Person-Centered & Experiential Psychotherapies

ISSN: 1477-9757 (Print) 1752-9182 (Online) Journal homepage: https://www.tandfonline.com/loi/rpcp20

Play therapists’ demonstration of the attitudinal

conditions in child-centered play therapy

Kimberly M. Jayne & Dee C. Ray

To cite this article: Kimberly M. Jayne & Dee C. Ray (2015) Play therapists’ demonstration
of the attitudinal conditions in child-centered play therapy, Person-Centered & Experiential
Psychotherapies, 14:2, 119-136, DOI: 10.1080/14779757.2014.952899

To link to this article: https://doi.org/10.1080/14779757.2014.952899

Published online: 10 Nov 2014.

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Person-Centered & Experiential Psychotherapies, 2015
Vol. 14, No. 2, 119–136, http://dx.doi.org/10.1080/14779757.2014.952899

ARTICLES
Play therapists’ demonstration of the attitudinal conditions in
child-centered play therapy
Kimberly M. Jaynea* and Dee C. Rayb
a
Department of Individual, Family, and Community Education, University of New Mexico,
Albuquerque, NM, USA; bDepartment of Counseling and Higher Education, University of North
Texas, Denton, TX, USA
(Received 14 November 2013; final version received 17 July 2014)

Although the attitudinal conditions of congruence, unconditional positive regard, and

empathy are essential to the therapeutic process in child-centered play therapy (CCPT)
there is limited understanding of how these conditions are conveyed by play therapists.
Utilizing a grounded theory approach, we identified internal experiences and external
nonverbal and verbal behaviors play therapists demonstrate when the attitudinal con-
ditions are present and absent in play therapy. Implications for clinical practice,
supervision, and research are discussed.
Keywords: congruence; unconditional positive regard; empathy; child-centered play
therapy; grounded theory

Les conditions attitudinelles dans la thérapie par le jeu centrée sur la

personne : leur mise en œuvre par les thérapeutes
Bien que les conditions attitudinelles de congruence, de regard positif inconditionnel
et d’empathie soient essentielles au processus thérapeutique dans la thérapie par le
jeu centrée sur la personne, la manière par laquelle ces conditions sont mises en
œuvre par les thérapeutes reste l’objet d’une compréhension limitée. Tirant parti
d’une approche théoriquement fondée, nous identifions les expériences internes et
les comportements externes verbaux et non-verbaux manifestés par les thérapeutes
selon que les conditions attitudinelles soient présentes ou absentes dans la thérapie
par le jeu. Les implications pour la pratique clinique, la supervision et la recherche
sont discutées.

Demostración de los terapeutas de juego de las condiciones actitudinales

en la terapia de juego centrada en la persona
Aunque las condiciones actitudinales de congruencia, aceptación positiva incondicio-
nal y empatía, son esenciales para el proceso terapéutico en la terapia de juego centrada
en el niño, hay una limitada comprensión de como los terapeutas de juego transmiten,
comunican estas condicione. Utilizando un enfoque basado en la teoría identificamos
experiencias internas y comportamientos externos, verbales y no verbales, que los
terapeutas de juego demuestran cuando las condiciones actitudinales están presentes o
ausentes en la terapia de juego. Implicaciones para la practica clínica, la supervisión y
la investigación.

*Corresponding author. Email: kjayne@unm.edu

© 2014 World Association for Person-Centered & Experiential Psychotherapy & Counseling
120 K.M. Jayne and D.C. Ray

Eine Demonstration der Grundhaltungen von Spieltherapeuten in der

kind-zentrierten Spieltherapie
Obwohl die Grundhaltungen von Kongruenz, bedingungsloser Wertschätzung und
Empathie für den therapeutischen Prozess in einer Spieltherapie (child-centered play
therapy, CCPT) wesentlich sind, ist bisher noch wenig verstanden, wie Spieltherapeuten
diese Haltungen übermitteln. Wir verwendeten einen fundierten Theorieansatz und identi-
fizierten internale Erfahrungen und externale non-verbale und verbale Verhaltensweisen,
die Spieltherapeuten zeigen, wenn die Grundhaltungen in einer Spieltherapie vorhanden
oder wenn sie abwesend sind. Implikationen für die klinische Praxis, Supervision und
Forschung werden diskutiert.

A manifestação das condições atitudinais pelos ludoterapeutas na

Ludoterapia Centrada na Criança
Apesar de as condições atitudinais da congruência, olhar incondicional positivo e
empatia serem essenciais ao processo terapêutico na Ludoterapia Centrada na
Criança (LCC), pouco se sabe de como estas condições são transmitidas pelos ludo-
terapeutas. Recorrendo a uma abordagem fundamentada na teoria, identificámos
experiências internas e comportamentos externos, verbais e não-verbais, que os ludo-
terapeutas exibem quando as condições atitudinais estão presentes e quando estão
ausentes na ludoterapia. São discutidas as implicações para a prática clínica, a
supervisão e a investigação.

