Trauma-focused integrated play therapy

1. Introduction

Version followed: Trauma-Focused Integrated Play Therapy (TF-IPT/TFIPT) as its developer, Eliana Gil (Gil Institute for Trauma Recovery and Education, Fairfax, Virginia; Starbright Training Institute), describes it in the California Evidence-Based Clearinghouse (CEBC) programme profile (content last reviewed by programme staff March 2026). Clinic format details come from the Gil Institute service flyer. Clinical reasoning comes from Gil's books, chiefly Helping Abused and Traumatized Children (2006) and Posttraumatic Play in Children (2017), and from a 2018 interview. Only the publisher pages, tables of contents and a review of these books are drawn on, not their full text. The treatment manual named by CEBC was not available. Where this guide goes beyond the sources it is marked [synthesis] or [uncertain]. [source: CEBC profile; Gil Institute flyer; Guilford pages; Google Books record]

TF-IPT is a structured, goal-oriented play therapy for abused and traumatised children (CEBC: ages 5–17; Gil's 2017 book addresses ages 3–12) and their caregivers. It combines nondirective, child-centred play with directive methods: expressive arts and sandtray, cognitive-behavioural skills and psychoeducation, and family and family play therapy. The developer names it in two ways. The CEBC listing calls it an integration of directive and nondirective approaches. The Gil Institute flyer calls it relationship-based, drawing on child-centred play therapy principles, with three aims: the child self-directs, gains a sense of control and mastery, and heals naturally through post-trauma play. [source: CEBC; Gil Institute flyer; Guilford, Helping Abused and Traumatized Children]

Core idea of change: children's own posttraumatic play is a natural vehicle for gradual exposure, narrative formation and trauma processing. CEBC calls it the child's "natural way to introduce gradual exposure, narrative formation, and trauma processing." Inside a safe, regulated relationship, the therapist lets this play unfold. They watch whether the play is moving (dynamic) or stuck (toxic), and step in with more directive, structured or family methods when the child cannot move forward alone. Gil's interview gives the aim as to "unfreeze" rigid play, so the child can move from fixed memory towards what they wished had happened, or towards resilience and fighting back. [source: CEBC; APA Division 56 review of Gil 2017; Psychotherapy.net interview 2018]

Professional frame. TF-IPT is a specialist trauma model delivered by licensed mental health professionals. It is not a stand-alone credential. CEBC lists these provider requirements:

a licence, or trainee status under a licensed professional;
at least 3 years of direct work with abused children and families;
at least 5 days of training in child trauma and sexual abuse;
at least 5 days of training in expressive therapy;
at least 2 days of training in this model.

Training comes through Starbright Training Institute, usually over 3 days, with 1-day introductions also offered. The Gil Institute says its clinicians complete Gil's TF-IPT training intensive. Gil is a former President of the Association for Play Therapy (APT). [source: CEBC; Gil Institute flyer; Google Books author note]

Where play therapy is a recognised field, a play-therapy credential is the natural base: APT's RPT/RPT-S in the US, or BAPT or PTUK registration in the UK. Play therapy is not a statutory regulated title in the UK, so the clinician's core professional registration and its safeguarding duties also apply. [synthesis; uncertain] Gil herself advises clinicians without art therapy training to say they are using art "in a therapeutic fashion" rather than calling themselves art therapists. [source: Psychotherapy.net interview] Do not use TF-IPT with abused children without trauma-specific training and supervision. Without that training the model's central judgement (when to leave play alone and when to step in) is unsafe. [synthesis, consistent with CEBC prerequisites]

Related guides: 157 Child-centred play therapy for non-directive tracking and limits, 152 Sandtray therapy and 154 Sandplay (Kalff) for sand methods, 160 Filial therapy for caregiver-led play, and 167 Cognitive-behavioural play therapy for the cognitive components. [synthesis]

2. Framework

Three phases, after Judith Herman [source: CEBC]:

Establishing safety. Goals: build the relationship, give the child an environment of calm, develop self-soothing and regulation, and begin assessment. In her interview, Gil draws on Bruce Perry's neurosequential ideas: a frightened child must first be helped to self-soothe, and talk-based or CBT work waits until the thinking brain is "online." [source: Psychotherapy.net interview]
Direct focus on traumatic material and processing. Goals: allow posttraumatic play as gradual exposure. The therapist uses more directive methods to focus on traumatic incidents, and the child builds a trauma narrative, verbal or nonverbal. This phase also covers psychoeducation, correcting negative thoughts, and coping and relaxation skills. [source: CEBC]
Social reconnection and orientation to the future. Goals: restore pre-abuse functioning, ensure access to internal and external resources, and build self-esteem and competence. Termination sessions allow meaningful goodbyes and a balanced view of life, positive and negative. [source: CEBC]

Overall goals [source: CEBC]:

assess the child's trauma experience and its impact comprehensively;
identify trauma symptoms;
help the child explore and express thoughts and feelings about the abuse;
build coping and self-regulation skills;
ensure access to resources;
enhance self-esteem and sense of competence.

