CHILD INTERVENTION

CHILD INTERVENTION

Cognitive Behavioral Play Therapy (CBPT), incorporating cognitive and behavioral interventions within Play Therapy, provides a theoretical approach that differs from other play therapies. Mainly in terms of its structure, psycho-educational components, and goal-directed and collaborative approaches between the therapist and child. In order for the child intervention to be appropriate, it must:

1. consider the child’s developmental stage.

2. focus on the child’s strength and abilities, rather than focusing on weaknesses.

3. focus on experiential interventions that incorporate play, rather than complex and verbal skills.

4. encourage and facilitate language to describe experiences and emotions.

STAGES OF CBPT TREATMENT

1. Exploratory interview

It is essential to guide and prepare both the child and parents for CBPT. Tipically, the therapist meets the parents without the child present, in order to complete a clinical interview. History and background information about child are obtained, through rating scales from the parents. In addiction, if necessary, the therapist provides information about therapy structure and parental involvement.

2. Assessment stage

In addiction to formalized assessments (i.e., clinical interview, rating scales) of the child’s symptoms, understanding their play skills and ability requested is important. These moments are important in determining whether CBPT is an appropriate and effective child intervention.

The aim of the assessment is to determine developmental level of the child’s ability, which includes: 

(a) cognitive skills such as organization, divergent thinking, and symbolism.

(b) emotional skills such as emotional expression, comfort/enjoyment of play, and emotional regulation.

(c) interpersonal/social skills such as empathy and communication.

(d) problem-solving skills such as approaches to problems and conflict resolution ability.

3. Intervention stage

Following the assessment stage, the therapist develops a treatment plan. The duration will be closely linked to the objectives to be set. The therapy is focused on increasing the child’s self-control, sense of accomplishment, and learning more adaptive responses to deal with specific situations. Depending on the presenting problem, the therapist chooses the most appropriate cognitive and behavioral interventions.

CBPT is developed using a cognitive behavioral theoretical model and by integrating empirically supported techniques with play. In fact, these techniques are aimed to help children develop adaptive skills that are appropriate to the child’s cognitive, emotional and social developmental level.

Among the COGNITIVE TECHNIQUES

Psycho-Education

Cognitive Restructuring

Positive Self-Statements

Problem Solving

BEHAVIORAL INTERVENTIONS

Relaxation

Exposure

Systematic Desensitization

Contingency Management

Stimulus Fading

Extinction/Differential Reinforcement of other Behavior (DRO)

Generalization

– Relapse Prevention

4. Termination

In the final stage, the child and the family are gradually prepared for the end of therapy. As the treatment nears its end, the child deals with the reality of termination and faces the feelings connected to it.

The concluded treatments are monitored over time and a follow-up after 6/12 months at the end of the intervention is required.

SETTING AND MATERIALS

CBPT is usually conducted in a playroom or office equipped ideally with a variety of toys and materials. Among these are used: Puppets, Papers of different colors, Markers/crayons, Dollhouse, Family set of figures, Books on many different topics, Toy cars, games to build therapeutic alliance, Clay and Play dough, Legos or other building supplies, Posters and stickers and feeling blocks, Dry erase board ecc. 

The child intervention can sometimes take place outside the playroom especially for those children with specific anxieties or phobias that are then treated in vivo.

Bibliography
Compton S. N., March J. S., Brent D., Albano A. 5th, Weersing R., Curry J. (2004). Cognitive-behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review. J Am Acad Child Adolesc Psychiatry; 43(8):930-59. 
Knell, S.M. (1999). Cognitive behavioral play therapy. In S.W. Russ & T. Ollendick (Eds.), Handbook of psychotherapies with children and families (pp. 385-404). New York: Plenum.
Knell, S. M., & Dasari, M. (2009). CBPT: Implementing and integrating CBPT into clinical practice. In A. A. Drewes (Ed.), Blending Play Therapy with Cognitive Behavioral Therapy: Evidence-Based and Other Effective Treatments and Techniques (pp. 321-352). Hoboken, Nj: Wiley.
Velting, O. N., Setzer, N. J., & Albano, A. M. (2004). Update on and Advances in Assessment and Cognitive-Behavioral Treatment of Anxiety Disorders in Children and Adolescents. Professional Psychology: Research and Practice, 35(1), 42–54.