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Journal of Child and Adolescent Counseling
ISSN: 2372-7810 (Print) 2372-7829 (Online) Journal homepage: http://www.tandfonline.com/loi/ucac20
Effect of Child-Centered Play Therapy on
Performance Anxiety and Academic Achievement
Pedro J. Blanco, Joel H. Muro, Ryan Holliman, Victoria K. Stickley & Kali
Carter
To cite this article: Pedro J. Blanco, Joel H. Muro, Ryan Holliman, Victoria K. Stickley &
Kali Carter (2015) Effect of Child-Centered Play Therapy on Performance Anxiety and
Academic Achievement, Journal of Child and Adolescent Counseling, 1:2, 66-80, DOI:
10.1080/23727810.2015.1079117
To link to this article: http://dx.doi.org/10.1080/23727810.2015.1079117
Published online: 30 Oct 2015.
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Effect of Child-Centered Play Therapy on Performance
Anxiety and Academic Achievement
Pedro J. Blanco, Joel H. Muro, and Ryan Holliman
Department of Family Sciences, Texas Woman’s University, Denton, Texas, USA
Victoria K. Stickley
Texas Woman’s University, Denton, Texas, USA
Kali Carter
Cumberland Children’s Home, Denton, Texas, USA
This study of normal functioning first graders examined the effectiveness of child-centered play
therapy (CCPT) on performance anxiety and academic achievement. The experimental group
received biweekly, 30-minute play therapy sessions for eight weeks. Findings indicated that the
first grade students participating in this study (n= 29) demonstrated a statistically significant increase
on the Early Achievement Composite of the Young Children’s Achievement Test (Hresko, Peak,
Herron, & Bridges, 2000) when compared with children in the waitlist control group (n= 30). No
significant difference was found for the Woodcock Johnson III Total Brief Achievement between
groups. Additional findings of the analysis indicated that from pretest to posttest the play therapy
(PT) group and the waitlist control (WC) group scored statically significantly lower mean scores on
the performance anxiety cluster of the Revised Children’s Manifest Anxiety Scale, Second Edition
(Reynolds & Richmond, 2008). Results support the use of CCPT as an intervention for academic
achievement.
Keywords: academic achievement, performance anxiety, child centered, play therapy
MENTAL HEALTH AND CCPT IN THE SCHOOLS
Since the passage of No Child Left Behind legislation, all U.S schoolchildren are expected to
meet certain academic standards within their respective grade levels and, as a result, school-
children are asked to work harder at younger ages. By and large, early educational experiences
have a strong influence on a child’s development, not only because most children are at school
on average seven hours a day but also because schools represent practical venues in which most
children can be identified, assessed, and provided mental health services (Rönnau-Böse &
Fröhlich-Gildhoff, 2009). Implementing viable mental health interventions beginning at the
Correspondence should be sent to Pedro J. Blanco, Texas Woman’s University, Department of Family Sciences, P.O.
Box 425769, Denton, TX 76204, USA. E-mail: PBlanco@mail.twu.edu
Journal of Child and Adolescent Counseling,1:66–80, 2015
Copyright © Association for Child and Adolescent Counseling
ISSN: 2372-7810 print / 2372-7829 online
DOI: 10.1080/23727810.2015.1079117
Downloaded by [Pedro Blanco] at 11:05 05 July 2016
elementary school level is essential to help promote access to necessary services that are
designed to simultaneously enhance emotional support and academic success (The President’s
New Freedom Commission on Mental Health, 2003). The use of a child-sensitive approach, such
as child-centered play therapy (CCPT), can assist children in elementary school in communicat-
ing and addressing their concerns and needs through a developmentally appropriate medium of
play (Stickley, Muro, & Blanco, 2013).
CCPT is a well-established, empirically supported, culturally responsive intervention that
originated in school-based settings (Garza & Bratton, 2005; Ray, Stulmaker, Lee, & Silverman,
2013; Tsai & Ray, 2011). The child-centered approach to play therapy is guided by humanistic,
nondirective principles that utilize a variety of toys and play-based materials in an environment
where toys represent children’s words and their play represents the their language (Landreth,
Ray, & Bratton, 2009). The primary tenant of this approach specifically relates to the therapeutic
relationship and nondirective nature of the therapeutic environment. Ideally, the relationship is
facilitated by a caring, sensitive, empathic, and genuine counselor. The atmosphere is established
through attunement to the child’s emotional and physical experiences and an inherent trust in the
child’s ability to direct his or her own growth (Bratton, Ray, Edwards, & Landreth, 2009;
Landreth, 2012).
