Cognitive Behavioral Play Therapy
A developmentally appropriate, evidence-based intervention that lets young children take an active role in change — through play, not complex verbal skills.
What Cognitive Behavioral Play Therapy is
CBPT is a developmentally appropriate therapeutic intervention designed specifically for young children (2½–8 years). Through this intervention, the child takes an active role in the process of change and mastery of their 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).
For an intervention to be appropriate, its complexity must consider the child's developmental stage. The CBPT therapist should:
- Focus on the child's strengths and abilities rather than weaknesses
- Favor experiential interventions that incorporate play rather than complex verbal skills
- Encourage and facilitate language to describe experiences and emotions
The child's vocabulary is still often limited; young children benefit from learning to associate behaviors with feelings and to express feelings in more adaptive, language-based ways.
Cognitive Therapy and child development
CT is a structured, directive approach that helps individuals change dysfunctional thoughts and behaviors. It is based on the cognitive model of emotional disorders, whereby maladaptive behavior is seen as an expression of irrational thinking; CT focuses on modifying irrational, maladaptive or illogical thinking.
Developed for adults, CT is applicable to children too — but young children lack sufficient cognitive skills and flexibility to benefit from it directly (following a logical/rational sequence; distinguishing rational from irrational). In the preoperational stage, thinking is self-centered, concrete and irrational, and action may precede thought.
Knell and colleagues demonstrated that CBT can be communicated to children through play (Knell, 1993a, 1994, 1997, 1998, 1999; Knell & Moore, 1990; Knell & Ruma, 1996, 2003; Knell & Dasari, 2006). Adapting CT to children modifies the methodology, not the theoretical foundation: the challenge was to adapt CT to child development without relying on sophisticated language.
The 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 with a structured, directive, goal-oriented approach — teaching new ways to play, solve problems and build relationships.
CBPT includes assessing the child and then creating a custom plan to improve behavior; the therapist recreates scenes from the child's life using modeling, role-playing, desensitization and other techniques (Knell, 1998). Puppets, stuffed animals, books and other toys model cognitive strategies and problem-solving. CBPT was developed for children between 2½ and 8 years and is based on cognitive, behavioral and traditional therapies; it is sensitive to developmental issues and emphasizes empirical validation.
Clinical applications of CBPT
Evidence-based CBPT protocols for the conditions clinicians treat most. Open any condition to see how the method assesses, structures treatment and involves parents.
Selective Mutism
See how CBPT builds the alliance and uses graded, play-based steps to help the child speak again.
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Specific Phobia
How CBPT treats children’s phobias — graded exposure and coping skills rehearsed safely through play.
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Oppositional Defiant Disorder
The CBPT approach to defiant behaviour: shaping cooperation and coaching parents, session by session.
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Obsessive Compulsive Disorder
Applying CBPT to childhood OCD — play-adapted exposure and response prevention children can tolerate.
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ADHD
How CBPT supports attention and self-regulation, with play-based strategies for focus and impulse control.
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Generalized Anxiety Disorder
CBPT for persistent childhood worry — restructuring anxious thinking and teaching coping through play.
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Childhood Depression
How CBPT lifts low mood through behavioural activation and cognitive work within a play context.
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Childhood Anger
The CBPT method for anger and emotion regulation — spotting triggers and building self-control skills.
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Elimination Disorders
How CBPT addresses encopresis and enuresis with behavioural routines, de-shaming and parent coaching.
Read more →Treatment description: the CBPT phases
CBPT unfolds across five structured phases, each building on the previous one.
Orientation
In the initial interview the therapist helps parents understand how to prepare the child for the first session and what explanation is developmentally suitable. Books such as "The World of Doctor Lulù: Preparing children for Cognitive Behavioral Play Therapy" (Geraci, 2024) can be recommended.
Assessment
Aims to define targets and a treatment plan. It includes a parent interview, observation of familiar play and of the child's spontaneous play, parent report inventories (e.g., the Child Behavior Checklist, Achenbach, 1991), family and child play assessment, the Puppet Sentence Completion Task (Knell, 1992; 1993a; 2018; Knell & Beck, 2000), or therapist-created measures.
Case conceptualization
Critical to understanding how the child functions and why they enact certain behaviors; it integrates assessment data through the CBPT model for treatment planning. Basic elements:
- Individual factors
- Relational factors
- Environmental factors
- Presenting problems
- Risk, protective and maintenance factors
(Geraci, Dasari, Knell, 2022)
Intervention
The therapist develops a treatment plan; therapy increases and reinforces the child's self-control, sense of accomplishment and adaptive responses. The therapist chooses appropriate cognitive and behavioral interventions using specific play techniques, evaluated with specificity to the child's problems.
Conclusion
The child and family are prepared for the end of therapy; the child deals with termination and the feelings connected to it.
