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    Filial Play Therapy - Compressed

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    Chapter 5 FILIAL PLAY THERAPY Louise Guerney Filial therapy is unique because it involves parents as the primary providers of child-centered play therapy (Axline, 1969) for their own children under 12 years of age. Parents are taught to functio:. independently in the therapeutic sole by trained filial therapists, who continue to offer supervision throughout the course of the play sessions. ‘This approach to therapy may strike many readers as a tenuous base for building a therapeutic relationship. Aren’t parent-child relationships frequently ambivalent at the least and pathological at the most? Is it really possible to expect parents, Who are experiencing many struggles in rearing their children, sometimes of horren- dous proportions, to assume the uncunflicted role of a professional therapist? Can anyone believe that the parent who lacks basic insight about how family and/or school or neighborhood factors affect a child, and frequently affect the parent well, could create a therapeutic growth atmosphere? Isn’t a thorough understand- ing of psychotherapy basic to delivering it? These questions illustrate how, in some ways, filial therapy was a wild leap at at the time of its creation in the early 1960s. Even after years of usage aid data to support its viability, a filial therapist és still not the conventional play therapist and must, unlike maay peers, believe in the powers of parents, the parent-child relationship, the child, and play itself, all uniting to result in important thera- pectic change. All of these factors are discusscd later in this chapter as is the Power of the believing filial therapist in making the method the success it has Proven to be. Filial therapy (1°T) was conceived by Betnard Guerney Jr., PhD, a child psy- ‘hologist, out of frustration with traditional approaches used in the 1950s and ems. In child Buidance 100 Filial Play Therapy . ro jonal and aviors! Prepild guidance model, the 1960s to deal with child emoll ges that jowe' cily play therapy of some type), -— sot headed the team, Tp centers and the many other pla! a play jl ist for ther sychiatt child was seen by a paycholOBist ker, and a psyoniett hers’ groups were helq rent was assigned to # S0C}# times, the parent was assigne’ red a client. ‘Some! a1 The bas ic tenets behind these essence, the parent was declare? ® fessio" Relationshi ; s with & ee off on child shins fren re onl ie Ee ake else, that no methods nerapy becae reason, # family mem! ‘much as anything rs together ai chi bere alnical work with children and fren than not—parent psychopath. were rarely addressed in intrapersonal and for the simple were currertly available to treat y First, B. Guerney had come t© believe in hi ee —more Oo! " . their parents (primarily mothers ems Rather, the obvious mistakes Parents ology was not at iy e n wledge—basically a learning were making were likely ki o result from lack of i y i problem. Parents were not educated {0 be parents, and they roi en informal in- struction from their family, friends, ‘and neighbors. Muc! ; sn instrveti was flawed, but because of the resilien |. MOst ce with which most of ut problems were everyday problems instead of serious ones. Unfortunately, the lack of institutionalized parent education s' till exists today. - Guerney, a Rogerian (Rogers, 1951) and a follower of Axline (1947, 1969), knew that child-ceatered play therapy worl ked well and even Netter when par- ents were supportive. He also knew that lack of parental support was a genuine problem for therapists—especial Ny if parents saw a positive relationship deve}- oping between the play therapist ani child and perceived the therapist as a rival. This could result in premature termination. After all, most parents are defensive about their children’s problems and having to turn their child over to a therapist. Guerney also realized that the bond between parent and child, in spite of relationship problems that often existed, was powerful enough to sus- tain the relationship—in some form. Consequently, he conceived the radical i ini peutically with their ows children. He mpeoal ia ein parepisito play, Bere the play therapist would be the ideal way for parents to rel aie: 2 appropriately to their children and, at the same time. x be eee for them, instead of a play therapist doing so. Thi: » provide an effective therapy threat of the play therapist, permit the positive nox meiod\might ehiinate te bestowed on parents, and take full advanta Power of the play therapist to be bond to build therapeutic rapport, 8¢ of the power of the parent-child It is impressive how much the “a, itati (1971) and Coopersmith (1967) ce Parent” described by Baumrind The behaviors of the anthortative paren ith the behavi ie ees but, ai the same time, exerting needed Wan aes as warm and nurturing Filial Play Therapy 101 of behaviors should make the learning of play therapy skills useful for Goth inside and outside the play sessions. ° 2 Guerney carried out development of FT at Rutgers University in collaboration with me (his wife), also a child psychologist, and later with two other psycholo- gists and a community (social) Psychiatrist. The task of iis group was to develop methodology that would transfer FT theory into practice. In 1964, B. Guerney published an article on FT in the Journal of Consulting Psychology in which he presented the following rationale for FT: + Child problems are usually not the product of pathology of the parent but rather of parental lack of knowledge and skill. Playing with their children in a therapeutic role should help parents relate more positively and appropriately to their children and vice versa by “dis- rupting the cycle of perception and misperception of the parent's feelings, or behaviors toward him [the child)" (B. Guerney, 1964, p. 306). Further, the nature of the play sessions allows the child to communicate thoughts, feelings, and needs through the medium of play that would not be expressed. in real-life situations. Having the parent be a part of this process should make the experience therapeutic for both parent and child. There is a precedent in the Rogerian (Rogers. 1951) tradition for parents holding play sessions with their children. Baruch (1949) advocated parents* doing home sessions with their children, irrespective of any problems, to assist children in working out personal issues encountered in “just living.” Moustakas (1959) had parents play with their children after the children improved through play therapy with him. He found it helped maintain gains and prevent further problems. However, Baruch and Moustakas did not pro- pose systematic training for parents to provide them with the skills of the play therapist. FT proposed thorough training of parents, with supervision, to bring their play session performance to an effective level. Training for the play sessions should be systematic and as similar as possible to the training given to professional students cf play therapy. . When parents are given the role of primary change agents, they become helpers, which should eliminate much of the resistance encountered when parents are threatened by the therapist’s relationship with their children. With FT, parents may be expected to see themselves as vital to aiding the child (B. Guerney, 1964, p. 208). The parent-child relationship is neariy always the most significant one in a child’s life. Therefore, if a child were provided the experiences of expres- sion, insight, and adult acceptance in the presence of such powerful people as parents: “ 102 Fillal Play Therapy herend, oat ete dope” he paren that of at 8 the same bit of success t ful than Oe i aeaabe may times me gmount OF affection, 1 Tee ‘har re