Beyond Adapting Adult Counseling Skills for Use with Children: The Paradigm Shift to Child-Centered Play Therapy Garry Landreth, Jennifer Baggerly, and Ashley Tyndall-Lind The authors describe the igm shit in the conceptual amework used when providing counseling for — laren. This shit cal for develop ‘counsel- ing skills specific to children’s needs rather than basic adult skills to child counseling. Play Therapy has been increasingly ‘ate ‘asan effective counseling mada with ciken a authors describe chil-centered Play Therapy and com- pare it with Adlerian Therapeutic considerations specific to il needs in counseling are ‘orem ree Frustration in counseling children tempts many counselors to fall back on familiar approaches and techniques that have worked with adults. A typi- cal example is Erdman and Lampe’s (1996) attempt to deal with counselors’ frustrations in counseling children by proposing adapting basic adult coun- seling skills to counsel children. Their intent to “encourage the adaptation of basic skills to make them more applicable to the needs of children” (p. 374) is typical of recommendations for counseling children. Erdman and Lampe recognized that “developmentally, children differ from adults cognitively, emotionally, physically, and psychologically, and these differences require special knowledge and sensitivity by the counselor” (p. 374), but what is missing from their description of the developmental characteristics of chil- dren and those of other authors is a recognition of how these factors affect a child's ability to communicate, an essential variable in the counseling rela- tionship. A review of general counseling literature revealed many examples of authors’ attempting to fit children into an adult counseling framework. Madigan (1994), Russell and Van den Broek (1992), and Stover and Stover (1994) em- phasized adapting a verbal process in counseling children by asking questions that scrutinize, searching for words that will be meaningful, or giving open- ended questions. A focus on adapting an adult verbal process sends a clear message that children are not prized as unique in their own right but rather are squeezed into an adult conceptual framework. Children in counseling have often been viewed as similar to adults who receive counseling (Bauers, ‘The Journal of individual Vol, 55, No. 3, Fall 1999 (©1999 by the University of Texas Press. P.O. Box 7819, Austin, TX 78713-7619Child-Centered 273 1994). Some authors simply overlooked children’s developmental issues, as in the case of Gurman (1993), who stated that there was no conceptual dif- ference in psychoanalysis of children and of adults and that children were able to verbalize their thoughts and to symbolize (e.g., in their dreams). By making such a statement, Gurman overlooked the developmental unique- ness of children and did not take into account the cognitive differences characteristic of children who are in a concrete operational stage and are not able to engage fully in abstract reasoning or thinking until approximately age 10 (Piaget, 1962). In the quest to work effectively with children, counselors have explored creative approaches such as songwriting (Miles, 1993), sandplay based on Jungian analysis (Grubbs, 1994), and mutual storytelling (Haubner, 1993; Henley, 1994; Stover & Stover, 1994). Again, these approaches rely on highly developed language acquisition and verbal skill, and they have been devel- oped in an attempt to deal with children in an adult counseling framework of talk and abstract analysis. Although Schliebner and Peregoy (1994) recognized that children af- fected by a parent's unemployment have unique concerns and specific problems such as self-blame, loss of friends, adjustment to new communi- ties, and feelings of insecurity, the counseling approach they recommended was limited to cognitive restructuring, positive self-affirmation, stress man- agement, social skills training, and group counseling. They did not appear to recognize that children have limited cognitive and verbal abilities, and they made no mention of play as children’s natural means of communication. Because children’s abilities to think and to reason abstractly lag behind those of adults (Piaget, 1962), children often experience difficulty when try- ing to communicate verbally to the counselor. It is precisely this dimension of the counseling relationship that has not been addressed in the counseling literature. Although generally recognized principles of building trust in a coun- seling relationship are suggested, the basic recommendation is that counselors should utilize a communication approach with children based either on ques- tioning entirely (Erdman & Lampe, 1996) or on the usual adult verbal exchange. The typical verbally based counseling approach does not take into consider- ation what is known about children’s development. Children’s abilities to grasp abstract concepts are less developed than those of adults, and children often lack abstract reasoning ability. However, like other researchers, Erdman and Lampe concluded that counseling with children required only “some modification of the techniques that are effective with adults” (p. 374). Their assertion is an oversimplification of the issues involved in effective counsel- ing with children. What is needed is not a focus on technique modification but rather the adoption of a counseling model devoted to the developmental needs of children.274 Garry Landreth et al. eee seeseseue se eesen sess seeseeaeee adres as the of the Child Counseling children requires that counselors go beyond the familiar