Origins and Theory
Child centred play therapy (CCPT) is an intervention based therapy that focuses on behaviours and emotions displayed through play. CCPT trained therapists create a safe and inviting environment that they can connect and build a relationship with the child , in order to teach the child acceptable behaviours with social context (Ray, D. C., Purswell, K., Haas, S., & Aldrete, C. 2017) Virginia Axline, an associate of Carl Rogers, created play therapy in order to help children with a wide range of problems but, also sets clear boundaries in order to educate the child.
The theory behind CCPT is that with guidance, children can self -direct in a positive manner with a few rapport- building techniques. Being self- directive can influence the child’s behaviour in social situations when the aggressive child has begun externalizing their anger and other towards other people. By teaching a child to be self-directive they begin to understand how their own actions directly impact others and their relationships, giving opportunity for the child to change their own behaviour to become more socially acceptable. However, not all children externalize issues they may be experiencing. CCPT also deals with any grieving or internal emotional trauma the child may have. In cases involving more timid children or children not experiencing outbursts against peers, CCPT is also effective in processing the child through traumas they may have experienced and teaching them coping mechanisms that are helpful to the child.
Due to research of play therapy outcomes over the last 70 years , Ray produced a Play therapy skills checklist (PTSC) to ensure proper training and a means of supervision of therapists conducting play therapy. The PTSC was developed at the University of North Texas Centre for Play Therapy with a combined effort from educators and experienced play therapists.
Play therapy has been used to treat a wide variety of problems in children such as , behavioural, truama and social issues that are troubling the child. Often, once there is a means of identifying the problem a child is facing secondary steps can be taken to begin the healing process. In cases of behavioural problems, the child usually acts out because they lack the language to fully express their opinions and desires.(Gill, 1991) Erik Erikson elaborated on play therapy by stating it is necessary to create a play situation of roles in which the child can act out scenes of interaction rather than strictly using language. Language is not enough for a child to fully express themselves because it is though that their cognition is not advanced enough to be able to use language successfully enough to convey exactly what they feel. It has been though of as a comparison to using talk therapy with a person who is not fluent in the language that the therapy is conducted in. They can usually just make it through but it comes into question of how effective it really is. (Landreth 2002) Erikson used a table as the stage , toys as the props/characters, and the child in the role of director and actor. Allowing the child to play “director” not only shows areas of concern for the child but, also allows the therapist to understand the strengths of the child as well.
Experienced therapists can gain a lot of insight from children engaged in play therapy and use the opportunity to conduct teaching in a way that is fun as well. CCPT can access the inner world of the child without the prying and prodding of other therapies, that can cause discomfort or distress in the child. In general , the more engaged a person is, the more that they benefit from therapy because they aid in changing themselves rather than having others do the work for them. If a child is having fun or engaging in play while learning, they are going to gain more from therapy than if they were simply sat in an office and talked to for an hour a week, considering a child’s attention is much less on average than an adult.
Process& Structure of CCPT
For Child Centered Play Therapy to be effective, it is essential for the therapist to build a relationship with the child. The means accepting the child’s desire to be disruptive and ensuring that an environment is created where the child feels safe and free to express raw emotion, as and explore new behaviours and scenarios. (Landreth, 2012) If the child is not comfortable the therapy cannot progress simply because the child will not offer enough information through play for the therapist to work with. Much like other therapies, CCPT needs to remain consistent. As stated above, the comfort of the child is critical in order for the therapy to be effective therefore, this means keeping the same therapist over the duration of the therapy as well as similar setting as to not cause set backs in the therapeutic relationship.It is believed that children are very capable in expressing themselves through play as usually the child has not had to been taught play, it is unaltered and raw. Considering this, it is important to let the child lead rather than expecting them to follow an agenda set by the therapist. (Watts&Garza)
Toys are used in play therapy along with other play media but, specific toys are used to serve a purpose and not just collected as a “toy”. Landreth (2002) lists three categories that CCPT toys fall into. the first category consists of toys pertaining to: real life, creative expression, emotional release, and acting out/aggression release. (Wattz & Garza). The real life toys are defined as objects or people that the child interacts with in a real world setting that can be represented by toys as well. These toys include: puppets of people, dolls, cooking utensils, dishes, doctor’s kits, ect. Creative expression and emotional toys are mainly art supplies where as acting out/aggression toys involve play guns, knives and other toys that would be associated to violence.
