Synergetic play therapy

1. Introduction

Version followed: the Synergetic Play Therapy Institute's (SPTI) current public description of SPT (the nine tenets and three pillars on its "What is Synergetic Play Therapy" page), Lisa Dion's conference keynote handout on aggression and intensity, and the SPTI 2021–2022 Certification Objectives. Dion's book Aggression in Play Therapy: A Neurobiological Approach for Integrating Intensity (Norton, 2018) is the main published text. It is not drawn on here, so no content is taken from it directly. [source: SPTI What is SPT; Dion keynote handout; SPTI Certification Objectives 2021–2022]

Synergetic Play Therapy (SPT) is a play therapy model that Lisa Dion (LPC, RPT-S) developed in 2008 in Colorado. It began as the Play Therapy Institute of Colorado, which later became the Synergetic Play Therapy Institute. SPTI calls it a "research-informed model of play therapy". It combines the therapeutic powers of play with nervous-system regulation, interpersonal neurobiology, attachment, mindfulness, physics and therapist authenticity. Its main influences are child-centred, experiential and Gestalt play therapy. It uses both non-directive and directive methods, and SPTI describes it as a way of being in relationship as well as a set of techniques. Its principles can be added to another play therapy approach or used as a stand-alone framework. [source: SPTI About; SPTI What is SPT; Dion keynote handout]

How change happens (the model's own theory). SPT reads a child's symptoms as signs of a dysregulated autonomic nervous system. In play, the child projects their inner world onto the toys and onto the therapist, and arranges the play so the therapist feels "how it feels to be them". The therapist notices those states in their own body, stays regulated and authentic, and says so out loud. Acting as an "external regulator", the therapist lets the child borrow their regulation. Over time the child's nervous system is said to integrate and re-pattern, the child's window of tolerance widens, and the child learns to move toward hard feelings instead of away from them, which SPTI calls learning to "attach to self". [source: SPTI What is SPT; Dion keynote handout]

Evidence status of the theory. Several of the model's mechanisms come from the model itself and its sources, not from tested findings. These include attunement healing "disorganisation in the lower brain stem", right-hemisphere-to-right-hemisphere communication, mirror-neuron "set-up" of the therapist, and the sympathetic / dorsal vagal / ventral vagal state map. Present them to colleagues and parents as SPT's explanatory theory, not as established fact. The state map comes from Porges' polyvagal theory, which SPTI cites (Porges, 2011). The physiological premises of polyvagal theory are disputed: Grossman (2023, Biological Psychology) argues that all five basic premises are likely refuted. Some clinicians still find its language clinically useful (Giroux et al., 2023). [source: SPTI What is SPT; SPTI Tenets; Dion keynote handout; Grossman 2023 Zenodo record; Giroux et al. 2023]

Published SPT research is small and mainly by the model's developers:

Dion & Gray (2014) is a study of therapist authentic expression and children's emotional tolerance across sessions. Its abstract reports gains by the fifth session, but the sample size is not given on the page.
Simmons (2020) reports two case studies combining SPT with child-centred play therapy (CCPT).
Townsend et al. (2021) compare CCPT and SPT (not drawn on).
Yian & Yong (2022) describe a pandemic programme in Malaysia (not drawn on).

No randomised trial of SPT was found. [source: SPTI peer-reviewed articles page; Dion & Gray 2014 abstract page; Simmons 2020 abstract page] [uncertain: whether further trials exist]

Professional frame. SPT is a post-qualification method taught and credentialled by SPTI. It is not a regulated profession.

Who can train. Training is open to people who work with children. Continuing-education credit requires graduate-level mental health training or equivalent.
Level 1 (Introduction). 30+ hours, online or in person, with 6 group consultations. It focuses on children aged 4–11.
Level 2 (Certification). 85+ hours online, with 10 individual and 3 group consultations.
Level 3 (Supervisor programme). 30+ hours.
Recertification. Further SPT continuing education is required every 3 years.

Use SPT only within your own licence: counsellor, psychologist, social worker or psychotherapist, or an HCPC-registered arts therapist in the UK. Ideally also hold play therapy training and a credential, such as APT's RPT in the US or BAPT or PTUK registration in the UK. Do not take on the aggression, "death" and intensity work described below, or call yourself an SPT therapist, without SPTI training and the consultation it requires. [source: SPTI What is SPT; SPTI About; Dion keynote handout] [synthesis: licensing advice] [uncertain: credential routes]

Related guides: 157 Child-centred play therapy (SPT draws on child-centred play therapy and can be combined with it) and 162 Gestalt play therapy, one of its main influences. [synthesis]

2. Framework

The model's structure. SPTI says SPT uses three planning tools to guide treatment planning, goals and integration:

the SPT Therapeutic Stages
the SPT Process of Change
identification of the child's starting points

