are available only by subscription or in print (publisher pages show catalogue entries or abstracts, and his typescripts in the Wellcome Collection's Winnicott papers need the Winnicott Trust's permission), so his procedure is reconstructed from short quotations and close paraphrases in secondary sources, and his interpretive practice in particular remains [uncertain]. Sourced: the Collected Works chapter details; the author of the 1980 storytelling variant (Lawrence Claman, Am J Psychother 34(3), 414–425); the authors of the 2014 Italian review (Stefana & Manfredi) and of the 2017 art-therapy article (Martínez Loné); the 1950s origin (Wittmann 2011); and Yamanaka's Japanese story-making variant (Imada 2008). Later adaptations (storytelling, focusing, art therapy, MSSM) are named separately as variants. [source: Encyclopedia.com "Squiggle"; Thurow 1989; Rodríguez Hernández 2024; OUP Collected Works vol. 8 chapter page; Claman 1980 record; Wittmann 2011 abstract; Wellcome Collection catalogue; Imada 2008]

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 (2011) places it in a line of psychiatric uses of patients' drawings going back to about 1900, made distinctive by Winnicott's theory of transitional phenomena. His fullest account came in 1971, with about twenty case consultations, most with children aged about 5–16, one at 21 months and one with a parent. He called it "one way of getting in contact" with a child (Winnicott 1971, p. 3, as quoted by Thurow). It is not a test, and it has no scoring system. [source: Encyclopedia.com; Thurow 1989; Routledge book page; Wittmann 2011 abstract]

How change happens (Winnicott's model, attributed). The game creates what Winnicott called a third or transitional area, the "area of experiencing". This is a space between the two people where each one's contributions overlap and play becomes possible. In that shared space, the child can put down "the current problem or the emotional conflict" (Winnicott 1971, p. 7, quoted by Thurow) in pictures. Winnicott held that early contacts can contain a "moment sacré" ("sacred moment", French edition p. 7). If the clinician uses it, that moment can restart the child's stalled development. If it is missed, it is lost. He presented the method as a diagnostic interview that also tests the therapeutic response, and he said it is often therapeutic in itself. He believed a "full and free use of the first interview" could be enough for many children, as long as the family and environment could then carry the gains. [source: Encyclopedia.com; Thurow 1989; Lemaître 2002; Routledge book description]

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 psychologists. Winnicott himself said the approach depends as much on selecting a suitable therapist as on training. Use it only within the child-protection, consent and supervision framework of your own registered profession. Do not use it as a stand-alone "assessment" if you lack training in child development and child safeguarding. [source: Routledge book description for the training point; the profession list is synthesis] [synthesis] [uncertain: registration and credential details are secondary, unverified]

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 drawings had enough evidence to identify sexual or physical abuse. Treat the drawings as communication within a relationship, never as evidence. [source: Allen & Tussey 2012; Encyclopedia.com notes that critics found Winnicott's use "idiosyncratic" and hard to reproduce]

2. Framework

Winnicott gave no fixed protocol. He resisted formalising the technique so that it would stay spontaneous, and Thurow notes he gave little prescriptive guidance beyond scattered comments. The sequence below is put together from the case accounts and later descriptions. [source: Thurow 1989; Rodríguez Hernández 2024] [synthesis for the ordering]

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 so the activity would not seem too important) and pencils, with crayons or markers in later adaptations. [source: Rodríguez Hernández 2024 citing Winnicott 1964–68 p. 27; Lemaître 2002; Thurow 1989]

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. Winnicott saw the game as belonging mainly to the first few hours of contact. Thurow's illustrative case used about twenty drawings in one initial interview. Art-therapy authors also use it later in longer therapy, once a bond exists. [source: Lemaître 2002; Thurow 1989; Rodríguez Hernández 2024]

Phases (Winnicott's consultation, reconstructed)

