Tools for play therapy

It is a relative judgment and depends on cultural and social standards and values. Because play unfolds in a socially shared context, group norms are appropriate to evaluate the child's play. Ideally, play activity is consistent across developmental dimensions. Several different sources supplied information for the compilation of these last categories. Gender identity assessment was influenced by the writing of Erikson, 8 , 10 , 16 Coates, 17 and Zucker; 18 psychosexual phases were based on the writings of Anna Freud 19 and Peller; 20 separation-individuation phases were based on the writings of Mahler; 21 and the social level of play includes Winnicott's concept of the capacity to play alone.

The adaptive analysis assesses the overall purpose of the play activity for the playing child. These clusters may be placed in sequence in order of their appearance. The concept of a spectrum of clusters of coping and defensive strategies was based on the writings of Vaillant, 23 Perry et al. A final subscale measures the child's awareness that he is engaged in play activity. This subscale condenses several cognitive and affective variables that determine how capable the child is of observing himself at play, or, alternatively, the extent to which he and his surroundings have been completely absorbed into the play.

Depending on the interests of the examiner, he or she may use the CPTI in its entirety or may select only certain scales or combinations of subscales. This level of analysis refers to patterns of the child's activity over time and seeks to assess changes in treatment.

The patterns of segmentation are expected to change over time. For example, the sequence and length of the different segments of the child's activity—Pre-play, Play Activity, Non-play, and Interruption—change in the course of treatment depending on the child's diagnosis and type of treatment. However, this level of analysis will not be addressed in this article. Construction of the instrument required multiple observations of videotaped play therapy sessions.

The associated discussions involved 10 experienced clinicians over a span of 3 years. The authors of the scale gleaned material from these discussions to write a manual defining the primary dimensions of the CPTI and formulating operational definitions for each scale and subscale, with clinical illustrations. A preliminary reliability study was planned using three members of the group as raters.

A videotape montage consisting of eight clinical vignettes was composed by an independent clinician trained to identify the different categories of child activity. The main selection criterion was to find segments that contained at least one segment of play activity and any of the other three child activities Pre-Play, Non-Play, and Interruption.

Table 2 describes the sample. The three raters one psychiatrist, two psychologists were child therapists, each with more than 10 years of clinical experience. They rated the eight vignettes independently, with subsequent discussions of the ratings to improve on the clarity of the segmentation in the manual. Agreement on the segmentation of the child's activity into four categories Pre-Play, Non-Play, Play, and Interruption as measured by the weighted kappa coefficient was 0.

Landis and Koch 27 furnished criteria to assess the level of agreement between judges as calculated from the kappa: 0. Two raters one psychiatrist, one psychologist completed ratings for level two. Analysis of the play activity segments was done by using intraclass correlation coefficient ICC 28 for ordinal categories of the CPTI and kappa for the nominal ones.

Jones et al. Among the Structural and Adaptive scales, good to excellent scores were obtained for all the subscales on these dimensions. These scores ranged from ICC 0. Despite acceptable levels of agreement between raters on many of the subscales, there were disparities on some subscales, which were attributed primarily to the lack of sufficient specificity in definition of categories in the manual.

A decision was made to revise the scoring manual and refine the definitions. To establish a consensual rating to be used as a standard for new independent raters, the raters of the preliminary study performed an item-by-item analysis of the ratings of the eight vignettes.

Three independent raters, recruited from different institutions, rated the same eight videotaped vignettes used in the preliminary reliability study.

The raters were all child psychologists, ranging in experience from 1 to 12 years in child therapy. They received 15 hours of training from one of the authors a psychologist. The training consisted of group discussions based on definitions and descriptions of the CPTI scales found in the manual. Eight vignettes were selected from a set of 19 videotaped play therapy sessions by an independent clinician who was trained to identify the different Level One categories of Child's Activity, namely Pre-Play, Play, Non-Play, and Interruption.

The main selection criterion was to find segments that contained at least one Play Activity, defined as a narrative with a beginning and an end, and any of the other three Child Activities. Also, the vignettes were chosen to provide a varied array of child diagnoses, levels of therapist experience, and phases of treatment. The duration of the vignettes ranged from 4 minutes, 6 seconds, to 11 minutes, 34 seconds, with a mean of 7 minutes, 47 seconds, and a standard deviation of 2 minutes, 37 seconds see Table 2.

To maintain each rater's accuracy, ratings sessions were split into two parts, as suggested by Hartmann, 31 each part consisting of the CPTI-based rating of four vignettes followed by a discussion with the trainer. After the submission of the whole ratings, discussion and comparison with the authors' consensus ratings were conducted. Reliability estimates were obtained for the degree of agreement of each individual rater with the consensus.

The raters contributed to the clarification of the manual categories and to their training by the exchange of opinions and clinical examples from their own experience. Three types of reliability estimates were derived from data, according to the different types of scales constituting the CPTI and the number of raters used in the experiment.

