Prescriptive play therapy

1. Introduction

Version followed: prescriptive play therapy as set out by Kaduson, Cangelosi and Schaefer in Prescriptive Play Therapy: Tailoring Interventions for Specific Childhood Problems (Guilford, 2019; 276 pp.), read together with Schaefer and Drewes's The Therapeutic Powers of Play: 20 Core Agents of Change (2nd ed., Wiley) and Drewes's prescriptive-integrative session model (APA video, 2017). Source status: the Guilford contents and summary pages, the 2019 publication details, and the account of the core tenets on Kaduson's Play Therapy Training Institute course page are cited below. Publication details for The Therapeutic Powers of Play (1993) and Foundations of Play Therapy (2nd ed., 2011), and the subtitle of The Playing Cure, follow publisher and library catalogue records. Cited by title only, so their content is [uncertain]: the text of chapter 1 (the publisher's free sample chapter); Ammen's assessment chapter; Schaefer's own chapter "Prescriptive Play Therapy" in Foundations of Play Therapy (ch. 20); and the chapter bodies of The Therapeutic Powers of Play. So the book's exact wording of the core tenets is not reproduced here, and the delivery steps for the 20 powers remain [synthesis] [uncertain].

Prescriptive play therapy is a framework for choosing and combining play therapy approaches, not a single school with its own fixed techniques. Charles Schaefer (1933–2020; co-founder of the Association for Play Therapy with Kevin O'Connor in 1982) and colleagues first presented it in The Playing Cure: Individualized Play Therapy for Specific Childhood Problems (1997, with Kaduson and Cangelosi) as an eclectic, evidence-informed approach built around the individual child's needs [source: Saucier, Schaefer memoriam; subtitle: NDHU library catalogue]. Schaefer also wrote the chapter "Prescriptive Play Therapy" in Foundations of Play Therapy (2nd ed., Wiley, 2011, ch. 20) [source: Wiley contents page; chapter content not reported here]. Kaduson's training institute calls the prescriptive-eclectic model "the most popular theoretical approach among play therapists" [source: Play Therapy Training Institute course page]. The 2019 volume describes its aim as a comprehensive treatment plan: a tailored therapy "prescription" fitted to the child's presenting problems, strengths, challenges and developmental level, with a roadmap running from assessment to case formulation to intervention [source: Guilford book and summary pages].

Core idea of change: play contains active forces, the therapeutic powers of play, that are "the active ingredients in play that help produce change" [source: Saucier memoriam, summarising Schaefer (Ed.), The Therapeutic Powers of Play, Jason Aronson, 1993]. Different problems are maintained by different processes, so the clinician identifies which change mechanisms a particular child needs and then selects the play methods, from whichever theoretical school, that most reliably deliver those mechanisms [source: Schaefer & Drewes 2014 preface; Drewes APA video]. In Drewes's words, selection is "not an arbitrary selection" but a careful integrative process [source: APA video page].

Related guides: for the nondirective ingredient see 157 Child-centred play therapy and 158 Non-directive and integrative play therapy; for structured cognitive-behavioural components see 167 Cognitive-behavioural play therapy; for systems-level case formulation see 169 Ecosystemic play therapy; for trauma work see 170 Trauma-focused integrated play therapy. This guide covers what is specific to prescribing and sequencing; it does not repeat those methods.

2. Framework

The published sources cited describe a sequence of assessment, case formulation, treatment planning and intervention rather than a numbered phase protocol with fixed session counts [source: Guilford book page; Ammen chapter title "Comprehensive, Individualized Assessment for Prescriptive Play Therapy"]. Nash and Schaefer describe play therapy generally as moving through rapport building, working through and termination, starting with a parent meeting without the child [source: Nash & Schaefer, Foundations of Play Therapy ch. 1, pp. 7, 9]. The phase structure below combines those two descriptions; the moving-on criteria are [synthesis].

Phase 0. Referral and parent/carer intake (session 1, adults only).

Goals: hear the concern, history and family context; explain play therapy; agree consent, confidentiality limits and parents' role [source: Nash & Schaefer p. 7 for parent-only first meeting; consent content is synthesis].
Move on when: legal consent is in place, the child's assent plan is agreed, and safeguarding information has been gathered [synthesis].

Phase 1. Comprehensive, individualised assessment (about 2–4 sessions) [synthesis on count].

Goals: define the presenting problem(s) operationally; map strengths, challenges and developmental level, which the prescription must fit [source: Guilford book page]; observe free play and the child's response to structured tasks; gather school and other informant data [synthesis].
Move on when: you can state the problem, its maintaining processes and the child's strengths in a written formulation [synthesis].

Phase 2. Case formulation and the prescription (planning; no child session needed).

Goals: link each maintaining process to one or more therapeutic powers (e.g. fears → counterconditioning, stress inoculation; poor peer skills → social competence, empathy) [source: power names from Schaefer & Drewes 2014; matching examples are synthesis]; choose approaches and techniques that deliver those powers; decide whether to integrate within sessions, across sessions or both [source: Drewes APA video]; fix the parent's role; set measurable goals and review points [synthesis].
Move on when: parents (and, at the child's level, the child) understand and agree the plan [synthesis].

