Staying Centered: Using The Golden Thread To Develop CCPT-Aligned Treatment Plans
By: Michelle Walker, LCSW, RPT-S
Staying Centered (adjective):
The ability to remain grounded through unconditional positive regard, trust in each client’s innate potential for growth, and approaching every moment with empathy, authenticity, and deep respect for their unique inner journey.
— Integrated Play Connections
Play therapists using Child-Centered Play Therapy often struggle to develop treatment plans that feel both aligned with their theoretical orientation and able to meet external requirements. Traditional treatment plans, such as those required by agencies and insurance companies, ask us to identify problems, establish measurable goals and objectives, document interventions, and define successful outcomes that are often clinician-driven. Yet Child-Centered Play Therapy (CCPT) is grounded in trust in the child’s innate capacity for growth and the belief that the therapeutic relationship, rather than a prescribed set of techniques and interventions, serves as a central agent of change (Landreth, 2023).
This theoretical belief can be traced back to Rogers’ (1957) person-centered theory, which proposed that a set of core conditions occurring within the therapeutic relationship, including congruence, unconditional positive regard, and empathic understanding, are necessary and sufficient for therapeutic change. Within CCPT, these conditions are translated developmentally into the therapist’s relationship with the child and a deep trust in the child’s capacity for growth and self-direction.
It is important to note that remaining grounded in these principles does not mean that CCPT is without measurable outcomes. That’s where meta-analyses come into play. A meta-analysis is one of the strongest and most reliable ways researchers can examine the overall effectiveness of a therapeutic approach across multiple studies. There are several meta-analyses documenting the effectiveness of child-centered play therapy approaches, including Lin and Bratton (2015), Pester et al. (2019), Parker et al. (2021), and Ray et al. (2015).
So how do we meet documentation requirements without losing the heart of CCPT?
We stay centered.
Following the Golden Thread
Integrated Play Connections supports the view that clinicians can “stay centered” in the theoretical integrity of CCPT while also developing ethical and clinically sound treatment plans that meet external requirements. External stakeholders want to see a golden thread approach that connects the referral concern to where we are going, how progress will be measured, what the clinician will do to support that progress, and what will indicate readiness for discharge. For CCPT clinicians, that golden thread can remain grounded in humanistic theory.
1. Begin with the REFERRAL CONCERN.
Rather than defining the child by a presenting “problem,” consider the behaviors that brought the child to therapy within the larger context of their emotional and relational world, and what the child’s behavior is communicating to those around them. A referral concern can acknowledge what caregivers are observing without allowing those behaviors to define the child.
This subtle shift in language helps clinicians remain grounded in a humanistic conceptualization from the very beginning: the child is not a collection of symptoms to eliminate, but a whole person with an inherent capacity for growth.
2. Develop growth-oriented GOALS.
Goals can address the concerns that brought the child to therapy while remaining focused on growth-oriented, self-driven inner resources, such as self-acceptance, emotional expression, resilience, confidence, self-direction, and relational security.
Research supports the ability of CCPT to facilitate meaningful change across a variety of child outcomes. Lin and Bratton’s (2015) meta-analysis found an overall moderate treatment effect across 52 controlled studies of child-centered play therapy approaches. Blanco, Holliman, & Carroll (2019), explored outcomes beyond simple symptom reduction, including areas such as academic improvement and intrinsic motivation.
This gives clinicians room to think beyond “What behavior needs to change?” and, instead, consider “What inner resources are developing within this child that will help shift the behavior towards more self-enhancement?”
A simple framework developed by Integrated Play Connections is:
The client will [humanistic, growth-oriented goal] through child-centered play therapy in order to reduce/decrease [referral concern] and/or improve/increase/strengthen [desired capacity].
For example:
The client will develop a stronger sense of self-worth and confidence through child-centered play therapy in order to reduce self-critical thoughts and strengthen positive self-concept and resilience.
3. Measure what naturally emerges through OBJECTIVES.
Measurable does not have to mean directive.
