Atlas›Domain VIII · Creative & expressive arts therapies›Guide 157
Guide VIII-157

Child-centred play therapy (Axline, Landreth)

Virginia Axline, Garry Landreth1947Ohio State University
A 42 · L 41 · M 1720 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the University of North Texas Center for Play Therapy (UNT CPT) model of child-centered play therapy (CCPT), meaning Landreth, Play Therapy: The Art of the Relationship (4th ed., 2023) together with the CCPT Treatment Manual published as an appendix to Ray (2011), Advanced Play Therapy, as these are described by UNT CPT and by the CEBC and Title IV-E Prevention Services Clearinghouse programme reviews. Axline's eight principles (Play Therapy: The Inner Dynamics of Childhood, Houghton Mifflin, 1947) are the historical base. The full text is not drawn on for Landreth, Ray or Axline. Content credited to them comes from those institutional summaries and is tagged accordingly. [source: UNT CPT CCPT page; CEBC CCPT; Title IV-E CCPT; MTSU catalogue record for Axline 1947]

What it is: a non-directive, relationship-based play intervention for children aged roughly 3 to 10 with social, emotional, behavioural or relational difficulties. The therapist gives the child a playroom with carefully selected toys and a relationship of full acceptance, empathy and genuineness. The child leads, and toys and play are the child's medium of communication. Landreth's often-quoted line is "Toys are children's words and play is their language" [source: TAMUCC TexCHIP CCPT module]. Axline worked with Carl Rogers at Ohio State University and carried his person-centred principles over into work with children [source: Wikipedia, Virginia Axline (secondary)].

How change happens: CCPT holds that children judge their worth from the acceptance and expectations they perceive in others. When the child's self-perception clashes with the messages they receive, they can develop rigid, fragile ways of being and problem behaviour. Inside a consistently accepting relationship, the child's self-actualising tendency can work again. The UNT CPT page calls the child's experience within the counselling relationship "the factor that is most healing and meaningful". Stated goals include a more positive self-concept, self-responsibility and self-direction, self-acceptance, a sense of control, an internal source of evaluation and trust in oneself. [source: UNT CPT CCPT page; CEBC CCPT; TAMUCC module]

Related entries, not repeated here: 156 (Relationship play therapy, Moustakas), 158 (Non-directive and integrative play therapy, the BAPT model), 159 (Child-Parent Relationship Therapy, CPRT, Landreth's 10-session parent model) and 160 (Filial therapy).

2. Framework

CCPT does not run as a sequence of planned phases with session content. The therapist's behaviour is the same in every session. What changes over time is the child's play. The structure below covers delivery format, then the stages of the child's process as the training literature describes them, then movement and ending criteria.

Format and dose (two published versions; name the one you follow):

  • Clinical (CEBC description of the Ray 2011 manual): individual 45-minute sessions, weekly, for 16 to 20 weeks, plus regular parent consultations as part of the protocol. [source: CEBC CCPT]
  • School (CEBC): 30-minute sessions twice weekly for 8 weeks, usually with limited parent involvement. [source: CEBC CCPT]
  • Title IV-E Clearinghouse review (Ray 2011; Cochran, Nordling & Cochran 2010): sessions typically 45 minutes (range 30 to 50), frequency set by need, and 35 to 40 sessions recommended. Consultation with parents, schools or teachers may be included but is not required. [source: Title IV-E CCPT]
  • The two counts differ: 16 to 20 versus 35 to 40 sessions. Treat 16 to 20 weekly sessions as the minimum course used in research, and expect longer work for complex or trauma-affected children. [uncertain: sources conflict; this resolution is my synthesis]
  • Room: CEBC describes a playroom of about 12 by 15 feet stocked from real-life, aggressive and creative categories. Title IV-E refers to five types of toys. Section 4 covers toy selection. [source: CEBC; Title IV-E; UNT CPT Playroom page]
  • No homework. [source: CEBC CCPT]
  • Child-Centered Group Play Therapy is a separate certified format listed by UNT CPT and CEBC. It is not covered here. [source: UNT CPT; CEBC search listing]

Stages of the child's process. The TAMUCC CCPT training module presents five stages without naming who first described them [uncertain: original attribution not verified]:

  1. Diffuse negative feelings appear throughout the play.
  2. Ambivalence, mainly anxiety or hostility.
  3. Negative feelings aimed more directly at parents, siblings or the therapist; regression may appear.
  4. Positive and negative feelings mix again, directed at significant people.
  5. Mostly positive feelings, with realistic negative feelings expressed appropriately.

