Child-Centered Play Therapy (CCPT)

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

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.

Dee C. Ray, PhD, LPC-S, RPT-S

• Agency/Affiliation: Center for Play Therapy, University of North Texas
• Website: http://cpt.unt.edu
• Email: dee.ray@unt.edu
• Phone: (940) 565-3864

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

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 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

Recommended Intensity

In clinical setting, 45-minute weekly individual play sessions; in school setting, 30-minute twice weekly sessions

Recommended Duration

In clinical setting, 16-20 weeks; in school setting, 8 weeks

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Hospital
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

This program does not include a homework component.

Languages

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

• Chinese
• Japanese
• Korean
• Mandarin
• Russian

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in 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 https://cpt.unt.edu/recommended-toy-list

Prerequisite/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 (https://cpt.unt.edu/child-centered-play-therapy-certification)

Manual Information

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

Program Manual(s)

Ray, D. (2011). Advanced play therapy: Essential conditions, knowledge, and skill for child practice. Routledge.

Readily available through Routledge's or Amazon's website among other retailers.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

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).

Pre-Implementation Materials

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

Formal Support for Implementation

There is formal support available for implementation of Child-Centered Play Therapy 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 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.

Established Psychometrics

Ray, D. C., Purswell, K., Haas, S., & Aldrete, C. (2017). Child-Centered Play Therapy-Research Integrity Checklist: Development, reliability, and use. International Journal of Play Therapy, 26(4), 207–217. https://doi.org/10.1037/pla0000046

Implementation Guides or Manuals

There are implementation guides or manuals for Child-Centered Play Therapy 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)

Implementation Cost

There are no studies of the costs of Child-Centered Play Therapy.

Research on How to Implement the Program

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

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• 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. https://doi.org/10.1037/h0089421

  Type of Study: Randomized controlled trial

  Participants: 22

  Sample / Population:

  • Age — 4–10 years (Mean=6.9 years)
  • Race/Ethnicity — 49% African American, 31% 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:

  The purpose of the 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), the Child Behavior Checklist (CBCL) and the Children's Play Session Behavior Rating Scale (CPSBRS). Results indicate that 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 controlled 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. https://doi.org/10.1037/h0088896

  Type of Study: Randomized controlled trial

  Participants: 29

  Sample / 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:

  The purpose of the study was to examine 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. Participants 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, lack of generalizability due to the ethnicity of participants, reliance on self-reported measures, and lack of follow-up.

  Length of controlled 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. https://doi.org/10.1037/1555-6824.16.2.95

  Type of Study: Randomized controlled trial

  Participants: 60

  Sample / 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:

  The purpose of the study was to examine 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 controlled 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 & Development, 89(2), 235–243. https://doi.org/10.1002/j.1556-6678.2011.tb00083.x

  Type of Study: Randomized controlled trial

  Participants: 41

  Sample / 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:

  The purpose of the study was to examine the effectiveness of Child-Centered Play Therapy (CCPT) with first graders who were academically at risk. Participants were randomly assigned into either CCPT or waitlist control group (WC) by school according to playroom space. Following postintervention administration of instruments, each WC-group participant was placed in CCPT. Measures utilized include the Young Children’s Achievement Test (YCAT) and the Play Therapy Skills Checklist (PTSC). Results indicate that the first 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 only to children in the Head Start program, use of a nontreatment control group, and lack of follow-up.

  Length of controlled 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. https://doi.org/10.1037/a0030403

  Type of Study: Randomized controlled trial

  Participants: 37

  Sample / 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:

  The purpose of the 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. Participants were randomly assigned to the CCPT intervention group or to the delayed-start control group. Measures utilized include the Impairment Rating Scale–Teacher (IRS). Results indicate that 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. Limitations include small sample size, lack of control group on specific number of sessions, use of a no-intervention control group, and lack of follow-up.

  Length of controlled 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. https://doi.org/10.1037/a0030318

  Type of Study: Randomized controlled trial

  Participants: 54

  Sample / 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:

  The purpose of the study was to examine the effectiveness of Child-Centered Play Therapy (CCPT) with preschool children exhibiting disruptive behavior in the classroom. Participants were randomly assigned to the CCPT or to the active control, reading mentoring (RM). 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 that 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 only to children in the Head Start program, and lack of follow-up.

  Length of controlled 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. https://doi.org/10.1016/j.childyouth.2015.08.005

  Type of Study: Randomized controlled trial

  Participants: 53

  Sample / Population:

  • Age — 6–8 years
  • Race/Ethnicity — 24 Caucasian, 11 African American, 11 Hispanic/Latino, 6 Biracial, and 1 Asian
  • 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:

  The purpose of the study was to explore the effects of Child-Centered Play Therapy (CCPT) on young children with anxiety symptoms. Participants were randomly assigned to CCPT or active control groups. 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 that 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 controlled postintervention follow-up: None.