The names, number and content of the Therapeutic Stages and the Process of Change are taught in Levels 1–2. They are not published in the public sources used here, so they are not reproduced or reconstructed. [source: SPTI What is SPT; SPTI Certification Objectives] [uncertain: stage names and criteria]

What SPTI training covers across a course of therapy: [source: SPTI What is SPT; SPTI Certification Objectives]

Intake and conceptualisation. Assess the child's nervous-system patterns (hyper- and hypo-arousal), their starting points, emotional age ("four clues", not listed publicly), developmental and sensory profile, and attachment context.
Explaining SPT to parents. Explain SPT, the nervous system, the Therapeutic Stages and the Process of Change. Decide whether and when a parent attends sessions.
Treatment planning and goals. These are framed as regulation, integration of perceived challenging events, and connection with the authentic self.
Tracking progress. Track progress against the Therapeutic Stages, including small and large moments of empowerment.
Translating the play for caregivers. Put the child's play into language caregivers can understand, and teach parents core playroom skills.
Ending. Endings and transitions use planned goodbyes with child and parent, ending rituals, and strategies for final sessions.

Format. Sessions are individual play therapy, mainly for children aged 4–11. The playroom can be non-directive (child-led) or directive, including Gestalt-style sand and art work. SPTI also applies the principles to teens, siblings, families, groups and adults, which needs further training, and to online play therapy. SPTI says the therapist is the main instrument and that toys and language are not strictly required. [source: SPTI What is SPT; SPTI Certification Objectives; SPTI peer-reviewed articles page (Keating 2023 chapter listed)]

Session count. No standard number of sessions is given in the sources. Dion & Gray (2014) tracked change from the first to the fifth session. A published single case ran over many months and moved to closure once the child's behaviour had improved. Plan weekly sessions with parent reviews and set the length by tracked progress. [source: Dion & Gray 2014 abstract; Howell 2020 case] [synthesis: weekly frequency and review rhythm]

Moving between phases. The model's formal stage-transition criteria are not public. [uncertain] Markers you can track: [synthesis, drawn from SPT concepts in the cited sources]

the child stays with intense play and returns to regulation within the session instead of flooding or shutting down
intense themes become more organised and predictable (in the published case, the room became "more regulated and predictable")
the child shows empowerment in play
caregiver-reported symptoms ease at home and school

When these hold over several sessions and parents report change, plan the ending. [source: Howell 2020; SPTI Certification Objectives] [synthesis]

3. Guiding principles

The tenets below follow SPTI's current nine-tenet list. Older versions (2020 and 2022) contain the same nine ideas in a different order. [source: SPTI What is SPT; SPTI Tenets 2020 (public copy)] [uncertain: the 2022 version was seen only as a members' download, not a public copy]

Symptoms reflect nervous-system activation. Read tantrums, aggression, withdrawal and anxiety as signs of hyper- or hypo-arousal, not as misbehaviour to stamp out.
Children project their inner world onto toys and onto you. When the play makes you feel scared, stupid, helpless or attacked, treat that as information about the child's experience.
Therapist mindfulness makes attunement possible. Notice your own body, emotions and thoughts in the moment before you try to attune to the child.
You are the external regulator. Your job in intense moments is to stay regulated, using breath, movement and voice, so the child can borrow your regulation. Your job is not to stop the feeling.
Congruence creates safety. Your words, face, tone and posture must match. If you are scared, do not say you are fine. SPTI notes that most communication is non-verbal.
Help the child integrate perceived challenges. Work with the child's perception of events and of self, others and the world, not only with the facts of what happened.
Support the authentic self. Welcome the child as they are, not the version they feel they should be.
"The therapist is the most important toy in the playroom". Your presence matters more than the toy kit. The work is possible even without toys or words.
Authenticity, attunement, congruence and regulation together. These four together help the child "attach to self", the outcome SPTI treats as the foundation of healing.

Further stance principles from SPTI materials: [source: Dion keynote handout; SPTI About; SPTI Certification Objectives]

Aggression is a normal biological response. It arises when safety or a belief about self, others or the world is challenged. Work with it rather than suppressing it.
Move toward uncomfortable sensations, do not flee them. SPT defines regulation this way.
Integration is not blending. Stay connected to the child while keeping your separate self.
Work at the edge of the window of tolerance. Aim for just past the edge of comfort, not inside comfort and not into flooding.
Your presence is the container. If you mentally leave, the play tends to escalate until you are back.
Boundaries exist to keep you regulated and present. Acknowledge the child's intent before you redirect, and repair after ruptures.
Transference and countertransference are inevitable. Use them as data.
Your own development is part of the method. SPTI states that "transformation begins with authenticity". Personal work, consultation and supervision are expected, and are also SPTI's protection against compassion fatigue and vicarious trauma.
Parents are often a vital part of the work. Plan their involvement from intake.

