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References
Post, P. B., Phipps, C. B., Camp, A. C., & Grybush, A. L. (2019). Effectiveness of child-centered play
therapy among marginalized children. International Journal of Play Therapy, 28(2), 88–97.
https://doi-org.go.libproxy.wakehealth.edu/10.1037/pla0000096

Effectiveness of Child-Centered Play Therapy Among Marginalized Children

By: Phyllis B. Post
Department of Counseling, University of North Carolina at Charlotte;
Christa B. Phipps
Department of Counseling, University of North Carolina at Charlotte
Ami C. Camp
Department of Counselor Education, Northeastern Illinois University
Amy L. Grybush
Department of Counseling, University of North Carolina at Charlotte
Acknowledgement:
The demographics in the United States are changing rapidly. In 2015, more than 50% of children
under 5 years old in the United States were children of color (Cohn, 2016). By the year 2020, the
U.S. Census Bureau reports that the number of minority group children under 18 years old will
surpass the number of children in the majority group, with the largest growth being in the Hispanic
community (Chappel, 2015). The relationship between race and poverty cannot be ignored. In
2009, the percentage of Caucasians in the United States was 66%, and 42% of them were low-
income families; Black families comprised 12% of the population and 22% of low-income families;
Hispanic/brown families comprised 15% of the population and 30% of low-income families (Milner,
http://web.a.ebscohost.com.go.libproxy.wakehealth.edu/ehost/deli…26sid%3de3c4fe4d-4587-4b51-b87a-b4b8a7d31fdd%2540sdc-v-sessmgr01 Page 1 of 16
2015). Whereas 21% of children in the United States live in poverty, the rate among minority group
children is higher, such that 50% of African American children live in poverty; 51% of American
Indians and 57% of Hispanics (Annie E. Casey Foundation, 2018). The intersectionality of
oppressive forces, that include culture, race, and socioeconomic status, create a group of
marginalized students (Carey, Yee, & DeMatthews, 2018).
Children from minority groups and low-income families are more likely to have problem behaviors
that place them at risk for challenges later in life. In 2011–2012, 42% of the preschool students
who were suspended one time and 48% of those who were suspended more than one time were
African American, despite representing only 18% of the preschool population (Milner, 2015).
Similarly, disparities in expulsion rates exist, such that African American preschoolers were twice
as likely to be expelled as European American preschoolers and five times more likely than Asian
American preschoolers (Gilliam, 2005).
Adverse childhood experiences (ACEs) impact the development of children. These experiences
are events in children’s lives that hinder normal childhood development. These include abuse,
neglect, household dysfunction, and not having the ability to meet physical needs within children’s
households before the age of 18. In their seminal work regarding ACEs, Felitti et al. (1998)
examined the responses of more than 9,500 primarily white (75.2%) adults aged 19–97 (M = 55)
who completed evaluations regarding their childhood experiences. More than half reported at least
one ACE, and a quarter reported three or more. Wade, Shea, Rubin, and Wood (2014) indicate
that ACEs are experienced disproportionately by minorities and low-income urban populations,
increasing the likelihood of adversity and developmental issues within this population.
Furthermore, research indicates that ACEs are correlated with behavior problems and negative
adult health outcomes (Felitti et al., 1998). These adverse experiences affect the structure and
function of the developing brain and can impact behavioral, cognitive, and emotional development
(De Bellis & Zisk, 2014). Research also indicates that consistent relationships with caring,
attentive, predictable adults can act as buffers to ACEs, increasing children’s ability to self-
regulate, which then increases their resilience (Ludy-Dobson & Perry, 2010). Play therapists can
meet the social-emotional needs and foster resilience of marginalized children by creating safe,
nonjudgmental environments that support adjustment and coping (Ceballos, Parikh, & Post, 2012;
Davis & Pereira, 2014).
Multicultural and Social Justice Competencies
In their seminal work, titled “Multicultural Counseling Competencies and Standards: A Call to the
Profession,” Sue, Arredondo, and McDavis (1992) addressed the need to develop a multicultural
perspective in the counseling profession. Their model addresses culture-specific strategies when
working with racial-ethnic minorities to include a focus on the dimensions of attitude, knowledge,
and skills. Recently, Ratts, Singh, Nassar-McMillan, Butler, and McCullough (2016) revised these
competencies and created the Multicultural and Social Justice Counseling Competencies, which
“reflect a more inclusive and broader understanding of culture and diversity that encompasses the
intersection of identities” (p. 29) with an emphasis on helping professional counselors include
social justice advocacy as central to their goals. Race and socioeconomic status reflect a major
intersection of cultural identities. Given the rapid changes in the demographics of children and
early educational experiences of marginalized children, play therapists have a responsibility to be
aware of and consider social, economic, and political events when addressing the developmental
needs of children living in an increasingly diverse society (Ceballos et al., 2012; Davis & Pereira,
2014).
This call to focus on the issues of multicultural and social justice competencies has been heeded
by play therapists. There is a body of outcome research about the impact of play therapy with
minority group and economically disadvantaged children. In an effort to increase awareness of and
sensitivity to cultural differences (Cochran, 1996), there is a body of literature that supports
modifications of play therapy models to meet the needs of different ethnic groups (Kranz, Ramirez,
Flores-Torres, Steele, & Lund, 2005; Perez, Ramirez, & Kranz, 2007).
Child-centered play therapy (CCPT; Landreth, 2012) is a developmentally appropriate intervention