Phase 3. Implementation: rapport building, then working through.

Format: typically weekly individual sessions of about 45–50 minutes, with parent sessions or parent participation alongside [synthesis; the sources cited give no fixed length].
Drewes's demonstrated session structure for middle childhood (ages 6–12): (1) check-in; (2) directive, play-based techniques targeting the presenting problem; (3) a nondirective, child-led period for relaxation and self-regulation [source: APA video page].
In working through, the therapist uses the change agents best suited to the case, for example abreaction, storytelling or the therapeutic relationship [source: Nash & Schaefer p. 9].
Move on to review when: goals are reached, progress stalls for about 3–4 sessions, or new information changes the formulation [synthesis].

Phase 4. Review and re-prescription (every 6–8 sessions) [synthesis].

Goals: compare goal ratings and parent/teacher reports with baseline; keep, add, drop or re-sequence components. Prescriptive work is expected to change as the child changes [synthesis consistent with the client-driven emphasis on the Guilford page].

Phase 5. Termination.

Goals: consolidate gains, hand skills over to parents and school, mark the ending in play [source: Nash & Schaefer p. 9 names termination as a stage; the content is synthesis].

Overall length. No fixed course is prescribed. Nash and Schaefer report that two meta-analyses found about 30–35 sessions associated with the best outcomes [source: Nash & Schaefer p. 11]. Treat this as an outcome-research average, not a protocol length.

3. Guiding principles

Individualised prescription. The plan is built for this child's problems, strengths, challenges and developmental level, not for the therapist's preferred school. Practical meaning: write the formulation before you choose a technique [source: Guilford book page].
Differential therapeutics. Different disorders and adversities call for different treatments. Practical meaning: ask "what works best for this problem in this child?" before "what do I usually do?" [source: Sweeney endorsement on the Guilford page; the term is the endorser's].
Flexibility over loyalty to one school. Kaduson's institute teaches that "rigid adherence to a single theoretical model is likely to result in considerable frustration" for therapist and child. The therapist selects, from both nondirective and directive theories, the intervention with strong empirical support for the child's presenting problem. Practical meaning: when the current approach does not fit the child, change the approach rather than pushing the child to fit it [source: Play Therapy Training Institute course page].
Systematic integration, not syncretism. Combining methods is legitimate only when it is principled; Norcross called uncritical, unsystematic mixing syncretism. Practical meaning: for every technique you can say which change mechanism it serves [source: Seymour, Integrative Play Therapy ch. 1, p. 10].
Therapeutic powers are the unit of selection. The 20 powers (communication, emotional wellness, social relationships, personal strengths) are the active ingredients. Practical meaning: name the target power for each session plan [source: Schaefer & Drewes 2014, contents and preface].
Deliberate, not arbitrary, choice. Practical meaning: record why each technique was chosen and what change you expect [source: Drewes APA video page].
Integration within and across sessions. Directive and nondirective work can sit in the same session or alternate across sessions. Practical meaning: plan the order of directive and child-led time on purpose [source: Drewes APA video page].
Three modes of play. Prescriptive (choosing the best treatment); play as therapy (nondirective, child-led); play in therapy (directive, technique-based). Practical meaning: know which mode you are in at any moment [source: Drewes APA video page].
Regulation before words. Expressive arts, movement and music can support emotional regulation before verbal work. Practical meaning: settle the child's arousal before you ask them to talk about anything difficult [source: Drewes APA video page].
Developmentally appropriate methods. Younger children often do not respond to verbal therapy or school-like tasks. Practical meaning: match the medium to the child's developmental age, not their chronological age [source: Drewes APA video page].
Evidence-informed. The approach draws on what research shows works for each problem. Practical meaning: check the evidence-supported treatment for the presenting problem first and adapt it into play [source: Saucier memoriam; Guilford book page; Play Therapy Training Institute course page].
Parents are part of the prescription. The 2019 volume illustrates work with children and their parents. Parent involvement helped maintain gains, and meta-analyses found larger effects when parents acted as co-therapists. Practical meaning: every plan states the parent's role [source: Guilford book page; Nash & Schaefer pp. 9, 11].
The relationship is itself a power. Empathy, warmth and genuineness were rated the most essential therapist qualities. Practical meaning: technique never overrides attunement [source: Nash & Schaefer p. 10; Schaefer & Drewes 2014, ch. 12 title].
Predictable, consistent setting. Every toy should have a therapeutic purpose; avoid fragile, costly or complicated items. Practical meaning: keep the room and routine the same across sessions [source: Nash & Schaefer p. 7].
Competence boundary. Prescribing a method does not license delivering it untrained. Practical meaning: refer or co-work when the best-matched method (e.g. PCIT, Theraplay, EMDR) needs its own certification [synthesis].

