Child-Parent Relationship Therapy (CPRT)

An Evidence-Based 10-Session Filial Therapy Model

Garry L. Landreth, Sue C. Bratton

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781134973026
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Child-Parent Relationship Therapy (CPRT), grounded in the attitudes and principles of Child-Centered Play Therapy (CCPT), is based on the belief that a parent acting as an agent for change in place of a play therapist has potential for significant and lasting therapeutic gains. This newly expanded and revised edition of Child-Parent Relationship Therapy (CPRT) describes training objectives, essential skills and concepts taught in each session, as well as the format for supervising parents' play sessions. Transcripts of actual sessions demonstrate process and content in the 10 CPRT training sessions. Research demonstrating the effectiveness of CPRT on child and parent outcomes is presented in support of CPRT's designation as an evidence-based treatment model.

This second edition is updated to include six new chapters exploring the topics of cultural considerations for working with ethnically and racially diverse families, neuroscience support for CPRT, and adaptions for specific populations including parents of toddlers, parents of preadolescents, adoptive families, and the teacher/student relationship. The authors' expertise and experience results in a book that is essential reading for both students and professionals. By using this text and the accompanying treatment manual, filial therapists will have a complete package for training parents in the CPRT model.

Chapter 1

History, Development, and Objectives of Child-Parent Relationship Therapy (CPRT): A 10-Session Filial Therapy Model

In Play Therapy: The Art of the Relationship, Landreth (2012) stated that if the mental health of future adult populations is to be significantly impacted in positive ways, greater effort must be made to substantially improve the mental health of all children. His position was that the skills of those in the mental health professions must be given away through training to parents, who are in the best position to profoundly impact the lives of future adults. Therapists helping parents to become therapeutic agents in their children’s lives is the most efficient way to significantly improve the mental health of adult populations of the future. CPRT is grounded in child-centered/person-centered theory and consistent with the principles of child development and attachment theory.

Child-Centered Play Therapy

CPRT/filial therapy applies the constructs and skills of Child-Centered Play Therapy (CCPT) to parent and child relationships in a manner similar to the relationship between a play therapist and a child. As in CCPT, the parent is taught to facilitate a permissive and growth-producing atmosphere in which the child can reach her full potential. Child-Centered Play Therapy is based upon the theoretical constructs of nondirective therapy developed by Carl Rogers (1942) and further developed and expanded by Rogers (1951) as client-centered therapy. CCPT is grounded in a belief in the innate human capacity of the child to strive toward growth and maturity and an attitude of deep and abiding belief in the child’s ability to be constructively self-directing. Rogers (1986) summarized the essence of the approach:

The person-centered approach, then, is primarily a way of being that finds its expression in attitudes and behaviors that create a growth-producing climate. It is a basic philosophy rather than simply a technique or a method. When this philosophy is lived, it helps the person expand the development of his or her own capacities. When it is lived, it also stimulates constructive change in others. It empowers the individual, and when this personal power is sensed, experience shows that it tends to be used for personal and social transformation. (p. 199)

It is this formative tendency that all persons—indeed, all of nature—possess that forms the foundation for the child-centered approach to working with children (Rogers, 1951).

These constructs were applied to working with children through play therapy by Virginia Axline (1969), a student and colleague of Rogers. She successfully applied nondirective (client-centered) therapy principles (i.e., belief in the individual’s capacity for self-direction) to children in nondirective play therapy. Her approach was later referred to as client-centered play therapy and then as Child-Centered Play Therapy. Axline (1950) summarized her concept of play therapy:

A play experience is therapeutic because it provides a secure relationship between the child and the adult, so that the child has the freedom and room to state himself in his own terms, exactly as he is at that moment in his own way and in his own time. (p. 68)