Session format. Individual sessions of about one hour, weekly, in a play therapy room stocked with basic tools [source: CEBC]. CEBC's resource list also includes a one-way mirror, video equipment and breakout rooms. Every session follows the same frame [source: CEBC]:

opening: an affect identification and scaling worksheet, then a structured mindfulness breathing exercise;
a period of nondirective play;
in the middle phase, directive trauma-focused work;
closing: the same affect scaling and breathing.

The opening and closing rituals frame the session; the play and directive work happen between them.

Length: versions differ [uncertain]:

CEBC recommends weekly sessions for 6–9 months, which works out to roughly 26–39 sessions (my arithmetic; CEBC gives no total).
The Gil Institute flyer describes TF-IPT as 12 weekly individual sessions.
The Gil Institute also runs a separate Extended Play-Based Developmental Assessment (EPBDA) of typically 8–12 sessions. EPBDA is explicitly not a custody or forensic evaluation.

Treat 12 sessions as the clinic's core package and 6–9 months as the profile's recommended course for complex (Type II) abuse. Set length by clinical progress. [synthesis]

Caregiver strand, running in parallel [source: CEBC]:

caregivers get coaching at intake and as needed;
they are shown the manual describing their child's lessons;
check-ins and progress updates;
nonoffending-parent groups or referral for individual treatment;
homework in which the child teaches the parent play-based skills such as relaxation, mindful breathing and affect scaling.

Family therapy and family play therapy form a full chapter of the 2006 book. [source: Guilford TOC]

Criteria for moving between phases. The sources give no formal criteria [uncertain]. The checks below are inferred from the stated phase goals and Gil's interview [synthesis].

Safety to processing:

the child is physically and legally safe from the alleged harm, and contact arrangements are known;
the child can use at least one self-soothing or breathing method, and session-end affect scaling returns to baseline;
the relationship is established, meaning the child uses the room freely and tolerates the therapist's presence in play;
the caregiver is engaged and supportive, or another supportive adult is identified;
dissociation, if present, is manageable within sessions.

Processing to reconnection:

the posttraumatic play has shifted from rigid repetition to variation, new endings or mastery themes;
a narrative, verbal or symbolic, has been made and, where appropriate, shared with a safe caregiver;
symptoms such as nightmares, regressions and reenactments are reducing;
trauma reminders produce less distress.

Ending: goals are met, a planned goodbye is made, and follow-up access is agreed.

3. Guiding principles

The child leads and sets the pace. Children should move at their own pace and "slowly walk towards the things" they fear. Gil warns that "sometimes we push him too hard." In practice: offer, don't drive. Slow down at signs of overwhelm. [source: Psychotherapy.net interview]
Regulation before cognition. Self-soothing comes first, cognitive work later. In practice: in early sessions, prioritise calm, predictable rituals, breathing and nurture over explanations. [source: interview; CEBC session structure]
Invite, don't interrogate. Gil offers a choice: the child can tell her or show her in whatever way they want. She removes pressure to disclose, noting children have often already been interviewed many times. In practice: no fact-finding questions about the abuse. Let the child choose words, play or silence. [source: interview]
Posttraumatic play is communication and gradual exposure. In practice: allow and document it rather than redirecting it. Make trauma-relevant toy symbols available. [source: CEBC]
Tell dynamic play from toxic play. Dynamic play helps the child progress and lowers anxiety. Toxic play shows a child stuck in repetition without relief. In practice: monitor every session; watch and wait while play is moving; step in when it is stuck. [source: APA Div. 56 review of Gil 2017; Guilford description]
Integrate directive and nondirective methods to fit the child. In practice: decide session by session, child by child, how much structure to add, using the case formulation rather than a fixed script. [source: Guilford description of Gil 2006; CEBC]
Protect the symbolic process. Gil cautions against interrupting art or play with questions such as "how are you feeling," which pull the child out of symbolic work. In practice: comment sparingly. Stay in the metaphor. Save reflection for natural pauses or the closing ritual. [source: interview]
Work systemically. Trauma is interpersonal, and the caregiver may be the source of harm. Gil's family play therapy invites everyone living in the home. In practice: assess and involve the caregiving system from intake; treat nonoffending caregivers as partners. [source: interview; CEBC; Gil 2017 ch. 5 title]
Developmentally informed, creative, flexible. In practice: adapt materials and language to developmental age, not chronological age. [source: Guilford description]
The therapist believes in what they offer and is warm, present and playful. In practice: bring a genuine playful stance. Use supervision to manage countertransference. [source: interview]
Therapy is not forensic. The Gil Institute separates its play-based assessments from custody and forensic evaluation. In practice: never use play to elicit or confirm an allegation (see section 5). [source: Gil Institute flyer; synthesis]