Introduction
Child-Centered Play Therapy (CCPT) is a developmentally responsive therapeutic
approach for children based on the person-centered philosophy of Carl Rogers (Axline,
1947; Landreth, 2012; Ray, 2011). CCPT is one of the most well-researched approaches in
play therapy, and one of few play therapy approaches with a treatment manual (Lambert
et al., 2007; Ray, 2011). Researchers have demonstrated that CCPT is an effective
intervention for children with challenges related to externalizing/disruptive behaviors,
attention deficit hyperactivity disorder, internalizing behavior problems, anxiety, depres-
sion, self-concept/self-esteem, social behavior, parent/teacher relationship, sexual abuse/
trauma, academic achievement/intelligence, and speech/language skills (Bratton, Ray,
Rhine, & Jones, 2005). However, there is limited exploration of the interactional, rela-
tional process between the play therapist and the child in CCPT research and few
researchers have explored the therapeutic conditions necessary to facilitate constructive
change in CCPT (Ray, 2011).
Rogers identified (1957) six “necessary and sufficient conditions” for personality
change in person-centered counseling. Although all six conditions are considered essential
for effective therapeutic practice (Ray, 2011; Rogers, 1957; Tolan, 2012; Wilkins, 2010),
the attitudinal conditions of congruence (CONG), unconditional positive regard (UPR),
and empathic understanding (EU) have received primary attention in person-centered
literature and research (Ray, 2011; Tolan, 2012; Wilkins, 2010) because they reflect
wholly on the person and practice of the therapist.
Virginia Axline (1947) was the first to apply Rogers’ person-centered approach to
children. She developed what she termed non-directive play therapy and provided eight
basic principles for enacting the philosophy and conditions of person-centered theory with
children. Paraphrased for brevity, those principles include that the therapist:
 Person-Centered & Experiential Psychotherapies 121

(1) develops a warm relationship with the child,

(2) accepts the child exactly as he or she is,
(3) establishes a feeling of permissiveness,
(4) is attuned to and reflects the child’s feelings,
(5) respects the child’s ability to solve problems,
(6) does not direct the child’s behavior,
(7) does not attempt to rush therapy, and
(8) sets only necessary limits.

Guerney (2001) and Landreth (2012) extended the person-centered, non-directive

approach to working with children into what is presently known as child-centered play
therapy (CCPT) in the United States. Landreth developed specific facilitative responses
based on Axline’s basic principles and presented tenets for relating to children from a
child-centered perspective.
Following Landreth’s seminal work in CCPT, many authors have focused almost
exclusively on the verbal skills of play therapists with limited consideration of the
therapeutic conditions or attitudes necessary to facilitate children’s growth in therapy.
Although the philosophy and principles of person-centered theory may be implied, few
authors explicitly discuss and explore the Rogerian philosophy, concepts, and conditions
that provide the framework for CCPT. The absence of a strong theoretical foundation in
CCPT training literature and research creates a problematic gap between theory and
practice in CCPT (Ray, 2011; Wilson & Ryan, 2005).

Attitudinal conditions
Authors have defined the attitudinal conditions of CONG, UPR, and EU in various ways
throughout the CCPT literature.

Congruence (CONG)
Landreth (2012) defined genuineness as “being real” (p. 70) and described congruence as
a way of being fundamental to the person of the therapist. Van Fleet, Sywulak, Sniscak,
and Guerney (2010) defined CONG as the therapist’s genuine regard for the child’s
perspective and feelings. Similarly, Cochran, Nordling, and Cochran (2010) identified
that CONG is actualized when the therapist is genuinely empathic and accepting towards
the child. Ryan and Courtney (2009) argued for explicit verbal expression of CONG and
noted that CONG is demonstrated through consistency between the therapist’s verbal
expression and what is expressed nonverbally through vocal tone, body language, eye
contact, and proximity to a child. Furthermore, they acknowledged that CONG is
expressed differently within each therapeutic relationship and cannot be fully prescribed
through a set of specific verbal skills. Ray (2011) acknowledged challenges and potential
risks of expressing CONG in the play therapy relationship and identified CONG as an
advanced skill highly correlated with the play therapist’s own self-regard and -awareness.

Unconditional positive self-regard (UPSR)

Although UPSR was not explicitly identified in Rogers’ six conditions for therapeutic
change, many child-centered authors have explored the role of the therapists’ self-
acceptance and -valuing as an extension of therapist congruence. Landreth (2012)
122 K.M. Jayne and D.C. Ray

acknowledged the necessity of the play therapist to be in a continual process of develop-

ing self-awareness and self-acceptance in order to be open and accepting of the child’s
experience and process in play therapy. Similarly, Cochran et al. (2010) identified self-
acceptance, self-empathy, and self-care as central to effectiveness as a play therapist. Ray
(2011) further acknowledged that a lack of self-regard and self-acceptance inhibits a
therapist’s ability to provide acceptance for one’s clients.

Unconditional positive regard (UPR)

UPR is often described or referred to as acceptance in CCPT literature; and few authors
have explored it fully. Axline (1947) captured the essence of UPR in her second principle
in which she encouraged the therapist to accept the child fully as he or she is without
wanting the child to be different in any way. Likewise, Cochran et al. (2010) identified
UPR as an attitude of treasuring and prizing the child. Ray (2011) presented UPR as the
antidote to the child’s conditions of worth and described the play therapist’s UPSR and
self-acceptance as the door to complete acceptance and UPR for the child.

