COGNITIVE BEHAVIORAL PLAY THERAPY
CBPT DEFINITION
CBPT is a developmentally appropriate therapeutic intervention designed specifically for young children (2 ½ – 8 years). Through this intervention, the child takes an active role in the process of change and mastery of the problems.
CBPT is based on cognitive and behavioral theories of emotional development and psychopathology. In particular, it derives from Cognitive Therapy (CT), conceptualized by Aaron Beck (1964, 1976).
In order for an intervention to be appropriate, its complexity must consider the child’s developmental stage. The CBPT therapist should:
- focus on the child’s strength and abilities rather than focusing on weaknesses;
- focus on experiential interventions that incorporate play rather than complex and verbal skills;
- encourage and facilitate language to described experiences and emotions.
The child’s vocabulary is still often quite limited. Young children often benefit from the opportunity to learn to associate behaviors with their feelings and express feelings in more adaptive language-based ways.
The Cognitive Therapy (CT) and child development
CT is a structured and directed approach to help individuals change their dysfunctional thoughts and behaviors. It is based on the cognitive model of emotional disorders, whereby maladaptive or disturbed behavior is considered an expression of irrational thinking. CT focuses on the cognitions and modification, in particular of irrational, maladaptive or illogical thinking.
This model, developed for adults, is applicable to children too, but young children do not have sufficient cognitive skills and flexibility to benefit from CT. CT requires the ability to follow a logical and rational sequence and the ability to distinguish between rational and irrational / logical and illogical thinking, skills that have not yet developed.
In the preoperational stage of the child’s development, thinking is self-centered, concrete and irrational by nature, and action may precede thinking due to cognitive immaturity or impulsiveness.
These characteristics make the use of CT problematic, thus, it is necessary to adapt it to practice with children and adolescents, in order to guarantee a more adequate approach to their development.
Knell and her colleagues have demonstrated that cognitive behavioral therapy can be communicated to children through play (Knell, 1993a, 1994, 1997, 1998, 1999; Knell & Moore, 1990; Knell & Ruma, 1996, 2003; Knell & Dasari, 2006).
CT adaptations to younger populations involves a modification of its methodologies but not of its theoretical foundation. One of the biggest challenges in the development of CBPT has been to find a way to adapt CT to child development without relying on sophisticated language.
ORIGINS OF CBPT
Knell (1998) built on the ideas of Beck (1976), Ellis (1971), Bandura (1977), and others. She used play therapy to help children. Her approach was structured, directive, and goal-oriented. She taught children new ways to play, solve problems, and build relationships. CBPT includes assessing the child. The therapist then creates a custom plan to improve behavior.(p. 30). The therapist recreates scenes from the child’s life. They use modeling, role-playing, desensitization, and other techniques to change behavior (Knell, 1998).
According to Knell (1993a, 1993b, 1994, 1997, 1998), CT could be applied to children if presented in a way accessible to them.
Puppets, stuffed animals, books and other toys can be used to model children’s cognitive strategies, verbalizing the ability to solve problems or find possible solutions to a problem similar to the child’s.
CBPT, as conceptualized by Knell (1993a, 1993b, 1994, 1997, 1998, 1999, 2000; Knell & Moore, 1990; Knell & Ruma, 1996, 2003; Knell & Beck, 2000, Knell & Dasari, 2006) was developed for use with children between 2½ and 8 years and is based on cognitive, behavioral and traditionally therapies. CBPT is sensitive to developmental issues and emphasizes the empirical validation of effectiveness of interventions.
TREATMENT DESCRIPTION: CBPT STAGES
ORIENTATION
During the initial interview, the therapist must help the parents understand how best to prepare the child for their first session and what explanation may be most developmentally suitable for him. So, can be recommended books such as “A Child’s First Book About Play Therapy” (Nemiroff & Annunziato, 1990).
ASSESSMENT
The aim of assessment is to define the targets and a treatment plan. In addition to a parent interview, it is important to provide a observation of familiar play and observation of child spontaneous play. In summary, the assessment includes parent report inventories (e.g., Child Behavior Checklist, Achenbach, 1991), familiar and children play assessment, The Puppet Sentence Completion task (Knell, 1992; Knell, 1993a; Knell, 2018, Knell & Beck, 2000) or therapist-created measures.
CASE CONCEPTUALIZATION
Case conceptualization in cognitive behavioral play therapy is critical to understanding how the child functions and why he/she enacts certain behaviors. It is achieved by integrating assessment data with a focus on clinically relevant behaviors through the cognitive behavioral play therapy model. It is aimed at effective treatment planning and provides the rationale and structure for developing and prioritizing treatment goals.