4. Intervention inventory

This inventory covers every procedure named in the SPTI materials. Where SPTI names a skill but does not describe it publicly, the entry says so. The working detail in those entries is marked [synthesis] or [uncertain] and is not attributed to Dion. All example wording is illustrative unless it is quoted and cited.

4.1 Therapist self-attunement (mindful tracking of your own state)

Purpose / when. Use this throughout every session. It is the base for co-regulation and congruence (tenet 3). SPTI also names interoception, awareness of the body from inside, as the first step in re-patterning a child's playroom behaviour. [source: SPTI What is SPT; SPTI Certification Objectives]
Steps.
1. Before the session, take a minute to notice your breath, body tension, mood and what you are carrying in from the day. [synthesis]
2. During play, keep part of your attention on your own sensations, such as heart rate, a tight chest, heat, heaviness, sleepiness or the urge to fix or to leave.
3. Name each state to yourself without judging it or defending against it. [source: Dion keynote handout]
4. Treat a sudden shift in you as possible information about the child's inner world (see 4.3). [source: SPTI Tenets]
Example language (internal, illustrative). "My stomach just dropped when the tiger lost; stay with it, breathe."
Watch for. Numbness, drifting thoughts or wanting to check the clock. The handout treats these as signs that you are going hypo-aroused (see 4.6). It is working when you can notice a state and stay present at the same time.

4.2 Authentic expression (saying your present experience out loud)

Purpose / when. Use this when play brings up a feeling, thought or body sensation in you, especially in intense, aggressive or frightening play. Speaking it shows the child that the state can be felt, named and survived. SPTI defines authentic expression as voicing your present thoughts, feelings and body sensations in response to the child's stories and play. Dion & Gray (2014) linked it to more emotionally tolerant behaviour in children. [source: Dion & Gray 2014 abstract; Dion keynote handout]
Steps.
1. Notice your own state (4.1).
2. Say it briefly, in the first person and in the present tense, at the intensity you actually feel it. Keep it congruent: your face and voice should match the words.
3. Add the regulation you are doing, such as breath or movement, so the child sees how you come back (4.5).
4. Do not ask the child to take care of your feelings or to stop the play. [synthesis: wording of this step]
Example language (illustrative).
- "Whoa, my heart is pounding. That came so fast. I'm going to take a big breath."
- "I feel so confused, I can't tell who the good guys are."
- "I feel small and stupid when I get the names wrong."
Watch for. Keep it short and about you, not interpretations of the child. Do not perform a feeling you do not have, since that breaks congruence (tenet 5). It is working when the child keeps playing, returns to the theme, or shows more tolerance of the feeling, for example staying with the scene instead of abandoning it. [source: Dion & Gray 2014 abstract] [synthesis]

4.3 Allowing the child to "set you up" (receiving the projection)

Purpose / when. Use this when the child gives you a role, such as victim, the one who gets it wrong, the scared one or the one who dies, or arranges the play so you feel what they feel. SPTI says children set up the toys and the therapist so the therapist feels how it feels to be them. [source: Dion keynote handout; SPTI Tenets]
Steps.
1. Accept the role the child assigns, within safety limits (4.7).
2. Let yourself feel the role. Do not keep it at arm's length.
3. Voice your experience from inside the role (4.2) and regulate (4.5 and 4.6).
4. Hold a working hypothesis that the role is a snapshot of the child's experience. Do not interpret it to the child.
Published example. In a published case, a therapist was repeatedly corrected about dinosaur names and felt stupid and ashamed. She regulated those feelings and treated them as a test of her authenticity. In later play the boy coached her through surviving a frightening night, and she understood the play as a picture of his helplessness and fear. [source: Howell 2020]
Example language (illustrative). "I keep getting it wrong. I feel embarrassed. I'm going to keep trying."
Watch for. Your own story getting hooked, which is countertransference (see 4.15). It is working when the theme repeats with more organisation and the child becomes more regulated across sessions. [source: Howell 2020; SPTI Certification Objectives]

4.4 Following the play: non-directive mode

Purpose / when. This is the default when the child can lead. It lets the child bring their inner world into the play at their own pace. SPT draws on child-centred play therapy here. [source: SPTI What is SPT; Dion keynote handout; Simmons 2020 abstract]
Steps.
1. Let the child choose the toys and the story.
2. Take part when invited.
3. Use reflections (4.9) and authentic expression (4.2) instead of questions or teaching.
4. Keep regulating (4.5 and 4.6).
Example language (illustrative). "You decide what happens next." "You're showing me how strong that dragon is."
Watch for. Drifting into passive observation, which is not SPT's active presence. Use directive work (4.11 and 4.13) when the child needs more structure. SPTI teaches when to choose each mode, but its criteria are not public. [uncertain]