adult counseling framework and into the world of a child. Nothing less will do than a total shift from the old paradigm of merely adapting basic adult coun- seling skills in counseling children to the new paradigm of Play Therapy which has been developed specifically for counseling with children. The new para- digm of Play Therapy allows counselors to communicate effectively with children through their natural language of play. Modifying basic adult counseling skills to work with children requires that the child adopt the communication style that is most comfortable for the adult. To make emotional contact with children, utilization of a method of communication that meets the needs of children is necessary. Play comes naturally to children and without effort the child is capable of reasonably expressing feelings, thoughts, and concerns by the manipulation of toys and materials (Axline, 1947; Bettelheim, 1987; Ginott, 1961; Landreth, 1991). Play media materials invite the child's participation and establish a natural means of communication which does not require verbal interaction. The play of the child becomes the medium of exchange and is utilized by the counselor not only to understand the child but also to build a therapeutic relationship. (Landreth, 1983, p. 202) Play is much more than simply a procedure to help children get ready to do something more important, such as talk. Play is a medium through which children are able to communicate fully and explore their experiences, their reactions to those experiences, and what they want or need in their lives. The utilization of play as a communication tool enables a child to tran- scend the restrictions presented by his or her inability to understand or articulate abstract thoughts. According to Piaget (1962), play bridges the gap between concrete experience and abstract thought. He also suggested that feelings are inaccessible at a verbal level until the child is approximately 11 years of age. Therefore, play provides the child with the opportunity to ex- press inner desires, feelings, problems, and anxieties. Play is described by Froebel (1903) as “the highest development in childhood, for it alone is the free expression of what is in the child's soul... Children’s play is not mere sport. It is full of meaning and import” (p. 22). In their recommendation that counselors appropriately utilize questions when working with children, Erdman and Lampe (1996) provided great de- tail about children’s possible negative responses to interrogative patterns, multiple-choice questions, and “why” questions. Although these techniques are suggested with a cautionary note, no consideration is given to eliminat- ing this procedure because of its apparent ineffectiveness. The use of simple words and concrete questions does not address the underlying difficulty thatChild-Centered Play Therapy 275 questioning a child presents, and questions of any kind place the child in a cognitive frame of reference (Piaget, 1962). Similar information can be gath- ered in a nonthreatening way, without fear of the child’s misinterpreting the counselor's meaning, by learning to understand the meaning of children’s play. A Play Therapy approach allows the child to express how he or she interprets the world and what experiences and issues are of concern to the child (Gil, 1991; Landreth, 1993; Moustakas, 1981). Play therapy is a more direct approach than questioning, and it allows a child to express what is distressing him or her. ‘The Counseling Environment The setting where counseling occurs is of primary importance, and some authors suggest using toys but misconstrue the purpose by stressing that toys serve the purpose of stimulating conversation, thus overlooking the commu- nication value of toys for children. Erdman and Lampe (1996) even recommended that the benefits of play materials needed to be balanced against their possible distractibility, especially in a school setting where space is of- ten limited. On the other hand, Landreth (1983, 1991) has asserted that the utilization of play materials in elementary school settings is vital regardless of the limited space available. Although adequate physical space for leaming experiences and other school activities is already a problem in many elementary schools, we should not con- sider it a major limitation or deterrent to the use of Play Therapy. Granted, space is necessary, but it is my contention that every elementary school has some space that will adequately accommodate a Play Therapy program. (Landreth, 1983, p. 203) When toys are utilized for Play Therapy, it is not necessary to “inquire about the child’s comfort,” as Erdman and Lampe (1996, p. 375) recommended, because children readily establish their own comfort zones. The therapeutic environment is comfortable for a child when it is inviting, not intimidating. Hence, toys selected should provide for a wide range of play activity and should welcome the child. A welcoming environment can be communicated through a careful selection of therapeutic toys that facilitate the seven essen- tials in Play Therapy: establishment of a positive relationship with the child, expression of a wide range of feelings, exploration of real life experiences, reality testing of limits, development of a positive self-image, development of self-understanding, and opportunity to develop self-control (Landreth, 1991). The selection of appropriate therapeutic toys enables children to immerse themselves in an environment that feels familiar and that allows for numer- ‘ous modes of expression. This environment should convey an