Child Therapy Institute - December 2025

Research demonstrating: Child Directed Play therapy, Sandplay,  Expressive Art, and Cognitive Behavioral Therapy are evidence based practices for children

Child-Directed Play Therapy (CDPT / CCPT)

Meta-Analyses

1. Bratton et al. (2005) - Meta-analysis of play therapy outcomes

This extensive meta-analysis of 93 controlled play therapy studies identified moderate to substantial treatment effects (≈0.80) across a diverse array of child emotional and behavioral issues. Improvements were consistent for both internalizing symptoms (anxiety, withdrawal) and externalizing symptoms (aggression, acting out). Humanistic and nondirective models, particularly CCPT, exhibited the most significant effects.

Citation: Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 376–390. https://doi.org/10.1037/0735-7028.36.4.376

2. Lin & Bratton (2015) - Meta-analysis of CCPT effectiveness

A moderate overall effect size (≈0.47) was found in this meta-analysis of 52 CCPT outcome studies, with particularly strong effects for children of color (≈0.76). CCPT increased self-efficacy and academic performance, decreased behavioral issues, and improved parent-child relationship stress. Significant moderators included treatment integrity, caregiver involvement, and child age, with younger children (≈6–7 years) exhibiting strong improvements.

Citation: Lin, Y.-W., & Bratton, S. C. (2015). A meta-analytic review of child-centered play therapy approaches. Journal of Counseling & Development, 93(1), 45–58.

3. Parker et al. (2021) - Meta-analysis of CCPT for disruptive behavior

CCPT outperforms waitlist and alternative treatments in reducing disruptive and externalizing behaviors in children, according to this meta-analysis of 23 group-design studies (N=908). The results supported CCPT as a versatile, developmentally sensitive intervention for behavioral dysregulation and were consistent in both school and outpatient settings. The relational aspects of CCPT (empathy, acceptance, and safe limit-setting) are emphasized by the authors as crucial mechanisms that improve behavioral control and self-regulation.

Citation: Parker, M. M., Hunnicutt Hollenbaugh, K. M., & Kelly, C. T. (2021). Exploring the impact of child-centered play therapy for children exhibiting behavioral problems: A meta-analysis. International Journal of Play Therapy, 30(4), 259–271. https://doi.org/10.1037/pla0000128

Systematic Reviews

4. Drisko et al. (2020) - Systematic review of individual child play therapy

For issues like aggression, anxiety, attention problems, and externalizing behaviors, individual child play therapy—most frequently CCPT—showed medium to large effect sizes (d ≈ 0.35–0.80) across 17 controlled studies in this systematic review. Results show that play therapy satisfies the requirements for an empirically validated treatment, with the best results in relational functioning, emotional expression, and self-regulation. Symbolic play, emotional processing, and the therapeutic alliance were among the mechanisms of change.

Citation: Drisko, J., Hunnicutt Hollenbaugh, K. M., Kelly, C. T., & others. (2020). Is individual child play therapy effective? Clinical Social Work Journal, 48(3), 307–324. https://doi.org/10.1007/s10615-020-00751-z

Randomized Controlled Trials (RCTs)

5. Burgin & Ray (2022) - CCPT for childhood depression in schools

In this randomized school-based trial involving 71 children aged 5 to 9, eight weeks of biweekly CCPT resulted in substantial decreases in depressive symptoms, as evidenced by both parental reports and independent behavioral observations. There were also fewer sluggish cognitive tempo and overall problem behaviors in the kids. Results were uniform among racially and ethnically diverse children enrolled in Title I schools, underscoring CCPT’s effectiveness for marginalized youth. This study indicates that CCPT may function as an efficacious early intervention for mood symptoms in young children in school or clinical environments.