Results of play therapy research have established current empirical evidence demonstrating
the effectiveness of play therapy with children in school settings; these results reveal that play
therapy increases support for children’s emotional health and feelings of academic competence
(Blanco & Ray, 2011; Ray, Henson, Schottelkorb, Brown, & Muro, 2008). More specifically,
Ray, Armstrong, Balkin, and Jayne (2015) conducted a meta-analysis of CCPT in schools and
found statistically significant effects for outcome constructs related to academic concerns.
Rönnau-Böse and Fröhlich-Gildhoff (2009) found that positive changes in self-esteem and
cognitive development, as a result of exposure to CCPT, affected children’s ability to grasp
classroom materials and interact in the classroom environment.
Green and Christensen (2006) studied the perceptions of children who were participating in
school-based play therapy. In the course of their study, the researchers found children tended to
prefer play therapy to talk therapy. Green and Christensen concluded that, in conjunction with
the therapist’s understanding and acceptance, children made better choices, felt less anxiety, and
experienced increased empathy and self-confidence both at home and in school. It is feasible,
then, to assert that the use of play therapy for children may be effective to overcome the
limitations that hinder academic achievement, while also helping to foster higher academic
confidence and ultimately improving their performance.
ANXIETY, CHILDREN, AND PLAY THERAPY
Anxiety is one of the most prevalent childhood emotional disorders and currently affects as
many as 1 in 8 children (Anxiety and Depression Association of America, 2010). Young
children express their anxiety primarily through behaviors and/or exhibiting emotional or
physiological distress. These children tend to experience low self-worth and social acceptance,
struggle more with peer interactions, and demonstrate deficits in academic performance
(Ginsburg, La Greca, & Silverman, 1998; McLoone, Hudson, & Rapee, 2006; Strauss, 1987).
In addition, anxiety in young, school-age children is predictive of difficulty with overall
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academic performance, maladaptive coping tendencies, and potential cognitive abilities, which
oftentimes increases in frequency and intensity as time passes (Bub, McCartney, & Willet, 2007;
Egeland, Kalkoske, Gottesman, & Erickson, 1990; Legerstee, Garnefski, Jellesma, Verhulst, &
Utens, 2010; Simon, Bögels, & Voncken, 2011; Wood, 2007).
While specific empirical evidence demonstrating a relationship between the use of play
therapy and a decrease in anxiety is limited, some researchers have studied and declared that
participation in play therapy can increase self-esteem (Baggerly, 2004; Green & Kolos, 2010;
Kot, Landreth, & Giordano, 1998). Children who develop higher self-esteem tend to have more
fulfilling personal relationships, a lower incidence of problem behaviors, and better academic
abilities, while children without confidence in their abilities may experience anxiety and low
performance in the classroom (Elias et al., 1997). In addition, Baggerly (2004), Shen (2002), and
Post (1999) each found decreases in anxiety when applying CCPT with children.
ACADEMIC PERFORMANCE ANXIETY AND INTERVENTIONS
The dearth of information regarding correlation between performance anxiety and CCPT is
evident. However, some studies have explored the link between academic performance and
anxiety correlations, as well as play-based interventions, that may mitigate the debilitating
consequences on the anxious student. Powell (2004) asserted that performance anxiety can
threaten the promise of academic achievement, contending that performance anxiety strips
the sufferer from moving forward. He noted that when anxiety is high, impairment is severe;
and such affected youth are in dire need of appropriate treatment. Furthermore, Ocak and
Yama ç ( 2013) examined the correlation between achievement and students’attitudes, find-
ing that intrinsic goal orientation predicted the attitude toward certain subject matters.
However, the authors noted that self-efficacy and test anxiety predicted level of achieve-
ment. Findings indicated that the higher the anxiety, the greater chance of unsatisfying
academic results.
The environment of high stakes testing is also related to levels of anxiety experienced by children.