that focuses on the relationship between play therapists and children as the dimension that
supports children’s ability to explore their world and resolve problems using their innate capacity
for self-direction and growth. Because CCPT is a relationship-based intervention, it is an ideal
approach for working with children who have experienced ACEs. Many marginalized children have
experienced trauma and ACEs and respond to those experiences with externalizing behaviors.
Moilanen, Shaw, and Maxwell’s (2010) longitudinal study examined 291 boys living in poor
neighborhoods. This study indicated that children living in poorer neighborhoods had higher
externalizing behaviors as a result of the negative effect of neighborhood environment. Child-
centered play therapy is sensitive to culturally relevant issues that children experience. Through
their play, children communicate their family and cultural values, as well as their needs. Child-
centered play therapists do not modify their approach with children; they remain steadfast in
honoring the basic tenets about the capacity for self-direction of children from different cultural
backgrounds (Bratton, Ray, Edwards, & Landreth, 2009).
Given the emphasis on self-awareness in the Multicultural and Social Justice Counseling
Competencies (Ratts et al., 2016), considering cultural similarities and differences of children and
their play therapists is important. For this reason, we examined the literature reviewed with regard
to the ethnicity of the play therapists who implemented the CCPT interventions. Studies reporting
the ethnicity of play therapists indicated high percentages of Caucasian play therapists: Shen
(2016) reported that 78% were Caucasian, Ceballos et al. (2012) reported 85%, Penn and Post
(2012) reported 88%, and Abrams et al. (2006) reported 92%. Although these percentages are not
play therapists who conducted interventions in the research studies, they do highlight the high
percentage of Caucasian play therapists, which is relevant for this review focusing on the impact of
play therapy interventions with minority group children.
The purpose of this review was to examine the effectiveness of CCPT with marginalized children.
To this end, both recent meta-analyses and controlled outcomes studies using CCPT as the
intervention were reviewed. The inclusion criteria for the intervention studies were those that had
control groups that assessed the effectiveness of CCPT (a) with minority group children only or (b)
were conducted in a high poverty school (i.e., Title 1 schools or Head Start) where more than half
of the participants in the intervention were minority group children.
Meta-Analyses
Researchers have used meta-analytic approaches to examine the effectiveness of play therapy.
Since 2000, four meta-analyses have been conducted that summarized play therapy research
outcomes. Two of the meta-analyses coded the approach to play therapy as directive or
nondirective, and two included only studies that have used CCPT. These studies were examined
relative to (a) their outcome in regard to using directive or nondirective approaches and (b) their
inclusion of ethnicity to describe the children or as a variable used in their analyses.
Leblanc and Ritchie (2001) conducted a meta-analysis that included 42 research studies from
1966 to 2001 and dissertations from 1945 to 2001. Their findings indicated that play therapy was
an effective treatment with a medium effect size (0.66; p < .001). The authors did not examine
directive or nondirective treatment as a predictor variable. Data on ethnicity/race and
socioeconomic status of children or play therapists were collected but not included in the data
analyses. However, the authors stated that it would be helpful to understand how characteristics of
the therapists could be related to the outcomes. Moreover, they recommend that future research
include both client characteristics and therapist characteristics.