The same module separates adjusted play (conversational, spontaneous, feelings shown concretely) from maladjusted play (silence or rapid-fire questions, cautious starts, symbolic expression of feelings). It notes that the main difference is how intense and frequent the negative attitudes are. Use the stages as a lens for supervision and parent feedback. They are not a checklist the child must pass through. [source: TAMUCC module; usage advice is synthesis]

Moving on and ending (criteria are synthesis; the sources give none):

  • Early sessions: the main task is for the child to experience the room as safe and predictable and the therapist as consistent. You will see testing of limits and checking of the therapist's reactions.
  • Middle work: play themes such as power and aggression, nurturance, control and safety, or mastery appear and repeat, and their intensity changes. [source for theme categories: TAMUCC module]
  • Consider ending when the presenting concerns have eased across settings (parent and teacher report), play has moved toward stage-5 quality, the child shows self-direction and self-control in the room, and limits are rarely needed. Agree an ending date with the parent and give the child notice over several sessions. [synthesis]

3. Guiding principles

Axline's eight principles (1947; restated in later CCPT texts). These are paraphrased from secondary summaries. Axline's original wording is not drawn on here [uncertain]. Cochran, Nordling and Cochran give the principles a full chapter in their Routledge Child-Centered Play Therapy (2022) [source: Taylor & Francis chapter page].

  1. Warm, friendly relationship from the start. Practical meaning: greet the child warmly, without pressure, and let rapport build through your attention, not through questions.
  2. Accept the child exactly as they are. Practical meaning: do not praise or criticise how the child is or what they make; respond to the child, not to the product.
  3. A permissive atmosphere so the child can express feelings freely. Practical meaning: no topic or feeling is off-limits in play. Only behaviour has limits.
  4. Recognise feelings and reflect them back so the child gains insight. Practical meaning: name the feeling you see in the child or in the play, briefly and tentatively.
  5. Respect the child's capacity to solve their own problems; the responsibility to choose and change is the child's. Practical meaning: do not rescue, fix or decide for the child. Return decisions to them.
  6. Do not direct; the child leads and the therapist follows. Practical meaning: no suggested activities, no questions that steer the play, no interpreting.
  7. Do not hurry the therapy; it is a gradual process. Practical meaning: tolerate repetitive or slow play and do not push toward the "real issue".
  8. Set only the limits needed to anchor therapy in reality and make the child aware of their responsibility in the relationship. Practical meaning: few limits, set only when needed and held consistently. [source: Wikipedia, Virginia Axline (secondary; the list carries a citation-needed tag there); Taylor & Francis chapter abstract]

Core conditions from the person-centred tradition:

  • Unconditional positive regard. Practical meaning: your acceptance does not depend on the child's behaviour, even when you are holding a limit. [source: TAMUCC module]
  • Empathic understanding. Practical meaning: try to see the room through the child's eyes, and put that into words only as far as the child shows it. [source: TAMUCC module; CEBC]
  • Genuineness. Practical meaning: your responses match what you actually feel and see; no performed enthusiasm. [source: TAMUCC module]

CCPT foundational beliefs (programme description):

  • Children have an innate capacity for growth. Practical meaning: the therapist provides conditions, not cures. [source: CEBC]
  • Play is the child's most natural form of communication and coping. Practical meaning: do not require the child to talk about the problem. [source: CEBC]
  • All feelings and wishes are accepted; not all behaviours are. Practical meaning: name and accept the wish while you hold the limit on the act. [source: CEBC]
  • The relationship, not technique, heals. Practical meaning: every response in Section 4 serves the relationship. Use them as ways of being with the child, not as a programme of interventions. [source: UNT CPT CCPT page]
  • Toys are "selected, not collected". Practical meaning: every item must allow expression, and the room should be orderly and predictable. [source: UNT CPT Playroom page, citing Landreth p. 176; the page dates the book 2024 while UNT CPT's CCPT page gives 2023, uncertain]
  • Treatment fidelity. Practical meaning: use a skills checklist to monitor whether you are actually practising CCPT and not a directive hybrid. [source: CEBC, on the Play Therapy Skills Checklist]

Practice principles for child work [synthesis, grounded in the professional frame in Section 4]:

  • Safety and safeguarding override non-directiveness. Practical meaning: a disclosure or a risk indicator moves you out of the non-directive stance into your safeguarding procedure.
  • The parent or carer holds legal consent; the child gives assent. Practical meaning: obtain both, and revisit assent when the child is distressed or refuses.
  • Play is not evidence. Practical meaning: never treat play themes, including sexualised play, as proof of abuse or as a diagnosis.

4. Intervention inventory

Professional frame (read before using). CCPT is a specialist method. Use it only if you are a licensed or registered mental-health professional with specific play-therapy training and supervision. Do not adopt it from reading alone.