Empathic understanding (EU)

EU is most frequently discussed in terms of specific communication skills including
tracking, empathic listening, reflective listening, or reflections of feeling in CCPT
(Landreth, 2012; Van Fleet et al., 2010; Wilson & Ryan, 2005). However, a skill-focused
definition of empathy lacks the depth and essence of Rogers’ fifth condition (Cochran
et al., 2010; Ray, 2011). Landreth (2012) conceptualized empathy as being “in full
emotional contact with the child’s perceptual, experiential world of reality” (p. 77).
Additionally, Ray (2011) defined EU as the process of “entering the client’s world as if
it were your own without losing a sense of self as the therapist” (p. 65) and described
empathy as a process of being open to and experiencing the child’s world.

Research on the attitudinal conditions with children

Although considered central to effective practice in CCPT, the attitudinal conditions of
CONG, UPR, and EU are largely unexplored in the CCPT literature. There is a gap
between the theory and practice of CCPT and an increasing emphasis on skills and
techniques rather than the essential conditions and characteristics of the play therapist
(Ray, 2011). Furthermore, research on the process of CCPT and the attitudinal conditions
has been limited both in scope and depth. Although measures have been developed to
assess therapeutic alliance with older children and adolescents (Shirk & Karver, 2011), no
measures of client perception of attitudinal conditions have been extended to young
children (Purswell, 2014).
Truax, Altmann, Wright, and Mitchell (1973) explored the effects of the attitudinal
conditions with children in counseling and reported a positive correlation between high
therapeutic conditions and positive therapeutic outcome. However, Truax et al. focused
exclusively on therapists’ verbal expression of the therapeutic conditions without regard
for nonverbal expression, and excluded clients and therapists’ ratings of the therapeutic
conditions.
Several additional researchers (Darr, 1994; Harnish, 1983; Siegel, 1972) examined the
relationship between therapist-offered conditions, changes in play therapy behaviors
across time, and therapeutic outcome. Darr studied the development of the therapeutic
 Person-Centered & Experiential Psychotherapies 123

relationship and the attitudinal conditions in CCPT and found that therapist responses can
enhance, as well as detract, from the therapeutic relationship. Harnish found that higher
levels of therapist-expressed conditions were positively related to children’s empathy and
self-concept and negatively related to children’s aggressiveness. Siegel found a positive
modeling effect for children who experienced the highest level of therapist-offered
conditions. However, these researchers neglected to provide concrete examples of the
attitudinal conditions or primarily focused on therapists’ verbal responses without con-
sideration of non-verbal ways of being.
The exclusive reliance on verbal communication is a major limitation within CCPT
research due to the primarily nonverbal nature of play therapy. Although play therapists
often communicate and make contact with children verbally, children communicate
primarily through the language of play and nonverbal communication between a child
and the therapist is often more critical than verbal communication (Landreth, 2012; Ray,
2011). Furthermore, the attitudinal conditions cannot be reduced to verbal communication
skills or techniques (Bozarth, 2001a; Hackney, 1978). The purpose of this study was to
explore how the attitudinal conditions of CONG, UPR, and EU are demonstrated and
communicated in CCPT.

Methods
We utilized a grounded theory approach (Corbin & Strauss, 2008) to explore how the
attitudinal conditions are actualized in CCPT as part of a larger study. Originally devel-
oped by Glaser and Strauss (1967) as an inductive, constant comparative methodological
approach, grounded theory is utilized to construct theoretical explanations of social
process through a systematic analysis of data. Grounded theory is recommended when
the purpose of research is to generate or expand theory in an area where limited theoretical
knowledge exists (Charmaz, 2006). Additionally, Creswell (2013) and Glazer and Stein
(2010) recommended a qualitative, grounded theory approach to develop a holistic under-
standing of complex human phenomena such as the attitudinal conditions in CCPT.

Research team
The research team consisted of two advanced doctoral students and one faculty member.
Both doctoral students had advanced training, supervision, and clinical experience in
CCPT, qualitative analysis, and grounded theory methodology. The two doctoral students
served as the coding team for the study. A faculty member with extensive experience and
expertise in CCPT practice, training, supervision, and research served as an expert
consultant and peer reviewer throughout the research process.

Participants
We utilized purposive, theoretical sampling for this study (Charmaz, 2006). Following
human subjects approval, we recruited child-centered play therapists from a university
clinic in the Southwestern United States. Four (n = 4) advanced doctoral students with at
least three courses in play therapy, at least 2 years of clinical experience in play therapy,
and weekly supervision of their clinical play therapy practice participated in this study. All
therapists were European American females. In order to participate, each play therapist
affirmed her beliefs in the basic philosophy of CCPT by signing a theoretical statement
including Rogers’ (1957) six conditions and Axline’s (1947) eight principles.
124 K.M. Jayne and D.C. Ray

Table 1. Child demographics.

Therapist Child Age Grade Gender Ethnicity Observed session#

Therapist A Child 1 5 Pre-K Male European American 7

Child 2 8 2nd Grade Female Asian American 51
Child 3 8 2nd Grade Male European American 46
Therapist B Child 4 4 Pre-K Male Bi-racial 13
Child 5 4 Pre-K Male European American 10
Child 6 5 ———— Female European American 52
Therapist C Child 7 8 3rd Grade Male Bi-racial 15
Child 8 7 1st Grade Female European American 9
Child 9 6 1st Grade Male African-American 11
Therapist D Child 10 8 3rd Grade Male European American 28
Child 11 7 2nd Grade Female European American 8
Child 12 6 1st Grade Female European American 35
Note: Observed Session: # = the number of times child had been seen in CCPT by the participating play therapist
at the time of observation.

