cprt 101 ‐foundations

CPRT 101 – Foundations September 17-19, 2020 Sue C. Bratton, PhD, LPC-S, RPT-S,

Copyright Center for Play Therapy - Permission Required to Copy. Material in this presentation is taken from Child-Parent Relationship Therapy (CPRT): An Evidence-Based 10-Session Filial Therapy Model, 2nd Ed.(Landreth, G. & Bratton, S. 2020) and Child-Parent Relationship Therapy (CPRT) Treatment Manual, 2nd Ed. (Bratton, S. & Landreth, 2020). NY: Routledge. Copyright © 2020, 1

CPRT 101 ‐ FoundationsAttachment and Healing Through

Child-Parent Relationship Therapy:An Evidence-Based Filial Play Therapy Model

September 17‐19, 2020

Sue C. Bratton, Ph.D. , LPC‐S, RPT‐SCertified CCPT‐S and Trainer and Certified CPRT‐S and Trainer

Professor Emeritus and Director EmeritusCenter for Play TherapyUniversity of North [email protected]

Centerforplaytherapy.com evidencebasedchildtherapy.com

Establishing a Safe Space for Sharing and Learning

Respect confidentiality of what is shared By me and youNo audio-video recording

Take care of your needs Check cell phone

CCPT and CPRT Certification Overviewcpt.unt.edu

Getting to Know You Activity

Go to Breakout Rooms

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Group IntroductionsThumbs Up

I have completed CCPT 102

I have completed CCPT Certification

I have completed training in other parenting models

I am a parent

I have the CPRT Treatment Manual with me

Our Time Together

Introduction and Overview of CPRT Rationale for Parent Involvement

Interpersonal Neurobiology Support Research Support / Evidence Base

Fundamental Tenets / Philosophy / Principles CPRT Play Session Structure and Skills (CCPT) Practice Teaching CCPT Skills to “Parents” Strategies for Successfully Implementing CPRT Glimpse of CPRT in Action

Why Caregiver/Child Intervention?Especially for Children Who Have Experienced

Interpersonal Trauma

Involving Parents is Supported by Research

Supported by research on child therapies

Supported by research in neuroscience (Siegel, Perry)

Healing through relationships and experienceIntense caregiver involvement; (repetitive, reparative experiences change the brain)Caregiver’s attunement, empathic understanding and responsivenessCaregiver as co-regulator of emotions and behavior Early, intervention focused on parental responsiveness and secure attachment

SCCAPCEBCNREPP

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Parents hold more emotional significance for their child than does a play therapist

Greater potential for long-term effect

Fostering Secure Attachment is Essential to Child’s Optimal Development Across Lifespan

Developed from attuned, predictable relationship; child has repeated experiences of feeling understood, connected, and protected by the primary caregiver

Parent interaction pattern: emotionally available and attuned/perceptive/responsive

Research on difference in quality of parent responsiveness

Patterns of inconsistently attuned relationships during the first 3 years are connected to the implicit memory system, often leaving the child with an insecure attachment style struggling to make sense of how to be in relationship with others and the environment (Internal Working Model; Siegel, 1999).

LFF Video https://youtu.be/apzXGEbZht0

Neuroscience/IPNB Conceptsfor Use with Parents

Importance of attachment and attunement (mirror neurons) Parent’s role in development of child’s emotional and

behavioral regulation Bottom-up development of the Brain

Lower level needs over-ride higher level functioning hand model of the brain

Brain Functioning: Left-Right Hemispheres of Brain Children live in their right brain; Adults tend to live in their left brain

**For adoptive-foster families (and others with disruptive attachment experiences): more emphasis on neuroplasticity and repetitive experiences to rewire the brain and the role of implicit memory

https://youtu.be/VNNsN9IJkws

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https://www.youtube.com/watch?v=gm9CIJ74Oxw

Attuned, responsive caregiver facilitates child’s emotional regulation and attunement.

Because of mirroring neurobiology, “one of the best ways to help someone else be calm and centered is to calm and center ourselves…” Perry & Salavitz, 2006, p. 245).

Involving Parents/CaregiversWhen and How, Not If

Considerations: Child’s attachment/trauma history and present needs Parents attachment/trauma history

At extreme, parent’s unconscious/implicit behavioral re-enactments may be harmful

Current level of distress in p-c relationship

Informal screening of P-C dynamics:• Your knowledge of family dynamics• Structured or Unstructured P-C Play Assessment

Play therapy and parent consultation vs. family play therapy vs. CPRT/filial therapy (group vs. individual)

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Child-Parent Relationship Therapy (CPRT)

History of CPRT / Filial TherapyFilial Therapy was developed by Bernard and Louise Guerney in

the early 1960’s Based on their belief that parents hold greater emotional

significance for children than therapists and that parents could learn skills to be change agents

Further refined by Garry Landreth in the 1980s This model was manualized and formally named: Child-Parent

Relationship Therapy (CPRT): A 10-Session Filial Therapy Model by Landreth & Bratton in 2006.

