The CBPT standard protocol
A structured, replicable protocol — a defined path for every difficulty.
What Cognitive Behavioral Play Therapy is
Cognitive Behavioral Play Therapy (CBPT) is a developmentally sensitive approach that combines the principles of cognitive behavioral therapy with the natural language of children: play. Through play, stories, drawings, role-play and symbolic play, children learn to recognize emotions, understand the links between situations, thoughts, feelings and behaviors, and practice new coping skills in a safe and engaging way.
CBPT is structured and goal-oriented, yet remains flexible and child-centered. The therapist uses play materials not only to build a trusting relationship, but also to explore the child’s difficulties, co-construct a shared formulation, and rehearse new ways of thinking and behaving. Parents and caregivers are typically involved as partners, supporting the generalization of skills across home, school and peer contexts.
The rationale for a standardized protocol
A defined protocol turns clinical intuition into a method that can be learned, taught and replicated. It gives the therapist a clear sequence — from assessment to relapse prevention — while preserving the flexibility each child requires.
Because the same structure applies across very different presentations — from anxiety and OCD to ADHD, depression, anger, oppositional behavior, selective mutism, phobias and elimination disorders — the protocol offers a single, coherent path that adapts its content to each difficulty without losing its evidence-based backbone.
How the standard CBPT protocol works
Five sequential steps that structure every course of therapy.
Assessment, engagement and case formulation
The therapist gathers information about the child’s difficulties and context, and builds a collaborative understanding of the problem.
- Clinical assessment and play observation: onset, frequency, intensity and impact of symptoms, alongside the child’s play themes, interaction style and regulation capacities.
- Parent and caregiver meetings: developmental history, family patterns, educational practices and current coping strategies. School information is included when relevant.
- Child-friendly case formulation: using drawings, puppets, cards or stories to model how situations, thoughts, emotions, body sensations and behaviors influence each other.
- Goal setting: clear, observable goals defined together with the family (fewer anger outbursts, more participation, reduced avoidance, better routines).
Psychoeducation and emotional literacy
Helping the child and family understand the presenting problem and learn the basic language of emotions and CBT.
- Normalizing and externalizing: difficulties are framed as understandable and changeable, often using metaphors (“worry monster,” “anger volcano,” “bossy thoughts”) to reduce shame and blame.
- Emotional vocabulary: through play and stories, children learn to differentiate emotions, recognize intensity levels and link feelings to events.
- Understanding the CBT model: in playful ways, the therapist shows how thoughts, feelings, body reactions and behaviors are connected, preparing the ground for later interventions.
Skill building through play
CBPT uses play to teach and practice specific cognitive and behavioral skills tailored to each disorder.
- Cognitive skills: noticing unhelpful thoughts, testing them and creating flexible alternatives via comic strips, thought-bubble games and puppet dialogues.
- Behavioral and regulation skills: breathing play, relaxation, positive self-talk, problem-solving steps and communication skills, practiced within play scenarios.
- Exposure and behavioral experiments: for anxiety, OCD, phobias or mutism, graded play-based exposure lets the child face feared situations while using new coping strategies.
- Reinforcement and strengths: progress supported through token systems, reward games and explicit recognition of the child’s strengths and efforts.
Parent work, environment and generalization
Parental involvement is central in CBPT, especially for behavioral and anxiety-related disorders.
- Parent guidance: sharing the formulation and skills, helping parents respond more consistently, and addressing patterns that maintain difficulties (overprotection, harsh discipline, accommodation of rituals).
- Home and school plans: session skills translated into simple weekly “missions” and routines, often involving teachers when needed.
- Monitoring change: charts, logs or simple scales to track behaviors, emotions and the use of new strategies.
Consolidation and relapse prevention
The final step stabilizes gains and prepares the child and family for future challenges.
- Review of goals and progress: comparing the initial situation with the current one, highlighting changes and helpful strategies.
- Relapse prevention stories: creating stories, games or “future movies” showing how the child can handle upcoming difficulties using their CBPT tools.
- Closure and transition: a meaningful ritual (certificate, “CBPT toolbox,” or skills booklet) reinforcing that difficulties may reappear, but the child now has resources to face them.
The same evidence-based structure, from assessment to relapse prevention — adapted to each child, replicable by every therapist.
One protocol, applied to specific childhood disorders
The protocol keeps its five steps while tailoring content to each presentation: ADHD (self-regulation, planning, frustration tolerance), childhood depression (behavioral activation, restructuring negative self-beliefs), anger and irritability (trigger awareness, alternative responses), elimination disorders (reducing shame and anxiety alongside medical care), generalized anxiety (externalizing worry, tolerating uncertainty), OCD (play-based exposure and response prevention), oppositional defiant disorder (emotion regulation, problem-solving, parent training), selective mutism (graded, safe steps toward verbal communication), and specific phobia (playful, graded exposure with coping skills).
Train in the CBPT standard protocol
Learn the full method, step by step, with the dedicated training program.
Explore CBPT training