Cognitive-Behavioral Play Therapy

Cognitive-behavioral play therapy is an approach to treating young children that adapts cognitive and behavior therapies in developmentally sensitive ways. Like adult-based cognitive and behavior therapies, cognitive-behavioral play therapy is psychoeducational in nature. However, the learning experiences designed to bring about cognitive and behavioral changes are transmitted through play

activities through the use of both verbal and nonverbal forms of communication.

Cognitive-behavioral play therapy is based on cognitive and behavioral theories of emotional development and disorder. CBPT is structured, directive, and problem-focused. CBPT involves the child in the treatment through play, using art materials, stuffed animals, puppets, and other toys. The child’s thoughts and feelings are the focus as the therapist provides a strategy for developing more adaptive behaviors and thoughts. Rather than being open-ended, CBPT is goal oriented, directive, and structured.

A primary goal of cognitive therapy is to identify and modify maladaptive thoughts associated with the patient’s symptoms (Bedrosian & Beck, 1980, as cited in Knell, 1997). Cognitive therapy assumes that there is a relationship between thoughts, feelings, and behaviors. Mutual influences exist such that changes in one of these areas of functioning will result in changes in the other two areas. Cognitive behavioral therapy recognizes these influences while trying to modify a child’s emotional, cognitive, and behavioral functioning.

There are both similarities and differences between cognitive-behavioral play therapy and traditional play therapies. The similarities are the establishment of a positive therapeutic relationship, communication through play, creating a safe container for the child, and the therapist gathering clues to understand the child. The therapist observes how the child may view him or herself and others, problem-solving approaches, and conflicts and fantasies. Some of the ways in which CBPT differs from traditional play therapy include the establishment of specific goals, the therapist playing an active role in selecting materials and activities, using play to educate the child, and using praise to encourage positive behaviors.

Before beginning treatment, the therapist may want to obtain the child’s self-statements, assumptions, and beliefs. The therapist can obtain this information from parents, observation, and various psychological tests. After a thorough assessment of the child, the cognitive-behavioral interventions can be presented through role-play, positive reinforcement, and modeling (Knell, 1997). A child with school phobia might role-play the experience of going to school while using new coping skills, such as positive self-statements. The therapist might reward the child for using newly acquired skills to cope with school phobia. Modeling is used to demonstrate adaptive coping methods to the child. During treatment, problem situations are reenacted to help the child learn alternative ways to respond to or perceive various situations.

The therapy must be designed to facilitate generalization. Therapeutic play scenarios should parallel the child’s real-life situations. When working with children, it is important to help them develop the skills necessary to take what they have learned in therapy and apply it to a variety of settings. Significant adults in the child’s life should reinforce the new behavior and be involved in the treatment.

Relapse prevention should be included in the treatment in order to prepare the child and family for the possibility of later problems. The therapist can teach the child and his or her parents how to learn from these setbacks while accepting the belief that setbacks are part of the learning process (Knell, 1997). The therapist and family might identify high-risk situations and facilitate problem-solving and coping skills to manage these situations.

Knell, Susan M. (1997). Child-centered play therapy. In Kevin J. O’Connor & Lisa Mages Braverman (Eds.), Play therapy theory and practice: A comparative presentation (pp. 17-45). New York: John Wiley & Sons, Inc.