4.5 Being the external regulator in hyper-arousal (sympathetic) play

Purpose / when. Use this in fast, loud, attacking, shooting or chaotic play, and when you feel fight-or-flight activation. The aim is to stay present so the child can borrow your regulation. [source: Dion keynote handout]
Steps. [source: Dion keynote handout]
1. Breathe deliberately, especially between hits, shots or swings.
2. Speak up rather than going quiet.
3. Ground the energy, for example by planting your feet and sending the energy into the floor or into a prop.
4. Match the intensity authentically: ask yourself how you would really respond if this were happening to you, and show that response at a safe level.
5. Keep naming your state (4.2).
Example language (illustrative). "Ow! That's a lot! I'm breathing… I'm still here."
Watch for. Going silent, freezing, or over-calming the child. The handout warns that a dysregulated or absent therapist tends to make the play escalate. It is working when the peaks come down faster within the session, the child checks in with you, and the play becomes more organised.

4.6 Regulating in hypo-arousal (dorsal) states

Purpose / when. Use this when the play goes flat or repetitive, or you feel sleepy, numb, drifting or as if you are disappearing. It is also for the child's collapsed or shut-down states. [source: Dion keynote handout]
Steps. [source: Dion keynote handout]
1. Breathe repeatedly.
2. Wiggle your toes.
3. Use bilateral input, for example alternate tapping. [synthesis: the example]
4. Imagine expanding your energy to fill the room so you do not disappear.
5. Use contemplative practice to notice when your mind wanders or you want to check out, and come back.
Example language (illustrative). "I notice I'm getting really sleepy and far away. I'm going to wiggle my toes and come back."
Watch for. Confusing your own fatigue with attunement. If it is your fatigue, note it for supervision. It is working when both of you seem more present and the play regains some energy.

4.7 Boundaries and limit-setting (acknowledge, then redirect)

Purpose / when. Use this when play risks hurting you, the child or the room, or when you can no longer stay regulated. SPT frames limits as protecting your ability to stay present as the external regulator. [source: Dion keynote handout]
Steps (Dion's sequence, paraphrased). [source: Dion keynote handout]
1. Breathe to ground yourself.
2. Get present so the child can feel you.
3. Use a calm, non-threatening but serious tone.
4. Make eye contact if possible, without forcing it.
5. Acknowledge the child's intent, then redirect.
6. Keep your own feelings out of the limit itself.
Redirecting with action. Gesture toward where the energy should go, contain it so it keeps moving, or move it into pretending (for example "pretend" hits, or a punching bag or pillow). [source: Dion keynote handout] [synthesis: examples]
Redirecting with words. Acknowledge, then offer an alternative. Dion's example phrases include "Show me another way" and "I don't need to hurt to understand." [source: Dion keynote handout]
Example language (illustrative). "You really want me to feel how much that hurts. I'm not for real hitting. Show me with the foam sword."
Watch for. Limits set from fear or anger, or delivered with a long lecture. The handout emphasises acknowledging before redirecting rather than just saying "no". After a limit, repair the connection (4.8). It is working when the energy keeps flowing in a safe form and the child does not collapse or escalate.

4.8 Repairing ruptures

Purpose / when. Use this after a limit, a misattunement, a moment when you checked out, or the child's sense of being shamed or misunderstood. SPTI lists repair as part of boundary work but gives no published steps. [source: Dion keynote handout] [synthesis: steps]
Steps. [synthesis]
1. Name what happened from your side, briefly.
2. Own your part.
3. Check, without pressure, how it was for the child.
4. Return to the play.
Example language (illustrative). "I said stop really fast there and my voice got sharp. I'm back now. Want to keep going?"
Watch for. Long apologies that put the child in charge of your feelings. It is working when the child re-engages.

4.9 Reflection statements

Purpose / when. Use these throughout, to show the child you are tracking their play, feelings and body. SPTI teaches five types of reflection statement. The five types are not described in the public materials, so they are not listed here. [source: SPTI Certification Objectives] [uncertain: the five types]
Steps. [synthesis]
1. Reflect what you see, such as actions and choices.
2. Reflect the feelings and energy of the play.
3. Reflect body cues you can see.
4. Mix these with your own authentic expression (4.2), so that you are not only an observer.
Example language (illustrative). "You're making him go faster and faster." "That one's all alone now." "Your fists are tight."
Watch for. Running commentary that feels intrusive, or reflections that hand the child an interpretation.