The revised 2nd edition text (Landreth & Bratton, 2020) and treatment manual (Bratton & Landreth, 2020) expanded to include 5 separate protocols (and “Evidence-Based” added to title)

Other contributors: Rise vanFleet and Barry Ginsburg

Why CPRT?

Emphasizes creating warm, lasting memories

What do you want your child to remember 20 years from now?

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CPRT Focuses on Parents’ Strengths and Belief in Their Capacityto Be Therapeutic Agentsin Their Children’s Lives

Rather than focusing on correcting parenting behaviors

…because parents already feel guilty enough!

CPRT Attends to The Needs of Both Parent and Child

The P-C relationship is a reciprocal experience; both parent and child contribute to relationship stress

Yet, the parent has more potential to influence and change negative cycle of interactions

Parents need emotional support and experiences that allow them to begin to view themselves in a more positive light (self acceptance) in order to respond to their child’s attachment needs in a positive manner

Definition of CPRT/Filial Therapy

Intervention and preventative approachParents are trained to become therapeutic change

agents—under the close supervision of a trained CCPT play therapist.

Parents learn CCPT principles, attitudes and skills and practice these skills in weekly, structured play sessions with their children

Parent-child relationship is enhanced and strengthened, resulting in change in the parent and the child

Unique group format that includes balance of supporting parents, didactic instruction and direct supervision

Teachable Moment 00-1:20 Facilitating Insight 4:09-4:55 and 4:56-6:15

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CPRT - Filial Therapy Model

Foundation: Humanistic / CCPT Principles CPRT is a CCPT delivery system with the parent

serving as the therapeutic agent Attachment theory Systemic intervention Informed by neurobiology research Protocolized, yet flexibly responsive to unique needs

of families across populations and cultures Intended for use by experienced CCPT therapists trained

and supervised in CPRT Clinical judgement takes priority over rigid adherence to

protocol

Culturally Responsive Intervention(Review Chapter 22 in Bratton & Landreth, 2020)

Results of several CPRT studies support it as an effective intervention for specific racial and/or ethnic populations in the U.S., e.g. Latinx, Black/African Americans, Native Americans, and Asians/Asian Americans as well as internationally (Bratton & Swan, 2020)

CPRT allows for the empowerment of parents---important when working with parents who face oppressive factors that disempower them

CPRT honors the more collective orientation that many minoritized populations share by working with the parent-child dyad and conducting the intervention in a group format

Fundamental Theoretical/ Philosophical Tenets Grounded in CCPT

Relationship-based intervention that fosters attunement & secure attachment

Healing only occurs in context of secure relationship

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Breakout RoomsGroups of 4-5 (20 minutes)

Who will be the recorder/reporter?

Share three core beliefs/principles that you see as the heart of CCPT

Which 1-2 do you see as most relevant to CPRT with parents?

Which 1 do you believe parents will find most difficult to embrace?

My picks!

Unwavering Belief/Trust in the Child’s Innate Capacity for Growth Towards

Unique Potential

Focus on the child and the child’s underlying needs,

rather than the problem video

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Help parents be responsive to the child’s feelings and needs, rather than reacting to the child’s behavior (interactive Hand Model of the Brain)

Based on a belief in the child’s inner wisdom and capacity for self-direction…

Focus on nurturing child’s internal locus of control and evaluation

Focus on fostering self-regulation (through co-regulation) rather than attempting to control/change the child’s behaviorKT/KLT

Whereas, other widely-used, evidence-basedmodels focus on external reinforcers, e.g. praising and ignoring in order to change child’s behavior, thus foster child’s external locus of control AND are not compatible with CPRT Video clip 3-Kazdin Method Video clip 1-CM Video clip 2-Mom/2 Boys

Share Your Reaction/Experience

Video EL/FL – Singing Princess

Compatible Parenting Models/Resources

Note: TRaymond.mp4he majority of

Other parenting models with similar attachment focus, but include substantial differences, e.g. Theraplay; Trust Based Relational Intervention (TBRI), Attachment Focused Parenting

Caution: Most parent programs are behaviorally-based with a goal to teach parents strategies to control their children

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Mechanism of ChangeBased on CCPT

Listening Partners

The child’s changed experience within the parent-child relationship is the factor that is most meaningful and healing. The child must experience UPR (being “seen,” fully accepted, and delighted-in)

Objective: For child to begin to experience his parent differently, initially during the

30 minute weekly playtime(Guerney, 1964; Badenoch, 2008)

And reciprocally, for parents to begin to experience their child differently

The Heart of CPRT:“Just You and Me Time”

(Special Play Time)

A “special” one-on-one time between caregiver and child that allows the child to experience full acceptance (without questions, advice, teaching, directing) Poem: Where Will I Go?