understanding276 Garry Landreth et al. oo of the child's view of the world by providing toys that not only appeal to the child’s interest but also serve a therapeutic purpose as well. In essence, toys provide a medium by which the counseling interchange will occur. Children can communicate a wide range of messages and feelings with a limited number of toys and materials. We consider the following items to be the minimal requirements for conducting a Play Therapy session: crayons, newsprint, blunt scissors, plastic nursing bottle, rubber knife, doll, Play-Doh, toy dart gun, handcuffs, toy soldiers, empty vegetable can (doubles as con- tainer for toy soldiers), plastic or tin play dishes, spoons (avoid forks because of sharp points), small airplane, small car, telephone, hand puppets or bendable doll family, a small cardboard box with rooms indicated by strips of tape (could double as a container for some materials), dollhouse furniture, small plain mask (Lone Ranger type), Nerf ball, bendable Gumby (nondescript fig- ure), Popsicle sticks, pipe cleaners, pounding bench, old cap or hat, and empty egg cartons. If storage space is available, an inflatable bop bag would be an asset (Landreth, 1991). The selection of toys should take into account the basic reason for using Play Therapy with children, the recognition of a child’s developmental level expressed naturally through his or her play and activity. Because children can express their feelings and reactions more fully through their play, the toys and materials selected for Play Therapy are a significant therapeutic variable. Play Therapy Landreth (1991) defined Play Therapy as .. a dynamic interpersonal relationship between a child and a therapist trained in Play Therapy procedures who provides selected play materials and facilitates the development of a safe relationship for the child to express and explore self (feelings, thoughts, experiences, and behaviors) through the child's natural medium of communication, play. (p. 14) Play Therapy has a long, rich, and well-documented history of For over 80 years, mental health professionals have realized the need for a different approach with children and have chosen to use play in counseling with children. The first recorded attempt to address the unique problems of counseling a child by using play was by Freud (1909) in his work with the father of “Little Hans,” a five-year-old boy with a phobia. Freud advised Hans's father of ways to respond in play sessions with suggestions based on the father’s notes about Hans’s play. In 1919, Klein (1955) began using play to adapt psychoanalytic tech- niques to children. She implemented play techniques as a substitute for free association for the purpose of transference and interpretation. “My experi-Child-Centered 277 ence has convinced me that with the help of the play technique it is possible to analyze the early phases of super-ego formation in quite little and in older children” (p. 204). Klein believed play had a symbolic basis and, thus, inter- preted the symbols for the child to promote contact with the child’s unconscious. She believed this insight into the child’s play behavior would diminish the child's anxieties and provide an effective means to accomplish psychoanalysis with children. Anna Freud (1946) also implemented play tech- niques in the early 1900s in her psychoanalytical work with children. Unlike Klein, Freud did not see play as necessarily symbolic. However, she did ef- fectively use play to create a dependency and thus transference of the child's parental conflicts onto the therapist. The second major counseling development in the use of Play Therapy was Levy's (1939) development of release therapy. Levy used play to facili- tate the creation of situations in which the child’s anxieties were given expression. As Schaefer (1985) elaborated, by repeatedly playing out a difficulty or loss, the natural slow healing process of nature can take place. By play repetition, a child can relive and gradually assimilate a stressful event and integrate it rather than denying or being over- whelmed by it. (p. 100) In release therapy toys representing the troubling situation are presented to the child who replays the event to develop a sense of mastery over the anxi- ety. In release therapy, play is highly structured and often directed by the play therapist. The third major counseling development in the use of Play Therapy was the work of Allen (1934) and Taft (1933) in relationship therapy. This ap- proach to Play Therapy emphasized “the curative power of the emotional relationship between the child and the therapist” (Rank, 1936, p. 198). The relationship is facilitated by allowing the child to choose to play or not to play and to assume responsibility for his or her own growth. The fourth significant development in Play Therapy was the work of Axline (1947) in nondirective or child-centered Play Therapy. Axline believed that children have the ability to solve their own problems given the safe and ac- cepting environment of Play Therapy. A play experience is therapeutic because it provides a secure relationship be- tween the child and the adult, so that the child has the freedom and room to state himself in his own terms, exactly as he is at that moment in his own way and in his own time. (Axline, 1950, p. 68) In child-centered Play Therapy, the child is the leader in play and the counse- lor is the follower who is fully with the child, providing warmth and understanding through empathic reflection. During this process, the counse- lor is communicating the core attitudes of faith, acceptance, and