HDF 460 Exam 2

According to lecture, how many children live in poverty?

1 in 5 children, and it is continuing to rise

Why must therapists consider the culture of poverty?

It is a major risk factor for children and families, and it impacts clients daily

How does poverty affect worldview and health-seeking behaviors?

Those in poverty are far less likely to seek needed healthcare because of insurance and financial reasons

Playroom and dress considerations (poverty/culture)

Not appearing overly or under professional; moveable dressware; playroom should be welcoming to all people no matter who they are

Multiculturalism in therapy: seen vs. unseen

Seeing a child holistically. Seen = age, race, etc. Unseen = ability, disability, trauma history, etc.

CCPT is based primarily on the work and theory of whom?

Carl Rogers and Person-Centered Therapy

CCPT stands for / age range

Child-Centered Play Therapy; ages 3-7

What is the first meeting of CCPT usually reserved for?

Caregivers: developing goals and strengths in working with their children (collaboration = greater success)

Skills of CCPT: list

Warm presence and unconditional positive regard; non-directive; non-pathologizing; communicate inner experiences through play

CCPT skill: non-pathologizing

Not trying to over-diagnose; views the child as a child continually developing; however insurance requires some diagnosis (adjustment disorder)

ACT method for limits

Acknowledge behavior; Communicate limit; Target alternative (behavior or choice)

Alexithymia

Inability to notice, identify, and describe emotions/what one feels inside

Alexithymia is correlated with...

Negative mental health outcomes

Limbic system and prefrontal cortex in feeling identification

Limbic system needs to connect to the prefrontal cortex or the child struggles to identify emotion; naming the emotion engages the prefrontal cortex

Emotional granularity

The ability to recognize and name your internal emotional experiences with high specificity rather than using broad, sweeping terms.

How to teach feeling identification

Open-ended (nondirective) play; directive play prompts; reflection of content AND feeling; "I wonder"; paraphrase

What does "I wonder" do?

Allows for exploration of emotion

CPRT stands for

Child-Parent Relationship Therapy

CPRT: How do parents help children regulate?

Parents help kids regulate their emotions and adverse experiences (your notes leave the rest of this line blank)

CPRT: what are interventions meant to do?

Strengthen parent/child bonds while providing support for caregivers

CPRT: parental efficacy

How effective parenting is (parenting skills, responding to challenges from kids); increasing efficacy treats a wide range of issues

CPRT: who developed it / history

Based on the parent training model of Bernard and Louise Guerney (Filial Therapy); Garry Landreth developed the more structured 10-session version

CPRT is grounded in...

Attachment theory, person-centered/child-centered theory, and the significance and importance of play in a child's life

CPRT: what kind of play?

Non-directive play therapy

CPRT: primary mechanism of change

The child-parent relationship

CPRT: who is the agent of change?

The parent

CPRT: strength-based?

Yes, strength based and person-centered

CPRT structure: format

Small, supportive groups; 1x/week for 2 hours; 10 two-hour sessions; normalizing and joining

CPRT: special play

1:1 special play; requirement of the treatment; once a week for 30 minutes; child-led

CPRT: what are parents taught about?

Child development, CCPT, philosophies, techniques, and concrete skills to improve their relationship with their children

CPRT sessions 1-3

Establish safety and support; teach basic CCPT skills (follow the child's lead, reflect feelings, reflect nonverbal content); provide full attention and genuine interest

CPRT sessions 4-10

Group process of supervised play; skills refined; 30-minute practice is all that is required

CPRT: role of the therapist

Train and closely supervise parents to become therapeutic change agents; group facilitator, play therapy trainer, supervisor, and mentor; demonstrate and supervise

CPRT objectives (2 main)

1. Improve the child, the caregiver, and the caregiver-child relationship. 2. Increase trust, security, and closeness between caregiver and child and ultimately the whole family

CPRT objectives: parents increase...