With therapist support and direct supervision, the parent is allowed to experience, understand, accept, and validate the child’s feelings, needs and perceptions (including distressing experiences)

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Parent-Child Playtimes Provide Right Brain To Right Brain Experience

Weekly “You and Me Time”

Provides parents a “controlled” setting to be intentional in attuning fully to their child and the child’s underlying needs and practice CCPT skills and convey fundamental CCPT Attitudes

“Be With Attitudes”:I am hereI hear you/I see youI understand I careI delight in you!video (W/J)

Playtime Structure

Each parent chooses child of focus 30 minute play time – 1 time per week Carefully selected, consistent time and place

(emphasize consistency and predictability) Special kit of select toys used only during weekly

play time Parents video record play sessions (typically at

home) and bring to the next CPRT session on assigned weeks to receive feedback and support

Fundamental CPRT Concepts

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Be a ThermostatNot a Thermometer

When Your Child is Drowning, Don’t Try to Teach Her to Swim

What May Be Most Important Is Not What You Do,

But What You Do After What You Have Done

A Secure Parent-Child Relationship Lays the Foundation for Future

Relationships and Can Have Intergenerational Effects

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CPRT/Filial Therapy Research

Over 40 Studies on process and outcome of CPRT with diverse populations, issues, & settings; Over 25 control group designs (over 15 RCTs) show statistically

significant findings and moderate to large treatment effects (Limitations to Findings: Parent Self-Report)

Two play therapy meta-analyses show moderate to large treatment effects for CPRT (Lin & Bratton, 2015; Bratton, Ray, Rhine, & Jones, 2005)

Currently conducting CPRT only meta-analysis

Manualized Protocol: Helps Ensures Treatment IntegrityMajority of studies conducted under supervision of Landreth or Bratton

Effectively Applied with Diverse Populations and Presenting Issues

and in a Variety of Settings

And Shown Effective When Delivered in Schools by Teachers

Also see research data base to identify studies with diverse populations which include specific adaptations

and strategies

evidencebasedchildtherapy.com

Low Income Immigrant Hispanic and Latinx Low Income Black/African American Immigrant Korean Immigrant Chinese in U.S. and in Canada Native American (living on reservation) Korean Israeli German Iranian (2) Studies underway in Turkey and the UK

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Adopted/Fostered Children (2 RCTs)

Child Witnesses of Domestic Violence

Child Victims of Sexual Abuse

Children of Incarcerated Fathers

Children of Incarcerated Mothers

Chronically and Terminally–Ill Children

Low‐Income, At‐Risk Children

Children Diagnosed with Learning Differences

Children Diagnosed with Autistic Spectrum Disorder

Children of Divorced/Single Parents

The Evidence Base for CPRTEvidencebasedchildtherapy.com

CPRT: Evidence-Based DesignationBe an Advocate!

Note: SAMHSA-NREPP website currently not active

Overview of Protocol & Resources

10-Session Protocol (flexible and adaptive) Requires therapist trained in CCPT and CPRT protocols,

and in group facilitation skills Typically small group, 2 hours per week Parent-child play sessions after week 3 (child of focus) Balance of support/didacticCPRT Treatment Manual, 2nd edition includes Companion Website (link) with over 900 pages of materials including:

5 therapist protocols and parent notebooks with handouts Study Guide Training resources, and supplemental materials and handouts

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Overview of 10-Session Protocol

S-1 Overview of CPRT; Reflective Responding S-2 Basic Principles of You and Me Time; Toys; Demo; Role Play S-3 Dos & Don’ts and Procedures; Demo; Role Play (Prep for 1st session)

- 1st Play Session Week Between S-3 and S-4

S-4 Limit Setting; Demo; Role Play; Supervision of 1st Play Sessions S-5 Put it All Together (no new skills); Demo; Role Play; Supervision S-6 Choice Giving; Supervision S-7 Esteem Building; Supervision S-8 Encouragement vs Praise; Supervision S-9 Adv. Limit Setting/Choices; Generalizing Skills; Supervision S-10 Supervision and Closing: Discuss Progress; Resources

CPRT Filial Playtime Skills (CCPT)

Do’s Don’ts

See handout or p. 31 in Treatment Manual

Do: Be-With (most important) Set the stage Let the child lead Join in the child’s play actively, as a follower Verbally reflect/track the child’s play Reflect the child’s feelings Set firm and consistent limits Salute the child’s power and encourage effort Be verbally active

(also see handout: CPRT Cliff Notes for Parents)

Don’t Criticize any behavior Don’t Praise Don’t Ask leading questions Don’t Allow interruptions of the playtime Don’t Give information, teach, or preach Don’t Initiate new activities Don’t Be passive/quiet

When you began CCPT, which was hardest for you? Which do you think would be hardest for parents?

