Mastering CPRT is open for registration - go to playtherapynow.com and use the code “CPRT100” to get $100 off for 10 days. It goes up to full price after 10 days, so grab this offer today!
In this episode, I answer a question from Orla in Ireland about what to do when a child says they don’t want to come to therapy anymore—and how to communicate that to parents. I break down two case examples and explain why child-led termination isn't reliable in CCPT, especially early in treatment. More often than not, these moments reflect resistance rather than readiness, and they can surface in any phase of therapy.
I walk through the clinical criteria we use to determine true readiness for termination, share specific ways to guide parents through resistance and avoidance, and offer practical tips on structuring expectations using 5-session increments. I also talk about the importance of preserving the therapeutic relationship, even when kids push back. If you’ve ever felt unsure about how to advise families during the messy middle of the work, this episode will help you feel more confident and clear in your CCPT decision-making.
PlayTherapyNow.com is my HUB for everything I do! playtherapynow.com. Sign up for my email newsletter, stay ahead with the latest CCPT CEU courses, personalized coaching opportunities and other opportunities you need to thrive in your CCPT practice. If you click one link in these show notes, this is the one to click!
If you would like to ask me questions directly, check out www.ccptcollective.com, where I host two weekly Zoom calls filled with advanced CCPT case studies and session reviews, as well as member Q&A. You can take advantage of the two-week free trial to see if the CCPT Collective is right for you.
Ask Me Questions: Call (813) 812-5525, or email: brenna@thekidcounselor.com
Brenna's CCPT Hub: https://www.playtherapynow.com
CCPT Collective (online community exclusively for CCPTs): https://www.ccptcollective.com
Podcast HQ: https://www.playtherapypodcast.com
APT Approved Play Therapy CE courses: https://childcenteredtraining.com
Twitter: @thekidcounselor https://twitter.com/thekidcounselor
Facebook: https://facebook.com/playtherapypodcast
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.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(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 Orla in Ireland.
(00:23):
I did not do that on purpose.
They actually came in in that order,
I promise.
So I know we've had two questions from Ireland back to back,
but
just coincidence,
not that I planned it that way.
But Orla's question is about.
Kids saying that they want to be done with therapy
and how we handle that and specifically what we say to parents.
(00:44):
So not only how do we understand if a child is ready.
And what do we need to communicate to parents about a child's readiness.
But before we get into that,
as promised,
it is July 7th,
2025,
and that means we are launching
the complete 16 hour CPRT course today through Corewell.
Very excited about that and For my email newsletter subscribers,
(01:07):
my podcast listeners,
and my collective members and my coaching participants,
you all get $100 off.
So
for 10 days only,
July 7th through July 17th,
$100 off,
the code is CPRT100
CPRT100
So the letters CPRT
and the numbers 100,
CPRT100.
(01:29):
Only
letters and numbers don't spell anything out.
CPRT100,
you will save $100 and you will get access to the entire course as a thank
you for being a part of my tribe and being a part of The Kid Counselor family.
So if you have been waiting,
I know so many of you have.
And thanks for your patience,
thanks for giving us time to work out the technical glitches and all
(01:51):
things related to the the back end of the programming of the course.
Corewell has never offered a comprehensive course like this before,
where you get videos in modules.
So a huge thank you to them for partnering with us and actually kind of
creating this type of course on their site from scratch for the CPRT curriculum.
So CPRT100 for 10 days,
(02:14):
July 7th through July 17th,
please take advantage of that.
It will go up to regular price after that 10 days.
So if you're thinking about it,
you might as well save the $100
and you still get the 16 CEUs for less money.
All right,
so let me read parts of Orla's email and then we'll dive into
processing when a child just says they don't want to come anymore.
I have a burning question that I'd loved your insight on.
(02:36):
How do we know when a child is truly ready to end therapy?
I understand the average number of sessions is around 20.
Let me pause there.
Orla,
it's actually 30 to 40 now.
So the average has changed.
It used to be 20,
and recent research has said 30 to 40.
