Blending Play Therapy with Cognitive Behavioral Therapy E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 940

Veröffentlichungsjahr: 2009

Beschreibung

In today's managed-care environment, therapeutic techniques must be proven to be effective to be reimbursable. This comprehensive volume is written by leaders in the field and collects classic and emerging evidence-based and cognitive behavioral therapy treatments therapists can use when working with children and adolescents. Step-by-step instruction is provided for implementing the treatment protocol covered. In addition, a special section is included on therapist self-care, including empirically supported studies. For child and play therapists, as well school psychologists and school social workers.

Leseprobe

Table of Contents

Title Page

Copyright Page

About the Editor

Contributors

Acknowledgements

Preface

Foreword

SECTION I - RATIONALE FOR INTEGRATING PLAY THERAPY AND CBT

CHAPTER 1 - The Therapeutic Powers of Play and Play Therapy

CURATIVE FACTORS OF PLAY

PRESCRIPTIVE PLAY THERAPY

FUTURE RESEARCH

CONCLUSION

REFERENCES

CHAPTER 2 - Play Therapy, Pedagogy, and CBT

CBTs FOR THE TREATMENT OF DEPRESSION AND POSTTRAUMATIC STRESS IN CHILDREN AND ADOLESCENTS

DEVELOPMENTAL ISSUES AND CBT

GUIDING CONCEPTS FROM EDUCATIONAL LITERATURE: WHAT TEACHERS ALREADY KNOW

CAN PLAY BE A “SERIOUS” METHOD?

PLAY-BASED PEDAGOGY AND CBT

CONCLUSION

REFERENCES

CHAPTER 3 - An Illustration of Science and Practice

THE MENTAL HEALTH NEEDS OF ABUSED CHILDREN PRIORITIZED

PRACTICE AND EMPIRICAL STUDY

THE TF-CBT: A MANUALIZED, EVIDENCE-BASED APPROACH

ADAPTATION OF TF-CBT

ABUSE-FOCUSED PLAY THERAPY

SUMMARY

REFERENCES

SECTION II - HISTORICAL CONTEXTUAL FOUNDATION

CHAPTER 4 - Data Are Not Mysterious

UNDERSTANDING PSYCHOTHERAPY OUTCOMES STUDIES

APPLYING PSYCHOTHERAPY OUTCOMES RESEARCH

CONDUCTING PSYCHOTHERAPY OUTCOMES STUDIES

APPENDIX A: ELECTRONIC MEDIA RESOURCES

REFERENCES

CHAPTER 5 - Play Therapy Research: History and Current Empirical Support

PLAY THERAPY RESEARCH: HISTORY ANDCURRENT EMPIRICAL SUPPORT

PHILOSOPHICAL AND HISTORICAL FOUNDATION FOR PLAY THERAPY RESEARCH

BREADTH OF PLAY THERAPY RESEARCH 1942-1999

EMPIRICAL SUPPORT IN THE NEW MILLENNIUM

PLAY THERAPY RESEARCH FUTURE DIRECTIONS

CONCLUSION

REFERENCES

CHAPTER 6 - Cognitive Behavioral Play Therapy

INTRODUCTION

ADAPTING CT FOR USE WITH CHILDREN

TREATMENT DESCRIPTION

METHODS AND INTERVENTIONS

DEVELOPMENTAL ISSUES

STRUCTURED VERSUS UNSTRUCTURED PLAY

GOALS

PRINCIPLES OF CBPT

GENERALIZATION AND RELAPSE PREVENTION

CBPT VERSUS TRADITIONAL PLAY THERAPIES

EMPIRICAL SUPPORT

SUMMARY AND CONCLUSIONS

REFERENCES

SECTION III - EFFECTIVE EVIDENCE-BASED TREATMENTS USING PLAY WITH CBT

CHAPTER 7 - Trauma Systems Therapy: A Replication of the Model, Integrating ...

NATIONAL SOCIAL CONTEXT

ULSTER COUNTY, NEW YORK

PHYSIOLOGY OF TRAUMA

THE TRAUMA SYSTEMS THERAPY APPROACH

PLAY THERAPY HISTORY AND RATIONALE

COGNITIVE BEHAVIORAL THERAPY

REFERENCES

CHAPTER 8 - Incorporating Play within a Manual-Based Treatment for Children ...

THE COPING CAT PROGRAM

THE INCORPORATION OF PLAY

FEAR PLAN

EXPOSURE TASKS

CONCLUSION

REFERENCES

CHAPTER 9 - The Role of Play within Cognitive Behavioral Therapy for ...