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CPRT/Filial Toy Kit

Real-Life Toys

Acting-Out Aggressive Toys

Toys for Creative and Emotional Expression

Avoid mechanical, competitive, and electronic toys

See handout or p. 22 in Treatment Manual

**If you haven’t gathered your toys yet, select a few from each category from your available toys for role plays.

Let’s Warm-up!Practice CCPT skills in Breakout Rooms:

Groups of 2

Sustained Role play in pairs (parent and child roles):

Switch Roles 5 minutes each

Post practice discussion: which of the DOs do you think will be hardest

for parents and why?

Balance Role of Teacher, Trainer, and Therapist Within the Group Process

Requires therapist to be well‐trained in CCPT CPRT/Filial Therapy, Group therapy process

Must be able to demonstrate and teach play therapy skills, provide constructive, gentle supervision, and facilitate a dynamic group process.

Use of co‐leaders maximizes the strengths of each therapist and can facilitate balance between teaching/training and providing support (video clip)

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CPRT Therapist Qualities

Objective: The CPRT therapist will be viewed as a caring, sensitive, real person, and easy‐going guide who isn’t perfect.

Be warm, empathic, open, personal, and vulnerable. Be intentional about creating a safe environment. Be up‐beat! You must be eager, excited and encouraging to motivate parents to want to come back.

Overview of Essential Teaching / Training Components For Effective CPRT (see handout)

Structure for Success: playtimes, video supervision Balance Didactic and Dynamic/Support Connect: Touch the inner world of the parent Utilize the “3 Ds”

Describe – Demonstrate – Do Provide concrete, specific examples (less is more) Model acceptance, focused attention, and reflection Model fallibility (imperfect expert) Use effective group process: link, normalize, generalize Return responsibility to the group

The 3 “Ds” to Teach the Dosvideo

Describe Demonstrate Do

Breakout: Practice Teaching the CPRT Do’s Groups of 3 – 8 minutes each

Take turns as therapist Describing and Demonstrating one skill/attitude to 2 ‘parents’ and have the ‘parents’ engage in

sustained role play of Dos(followed by feedback and questions and demonstrate)

Take a few moments to review the Dos (handout) Be-with and Allow the child to lead the play Join in the child’s play actively, as a follower Verbally reflect/track the child’s play Reflect the child’s feelings Set firm and consistent limits Salute the child’s power and encourage effort

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Breakout group discussion: What was hardest?

Supervising Play Sessions Encourage and look for strengths Limit corrective feedback (4:1 Rule) Point out Do’s (use poster) Identify shifts in parent and child (insight) Point out moments of connection and delight Point out moments of child receptivity Demonstration of supervision and feedback

(video clip)

Practice giving feedback as time allows B/M Adoptive Family ; Sean/Dad;

Multicultural Considerations Be aware that parents engage in child rearing practices

that come from their cultural background: Be sensitive to the level of congruence that exists between the

CPRT skills and the parents’ cultural background

Engage in self-reflection about your biases and beliefs regarding child rearing. Reflect on how these affect your view of parents and your degree of empathy for parents who come from a different cultural background

Be sensitive to socio-cultural factors affecting the parent-child dyad and the impact on conducting CPRT (e.g. socio-economic status, family characteristics)

Multicultural Considerations Assess the level of intergenerational cultural differences

within the parent-child dyad Be aware of the cultural meaning of play for the parents

and children you serve Choose toys that are representative of the family’s cultural

background Facilitate collection/substitution of toys for low-income

families Recognize that families come in many shapes and sizes and

use inclusive language to represent diverse family compositions

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Multicultural Considerations Be intentional about group composition and how

cultural identities impact members’ sense of cohesion and safety

If you hold majoritized or privileged identities and are working with minoritized parents/caregivers practice cultural humility be sensitive to power dynamics do not assume you know parents’ culture: learn from

parents about their unique family culture consider co-facilitating the group with a member of the

community or co-therapist who has similar identity/lived experience with a specific group of parents

Preparing for CPRT 102 and Beyond

Is this approach a fit with your belief system about what facilitates lasting change in children?

Read and gather resources (see Treatment Manual p. 179) Complete CCPT 102 Practice with a few, non-clinical parents/ children

CPRT Crash Course materials available at https://cpt.unt.edu/webinar-handouts-may-14

Participate CPRT 102 Supervised CPRT Practice (CPRT Practitioner vs. CPRT Associate) Apply for CPRT Certification

Note: only application of the full CPRT practitioner model is evidenced based (not the parent education model)

Thank you for all you do for parents and children!

Remember that YOU (and who you are) are/is making an important difference -

A difference that will not only effect the families you work with, but also impact future generations and ultimately the world!

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cprt 101 ‐foundations

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