Child-Centered Play Therapy (CCPT)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Child-Centered Play Therapy (CCPT) has been rated by the CEBC in the areas of: Anxiety Treatment (Child & Adolescent), Disruptive Behavior Treatment (Child & Adolescent) and Domestic/Intimate Partner Violence: Services for Victims and their Children.

Target Population: Children ages 3-10 who are experiencing social, emotional, behavioral and relational problems

For children/adolescents ages: 3 – 10

Brief Description

CCPT is a developmentally responsive, play-based mental health intervention for young children ages 3 to 10 who are experiencing social, emotional, behavioral and relational disorders. CCPT utilizes play, the natural language of children, and therapeutic relationship to provide a safe, consistent therapeutic environment in which a child can experience full acceptance, empathy, and understanding from the counselor and process inner experiences and feelings through play and symbols. In CCPT, a child’s experience within the counseling relationship is the factor that is most healing and meaningful in creating lasting, positive change. Based on person-centered principles, overarching goal of CCPT is to unleash the child’s potential to move toward integration and self-enhancing ways of being. Child outcomes following CCPT include decreased symptomatic behaviors and improvement in overall functioning.

Program Goals:

The goals of Child-Centered Play Therapy (CCPT) are:

  • Develop a more positive self-concept
  • Assume greater self-responsibility
  • Become more self-directing
  • Become more self-accepting
  • Become more self-reliant
  • Engage in self-determined decision making
  • Experience a feeling of control
  • Become sensitive to the process of coping
  • Develop an internal source of evaluation
  • Become more trusting of self

    Essential Components

    The essential components of Child Centered Play Therapy (CCPT) include:

    • Foundational Principles:
      • Children possess an innate capacity to strive toward growth and maturity. The play therapy relationship facilitates the development of that capacity.
      • Play is the children’s most natural medium of communication.
      • Play is the concrete expression of the child and is the child’s way of coping with their world.
      • Child’s feelings are often inaccessible at a verbal level and play provides a means through which conflicts can be resolved and feeling can be communicated.
    • Establish a Therapeutic Working Relationship with Child:
      • Therapists provide a playroom with carefully selected toys to match the developmentally appropriate communication style of children, which is play, thereby supporting the message that the counselor seeks to understand the whole child in the context of their world.
      • The therapist aims to sensitively understand a child from the child’s viewpoint so they can feel fully accepted, safe, and understood by the therapist.
      • By communicating sensitive understanding to child, the child can experience a sense of freedom to express self fully and process inner experiences through play and the therapeutic relationship
    • Facilitative Responses and Esteem Building:
      • Nine categories of responses utilized in CCPT include:
        • Tracking behavior
        • Reflecting content
        • Reflecting feeling
        • Returning responsibility
        • Facilitating creativity
        • Esteem-building
        • Facilitating relationship
        • Reflecting deeper meaning
        • Limit-setting
      • Reflecting content, feeling, and meaning responses as well as facilitating relationship responses express empathy toward the child, while returning responsibility and limit-setting responses provide opportunities for the child to experience emotional expression and regulation.
    • Therapeutic Limit Setting and Choice Giving:
      • All feelings, desires, and wishes of the child are accepted, but not all behaviors are accepted.
      • Several specific steps are utilized in therapeutic limit setting in CCPT:
        • (A) Acknowledge the child’s feelings wishes, and wants
        • C) Communicate the limit
        • (T) Target Acceptable Alternatives

    Child/Adolescent Services

    Child-Centered Play Therapy (CCPT) directly provides services to children/adolescents and addresses the following:

    • Trauma symptoms, academic and speech impairment, chronic illness, anxiety, aggression, attention problems, hyperactivity, and disruptive classroom behavior as well as co-morbid internalizing and externalizing problems impeding holistic development
    Services Involve Family/Support Structures:

    This program involves the family or other support systems in the individual's treatment: Regular, ongoing parent consultation is part of the CCPT protocol in clinical mental health settings; however CCPT has been delivered in school settings with limited parent participation.

    Delivery Settings

    This program is typically conducted in a(n):

    • Community Agency
    • Hospital
    • Outpatient Clinic
    • School

    Homework

    This program does not include a homework component.

