Child-Centered Play Therapy

While most people have heard of play therapy, individuals without direct experience with play therapists are unsure about what they actually do. Play therapy is a broad field with many different interventions designed to address a broad range of concerns and experiences. This blog specifically provides information about Child-Centered Play Therapy (CCPT), a kind of play therapy that allows the child to take charge of their own therapeutic process with the specialized support and facilitation of a CCPT therapist.

Who could benefit from CCPT?

CCPT is designed for children experiencing difficulties in social, emotional, behavioral, and relational domains (Center for Play Therapy (CPT), n.d.a.). Most CCPT clients are between ages 3-10, but older children may be able to benefit as well. Because of the flexible approach taken in CCPT, it can address a wide range of experiences. In general, CCPT could benefit children who have experienced trauma, anxiety and mood difficulties, and engage in harmful or disruptive behaviors (CPT, n.d.c.). Finally, CCPT engagement can lead to improved familial relationships, decreased parent stress, greater academic achievement, and improved expressive and receptive language skills (CPT, n.d.c.; Ray & McCullough, 2015; Title IV-E Prevention Services Clearinghouse, 2022). 

What is CCPT?

CCPT was created by Virginia Axline beginning in 1947, and was initially referred to as “nondirective play therapy” (Ray, 2011, p. xi). Axline was a student of Carl Rogers, and his person-centered approach to therapy resonated with her (Stitch, 2020). She agreed with Rogers’ belief that “each individual has a natural tendency or inclination toward growth” (Stitch, 2020, p. 12). With an extensive background in elementary education, Axline applied the person-centered beliefs to children, resulting in the child-centered model (Stitch, 2020). Believing that play was the “natural medium for self-expression” for children, she developed CCPT to allow children to express themselves through play without the direction or interference of adults (Axline, 1947b, p. 16, as cited in Stitch, 2020). 

Because CCPT is rooted in Rogers’ person-centered theoretical background, emphasizing self-determination within the therapeutic process, the child is given significant freedom in directing therapy sessions. CCPT is “non-directive” — this means the child gets to decide what happens in each session (Ray, 2011). The playroom is purposefully one of the most permissive spaces a child will encounter. This does not mean that there are no limits in the playroom to account for safety, but instead that minimizing limits to allow for expressions of emotion that are usually “unacceptable” gives the child a safe space to process these emotions. This also allows the child to directly experience the consequences of their actions without adult interference, allowing them to develop self-regulation skills rather than relying on adults to regulate for them (Hicks, 2022).  

Today, CCPT is widely recognized as a historically significant approach in the field of play therapy (Association for Play Therapy (APT), 2023). Garry Landreth, known for his work in developing CCPT through writing and training, currently oversees the Center for Play Therapy at the University of North Texas (UNT) (CPT, n.d.d). Landreth founded the Center of Play Therapy in 1987, and it is now the largest play therapy training center in the world (Ray, 2011). UNT offers extensive training and certification opportunities in CCPT, and CCPT is widely used by professional play therapists. 

What Happens in CCPT Sessions?

Because CCPT is non-directive, it’s very different from many other types of therapies that give the client specific directions or ask certain questions. In fact, in CCPT, directions and questions from the therapist are avoided unless they are absolutely necessary. For many who are new to this modality, the non-directive nature can be puzzling. Many people wonder how the child works through their challenges without being asked questions, and how the sessions focus on the “right thing” without directions from the therapist. This is because many common therapeutic approaches believe that the therapist in some regards takes on the role of a “teacher,” guiding the client to a “correct” solution or a “healed” state.

Because the CCPT model emphasizes the importance of trust in the child to work through the things they already know to be challenging for them, as well as giving them the space to work through these challenges without fear of judgment, the therapist fills a different role. CCPT therapists are trained in specific ways of facilitating the therapeutic process that allow the child to stay in the lead (Ray, 2011). These ways of responding have varying purposes. Some of these include drawing the child’s attention to their behavior without judgment or evaluation; using statements that build a child’s internal sense of self-esteem; acknowledging the feelings the child expresses through their actions and play to allow the child to begin identifying these independently; and facilitating decision-making within the playroom so the child develops skills like responsibility, accountability, and independence. 

Additionally, therapists are trained in the careful selection of toys and design of the playroom to best facilitate the therapeutic process (Ray, 2011). Therapists select a range of toys that can be used to express all experiences of emotion so that the child feels free to explore. Finally, the therapist is skilled at “facilitating the development of a safe relationship” with the child, allowing the child to trust the therapist and engage with them throughout the process (Landreth, 2002,  p. 148 as cited in Ray, 2011). The child’s self-directed play, integrated with the therapist’s intentional responses and relationship building, create the child-centered process.

