254 | From Cutting to Conversations: Handling Safety Concerns in CCPT

In this episode of the Play Therapy Podcast, I respond to a question from Christy in New Mexico about working with a 12-year-old client who has a history of cutting and suicidal thoughts. I explore how to approach such sensitive issues within the child-centered play therapy (CCPT) model, emphasizing the importance of adhering to the framework while addressing safety concerns. I discuss setting clear expectations about confidentiality during the first session, which allows safety-related conversations to occur later without disrupting the therapeutic relationship.

I also answer a second question about appropriate toys for older clients in the playroom, sharing suggestions for games, activities, and tools that engage preteens and teens in developmentally appropriate ways. This episode provides practical strategies for balancing adherence to CCPT principles with the necessity of addressing safety issues when they arise.

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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 am answering a question from Christie in New Mexico.

(00:23):
And her question is about
a
client who's going to be starting in a couple of weeks,
but the parent noted that the 12 year old client cuts and has suicidal thoughts.
So she wanted some suggestions and tips and strategies for
how to handle knowing that that's the background on

(00:44):
a client before we begin working with them.
And I think this is actually a really
helpful and appropriate thing for us to discuss.
So Christy,
thanks so much for the email.
So let me read parts of what she wrote and then we'll dive in.
I'm seeing a new client in a couple of weeks,
and the parent noted in their paperwork that their
12 year old child cuts and has suicidal thoughts.
I know as a CCPT we don't ask questions or conduct a

(01:07):
session based off of what parents believe is the presenting issue,
but what if we feel a safety check needs to be conducted?
I'm not sure how to handle this.
Also,
what toys do you recommend for older children in the playroom?
So kind of a twofer,
I suppose,
so a little bit of a lighter topic toward the end,
but we'll dive into the first one.
And then I can absolutely share some thoughts on older options.

(01:29):
OK,
so I,
I think I'm going to echo what you already said and what you already know.
We don't ask questions
and nothing that has been presented to us in intake paperwork
or in our meeting with the parents in the initial parent consultation
influences anything that we do in the playroom.
So

(01:49):
we essentially are going to cash out everything that we've been
told and everything that we know as much as possible.
I know that's easier said than done.
You can't forget what you've been told,
but
it,
it should really just be kind of a,
a back burner awareness
and nothing
that we have heard or learned influences anything.

(02:10):
So when you meet with her,
Christy,
when she first comes in,
you're going to do the same exact process that you
would with any other client for their first visit.
So you're going to
talk through confidentiality,
you're going to talk about the process,
you're going to set the expectations for what's going to happen.
I'm going to see you the same time,
same day each week.
We're gonna be together for 50 minutes each time.

(02:31):
When we're all done,
you can choose to get a snack.
These are my.
Components of my spiel,
so maybe these do not universally apply,
but
I'm just covering the things that I share with my clients.
We talk that every 5 sessions with
the child,
we're going to have a meeting with parents.
We talk about the limits of confidentiality,
which is where I'm going to actually answer your question,

(02:53):
Christy,
and then we do house tree person and kinetic family drawing.
We talk about the fact that we write notes,
we talk about the fact that
the notes are in a locked cabinet,
no one ever sees them,
etc.
etc.
So
that's kind of our first session process.
You need to have a routine and you need to have a framework that you follow

(03:13):
the exact same way,
the exact same time,
every single first session.
If you don't already have that established for all of you,
if you do not have a framework,
and if you do not have a system
that is essentially a checklist for you mentally.
What do I do?
What do I say?
What do I communicate?
How do I present this?
What is my first session process?

(03:33):
If you don't have that established,
take time to make sure that you do that.
You have to be consistent
in what you do with your kids,
especially on the first session,
because the first session
is when you actually have the ability to
communicate and set expectations.
So getting back to your question specifically,
Christy.
What if you feel that a safety check needs to be conducted?

(03:56):
OK,
well,
obviously the first visit,
that's probably not going to happen,
but you set the expectation
for that as a possibility down the road in the first session.
So how you handle this is as you cover confidentiality.
You talk about what confidentiality means.
The way that I phrase that for kids is it's a secret for me but not for you.

