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Journal of Child and Adolescent Counseling
ISSN: 2372-7810 (Print) 2372-7829 (Online) Journal homepage: https://www.tandfonline.com/loi/ucac20
The Effect of Child - Centered Play Therapy on
Intrinsic Motivation and Academic Achievement of
At-risk Elementary School Students
Pedro J. Blanco, Ryan P. Holliman & Nicole C. Carroll
To cite this article: Pedro J. Blanco, Ryan P. Holliman & Nicole C. Carroll (2019) The Effect
of Child - Centered Play Therapy on Intrinsic Motivation and Academic Achievement of At-risk
Elementary School Students, Journal of Child and Adolescent Counseling, 5:3, 205-220, DOI:
10.1080/23727810.2019.1671758
To link to this article: https://doi.org/10.1080/23727810.2019.1671758
Published online: 08 Jan 2020.
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The Effect of Child - Centered Play Therapy on Intrinsic
Motivation and Academic Achievement of At-risk
Elementary School Students
Pedro J. Blanco and Ryan P. Holliman
Department of Counseling, Tarleton State University, Stephenville, Texas, USA
Nicole C. Carroll
Department of Family Sciences, Texas Woman’s University, Denton, Texas, USA
Academic achievement is an important concern for professionals in schools and for school
counselor in particular. In this study of at-risk elementary school students, researchers examined
the effectiveness of child-centered play therapy (CCPT) on academic achievement and academic
self-regulation. The experimental group participated in biweekly, 30-minute play therapy sessions
for eight weeks. Findings indicated that the at-risk students participating in the experimental group
in this study (n= 21) demonstrated a statistically significant increase on the Early Achievement
Composite of the Young Children’s Achievement Test, when compared to children in the waitlist
control group (n= 21). The researchers found no significant differences for the Academic Self-
Regulation Questionnaire between groups. Additional findings of the analysis indicated that from
pretest to posttest, the play therapy (PT) group Intrinsic Motivation scores remained the same over
the time of treatment, while the waitlist control (WC) group scores decreased. Results demonstrate
continued support for the use of CCPT as an intervention for academic achievement and as an
important tool for school counselors to implement in a comprehensive school counseling program.
Keywords: play therapy, academic achievement, child-centered, at-risk, intrinsic motivation
There is a growing urgency for the availability of mental health services for children over the
past decade. The National Health Policy Forum found that about one in five children suffer
from psychological or behavioral issues that meet the criteria for a mental health disorder
(Frank, Sandler, & McFarlane, 2009). A lack of early mental health intervention increases the
risk of developing more severe mental health issues in the future (Bratton et al., 2013).
Unfortunately, children in certain populations have lower access and utilization of mental
services. Specifically, children in minority and uninsured populations tend to receive fewer
counseling services (Kataoka, Zhang, & Wells, 2002). Research tends to indicate that if under-
served children receive services they are more likely to receive them through the school system
Correspondence should be addressed to Pedro J. Blanco, Tarleton State University, Box T 0765, Stephenville,
TX 76402, USA. E-mail: blanco@tarleton.edu
Journal of Child and Adolescent Counseling, 5: 205–220, 2019
Copyright © Association for Child and Adolescent Counseling
ISSN: 2372-7810 print / 2372-7829 online
DOI: https://doi.org/10.1080/23727810.2019.1671758
(Foster, Rollefson, Doksum, Noonan, & Robinson, 2005; Rones & Hoagwood, 2000). Thus
school counselors are prime candidates to both provide mental health services for under-served
children, and to important professionals in the use of mental health services to improve
academic achievement.
Mental health interventions in a school setting
Within the school setting, demand for mental health services has grown, along with the diverse
needs of children in schools. Researchers found that if children do receive mental health
services, it is most likely to be within the school setting (Brener & Demissie, 2018). Mental
health disorders negatively effect on academic development and success (Dahir, Burnham, &
Stone, 2009). Utilizing mental health interventions within the school setting promotes access to
fundamental services to address childhood mental health needs, while also supporting academic
success (The President’s New Freedom Commission on Mental Health, 2003). The early school
classroom and school counseling experiences influence a child’s academic development and
mental health (Rönnau-Böse & Fröhlich-Gildhoff, 2009).
Mental health counseling interventions within school settings provide a unique opportunity
to serve as a platform for systemic intervention in the identification, evaluation, and treatment
of children’s mental health (Muro, Stickley, Muro, Blanco, & Tsai, 2015). Play therapy
interventions within the school setting, in order to meet the mental health needs of children,
have shown to be beneficial for the well-being of students (Bratton, 2010; Landreth, Ray, &
Bratton, 2009; Ray, 2011; Ray, Armstrong, Balkin, & Jayne, 2015). Sanchez et al. (2018) found
that targeted mental health intervention and services implemented several times a week within
a school setting demonstrated large effects. Providing play therapy in schools serves as
a innovative solution to address the challenge of access and utilization of counseling services
for children (Mellin, 2009). This type of intervention has the advantage of having an ability to
meet the demands for both easy access to mental health services for children and respond to the
needs of schools to promote academic success in children at risk.