Professional frame. Play therapy is defined by the Association for Play Therapy (APT) as the systematic use of a theoretical model by trained play therapists [source: Nash & Schaefer p. 3]. In the US the APT credential is Registered Play Therapist (RPT) and supervisor (RPT-S); Drewes holds RPT-S [source: APA video page for her credential]. Kaduson (RPT-S) directs the Play Therapy Training Institute, an APT Approved Provider that runs a CE course on the prescriptive approach [source: Play Therapy Training Institute course page]. The detailed APT requirements are not set out here; check APT's current credentialing standards [uncertain]. In the UK, BAPT and PTUK hold registers; play therapy is not an HCPC-regulated title (see 158 for BAPT routes) [uncertain: not verified here]. Use prescriptive play therapy only on top of a recognised core mental health qualification plus supervised play therapy training [synthesis].

Child work: safeguarding, consent and assent, parents [synthesis throughout; follow your local law and employer policy].

Consent: get informed consent from whoever holds parental responsibility, and check custody orders in separated families before the first child session. Assent: explain to the child in simple words who you are, what the playroom is for, what stays private and what does not, and that they may stop an activity at any time. Re-check assent whenever you introduce a directive technique.
Confidentiality limits: agree with parents what you will share (themes and progress, not play content verbatim), and say in advance that safety concerns override privacy.
Mandatory reporting: duties differ by country, state and profession (e.g. statutory reporting in US states; Working Together guidance and local safeguarding partnership procedures in England). Know your route and your designated safeguarding lead before the first session. A disclosure in play is handled as any disclosure: listen, do not lead or interrogate, record the child's words exactly, report promptly, and do not promise secrecy.
Play is not evidence: do not treat play themes, drawings or sandtray scenes as proof of abuse. Raise concerns from what the child says and does, through the proper channel, and leave investigation to the agencies.
Touch: follow the physical-boundary rules in 157 and 161. Never initiate touch without the child's agreement and a clear reason. Never touch the genital, chest or buttock area, and redirect any sexualised touch calmly. Have a written restraint/safe-holding policy, use it only for imminent danger, and record it. Keep the door glazed or ajar, or in line with service policy.
Parent involvement levels: consult only, parallel parent sessions, conjoint sessions, or parent as co-therapist (filial; see 160). Choose the level as part of the prescription.

Play materials and room safety [source: Nash & Schaefer pp. 6–7 for room and toy principles; hazard list is synthesis].

Room of roughly 150–200 sq ft, washable surfaces, child- and adult-sized furniture, sink, storage, attached toilet if possible [source: Nash & Schaefer pp. 6–7, citing Landreth].
Check toys for small parts with under-3s or children who mouth objects, sharp edges, loose batteries (especially button cells), magnets, long cords and strings, and broken items. Use non-toxic, labelled art materials. Keep sand clean and sieved, and dampen it to limit dust. Use soft toy weapons and bop bags only within agreed limits. Clean toys between clients.
Keep scissors, glue guns and similar items out of sight and supervised. Note allergies (latex balloons, food-based play dough, wheat flour) at intake.

4. Intervention inventory

Prescriptive play therapy has no techniques of its own. Its interventions are (A) the prescribing procedures: assessment, formulation, matching, sequencing and review; and (B) the therapeutic powers of play, which are the change agents you prescribe, each delivered through methods borrowed from other approaches [source: Schaefer & Drewes 2014; Guilford book page]. The step-by-step procedures under each power are [synthesis] unless a source is named. The chapter bodies of The Therapeutic Powers of Play are cited by contents only, so no chapter author's specific technique is reproduced [uncertain]. For full methods, follow the cross-referenced guides.

A. Prescribing procedures

A1. Parent/carer intake interview

Purpose / when: first contact; sets consent, history and the parents' role. Done without the child [source: Nash & Schaefer p. 7].
Steps [synthesis]: (1) Ask for the concern in specific behavioural terms: when, where, how often, since when. (2) Take a developmental, medical, family, school and trauma history; screen for safeguarding risks and domestic abuse. (3) Ask about the child's strengths, interests and favourite play. (4) Explain play therapy, the confidentiality limits and reporting duties. (5) Agree consent and who holds parental responsibility. (6) Agree how to introduce therapy to the child. (7) Get permission to contact school and others.
Example language (illustrative): "Children often show us through play what they can't yet put into words. My job is to work out what kind of help suits your child best, and that includes how you can help at home."
Watch for: parents who disagree about the problem or about consent; signs that parental conflict or harm is the main driver (then the prescription may be family or safeguarding work first; see 169).

A2. Comprehensive, individualised assessment

Purpose / when: sessions 2–4. Build the picture the prescription must fit: problems, strengths, challenges, developmental level [source: Guilford book page; Ammen ch. 2 title]. Ammen's chapter (ch. 2 of the 2019 volume) has no publisher preview, so her assessment procedures and instruments are not described here, and the steps below are not hers [uncertain].
Steps [synthesis]: (1) Hold one session of free, child-led play with a standard toy set, and note themes, play maturity, regulation, how the child relates to you and how they tolerate limits. (2) Offer one or two structured tasks (a drawing, a puppet story, a feelings game) and note how the child responds to structure versus freedom; this predicts the directive/nondirective mix. (3) Use standardised parent and teacher rating scales suited to the presenting problem, chosen and scored by their manuals. (4) If useful, observe a parent–child play session (see 159, 161). (5) Screen development (language, motor, social) and refer for specialist assessment if needed.
Example language (illustrative): to the child: "This is a special playroom. You can choose almost anything to play with today. I'll be here with you."
Watch for: reading play content as diagnostic. Use play observation to build hypotheses about process (regulation, avoidance, relatedness), not to establish events.