    Languages

    Child-Centered Play Therapy (CCPT) has materials available in languages other than English:

    Chinese, Japanese, Korean, Mandarin, Russian

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

    Resources Needed to Run Program

    The typical resources for implementing the program are:

    • A playroom approximately 12 feet by 15 feet with shelves on two walls to provide space for toys and materials
    • Play is an essential part of communicative and emotional expression processes for children, so toys and materials for the playroom should be selected that facilitate a wide range of play activity, including toys from three broad toy categories: real life toys, aggressive toys, creative toys
    • Further recommendations for creating a fully equipped playroom, can be found at the following link: http://cpt.unt.edu/about-play-therapy/recommended-toy-list

    Minimum Provider Qualifications

    Licensed mental health provider who has received extensive training and supervision in the CCPT protocol which can include approved university coursework or postgraduate certification in CCPT (http://cpt.unt.edu/treatment-protocols/ccpt-overview#certification)

    Education and Training Resources

    There is a manual that describes how to implement this program, and there is training available for this program.

    Training Contact:
    • Dee C. Ray
      University of North Texas
      dept.: Center for Play Therapy

      phone: (940) 565-3864
    Training is obtained:

    Onsite

    Number of days/hours:

    UNT Center for Play Therapy hosts two levels of training needed for certification in Child-Centered Play Therapy: 1) Basics in CCPT 101: (12 hour training to teach basics of CCPT) and 2) CCPT Practice and Application (18 hour training to teach advanced skills in CCPT).

    Additional Resources:

    There currently are additional qualified resources for training:

    In addition, numerous universities and play therapy centers and institutes in the U.S. and internationally provide training in Child-Centered Play Therapy. A list of institutes offering training can be found at the following link: http://cpt.unt.edu/training/university-training-sites

    Implementation Information

    Since Child-Centered Play Therapy (CCPT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

    Show implementation information...

    Pre-Implementation Materials

    There are no pre-implementation materials to measure organizational or provider readiness for Child-Centered Play Therapy (CCPT).

    Formal Support for Implementation

    There is formal support available for implementation of Child-Centered Play Therapy (CCPT) as listed below:

    Implementation support is available through Center for Play Therapy, email: cpt@unt.edu, phone: 940-565-3864

    Fidelity Measures

    There are fidelity measures for Child-Centered Play Therapy (CCPT) as listed below:

    Play Therapy Skills Checklist: Instrument used to ensure treatment fidelity (Available through University of North Texas Center for Play Therapy, 940-565-3864; cpt.unt.edu)

    The CCPT Treatment Manual requires the use of the Play Therapy Skills Checklist (PTSC) to ensure fidelity of intervention protocol. The PTSC was first published in 2004, presented as a training and supervision instrument for CCPT. The PTSC was first used and presented in CCPT research in 2006 as a means of supervising play therapists who delivered CCPT in studies. The PTSC was reported as a supervision instrument in five studies throughout the 2000s. In three subsequent studies, the PTSC was reported in research and used to check fidelity of implementation yet specific adherence percentages were not reported. Two studies reported adherence percentages for CCPT fidelity implementation using the PTSC, each reporting adherence percentages of over 90%.

    The CCPT Treatment Manual provides instructions on how to use the PTSC to determine adherence to protocol. Instructions include full descriptions of verbal and non-verbal categories as well as procedures for coding. Additionally, the manual suggests that adherence above 90% indicates faithful implementation of CCPT protocol. Research on the PTSC reports a free marginal multirater kappa at .82 and an intraclass correlation coefficient at .95 indicating strong interrater reliability on the instrument.

    Implementation Guides or Manuals

    There are implementation guides or manuals for Child-Centered Play Therapy (CCPT) as listed below:

    Child-Centered Play Therapy Treatment Manual (Author: Dee Ray) which is available within the book, Advanced Play Therapy: Essential Conditions, Knowledge, and Skills for Child Practice (Author: Dee Ray)

    Research on How to Implement the Program

    Research has not been conducted on how to implement Child-Centered Play Therapy (CCPT).

    Relevant Published, Peer-Reviewed Research

    This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

    Child Welfare Outcome: Child/Family Well-Being

    Show relevant research...

    Kot, S., Landreth, G. L., & Giordano, M. (1998). Intensive Child-Centered Play Therapy with child witnesses of domestic violence. International Journal of Play Therapy, 7(2), 17-36. doi:10.1037/h0089421

    Type of Study: Randomized controlled trial
    Number of Participants: 22

    Population:

    • Age — 4-10 years (Mean=6.9 years)
    • Race/Ethnicity — 48.5% African American, 30.5% Caucasian, and 21% Hispanic
    • Gender — 13 Female and 9 Male
    • Status — Participants were children who witnessed domestic violence.