4. Intervention inventory

Scope: CEBC names the components of TF-IPT, and Gil's books and interview describe her reasoning. The sources do not give step-by-step manual procedures. The steps below are therefore my operationalisation of each named component, marked [synthesis] unless cited. CEBC says four or five play-based techniques are used both therapeutically and to assess functioning, relationships and communication, but it does not name them. The Gil Institute lists sand, play, art and puppet therapy. The index terms of Gil's 2006 book include sand tray, play genogram, gradual exposure, family play therapy, posttraumatic play and dissociation. [source: CEBC; Gil Institute flyer; Google Books record] The proprietary worksheets are not reproduced here.

4.1 Opening and closing affect identification and scaling

Purpose / when: Every session, at the start and end. It tracks the child's emotional state, builds emotional vocabulary, and checks that the child leaves no more aroused than they arrived. [source: CEBC]
Steps [synthesis]:
1. Use a simple feelings sheet, either the programme's own or a home-made one with faces or colours.
2. Ask the child to mark which feelings are present today and how big each is, on a visual scale (e.g. a thermometer or 1–5 blocks).
3. Note the ratings in the record.
4. Repeat at the end of the session.
5. If end ratings are higher than start ratings, extend the closing regulation (4.2, 4.14) before the child leaves.
Example language (illustrative): "Let's check in. Which feelings came with you today? Show me how big each one is." At close: "Let's see how your feelings are now, before you go back to Mum."
Watch for: ratings that stay flat at "fine" (possible avoidance or wanting to please); a jump at session end (the work went too fast). Signs it is working: the child names a wider range of feelings, and end ratings settle within or below the start level.

4.2 Structured mindfulness breathing

Purpose / when: Start and end of every session. Use it also whenever arousal rises mid-session. [source: CEBC] Gil places self-soothing before cognitive work. [source: interview]
Steps [synthesis]:
1. Sit together. Invite the child to place a hand on their belly or hold a soft toy on it.
2. Breathe in slowly through the nose while the toy rises, and out slowly while it falls, for 3–5 cycles.
3. Keep it brief and identical each time so it becomes a ritual.
4. Let the child lead it once they know it.
Example language (illustrative): "Let's give our teddy a slow ride up … and slowly down."
Watch for: breath-holding, hyperventilation or distress when the child attends to their body. For some abused children, attention to the body is itself a trigger: keep eyes open, offer an external focus such as bubbles or a pinwheel, and shorten the exercise. [synthesis]

4.3 Nondirective play period

Purpose / when: Part of every session. It gives the child control, a relationship, and room for posttraumatic play to emerge. [source: CEBC; Gil Institute flyer]
Steps:
1. Offer a room stocked with basic play tools. [source: CEBC]
2. Explain that this is the child's time to choose. Give the invitation that they can tell you or show you in any way they wish. [source: interview]
3. Follow the child's lead: track their actions, reflect feelings, and join the play when invited. [synthesis, child-centred method]
4. Do not question the child about the abuse. [source: interview]
5. Set limits only for safety and for protecting the room. [synthesis]
Example language: Gil's invitation is "You can tell me, or you can show me in whatever way you want." [source: interview] Tracking (illustrative): "You're putting all the animals behind the fence."
Watch for: play themes, the emergence of posttraumatic play (4.4), and how the child uses the therapist (included or kept outside). Signs it is working: the child engages freely, play becomes richer, and the child begins to bring meaningful material.