So I just wanted to make sure you were aware of that,
we need to
extend that time frame.
(02:58):
I understand the average number of sessions,
I'll change it for you,
is around 30 to 40,
but I've had a couple of recent cases that left me wondering.
In one case,
I worked with a boy who said straight off the
bat that he didn't want to be in play therapy,
and he was only doing it because he got to miss school,
but he engaged in play nonetheless and processed some deep stuff.
I stayed fully child-centered throughout it all.
At the review,
(03:18):
his parents reported great improvements.
He was happier,
sleeping better,
more confident,
and more regulated overall.
I suggested continuing therapy as he still seemed to be working through things,
but after one more session,
he said he didn't want to come back.
We had only done 6 sessions.
In another case,
I worked with a 6 year old girl who
initially came in with anxiety and people pleasing behaviors.
(03:38):
For the 1st 6 sessions,
she played games where we took care of babies in
daycare and made sure they weren't misbehaving or messy.
At the 6-week review,
her parents said she was completely back to her happy,
confident self with no anxiety or school issues.
I recommended continuing,
and we did 6 more.
In the second phase,
her play changed.
She became messier,
which was unusual for her,
(03:59):
more assertive and angry,
and at times very quiet.
Her play was a lot more fragmented,
and she wasn't people pleasing to me at all.
It seemed like she was doing deeper processing.
Yesterday was her 12th session,
and she told me she's had enough and doesn't want
to return because she has other things to do.
She also made,
she's 6.
That's hilarious.
She also made a huge mess in the room,
(04:20):
even dumping out the trash can.
My question is,
do we trust the child's sense of when they're done?
No.
There's the simple answer.
I'll,
I'll go into further detail in a minute.
Should I avoid getting too focused on a specific number of sessions,
or is this the type of resistance,
a sign
they need more support?
Any insight you can share would be so appreciated.
I have another kid who has been doing lots of process and play
(04:42):
who has decided that he doesn't want to come to therapy anymore too.
I'm finding this type of attrition so hard and I'm
completely at a loss as to how to advise parents.
All right,
so,
gosh,
Orla,
this is a very layered question.
So we're gonna dive in and we'll,
we'll do our best to work through this.
All right,
so now that we understand that the average is 30 to 40,
and you were operating on the 20 session model,
(05:04):
I think this might already answer your own question
because 6 sessions in,
12 sessions in,
the likelihood that they are done is
slim to none,
even just from a statistical standpoint.
But with the case of the boy,
for example,
he said that he didn't want to be in play therapy and
he was only doing it because he got to miss school.
All right,
well,
there's a power control grab straight off
(05:26):
from the beginning.
But then he engaged and processed some deep things.
OK,
well,
that's exactly what we expect.
A child's going to be very power and control hungry at the
beginning when he realizes that you're giving him power and control,
he has no need to try to fight for it so much,
and they know that they need and want to work on things,
so he did.
(05:47):
And of course parents are going to report improvements.
That's exactly what we expect
because as he works through things,
he becomes more regulated.
Now that is in the 1st 6 sessions.
It sounds as though he dove in really quickly.
We know that the phases are inevitable,
so we have those 4 phases and we know that kids will work through every single phase.
(06:09):
He dove in,
it seems as though straight into work phase.
But what we know,
just like the stages of grief is that you can't go around or bypass the phase.
So therefore,
he dove straight into work and then was like,
wait a second,
this was too deep,
too much,
too far,
too fast,
too overwhelming,
to fill in the blank.
So now,
hold on,
(06:29):
I need to backpedal.
I need to back up,
and I don't even really have a relationship with you yet.
I haven't even really faced the resistance of this yet.
And
because he dove in so quickly,
of course we would anticipate parents would see changes
in behavior because he actually started doing meaningful work,
but he went to the 3rd phase
and now he's saying,
(06:51):
wow,
OK,
this is getting a little more serious now,
this is getting a little bit more deep and dark and overwhelming.
I don't really know how I feel about this.
Can I really even be vulnerable?