thing... relatively am expected 1 be more therapet nan a laree, arent can ha from the Lee 1. (p- 309) 1s in cal OTHER INFLUENCES tert . i helped create a more fertile groung n the field a Ba fi lis 10 be published inthe cacy mily temic explanation for the adjustment Problems of Y the vehicle for generating and elim. the individual. That is, the Oe neat veh one individual was insufficient ya i ly ate contributed to and maintained the problems of jx, individual members. Family therapy also provided a vehicle for treating the ailing family system. To address the whole system as their approach required, the whole family needed to be seen together for family group sessions. This thinking was q boost for FT becau: elped to broaden the focus of treatment from a single fam. ily member seen individually to multimembers as a unit. There was a movement in the 1960s to use mental health resources more eff. ciently than the standard “one client with one therapist for one therapeutic hour” (Hobbs, 1964). A great unmet need for mental health services hac been identified that led leaders in the field to call for innovative ways and better use of mental health resources. Innovations were being tried on many fronts, which led some leaders to call the proposed changes the Third Mental Health Revolution (Hobbs, 1964), making mental health activities available to more people, Some of the chasers we scenes a ada Psychopathology; greater recognition of ; ly and the community; and the introduction of onpeotcssiootleparentoieisionals eet ioc y; ¢ introduction — . and indigenous community member as interventionists—that is, broadly—introduei i tail concepts ino the delivery “ vo PLE suotveing the greater use of public health ic i B. Guerney particularly emphasized in bie aa ' Niche! 64 article the call issued by as Hobbs, leading psychologi be expended for children mad = “adults wi Ne demanded that more resoures aa with theit children” (bbe. 1966 nse Goan ook 5 new » 1964, p. 3). Groups were ce ogy and replacing the betetofore pron etaing the reach of iia payehe BrOUp approaches as increasing the « \jeye on ON ONE therapies. Guerney sa tive psychotherapy” (1964, p.303), "8° Of professionals’ time’ on effer Parallel supports i the advancement of FT. Fat 1960s, which introduced the syst ile The Pilot Study 103 pisY THERAPY MODEL jne's child-centered pl aatine's chi Play therapy (CLPT) model (1947, 1969) was the method on which Guerney conceptualized FT, Se eee eer The ccPT ree is without a doubt the optimal one for parents serving as primary for cosas Unlike many other play therapy approaches, the Axline (1947, 1969) method does not require parents to learn about psychodynamics or 'S are al! Rogerian-derived approaches, is the “here and now”— that is, what is happening in the therapy session. A detailed history of the child’s problems or a psychological profile is not re- quired to provide appropriate therapeutic responses. It is an interpersonal proach, focusing on the way the child interacts with the therapist in the session se. Because parents need to learn on!y how to respond appropriately to the im- mediate behaviors and verbal expressions cf the child in the play session, they can be taught to master the therapeutic principles and the specific responses of the therapist via skills training strategies. ‘VHE PILOT STUDY Following extensive planning about application, two pilot groups were created to test the method. The two groups were composed of parents seeking help for their children at the Rutgers University Clinic wino were willing to participate in the pilot program, Eight parents were in each group, both men and women from dif- ferent families. The problems of their children fell about evenly between internal- izing and externalizing behaviors. Because the method was designed only for nonorganically based condi s, no children with the slightest suggestion of or- ganicity were inclided. While the pilot program proved groups to be a successful medium for teach- ing and processing play sessions, it was clear to all the professionals invclyed in the development of FT that a great deal of emotional support was needed for parents to carry out this unique and alien role. Parents liked it and got a lot of satisfaction from doing so but, at the same time, found it somewhat intimidating to try to learn a new role and to temporarily abandon the everyday parenting role for the duration of the play sessions. Informal discussion revealed that the putting aside of the practices of the parenting rote was the more difficult of the two challenges. oo : ‘The pilot experience made it evicent that, in addition to teaching the skills of the CCPT play therapy, a standard technique was necessary that would be an eI 2 104 Filial Play Therapy ling with sr feelings and concerns abont ey, integral part of FT for dealing ing their new skills. PARENT SESSIONS 2 requires therapists (paren, Ttwas decided that because the practice Se and feelings about events a focus onthe child and not on their o#” OUD Te oriented ta ing the play sessions, the postPlay vsontent. This kind of attention at the parent reactions to the play S°SS°" © ine same opportunities given to 4 session meetings would provide Area reel without concern children in their play sessions 10 AP'S) therapist should provide q” being judged or Sensi eee for the parents as the parents one same kind of psychological ¢ for te races was developed for postplay session parent discussion meeting, (some current practitioners call these debriefing sessions) [ire developers g label discussions with parents as “dynamic and didactic” ( meronico, Fidler, Guerney, & Guerney, 1967). Operationally, this meant that the tt rapist Provides instruction and feedback about conducting play sessions and also atten iy pap ents’ feelings about carrying out the role, their atitudes toward their chiidren agg parenting in general, and other issues relevant to the FT experience. The therapig, must learn when to be instructive and when to give higher priority to parents feelings. Other issues that emerged from the pilot work dealt with the group format, Should spouses be together in groups? They were in separate groups for the pilot to avoid potential marital issues perhaps requiring intervention not seen as pant of the agenda of FT.Should parents’ psychotherapeutic issues not directly related to the FT agenda be encouraged or referred for later individual attention? These and other questions had to be addressed and standardized in the ongoing devel. ‘opment of FT. Because FT is a skills training approach, it was important that it be replicable by other practitioners who would train other parents. HOME SESSIONS In the course of FT development, it was decided that cor home after adequate training should be tri discussing them afterward in the BFoup was seen as a major contribution to ther apist leverage. Questions arose in relation to the logistics of home sessions When was the optimal time to Start these sessions? How many sessions of # nducting play sessions at Having most sessions at home and oil Home Sessions 105 series should be held at the treatment site to be able to monitor parent perfor- mance and child status? Should parents play at home with all their chfidren—not just the referred child? * A continuing grant from the National Institute of Mental Health (NIMH) al- Jowed us to address these and many other questions. The most important one was: Did FT really work? FT outcome research is discussed later in the chapter, but the first study done was step one toward addressing this most critical question. This foundation study was essential to our knowing whether further development of FT held promise. This first study (Stover & Guerney, 1967) asked if mothers could learn to carry out play sessions successfully. If they could not reach a