4.4 Assessing, documenting and monitoring posttraumatic play

Purpose / when: Every session. The clinician assesses for posttraumatic play and documents play themes. [source: CEBC] Gil's 2017 book contains a reproducible checklist for telling useful posttraumatic play from dangerous posttraumatic play. It is not drawn on here; obtain it from the book. [source: Guilford description; uncertain on items]
Forms (as reported from Gil 2017) [source: APA Div. 56 review]:
- literal (events played as they happened);
- symbolic (real names avoided but the story is clear);
- individual behavioural reenactment (replaying the trauma without involving others);
- behavioural reenactment that enlists others, including the therapist.
Features of posttraumatic play [source: interview]:
- self-initiated, miniaturised acting-out of the event;
- highly repetitive, begun and ended the same way;
- rigid, with "very little joy or spontaneity."
Steps [synthesis]:
1. After each session, record the sequence: who and what was played, the start, the end, and the affect.
2. Note any change across sessions in characters, endings, rescue or mastery themes, and the child's affect during and after the play.
3. Rate the trajectory as dynamic or toxic using the published checklist.
4. Review the trajectory in supervision.
Example language (illustrative): tracking during the play: "The car crashed again... and this time the ambulance came." [synthesis]
Watch for, dynamic: variation, new endings, reduced anxiety, and the child appearing relieved afterwards. Watch for, toxic: identical repetition over sessions, rising distress, dissociation during play, play spilling into reenactment outside sessions, and no relief. [source: APA Div. 56 review; Guilford description; specific indicators partly synthesis]
Caution: play themes are clinical hypotheses only. Never present them as evidence that abuse occurred (see 5.1). [synthesis]

4.5 Making trauma-relevant symbols available ("tickling the defenses")

Purpose / when: Toy symbols of aspects of the child's trauma may be made available in the room. [source: CEBC] When posttraumatic play does not emerge, Gil may offer literal symbols linked to the specific event. She calls this "tickling the defenses," a phrase she credits to Carl Whitaker. She works on the relationship first, because some children cannot reach this play for a long time. [source: interview] A chapter of Gil 2017 addresses play that does not emerge naturally. [source: Guilford TOC]
Steps [synthesis]:
1. From the referral history, which comes from carers and agencies and not from questioning the child, identify neutral symbols of the trauma context, e.g. toy ambulance, hospital bed, cars, a house, a police car, or a family of figures.
2. Place them among the ordinary toys without drawing attention to them.
3. Never hand the child a symbol of an alleged act or perpetrator, and never suggest what happened.
4. Observe whether the child approaches the symbols, avoids them, or ignores them over several sessions.
5. Respect avoidance. Do not escalate.
Example language (illustrative): none needed. If the child asks, say "Some new things are on the shelf. You can use them or not."
Watch for: sudden avoidance, freezing, or agitation near the items. If this happens, return to regulation and relationship work. Signs it is working: the child approaches the material at their own pace, and play begins to carry the theme.

4.6 Intervening when posttraumatic play is toxic ("unfreezing")

Purpose / when: When monitoring (4.4) shows the play is stuck. Gil 2017 ch. 3 covers evaluating posttraumatic play and intervening when it is toxic. Gil's stated goal is to "unfreeze" the play so the child can move towards what they wished had happened, or towards resilience and fighting back. [source: Guilford TOC; interview] The book's specific interventions are not drawn on here [uncertain].
Steps: the following are graded options, from least to most directive [synthesis]:
1. Name what you see in the play, staying inside the metaphor.
2. Ask the characters how they feel or what they need.
3. Wonder aloud about alternatives.
4. Introduce a helper or protector figure, or offer the child a choice point in the story.
5. Pause the play for a regulation break, then resume.
6. Move to a different medium, e.g. draw the scene or build it in the sand.
7. Discuss with the caregiver and the supervisor whether the play signals current danger.
Go one step at a time and return to the child's lead as soon as the play moves.
Example language (illustrative): "That little bear keeps getting hurt, every time. I wonder what he wishes would happen." Or: "Is there anyone who could help the bear?"
Watch for: the child accepting or rejecting the change. If they reject it, respect that and try a lower step later. Mounting distress or dissociation means stop and regulate. Signs it is working: a new element appears, endings change, and the child's affect lightens.