Play therapy & child-centered play therapy
Play therapy is an evidence-based method of children’s mental health counseling that utilizes
a child-friendly, play-based environment (Bratton, Ray, Edwards, & Landreth, 2009). The play
environment is designed to allow children to express their feelings and experiences through
play. Communication for many young children at the early elementary age is primarily action-
oriented and play-based, due to a lack of cognitive development necessary to interact through
verbal communication alone (Blanco, Holliman, Muro, Toland, & Farnam, 2017). This pro-
motes the method of play as the most appropriate and effective method of communication for
young children.
Blanco and Sheely-Moore (2012) defined Child-Centered play therapy as “a developmen-
tally- appropriate, humanistic, non-directive approach for children that includes the use of toys
and play-based materials to facilitate a broad range of verbal and non-verbal expression”(p.
66). In Child-Centered play therapy (CCPT), toys serve as children’s words and play acts as
their language (Landreth, 2012). CCPT is based on a humanistic, person-centered approach to
mental health counseling (Moustakas, 1953; Rogers, 1961) and adapts this non-directive
206 P. J. BLANCO ET AL.
approach to counseling with children (Axline, 1969; Landreth, 2012). The objective of CCPT is
to facilitate the child’s self-actualization of their own developmental capabilities and encourage
the child’s self-exploration and self-discovery with a goal of constructive change (Landreth,
2012).
Axline (1969) proposed eight basic principles of the nature of the child-therapist relationship
within CCPT. These include that the therapist: a) is genuinely interested in the child b) shows
unconditional positive regard for the child c) creates an environment of safety and permissive-
ness d) is sensitive to the child’s feelings and reflects them for the child to develop self-
understanding e) believes deeply in the child’s personal ability to act responsibly f) trusts the
child’s inner direction g) trusts in the therapeutic process and h) establishes only limits that are
necessary in order to develop the child’s own responsibility. The counselor’s non-directive
approach within CCPT is “not defined by a set of passive behaviors but as an attitude that
promotes the client’s self-sufficiency by not guiding the client’s goals or therapeutic content”
(Ray, 2011, p. 51). This approach encourages the internal motivation of the child through
support of the child’s autonomy and independent change. Inner motivation in the face of
a challenge is emphasized “because in these experiences the infant has been responsible for
self, the accomplishment and accompanying satisfaction are internalized and strengthen the
self”(Landreth, 2012, p. 62).
Landreth (2012) further described that the process of CCPT is to aid in the resiliency of the
child, adding that self-control and inner motivation are major contributing factors. Children are
capable of self-determination and this “propensity to move in the direction of increasing
independence, self-regulation, and autonomy and away from control by external forces …
can be seen as a primary motivating force of the whole person at all developmental levels and
phases of life as individuals strive for meaningful interpersonal relationships and enhancement
of self”. (Landreth, 2012, p. 62). Within the CCPT approach, children learn: a) to accept
themselves, b) to respect themselves, c) to assume responsibility for their actions, d) to be
resourceful in confronting problems, e) self-control and self-direction, and f) to make choices
and to be responsible for their choices (Landreth, 2012).
CCPT in the school setting
Strong research evidence exists that play therapy within a school setting serves as a beneficial
and developmentally appropriate intervention for the mental health of students (Bratton, 2010;
Landreth et al., 2009; Ray, 2011; Ray et al., 2015; Trice-Black, Bailey, & Riechel, 2013), and
consequently relieves the stress of school counselors (Stickley, Muro, & Blanco, 2013). In
a meta-analysis of 23 studies examining CCPT conducted in elementary schools, researchers
found a statistically significant effect for the following student issues: academic, externalizing
problems, internalizing problems, total problems, self-efficacy, and other behaviors (Ray et al.,
2015).
These student benefits expand further when the play therapy interventions used are a direct
intervention as part of a collaborative program between school play therapy programs and
school counselors (Muro et al., 2015). Play therapy interventions within elementary school
settings have been shown to improve student self-esteem (Green & Kolos, 2010), reduce
ADHD symptomology (Ray, Schottelkorb, & Tsai, 2007), and ameliorate aggressive behaviors
(Ray, Blanco, Sullivan, & Holliman, 2009). Additionally, elementary school students have self-
THE EFFECT OF CHILD - CENTERED PLAY THERAPY 207
reported making better choices, having decreased anxiety, increased empathy, and increased
self-confidence as a result of play therapy (Green & Christensen, 2006). CCPT is easily
adaptable to diverse cultural populations and is shown to be effective when student cultural
considerations are applied (Garza & Bratton, 2005).
