245 | Separation Anxiety and Resistance: Trusting the CCPT Process

In this episode of the Play Therapy Podcast, I address two questions from Alison in Arkansas related to separation anxiety and resistance in child-centered play therapy (CCPT). Alison shares concerns about a 2-year-old client who exhibits extreme separation anxiety and a 5-year-old client resisting play therapy sessions. I offer guidance on why CCPT is essential for the 2-year-old and how to build trust and rapport patiently, even if it takes time. For the 5-year-old, I explain why playing games is still valid play and not avoidance, emphasizing the importance of adhering to the CCPT model without trying to control or direct the process.

I also highlight how the urge to intervene or “do something” can signal a deviation from the CCPT approach. Staying true to the model by trusting the child and the process ensures the best outcomes. This episode serves as a reminder to stay patient, maintain adherence to CCPT principles, and let the child work through their challenges in their own time.

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Common References:
Cochran, N., Nordling, W., & Cochran, J. (2010). Child-Centered Play Therapy (1st ed.). Wiley.
VanFleet, R., Sywulak, A. E., & Sniscak, C. C. (2010). Child-centered play therapy. Guilford Press.
Landreth, G.L. (2023). Play Therapy: The Art of the Relationship (4th ed.). Routledge.
Bratton, S. C., Landreth, G. L., Kellam, T., & Blackard, S. R. (2006). Child parent relationship therapy (CPRT) treatment manual: A 10-session filial therapy model for training parents. Routledge/Taylor & Francis Group.
Benedict, Helen. Themes in Play Therapy. Used with permission to Heartland Play Therapy Institute.

Episode Transcript

(00:00):
You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,
your source for centered and focused play therapy coaching.
Hi,
I'm Dr. Brenna Hicks,
The Kid Counselor.
This is the Play Therapy Podcast where you get
a master class in child-centered play therapy
and practical support and application for your
work with children and their families.
In today's episode,
I'm answering a question from Allison in Arkansas.

(00:23):
Allison,
you might be my first Arkansan.
Maybe there's been one other,
but
I don't get a lot of emails from Arkansas.
So hello to all my
Arkansans.
I don't know if that's how you call yourself,
sorry.
So it's nice to have you and there's actually two questions that Alison sent,
so I want to dive into both of those.
Quick reminder though,

(00:44):
do not forget about registering for the live podcast event.
Really looking forward to that on January 3rd at 2 Eastern,
and the link is in the show notes to get registered for that.
So really looking forward to that,
excited to get to see your faces,
since I know that you listen,
but don't usually get to put faces with names,
so I'm excited for that.

(01:04):
OK,
so I'm going to read parts of Alison's email and then we'll dive into the questions.
I have a 2,
almost 3 year old in which I was doing CPP.
That is
a different modality of parent training for those of you that are not aware of that.
Child has extreme separation anxiety.
I have completed CPP with mom.

(01:25):
As Dad will not engage in therapy at all,
I'm thinking about discharging her or starting CCPT.
She will not come back with me and throws herself on
the ground screaming and almost vomiting if Mom leaves the room.
I'm not sure I can even do CCPT at this point.
If she does that,
what would you advise?
My next question,
I have a 5 year old who is having anxiety over parent separation.

(01:46):
Do you all see the,
the theme in all of these questions that I've been answering lately?
Holy Moses,
it's just nothing but anxiety.
So sad.
He's in,
you said regression,
Alison.
I'm thinking you probably mean resistance.
So if I'm incorrect on that,
I apologize,
but I'm gonna read this as he's in the resistance phase.

(02:07):
And now refuses to stay in the playroom and wants to leave.
He only wants to play games at this point and quit playing.
I took the games away as I thought this was avoidance.
It seemed to make things worse.
Should I leave the games in the room?
All righty.
So
Sort of related questions,
but distinct as well,
so we're gonna dive into each 11 at a time.

(02:27):
So the first
You have a really,
really young little girl
and you were doing a parenting program with mom.
Just a related aside,
Alison,
I'm not sure how familiar you are with CPRT,
child parent Relationship therapy,
but
I would actually really highly encourage you if
you want to be a child-centered play therapist,
I would really encourage you to use the CPRT curriculum

(02:51):
rather than CPP.
It is fully aligned with the theoretical model,
and it would give you a lot of carryover in your
work in the playroom and then your work with parents.
So,
just a thought on that.
But since you've completed CPP with mom,
You,
you said I'm thinking about discharging her or starting CCPT.
All right,

(03:11):
if
the little girl is still almost vomiting and
throwing herself on the ground screaming when mom
leaves the room.
I would argue that the little girl desperately needs
CCPT.
She clearly is not regulated.
She clearly does not have a handle on her emotions.
The attachment and separation anxiety has not
been reduced or resolved,

(03:33):
so I would say absolutely she needs CCPT.
I would not discharge the family.
We're not even close to a point where termination would be appropriate.
And you said,
I'm not sure I can even do CCPT at this point.
You can.
CCPT is predicated on building the relationship with the girl.

