1. Cognitive Behavioral Play Therapy (CBPT)
Theory and Practice with Children and Adolescents
Summer, 2012

2. CBPT Theory
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. CBPT Theory (cont.) 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).

4. CBPT Theory (cont.)
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.

5. CBPT Theory Concepts
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.

6. CBPT Process It is brief Time limited Structured Directive
Problem oriented
Depends on a sound therapeutic relationship which incorporates the therapy as educational

7. Goal/Cure for CBPT
“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.

8. Cognitive Treatment Components
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”)

9. Behavioral Techniques
Shaping
Therapist uses systematic desensitization
Exposure and Response Prevention
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

10. CBPT and Young Children
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

11. Clinical Implications
Match between developmental level of child and complexity of the intervention
Capitalize on child’s strengths
Decrease emphasis on complex linguistic cognitive tasks
Experiential

12. Clinical Implications (cont.)
Help child develop match between behaviors and feelings
Learn to express maladaptive behaviors in more adaptive ways
Encourage language development regarding affect

13. Assessment Skills with Preschoolers and Young Children
Anxiety in Preschoolers
Butterflies in my Stomach
Worry Bee
ADHD in Young School Age Children
Color your World (Activity)
Beat the Clock (Activity)

14. Assessment Skills with Adolescents
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?

15. Working Phase Preschooler (Aggressive, Impulsive, no Self Control)
Activities for Cognition
I like my neighbor who…..
Puppets
Sandplay
Activities for Behavior
Candy Temptation (activity)
Feeling Board (Flip Chart)

16. Working Phase School Age ADHD
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 **

17. Working Phase Adolescents Depression
Activities for Cognition
A lot on my Plate (Activity)
Anger Shield(Activity)
Theme Song
Activities for Behavior
Clay vessel
Stress Beaker (Activity)
Journaling

18. Termination with Preschoolers
Activities for Termination
Construction Paper Rings
Calendar
Pictures of self and therapist
T-shirt

19. Termination with School Age Children
Activities for termination
T-Shirt
Plants
Video
Time Capsule

20. Termination with Adolescents
Activities for Termination
Hero (Activity)
Letter from Therapist
Candle Lighting Ceremony
Clay figure