A3. Prescriptive case formulation

Purpose / when: after assessment; turns information into a rationale [source: Guilford book page names case formulation as a step; template is synthesis].
Steps [synthesis]: write one page with these headings: (1) Problem list, in observable terms. (2) Maintaining processes for each problem (e.g. avoidance, skill deficit, dysregulation, insecure attachment, coercive family cycles, unprocessed trauma). (3) Strengths and resources. (4) Developmental level and preferred play media. (5) Target therapeutic powers for each process. (6) Approaches and techniques selected, with the evidence for each. (7) Parent and school roles. (8) Measurable goals and review date.
Example language (illustrative): to parents: "Here's how I understand what keeps Leo's worries going, and what I'd like to try first. Does this fit what you see at home?" [synthesis]
Watch for: a long list of powers with no priority. Choose two or three primary targets per treatment block.

A4. Matching problems to approaches (prescriptive matching)

Purpose / when: choosing which established approach(es) to draw on. The 2019 volume and Integrative Play Therapy (2011) give problem-specific chapters that serve as the matching map [source: Guilford contents; Integrative Play Therapy contents].
Steps: (1) Find the closest problem chapter (list below). (2) Identify the evidence-supported treatment for that problem and the play adaptations the chapter describes. (3) Check your competence and refer if needed. (4) Fit the method to the child's developmental level and preferences.
Problem chapters in the 2019 volume [source: Guilford contents]: depression (Newman); fears and phobias (Zelinger); OCD (Carter); selective mutism (Wonders); survivors of disaster, terrorism and other tragic events (Shelby & Smith); divorce (Cangelosi); sexual abuse (Gil & Koelfgen Smelser); ADHD (Kaduson); problem sexual behaviours (Gil & Koelfgen Smelser); aggressive behaviour (Crenshaw & Swan); autism spectrum (Grant); attachment disruptions (Goodyear-Brown); school behaviour problems (Drewes).
Pairings in Integrative Play Therapy [source: contents of the publisher sample]: PCIT for oppositional behaviour; sandtray with solution-focused techniques; cognitive-behavioural play therapy for traumatised children; the Worry Wars protocol for anxiety; filial therapy for maltreated and neglected children; play therapy with EMDR; bibliotherapy within play therapy; CBT with Adlerian play therapy for perfectionism; family and play therapy for reactive attachment disorder; attachment theory with nondirective play therapy; child-centred play therapy with Theraplay. Chapter content is not reported here [uncertain].
Cross-refer: CBPT steps → 167; trauma sequencing → 170; child-centred → 157; filial/CPRT → 159, 160; Theraplay → 161; Adlerian → 164; ecosystemic → 169.
Example language (illustrative): to parents: "For fears like this, a step-by-step practice plan has the most research behind it. I'll build it into play so it feels manageable for Ava." [synthesis]
Watch for: choosing a method because it is familiar rather than because it fits the formulation, or prescribing one you are not trained to deliver; refer or co-work instead. [synthesis]

A5. The three-part prescriptive session (Drewes)

Purpose / when: a default session shape when directive and nondirective work are combined, demonstrated with a middle-childhood client (ages 6–12) [source: APA video page].
Steps: (1) Check-in [source]: how the week went, with a feelings rating or object choice [synthesis on method]. (2) Directive segment [source]: one play-based technique aimed at the presenting problem (e.g. an anger thermometer game, puppet role-play of a bullying scene) [examples are synthesis]. (3) Nondirective, child-led segment [source]: the child chooses, and you track and reflect, which supports relaxation and self-regulation. (4) Close with a 5-minute warning and a tidy-up or goodbye ritual [synthesis].
Time split [synthesis]: about 10 / 20 / 15 minutes in a 45–50 minute session. Shift toward more child-led time for anxious or traumatised children, and more structure for skill-deficit problems.
Example language (illustrative): "First we'll check in, then I have a game for us, and after that the rest of the time is yours to choose."
Watch for: the child rushing through the directive part to get to free time (shorten it, make it more playful), or being unable to settle in free time (add predictable structure).

A6. Integration across sessions

Purpose / when: when a single session cannot hold both modes, or when the child needs a block of one mode first [source: Drewes APA video, "within sessions, across sessions, or both"].
Steps [synthesis]: (1) Choose a pattern: alternate (directive and nondirective weeks), phase (e.g. 4–6 child-led sessions to build safety, then a skills block), or parallel (child sessions in one mode, parent sessions in another). (2) Tell the child the pattern in advance. (3) Review the pattern at each review point.
Example language (illustrative): "On Mondays you choose what we play. On Thursdays I'll bring a game I've picked to help with the worry." [synthesis]
Watch for: confusion if the pattern changes without warning.

