Theory and Practice with Children and
Adolescents
Summer, 2012


Cognitive-behavioral play therapy
incorporates cognitive and behavioral
interventions within a play therapy paradigm
(Knell, 1997).
Focus is more on psychopathology rather
than personality development. “Factors that
contribute to development gone awry” (Knell,
1997)

3 Major Premises of Cognitive Therapy
◦ Thoughts influence the individual’s emotions and
behaviors in response to events
◦ Perceptions and interpretations of events are
shaped by the individual’s beliefs and assumptions
◦ Errors in logic or cognitive distortions are prevalent
in individuals who experience psychological
difficulties (Beck, 1976).



In adults distortions are considered
irrational. In children they are considered
maladaptive. By nature children are
illogical, egocentric, and concrete.
Psychopathology is a result of one’s
perceptions of events-not the
circumstances themselves-that determine
how a person understands events.
*If we know the meaning that a person
attaches to particular situations, we can
predict his or her emotional reactions.



Intricate reciprocal interaction among
cognitions, emotions, behaviors, and
environment.
The play therapist seeks to reduce symptoms,
modify attitudes, beliefs, and expectations.
CBPT places a strong emphasis on the child’s
involvement in treatment and on a framework
for the child’s participation by addressing
issues of control, mastery, and responsibility
for one’s own behavior change.






It is brief
Time limited
Structured
Directive
Problem oriented
Depends on a sound therapeutic relationship
which incorporates the therapy as educational



“Quieting down of the hyperactive
organization” (Rachman, 1968).
Give children the opportunity to experience
and to test reality of verbal or pictorial
cognitions that are causally connected to
their affect.
Modification or shift of the child’s ideational
system.

Identifying Irrational Beliefs
◦ Therapist utilizes play to uncover these

Changing Irrational Beliefs (Bibliotherapy)
◦ Therapist utilizes play to replace irrational belief
(Maladaptive)

Positive Self Statements
◦ Therapist verbalizes the benefits of changing
maladaptive belief (“It will get easier”)

Shaping

Exposure and Response Prevention


◦ Therapist uses systematic desensitization
◦ Therapist models scenario without disaster
Positive Reinforcement (Contingency
Management)
◦ Therapist praises with verbal and tangible
reinforcers
Shaping Socially Appropriate Expression of
Feelings
◦ Therapist gives words to feelings

Preoperational Thought
◦
◦
◦
◦
◦
◦
◦
◦
Illogical - Attend to only one aspect at a time
Concrete - Judgment Influenced by perceptions
Egocentric
Less Reflective in Thought
Object vs. Label
Symbolic Thought/Language Emerging
No logical reasoning
Representation of Object in its Absence




Match between developmental level of child
and complexity of the intervention
Capitalize on child’s strengths
Decrease emphasis on complex linguistic
cognitive tasks
Experiential



Help child develop match between behaviors
and feelings
Learn to express maladaptive behaviors in
more adaptive ways
Encourage language development regarding
affect

Anxiety in Preschoolers
◦ Butterflies in my Stomach
◦ Worry Bee

ADHD in Young School Age Children
◦ Color your World (Activity)
◦ Beat the Clock (Activity)

Depression
◦ Painting/Drawing
◦ Theme Song (Activity)
 Play my Theme Song
 What do we talk about now?
 What is your Theme Song?
 How will you handle it if you don’t like the song?

Activities for Cognition
◦ I like my neighbor who…..
◦ Puppets
◦ Sandplay

Activities for Behavior
◦ Candy Temptation (activity)
◦ Feeling Board (Flip Chart)
◦ Puppets

Activities for Cognition
◦ Feeling Word Game (Activity)
◦ Puppets
◦ Garbage Bag Technique

Activities for Behavior
◦
◦
◦
◦
◦
◦
Pick Up Sticks
Slow Motion Game**
Candy Temptation
Jenga
Blowing Bubbles **
Beat the Clock **

Activities for Cognition
◦ A lot on my Plate (Activity)
◦ Anger Shield(Activity)
◦ Theme Song

Activities for Behavior
◦ Clay vessel
◦ Stress Beaker (Activity)
◦ Journaling

Activities for Termination
◦
◦
◦
◦
Construction Paper Rings
Calendar
Pictures of self and therapist
T-shirt

Activities for termination
◦
◦
◦
◦
T-Shirt
Plants
Video
Time Capsule

Activities for Termination
◦
◦
◦
◦
Hero (Activity)
Letter from Therapist
Candle Lighting Ceremony
Clay figure