Segool, Carlson, Goforth, Von Der Embse, and Barterian (2013) concluded that the higher the stakes
were for testing, the greater the possibility for test anxiety to manifest. While not addressed by the
research team, the authors of this work noted that a variety of interventions, including CCPT, may
have the potential for reducing test anxiety. Boxer, Goldstein, DeLorenzo, Savoy, and Mercado
(2011) researched performance anxiety and high-stakes testing in relation to student attitudes. Their
study yielded a variety of conclusions regarding testing and highlighted the academic and social risks
of children who reported higher levels of test/performance anxiety. Students not only had anxiety
regarding testing but also were affected emotionally and presented with more frequent behavioral
problems as compared to students who reported having focused educational goals.
ACADEMIC ACHIEVEMENT IN CHILDREN AND PLAY THERAPY
In a review of more contemporary research, Elias, Zins, Graczyk, and Weissberg (2003)
investigated the literature of educational innovations. They identified several assumptions as
vital for academic success including the need to incorporate social and emotional learning as an
68 BLANCO ET AL.
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essential part of academic curriculum. Elias and colleagues (2003) reported, “Children who are
hurting cannot learn effectively, and their presence in schools without getting needed attention
drains energy, focus, and potential from the learning environment”(p. 304).
Carlson and colleagues (1999) utilized longitudinal data to measure whether early social and
emotional support in elementary school students could predict their ease of adjustment to high
school. Over a period of 17 years, researchers found that the emotional health of children who
were labeled at risk due to poverty, along with peer relations and externalizing behaviors,
predicted later school maladjustment. De Lugt (2007) investigated studies of academic achieve-
ment in students with emotional and behavioral disorders and specifically found that the reading
achievement of students with emotional difficulties was significantly lower than their peers.
More importantly, as they progressed in school, this trend increased over time.
In the field of play therapy, early studies primarily focused on enhancing academic perfor-
mance by improving IQ scores (Axline, 1947,1949; Bills, 1950; Mundy, 1957; Shmukler &
Naveh, 1985). In contemporary studies there has been a shift to instead measure emotional- and/
or behavioral-driven assessments. Recent research in school-based play therapy has established a
link between participation in play therapy and improvement in academic functioning. In addi-
tion, children expressed increased feelings of academic competence, openness to learning, and
improved teacher–student interactions (Blanco & Ray, 2011; Blanco, Ray, & Holliman, 2012;
Ray et al., 2008). Further exploration revealed that these wide-ranging changes relate directly to
the unique relationship established in CCPT, a relationship that is established by a play therapist
who accepts, encourages, and reflects emotional expression and facilitates a connection that
allows children to be more empowered and accepting of themselves and others (Green &
Christensen, 2006; Landreth, 2012). In addition, Blanco and Ray (2011) proposed that the use
of CCPT “allow[s] children to develop a better sense of their current abilities in safety, without
the anxiety of performance, unlike that in the classroom. This nonevaluative environment gives
the child freedom to express his or her feelings without judgment”(p. 240).
PURPOSE OF STUDY
Given the wealth of empirical support for the existence of a strong relationship between poor
academic achievement and emotional and behavioral problems, it is imperative to examine
potential interventions that schools can use to address these problems. Young elementary school
students will likely continue to experience pressure to perform well academically. Hence, there is
a need for school-based interventions, supplemental to the traditional learning environment,
designed to meet the child’s emotional needs.
The purpose of the current study was to follow the impact of CCPT on academic achieve-
ment, while also investigating the effect CCPT potentially has on performance anxiety. A unique
aspect of this study was the inclusion of normal functioning children as compared to previous
studies exploring the impact of CCPT on academic achievement of at-risk children (Blanco &
Ray, 2011; Blanco et al., 2012). The decision to focus on children with normal achievement
patterns was based on two important precedents in professional literature. Moustakas (1953)
stated, “Play therapy presents a unique experience for normal children . .. in the play room these
children need not submit to the everyday pressures of their school and family environments”(p.
19). As Moustakas clearly stated, the playroom has value for children who are “normal”but still
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vulnerable to the everyday pressures of life. Furthermore, we propose that performance anxiety
is a natural occurrence for many normal functioning children due to the environmental pressures
of the current school setting. The consequences of performance anxiety can be deleterious to
overall achievement (Ocak & Yamaç, 2013; Powell, 2004). Adjunct school services seem
necessary to help normally developing children develop positive coping skills to deal with
school pressures. The present study was conducted using a manualized delivery of CCPT to
observe the effects of the intervention as a best practice for school-age children. Two research
questions were explored:
RQ1: What is the impact of CCPT on normal functioning first graders regarding academic
achievement?