  • USA and international (APT): the Association for Play Therapy's Registered Play Therapist (RPT) credential requires all of the following:
    • a mental-health graduate degree and a state licence or certification
    • 150 hours of play-therapy instruction (from 1 April 2025, at least 75 of them in person)
    • supervised play-therapy experience under an RPT-S, including 35 hours of supervision (up to 15 in a group, at least 20 individual)
    • completion of all of this within 2 to 10 years
    • annual renewal and play-therapy continuing education every three years.
    The RPT-S (supervisor) and SB-RPT (school-based) credentials also exist. UNT CPT puts the supervised experience at 350 to 500 hours. [source: APT Credentials page; UNT CPT RPT page]
  • Model-specific certification: UNT CPT offers CCPT certification, and its courses count toward the RPT hours. The Title IV-E review describes two levels:
    • Level 1: 40 hours of CCPT coursework, an exam, 30 supervised sessions with three children aged 3 to 10, a self-evaluation paper and a licence.
    • Level 2: 100 sessions with at least 10 children, plus supervision training.
    The National Institute of Relationship Enhancement (NIRE) also certifies: 13 hours of basic training and at least 26 hours of consultation. CEBC lists UNT trainings CCPT 101 (12 hours) and CCPT Practice and Application (18 hours). UNT CPT warns that some trainings do not teach the evidence-based model. [source: Title IV-E CCPT; CEBC; UNT CPT CCPT page]
  • UK: play therapy is not regulated by statute. BAPT's own page notes that practitioners can work in play therapy without being on a register. BAPT (British Association of Play Therapists) keeps a register accredited by the Professional Standards Authority (PSA), reviewed annually; the certificate file is dated July 2023. The PSA's accredited-register directory also lists Play Therapy UK (PTUK). Check that a UK practitioner is on one of these registers and holds that body's recognised qualification. [source: BAPT PSA page; PSA directory listings for BAPT and PTUK, uncertain] For BAPT's non-directive and integrative model, see 158.

Intake: consent, assent and safeguarding information

  • Purpose / when: before the first playroom session, and again whenever circumstances change, for example a custody change or a new referrer. [synthesis]
  • Steps: [synthesis]
    1. Meet the parent or carer without the child.
    2. Confirm who holds legal authority to consent. Check custody and court orders, and for a looked-after child confirm who consents (local authority, foster carer or birth parent).
    3. Take a developmental, family and school history and the presenting concerns.
    4. Explain the method in plain terms: the child leads, there are few rules, there is no homework, and you will meet the parent regularly.
    5. Explain confidentiality and its limits. You will share themes and progress with the parent, not a commentary on the child's play. You will act on any safeguarding concern and may have to involve other agencies.
    6. Give your local reporting duties in writing.
    7. Get written consent from the person with authority.
    8. Agree logistics. The same day, time and room each week support predictability.
    9. Ask about the child's experiences of touch, restraint, medical procedures and trauma, so you can anticipate triggers.
  • Child assent: at the first session, explain in age-appropriate words what the room is, how long you will be together, and that the child may choose what to do. Treat sustained distress, refusing to enter, or asking to leave as information. Do not force entry. [synthesis]
  • Mandatory reporting: [synthesis; check your jurisdiction, uncertain]
    • Duties vary by jurisdiction. In US states, licensed mental-health professionals are generally mandated reporters of suspected child abuse or neglect. Learn your state's threshold, timeline and reporting route before you see children.
    • In England, you follow statutory safeguarding guidance, local multi-agency procedures, your employer's policy and your register's ethics framework. Specific statutory reporting duties apply to some professions.
    • Elsewhere, follow national law.
    • Know your designated safeguarding lead, or the clinical lead in private practice, before you start.
  • Example language (illustrative, to parent): "Your child will mostly choose what to play. I won't report every detail of the play to you, because that is how children feel free to express themselves. I will tell you about overall themes and progress, and if I ever believe your child is at risk of harm I have to act on it."
  • Watch for: a parent who wants a forensic assessment or wants you to ‘find out’ whether abuse happened. CCPT is not an investigative interview, so refer to the appropriate service. Watch also for contested custody where only one parent has consented. [synthesis]

