effective parent consultation in play therapy

International Journal of Play Therapy, 15(1), pp. 87-100 Copyright 2006 APT, Inc.

EFFECTIVE PARENT CONSULTATION IN PLAYTHERAPY

Jennifer Cates Tina R. PaoneCentral Washington University Monmouth University

Jill Packman Dave MargolisUniversity of Nevada Practicing Clinician

Abstract: Effective communication with caregivers can contribute tosuccessful play therapy outcomes. This article examines the structure of parentconsultation in play therapy. The components of effective parent consultationare outlined, from the initial phone interview through termination, to provideguidance to play therapists for communicating with caregivers throughout thetherapy process.

A thorough review of the literature suggests that authors agreeon the importance of parent consultation in maximizing the benefits ofplay therapy (Kottman, 2003; Landreth, 2002; McGuire & McGuire, 2001;Van Fleet, 2000). Much has been written on the concept of parentconsultation in various play therapy books; however, a briefconsolidation of the important points in the consultation process may beof benefit to play therapists looking to increase their understanding oftherapeutic collaboration with caregivers and how communicationaffects the outcome of the play therapy process.

Parent consultation in conjunction with play therapy has beennoted to improve the chance of successful treatment (Kottman & Ashby,Jennifer Cates, M.A., MFT, NCC, is a doctoral candidate and assistant professor at CentralWashington University. Tina Paone, M.A., RPT, NCC, is a doctoral candidate and assistantprofessor at Monmouth University. Jill Packman, Ph.D., RPT-S, NCC, is an assistantprofessor at the University of Nevada, Reno. Dave Margolis, M.A., MFT, provides playtherapy to children in the Chicago, II area. All correspondence regarding this article can besent to Jennifer Cates at the University of Nevada, Reno, Department of Counseling andEducational Pyschology, MS 281, Reno, NV, 89557.

88 Cates, Paone, Packman, & Margolis

1999). According to Landreth (2002), helping caregivers understand theprocess of play therapy may be one of the most important tasks of a playtherapist, as caregiver cooperation is essential in order to get a child intotherapy. However, play therapists sometimes avoid thorough parentconsultation due to a lack of understanding of the process or of thecaregivers. Following parent consultation guidelines may help tocounteract a play therapist's hesitancy to work closely with caregivers.Additionally, a clear structure for consultation may minimize caregivers'defensive reactions and increase the chances of a positive response totherapeutic recommendations (Kottman & Ashby, 1999).

Play therapists that listen to, validate, and build a therapeuticrelationship with caregivers create partners who are willing and able toalter the attitudes, perceptions, and behaviors necessary to support theirchild's treatment (Kottman, 2003). Caregivers who are uninformed aboutthe process of play therapy are more likely to terminate their child'streatment simply for a lack of understanding of what is occurring duringtherapy (Athanasiou, 2001; Berryman, 1957). A number of factors mayinfluence a caregiver's decision to terminate a child's treatmentprematurely. Among these factors may be doubts about the value oreffectiveness of play therapy, unrealistic expectations of quick fixes, andthe expected use of talk therapy. It has been suggested that there is apositive relationship between the accuracy of caregiver expectations oftherapy and the number of kept appointments (Shuman and Shapiro,2002).

Caregivers' motivations for seeking therapy for their child mayalso impact the level of participation in the process, especially if court-ordered or coerced into the counseling process by a spouse or partner(Van Fleet, 2000). Caregivers are frequently the most important people ina child's life, so caregiver resistance to play therapy has the potential tohinder the treatment process, producing less than optimum outcomes(Van Fleet, 2000). However, if the therapist focuses on developing atherapeutic relationship with the child as well as the child's caregivers,chances for the child's successful completion of treatment can beincreased (Van Fleet, 2000; LeBlanc & Ritchie, 2001). In conceptualizingcommunication strategies, it is important to consider caregivers'

Parent Consultation in Play Therapy 89

motivations for seeking play therapy and their expectations about theprocess.