    Location/Institution: Battered women's shelters in a large metroplex area.

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    The purpose of this study was to determine the effectiveness of Child-Centered Play Therapy (CCPT) sessions every day for two weeks as an intervention for child witnesses of domestic violence. Participants were randomized to either CCPT or a control group. Measures utilized include the Joseph Pre-School and Primary Self-Concept Screening Test (JPPSST), Child Behavior Checklist (CBCL) and the Children's Play Session Behavior Rating Scale (CPSBRS). Results indicated children in CCPT as compared to those in the control group experienced a significant increase in self-concept; a significant decrease in external and total behavior problems; a significant increase in the play behavior of physical proximity to the therapist; and a significant increase in the play behavior of nurturing and creative play themes. Limitations include small sample size, reliance on self-reported measures, and lack of follow-up.

    Length of postintervention follow-up: None.

    Garza, Y., & Bratton, S. C. (2005). School-based Child-Centered Play Therapy with Hispanic children: Outcomes and cultural consideration. International Journal of Play Therapy, 14(1), 51-80. doi:10.1037/h0088896

    Type of Study: Randomized controlled trial
    Number of Participants: 29

    Population:

    • Age — 5-11 years
    • Race/Ethnicity — 100% Hispanic
    • Gender — 17 Male and 12 Female
    • Status — Participants were children identified with behavior problems.

    Location/Institution: Southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined the effects of Child-Centered Play Therapy (CCPT) compared to a curriculum-based small group intervention with Hispanic children referred for school counseling due to behavior problems. Children were assigned to treatment groups by random drawing within grade levels. Measures utilized include the Behavior Assessment Scale for Children (BASC), the Behavior Assessment System for Children-Parent Rating Scale (BASC-PRS), the Teacher Rating Scale (BASC-TRS), the Peabody Picture Vocabulary Test - Revised (PPVT-R) and the Clinical Evaluation of Language Fundamentals Third Edition (CELF-3). Results indicated that, according to parent report, children receiving CCPT showed statistically significant decreases in externalizing behavior problems when compared to the curriculum-based treatment group. Effect size calculations revealed that CCPT demonstrated a large treatment effect on externalizing behavior problems and a moderate treatment effect on internalizing behavior problems. Limitations include small sample size, generalizability due to ethnicity of participants, reliance on self-reported measures, and lack of follow-up.

    Length of postintervention follow-up: None.

    Ray, D. C., Schottelkorb, A., & Tsai, M. H. (2007). Play therapy with children exhibiting symptoms of attention deficit hyperactivity disorder. International Journal of Play Therapy, 16(2), 95-111. doi:10.1037/1555-6824.16.2.95

    Type of Study: Randomized controlled trial
    Number of Participants: 60

    Population:

    • Age — 5-11 years
    • Race/Ethnicity — 28 Caucasian, 21 Hispanic, 10 African American, and 1 Biracial
    • Gender — 48 Male and 12 Female
    • Status — Participants were young children identified with attention deficit disorder.

    Location/Institution: Three elementary schools in the southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined the effectiveness of Child-Centered Play Therapy (CCPT) for elementary school age children qualified as symptomatic of attention deficit/hyperactivity disorder (ADHD). Participants were randomly assigned to 1 of 2 treatment conditions: CCPT or reading mentoring (RM). Measures utilized include the Index of Teaching Stress (ITS), the Conners Teacher Rating Scale—Revised: Short Form (CTRS-R:S) and the Play Therapy Skills Checklist (PTSC). Results indicated that children who participated in 16 sessions of CCPT and RM demonstrated statistically significant improvement on the ADHD and student characteristics domains, as well as the Anxiety/Withdrawal and Learning Disability subscales of the ITS and the ADHD Index of the CTRS-R:S. Children who participated in CCPT demonstrated statistically significant improvement over RM children on the student characteristics domain and on the Emotional Lability and Anxiety/Withdrawal subscales of the ITS. Limitations include small sample size, reliance on self-reported measures, use of a nontreatment control group, and lack of follow-up.

    Length of postintervention follow-up: None.