Phase A – Pre-contact with parents or referrer. Goal: understand the referral and decide whether a consultation, rather than long treatment, is suitable. Winnicott's view was that this depends on whether the child's environment can use what the consultation produces. A later commentary on Ithier stresses that Winnicott drew these cases from children in an "average expectable environment", not severely traumatised ones. Move on when consent is in place and a time is set. [source: Routledge description; Lemaître 2002 on parents managing Cécil's regression; Int J Psychoanal commentary on Ithier, abstract] [synthesis for steps]
Phase B – Settling and invitation. Goal: reduce anxiety and offer the game in a way the child can refuse. Move on when the child accepts, or when you switch to another activity if they decline. [source: Encyclopedia.com; Thurow 1989]
Phase C – Early exchanges. Goal: alternate squiggles, let the child find the clinician playful and safe, and observe. In Thurow's version, the child decides whether to risk deeper involvement during these "transitional" exchanges; they have no set length. [source: Thurow 1989]
Phase D – Point of contact / emergence of the conflict. Goal: notice when drawings start carrying the child's current problem, and when the two of you are now playing together rather than performing. Winnicott's "sacred moment" is placed here. Work with it through comment, and through interpretation where appropriate. [source: Lemaître 2002; Thurow 1989]
Phase E – Closing the game. Goal: end on a final drawing and leave the child settled. In Thurow's sequence, the child often marks a drawing as the last. [source: Thurow 1989]
Phase F – Work with parents and follow-up. Goal: give parents an understanding they can act on. Where the child agrees, this can use the drawings to help explain the child's difficulty to parents or teachers. Offer further consultations if needed. In family sessions with Cécil, Winnicott interpreted nothing to the child and encouraged the parents to tolerate the child's regression. [source: Thurow 1989; Lemaître 2002]

Criteria for moving on, or for changing course. If the drawings settle on a theme, the child appears relieved, and the parents can use the understanding, end the consultation and offer follow-up "as needed". If the child cannot play, if severe disturbance appears, or if the environment cannot hold the gains, refer for ongoing therapy or other services. If a safeguarding concern arises at any point, the safeguarding procedure takes priority over the game (see 4.13). [synthesis]

3. Guiding principles

No rules. Present the game as having no rules or right answers. Practical meaning: never correct a drawing, never show a "proper" way, and accept refusals and odd turns. [source: Rodríguez Hernández 2024 citing Winnicott]
Reduce anxiety; freedom to decline. Practical meaning: tear the paper in half, keep the tone light, and make it easy to say no. [source: Encyclopedia.com; Rodríguez Hernández 2024]
Reciprocity. Both partners draw and both partners transform. Practical meaning: take turns evenly, and do not slide into watching the child perform. An Italian review sums this up as "me a little and you a little". [source: Encyclopedia.com; Stefana & Manfredi 2014 abstract]
Third / transitional area. Practical meaning: the drawings belong to the shared space. Do not treat them as the child's "products" for you to decode. [source: Encyclopedia.com; Rodríguez Hernández 2024]
Identification with the patient. Winnicott stressed the capacity to "identify with the patient" (1971, p. 2, quoted by Thurow). Practical meaning: let your squiggles answer the child's emotional tone and earlier drawings, not your own preoccupations. [source: Thurow 1989]
Observe all parties, yourself included. Practical meaning: note your own impulses, the child's spontaneous remarks and actions, and the sequence of drawings. Your responses are data (countertransference). [source: Encyclopedia.com; Martínez Loné 2017 abstract on countertransference]
Use the first interview fully ("sacred moment"). Practical meaning: prepare well, protect the time from interruption, and be ready to work with something important in session one. [source: Lemaître 2002; Routledge description]
Consultation is diagnostic and therapeutic at once. Practical meaning: ask how the child uses the contact, not just what the child shows. Here "diagnostic" means clinical understanding, not a formal diagnosis. A commentary in the International Journal of Psychoanalysis describes the squiggle game as a diagnostic application of psychoanalysis, close to ordinary analytic work. [source: Encyclopedia.com; Int J Psychoanal commentary on Ithier, abstract] [synthesis for the caveat]
The environment does the rest. Practical meaning: the work with parents is part of the method. Gains depend on the family's capacity to respond. [source: Lemaître 2002; Routledge description]
Spontaneity over technique. Winnicott resisted formalising it, and critics call his use idiosyncratic. Practical meaning: use the steps below as scaffolding, not as a script, and get supervision until the method feels natural. [source: Rodríguez Hernández 2024; Encyclopedia.com] [synthesis]
Drawings are communication, not evidence. Practical meaning: never write in a report that a drawing "shows" abuse, trauma or a disorder. Record what was drawn and said. [source: Allen & Tussey 2012]
Child protection first. Practical meaning: a disclosure or safeguarding concern stops the game's agenda. Then follow your jurisdiction's procedure. [synthesis; see 4.13]

4. Intervention inventory

Items 4.1–4.12 are Winnicott's consultation use as reconstructed from the sources. Items 4.13–4.15 are the child-work safeguards that apply to every use. Items 4.16–4.19 are later named variants. Unless a source says otherwise, the step-by-step detail is synthesis built around the sourced core. [source: as tagged per item]

