Therapist-Provided Conditions in Child-Centered Play Therapy

The therapist-provided conditions of congruence, unconditional positive regard, and empathy are essential to the therapeutic process in child-centered play therapy (CCPT). This grounded theory study explored how these conditions are actualized in CCPT. Participants included 4 therapists and 12 children. A process model of the conditions and implications for practice and research are discussed. Keywords: congruence, unconditional positive regard, empathy, child-centered play therapy, grounded theory ********** Child-centered play therapy (CCPT) is a developmentally responsive intervention for children based on the philosophy of Carl Rogers's (1957) person-centered approach (Axline, 1974; Landreth, 2012; Ray, 2011). Landreth (2012) defined CCPT as a dynamic interpersonal relationship between a child and a therapist who provides selected play materials and facilitates the development of a safe relationship for the child to fully explore and express self through play. Although it is one of the most widely used approaches in the United States and has been shown to be an effective treatment for children with a variety of emotional and behavioral issues, few researchers have explored the therapeutic relationship, relational variables, and therapeutic process in CCPT (Bratton, Ray, Rhine, & Jones, 2005; Lambert et al., 2007; Ray & Bratton, 2010; Shirk & Karver, 2003). Child-centered practice is based on the conditions identified by Rogers (1951) to facilitate client movement toward personality change. However, little is under stood about how the facilitative conditions are demonstrated and actualized in CCPT. Rogers (1951) provided a comprehensive framework for understanding human development, psychological maladjustment, and personality change in his 19 propositions (Ray, 2011; Wilkins, 2010), and Rogers (1957) described the environment necessary for constructive personality change to occur when he outlined six necessary and sufficient conditions for therapy: (a) The therapist and the client are in psychological contact, (b) the client experiences incongruence, (c) the therapist is congruent in the relationship, (d) the therapist experiences unconditional positive regard (UPR) toward the client, (e) the therapist experiences and communicates empathic understanding toward the client, and (f) the client perceives the therapist's UPR and empathic understanding. The third, fourth, and fifth conditions are often referred to as the attitudinal or therapist-provided conditions because they address the therapist's experience and communication of congruence, UPR, and empathic understanding within the therapeutic relationship. Essential to effective therapeutic practice, the attitudinal conditions are provided by the therapist with the primary purpose of creating a nonthreatening environment that allows the actualizing tendency of the client to be realized and growth to occur. Although the attitudinal conditions are minimally explored in research and therapeutic practice, understanding how these three conditions are defined, experienced, and conveyed in CCPT is central to providing effective interventions for children and understanding the process and outcome of CCPT. DEFINING THE THERAPIST-PROVIDED CONDITIONS In person-centered literature, congruence has often been defined as a therapist's ability to be genuine, open, aware, and integrated within the therapeutic relationship (Mearns & Thome, 2000; Rogers, 1957; Wyatt, 2001). Congruence includes consistency between the therapist's internal awareness and external expression and facilitates empathy and acceptance toward the client (Bozarth, 2001c; Greenberg & Geller, 2001). In CCPT, congruence is described as "being real" (Landreth, 2012, p. 70) and is expressed through the play therapist's openness and genuine empathy toward and acceptance of the child (Cochran, Nordling, & Cochran, 2010; VanFleet, Sywulak, & Sniscak, 2010). …