RQ2: What is the impact of CCPT on normal functioning first graders regarding performance
anxiety?
METHOD
Participants
In this study, the authors included 60 student participants from three elementary schools in the
Southwestern United States. All schools were designated as Title I schools targeted by the state
for schoolwide assistance because of high percentages of children qualifying for free or reduced
lunch. School 1 listed 42% of its population as economically disadvantaged; School 2, 39%; and
School 3, 50.3%. School counselors in the schools in the study sent written informed consents to
all parents or guardians of first-grade students in selected classrooms providing mainstream
education. Classrooms were selected by being identified as a mainstream education classroom
and by the teacher’s willingness to have students pulled out for services. Bilingual classrooms
were not selected for the study due to the linguistic limitations of assessment instruments. All
students in the selected classrooms were able to be participants in the study because the
researchers recruited a sample of typical students rather than identifying those with anxiety or
at risk for school failure. The only qualification necessary for inclusion was a student’s enroll-
ment in first grade. No screening procedures were utilized at this point in the study. We obtained
written informed consent for all 60 students according to the procedures by the local human
participants review board.
Children were randomly assigned to one of two treatment groups stratified by the schools.
There were 26 child participants from School 1, 18 children from School 2, and 16 children from
School 3. One student from School 3 in the experimental group moved to a different school and
was removed from the study. The final participant of number 59 represented 29 children
assigned to CCPT treatment group and 30 children assigned to the waitlist control (WC)
group. In all, 31 boys and 28 girls participated in the study. Of the boys, 15 were assigned to
the play treatment (PT) group and 16 were assigned to the WC group. Of the girls, 13 were
assigned to the PT group and 15 were assigned to the WC group. For the duration of the study,
all participants were between the ages of six and seven years old. Ethnicity breakdowns were as
follows: 4 were African American (3 PT, 1 WC); 1 was Asian American (0 PT, 1 WC); 41 were
Caucasian (21 PT, 20 WC); and 10 were Hispanic (5 PT, 5 WC).
70 BLANCO ET AL.
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Instruments
Revised Children’s Manifest Anxiety Scale, 2nd Edition (RCMAS-2; Reynolds &
Richmond, 2008). The RCMAS-2 was developed to measure the anxiety levels of children
ages 6 to 19 years old with respect to anxiety problems over six domains and an additional content-
based cluster. The RCMAS-2 is a comprehensive assessment that measures anxiety levels and can be
used to monitor a student’s level of performance anxiety. The RCMAS-2 is administered by a trained
examiner and requires 10 to 15 minutes to complete. The total anxiety score is the result of the
following subscales: (a) physiological anxiety, (b) worry, and (c) social anxiety. This composite score
reflects the child’s overall level of anxiety. In addition, the content-based cluster is performance anxiety,
whichismadeupof10itemsdirectlyaddressingfears or worries related to social performance. The
performance anxiety scale is a subscale of the social anxiety scale that focuses on performance in public
or group settings, in which there is a potential for negative appraisal. The instrument’s authors indicate
that children who endorse a high percentage of items on the performance anxiety subscale are at risk for
anxiety in public performance situations. According to Reynolds and Richmond (2008), high reliability
has been established for the RCMAS-2 instrument; internal consistency averaged above 0.90. The test-
retest reliability was established at 0.76. The calculated Cronbach’s alpha for students was .92,
indicating high reliability for the standardization sample (Reynolds & Richmond, 2008). The
RCMAS-2 was specifically chosen for this study because of its performance anxiety content-based
cluster and because the instrument does not require a significant wait time needed for multiple
administrations. For the purposes of this study, only the performance anxiety cluster was used for
analysis.
