Applications of Play Therapy

Alyssa Swan, PhD, LCPC, RPTCertified CCPT-S, Certified CPRT-S

January 23, 2020alymswan2@gmail.com

Agenda

*Please feel welcome ask questions and/or post comments in chat box.

Intentions for Today’s WebinarPart 2 follow up to CTAC webinar hosted by Ann Beckley Forest on the foundations to play therapy.

Focus on applications of play therapy and identifying additional resources for individuals seeking training and/or credentialing in play therapy.

Spark your curiosity and encourage your heart and mind to enhance your play therapy practice.

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Evidence Based Play Therapy Approaches

Play Therapy approaches that have been designated as “evidence-based:”‣ Child-Centered Play Therapy (CCPT)‣ Adlerian Play Therapy (AdPT)‣ Child-Parent Relationship Therapy (CPRT)‣ Theraplay ‣ Filial Family Therapy

SAMHSA National Registry of Evidence-based Programs and Practices, now called EBP Resource Center

California Evidence-based Clearinghouse (CEBC) for Child Welfare

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Evidence Based Play Therapy Approaches‣ Association for Play Therapy (APT)

• https://www.a4pt.org/page/EvidenceBased‣ International Journal of Play Therapy (IJPT)

• https://www.apa.org/pubs/journals/pla/‣ University of North Texas Center for Play Therapy

• https://cpt.unt.edu/research-and-publications‣ PlayLit: World’s Largest Play Therapy Library

• https://cpt.unt.edu/playlit‣ Summary of Play Therapy Meta Analyses

• https://cpt.unt.edu/researchpublications/meta-analyses‣ Online Play Therapy Research Database

• http://evidencebasedchildtherapy.com/5

Screenshot of Evidence-Based Child Therapy website portal: http://evidencebasedchildtherapy.com/

Poll QuestionIn what setting do you work?

A. SchoolB. Private PracticeC. ClinicD. ResidentialE. HospitalF. Other

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Evidence Based Play Therapy Approaches‣ Child-Centered Play Therapy (CCPT)

Resources: Landreth (1991, 2002, 2012), Axline (1950, 1964)

“Child-centered play therapy is a complete therapeutic system, not just the application of a few rapport-building techniques, and is based on a deep and abiding belief in the capacity and resilience of children to be constructively self-directed” (Landreth, 2012, p.53)

Articles to read: Lin & Bratton (2015), Ray, Armstrong, Balkin, & Jayne (2015), Bratton et al. (2013), Stulmaker & Ray (2015)

Videos: https://cpt.unt.edu/shopping/streaming-video

Training/Supervision: Become a Certified Child-Centered Play Therapist (Certified CCPT) through the Center for Play Therapy, located at the University of North Texas. Website: https://cpt.unt.edu/child-centered-play-therapy-certificationContact person for certification training is Hannah.Robinson@unt.edu

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Child-Centered Play Therapy (CCPT)CCPT Theory Resources: Ray (2011), Schottelkorb, Swan, Garcia, Gale, & Bradley (2014), Jayne & Ray (2015), Ray, Jayne, & Stulmaker (2014), Jayne, Purswell, & Stulmaker (2019)Therapist experiences CCPT attitudinal conditions: unconditional positive regard, empathy, genuineness.

Structuring Session: “In here, you can play with the toys in lots of the ways you want.” (highlight, not “any” of the ways that you want)

CCPT Playroom Tour: https://youtu.be/LZSVQI-Be5c

The overarching goal of CCPT is to unleash the child’s potential to move toward integration and self-enhancing ways of being.

Observable outcomes (improvement in academics, aggression, anxiety, disruptive behaviors, overall functioning)

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Child-Centered Play Therapy (CCPT)

CCPT is a way of being with children.

CCPT skills: “Be with” attitudes, reflecting content and feelings, relational responding, encouragement vs. praise, limit setting, choice giving

I don’t have expectations of what we will play on a given day, I wait to find out where the child takes us.

Child can experience themselves as someone worthy of the play therapist’s consistent and unwavering relationship. Child can develop less rigid views of self and others.