    Ray, D. C., Blanco, P. J., Sullivan, J. M., & Holliman, R. (2009). An exploratory study of Child-Centered Play Therapy with aggressive children. International Journal of Play Therapy, 18(3), 162-175. doi:10.1037/a0014742

    Type of Study: Pretest-posttest with control group
    Number of Participants: 41

    Population:

    • Age — 6-11 years
    • Race/Ethnicity — 18 Caucasian, 13 Hispanic, 6 African American, and 4 Biracial
    • Gender — 26 Male and 15 Female
    • Status — Participants were young children identified with disruptive behaviors.

    Location/Institution: Four elementary schools in the southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined the effectiveness of Child-Centered Play Therapy (CCPT) to reduce aggressive behaviors as reported by teachers and parents. Children were assigned to the CCPT (n=19) treatment group or wait-list control (WC) group (n=23). Following postintervention administration of instruments, each WC-group child was placed in CCPT. Measures utilized include the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the Play Therapy Skills Checklist (PTSC). Results indicate that children who participated in 14 sessions of CCPT showed a moderate decrease in aggressive behaviors over children in the control group, according to effect sizes as reported by parents. Teachers reported that both groups significantly improved over time. Analysis also revealed that children assigned to CCPT decreased aggressive behaviors statistically significantly and children assigned to control group demonstrated no statistically significant difference. Limitations include lack of randomization, small sample size, reliance on self-reported measures, generalizable to children in Head Start program, use of a nontreatment control group, and lack of follow-up.

    Length of postintervention follow-up: None.

    Blanco, P. J., & Ray, D. C. (2011). Play therapy in elementary schools: A best practice for improving academic achievement. Journal of Counseling and Development, 89(2), 235-243. doi:10.1002/j.1556-6678.2011.tb00083.x

    Type of Study: Randomized controlled trial
    Number of Participants: 41

    Population:

    • Age — 4-11 years
    • Race/Ethnicity — 19 Caucasian, 14 Hispanic, 7 African American, and 1 Asian
    • Gender — 26 Male and 15 Female
    • Status — Participants were young children identified with disruptive behaviors in the Head Start Program.

    Location/Institution: Four elementary schools in the southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined the effectiveness of Child-Centered Play Therapy (CCPT) with 1st graders who are academically at risk. Children were randomly assigned into either CCPT (n=21) or wait list control group (WC, n=20) by school according to playroom space. Following postintervention administration of instruments, each WC-group child was placed in CCPT. Measures utilized include the Young Children’s Achievement Test (YCAT) and the Play Therapy Skills Checklist (PTSC). Results indicate that these 1st graders participating in CCPT demonstrated a statistically significant increase on the Early Achievement Composite of the YCAT when compared with children in the control group. Limitations include small sample size, reliance on self-reported measures, generalizable to children in Head Start program, use of a nontreatment control group, and lack of follow-up.

    Length of postintervention follow-up: None.

    Ray, D. C., Stulmaker, H. L., Lee, K. R., & Silverman, W. K. (2013). Child-Centered Play Therapy and impairment: Exploring relationships and constructs. International Journal of Play Therapy, 22(1), 13-27. doi:10.1037/a0030403

    Type of Study: Randomized controlled trial
    Number of Participants: 37

    Population:

    • Age — 6-8 years
    • Race/Ethnicity — 14 Latino/a, 12 African American, and 11 Caucasian
    • Gender — 29 Male and 8 Female
    • Status — Participants were young children with emotional and behavioral problems.

    Location/Institution: Four elementary schools in the southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    The purpose of this study was to investigate the use of Child-Centered Play Therapy (CCPT) as an intervention to improve children’s clinical levels of functional impairment associated with many emotional and behavioral problems in two phases. Of the 40 children, 20 were randomly assigned to the CCPT intervention group and 20 were assigned to the delayed-start control group. Measures utilized include the Impairment Rating Scale–Teacher (IRS). Results indicate the CCPT group demonstrated lower overall impairment. In following the CCPT group over time, children demonstrated drops in overall impairment, improvement in academic progress, and decreases in classroom problems. Additionally, they demonstrated large levels for peer relationships and academic progress indicating a strong relationship between intervention and these variables. Children in the control group demonstrated stagnant or increased levels of impairment when not receiving CCPT. However, following a mean of nine CCPT sessions, children in the control group demonstrated drops in impairment related to peer-relationships and classroom problems. Additionally, after participating in CCPT, the control group also demonstrated drops for overall impairment, teacher relationships, and academic progress. Impairment related to self-esteem demonstrated inconsistent relationships with CCPT. The CCPT intervention group demonstrated minor drops in means for impairment related to self-esteem. After an increase in the mean for impairment related to self-esteem following no intervention, the control group demonstrated a drop in the mean for impairment to self-esteem following the CCPT intervention. Limitations include small sample size, lack of control group on specific number of sessions, and use of a no-intervention control group, and lack of follow-up.