• Blanco, P. J., Holliman, R. P., Ceballos, P. L., & Farnam, J. L. (2019). Exploring the impact of Child-Centered Play Therapy on academic achievement of at-risk kindergarten students. International Journal of Play Therapy, 28(3), 133–143. https://doi.org/10.1037/pla0000086

  Type of Study: Randomized controlled trial

  Participants: 36

  Sample / Population:

  • Age — 5–6 years
  • Race/Ethnicity — 16 Caucasian, 11 Hispanic/Latino, 3 African American, 2 Asian American, 2 Native American, and 1 Biracial
  • Gender — Not specified
  • Status —

    Participants were children considered academically at risk.

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

  Summary:

  The purpose of the study was to examine the effectiveness of Child-Centered Play Therapy (CCPT) on academic achievement. Participants were placed into one of two treatment groups (CCPT or a waitlist control group) using random assignment which were stratified by the schools. Measures utilized include the Young Children’s Achievement Test (YCAT). Results indicate that the kindergarten students participating in the experimental group in this study demonstrated a statistically significant increase on the Early Achievement Composite of the YCAT when compared to children in the waitlist control group. Limitations include a sample that was limited to a specific age range as well as being limited to a small number of schools in a particular geographic region, which limits generalizability; and did not implement the use of an alternative treatment.

  Length of controlled postintervention follow-up: None.

• Taylor, L., & Ray, D. C. (2021). Child-Centered Play Therapy and social–emotional competencies of African American children: A randomized controlled trial. International Journal of Play Therapy, 30(2), 74–85. https://doi.org/10.1037/pla0000152

  Type of Study: Randomized controlled trial

  Participants: 37

  Sample / Population:

  • Age — 5–10 years (Mean=6.68 years)
  • Race/Ethnicity — 100% African American
  • Gender — 29 Male and 8 Female
  • Status —

    Participants were African American children who were referred by the teacher or school counselor due to problematic school behaviors.

  Location/Institution: Four Title I elementary schools in the Southwestern United States

  Summary:

  The purpose of the study was to examine the impact of Child-Centered Play Therapy (CCPT) on the social–emotional competencies of African American children. Participants were randomly assigned through block randomization procedures by school to the CCPT experimental group or to the waitlist control group (WC). Measures utilized include the Social Emotional Assets and Resilience Scale-Parent and Teacher reports. Results indicate that parents reported statistically and practically significant improvement for children who participated in CCPT in overall social–emotional competence when compared with children in the WC group. Teachers reported practically significant improvement of children in CCPT as compared to the WC group. Follow-up analysis revealed statistically significant improvement in children’s empathy as reported by parents and responsibility as reported by teachers. Limitations include limited sample size, lack of generalizability due to the sample including primarily male students from lower-income and single-parent families, and lack of follow-up.

  Length of controlled postintervention follow-up: None.

• Ray, D. C., Burgin, E., Gutierrez, D., Ceballos, P., & Lindo, N. (2022). Child‐Centered Play Therapy and adverse childhood experiences: A randomized controlled trial. Journal of Counseling & Development, 100(2), 134–145. https://doi.org/10.1002/jcad.12412

  Type of Study: Randomized controlled trial

  Participants: 120

  Sample / Population:

  • Age — 5–9 years (Mean=6.34 years)
  • Race/Ethnicity — 48 White, 28 African American, 24 Latino, 19 Mult-Cultural, and 1 Asian
  • Gender — 91 Male and 29 Female
  • Status —

    Participants were in kindergarten through third grade at one of the recruiting schools and a caregiver report of a minimum of two ACEs.

  Location/Institution: Five Title I elementary schools in the Southwestern United States

  Summary:

  The purpose of the study was to explore the impact of Child-Centered Play Therapy (CCPT) among children with two or more adverse childhood experiences (ACEs) on improvement of social and emotional assets and behavioral problems. Participants were randomly assigned through block randomization procedures by school to the CCPT group or to the waitlist control group (WC). Measures utilized include Social Emotional Assets and Resilience Scales—Parent (SEARS-P), the ACE-E Measure, and the Direct Observation Form (DOF). Results indicate that there were statistically significant increases in social-emotional competencies including empathy, social competence, and self-regulation/responsibility and decreases in total behavior problems among children who participated in CCPT. Limitations include the use of the ACE-E measure due to the reliance on parent self-reports and there was no standardized expanded version of the ACEs questionnaire available for the current study, the likelihood that ACEs were underreported for participants, and the overrepresentation of males comprising 76% of the sample.

  Length of controlled postintervention follow-up: None.

• Bratton, S., Ray, D., Edwards, N., & Landreth, G. (2009). Child-centered play therapy (CCPT): Theory, research, and practice. Person-Centered and Experiential Psychotherapies, 8(4), 266-281. https://doi.org/10.1080/14779757.2009.9688493

• Landreth, G., Ray, D., & Bratton, S. (2009). Play therapy in elementary schools. Psychology in the Schools, 46(3), 281-289. https://doi.org/10.1002/pits.20374

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