A7. Regulation-first opening

Purpose / when: for dysregulated, traumatised or nonverbal children, before any verbal or cognitive work [source: Drewes APA video mentions expressive arts, movement and music for emotional regulation before verbal interaction].
Steps [synthesis]: (1) Begin with a short rhythmic or sensory activity: drumming a steady beat together, bubble breathing, rolling a ball back and forth, squeezing clay. (2) Keep it the same each week. (3) Move to talk or a directive task only once breathing, voice and movement have settled.
Example language (illustrative): "Let's get our bodies ready first. Blow the bubbles slowly, as big as you can."
Watch for: sensory overload (lower volume, cut materials). Keep drum volume moderate in small rooms.

A8. Prescribing the parent component

Purpose / when: every case. Parent involvement maintained gains, and parents as co-therapists showed larger effects [source: Nash & Schaefer pp. 9, 11].
Steps [synthesis]: (1) Pick a level: consultation, parallel parent sessions, conjoint parent–child sessions, or parent as co-therapist (filial/CPRT; see 159, 160; or PCIT, Theraplay). (2) Set 1–2 concrete home tasks (e.g. 10 minutes of child-led special play, a consistent calm-down routine). (3) Review them at every parent contact.
Example language (illustrative): to parents: "Play sessions are one part; the other part is what happens at home. Could you try ten minutes of special play, with Sam in charge, three times this week?" [synthesis]
Watch for: parents expecting the therapist to "fix" the child alone. Explain that the prescription includes them.

A9. Progress monitoring and re-prescription

Purpose / when: every 6–8 sessions, or sooner if stuck [synthesis].
Steps [synthesis]: (1) Re-administer baseline measures and goal ratings. (2) Review play process markers: longer play episodes, richer themes, better tolerance of limits, mastery endings. (3) Decide to continue, add a power, change the method, change the parent level, or refer. (4) Record the reasoning.
Example language (illustrative), to parents: "We've seen the bedtime fears ease, but the school worries haven't shifted. I'd like to add a more structured coping-skills part to sessions."
Watch for: continuing the same plan because the child enjoys sessions although the measures show no change, or changing method so often that no effect can be judged. [synthesis]

A10. Termination

Purpose / when: goals met and stable across settings [source: Nash & Schaefer p. 9 names termination as a stage; steps are synthesis].
Steps [synthesis]: (1) Give the child several weeks' notice and use a visual countdown. (2) Review progress in play (a "then and now" drawing or story). (3) Hand strategies over to parents and school. (4) Hold a goodbye ritual. (5) Offer a follow-up or booster session.
Example language (illustrative): "We have four more sessions. Let's draw how things were when you started, and how they are now." [synthesis]
Watch for: regression near the end. It is common and usually brief; name it and hold the ending unless risk has changed.

B. The 20 therapeutic powers as prescribable change agents

Names and grouping follow Schaefer & Drewes (2014): four clusters of 20 powers [source: Wiley contents; e-bookshelf sample]. A one-line definition is sourced only where marked. Delivery steps, example language and markers are [synthesis] built from standard play methods, so treat them as a starting menu. No openly available source gives the chapter authors' own delivery procedures, and no published step-by-step protocol was found, so the delivery steps below are the writer's synthesis [synthesis]. Neither the chapter bodies of the 2014 book nor Schaefer & Drewes's overview chapter "The Therapeutic Powers of Play and Play Therapy" (Foundations of Play Therapy, 2011, ch. 2) is drawn on here [uncertain]. For each power, prescribe it when the formulation names the matching maintaining process.

Cluster 1: Facilitates communication

B1. Self-expression

Purpose / when: for children who cannot or will not put feelings and experiences into words (young age, language delay, shame, selective mutism). Play gives a nonverbal channel.
Steps [synthesis]: offer expressive media (puppets, figures, art, sandtray; see 152). Let the child choose. Reflect what you see rather than asking questions. Move toward words only when the child does.
Example language (illustrative): "That dragon is roaring really loudly at the little one."
Watch for / working when: play becomes richer and more specific; the child starts naming feelings in the third person, then the first.

B2. Access to the unconscious

Purpose / when: material the child cannot reach directly shows up through symbol, metaphor and displacement. Use with children whose difficulties seem driven by conflicts they cannot verbalise.
Steps [synthesis]: keep sessions nondirective with symbolic toys. Stay inside the metaphor. Interpret sparingly and only within a psychodynamic or Jungian frame you are trained in (see 163).
Example language (illustrative): "The castle has very high walls. Nobody can get in."
Watch for: over-interpretation. Treat themes as hypotheses only, never as evidence of events.

B3. Direct teaching

Purpose / when: skill deficits (coping, social, problem-solving, emotion naming). Teach explicitly through games, modelling and practice.
Steps [synthesis]: (1) Name the skill. (2) Model it with a puppet. (3) Have the child practise in a game. (4) Praise specifically. (5) Assign home practice with the parent. Follow 167 for CBPT structure.
Example language (illustrative): "Mr Turtle has a trick when he gets mad: he goes into his shell and takes three slow breaths. Let's try it."
Watch for: the child generalising the skill outside the room (parent or teacher report).

