Cognitive-behavioural play therapy

Domain VIII · Creative & expressive arts therapies · Susan M. Knell · 1986

What it is

CBPT is a play therapy that delivers cognitive-behavioural therapy through play for young children, roughly 2½ to 8 years old. Knell developed it from the late 1980s (Knell & Moore, 1986 poster on encopresis; Knell, 1993) in answer to the view that young children were too concrete, egocentric and…

Format

• Format. Individual sessions with the child in a playroom, run alongside parent sessions. The therapist plays actively and works toward specific goals. Structured, directive segments are woven into unstructured play rather than run in fixed blocks. Goals come from the child and the therapist, often…
• Stage 1: Introductory/orientation. This is Knell's first stage. The child gets used to the therapist, the room and how sessions run. Use unstructured play to gather clinical information and build the relationship. Drewes & Cavett put three things at the outset: setting goals with measurable…

Who practises it, and how they are trained or regulated

• Emotional dysregulation (Geraci, Rome): 15 CBPT sessions over 6 months, after 12 child-centred play therapy sessions meant to give the child a safe climate and acceptance; follow-up at 30 months.
• Separation anxiety in a girl aged 4½ (Geraci & D'Angelo 2025): 25 sessions over 9 months, plus parent training, with follow-ups at 3 and 6 months.
• How change happens: the child takes part directly in their own change. This is unlike parent-run behavioural programmes alone. Modelling and behavioural rehearsal through puppets and toys stand in for the verbal reasoning adult CBT relies on. The child watches a character with a problem like theirs learn coping thoughts and actions, copies them in play, and then practises them in real life. Parents and other adults…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Lecturing. Keep it short and inside the play.
• Stories in which the hero takes unsafe risks.
• The child shutting down. Go back into the metaphor.
• A belief that worry must never come back. Normalise lapses.
• A child who cannot coach yet. Model the coaching again first.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.