EVIDENCE-BASE FOR THE COPING POWER PROGRAM

PLAY COMPONENTS IN COPING POWER

CHAPTER 10 - Innovation and Integration

WHAT IS PARENT-CHILD INTERACTION THERAPY?

IS PCIT AN EFFECTIVE INTERVENTION?

IS A PARENTING TRAINING (PCIT) PLAY THERAPY?

CAN PCIT INCORPORATE ELEMENTS OF TRADITIONAL PLAY THERAPY?

SUMMARY

REFERENCES

CHAPTER 11 - Primary Project

INTRODUCTION

PRIMARY PROJECT

EVIDENCED-BASED TREATMENT

THE ROLE OF PLAY IN PRIMARY PROJECT

THE PRIMARY PROJECT PLAYROOM

CORE COMPONENTS OF PRIMARY PROJECT

CONCLUSION

REFERENCES

SECTION IV - POSITIVE-OUTCOME EMPIRICALLY BASED PLAY THERAPY TREATMENTS

CHAPTER 12 - Child-Parent Psychotherapy

PRESENTING PROBLEM

FRAMING THE TREATMENT

REFLECTIONS ON THE SESSION

UNFOLDING OF THE TREATMENT

REFLECTIONS ON THE SESSION

A SHIFT IN ROLES

REFLECTIONS ON THE SESSION

THE DOCTOR’S KIT

REFLECTING ON THE SESSION

COLLATERAL SESSIONS: SUPPORTING THE PARENT

THE ABSENT PARTICIPANTS

REFLECTIONS ON THE SESSION

SPONTANEOUS PLAY

REFLECTIONS ON THE SESSION

CONCLUDING REFLECTIONS

REFERENCES

CHAPTER 13 - Filial Therapy

OVERVIEW OF FILIAL THERAPY

THE GOALS OF FILIAL THERAPY

PLAY SESSION SKILLS OF FILIAL THERAPY

THE SEQUENCE OF FILIAL THERAPY

THEORETICAL FOUNDATIONS OF FILIAL THERAPY

THE RELATIVE CONTRIBUTIONS OF PLAY THERAPY AND COGNITIVE BEHAVIORAL THERAPY IN FT

INTAKE AND RECOMMENDATION PHASE

TRAINING PHASE

SUPERVISED PLAY SESSION PHASE

HOME PLAY SESSION AND GENERALIZATION PHASE

DOES FILIAL THERAPY REALLY WORK? THE RESEARCH

SUMMARY

REFERENCES

CHAPTER 14 - Kinder Training: An Adlerian-Based Model to Enhance ...

WHAT IS KINDER TRAINING?

THEORETICAL FOUNDATIONS OF KINDER TRAINING

THE KINDER TRAINING MODEL

REFERENCES

CHAPTER 15 - Sandtray Therapy

BRIEF HISTORY OF SANDTRAY THERAPY

RATIONALE FOR THE USE OF SANDTRAY THERAPY

GENERAL PROCESS OF SANDTRAY THERAPY

REVIEW OF SANDTRAY LITERATURE AND RESEARCH

SUMMARY

REFERENCES

SECTION V - INTEGRATION AND APPLICATION OF PLAY-BASED TECHNIQUES WITH CBT

CHAPTER 16 - CBPT: Implementing and Integrating CBPT into Clinical Practice

HISTORICAL USE OF PUPPETS AND OTHER PLAY MATERIALS IN PLAY THERAPY

PHASES OF CBPT

ASSESSMENT

METHODS OF DELIVERING CBPT

INTERVENTIONS: INTEGRATING EMPIRICALLY SUPPORTED TECHNIQUES INTO CBPT

GENERALIZATION AND RELAPSE PREVENTION

TERMINATION

PARENT INVOLVEMENT IN CBPT

TROUBLESHOOTING/COMMON PROBLEMS AND HOW TO HANDLE THEM

CASE DESCRIPTION

COURSE OF TREATMENT

TREATMENT OUTCOME

FOLLOW-UP

QUALIFICATIONS FOR COGNITIVE BEHAVIORAL PLAY THERAPISTS

SUMMARY AND IMPLICATIONS FOR PRACTICE

APPENDIX A: RECOMMENDED BIBLIOTHERAPY BOOKS

REFERENCES

CHAPTER 17 - Play Therapy Techniques for Affect Regulation

WHAT IS AFFECT DYSREGULATION?

STEPS FOR USING COGNITIVE BEHAVIORAL PLAY THERAPY TO ADDRESS DYSREGULATION

BUILDING COPING SKILLS

A FINAL NOTE FOR THERAPISTS

REFERENCES

CHAPTER 18 - Building Self-Esteem, Coping Skills, and Changing Cognitive Distortions

BENEFITS OF PLAY THERAPY AND CBPT

CASE STUDIES IN CBPT

CHAPTER 19 - Playful Strategies to Manage Frustration: The Turtle Technique ...