Can I really even trust this person?
Can I really open up and let all this raw stuff out?
How is she going to handle it?
How am I going to handle it?
Am I ready for this?
(07:11):
Am I able to do this?
All of these questions are now swirling.
So of course,
he's going to say,
yeah,
I don't want to do this anymore.
This is resistance after work.
Do you see how we don't always go in a 1, 2, 3, 4 order?
That's what's going on there.
Let's dive into the six year old girl.
She came in with anxiety and people pleasing behaviors.
Makes sense.
(07:32):
She played games where you took care of babies in daycare.
All right,
if this next line doesn't
just speak volumes,
made sure they weren't misbehaving or messy.
That is literally a picture of her own self temper and her own self-control,
and her own self regulation.
I can't misbehave and I can't be messy.
She's in real time sorting out,
(07:54):
making sure that other kids do not do the things that she would never let herself do.
And at the six-week review,
her parents said that she
had totally transformed.
There were all kinds of improvements in a positive direction.
That's exactly what we expect because she dove into deep work.
So then you convinced mom and dad that she needed to continue.
(08:15):
So she continued for 6 more sessions.
Then she becomes messier,
then she becomes assertive and angry,
and then she becomes quiet.
Then
she's fragmented,
she's not people pleasing.
Now all of a sudden,
she's letting herself explore
ideal versus actual.
She's becoming more of what was prohibited.
(08:36):
She wouldn't let anyone at the daycare
misbehave or be messy.
Now she's misbehaving and being messy.
That's a reduction in anxiety.
That is ideal versus actual.
That is testing the water of what does it feel
like to do the thing that would be most forbidden
to a highly anxious people pleasing child.
It's overwhelming.
All of a sudden she's like,
(08:56):
wow,
I can't handle this.
This is too much.
I have other things to do.
I'm not gonna come back.
All right,
another form of resistance.
We can see it.
Keep in mind,
resistance comes at every phase.
Resistance is its own phase,
but resistance can be witnessed in the initiation phase.
(09:17):
It can be resistance in the work phase.
It can be resistance in the termination phase.
And then we have the actual resistance phase.
We understand that it is its own separate entity,
but it's also evident in all of the phases.
So I think that's what's going on there.
And then she makes a mess in the room.
(09:37):
OK,
she literally said that the kids weren't allowed to
be messy and then she makes a mess.
You can see how that would absolutely unnerve her.
It would completely catch her off guard.
She would feel ill equipped to handle it.
It's meaningful work that she needs to do,
but it's scary to her.
So she says,
no,
never mind,
I don't want to come anymore.
(09:58):
Child,
you mentioned at the end,
he doesn't want to come to thera therapy anymore either.
He's been doing lots of process and play.
It's resistance.
He feels scared and look,
many kids will avoid.
Avoidant behavior is very consistent with resistance.
If I just don't come anymore,
I don't have to deal with this.
So,
Orla,
let me go back to your question.
(10:18):
Do we trust the child's sense of when they're done?
No.
Because often a child is going to say that they don't
want to come right when they need to come the most.
Now,
toward the end of treatment,
when a child has actually done the work that they need to do and
they have processed most of all of the stuff that they came in for,
they'll start to not really know what they're supposed to be doing.
They'll say things like,
(10:39):
I don't know what to do.
It's kind of boring.
I don't really know.
I'm,
I'm kind of bored.
I don't know what I'm supposed to do today.
You can tell they don't have pressing work.
So at that point,
we could trust their assessment that they don't really know
that they have anything that they're supposed to be addressing.
We would listen at that stage,
but 6 sessions in,
12 sessions in,
(11:00):
it's highly unlikely that kids are done,
and that tracks with the resistance phase
and the avoidance and the hesitancy
more than it does the child has actually worked through everything.
So then what do you do to advise parents?
You have to set expectation that the average is 30 to 40 weeks,
first of all.
Second of all,
you have to set the expectation that you're going to commit to 5 at a time.