In another meta-analysis, Bratton, Ray, Rhine, and Jones (2005) examined the efficacy of play
therapy using 93 controlled outcome studies published between 1953 and 2000 that included
3,248 children. The result of this study found a large treatment effect size of 0.80, demonstrating
the strong impact that play therapy had on children. Among the characteristics coded in this study
were humanistic or nonhumanistic approaches and the ethnicity of the children. Although the
findings demonstrated that play therapy was effective regardless of the approach, the humanistic
interventions had a larger effect size than the nonhumanistic approaches. The authors were not
able to examine the impact of ethnicity on the outcome because the majority of the studies
included in their analysis did not report ethnicity data.
Two recent meta-analyses have examined the effectiveness of CCPT. Lin and Bratton (2015)
included 52 research studies conducted between 1995 and 2010 and found a moderate effect size
(.47; p < .001) that determined CCPT was more effective than no treatment and alternative
treatments. Among the characteristics examined in the study were children’s ethnicity and
treatment provider characteristics. Although only a limited number of studies included ethnic
groups other than Caucasian, the authors were able to categorize 30 of the studies as identifying
the ethnicity of the children as either more than 60% were Caucasian (n = 15) or more than 60%
were non-Caucasian which included African American, Latino/Hispanic, Asian/Asian American and
other ethnic minorities (n = 15). In the final model, and treatment provider characteristics was not
included. Children’s ethnicity did contribute to the effectiveness of CCPT. The mean effect size for
studies with more non-Caucasian was .76 compared with an effect size of .33 for studies with more
Caucasian participants which indicates that CCPT is a culturally sensitive intervention for children.
Lin and Bratton stated:
Child-centered play therapy provides children with a nonverbal and symbolic means of expression
that transcends language, sociopolitical, and cultural barriers that children of ethnic minority
groups can experience on a daily basis. . . . The fully accepting environment and opportunity for
free expression in a counseling relationship based on CCPT may be an additional therapeutic
factor that accounts for the present finding regarding CCPT’s superior benefit for ethnic minority
children. (p. 50)
Ray, Armstrong, Balkin, and Jayne (2015) examined the effectiveness of CCPT, with 23 outcome
research studies that were conducted in elementary schools, and found that CCPT was an
effective intervention in elementary school settings with a small to medium effect size (d = .38).
The authors reported that 20 of the 23 studies included information on the ethnicity of the children.
Thirty-two percent of the children were African American, 37% were Caucasian, 23% were
Hispanic, and the remaining were Asian American, other, or international. However, ethnicity was
not used in the data analysis to determine the effectiveness of CCPT.
The outcomes of the meta-analyses demonstrate the effectiveness of CCPT. However, only Lin
and Bratton (2015) included the ethnicity of the child in the data analysis. As reported above, the
findings indicated that CCPT was more effective with non-Caucasian children than with Caucasian
children.
CCPT Intervention Studies
As stated above, the inclusion criteria for the intervention studies was that they all had control
groups that assessed the effectiveness of CCPT (a) with minority group children or (b) in a high-
poverty school (i.e., Title 1 schools or Head Start) where more than half of the participants in the
intervention were minority group children. Each article was examined with regard to the results, the
type of outcome measures used, who completed the assessments that identified participating
children, and the ethnicity of the play therapists.
Ethnicity of the Children

