Can I Use Play Therapy with TF-CBT?

Two therapeutic methods that have been integrated and show promise when combined are Trauma-focused cognitive-behavioral therapy (TF-CBT) and Play therapy. Can practitioners use play therapy in conjunction with TF-CBT. Let’s dive into the intersection of these two modalities and understand how they can work in tandem.

Quick Look

Integrating play therapy with TF-CBT is not only possible but can also enhance the therapeutic experience for many children. It allows for a more tailored approach, taking into account a child’s developmental stage, preferences, and unique needs. By harnessing the power of play and the effectiveness of TF-CBT interventions, therapists can tap into a child's inherent ability to heal, grow, and overcome traumatic experiences.

by Georgie Wisen-Vincent, LMFT RPT-S

Director, Play Strong Institute

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What is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)?

TF-CBT is a short-term, evidence-based treatment designed to help children and adolescents (and their families) overcome the negative effects of traumatic experiences. It’s specifically tailored to address Post Traumatic Stress Disorder (PTSD) and related conditions.

TF-CBT is structured around several core components, often remembered by the acronym 'PRACTICE':

Psychoeducation: Educating the child and caregiver about trauma and its effects.
Parenting skills: Enhancing the caregiver's capacity to support the child.
Relaxation techniques: Helping children and caregivers manage trauma-related stress and arousal.
Affective modulation skills: Assisting children in identifying and managing their emotions.
Cognitive coping and processing: Challenging and modifying unhelpful beliefs related to the trauma.
Trauma narrative and cognitive processing: Helping the child create a detailed account of their traumatic experience, followed by the reprocessing of this narrative to build a healthier perspective.
In vivo exposure: Gradually and safely confronting situations that the child may be avoiding due to trauma-related fear.
Conjoint child-parent sessions: Enhancing the communication between the child and caregiver regarding the traumatic event.
Enhancing safety and development: Teaching skills to reduce the risk of future harm and promoting optimal development.

What is Play Therapy?

Play therapy is a modality that uses play, a natural medium of expression for children ages 3-12, to help them share their feelings, solve problems, and understand their experiences. Play therapists employ a variety of techniques, including games, art, and toys, to create an environment in which the child feels safe and encouraged to explore deeper emotions and conflicts.

Integrating TF-CBT and Play Therapy

Playful TF-CBT uses play therapy techniques consistent with each of the components to engage the child in a developmentally appropriate approach (Cavett, 2016). Sueann Kenney-Noziska (2012) has developed a number of playful TF-CBT techniques for younger children.

Why might it be helpful to use playful TF-CBT?

Natural Medium of Communication: Play therapy serves as a child's natural language. Incorporating play into TF-CBT can make the therapy more accessible and engaging for the child, thereby enhancing the therapeutic relationship and facilitating the exploration of traumatic events.
Facilitating Trauma Narration: One of the core components of TF-CBT is trauma narration, where the child is encouraged to share about their traumatic experience in order to reduce self-blame and consider new ways of coping. For many children, directly narrating a traumatic event can be challenging. Play therapy provides an alternative medium to express and process these memories.
Safety and Boundaries: Play can provide a safe distance from the trauma, allowing children to explore their feelings and memories at their own pace. Using toys and games, children can externalize their experiences, making them less threatening.
Enhanced Engagement: For younger children or those who might be hesitant to engage in direct conversation about their trauma, play therapy can enhance engagement into the therapeutic process.
Flexibility for Therapists: Integrating play therapy offers therapists additional tools and techniques to tailor their approach based on a child's unique needs, developmental stage, and preferences.

Considerations

While integrating play therapy with TF-CBT can be immensely beneficial, it's essential for therapists to:

Stay Trained and Updated: It’s crucial to have appropriate training in both TF-CBT and play therapy to integrate them effectively.
Avoid Re-traumatization: Therapists should be cautious and ensure that the play does not re-traumatize the child. It is essential to provide safe psychological distance for the child in session, striking a balance between allowing the child to process trauma and ensuring they are not overwhelmed.
Involve Caregivers Where Appropriate: As with all child-centered therapy, the involvement of caregivers is vital if it is possible. They can provide insights, support, and reinforcement of therapeutic practices at home. Some situations may not allow enough safety for the child to include the caregiver, so use sound clinical judgement before inviting caregivers to participate.