Preparing the playroom and materials safety

  • Purpose / when: before you start, and checked before every session. The room is part of the intervention. [source: UNT CPT Playroom page]
  • Steps:
    1. Choose an orderly, predictable room that can tolerate mess and is easy to clean. UNT CPT illustrates a playroom, an activity room and a sandtray room; CEBC gives about 12 by 15 feet. [source: UNT CPT Playroom; CEBC]
    2. Stock three broad categories [source: UNT CPT Playroom page]:
      • real-life and nurturing toys: doll family and dollhouse, puppets, animal families, vehicles, cash register and money, kitchen and food, medical kit, two telephones
      • aggressive-release and acting-out toys: bop bag, soldiers, scary puppets and animals, rubber knife, foam sword, handcuffs, plus breakable egg cartons and popsicle sticks. The page marks this category with a question.
      • creative-expression toys: sand, water, paints and easel, crayons, clay or play-dough, instruments, dress-up, magic wand.
    3. Use toys that are durable, simple, easy to operate and allow success, and that offer variety of expression and reality-testing of limits. Avoid complex or fragile items. [source: UNT CPT Playroom page]
    4. Toy guns should be coloured plastic and must not look real. [source: UNT CPT Playroom page]
    5. Keep the same toys in the same places every session so the room is predictable. [synthesis consistent with UNT CPT "orderly and predictable"]
  • Safety checks (all [synthesis]):
    • Use only non-toxic, age-labelled paints, clay and markers, and blunt scissors (the UNT list specifies blunt scissors).
    • Remove small parts if you see very young or developmentally younger children who mouth objects.
    • Supervise rope, handcuffs, dress-up cords and anything that could wrap around a neck or be used to restrain. Remove them for children with self-harm or strangulation-game risk.
    • Check sand for debris and clean or replace it on a schedule. Mop water spills at once, because wet floors cause falls.
    • Anchor the easel and shelving.
    • Check for latex allergy (balloons, gloves in medical kits) and food allergy (play-dough may contain wheat).
    • Keep drums and cymbals at a volume that does not hurt.
    • Make sure no glass, real sharp objects, cleaning chemicals or medication are reachable.
    • Remove broken toys.
    • In multi-use rooms, clean and disinfect toys between children.
    • Keep a first-aid kit, and know the exit route and how to call for help.
  • Watch for: toys that invite only one use, cluttered collections, and personal items or screens in the room. [synthesis]

Structuring the session (opening and ending)

  • Purpose / when: the start and end of every session. Predictable structure is part of the safety the child needs. [synthesis; the UNT CPT and clearinghouse pages describe the room and dose but not opening or ending scripts, uncertain]
  • Steps: [synthesis]
    1. Meet the child in the waiting area and walk to the room together.
    2. Give a brief opening that tells the child they may choose how to play and that you will say if there is something they cannot do. Do not list rules in advance.
    3. Sit at the child's eye level and stay attentive and verbally responsive. Do not play with your own agenda.
    4. Give advance notice before the end, for example a few minutes before, and again one minute before.
    5. End on time, even if the child is mid-game.
    6. Leave the room as it is. Do not ask the child to tidy, so that cleaning up is not made part of whether they are acceptable.
  • Example language (illustrative): "This is our playroom. You can choose what you'd like to do here, and if there's something you can't do, I'll tell you." "Five more minutes in the playroom today." "Our time is up for today. You can play with that again next week."
  • Watch for: a child who cannot separate from the parent. Allow the parent to sit in the doorway for the first session or two, then fade. A child who resists leaving gets the same limit-setting as any other behaviour (see the limit-setting entry below). [synthesis]

Tracking behaviour

  • Purpose / when: throughout the session, especially early on and with quiet children. It shows the child that you are fully present and following. [source: TAMUCC module; CEBC]
  • Steps:
    1. Briefly describe what the child, or the object the child is moving, is doing.
    2. Use neutral words. Do not name the toy before the child does, because labelling imposes your meaning. [source: TAMUCC module: follow the child's or the object's behaviour, avoid labelling]
    3. Keep a rhythm that is not a running commentary; match the child's pace. [synthesis]
  • Example language (illustrative): "You're putting that one over there." "That's going fast, up and over." "You're filling it all the way up."
  • Watch for: the child looking up when you track, or carrying on more freely, is a sign of contact. Irritation means you are tracking too often, so cut back. [synthesis]

Reflecting content

  • Purpose / when: when the child tells a story, explains, or gives a narrative through play. It conveys understanding. [source: CEBC; TAMUCC module]
  • Steps: paraphrase the child's words or story briefly, in the child's vocabulary, without adding interpretation. [synthesis]
  • Example language (illustrative): "So the tiger went to his house and nobody was there." "You went to your grandma's at the weekend."
  • Watch for: the child correcting you is useful, so accept the correction. Do not ask questions to extend the story. [synthesis]

Reflecting feelings

  • Purpose / when: whenever the child's emotion shows, in the child or in the play characters. It builds the child's awareness and acceptance of their feelings. [source: CEBC; TAMUCC module; Axline principle 4 as summarised]
  • Steps: [synthesis]
    1. Notice the feeling in the face, body, voice or play.
    2. Name it simply and tentatively.
    3. When the child speaks through a character or puppet, reflect within the metaphor.
    4. Do not reassure the feeling away.
  • Example language (illustrative): "You're really angry at that." "That one's scared, all alone." "You're proud you got it to stand up."
  • Watch for: the child taking up the feeling word, or shifting intensity, shows it is landing. Denial ("I'm NOT mad!") can be reflected too: "You don't want to be called mad." [synthesis]