4.7 Sandtray

Purpose / when: For symbolic expression, assessment of themes such as separation, and processing at a distance. Gil uses a large miniature collection. In her interview, she describes a child whose sandtray kangaroo searched for its buried baby, which revealed a separation theme. [source: interview; Gil Institute flyer; Google Books index terms]
Steps [synthesis]:
1. Offer the tray and the shelves of miniatures.
2. Invite the child to make a world, with no theme imposed in nondirective time.
3. Watch quietly.
4. When the child is done, invite them to tell you about the world, if they wish.
5. Stay in the metaphor.
6. Photograph the tray, with consent, for the record.
7. In the directive phase, the therapist may suggest a theme, e.g. a safe place, or a world before and after something changed.
Example language (illustrative): "Would you like to tell me about your world? Who's this one here?"
Watch for: repetitive scenes (4.4), burying, or empty trays. Do not read trays diagnostically.

4.8 Art in a therapeutic fashion

Purpose / when: Nonverbal expression and narrative. Gil values both the process and the product of art, and warns against interrupting with feelings questions. [source: interview]
Steps [synthesis]:
1. Provide paper, crayons, markers, paint and clay. Let the child create without interruption.
2. Afterwards, invite them to share, if they want: a title, a story, what the picture would say.
3. Keep the artwork safely, or agree with the child what happens to it.
Example language (illustrative): "If your picture could talk, what would it say?"
Watch for: drawings are not diagnostic of abuse. Unless you are an HCPC-registered or credentialed art therapist, describe this as art used therapeutically, as Gil advises. [source: interview; synthesis]

4.9 Puppets and symbolic and nurturing play

Purpose / when: Puppet therapy is one of the expressive methods the Gil Institute lists. [source: Gil Institute flyer] Gil describes symbolic play, props, and feeding and nurturing play, which featured in her first case. She mentions blowing bubbles with a child before explaining the plan. [source: interview]
Steps [synthesis]:
1. Keep a range of puppets: family, animal, helper, and "scary" figures.
2. Let the child choose puppets and give them voices. The therapist voices a puppet only when invited.
3. For nurture play, offer a baby doll, bottle, blanket or play kitchen. Follow the child's caretaking or neglect themes.
4. Use bubbles or other calming play for early-session regulation.
Example language (illustrative), as a puppet: "I'm a bit scared. Can you help me?"
Watch for: puppet aggression that escalates into real-world aggression (set limits), and caretaking themes that may point to unmet needs. Do not interpret these as disclosures.

4.10 Play genogram [uncertain]

Purpose / when: "Play genogram" appears among the index terms of Gil 2006. The procedure is not drawn on, so the steps here are a general description, not Gil's text. [source: Google Books record; steps synthesis] Use it to explore family relationships symbolically, often in assessment or family sessions.
Steps [synthesis]:
1. Draw a simple family diagram with the child or family on large paper.
2. Invite them to choose miniatures that show their thoughts and feelings about each person, including themselves, and place them on the diagram.
3. Invite comments and stay curious.
4. Photograph the result.
Example language (illustrative): "Pick something from the shelves that shows how you feel about each person, and put it on their place."
Watch for: distress about a particular figure. With a child in care, take care over who is included, and do not seat an alleged perpetrator in the family session.

4.11 Directive trauma-focused activities (middle phase)

Purpose / when: In phase 2, clinicians may use more directive methods to focus on traumatic incidents. [source: CEBC] Use them once safety and regulation are established and the child can tolerate structure.
Steps [synthesis]:
1. Agree a focus for the session with the child, e.g. "the day things changed."
2. Offer a medium: sand, drawing, a comic strip or puppets.
3. Work in small chunks, with regulation breaks.
4. Return to nondirective play before the closing ritual.
Example language (illustrative): "Today, if you're OK with it, we could make a picture about the time you told me was the hardest. You can stop whenever you want."
Watch for: overwhelm (5.3) and compliance driven by wanting to please. The child must be able to stop.

4.12 Trauma narrative, verbal or nonverbal

Purpose / when: Children create trauma narratives, verbally or nonverbally. [source: CEBC] A chapter of Gil 2017 is titled "Conjoint Narrative Sharing," which points to narratives being shared with caregivers. The procedure is [uncertain].
Steps [synthesis]:
1. Build the narrative across sessions in the child's chosen form: a book of drawings, a sequence of sandtray scenes, a puppet story or dictated text.
2. Include before, during and after, and what helped.
3. Review it with the child for accuracy as they see it. The narrative is the child's account for healing, not a forensic statement.
4. With the child's assent and after preparing the caregiver separately, plan a conjoint sharing session.
Example language (illustrative): "This is your story, told your way. You decide what goes in it."
Watch for: new disclosures, which trigger safeguarding procedures (5.1). A caregiver who is not ready to hear the narrative should not be present.