Academic achievement and play therapy
It is well-documented that mental health issues are related to decreased academic achievement
in students (Bub, McCartney, & Willett, 2007; De Lugt, 2007). Children at two years of age
with high levels of both internalizing and externalizing behavior issues showed lower cognitive
ability and achievement scores at first grade in one study (Bub et al., 2007). Without mental
health intervention, students with behavior issues are more likely to have academic difficulties
and be at risk of dropping out of school (De Lugt, 2007).
Research evidence indicates that CCPT in the school setting improves academic achieve-
ment in young students who are academically at risk (Blanco, Holliman, Ceballos, & Farnam,
2019; Blanco & Ray, 2011; Blanco, Ray, & Holliman, 2012). In one study, a group of first
graders who were identified as academically at risk, received bi-weekly 30-minute CCPT
sessions and showed a significant increase in academic achievement in comparison to
a control group (Blanco & Ray, 2011). In addition, CCPT utilized as a long-term method has
shown significant improvement in academic achievement, as well as increases in reading,
mathematics, and spoken language for students (Blanco, Holliman, Farnam, & Pena, 2018;
Blanco et al., 2017; Blanco & Ray, 2011). In addition, several studies report the positive impact
of CCPT on normal functioning students’academic achievement levels (Blanco et al., 2018;
Blanco, Muro, Holliman, Stickley, & Carter, 2015; Blanco & Ray, 2011). School-based CCPT
has also demonstrated increased self-concept and improvement in teacher-child relationships, in
addition to improved academic achievement (Blanco, 2010). While the aforementioned
research provides support for the conclusion that play therapy has a positive impact on
academic achievement, there is little explanation of the mechanism by which play therapy
helps academic achievement improve, which is a question that the current study seeks to
address.
Academic achievement, motivation, and self-regulation
Academic intrinsic motivation has been shown to play a large role in academic achievement
throughout childhood within research databases. Many of these studies utilize a theory called
Self-Determination Theory (Ryan & Deci, 2008). Self-Determination Theory proposes that
there are different types of motivation, including external motivation and intrinsic/internal
motivation. Intrinsic motivation is associated with an independent motivation for an internal
reward. “When intrinsically motivated, individuals freely engage in an interesting activity
simply for the enjoyment and excitement it brings, rather than to get a reward or to satisfy
a constraint”(Taylor et al., 2014, p. 342). When applied to academic achievement, internal
motivation means a desire and drive toward high grades or test scores for the internal feeling of
satisfaction and accomplishment one receives.
When a child feels in control and personally responsible for an accomplishment, this reciprocal
relationship encourages internal motivation to grow. Segal and Yahraes (1979) found that the best
208 P. J. BLANCO ET AL.
predictor of academic achievement across 2,800 children from an inner-city neighborhood was the
child’s sense of control over the environment. Additionally, three studies of adolescents and college
students indicated that intrinsic motivation was the only motivation type to be positively associated
with academic achievement, controlling for baseline achievement, over a one-year time period
(Taylor et al., 2014). One study involved a comparison between student’s academic self-regulation
and students’self-discipline (Zimmerman & Kitsantas, 2014). Results revealed that academic self-
regulation was significantly more influential on both student grade point average and a state-wide
achievement test than student discipline, utilizing both student self-report and teacher measurements.
According to results obtained from another study, academic self-regulation, self-efficacy, task value,
and intrinsic motivation predicted student attitudes toward mathematics (Ocak & Yamac, 2013).
Additionally, task value, self-efficacy and internal motivation predicted self-regulated learning
strategies. While the previously discussed studies examined relationships between motivation and
academic achievement, questions still remain about how this may inform interventions.
The relationship between childhood academic intrinsic motivation and later academic
achievement can be seen in long-term studies, and into adulthood (Gottfried, Nylund -
Gibson, Gottfried, Morovati, & Gonzalez, 2017). Gottfried et al. (2017) found in their study
that initial childhood academic internal motivation significantly predicted adulthood educa-
tional attainment. Research evidence demonstrates that there may be a strong connection
between play therapy and internal motivation. There is an established research connection
between play therapy and academic achievement (Blanco, 2010; Blanco et al., 2018,2017,
2015; Blanco & Ray, 2011). However, the mechanism by which CCPT improves academic
achievement is still unknown. Therefore, the purpose of the study was to examine the potential
link between a child’s academic achievement and internal motivation when attending CCPT. To
this end, the study was designed to answer to research questions.