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Evidence Based Play Therapy Approaches‣ Adlerian Play Therapy (AdPT)

Resources: Kottman & Meany Walen (2016), Kottman (1995, 2003)

“...the Adlerian play therapist can develop a picture of children’s lifestyles and how their lifestyles are reflected in the patterns of their behaviors, thoughts, attitudes, and relationships” (Kottman & Meany-Walen, 2016, p. 35).

Articles to Read: Meany-Walen, Bratton, & Kottman (2014), Meany-Walen, Kottman, Bullis, & Dillman Taylor (2015), Dillman Taylor & Bratton (2014)

Videos: https://www.psychotherapy.net/video/adlerian-play-therapy

Training/Supervision: Become a Certified Adlerian Play Therapist through the League of Extraordinary Adlerian Play Therapists (LEAP). Website: https://adlerianplaytherapy.com/

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Adlerian Play Therapy (AdPT)Four Phases of Adlerian Play Therapy1. Building a relationship2. Exploring the client’s lifestyle3. Helping the client gain insight into their

lifestyle4. Reorienting and Re-educating the client

Lifestyle AssessmentCrucial C’s Goals of MisbehaviorParent/Teacher ConsultationResource: Kottman & Meany Walen (2016)

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Evidence Based Play Therapy Approaches‣ Child-Parent Relationship Therapy (CPRT)

Resources: Landreth & Bratton (2006, 2019), Bratton & Landreth (2019), Landreth (1991), CPRT is a model of Filial Therapy (Guerney, 1964)

“...a unique approach used by professionals trained in play therapy to train parents to be therapeutic agents with their own children through a form of didactic instruction, demonstration of play sessions, required at-home laboratory play sessions, and supervision in a supportive atmosphere” (Landreth & Bratton, 2019, p. 10).

Articles to Read: Carnes Holt & Bratton (2014), Opiola & Bratton (2018), Ceballos & Bratton (2010), Bratton & Landreth (1995)

Videos: https://cpt.unt.edu/shopping/child-parent-relationship-therapy-cprt-action-dvd

Training/Supervision: Become a Certified Child-Parent Relationship Therapist (Certified CPRT) through the Center for Play Therapy, located at the University of North Texas. Website: https://cpt.unt.edu/child-parent-relationship-therapy-certification

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Filial Kits

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Swan, 2017

Landreth & Bratton, 2019

Child-Parent Relationship Therapy (CPRT)

Three Components of CPRT:

DIDACTIC: Learn CCPT attitudes, principles and skills of relational responding, self-esteem building, and limit setting/choice giving.

GROUP PROCESS/SUPERVISION: Process experiences that week in group setting. Supervision of 1:1 play times.

SPECIAL PLAY TIMES: Parents facilitate at-home child-directed play times 1:1 and practice reflective responding skills learned in group training.

Goal of CPRT: Strengthen the Parent-Child Relationship

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1

2

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Resource: Landreth & Bratton (2006, 2019)

Evidence Based Play Therapy Approaches‣ Theraplay®

Resources: Booth & Jernberg (1999, 2010), Jernberg (1979),

“Theraplay is an attachment-based model of play therapy that is characterized by playful, joyous interactions between parents and their child” (Munns, 2015, p. 53).

Articles to Read: Howard et al. (2018), Siu (2009), Wettig, Coleman, & Geider (2011), Simeone-Russell (2011), Munns (2000)

Videos: https://www.theraplay.org/js-books-videos-media/theraplay-activities-demonstrated

Training/Supervision: Become a Theraplay Practitioner through The Theraplay Institute, located in Evanston, IL. Website: https://theraplay.org/training

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In addition to identifying “what works” and becoming a responsible consumer of play therapy research,

❏ Theoretical Orientation & Conceptualization,

❏ Quality Training & Ongoing Supervision,

❏ Clinical Experience & Client Concerns, and

❏ Cultural Competence (including Development)

guide play therapy intervention.

For example, have you ever wondered “how child-directed vs. therapist-directed should I be with this child in this session?”

As a play therapist, Personal reflections:

➔ What do I believe about the nature of humans?