4.13 Psychoeducation

Purpose / when: To correct negative thoughts such as self-blame, encourage emotional expression, identify supportive adults, and teach children how their brains work. [source: CEBC] Gil warns against loading psychoeducation on children too early: "Too much. Too much." [source: interview]
Steps [synthesis]:
1. Introduce one idea per session.
2. Make it concrete and playful, e.g. a hand model of the brain, or a body outline to colour where feelings live.
3. Make a list or drawing of supportive adults.
4. Address self-blame gently and repeat as needed.
Example language (illustrative): "When something scary happens, the alarm part of our brain gets really loud. It isn't your fault it got loud."
Watch for: glazed attention, which means too much information. Signs it is working: the child uses the language spontaneously and self-blame statements decrease.

4.14 Relaxation with biofeedback (bio-dots) and muscle relaxation

Purpose / when: To teach relaxation, using bio-dots that show physical changes during breathing and muscle relaxation. [source: CEBC]
Steps [synthesis]:
1. Place a bio-dot, a small temperature-sensitive sticker, on the back of the child's hand and note its colour.
2. Practise slow breathing, or tense-and-release of muscle groups ("spaghetti and robot"), for a few minutes.
3. Look at the colour change together and praise the child's control over their body.
4. Check product guidance and skin sensitivity before use.
Example language (illustrative): "Look, your dot changed colour. Your body did that because you calmed it."
Watch for: distress at body focus or at touch on the skin. The child applies the dot themselves if they prefer.

4.15 Caregiver coaching, parent manual and child-teaches-parent homework

Purpose / when: From intake and throughout treatment, as needed. [source: CEBC]
Steps:
1. Coach parents at intake. [source: CEBC]
2. Show them the manual describing the lessons their child is learning. [source: CEBC]
3. Offer nonoffending-parent groups, or refer for individual treatment. [source: CEBC]
4. Hold regular check-ins and give progress updates. [source: CEBC]
5. Set homework in which the child teaches the parent the relaxation, mindful breathing and affect scaling they learned in session. [source: CEBC]
6. Agree beforehand which session content stays private and which is shared. [synthesis]
Example language (illustrative): "This week, Sam is going to teach you the teddy breathing. Your job is to be the student."
Watch for: a caregiver who disbelieves the child, blames them, or is still in contact with the person who harmed them. Address this before conjoint work. Signs it is working: home practice is happening and the caregiver responds more attuned.

4.16 Family therapy and family play therapy

Purpose / when: To address trauma as an interpersonal, systemic problem. Gil 2006 has a chapter on family therapy and family play therapy, and Gil 2017 a chapter on the systemic treatment context. In Gil's family play therapy she invites everyone living in the home, including grandparents. [source: Guilford TOCs; interview]
Steps [synthesis]:
1. Hold at least one family session in assessment.
2. Use shared play tasks, e.g. a family sandtray, a family drawing or a puppet story, and observe roles and interactions.
3. Later, use conjoint sessions to share narrative and practise skills.
Example language (illustrative): "Let's make one world together in the sand, everyone adding something."
Watch for: never include an alleged or known abuser in sessions with the child without a specialist safety assessment and a protective plan agreed with the statutory agencies.

4.17 Termination

Purpose / when: End of treatment. Termination sessions allow meaningful goodbyes and a balanced view of life, including positive and negative events. [source: CEBC]
Steps [synthesis]:
1. Announce the ending several sessions ahead.
2. Review the work together, e.g. with photos of trays and the narrative book.
3. Make a life timeline or picture that holds hard events alongside good ones and the child's strengths.
4. Hold a goodbye ritual.
5. Agree who the child can turn to, and how to come back if needed.
Example language (illustrative): "Let's look at everything you've done here, the hard parts and the brave parts."
Watch for: regression near the ending (common and usually temporary), and abandonment themes in children who have experienced loss.

4.18 Related Gil Institute services (not TF-IPT components)

Extended Play-Based Developmental Assessment (EPBDA): typically 8–12 sessions of play-based activities, observation, interpretation of play themes, paper-and-pencil tests where appropriate, and therapeutic dialogue. It suits young, less verbal or hesitant children. There is a version for young children (EPBDA-YC). It is explicitly not a custody or forensic evaluation. [source: Gil Institute flyer]
Assessment of Sexual Behavior Problems in Children: 4–6 sessions for ages 4–12, starting nondirectively.
Boundary Project: a family treatment.
Theraplay, with the Marschak Interaction Method as its assessment.
Filial Therapy (staff training), and Therapeutic Parent-Child Sessions after Separation. [source: Gil Institute flyer; Gil Institute newsletter 2016]

Each of these is a separate model with its own training. Refer or train before using them.