Parental acceptance and empathy; sensitive response to emotional needs; more realistic developmental expectations and limits; greater confidence as parents

CPRT skill: tracking

"You have the doll." Shows kid they have your full attention

CRPT: "Be with" attitude: I am here with you

Tracking with body

CRPT: "Be with" attitude: I hear you

Restatements (e.g. "I can hear your excitement")

CRPT "Be with" attitude: I see you

Watching, eye contact; I see you as a person and care

CRPT: "Be with" attitude: I understand you

Reflection of feeling, clarifying what a kid is saying

Object Relations and Attachment-Based Play Therapy: who is it for?

Children who need to move from an insecure attachment style (or are dealing with attachment issues) to a secure attachment

Object Relations and Attachment-Based Play Therapy: informed by

Object relations theory ; thematic play; neurobiological attachment

Internal working model

Shapes how we see our surroundings and future: Is the world a safe place? Am I worthy of love and belonging in it?

Internal working model and attachment

Infants and attachment figures co-create interactive patterns; these templates = beliefs about self and others

Attachment styles (from the chart)

Secure, anxious, avoidant, fearful (based on positive or negative model of self and of others)

Object Relations skills: sensitive clinicians can...

Identify affects; recognize the internal working model; enter the child's representational world and communicate within metaphor (invitations)

Object Relations: primary interventions

Therapist's secure base relationship with the child; brainstem focused calming activities; thematic play interventions in a safe, empathic interpersonal context

Object Relations: how does the therapist intervene?

Creating a healthy therapeutic relationship and sensory focused play; models healthy attachment until another long-term adult (ideally parent or caregiver) can step in

Thematic play

A lot of play (sandtray, movement, play themes); remember the idiosyncratic meaning, like what the kid names your toys and the personality they give them

Metaphorical invitations

Shift maladaptive working models; e.g. a child plays out aggression between two figures and the therapist asks if another figure can step in and stop the fight

Therapist and attunement

Intersubjective attunement (mutually created and shared emotional states); consistency, safety, allow child to lead; therapist = coregulator for the child

Typical presentation of trauma in children

Hypervigilance, poor emotional regulation, impulsivity, irritability, aggression, inattention, recklessness

How is attachment trauma repaired? (brain)

Symptoms originate in lower brain areas (like the brainstem); remediating requires repetitive, patterned sensory input

Attachment trauma repair: caregivers and supplements

Caregiver work supports repetition; supplemental work such as occupational therapy, music and movement classes, educational programming

If parents contributed to the issue...

The therapist is available for the long term to work with the child; a safe supportive outside source is identified (school counselor, teacher, grandparent, big sibling)

Theoretical formulations of Object Relations

1. Significant relationships and human development. 2. Infants and attachment figures co-create interactive patterns. 3. These templates = beliefs about self and others

Object Relations: false self

a not true version of ourselves we put on to be liked; therapists help children be their authentic selves

Object Relations: good-enough parenting

Acceptance, fulfillment of needs, protection of psychological well-being; therapists provide acceptance and care of wellbeing and support parents in this

Object Relations: holding environment

Recreating the caregiving environment within therapeutic relationships

Object Relations: transitional object

Stands in for something but is not that thing (e.g. stuffed animal that smells like home brought to school); therapists may need to act as an attachment figure

Middle childhood: ages and what it is

Ages 7-12; developmental period between early childhood and adolescence with significant cognitive, emotional, and social growth

What is adenarche?

First wash of hormones before physical signs of puberty begin

Middle childhood: why it matters for counselors

Children better articulate and reflect on thoughts and emotions, but face declining self-esteem from social comparison.

Middle childhood: implications for counseling

Use concrete play activities, emotion-identification tools, CBT techniques, problem-solving skills, and family/school involvement.

Middle childhood: counselors should remember

Logical yet concrete thinking, emerging emotional awareness, and self-esteem shaped by peers and academics.

Piaget: what can children discuss? What is difficult?

Can discuss real experiences and emotions; abstract metaphors may be difficult

Middle childhood: children can participate in / begin learning

Participate in structured problem solving; begin learning coping strategies and emotional regulation techniques

Erikson's stage for middle childhood

Industry vs. Inferiority (ages 6-12); developing a sense of competence and mastery

Emotional development in middle childhood

Enhanced self-regulation, complex emotion labeling, and greater awareness of others' emotions.