Play therapists were asked to identify three children they were currently seeing in
individual CCPT (n = 12). Child participants met the following inclusion criteria: (a) age
4–8 years; (b) attended play therapy on a weekly basis; (c) completed at least six play
therapy sessions with the therapist; and (d) demonstrated incongruence, anxiety, or vulner-
ability at initiation of play therapy. The child participants demonstrated some level of
incongruence, anxiety, or vulnerability as demonstrated through problematic behaviors at
the initiation of play therapy (Ray, 2011). Initial parent consultations were utilized to assess
children’s problematic behaviors prior to the initiation of play therapy. The therapists
identified children on their caseloads who met inclusion criteria, were consistent in their
weekly attendance, and appeared responsive to CCPT. All therapists and parents signed an
informed consent to participate in the study. Child demographics are summarized in Table 1.

Data collection
Play therapists were asked to complete a demographic questionnaire for themselves and for
each of their participating child clients. The primary researcher observed each therapist-child
dyad once in an individual CCPT session. Children were observed following their sixth session
or more of CCPT with no maximum limit on the total number of CCPT sessions (See Table 1).
Observations were conducted using two-way mirrors and each observed session was video-
recorded. Immediately following the observed play session, play therapists made brief session
notes regarding their experience with the child. Within three days of the live observation, the
primary researcher conducted a 90–120-minute, semi-structured interview with the play
therapist regarding the observed session. Therapist interviews were video-recorded. During
the interviews, play therapists were asked to reflect on their relationship and their experiences
in the session with the child as they watched the video-recorded play session. Field notes and
the therapist’s session notes were used to inform the interview process.

Data analysis
The comparative data analysis procedures included three phases of coding: (1) open
coding, (2) axial coding, and (3) selective coding (Corbin & Strauss, 2008; Fassinger,
 Person-Centered & Experiential Psychotherapies 125

2005). Before coding began, the coding team met to discuss the methods for data
collection and analysis and to identify researcher biases that may influence data collection
and analysis.

Open coding
Video-recorded play sessions
The coding team independently analyzed four of the video-recorded play sessions. A
15-minute segment of each play session (15–30 minutes) was coded minute-by-minute.
Based on the therapist interviews, additional minutes of each play session were also
identified for coding. The coding team coded each minute twice; first with a focus on the
child’s behavior and second with a focus on the therapist’s behavior. Analysis of chil-
dren’s behaviors, responses, and interactional processes with therapists was coded first to
observationally capture the child’s experience of the attitudinal conditions in CCPT.
Following the first phase of open coding, the coding team discussed the coding process
and compared codes. During the second phase of open coding, the coding team indepen-
dently analyzed the remaining eight video-recorded play sessions and then met to compare
codes. Analytic memos were maintained throughout open coding of the play sessions.

Video-recorded therapist interviews

In the first phase of open coding of the therapist interviews, the coding team indepen-
dently analyzed four of the video-recorded therapist interviews. The coding team coded
the therapist interviews in their entirety idea-by-idea. After the first phase of open coding,
the coding team discussed the coding process and compared codes. Following the
comparative analysis of the first four interviews, the coding team independently analyzed
the remaining eight therapist interviews. Upon completion of open coding of the therapist
interviews, the coding team compared codes and theoretical saturation was achieved as no
new categories or codes emerged from the analysis of data.

Axial coding
In the axial coding phase, the coding team compared codes from the play sessions to
codes from the therapist interviews to identify the most frequent and significant categories
as axial codes. The axial codes were then used to analyze larger segments of data and to
facilitate comparison of the play therapists’ and child participants’ behaviors, experiences,
and interpretations of the attitudinal conditions in CCPT.

Selective coding
In the selective coding phase, the coding team compared and diagrammed the focused
codes and utilized analytic memos to identify relationships between the categories. The
researchers utilized selective codes to develop a grounded theory of how the attitudinal
conditions of CONG, UPR, EU, and UPSR are demonstrated and communicated in
CCPT.
The research team met with the expert peer reviewer to debrief throughout the data
collection and analysis process.
126 K.M. Jayne and D.C. Ray

Results
Presence of the attitudinal conditions in CCPT
Through the comparative analysis of the play therapy sessions and the therapist inter-
views, we identified specific internal thoughts, feelings, and attitudes play therapists
experienced when they were communicating and demonstrating CONG, UPR, EU, and
UPSR in CCPT. We also identified specific verbal and nonverbal behaviors that play
therapists demonstrated when they were experiencing the attitudinal conditions. Table 2
includes examples of therapists’ internal experiences and external behaviors when each of
the attitudinal conditions is present in CCPT. Although some experiences and behaviors
are linked exclusively to one of the attitudinal conditions, several of the therapists’
internal experiences and external behaviors overlap across multiple categories due to the
dynamic, interactional process of the conditions.