B4. Indirect teaching

Purpose / when: children who resist direct instruction. Lessons are carried by story, metaphor and modelling (therapeutic stories, bibliotherapy, mutual storytelling).
Steps [synthesis]: build a story with a character facing a problem like the child's, which the character solves through a coping step. Let the child add to it. Do not spell out the moral.
Example language (illustrative): "Once there was a little fox who was scared to go into the big forest school… What do you think the fox did next?"
Watch for: the child bringing the character back in later sessions, or using its solution.

Cluster 2: Fosters emotional wellness

B5. Catharsis

Purpose / when: release of pent-up feeling through physical or expressive play. Nash and Schaefer distinguish it from abreaction [source: Nash & Schaefer p. 4].
Steps [synthesis]: offer safe outlets (bop bag, clay pounding, drums) within clear limits. Pair the release with naming the feeling and a calm-down step afterwards.
Example language (illustrative): "You're really angry. You can punch the clay as hard as you like. Then we'll breathe together."
Watch for: escalation rather than relief. Unstructured venting can raise aggression in some children, so stop if arousal climbs and switch to regulation (B10). [uncertain: chapter guidance not reported here]

B6. Abreaction

Purpose / when: reliving a distressing experience in play, with matching feeling, in order to master it. Nash and Schaefer trace this to Freud and define it as reliving and mastering an experience [source: Nash & Schaefer p. 4].
Steps [synthesis]: only after safety and regulation are established. Let the child set the pace and the play distance (miniatures before role-play). Track and reflect. Support a mastery ending. Use trauma pacing (see 170).
Example language (illustrative): "The ambulance came and helped. Now the little one is safe."
Watch for: post-traumatic play that repeats without resolution, rising distress or dissociation. Interrupt gently, regulate, and change the play distance (see section 5).

B7. Positive emotions

Purpose / when: depression, anhedonia, family relationships dominated by conflict. Joy, fun and laughter in play build resources.
Steps [synthesis]: schedule playful, mutually enjoyable activities (silly games, cooperative building). Prescribe parent–child fun time at home.
Example language (illustrative): "That was so funny. You made me laugh so hard!"
Watch for: spontaneous smiling, and initiating play.

B8. Counterconditioning fears

Purpose / when: specific fears and phobias. Play produces a pleasant state that is paired with graded exposure to the feared stimulus.
Steps [synthesis]: (1) Build a fear ladder with the child using pictures. (2) Pair each step with a play activity the child enjoys. (3) Move up only when the current step is easy. (4) Follow consent and stop rules (see 167). Exposure needs informed parental consent, the child's assent to each step, and the option to pause.
Example language (illustrative): "The toy dog can sit at the far side of the room while we play your favourite game. You tell me if it can come one step closer."
Watch for: avoidance ratings falling; the child volunteering the next step.

B9. Stress inoculation

Purpose / when: preparing for a known upcoming stressor (surgery, court, a house move, a new school). Rehearsal in play lowers anticipatory anxiety.
Steps [synthesis]: use a doctor kit, a dollhouse or miniatures to rehearse the event step by step. Include a coping statement and a supporter at each step.
Example language (illustrative): "Let's show what happens at the hospital, from the car park all the way to going home."
Watch for: the child correcting details, and taking a coping role in the play.

B10. Stress management

Purpose / when: general anxiety, dysregulation, somatic complaints. Teach relaxation and calming through play.
Steps [synthesis]: use bubble or pinwheel breathing, "spaghetti/robot" muscle relaxation, guided imagery stories and calm boxes. Practise each session and at home.
Example language (illustrative): "Make your body stiff like a robot… now floppy like spaghetti."
Watch for: the child using the strategy on their own in a stressful moment.

Cluster 3: Enhances social relationships

B11. Therapeutic relationship

Purpose / when: every case, and the main agent for mistrustful, relationally hurt or very withdrawn children. The relationship is listed as a change agent in its own right [source: Schaefer & Drewes 2014 contents; Nash & Schaefer p. 9].
Steps [synthesis]: use child-centred skills (tracking, reflecting feelings, returning responsibility, limit setting) in a consistent setting (see 157).
Example language (illustrative): "You decided to build it all by yourself."
Watch for: the child seeking you out, showing you things and tolerating limits without collapse.

B12. Attachment

Purpose / when: attachment disruptions, care-experienced and adopted children, and parent–child relationships under strain [source: power listed in Schaefer & Drewes 2014; Goodyear-Brown chapter on attachment disruptions in the 2019 volume].
Steps [synthesis]: use dyadic methods with the carer present: Theraplay-style structure, nurture, engagement and challenge (see 161); filial/CPRT (see 159, 160). Coach the carer, don't replace them.
Example language (illustrative), to carer: "Notice how she checked your face just then. Smile back, and say what you see."
Watch for: the child turning to the carer for comfort; carer reflective comments increasing.

B13. Social competence

Purpose / when: peer difficulties, ASD, ADHD. Practise turn-taking, joining in, negotiating and losing gracefully.
Steps [synthesis]: use structured board and cooperative games, puppet rehearsals of social scenes, and small-group play with 3–5 children of similar developmental level. Give explicit feedback.
Example language (illustrative): "You waited for your turn even though you really wanted to go. That's what makes friends want to play again."
Watch for: teacher or parent reports of peer contact; less conflict in games.

