Cognitive Behavioral Play Therapy (CBPT)

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

2. 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)

3. 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).

4. 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.

5. 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.

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

7. 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.

8. 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”)

9. 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 Socially Appropriate Expression of Feelings • Therapist gives words to feelings

10. 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

11. 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

12. 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

13. 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)

14. 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?

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

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

17. Working Phase AdolescentsDepression • Activities for Cognition • A lot on my Plate (Activity) • Anger Shield(Activity) • Theme Song • Activities for Behavior • Clay vessel • Stress Beaker (Activity) • Journaling

18. Termination with Preschoolers • Activities for Termination • Construction Paper Rings • Calendar • Pictures of self and therapist • T-shirt

19. Termination with School Age Children • Activities for termination • T-Shirt • Plants • Video • Time Capsule

20. Termination with Adolescents • Activities for Termination • Hero (Activity) • Letter from Therapist • Candle Lighting Ceremony • Clay figure