CHRD 692 – PLAY THERAPY TECHNIQUES
PLAY SESSION OBSERVATION
DATE: ____________________ COUNSELOR/STUDENT: _____________________________________________________________
CHILD (FIRST NAME)/AGE: _________________________ / __________
I.
SUBJECTIVE
Underline all feelings including caplitalized words, either expressed directly or through a toy (write toy above
feeling); circle predominant feeling(s)
HAPPY: relieved, satisfied, pleased, delighted, excited,
surprised, silly, free
ANGRY: impatient, annoyed, frustrated, mad, mean,
jealous
CONFIDENT: proud, strong, powerful, determined
CURIOUS: interested, focused
SAD: disappointed, hopeless, pessimistic, discouraged,
lonely, ashamed
AFRAID: vulnerable, helpless, distrustful, anxious, fearful,
scared, terrified
HESITANT: timid, confused, nervous, embarassed
FLAT: contained, ambiguous, restricted
II.
OBJECTIVE:
A. TOYS/PLAY BEHAVIOR: CIRCLE specific toys used (not category), give brief description of play. In blank, indicate
meaningful/sustained play with an “*”, indicate play disruptions as “PD”, and indicate therapist initiated activity as
“TH”
___ hammer/log/woodworking
___ sandbox/water/sink
___ theater/puppets
___ kitchen/cooking/food
___easel/paint/chalkboard
___ bean bag/pillows/sheet/blankets
___ dress up: clothes/fabrics/shoes/jewelry/hats/masks/want
___crafts/clay/markers
___ doll house/dolly family/bottle/pacifier/baby
___ cash register/money/phone
___camera/flashlight
___medical kit/bandages
___musical instruments
Adapted from Green 2013; Bratton & Homeyer, 2002
___ games/blowing/ring toss/balls
___ cars/trucks/bus/emergency vehicles/planes/boats/riding car
___ animals: domestic/zoo/alligator/dinosaurs/shark/snake
___ soldiers/guns/knife/sword/handcuffs/rope
___constructive toys/blocks/barricade
___ sandtray/miniatures
B.
SIGNIFIACNT VERBALIZATION: CH=Child Imitated; TH=Therapist Initiated
C.
LIMITS SET:
Write limits set beside the RATIONALE (ex: threw sand on floor) and in the blank indicate # of times limit set. If
consequence and/or ultimate limit was set in response to broken limit, note.
___ Protect Child (Physical and/or emotional safety)
___ Protect therapist and/or maintain therapist acceptance/relationship
___ Protect room/Toys
___ Structuring
___ Reality Testing
ASSESSMENT: GENERAL IMPRESSION:
III.
A. DYNAMICS OF SESSION: Rate child’s overall play behavior
Child’s Activity Level (LOW)
Intensity of Play (LOW)
Inclusion of Counselor (LOW)
Destructive
Mess/Chaotic/Disorganized
B.
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Child’s Activity Level (HIGH)
Intensity of Play (HIGH)
Inclusion of Counselor (HIGH)
Constructive
Neat/Orderly
PLAY THEMES: Underline all that apply, including capitalized words and describe how themes was played out. Circle
predominant theme(s)
EXPLORATORY: (not a true play theme – rather the way child gets comfortable and familiar with space)
RELATIONSHIP: connecting/trust/approval seeking/manipulative/collaborative/testing limits
POWER/CONTROL:
HELPLESS/INADEQUATE:
AGGRESSION/REVENGE:
SAFETY/SECURITY:
MASTERY: deconstructing/constructive/competency/integration/resolution
Adapted from Green 2013; Bratton & Homeyer, 2002
NURTURING: self-care/reparative/healing
DEATH/LOSS/GRIEVING:
SEXUALIZED:
OTHER:
C.
OVERALL, CHILD’S BEHAVIOR/AFFECT WAS:
MALADAPTIVE/NON-COPING
Sad/depressed/angry/fearful
Anxious/insecure
Dependent/clingy/needy
Immature/regressed/hypermature
Low frustration tolerance
External locus of control
Impulsive/easily distracted
Inhibited/constricted
Isolated/detached
ADAPTIVE/COPING
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Content/satisfied (appropriate affect)
Confident/secure
Autonomous/Independent
Age Appropriate
High frustration tolerance
Internal locus of control
Purposeful/focused
Creative/expressive/spontaneous/free
Connected/Sense of belonging
D. CONCEPTUALIZATION OF CLIENT AND CLIENT’S PROGRESS BASED ON THEORETICAL ORIENTATION:
IV.
PLANS / RECOMMENDATIONS: check all that apply
___ Parent consult
___ Family session
___ Professional consult: Psychiatrist,
pediatrician
___ Sibling session
___ Medication evaluation
___ Filial therapy
___ Psychological testing
___ Therapy for parent(s)
___ School consult
___ Classroom observation
___ Request records:
___ Recommended parent resources:
___ Other plans/Recommendations:
___ Therapy for parent(s)
Adapted from Green 2013; Bratton & Homeyer, 2002