Play therapy is considered as an ideal approach to help children with mental health issues. It is a form of therapeutic method to help children understand and address their psychological and psychosocial issues through play. Play therapy treatment approaches are directive (or structured PT) or non-directive (client or child-centric play therapy). This article compares and contrasts Cognitive Behavioural Play Therapy (CBPT), a directive approach, with Child-Centric Play Therapy (CCPT), a non-directive approach.
CBPT and CCPT Approach
CBT, when paired with play and play-based activities is called CBPT. It is structured short-term, goal-oriented and directive. Play is used to teach skills, alter cognitions, create alternative behaviour, generalize positive functioning across various environments, etc. It emphasizes a child’s involvement in treatment and a framework for a child’s participation by addressing issues of control, mastery, and responsibility for one’s own behaviour change. CCPT on the other hand is a non-directive, developmentally-responsive, play-based mental health intervention that can be called a complete therapeutic system. It is built on a deep belief in the capacity and resilience of a child to be constructively self-directing. It helps treat children experiencing social, emotional, behavioural and relational disorders (Landreth, 1991; 2002; 2012). It allows children to act according to their actual developmental age and chooses play activities accordingly (Josefi & Ryan, 2004). The therapist views maladaptive behaviour as resulting from the drive for complete self-realization hence does not attempt to control the child (Axeline, 1947; Ray, et al., 2009).
CBPT and CCPT have certain similarities too - like play is not only a treatment modality but also a means of communication between the child and the therapist. Both emphasize an empathic therapeutic relationship in which the child feels known and understood (Phillips & Landreth, 1998; Hall, et al., 2002; Jones, et al., 2003; Barish, 2004). By genuinely connecting with children through play, therapists can help them shift their organizations of self and relationships and thereby permit new possibilities to arise (Levy, 2008). There are a few differences also. In CBPT, play is educational and led by the therapist. It teaches skills and alternative behaviours. Direction goals are the basis of intervention. CCPT and non-directive in nature and the session is led entirely by the child as any direction imposed indicates non-acceptance, which is against the tenets for relating to children (Landreth, 2012, p. 33). In CBPT, the therapist (sometimes the child) selects the materials beforehand. Structured activities are encouraged for improving social and coping skills, emotional awareness and regulation and self-resilience and control. However, in CCPT a free play is encouraged and the child always selects the item/activity/ toy. The play remains non-judgmental, accepting and respectful. In CBPT, positive behaviour is reinforced by reward or praise while in CCPT it is not. The key differentiator between both approaches is the role of the therapist.
Interventions
In CBPT, every session starts with an agenda and homework review, threading multiple components together. CBPT uses play as a medium such sand, puppet, soft toys or action figures in a story to model solutions to a problem which is in line with child’s problems (Knell, 1998), which helps the child investigate, understand and discover many/new ways of thinking and behaving. The therapist directs the session and leads the child to their positive self. It also incorporates psychoeducation, somatic management, time-out procedures, cognitive restructuring, behavioural shaping, modelling and guided participation, role plays, skill-training and rehearsal, delineating expectations and rewards to avoid confusion. Operant conditioning (positive reinforcement) (Skinner, 1938) is commonly employed and classical conditioning (systematic desensitization) (Wolpe, 1982) is utilized for exposure. In CCPT, the clinical assessment is done through various play themes and the child is not expected or required to do homework, verbalize stories, descriptions, thoughts, feelings, insights, problems, issue or concern (Landreth, et. al., 1999). The child plays out what is important to him as opposed to what the therapist believes the issues are (Axeline, 1947; Joiner & Landreth, 2005; Ray, et.al.,2009). The therapist is an observer who uses responsive language and guides the child (Guzzi-DelPo & Frick, 1988). Empathy towards the child is expressed through reflecting content, feelings, and responses. Limit setting and responsibility responses provide opportunities for the child to experience emotional release and regulation. Open-ended treatment like CCPT can sometimes be longer as compared to CBPT. Both approaches have a pre-session assessment, middle and graduation (CBPT)/termination session. In both, tracking, treatment progress and sessions effectiveness are regularly assessed.
Conclusion
Both CBPT and CCPT approaches have proven their effectiveness in treating children. Both approaches rely on the positive therapeutical relationship, use of play as a means of communication and making therapy a safe place for a child. However, CBPT merely focuses on a person’s capacity to change their thought process. Confronting emotions and rules can make the child more anxious and may frustrate them. It may not be suitable for non-verbal children and children with more complex mental issues and learning difficulties. In CCPT, the child feels accepted and self is strengthened with the experience of a feeling of being in control. The child learns to develop coping and problem-solving skills. Children perceive an activity as play when they exercise their choice and a task when an adult chooses it for them. Therefore, ceteris paribus, I prefer CCPT over CBPT. The former is non-directive, non-threatening, self-directing and delivers long-lasting results. It strengthens self-concept and believes in the child’s intrinsic capacity and resilience. It also helps with non-verbal children.
References:
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