EMOTIONAL COMPETENCE IN CHILDREN

ANGER AND AGGRESSION IN YOUNG CHILDREN

ANGER MANAGEMENT APPROACHES FOR YOUNG CHILDREN

PLAY THERAPY AND ANGER MANAGEMENT FOR YOUNG CHILDREN

SUMMARY AND RECOMMENDATIONS

REFERENCES

CHAPTER 20 - Narrative Approaches: Helping Children Tell Their Stories

NARRATIVE THERAPY IN PLAY THERAPY

SOCIAL CONSTRUCTIONIST STANCE

HERMENEUTIC APPROACH

THE NARRATIVE FOCUS

PRETEND PLAY: THE LANDSCAPE OF THE IMAGINATION

PRETEND PLAY AS NARRATIVE

ADULT AND CHILD PLAYING TOGETHER

PLAY AS A CULTURAL ROUTINE

THE PLAYING SPACE

RULES WHEN PLAYING TOGETHER

TOYS FOR PRETEND PLAY

THE ADULT AS STORYTELLER

THE IMPORTANCE OF PRETEND PLAY AND COGNITIVE COMPETENCE

TWO STORIES FOR THERAPISTS

REFERENCES

CHAPTER 21 - Family Problem Solving: Using Expressive Activities

OVERVIEW OF TREATMENT APPROACH

BACKGROUND

USE, PURPOSE, AND IMPORTANCE OF PLAY

TYPES AND USES OF DIRECTED PLAY ACTION

AN APPLICATION FROM THE CASE EXAMPLE

SUMMARY

REFERENCES

SECTION VI - THERAPIST SELF-CARE

CHAPTER 22 - Self-Care for Child Therapists: Leaving It at the Office

THE ETHICS AND IRONIES OF SELF-CARE

STRESSORS OF THE IMPOSSIBLE PROFESSION

SELF-CARE STRATEGIES

IN CLOSING

REFERENCES

Epilogue

APPENDIX - Books with Play-Based Techniques for Use with Children in Directive ...

AUTHOR INDEX

SUBJECT INDEX

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Library of Congress Cataloging-in-Publication Data:

Blending play therapy with cognitive behavioral therapy : evidence-based and other effective treatments and techniques / edited by Athena A. Drewes. p. ; cm. Includes bibliographical references and index.

eISBN : 978-0-470-49552-0

1. Play therapy. 2. Cognitive therapy for children. I. Drewes, Athena A., 1948- [DNLM: 1. Play Therapy—methods. 2. Adolescent. 3. Child. 4. Cognitive Therapy—methods. 5. Evidence-Based Medicine. WS 350.2 B647 2009] RJ505.P6B64 2009 618.92’891653—dc22 2008032158

About the Editor

DR. ATHENA A. DREWES is a licensed child psychologist, certified school psychologist, and Registered Play Therapist-Supervisor. She is Director of Clinical Training and the APA-Accredited Doctoral Internship Program at The Astor Home for Children, a full range, multiservice, nonprofit mental health agency with over 750 employees serving Dutchess, Bronx, and Orange counties in New York. Dr. Drewes is adjunct professor of play therapy at Marist and Sage Colleges, past Board of Director of the Association for Play Therapy (2001-2007), Founder and Past President of the New York Association for Play Therapy, and Director of the Play Therapy Institute.

She is Secretary for the Child and Adolescent Special Interest Group of Division 56 Trauma of the American Psychological Association. She is on the editorial board for Training and Education in Professional Psychology, and the International Journal of Play Therapy. Drewes has written and lectured extensively about play therapy nationally and internationally. She is co-editor and chapter author of School-Based Play Therapy (Drewes, Carey, & Schaefer, 2001), Cultural Issues in Play Therapy (Gil & Drewes, 2005), and Supervision Can be Playful: Play-Based Techniques for Child and Play Therapist Supervisors (Drewes & Mullen, 2008).

She is also on the Disaster Mental Health Leadership Team of the Red Cross in Greater New York, and a member of the Disaster Response Network of the New York State Psychological Association. She has worked for over 25 year across all settings with children and adolescents, specializing in treatment involving sexual abuse, trauma, attachment disorder, foster care children, supervision, and play therapy in the schools.

