Cochran, J.F., Cochran, N.H., Nordling, W.J., McAdam, A., & Miller, D.T. (2010). Two case studies of child-centered play therapy for children referred with highly disruptive behavior. The International Journal of Play Therapy, 19, 130-143.
In the most recent issue of The International Journal of Play Therapy, Cochran et al. (2010) detail the use of child-centered play therapy (CCPT) in the treatment of two 6-year-old male children referred for disruptive behavior disorders. For those unfamiliar with CCPT, it is a type of play-therapy that “emphasizes genuine, deep empathy and unconditional positive regard from therapist to child clients, child self-expression within necessary limits, and opportunities for the child to “think through” inter- and intra-personal conflicts in play and to use play to communicate to self and counselor in therapeutic sessions” (Cochran et al., p. 131; see also Axline, 1969; Guerney, 1983, 2001; Landreth, 2002; Nordling, 2009). The authors conceptualize disruptive behavior disorders as reflecting a foundational deficit in relating to others, and hence hypothesized that CCPT would be an effective form of treatment.
The subjects of the study were both Hispanic and had failed to respond to typical interventions in the school setting during Kindergarten. Both boys displayed severe (defined as clinically significant as measured on the Teacher Report Form [TRF] of the Child Behavior Checklist) symptoms of inattention and aggression. The children received twice-weekly, 30-minute sessions of CCPT in addition to classroom guidance lessons, parent and teacher consultation, and crisis management in the classroom on an as-needed basis. Results showed that both children showed clinically significant reductions in problem behaviors and increased pro-social interactions with others, according to the TRF.
The most significant contribution of this article, however, comes from the unique conceptualization of each child’s disruptive behavior. CCPT practitioners often emphasize the uniqueness of each child, and the need to formulate case conceptualizations and treatment plans on a case-by-case basis. In the case of the first subject, the authors conceptualized his disruptive behavior as resulting from hypervigilance and anxiety about his home-life, which school authorities believed to be chaotic. The authors wrote “many of his difficulties [were likely] resulting from hypervigilance related to living with high levels of worry and stress” (Cochran et al., p. 135). In the second case, the subject’s disruptive behavior was seen as resulting from his negative self-perception, depression, and an attempt for force a favorable opinion of himself on others, often in ways that were aggravating or aggressive. Interestingly, Cochran and colleagues ultimately see each child’s disruptive behavior, or externalizing behavior, as a manifestation of a distressing internal experience.
In both cases, the authors emphasize that CCPT gave the children an opportunity to express their underlying emotions, receive empathy, and feel safe enough to try alternate solutions. Although more traditional therapies, such as cognitive-behavioral therapy, have similar goals (feeling and thought identification, replacing unhelpful thoughts with helpful thoughts, etc.), it most often utilizes talk-therapy techniques and requires some level abstract thinking that is often developmentally beyond younger children. In this way, CCPT offers a developmentally-appropriate means through which to access children’s unhelpful thoughts and feelings and provide opportunities for them to find alternate solutions.
The bottom line: If you have a young child with a disruptive behavior disorder, you may want to consider supplementing traditional behavior therapy and parent-training with CCPT.