Psychotherapy & Play Therapy

What is Psychotherapy?

Formal interpersonal process between patient and therapist for the purpose of ameliorating distress by addressing cognitive, affective, and behavioral functioning

What are some requirements of the therapist?

• They must have specialized training to practice mental health services

• Use theories of development and causes of psychopathology to guide treatment

• Be skilled in evidence-based approaches

What are the Motivational Differences in adults vs youth?

Adults often would self-refer to therapy and typically demonstrate higher intrinsic motivation to change.

Children/adolescents must be referred, would show lower motivation or resistance to change, and may not recognize the need for therapy or see its relevance

What are the cognitive and social-emotional differences in adults vs youth?

Children and adolescents often lack the cognitive, verbal, and emotional skills required to benefit from adult therapies

What are the therapeutic technique constraints?

Cognitive and psychodynamic therapies depend heavily on:

• Abstract thinking

• Insight

• Verbal articulation of thoughts and feelings

These demands often exceed the capabilities of young patients!

What are the goals of therapy for adults?

Symptom reduction (e.g., alleviating depression, anxiety, etc)

What are the goals of therapy for youth?

• Therapy must address both symptom reduction and developmental progress

• Enhance social skills

• Promote emotional regulation

• Improve academic functioning

• Facilitate peer acceptance

What are the common factors to all forms of therapy?

• Having a therapeutic alliance → patients trust you and feel comfortable to share things

• takes longer with children

• a theory for the patients suffering

• interventions to alleviate or attenuate distress or impairment

What are some key factors of Behavioral Therapy?

• Based on the scientific method

• Principles of learning are applied to help people change their maladaptive behaviors (conditioning and social learning theory)

• Goals are in concrete objective terms to make replication of interventions possible

• Behavior is not limited to overt actions; includes internal processes

• Recognizes the importance of the interaction between the person and the environment in facilitating change

What are the key factors of Applied Behavioral Analysis?

• A functional approach to understanding problems and addresses these problems by changing antecedents and consequences

• We respond in predictable ways because of the gains we experience (positive reinforcement) or because of the need to escape or avoid unpleasant consequences (negative reinforcement)

• Specific behaviors are targeted

• Goal of reinforcement: Increase a target behavior

What is Contingent Electric Skin Shock (CESS)?

• An aversive therapy — not considered ethically sound or clinically appropriate

• An extreme form of punishment that is sometimes classified under behavioral interventions but has been banned in 2020

• Physical punishments are harmful, ineffective, and often counter-productive

What is Play Therapy?

The therapeutic powers of play are used to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development

What are the key points of assessment in play therapy?

• build rapport and empathy

• assess affective (emotional) state

• observe coordination and motor skills

• evaluate speech and language development

• assess attention span

• understand capacity for abstract or complex thinking

• evaluate interactive play and pretend play

• gather information for the MSE

True or False: Play therapists should direct the child’s play or conversation

False; they are communicating through the play so they can use the toys to freely communicate

What is the evidence for play therapy?

• Large positive effects of play therapy on treatment outcomes with children for a variety of presenting problems and diagnoses

• Decreased maladaptive school behaviors

What are the categories for toys and tool selection?

• Real life

• Aggressive relief

• Creative expression

**Note that there is overlap!

How do toys and tools demonstrate real life?

These toys are ones that can easily be incorporated in a child’s life and can give them a way to communiate what is going on in their life

How do toys and tools demonstrate aggressive relief?

Children can use toys to represent expression of emotions or power struggles they experience. As long as they aren’t hurting themselves or breaking things, it may be fine to have “controversial items” such as handcuffs

How do toys and tools demonstrate creative expression?

Children can use so many items to facilitate expression of emotions via creative play

What is tracking in play therapy?

When the therapist follows along the child’s choices and actions; communicates that the therapist is paying attention and that the communication in the play is being ‘heard’.

How can puppets be used in play therapy?

• they can represent people, interactions, allow people to develop social, emotional, and coping skills

• they can be used in group and individual sessions

• can be used in nondirective and directive approaches

• lack of personalizing the problem

What is selective mutism?

• the consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations

• the disturbance interferes with educational or occupational achievement or with social communication

• the duration of the disturbance is at least 1 month

• the disturvance is NOT better explained by a communication disorder