level of perfor- mance comparable to professional therapists, the succeeding pieces of FT would be of little value. One group of mothers was trained in CCPT play session skills (Axiine, 1947); the other group was untrained. Trained mothers were able to wality play sessions, as measured by actual observed and tabulated be- in the play sessions of the mothers with their children, Untrained mothers made few therapeutic responses, and their children did not make the responses typically seen in child-centered play sessions. In fact, some of these untrained sessions were a downright negative experience for the relationship, with decreas- ing scores on positive child :-sponses. (T> eliminate bias, observersicoders were not aware of which group the mothers were in.) hi ‘These results also provided the answer to a second question and an alterriate hypothesis that needed to be refuted in order to conclude that the observed clini- cal successes with FT pilot groups were not due merely to parent and child hav- ing an uninterrupted, shared private time together. Was the special environment of a structured, goal-oriented, theoretically based play session an essential in- gredient in producing positive fesponses? The results indicated, unequivocally, that time simply spent together in a playroom, with-no play therapy training, did not produce positive interactions (Stover & Guerney, 1967). Because FT took about 30 years of limited use to become a major play therapy method, much time has been spent researching it in the inierim. Data have accu- molated that provide much more empirical evidence supporting FT’s effective- ness and efficacy. Some of these studies are summarized in the research section of this chapter, However, the message gleaned from this body of research should be noted in this introduction. FT has come into major usage undergirded by a great deal of support for its effectiveness and efficacy and can now be correctly de- scribed as a research-based, evidence-based, science-based, or empirically based method—terms applied to treatments with a history of empirical support for their efficacy and effectiveness. These kinds of treatments are currently in demand by those who approve grant and contract funding and frequently by those who dis- tribute insurance reimbursements. ‘ 106 Filial Play Therapy . | pagic CONSTRUCTS, WHAT FILIAL THERAPY IS ropay: BAS : GOALS, AND TECHNIO nge the name of filial therg agro cha : Over the years, there have beet effo. mew used, though @ proper dictig. tk eon) vy Filial is Not COMMON. ie qntil it is fully expla 10 make it more descriptive. FIllA' coupe with visibly 20 wet nary word, and clients sometinns ily the hs hen when ‘Second, the therapy is ganna al in a fas re invol [Tr a ‘ery mde two parents and more than a escriptive: Bocuse Fr od ih fo. ial famil Jemed 10 associ it ae theron) a child relationship 2” closes, families, and nd cused on the p ortater by B. GUErneY jor adolescents a ples ae er later by hd nr@) therapies (L. Guerney it iam 1985), nown as Relations De id relationship ‘enhancement family therapy. Some. For a time, FT was called lt ee spake it more descriptive. However times it is called filial play ean virtue of ties to a great deal of pub. by frequency of professional vse ae py the vore has come JOWN on the Hehe Titerature under the name of ilal BEY ometimes fail to ful side of keeping the name filial therapy, © ¥ convey its features. Goals of Filial Therapy tions in the application of the original PT There have been some changes and addi of | procedures used for training parents, bu model, mainly in the modifications in the basic model has been sustained. ‘The goals of FT are: To reduce problem behaviors in childrer. To enhance the parent-child relationship. ‘To optimize child adjustment and increase child competence and self- confidence. + To improve parenting skills. These goals are attained by including the parents (or parent surrogates), for ex- ample, foster parents, as the primary change agents for their children by having them conduct the child-centered therapeutic piay’sessions and by focusing on the use of play therapy principles and skills in real life as a final step. The skills ae those 7 the: child-centered therapist: empathy, tracking. structuring, and limit set- ean ee supervision by professional therapist is an esseatial Foto en car can work together, a group of eight— ‘What Filial Therapy Is Today: asic Constructs, Goals, and Techniques 107 maximum nine-—would be workable provided that the number of children involved does not exceed 18. Couples or individual parents may also be seen. Spouses may be part of the same group. (We have learned that competition and differences as to parenting as well as marital conflicts can be handled in groups without detracting, trou the FT work needed to be done.) Conducting play sessions independently be- fore reaching a minimal level of competence (as compared to professional client- centered play therapists) is expected before parents do home or other independent sessions. Parent meetings are most often on a weekly schedule. Parents are generally asked to p! their children ages 6 and under and 45 minutes per session for older children, preferably in their homes. Playing at treatment sites and other training locations is also possible. When parents play at home, they purchase (or are issued, depending on agency policies and parent income levels) a toy kit containing basic toys that would be in aplayroom. These toys are to be kept separate from the children’s other toys and used exclusively for the play sessions with parents. This measure serves to dis- ish play sessions from the rest of home life, a distinction we work hard to have parents establish and adhere to. ‘We have found over the years that when FT is used for clinical purposes," i wise to encourage parents to play with all the children in the family, even those below and above the usual FT age range, fo: three reasons. First, the referred citild does not feel singled out as a “problem.” Second, siblings do not become jealous of the extra attention the referred child is receiving through the play sessions with the parents. These two reasons may seem to be polar oppositzs; nonetheless, it is not unusual for both reasons to be cited by sittings of referred children. The third rea- son is related to a phenomenon noted also by family therapists—the “passing of pathology” onto another child when the referred child is making progress. It is not ‘uncommon that after the “problem child” is perceived as improving by the parents, another child, often the child described as “perfect” initially, begins to develop problems that require attention. This phenomenon is avoided when all of the chil- dren have their own separate special play sessions with a parent or parents, Re- girdless of how many children in the family have play sessions, the sessions remain one on one—one parent and one child. Fach child, we believe, needs this special individual time with the parent. ‘When alt the family’s children are having play sessions with one or both par- ents, we have a true form of family therapy. Even with a dyad of parent and child, there is impact on the while family, and family change is seen. It is not umisual tg find one or two parents playing with two to four childzen, whether the nonreferred is "Unless otherwise noted, descriptions of FT given here are for clinical applications in groups ‘more than 10 weeks long. 108 Filial Play Therapy ics must be worked out for this leva ” children are symptomatic or not. nd burned ot involvement to keep parents from becom! For Whom Is Filta! Therapy Approptiate? Children ited to the kind of play oy; Children between the ages of 3 and 10 are most suited t0 = or Cte et gee stituted for the more “pretend”-oriented toys standar nger chil , benefit from