Research Question 1: What impact would 16 sessions of CCPT have on the academic self-
regulation of academically at risk first grade students?
Research Question 2: What impact would 16 sessions of CCPT have on the academic
achievement of academically at-risk first grade students?
METHOD
Participants
To address the research questions about the impact of CCPT on the academic achievement and
academic regulation of first graders, 42 academically at-risk first grade students from three different
schools in southwestern United States were recruited for participation in the study. Each of the three
elementary schools were categorized as Title I school, indicating that a majority of students qualified
for free or reduced school lunches. School one identified 43.9% of its students as economically
disadvantaged, School two indicated 78.2% of its students as economically disadvantaged, and
School three reported 57.3% of its students as economically disadvantaged.
The participants were within the ages of six and seven through the duration of the study.
Ethnicity analysis were as follows: (a) three were African American (one in CCPT group, two
in Waitlist Control), (b) two were Asian (Both were in CCPT group), (c) eleven were Caucasian
THE EFFECT OF CHILD - CENTERED PLAY THERAPY 209
(five in CCPT group, six in Waitlist Control), 24 were Hispanic/Latino (12 in CCPT group, 12
in Waitlist Control), one child was Native American (in Waitlist Control), and one child was Bi-
Racial (in CCPT group).
Instruments
Young children’s achievement test
(YCAT; Hresko, Peak, Herron, & Bridges, 2000). The YCAT is an instrument designed to measure
the academic performance of children ages four to eight years old. The YCAT is administered by
a trained examiner and requires 25–45 minutes to complete. The results from the five subtests
comprise the child’s Early Achievement Composite score. This composite scale indicates the child’s
school-related achievement across the major areas of academic tasks. According to Hresko et al.
(2000), Early Achievement Composite is the most advantageous indicator of the child’s academic
competencies. The five subtests are General Information, Reading, Mathematics, Writing, and
Spoken Language. According to Hresko et al. (2000), high reliability has been established for the
YCAT instrument; the 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 et al. (2000). The YCAT subscales also have a significant body of veritable
evidence to support them. The YCAT can be administered expeditiously, resulting in the reduction of
the removal of class time. The YCAT is additionally an instrument that is concentrated on early
childhood achievement, while sensitive to developmental nuances of young children.
Academic self-regulation questionnaire
(SRQ-A; Deci, Hodges, Pierson, & Tomassone, 1992). The Self-Regulation Questionnaires
are a series of assessment instruments developed to measure different domains of self-
regulation as defined in self-regulation theory (Ryan & Connell, 1989). The Academic Self-
Regulation Questionnaire Learning Disorder Version (SRQ-A LD) is a 17-item instrument that
is specifically designed for children with academic difficulties in elementary and middle school
(Deci et al., 1992). The SRQ-A LD provides a measure of general academic self-regulation, as
well as four separate subscales of academic self-regulation: external regulation, introjected
regulation, identified regulation and intrinsic motivation. In addition to the four subscales, the
SRA-A LD yields a scale referred to as the Relative Autonomy Index (RAI). The RAI is
a weighted scale composed of the four subscales that measures the degree to which an
individual uses autonomous regulatory styles (Deci et al., 1992). In the initial validation
study, internal consistency reliability coefficients were gathered for each of the subscales,
which ranged from .62 to .82, indicating a moderate degree of internal consistency (Ryan &
Connell, 1989). Validity was developed for the instrument through correlational studies com-
paring the SRQ-A LD to several instruments with similar constructs, including the Intrinsic vs.
Extrinsic Orientation in the Classroom Scale (Harter, 1981), Origin Climate Questionnaire
(DeCharms, 1976), and the Multidimensional Measure of Student’s Perceptions of Control
(Connell, 1985). Thus, the SRQ-A LD demonstrates both sufficient reliability and validity for
use in measuring the academic motivation and academic self-regulation of students.
210 P. J. BLANCO ET AL.
Procedures
The researchers began by working with school counselors at each school to identify children
who were academically at risk. Students were identified as at-risk by the school counselor at
each of the three schools, using the school district’s academically at-risk criteria. In order for
a student to qualify as academically at-risk, the student met one or more of the following
categories: (a) the student did not previously advance from one grade level to the next, (b) the
student did not perform satisfactorily on a readiness test, or (c) the student is in the custody or
care of the state department of protective services. Following this criterion is important to
indicate that the students in the study were in danger of not successfully performing at their
academic grade level and hence falling further behind. For the study, the researchers obtained
42 completed informed consents from the student’s legal guardians.