The child-centered approach to play therapy, like client-centered therapy with adults, is based upon a process of being with children as opposed to a procedure of application. It is not so much a process of reparation as it is a process of becoming. Thus, the focus is on the child, not the problem. The child-centered play therapist makes no effort to control or change the child, based on the theory that the child’s behavior is at all times internally motivated toward self-realization, positive growth, improvement, independence, maturity, and enhancement of self. The child’s behavior in this process is goal directed in an effort to satisfy personal needs, as experienced in the unique phenomenal field that for that child constitutes reality. A fundamental rule of thumb in Child-Centered Play Therapy is that the child’s perception of reality is what must be understood if the child and behaviors exhibited by the child are to be understood (Landreth, 2012). (This concept that the child’s phenomenal field constitutes reality for the child is central to Child-Parent Relationship Therapy and is the basis for the structure of much of the training. Rule of Thumb: Look through the child’s eyes. The parent is to avoid judging or evaluating even the simplest of the child’s behaviors, e.g., painting or stacking blocks, and works hard to try to understand the internal frame of reference of the child.)

In Child-Centered Play Therapy, it is the relationship that is the agent of change. Child-Centered Play Therapy is an experience for children in which the therapeutic process emerges from a shared living relationship developed based on the therapist’s consistently conveyed acceptance of children and confidence in their ability to be of help to themselves, thus freeing children to risk using their own strengths. Virginia Axline (1969) concisely clarified the fundamental principles that provide guidelines for establishing and maintaining a therapeutic relationship and making contact with the inner person of the child in the play therapy experience. Landreth (2012, p. 80) revised and extended Axline’s eight basic principles as follows:

• The therapist is genuinely interested in the child and develops a warm, caring relationship.
• The therapist experiences unqualified acceptance of the child and does not wish that the child were different in some way.
• The therapist creates a feeling of safety and permissiveness in the relationship so the child feels free to explore and express self completely.
• The therapist is always sensitive to the child’s feelings and gently reflects those feelings in such a manner that the child develops self-understanding.
• The therapist believes deeply in the child’s capacity to act responsibly, unwaveringly respects the child’s ability to solve personal problems, and allows the child to do so.
• The therapist trusts the child’s inner direction, allows the child to lead in all areas of the relationship, and resists any urge to direct the child’s play or conversation.
• The therapist appreciates the gradual nature of the therapeutic process and does not attempt to hurry things along.
• The therapist establishes only those therapeutic limits that help the child accept personal and appropriate relationship responsibility.

These principles all point to the development and maintenance of a strong therapeutic relationship. Moustakas (1959) further emphasized the therapeutic value of children experiencing this kind of relationship: “Through the process of self-expression and exploration within a significant relationship, through realization of the value within, the child comes to be a positive, self-determining, and self-actualizing individual” (p. 5).

Filial Therapy: A Radical Approach

The development of filial therapy was an evolutionary process for Bernard Guerney (1964), a child-centered play therapist who ascribed to the theoretical principles of client-centered therapy as conceptualized by Carl Rogers and the play therapy principles of Virginia Axline. Early in his professional career, in the l950s and early 1960s, Guerney (personal communication, October 22, 1992) viewed parents as potential effectual allies in the treatment of their children and began to contemplate the need to involve parents more directly in the therapeutic process. Guerney’s first step in the process of involving parents in the therapeutic process of helping their children was to include parents in the playroom as observers, followed by discussions with parents to explain what they had witnessed in the play sessions. His next step in the evolutionary process was to give parents more of a role in the therapeutic process.

These successful experiences led him to conceptualize a training program in which parents would be trained in basic Child-Centered Play Therapy skills to become the therapeutic agent in their children’s lives, based on the view that play is the primary way children express themselves and work through issues. Guerney’s premise for his innovative approach was that children’s problems are often the product of parental lack of parenting knowledge and skill. Furthermore, he proposed that children’s problematic behaviors that were influenced by parental attitudes could be more effectively ameliorated under similar conditions. This was a revolutionary idea, because a prevailing attitude in the mental health field in the l950s and early l960s was that children’s problems are usually a product of the pathology of the parents. This shift from viewing the parents as pathological to being the primary therapeutic agent of change in their child’s life was a radical departure for the time.