The Hispanic population is the fastest growing and youngest population in the United States
(Flores, 2017). Many of these children live in poverty, which can impact their risk for school failure.
Moreover, some Hispanic children experience challenges as a result of English being their second
language. Hispanic families are also unlikely to utilize clinical mental health services in the
community. Garza and Bratton (2005) examined the impact of CCPT with Hispanic elementary
school-aged students referred to the school counselor for externalizing behaviors. Pre and post
assessments were completed by both teachers and parents. The authors found that parents
perceived significant reductions in externalizing behaviors of participating students after 15
sessions of CCPT compared with a curriculum-based group intervention. However, the teachers
did not perceive differences in the children’s behaviors who participated in the intervention. All of
the children identified as Hispanic, and two bilingual Hispanic play therapists implemented the
CCPT intervention.
In a study composed of only African American students, Taylor (2016) examined the impact of
CCPT on 37 students with identified by teachers and school counselors as having problematic
interpersonal behaviors. The students attended four suburban elementary schools that included
high numbers of low-income students. Students were randomly assigned to CCPT or a wait list
control group. Parents and teachers completed assessments about students’ social-emotional
competence which included assessments of self-regulation/responsibility, social competence,
empathy, and responsibility. The results indicated that parents reported improvements in overall
social-emotional competence, but the teachers did not report statistically significance differences.
The ethnicity of the therapists was reported and included one African American female, seven
Caucasian females, and one Caucasian male.
Refugee children are an underserved minority group unlikely to receive adequate mental health
services. In an effort to compare the effectiveness of CCPT and trauma-focused cognitive–
behavioral therapy (TF-CBT), Schottelkorb, Doumas, and Garcia (2012) randomly assigned 31
elementary school-aged, traumatized, refugee children who experienced PTSD to either CCPT or
TF-CBT interventions. The children participating in the study were from Africa (67%), the Middle
East (10%), Asia (10%), and Europe (7%). Children completed assessments regarding an
upsetting traumatic experience and their perception of the severity of the event. In addition,
parents assessed posttraumatic symptoms in the children before and after the intervention.
Because of language barriers, two of the authors administered the assessment with interpreters.
Moreover, the findings indicated that both interventions, CCPT and TF-CBT, resulted in a reduction
of PTSD symptoms, but there was no change in their level of severity as a result of the
interventions. The ethnicity of the play therapists was not reported in this study.
High Poverty Schools and Majority of Participants Ethnic Minorities