4.10 Working at the edge of the window of tolerance; responding to flooding

Purpose / when. Use this in every intense sequence. The aim is to stay just at the edge of discomfort so the child's tolerance grows, and to respond when the child floods. [source: Dion keynote handout; SPTI Certification Objectives]
Steps.
1. Track signs of approaching the edge in the child, such as faster play, louder voice, dysregulated movement or a glazed look, and in yourself. [synthesis: indicators]
2. Increase your own regulation and authentic expression as intensity rises (4.2, 4.5, 4.6).
3. If the child floods (play loses its symbolic frame, real aggression, panic, or collapse), slow down. Lower the stimulation, move to grounding and breathing together, and use containment and limits (4.7). [synthesis: the specific flooding steps, since SPTI's own procedure is taught in training and not public]
4. When the child has settled, go back to the theme at a lower intensity, or stop for that session.
Example language (illustrative). "That got really big really fast. Let's slow our bodies down. Feet on the floor with me."
Watch for. Repeated flooding across sessions means the work is pitched too far past the edge. Pace down, increase parent support, and consult. It is working when the child can stay with intensity longer and recover faster.

4.11 Breathwork with the child

Purpose / when. SPTI training covers using breathwork to regulate the nervous system and applying it with clients. It can be done in play, for example blowing out "candles" or bubbles, or explicitly with older children. [source: SPTI Certification Objectives] [synthesis: the examples]
Steps. [synthesis]
1. Model the breath yourself first (4.5).
2. Invite the child, never instruct.
3. Make it playful and short.
4. Stop if the breathing makes them more anxious or dizzy. Avoid forced breathing patterns.
Example language (illustrative). "I'm going to blow my dragon-fire out slowly… want to try yours?"
Watch for. Breath used to shut feelings down rather than to stay with them. Light-headedness.

4.12 "Dying" in the playroom

Purpose / when. Use this when the child kills your character or you. The aim is to stay present and regulated in a hypo-aroused, helpless state that the child may need you to hold. [source: Dion keynote handout]
Steps. [source: Dion keynote handout]
1. Stay "dead" and do not talk.
2. Fall facing the room in a fetal position, cover your head, and if possible keep your eyes slightly open so you can still see the child.
3. Regulate silently with breath and toe movement (4.6).
4. Keep track of time.
5. With young children, during a long stretch, you may remind them they are in charge and can bring you back to life.
Example language (illustrative, for step 5). "You can bring me back when you're ready."
Watch for. Safety comes first: do not fall in a way that risks injury, and do not leave a child unsupervised near hazards while your eyes are closed. Check for signs that the child is frightened rather than in control. [synthesis: safety points]

4.13 Sand and art: non-directive and directive (Gestalt) uses

Purpose / when. SPTI teaches sandtray and art in both non-directive and directive Gestalt-informed formats. It links how a child handles sand and art materials to their nervous-system state, and uses the stages of art development to estimate emotional age. [source: SPTI Certification Objectives] [uncertain: SPTI's specific directive prompts are not public]
Steps. [synthesis]
1. Non-directive. Offer the tray, miniatures and art materials and follow the child (4.4).
2. Directive. Invite the child to give voice to a figure or part of an image ("be the wall"), or to make an image of a feeling or a body sensation, while you track and regulate.
3. Notice the child's state as they work: frantic burying, rigid order, avoidance of materials.
4. Use what you see to guide pacing. Do not interpret the product.
Example language (illustrative). "If that fence could talk, what would it say?" "Show me what the worried feeling looks like in the sand."
Watch for. Do not treat images, trays or art stages as diagnostic evidence of abuse, trauma or disorder. They have no validated diagnostic standing in SPT, and emotional-age estimates are a clinical hypothesis only. [synthesis]

4.14 Working "under the story": perceptions, plateaus and peak experiences

Purpose / when. SPTI trains therapists to work "under the story", meaning the nervous-system and perceptual level beneath the play narrative, in order to change neural firing in session. It also uses three concepts called planes of possibility, plateaus and peak experiences. Regulation in session is said to shift a child's plateau and peak experiences. Separately, tenet 6 aims at changing the child's perception of challenging events. [source: SPTI Certification Objectives; SPTI What is SPT] [uncertain: SPTI's definitions of these terms are not public; the steps below are an interpretation]
Steps. [synthesis]
1. Notice the feeling-tone or belief the play carries, for example "no one is coming" or "I'm always wrong", rather than the storyline.
2. Respond to that level with authentic expression and regulation.
3. Notice moments when the child first tolerates, or acts against, the old pattern, and mark them softly.
Example language (illustrative). "I keep waiting for someone to help… nobody comes. That feels so lonely."
Watch for. Explaining the meaning to the child. Do not do it.

4.15 Transference, countertransference and the therapist's own narrative

Purpose / when. Use this when you are hooked, such as feeling furious, ashamed, rescuing or numb beyond what the play explains. SPTI treats transference and countertransference as inevitable and as a route to earlier memories. It also trains therapists to see how their own life story can narrow their window of tolerance and weaken them as external regulator. Training covers questions to ask yourself when dysregulated, so you can integrate your perceptions and regulate both body and mind. [source: SPTI Certification Objectives] [uncertain: SPTI's actual question list is not public]
Steps. [synthesis]
1. In session, regulate your body first.
2. Ask yourself silently: "What is mine here, and what might be the child's?"
3. After the session, note the trigger and take it to SPTI consultation, supervision or personal therapy.
Example language (illustrative). To yourself or in supervision: "I'm furious and I want to win this game. Is that mine, or am I feeling what it's like to be her?" [synthesis]
Watch for. Repeated flat or reactive sessions with one type of child or theme. That points to a supervision need, not a child problem.