(11:23):
So they're not committing to 30 or 40,
they're committing to 5 at a time because every 5 sessions with the child,
you're going to meet with the parents
for their 5-week consult.
And at that 5 week,
if they're really pleased,
we chalk that up as a win,
but then we share all the meaningful work that's happening in the playroom
and therefore we know that we're not ready to wrap up yet.
(11:45):
I'm celebrating with you and I'm so thrilled to hear
that things have gotten better.
That's always what we're hoping for,
that you will see the progress.
And they are right.
In the middle of deep work,
so we're obviously going to need to do another round of 5,
and then we'll re-evaluate in 5 weeks
if we need to do 5 more or if we're ready to wrap up.
If you can chunk it into sets of 5,
(12:06):
it seems more manageable for parents and it seems like there's a constraint of time.
So I'm committing to 5 and then we will reassess.
So that's a really helpful way to handle that and keep in mind,
I've talked about this in earlier podcast episodes,
but I know there's always new listeners.
So if you're new,
welcome,
I'm really glad you're here.
There are 4 questions that we ask ourselves to determine
(12:28):
whether or not a child is ready to terminate,
and that is,
have all of the presenting concerns and issues either reduced or resolved?
Is the child regulated across all environments?
Are no new themes emerging in play?
And are any persistent themes,
there's no changes within those themes.
(12:48):
And so Orla,
based on the
cases that you described,
they did not meet criteria for termination.
So that's another thing you can share with parents,
that
you have a set of questions that you are able to implement
in your consideration of termination.
There's,
there's no like magic thing where it's just like we just
(13:09):
see pixie dust fly through the air and we're like,
OK,
child's done.
There's something that we're measuring.
We're obviously going to see evidence of the four universal outcomes.
We're obviously going to see evidence of
changes over the course of time,
but there are 4 actual termination criteria.
So unless all 4 of those are met,
(13:29):
we have clinical justification
for continuing with a child,
even if the child says they don't want to come anymore.
So you also have to reassure parents that it's very normal
that a child says they don't,
they don't want to come.
It's very normal that a child will resist.
It's very normal that a child will try to avoid
the work because it's hard.
(13:50):
So we normalize that,
we reassure them.
And we help them to know that if they stop,
that it's actually
potentially damaging and dangerous for the child,
because when they are right in the throes of work,
and then their therapeutic alliance and the
therapeutic environment and relationship are pulled away,
They have nowhere
(14:10):
and no one.
With whom to process
what they're trying to work through.
So we also have to help parents understand the importance of remaining in
therapy even if a child says that they don't want to come.
And the most simple response for a parent is,
well,
you know that you get to choose what you do when we go.
So we have an appointment with Orla
(14:32):
on Wednesdays at 2.
And we're gonna go to the appointment because we've committed that
we're going to go see her every Wednesday at 2,
but you know you're in charge once you're there,
so you can choose to play or not to play.
And so child still has control,
child still has a measure of power,
but the expectation is that they are going to go to
the appointment and then they decide what that looks like.
(14:55):
So there is a little bit of responsibility and power being returned to the child
even when they're in resistance or avoidance.
All right,
Orla,
thank you so much for the question.
I hope that that is helpful for all of you because
you know one of our challenges is definitely
helping parents understand what's happening
to normalize and reassure,
and then also to
(15:17):
make clinical decisions
and they have to default to us.
We have to be able to articulate and communicate
the justification for the things that we're doing and the
time frame and the phases and all of that.
And so that's something that's really important to discuss and
I'm really glad we were able to process that.
Keep in mind that you can also use CPRT
(15:38):
content
for your psychoeducation when you meet with parents as well.
So CPRT content becomes really valuable for your
five week consults because you're able to educate parents
with some of the CCPT skills.
That's something else that you want to do as you're meeting with parents.
It's not just to give them updates,
it's also to provide them with resources,
tips,
strategies,
(15:58):
skills,
etc.
and many of that
can come from the CPRT curriculum.
So just,
you know,
an FYI if you're on the fence about the CPRT program.