B14. Empathy

Purpose / when: aggression, bullying (as perpetrator), callous or poorly attuned behaviour. Role play and perspective taking.
Steps [synthesis]: use role reversal with puppets ("you be the one who was pushed"), feelings-guessing games and stories told from several viewpoints. Reflect the other character's feelings.
Example language (illustrative): "How do you think the little bear felt when the big bear took his ball?"
Watch for: spontaneous comments on others' feelings; repair attempts.

Cluster 4: Increases personal strengths

B15. Creative problem solving

Purpose / when: rigid thinking, perfectionism, poor coping. Pretend play builds flexible, divergent thinking.
Steps [synthesis]: set open-ended play problems ("the bridge has broken, how do the animals cross?"); generate several solutions; try them out in play; praise ideas, not just results.
Example language (illustrative): "That's one way. What's a totally different, silly way?"
Watch for: more solutions generated per problem; less distress when a plan fails.

B16. Resiliency

Purpose / when: children facing adversity (divorce, disaster, illness). Build mastery, hope and connection.
Steps [synthesis]: create strength-focused play: hero stories, "survival kit" boxes, mapping support people. Link the play to real resources.
Example language (illustrative): "Your superhero got knocked down three times and kept getting up. What helped her?"
Watch for: hopeful themes; the child naming people who help.

B17. Moral development

Purpose / when: rule-breaking, cheating, aggression. Rule-based games and fair-play dilemmas.
Steps [synthesis]: play games with rules; discuss fairness when rules are broken; let the child invent rules and test them; explore dilemmas in story.
Example language (illustrative): "If we change the rule so only you can win, will it still be fun for both of us?"
Watch for: the child holding to rules without prompting; fairer play.

B18. Accelerated psychological development

Purpose / when: developmental lags in play maturity, self-control or symbolic thinking. Play scaffolds the next developmental step. The chapter's theoretical base is not reported here [uncertain].
Steps [synthesis]: assess the current play level (sensory → functional → symbolic → rule-based). Play just one step above it, modelling and scaffolding, and fade support as the child takes over.
Example language (illustrative): "Let's pretend this block is a phone. Ring ring! Who's calling?"
Watch for: new play forms appearing spontaneously.

B19. Self-regulation

Purpose / when: ADHD, impulsivity, emotional outbursts. Games that require stop/go, waiting and arousal control.
Steps [synthesis]: use red-light/green-light, statues, slow-motion races, Jenga-type games, "feelings thermometers". Increase the difficulty step by step. Rehearse the plan for real-life triggers. See Kaduson's ADHD chapter in the 2019 volume for the source author's own selection [content not reported here].
Example language (illustrative): "Can you move as slowly as a sloth to the door, without stopping?"
Watch for: longer waiting tolerance; faster recovery after frustration.

B20. Self-esteem

Purpose / when: low self-worth, depression, bullying victims (as in Drewes's demonstration case of an 8-year-old with bullying, low self-esteem and anger problems [source: APA video page]).
Steps [synthesis]: offer achievable mastery tasks with gradually increasing challenge; use specific, effort-focused encouragement; let the child teach you a game; use "strengths" art.
Example language (illustrative): "You kept trying with that tricky tower until it worked."
Watch for: fewer self-critical statements; more willingness to try new things.

B21. Combining powers: worked example (Drewes's demonstration case)

Case [source: APA video page]: an 8-year-old bullied at school, with low self-esteem and anger management problems, seen in a session of check-in, then directive play techniques targeting the problems, then child-led play.
A possible prescription [synthesis, not Drewes's actual plan]: primary powers: stress management and self-regulation (anger), self-esteem, social competence. Methods: CBPT anger-thermometer and coping-puppet work (167); puppet role-play of bullying scenes with assertive responses; mastery tasks; nondirective time for regulation and relationship (157). Parent: consultation plus a home calm-down routine. School: liaison on the bullying.

5. Handling problems

The sources cited give little problem-specific guidance. Everything below is [synthesis] unless a source is named. The prescriptive logic itself is the main tool: when something is not working, go back to the formulation (A3) and re-prescribe (A9).