Upon receiving informed consents, participants were randomly assigned into one of the two
groups, the experimental group or the waitlist control, based upon the number of participants at
each school. There were 19 children participants in School one, 17 participants in school two, and six
participants in School three. In total, 42 students were participants in the study, with 21 students
designated in the experimental group which attended 16 CCPTsessions over the period of eight weeks,
and 21 students who were placed on a waitlist control. The researchers decided upon 16 sessions of
CCPT due to past research which indicated positive treatment effects could be obtained via 16 sessions
in eight weeks (Muro, Ray, Schottelkorb, Smith, & Blanco, 2006;Ray,2007). Overall, 30 of the
students were male, and 12 were female. In regard to the males, 15 were randomly assigned into the
CCPT group, and 15 were assigned to the waitlist control group. For the females, six were randomly
assigned to the CCPT group, and six were assigned to the waitlist control. Upon receiving informed
consent, all children were administered the YCAT and SRQ-A LD. These were completed by master’s
level counseling and development students trained in administering the instruments used in the study,
before the child was randomly assigned a treatment group. The graduate students each had completed
a course in psychometrics, as well as attending four hours of additional training to prepare them in
conducting the instrument administration. After completing the instruments, the participants were
randomly selected into one of two treatment groups: the treatment group which were provided 16
sessions CCPT across eight weeks or a waitlist control group which were provided no intervention
during the duration of the eight weeks. The researchers ensured that the counseling students who
administered tests were not assigned as the child’s counselor during the study, so as to avoid potential
complications in gathering objective and standardized assessment results. At the end of the eight
weeks, all children were then administered both the YCAT and the SRQ-A LD as a post measure.
CCPT treatment group
For the treatment group, participants were assigned to receive CCPT within the school
setting. The schools were equipped with an on-site playroom within the school. The treatment
group consisted of twenty-seven students who received CCPT for 16 play therapy sessions,
which were scheduled over an eight-week time period. These play therapy sessions were
30 minutes in length and occurred twice a week. The play therapy sessions were provided by
master’s level therapy students who had received training in CCPT and play therapy. Every play
therapist had previously completed, or were currently enrolled in, a graduate course on play
therapy.
THE EFFECT OF CHILD - CENTERED PLAY THERAPY 211
In addition to training in play therapy through a graduate course, the play therapists were
required to attend training sessions on school-based play therapy. Each play therapist student
also received one-hour play therapy supervision once a week throughout the study’s duration.
The supervisors were two faculty members who were both Registered Play Therapy
Supervisors and held a PhD in counseling. During these weekly supervision sessions, super-
visors attempted to ensure play therapists were following CCPT treatment guidelines by
auditing video recorded play therapy sessions of the students and implementing the Play
Therapy Skills Checklist (PTSC; Ray, 2011). Additionally, random and periodic audits of the
student’s play therapy skills were gathered by the supervisors using the PTSC.
Throughout play therapy sessions, student play therapists were required by supervisors to
follow CCPT principle standards in 93% of their total play therapy sessions. Student therapists
who failed to follow these standards were guided within weekly supervision to follow CCPT
guidelines more rigorously. Play therapy audit results and weekly supervision demonstrated that
the student therapists were able to follow CCPT principles closely throughout the study.
The students facilitated play therapy sessions following the guidelines of a CCPT treatment
manual (Ray, 2011). The CCPT skills include both verbal and nonverbal skills as outlined by
a CCPT treatment manual (Ray, 2011). These skills include a) maintaining a leaning forward,
open stance; b) enacting interest; c) remaining comfortable; d) matching verbal tone with the
child’s emotional affect; e) responding with appropriate verbal affect; f) using frequent inter-
active responses; g) using behavior-tracking responses; h) responding to child’s verbalization
with paraphrasing; i) reflecting the child’s emotions; j) returning responsibility to child to
facilitate empowerment; k) encouraging creativity within the child; l) utilizing responses which
are designed to boost self-esteem and; m) providing relational responses.
Waitlist control group
The waitlist control group did not receive treatment during the eight-week intervention stage
duration of the study. This group consisted of 21 at-risk elementary students. Every child in this
group attended CCPT after the duration of the study following the post administration of the
instruments.
Data analysis
After data collection was completed, the authors scored the pre- and posttest measurements by
hand for the YCAT and SRQ-A LD, according to the manual. The researcher conducted
independent sample T-tests of the experimental group and the waitlist control group for the
YCAT EAC and all subtest as well as all scales of the SQR-A LD. The results of the
independent sample T-test yielded insignificant results for all measures with t-scores that
ranged from 1.233 to −.911, indicating that no statistically significant differences existed
between the groups at pre-test. Two split-plot analyzes of variance (SPANOVA; time
X treatment group) were conducted on the dependent variables, academic achievement (mea-
sured through the YCAT) and academic self-regulation (measured through the SRQ-A LD), to
assess for group differences across time. While it is possible to use other analyses, such as
MANOVA, for analysis of the variables, SPANOVA has proven to be a well-established
analysis tool within play therapy research and it can be used to analyze many variables
212 P. J. BLANCO ET AL.
(Blanco et al., 2015; Blanco & Ray, 2011; Meany-Walen, Bratton, & Kottman, 2014; Ojiambo
& Bratton, 2014). Additionally, SPANOVA allows for the exploration of individual constructs
of achievement and intrinsic motivation.