respect “so278 Garry Landreth et al. that eventually they (children) may achieve feelings of security, adequacy, and worthiness through emotional insight” (Moustakas, 1953, p. 2). Child-Centered Play Therapy The child-centered philosophy of Play Therapy is an encompassing phi- losophy for living one’s life in relationships with children. Child-centered Play Therapy is not a cloak the play therapist puts on when entering the play- room and takes off when leaving; rather it is a way of being with a child based on a deep commitment to and belief in the child’s ability to be con- structively self-directing. Child-centered Play Therapy is a complete therapeutic system, not just the application of a few rapport-building techniques. The relationship that is created with the child is so powerful that it is the factor that determines whether therapy is a success or failure. The child-centered play therapist believes in and trusts the child’s intrin- sic motivation toward adjustment, mental health, independence, autonomy, and self-actualization and therefore allows the child to move at a pace of growth determined by the child’s unique, forward-moving, inner directed- ness. As the child reacts to his or her changing world of experience, the child does so as an organized whole so that a change in any one part results in changes in other parts. The child’s behavior in this process is goal directed in an effort to satisfy personal needs as experienced in the unique phenomenal field that constitutes reality for that child. Personal needs, then, influence the child’s perception of reality. Therefore, the child’s behavior must always be understood by looking through the child’s eyes. The play therapist unyieldingly avoids judging or evaluating even the simplest of the child’s behaviors (i.e., 2 painting, a puppet show, something constructed in the sand box) and works hard to understand the internal frame of reference of the child (Landreth, 1991). It would be inappropriate for the play therapist to respond to a child’s question, “Do you think my picture is pretty?” by saying, “It is beautiful.” Instead, the play therapist would respond either to the child's reaction to his or her own picture, or prize the picture by describing what is seen in the picture. “You put some blue all the way across the top, and you drew this (pointing) all the way up to here.” Evaluative statements deprive the child of inner motivation. The play therapist trusts the child to take the Play Therapy experience into those emotional areas the child needs to explore. This dynamic variable of following the child’s lead is central to the child-centered approach. It is a child’s natural striving toward inner balance that takes him or her to where he or she needs to be. Therefore, the focus of the play therapist is on the inner person of the child and on what the child is capable of becoming, not on theChild-Centered Play Therapy 279 child’s ways of being in the past. In this approach, the child, rather than the problem, is the point of focus. Knowing about the causes or extent of the child’s maladjustment is not a prerequisite for establishing a therapeutic rela- tionship with the child. Diagnosis of maladjustment is not necessary because this is not a pre- scriptive approach. What the play therapist does is not based on a specific problem the child may be experiencing. Terms such as goal of therapy and cure are inconsistent with the child-centered philosophy and are avoided because they generally are evaluative and imply specific accomplishments needed by the child as determined by some external person. In the child- centered approach, the child is related to as a person to be understood rather than as someone to be changed (Landreth, 199). ‘The building of a relationship begins with what the child sees and perceives in the therapist and is dependent on the therapist's sensitivity to the child’s experi- encing at the moment. Making contact with the child means responding with gentleness, kindness, and softness to the child's communications of self. Through the process of accepting the child's attitudes, feelings, and thoughts, the thera- pist enters the child’s world. Once contact with the child has been made in this ‘way, a trusting relationship can begin to develop. (Landreth, 1991, p. 157) A major premise of child-centered Play Therapy is that children are always communicating, not necessarily with words but with their bodies, their play, their total selves. Therefore, they are not required or expected to verbalize any stories, descriptions, thoughts, feelings, guesses, ded issues, prob- lems, or concerns. They are free to talk once they take the initiative to do so. The therapist does not try to elicit verbalization or suggest that a child should begin to play. Initiation is the child’s decision. The child is allowed to lead, to choose to play or not to play, to talk or not to talk. The role of the play thera- pist is to create the kind of relationship that enables the child to discover how he or she can function independently. Axline (1947) clarified the basic principles of child-centered Play Therapy that provide guidelines for establishing a therapeutic relationship and mak- ing contact with the inner person of the child in the Play Therapy experience. Landreth (1991) revised and extended these eight basic principles as follows: 1, The therapist is genuinely interested in the child and develops a warm, caring relationship. 2. The therapist experiences unqualified acceptance of the child and does not wish that the child were different in some way. 3. The therapist creates a feeling of safety and permissiveness in the rela- tionship so the child feels free to explore and express self completely. 