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Determining therapeutic movement within sessions
o Changes in outside behavior might occur before changes in therapy
behavior
• Less need for inappropriate behavioral expression outside session
• Still need for inappropriate behavioral expression in session because it
is a safe place
o Be consistent, patient, and understanding, and wait for change
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Dimensions of change
o Firsts (first-time behaviors)
• Self-direction of play
• Helpfulness with clean-up time
• Separation from parents and therapist
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Dimensions of change (cont.)
o Themes in play behavior
• Definition: “The recurrence of certain events or topics in a child’s play,
either within a session or across several sessions. A key point here is
the recurrence of the play after some lapse of time or an intervening
period of play in which the theme is not played out” (p. 353).
• Theme might not always be recognizable
• Repetition of play behaviors reflects underlying emotional issues that
can vary in intensity
• When themes disappear, it could mean that the child has resolved the
conflict
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Dimensions of change (cont.)
o Clarifying themes
• For therapist’s sake
• To understand what child is exploring, experiencing, and working
through
• To help therapist become more sensitive and empathic toward child
• Not intended to provide child with insight
• Therapist could be wrong
• Therapist could be predisposed to seeing certain themes for personal or
theoretical reasons
• Therapist’s clarification is more likely accurate when the play
approximates a known significant event in the child’s life

The meaning of termination
o Reference points for determining termination
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Less dependence on therapist
Less concern about other patients
Acceptance of both good and bad parts in same person
Attitudinal changes toward time (awareness, interest, acceptance)
Attitudinal changes to clean-up time
Self-acceptance
Evidence of insight and self-evaluation
Change in quality or amount of verbalization
Less aggression toward or with toys
Acceptance of limits more readily
Change in forms of artistic expression
Less need to engage in regressive, infantile play
More creative constructive play
Reduction in number and intensity of fears
Children give cues about readiness to end treatment

The meaning of termination (cont.)
o Procedures for ending the relationship
• Therapist asks the child how many more times the child feels he or she
needs to come for therapy
• No reassurance given
• Leave the door open to return if needed
• Plan for two or three sessions to complete termination process
• “The child has the opportunity to discover what the ending of a
meaningful relationship feels like” (p. 360).
• Temporary regression is expected
• Tapering-off process might be indicated
• Give reminders of number of sessions left at the beginning and end of
sessions

The meaning of termination (cont.)
o Children’s reactions to the last session
• Natural reluctance to leave the playroom and end the relationship
• Ambivalent feelings about ending often emerge
o Premature termination
• Try to schedule a final session
• Final session allows the child to experience a positive end to an
important relationship
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Play therapy is not necessarily a long-term process
o Resist pressures for quick solutions
o Educate managed care providers about
• Emotional and developmental needs of children
• Efficiency of the play therapy process
o Resist imposing predetermined solutions on the child to hurry up
the growth process

Intensive play therapy
o A week between sessions can be a long time for some children

Intensive play therapy (cont.)
o Play therapy can be scheduled for five or six days per week for the
first week or two
• Because of play in displacement (“distancing”), children less likely than
adults to feel overwhelmed by painful material
• Children are not directed to play out traumatic experiences
o Play therapy can be scheduled for three 30-minute sessions per day
for three days

Research on intensive play therapy
o Improvements in children exposed to domestic violence
• Individual play therapy benefits
• Sibling group play therapy benefits
• Child-Parent Relationship Therapy (CPRT) benefits
o Improvements in children exposed to an earthquake
o Improvements in children living in a homeless shelter

Short-term play therapy
o 10-12 sessions or fewer
o Indicated for less severe emotional problems

Research on short-term play therapy
o Improvements in girls
o Improvements in selectively mute boy
o Improvements in children experiencing reading difficulties
o Improvements in young children experiencing social maladjustment
o Improvements in adolescent girl diagnosed with schizophrenia
o Improvements in sexually abused children
o Improvements in bilingual Puerto Rican children
o Improvements in children with hospital fears
o Improvements in children retained in first grade because of poor
reading performance
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Research on short-term play therapy (cont.)
o Improvements in a girl experiencing parental loss
o Improvements in children with an emotional or physical disorder
o
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o
o
affecting learning
Improvements in “at-risk” children
Improvements in young children experiencing behavioral adjustment
difficulties
Improvements in children traumatized by the Oklahoma City
bombing
Improvements in socially immature children
Improvements in hearing-impaired children
Improvements in a girl diagnosed with trichotillomania
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Short-term Child-Parent Relationship Therapy (CPRT)
o 10 sessions of parent training in basic child-centered play therapy
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principles and skills
7 sessions with parents practicing on child
Parents start therapy after third filial training session
Improvements in parents and children reported in over 40
controlled outcome research studies with over 1,000
paraprofessionals (primary parents)
CCPT and CPRT have been used in
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School settings
Hospital settings
Group settings
Short-term
Intensive