Initial Parent Contact - By PhoneFrom the initial communication with caregivers until the last, a

therapeutic intention can be planned and modeled. It is important toremember that caregivers seeking counseling for their children may beexperiencing a multitude of uncomfortable thoughts and feelingsthemselves (Holmberg & Benedict, 1997; Landreth, 2002). In order to joinwith the caregivers, attending skills may be useful so that they have asense of being understood by the therapist. Caregivers may often befeeling frustrated, guilty, afraid, or confused about what to do for theirchild. Therefore, it may be helpful for the therapist to be responsive tothe dynamics underlying a caregiver's communication of the presentingissues by using reflective listening (Landreth, 2002). With this sensitivityin mind, efforts are made to gain a preliminary understanding andhistory of the presenting issues. However, limiting reflective statementsmay be important to minimize the length of a phone conversation. Often,sensitive issues, such as detailed caregiver concerns, are better suited forthe intake session.

Sharing of the basic structure of the play therapy process mayalso be helpful to include in the initial communication with caregivers.Explanation of fees, session time and length, and expectation of caregiverinvolvement are appropriate to discuss. A short explanation of playtherapy and the therapist's theoretical approach to the process of playtherapy is recommended (Kottman, 2003). During this initial contact it isalso suggested that the therapist take the opportunity to briefly explainthe rationale for use of play versus talk therapy for children, includingthe nature of the therapeutic relationship and its potential for a positiveimpact on the child's development in all domains - physically,emotionally, cognitively, socially, and spiritually (McGuire & McGuire,2001). At this point, it may be important to be as concise as possible inorder to not inundate the caregivers with too much information.Allowing time to ask questions during the course of the initialcommunication can contribute to the building of a therapeutic alliance


between the therapist and caregivers, which is essential to the child'ssuccess in therapy (Webb, 1999).

Intake SessionIdeally, the intake session is face to face with the caregivers only.

If at all possible, both parents should be invited and encouraged toattend the intake session. Any adult figure who is involved in the child'slife can provide important information about the child and familydynamics, as well as have a significant impact on the child throughoutthe course of therapy. The initial meeting without the child present willallow caregivers to openly express their concerns, as well as create anopportunity to continue to build a strong caregiver/therapist alliance(McGuire & McGuire, 2001). The primary goals of this initial session areto continue to establish rapport, gain a clearer understanding of thecaregivers' reasons for seeking counseling for the child, establishpreliminary treatment goals, and to further educate the caregivers aboutthe play therapy and parent consultation processes (Kottman, 2003;McGuire & McGuire, 2001).

Cultural Considerations. It is important to reflect the values andworld views of all families through creating a culturally sensitiveorganization (Gil & Drewes, 2005). Having bilingual staff members anddesigning a reception area that is reflective of a diverse societydemonstrates a commitment to inclusiveness for all clients and may beimportant for establishing rapport with racial/ethnic minority families.Decorations and reading materials can be selected to represent a varietyof cultural groups. In addition, setting up the play therapy room withculturally sensitive arts and crafts, toys, dolls, and games will benefitfamilies from all five major racial/ethnic backgrounds. In their book, Giland Drewes (2005) provide a detailed list of resources for selectingreading materials and culturally appropriate play therapy items.

Establishing rapport. Just as in all sessions, attending skills areessential during the intake session. McGuire & McGuire (2001)recommend the use of the "question-response-reflect cycle" in order toassure that caregivers are understood and validated. This consists of thetherapist asking questions about the presenting problem, the caregiver


responding, and the therapist reflecting these responses. Use of this cyclewill aid caregivers in expressing their feelings, clarifying their thoughts,and eventually establishing goals for treatment. In this first meeting, itmay also be helpful to encourage caregivers for their strengths and notewhat they are already doing well in order to help them reconnect with asense of hopefulness and self-respect (Kottman, 2003). McGuire &McGuire (2001) note that only after trust is developed can the therapistbegin to gather data.

Gathering data. Landreth (2002) and Kottman (2003) bothrecommend gathering background information in order to developrapport and increase understanding of therapeutic goals. Kottman, inparticular, encourages gathering a detailed history of the problem, adevelopmental history of the child, and information about daily routines,family interactions, and past trauma. Some useful tools for gatheringdata include: the Vineland II Adaptive Behavior Scale for Children -Parent/Caregiver Rating Form (Sparrow, Cicchetti, & Balla, 1984), theChild Development Inventory (Ireton, 1992), and the BehaviorAssessment System for Children- Structured Developmental History(BASC, SDH) (Reynolds & Kamphaus, 1992). These assessments canprovide information about a child's experiences at school, changes in thehome environment, or late or early developmental milestones whichmay give the therapist insight into the origin of the problem. In additionto finding out specific information about the child, it may be useful todiscuss what other issues in the family are affecting the child's behavior.When appropriate, the play therapist may recommend that caregiversseek out individual or couples counseling, or refer them to othercommunity resources, such as parenting classes or self-help groups(Kottman, 2003; Landreth, 2002).