4. The therapist is always sensitive to the child’s feelings and gently re- flects those feelings in such a manner that the child develops self-understanding.280_Garry Landreth et al. 5. The therapist believes deeply in the child’s capacity to act responsibly, unwaveringly respects the child’s ability to solve personal problems, and al- lows the child to do so. 6. The therapist trusts the child's inner direction, allows the child to lead in all areas of the relationship, and resists any urge to direct the child’s play or conversation. 7. The therapist appreciates the gradual nature of the therapeutic process and does not attempt to hurry the process. 8. The therapist establishes only those therapeutic limits that help the child accept personal and appropriate relationship responsibility (pp. 77~8). The general objective of child-centered Play Therapy is to provide chil- dren with a positive growth experience in the presence of an understanding, supportive adult who responds in ways that enable and empower children to discover their internal strengths. When a child feels safe in a relationship, he or she extends the person he or she is, the self, into the creative expression of play. Thus, the Play Therapy relationship provides a means through which conflicts can be resolved and feelings can be communicated. According to Axline (1947), when children play freely and without direction, they are ex- pressing a period of independent thought and action. They are releasing the feelings and attitudes that have been pushing to get out into the open. Be- cause the child's world is a world of action and activity, Play Therapy provides the counselor with an opportunity to enter the child’s world and in that pro- cess to experience and participate in the emotional life of the child rather than reliving situational happenings. Therapeutic Limit Setting Limit setting is a facilitative dimension in the child-centered Play Therapy because limits exist in all relationships as a result of natural restraints of the individual human organism or self-imposed conditions. Limits provide structure for the Play Therapy relationship and thus help children to feel safe, valued, and accepted. The purposes of setting limits are (a) to define the boundaries of the therapeutic relationship, (b) to provide security and safety for the child, both physically and emotionally, (c) to demonstrate the therapist's intent to provide safety for the child, (d) to anchor the session to reality, (e) to allow the therapist to maintain a positive and accepting attitude toward the child, (f) to allow the child to express negative feelings without causing harm or experiencing a subsequent fear of retaliation, (g) to offer stability and con- sistency, (h) to promote and enhance the child’s senses of self-responsibility and self-control, (i) to protect the Play Therapy room, and (j) to provide for the maintenance of legal, ethical, and professional standards (Axline, 1947; Bixler, 1949; Ginott, 1961; Landreth, 1991; Moustakas, 1959).Child-Centered Play Therapy 281 Child-centered Play Therapy is not a completely permissive relationship. The child is not allowed to do just anything the child may want to do. The play therapist has already determined that some limits are necessary. These limits, however, are not communicated to the child until they are needed. Limits need to be set on harmful or dangerous behavior to the child and counselor, behavior that disrupts the therapeutic routine or process (continu- ally leaving playroom, wanting to play after time is up, etc.), destruction of room or materials, taking toys from playroom, socially unacceptable behav- ior, and inappropriate displays of affection (Landreth, 1997). Therapeutic limit setting is communicated to the child in such a way that the child is allowed to make choices about what will happen next. This pro- cess allows the child to experience how responsibility feels and to develop self-control. Limits assure that the Play Therapy experience will have a real life quality and are applied because they are recognized as facilitating the attainment of accepted psychological principles of growth. Because bound- aries have previously been determined, the play therapist can be consistent and thus predictable in setting limits. This consistency and predictability help the child to feel safe. It is within this structure that the feeling of permissive- ness is more important than actual permissiveness. Comparison of Child-Centered and Adlerian Play Therapy The child-centered and Adlerian approaches to Play Therapy have sev- eral theoretical, philosophical, and procedural similarities, as well as variations that make each approach unique. Child-centered Play Therapy has a much longer historical background in the literature (Axline, 1947) than does Adle- rian Play Therapy (Yura & Galassi, 1974). Kottman (1995) described Adlerian Play Therapy in some ways that are quite similar to what is described in Axline (1947) and Landreth (1991), with many references to child-centered Play Therapy authors, but there are also many specific differences in the two approaches. Child-centered and Adlerian play therapists both tenaciously hold a view of children that emphasizes the children’s positive capacities. Children are viewed as holistic, phenomenological, forward-moving individuals. They are valued as they are at the moment, and conveying unconditional positive re- gard for the child is considered crucial to therapeutic