Reflecting deeper meaning

  • Purpose / when: after a theme has repeated across sessions. It conveys understanding of the theme or need behind the play. CEBC lists it as a separate response category. [source: CEBC]
  • Steps: [synthesis]
    1. Wait until you are reasonably confident of a pattern, for example several sessions of rescue play.
    2. Name the pattern or need in the child's terms, briefly.
    3. Use it sparingly and do not link it to the child's real-life events unless the child does.
  • Example language (illustrative): "It's really important that the baby is always kept safe." "You like being the one who decides."
  • Watch for: this is not interpretation of unconscious content. If the child stops or withdraws, you went too far or too soon. [synthesis]

Returning responsibility (facilitating decision-making)

  • Purpose / when: whenever the child asks you to decide, do something for them, or tell them what something is. It builds self-direction and self-efficacy. [source: TAMUCC module; CEBC]
  • Steps:
    1. Choose the indirect form or the direct form. [source for the indirect and direct forms: TAMUCC module]
      • Indirect forms: respond within the child's metaphor; use minimal encouragers, restating, reflecting or tracking; or use the whisper technique (next entry).
      • Direct form: tell the child plainly that the choice or action is theirs.
    2. If a task is beyond the child's ability, give only the help needed and let the child direct it. [synthesis]
  • Example language (illustrative): "In here, you can decide what that is." "You can choose the colour." "You'd like me to open it. Show me what you want me to do." "You can figure that out."
  • Watch for: fewer requests for permission over the sessions, and more spontaneous choices. A child who becomes frustrated needs a reflection of the frustration before responsibility is returned again. [synthesis]

Whisper technique (child-led role play)

  • Purpose / when: when the child casts you in a role, such as teacher, robber or baby, and the scene needs your lines. It keeps the child in charge of the play. [source: the TAMUCC module names it as an indirect way of returning responsibility; the steps below are my synthesis, uncertain]
  • Steps: [synthesis]
    1. Accept the role.
    2. Ask quietly, out of role, what your character says or does.
    3. Then play it as directed, with appropriate but moderate emotion.
    4. Do not add plot twists.
  • Example language (illustrative): (quietly) "What does the teacher say now?" (in role, after the child's direction) "Oh no, you're in trouble!"
  • Watch for: play that becomes physically rough toward you, such as tying you up or hitting the 'robber'. Stay in role only within safety limits, and set a limit if the play turns to hurting you. [synthesis]

Facilitating creativity

  • Purpose / when: when the child creates, invents or experiments. It supports flexibility and the child's own ideas. CEBC lists it as a response category. [source: CEBC]
  • Steps: reflect the child's freedom to create, and acknowledge their inventiveness without evaluating the product. [synthesis]
  • Example language (illustrative): "You're making it just the way you want." "You thought of a new way to use that."
  • Watch for: a child who asks "Is it good?" Return the evaluation: "You're wondering what I think. What do you think of it?" [synthesis]

Esteem-building

  • Purpose / when: when the child shows effort, persistence or mastery. It strengthens an internal sense of competence. CEBC lists it as a response category. [source: CEBC]
  • Steps: describe the child's effort or ability in place of evaluative praise, which would make you the judge. [synthesis, consistent with CCPT's goal of "an internal source of evaluation" in CEBC and TAMUCC]
  • Example language (illustrative): "You kept trying until you got it." "You knew just how to do that." Avoid "That's beautiful!"
  • Watch for: a child who starts to self-evaluate ("I did it!") is moving the locus of evaluation inward. [synthesis]

Facilitating relationship

  • Purpose / when: when the child makes a bid toward you, such as offering you food, asking about you, or showing care or anger directed at you. CEBC lists it as a response category. [source: CEBC]
  • Steps: respond to the bid by reflecting the child's intention toward you and your relationship. Answer simple personal questions briefly if that serves the child; otherwise reflect the curiosity. [synthesis]
  • Example language (illustrative): "You made that for me." "You want to know if I see other kids." "You're mad at me because time's up."
  • Watch for: relationship bids increasing, and anger at you being expressed and survived. Both are signs of trust. [synthesis]