Stuck: no change after 6–8 sessions. Check four things in order. (1) Is the formulation right? Re-assess with new informants. (2) Is the right power targeted? For example, a child given relaxation training whose real driver is a coercive cycle at home needs parent work, not more relaxation. (3) Is the delivery method a good fit for this child's developmental level and interests? (4) Is the dose sufficient: frequency, parent practice, attendance? Then change one variable at a time and record why.
Eclectic drift. Sessions slide into a different technique each week with no rationale; this is the unsystematic mixing Norcross called syncretism [source: Seymour p. 10]. Fix: each session plan names its target power and the technique serving it. Keep a technique long enough to judge its effect (usually 3–4 sessions).
Resistance to directive segments. The child refuses, rushes or sabotages the structured task. Responses: make the task more playful; give the child choices within it ("puppets or drawing?"); shorten it; put it after some child-led time; or move it into a story or metaphor (indirect teaching, B4). If refusal persists, the child may need a longer nondirective phase first (A6). Respect a clear "no" as a matter of assent.
Unable to use free time. Some children become disorganised, aggressive or anxious when play is unstructured. Responses: add predictable structure (a choice of three activities, a timer, a visual schedule); stay closer; set limits early and consistently (see 157 for limit-setting steps).
Overwhelm, flooding or dissociation in play (especially during abreaction, B6). Signs: frozen or glazed look, sudden collapse of play, panic, repetitive post-traumatic play that escalates without resolution. Responses: slow down; name what you see; shift to regulation (breathing, rhythm, a grounding object); increase play distance (from role-play to miniatures, from first person to a character); bring the play to a safe ending; inform the parent after the session; then revise pacing in the formulation. Follow 170 for trauma sequencing.
Escalating aggression. Release activities (B5) may raise arousal. Responses: stop the release activity; use firm limit setting with a choice; move to regulation; replace venting with self-regulation (B19) and empathy (B14) work. Never allow hurting the therapist or the child themselves, or damaging the room beyond agreed limits.
Non-adherence: parents not doing home tasks or missing sessions. Responses: reduce tasks to one small, specific action; practise it with the parent in session; explore barriers (time, mental health, conflict, disagreement with the plan); re-prescribe the parent level (consult instead of co-therapist, or the reverse). If a parent's own difficulties block progress, refer them for their own support.
Parent pressure for a quick fix or a single school. Explain the prescription and its review points. Agree what change would look like and when you will review it together.
Ruptures with the child (anger at the therapist, withdrawal after a limit or a missed session). Name the rupture in the child's language; acknowledge your part; repair in play (e.g. a puppet that says sorry); keep the routine predictable. With parents: invite disagreement at reviews and take complaints seriously.
Disclosures and safeguarding concerns during play. Follow the steps in section 3: listen, don't lead, record exactly, report through your local route, and don't promise secrecy. Afterwards, plan with your supervisor how to keep the therapy safe and what to tell parents (unless telling them would increase risk).
Sexualised play or behaviour. Set clear, calm limits on touching. Redirect to permissible play. Record what happened. Consider whether it raises safeguarding concerns and consult. Consult specialist guidance on problem sexual behaviours; the 2019 volume has a chapter by Gil & Koelfgen Smelser (content not reported here).
Competence limits. The best-matched method may be outside your training (e.g. PCIT, EMDR, Theraplay certification). Refer on, co-work, or get supervision from someone trained. Don't improvise a protocol you're not qualified to deliver.
Cultural mismatch. Toys, stories and family roles may not fit the child's culture. Review the toy set for diversity (dolls, families, food, clothing). Ask the family about play, discipline and help-seeking norms. Adapt the parent component accordingly.
Developmental mismatch. The technique is too verbal or too babyish for the child. Re-check developmental level (A2) and adjust the medium: sensory and motor play for younger children, games and art for middle childhood, sandtray, music or digital-creative media for adolescents.
Ending too early or too late. Base termination on goals and on gains holding up across settings, not on session count. The 30–35 session figure is a research average, not a target [source: Nash & Schaefer p. 11].

Sources

Online sources:

Books and media cited:

Kaduson, H. G., Cangelosi, D., & Schaefer, C. E. (Eds.) (2019). Prescriptive Play Therapy: Tailoring Interventions for Specific Childhood Problems. New York: Guilford Press. 276 pp.; paperback ISBN 978-1-4625-4167-6 [source: Guilford contents page].
Schaefer, C. E., & Drewes, A. A. (Eds.) (2014). The Therapeutic Powers of Play: 20 Core Agents of Change (2nd ed.). Wiley. (Wiley-VCH lists publication as November 2013.)
Drewes, A. A., Bratton, S. C., & Schaefer, C. E. (Eds.) (2011). Integrative Play Therapy. Wiley.
Nash, J. B., & Schaefer, C. E. (2011). Play therapy: Basic concepts and practices. In C. E. Schaefer (Ed.), Foundations of Play Therapy (2nd ed., ch. 1, from p. 3). Wiley (April 2011; ISBN 978-0-470-52752-8) [source: Wiley table of contents].
Schaefer, C. E. (2011). Prescriptive play therapy. In C. E. Schaefer (Ed.), Foundations of Play Therapy (2nd ed., ch. 20, from p. 365). Wiley. [listed in the Wiley contents]
Schaefer, C. E., & Drewes, A. A. (2011). The therapeutic powers of play and play therapy. In C. E. Schaefer (Ed.), Foundations of Play Therapy (2nd ed., ch. 2, from p. 15). Wiley. [listed in the Wiley contents]
Kaduson, H. G., Cangelosi, D., & Schaefer, C. E. (Eds.) (1997). The Playing Cure: Individualized Play Therapy for Specific Childhood Problems. Child Therapy Series. [Subtitle confirmed by the NDHU library record; series from Goodreads; publisher not confirmed [uncertain].]
Schaefer, C. E. (Ed.) (1993). The Therapeutic Powers of Play. Northvale, NJ: Jason Aronson. xii + 362 pp.; ISBN 0-87668-454-1 [source: KMU library record; Eurolivre].
Drewes, A. A. (2017). Prescriptive Integrative Play Therapy [DVD]. APA Psychotherapy Video Series IX: Children and Adolescents.

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