There is a growing body of literature of outcome studies of children in schools characterized by
high percentages of low-income children. In a comparison study of 168 at-risk fourth-, fifth-, and
sixth-grade children, Post (1999) examined the impact of CCPT on self-esteem, ability to assume
responsibility for their academic work, and anxiety. Assessments were completed only by the
students. Ninety-five percent of the students in the school received free or reduced lunch, and 82%
(n = 136) were African American. The results indicated that CCPT helped the participating
students maintain an internal locus of control; however, students who did not participate in play
therapy showed a decrease in both self-esteem and internal locus of control over the course of a
school year. The ethnicity of the 12 play therapists was not reported.
Muro, Ray, Schottelkorb, Smith, and Blanco (2006) examined the long-term impact of 32 sessions
of CCPT on the problem behaviors of children and teacher stress among students from three Title
1 elementary schools. Fourteen percent of the students were Caucasian, and 86% were non-
Caucasian. Assessments were completed by teachers at pretest, after 16 sessions, and after 32
sessions. The findings demonstrated a significant change in teachers’ perceptions of problem
behaviors between Time 1 and Time 3. Similar findings emerged regarding teacher stress in that
there were significant changes between Time 1 and Time 3. Overall, the findings indicate that
children’s behaviors and teacher child relationships improve as a result of CCPT over the course of
32 sessions. The ethnicity of the therapists was not reported.
Using a sample of children identified by their teachers as having attention problems and
hyperactivity in a Title 1 elementary school, Ray, Schottelkorb, and Tsai (2007) examined the
effectiveness of CCPT on children’s behaviors. The ethnicity of the children was 47% Caucasian
and 53% African American, Hispanic, or Biracial. Teachers completed assessments of students’
ADHD behaviors and teacher stress. The findings indicated that all of the participating children
demonstrated improvement in their ADHD behaviors, and that those children receiving CCPT
demonstrated statistically significant improvement compared with children who participated in
reading mentoring on several subscales of teaching stress. The ethnicity of the play therapists was
not reported.
Using a wait-list control group, Ray, Blanco, Sullivan, and Holliman (2009) examined the impact of
14 sessions of CCPT conducted with 42 students in two Title 1 schools whose teachers rated them
as having aggressive behaviors in their classrooms. The sample consisted of a majority of non-
Caucasian (56%) students. Assessments of aggressive problems were completed by both
teachers and parents. The findings indicated differences in perception found between parents and
teachers. Teachers indicated a significant decrease on aggressive problems over time, but there
was no difference between the CCPT and waitlist group. Parents did not report a difference in
children’s scores on the aggressive problems over time or between the groups. The ethnicity of the
play therapists was not reported. A second study waitlist control group study (Wilson & Ray, 2018)
compared the levels of aggression, self-regulation, and empathy of 71 children in two Title 1
schools whose teachers rated them as having aggressive behaviors in their classrooms. The
sample consisted of a majority of non-Caucasian (80%) students. Assessments were completed
by both teachers and parents. The results of parents’ assessments indicated that children who
received CCPT were less aggressive, more self-regulated, and more empathic that children in the
control group. There was no difference in teachers’ perceptions between children who participated
in CCPT and those who did not with regard to the variables of interest. The ethnicity of the
counselors was reported in this study. There were seven females (one African American and six
Caucasian) and one Caucasian male.
In the first study to examine the impact of CCPT on school-related achievement, Blanco and Ray
(2011) examined the achievement of 43 academically at-risk first graders who attended from four
Title 1 schools. The ethnicities of the children were seven African American, 14 Hispanic, 19
Caucasian, and one Asian American. Trained examiners assessed the outcome variable in this
study. The results indicated that students in both the experimental and control groups
demonstrated improved school-related achievement over time; however, the children who
participated in the CCPT intervention obtained significantly higher scores than the children in the
control group. The ethnicity of the play therapists was not reported.
Another study examined the effectiveness of CCPT on disruptive behaviors among low-income
preschool children attending a Head Start program (Bratton et al., 2013). The ethnicities of the
children were 42% African American, 39% Hispanic, and 18% Caucasian. The Hispanic children,
whose primary language was Spanish, received CCPT from bilingual Spanish-speaking play
therapists. The children were assigned to the CCPT intervention or to an active control group
utilizing a reading mentoring program. Assessments were completed by teachers who were
unaware of the intervention received by the child. The outcomes indicated that the children who
received CCPT exhibited a decrease in aggression and attention-related problems compared to
the control group. The ethnicity of the play therapists was not reported.
Results
The review of the meta-analyses revealed that nondirective approaches had larger effect sizes
than directive approaches (Bratton et al., 2005) and that non-Caucasian children demonstrated
greater benefit from nondirective therapy than Caucasian children (Lin & Bratton, 2015). One of
the meta-analyses (Ray et al., 2015) provided information on the ethnicity of the children, but it