Citation: Burgin, E., & Ray, D. C. (2022). Child‐centered play therapy for childhood depression in elementary school settings: A randomized controlled trial. Journal of Child and Family Studies, 31(2), 293–307. https://doi.org/10.1007/s10826-021-02153-2

6. Ray et al. (2022) - CCPT for Children with ACEs

In children with two or more ACEs, this randomized controlled trial showed that CCPT significantly improved empathy, social competence, self-regulation, and decreased general behavioral issues. Results show that CCPT promotes the development of protective social-emotional skills as well as the reduction of symptoms. The improvements observed here imply that CCPT can serve as an early buffering intervention for children on high-risk developmental trajectories because ACEs raise the risk of complex trauma. For kids whose early experiences include danger, stress, or instability, the study emphasizes the importance of stable, accepting relational environments.

Citation: Ray, D. C., Burgin, E., Gutierrez, D., Ceballos, P., & Lindo, N. (2022). Child-centered play therapy and adverse childhood experiences: A randomized controlled trial. Journal of Counseling & Development, 100(2), 134–145. https://doi.org/10.1002/jcad.12412

7. Stulmaker & Ray (2015) - CCPT for young children with anxiety

Compared to an active control group, children receiving CCPT in this controlled trial with 6–8-year-olds demonstrated significant reductions in overall anxiety and worry. The nondirective, symbolic, play-based format seemed developmentally appropriate and approachable because anxiety in young children frequently shows up somatically or behaviorally rather than verbally. One of the main mechanisms promoting emotional integration was found to be the therapeutic relationship, which includes empathy, unconditional positive regard, and child-led pacing.

Citation: Stulmaker, H. L., & Ray, D. C. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127–133. https://doi.org/10.1016/j.childyouth.2015.08.005

8. Topal et al. (2025) - RCT of play-based therapy for earthquake survivors

A structured therapeutic play program (TOTEM) with preschool earthquake survivors was assessed in this randomized controlled trial. When compared to standard care, children receiving play-based intervention demonstrated notable improvements in anxiety, psychosocial distress, and sleep disturbances one month after treatment. The results highlight how crucial play is for young children who are unable to verbally process traumatic events. This trial demonstrates to clinicians that structured play interventions can lessen post-disaster symptoms, stabilize emotional expression, and reestablish a sense of safety after acute trauma.

Citation: Topal, S., Yalnızoğlu Çaka, S., Uysal, G., Alabay, E., Demir, Y., & Arslan, S. C. (2025). The effect of therapeutic play-based intervention programme applied to earthquake victim preschool children on psychosocial well-being: A randomized controlled trial. BMC Psychology, 13(981). https://doi.org/10.1186/s40359-025-03317-4

9. Wong et al. (2023) - CCPT for executive function in children with ADHD

Compared to a waitlist control, children with ADHD showed notable improvements in cognitive flexibility, a fundamental executive function (EF), following 12 CCPT sessions. Additionally, compared to peers who were typically developing, behavioral symptoms were typically higher at baseline, supporting the clinical significance of EF-focused outcomes. The authors suggest that the relational safety, autonomy, and expressive play activities of CCPT may trigger neuroplastic pathways associated with executive functions and self-regulation.

Citation: Wong, T.-Y., Chang, Y.-T., Wang, M.-Y., & Chang, Y.-H. (2023). The effectiveness of child-centered play therapy for executive functions in children with attention-deficit/hyperactivity disorder. Clinical Child Psychology and Psychiatry, 28(3), 877–894. https://doi.org/10.1177/13591045221128399

Quasi-Experimental / Pre–Post Designs

10. Cochran & Cochran (2017) - CCPT in high-poverty schools

This pre–post study conducted in high-poverty elementary schools demonstrated that children undergoing CCPT experienced substantial, clinically significant reductions in disruptive, aggressive, and attention-related behaviors over nine sessions. Teachers observed substantial improvements in self-efficacy, with progress being notably robust across all demographic groups, including children of color. The findings underscore CCPT as a relational intervention that facilitates regulation and behavioral recovery for children affected by chronic stress, educational disparities, and environmental challenges.

Citation: Cochran, J. L., & Cochran, N. H. (2017). Pre–post demographic study of child-centered play therapy for students with highly disruptive behavior in high-poverty schools. Children and Youth Services Review, 82, 362–370.