progress. Both approaches view the building of a relationship with the child as essential to later progress in therapy (Kottman, 1995; Landreth, 1991). Theoretical differences in child-centered and Adlerian Play Therapy re- sult in different procedures. Child-centered play therapists view maladjustment as resulting from an incongruence between what the child actually experi- enced and the child’s concept of self (Landreth, 1991). Adlerian play therapists282_ Garry Landreth et al. believe that maladjustment is due to discouragement and mistaken beliefs in the child's lifestyle (Kottman, 1995). Unlike the child-centered play therapist, Adlerian play therapists inter- view children to uncover goals of their behavior, verbalize interpretations and insight into children’s play, and actively reeducate children through ques- tions. The play therapist works to understand the child's lifestyle and then shares that understanding with the child. The Adlerian therapist's role of ex- ploring with a child his or her lifestyle goals and reeducation requires verbalization by the child (Kottman, 1995). Therefore, because many younger children have limited verbal and reasoning ability, Kottman (personal com- munication, November 1998) recommends that children younger than 4 years old be referred for child-centered Play Therapy. The child-centered play therapist does not require or expect the child to verbalize any background information, concerns, or problems. The therapist does not try to elicit verbalization. No questions are asked. The child’s com- munication through play is viewed as sufficient and complete. The play therapist's job is to understand the child's nonverbalized feelings and play. In the child-centered Play Therapy approach, the child rather than the problem is the point of focus, while in Adlerian Play Therapy, goals of misbehavior are points of focus (Kottman, 1995). The toys utilized in both approaches are very similar, with an emphasis on careful selection rather than random choice. Play therapists in both ap- proaches are verbally interactive with the child, and a therapist's tracking statements, restatement of content, and reflection of feelings sound very much the same, so much so that an observer might not be able to identify an iso- lated Play Therapy segment as being either child-centered or Adlerian. Play Therapy Training and Research Few counselor education programs offer specific training or a specialty in counseling with children (Hollis, 1997). Even fewer programs offer train- ing in Play Therapy. The Center for Play Therapy at the University of North Texas conducts a biennial survey of the counselor education programs in the United States and publishes its Play Therapy Training Directory. The 1997 directory listed only 39 universities that provided one or more courses in Play Therapy despite mounting research recommending and supporting the effectiveness of Play Therapy in counseling with children. The popular assumption that Play Therapy has limited applicability to the myriad of children’s problems and is a slow process requiring a long-term commitment and many months of sessions is not supported by published research studies. Landreth, Homeyer, Glover, and Sweeney (1996) demon- strated that Play Therapy was an effective therapeutic approach for a varietyChild-Centered 283 of children’s problems, such as abuse and neglect, aggression and acting out, attachment difficulties, autism, chronic illness, deafness, physical challenge, dissociation and schizophrenia, emotional disturbance, enuresis and enco- presis problems, fear and anxiety, grief, hospitalization, learning disability, mental challenge, reading difficulties, selective mutism, low self-esteem, so- cial maladjustment, speech difficulties, traumatization, and social withdrawal. Landreth et al. reported 92 studies documenting the effectiveness of Play ‘Therapy, and in 23 of these researchers achieved successful results in allevi- ating the presenting problems of child clients in 10 or fewer sessions. A survey by Phillips and Landreth (1995) of 1,166 practicing play therapists in hospi- tals, agencies, private practice, and schools reported the modal and median number of Play Therapy sessions before termination fell somewhere between 11 and 20. The purpose of this section is not to review the multitude of available research studies but rather to focus on a few of the short-term studies. Over 45 years ago, Bills (1950) investigated the effects of child-centered Play Therapy with children identified as slow readers and found that, after six individual and three group Play Therapy sessions, students who had received Play Therapy showed significant gains in their reading ability when compared to a control group. Crow (1989), an elementary school counselor, had ten 30-minute child- centered individual Play Therapy sessions with 12 first-grade students who had been retained because of low achievement in reading and found that their self-concepts were significantly improved as compared to a matched control group. Based on what is known about the impact of a positive self- concept on academic learning, Crow's findings have tremendous significance, especially in view of the short-term nature of the study. Barlow, Strother, and Landreth (1985) reported on the case of a 4-year- old child whose emotional reactions were so severe that she had, over a period of several months, pulled all her hair out and was completely bald. By the end of the eighth child-centered Play Therapy session, previously reported behavioral symptoms had disappeared and the child's hair had begun