4.16 Development, emotional age and regression

Purpose / when. Use this to pitch your responses at the child's emotional age, not their chronological age, and to support regression when it appears. SPTI teaches developmental stages as they show up in play, four clues to emotional age, and how to support regression. [source: SPTI Certification Objectives] [uncertain: the four clues are not public]
Steps. [synthesis]
1. Observe the play level, language, need for closeness, and tolerance of frustration.
2. Meet regressive play, such as baby play, bottles or wanting to be carried, with matched simple language and steady presence, inside your touch policy (Section 5).
3. Tell parents that some regression is expected.
Example language (illustrative). "You want to be the little baby today. I can make a cosy bed for the baby right here." [synthesis]
Watch for. Regression that spills into daily life with distress. Assess and coordinate with the parents.

4.17 Sensory-informed SPT

Purpose / when. Use this for children with sensory-processing difficulties or on the sensory or autism spectrum. SPTI covers vestibular, proprioceptive and tactile experience, its links to the brainstem, and applying SPT with children on the sensory spectrum. [source: SPTI Certification Objectives]
Steps. [synthesis]
1. Get sensory information from parents and any occupational therapist.
2. Offer proprioceptive options (heavy pillows, pushing games), vestibular options (rocking, spinning within safe limits) and tactile options (sand, clay).
3. Watch the child's arousal as each one is used.
Example language (illustrative). "Do you want to push really hard against this big pillow? Let's see how strong you are." [synthesis]
Watch for. Sensory overload. Coordinate with occupational therapy rather than substituting for it.

4.18 Tracking and deepening empowerment

Purpose / when. SPTI defines empowerment, tracks small and large empowerment moments across the child's therapy, and uses directive interventions to deepen them. [source: SPTI Certification Objectives] [uncertain: SPTI's specific directives are not public]
Steps. [synthesis]
1. Note moments when the child takes charge, defeats a threat, says no, or asks for help.
2. Reflect them.
3. Where useful, invite a short replay ("Show me that part again").
4. Record them for parent reviews.
Example language (illustrative). "You stood up to the monster. Your whole body got tall."
Watch for. Empowerment that depends on hurting you or breaking limits; reflect the strength and redirect it (4.7). [synthesis]

4.19 Case conceptualisation: starting points and tracking the stages

Purpose / when. Use this at intake and throughout therapy. SPTI identifies a child's starting points and tracks progress through the SPT Therapeutic Stages and Process of Change. [source: SPTI What is SPT; SPTI Certification Objectives] [uncertain: content not public]
Steps. [synthesis]
1. At intake. Map the child's typical hyper- and hypo-arousal patterns at home and school, triggers, perceived challenges (beliefs about self, others and the world), attachment context, sensory profile and emotional age.
2. Each session. Note the themes, the intensity, how the child recovers, empowerment moments and your own states.
3. Review. Every 4–6 sessions, review progress against goals with the parents.
Example language (illustrative). To parents: "When Ella gets overwhelmed, does she tend to get louder and faster, or go quiet and far away?" [synthesis]
Watch for. Fitting the child to a stage too early; revise the map as the play shows more. [synthesis]

4.20 Parent and caregiver work

Purpose / when. SPTI describes parent involvement as often vital. Its training covers explaining SPT, the nervous system and the stages of change to parents, deciding when a parent should be in session, teaching parents key playroom skills, and translating play into language parents understand. SPTI also offers a parenting programme. [source: SPTI What is SPT; SPTI Certification Objectives; SPTI About]
Steps. [synthesis]
1. Intake with the parents. Gather history, set goals, obtain consent, and explain the model, including that play may get more intense before it settles.
2. Regular parent sessions without the child. Share themes in general terms that protect the child's privacy, give a nervous-system reading of the behaviour, and coach the parent's own regulation.
3. Joint sessions when the child's goals involve the relationship and the parent can stay regulated.
4. Home skills. Teach the parent to notice their own state, name it simply, and acknowledge before redirecting.
Example language (illustrative). "When he melts down, his body is in alarm. The first job is to settle yours, so he has something steady to lean on."
Watch for. A parent too dysregulated to join sessions. Refer the parent for their own support, and do not bring them into intense play.