Reliability of the categorical data obtained from the segmentation of the eight vignettes Level One was appraised by using a weighted kappa. Therefore, the relative importance of different types of disagreement among the four categories of the Child Activity Pre-Play, Play, Non-Play and Interruption was established in order to perform the data analysis. However, weighted kappa is restricted to cases where the number of raters is two and the same two raters rate each subject vignette.

For reliability of the categorical scales from Level Two of the CPTI, namely Category of Play Activity, subscales of Child and Adult Script Description, Topic, Theme, and Gender Identity, a multiple-rater kappa is estimated, 32 , 33 in which the average pairwise kappas are adjusted for covariation among pairwise kappas and chance agreements. For appraising reliability of the remaining quantitative scales of the CPTI ordinal scale ranging from 1 to 5 , an intraclass correlation coefficient is calculated, using a two-way analysis of variance, where the three raters are considered random effects.

Thus, differences at the between-raters level are included as error from the analysis. The choice of this statistic is based on the wish of the authors to generalize the estimated results to raters who have at least 1 year of clinical experience and as much as 12 years of experience, so that the CPTI could be reliably used by a variety of clinicians. Agreement among three raters on the segmentation of a child's activity into four categories Pre-Play, Play Activity, Interruption, and Non-Play as measured by the weighted kappa coefficient was 0.

Interrater reliabilities measured by the kappa coefficient for the twelve categorical subscales of the CPTI indicate an average coefficient of 0. The single exception was 0. The kappa statistic is extremely sensitive to an unbalanced distribution of categories presence versus absence , and this sensitivity accounted for some of the variability in our results.

The intraclass correlation coefficients for the 25 main ordinal subscales of the CPTI—specifically the global scores for Script Description, Affective, Cognitive, Developmental, and Dynamic components; Adaptive functions; and Awareness—show a mean tendency of 0.

Generally, the new raters did almost as well as the authors of the scale and in several instances were able to obtain higher levels of interrater reliability. Each rater's performance was compared with the standard provided by the consensus of the authors of the scale. Results indicate that, overall, satisfactory to excellent agreement with the standard was obtained by all three judges.

Further comparisons were performed for each individual vignette and revealed a similar pattern of results on the main structural categories of the CPTI.

Raters A, B, and C reached good to excellent agreement with the standard. These comparisons were derived from the consensual mean and standard deviation scores obtained for each vignette Table 4. One should note that vignettes that are associated with high mean scores and small standard deviation scores are mainly associated with the middle—advanced and late phases of treatment, whereas low mean scores and large standard deviation scores are associated with vignettes from the beginning or middle phases of treatment.

These preliminary studies demonstrate the feasibility of using the CPTI to measure a child's activity in psychotherapy. The CPTI provides a means to identify play activity within a psychotherapy session. The play activity is then measured from three different perspectives: descriptive, structural, and adaptive. Each of these dimensions consists of individual subscales that are operationally defined. The quantification of these subscales provides both the flexibility to derive individual profiles of play activity in psychotherapy and a methodology to identify relevant dimensions of a child's play activity.

Training procedures established the credibility of these measures in assessing play activity. The independent raters, with varying levels of experience, required 15 hours of training to reach satisfactory levels of agreement. This result is preliminary evidence to suggest CPTI may be a usable tool for researchers and clinicians who receive a minimum of 15 hours of intensive training.

Despite the small number of vignettes used to establish the reliability of the instrument, it must be stated that the vignettes embrace the whole spectrum of the different ordinal scales. The vignettes that showed higher mean scores with smaller standard deviations were associated with the middle—advanced and late phases of treatment; lower mean scores with larger SDs were associated with vignettes from the beginning or middle phases of treatment.

Likewise, the raters were consistently able to make these sensitive distinctions. This disproportionate pattern was likely to lower the reliability coefficient each time a disagreement on the less represented category was encountered. The Separation-Individuation category of the Developmental scale gave results below acceptable standards.

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Homemade play therapy tools can be a refreshing alternative that children will enjoy. Believe me, anyone can make homemade play therapy tools. If I can do it you certainly can.

So many of my play therapy graduate counseling students come to play therapy class thinking they can't make anything creative. My goal is to change their mindset with Play Therapy! By the time they leave class they have build a play therapy doll house, a play therapy puppet theater, a sand tray, play therapy puppets, and more. They leave my class as a Creative Counselor and play therapist. So let's get creative and make our own play therapy tools with the help from Creative Counseling If you still don't want to create your own play therapy toys check out our selection of custom made play therapy doll houses and play therapy sand trays!

My wish is that you will find the benefits of play therapy either as a trained professional play therapist, or play therapy client! I truly hope that Creative Counseling can open the creative doors for your practice with clients! See more Play Therapy Ideas Here:. Learn the History of Play Therapy. What is Play Therapy?