Fi. The special time youngsters up to 12 ot even older can benefit [FOR i am Speng witha parent, who continues to play the accepting (NeraPl the Key ig, gredient so that the essence of FT remains, regardless of the ect ties ; Children under age 3 are also sometimes treated via FT either wt referred OF ag the younger sibling of a referred chi Speech clarity is not required in FT (or tra. ditional CPT). Only the communication skills necessary 10 make it possible fo, the therapist or parent to understand and respond to the child are needed. For this reason, children with speech or hearing problems can participate Children with physical and mental impairments, for example, pervasive deve opment disorders (nonautistic) can be included. There are only two categories of children for whom caution should be urged before includ children with extreme autistic behaviors and schizophrenic children who are not lucid enough for an adult to respond to them. However, even children who have diagnoses of an extreme nature should be considered on a case-by-case basis because labels do not necessarily convey the potential of a child to re. spond to a possibly enhancing experience. g them in Fy. Parents As a clinician totally committed to the effectiveness of FT to bring about needed and desired changes in both children and their parents, I make the assumption that any parent (and his or her child; is 9 suitable candidate for FT until proven otherwise. The dynamic and didactic elements of FT seem to meet the needs of most parents, giving them both a medium te help their children and a parallel one to help them with their own feelings and concerns. In exchange, however, parenls rust take on additional responsibilities that some may not be able to manage. I they seek help voluntarily, parents typically expect some effort to be required of them—at the least. to bring in their children for treatment. It is important to a sess parents’ willingness and ability to do more than just that, In the intake inte yes fis — need (0 estimate parents” level on both these variables rents who have problems keeping appoit ‘i 1 other impediments a carying tthe capone re ural omnes ies of regular attendance What Fillal Therapy Is Today: Baste Constructs, Goals, and Techniques. 109 gucting regular play sessions for their o parents suffering from deep depression, tively schizophrenic, or have major debi jrelinood be excluded. Other shorter, fered for their children instead. In ou excluded on any ground, hildren are questionable cgndidates. Are presently in a manic state, are ac- litating medical problems would in all More managcable approaches would be of- it experience, very few parents have had to ound, zven those suffering from chemical addictions. Most exclusions are for unwillingness or logistical inal ility to make a reasonable com- mitment to the program. Decisions about such Parents, again, need to be made on a case-by-case basis because some parents who are higiily motivated will over- cuine extraordinary barriers to complete FT. ‘Theoretical Bases of Filial Therapy Two bodies of theory are drawn on for the application of FT. First, the child- centered theory of Virginia Axline (1947, 1969) is the theuretical vase for the play sessions taught to the parents. The method of teaching the parents is drawn from the reinforcement theory of B. F. Skinner (1953). The Play Therapy Method Taught to Parents ‘The child-centered play therapy was created by Virginia Axline (1947, 1969), who called her method nondirective play therapy, following the ieachings of her mentor, Carl Rogers, the creator of nondirective or client-centered therapy (Rogers, 1951), primarily for adults, Axline constructed her theoretical principles on those of Rogers but adapted them for play therapy with children. The theory of Rogers’ per- sonality development and therapy and Axline’s principles are described in detail in Chapter 4 of this book. However, a brief synopsis of the tenets of the CCPT ap- proach are given here. To operationalize the theory and principles of the method, Axline laid out eight basic principles (Axline, 1969, p. 78), which are condensed to three primary principles: 1. Acceptance of the child as the child is: Acceptance here weans tit the adult does not criticize; judge; question; advise; challenge the child’s ideas, wishes, or feeling expressions; or otherwise make any evaluation of the child. Praise and other overt reinforcements are avoided so that the child gets no suggestion that ac- ceptance is ¢ependent on certain behaviors instead of the child himself or herself. Acceptance is totally noncontingent—except for behaviors that violate the few lim- its (discussed later). ‘The therapist conveys acceptance to the child via the use of empathy, acknowl- edgment, respect, and other expressions of understanding. With this accepting at- titude of the therapist, the child is freed to explore all aspects of himself or herself, feelings about other people, and experiences—frequently unexpressed or ‘110 Filial Play Therapy expressed in more juan panodane ‘All facets of the child, even imate to ee ail ihe fcety of adult permits the child to develoP ini mits aerenses (0 BE kone Defenses himself or herself. Self-ecceptance “ prevent the child from functioning to pi, contribute to maladaptive pehaviors or ial. serapii Eye vee leads the way: The ae ve means that the adult does oj principle that the “child leads the 4 or overt behaviors in cven subtle : to direct the child's feelings of HOVE S19 goin the play Session 28 wey ‘The therapist permits the child (© on of Rogers and Axline that clients, in. as what to say. It is a theoretical pot their own route 10 healing, expressey cluding young children, can best mp oibais ‘own perception of their emotiona sg cl me eae py ah as pretending to be a baby and the eps Selle or t ted he draw pictures instead, this could block the child fr caling with his eiceeseaiees need to resolve issues around early norturing Aeprivations ; 3. Limits: Because play sessions are active and involve the use Of objects, Axline includes a principle about limits on behavior. These are est ablished by the adults—the one action of the adult that is not child led. Linuts should be only “those that are necessary to anchor the therapy to the world of reality and make the child aware of his responsibility in the relationship” (Axline, 1969, p. 76), For example, the child would not be permitted to hit the therapist, hurt himself, or break furniture in the playroom. Safety for both child and therapist is the bor. tom line in regard to limits. 1 must adhere consistently to As might be expected, parents are challenged in complying with these basic principles. The principles run headlong into the everyday responsibilities of par enting. Parents must be taught through convincing information and demonstra: tions that following these principles will not ead ther child to think that it is okay to be so expressive or self-directed outside the play sessions. Rather, it should lead children to be more manageable and better adjusted, \ Clearly and fie, Parents are instructed to use their play session skills only in play sessions. Parcnis are not being asked to gi i ‘This would be disastrous becatse parents ane realy and orl ie aif Culfilng parental responsibilities. Nothing about assuming th Te cl for a limited time is intended o diminish thos fee responsibilit'cs, It is an added role. However, Fins : 8. It is an adde would eto cary na their purening behaviors Of the therapist role that they i ir chi : - oF example, listeni stand pe! rea eno ing th Kimit-setting technique of i ee de- lop better control of their childr ki the play session to: '$ SO well in the play session. ren because it worl ‘What Fillal Therapy Is Today: Basic Constructs, Goals, and Techniques 111 While most parents