Contributors

Jennifer Baggerly, Ph.D., LMHC-S, RPT-S Counselor Education University of South Florida Tampa, Florida

Michele S. Berk, Ph.D. Assistant Professor at UCLA Director of the Adolescent DBT and CBT Clinic Department of Psychiatry Geffen School of Medicine Harbor-UCLA Medical Center Torrance, California

Dawn Blacker, Ph.D. University of California at Davis Children’s Hospital CAARE Diagnostic and Treatment Center Sacramento, California

Caroline Boxmeyer, Ph.D. Department of Psychology University of Alabama Tuscaloosa, Alabama

Suzanne Button, Ph.D. Director of Program Improvement, Outcomes Management and Research The Astor Home for Children Rhinebeck, New York

Ann Cattanach, Ph.D. Formerly Course Leader, Play Therapy, Roehamption University, London Present Teaching Fellow, University of York, England Consultant Adoption & Fostering Moray and Highland, Scotland

Meena Dasari, Ph.D. Metropolitan Center of Cognitive Behavioral Therapy New York University School of Medicine New York, New York

Stephen P. Demanchick, Ph.D., LMHC Assistant Professor Creative Arts Therapy Department Nazareth College Rochester, New York

Athena A. Drewes, Psy.D., RPT-S Director of Clinical Training and APA Internship The Astor Home for Children Poughkeepsie, New York

Eva L. Feindler, Ph.D. Director, Psychological Services Center Professor of Psychology Long Island University Brookville, New York

Diane Frey, Ph.D., RPT-S Wright State University Dayton, Ohio

Eliana Gil, Ph.D., RPT-S Director of Clinical Services Childhelp Children’s Center of Virginia Fairfax, Virginia

Lauren S. Hallion Quality Assessment and Improvement Coordinator The Astor Home for Children Rhinebeck, New York

Susan Hansen, LCSWR, RPT-S Program Supervisor Children’s Services Ulster County Mental Health Kingston, New York

Steve Harvey, Ph.D., RPT-S Educational Psychology New Zealand Registered Psychologist Consultant Psychologist Taranaki District Health Board New Plymouth, New Zealand

Linda E. Homeyer, Ph.D., RPT-S Texas State University-San Marcos San Marcos, Texas

Lisa R. Inman, M.D. Child and Adolescent Psychiatrist San Francisco Department of Public Health Southeast Child Family Therapy Center San Francisco, California

Nicole Jalazo, LCSW Senior Clinical Staff Member Childhelp Children’s Center of Virginia Fairfax, Virginia

Deborah B. Johnson, M.S. Children’s Institute Rochester, New York

Philip C. Kendall, Ph.D., ABPP Child and Adolescent Anxiety Disorders Clinic Temple University Philadelphia, Pennsylvania

Susan M. Knell, Ph.D. Spectrum Psychological Associates Shaker Heights, Ohio

Alicia F. Lieberman, Ph.D. Irving B. Harris Endowed Chair in Infant Mental Health Professor and Vice Chair for Academia Affaire UCSF Department of Psychiatry Director, Child Trauma Research Project San Francisco, California

John E. Lochman, Ph.D., ABPP Editor-in-Chief, Journal of Abnormal Child Psychology Director, Center for Prevention of Youth Behavior Problems Professor and Saxon Chairholder in Clinical Psychology Department of Psychology University of Alabama Tuscaloosa, Alabama

Erin D. Martin, Ph.D. Child and Adolescent Anxiety Disorders Clinic Temple University Philadelphia, Pennsylvania

Donald Meichenbaum, Ph.D. Distinguished Professor Emeritus University of Waterloo Waterloo, Ontario, Canada Visiting Distinguished Professor University of Miami Research Director of The Melissa Institute for Violence Prevention

John C. Norcross, Ph.D., ABPP Professor of Psychology & Distinguished University Fellow Editor, Journal of Clinical PsychologyIn SessionDepartment of Psychology University of Scranton Scranton, Pennsylvania

Susan Trachtenberg Paula, Ph.D. Center for Trauma Program Innovation Jewish Board of Family and Childre Services New York, New York

Mary Anne Peabody, LCSW Clinical Associate Children’s Institute Rochester, New York

Jennifer L. Podell, Ph.D. Child and Adolescent Anxiety Disorders Clinic Temple University Philadelphia, Pennsylvania

Nicole Powell, Ph.D. Research Psychologist Center for the Prevention of Youth Behavior Problems University of Alabama Tuscaloosa, Alabama

Glenn Saxe, M.D. Associate Chief of Psychiatry for Research and Development Department of Psychiatry Children’s Hospital Boston, Massachusetts

Charles E. Schaefer, Ph.D., RPT-S Professor Emeritus Fairleigh Dickinson University Teaneck, New Jersey Director Emeritus of the Association for Play Therapy