4.1 Preparing the consultation and consent

Purpose / when: Before the first contact with the child, gather the reason for referral and get consent. Decide whether a short consultation format suits the case. [synthesis; Winnicott's emphasis on parents' capacity: Lemaître 2002]
Steps: (1) Hear the referral from the parent, carer or referrer, by phone or in a meeting. (2) Get consent from the person with parental responsibility. Explain that you will play a drawing game with the child, that the drawings may be kept in the file, and where confidentiality ends (safety). (3) Agree how and when the parents will be seen, and with whom: one parent, both parents, or with the child. (4) Check developmental, sensory and motor factors (for example, fine-motor difficulty, visual impairment, autism) so you can adapt the materials. (5) Prepare plain paper, tearing sheets in half as Winnicott did, plus two pencils. In adaptations, add crayons or markers. For children under about 3, use only non-toxic, chunky materials with no small parts. [source: Rodríguez Hernández 2024 for half-sheets and pencils; Thurow 1989 for crayons and markers; rest synthesis]
Example language (illustrative): "When I meet Sam, we'll probably do some drawing together, a sort of game. I'll keep the drawings with my notes. I won't tell you everything Sam says, but if I'm worried about anyone's safety I will tell you or the right people."
Watch for: Disputes over parental responsibility or consent. A parent wanting a "test" for abuse or for a diagnosis (decline, and explain why; see 5.6). Referrals that are really forensic. [synthesis]

4.2 Settling and separation from the parent

Purpose / when: At the start of the child's session, set up a one-to-one space. [source: Rodríguez Hernández 2024 citing Winnicott 1964–68: the parent waits in the waiting room]
Steps: (1) Greet the child and parent together. (2) Invite the child into the room, and say where the parent will be waiting. (3) Allow a short settling period. Thurow lets child and therapist settle in briefly. (4) If separation is not possible (a very young child, or high anxiety), begin with the parent present, as Winnicott did in joint sessions in the Cécil case. [source: Rodríguez Hernández 2024; Thurow 1989; Lemaître 2002]
Example language (illustrative): "Mum's going to wait just outside in the waiting room. You can go and check she's there whenever you like."
Watch for: The child's way of separating, which is clinical data in itself. Distress that does not settle: bring the parent in, and do not force it. [synthesis]

4.3 Inviting the game (with freedom to decline)

Purpose / when: Make contact in a way that lowers anxiety and leaves the child free. [source: Encyclopedia.com: Winnicott let the child decline; Thurow 1989 phase 1: accepting or refusing]
Steps: (1) Sit side by side or at a corner of the table so you can both reach the paper. (2) Explain lightly: it is a drawing game, it has no rules, and it is not about drawing well. (3) Show how it works with your first squiggle (4.4). (4) Accept a "no" and offer another activity, such as free drawing, toys or talking. You can offer the game again later. [source: Rodríguez Hernández 2024 citing Winnicott on "no rules"; Thurow 1989 on introducing it as a drawing game; steps 1 and 4 synthesis]
Example language (illustrative): "Shall we play a drawing game? There aren't any rules. I make a quick squiggle, you turn it into anything you like, and then it's your go to make one for me."
Watch for: Whether and how the child accepts. Thurow treats the first exchange as the child's decision about whether to play at all. Worries about drawing ability: reassure them that silly is fine. [source: Thurow 1989]

4.4 Making the clinician's squiggle

Purpose / when: At each of your turns, offer an open, ambiguous starting line the child can use. [source: Encyclopedia.com: a twisted or wriggly line drawn spontaneously; Rodríguez Hernández 2024: a "blind" squiggle]
Steps: (1) Draw one quick, continuous wriggly line without planning it. Sources describe it as made blind or spontaneously, for example with eyes closed or looking away. (2) Keep it simple and non-representational. Do not plant a recognisable shape. (3) Pass the sheet to the child. (4) In later turns, Thurow lets the child's previous drawings inform your line, as an empathic reply rather than a personal statement. [source: Encyclopedia.com; Rodríguez Hernández 2024; Thurow 1989] [uncertain: the exact meaning of "blind" in Winnicott's text]
Example language (illustrative): "Here's mine. I did it with my eyes shut, so it's a really silly one. What could it be?"
Watch for: Squiggles that are too suggestive (you are leading) or too complex (the child feels overwhelmed). [synthesis]