Y'all,
it's,
it's so fantastic and it's not my curriculum,
so I'm not taking credit for it.
I didn't write it.
Obviously,
you know,
Landreth and Bratton wrote it.
It's just,
it's
going to make you so confident in your ability to work with parents.
(16:22):
I've been doing this for 20 years and I have loved every single CPRT group
or individual I have ever
done.
I've loved every second of it.
If you like supporting parents,
if you like working with parents,
if you want a more comprehensive approach,
CPRT is it.
If you're all in on child-centered,
CPRT is wholly aligned
(16:43):
and it gives you everything you need to not only train parents
but also psychoeducate them if you're working with their children.
So
not because of me,
it's awesome.
This curriculum is well worth your time and investment.
It truly is,
and you get CEUs.
So often CPRT training
is just that,
it's training.
You're gonna get hours for this as well.
So
(17:04):
if you're interested,
please make sure you save the money "CPRT100" until the 17th of July.
All right y'all,
I love you.
Have a great week.
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.
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 Orla in Ireland.
(00:23):
I did not do that on purpose.
They actually came in in that order,
I promise.
So I know we've had two questions from Ireland back to back,
but
just coincidence,
not that I planned it that way.
But Orla's question is about.
Kids saying that they want to be done with therapy
and how we handle that and specifically what we say to parents.
(00:44):
So not only how do we understand if a child is ready.
And what do we need to communicate to parents about a child's readiness.
But before we get into that,
as promised,
it is July 7th,
2025,
and that means we are launching
the complete 16 hour CPRT course today through Corewell.
Very excited about that and For my email newsletter subscribers,
(01:07):
my podcast listeners,
and my collective members and my coaching participants,
you all get $100 off.
So
for 10 days only,
July 7th through July 17th,
$100 off,
the code is CPRT100
CPRT100
So the letters CPRT
and the numbers 100,
CPRT100.
(01:29):
Only
letters and numbers don't spell anything out.
CPRT100,
you will save $100 and you will get access to the entire course as a thank
you for being a part of my tribe and being a part of The Kid Counselor family.
So if you have been waiting,
I know so many of you have.
And thanks for your patience,
thanks for giving us time to work out the technical glitches and all
(01:51):
things related to the the back end of the programming of the course.
Corewell has never offered a comprehensive course like this before,
where you get videos in modules.
So a huge thank you to them for partnering with us and actually kind of
creating this type of course on their site from scratch for the CPRT curriculum.
So CPRT100 for 10 days,
(02:14):
July 7th through July 17th,
please take advantage of that.
It will go up to regular price after that 10 days.
So if you're thinking about it,
you might as well save the $100
and you still get the 16 CEUs for less money.
All right,
so let me read parts of Orla's email and then we'll dive into
processing when a child just says they don't want to come anymore.
I have a burning question that I'd loved your insight on.
(02:36):
How do we know when a child is truly ready to end therapy?
I understand the average number of sessions is around 20.
Let me pause there.
Orla,
it's actually 30 to 40 now.
So the average has changed.
It used to be 20,
and recent research has said 30 to 40.
So I just wanted to make sure you were aware of that,
we need to
extend that time frame.
(02:58):
I understand the average number of sessions,
I'll change it for you,
is around 30 to 40,
but I've had a couple of recent cases that left me wondering.
In one case,
I worked with a boy who said straight off the
bat that he didn't want to be in play therapy,
and he was only doing it because he got to miss school,
but he engaged in play nonetheless and processed some deep stuff.
I stayed fully child-centered throughout it all.
At the review,
(03:18):
his parents reported great improvements.
He was happier,
sleeping better,
more confident,
and more regulated overall.
I suggested continuing therapy as he still seemed to be working through things,
but after one more session,
he said he didn't want to come back.
We had only done 6 sessions.
In another case,
I worked with a 6 year old girl who
initially came in with anxiety and people pleasing behaviors.
(03:38):
For the 1st 6 sessions,
she played games where we took care of babies in
daycare and made sure they weren't misbehaving or messy.