5. Handling problems

The sources say little about problem-handling beyond pacing, regulation, stuck play and dissociation. Most of this section is my own synthesis of standard child-trauma practice and is marked as such.

5.1 Safeguarding, disclosures and the forensic boundary

Never use play to elicit, test or confirm an abuse allegation. Forensic interviewing is a separate specialist role, with its own protocols, training and recording standards. The Gil Institute separates its play-based assessment from custody and forensic evaluation. Gil notes that many children arrive already interviewed many times, and she removes pressure to tell. [source: Gil Institute flyer; interview] Do not use leading questions, anatomical dolls, or toy symbols of a suspected perpetrator or act to "see what the child does" (cf. 4.5). [synthesis]
If a child discloses or play raises a concern [synthesis]:
1. Stay calm and listen.
2. Do not probe for detail or ask leading questions. Use only open prompts if any, e.g. "Tell me more if you want."
3. Do not promise secrecy.
4. Record the child's exact words, the context, and the play that preceded them, with date and time, as soon as possible.
5. Follow your agency's safeguarding procedure the same day.
Mandatory reporting duties vary by jurisdiction. Examples: US state mandated-reporter statutes; local child-protection procedures and statutory guidance in each UK nation; Australian state and territory schemes. Know the law where you practise, including who you report to, the threshold and the timescale. Tell caregivers at intake, and children in age-appropriate words, that safety concerns will be shared. [synthesis]
Requests to use therapy material in court: clarify your role in writing. Seek legal and supervisory advice. Present play themes as clinical observations, not evidence. A therapist should not also serve as the forensic evaluator. [synthesis]

5.2 Consent, assent and caregiver involvement

Obtain informed consent from whoever holds legal authority: a parent, or the local authority or child-welfare agency for a child in care. Check court orders about contact and information-sharing. [synthesis]
Obtain the child's assent in developmentally appropriate words. Explain what play therapy is, what is private, and when you would have to tell someone. Let the child refuse specific activities, and re-check assent before any directive trauma work (4.11, 4.12). [synthesis]
Caregivers are partners in TF-IPT: coaching, the manual, groups, updates and homework. [source: CEBC] If a caregiver is unsupportive, disbelieving or still in contact with the person who harmed the child, prioritise the caregiver's own support or referral (CEBC lists referral for individual treatment). Delay conjoint work. Involve another safe adult. [source: CEBC; synthesis]
Older children and adolescents: agree confidentiality limits with them directly, and adapt materials, e.g. more art, sand and narrative writing, fewer toys. [synthesis]

5.3 Overwhelm, retraumatisation and dissociation

Signs: freezing, glazed eyes, losing track of the play, sudden flat affect, a sharp rise in session-end affect ratings, regression, nightmares or reenactment at home after sessions. [synthesis] Gil 2006 has a chapter on posttraumatic play and problems of dissociation. The review of Gil 2017 reports that she treats dissociation as a sign of "system overload." [source: Guilford TOC; APA Div. 56 review]
In session [synthesis]:
1. Stop the trauma-focused activity.
2. Orient the child to the here and now: name, room, time, and touch a known object.
3. Use breathing or bubbles (4.2).
4. Move to nurturing or neutral play.
5. Close with the scaling ritual and make sure the child is regulated before handover.
6. Tell the caregiver what to expect that evening.
Across sessions: return to phase 1 work, reduce directive content, and review pacing in supervision. Gil's warning applies: "sometimes we push him too hard." [source: interview]
Contraindications or reasons to delay processing [synthesis]:
- ongoing abuse or unsafe living arrangements;
- an active forensic process where the investigators have asked that trauma processing wait;
- acute suicidality or self-harm (assess with standard risk procedures and safety planning first);
- severe dissociation that is not yet stabilised;
- a psychotic presentation.

5.4 Stuck or toxic posttraumatic play

Use the graded steps in 4.6 [synthesis]. Also check:

Is the child still exposed to trauma reminders or current danger?
Does the caregiver know about, and support, the work?
Is a more directive or family intervention needed?
Does the child need a different medium?