4.5 Child completes the clinician's squiggle

Purpose / when: The child's main expressive turn. [source: Encyclopedia.com step 2; Rodríguez Hernández 2024]
Steps: (1) Let the child turn the line into something, or simply say what it looks like. Both count. (2) Do not help, correct or praise skill. (3) When it is finished, ask what it is, or let the child tell you. (4) Write the sequence number (and, if you wish, the child's title) on the sheet afterwards, or with the child's permission. [source: Rodríguez Hernández 2024 for "says what it resembles or turns it into something"; numbering is synthesis, though Thurow's analysis depends on keeping the sequence]
Example language (illustrative): "Oh, what's happening there?" / "Tell me about this one."
Watch for: Turning the squiggle into something versus refusing it. Repeated themes. Sudden changes in style, such as stiff figures becoming more expressive. Pressure on the pencil, scribbling out, and speed. [source: Thurow 1989 on shifts in content and style]

4.6 Child's squiggle for the clinician, and the clinician's transformation

Purpose / when: Reverse the roles, so the child has the active position and you respond to what the child offers. [source: Encyclopedia.com steps 4–5; Rodríguez Hernández 2024; Duval's list of functions, cited there, includes alternating active and passive positions]
Steps: (1) Hand the child a fresh half-sheet for their squiggle. (2) Take it and turn it into something. Let the emotional tone of what the child has drawn so far guide your choice: empathic, not clever. (3) Say briefly what you made, and invite the child's comment. (4) Fantasy elaboration is allowed. Some authors describe the therapist sometimes drawing an emotion the patient avoids. That is an active move: use it sparingly, and only once there is trust. [source: Thurow 1989 on empathic response; Rodríguez Hernández 2024 citing Fernández-Manchón 2012 on drawing avoided emotion; caution is synthesis]
Example language (illustrative): "I've made yours into a little creature hiding behind a rock. I wonder what it's hiding from?"
Watch for: How the child reacts to your version (pleased, corrective, anxious). A child who "corrects" you is engaged, not resistant. [synthesis]

4.7 Commenting together

Purpose / when: After each drawing, find the meaning together through talk. [source: Encyclopedia.com: analyst and child comment on meaning after each turn]
Steps: (1) Ask open questions about the picture (who, what is happening, what happens next). (2) Use the child's own words for things. (3) Keep comments within the picture's world ("the creature") rather than jumping to the child ("you"), unless the child makes the link. (4) Write down the key words the child uses straight after the session. [source: Thurow 1989 on inviting the child's words; steps 3 and 4 synthesis]
Example language (illustrative): "What is this one feeling?" / "Does he have anyone with him?"
Watch for: Surprise and relief when a vague feeling suddenly takes shape (Thurow's "unfolding"). Withdrawal when you go too fast. [source: Thurow 1989]

4.8 Following the series to the central theme ("sacred moment")

Purpose / when: Throughout the game, track the sequence so you notice when the drawings start to carry "the current problem or the emotional conflict" (Winnicott 1971, p. 7, per Thurow). [source: Thurow 1989; Lemaître 2002]
Steps: (1) Keep the sheets in order on the table where you can both see them. (2) Notice images that recur or develop (Thurow's "later drawings carry earlier images forward"). (3) When an image seems charged, slow down: stay with it, invite more, and let the child lead. (4) If it fits, you may bring two drawings together ("this one and this one"). [source: Thurow 1989 for steps 2–3; steps 1 and 4 synthesis]
Example language (illustrative): "The cat came back. Last time it was all alone; now it's found a house."
Watch for: Your own sense that "something important has happened". The child's absorption. A shift from performing to playing (Thurow's "empathic point of contact"). [source: Thurow 1989; Encyclopedia.com on observing your own responses]

4.9 Interpretation (sparing, timed)

Purpose / when: Put the emerging conflict into words, only once the child's material has reached it. [uncertain: Winnicott's own interpretive practice in the 1971 cases is known here only through secondary sources; Lemaître reports he interpreted nothing in the family sessions with Cécil and interpreted later, one to one, when Cécil was 8]
Steps (synthesis): (1) Offer at most one link, framed tentatively. (2) Link the picture to the child's situation in ordinary words, never in technical terms. (3) Let the child accept it, reject it or ignore it, and go back to drawing. (4) In joint sessions with parents, and with very young children, prefer not to interpret, as in the Cécil case. [source: Lemaître 2002 for step 4] [synthesis]
Example language (illustrative): "I wonder if the little one in the corner feels a bit like you did when the baby came."
Watch for: Relief versus shutting down. If the child stops drawing, go back to playing without pressing. [synthesis]