to grow back, a dramatic picture of the effectiveness of child-centered Play Therapy. Kot (1995) investigated the effects of short-term, intensive, child-cen- tered Play Therapy with children who had witnessed domestic violence and were temporarily residing in women’s shelters. Eleven children each received 12 individual 45-minute Play Therapy sessions in a span of 14 to 21 days. A matched control group in the shelters received no Play Therapy treatment. The children in child-centered Play Therapy scored significantly higher than the control group on self-concept, reduction of externalizing behavior prab- lems, and reduction of total behavior problems on standardized measures. ‘These results demonstrate the healing power of the child-centered Play Therapy relationship and the capacity of this approach to facilitate significant changes in a very short period of time.284 Garry Landreth et al. Landreth and Lobaugh (1998) trained 16 fathers incarcerated in a federal prison to use child-centered Play Therapy procedures in filial therapy ses- sions with their children. The fathers had special 30-minute play sessions with their children once a week on visitation day for 10 weeks. These children’s self-concepts improved significantly as compared to a control group of incar- cerated fathers and their children. The fathers who received the filial therapy training also exhibited significant improvement on a variety of measuring instruments, demonstrating the therapeutic impact of the training and the child-centered play sessions under very difficult circumstances, not only on the children but also on the fathers who were learning this approach. In a related research project, Harris (1995) trained 12 mothers incarcerated in a county jail to use child-centered Play Therapy procedures in 30-minute filial play sessions with their children twice a week for 5 weeks. These children demonstrated significantly fewer problem behaviors on the posttest instru- ment than did the children of a matched control group of incarcerated mothers. The mothers in the filial therapy training also demonstrated significant in- creases in their level of empathic interactions with their children and significant increases in their attitude of acceptance toward their children. Bratton (1994) trained 22 single mothers to use child-centered Play Therapy procedures in filial therapy sessions with their children. The mothers had special 30-minute play sessions once a week with their children for 10 weeks. A matched control group of single parents received no treatment. Parents in the experimental group demonstrated significant increases in the level of empathy in their interactions with their children and attitudes of ac- ceptance toward their children. They also reported significantly reduced levels of parental stress and significantly fewer problems with their children’s behavior. These reported results attest to the effectiveness of Play Therapy as a healing, dimension in the lives of children. The field of Play Therapy continues to grow and develop at a rapid pace. The second edition of The World of Play Therapy Literature: A Definitive Guide to Authors and Subjects in the Field (Landreth, Homeyer, Bratton, & Kale, 1995) contains approximately 2,400 entries on Play Therapy literature, a notable increase over the 1,800 refer- ences in the 1993 edition, Likewise, the number of mental health professionals who are interested in and utilize Play Therapy procedures has increased dra- matically in the last 10 years. Membership in the Association for Play Therapy increased from a total of 450 in 1988 to almost 4,000 in 1998. The emerging growth in Play Therapy research, literature, and number of mental health professionals utilizing Play Therapy suggests a paradigm shift from the old paradigm of adapting basic adult counseling skills in counseling children to the new paradigm of Play Therapy is already underway.Child-Centered Play Therapy 285 Conclusion Child-centered Play Therapy is not an approach based on guess, trial- and-error, or whims of the play therapist at the moment. Child-centered Play Therapy is a well thought out, philosophically conceived, developmentally based, and research-supported approach to helping children cope with and overcome the problems they experience in the process of living their lives. The problems children experience do not exist apart from the persons they are. Therefore, Play Therapy procedures are needed to match the dynamic inner structure of the developing child with an equally dynamic develop- mentally based approach. In counseling sessions, children should not be restricted to verbal communication of their experiences and reactions to those experiences. To restrict counseling experiences of children to verbal expres- sion is to deny the existence of the most graphic form of expression, activity. The goal of counseling sessions is not to get children to talk but rather to provide them with developmentally appropriate methods through which they can extend themselves into areas which they have difficulty entering ver- bally. Play is the concrete expression of children and is their way of coping with their world. References Allen, F. (1934). Therapeutic work with children. American Journal of Orthopsychiatry, 4, 256-61. Axline, V. (1947). Play therapy. Boston: Houghton Mifflin. Axline, V. (1950). Entering the child’s world via play experiences. Pro- gressive Education, 27, 68-75. Barlow, K., Strother, J., & Landreth, G. (1985). Child-centered Play Therapy: Nancy from baldness to curls. Schoo! 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