1. “Thinking through issues prior to beginning relationships with children can help the therapist to react with assurance so as not to confuse children by indecisiveness” (p. 303).  Confidentiality o Very young children not concerned about confidentiality o “In this special time, what you say or do is private. I will not tell your parents or teacher or anyone unless it is necessary to keep you safe. If you want them to know what you do here, you can tell them. That will be fine. You can decide” (p. 304). o Do not display artwork – personal like a therapy transcript of an adult session o General impressions, not specific behaviors can be shared with parents

2.  Limits of confidentiality o Suicidal threat o Homicidal threat o Threat against child by someone else  Confidentiality is a difficult issue to navigate o Parents want to know about therapy and how they can be helpful to their child o Parents pay the bill and feel they have a right to know what they are paying for and what is happening in sessions o A tension exists between the parents’ right to know and the child’s privacy o Informing the child about confidentiality has the potential for the child to feel that therapy is a secretive time and to feel guilty about keeping playroom experiences from parents

3.  Participation in child’s play o Child does not need a playmate o Child needs someone to understand and accept him or her o When participating, therapist must Keep the child in the lead Keep the child in view Maintain an adult-therapeutic role Maintain appropriate boundaries through limit setting o Therapist should stop participating if negative feelings in therapist begin to develop

4.  Accepting gifts from children in play therapy o Consider the timing of gift giving Is it spontaneous? Is it in response to limit-breaking in the previous session? Or is it reparation? o Consider the nature of the gift Is it purchased? Is it self-made? o Consider the cost of the gift Candy bar Rolex watch o The implications of accepting or not accepting the gift Artwork is emotional giving Emotional gifts are more satisfying than tangible gifts

5.  Do not display gifts o Could foster competition o Could encourage other children to bring gifts  Declining a gift: “I would like for you to take this and get something for yourself.”  Don’t give gifts: “What is held in the hand can be lost. What is held in the heart can never be lost.”

6.  Giving a child a reward at the end of sessions or a memento at termination o Play experiences for children are intrinsically rewarding; they do not need a reward for playing o What a child carries away in his or her heart is infinitely more important than anything the child can hold in his or her hand o Rewards for good behavior are part of the child’s life experiences; bringing the same into the playroom continues the same expectation of behavior o Rewards inhibit children’s behaviors in the play therapy experience

7.  Asking the child to clean up o If toys are words, then the request to clean up is like telling the child to clean up what has been expressed o If cleaning up is required, therapist conveys the message that making a mess is not permissible o Leave 15 minutes after session to clean up  Informing children of the reason they are in play therapy o Child-centered play therapy is not problem-focused o Therefore, the reason for referral may not be known o Informing children of the specific reason they are coming to the playroom is not necessary o “Your parents are concerned because sometimes things don’t seem to go very well for you at home, and they thought you would like to have a special time in the playroom each Tuesday just for you”

8.  Bringing a friend to the playroom o Contraindicated for children who need therapist’s total attention and acceptance (e.g., trauma) o Contraindicated for children who are sensitive to comparisons with other children o Contraindicated for children who have been sexually abused or are overly aggressive o Contraindicated early in treatment  Inviting parents or siblings to the playroom o Parents are generally not allowed in sessions Restricts therapeutic relationship Violates confidentiality o Overly anxious children can request parents if anxiety threatens to become debilitating o What does the child have in mind with invitation?

9.  Nancy – trichotillomania o Fear of maternal separation o Competition with younger sister o Rebellion against overwhelming number of limits and demands placed on her o Cautious, then messy, then free and accepted o Regression was temporary, not self-reinforcing o Why did therapy stop at eight sessions? o Parent consultations Provide insight with respect to child’s feelings Help parents develop communication skills Help parents develop parenting skills

10.  Nancy – trichotillomania (cont.) o Four stages of therapy Acclimation to playroom situation and therapist Limit testing, expression of anger, and experience of freedom Experiencing independence/dependence relationship Expression of positive feelings; decision-making about how she will interact with her world  Cindy – borderline personality disorder? Oppositional defiant disorder? o Punitive conscience (superego) o Controlling

11.  Amy – selective mutism and enuresis o Child-centered play therapy indicated because verbal production is not necessary o Introduction of sibling group therapy Help each other assume responsibility in interpersonal relationships Natural opportunity to generalize interactions outside play therapy setting Faster results Immediate definition of issues Work on the shift in communication patterns could begin in sessions and at home immediately Diagnostic tool for the play therapist