If the play stays toxic after several sessions of graded intervention, consult a TF-IPT-trained supervisor and Gil's 2017 checklist. [source: Guilford description of the checklist; synthesis]

5.5 Posttraumatic play does not emerge; the child is withdrawn or 'resistant'

Gil works on the relationship first and may gently offer literal symbols (4.5). Some children cannot reach this play for a long time and may look unresponsive. [source: interview] Treat apparent resistance as protective [synthesis]:

keep the frame predictable;
give the child more control, e.g. letting them choose the opening activity;
try other media;
never push disclosure.

5.6 Behavioural reenactment involving the therapist, aggression and sexualised play

The review of Gil 2017 reports a form of posttraumatic play that enlists others, including the therapist. [source: APA Div. 56 review] The following is [synthesis]:

Keep the therapist's role symbolic: puppets or figures, not your own body.
Set clear, calm limits on hurting people or the room.
Redirect sexualised behaviour towards you, or towards the child's own body, at once and without shaming. Offer an alternative activity.
Document the behaviour, inform your supervisor, and consider whether a specialist sexual-behaviour assessment is needed. The Gil Institute offers one as a separate service. [source: Gil Institute flyer]
Consider whether the behaviour signals current risk. If so, follow safeguarding procedures.

5.7 Touch boundaries

The sources give no protocol. Gil's interview mentions patting a boy's back when he hugged her knees. The reviewer of Gil 2017 questions a case where Gil stroked a 12-year-old's back, warning that touch can be misread and can undo therapeutic work. [source: interview; APA Div. 56 review] Guidance [synthesis]:

Have a written touch policy and explain it to caregivers at intake.
Do not initiate touch.
Respond to a child's hug briefly and side-on, then redirect to play.
Ask before any helping touch, e.g. a bio-dot or a hand on a puppet, and accept "no."
Never touch in sexual, genital or restraining ways. Physical restraint applies only under your agency's emergency policy.
Be alert to cultural norms and to how touch may echo the abuse.
Record any touch that occurs. Where possible, work with the door ajar, an observation window or a recording policy.

5.8 Play materials and room safety

The following is [synthesis]:

Choose toys appropriate to age and supervision. Remove small parts and miniatures that are choking hazards for young children.
Use only clean, washable sand sold for play. Damp it or avoid pouring to limit dust, and keep it from eyes.
Exclude or limit realistic weapons according to agency policy. If symbolic weapons are kept, keep them toy-like.
Avoid breakable glass and sharp tools.
Use non-toxic art materials. Check allergies and latex before using clay, food play or bio-dots.
Wipe up spilled bubble solution and water at once, because they make the floor slippery.
Secure heavy shelving.
Clean toys between clients, especially those that go near the mouth.
Store artwork and tray photographs as confidential clinical records.

5.9 Non-attendance, caregiver disengagement and placement changes

The following is [synthesis]:

Clarify the attendance agreement at intake.
Use caregiver check-ins (4.15) to address practical barriers.
If a placement moves, ask the agency to plan for continuity or a proper goodbye session (4.17). For children in care, an unplanned ending repeats the original loss.

5.10 Ruptures

The following is [synthesis]:

Notice withdrawal, anger at the therapist, or play in which the therapist figure is hurtful.
Name the rupture gently inside or outside the metaphor, take your share of responsibility (e.g. "I went too fast"), and return control to the child.
With caregivers, ruptures often follow information-sharing or perceived blame. Hold a separate meeting.

5.11 Therapist reactions

Gil recalls that a supervisor helped her manage countertransference in her first case, and Gil 2006 indexes countertransference. [source: interview; Google Books record] Arrange regular supervision with a clinician experienced in child trauma and play therapy, and monitor yourself for vicarious trauma. [synthesis]

Sources

Sources:

Further reading (full text not drawn on):

Gil, E. (1991). The Healing Power of Play: Working with Abused Children. New York: Guilford Press.
Gil, E. (2006). Helping Abused and Traumatized Children: Integrating Directive and Nondirective Approaches. New York: Guilford Press.
Gil, E. (2017). Posttraumatic Play in Children: What Clinicians Need to Know. New York: Guilford Press.
Gil, E. (2012). Trauma-Focused Integrated Play Therapy (TF-IPT). In P. G. Brown (Ed., as listed by CEBC; editor name not verified [uncertain]), Handbook of Child Sexual Abuse: Identification, Assessment, and Treatment. New York: Wiley (per CEBC). The page range in CEBC's listing appears garbled, and the Wiley page (DOI 10.1002/9781118094822.ch11) is not drawn on [uncertain].
The TF-IPT treatment manual referred to by CEBC: title and availability not found [uncertain]. Training enquiries: Starbright Training Institute and the Gil Institute.

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