While gathering data the therapist should inquire about culturalfactors that may influence the relationship with the child and family. Inorder to gain a more complete understanding of what behaviors arevalued and considered normal by the child and family, it may be helpfulto explore cultural variables, such as race/ethnicity, religious preferences,socioeconomic status, sexual orientation, gender roles, and differences inabilities. Additionally, variation in cultural backgrounds between the


therapist and client may require more time for rapport development andmay need to be addressed directly (Gil & Drewes, 2005). In order tomaintain a positive relationship with caregivers, it may be useful fortherapists to engage in a reflective process, such as consultation orjournaling, in order to process thoughts and feelings. Negativeattributions toward the caregiver that stem from cultural differences canoften arise and interfere with rapport building and undermine therapy.

Explaining the process. Anderson & Anderson (1984) suggest thatproviding caregivers with a good understanding of the play therapyprocess and how it works is important. It is helpful to reiterate therationale for using play rather than talking to their child, as this is thefundamental basis for play therapy. Additionally, it can be helpful fortherapists to predict the general course of therapy by explaining that achild may experience an initial period of improvement, followed by aworsening of symptoms, and then eventual mastery of new behaviorsand acquisition of more positive attitudes toward self and others. It isimportant to communicate that every child reacts differently to playtherapy (Guerney & Guerney, 1989). Caregivers often want to know howlong the play therapy process will take. It may be helpful if caregiversunderstand that children learn and develop at different speeds, andconsequently, treatment length will be determined through acollaborative process tailored to the individual child.

Anderson and Anderson (1984) recommend discussing thatthere are few limitations in the playroom. As long as there is not harm toself, others, or damage of property, the child will be allowed to play asneeded. In their everyday worlds, children encounter many externalrules that they are required to follow. Play therapy offers an opportunityto shift from an external locus of control and gives children a chance toexperiment with their internal values and develop self reliance. Fewerlimits also provide children with a sense of power by allowing them tomake their own decisions and decide what to play with and what to do.It may help if caregivers understand that this freedom of play allowschildren to express feelings and problems. Often, caregivers may beconcerned that their child will expect the same freedom of play at home.Therapists can explain that by developing self reliance and an internal


locus of control, children learn to understand that limits are different invarious settings.

Communicating about play therapy. Along with building thecaregiver/therapist alliance, gathering information, and explaining theprocess, the initial meeting with caregivers presents the opportunity tosuggest ways to introduce play therapy to their child. Avoidingexpressions that suggest that the child is the problem contributes to apositive relationship between the therapist and the child. Phrases such as"fix your problems," "bad feelings," or "therapy" may contribute toderogatory perceptions of self for the child, as well as initial negativeexpectations of therapy (McGuire & McGuire, 2001). Play therapists candemonstrate how to communicate with children about play therapy(Anderson & Anderson, 1984; McGuire & McGuire, 2001). With regard toexplaining to the child where s/he is going, Landreth (2002) recommendsthat caregivers say, "You're going to see [therapist's name] in a specialplayroom with lots of toys for you to play with" (p. 169). If the childwants to know why, caregivers can be taught to say, "Things don't seemto be going well for you at home...," or "Sometimes it helps to have aspecial time just for yourself to share with a special person" (p.169).Within this context caregivers may be taught to reflect their child'sfeelings about attending play therapy in order to relieve anxiety aboutbeing in an unfamiliar situation (McGuire & McGuire, 2001).

Explaining the child's privacy. Many caregivers greet their childafter a play therapy session by asking, "Did you have fun?" or "Whatdid you do today?" Many authors agree that the first meeting is a goodopportunity to help caregivers understand how to communicate withtheir child about their experiences in play therapy (Landreth, 2002).Landreth suggests a discussion about the importance of the child'sprivacy so that caregivers are discouraged from asking their child aboutthe play therapy session when they come out of the playroom. Hesuggests that caregivers instead say, "Hi. We can go home now" (p. 168).It is common for a child to bring an arts or crafts project out of the playroom to show their caregivers. While it is the caregivers' natural instinctto praise the child's project, Landreth recommends that the therapisteducate the caregiver about refraining from praise, instead encouraging


them to focus on reflection of the child's feelings or actions. For example,caregivers can be guided to say, "You're proud of what you did."Additionally, the therapist may explain that s/he will only talk to thecaregivers in general themes about the child's progress (Anderson &Anderson, 1984; Landreth, 2002).