Absence of the attitudinal conditions in CCPT

We also identified specific internal thoughts, feelings, and attitudes play therapists
experienced when they encountered barriers or deficits in their experiences and commu-
nication of CONG, UPR, and EU in CCPT. Table 3 includes examples of therapists’
internal experiences and external behaviors associated with those internal experiences
when CONG, UPSR, UPR, and EU are limited or lacking in CCPT.

Experiencing and demonstrating the attitudinal conditions in CCPT

Congruence (CONG)
Through our analysis, therapist incongruence was easier to identify than CONG in CCPT.
We found the fewest examples of therapist behaviors for the category of CONG. This
finding is consistent with how CONG has been defined and discussed throughout person-
centered literature as one of the most complex and challenging conditions to define,
communicate therapeutically, and measure within the therapeutic relationship (Cornelius-
White, 2007; Greenberg & Geller, 2001; Truax & Carkhuff, 1967; Wyatt, 2001).
Incongruence was demonstrated most frequently through therapists’ automatic, rote, and
robotic verbal responses and through stiff, slow body movements and fidgeting. These
findings are consistent with Barrett-Lennard’s (1962) conclusion that incongruence was
demonstrated through inconsistency between verbal and nonverbal communication and
indications of discomfort and anxiety.
Setting limits and returning responsibility with children appeared to pose the biggest
challenges to therapist congruence and unconditional positive self-regard. Play therapists
experienced more self-doubt and became more self-critical in these moments and often
compared their responses to external authorities or play therapy training models. Although
providing models for setting limits or facilitating children’s self-expression and self-
direction can be helpful, it is important for play therapists to develop their own genuine
ways of responding based on their own empathic and accepting experiences of the child in
the moment.

Unconditional positive self-regard (UPSR)

UPSR emerged as a critical dimension of play therapists’ abilities to experience and
communicate CONG, UPR, and EU. Our findings were consistent with person-centered
Table 2. Therapist experiences and behaviors when attitudinal conditions are present.

Condition Internal experience of play therapists Behaviors of play therapists Examples of therapist’s verbal statements

CONG Feeling free, spontaneous, and natural in Talking in a natural tone and rhythm
interactions with child* Moving and responding in a fluid,
Being aware of own thoughts, feelings, and spontaneous, and natural manner
experiences Verbalizing therapeutically relevant “That surprised me.”
Being open to own thoughts, feelings, and personal feelings and experiences to “That makes me nervous.”
experiences child
Accepting own feelings, thoughts and Making “I” statements that reflect “I’m not sure what you want me to do.”
experiences* therapist’s experience in the relationship “I’m a little worried you may fall.”
Considering and balancing own needs with
child’s needs
Being aware of breaks or deficits in CONG, EU,
UPR, UPSR
Wanting to understand child
Wanting to accept child
Wanting to be present and attentive
Person-Centered & Experiential Psychotherapies

(continued )
127
Table 2. (Continued).
Condition Internal experience of play therapists
UPR Valuing all aspects of child’s play and self-
expression
Trusting child to lead play
Trusting child to lead therapist
Trusting child’s motivation/reasons for play/
behavior
Accepting ambiguity of child’s play/process
Understanding how child perceives therapist
128
Behaviors of play therapists Examples of therapist’s verbal statements
Responding verbally to child’s positive and
negative feelings/behavior
Following child’s directions “Show me what you want me to do.”
Seeking clarification or guidance from “Do want me to sit down or stand up?”
child* “What should I say?”
Moving in closer physical proximity to
child
Openly receiving toys/objects from child
Being physically open to child
Accepting criticism/correction from child* “I was wrong.”
“You didn’t want me to do it that way.”
Accepting disruptions/changes in child’s “You changed your mind.”
play “You’re done with that.”
Accepting child’s verbal, physical, or “You don’t want me to see what you’re doing.”
emotional rejection of therapist
Accepting child’s negative and/or positive
perception of therapist*
Reflecting intention for child’s questions “You’re wondering what I do away from here.”
K.M. Jayne and D.C. Ray
“You’re not sure about that.”
Allowing child to struggle with a task or
experience
Leaning towards child
Tilting head to see child/child’s play
Avoiding teaching or correcting child
Avoiding setting nonessential limits*
Changing verbal response due to child’s “That one didn’t work. [corrected by child] Oh, it
correction/clarification did.”
“You’re showing your muscles. [corrected by
child] Oh, that’s not what you were doing.”
(continued )
Table 2. (Continued).
Condition Internal experience of play therapists
EU Wanting to be present and attentive to child
Wanting to understand child’s experiences
Understanding meaning/significance of child’s play
Being open to child’s negative/painful experiences
Wanting to avoid disrupting child’s play/process
Understanding child’s intentions
Understanding child’s needs
Understanding motivation for child’s behavior
Understanding impact of the child’s external (home,
school, etc.) environment on child
Wanting to help child when child is struggling
Valuing process of child’s play more than outcome
Knowing what child needs from therapist in the
moment
Understanding how child perceives therapist verbal
responses/behaviors
Understanding how child experiences limit-setting
Appreciating correction from child*
Behaviors of play therapists Examples of therapist’s verbal statements
Matching child’s physical movements
Matching child’s facial expression
Matching child’s affect with tone,
inflection, and volume
Matching child’s paraverbal expressions
Matching child’s energy/activity level
Reflecting child’s feelings in a manner that
matches child’s experience
Reflecting child’s feelings to better
understand child’s experience
Leaning towards child
Making eye contact with child
Answering child’s questions honestly/ CH: How many minutes left?
openly TH: We have 15 minutes left today.
CH: Have you heard any songs?
TH: Yes, I’ve heard some songs.
Helping child when asked for assistance
Staying in child’s metaphor/symbolic play
Responding to objects and character’s “Mmm. Snake [referring to toy] got him.”
actions “The bad guys [referring to toys] are telling him
they are gonna get him.”
Responding to objects and character’s feelings “Whoa. That surprised him [referring to toy].”
“He’s scared [referring to toy].”
Adapting quickly to change or movement in “Oh. I’m in your way [moving out of way].”
child’s play
Person-Centered & Experiential Psychotherapies
Seeking clarification, direction, or guidance
from child*
Accepting child’s perception of experience,
play, and/or therapist*
Avoiding setting nonessential limits*
Changing verbal response due to child’s
correction/clarification*
Turning towards child
129
Using previous experience with child to
respond to child in the moment
Attending to child’s face and body during play
(continued )

