Descriptions in this case study of child-centered play therapy (CCPT) for a boy referred for highly disruptive behavior include observations of his process through stages of CCPT, teacher and parent ratings on the Child Behavior Checklist (Achenbach & Rescorla, 2001), and explanations of how CCPT worked for him.
Children with highly disruptive behavior present problems for their peers and are often a heavy burden to the schools, teachers, counselors, and other adults who care for them. Without successful intervention, such children certainly face lives of high risk, emotional pain, and ever-increasing difficulty; from a humanistic perspective, such an outcome would represent the loss of personal, social, and academic potential. Aggressive disruptive behavior of children is the most common presenting problem area for psychotherapists, including play therapists (Kazdin, Siegal, & Bass, 1990). Impairments in behavioral control were found to be among the top reasons for referral to school and clinical psychologists (DuPaul & Stoner, 2003), as well as the most commonly stated reason for referral from elementary school teachers for psychoeducational assessment of children (Abidin & Robinson, 2002). In addition to prompting referrals, Cornett-Ruiz and Hendricks (1993) found that the frequent disruptive behaviors commonly associated with attention-deficit/hyperactivity disorder (ADHD) negatively influenced the perceptions of both peers and teachers. Furthermore, Greene, Beszterczey, Katzenstein, Park, and Goring (2002) reported that students with behaviors such as inattention, hyperactivity, and impulsivity were found to cause higher levels of stress in teachers than did students without these difficulties.
Aggressive behaviors have been found to be stable across time without effective intervention (e.g., Cummings, Ianotti, & Zahn-Waxler, 1989; Olweus, 1979), and longitudinal studies have indicated that young children with high levels of externalizing behaviors are at high risk for future social and emotional problems (Olson, Bates, Sandy, & Lantheir, 2000; Patterson, DeBaryshe, & Ramsey, 1989). Patterson et al. (1989) described a pattern in which childhood conduct disordered behaviors led to academic failure and peer rejection, which in turn led to increased risk for depressed mood and involvement in deviant peer groups, thereby further increasing the probability of delinquent behavior. Early aggressive behavior problems are highly predictive of later antisocial behaviors that increase in severity and become emotionally and materially costly to society in numerous ways (see Caspi, Elder, & Bem, 1987; Coie & Dodge, 1998; Patterson, Reid, & Dishion, 1992).
Play therapy, especially child-centered play therapy (CCPT), has demonstrated effectiveness across a wide range of children's mental health and behavioral problems, from developing self-efficacy (Fall, 1999) to recovering from trauma and major clinical concerns (e.g., see Demanchick, Cochran, & Cochran, 2003; Guerney, 1983, 2001; Landreth, 2002; Ray, Bratton, Rhine, & Jones, 2001). We conceptualized CCPT as a particularly effective approach for children with highly disruptive behavior. Cochran and Cochran (1999) found that conduct disorder behaviors were based in core mistaken beliefs that stem from the expectation of failure in relationships. Therapeutic relationships, as defined by Cochran and Cochran (2006), include deep empathy and unconditional positive regard to facilitate clients' "rethinking" mistaken beliefs and patterns in relating to others. Likewise, CCPT emphasizes deep empathy and unconditional positive regard to facilitate a child's self-expression within necessary limits, and opportunities for the child to "think through" inter- and intrapersonal conflicts through the use of play as a therapeutic medium (Axline, 1969; Guerney, 1983, 2001; Landreth, 2002).
Beyond the general effectiveness evidenced by play therapy, there are a number of studies indicating the effectiveness of CCPT for children who are similar to the child described in the case study presented here. …