4.21 Endings and transitions

Purpose / when. Use this when tracked change holds. SPTI covers goodbyes with the child and parents, ending rituals and final-session strategies. [source: SPTI Certification Objectives; Howell 2020]
Steps. [synthesis]
1. Agree an end date with the parents.
2. Count down the sessions with the child, for example on a calendar.
3. Expect old themes to return briefly.
4. Plan a closing ritual chosen with the child, such as a goodbye drawing.
5. Hold a final parent review.
Watch for. Old themes or intensity returning near the end; treat it as expected, keep the date unless risk has changed, and prepare parents in advance. [synthesis]

4.22 Adaptations: teens, siblings, families, groups, adults, online, and combined models

Teens. SPTI teaches facilitating pre-teen and teen stories with SPT principles. Use more talk, art and sand and less toy play. [source: SPTI Certification Objectives] [synthesis: format]
Families, siblings and groups. View the family system through nervous-system states, with the therapist as external regulator for the whole room. This needs further SPTI training. [source: SPTI What is SPT; SPTI Certification Objectives]
Online. A chapter on online play therapy from an SPT perspective is listed by SPTI (Keating, 2023), not drawn on. [uncertain]
EMDR. A chapter combining SPT with EMDR (Dion & Schaad, 2021) is listed, not drawn on. Use it only with EMDR training. [uncertain]
Nature-based work for medical trauma. A chapter by LaPiere & Dion (2022) is listed, not drawn on. [uncertain]
CCPT. SPT can be combined with child-centred play therapy (Simmons, 2020; Townsend et al., 2021). [source: SPTI peer-reviewed articles page]

5. Handling problems

The SPTI materials cover the therapist's own dysregulation, aggression, "death" play, flooding and therapist fatigue. Everything else here is marked [synthesis].

Safeguarding, consent and assent, reporting [synthesis unless cited]

Consent and assent.
- Get informed consent from whoever holds legal parental responsibility; with separated parents, check who holds it.
- Explain SPT's approach before you start: intense or aggressive play is allowed, and you will voice your own feelings.
- Get the child's assent in age-appropriate words: what the playroom is, that they choose much of what happens, the safety rules, and what you will and will not tell their parents.
- Revisit assent if the child is reluctant.
Confidentiality.
- Tell child and parents at the start that you share themes and progress, not the details of play.
- Say that safety concerns override this.
Mandatory reporting.
- Duties vary by jurisdiction: US state laws, the UK's Working Together statutory guidance and local safeguarding partnership procedures, and Australian state and territory schemes.
- Know your local duty, your agency's designated safeguarding lead, and the referral route before you see children.
- Report on the basis of disclosures, observed injuries and reported events.
- Aggressive, sexualised or death themes in play are not by themselves evidence of abuse. Neither SPT nor play interpretation is a validated way to detect abuse.
- If play or a disclosure raises concern, record it factually in the child's words, do not ask leading questions, and follow the reporting procedure. Do not investigate in the playroom.
Self-harm.
- SPTI lists self-harm as one form of inward aggression. [source: Dion keynote handout]
- Any self-harm or suicidal talk needs a standard child risk assessment, safety planning with the caregivers, and onward referral where indicated. Do not treat it only as play material.

Touch, physical safety and play materials [synthesis unless cited]

Touch policy.
- Have a written policy, agreed with the parents at intake, covering hugs, the child sitting on your lap, help with toileting, rough-and-tumble play and restraint.
- Explain body rules to the child simply.
- Never sexual or genital touch, and no tickling games that override a child's "stop".
- Ask before any touch you start, and honour the child's "no" at once.
- Be especially careful with children who have experienced abuse, and with cultural differences in touch.
Aggression toward your body.
- SPTI names the therapist's fear of getting hurt as a common concern. The model's answer is limits that keep you present (4.7). [source: Dion keynote handout]
- Set a clear rule that real hitting, biting, kicking, or aiming at faces and heads stops. Redirect to a punching bag, pillows or foam.
- Protect your back and joints when falling or "dying" (4.12).
- If a child repeatedly hurts you despite limits, end the intense sequence, debrief with the parents and consult. Your safety is a precondition for regulation, not a lack of attunement.
Materials.
- Use only foam or soft toy weapons and non-toxic, age-rated art materials.
- Keep small parts and choking hazards away from young children.
- Check sand for sharp debris and keep it clean.
- Avoid or closely supervise cords, scissors and glass miniatures.
- Anchor or remove heavy furniture that could tip.
- Clean shared toys and sand between children.
- Keep the door closed for privacy but never locked, with a vision panel or open-door arrangement where agency safeguarding policy requires it, and know where the parent waits.

Stuck child (repetitive play, no change)

First check your own presence. Repetitive or flat play can mean you are hypo-aroused or not voicing your experience, and the handout notes that play escalates or repeats until the therapist "shows up". Use 4.1, 4.2 and 4.6. [source: Dion keynote handout]
Ask yourself whether you are inside the window, or so comfortable that you are below the edge (4.10). [source: Dion keynote handout]
If presence is solid, consider brief directive work (4.13 and 4.18), review the starting points with the parents (4.19), and check for factors outside therapy, such as ongoing exposure to threat at home. Therapy cannot regulate a child who is still unsafe. [synthesis]

Resistance or refusal to come into the room [synthesis]

Treat refusal as nervous-system protection, not defiance.
Allow the parent to join for the first sessions, start in the doorway, or bring a familiar object.
Voice your own experience ("I really want to show you the room, and I feel a bit nervous too").
Do not coerce, and record the child's assent each time.