Table 2. (Continued).
Condition Internal experience of play therapists
UPSR Accepting own feelings, thoughts, and
experiences
Accepting breaks or deficits in CONG, EU, UPR,
UPSR
Accepting own mistakes
Accepting own inaccurate responses to child
Feeling free, spontaneous, and natural in
interactions with child*
Feeling capable of responding to child’s needs,
experience, play, and/or behavior
Appreciating correction from child
Note: CONG, congruence; UPSR, unconditional positive self-regard; EU, Empathic understanding; UPR, unconditional positive regard.
130
Behaviors of play therapists Examples of therapist’s verbal statements
Refocusing attention on child
Accepting criticism/correction from child* “You are really mad at me. You wanted me to do
it that way.”
“I’m wrong again.”
Accepting child’s verbal, physical, or “You went where I couldn’t see you.”
emotional rejection of therapist
Accepting child’s perception of experience
and play*
Accepting child’s negative and/or positive “You think I’m stupid.”
perception of therapist* “You are really impressed [by therapist].”
K.M. Jayne and D.C. Ray
Changing verbal response due to child’s TH: That one didn’t work out this time.
correction CH: Yeah, it did.
TH: Oh, it did.
 Person-Centered & Experiential Psychotherapies
Table 3. Therapist experiences and behaviors when attitudinal conditions are absent.
Internal experience of play therapists in
Condition session
CONG Questioning self
Criticizing self
Doubting self
Being dismissive or avoidant of own
experience/feelings
Feeling distracted by external
environment and/or factors
Feeling distracted by own thoughts
UPR Valuing some aspects of child’s play,
behavior, and/or experience more
than others
Wishing child would behave or play
differently
Wishing child would be or feel
differently
Feeling reluctant to follow child’s lead
Feeling threatened emotionally or
physically by child or child’s play
Feeling bored or disengaged from child
EU Needing to understand meaning of
child’s play
Expecting child to play or behave in
certain ways based on own values or
prior experiences with child
Being confused or distracted by
changes in child’s play or behavior
UPSR Expecting self to provide conditions
perfectly
Expecting self to meet all of child’s
needs
Expecting self to always respond
effectively to child
Expecting self to always make accurate
verbal reflections to child
Expecting self to always understand
child’s experience, play, and/or
behavior
Comparing self to external authority or
prior instruction
Questioning own competence or
abilities
Being self-critical
Being self-focused
Rejecting own experiences/feelings
Rejecting aspects of self
Note: CONG, congruence; UPSR, unconditional positive self-regard; EU, Empathic understanding; UPR,
unconditional positive regard; *multiple categories.
131
Behaviors of play therapists in session
Setting limits that are nonessential
Avoiding setting limits that are essential
Responding to child in a rote, robotic,
or flat manner*
Responding automatically to child with
prepared or practiced responses*
Moving in a stiff, inflexible manner
Fidgeting or shifting body position
frequently
Responding exclusively or primarily to
child’s positive or negative feelings
Responding exclusively or primarily to
child’s positive or negative behavior
Dismissing/ignoring child’s play/
behavior
Dismissing/ignoring child’s experience
Moving away from child physically
Setting arbitrary or rigid limits
Thinking about child’s background or
external environment in session
Returning responsibility automatically
when child asks for help
Conceptualizing child in session
Interpreting child’s play in session
Over or under-responding verbally to
child
Responding to child in a rote, robotic,
or flat manner*
Responding automatically to child with
prepared or trained responses*
Becoming less verbally responsive to
child
Paying less attention to the child in the
moment
Thinking excessively about responses
to child
Making less eye contact with child
Not responding verbally or nonverbally
to certain aspects of child’s
experience
Tensing body
Responding more slowly or out-of-sync
with child
132 K.M. Jayne and D.C. Ray

and CCPT authors’ understandings of the role of therapist UPSR in play therapy practice
(Bozarth, 2001b; Landreth, 2012; Ray, 2011; Wilkins, 2010). As therapists experienced
greater self-acceptance they were able to demonstrate greater acceptance towards children.
The demonstration of UPSR was most transparent in interactions when children were
expressing negative thoughts, feelings, and behaviors in their play, towards themselves, or
towards the therapists. UPSR was conveyed in the therapist’s ability to openly accept
criticism, feedback, and correction from children. As therapists experienced greater self-
doubt, self-criticism and held untenable expectations for themselves, they had difficulty
responding in an accepting and open manner towards children. Deficits in UPSR were
most often expressed through the therapists’ verbal and nonverbal unresponsiveness
towards children.