4.10 Closing the game

Purpose / when: Toward the end of the consultation, close the play and return to ordinary reality. [source: Thurow 1989 phase 6: a final drawing, often labelled as such, ends the game]
Steps: (1) Give a time warning ("two more goes"). (2) Invite a last drawing. (3) Look back over the series with the child, briefly. (4) Agree who keeps the drawings: they belong to the clinical record, but the child may keep one. Where the record must keep the originals, offer to photograph or copy for the child. (5) Say what happens next. In the Cécil case, Winnicott gave the child a toy at the end of the first session. [source: Thurow 1989; Lemaître 2002 for the toy; steps 1, 3 and 4 synthesis]
Example language (illustrative): "We've got time for one more each. Which shall be the last one?"
Watch for: A child who is left stirred up. Allow settling time and a return to neutral talk before they rejoin the parent. [synthesis]

4.11 Working with parents after the consultation

Purpose / when: Turn the consultation's understanding into changes at home. In Winnicott's model, the environment completes the work. [source: Lemaître 2002; Thurow 1989]
Steps: (1) Meet the parents, separately or jointly. (2) Share your understanding in plain words. (3) With the child's agreement where age-appropriate, show selected drawings. Winnicott suggested drawings can help explain a child's troubles to parents and teachers. Thurow found parents responded with little defensiveness and added history. (4) Agree concrete things parents can do. In the Cécil case, Winnicott judged the parents could do the treatment by tolerating the child's regression, and encouraged them to put up with the inconvenience. (5) Record what was shared. [source: Thurow 1989; Lemaître 2002; steps 1, 2 and 5 synthesis]
Example language (illustrative): "Across the drawings, Mia kept returning to a small animal left behind. I think she's telling us how left out she's felt since the move. What might help is …"
Watch for: Parents treating drawings as proof or as a diagnosis (correct this; see 5.6). Content that would breach the child's trust if shared: share the theme, not the picture. [synthesis]

4.12 Follow-up consultations "on demand"

Purpose / when: Offer further single consultations when development stalls again, instead of committing straight away to long therapy. [source: Lemaître 2002 on the Cécil series spread over years; Thurow 1989 on use mainly in the first few hours]
Steps: (1) Agree with the parents how to get back in touch. (2) At follow-up, check how the environment has responded. (3) Repeat the game, or use other play. (4) Refer for ongoing therapy if one or two consultations are not enough. [synthesis]
Example language (illustrative): "Let's see how things go. If the worries come back, ring me and I'll see Tom again."
Watch for: Repeated returns with no change: think about longer treatment or other services. [synthesis]

4.13 Safeguarding and disclosure during the game

Purpose / when: Any time a child says something, draws something or shows behaviour that raises concern for their safety. Clinicians do describe disclosures emerging in squiggle work, for example Rodríguez Hernández's vignette of a 6-year-old who had disclosed sexual abuse. [source: Rodríguez Hernández 2024] [steps: synthesis]
Steps: (1) Stay calm and listen. Let the child say what they want to say. (2) Do not ask leading questions. Do not use the drawings to probe for details. Do not ask the child to draw "what happened". Investigation belongs to trained forensic interviewers. (3) Tell the child, in age-appropriate words, that you will need to tell people whose job is to keep children safe. (4) Afterwards, write down the child's words verbatim, the date and time, and what was happening in the game. Keep the drawings as part of the record, and describe them factually without interpreting them. (5) Follow your organisation's safeguarding procedure and consult its designated safeguarding lead. Report to the child-protection agency or police where your jurisdiction requires it. (6) Do not tell a parent first if that could put the child at risk. [synthesis]
Mandatory reporting: Duties vary by jurisdiction: who must report, the threshold (for example, reasonable suspicion or reason to believe), timelines, whether privileged communications are exempt, and the agency to contact. In the US, each state and territory has its own statute. Elsewhere, duties may sit in law, in professional codes or in statutory guidance. Check your local law and your professional body's code before you start child work. [source: Child Welfare Information Gateway 2023] [synthesis for non-US]
Drawings are not evidence of abuse. A drawing alone is not a valid indicator of abuse, and the squiggle game is not a diagnostic test. However, what the child says or does, or other information, may still meet your jurisdiction's reporting threshold. [source: Allen & Tussey 2012]
Example language (illustrative): "Thank you for telling me. You haven't done anything wrong. Part of my job is to keep children safe, so I'm going to need to talk to someone who can help."
Watch for: Your own urge to interpret a drawing as "proof", or to keep questioning. Both can contaminate later investigation. [synthesis]