The two participant groups were categorized as the waitlist control group and the experi-
mental group. The two separate levels of time were defined as pretest and posttest for the
dependent variables. Significant differences were tested at the .05 alpha level between the
means across time. The effect size was computed for significant findings using eta-squared to
assess for practical significance of outcomes. Effect size interpretation will utilize Cohen
(1988) guidelines of small (.01), medium (.04), and large (.14) effect sizes.
Results
The participants were administered the YCAT and the SRQ-A LD at pre-test and post-test.
Table 1 provides an overview of the academic achievement category (as defined by the YCAT)
that each participant was in at pre-test and at post-test. Tables 2 and 3provide the means and
standard deviations from pre-test to post-test for both the YCAT and the SQR-A. The following
subscales yielded statistically significant results: The YCAT General Information subscale
yielded a p-value of .003 for the interaction effect between time and treatment group, with
aη
2
of .190, which indicates a large effect size. A comparison of the descriptive plots indicates
that the treatment group demonstrated significant improvement, while the control group
demonstrated a decrease in performance on the General Information Scale. The YCAT
Reading subscale yielded a p-value of .003 for the interaction effect between time and treatment
group, with a η
2
.029, which indicates a large effect size. A comparison of the descriptive plots
indicates that the treatment group demonstrated significant improvement as compared to the
control group. The YCAT Writing subscale yielded a p-value of .003 for the interaction effect
between time and treatment group, with a η
2
of .149, which indicates a large effect size.
A comparison of the descriptive plots indicates that the treatment group demonstrated sig-
nificant improvement as compared to the control group on the Writing subscale. The YCAT
Spoken Language subscale yielded a p-value of .013 for the interaction effect between time and
treatment group, with a η
2
of .134, which indicates a large effect size. A comparison of the
TABLE 1
Academic Achievement Levels at Pre & Post Test on the Young Children’s
Achievement Test (YCAT)
Experimental Group n = 21 Control Group n = 21
Pretest Posttest Pretest Posttest
Achievement Level
Normal Range 6 13 10 7
Below Average 4 7 5 9
Poor 8 1 4 2
Very Poor 3 0 2 3
Note: All scores are based upon the child’s Early Achievement Composite score
THE EFFECT OF CHILD - CENTERED PLAY THERAPY 213
descriptive plots indicates that the treatment group demonstrated significant improvement as
compared to the control group on the Spoken Language subscale.
The YCAT Early Achievement Composite yielded a p-value of <.001 for the interaction
effect between time and treatment group, with a η
2
of .308 which indicates a large effect
size. A comparison of the descriptive plots indicates that the treatment group demonstrated
significant improvement as compared to the control group on the Early Achievement
Composite.
For the SRQ-A LD external regulation subscale, the main effect of treatment group was
insignificant, F(1,40) = .021, p= .866. The main effect for Time for the SRQ-A LD external
regulation was insignificant F(1,40) = 2.618. The main effect for the SRQ-A LD external
regulation subscale yielded a p-value of .770 for the interaction effect between time and the
treatment group, which indicates a lack of statistical significance. The η
2
for the interaction
effect was .0002, indicating an overall small effect size. A visual analysis of the plots indicates
that both groups of children increased in external regulation over time, but there was not
a significant difference in their growth. This indicates that both groups increased in the amount
of activities done to avoid external consequences.
TABLE 2
Means and Standard Deviations for YCAT Early Achievement Composites and Subscales
PT Group(41) WC Group(41)
Pre-test Post-Test Pre-test Post-Test
MSD M SDMSDMSD
General Information 84.81 11.38 92.43 10.57 88.48 14.50 86.43 13.44
Reading 85.33 17.67 98.52 13.90 85.33 17.67 85.76 13.24
Math 91.29 9.82 97.86 9.83 91.91 10.06 94.43 13.55
Writing 91.10 12.09 100.67 6.58 93.38 9.50 94.71 10.38
Spoken Language 86.71 17.32 97.71 19.03 90.62 19.97 88.48 12.31
ECA 82.95 15.02 96.19 13.16 87.05 14.62 86.05 15.57
TABLE 3
Means and Standard Deviations for SQR-A
PT Group(41) WC Group(41)
