Initial Investigation of Nature‐Based, Child‐Centered Play Therapy: A Single‐Case Design

A need exists for providing mental health services to children, with approximately 20% of children in the United States meeting the criteria for a mental health diagnosis (Merikangas et al., 2010). Failure to identify the mental health needs of children and provide services to them may lead to costly psychiatric treatment, as well as involvement with the juvenile justice system (DeSocio & Hootman, 2004). Additionally, children who exhibit behavioral and academic problems in early elementary school are more likely to have other negative long-term outcomes, including low academic achievement, school suspensions, involvement with defiant peer groups, and a greater risk for conduct problems (Reinke, Herman, Petras, & Ialongo, 2008). Therefore, providing mental health interventions to young children that promote their optimal development and well-being over the lifespan is crucial. The National Association of School Psychologists (2008) estimated that nearly 50% of children with emotional disorders receive interventions within the school environment. With provision of mental health services within schools, counselors can mitigate barriers that families often experience related to obtaining services by offering a familiar environment for children and families; reducing transportation issues; and providing information about children across social, emotional, and academic areas of development (Committee on School Health, 2004). Bruns, Walrath, Glass-Siegel, and Weist (2004) found that teachers within elementary schools with expanded school mental health services made fewer referrals for special education evaluations due to emotional or behavioral problems, and fewer students within these schools met the eligibility criteria for related disabilities. * Child-Centered Play Therapy Child-centered play therapy (CCPT) is one approach that counselors may use with children within the school environment to address mental health issues. CCPT is grounded in Axline's (1947) nondirective approach to working with children that was adapted from Rogers's (1942) person-centered counseling approach. Within CCPT, counselors designate play materials and strive to foster a caring, supportive relationship and a safe environment that facilitates exploration and expression of the self through play, a child's natural mode of communication (Landreth, 2012). Following Axline's (1969) principles, the child-centered play therapist allows the child to take a leadership role during the session, offering the child the freedom to fully experience him/herself, while acknowledging and reflecting the child's feelings and experiences and only setting limits when needed to promote a safe environment. Researchers have found support for using play therapy to address various childhood issues (Blanco & Ray, 2011; Bratton & Ray, 2000; Bratton, Ray, Rhine, & Jones, 2005; Ray, Schottelkorb, & Tsai, 2007). In a review of play therapy studies, Bratton and Ray (2000) reported that play therapy was an effective method in addressing a variety of childhood concerns (i.e., behavioral issues, anxiety, poor social skills). Bratton et al. (2005) found further evidence to support the efficacy of play therapy with children in another review of play therapy studies, noting that play therapy had a large effect on children's behavior, personality, and social adjustment. In evaluating the effectiveness of CCPT on academic achievement, Blanco and Ray (2011) found that children who participated in CCPT sessions, held within the school setting, scored significantly higher on a measure of academic achievement compared with children who were on a waiting list. Additionally, in using CCPT in the school setting with children with attention deficit hyperactivity disorder (ADHD) symptoms, Ray et al. (2007) found that children had fewer symptoms of ADHD following participation in CCPT overall and in specific areas of anxiety, withdrawal, and emotional instability. …