(03:53):
I mean,
obviously you have a relationship with mom,
if you've done parent training with her.
So you're going to build a relationship with the daughter.
And you're going to give the child
the opportunity to choose to come back to the playroom when she's ready.
And is this going to be a long process likely?
Is this going to be a challenging

(04:14):
trying process?
I can almost guarantee it.
Is it going to require a lot of patience?
Absolutely.
But you absolutely can do CCPT with her because
when the child finally chooses to come back,
she's all in.
And mom needs to be coached on
ways to support this and not undermine it.

(04:38):
I've talked about that in some other episodes.
We have to advise parents what their role is when we're doing CCPT
with a child that doesn't want to come back to the playroom.
But the goal in this scenario is you continue to
let
the daughter build a relationship with you,
feel that she can trust you.

(04:58):
That bond and rapport needs to be built,
and then over time,
she will realize that
she can go back to the playroom with you.
And it's it,
is it going to take a while?
I suspect so.
But we've all
had kids that take a really long time to go back to the playroom with us.
And we have lobby sessions or we have

(05:19):
parking lot sessions or we have vehicle sessions,
or we have sidewalk sessions or hallway sessions or whatever.
One kid locked himself in the bathroom not too long ago at our center,
so he's on one side of the bathroom door and the
therapist is on the other side of the bathroom door,
but they're all
doing what CCPT does,
which is

(05:41):
trusting the child
and trusting the process.
And knowing that the child will choose to come
back when the child feels capable of doing so.
So,
Alison,
I hope that's helpful in that scenario.
I would absolutely not discharge.
I would
transition to play therapy
and
help mom understand what that looks like,

(06:02):
prepare her for
The process
and if you need to go back and listen to earlier episodes,
please do.
By the way,
I know I say this every once in a while,
but we have new listeners every single day.
So if you are new,
first of all,
we're so glad you're here.
Welcome.
Hope that you absolutely love being a part of this podcast family.
If you are new and you have not gone back

(06:24):
and listened to the episodes in order from the start,
please do that.
Because if you are new and you're only getting,
you know,
let's say the last couple of months of content,
you've missed
so much foundational training,
and you really can't implement any of this stuff if you
don't understand from a theoretical perspective why we're doing these things.

(06:45):
So I encourage you,
if you've not,
please make sure that you go back and listen in order.
Speed me up if you have to binge listen.
I,
I don't know what your process may look like,
but
make sure that you really have a sense of what this looks like.
Another thought.
So my coaching people and my collective people know this,
my podcast listeners,
I don't think I've mentioned it.
Eric and I

(07:07):
Just
live,
sleep,
eat,
breathe,
CCPT,
no surprise,
I know,
but
we have been,
I say we,
Eric has been buying.
Every seminal CCPT
book that we can find.
So he probably at this point has a dozen or so
different books
and we're really kind of trying to look at

(07:30):
what has been published,
what does the model look like in a framework,
what are the variances because
the Cochrane's CCPT is different than the Van
Fleet's CCPT is different than Landrith's CCPT.
So,
you know,
what,
what are the variations,
what does that look like practically speaking?
So we're just deep diving all things CCPT in published literature right now.

(07:52):
I'm,
I'm circling back on purpose.
There,
there was a reason for that story.
You all need to be reading these books.
So Alison,
if you've not read The Art of the Relationship,
if you've not read D Ray's Advanced Play Therapy,
if you've not read
some of these child-centered play therapy books.
Ax Lain wrote a book called Play Therapy in 47.

(08:14):
You,
you need to be reading these books
because
that is the foundation upon which our practice is built.
If we don't go back to the basics and learn
from the original work,
what this is all about,
then it's really hard to implement some of these things.
So just wanted to make you aware of that.
Please make sure that you are

(08:36):
educating yourself and knowledgeable from the original works.
OK,
your second question,
Alison,
5 year old with parent separation,
resistance phase,
refusing to stay in the playroom and wanting to leave.
OK,
very common,
very normal.
And our ninja trick,
if you will,
for that is we make sure that our chair is positioned in front of the door.

(08:58):
So when you have a spinny rolly chair,
you can just position yourself in front of the door,
not
necessarily abutted to the door,
but you would want to make sure that you are,
you know,
within 1 or 2 ft of the door so that
it becomes a natural obstacle to the child leaving.
That is a very helpful strategy.