Janine S. Shelby, Ph.D., RPT-S Assistant Professor UCLA Director of Child Psychology Training, and Child Trauma Clinic Department of Psychiatry Geffen School of Medicine Harbor-UCLA Medical Center Torrance, California

Daniel S. Sweeney, Ph.D., LMFT, LPC, RPT-S Professor of Counseling Director, NW Center for Play Therapy Studies Graduate Department of Counseling George Fox University Portland, Oregon

Anthony J. Urquiza, Ph.D. Director, Mental Health Services CAARE Diagnostic and Treatment Center Department of Pediatrics University of California, Davis Medical Center Sacramento, California

Risë VanFleet, Ph.D., RPT-S President, Private Practice Family Enhancement and Play Therapy Center, Inc. Boiling Springs, Pennsylvania

JoAnna White, Ed.D., L.P.C., RPT-S Professor and Chair Department of Counseling and Psychological Services Georgia State University Atlanta, Georgia

Lauren Stern Wynne, Ph.D., L.P.C., RPT-S Assistant Professor Department of Counseling and Psychological Services Georgia State University Atlanta, Georgia

Nancy M. Zebell, Ph.D. Supervising Psychologist CAARE Diagnostic and Treatment Center Department of Pediatrics University of California Davis Medical Center Sacramento, California

Acknowledgments

WITHOUT THE GUIDANCE and helpful suggestions of Charles Schaefer and Don Meichenbaum, this book could not have evolved as it did. Their wisdom and insight helped me to hone my concept into reality. They were most generous with their time and their opinions. I am honored to count them as friends and colleagues, and doubly proud to have them included in this book. They represent the best of both worlds: play therapy and cognitive behavioral therapy.

This book would not have been possible without the support and encouragement of Isabel Pratt, editor and Lisa Gebo, senior editor at John Wiley & Sons. They have persevered over the past three years tweaking, revising, and pushing for what you will now read. Their faith in this project and in me has been unconditional and greatly appreciated. Isabel Pratt did a masterful job in maneuvering this tome into a polished product that will help leave a lasting contribution to the field of child and adolescent psychology.

Special thanks go to James Richard Bridges, Scott Richard Drewes Bridges, and Seth Andrew Bridges for their always present, unconditional love and support. You are the wind beneath my wings!

Thanks to my family and friends who helped keep me motivated and energized: John C. and Doris Drewes, Nick H. and Rosemarie Drewes, Nick and Laurie Drewes, Nicolette Marie and Natalie Elin Drewes, Eliana Gil, Ana Sutton, Akiko Ohnogi, Debra Sheafe, Twila Smith, Peggie Land-rum, Linda Mangelsdorf, Linda Shutts, Janie Keller, Sheila Doherty, Chris Foreacre, and Dave Crenshaw.

Preface

THIS BOOK IS borne out necessity and from over 25 years of professional clinical experience with children and adolescents. My career began after obtaining my master’s degree in clinical psychology from New York University. I was employed by the Jewish Board of Family and Children’s Services (then known as the Jewish Board of Guardians, Inc.) and worked at the Child Development Center testing and treating latency age children. Eva Landauer was my supervisor and mentor in psychodynamic play therapy. She had been trained by Anna Freud. It was there, at JBG, that my passion for play therapy began and I saw how potent it was to use play as therapy, with children using metaphor and play while not saying one word in the session. I was witness to children who made gains, blossomed, and interacted over time through symbolic play.

After five years at JBFCS, I moved to Orange County, New York, with my husband to start a family. My work shifted to being a play therapist at an outpatient clinic, and I worked with a wide variety of ages and problems, but most notably sexually abused children who were living in foster care. The field of sexual abuse was relatively new, and the work often felt like we were improvising and flying by the seat of our pants. We were all struggling for ways to engage the children and find skills that would work with every child in treatment. In time I worked in a special education preschool doing play therapy and parent and teacher consultation, and I also worked a few years in regular education as a school psychologist. As the need for a license loomed by New York State mandates, I returned for a doctorate at Pace University in New York City. Its combined school and child clinical program was the best of both worlds in allowing me to get clinical practicum placements. My clinical internship was at the Astor Home for Children in Rhinebeck, NY, a large, multiservice, nonprofit mental health agency that had an APA-accredited program with a strong play therapy component.

I was fortunate enough to be hired upon completion of the internship and have remained there since, more than 16 years. I worked for 10 years as a clinical coordinator and senior psychologist in the Residential Treatment Center in Rhinebeck seeing children from 5 to 13 years of age whose presenting problems were predominantly the result of sexual abuse and attachment disorder, along with a dysfunctional family.

