COGNITIVE BEHAVIORAL
| ATHENA DREWES, PSYD, RPT-S & ANGELA CAVETT, PHD, RPT-S
Play Therapy
in a systematic and goal-oriented manner. When paired with play and play-based activities, cognitive behavioral play therapy (CBPT) provides a therapeutic model for how to view children’s problems and provide a structure for sessions that has been shown to be effective in treating many different disorders. Children under eight do not have abstract thinking or language abilities necessary for CBT. Consequently, CBPT was developed to be developmentally appropriate by integrating play (Knell, 2011). However, CBPT has not been extensively researched, although it has been extensively utilized and written about.
C
Basic Tenets CBT theory underlies CBPT practice (Knell, 2011). Based on behavioral concepts of classical and operant conditioning and social learning, the goal is to help change negative behavior. CBPT is predominantly a structured, directive and goal-oriented treatment modality that systematically incorporates empirically demonstrated techniques. It includes cognitive and behavioral interventions within a play paradigm allowing the child mastery and control over his/her environment while being an active participant in change (Knell, 2011).
CBPT focuses on the child’s thoughts, perceptions, feelings, and environment, while providing a strategy for the development of more adaptive thoughts and behaviors. Traditional play therapy materials are used, especially puppets for role playing and gradual exposure, and books using a bibliotherapy approach. Play is used to teach skills, alter cognitions, create alternative behaviors, generalize positive functioning across various environments, and reduce symptoms.
Operant conditioning (Skinner, 1938) is most commonly employed through positive reinforcement of behaviors. Systematic desensitization (Wolpe, 1982), based on classical conditioning, is utilized for exposure. CBPT typically provides positive reinforcement in the form of praise or tangible rewards; psychoeducation, affect education and regulation; cognitive coping and problem-solving skills; calming skills, including relaxation and mindfulness; narratives; and exposure therapy interventions (Cavett, 2015).
24 | PLAYTHERAPY September 2019 |
www.a4pt.org
ognitive behavioral therapy (CBT) is the most researched, evidence-based, empirically-validated treatment approach that incorporates cognitive and behavioral interventions
Caregivers are involved in treatment and taught CBPT concepts, positive reinforcement and time out, for increasing their child’s expected behaviors.
Psychopathology and Client Dysfunction In CBPT,
“there is no personality theory, per se, that underlies this
theory” (Knell, 2009, p. 203), rather, psychopathology is caused by unhelpful thoughts. Beck (1976) posited that
irrational thoughts are
the underlying reason for psychopathology, and subsequently impact feelings and behaviors (cognitive triangle). Irrational thoughts resulting from trauma, abuse, negative life events, etc., lead to negative affect (e.g., If thoughts are changed, then both feelings and behaviors can change.
Once the child has acquired adequate coping strategies,
problem-solving skills and trauma narratives are explored through play, art, or drawing…
Treatment Description Psychoeducation is integrated throughout all phases of
treatment. A
three-headed dragon puppet (Drewes & Cavett, 2012) helps children learn the cognitive triangle, with each head separately representing thoughts, feelings, and behaviors. Children learn how to identify and quantify intensity of feelings and understand associated physiological sensations through directive play therapy interventions (i.e., gingerbread person feelings map; Drewes, 2001) or bibliotherapy.
Once the child has acquired adequate coping strategies, problem-solving skills and trauma narratives are explored through play, art, or drawing (Cavett, 2018). Coping skills, such as relaxation, mindfulness meditations, guided imagery, and sensory experiences are taught to reduce physiological arousal and affect dysregulation. CBPT utilizes exposure therapy through
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
