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Child Centered Play Therapy Research

Non-Directive Child Centered Play Therapy is a systematic and evidence-based approach to counselling children. This form of Play Therapy has been in use for over 60 years and has a long history of efficacy in therapeutic work with children. It is well supported by extensive research.


Click on the boxes below for summaries of research in specific areas.

General Child Centered Play Therapy Research
    • Four meta-analytic studies (a powerful analysis that combines the results of many studies) examining the effectiveness of play therapy have been conducted since 2000. Each study found that play therapy had a reasonable treatment effect, indicating that child centered play therapy is an effective treatment for childhood issues. Click here for a summary of the studies. 
    • For evidence based research on the effectiveness of Child Centered Play Therapy, the following book is available:

Child Centered Play Therapy Research: The Evidence Base for Effective Practice Child Centered Play Therapy Research book
Jennifer N.Baggerly (Author, Editor), Dee C. Ray (Author, Editor), Sue C. Bratton (Author, Editor).

    • The Center for Play Therapy (Texas) has created a database of Play Therapy research as well as other play-focused modalities for children. Please visit their website for this resource.
Selective Mutism

Play Therapy is the recommended treatment of choice for children who are selectively mute because there is no pressure or expectation to verbalise. Play allows them to safely express feelings about the self that they have felt were unacceptable. The play therapist’s acceptance of these feelings allows the children to experience themselves in a more positive way. As these children are able to accept themselves, they can relinquish the silence that has defended their sense of self.

Non Directive Play Therapy with a Selective Mute Child
Author: Virginia Axline

Focus: Use of non-directive Play Therapy with a 5 year old boy with selective mutism and undersocialised behaviours.

Introduction:  Billy was referred for Play Therapy because of the threat of expulsion from Kindergarten. Billy would not interact with other children and would not speak to anyone. He crawled around the room close to the wall, and when approached by another child rolled up into a ball and hid his face. He would not participate in any school activities and would not listen to stories. Billy had not been like this when he entered kindergarten six months earlier.

CASE STUDY:  Billy’s Mother reported that his development appeared to be healthy until the age of 3 when he suddenly stopped talking, stopped walking, and regressed to a completely infantile stage. This change in behaviour followed the mother’s (recent) hospitalisation for emergency surgery. She took Billy to a physician, who diagnosed him as having a mental health concerns. She reported that Billy’s brother had mental health issues and she was fearful that Billy might experience similar difficulties. He was physically in good health, but had received a psychometrist’s report of an IQ score of sixty-eight, which is extremely low.

INTERVENTION:  Billy entered the play room with a blank stare and shuffling gait. He went to the middle of the room and stared and was told by the therapist that he could play with any of the toys if he wanted to. After standing for a long period of time, Billy played by sifting his hands in the sandbox for the entire session. He seemed more alert in the second session, playing in the sand and occasionally looking silently at the therapist. During the third session he played with cars in the sand and made a few comments to the therapist, who replied each time Billy spoke. When Billy came in for his fourth session, there was a significant change in his behaviour. He did not drag his feet, he was more alert, and he talked with the therapist.  Billy’s Mother reported a noticeable change at home, with Billy talking more, appearing less tense, and the regressive behaviour disappearing. During the fifth week the school called home to inquire what was happening with Billy, as his behaviour at school was also changing positively.

RESULTS:  Billy continued to improve during the ensuing weeks of Play Therapy. He talked more with the therapist, his play became more complex and imaginative and his demeanour more positive and free. His Mother reported more assertive behaviour at home and a greater willingness to venture out into the neighbourhood. There were still some difficulties at school, however, where Billy had been labelled by the teachers and ostracised by the other students.  The therapy was concluded with a series of group Play Therapy sessions that significantly reduced the social difficulties at school. One year after termination his Mother reported that Billy had adjusted excellently to a new school situation, was doing well academically (a new IQ score put him well within the average range), and was a “happy, relaxed child”.

COMMENTARY:  Axline postulated that a child behaves as he perceives himself in relation to others and their behaviour is dependent upon the current feeling of adequacy or inadequacy in coping with the particular circumstances. She believed that Billy’s Play Therapy provided a freeing experience from the “chains of past experiences” and gave him a safe place in which to operate. It was in this environment that Billy was able to process his issues and express himself fully. The changes that occurred for Billy in the play room naturally translated outside into his life at home and in school. The safety and the relationship that Axline’s approach offered Billy are conditions that the selective mute child seems to need in order to find the freedom so desired.

SOURCE:  Axline, V.M (1948).  Some observations on Play Therapy. Journal of Consulting Psychology 12:209-216.

 Possible DSM-IV Diagonoses:
313.23 Selective Mutism
300.23 Social Phobia, Generalised.

Disruptive Behaviours

Two Case Studies of Child-Centered Play Therapy for Children Referred With Highly Disruptive Behavior
Cochran, J.L., Cochran, N.H., Nordling, W.J., McAdam, A., & Miller, D.T. (2010)

This article presents two cases with strong evidence measures in which child-centered play therapy (CCPT) was provided for children referred for highly disruptive behavior, including attention problems and aggression. Apparent progress was evidenced on the Teacher Report Form (TRF) of the Child Behavior Checklist (Achenbach & Rescorla, 2001). One client had a waiting period equal to his treatment period in which ratings were stable before change across his treatment period. The cases provide opportunities to consider how CCPT may work differently for similar behavioral difficulties in individual children. Researchers conceptualized each client’s areas of difficulty and apparent treatment effects as an expert panel, aided by indications from the TRF. Individual discussions are provided regarding rationales for apparent progress and why CCPT seemed to have been effective.

Child Witnesses of Domestic Violence

Intensive Child-Centered Play Therapy with Child Witnesses of Domestic Violence
Kot, S., Landreth, G.L., & Giordano, M. (1998).

The purpose of this study was to determine the effectiveness of child-centered play therapy sessions every day for two weeks as an intervention for child witnesses of domestic violence. The analyses of covariance indicated that children in the experimental group experienced: a significant increase in self-concept; a significant decrease in external and total behavior problems; a significant increase in the play behavior of physical proximity to the therapist; and a significant increase in the play behavior of nurturing and creative play themes. The results support utilizing intensive play therapy to treat child witnesses of domestic violence.

Foster Care

For As Long As It Takes: Relationship-Based Play Therapy for Children in Foster Care
Clausen, J.M., Ruff, S.C., Wiederhold, W.V., & Heineman, T.V. (2012).

The trauma of child abuse is magnified for children placed in foster care. The disruption, disorganization, and discontinuity experienced in foster care further extend the trauma of abuse. Effective treatment of foster youth must prioritize the basic need for children to experience continuity, stability, and permanency in attachment to a healthy adult(s). Short-term, symptom-focused interventions are inappropriate for this population of ethnically diverse, socioeconomically disadvantaged, underserved, multiply traumatized youths with complex psychiatric comorbidity. We describe a long-term, psychoanalytically oriented, relational play therapy intervention for foster youth and present initial empirical results describing the impact of this approach.

Access the full text article here.

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