was not examined with regard to its impact on the effectiveness of CCPT. Although ethnicity of the
play therapist was not addressed in any of the meta-analyses, Leblanc and Ritchie (2001)
recommended reporting ethnicity of the children and the play therapists in future research.
The individual outcome studies in this review indicated that CCPT is effective with marginalized
children. Of interest in this review were the findings about the impact of the CCPT interventions,
the outcome variables examined, who completed the assessments, and the ethnicity of the play
therapists. Although our intention was not to examine where the studies were conducted, all of the
intervention studies, as well as one meta-analysis (Ray et al., 2015), were conducted in school
settings. This finding is noteworthy, though not surprising, because ethnic minority group children
are more accessible in schools because they are less like to use clinical mental health services
(Blanco & Ray, 2011).
Most of the individual studies examined the impact of CCPT on problem or externalizing behaviors
(Bratton et al., 2013; Garza & Bratton, 2005; Muro et al., 2006; Ray et al., 2009; Ray et al., 2007;
Wilson & Ray, 2018). Other studies examined the impact of CCPT on PTSD symptoms
(Schottelkorb et al., 2012), social-emotional competence (Taylor, 2016), academic achievement
(Blanco & Ray, 2011), facilitating self-confidence, anxiety of children, locus of control (Post, 1999),
and teacher stress (Muro et al., 2006; Ray et al., 2007).
Three of the studies included children who identified as Hispanic (Garza & Bratton, 2005), African
American (Taylor, 2016), or refugees (Schottelkorb et al., 2012). Regarding the ethnicity of the play
therapists, Garza and Bratton (2005) reported that two bilingual Hispanic play therapists conducted
the CCPT sessions, and Taylor (2016) reported that one of the nine play therapists was an African
American female. The other studies were conducted in high-poverty schools, and the ethnicity of
the play therapists was not reported frequently. When reported, the play therapists were
predominantly Caucasian, which is consistent with the literature about the ethnicity of play
therapists (Abrams et al., 2006; Ceballos et al., 2012; Penn & Post, 2012; Shen, 2016).
The people who completed the assessments of the children varied. In most of the research cited,
the dependent variables were assessed either by teachers (Bratton et al., 2013; Muro et al., 2006;
Ray et al., 2007) or by both teachers and parents (Garza & Bratton, 2005; Ray et al., 2009; Taylor,
2016; Wilson & Ray, 2018). The perceptions of teachers and parents differed in several of the
studies (Garza & Bratton, 2005; Ray et al., 2009; Taylor, 2016; Wilson & Ray, 2018). Students
completed assessments in one study (Post, 1999), whereas both the students and parents
completed assessments in another study (Schottelkorb et al., 2012). Moreover, trained examiners
were used in one study to complete assessments about the children (Blanco & Ray, 2011).
Discussion
Research on the impact of trauma on children and their development is increasing (Barboza, 2018;
Slack, Font, & Jones, 2017). In a recent interview facilitated by Oprah (Stahl & Winfrey, 2018),
Bruce Perry expressed that the one thing that most supports resilience for trauma and the brain is
relationships. This statement highlights and further emphasizes the significance of the relationship
within the counseling and mental health profession. The quality of the relationship is the
undergirding value of child-centered play therapy as it fosters the ability for children to
communicate, using their language (play) and words (toys; Landreth, 2012). The CCPT approach
aligns with the recommendations found in the literature regarding trauma-informed schools that
emphasize the importance of focusing what happened to children rather than on the child’s
behaviors (Cole, Eisner, Gregory, & Ristuccia, 2005). Either through their words, play behaviors, or
way of being in the playroom, children express what happened to them. In this way, child-centered
play therapists develop relationships with children that can enhance their resiliency when facing
personal struggles.
The fact that 75% to 80% children who are in need of mental health interventions do not receive
them (Kataoka, Zhang, & Wells, 2002) and that those students in need of services are more likely
to receive them at school is especially relevant for marginalized children. This review
demonstrates a strong commitment among play therapists to promote social justice advocacy and
support children who are likely to have experienced ACEs and high levels of trauma. The overall
conclusions are that (a) CCPT is effective with marginalized children, (b) the outcome variables
tend to focus on externalized problem behaviors, (c) teachers most frequently completed
assessments about the children, and (d) most of the existing research does not address the
ethnicity of the play therapist(s) conducting the CCPT intervention.
These findings are important in light of Milner’s (2015) differentiation between equality and equity,
stating that “Equality means sameness, while equity means, in the effort to achieve equal results,
being responsive to the particulars of the circumstances” (p. 34). To be equitable, schools must
provide students “with what they need to succeed, regardless of their racial, ethnic, cultural, or
socioeconomic background” (p. 34) and “if public school systems are serious about closing
achievement gaps, they must begin to allocate more resources to the students with the greatest
needs” (p. 35). This review indicates that CCPT is an intervention that can help at-risk children with
regard to their externalized behaviors, self-esteem, and academic achievement.
Although one study included independent or blind ratings of the children participating in the
interventions (Blanco & Ray, 2011), in most of the studies reviewed, the individuals who rated the
outcome variables regarding the children’s behaviors knew that the children participated in the