Emotional regulation skills in middle childhood

Impulse control; delayed gratification; managing frustration; using coping strategies

Counseling strategies for emotional regulation

Emotion identification activities; relaxation techniques; cognitive-behavioral coping skills

Self-concept in middle childhood: changes

complex self-concept, more social comparison, skill-based self-evaluation, and greater influence of teacher and peer feedback.

How do children describe themselves in middle childhood?

Personality traits and competencies (e.g. "good at math," "bad at sports")

Self-concept: counseling implications

Self-esteem becomes vulnerable to academic or peer difficulties; important to reinforce strengths and resilience

CBPT

Cognitive Behavioral Play Therapy; Susan Knell

CBPT: what does it consider developmentally?

Emotional, cognitive, and linguistic development

What is the cognitive triangle?

Aaron Beck's triangle of thoughts, feelings, and behaviors

How is the cognitive triangle used in CBPT?

The child's current triangle is explored, honored, and respected (clinicians do not comment on anything as "bad")

What is cognitive therapy?

Changing thoughts helps change our feelings

What is behavioral therapy?

Impact of environmental influences on behavior and pathology

What three theories shape behavioral therapy?

Operant conditioning, classical conditioning, and social learning theory

Operant conditioning

Function of reinforcers and punishments to manipulate behavior (Skinner, 1938)

CBPT history: why adapt CBT for kids?

CBT was designed for adults; the preoperational stage (approx. ages 2-7) is a challenge because kids cannot think about thinking successfully yet; Knell used play therapy to teach the skills and have kids thinking about their thoughts

CBPT theory: style

Does not rely on typical open-ended questions; structured and directive; communication can be verbal, non-verbal, or play-based; begins to teach the cognitive triangle

CBPT properties (Knell, 2009)

Play engagement (play is an expression of thought/language); uses play to teach coping strategies in external situations

CBPT: role of the therapist

Directive (similar to other adults); respect for the triangle; may make suggestions for change

CBPT developmental consideration: under age 7

Children under 7 can rarely explain their thoughts; therapist might guess thoughts and motivations through observation (e.g. "it looks like you are feeling angry because I moved your figurine")

CBPT strategy: emotions and behavior

Child learns how emotions impact behavior (e.g. big anger = lose control of your body vs. small anger and behavior)

CBPT strategy: modeling and role play

Modeling positive self-talk; dolls show how to manage big emotions; art projects centered on problem solving

CBPT: parents' role

Parents are partners in therapy; parents keep journals; parents are brought into the meeting so they can facilitate this work at home

Systematic desensitization and in vivo exposure: when used?

Children with generalized anxiety, specific phobias, or trauma-related anxieties (all anxiety related)

How is exposure explained to children and families?

Metaphors give psychoeducation about how exposure decreases arousal; the therapist explains that once the child is exposed to the stimulus enough, it will fail to elicit the same response

Exposure example

A child was abused in a tub and now fears the tub; the anxiety of the tub is addressed, not the trauma of abuse

What is termination?

Healthy closure of the therapeutic relationship

What do we do during termination?

Reinforce skills learned in therapy; continue to strengthen the relationship between child and parents; bring up the chance to process grief/goodbye; allow expression of loss and anger

What is bibliotherapy?

A form of supportive psychotherapy in which the client is given carefully selected material to read

Common goals of bibliotherapy: list

Validates feelings and normalizes shared experiences; sparks discussion and play; builds self-awareness; explores coping skills.

Importance of metaphors in bibliotherapy

Metaphors offer safe distance from problems

Why do play therapy and bibliotherapy complement each other?

They both offer safe psychological distance from the child's problems and take you on magical adventures that hold significant symbolism and metaphors (Van Hollander, 2024)

Bottom-up approach: order

Brainstem (regulate) then limbic (relate) then cortical (reason)