(09:18):
When the child says,
I don't want to be in here anymore,
you just set a limit.
Oh,
you really wish that our time was up,
but we still have 20 minutes left.
You can choose to leave when we have 2 minutes left at the 2
minute warning or you can choose to stay and play the whole time.
Which do you choose?
And even if they say,
no,
I wanna leave,
you go through the whole process again.

(09:40):
Oh,
you really don't want to be here right now,
but you know that our time is for the playroom and it's for 50 minutes,
and we still have 20 minutes left.
You just broken record that
because
Landrith's CCPT way
is that
the playroom
and the playtime
is non-negotiable.

(10:02):
We're here for 50 minutes,
and when the 50 minutes are up,
our time is over.
So
that is
my first thought.
You said he only wants to play games and quit playing.
OK,
so Alison,
I'm going to challenge that notion here for a second.
In a child-centered playroom.

(10:23):
A child
doesn't necessarily play in a prescribed way.
So playing games is playing.
That's not a deviation,
that's not
resistance,
it's not avoidance.
It's,
it's a lot of things.
It's safe play,
it's contained play,
it's prescribed play,

(10:43):
it's high levels of anxiety kids play,
we we,
we can recognize all kinds of nuances there.
But it is not
not playing.
So we have to be really careful
with our notion of what playing in a playroom looks like.
Playing a game in a playroom is absolutely playing.

(11:05):
It's serving a lot of needs and there's a lot of undercurrent purpose there.
But it is still playing.
So if he's coming in and playing games,
that's a win.
We celebrate that.
Even when he doesn't want to be there,
he chooses to play a game.
wow,
self-control,
self regulation,
reduction of anxiety,
compliance with limits.

(11:27):
So
that's not not playing.
And then you said I took the games away as I
thought this was avoidance and it seemed to make things worse.
OK,
I'm sure it did
because the games
were what felt safe to him.
The games were what he could handle.
He didn't want to be there,
but he was comfortable enough to play a game.

(11:50):
That was probably all he could muster.
So then you basically took away the one thing that he could actually handle
when he was really upheaved and uncomfortable,
and it sent him over the top.
Highly anxious kids
have a very low threshold for
big feelings.
So when the games are no longer there,

(12:10):
and that was the only thing that he felt comfortable doing.
I'm sure it elevated the emotions to a point where it almost became unmanageable.
So this is something that I wanna actually take a little bit of a,
a left turn here,
but it's a related aside.
We have to be really careful
as clinicians.
If we are

(12:31):
CCPT.
Remember,
we don't do CCPT we are CCPT.
When we are CCPT.
We
do not do anything
that undermines the process.
We don't do anything that's directive.
We don't do anything that tries to control something.

(12:54):
We don't do anything that tries to regulate something.
We have to
monitor that.
Because often even with the best of intentions.
We feel compelled
to do something.
And that should be your really
big red flag.

(13:15):
Actually,
I've never conceived of that phrase before,
but I'm gonna write it down.
When
we feel compelled to do something in the playroom.
It's no longer CCPT.
I'm gonna take the games out of here,
not CCPT.
I'm going to suggest that the child does an art project.

(13:36):
Not CCPT.
I'm gonna talk to this kid about anger.
Not CCPT.
If we are
thinking or considering
doing anything.
We're in violation of the theory and the model.

(13:56):
So catch yourself thinking about the things that you might do
because it's a way of being,
number one.
And we don't do this,
we are this.
So,
Allison,
the best thing you can do for this little guy?
Is to reflect
Track his behavior.
Reflect his content.

(14:17):
reflect his feelings.
Set limits when necessary.
Esteem build
encourage.
Provide choices when
an opportunity arises.
And honor the fact that if we trust him
and we trust the model.
We know that he will do the work that he needs to do

(14:39):
when he's ready,
willing and able.
And
he might very well be in resistance phase.
But guess what comes on the heels of resistance?
Work.
So when he gets through the resistance,
he's gonna be ready to dive in.
But he needs the space
to resist.

(14:59):
And we don't do anything
to get him through it.
He works through it himself.
I hope that that's helpful to all of you.
We need those reminders,
we need those refreshers.
So,
Alison,
thank you so much for the email.
I really appreciate it.
Thanks for giving me the opportunity to talk through this.
For those of you that

(15:20):
tend to want to try to control things in the playroom.
Or second guess the model and maybe I should.
Be aware of what that really means and what that really means is deviation.
And we don't deviate when we're adherent.
So,
focus wholly
on adherence to the model
and our outcomes are the best that they can be.

(15:43):
All right.
I love y'all.
Thanks for hanging out with me.
We'll talk again soon.
Bye.
Thank you for listening to the Play Therapy Podcast with Dr.
Brenna Hicks.
For more episodes and resources,
please go to www.playtherapypodcast.com.