At the 6-week review,
her parents said she was completely back to her happy,
confident self with no anxiety or school issues.
I recommended continuing,
and we did 6 more.
In the second phase,
her play changed.
She became messier,
which was unusual for her,
(03:59):
more assertive and angry,
and at times very quiet.
Her play was a lot more fragmented,
and she wasn't people pleasing to me at all.
It seemed like she was doing deeper processing.
Yesterday was her 12th session,
and she told me she's had enough and doesn't want
to return because she has other things to do.
She also made,
she's 6.
That's hilarious.
She also made a huge mess in the room,
(04:20):
even dumping out the trash can.
My question is,
do we trust the child's sense of when they're done?
No.
There's the simple answer.
I'll,
I'll go into further detail in a minute.
Should I avoid getting too focused on a specific number of sessions,
or is this the type of resistance,
a sign
they need more support?
Any insight you can share would be so appreciated.
I have another kid who has been doing lots of process and play
(04:42):
who has decided that he doesn't want to come to therapy anymore too.
I'm finding this type of attrition so hard and I'm
completely at a loss as to how to advise parents.
All right,
so,
gosh,
Orla,
this is a very layered question.
So we're gonna dive in and we'll,
we'll do our best to work through this.
All right,
so now that we understand that the average is 30 to 40,
and you were operating on the 20 session model,
(05:04):
I think this might already answer your own question
because 6 sessions in,
12 sessions in,
the likelihood that they are done is
slim to none,
even just from a statistical standpoint.
But with the case of the boy,
for example,
he said that he didn't want to be in play therapy and
he was only doing it because he got to miss school.
All right,
well,
there's a power control grab straight off
(05:26):
from the beginning.
But then he engaged and processed some deep things.
OK,
well,
that's exactly what we expect.
A child's going to be very power and control hungry at the
beginning when he realizes that you're giving him power and control,
he has no need to try to fight for it so much,
and they know that they need and want to work on things,
so he did.
(05:47):
And of course parents are going to report improvements.
That's exactly what we expect
because as he works through things,
he becomes more regulated.
Now that is in the 1st 6 sessions.
It sounds as though he dove in really quickly.
We know that the phases are inevitable,
so we have those 4 phases and we know that kids will work through every single phase.
(06:09):
He dove in,
it seems as though straight into work phase.
But what we know,
just like the stages of grief is that you can't go around or bypass the phase.
So therefore,
he dove straight into work and then was like,
wait a second,
this was too deep,
too much,
too far,
too fast,
too overwhelming,
to fill in the blank.
So now,
hold on,
(06:29):
I need to backpedal.
I need to back up,
and I don't even really have a relationship with you yet.
I haven't even really faced the resistance of this yet.
And
because he dove in so quickly,
of course we would anticipate parents would see changes
in behavior because he actually started doing meaningful work,
but he went to the 3rd phase
and now he's saying,
(06:51):
wow,
OK,
this is getting a little more serious now,
this is getting a little bit more deep and dark and overwhelming.
I don't really know how I feel about this.
Can I really even be vulnerable?
Can I really even trust this person?
Can I really open up and let all this raw stuff out?
How is she going to handle it?
How am I going to handle it?
Am I ready for this?
(07:11):
Am I able to do this?
All of these questions are now swirling.
So of course,
he's going to say,
yeah,
I don't want to do this anymore.
This is resistance after work.
Do you see how we don't always go in a 1, 2, 3, 4 order?
That's what's going on there.
Let's dive into the six year old girl.
She came in with anxiety and people pleasing behaviors.
Makes sense.
(07:32):
She played games where you took care of babies in daycare.
All right,
if this next line doesn't
just speak volumes,
made sure they weren't misbehaving or messy.
That is literally a picture of her own self temper and her own self-control,
and her own self regulation.
I can't misbehave and I can't be messy.
She's in real time sorting out,
(07:54):
making sure that other kids do not do the things that she would never let herself do.
And at the six-week review,
her parents said that she
had totally transformed.
There were all kinds of improvements in a positive direction.