need to work to master the principles, individual parents tend to have more difficulty with one set of principles than the other, depending on their usual parenting style, Authoritarian parents have more d'fficulty letting the child take the lead and make the session decisions and, in their concern over control, may overlook the child’s feelings, Parents who tend to be laissez-faire or overly permissive tend to have less trouble with letting the child direct the ses- sion agenda and are not as apt to overlook feelings. However, they tend to have trouble setting reasonable limits or enforcing them. Thus, parenting issues sur- fave waiutally in the course uf the sessions, providing a unique opportunity to discuss difficulties in the relatively nonthreatening context of learning aew be- haviors in a new role intended for functioning in a circumscribed situation. This effort is intended, in turn, to help their children to move in directions that will be good for the parent as well as the child. Behavioral Approaches Used in Filial Therapy Parent Training Procedures The play sessions are the principle content of FT training. In terms of teaching methods, FT parent training uses the principles of behaviorism and, most partic- ularly, those of iciaforcement: 1, Parents are taught the skills needed to conduct play sessions by demonstra- tion and observation, They practice the skills observed, skill by skill. Even parts of skills may be taught if the parents seem to have difficulty learning the whole skill. Closest approximations to correctly using a skill are reinforced. However, there is also noncontingent praise simply for engaging in learning and practicing. Shaping techniques are used to make learning of tasks manageable and to take notes of advancements Parents are not expected to read anything more than a basic manual about play sessions and their part in the sessions, which the therapist might give them (e.g., Training Manual for Play Sessions, L. Guerney, 1976, 2001). If parents are non- readers, the manual contents may be read to them. 2. Mock play sessions. Parents are given opportunities at many points through the training sessions to practice the therapist role and the role of a child in play and to rehearse appropriate responses. Before parents start to play with their own children at the treatment site. the filial therapist conducts mock play sessions with the parents in which the therapist and parent interact as might a parent and child in a play session. The therapist plays the rote of a child (frequently taking ‘on some of the behaviors of the parent’s own child), and the parent responds as a therapist would throughout a play session of no more than 10 to 15 minutes, going through all of the steps of a full play session, in abbreviated form. This bring; the \ riiot Play Ther#P : 12 wt ession that they have attempted. Usuay ay 8 warehing ME therapist play on are fun, nt, BFOUP members are sy ila these sessions rae el amon on i i to Je] one OF ‘tices, ‘of one another, and & te herapist an ™ ive six members ee play children for one another. However ip membe to conduct a full play seni cup develer™e™” a pole are merely noted and followed immediay, in cal ad for ge rryin8 th of thi correct response. Te 3. Brrois in out for discussions Of "6 nse Perino}, by . Pron pork beter «OF Tt would be more in lng ogy is usually in ee a 1d ‘understand you better if...” followed with the goals - by the preferred behavior. potential for success. Reinforcement is framed is toward the mastery of the skill or procedig, u were working Of the middle part, and now Fa plete next session. Keep up the good work.” Practig be) congenial and upbeat. e if there is more than one parent, is a very pleasany, friendly affair that parents usually look forward 10 each week. The collegiality between therapist and parents in therapist training for their own children is vig. ble after the first couple of introductory sessions. Parents seem to perceive the partner relationship between the therapist and themselves and rise te the highe - T functioning role. 4, Emphasis is 0" parent For example: have it. You will have it comy es of FT are (and should 5, The training, especially Intake ((9/ 9) ‘When pen Ee Purposes, intake procedures of some sort should be ‘would use with child eee clita! ane need Pe liaaed On sues need to be wat eps sets by the child be appropriate for rte, — ed chron aa plana as primary change agent? We have alr ady di forlchaioa a FT fre oe eae categorically ext — jo for example, severely autistic chi a eee Fouiy Seprssed. ndlval asleasanacs cr children or parents who are st che tak mast alo be made on cate-by-ca, werest and promise for undertaking ¢ basis. This is necessary regardless¢! the diagnostic labels that mi; might be assi dren would be excluded assigned. As menti ‘ from FT because of the Bagi Moet pares ox ci . More subtle ‘What Fillal Therapy Is Today: Basle Constructs, Goals, and Techniques 113 information about how the child and at Parent interact. This observation can be made at any point in the intake. The fi order that we have found best is: 1. See the parent(s) first and Bet the history, 2. Conduct the family observation session, 3. Have a final recommendation intake meeting. problems, and so on. Present to the parent(s) in the first meeting a description of FT, and tell them that you will be assessing the appropriateness of FT when you sce the child, Pro- vide the rationale for observing parent and child together in a free play situation that will iast no more than 30 minutes. We urge the parent(s) to come with all of the children in the family so that we can observe the child in as natur ting as possible. We also explain that after the family session, we will let the child(ren) continue to play while we discuss ‘ith the parent(s) what we observed. This session ideally is no more than 30 minutes. Few parents object, but fre- quently they anticipate being nervous about the observation—particularly fa- thers. Older teen siblings may be omitted from the observation if parents state that the teen is rarely at home or would resent it. ‘Unless parents make a case for not bringing a baby, we try to encourage them to bring the infant because attend- ing to him or her would be more like life at home, We acknowledge to the parents that this s wvill be unnatural for them and that we appreciate their courage in placing themselves ia an observation situation. Observation During the observation session, the major interest is in how parents control the children and whether the target child is especially singled out in some way by par- ents and/or siblings. ‘Vho is leader among the children? Who requires most parent attention, and by what means? How responsive are the parents to the children? With two parents, how do they interact with each other? Are they so self- conscious about the target child that they try to provoke some response from him or ker? For example, “Show us how you can do your 9 x’s table.” or “Why don’t you see if you can build a cabin with those logs?” or “Let’s see how many times you can jump with the ope without missing a jump.” How guarded do the parents and/o: target child appear to be? ‘When the parents rej the FT therapist, another staff person plays with the children and reports the activities and interpersonal interactions among them to the FT therapist. Most of the time, the children continue in the same vein as ob- served with the parents. Sometimes there is a dramatic change—either to more limit testing or away from limit testing. This dynamic is shared with parents in the third and last intake interview. 