Unconditional positive regard (UPR)

UPR was most often expressed through a play therapist’s trust in the child, the child’s
intentions and motivations, the child’s process, and the child’s self-direction. Several key
aspects of communicating UPR in CCPT emerged from the analysis. Reflecting or
responding to the total experiencing of the child was essential to the communication of
UPR. When play therapists experienced and conveyed UPR they responded verbally to
both positive and negative aspects of a child’s experience and/or behavior rather than
focusing exclusively on positive aspects of the child’s being. Tolan (2012) described this
dimension of UPR in terms of therapists attending to both the client’s self-actualizing
tendency as positive and forward-moving and to the client’s potentially negative or
limiting self-structure. UPR was also conveyed consistently through play therapists’
openly receiving and accepting children’s’ criticism, correction, feedback, and perceptions
of the therapist and through play therapists’ accepting changes or disruptions in the child’s
play.

Empathic understanding (EU)

Essential to the experience and communication of EU was the concept of matching. When
EU was realized in CCPT, play therapists matched the child’s movements, tone, affect,
volume, facial expression, and paraverbal expressions. The play therapists’ physical
movements and nonverbal and verbal expressions paralleled the child in a natural and
flowing manner. Hatfield, Rapson, and Le (2011) highlighted the mechanisms of facial
mimicry, vocal mimicry, and postural mimicry to increase empathy based on the evidence
that “people tend to feel emotions consistent with the facial, vocal, and postural expres-
sions they adopt” (p. 24). According to Hatfield et al., the natural processes of emotional
contagion and feedback allow people to enter into one another’s emotional experience.
Although the play therapists’ were often unaware of their matching behaviors in the
moment, this imitation and mirroring served to promote their experience and demonstra-
tion of empathy.
Cognitive aspects of EU also emerged as central to the play therapist’s ability to enter
into the child’s world and communicate empathy. When play therapists could not under-
stand meaning of a child’s behavior or the child’s play was unexpected, they had more
difficulty experiencing and conveying empathic understanding. Alternatively, understand-
ing contextual factors such as a child’s developmental history or family dynamics often
facilitated therapists’ experience and demonstration of empathy. Therapists’ prior knowl-
edge and experience with a child served as both a facilitator and a barrier to EU within
 Person-Centered & Experiential Psychotherapies 133

CCPT. Therapists often used their understanding of a child’s home environment, family
relationships, or previous play behaviors to more fully enter into the child’s present frame
of reference. Therapists were able to identify connections between a child’s play or
behavior and their experiences at home or to identify themes across sessions that allowed
them to respond more empathically to the child. However, when children acted or played
in a manner that was inconsistent or grossly different from previous sessions play
therapists’ often struggled to stay with the child’s present experience.
EU was most often conveyed to children through the therapists’ nonverbal and
paraverbal responses to the child. Although verbal reflections of feeling and meaning
were utilized to convey EU, they often served to promote rather than communicate the
play therapists’ experiences of EU. Reflecting the child’s feelings, thoughts, or actions
facilitated the therapist’s movement into greater contact with the child’s experience.
Bozarth (2001a) similarly argued against the equation of empathy with reflective respond-
ing and identified reflection as being for the benefit of the therapist rather than the client.
Empathy may be the intention behind the reflective response, but is not the primary means
by which EU is conveyed in CCPT.

Internal experiences and external behaviors of play therapists

Results of our analysis included examples of play therapists’ internal experiences and
external behaviors when the attitudinal conditions were present and absent in CCPT.
Although we identified numerous external behaviors play therapists use to demonstrate
CONG, UPR, and EU to children, the behaviors could not be separated from the therapists’
internal experience of the attitudinal conditions. The internal experience of CONG, UPR,
and EU preceded and facilitated the expression and communication of those attitudes to the
child. An exclusive focus in training and clinical practice on therapeutic skills or behaviors
appears insufficient for developing and communicating CONG, UPR, and EU in CCPT.
Additionally, we found that even experienced therapists with advanced training in
CCPT used minimally helpful, practiced, or automatic verbal and nonverbal responses in
play therapy sessions. Although breaks in the therapeutic relationship were expected and
therapists’ could not provide the conditions perfectly at all times, it is important to
recognize that utilizing specific skills such as tracking, reflections of feeling, leaning
towards a child, or turning to follow a child’s movement were insufficient and incongruent
when the therapist was not genuinely experiencing empathy and acceptance for the child.
Although communication of the attitudinal conditions to the child is essential to facilitate
growth in CCPT, verbal and nonverbal responses appear minimally beneficial and empty
unless they are genuine expressions of the therapists’ CONG, UPR, and EU.
The results of the study also revealed that therapists often made intentional decisions
about responding verbally and/or nonverbally to a child based on how their responses
facilitated and communicated a specific attitudinal condition. Depending on a therapist’s
internal attitude, the same behaviors or responses conveyed multiple or different condi-
tions in the moment. A therapist’s response to a question posed by a child or to a limit
being broken varied widely based on the therapist’s sense of what the behavior meant for
a specific child in a specific moment, how an individual child experienced the therapist
setting or not setting the limit in a given moment, and what it meant for the therapist to
respond in a certain way in the moment. Conveying the attitudinal conditions in CCPT
includes an awareness of how a specific response or behavior is experienced and
perceived by the child.
134 K.M. Jayne and D.C. Ray