It was at that point that I saw how traditional child-led therapy was not productive with some of the sexually abused children I worked with. Our work became stagnant. If I did not talk about sexual abuse, they were more than happy to avoid talking about it too. Their play avoided the topic and gave no insights. We were at a stalemate, and I had no tools with which to move the treatment forward. Having discovered the Association for Play Therapy in 1992, I attended a workshop by Beverly James, author of Treating the Traumatized Child. She introduced the idea of a developmentally sequenced treatment approach and the need to be directive using play therapy materials and play-based techniques. This was the piece that was missing in my work. Applying her techniques and others learned through attendance at the Association for Play Therapy conferences and workshops with the leading play therapists, an integrated treatment style developed. I realized that in order to work with severely abused and traumatized children, who also had attachment deficits, I needed to become flexible in moving between child-led and directive approaches. I needed to become a prescriptive therapist. I needed to apply the best practices, evidence-informed treatment with this child, at this time, for this symptom.

No longer could it be one size fits all in my treatment of trauma. I needed to use play in therapy as well as play as therapy. This thinking went against other play therapists who believed, and still believe, that child-led treatment is the only way to work with children. They believed it was the only form of play therapy. I believe you need both: not only child-led, nondirective work with children, but also for some children you need to be directive, and at times you need to do both within the same session. And moreover, I believe you need to bring in cognitive behavioral therapy to help deal with affect regulation, self-esteem issues, problem-solving, and coping and social skills deficits, among other things. Attachment issues often were beneath the severe abuse issues both in the Residential Treatment Center and with the children I see in Astor’s Therapeutic Foster Care program.

It was at this point that I realized that the worlds of play therapy and cognitive behavioral therapy can blend together very well. Susan Knell’s book Cognitive Behavioral Play Therapy confirmed what I had felt intuitively. With the advance of credentialing bodies dictating and man-dating the use of evidence-based treatments with the children and adolescents seen at Astor, as an agency, we needed to show that what we did worked. And we needed to learn other evidence-based treatments in our work with children and adolescents, especially those with sexual abuse.

Some professionals and some of the literature continue to question the value of play therapy. In large part this may be because of old views that play therapy is psychodynamic or child-centered and nondirective. Indeed this is a part of play therapy: play as therapy. However, the world of play therapy has expanded significantly. It also includes the expressive arts, which allows for sandtray therapy, art therapy, use of narrative storytelling, poetry and creative writing, drama, dance, and music therapy, among many treatment approaches. Parent-child treatment using Filial Therapy, Child-Parent Relationship Therapy, along with Theraplay for attachment disorders are also included under the umbrella of play therapy. More and more over the past several years clinicians working with children and adolescents, be it in a school or clinical setting, are seeking techniques and skills to help them work with this population and the myriad of problems they bring to the clinician. Practical application and an integrated approach in seeing children and adolescents have been developing in the field. Play in therapy is becoming more the norm. Clearly one size does not fit all.

Over the past three years I have had three workshop proposals accepted at the American Psychological Association annual conferences, and two at the National Association of School Psychologists conferences. These were skill-based trainings in how to utilize play-based techniques and approaches in working with children and adolescents. The strong attendance at these workshops clearly reflects the changing viewpoint and fading of old biases around play therapy. Clinicians need to embrace treatments that are effective and research evidence that informs their work.

This book grew out of the need to bring an awareness to CBT and mainstream clinicians that play therapy has evolved and is no longer just what was thought of 50 years ago. Play therapy has a lot to offer to the growing use of CBT evidence-based treatments. Play itself has curative factors, and when combined with effective treatment methods it becomes a potential change agent in healing children and adolescents. CBT has a lot to offer to play therapists in creating an integrated treatment approach that allows for generalization of skills. There is a lot that both play therapists and CBT clinicians can learn from and share with one another. There is a need for collaboration not polarization.

The chapters you will read within this book are written by many notable clinicians and researchers, some are play therapists and others are CBT researchers. It has been my privilege to personally know Don Meichenbaum and Charles Schaefer, both notable pioneers in their respective fields, CBT and play therapy. Readers will be able to read about evidence-based CBT treatments for children and adolescents that utilize play and consider play as an important component in the treatment of childhood disorders. The reader will also learn about how to conduct and critically read research in order to offer the best treatment for their client. CBT clinicians will be able to obtain practical skills and play therapy techniques that they can integrate into their treatment approaches to help engage children and sustain their attention while working on psychoeducational components.

It is my hope that this book will help to dispel biases and misinformation regarding both play therapy and cognitive behavioral therapy by child and adolescent clinicians. All must remain open to the possibility that play can be a useful component and a healing factor in evidence-based practices. Now is the time for the field of child and adolescent psychology to come together and develop a mutual and respectful collaboration, allowing for the best of both worlds.