Young Children’s Achievement Test (YCAT; Hresko et al., 2000). The YCAT was
developed to measure the achievement levels of children ages four to eight years old with respect to
skills needed to succeed in school over five domains. The YCAT is a comprehensive assessment that
measures early academic achievement levels and can be used to monitor a student’s progress. The
YCAT is administered by a trained examiner and requires 25 to 45 minutes to complete. The results
from the five subtests make up the child’s Early Achievement Composite score. Thiscomposite scale
reflects the child’s school-related achievement across the major areas of academic tasks. Hresko and
colleagues (2000) further note that the Early Achievement Composite is the best indicator of the
child’s overall academic abilities. The five subtests are general information, reading, mathematics,
writing, and spoken language. Children responded to questions both orally and in writing, depending
on the subtest. According to Hresko and colleagues (2000), high reliability has been established for
the YCAT instrument; internal consistency was reported to be 0.85. The test-retest reliability was
established at 0.98. Interrater reliability was reported to be 0.98 (Hresko et al., 2000). The calculated
Cronbach’s alpha for students was .95, indicating high reliability for the standardization sample
utilized by Hresko and colleagues (2000). The YCAT subscales also have a significant body of
reliability evidence to support them. The general information subscale has an established test-retest
reliability of .98, an interscorer reliability of .98, and a coefficient alpha of .80. The reading subscale
has an established test-retest reliability of .99, an interscorer reliability of .99, and a coefficient alpha
of .89. The mathematics subscale had a test-retest reliability of .99, an interscorer reliability of .98,
and a coefficient alpha of .88. The writing subtest has an established test-retest reliability of .99, an
interscorer reliability of .98, and a coefficient alpha of .86. The spoken language subscale, has an
established test-retest reliability of .97, an interscorer reliability of .97, and a coefficient alpha of .86.
ACHIEVEMENT IN PLAY THERAPY 71
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The YCAT was specifically chosen for this study because of past research findings in play therapy
(Blanco & Ray, 2011; Blanco et al., 2012). Findings from this previous research led to using the
YCAT for both practical and methodological reasons. The YCAT is an instrument that can be
administered quickly, which results in reduced missed class time. As well, when working with young
children, the researchers have found that lengthy instruments can result in the loss of the children’s
attention, which may impact the quality of the results. The YCAT is also an instrument focused on
early childhood achievement and sensitive to the developmental nuances of young children. In
previous studies it yielded more in-depth information about children’sacademicprogressthan
instruments with broader purposes and age ranges.
Woodcock Johnson III Total Brief Achievement (WJIII ACH; Mather & Woodcock,
2001). WJIII ACH is an instrument battery that is designed to measure the academic achievement
abilities of individuals age two and up. The WJIII ACH assessment provides information about a
wide variety of academic subjects, yielding academic cluster scores in the areas of reading, oral
language, written expression, and mathematics (Mather & Woodcock, 2001). For this study, the brief
achievement cluster tests were used to establish a brief measure of academic abilities. This was
generated by administering three subtests, which take approximately 10 to 15 minutes each: (a)
letter-word identification, (b) spelling, and (c) applied problems.
The WJII ACH has a well-established history of sound psychometric qualities. Various
studies have established reliability using test-retest, internal consistency, and interscorer relia-
bility. Internal consistency reliability estimates, or the degree to which the items correlate with
one another, for the Brief Achievement Cluster ranged from .97 to .96 for school-age children
(McGrew, Schrank, & Woodcock, 2007). The WJIII ACH was specifically chosen for our study
because of its applicability to various age ranges throughout the life span. The WJIII ACH was
also used due to the flexibility of test administration procedures.
Procedures
Once informed consent from each student’s parent or legal guardian was received, all children
were individually administered the RCMAS-2, YCAT, and WJIII ACH. Instrument administration
was conducted by advanced master’s-level students who were well trained in assessment and were
blinded in regard to assignment of the two treatment groups, PT or WC. These master’s-level
administrators had completed a graduate-level course in psychometrics and received four hours of
additional training covering the administration of the instruments used in this study. Children were
scheduled to participate in either eight weeks of play therapy or eight weeks of no intervention
during the fall semester. At the end of the eight weeks, each participant was individually
administered the RCMAS-2, YCAT, and WJIII ACH as a post measure.