➔ How does change happen?➔ What are the goals of therapy?➔ Am I able to unconditionally accept the

child? What moments make this easy/difficult?

➔ What inspires/challenges me most as a play therapist?

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Theoretical Orientation and Conceptualization: Be cautious to not rely on techniques, without sound theoretical alliance and clear clinical relevance.Training/Supervision: Utilize supervision, ongoing training, and peer support to enhance case conceptualization and play therapist awareness.Cultural Considerations, Awareness, and Competence: Avoid pathologizing reactions to valid discrimination and/or bias. Consider toys/materials, language, access to services, diversity of cultural experiences and identities, etc. Play Therapy resources: Garza & Bratton (2005),Barcenas (2017)

Developmental considerations for play therapy.Play Therapy resource: Dee Ray’s 2016 book, A Therapist’s Guide to Child

Development: The Extraordinarily Normal Years

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Resource: Ray (2011), Chapter 7, p. 105-116

Supervision and consultation are important when beginning to identify themes, particularly for therapist self-awareness

Play Behavior: acted out by children in the playroom to which a variation of meanings can be attributed.

Play Theme: a coherent metaphor from which the child communicates the meaning they attribute to experience.➢ informs therapist about child’s internal meaning

making system

Distinguishing Between Play Behaviors and Play Themes

Ray (2011), Chapter 7, p. 107

Identifying Play Themes: 3 Characteristics

Repetition

Intensity

Context

★ Regularly Scheduled Parent Consultation○ Resources: Stulmaker & Jayne (2018),

Schottelkorb, Swan, & Ogawa (2015), VanFleet (2000)

○ Empathize, Listen, Provide Resources & Skills, Role Model, Be in Relationship with parents.

★ Including parents as direct “agents of change” in the therapeutic process using interventions such as Child-Parent Relationship Therapy (CPRT)

★ Family Play Therapy ○ Resources: Gil (2015), Sweeney & Rocha (2000)

Including Parents and Families

Attitudes for Building Relationship with Parents

Respect for parent’s role-

Parent as expert on

their family

Respect for parent’s

knowledge of child

Therapist as expert on treatment

Affection for parent as

person

Patience Clear Focus on child as

client

Ray (2011), p. 142-143

SummaryToday we discussed:

➔ Resources and Description of CCPT, AdPT, CPRT, & Theraplay

➔ How theory informs intervention

➔ Distinguishing between play behaviors and play themes

➔ Involving parents and families in play therapy

Q & APlease chat in your questions to “the host” at this time!

Thank you!

Please feel welcome to contact Dr. Alyssa Swan at alymswan2@gmail.com.

If you have questions about CTAC, please contact ctac.info@nyu.edu

ReferencesBratton, S., & Landreth, G. (1995). Filial therapy with single parents: Effects on parental acceptance, empathy, and stress. International Journal of Play Therapy, 4(1), 61–80. Bratton, S., Ceballos, P., Sheely-Moore, A., Meany-Walen, K., Pronchenko, Y., & Jones, L. (2013). Head start early mental health intervention: Effects of child-centered play therapy on disruptive behaviors. International Journal of Play Therapy, 22(1), 28–42. Bratton, S., Landreth, G., Kellam, T., & Blackard, S. (2006). Child-parent relationship therapy (CPRT) treatment manual: A 10-session filial therapy model for training parents. New York, NY: Taylor & Francis Group. Carnes-Holt, K., & Bratton, S. (2014). The efficacy of child parent relationship therapy for adopted children with attachment disruptions. Journal of Counseling and Development, 92(3), 328–337. Ceballos, P., & Bratton, S. (2010). Empowering Latino families: Effects of a culturally-responsive inter- vention for low-income immigrant Latino parents on childrens behaviors and parental stress. Psychology in the Schools, 47(8), 761–775. Garza, Y., & Bratton, S. (2005). School-based child-centered play therapy with Hispanic children: Out- comes and cultural considerations. International Journal of Play Therapy, 14(1), 51–79. Gil, E. (2015). Play in family therapy (2nd ed.). The Guildford Press: New York, NY. Hiles Howard, A. R., Lindaman, S., Copeland, R., & Cross, D. R. (2018). Theraplay impact on parents and children with autism spectrum disorder: Improvements in affect, joint attention, and social cooperation. International Journal of Play Therapy, 27(1), 56–68. Jayne, K. M., Purswell, K. E., & Stulmaker, H. L. (2019). Facilitating congruence, empathy, and unconditional positive regard through therapeutic limit-setting: Attitudinal conditions limit-setting model (ACLM). International Journal of Play Therapy, 28(4), 238–249. Jayne, K., Ray, D., & Stulmaker, H. (2014). A Way of Being in the Playroom: Experience- Expression Congruence Model (EECM). International Journal of Play Therapy, 23(1), 18-30. Landreth, G. (2012). Play therapy: The art of the relationship (3rd ed.). New York, NY: Routledge.