Pre-test Post-Test Pre-test Post-Test
M SD M SD M SD M SD
Externalized 2.91 .82 3.15 .56 2.97 .92 3.14 .72
Introjected 2.89 .80 3.06 .60 2.66 .81 2.89 .88
Identified 3.05 .85 3.32 .73 2.91 .04 3.02 .90
Intrinsic 3.10 .78 2.70 .78 2.79 .81 2.65 1.02
RAI .55 1.20 .472 1.53 −.110 1.36 −.610 2.06
214 P. J. BLANCO ET AL.
For the SRQ-A LD introjected regulation subscale, the main effect of the treatment group
was insignificant, F(1,40) = 1.043, p= .313. The main effect for time was insignificant, F
(1,40) = 2.055, p= .159. The interaction effect between time and treatment group was
insignificant, F(1,40) = .039, p= .845. A visual analysis of the plots indicates both groups
increased in the activities done to avoid guilt or anxiety because of a desire for the approval of
adults, but that there was not a statistically significant difference in the groups across time.
For the SRQ-A LD subscale identified regulation, the main effect of the treatment group was
statistically insignificant F(1,40) = 1.069, p= .307. The main effect for time was statistically
insignificant F(1,40) = 1.514, p= .226. The interaction effect between time and treatment group
also yielded statistically insignificant results, F(1,40) = .264, p= .610. A visual analysis of the
plots indicated that both groups increased, with the treatment group having a slightly higher
rate of growth, but not to a statistically significant degree.
For the SRQ-A-LD intrinsic motivation subscale, the main effect for treatment group yielded
statistically significant results, F(1,40) = 4.441, p= .041, η
2
= .100. For the main effect for
time, the results yielded a statistically insignificant result, F(1,40) = .003, p= .959. The
interaction effect between time and treatment group yielded statistically insignificant results
F(1,40) = .974, p= .330, η
2
= .024. A visual analysis of the plots indicates that the play therapy
group had a slight increase, and the control group experienced a slight decrease.
Lastly, for the SRQ-A LD total score, the relative autonomy index (RAI), the main effect for
treatment group yielded statistically significant results F(1,40) = 5.626, p= .023, η
2
= .123. The
main effect for time yielded statistically insignificant results, F(1,40) = .830, p= .368. The
interaction effect between time and treatment group yielded statistically insignificant results, F
(1,40) = .442, p= .510. A visual analysis of the plots indicates there was a subtle decrease for
those in the play therapy group and a slightly larger (though still small) decrease for those in the
control group.
DISCUSSION
This study was the first to examine the impact of CCPT with intrinsic motivation and academic
achievement with at-risk elementary school children. The findings for the YCAT continue to
demonstrate CCPT as an effective intervention in increasing the academic achievement levels
of at-risk elementary school children. Specifically, the findings for the YCAT’s Early
Achievement Composite indicated that the experimental group had a thirteen- point increased
mean score, as compared to a one point decreased mean score from the waitlist control group.
These statistically significant results support the past findings of Blanco and Ray (2011),
Blanco et al. (2012) and Blanco et al. (2019); where CCPT as a school intervention demon-
strated an increase in at-risk children’s academic achievement scores. Additionally, the results
from this study are also consistent with past studies measuring CCPT with normal functioning
children (Blanco et al., 2017,2015).
For the SRQ-A LD, the researchers found that although CCPT did not have a significant
difference in increasing the Relative Autonomy Index (RAI) of at-risk children when compared to
the waitlist control group, there were however remarkable preliminary findings. The overall results
(RAI) of the SRQ-A LD demonstrated a decrease in both groups, however, the rate of the decrease
differed with the experimental group displaying a six times less gradual mean score drop. Thus, it
THE EFFECT OF CHILD - CENTERED PLAY THERAPY 215
may be plausible that CCPT may have provided a preventative effect. This is further highlighted in
the Intrinsic Motivation (IM) subscale of the SRQ-A LD, where overall the experimental group
demonstrated an increase in their intrinsic motivation mean score while the waitlist control
experienced a decrease mean score over time. While the interaction effect results are not
statistically significant, there does appear to be a trend with the experimental scores increasing
at the rate in which the waitlist control scores decreased. These results are similar to Post (1999),
where she found CCPT as a preventative measure for at-risk children in relation to maintaining the
student’s responsibility for their own academic success. These findings are also aligned with the
central tenant of CCPT, in that children have the capacity to develop an internal motivation which
can be fostered by providing the therapeutic climate. Furthermore, in a recent study Swank,
Cheung, and Williams found that providing “CCPT may promote social skill development that
reduces problem behaviors within the classroom and enhances learning”(2018, p. 245).