Therapeutic limit-setting

  • Purpose / when: only when it is needed. The TAMUCC module names danger to the child, to the therapist or to the room. Limits help the child feel secure and keep therapy anchored in reality (Axline principle 8 as summarised). Typical needs are hurting self or therapist, damaging the room or expensive equipment, leaving the room, staying past the end, and taking toys home. [source: TAMUCC module; CEBC; the list of typical needs is synthesis]
  • Steps (the three-step sequence in the CCPT manual as CEBC describes it; Landreth's training material often abbreviates it as an acronym [uncertain]):
    1. Acknowledge the child's feeling or wish.
    2. Communicate the limit: brief, specific, calm, and impersonal ("the X is not for Y" rather than "you mustn't") [phrasing style is synthesis].
    3. Offer an acceptable alternative for the same feeling or wish. [source: CEBC; TAMUCC module]
    Set the limit at the moment it is needed, not in advance. [synthesis]
  • Example language (illustrative): "You're really angry with me. I'm not for hitting. You can hit the bop bag." "You'd like to stay longer. Our time is up for today. You can come back next week." "You want to throw it at the window. The window's not for throwing at. You can throw the soft ball at the wall."
  • Watch for: testing is expected, so hold the limit consistently and with the same warmth. Do not set limits on feelings or themes, only on actions. Limits that keep growing in number may mean the room is overstimulating, so reduce the toys. [synthesis]

Choice-giving when a limit is repeatedly broken

  • Purpose / when: when the child keeps breaking the limit after the three steps. CEBC lists "choice-giving" together with limit-setting. [source: CEBC; the steps below are my synthesis, uncertain]
  • Steps: [synthesis]
    1. Repeat the three steps once more.
    2. Then state a choice with a consequence inside the session. Example consequences: choosing not to play with that toy for the rest of today, or ending the session early only as a last resort for safety.
    3. Let the child choose, and follow through calmly without shaming.
    4. Never threaten consequences outside the session, and never involve the parent as a punishment.
  • Example language (illustrative): "If you choose to throw the car at me, you choose not to play with the car for the rest of today. If you choose to put it on the floor, you choose to keep playing with it." Then: "You chose to throw it, so the car goes on the shelf until next time."
  • Watch for: if a safety risk is imminent, act physically to protect without waiting for the sequence. Move objects or step away, and use the minimum contact needed (see the touch entry). Record any incident and inform the parent. [synthesis]

Touch boundaries

  • Purpose / when: touch arises when a child seeks a hug, climbs on you, wants you as a 'patient' in medical play, or needs physical protection. Have a clear policy before therapy starts. [synthesis; No published touch guideline from APT, BAPT or PTUK is drawn on here, so check your body's current guidance, uncertain]
  • Steps: [synthesis]
    1. Tell parents your touch policy at intake.
    2. Never initiate touch for your own comfort.
    3. Accept only brief, child-initiated, non-sexual contact that suits the child's age and culture, such as a side hug or a high-five. Reflect the wish when you redirect contact.
    4. In role play, keep any touch symbolic. For example, the doctor's kit is used on a doll, or 'pretend' touch stops short of your body.
    5. Never allow or engage in sexual or genital touch, or touch under clothing. Physical holding or restraint only as a last resort to prevent immediate harm, under your service's policy and training; record it and inform parents or carers. [synthesis]
    6. If a child touches you sexually, set a calm limit, redirect, record it, and consider it under safeguarding without assuming abuse.
    7. Use protective touch only to prevent harm, at the minimum level, and document it.
    8. Use observation windows, open-door or recording policies and supervision as your service requires.
    9. Ask about cultural norms around touch, and about any trauma history in which touch is a trigger.
  • Example language (illustrative): "You want to sit on my lap. You can sit right here next to me." "You want to give me a shot. You can give the shot to the doll and I'll watch."
  • Watch for: repeated sexualised touch or sexual knowledge beyond the child's age. Discuss it with your safeguarding lead. Do not investigate it through play. [synthesis]

Responding to a disclosure or risk during play

  • Purpose / when: the child says something that suggests harm, or there is self-harm, injury or neglect. This is the point where non-directive stance gives way to safeguarding. [synthesis]
  • Steps: [synthesis]
    1. Stay calm and listen.
    2. Reflect what the child said. Do not ask leading questions or probe for details.
    3. Do not promise secrecy.
    4. Tell the child, in simple words, that you will need to tell someone whose job is to help keep children safe.
    5. After the session, record the child's exact words, the time and context, separately from your interpretation.
    6. Follow your jurisdiction's reporting procedure and your service's policy. Consult your safeguarding lead.
    7. Decide with them whether and when to inform the parent. Do not do this if it could put the child at risk.
  • Example language (illustrative): "You told me something really important. I need to make sure you're safe, so I'm going to talk to someone whose job is helping keep kids safe."
  • Watch for: do not use the playroom to gather evidence. Forensic interviewing is a separate, specialist role. [synthesis]