Athena A. Drewes, PsyD, RPT-S

Foreword

ATHENA DREWES’S EDITED volume, Blending Play Therapy with Cognitive Behavioral Therapy, arrived as I was about to babysit my four grandchildren, ages 8, 6, 4, and 2. My wife and I were in for a fun-filled week of engaging in childhood play behaviors. As my daughter-in-law was leaving, she announced, “Don’t let them take advantage of you!” For any grandparent, this is a nonsensical request. In fact, I took advantage of them, as I watched, participated, and engaged in various forms of play. In between play activities, when the children napped or were otherwise entertained, I read this engaging and welcomed resource on the functions and the “healing power of play.”

How do my grandchildren’s play behaviors differ developmentally? What are the functions of play in terms of their emotional, cognitive, and social development? These questions were further highlighted when we next all left for Whistler, British Columbia, to attend my youngest son’s wedding. While hiking on a trail in Whistler, my four grandchildren and their mother and aunt encountered a sizeable bear no more than three feet away. When they all returned home to tell us of their “scary” encounter, they reenacted the entire bear episode using stuffed animal bears, and they used drawings and songs to tell their accounts. We even videotaped their reenactment and watched it together, noting their quick-mindedness, courage, bravery, and family supports.

It is with this background that I now turn my attention to writing this foreword. Since its origin, cognitive behavior therapy (CBT) has incorporated the medium of play to nurture children’s affect regulation, teach coping skills, provide psychoeducation, correct misconceptions, help abused children organize fragmented memories, and develop integrative narratives of traumatic events. CBT has also used play as a means of improving parent-child relationships. A number of CBT procedures are described in this volume as applied to socially anxious children (Coping Cat program) and aggressive children (Dino the Dinosaur, Do Turtle, and Coping Brain Power programs), as are trauma-focused CBT and play-based cognitive restructuring procedures for depressed children and adolescents. These play-oriented psychotherapeutic activities have such titles as “Beat the Clock,” “Hot Seat,” “Color My Feelings,” “Filling in the Thought Bubbles,” and “Role-Playing Spaghetti and Robot.” A full array of puppet play, sandtray, art expressive techniques, storytelling, and bibliotherapy are described.

The cognitive behavior therapists are indebted to their forerunners who discussed the value of play from psychodynamic and humanist nondirective perspectives and to those who pioneered filial therapy with parents who were taught how to supplement and eventually replace play therapists.

All schools of play therapy are brought together in this volume so the reader can compare and contrast the respective approaches. As Athena Drewes proposes, the goal of this book is to help dispel the biases and misinformation regarding play therapy and CBT and to nurture a collaborative relationship between researchers and clinicians. In large part, the book accomplishes these objectives.

Thus, we know that providing distressed children with play therapy has a healing power and contributes to behavioral change. What we do not know is how best to integrate directive and nondirective forms of play therapy; nor what proscriptive algorithms to follow or how best to implement various forms of play therapy; nor what are the active mechanisms in play therapy. How much of the treatment outcomes are a result of the nonspecific relationship with the play therapist, and how much are the result of specific intervention procedures? Is it all DODO bird effects or are there active ingredients that contribute to change? Moreover, why can’t troubled children create therapeutic play activities on their own or with peers, without the help of an adult play therapist? The examination of questions such as these will help further blend the science and art of play therapy.

There is one additional nugget in reading this book and that is the final chapter by John Norcross and Athena Drewes on self-care for child therapists. If you can’t go home and play with your grandchildren (or children) to recover from a stressful day at the office, be sure to read this chapter.

Play is the way children tell us what is on their minds and what are their concerns and fantasies. If you work with children, this edited volume will help you become a more perceptive listener. Enjoy!

Donald Meichenbaum Distinguished Professor Emeritus University of Waterloo Ontario, Canada Research Director of the Melissa Institute for Violence Prevention, Miami, Florida

REFERENCE

Bratton, S., Roy, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of the outcome research. Professional Psychology: Research, and Practice, 36, 376-390.

SECTION I

RATIONALE FOR INTEGRATING PLAY THERAPY AND CBT

SECTION I PROVIDES the reader with three chapters that help to frame the rationale for and benefit of play and play therapy, and why cognitive behavioral evidence-based interventions can become even more effective with a developmental approach that incorporates play and play-based components.