In cognitive behavioral play therapy, the basic elements of a case conceptualization are logically and consistently connected are:
- the description of individual factors
- the description of relational factors
- the description of environmental factors
- the presenting problems
- the risk, protective and maintenance factors
The description of individual, relational, and environmental factors define the child’s background, presenting problems is the reason why the caregiver or family seeks CBT for their child, and risk, protective, and maintenance factors govern the child’s developmental trajectory and are analyzed taking into account the influence single factors may have (Geraci,2022).
INTERVENTION
The therapist develops a treatment plan and the therapy focuses on increasing and reinforcement of the child’s self-control, sense of accomplishment, and learning more adaptive responses to deal with specific situations. Depending on the presenting problem, the therapist chooses the most appropriate cognitive and behavioral interventions using specific play techniques, to which the child responds most. The interventions must be evaluated carefully, with as much specificity as possible related to the intervention and the child’s specific problems/concerns.
CONCLUSION
During this phase, the child and the family are prepared for the end of therapy. As the treatment nears its end, the child deals with the reality of termination and faces the feelings connected to it.
BIBLIOGRAPHY CBPT
- Achenbach (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.
- Axline, V. (1947). Play therapy. New York: Ballantine Books.
- Bandura A. (1977). Social Learning Theory, Prentice Hall, Englewood Cliffs, NJ.
- Beck A. (1964). Thinking and depression: 2. Theory and therapy. In Archives of General Psychiatry, 10.
- Beck A. (1976). Cognitive therapy and emotional disorders, New York: Meridian. T.
- Ellis (1971). An experiment in emotional education. Educational Technology, Reprinted: New York, Institute for Rational-Emotive Therapy.
- Knell, S. M. (1993a). To show and not tell: Cognitive-Behavioral Play Therapy in the treatment of Elective Mutism. In T.Kottman & C.Schaefer (Eds.) Play Therapy in Action: A casebook for practitioners. (pp. 169-208). New Jersey: Jason Aronson.
- Knell, S. M. (1993b). Cognitive-behavioral play therapy. Northvale, NH: Jason Aronson.
- Knell, S. M. (1994). Cognitive-Behavioral Play Therapy. Directions in child and Adolescents Therapy. (pp.1-13). New York: The Hatherleigh Company, Ltd (Reprinted in The Hatherleigh Guide to Child and Adolescent Therapy).
- Knell, S.M. (1997). Cognitive-Behavioral Play Therapy. In K. O’Connor & L. Mages (Eds.). Play Therapy Theory and Practice: A comparative presentation(pp.79-99). New York: John Wiley and Sons.
- Knell, S. M. (1998a). Cognitive-behavioral play therapy. Journal of Clinical Child Psychology, 27, 28-33.
- Knell S. (1998b) Il gioco in psicoterapia : nuove applicazioni cliniche, Edizione italiana a cura di Francesca Pergolizzi McGraw-Hill Companies
- Knell, S.M. (1999). Cognitive-Behavioral Play therapy. In S.W. Russ & T. Ollendick (Eds.) Handbook of psychotherapies with children and families (pp.385-404) NY: Plenum
- Knell S.M. (2000). Cognitive-Behavioral Play Therapy with children with fears and phobias. In H.G. Kaduson & C.E.Schaefer (Ed.). Short term therapies with children(pp.3-27). NY:Guilford.
- Knell, S.M. (2018). Puppet Sentence Completion Task. In A.A. Drewes & C.E. Schaefer (Eds.). Puppets in Play Therapy: A Practical Guidebook. (pp. 59-73). Routledge Press.
- Knell, S.M. & Moore, D. J. (1990). Cognitive-behavioral play therapy in the treatment of encopresis. Journal of Clinical Child Psychology, 19(1), 55-60.
- Knell, S.M. & Ruma, C. D. (1996). Play therapy with a sexually abused child. In M. Reinecke, F.M. Dattilio, & A. Freeman (Eds.). Cognitive therapy with children and adolescents: a casebook for clinical practice (pp.367-393). NY: Guilford.
- Knell, S.M. & Ruma, C.D. (2003). Play Therapy with a sexually abused child. In M.A. Reinecke, F.M. Dattilio & A.Freeman (Eds.). Cognitive Therapy with children and Adolescents: a casebook for cli ical practice. (2nd ed.) (pp. 338-368). NY:Guilford.
- Knell, S.M.& Beck, K.W. (2000). Puppet Sentence completion Task. In K Gitlin-Weiner, A. Sandgrund, & C.E. Schaefer. (Eds.) Play Diagnosis and Assessment, 2nded. (pp. 704-721). NY: Wiley.
- Knell, S.M. & Dasari M. (2006). Cognitive-Behavioral Play Therapy for Children with Anxiety and Phobias. In H.G. Kaduson & C.E. Schaefer (Ed.). Short term therapies with children (2nd ed.) (pp.22-50). NY:Guilford.
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