Cognitive Behavioral Play Therapy CBPT Theory and Practice

Cognitive Behavioral Play Therapy (CBPT) Theory and Practice with Children and Adolescents Summer, 2012

CBPT Theory � Cognitive-behavioral play therapy incorporates cognitive and behavioral interventions within a play therapy paradigm (Knell, 1997). � Focus is more on psychopathology rather than personality development. “Factors that contribute to development gone awry” (Knell, 1997)

CBPT Theory (cont. ) � 3 Major Premises of Cognitive Therapy ◦ Thoughts influence the individual’s emotions and behaviors in response to events ◦ Perceptions and interpretations of events are shaped by the individual’s beliefs and assumptions ◦ Errors in logic or cognitive distortions are prevalent in individuals who experience psychological difficulties (Beck, 1976).

CBPT Theory (cont. ) � In adults distortions are considered irrational. In children they are considered maladaptive. By nature children are illogical, egocentric, and concrete. � Psychopathology is a result of one’s perceptions of events-not the circumstances themselves-that determine how a person understands events. � *If we know the meaning that a person attaches to particular situations, we can predict his or her emotional reactions.

CBPT Theory Concepts � Intricate reciprocal interaction among cognitions, emotions, behaviors, and environment. � The play therapist seeks to reduce symptoms, modify attitudes, beliefs, and expectations. � CBPT places a strong emphasis on the child’s involvement in treatment and on a framework for the child’s participation by addressing issues of control, mastery, and responsibility for one’s own behavior change.

CBPT Process � It is brief � Time limited � Structured � Directive � Problem oriented � Depends on a sound therapeutic relationship which incorporates therapy as educational

Goal/Cure for CBPT � “Quieting down of the hyperactive organization” (Rachman, 1968). � Give children the opportunity to experience and to test reality of verbal or pictorial cognitions that are causally connected to their affect. � Modification or shift of the child’s ideational system.

Cognitive Treatment Components � Identifying Irrational Beliefs ◦ Therapist utilizes play to uncover these � Changing Irrational Beliefs (Bibliotherapy) ◦ Therapist utilizes play to replace irrational belief (Maladaptive) � Positive Self Statements ◦ Therapist verbalizes the benefits of changing maladaptive belief (“It will get easier”)

Behavioral Techniques � Shaping ◦ Therapist uses systematic desensitization � Exposure and Response Prevention ◦ Therapist models scenario without disaster � Positive Reinforcement (Contingency Management) ◦ Therapist praises with verbal and tangible reinforcers � Shaping Feelings Socially Appropriate Expression of ◦ Therapist gives words to feelings

CBPT and Young Children � Preoperational ◦ ◦ ◦ ◦ Thought Illogical - Attend to only one aspect at a time Concrete - Judgment Influenced by perceptions Egocentric Less Reflective in Thought Object vs. Label Symbolic Thought/Language Emerging No logical reasoning Representation of Object in its Absence

Clinical Implications � Match between developmental level of child and complexity of the intervention � Capitalize on child’s strengths � Decrease emphasis on complex linguistic cognitive tasks � Experiential

Clinical Implications (cont. ) � Help child develop match between behaviors and feelings � Learn to express maladaptive behaviors in more adaptive ways � Encourage language development regarding affect

Assessment Skills with Preschoolers and Young Children � Anxiety in Preschoolers ◦ Butterflies in my Stomach ◦ Worry Bee � ADHD in Young School Age Children ◦ Color your World (Activity) ◦ Beat the Clock (Activity)

Assessment Skills with Adolescents � Depression ◦ Painting/Drawing ◦ Theme Song (Activity) �Play my Theme Song �What do we talk about now? �What is your Theme Song? �How will you handle it if you don’t like the song?

Working Phase Preschooler (Aggressive, Impulsive, no Self Control) � Activities for Cognition � Activities for Behavior ◦ I like my neighbor who…. . ◦ Puppets ◦ Sandplay ◦ Candy Temptation (activity) ◦ Feeling Board (Flip Chart) ◦ Puppets

Working Phase School Age ADHD � Activities for Cognition � Activities for Behavior ◦ Feeling Word Game (Activity) ◦ Puppets ◦ Garbage Bag Technique ◦ ◦ ◦ Pick Up Sticks Slow Motion Game** Candy Temptation Jenga Blowing Bubbles ** Beat the Clock **

Working Phase Adolescents Depression � Activities for Cognition � Activities for Behavior ◦ A lot on my Plate (Activity) ◦ Anger Shield(Activity) ◦ Theme Song ◦ Clay vessel ◦ Stress Beaker (Activity) ◦ Journaling

Termination with Preschoolers � Activities ◦ ◦ for Termination Construction Paper Rings Calendar Pictures of self and therapist T-shirt

Termination with School Age Children � Activities ◦ ◦ for termination T-Shirt Plants Video Time Capsule

Termination with Adolescents � Activities ◦ ◦ for Termination Hero (Activity) Letter from Therapist Candle Lighting Ceremony Clay figure