Instead of creating objectives that prescribe what the child must do, CCPT clinicians can identify observable shifts and indicators of progress that may naturally emerge through verbal, behavioral, relational, emotional, or symbolic expression.
We might observe subtle shifts, such as increased exploration, emotional expression, problem-solving, symbolic mastery, self-acceptance, autonomy, self-advocacy, resilience, or other indicators of growth.
In other words, measurement can focus on observing change without directing change.
The clinician remains responsible for identifying meaningful indicators of progress, but the child retains the freedom to determine how that growth unfolds within the therapeutic process.
4. Remember that the relationship is the INTERVENTION.
Within CCPT, intervention is not simply a list of techniques used to produce a particular behavior.
Our intervention begins with how we show up in the playroom.
Tracking. Reflecting feelings and content. Returning responsibility. Therapeutic limit setting. Emotional attunement.
These skills matter deeply, but they are expressions of something even more foundational:
Unconditional positive regard. Empathy. Congruence. Trust in the child. Axline’s eight basic principles.
Rogers (1957) placed the therapeutic relationship at the center of personality change, identifying therapist congruence, unconditional positive regard, and empathic understanding among the necessary relational conditions for therapeutic change.
More recent CCPT research continues to explore how this relationship may facilitate change. Frawley and Dillman Taylor (2024), for example, examined relational and coregulatory mechanisms within CCPT sessions with young children who had experienced multiple adverse childhood experiences. Their work provides emerging empirical support for examining the therapeutic relationship itself, not simply individual therapist techniques, as part of the change process within CCPT.
This distinction matters when writing a treatment plan.
Tracking is not the intervention, simply because tracking itself does not make a child change.
Rather, tracking is one way the therapist communicates: I see you. I am with you. What you are doing here matters. In this way, the skill becomes an expression of Rogers’ core conditions and guides Axline’s eight basic principles
Returning responsibility communicates trust in the child’s capability. Reflecting feelings communicates empathic understanding. Therapeutic limit setting communicates acceptance of the child while maintaining the safety and boundaries of the relationship.
The skills are important because they allow us to embody the relationship, but it is equally important for the clinician to remember that these skills are secondary to the core conditions from which they emerge.
5. Let DISCHARGE reflect growth, not perfection.
Discharge criteria can reconnect us to the original hopes expressed by the child and caregiver. Rather than asking only whether a child has “eliminated” a behavior, we can consider whether they demonstrate greater self-acceptance, emotional flexibility, confidence, resilience, relational security, or capacity to navigate difficult experiences.
The golden thread then becomes clear:
Referral concern → growth-oriented goal → naturally emerging indicators of change → relational intervention → meaningful evidence of growth.
Staying Centered From Beginning to End
Ethical documentation and theoretical integrity do not have to compete with one another. We can identify diagnoses, develop measurable objectives, demonstrate progress, and meet external documentation requirements while continuing to view the child through a deeply humanistic lens. The goal is not to make CCPT fit perfectly into a traditional treatment-planning model. It is to create a treatment plan that meets necessary clinical standards without losing sight of the child underneath the documentation.
That is the golden thread.
And that is what it means to stay centered.
References
Blanco, P. J., Holliman, R. P., & Carroll, N. C. (2019). The effect of child-centered play therapy on intrinsic motivation and academic achievement of at-risk elementary school students. Journal of Child and Adolescent Counseling, 5(3), 205–220.
Frawley, C., & Dillman Taylor, D. (2024). The relational change mechanisms of child-centered play therapy with children exposed to adverse childhood experiences. Journal of Counseling & Development, 102(2), 153–162.
Landreth, G. L. (2023). Play therapy: The art of the relationship (4th ed.). Routledge.
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.
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
Pester, D., Lenz, A. S., & Dell’Aquila, J. (2019). Meta-analysis of single-case evaluations of child-centered play therapy for treating mental health symptoms. International Journal of Play Therapy, 28(3), 144–156. https://doi.org/10.1037/pla0000098
Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools,52(2), 107-123. https://doi.org/10.1002/pits.21798
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.