In 1964, Bernard Guerney published the first article, “Filial Therapy: Description and Rationale,” explaining the principles and results of filial therapy. In that article, he described the importance of parents as key to the filial therapy approach:

The parent-child relationship is nearly always the most significant one in a child’s life. Therefore, if a child were provided the experiences of expression, insight, and adult acceptance in the presence of such powerful people as parents, every bit of success the parent achieves in carrying out the therapeutic role should be many more times more powerful than that of a therapist doing the same thing … a relatively small amount of affection, attention, interest, and so on, from the parent can be expected to be more therapeutic than a larger amount from a therapist. (p. 309)

Because the parent potentially has more emotional significance to the child than does the therapist, the objective of this approach is to help the parent become the primary change agent in the child’s life by using the naturally existing bond between parent and child; thus, the term filial therapy was coined by the Guerneys. (Louise Guerney participated with her husband in the early research and development of filial therapy at Rutgers University and has continued as one of the leading proponents of this innovative approach to helping children and families.) Stover and Guerney (1967) proposed further advantages of using filial therapy over play therapy. Utilizing parents as the agent of change would empower parents, reducing feelings of guilt and helplessness parents may experience when dependent upon a professional to help their child. Additionally, as parents learn more effective ways of interacting with their child, there is greater potential for long-lasting change as parents continue to utilize these acquired skills and attitudes throughout their child’s life.

The next step in development of this revolutionary approach was the establishment of a sound research program to verify the effectiveness of this program of parent training. The Guerneys’ early research results on filial therapy were highly encouraging and provided a strong foundation for the research that followed (Chapter 26 provides an overview of their groundbreaking research).

In the initial stages of development, the Guerneys (personal communication, March 8, 1995) conceptualized filial therapy as a structured treatment program for children with emotional problems and accepted only couples for filial therapy training. Using a small group format, parents were trained in basic Child-Centered Play Therapy principles and skills. Husbands and wives were not placed in the same groups, though, because there were concerns about marital issues dominating the training sessions. Experience and success with their model quickly resulted in a shift in attitude, and they found that when couples were allowed in the same group, they could deal with some marital issues appropriately.

Another important learning was that filial therapy groups composed of parents whose children all had similar personality dynamics, such as acting-out behaviors, were not very effective because the parents had similar dynamics of their own, and they reinforced each other’s negative behaviors because they had difficulty viewing each other’s children from a different perspective as parents who have children with other kinds of problems might do. This same concern does not apply to groups composed of parents whose children have a similar issue that has nothing to do with dynamics: children with learning disabilities, children with chronic diabetes, etc. These children share a common problem, but they are different in terms of their personality and dynamics. Heterogeneous groups are preferred.

Originally, the Guerneys met with filial groups for 2 hours once a week for about a year. Their experience and success led them to streamline training procedures so that groups now meet 2 hours once a week for about 5 to 6 months. Research on these shorter groups has produced comparable results to those of the longer groups. Ginsberg (1997) and VanFleet (1994), both protégés of the Guerneys, have successfully adapted the Guerneys’ model for use with individual parents.

Development of the Child-Parent Relationship Therapy (CPRT) 10-Session Filial Therapy Model

I (first author) have, throughout my professional career as a high school counselor, university professor, and consultant, been involved in working with parents through counseling and training experiences. For many of my early years as an assistant professor teaching play therapy and carrying play therapy cases, I was involved in teaching parents “Lessons from Play Therapy for Parents” but without any emphasis on having playtimes. I had an intensifying belief that if what I did in the playroom was helpful to children, then parents could develop those same kinds of attitudes and learn to utilize those same kinds of skills with their children. Play therapists should be giving their skills away to parents and teachers. We should not hide our skills behind the door of the playroom. When I read the Guerneys’ work in filial therapy, I immediately resonated to this dynamic structure of training and supervising parents that incorporated the facets of teaching, supervision, play therapy, and group process, dimensions that are exciting to me and have occupied my professional focus. Here was a model that allowed me to meld my fascination with group process, my passion for play therapy, and my love of teaching. Filial therapy was a natural fit.