4 I ‘Therapy case * tne, Fina Pe ‘Their opinions are en ess. part of the re teit explanations for 4 - From he jn r2l8tiOn Se evation, we first ask if - fh val couraged a hen tne fai “child behaves at child's behavior. talking ert from the W4Y tm orgs Sia _ Trea ear : met parents this quest! eeperiences ith thee one ven with the moa ; cui. Te fact hat the CHAP nore ee ee feelings about it to stimulate a desire (0 tell about become * rticotarlY 7 Last Intake Meeting ares wheat the child obserye, In this last pretreatment meetings playing wit ‘out the parents present. Often, reported about the child or children PY Gf the children changed 2 greay this conversation is Very ctive, POY with the parents. Gea rom the way they behaved in OTT mterevidence that the child and par. “assaming ine therapist n0™ has SC and how the FT approach cnt wouid gain from FT, the therspist expla fter an explanation of ore ald be helpfl to the child and parenis as well. Afiet Fe sa what nefits might be expected, the therapist outlines the requirements for FT (e.g.,at- vend weekly, do home sessions, Dring it their child every so often, Join @ Broup). If parents do not wish to be in 9 2fOUP for privacy reasons, efforts t0 see them indi- vidually are made. Pareats are given an PT training manual t0Te8d. Training Manual for Play Ses. sions (L. Guerney, 1976, 2001. If they are not certain yet that they want FT, they are given a specified iength of time to read the manual and make their decision, (Acceptance rate runs about 80 percent.) If they do not accept, offers of other ap- proaches (¢.g., CCPT for the child with a professional and a parenting skills train- ing grovp for the parents) would be made. the FT therapist SI Measures Used at Intake Clinicisns and z2searchers use measures that reflect their cli ‘ A ject th i it ar aot eat ce la ot pa “i ny other mea- purr ne pa a included the Filial Problem Checklist (FPL) (Horne:, 1974). We ask Gurcls Wipomplaten & Stover, 1971) or its revised form meeting and refer to it during dwt complete the form at or before the first intake hanes meeting, This is a li phanicress and 108 (revised edition) child problems (e,g,, temper Gta tt) ms) common in chil case presentations. Parents complete this this for ese meee rm for each target chi ply the number of pletes a separate form without aii oh i abi is problems with degree of consultation. Scoring is sia” upto a3 (if the ior is intensity; a 1 (i p to 23 (ifthe behavior is a severe problem). The eae the problem is preset!) feature of this measures What Fillal Therapy Is Today: Basic Constructs, Goals, and Techniques 115 jas ease of scoring and ability to reflect pretreatment status and posttéeatment . Clinicians can use it to evaluate Progress with a single case by giving the measure both before and after treatment, as can researchers for group scores. phases (or Stages) of Filial Therapy _ Training in play session si s, including mock play sessions. Observed practice of parents’ initial attempts to conduct play sessions with their children, x Home sessions (or independently conducted play sessions) by the parents. . Transfer and generalization, yay Evaluation and follow-up or “phaseout phase.” Phase One: Training The rationale, theoretical basis, and empirical evidence for CCPT and FT are presented to the parents in abbreviated fi and nontechnical terminology. Ample time is allowed for parents to raise doubts and other concerns. Logistics of scheduling sessions, bringing in children, and so on are reviewed. Group members occasionally ask how at is possible that this une approach is being used by all parents when the \dren’s problems differ. The theory behind CCPT is again offered to help them see that the approach is designed to address the child and not the symptoms and that the child will select areas for therapeu- tic work that are most needed, thus tailoring the play to meet his or her individ ual psychological needs. The therapist conducts play sessions with the children of the participating parents to demonstrate how to conduct play sessions after first showing a video- tape and/or play session with a nontreatment child as an introduction. Parents ob- serve and discuss what they have seen; they will be taught the skills, practice, and play the therapist. By the time the demonstration phase is over, parents usu- ally have learned the skills well enough to ply them in a session. We have built in a trial of skill performance in the exercise known as mock play sessions. (Mock play sessions were described previously in the section on iraining methods.) At the end of the skills training and immediately before par- ents are presumed ready to apply their playing skills with their own children (i.e., at the end of Phase One), we hold mock play sessions. Through these exercises of the therapist playing child and the parent serving as therapist, parents get a feel for carrying out a play session, albeit short, and a role play. Though nervous about doing them, most parents do quite well and require only some skill tweak- ing to reach an adequate level of play-therapist competence. If a parent really has a struggle carrying ont this short session, Parent and therapist go back over the 116 Fitiat Piay Ther . . session opportunity nother moe play have both parent. eat fry sits again and ive th8 OR Aig, THe Bot anienges, the patent wind they begin play with thelt A ies oF nese ‘hil Nb any jth his OF . ing, tracking | it Setting, sty i ice Phase Two: Puitin8 spills in! Pract wt ‘ the sesgi nts are empath ld about the nature ol Session Skills learned by pare! tion to the chil d decides what (0 do, ete), ), jing informatio’ ) turing (€.g.. Pre jing int ene ci . and time available skills explaining at acely saeieph fen - 1 CCPT therapi fe hoa mig skills of the profession 5 7 jacement in the sht dic reasons; for examplé, FOO size oF adjustment might be necessary foy rie changes 8 i iy The tock pay session decribed pe, child's or parent’s phys! mock play Sessions parents practice play seq. aw i apist observes. jons with thei pildren while the theraP bos eet ceri ig blessed with one-WaY observation windows or must sp quietly in the corner of the room: the iherapist observes the parent playing win the target child one on one. Following the play session (generally short at frst the therapist provides “systematically Oriented feeg. encouragement, and further skills practice ip lems carrying out the role and using the 10 stick it out in spite of their doubts maximize parent success), back” along with much praise, needed. Even if parents had many pro’ play therapist skills, their willingness t0 UY U and fears is heavily acknowledged. Each parent plays two times in observed sessions with the target child. Parents usually practice once with a sibling who will be playing with them. In any in. stance, if the parent has difficulties carrying out the role, extra practice with skills that were not up (o standard and extra observed time is scheduled. The goal is have the parents able to function competently when their sessions are not so care- fally observed and analyzed. | Encouragement, reinforcement, and much empathy dominate the FT there pists’ responses here, as well as instructional responses when need=. This ‘the most delicate stage of FT—when parents are having to d a iis vs standing of the task and early signs of competen s lemonstrate their under- Aaschgis singe aanlorsihsps or sopra eee tate stresses that this is a very different role and th most parents, because feedbath outside the play session, parents can separ, at they are leaving their parent roe people foo themselves ss pay therapists n.g thedt evaluation of themselss™ - In other words, there is little disin™ if they stumble in learning i ig NeW skills. There is. di threat aad detent REM Skills. There is dishonor, perh d ae ee sean veelae Parent stumbles in otoreruatiegth still might be chosen from the dotens avant tiRes” a NS available) Ee Cehateves its in dei 7 r vemonstrating their parenting: gl ay TEA 1 sashes ck son opera sky api