PT Group
As noted, 29 students were assigned to the PT group, which consisted of 16 sessions of
CCPT scheduled over eight weeks. Children receiving play therapy participated in two 30-
minute sessions per week in on-site, equipped, school playrooms. All play therapy sessions
followed procedures according to a CCPT treatment manual (Ray, 2009) and were facilitated by
master’s-level counseling students trained in play therapy. The procedures facilitated by the
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student-therapists included both nonverbal and verbal skills outlined by Ray (2009): (a) main-
taining a leaning forward, open stance; (b) appearing to be interested; (c) remaining comfortable;
(d) having a matching tone with the child’s affect; (e) having appropriate affect in responses; (f)
using frequent interactive responses; (g) using behavior-tracking responses; (h) responding to
verbalizations with paraphrases; (i) reflecting the child’s emotions; (j) facilitating empowerment
through returning responsibility; (k) encouraging creativity; (l) using self-esteem-boosting state-
ments; and (m) using relational responses. All play therapists had either completed or were
concurrently enrolled in a play therapy graduate course. In addition, prior to the beginning of
treatment, all play therapists attended additional specific school-based play therapy training
sessions. Also, all therapists received one hour weekly play therapy supervision during the
course of the study to ensure that each therapist was following CCPT protocol. At that time, the
play therapists, with their respective supervisors present, were required to review their video-
recorded play therapy sessions; each play therapist’s supervisor ensured that the play therapist
was following CCPT protocol through the use of the Play Therapy Skills Checklist (PTSC; Ray,
2009). Furthermore, a randomized check of play therapy session recordings was conducted by
the research team using the PTSC to ensure that the play therapy sessions were conducted using
CCPT procedures. Students were held to a standard of adhering to CCPT principles in 93% of
sessions, and therapists who deviated were directed in supervision to adhere more strictly to
CCPT. Overall the results of the fidelity check indicated that therapists adhered to the principles
of CCPT.
WC Group
As mentioned previously, 30 children were assigned to the WC group that received no
treatment intervention during the course of the study. Following postadministration of instru-
ments, each WC group child was placed in CCPT.
Data Analysis
Following the completion of data collection, the authors scored the pretest and posttest
instrumentsbyusinghandscoringontheYCATandRCMAS-2accordingtothemanual.
The WJIII ACH protocols were hand scored according to the manual procedures, and data
were entered into the publisher-provided scoring software to generate total scores. Three
individual, two-factor repeated measures, split-plot analysis of variance (SPANOVA; time
× treatment group) were performed on the dependent variables, performance anxiety
(RCMAS performance anxiety cluster score) and academic achievement (YCAT & WJIII
ACH), to determine differences between groups and across time. While it is certainly
possible to use different analyses, such as MANOVA, to analyze the variables, SPANOVA
is a well-established analysis tool for play therapy research that can be used to analyze
multiple variables (Blanco & Ray, 2011; Oijambo & Bratton, 2014; Meaney-Walen,
Bratton, & Kottman, 2014). In addition, using SPANOVA allowed exploration of the
individual constructs of performance anxiety and achievement.
The two groups were defined as the experimental group (PT) and the nontreatment control
group (WC). The two levels of time were pretest and posttest for the dependent variables.
Significant differences between the means across time were tested at the .05 alpha level. To
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assess the practical significance of outcomes, an effect size was computed for significant
findings using the eta-squared statistic. The effect size will be interpreted according to Cohen
(1988) for small (.01), medium (.04), and large (.14) effect sizes.
RESULTS
Table 1 presents the pre- and posttest means of both the PT and WC groups for the RCMAS-2
performance anxiety subscale, YCAT Early Achievement Composite, and WJIII Total Brief
Achievement.
Anxiety
Results of the SPANOVA indicated that the dependent variable, the RCMAS-2 performance anxiety
subscale, revealed a statistically insignificant interaction effect of time (pretest, posttest) × treatment
group (PT, WC), Wilks Λ= .990, F(1, 57) = .558, p=.458 (partial η
2
= .010), and a statistically
significant effect for time, Wilks Λ= .918, F(1, 57) = .509, p= .028 (partial η
2
= .082). There was
no statistically significant difference for group, F(1, 57) = .250, p=.619 (partial η
2
= .004). At
pretest, the performance anxiety scores were 4.3 for the PT group and 4.9 for the WC group, placing
both groups in the normal range for performance anxiety. Overall, these results indicate that when
grouped together the PT and WC groups showed statistically significant reduction in performance
anxiety subscale scores from pretest to posttest, and the effect size of .082 indicates a moderate
degree of change.