(04:20):
I'm not allowed to tell anybody what happens in here,
but you can choose to tell anybody that you want.
That's my approach
to helping a child understand confidentiality.
And then I say there are 3 reasons
why I would have to tell someone
about what happens in here,
and that is if someone is hurting you,
if you are going to hurt someone,

(04:40):
or if a judge orders me to speak about it in court.
Once you communicate those reasons why you would break confidentiality.
You now fall back on that if ever.
You need to bring something up
and or discuss something
either with her or with someone else,

(05:02):
because you're able,
even if it's 12 weeks down the road.
She comes in and she has visible cuts on her arms or her legs or her wrists or wherever
or
she comes in and actually starts talking about something
or,
you know,
there,
there's some very clear indication that
the self-harming or the suicidal ideation

(05:25):
is a factor.
So then you say,
remember on our very first session
when I told you that I will never tell anyone
what happens in here
unless.
It's a safety issue.
So I'm a little bit concerned about the cuts that I see on your arm.
And or
I,

(05:45):
I feel like we need to talk about
what happened this week,
or whatever.
If you fall back on the expectations that you've already set,
you can bring it up.
It doesn't become a safety check in the sense of,
do you have a plan and are you going to execute and
all of the things we learn in grad school to address adult

(06:06):
safety checks.
That's not how this goes.
We stay adherent to the model.
The deviation is
we bring up the topic because we promised her
that the only reason we would ever
bring up something
is if it's a safety concern.
And here's the beauty of this.

(06:28):
Kids know that they need to be kept safe,
and they will never argue that fact.
Even when they don't like the rule.
You know,
when
our son was little and I said,
you really wish that you could play video games,
but video games are not good for your brain.
But that's not fair.
All my kids,
all my friends play blah blah blah blah blah.

(06:49):
I'm the only kid that doesn't da da.
I know,
buddy,
but what's my job?
To keep me safe
with with that tone and demeanor
to keep me safe.
Um,
so am I doing my job if I let you play video games?
No.
OK,
he didn't like it,
but he understood the why

(07:10):
because
kids will never fight being kept safe.
And if you have a relationship with her,
Christie,
you've established the rapport,
the bond,
the trust,
all of that,
she will not have an issue with you caring about her
and wanting to make sure that she's OK and safe.
So we fall back on expectations that were set in the very first session.

(07:31):
The only reason we would bring it up is if it is clearly communicated.
It can't be on a whim.
Now,
if you observe cuts,
scratches,
whatever,
you can bring them up because
you noticed them.
It would be no different if a child came in with a cast on their arm to play with you.
You would say,
oh my goodness,
you have a cast on your arm.

(07:53):
OK,
it's no different than saying,
hmm,
it looks like you have cuts on your arm.
I wonder what that's about.
OK,
it's concern
and it's observation and it's factual discussion.
So
If we ever needed to talk about it outside of the playroom though,
that's when you say,
remember on the very first session when I said I might have to tell someone if

(08:14):
you're getting hurt or if someone else is getting hurt.
So I wonder if you choose to be there when I talk to mom and dad,
or if you choose for me to talk to them and you not be there,
I wonder how you'd like this to go.
And she has buy-in of how it gets brought up.
That will not rupture or fracture if everything
has been clearly communicated from the get-go.

(08:37):
So I hope that that's helpful.
And then to answer your second question,
what toys do you recommend for older kids?
OK,
you said she's 12,
that's actually right in the sweet spot of CCPT,
so I don't know that she will necessarily need
older options,
but you want to make sure that you have board games
that are suited for 10 and up.
You wanna make sure that you have card games.

(08:58):
You wanna make sure that you have
active toys,
so older kids will play with active toys such as
bows and arrows and anything that they can shoot,
anything they can throw against a target,
that kind of thing.
Some of my favorites are the thumb ball,
Choices jars,
and the would you rather game.

(09:18):
My teens really,
really like those type of games.
Any kind of challenging things like bop it or the sphere mazes,
where it's like a clear ball and then the
Ball bearing has to roll on the track,
on the
plastic parts inside the sphere.
Those are the kind of very challenging for older kids

(09:40):
type of thing that are really helpful and appropriate.
Teens really like sand work as well,
so I don't know,
Christy,
if you have a sand tray in your room,
but
kids do like
running their fingers through sand and Creating designs in the
sand and kind of just sifting it as they talk
again,
older kids are going to tend to be an
activity-based kind of play rather than a play-based play,

(10:02):
and they will be more conversational.
So it will kind of be a balance between
talking and doing something.
It's sometimes it is playful,
but it sometimes is also just activity based.
All right,
Christy,
thank you so much for the email.
I appreciate it and I hope that that is helpful for all of you because
it is tricky to try to remain adherent to CCPT while we're dealing with a safety issue

(10:26):
and that's something that we really kind of have to find a balance.
So appreciate the email.
I appreciate each and every one of you as well.
We'll talk again soon.
Love you all.
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.