That's exactly what we expect because she dove into deep work.
So then you convinced mom and dad that she needed to continue.
(08:15):
So she continued for 6 more sessions.
Then she becomes messier,
then she becomes assertive and angry,
and then she becomes quiet.
Then
she's fragmented,
she's not people pleasing.
Now all of a sudden,
she's letting herself explore
ideal versus actual.
She's becoming more of what was prohibited.
(08:36):
She wouldn't let anyone at the daycare
misbehave or be messy.
Now she's misbehaving and being messy.
That's a reduction in anxiety.
That is ideal versus actual.
That is testing the water of what does it feel
like to do the thing that would be most forbidden
to a highly anxious people pleasing child.
It's overwhelming.
All of a sudden she's like,
(08:56):
wow,
I can't handle this.
This is too much.
I have other things to do.
I'm not gonna come back.
All right,
another form of resistance.
We can see it.
Keep in mind,
resistance comes at every phase.
Resistance is its own phase,
but resistance can be witnessed in the initiation phase.
(09:17):
It can be resistance in the work phase.
It can be resistance in the termination phase.
And then we have the actual resistance phase.
We understand that it is its own separate entity,
but it's also evident in all of the phases.
So I think that's what's going on there.
And then she makes a mess in the room.
(09:37):
OK,
she literally said that the kids weren't allowed to
be messy and then she makes a mess.
You can see how that would absolutely unnerve her.
It would completely catch her off guard.
She would feel ill equipped to handle it.
It's meaningful work that she needs to do,
but it's scary to her.
So she says,
no,
never mind,
I don't want to come anymore.
(09:58):
Child,
you mentioned at the end,
he doesn't want to come to thera therapy anymore either.
He's been doing lots of process and play.
It's resistance.
He feels scared and look,
many kids will avoid.
Avoidant behavior is very consistent with resistance.
If I just don't come anymore,
I don't have to deal with this.
So,
Orla,
let me go back to your question.
(10:18):
Do we trust the child's sense of when they're done?
No.
Because often a child is going to say that they don't
want to come right when they need to come the most.
Now,
toward the end of treatment,
when a child has actually done the work that they need to do and
they have processed most of all of the stuff that they came in for,
they'll start to not really know what they're supposed to be doing.
They'll say things like,
(10:39):
I don't know what to do.
It's kind of boring.
I don't really know.
I'm,
I'm kind of bored.
I don't know what I'm supposed to do today.
You can tell they don't have pressing work.
So at that point,
we could trust their assessment that they don't really know
that they have anything that they're supposed to be addressing.
We would listen at that stage,
but 6 sessions in,
12 sessions in,
(11:00):
it's highly unlikely that kids are done,
and that tracks with the resistance phase
and the avoidance and the hesitancy
more than it does the child has actually worked through everything.
So then what do you do to advise parents?
You have to set expectation that the average is 30 to 40 weeks,
first of all.
Second of all,
you have to set the expectation that you're going to commit to 5 at a time.
(11:23):
So they're not committing to 30 or 40,
they're committing to 5 at a time because every 5 sessions with the child,
you're going to meet with the parents
for their 5-week consult.
And at that 5 week,
if they're really pleased,
we chalk that up as a win,
but then we share all the meaningful work that's happening in the playroom
and therefore we know that we're not ready to wrap up yet.
(11:45):
I'm celebrating with you and I'm so thrilled to hear
that things have gotten better.
That's always what we're hoping for,
that you will see the progress.
And they are right.
In the middle of deep work,
so we're obviously going to need to do another round of 5,
and then we'll re-evaluate in 5 weeks
if we need to do 5 more or if we're ready to wrap up.
If you can chunk it into sets of 5,
(12:06):
it seems more manageable for parents and it seems like there's a constraint of time.
So I'm committing to 5 and then we will reassess.
So that's a really helpful way to handle that and keep in mind,
I've talked about this in earlier podcast episodes,
but I know there's always new listeners.
So if you're new,
welcome,
I'm really glad you're here.