Academic Achievement
Results of the SPANOVA indicated that the dependent variable, YCAT Early Achievement
Composite, revealed a statistically significant interaction effect of time (pretest, posttest) ×
treatment group (PT, WC), Wilks Λ= .923, F(1, 57) = 4.722, p= .034 (partial η
2
= .077); a
TABLE 1
Mean Scores of Instruments From Pretest to Posttest
PT Group (N= 29) WC Group (N= 30)
Instrument Pretest Posttest Pretest Posttest
RCMAS-2: Performance Anxiety
M4.31 3.72 4.93 3.77
SD 3.04 2.94 3.05 2.81
YCAT: Early Childhood Composite
M94.79 100.21 97.63 99.53
SD 12.25 12.73 16.43 16.13
Woodcock Johnson III (ACH) Total
M100.89 103.59 103.47 103.67
SD 12.25 12.73 16.43 16.13
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statistically significant effect for time, Wilks Λ= .736, F(1, 57) = 20.457, p< .01 (partial
η
2
= .264); and no statistically significant effect for group, F(1, 57) = .088, p= . 768, (partial
η
2
= .002). These results indicate that, when grouped together, the children in the WC group and
the PT group demonstrated statistically significant results from pretest to posttest on the Early
Childhood Composite of the YCAT. Furthermore, the results from the pretest of the YCAT
demonstrate that both the PT and WC group had scores of 90 to 100, which places them both in
the normal range. This indicates that the children were considered academically average and thus
part of our population of interest. The results from the interaction effect reveal that children who
attended CCPT obtained statistically significantly higher results on the YCAT Early
Achievement Composite from pretest to posttest when compared with the scores of children
who were in the WC group from pretest to posttest. The effect size of .264 for change over time
exhibited a large effect size, and the effect size of .077 for the interaction effect indicated a
moderate effect size.
Results of the SPANOVA indicated that the dependent variable, the WJIII Total Brief
Achievement, revealed a statistically insignificant interaction effect of time (pretest, posttest) ×
treatment group (PT, WC), Wilks Λ= .964, F(1, 57) = 2.110, p=.152 (partial η
2
= .036); and a
statistically insignificant effect for time, Wilks Λ= .972, F(1, 57) = 1.646, p= .205 (partial
η
2
= .028). There was no statistically significant effect for group, F(1, 57) = .109, p=.743
(partial η
2
= .002). Overall, the results depict that, when grouped together, the WC group and the
PT group did not show statistically significant differences from pretest to posttest in their scores
on the WJIII Total Brief Achievement, and the overall effect of the changes were small as
indicated from the effect size of .028.
DISCUSSION
This study was the first to examine the impact of CCPT with performance anxiety and
academic achievement with normal functioning children in grade school. We found that
CCPT as an intervention did not have a significant difference in lowering the performance
anxiety of normal functioning school-age children when compared to a waitlist control
group. The results indicated a decrease in performance anxiety mean scores, but this was
foundinbothgroups.Duetothestudents’nonclinical initial mean scores of anxiety, perhaps
the hope of providing CCPT to demonstrate a significant decrease is implausible, as
exhibiting lower than normal levels of anxiety and establishing significance between groups
could be unlikely. Previous studies (Baggerly, 2004;Post,1999;Shen,2002) have found
positive results examining the use of CCPT as a way of decreasing anxiety in children.
While the implications of CCPT’s impact on performance anxiety still remains largely
unknown, Powell (2004) indicated that performance anxiety can impact academic achieve-
ment in negative ways at any level.
Two instruments were utilized to examine the academic achievement of normal-functioning
school-age children. The WJIII ACH (brief) scores, similar to the RCMAS-2, also did not reveal
statistically significant results when normal-functioning, school-age students were compared to a
waitlist control group. There was a small difference, although not significant, as the experimental
group had an increased mean score of 2.7 compared to .2 for the waitlist control group. However, the
findings for the YCAT indicated that CCPT was effective in increasing academic achievement scores
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with normal-functioning, school-age children, with a 5.4 increased mean score in the experimental
group, as compared to the 1.9 from the waitlist control group. Our results support the findings of
Blanco and Ray (2011) and Blanco et al. (2012);whereCCPTappearedtobeeffectiveasawayof
increasing at-risk school-age children’s academic achievement. The previously mentioned studies
with significant findings mentioned utilized the YCAT Early Achievement Score as a way of
measuring the effectiveness of CCPT on academic achievement. It may be possible that the
YCAT as an instrument provides a more subtle indicator of academic achievement in children
then the WJIII ACH (brief). In addition, one factor to consider in the interpretation of the WJIII ACH
is that the scale used was a brief measure of achievement as opposed to a more comprehensive scale,
such as the YCAT. Because a small change was indicated, further researchers could conduct a
follow-up study investigating the long-term effects of CCPT with academic achievement utilizing the
WJII ACH (brief).