Ethical and legal issues. While the child's confidentiality is of theutmost importance in maintaining the therapist/child relationship, it isimportant that both caregivers and children (depending on thedevelopmental level and age of the child) understand the limits toconfidentiality. These limits vary from state to state but generally includechild abuse, elder abuse, when a child threatens to harm herself orhimself, and when a child threatens to harm someone else. Childrenshould not be coerced into therapy, so it may be helpful for them to givetheir assent to participate in the process. Children are defined by the U.S.Department of Health and Public Service (Penslar & Porter, 1993) asthose who have not yet reached the legal age of consent. These childrentypically fall between the ages of 7 and 17. For all clients, it can behelpful to have both parents give informed consent when possible. If thechild has parents/guardians that live in different homes, Landreth (2002)recommends that the therapist obtain a copy of the most recent courtorder to verify legal guardianship. Therapists are required to haveinformed consent for treatment from all legal guardians before treatmentbegins. Additionally, it is imperative that therapists obtain separatepermission forms before releasing information to anyone other than thelegal guardians or before audio or video recording any sessions.

Playroom tour. Landreth (2002) encourages the therapist to givecaregivers a tour of the playroom and to discuss how the first meetingwith the child will unfold. It may be important for the caregiver tounderstand that the focus will be on the child and that caregiverquestions or comments can be addressed during ongoing parentconsultations. Landreth (2002) also recommends telling caregivers abouthow the initial session with the child will start in that the therapist willstate to the child that it is time to go to the playroom, and that thecaregiver can respond with, "I'll be here when you are finished playing"(p. 170), rather than saying "bye-bye," to let the child know that s/he is


not being abandoned with a stranger. The therapist can explain thatchildren react in many different ways to the first play therapy sessionand that if the child wants the caregiver to come to the playroom, thetherapist will respond for the caregiver and let her or him know what todo (Landreth, 2002).

Setting a consultation structure. The play therapist can create botha play therapy approach and a parent consultation structure that isconsistent with her/his own theoretical orientation. Some approachesmay be long term and more insight oriented, others may be brief andsolution focused, some may focus on family systems and involve manyfamily members, and still others may require less caregiver and familycontact. It is important to pay close attention to cultural factors whencreating a structure for play therapy and parent consultation, so that thetheoretical orientation and approach can be tailored to be consistent withclient value systems. Kottman (2003) recommends emphasizing theimportance of caregiver involvement with their children at home, inschool, and in play therapy. She suggests that therapists talk withcaregivers about the benefits of changing their own behaviors, such asimproving communication and attending consults, in order to help theirchild. Therapists vary in their theoretical orientations and theirapproaches. Some therapists schedule meetings with caregivers once amonth, while other therapists schedule with caregivers as needed orallow for regular contact by phone (Landreth, 2002; Webb, 1999).Kottman (2003) typically allows for twenty minutes with the caregiversand thirty minutes with the child each session. However, she notes thatcaregiver consult time may vary depending on family needs or the playtherapy setting. Creativity and flexibility may be useful whenconsidering caregiver needs, as well as demands on the individualtherapist's time. Landreth (2002) recommends informing the child that acaregiver meeting will be taking place and to meet with the caregiverfirst so that the child does not perceive that the therapist is telling thecaregiver what the child has just done during the play therapy session.


Ongoing Parent ConsultationThe primary goal of ongoing consultation is to continue to

develop and maintain a strong and trusting rapport with the caregivers.Through the use of attending skills and reflective listening, the therapistcan use the consultations to empathize with the caregivers, give updateson the child's progress in play therapy, inquire about the child'sbehaviors, modify treatment goals, provide education, encourageadvocacy, and facilitate appropriate closure of the therapeuticrelationship with the child and the caregivers.