Limitations and directions for future research
The findings of this study demonstrate important evidence of the benefits of CCPT with first
graders who are academically at risk. However, similar to other research of play therapy within
a school setting, there are limitations that should be accounted for when understanding the
study’s results. The study’s participants represent only a limited age range. Additionally, the
participants were selected from a small sample in a southwestern metropolitan area. The
utilization of a population from a certain geographic location and a specific range of grade
levels of students limits possible generalizations of the anticipated results. The number of
participants used in this study further limits potential generalization of findings. In order to
increase generalizability, a larger scale replication study in the future is suggested.
Furthermore, another study limitation is the use of a nontreatment control group. It is
possible that the changes found between the control and experimental groups could instead
result directly from the use of an intervention alone or from an unknown extraneous variable,
rather than the findings resulting specifically from a CCPT intervention. However, the use of
a treatment comparison group provides support for the present study’s results. A larger
replication study, with a treatment comparison group included, is suggested as a method to
increase the certainty that these results were directly related to a CCPT intervention.
Research of the impact of CCPT on academic achievement in elementary school students
provides a promising rationale for the use CCPT in schools. However, there are several
directions for future research which should be explored. One direction for the future would
include gathering data not only from children but from teachers and the parents of the children,
in an effort to create a more comprehensive set of data about the child. This study followed
children for sixteen weeks and ended treatment and assessment after that time. In the future the
researchers may explore effects on the children in a longitudinal study. Such research could
help counselors determine how long-reaching the effects of sixteens CCPT sessions might be.
Implications for practice
To determine the implications for practice, authors viewed the clinical significance of the
YCAT’s Early Achievement Composite scores (EAC). These scores were examined to evaluate
improvement of children’s academic achievement from pre to post test. EAC scores below 90
216 P. J. BLANCO ET AL.
are considered to be “at risk for academic failure”(Hresko et al., 2000). EAC scores between
90–110 are considered in the normal range. Scores between 80–89 are considered below
average and at-risk of academic failure. Scores between 70–79 are considered to be poor,
while scores between 35–69 are considered to be very poor; both poor and very poor scores are
indicative of academic failure.
A total of fifteen of the twenty one experimental group children were identified as at-risk for
academic failure at pre-test. Of the three students who presented in the very poor range (scores
35–69), one moved to the poor range, and the remaining two moved into the below average range.
Of eight children who presented in the poor range (70–79), five moved to the below average range,
and the remaining three moved into the average range. Of the four students who presented in the
below average range (80–89), all four moved to the normal range. Of the four students who
presented in the average range (90–110), two children remained in the average range, and two
moved to the above average range. Of the two students who presented in the above average range
(111–120), one remained in the above average range, and one moved to the superior range. No child
from the experimental group scores decreased to a more severe level of potential academic failure.
For the control group, a total of eleven of the twenty-one children were identified as at-risk
for academic failure at pre-test. Of the two students who presented in the very poor range
(scores 35–69), they both remained in that category. Of the four students who initially scored in
the poor range (70–79), two remained at that level, one moved into the below average range,
and one fell into the very poor range. Of the five children who initially scored in the below
average range (80–89), all five remained at that level. Of the remaining ten students who
initially scored in the average range (90–110), six remained at that level, three fell to the below
average level, and one moved into the above average level. In summary, 47% of the fourteen
experimental group children (n = 7) moved from at risk of academic failure to one of normal
functioning following their participation in CCPT, compared to a 14% increase in scores of
academic failure in the at-risk students in the control group (n = 3).
The results of this study pose a number of important implications for counselors who work
with children. First and foremost, this study contributes to the already existing literature which
demonstrates the efficacy of CCPT in improving academic achievement. This evidence will be
of great import to school counselors who may have to advocate for time spent providing direct
services, and it will provide needed evidentiary support for the link between mental health
intervention and the academic mission of schools.
This study also presents intriguing findings regarding motivation. Initially the results
regarding academic motivation in this study would seem underwhelming. However, the relative
stability of the experimental group’s scores on academic motivation when compared to the
waitlist control group indicates that CCPT may serve as a protective factor in preserving
intrinsic motivation. School counselors may benefit from considering not only how to provide
play therapy to protect academic achievement, but how to infuse principles of play therapy
throughout the school to help maintain children’s level of intrinsic motivation for learning.
CONCLUSION
The overall findings indicate that CCPT is a therapeutic intervention that supports the devel-
opment of academic achievement in the school system for at-risk children. The outcomes
THE EFFECT OF CHILD - CENTERED PLAY THERAPY 217
advocate for the use of CCPT as potential curriculum for elementary schools to use for children
with emotional and/or academic needs. The preliminary findings related to the impact CCPT
has on intrinsic motivation, while not significant, potentially open the door for continued
research in examining the change agent as to why children attending child-centered play
therapy academic achievement scores improve.
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