Case conceptualization at the core
At the heart of the method, case conceptualization integrates assessment data through the CBPT model to drive a tailored treatment plan, organized around five basic elements:
- Individual factors
- Relational factors
- Environmental factors
- Presenting problems
- Risk, protective and maintenance factors
(Geraci, Dasari, Knell, 2022)
The tools of CBPT
CBPT speaks the child's language through dedicated tools: puppets create an atmosphere of free expression and projection; therapeutic storytelling turns narrative into a vehicle of change; and expressive arts give shape to emotions that have no words. Each tool is combined with cognitive-behavioral techniques such as modeling and role-play.
Evidence and scientific direction
CBPT is grounded in cognitive and behavioral theory and in the broader empirical tradition associated with the APA, emphasizing empirical validation throughout assessment, conceptualization and intervention. The method preserves the theoretical foundation of Cognitive Therapy while adapting its methodology to child development.
The Center's work is conducted under the scientific direction of Maria A. Geraci, an internationally renowned CBPT researcher, and Susan M. Knell, a pioneer of Cognitive Behavioral Play Therapy, and is based on published manuals and a body of peer-reviewed work developed over decades. This direction consolidates CBPT as a global reference method.
In CBPT the child is no longer a passive subject, but the active author of their own improvement.
Bibliography
View all references (20)
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. University of Vermont, Department of Psychiatry.
Axline, V. M. (1947). Play Therapy. Houghton Mifflin.
Bandura, A. (1977). Social Learning Theory. Prentice Hall.
Beck, A. T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry.
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. International Universities Press.
Ellis, A. (1971). Growth Through Reason.
Knell, S. M. (1993a). Cognitive-Behavioral Play Therapy. Jason Aronson.
Knell, S. M. (1993b). To show and not tell: Cognitive-behavioral play therapy.
Knell, S. M. (1994). Cognitive-behavioral play therapy.
Knell, S. M. (1997). Cognitive-behavioral play therapy.
Knell, S. M. (1998a). Cognitive-behavioral play therapy. Journal of Clinical Child Psychology.
Knell, S. M. (1998b). Cognitive-behavioral play therapy.
Knell, S. M. (1999). Cognitive-behavioral play therapy.
Knell, S. M. (2000). Cognitive-behavioral play therapy.
Knell, S. M. (2018). Cognitive-behavioral play therapy.
Knell, S. M., & Moore, D. J. (1990). Cognitive-behavioral play therapy in the treatment of encopresis.
Knell, S. M., & Ruma, C. D. (1996). Play therapy with a sexually abused child.
Knell, S. M., & Ruma, C. D. (2003). Cognitive-behavioral play therapy.
Knell, S. M., & Beck, K. W. (2000). The Puppet Sentence Completion Task.
Knell, S. M., & Dasari, M. (2006). Cognitive-behavioral play therapy for children with anxiety and phobias.
Explore our own work: Publications · Scientific articles · CBPT textbook
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Why Cognitive Behavioral Play Therapy
- ✓ Adapts Cognitive Therapy (Beck, 1976) to children ages 2½–8, who lack the language for traditional CBT
- ✓ Founded by Susan Knell (1993), continuously developed by the CBPT Research Center directed by Maria A. Geraci (2022)
- ✓ Applied across 9 child psychopathologies: anxiety, mood, behavior, elimination disorders
- ✓ Brief, structured, goal-oriented: avg. 12–20 sessions including parent training
- ✓ Documented in peer-reviewed literature and clinical textbooks (Geraci, 2022; Knell, 1998; Schaefer & Drewes, 2014)
Reference: Geraci, M. A. (2022). La play therapy cognitivo-comportamentale. Armando Editore. Knell, S. M. (1993). Cognitive-Behavioral Play Therapy. Jason Aronson.
Choose Your Training Path
Cognitive Behavioral Play Therapy is taught at the CBPT Research Center through a structured curriculum. Choose the entry point that matches your background and goals.
CBPT Basic Theoretical Model
Foundations of Cognitive Behavioral Play Therapy: theoretical framework, 5-phase protocol, integration of cognitive therapy with play modality.
For: Psychologists and child psychotherapists new to CBPT
Start Here →Clinical Applications Package
Apply CBPT to 5 specific clinical conditions: OCD, Selective Mutism, Separation Anxiety, Toileting Issues, Anxious & Fearful children. Bundle of clinical applications.
For: Therapists ready to apply CBPT in clinical practice
Explore the Package →CBPT Certification
The complete curriculum: theoretical foundations, clinical applications, supervised practice. Earn a recognized certification in Cognitive Behavioral Play Therapy.
For: Professionals committed to mastering CBPT methodology
Get Certified →CHOOSE YOUR PATH IN COGNITIVE BEHAVIORAL PLAY THERAPY
Whether you’re starting your CBPT journey or aiming for certification, the CBPT Research Center offers a complete training pathway.
CBPT, condition by condition
See how the method is applied across clinical areas — anxiety, OCD, ADHD, phobias, selective mutism and more — each with its assessment and treatment protocol.
Explore CBPT by clinical area →