Trauma-Focused Integrated Play Therapy - Detailed Report

Scientific Rating:

Not able to be Rated
See scale of 1-5

Scientific Rating:

NR - Not able to be Rated

On a scale of 1-5

Relevance to Child Welfare Rating:

Not able to be Rated
See scale of 1-3

Relevance to Child Welfare Rating:

NR - Not able to be Rated

On a scale of 1-3

Type of Maltreatment: Sexual abuse

Target Population: Young sexually abused children who may be victims of other forms of trauma as well, including physical abuse, neglect, witnessing domestic violence, placement in foster care, etc.

Brief Description:(The information in this program outline is provided by the program representative and edited by the CEBC staff.)

The Trauma-Focused Integrated Play Therapy has been reviewed by the CEBC in the area of Trauma Treatment for Children, but lacks the necessary research evidence to be given either a Scientific Rating or a Child Welfare Relevance Rating. Trauma-Focused Integrated Play Therapy (TFIPT) is a program that utilizes a combination of directive and nondirective approaches in order to advance structured, goal-oriented therapy for abused children and their families. TFIPT attends to the developmental needs of young children, incorporates the scientific and practice literature, as well as evidence-based practices currently available, and promotes resolution of traumatic events by direct or indirect processing of traumatic incidents. This model includes a focused interest in facilitating, encouraging, and allowing nondirective play therapy which often leads to children’s discovery and utilization of post-traumatic play, a unique form of play which is a spontaneous occurrence with young children who experience psychic trauma. Post-traumatic play appears to be a child’s natural way to introduce gradual exposure, narrative formation, and trauma processing. Incorporating the curative factors of expressive therapy techniques (e.g., play, art, and sand therapy techniques) as valuable therapy components in and of themselves, rather than as a way to primarily engage or teach children or advance other goals, is also a distinctive feature of this approach.

Essential Components

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A structured twelve-week approach based on the three phases of treatment developed by Judith Herman: 1) The establishment of safety; 2) A direct focus on traumatic material and processing; and 3) Social reconnection and orientation to future.
A specific beginning and ending includes children’s use of an affective identification and scaling worksheet in which they identify their feelings (as they enter and leave therapy) and the intensity of that feeling.
A specific beginning and ending also includes the use of a structured mindfulness breathing exercise after and before affective identification and scaling when the session starts and ends.
A period of nondirective play therapy is allowed in each treatment session and the session is provided in a play therapy office that is stocked with the basic tools of a trained play therapist.
The clinician assesses for the potential use of post-trauma play; document play themes; and generally allow and encourage the child to use play as a form of gradual exposure to traumatic events.
The clinician ensures that literal (toy) symbols of specific aspects of the child’s trauma may be available in the play therapy office.
Four or five play-based techniques are used both as therapeutic experiences as well as to inform an assessment of the child’s overall functioning, his or her perceptions of the environment and important relationships, affective expression and communication styles (including verbal and nonverbal methods).
During the middle phase of treatment, clinicians may utilize more directive methods to direct children’s attention to traumatic incidents.
Clinicians assist children in creating trauma narratives that can be completed in verbal or nonverbal ways.
Clinicians provide children with psychoeducation to correct negative thoughts, to encourage affective expression, and to identify adults who can provide assistance, support, and nurturance to children.
Termination sessions provide children with opportunities to say meaningful goodbyes, to view their lives in a more balanced way (that is, a life that has included positive and negative events), and encourages the development of optimism.
Clinicians also teach children about how their brains work in order to support them making good choices and feeling more in control.
Relaxation techniques are also taught throughout to encourage children to learn how to calm themselves. Children are given the opportunity to use “bio-dots” (similar to mood rings) to actually see the changes that can occur in their bodies as they control their breathing and relax their muscles.
Parents receive coaching as needed during the intake session and throughout the therapy process.
Parents are informed about TFIPT and are shown a manual that includes the lessons their children will receive.
Parents have ample opportunity to ask questions, receive specific psychoeducational materials, and request additional services.
Parents may participate in nonoffending parent groups or may be referred for individual treatment.
Parents check in with children’s therapists on an as-needed basis and clinicians keep them informed of children’s progress.

Group Format

Trauma-Focused Integrated Play Therapy was designed to be conducted in a group.

Trauma-Focused Integrated Play Therapy has not been tested for use in a group setting.

The recommended group size is: Eight

Recommended Parameters

Recommended intensity: Weekly one-hour session.

Recommended duration: Three - six months

Homework

Trauma-Focused Integrated Play Therapy includes a homework component.

Description: Children are asked to teach their parents a variety of play-based strategies (such as relaxation, mindful breathing, affective scaling, etc.)

Delivery Setting

Trauma-Focused Integrated Play Therapy is typically conducted in a(n): Community Agency and Outpatient Clinic.

Parent Component

Trauma-Focused Integrated Play Therapy was designed with a Parent Component.

Trauma-Focused Integrated Play Therapy addresses the following presenting problems and symptoms: Parent of a child who has been sexually abused

Child Component

Trauma-Focused Integrated Play Therapy was designed with a Child Component.

Trauma-Focused Integrated Play Therapy addresses the following presenting problems and symptoms: Range of internatlizing or externalizing behaviors as measured by psychological instruments (e.g., fear and anxiety, aggression, and sexual acting out).

Age range(s): 5-17

Trauma-Focused Integrated Play Therapy was not developed for children with developmental delays.

Trauma-Focused Integrated Play Therapy has not been tested for children with developmental delays.

Languages

Trauma-Focused Integrated Play Therapy has materials available in a language other than English.

Language(s) available:

Spanish. For information on which materials are available in this language, please check on the program's website or contact the program representative (all contact information is listed at the bottom of this page).

Education and Training Resources

There is a manual that describes how to implement this program.

There is training available for Trauma-Focused Integrated Play Therapy.

Training contact: Eliana Gil, PhD, Email: emgil@earthlink.net, Phone: 703-208-1519

Number of days/hours: Training is usually best provided in two days

Training is obtained: Training provided through a small training program called Starbright Training Institute

There currently are additional qualified resources for training.

List of additional qualified resources: Dr. Georgianna Achilles, Dr. Jennifer Shaw, Dr. Megan Fiore, Maria Ines Butler, and Nicole Jalazo, staff members of Childhelp Children’s Center of Virginia (Fairfax, VA). In addition, Sarah Briggs from Creative Therapy Associates in Fairfax, VA, is also available to provide trainings.

Identified Resources Necessary to Implement Program

The typical resources for implementing Trauma-Focused Integrated Play Therapy are: Play therapy offices, one-way mirror, VCR with monitor, overhead projectors, break out rooms.

Minimum Provider Qualifications

-Licensed mental health professionals or trainees working under licensed professionals;
-At least three years experience of direct work with abused children and their families;
-Basic training in child trauma and sexual abuse (at least five days);
-Basic training in expressive therapy (at least five days)
-Basic training in this specific model (at least two days).

Relevant Published, Peer-Reviewed Research

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Trauma-Focused Integrated Play Therapy has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated. " It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR – Not able to be Rated" classification, please see the Scientific Rating Scale.

There are currently no published, peer-reviewed research studies for Trauma-Focused Integrated Play Therapy.

References

Show References

Gil, E. (2006). Helping abused and traumatized children: Integrating directive and nondirective approaches. New York: Guilford Press.

Contact Information

Contact name: Eliana Gil, PhD

Affiliation/Agency: Childhelp Children’s Center of Virginia

Email: emgil@earthlink.net

Phone: 703-208-1519

Fax: 703-208-1540

Date reviewed: December 2009 (originally reviewed in May 2006)