Kottman broke down the toy categories further into five distinct groups but, reflected similarities to those of Landreth’s groups. Kottman lists: scary toys, family/nurturing toys, aggressive toys, pretend/ fantasy toys and expressive toys. Family toys are similar to Landreth’s “real toys" and expressive toys are much like Landreth’s creative toys. toys belonging to Landreth’s aggressive release/acting out toy category are very much a like Kottman’s aggressive toys. Kottman differs in his use of scary toys (monsters, sharks and dragons) and also in the pretend/fantasy category(dress up , building materials, etc). The important thing for a therapist to have falls in the doll or family characters regardless of the therapists’ preference of toy categorical model.()It is also important to mention that it is not necessary to have all of the toys listed above in order to successfully conduct play therapy however, toys need to be representative of all five categories of play media and should be organized in the five categories respectively.()Toys should be out in the open and the child should have easy access to them through out the session.
As stated previously , it is important for the child to feel comfortable but, it is also important for the therapist to be comfortable as well. Unfortunately many play therapists are underfunded and this can result in multiple settings and a traveling bag of toys instead of a consistent setting. As long as the therapist maintains a level of comfort and is able to express his or her creativity, they are often able to maintain flexibility with their clients and gain desired results.
Once CCPT has commenced, the therapist must track the child’s behaviour. This is more than just observing or taking notes, it is key to actually involve the child by speaking to them about how they are playing. In a way the therapist is interpreting the child’s behaviour and putting it into words to repeat back to the child for thought. This “tracking” is done to let the child know that the therapist is present and that the child has their full attention. Tracking is used to reflect other aspects as well such as: feelings, esteem building, returning responsibility to the child. The therapist can use this tool to help validate the feelings of the child, offer words to express their non verbal behaviour then begin correction.
A large portion of correction falls into the “limit setting” phase. this is where the child is taught self restraint and is given rules or regulations within play. Landreth (2002) developed the “A-C-T” model for setting limits with the child .
A = Acknowledge the child's feeling, wishes, and wants. Example: "You're so angry you want to hit me."
C= Communicate the limit. Example: "But I'm not for hitting."
T = Target acceptable, appropriate alternatives. Example: "The Bobo (bopbag) is for hitting.(Landreth 2002 pp.260-262)
If “ACT” does not stop the child the therapist can use “ultimate limit” techniques as well. Ultimate limits are set by putting items off limits for the child’s use for the rest of the therapy session. The therapist needs to elaborate however, by saying to the child that the toy is off limits because they are misusing it. If the child continues to break the rules then the child should be removed from the play room all together and again receive an explanation as to why these measures are being taken.
CCPT is often structured in once a week sessions however , there is some evidence that more frequent sessions produce better results in certain areas over time. Jones and Landreth (2002) found that 12 sessions over 3 weeks did have a significant impact on depression and anxiety in children when compared to a control group however, behavioural problems remained fairly consistent . With research coming from several studies producing similar results the once a week session structure has been modified to fit specific settings and severity of the issues.
It is also important for the child to feel the unconditionally accepting environment as a place they can explore their emotions as well as the emotions of others due to the impact of their behaviours towards others and themselves.
CCPT includes the parents and sometimes other adults in the child’s life such as coaches, teachers or step parents.Studies done by Carlson, Watts & Maniacci (2006) found that improvement can occur without parental involvement however, progress that is long lasting mostly occurs when parents play an active role in CCPT. Teachers become the active role when the child’s problems are more relevant to the school environment. Whether the poor behaviour directly involves other student or has to do with academics, teacher involvement does not only aid the child but, also helps maintain changes in real life settings that are established in Play Therapy. Parents or other caregivers can offer valuable information however, they should not be directly involved if they are the source of abuse or trauma to the child. Having support from a parent or teacher can positively impact the outcomes of play therapy but unfit candidates can have the opposite effect on play therapy outcomes as well.