Understanding play therapists’ internal experiences and external behaviors when

CONG, UPR, and EU are present and absent in CCPT may help therapists and supervisors
identify gaps between a play therapist’s attitudes and responses to a child in play therapy.
When play therapists’ are demonstrating specific behaviors, it may be helpful to reflect on
the attitude or internal experience they were having in that moment to develop self-
awareness and inform therapeutic responding. Within the context of a well-established
supervisory relationship, it may also be helpful for supervisors to notice the identified
behaviors symptomatic of the absence of the attitudinal conditions or a break in the
relationship in their supervision of play therapy sessions. The examples of therapists’
internal experiences and external behaviors may be utilized to help therapists gain
awareness of moments where they are more or less genuine, accepting, and/or empathic
and increase therapeutic intentionality in their practice.

Discussion
Although the interactional dynamics and process of the therapist-child dyads were
analyzed through live observations and multiphasic coding of the recorded play sessions,
the participating children’s experiences of congruence, unconditional positive regard, and
empathic understanding were not fully represented in this study. Due to a lack of valid
instruments to measure person-centered conditions for young children (Purswell, 2014),
child participants’ perceptions were not addressed in this study. We recommend further
research to develop additional methods for capturing children’s perspectives and experi-
ences of the therapeutic relationship and attitudinal conditions in play therapy.
The sample of participating therapists in this study was largely homogenous. All of the
play therapists in this study were female, European American, ranging in age from 26–28
years old, and had similar educational and training experiences in CCPT. Rather than
seeking a representative sample, we collected data that was relevant to clarify and
elaborate the emerging categories and theory as is consistent with grounded theory
methods (Charmaz, 2006; Corbin & Strauss, 2008). Although lacking diversity, the
sample of therapists included in this study was consistent with demographic surveys of
play therapists in the US. Lambert et al. (2007) found that 92% of play therapists in the
US were female and 85% were White in their survey of 958 play therapists.
The attitudinal conditions of CONG, UPR, and EU were the primary focus of this
study. However, the attitudinal conditions are only three of the six conditions Rogers
(1957) identified as necessary for therapeutic change to occur. The results of this study do
not provide a complete picture of the therapeutic process in CCPT. Further research is
needed to understand how the conditions of psychological contact, incongruence, and
perception are experienced in concert with the attitudinal conditions in CCPT.

Implications for training and supervision

Although specific behaviors were associated with each of the attitudinal conditions, a play
therapist’s internal attitude and experience of CONG/UPSR, UPR, and EU were central to
how those conditions were conveyed to children in CCPT. Utilizing practiced or auto-
matic responses, learned in early training and not reflective of a play therapist’s true
experience of CONG, UPR, or EU, was often an indication of the restriction or absence of
the attitudinal conditions in CCPT. In many instances, prescriptive or skills-focused
training may have inhibited the play therapist’s experience and ability to convey
CONG, UPR, and EU, and at times, challenged therapists’ UPSR as they questioned
 Person-Centered & Experiential Psychotherapies 135

and criticized themselves based on their original play therapy training experiences.
Although teaching specific verbal and nonverbal skills may be helpful for play therapists
to learn potential means to express the attitudinal conditions, responding skills are
insufficient for promoting the attitudinal conditions in CCPT and secondary to the
therapists’ real experiences of genuineness, acceptance, and empathy. It is essential that
educators and supervisors focus on the person of the play therapist and personal devel-
opment of facilitative attitudes in addition to helping therapists’ develop genuine, perso-
nalized responses that convey these attitudes to children.

Implications for research

Though substantial research has been conducted to explore the impact of relational
variables and the attitudinal conditions on therapeutic outcome with adults, researchers
have primarily utilized self-report instruments and measures of verbal communication
between counselor and therapist to examine the role of CONG, UPR, and EU. Due to the
primarily nonverbal dynamics of play therapy and the primacy of nonverbal behaviors in
experiencing and communicating the attitudinal conditions, continued use of visual
analysis and observational methods in child counseling research is recommended to
further develop understanding of the processes, experiences, and key relational variables
at work within the therapeutic relationship.
The essential nature of the therapists’ internal experiences and attitudes to the ther-
apeutic process in CCPT has further implications for evaluation and measurement of the
attitudinal conditions. The majority of studies on therapeutic outcome in person-centered
therapy and CCPT are based on the measurement of therapeutic behaviors or verbal
responses. Ongoing research is necessary to explore if and how therapists’ internal
experiences and attitudes can be measured or assessed through self-report, observational,
or multiple reporter methods. Additionally, instrument development is needed to create
accurate observational measures to identify therapeutic behaviors and conditions in CCPT.

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