an ve Be PH Te eel isthe bth paca ange vee in ee wee eT hei eed ht a er cil ne ste to handle the fret ays into Practice ‘Phase Te: Ping Stil ee eet hi iii. Sei ae ye ain ci HABE UC fhe tering etn ifomatin it decides wha odo, ee) ta ie wai lin led exept fo silt the profession COFT Heri emt in their Dome igh "8 ‘earns; for eam om eases might be necessag ior hangs in ie es ee Be eect ‘child's or paeats sical diay The mock play s#s8I0n5 described, Prev, ‘uly ae wed ere. Fllove te ack hy SUD PENS Practice py Son wih heir chien whet eis bere Whether he herpetic wih way aon Window. my sity inthe caer of hohe eit eres he per paying wae ‘eae hee ove Fig ey son erly sh a fg | ‘esa pe seca be hep pois yeaa onened Sack slong sith much ie exaust, a fries Sls pac ede ven if pare a any poi cargo the read ning ‘ye ering ey ost otn pe ta See 1d fears hewlett Each rent play ois send tin tly ae sce with gw wil pay ah oe snc ep deat apogee 8 Sie onmat on econ ree th the pret eo econ lo oui fully observed and analyzed, Sooty when sens a Encouegnest, infreet, ad mach fit espns here wlls lene ost tate age of Fen pra near hh ed ‘standing ofthe task and ext signs of coneunee nS": thee under ‘Altbongh thi stags is 4 major challenge fermen NEE hy row nag sess that hiss avery diferent lend haa beens face ‘tse te ply sete, pnts can separate he eM ri parece ae fee om hme pina ng ls. Ther To eet neat feos rte feecaam tt 2 paren. Pans ae exgcied 1 the "ripe ings Smee eee hte target child, Pacey Fn $0 care: ees ome enon ' ing mn te te Cty ce nae a protecting distance ie near J learning this “in rect a role, o poet th ada ‘he stropaing earner. In Tee He eae ‘St the notion among themselves Following the on te ea cannes ‘week and the mother the en Logistics of ome session are rmaximie succes, Times, places = a nets Cartier coe wii ay Si tn ‘here shi be wo inerroptions a he Sessions a «gemine om teres compelling reson 1 i ine areas bring ina report on the home ston (ev tsbuted by the therapist) fr he next meting wie te sion is diseased in celtion o comet, he cil's express, the pros feetng about, and ses forte patent concerning te seson Curia oe ents videotape ter home seston. These apes can b brought int ie meee ings and observed withthe brags (andthe group) ere ino stsactry place at hare oration becuse finite pce ‘snd 0 0, the parent ad therapist could aie io have the “howe” sessions bed ‘the treatment site This ges a step fater in many instances (garter in ‘ivae pectic situations where he therapist make the ay seins the heat fhe “therapy hout™ with be arent and chil. The patent lay withthe eid form more than 30min; nd the ast 20 mines te spent casing these atm em i sb i workable logistically and in terms of pstv ests, Observing beri ee ee on simple form die. therapist, where the ses- iti, v sg rar TY \ nits TEAC Leneert ieee ae ma, ma esr arias ce ee ge eee es reget, whieh i aoe hile ah eee eis witb WE te lye) ce wa ee os, aig Me howe Sicha can OW TFORTESS. AW fr ca ange nuk extend te cove OFF, whlch would need a acre atom cae cient grrumtiag “Teen op ee ete testament skool ‘workout any role pens re having inthe pay sessions a ome. the at tthe paee, skill sf sly ao 25 much of a ise for ‘sia and herp hecaoe parents ly maa their Sis wel (even be. ‘ome alc peesin i sone tines). The messing ofthe child's expres. sons and paentreasions theme a heritable improving ways of ‘cating ther heen become morte fs, which ney satisfying for al Inve, Many ich escusions ake pace thse. | ‘Phase Four: Transfer and Generalaion ‘Technicalities of play sessions now take much less time in the postplay session | ‘tn ‘ery natural fe ie thera initepatets to nk rlising pay tesion picpes ad sls to Me te ane ‘me when Many pareve aletyspontanezl Sanaed onthe on Te Fara easy soars ied eae te oh oma ‘While the ply sessions nays rnin he cena fo begin to fame rome comments toute ae tole oaie te payoom Us ‘ple ass the pres consi rad poin out thatthe purest wi he eared how t achive eter cits forcing imits she pare cares. has fecing conrline phage 2 as Pah att ast ng td en vise ES aha a Woe Fa Mey eg Nae Cnt a, the ayo9M Without 0 ee tame Lindo inti cs copay Bore mt oe ite seen ate ed Making clea ety on nee oo ow sone. hea a ie sol be ced a ge Ex eer, nce Sergent tre pe Fe Bvlation oni Pome Tey on sotines MMi dente gen femors, which ey withthe parents howto pave limes” thee place. Dpoveviated. The ese 00D 2th me be oi ge mela ned to Pate ie fri tin il psi, istiate ki ta Asie has impeel ss tly appease the ng oe eu pay et Sty onpens in he ast thie mene a eer (ea are hep sppied ofl changin sean ane wil end at the treatment site and at home, The ben ply tessions therayist educa Seteprace of hi ing es a nee toe sk ih hem Be seh he aig pen isnot fhe cil, For example paming canto stemporah ene ee sedi appeased vteot cca ee ‘gesioe npn sesoe snr in el ie), Te tetera FT therapist is relly needed here. ee omen Special Times Paes are asked to try to substitute fo: te play sessions peo of tine that are ‘ranged between parent and child and devoted oan activity choten by the child ‘sare with the peat. These activites can be anything that both prea and ‘ld are willing to do and meet the further criteria of allowing the paret wo 3 al Therapy ts toe ary TH wnat THOT Bae Caen mas ca 1 meting Seta i ce ee ein pen cr gh ET teat yy gassed ines oye ME ing pers if proble-8 arse withthe yo cngrt jg acter activity cam Be ove a ong = force Restroctaing the choice. Children ‘leo inthe egaton i ly Bs ee ps Bh PY Ti ei ne or mt ai 8 ay Sp eo tee noe 1 ee cma a ey coer nat nate Se come enue Te eee seer eee om ‘eaiing groups o, petra added if time i availabe wo the end of the 20-week, a therapeutic goals usualy last 20 to FE pega Th oa Pi Siig rer (LGaeney, gues When FT alee oa india rca oe oy 1895.1 fen ieee. is nae ve 10D sessions. Beesre paren iy sulice. Crops conducted for eancene or secondary nese ni aeig eps ome into hee ets. a lon yeas nse secede te, or ‘Alpes ead beg poste omer one sessions. Follow-up sessions are I's behay faw-uP . ereralarly scheduled sessions cine ‘hoe cg Se mena stat od caren ean ‘ministered before and atter to track changes, for example, paren: ao ull eld woo four weeks afer the tad Peach reap sees ity eat ee at ht ih pn ad ae late She 0 alk about ‘on the Model pte hat hy en nds othe messes to — ea oo ‘spsdeve the items Tis nga sent serving of ove mete eerste eee ee TO cera ee eat mary change ge for thei owncidren dc otig patent's response. Calleges, wit ane roberto cae ‘ere fll course cf the treatment. The FT therapist tines nd opera Spe cere arte pron Pas en 8H, eta tie press and det ct provide pay therapy ety teem ee {ees addoel revere orctanger hey banc bance: Th, pares semen pars. Th i rate he gil nt of Fe herpetic with ir oe Mt¥ig stout by pay. "Dw yer; cominl pier ol nd ‘onthe “pure” mode! for use when they recognize that features of the child and/or ‘arcat would possibly intecfere with its successful applicativn, bat the therapist ‘teognizes that the positive play interaction between the parent and child would ‘eaconstructive modality for acquiring corrective behaviors. Rather than aban the model compietly, the fila therpit recommends 2 varaion that ‘serves the major advantage of FT while making demands onthe parent man- ‘erie. For example, a child who is extremely angry with tbe parents has shown, | Setened pay sessions that he wil be very agressive nt diffi o contr sgh, SBE tags tel mt a sepsis ate Dg se a i or wl a SENS rei al wig CIS, im controls, defeating the FO te pistenationa involvement. My onsisenly enforce wither ontinescondeet the FFE FEW Sesion Insc isa pe therpisled sesions. (OBSEIVtion ig eden! ties ave available and the parent Would neeg ‘where the play takes place. eS terete) the me ‘nthe sre im wher yaks the esponsibility Fe the play session, f° Cragin lo ea epnsty a eis