interventions. Given that most of the research is conducted in school settings, the finding that
teachers identify the children with externalized behaviors is not surprising, because children who
have externalized, or aggressive, behaviors can be disruptive in the classrooms. Externalized and
aggressive behaviors impact the way the teachers view children, because these behaviors
increase teacher stress and are frustrating to teach (Greene, Beszterczey, Katzenstein, Park, &
Goring, 2002). Parents also completed assessments of their children’s behaviors even if their
assessments were not the criteria used for participating in the study. From the perspective of both
the teachers and parents, this knowledge about inclusion in the studies could have impacted the
findings. For example, teachers could be biased about the value of the intervention or have a
strong commitment to the researchers conducting the studies, which could unconsciously impact
the outcomes. Additionally, parents’ assessments could reflect biases, in pre- and posttests,
regarding their beliefs or disbeliefs that their children had the problem because some children
exhibit behaviors at schools that are not recognized by parents as problems that they see at home.
The ethnicity of the play therapists who conduct the interventions was not usually reported;
however, when it was reported, most of the play therapists were Caucasian. According to the
Multicultural and Social Justice Counseling Competencies (Ratts et al., 2016), when the counselor
is Caucasian and the children are minority group members or economically disadvantaged,
counselors hold social power and privilege. For this reason, multicultural and social justice
competence begins with the self-awareness of the counselor regarding their cultural values and
biases. Such attention to self-awareness helps play therapists understand of how culture, power,
privilege, and oppression can impact their relationships with children.
Future Research
In contrast to those children who exhibit externalizing behaviors, children who have experienced
ACEs may exhibit internalizing behaviors, such as social withdrawal, anxiety, or depression. These
children should be included in future research with marginalized children. Inclusion criteria could
include ACEs and assess the impact of CCTP on children’s resilience.
Although the logistics can be complicated, future studies should also strive to maintain anonymity
of students to ensure that teachers who complete assessments are not biased because of knowing
which children were participating in the studies. One way to do this is to use raters who are blind to
whether the children are receiving the intervention and have no other contact with the children, as
described by Phipps (2017). Should maintaining anonymity be impossible, it would be beneficial to
include a qualitative component to the research to address any factors that could influence
teachers’ or parents’ assessments of the children. In addition, in studies where data are collected
from both teachers and parents, it would be helpful to include comparisons of their ratings when
the scores on the different versions of the assessments are aligned.
An additional recommendation for future research is to consistently provide data about the
ethnicity of the children and play therapists. Because our findings indicate that the majority of
practicing play therapists are Caucasian, future research should examine the impact of the
children’s ethnicity and that of the play therapist on the outcomes. Finally, follow-up studies should
be conducted to determine whether the outcomes found in the research are maintained over time.
A gap in the literature is research examining whether changes resulting from CCPT last over time.
Recommendations
The new School-Based Registered Play Therapist credential of the Association for Play Therapy
will promote future training at the university level and through continuing education for play
therapists who conduct research and work in school settings. School-based play therapists are
more likely to use play therapy techniques if they believe they are effective (Van Horne, Post, &
Phipps, 2018). It could be beneficial for school-based play therapists to receive training on
research modalities they can integrate into their work to assess the effectiveness of their
interventions using single-case and qualitative designs. It is our professional and ethical
responsibility to increase equity and counter institutional oppression through our service to our
most vulnerable and underserved children. Child-centered play therapy holds great promise for
helping marginalized children. Although we cannot change the past of the children with whom we
work, we can use CCPT interventions to enhance the present and future lives of children.
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Submitted: August 9, 2018 Revised: November 29, 2018 Accepted: December 21, 2018
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the individual user.
Source: International Journal of Play Therapy. Vol. 28. (2), Apr, 2019 pp. 88-97)
Accession Number: 2019-09991-001
Digital Object Identifier: 10.1037/pla0000096

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Effectiveness of Child-Centered Play Therapy Among Marginalized Children

Multicultural and Social Justice Competencies

Child-centered play therapy (CCPT; Landreth, 2012) is a developmentally appropriate intervention

CCPT Intervention Studies

Ethnicity of the Children

High Poverty Schools and Majority of Participants Ethnic Minorities

Gilliam, W. (2005). Prekindergarteners left behind: Expulsion rates in state prekindergarten

multicultural counseling competence. International Journal of Play Therapy, 21, 14–29.

J.Fager (Executive Producer), 60 minutes. New York, NY: CBS.

Taylor, L. (2016, May). Social-emotional competencies of African American children: Impact of

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