4.14 Consent and assent throughout

Purpose / when: At the start, before sharing drawings, and before any use of the material outside the clinical file. [synthesis]
Steps: (1) Get consent from the person with parental responsibility, plus the child's own assent in words that suit their age. Older adolescents may be able to consent for themselves, depending on local law. (2) Let the child decline the game, which Winnicott also allowed. (3) Before showing drawings to parents or teachers, ask the child, especially from school age upwards. (4) Get separate written consent before any teaching or publication use of drawings or case material, and anonymise. Do not copy Winnicott's era of publishing case drawings without this. (5) Explain confidentiality and its limits in child-friendly words. [source: Encyclopedia.com for freedom to decline; rest synthesis]
Example language (illustrative): "Would it be okay if I showed your mum the cat drawing? You can say no, and I'll just tell her what we talked about."
Watch for: Compliance that hides a wish to refuse. Watch the child's body language as well as the answer. [synthesis]

4.15 Age, development and access adaptations

Purpose / when: Fit the game to the child. [synthesis, except where tagged]
Steps: Winnicott used the squiggle with children old enough to talk. With babies and toddlers he used other observational settings, such as the "set situation" with a spatula. For pre-schoolers: use larger paper and chunky crayons, keep sessions shorter, and expect naming rather than elaborate drawings. For school-age children: the core game as described. For adolescents: present it as a creative or improvisational exchange, and expect jokes and irony. Some art therapists also use it with adults. For motor difficulties: use thick markers or a tablet, or let the child tell you what to add. [source: Lemaître 2002 on verbal age and the set situation; Encyclopedia.com on the spatula game; Stefana & Manfredi 2014 abstract on adolescents and adults; rest synthesis]
Example language (illustrative, adolescent): "It's a bit of an improv game. Either of us can make something ridiculous out of the other's line."
Watch for: Embarrassment at drawing, in teenagers especially. Fatigue in younger children. [synthesis]

4.16 Variant: squiggle-drawing game with storytelling (Claman 1980)

Purpose / when: With latency-age children who resist direct questions about problems and feelings. It gathers thematic material and allows communication through metaphor. [source: Claman, L. 1980, "The Squiggle-Drawing Game in Child Psychotherapy", Am J Psychother 34(3), 414–425 (abstract)]
Steps: Claman (1980) adapts Winnicott's technique by adding a storytelling element, drawing on Gardner's and Kritzberg's storytelling approaches. In practice: (1) complete a set of squiggles; (2) invite a story about one or more drawings; (3) the clinician may answer with a story of their own that offers a healthier resolution. [uncertain: Claman's full article is not drawn on here. Steps 2 and 3 are synthesis from the abstract, which names only Gardner's and Kritzberg's storytelling approaches as the model.]
Example language (illustrative): "Can you tell me a story about this creature: beginning, middle and end?"
Watch for: Stories that repeat the same unresolved ending, which is a theme to hold rather than fix at once. [synthesis]

4.17 Variant: interactional squiggles with focusing (Thurow)

Purpose / when: To follow the felt-sense change process across a series of squiggles. Thurow maps the drawings onto Gendlin's focusing phases: direct referent, unfolding, global application and referent movement. [source: Thurow 1989]
Steps: (1) Use half sheets and other paper sizes with pencils, markers and crayons. (2) Introduce the game and exchange squiggles back and forth for as long as both want. (3) After the session, read the series for phases, images, colours and themes, and link them to the child's history. (4) Share selected drawings with the parents. [source: Thurow 1989]
Example language (illustrative): "Let's keep going as long as we both feel like it."
Watch for: Moments of surprise or relief ("unfolding"), and images that come back softened or stronger in later drawings. [source: Thurow 1989]

4.18 Variant: art-psychotherapy adaptation (colour, other media, later in therapy)

Purpose / when: To use the squiggle game inside ongoing art psychotherapy, not only in a first interview. Adaptations include colour and other materials, and use once a bond is established. Single-session art-therapy use is also described, building on Winnicott's "Iiro" case. [source: Rodríguez Hernández 2024; Martínez Loné 2017 abstract]
Steps: (1) Offer the core exchange. (2) Allow the media to widen: paint, colour, collage. One vignette involved paint applied to the therapist's hands. (3) Combine drawing, play and words. (4) Keep firm, non-punitive limits on behaviour. [source: Rodríguez Hernández 2024]
Example language (illustrative): "Do you want to add colour this time?"
Watch for: Paint and messy media raise the regressive pull and need firmer structure. Use non-toxic, washable materials, and have clean-up and allergy checks ready. Physical contact (paint on hands): agree limits clearly beforehand, and stop if contact feels unsafe or erotised (see 5.9). [source: Rodríguez Hernández 2024 for the vignette; safety steps synthesis]