Long-term therapy has always been a problematic concern for me, as I believe we do not fully comprehend the potential of the human organism for growth and change. My doctoral dissertation focused on the effects of collapsing the time between group counseling sessions in time-limited settings. Therefore, I was naturally attracted to the possibility of reducing the number of filial therapy training sessions from what was at that time typically a year of training. I had already learned from my counseling experiences—with parents in the Albuquerque, New Mexico, public schools and parents who brought their children for counseling and play therapy sessions at the University of New Mexico counseling clinic where I was a graduate assistant and intern—that it was very difficult for parents to stay committed for long periods of time. I had similar experiences with parents in the Pupil Appraisal Center (later named the Child and Family Resource Clinic), which employed a multidisciplinary approach to children with learning problems and that I helped found in 1967 at the University of North Texas. In public schools, the typical semester of 15 to 17 weeks is a natural break, and many parents have difficulty carrying through with a commitment beyond that time frame. Therefore, my first filial therapy groups were structured around a 15-week model.

Although these experiences were rewarding, maintaining consistent attendance at training sessions in the last four or five sessions was very difficult; I began to experiment with 12 sessions, but still had problems with dropouts. A 3-month commitment seemed to parents to be much too long, so I decided to try 10 sessions and had immediate attendance success. During these early experiences with filial therapy, I was encouraged to find Arthur Kraft’s (1973) book, which provided a case description of his use of 10 sessions of filial therapy training.

The immediate problem confronting me in developing my 10-session model was how to efficiently cover all the material and training experiences I thought necessary in only 10 2-hour sessions. The training content, method, and style of presentation, as well as the sequence of training in the 10-session model, was greatly influenced by my years of experience teaching master’s- and doctoral-level courses in Child-Centered Play Therapy and by my experiences in play therapy in the Pupil Appraisal Center at the University of North Texas, where I joined the faculty as an assis...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgments
• Contributing Authors
• 1 History, Development, and Objectives of Child-Parent Relationship Therapy (CPRT): A 10-Session Filial Therapy Model
• 2 Neuroscience and CPRT
• 3 Unique Features of CPRT
• 4 Training and Supervision of CPRT Filial Therapists
• 5 Critical Components in Facilitating the Process of CPRT
• 6 CPRT Skills, Concepts, and Attitudes to Be Taught
• 7 The 10-Session CPRT Training Process
• 8 CPRT Training Session 1: Training Objectives and Reflective Responding
• 9 CPRT Training Session 2: Basic Principles for Play Sessions
• 10 CPRT Training Session 3: Parent-Child Play Session Skills and Procedures
• 11 CPRT Training Session 4: Supervision Format and Limit Setting
• 12 CPRT Training Session 5: Play Session Skills Review
• 13 CPRT Training Session 6: Supervision and Choice Giving
• 14 CPRT Training Session 7: Supervision and Self-Esteem-Building Responses
• 15 CPRT Training Session 8: Supervision and Encouragement vs. Praise
• 16 CPRT Training Session 9: Supervision and Generalizing Skills
• 17 CPRT Training Session 10: Evaluation and Summing Up
• 18 Adapting CPRT for Parents of Toddlers
• 19 Adapting CPRT for Parents of Preadolescents
• 20 Adapting CPRT for Adoptive Families
• 21 Adapting CPRT for Teachers
• 22 Culturally Responsive CPRT
• 23 Debbie’s Journey Through CPRT Training: A 1-Week, 4-Year, and 13-Year Follow-Up
• 24 Solutions to Common Problems and Questions Parents and Children Ask
• 25 Variations of the 10-Session CPRT Model
• 26 Research Evidence for CPRT
• Index