Overwhelm and flooding (child)

Follow 4.10. Lower stimulation, ground, slow your own breathing, and contain with limits (4.7). Return later at a lower intensity. [source: Dion keynote handout; SPTI Certification Objectives] [synthesis: steps]
Signs of dissociation, such as a glazed look, "I'm not scared" alongside a frozen body, or loss of contact, call for orienting and grounding, not more intensity. A published SPT case notes apparent dissociation alongside a child's denial of fear. [source: Howell 2020] [synthesis: response]
Tell the parents that behaviour may temporarily get worse after intense sessions, and give them home strategies.

Overwhelm in the therapist; compassion fatigue

SPTI holds that a dysregulated therapist risks escalation, vicarious trauma and compassion fatigue, and that regulation and personal development protect against them. SPTI has researched compassion fatigue among SPT therapists. [source: Dion keynote handout; SPTI What is SPT]
Limit how many high-intensity cases you hold at once, regulate between sessions, and use regular SPT consultation and supervision. [synthesis]

Non-adherence (missed sessions, parents not engaged) [synthesis]

Explain from the start that the nervous-system re-patterning SPT aims for depends on consistency.
Hold parent sessions at times the parents can manage, and use the parent session to look at the parent's own stress.
If attendance stays erratic, agree a shorter, focused contract, or refer to family work.

Ruptures [source: Dion keynote handout] [synthesis: steps]

With the child, repair as in 4.8.
With parents, ruptures often come from not understanding why aggression is "allowed". Re-explain the limits, show that safety rules exist, share tracked progress, and invite them to observe one session if appropriate.

Modality-specific difficulties [synthesis]

Over-disclosure. Authentic expression means naming a state that is present in the moment, briefly. It does not mean sharing your life story or your distress outside the play. If you notice you want the child to comfort you, stop and regulate.
Performed authenticity. Exaggerated or scripted feeling statements break congruence (tenet 5). Say less, and only what is true.
Over-matching intensity. Matching is meant to be authentic and at a safe level. If your matching frightens the child, step it down at once.
Explaining SPT neuroscience as fact. Describe the nervous-system ideas as the model's way of understanding behaviour. Avoid telling parents that you are "rewiring the brainstem" or "healing the vagus nerve". Polyvagal claims are scientifically disputed (Section 1).
Unclear stages and criteria. The model's own stage tools are taught only in SPTI training. Until trained, use the progress markers in Section 2 and do not present your own staging as the SPT model.
Scope. SPT does not replace medical, psychiatric, occupational therapy or speech-language assessment. Refer when symptoms suggest a developmental, medical or sensory condition.

Sources

Sources:

Further reading (as listed in the sources; full texts not drawn on):

Dion, L. (2018). Aggression in play therapy: A neurobiological approach for integrating intensity. W. W. Norton.
Dion, L., & Gray, K. (2014). Impact of therapist authentic expression on emotional tolerance in synergetic play therapy. International Journal of Play Therapy, 23(1), 55–67. https://doi.org/10.1037/a0035495
Simmons, J. (2020). Moving toward regulation using synergetic play therapy. Canadian Journal of Counselling and Psychotherapy, 54(3), 242–258.
Townsend, B., Ishman, L., Dion, L., & Holt, K. (2021). An examination of child-centered play therapy and synergetic play therapy. Journal of Child and Adolescent Counseling, 7, 1–14. https://doi.org/10.1080/23727810.2021.1964931
Dion, L., & Schaad, J. (2021). Synergetic play therapy combined with EMDR therapy. In A. Beckley-Forest & A. Monaco (Eds.), EMDR with children in the play therapy room. Springer Publishing.
Keating, B. (2023). Diving into the world of online play therapy. In H. Weinberg, A. Rolnick, & A. Leighton (Eds.), Advances in online therapy. Routledge.
LaPiere, R., & Dion, L. (2022). Using nature to create safety for medical trauma. In J. A. Courtney et al. (Eds.), Nature-based play and expressive therapies. Routledge.
Yian, Q. S., & Yong, M. (2022). The Inner Hum Project. Bookbird, 60(2), 50–59.
Grossman, P. (2023). Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology, 180, 108589. https://doi.org/10.1016/j.biopsycho.2023.108589 (journal details as cited by Giroux et al. 2023)
Porges, S. W. (2011). The polyvagal theory (cited by SPTI; not drawn on). [uncertain: full title]

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