4.19 Other named variants

Story-based squiggle methods developed in Japan are widely used there; the best documented, Yamanaka's Mutual Scribble Story Making (MSSM), is set out in 4.20. [source: Imada 2008]
An Italian review describes many variations, all built on reciprocity ("a little me and a little you"), used with children, adolescents and adults, and presents the game mainly as a way to build a relationship in which the patient feels held. The review is Stefana & Manfredi 2014. It traces the game's antecedents (Freud, Jung, Klein, Fordham, Milner's free drawings) and compares Winnicott's use with current practice. [source: Stefana & Manfredi 2014, abstract on the IRIS Verona record] [uncertain: the variants themselves are not named in the abstract]

4.20 Variant: Mutual Scribble Story Making (MSSM, Yamanaka)

Purpose / when: A Japanese single-sheet adaptation devised by Yasuhiro Yamanaka in 1984, combining Naumburg's scribble technique, Winnicott's squiggle game and Nakai's frame technique, and adding a story built from all the pictures. Its stated aim is to give the client a sense of breathing room (yutori), not to produce material for interpretation. It is usually introduced after assessment and once the relationship is stable, not in the first contact, and is generally avoided during acute psychotic episodes. [source: Imada 2008, Bulletin of Naruto University of Education 23]
Steps: (1) The therapist draws a frame on one sheet of paper. (2) The client divides the framed area into six to eight panels. (3) Decide who goes first (in the published account, by rock-paper-scissors). (4) Take turns: one person draws a scribble in a panel and the other finds and draws an image in it, panel by panel. (5) In the last panel the client writes a story that uses all the images. (6) The therapist looks closely at the finished sheet and may ask about associations, without interpreting. [source: Imada 2008; step (6) wording synthesis]
Example language (illustrative): "Let's split this into boxes. We'll take turns scribbling and finding pictures, and in the last box you can make up a story that uses all of them, any kind of story."
Watch for: the therapist's own drawings intruding on the client's material, especially with children (keep yours simple and follow the client's lead); your own reactions showing up in what you choose to draw (countertransference); clients who are acutely psychotic or very disorganised. Working: the client becomes more relaxed and playful and the story links the images in a way that matters to them. [source: Imada 2008; working signs synthesis]

5. Handling problems

The sources say little about difficulties. Unless tagged otherwise, the guidance below is synthesis from general child-psychotherapy practice. [synthesis]