ReferencesLin, Y., & Bratton, S. (2015). A meta-analysis of child-centered play therapy outcome research. Journal of Counseling and Development, 93, 45–58. Meany-Walen, K., Bratton, S., & Kottman, T. (2014). Effects of Adlerian play therapy on reducing stu- dents disruptive behaviors. Journal of Counseling and Development, 92(1), 47–56. Meany-Walen, K., Kottman, T., Bullis, Q., & Dillman Taylor, D. (2015). Effects of Adlerian Play Therapy on Children's Externalizing Behavior. Journal of Counseling and Development, 93(4), 418-428.Munns, E. (2000). Theraplay: Innovations in attachment enhancing play therapy. Jason Aronson Inc.Opiola, K., & Bratton, S. (2018). The Efficacy of Child Parent Relationship Therapy for Adoptive Families: A Replication Study. Journal of Counseling and Development, 96(2), 155-166. Ray, D. (2011). Advanced play therapy: Essential conditions, knowledge and skills for child practice. New York, NY: Routledge. Ray, D. (2016). A therapist’s guide to child development: The extraordinarily normal years. Routledge: New York, NY. Ray, D., Armstrong, S., Balkin, R., & Jayne, K. (2015). Child centered play therapy in the schools: Re- view and meta-analysis. Psychology in the Schools, 52(2), 107–123. Schottelkorb, A. A., Swan, K. L., & Ogawa, Y. (2015). Parent consultation in child-centered play therapy: A model for research and practice. International Journal of Play Therapy, 24(4), 221–233.Schottelkorb, A. A., Swan, K. L., Garcia, R., Gale, B., & Bradley, B. M. (2014). Therapist perceptions of relationship conditions in child-centered play therapy. International Journal of Play Therapy, 23(1), 1–17.Simeone-Russell, R. (2011). A practical approach to implementing Theraplay for children with autism spectrum disorder. International Journal of Play Therapy, 20(4), 224-235.Siu, A. F. Y. (2009). Theraplay in the Chinese world: An intervention program for Hong Kong children with internalizing problems. International Journal of Play Therapy, 18(1), 1–12. Stulmaker, H. L., & Jayne, K. M. (2018). Child-centered play therapy parent consultation model: Clinical implementation and implications. Journal of Child and Adolescent Counseling, 4(1), 3–19.

ReferencesStulmaker, H., & Ray, D. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127–133. Sweeney, D. S., & Rocha, S. L. (2000). Using play therapy to assess family dynamics. In R. E. Watts (Ed.), The family psychology and counseling series. Techniques in marriage and family counseling, Vol. 1 (p. 33–47). American Counseling Association.Taylor, D., & Bratton, S. (2014). Developmentally appropriate practice: Adlerian Play Therapy with preschool children. The Journal of Individual Psychology 70(3), 205-219. VanFleet, R. (2000). Understanding and overcoming parent resistance to play therapy. International Journal of Play Therapy, 9(1), 35–46. Wettig, H. H. G., Coleman, A. R., & Geider, F. J. (2011). Evaluating the effectiveness of Theraplay in treating shy, socially withdrawn children. International Journal of Play Therapy, 20(1), 26–37.

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