Dr. Dee Ray, a current leader in the field of CCPT and a child-centered play therapist herself, created two videos to share with her clients to explain what therapy is and how it works (Ray, 2010a; Ray, 2010b). These videos are included below to provide a general summary: 

CCPT Outcomes

Because CCPT allows the child to direct their own therapeutic process, it addresses countless challenging experiences. Despite this strength of the modality, this also makes outcomes difficult to measure — every child is different, so no two processes look the same. At the same time, having consistent ways of responding to the child has allowed for enough standardization to support research efforts. Additionally, it was found that the impact of CCPT was greater when the therapist followed the model more closely and parents were more involved in the process (CPT, n.d.c.). Currently, there is evidence for the following outcomes of CCPT (CPT, n.d.c.; Ray & McCullough, 2015; Title IV-E Prevention Services Clearinghouse, 2022): 

CCPT has been found to decrease: 

• Anxiety and worry
• Trauma-related symptoms
• Social anxiety and withdrawal 
• Suicide risk
• Disruptive and externalizing behaviors
• Parent stress

CCPT has been found to improve: 

• Expressive and receptive language skills
• Social and emotional adjustment
• Self-efficacy and self-concept 
• Social relationships
• Teacher-student relationships
• Parent-child and sibling relationships
• Academic performance

Despite many demonstrated benefits of CCPT, there are still areas where further research is necessary. For example, many studies conducted have had small sample sizes and limited follow-up, making it difficult to generalize results and demonstrate their long-term effects. Additionally, because CCPT is not a behavioral modality, measuring its outcomes in terms of behavior may not fully represent the impact it has on a child’s experience of themself. 

Finding a Play Therapist 

If you’re interested in finding a play therapist, the best place to start is the Association for Play Therapy’s (APT) provider directory. A person with a certification of “Registered Play Therapist” has extensive training and experience using play therapy. While not all Registered Play Therapists will specifically use CCPT, it is one of several specialties RPTs can choose from and will be indicated on the individual’s profile. 

While it is less common than the Registered Play Therapist certification, the University of North Texas also certifies therapists with a CCPT-Level 1 or CCPT-Level 2 certification. These certifications also indicate extensive training specific to the CCPT modality. There is not a directory for this certification specifically, but it is helpful to know what the certification designates. 

Finally, Psychology Today also allows for specific searches for play therapists. It’s important to note that one limitation of this search method is that there are no requirements for therapists to have any specific training or experience to list themselves as “play therapists” on this website. This does not necessarily mean that individuals without certification are not qualified; there are many reasons why a provider may not seek a certificate and many provide excellent, evidence-based services without one. Additionally, many providers may be working towards certification, or have received additional training and education that qualify them to provide play therapy. It’s important to talk to any potential provider about their background in play therapy to ensure your child receives services from an informed and experienced provider. 

References

Association for Play Therapy (APT) United States. (2023). Credentialing Standards for the Registered Play Therapist: APT Professional Credentialing Program. https://cdn.ymaws.com/www.a4pt.org/resource/resmgr/credentials/RPT_Standards.pdf 

Association for Play Therapy. (n.d.) Find an Approved Provider [Search directory]. Association for Play Therapy. Retrieved July 20, 2023 from https://www.a4pt.org/page/ApprovedProviders

Axline, V. M. (1947b). Play therapy. Ballantine Books.

Center for Play Therapy. (n.d.a). Child-Centered Play Therapy. UNT College of Education, Center for Play Therapy. https://cpt.unt.edu/child-centered-play-therapy 

Center for Play Therapy. (n.d.b). Child-Centered Play Therapy Certification. UNT College of Education, Center for Play Therapy. https://cpt.unt.edu/child-centered-play-therapy-certification 

Center for Play Therapy. (n.d.c). Meta Analyses. UNT College of Education, Center for Play Therapy. https://cpt.unt.edu/researchpublications/meta-analyses 

Center for Play Therapy. (n.d.d). Our Story. UNT College of Education, Center for Play Therapy. https://cpt.unt.edu/our-story 

Child Centered Play Therapy. (Last reviewed 2022, Dec.). Title IV-E Prevention Services Clearinghouse. Retrieved July 20, 2023 from https://preventionservices.acf.hhs.gov/programs/451/show 

Find a Play Therapist [search engine]. (n.d.). Psychology Today. Retrieved July 20, 2023 from https://www.psychologytoday.com/us/therapists/play-therapy 

Hicks, B. (Executive Producer; Host). (2022-present). The Play Therapy Podcast [Audio Podcast]. The Kid Counselor. https://www.playtherapypodcast.com/ 

Landreth, G. (2002). Play Therapy: The art of the relationship (2nd ed.). New York: Brunner-Routledge. 

Ray, D. C. (2011). Advanced Play Therapy: Essential conditions, knowledge, and skills for child practice. Routledge.  

Ray, D. [@deeray8]. (2010a, Jan. 12). Introduction to Play Therapy for Children [Video]. YouTube. https://www.youtube.com/watch?v=fmKxvTtSWoc 

Ray, D. [@deeray8]. (2010b, Jan. 12). Introduction to Play Therapy for Parents [Video]. YouTube. https://www.youtube.com/watch?v=Onn_qF4pZ9Q 

Ray, D. C, & McCullough, R. (2015; revised 2016). Evidence-based practice statement: Play therapy (Research report). Retrieved from Association for Play Therapy website: http://www.a4pt.org/?page=EvidenceBased 

Stitch, E.T. (2020). A Historical Biography of Virginia Axline [Unpublished doctoral dissertation]. University of North Texas. Retrieved July 20, 2023 from https://digital.library.unt.edu/ark:/67531/metadc1703343/m2/1/high_res_d/TURLEYSTICH-DISSERTATION-2020.pdf