Treatment goals. The therapist may elicit information about whichof the child's behaviors are changing and which of them are staying thesame. It may be helpful to continually monitor whether the goals oftherapy are being met and to clarify understanding of the child'sbehaviors at home, school, and in other settings. This will increase thetherapist's understanding, as well as encourage the caregivers to observetheir child's behaviors. After listening to and validating caregivers'concerns, it may be helpful to inquire about what they see as the child'sstrengths. Reframing frustration and anger as care and concern can helpcaregivers to examine other feelings they may be experiencing and tohelp them increase empathy for the child. Additionally, this willencourage caregivers to notice more of the child's positive behaviors(O'Connor & Schaefer, 1994).

Education. Often, it is difficult for children to maintain changefrom their play therapy sessions without some adjustments in their homeenvironment (Kottman, 2003). It can be helpful to educate caregivers onreflective listening, limit setting, giving choices, validating feelings, andfollowing through with consequences. These are the skills that will havea lasting impact on the caregiver/child relationship and improve thecaregivers' ability to understand and communicate with their child(O'Connor & Schaefer, 1994). Guerney & Guerney (1989) attribute lack ofparenting knowledge, not parent character deficiencies, to childbehavioral problems. Educating caregivers about development andencouraging them to learn about parent/child communication canincrease caregiver curiosity about their child's appropriate and evolvingbehaviors. Morris (1974) also recommends informing caregivers about


the tendency for behavior to worsen temporarily as a new stage ofdevelopment is encountered. For example, as a child begins school, itbecomes important to develop the capacity to work and cooperate withothers. Caregivers may notice an increase in disruptive behavior at homeas children make this adjustment. This kind of caregiver education canalleviate anxiety in response to normal developmental transitions.

Advocacy. Frequently, a child that is participating in play therapywill be struggling in other social contexts besides the home. The therapistcan coach the caregivers on how to advocate for their child at school byteaching them to communicate with teachers, counselors, andadministrators. The therapist can role-model this advocacy by getting arelease from the caregivers to talk with the child's counselor and/orteachers (Sweeney & Homeyer, 1999).

Termination. As play therapists build relationships with childrenand caregivers, proper termination becomes vital. Ideally, terminationoccurs when the caregiver and therapist agree that the goals of therapyhave been met, and the therapist has observed that the child's attitudes,self-expression, and behaviors have changed (Benedict, 2003).Depending on the relationship, it may be necessary to discusstermination over several sessions with both caregivers and children, inorder to make the transition as smooth as possible. Informing caregiversof the importance of this process can prevent abrupt and suddentermination. Additionally, it may be beneficial to prepare caregivers forthe possibility that their child's sadness about no longer participating inplay therapy may be expressed through a relapse in behavior.Encouraging caregivers to continue using the skills they have learnedwhile the child was in play therapy, such as reflecting and limit setting,may be sufficient for addressing these concerns. If, however, thebehavior continues, caregivers should contact the play therapist todiscuss options, one of which may be to schedule follow-up sessions tomake the termination process more gradual for the child and thecaregiver.


CONCLUSION

Parent consultation is referred to by Athanasiou (2001) ascollaborative problem solving, allowing for specific interventionstrategies directly tailored to the caregivers' needs. Upon in-depthexamination it becomes clear that effective work with caregivers is anessential part of the play therapy process. Caregiver/therapist alignmentcan improve child attendance to sessions and caregiver compliance withtreatment recommendations. It can help to clarify treatment goals,explore systemic issues, and provide an opportunity for teaching newskills. Effective parent consultation can increase the likelihood thatchange of behavior will be transferred from the play therapy sessions tohome, school, and other settings, having a positive, lasting impact onchildren, their families, and their larger social contexts.


REFERENCES

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Benedict, H. E. (2003). Object relations/thematic play therapy. In C.Schaefer (Ed.), Foundations of play therapy (pp 281-305). Hoboken,NJ: John Wiley & Sons, Inc.

Berryman, E. (1957). Simultaneous treatment of mother and child.American Journal of Psychotherapy, 11, 821-829.

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Morris, A. (1974). Conducting a parent education program in a pediatricclinic playroom. Children Today, 3(36), 11-14.

O'Connor, K. J., & Schaefer, C. E. (1994). Handbook of -play therapy:Advances and Innovations, Volume II. New York, NY: John Wiley& Sons, Inc.

Penslar, R. L., & Porter, J. P. (1993). IRB Guidebook. US Department ofHealth and Public Services. Retrieved July 11, 2005 fromhttp://www.hhs.gov/ohrp/irb/irb_guidebook.htm.

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