Ecosystemic play therapy

Domain VIII · Creative & expressive arts therapies · Kevin J. O'Connor · 1987

What it is

EPT is an integrative, "meta-theoretical" model of child therapy that O'Connor developed in the late 1980s. It is a framework for conceptualising and planning treatment, not a fixed technique set: O'Connor describes it as "theory dependent, as opposed to technique dependent." It draws on…

Format

• Intake. A comprehensive, multi-systemic intake before treatment begins. The workbook organises it as: Part I clinician and facility information; Part II client and responsible-adult information; Part III a systems review; plus a mental status examination. The parent interview covers early…
• Assessment (workbook Part IV). Individual and interpersonal functioning, developmental functioning across several dimensions early in the process, and baseline data for monitoring. Optional depth ranges from a parent questionnaire to child questionnaires, drawings, formal testing, or observed…

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

• Defaulting to one category (often pretend play) for every child.
• A child whose arousal or aggression disrupts the group; move to individual work.
• Activities chosen by age or by therapist preference rather than by assessed level.
• Talk that comes before the child is ready, or play that never links back to life outside.
• Sharing information beyond what consent covers; becoming the family's permanent go-between.

Problems the guide addresses

• Negative reaction and refusing to come
• Setbacks during growing and before termination
• Overwhelm and over-arousal in session
• Stuck treatment
• Caregiver non-adherence and system resistance
• Safeguarding disclosures and suspected abuse
• Ruptures with the child
• Ruptures with caregivers
• Model-specific difficulties

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.