Observing play themes, not interpreting them as diagnosis

  • Purpose / when: throughout therapy, for your own case conceptualisation, supervision and parent feedback.
  • Steps:
    1. After each session, note recurring themes. The TAMUCC module groups them as:
      • power and aggression (good guy versus bad guy, dying and death)
      • family and nurturance (consistency, lack of attachment)
      • control and safety (danger, rescue)
      • exploration and mastery (creativity, competence)
      • interaction (positive interaction, boredom)
      • sexualised play (sexual activity, sexual curiosity).
    2. Track changes in intensity and frequency over time. [source: TAMUCC module]
  • Watch for: play themes are not validated evidence of abuse or of any disorder, and CCPT has no diagnostic scoring. Use them only for hypotheses. If concern arises, refer for appropriate assessment and follow safeguarding procedures. [synthesis; CCPT play is not presented as diagnostic in any source]

Parent and carer consultations

  • Purpose / when: in clinical settings, regular ongoing consultations are part of the CCPT protocol (CEBC). In schools, involvement is limited. The Title IV-E version treats consultation with parents, school or teachers as optional. [source: CEBC; Title IV-E] The TAMUCC module's stance: respect the parent as the most important relationship in the child's life and as the expert on the child, hold affection for the parent as a person, be patient, and keep the child as the focus. [source: TAMUCC module]
  • Steps: [synthesis for frequency and content]
    1. Hold consultations without the child, for example every three to five sessions, or more often in crisis.
    2. Share themes and changes, not session details or quotes.
    3. Ask for news from home and school, and for current stressors.
    4. Give brief, practical support.
    5. Note when the parent might benefit from structured parent-training in relationship skills. For that, refer to or switch to CPRT (159) or Filial therapy (160); do not improvise it inside CCPT.
  • Example language (illustrative): "In the last few sessions there has been a lot of play about keeping things safe and in control. How has bedtime been?" "You know your child best. What are you noticing?"
  • Watch for: a parent's distress or their own mental-health needs. Refer them to adult services. Watch also for a parent pressing for a quick fix, or wanting a report for a court case: clarify your role and boundaries. [synthesis]

Fidelity self-review (Play Therapy Skills Checklist)

  • Purpose / when: after recorded sessions, especially in training, supervision or research delivery. The CCPT manual requires the Play Therapy Skills Checklist (PTSC). CEBC reports that adherence above 90% counts as faithful delivery, with good interrater reliability. Ray et al. (2017) developed a separate CCPT Research Integrity Checklist. [source: CEBC; UNT CPT CCPT page]
  • Steps: [the PTSC items are not drawn on here, so this procedure is my synthesis; obtain the checklist from the manual]
    1. With consent, video-record a session.
    2. Code each of your responses against the response categories in this inventory.
    3. Count non-CCPT responses: questions, suggestions, praise, interpretation, teaching.
    4. Bring the patterns to an RPT-S or CCPT-certified supervisor.
  • Example language: not applicable. Note: "Count how many questions I asked in the first 10 minutes" (illustrative self-prompt).
  • Watch for: drift into directive or teaching responses, especially with anxious parents or stuck cases. [synthesis]

Ending therapy

  • Purpose / when: when the criteria in Section 2 are met, or when an external limit applies, such as the end of the school term or of funding. [synthesis]
  • Steps: [synthesis]
    1. Agree the ending with the parent.
    2. Tell the child several sessions ahead.
    3. Mark the remaining sessions out loud each week.
    4. Reflect the child's feelings about ending, including anger or indifference.
    5. Keep the last session the same as any other, with no party and no gifts from you.
    6. Offer a follow-up check-in with the parent.
  • Example language (illustrative): "We have three more times together in the playroom." "You're not sure you want to stop coming."
  • Watch for: a temporary return of earlier behaviour around the ending is common, and it usually settles if the ending is held. [synthesis]

5. Handling problems

Most of the guidance in this section is my own synthesis. The sources describe the model and its delivery but give little problem-specific guidance.