ver aang cx fre pe oye avy eed var the tine Te ey tet Fe ae nly, hag re ay scans all tat 0 come Ou nde eae el my opin 8K 6D Py ata tc apse oft hrapy wk” a farts aes, might be wavs pene tbe cen esi becate his behrn part The FT dept as the responsibility of i esl ith uch ply I ether at ele decig leanne ene nena Feat tyoweg men pe of videotape ofthe ea ear asons icons nl xbly ines of wal Frotapet Teer heap vans gardai i's ply sessio espones mle ings pro acorn tf tt or tata paral a catvny. Sme erm vache tn wy enc ana oun al thee eilen become aaious and resist the ply session format. Ultimately, ay Tih ess whl ply py deve he progr fy only eed ‘While readying for parent sessions, the therapist's behavior is explai sheng wih danion ote c's bbe Thea seasons cea be ea “el forthe pre ic nr tn be mee ual parareccee eg ‘ha Caneenten oh ls ly etn eats cheered el limited permit eater ciecions a ‘tending to the child's cheice of activities in ths rae tated what TT etre ates 182 “The therapist speaks in terms of rf tow sett nt the place of he child and ewes ‘barged with child abuse, corrective experiences about thei elatonsigs such those provide in ieripeiti play seston would be extremely importa for preted lc of hep ct get or ren after the els play therapy ‘has been Finished by the professions, might be the optimal choice. Both child and parent would have Been edested thoogh their playing and cbuerving ora eat ‘iscussing play therapy sessions. These corective experiences wold seady Bch partes fora geoinly therapeutic experience ented toward ive relatonship. 1 parent-child visits are limited and series by acid protective agency, ving the parent lay theraeaiay wih the eid Fn use of ve visi ime, Patents, im thiscase, sould be ued witout her child aa extent te. Either ‘Sportontis 10 play with oer chien wile he therapist observed ne merely ‘aerplaying with the PT therapist could pepe the pret (tet minimally) For the supervised visits in summary, the pola st which he paren bens to take onthe responsibility ‘of providing the child wit the pay sesions i ot te ting factor of FT If the parent has not bees the primary provier ofthe CCPT, itis step away fom (he basic model But taking on the role of ply therapist, whether a primary or vm dary change seat sill apres the esteace of PT Both child and patent [eetthaced in a enperince ta is ign and corrective for bth and penerally vrei ina raore postive paret-cidelatonship at whatever pint it begins. snp cine ing sake ae ag gnc aiden. The hei okt iene as Seaport ‘a child to making the parent the most effective play ane a in nan ‘maces omen svccessfaly he pret il be ae 10 ety ening 8 aS ra rein Sal dvi fam gy etd wih sl HSA ent parents yng wih the ky del CCT therapist arying out the session. Itis the a En ag es penne tae ind re a puts is beh, pine othe sane behav epee BY 2 hope Tye ies he rr eps the parent mere ay a pa i nds sce i tel sma we AN ei, Tapes ine eile aoa yn (Meter ech nd el mo Othe ate. Cheng eo at fly erp Cai he eran iaeA et the meds dsesbed pent for woking with parents ay Sind cig hs a naps edo woo iow aeinent to the secondary slop tenptrendlearthaautndering the ea ele othe patent eda of pee wale ha fey wre 1 oa mre potssional ob of ondorting py sens, Beigel a nine an supervise may be less sSnyng anv ey th lt cry Wa paren ap ‘ling do itl an ening he thept ehg it he ei ot aking the popes ath or sh wad ak the harpist ‘ is dong he ny Whee theraptepvie eit mses, Wey ened puis dtecy to ‘hel peofessoeal trvearon. FT peoenals earn et a sven om eng mal in in he rn te cia eaten Te ers pic enonud yay obi te CEP aon sed ay ener positive changes hl ke pce. This empove sedated ob ee shor a cata cere en ga FE epee pe weary stemevenacreaen ee pel meat ete es a COPT filial therapy are essential. shops and courses Om CASE ILLUSTRATION “This ete as een a une ing cic where die tram K demonstrates the eres: flexibly of Pro sang Me FT peo: then frat and proctdats te modified to meet cate need tt negrity Tmetod. As ing as its base tre the pares playing ge hSEYfobost fee inthe therapy iets bona Fide PT with meat ote pagent 4 part for postive change Poel eo all, ‘N bx Con aneaen a5 van eftsed pay Within Preorder nt ta ation be as wtcbopertn nd dupe end cone ny, He sss aval of yng nt geste butte ny ct ce and hone. the ely cil te ay va ste bt typi. He wave ag insiae frie and tain in agpearns Hato’ wk ween fequred Rot hy cae jong ead to eclatere Wn Be wat {Gained fom dy cae cence, te vee period when nate bad one Sort cae fr him util oer ay ce rngenent wa ted The Daven wee rather deperae Becton ny aot wee Sore who damit hin vould aa ene epteve, Background and Intake ‘Rad been ia group day cae sting tien anther community where the moe ad been previuly stationed, arly chido bod bees relatively fee of prot, Wat Me bad some feedings cating pcblens a mint. Daycare centers a i att dye feet been divided into groupings by as and he nambe of children alts varceted to were fewer a namber thn in heel day ar ene be had rem vending since he wa8 3 years Intake nay ns eed wit i te ca ib eo ein, to ann tly Bh at ly ik npn im esate hrs * cae of the puns in the playroom. yi cern iw ot sa cee a ee es fo ry treason with moat was 2 anni tas appened:RECOVET img ste eet iy ct 08. ane eran ‘Were Wit ed somthing wel ih Frente 92 Simp end, Mer othr 0 ety or i aw Ths hd added aratge - Satorteneet ee egacetnen iar tiene peu a esr oral i -hr [| * wetpericsel tau ihe win son w wn i | Rapatchanargib sll pt copra puto thy | {ES justin sae potion home cr gi ens 4 ‘Both pareats completed the Filial Problem List (Horner, 1974) sith 108 pireternenemartatrentna ctr stearate he cme hem. Paes conplt the forms separates. bat R's pene, pion he problems Fy eal expectations rp of he stra ys foun chee To Nil a Tee ang ey HEN niin their son and litle Tif unerstand, do, andpreteeed wo do fare, Me ieasion that he dlr ae es : aoa eae mi rae Sere aetna, te aot ace pecommendation commended cane : yr lay } Screen ther oped otf diay eee etn se nsobeer teenage stan =: Yet ocomein taee on {© Sm to share information. He ay gives BOO On cld beta of cen re ion. We was. (L, Cuerney, 1999), wie SAB td he Parent stra care aha wee een tpset. She though hat he weld be mara permissiveness. She alo did nha sessions: cbserv the play seston ha the py erp er ase ‘oral stuieat) was going old wih R eigen for Mother. However, Moher word st stat plaig an se oo apis agreed that the ime was right. The lan va that ser cp ing sessions, she would gradhally begin parti he play thr tid of cbr player eral Tacidentally, the dingosis for R. (sed only for armed frees inurance purposes) was adjustment disorder. We lta he aaliyah be havior was unnecess 0 include in formal pottion because Of Nie very ‘young age. This dingnoss on records could set him wp for unecesay sues ‘vith forure mental health professionals and inarance eit. ‘The Play Sessions ‘The therapiet carried ont standaré CCFT wth R. while is mother observed, At Scene ch enon eat el ih oe ol ict ee sessions, seat Feed and why she responded at she did or the fi ‘ot of exch play season with Mt tevin wh Wc anh \ndow and providing be with istrton abut what ws agpeing, td chance to discuss her distaste for as nutri TT nikon eat | gonna mewn cm 2 oe tie ily ening tee Tat eve cng a ws) eet setae ae nso be Neg Perera nt a trac ero COT Me ig, nines ine ith paying ce Payee int aly are og | se gn i en con te SSG ens pct oni Res euvber gx move comforube with the sessions as they ‘caine Wel aged that te shoul begin laying with. for 10 miner ‘hed eas, Sad bec ee ang ae Ses Ory, 20) wach edo aE pe refered to it in ter wey posta seson meeting with the Before aking onthe terapt e or Ploy and she Pay teria th pln therapist rehearsed wah he the opening and closing statements and reviewed the limit routine wit

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