We begin with Chapter 1, Charles Schaefer’s and Athena Drewes’s overview of how play is universally the child’s natural expression and critical to childhood development. Schaefer’s 25 therapeutic powers of play, based upon a review of the literature, allows the reader an in-depth view into the change mechanisms within play that can help child and adolescent clients overcome their psychosocial difficulties. Each of the well-known schools of therapy, including cognitive behavioral, emphasizes one or more of the curative powers of play. The authors promote the need for a prescriptive eclectic approach for clinicians whereby child and play therapists become skilled in numerous therapeutic powers and differentially apply them to meet the individual needs of clients. This approach is based on the individualized, differential, and focused matching of curative powers to the specific causative forces underlying the client’s problem. The authors conclude with a note that future research is needed to elucidate the specific therapeutic powers of play that are the most effective with specific presenting problems.

This chapter is followed by Janine Shelby and Michele Berk, who address in Chapter 2 the increasing emphasis on and empirical support of evidence-based therapies that are commonly cognitive behavioral in approach. They make the case that while these treatments are effective for adolescents and adults, younger children may not have the skills required to learn CBT techniques that require metacognition. A developmentally sensitive approach is suggested. The authors focus on how CBTs for children and adolescents might be advanced by practices from the education and play therapy literature, which place intense focus on developmentally sensitive methods for interacting with, teaching, and/or delivering therapeutic or academic content. They initially describe two CBT treatments for depression and posttraumatic stress that are commonly used with children and adolescents. They continue with a discussion of findings from the fields of education, child development, and play therapy that can be successfully blended with CBT in order to increase developmental sensitivity, engagement, and experiential utility over verbal methods of instruction. Specific suggestions and examples are given for how the reader can synthesize learning and play therapy methods into CBTs.

This section is rounded out in Chapter 3 with Eliana Gil and Nicole Jalazo offering a unique example of how well science and clinical practice can collaborate in the field of child sexual abuse. They discuss the challenge of therapy with abused children in taking evidence-based approaches and then being able to translate them for use with young, resistant children with limited linguistic and cognitive skills and who may be too anxious to learn cognitive lessons due to chronic and severe trauma. Implementation of evidence-based treatments with children is often hampered by trying to utilize a single approach for all situations. The authors highlight the difficulties clinicians encounter when relying exclusively on techniques or approaches that focus on verbalization and intellectualization. Trauma-focused cognitive behavior therapy (TF-CBT) is highlighted for its empirically researched effectiveness. The authors illustrate how play therapy and play-based interventions, through two case studies, can effectively strengthen the TF-CBT approach, working in tandem. They advocate a Trauma-Focused Cognitive Behavioral Play Therapy approach that is user-friendly and capable of engaging difficult clients, less verbal clients, and most challenging families, as well as facilitates work across cultures.

CHAPTER 1

The Therapeutic Powers of Play and Play Therapy

CHARLES E. SCHAEFERATHENA A. DREWES

PLAY IS AS natural to children as breathing. It is a universal expression of children, and it can transcend differences in ethnicity, language, or other aspects of culture (Drewes, 2006). Play has been observed in virtually every culture since the beginning of recorded history. It is inextricably linked to how the culture develops poetry, music, dance, philosophy, social structures—all linked through the society’s view of play (Huizinga, 1949). But how play looks and is valued differs across and within cultures (Sutton-Smith, 1974, 1999).

The use of fantasy, symbolic play, and make-believe is a developmentally natural activity in children’s play (Russ, 2007). Play is not only central but critical to childhood development (Roopnarine & Johnson, 1994). For a variety of species, including humans, play can be nearly as important as food and sleep. The intense sensory and physical stimulation that comes with playing helps to form the brain’s circuits and prevents loss of neurons (Perry, 1997). Play is so critical to a child’s development that it is promoted by the United Nations 1989 Convention on the Rights of the Child, Article 31.1, which recognizes “the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts.” Play is perhaps the most developmentally appropriate and powerful medium for young children to build adult-child relationships, develop cause-effect thinking critical to impulse control, process stressful experiences, and learn social skills (Chaloner, 2001). Play can provide a child the sense of power and control that comes from solving problems and mastering new experiences, ideas, and concerns. As a result, it can help build feelings of confidence and accomplishment (Drewes, 2005). Through play and play-based interventions children can communicate nonverbally, symbolically, and in an action-oriented manner.

Play is not only essential for promoting normal child development, but it has many therapeutic powers as well. All therapies require, among other factors, the formation of a therapeutic relationship, along with the use of a medium of exchange (Drewes, 2001). The use of play helps establish a working relationship with children, especially those who lack verbal self-expression, and even with older children who show resistance or an inability to articulate their feelings and issues (Haworth, 1964). The presence of toys and play materials in the room sends a message to the child that this space and time is different from all others. It indicates to the child that they are given permission to be children and to feel free to be fully themselves (Landreth, 1983).