The recent proliferation of academic work regarding the use of CCPT in public school
settings suggests that many play therapy scholars see merit in using this intervention as well
as the importance of distributing their findings (Ray et al., 2015). Indeed, we are in concurrence
with that assessment. A unique aspect to this study was that we measured children who were
categorized as academically typically functioning as compared to the previous research that
focused on at-risk children. Although we hoped to find significance with the effect of CCPT on
performance anxiety and did not, we did find significance in academic achievement while
utilizing the YCAT. This suggests that CCPT helps children who are both at risk and not at
risk with academic achievement, thus keeping them at their level or perhaps even slightly
elevating their current standing. This is similar to Post’s(1999) findings that the use of CCPT
maintains the level of self-esteem the students possessed and can be a preventive intervention for
future academic success.
LIMITATIONS
While the results of our study offer valuable insight regarding how CCPT with first graders may
be of assistance regarding academic achievement, limitations to this study need to be considered
when interpreting the results. Participants in this study were representative of a limited age and
were selected from a relatively small sample size living in a metropolitan area in the Southwest.
The researchers proceeded through this project using a limited range of grade levels and using a
population base from a specific geographic location; this limits the possibility of generalizing for
future findings. The authors advocate the use of a larger-scale replication study to increase
generalizability.
Equally limiting to this study is the use of a nontreatment waitlist control group. Any
differences found between the control group and the experimental group feasibly may have
resulted from the use of any intervention rather than findings that were the specific result of
CCPT. Support for the present findings does come from the use of a treatment comparison
group. A replication study that is larger and containing a treatment comparison group is
submitted as a way of finding assurance that the outcomes were indeed directly related to CCPT.
In addition, the selected instruments may have also been a limitation for this current study, as
the RCMAS-2 is designed to detect clinical levels of anxiety, not to assess brief episodes of
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performance anxiety. A more sensitive instrument to normal functioning in anxiety would have
potentially been a better match for this study.
IMPLICATIONS FOR PRACTICE
The counselors providing service in the study were trained in CCPT techniques and were not
school-based counselors. The results presented in this article offer support for training and using
CCPT interventions in the school setting. According to the ASCA National Model (American
School Counselor Association, 2004), school counselors are mandated to offer responsive
services to students. Oftentimes, these services are defined as group counseling or individual
counseling. CCPT as a response to services was supported by Bratton (2010) in her chapter
regarding children with behavior problems, as well as by Mishna, Morrison, Basarke, and Cook
(2012). These supportive studies buttress the assertion that CCPT interventions may be of
benefit for those children who are struggling academically.
School-based therapists who are in the role of consultant might find CCPT an effective tool
with which to respond to children’s behavioral, social, and academic problems. The practical
delivery process of CCPT can be beneficial to the school-based therapist who is seeking to make
a connection with a struggling child by using the six core conditions as outlined by Rogers
(1961). The practice of CCPT is a logical fit in the school setting because it can be facilitated in
30-minute sessions, which, as noted by Ray and colleagues (2008), is an appropriate time period
for school setting interventions. The school-based therapist might also take heed of the sugges-
tion by Landreth (2012), who advocated for a traveling play kit. This would be of high value for
the school-based counselor who works in multiple settings.
CONCLUSION
Overall, the findings imply that CCPT is a method that supports academic achievement in
the school system with first-grade students. The outcomes suggest CCPT can be an inter-
vention for elementary school counselors to use with children who have emotional or
academic needs, thus opening the door for school counselors to use play therapy to children
in the school system as a way of providing academic support and thereby further promoting
the field of play therapy in the school system. The findings related to the impact CCPT has
on performance anxiety appears to be inconclusive, especially with well-functioning chil-
dren. Though the results of child-centered play therapy as an effective intervention in aiding
academic achievement continue to be confirmed in research, the mechanism or change agent
by which this growth occurs merits exploration in future research.
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