    Length of postintervention follow-up: None.

    Bratton, S. C., Ceballos, P. L., Sheely-Moore, A. I., Meany-Walen, K., Pronchenko, Y., & Jones, L. D. (2013). Head start early mental health intervention: Effects of Child-Centered Play Therapy on disruptive behaviors. International Journal of Play Therapy, 22(1), 28-42. doi:10.1037/a0030318

    Type of Study: Randomized controlled trial
    Number of Participants: 54

    Population:

    • Age — 6-8 years
    • Race/Ethnicity — 42% African American, 39% Hispanic, and 18% Caucasian
    • Gender — 34 Male and 19 Female
    • Status — Participants were young children identified with disruptive behaviors in the Head Start Program.

    Location/Institution: Four elementary schools in the southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined the effectiveness of Child-Centered Play Therapy (CCPT) with preschool children exhibiting disruptive behavior in the classroom. Participants were randomly assigned to the CCPT (n=27) or active control group (n=28). Participants were block randomized to account for differences in time for when consent forms were received. Participants were randomized per school to ensure equal amounts of participants in each group. Measures utilized include the Caregiver–Teacher Report Form (C–TRF). Results indicate CCPT children demonstrated a statistically significant decrease in disruptive behaviors compared with the RM group across 3 points of measurement. Analysis also showed that children receiving CCPT demonstrated statistically significant decreases in aggression and attention problems. Of the 27 children receiving CCPT, 21 children moved from clinical levels of behavioral concern at pretest to more normative levels of functioning following treatment. Limitations include small sample size, reliance on self-reported measures, generalizable to children in Head Start program, and lack of follow-up.

    Length of postintervention follow-up: None.

    Stulmaker, H. L., & Ray, D. C. (2015). Child-Centered Play Therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127-133. doi:10.1016/j.childyouth.2015.08.005

    Type of Study: Randomized controlled trial
    Number of Participants: 53

    Population:

    • Age — 6-8 years
    • Race/Ethnicity — 24 Caucasian, 11 African American, 11 Hispanic/Latino, 1 Asian, and 6 Biracial
    • Gender — 34 Male and 19 Female
    • Status — Participants were young children with anxiety symptoms.

    Location/Institution: Four elementary schools in the southwest United States

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    The purpose of this study was to explore the effects of Child-Centered Play Therapy (CCPT) on young children with anxiety symptoms. Participants were randomly assigned to the CCPT (n=27) or active control group (n=28). Participants were block randomized to account for differences in time for when consent forms were received. Participants were randomized per school to ensure equal amounts of participants in each group. Measures utilized include the Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2), the Play Therapy Skills Checklist (PTSC), and the Teacher Report Form (TRF). Results indicate children who received CCPT significantly decreased their overall levels of anxiety and worry. Limitations include small sample size, reliance on self-reported measures, participants who were in the play therapy group received twice as much time with counselors over children in the active control group, and lack of follow-up.

    Length of postintervention follow-up: None.

    References

    Ray, D. (2011). Advanced play therapy: Essential conditions, knowledge, and skill for child practice. New York: Routledge. (CCPT Treatment Manual) Readily available through centerforplaytherapy.com; Routledge.com or Amazon.com among other retailers

    Ray, D., Purswell, K., Haas, S., & Aldrete, C. (2017). Child-Centered Play Therapy-Research Integrity Checklist: Development, reliability, and use. International Journal of Play Therapy. Advance online publication. doi:10.1037/pla0000046

    Landreth, G. (2012). Play therapy: The art of the relationship (3rd ed.). New York: Routledge.

    Contact Information

    Name: Dee C. Ray, PhD, LPC-S, RPT-S
    Agency/Affiliation: Center for Play Therapy, University of North Texas
    Website: cpt.unt.edu
    Email:
    Phone: (940) 565-3864
    Fax: (940) 565-4461

    Date Research Evidence Last Reviewed by CEBC: March 2017

    Date Program Content Last Reviewed by Program Staff: July 2017

    Date Program Originally Loaded onto CEBC: August 2017