Play therapy
The strategic use of play within therapeutic contexts to promote the expression and processing of a child's thoughts, needs and feelings.
Play as a therapeutic paradigm
Play therapy is the strategic use of play within therapeutic contexts to support the expression and processing of the child's thoughts, needs and feelings. Play has long been recognized as a means of communication, a route to understanding the child and a foundation for the therapeutic relationship.
As a paradigm, play therapy has developed across different theoretical orientations that share similarities yet differ in approach — most notably Directive Play Therapy and Non-Directive Play Therapy. Cognitive Behavioral Play Therapy (CBPT) is situated among the directive approaches.
Two orientations
Directive — play is used to build a strong therapist–child bond while guiding actions toward defined goals.
Non-directive — an effective, non-intrusive therapy that values the child as they are, without external demands.
Where CBPT comes from
Historically, play therapy has been grounded in either psychodynamic or client-centered theories, such as Child-Centered Play Therapy (Axline, 1947). CBPT differs from these more traditional forms, while sharing their reliance on a positive therapeutic relationship, the use of play as a means of communication between therapist and child, and the experience of therapy as a safe place.
Knell (2009) describes the most salient similarities and differences between directive and non-directive play therapy, grouping them into five areas: direction and objectives of therapy, play materials and activities, the educational value of play, interpretation of the child's play, and the role of praise.
What distinguishes CBPT
Across the five areas described by Knell (2009), CBPT takes a distinctive directive stance:
In CBPT (directive)
- Therapeutic goals are defined; intervention directs actions toward them.
- Child and therapist together choose play materials and activities.
- Play teaches alternative, more adaptive skills and behaviors.
- The therapist interprets play, helping the child discuss conflicts.
- Praise is a crucial component, reinforcing appropriate behaviors.
In non-directive play therapy
- The child is valued as they are, without external demands or directions.
- The child selects materials and decides how to play.
- Education is seen as unsuitable, as a form of direction.
- The therapist does not interpret play, but communicates full acceptance.
- Praise is avoided, to prevent implying a need for change.
What the research supports
Research on play therapy broadly supports its effectiveness across a wide range of social, emotional, behavioral and learning problems — including post-traumatic stress, conduct disorder, depression, attention deficit and hyperactivity, disruptive behaviors, aggression, anxiety and fear, impulsivity, low self-esteem, reading difficulty and social withdrawal.
The literature also supports its cross-cultural effectiveness and beneficial outcomes with diverse populations, including children facing chronic illness, grief and loss, abuse, domestic violence, adoption disruptions, attachment difficulties, natural disasters, and stressors such as divorce and relocation.
Bratton & Ray, 2000; Drewes, 2006; Ray & Bratton, 2010; Reddy et al., 2005; LeBlanc & Ritchie, 2001.
In CBPT we define therapeutic goals, and the foundation of intervention is directing actions toward them.
Frequently asked questions
What is play therapy?
Play therapy is the strategic use of play within a therapeutic context to help a child express and process thoughts, needs and feelings. Play has long been recognized as a means of communication with the child and a foundation for the therapeutic relationship.
What is the difference between directive and non-directive play therapy?
In directive play therapy the therapist defines therapeutic goals and guides the child's play toward them. In non-directive play therapy, such as Axline's Child-Centered Play Therapy, the child chooses materials and activities and the therapist communicates full acceptance without interpreting the play. Knell (2009) compares the two along five areas: goals, materials, the educational value of play, interpretation and the role of praise.
Is Cognitive Behavioral Play Therapy directive or non-directive?
CBPT belongs to the directive approaches. Goals are set with the family, therapist and child choose play materials together, play is used to teach more adaptive skills, the therapist interprets play to help the child discuss conflicts, and praise is used to reinforce appropriate behavior.
What does research say about the effectiveness of play therapy?
Reviews and meta-analyses (Bratton and Ray 2000, LeBlanc and Ritchie 2001, Reddy et al. 2005, Drewes 2006, Ray and Bratton 2010) support play therapy across a wide range of social, emotional, behavioral and learning problems, including anxiety, depression, ADHD, aggression and low self-esteem, and with diverse populations such as children facing chronic illness, grief, abuse or divorce.
Where does CBPT come from?
Play therapy historically grew out of psychodynamic and client-centered theories. Cognitive Behavioral Play Therapy, developed by Susan M. Knell, keeps the positive therapeutic relationship and the use of play as communication, but adds the structure and goals of cognitive behavioral therapy.
Train in Cognitive Behavioral Play Therapy
Go deeper into the method, its tools and its clinical application with the dedicated CBPT training.
Explore the CBPT courses