5.1 Child refuses to play. Winnicott let children decline, and Thurow treats the first exchange as the child's choice. Accept the refusal, and offer free drawing, toys or talk instead. You can draw a squiggle for yourself and wonder aloud what it could be, with no request attached. Offer the game once more later, and not again after that. [source: Encyclopedia.com; Thurow 1989 for accepting refusal; the rest is synthesis]
5.2 "I can't draw" / perfectionism. Make your own squiggles deliberately clumsy, tear the paper smaller, and say again that silly is good. Let the child name the squiggle instead of drawing it. [synthesis; half-sheets: Rodríguez Hernández 2024]
5.3 Stereotyped or repetitive drawings (the same car every time), copying. Do not push for variety. Repetition may carry the theme. Change your own squiggle shapes gently, comment on the repetition with curiosity, and watch for small variations. [synthesis]
5.4 Competitive or controlling play (wants to "win", rejects your turns). Treat it as a communication. Narrate the rules the child is inventing, keep the turns even where you can, and comment through the pictures on characters who need to be in charge. [synthesis]
5.5 Overwhelm: frightening, violent or sexualised content, or distress. Slow down and stay in the metaphor. Help the child find safety inside the picture ("Does he need somewhere safe?"). Offer to put the drawing face down or in a folder, and move to a neutral drawing or activity. Allow time to settle before the child goes back to the parent. If sexualised content or knowledge seems unusual for the child's age, follow 4.13. Neither the content nor the drawing alone is proof. [source for "not proof": Allen & Tussey 2012; rest synthesis]
5.6 Parent or referrer wants a diagnosis or an abuse "test" from the drawings. Explain plainly that squiggle drawings have no scoring and no validity as diagnostic or forensic evidence, and that projective drawings have not been shown to identify abuse. Offer to describe the themes the child explored. Signpost to proper assessment or forensic services where needed. Do not write interpretive statements about drawings in court or school reports. [source: Allen & Tussey 2012; rest synthesis]
5.7 Clinician over-interprets or leads. Warning signs: your squiggles turn into recognisable shapes, you name what the child's drawing "really" is, or the child goes quiet after your comments. Go back to open lines and the child's words, and take the series to supervision. Critics note that Winnicott's own skill was idiosyncratic. Build competence under supervision rather than imitating his published interpretations. [source: Encyclopedia.com for the critique; rest synthesis]
5.8 Rupture (the child is hurt by a comment or by your drawing). Name it simply and repair: "I think I got that wrong. You tell me what it is." Let the child change your drawing, and continue at their pace. [synthesis]
5.9 Boundary-testing or erotised behaviour (for example, touching, or reaching for the clinician's body with paint). In one published vignette, the therapist kept limits firm without punishment or blame. Rodríguez Hernández describes this as a major challenge when it happens alongside building a bond. Practical steps: state the limit calmly, redirect to the paper, and do not shame the child. Record it, and consider whether it is a safeguarding indicator (4.13). Never allow sexual or genital touch. Any physical contact in messy-media work needs agreed limits and must stop when the child or the clinician is uncomfortable. Physical holding or restraint only as a last resort to prevent immediate harm, under your service's policy and training; record it and inform parents or carers. [source: Rodríguez Hernández 2024 for the first part; practical steps synthesis]
5.10 Disclosure mid-game. Pause the game and follow 4.13. Do not use further squiggles to gather detail. [synthesis]
5.11 Parent cannot separate, or intrudes. Run the game with the parent present, as Winnicott did in some consultations with very young children. Seat the parent slightly apart, and ask them to watch without commenting. Then offer separate time with the parent. [source: Lemaître 2002 on joint consultations; rest synthesis]
5.12 Parents cannot use the understanding ("non-adherence" in the family environment). In Winnicott's model, the consultation relies on the environment to carry on the work. If parents cannot do this because of their own difficulties, conflict or chaos, single consultations are not enough. Offer parent work, family work, ongoing child therapy or a referral to social care. [source: Lemaître 2002; Routledge description for the model; the referral steps are synthesis]
5.13 Adolescent finds it babyish. Frame it as improvisation, doodling or a design challenge. Allow ironic drawings, and offer pens and other materials the young person chooses. [synthesis]
5.14 Motor, sensory or communication differences (dyspraxia, visual impairment, autism, selective mutism). Use thicker tools or a tablet. Try textured lines or tactile materials, and let the child dictate additions. For children who do not speak, accept naming by pointing or writing. For autistic children, warn them ahead of each change of turn and keep the structure predictable. [synthesis]
5.15 Remote or video sessions. Use a shared digital whiteboard, or have both of you draw on paper and hold it up to the camera. Ask a parent to set up the materials while respecting the child's privacy. Check that the child has a private space, and agree a safety plan in case the call drops during distress. [synthesis]
5.16 Keeping and sharing drawings. Drawings are part of the clinical record. Store them securely, and follow your records-retention rules. Share them only with the child's agreement (see 4.14), and anonymise them for supervision or teaching. [synthesis]

Sources

Sources:

Books and papers cited (bibliographic details as given in the sources above):

Winnicott, D. W. (1971). Therapeutic Consultations in Child Psychiatry. London: Hogarth Press and the Institute of Psycho-Analysis. (Reissued by Routledge, ISBN 9781855751460.)
Winnicott, D. W. (1968). The squiggle game. Voices: The Art and Science of Psychotherapy, 4(1). [cited from Encyclopedia.com]
Winnicott, D. W. (1958). Symptom tolerance in paediatrics. In Collected Papers: Through Paediatrics to Psycho-Analysis (pp. 101–117). London: Tavistock. (Originally 1953.) [cited from Encyclopedia.com]
Winnicott, D. W. (1941). The observation of infants in a set situation. International Journal of Psycho-Analysis, 22, 229–249. [cited from Encyclopedia.com]
Winnicott, D. W. (2016). The Collected Works of D. W. Winnicott, Vol. 8, 1967–1968. Oxford University Press. [chapter "The Squiggle Game"]
Winnicott, D. W. (1989). The squiggle game. In Psychoanalytic Explorations. [cited from de Rijke 2023]
The Winnicott Squiggle Game: a vehicle for communicating with the school-aged child (PubMed 7005855). [uncertain: authors, journal and year]

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