There are 4 questions that we ask ourselves to determine
(12:28):
whether or not a child is ready to terminate,
and that is,
have all of the presenting concerns and issues either reduced or resolved?
Is the child regulated across all environments?
Are no new themes emerging in play?
And are any persistent themes,
there's no changes within those themes.
(12:48):
And so Orla,
based on the
cases that you described,
they did not meet criteria for termination.
So that's another thing you can share with parents,
that
you have a set of questions that you are able to implement
in your consideration of termination.
There's,
there's no like magic thing where it's just like we just
(13:09):
see pixie dust fly through the air and we're like,
OK,
child's done.
There's something that we're measuring.
We're obviously going to see evidence of the four universal outcomes.
We're obviously going to see evidence of
changes over the course of time,
but there are 4 actual termination criteria.
So unless all 4 of those are met,
(13:29):
we have clinical justification
for continuing with a child,
even if the child says they don't want to come anymore.
So you also have to reassure parents that it's very normal
that a child says they don't,
they don't want to come.
It's very normal that a child will resist.
It's very normal that a child will try to avoid
the work because it's hard.
(13:50):
So we normalize that,
we reassure them.
And we help them to know that if they stop,
that it's actually
potentially damaging and dangerous for the child,
because when they are right in the throes of work,
and then their therapeutic alliance and the
therapeutic environment and relationship are pulled away,
They have nowhere
(14:10):
and no one.
With whom to process
what they're trying to work through.
So we also have to help parents understand the importance of remaining in
therapy even if a child says that they don't want to come.
And the most simple response for a parent is,
well,
you know that you get to choose what you do when we go.
So we have an appointment with Orla
(14:32):
on Wednesdays at 2.
And we're gonna go to the appointment because we've committed that
we're going to go see her every Wednesday at 2,
but you know you're in charge once you're there,
so you can choose to play or not to play.
And so child still has control,
child still has a measure of power,
but the expectation is that they are going to go to
the appointment and then they decide what that looks like.
(14:55):
So there is a little bit of responsibility and power being returned to the child
even when they're in resistance or avoidance.
All right,
Orla,
thank you so much for the question.
I hope that that is helpful for all of you because
you know one of our challenges is definitely
helping parents understand what's happening
to normalize and reassure,
and then also to
(15:17):
make clinical decisions
and they have to default to us.
We have to be able to articulate and communicate
the justification for the things that we're doing and the
time frame and the phases and all of that.
And so that's something that's really important to discuss and
I'm really glad we were able to process that.
Keep in mind that you can also use CPRT
(15:38):
content
for your psychoeducation when you meet with parents as well.
So CPRT content becomes really valuable for your
five week consults because you're able to educate parents
with some of the CCPT skills.
That's something else that you want to do as you're meeting with parents.
It's not just to give them updates,
it's also to provide them with resources,
tips,
strategies,
(15:58):
skills,
etc.
and many of that
can come from the CPRT curriculum.
So just,
you know,
an FYI if you're on the fence about the CPRT program.
Y'all,
it's,
it's so fantastic and it's not my curriculum,
so I'm not taking credit for it.
I didn't write it.
Obviously,
you know,
Landreth and Bratton wrote it.
It's just,
it's
going to make you so confident in your ability to work with parents.
(16:22):
I've been doing this for 20 years and I have loved every single CPRT group
or individual I have ever
done.
I've loved every second of it.
If you like supporting parents,
if you like working with parents,
if you want a more comprehensive approach,
CPRT is it.
If you're all in on child-centered,
CPRT is wholly aligned
(16:43):
and it gives you everything you need to not only train parents
but also psychoeducate them if you're working with their children.
So
not because of me,
it's awesome.
This curriculum is well worth your time and investment.
It truly is,
and you get CEUs.
So often CPRT training
is just that,
it's training.
You're gonna get hours for this as well.
So
(17:04):
if you're interested,
please make sure you save the money "CPRT100" until the 17th of July.
All right y'all,
I love you.
Have a great week.
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.
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