  • The child won't enter the room or separate from the parent. Allow the parent to accompany the child for the first session(s), seated and non-participating, then move them to the doorway and then to the waiting room. Reflect the child's worry. Do not bribe. [synthesis]
  • The child is silent or passive, or sits without playing. Accept it. Track small movements and reflect the uncertainty ("You're not sure what to do in here."). Return responsibility. Do not suggest toys. Silence and cautious starts are described as typical of more troubled play. [source: TAMUCC module on maladjusted play; responses are synthesis]
  • Rapid-fire questions. Reflect the wish to know, answer only factual or safety questions briefly, and return the rest: "You want to know what that is. In here it can be whatever you want." [synthesis]
  • Repetitive or 'stuck' play over many sessions. Remember Axline principle 7: do not hurry. Check in supervision whether your responses have become mechanical, or whether you are missing a deeper-meaning reflection. Look at the intensity of the theme, not only its content. [synthesis; Axline principle as summarised]
  • Escalating aggression or limit testing.
    • Set limits early and consistently, using the three steps and then choice-giving.
    • Reduce overstimulating toys, and check that the room is predictable.
    • Review whether the child needs a different or added intervention, such as trauma-focused or behavioural work, or CPRT and Filial work for parents (159, 160).
    • If you or the child are hurt, stop, ensure safety, record it, and inform the parent and your safeguarding lead as appropriate.
    [synthesis; three steps per CEBC]
  • Overwhelm, dysregulation or trauma re-enactment.
    • Slow down and stay close.
    • Reflect the feeling in simple words.
    • Offer grounding alternatives inside the room, such as water, sand or a quiet corner, without directing the play.
    • If the distress is extreme or the child dissociates, step out of the non-directive stance briefly: orient the child to the room and to you, and end with plenty of warning if needed.
    • Debrief the parent about after-session reactions.
    • For children with recent trauma, consider whether trauma-specific treatment should come first or run alongside.
    [synthesis]
  • Sexualised play or behaviour. Do not interpret or question. Reflect neutrally if it is symbolic, and set limits on any behaviour involving you or the child's body. Record, and consult your safeguarding lead. The TAMUCC module lists sexual activity and sexual curiosity as play themes. That listing is not a diagnostic sign of abuse. [source: TAMUCC module; responses are synthesis]
  • Parent non-attendance, missed sessions or dropout (non-adherence). Keep the schedule predictable, and explain to the parent that consistency is part of the treatment. Offer school-based delivery if travel is the barrier; CEBC describes a 30-minute, twice-weekly, 8-week school format. Hold a review if more than two sessions in a row are missed. [source for the school format: CEBC; the rest is synthesis]
  • A parent who wants directive advice or reports. Validate the request and offer separate parent consultations. If structured parent skills are needed, refer to CPRT (159) or Filial therapy (160). For a court or forensic report, clarify that CCPT is a treatment, not an assessment. [synthesis]
  • Ruptures (the child is angry at you, refuses to come, or is upset after a limit). Reflect the anger toward you, which facilitates the relationship. Keep the next session the same as usual. Do not apologise for holding a necessary limit, but repair any real mistake, such as a broken promise or a late start, simply and honestly. [synthesis]
  • Therapist drift into teaching, praising or questioning. Review a recording against the PTSC and take it to supervision. [source: CEBC on PTSC; the rest is synthesis]
  • Custody conflicts or a parent withdrawing consent. Stop until consent is clarified. Do not continue on one parent's say-so if a court order requires both. Plan an ending session with the child if you can. [synthesis]
  • The child wants to take a toy home, or brings gifts. The limit is that toys stay in the playroom; the alternative is that the child can show you next time, or make a drawing to take. Accept small handmade gifts and reflect the child's intention. [synthesis]
  • Cultural mismatch, for example toy guns, mess or dress-up. Explain the purpose of the aggressive-release toys to the parent. UNT CPT itself marks this category with a question. Remove items that are culturally unacceptable to the family, and include dolls and toys reflecting the child's culture. [source: UNT CPT Playroom page for the question mark; the rest is synthesis]
  • The child is outside the 3 to 10 age range. For adolescents, use an activity room or other adaptations. UNT CPT illustrates an activity room and a sandtray room. Consider other models. For children under 3, parent-child models are usually more fitting. [source: UNT CPT Playroom page and the age range on the CCPT page; the advice is synthesis]

Sources

Sources:

Further reading (not drawn on): Play Therapy UK, PSA accredited register entry [uncertain].

Further reading (not drawn on in full; details from the pages above):

  • Axline, V. M. (1947). Play therapy: The inner dynamics of childhood. Boston: Houghton Mifflin. (The catalogue supplies the year in brackets.)
  • Landreth, G. L. (2023). Play therapy: The art of the relationship (4th ed.). Routledge. (The UNT CPT Playroom page cites it as 2024, uncertain.)
  • Ray, D. C. (2011). Advanced play therapy: Essential conditions, knowledge, and skills for child practice. Routledge. (Contains the CCPT Treatment Manual.)
  • Cochran, N. H., Nordling, W. J., & Cochran, J. L. (2010). Child-centered play therapy: A practical guide to developing therapeutic relationships with children. Wiley. A Routledge edition dated 2022 contains a chapter on the eight principles.
  • Ray, D. C., et al. (2017). CCPT Research Integrity Checklist. doi:10.1037/pla0000046 (cited by UNT CPT).
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