Next Level Play Therapy: A Podcast for Play Therapy Excellence

What Are Best Practices in Play Therapy for Clinical Decision-Making?

• Cathi Spooner, LCSW, RPT-S • Episode 101

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Happy holidays!!  I’ve decided to take two weeks off to spend the holiday season focusing on my family.


So – I went back into my livestream vault and found this oldie but goodie!


Check out this podcast discussing some interesting information I gleaned from research and what it means for play therapists.


How does being trained to use a specific play therapy model influence clinical decision-making vs clinical decision-making of child/adolescent therapists using play in therapy?


Hmmmmm.  What the heck does that question even mean?


Essentially clinical decision-making involves our expertise and training in a play therapy model and how play therapists engage in the decision-making process to get excellent treatment results for their clients.


Is the clinical decision-making skill level of play therapists who are trained to use specific play therapy models better than child/adolescent therapists not trained who are using play in sessions?


A study by Baker-Ericzen, Jenkins, Park, and Garland (2015) explored the quality of clinical decision-making for child/adolescent therapists who were trained in an evidence-based treatment model (EBT) versus therapists who were not.


This study- Clinical Decision-Making in Community Children’s Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment 👇🏼


Had some interesting results.


I’ll discuss the findings of their study and how it relates to play therapy.  


There are several play therapy models considered to be EBT models, so this study provides some interesting points for child and adolescent therapists to consider when working with children using play.


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Cathi Spooner:

Welcome to Next Level Play Therapy. A weekly podcast dedicated to supporting the next adolescent therapists to provide exceptional play therapy We'll explore all things play therapy to elevate your and adolescents using the therapeutic powers of play. I'll discuss practical tips and ideas so you can transformative experience for your young clients real difference in their lives. So get ready to take your play therapy skills to the next level and make a lasting impact in the lives of adolescents, and families. Hey there. Good morning. So today I wanna talk about, um, what the research is One of the things that I like to do when I am working creating a course, and I'm pulling a course together days on case conceptualization in play therapy, my, in my mind also includes clinical decision making. So one of the things that I like to do when I'm pulling together a new course is to go through and look at what the current research says. And so I ran across this study and what took, what, what struck me about the study is that it was using clinical decision making regarding mental health treatment And it was set in community mental health settings. Typically, community health, typically, not always for on an outpatient basis, you tend to have some of the more acuity families, and so in my mind, clinical decision with some of these higher acuity families definitely some, uh, expertise, experience. These, they, they can be challenging. I work in, uh, over the years, have worked in community health and some of the more, uh, like residential working in homeless shelters. So in my mind, when we're using play therapy, it would the research says about clinical decision making. And so in the last couple of livestream episodes, like before, I talked about what is clinical decision What are, um, some of the things to keep in mind about making and play therapy. So if you're interested in learning more about heck is clinical decision making, then I would recommend that you go back and, and listen to or watch of my live replays and if so. I stream live every week into Instagram. I live stream into my Facebook group for child adolescent therapists using play an expressive arts therapy. If you're interested in that group and you're on Um, and you meet that criteria, that group is called Play Its Play and Expressive Arts, Therapy Playground. You do have to answer all the questions, like there's are That's one of the things that people regularly don't they don't get in the group. Um, so you do have to answer all the questions. And then I stream into my YouTube channel and also So if you're on Instagram and you wanna watch some replays, you can just go into my grid, I think, and you should find them all there. In my Facebook group. Click in the featured section, or the easiest place to it is hop over to my YouTube channel, Cathi Spooner, Hearts Consulting, and uh, click on the live tab and see all my live streams there. But the last couple weeks I have talked about clinical And so if you wanna know more about that, you can hop there and watch the replays. So I'm Cathi Spooner. I'm a licensed clinical social worker and a therapist supervisor here in the United States with over working with children, adolescents, and families. And I love using play therapy and expressive arts play I use expressive arts uh, with a play therapy lens. And so I find that's a really, really effective way to especially family play therapy. It's a really effective way to get siblings of stages to engage in the, in the change process and have parents in there, caregivers. So, um, today what I do wanna talk about is this study ran across and I'll post a link in the con, I'll not the I'll post the study citation. So those of you who have access to university libraries. If you wanna check it out, you can check it out. So the name of the study is Clinical Decision Making Community Children's Mental Health, using innovative with and without training in evidence-based I have my notes, I have to read that off my notes. Um, and so what, so the purpose of this study is, what look at kind of looking at some of the gaps in health services for children because one of the things they found is through, through the current data is not a lot of really good access to evidence-based or, um, quality treatment for children that's gonna overcome whatever mental health challenges they're And to me, this is especially important. Even post pandemic because what we're finding in mental health and adolescent mental health is that families are still struggling. Um, so, access to good quality mental health care for really important, and if you live in an area where access mental health services is kind of limited, then even finding now is trying to figure out ways to get to children in those more rural areas or areas where isn't a lot of good access. And so for that reason, I thought, well, it would be the research says about clinical decision making. I have not found, I haven't found any information in the clinical decision making. I think sometimes it, um, kind of gets in there, um, talking about it directly. I think whenever you're learning a specific play you're learning is how do you, especially, you get the supervision or the consultation. I think a lot of what good consultation will do is help theory, that play therapy theory, and how are you to use your clinical decision making to apply the theory for each of your clients.'Cause they're gonna be different nuances and you're kind of different barriers, sometimes a little Roadblocks. How do you navigate through that? And so. I don't think we necessarily directly talk about making in and of itself. And so when I found this research, I got really excited. Um, and so in this, I'm gonna read a quote. This is the research. It's actually a lot of pages, so I wanna read a quote study about kind of the overview of what this study was accomplish and the issues that they were trying to So the authors say to compliment, so what they're talking evidence-based treatment. What the, what these researchers did is they, they were to compare the quality of, uh, clinical decision in clinicians who had been trained in evidence-based who had not been claimed in evide, uh, who have not trained in evidence-based treatment. And to me this is relevant for play therapy because are play therapy models that are considered And the other thing is that play therapy is based in And the theory dictates how you're gonna help your therapeutic powers of play. And so it's, it's grounded in theory. And then you have to do your clinical decision making how you are going to apply and implement the theory with each one of your clients and within their family And so maybe not every single play therapy model is evidence-based treatment by samhsa, but they're all in a theoretical model and the model that takes how going to apply the theory. So I thought it was, I thought it was relevant for play therapy, the play therapy community to think about And if you and child and adolescent mental health maybe you don't consider yourself a play therapist. And so we're looking at even if, like what evidence-based models are you using that are geared towards children? Um, so here's the quote and, um, to compliment the treatment protocol training model, some reachers propose greater attention to a trans treatment model suggesting that empirically supported treatments several different protocols. So I kind of looked at this as, um, so I love using There are lots of different attachment theory models you can use with children and children and their If you're using attachment theory there are a lot of all the attachment models. They're gonna kind of, I call it, package 'em a little them even in play therapy, there are lots of similar um, in, in play therapy models and then they're just of utilized differently. So, so what this is talking about, the way that I read across all of these different ev evidence-based models, and so they were proposing kind of doing more of like um, protocol, which, you know, in any of us in the mental us use an integrated approach. So in my mind this was kind of even more interesting, idea of using clinical decision making, if you're of an integrated approach, how do you look at some of common elements across all the different play And so here's what they said. A major commo component of the common elements the use of clinical decision making, and I a hundred agree with that, which involves the use of an approach to guide decisions. So basically you are kind of, using like decision trees your head, well if this happens and I go this way, or happens, I need to try this way. And they're all gonna be based on whatever your model is that you're using. So one of the things that, that some of the researchers about and maybe something to think about, I think, Um, the article brings up, the research study brings using those common elements to do your clinical making and what would quality decision making look like. Excuse me. All right. So this type of clinical skill development may growth of metacognitive skills involved in decision making and that, and that can be used across effectiveness of treatment while reducing training With the larger evidence-based framework, clinical making plays a crucial role. And I would 100% agree with that. Because evidence-based treatment is grounded And then that model is gonna require decision making to you're going to apply it. So I thought this was really, really interesting research. Um, and so what the, so the results of the study, so in me back up a little bit. So in this study, they took 48 clinicians. And they divided them into two groups. There were, there were 14 clinicians who were in the trained, uh, group, and then 34 were in the non treatment trained group. And so the way that the research worked was they were in both groups were given the same case vignettes. Um, the case vignettes were about children with behavior, and the therapists had to verbalize their so loud, they had to verbalize their clinical decision process and their treatment. Uh, their treatment planning. So what we know is, um, when we're using case using clinical decision making. And if you're interested in learning more about therapy, that was a few live stream episodes before as over easiest places to hop over to my YouTube channel, them there in the live tab. If you're in my Facebook group, you can find them in So what they did was they had the, so what we know is important in the, in the case conceptualization process. And part of that is treatment planning. Like I'm doing treatment formulation, I take this I use it to help me develop my plan of action for But we also know as clinicians in the mental health that we are doing clinical decision making all and a to kind of, um, navigate our case conceptualization beginning to end of treatment. So again, clinical decision making and our ability to is really important for the treatment outcomes that you And so that's what the study was focused on. The, they used what they call, there's a naturalist naturalistic decision making theory, and they used that theory, the coder, uh, the researchers used that theory to code the verbalizations and the decision And essentially this naturalistic decision making theory is focused on using decision making more in a realistic kind of real world setting and looking at specific set making and how they're doing that evolving kind of um, process to basically figure things out And so this NMD naturalistic decision making model expert and novice decision making based on some that accesses, assesses that decision making So here's what they found that, so that's a, that's the And it was kind of quasi experimental. If you're into those things, you wanna know those things. Um. So here were the re results of this study, and what they found was that evidence-based trained clinicians cognitive processes more closely aligned with the expert non EBT trained that non EBD, eBT evidence-based They were more aligned with the expert novice Hey, Carla. Carla, so glad. Oh, that's awesome. I'm glad you could join us. Hey, which reminds me, I totally forgot to say, if Uh, post your name. I would actually really love to know who's here, what you work with, um, which play therapy and expressive using, what questions you have about, uh, the decision process and play therapy. Feel free to post those in the comments. Thank you, Carla. When I saw your post, I realized, Ooh, I forgot to ask tell people to do that. Feel free to join the conversation. So, um, the results of the study, so, so the, the an, uh, evidence-based treatment model, was much more aligned with expert decision making quality. And so what they found was with these EBT trained they, they used reasoning that focused on relevant and their questioning was more focused when they were And they, they used about half the questions that the used because they were, they were much more focused. And what they, they found was, uh, one of the reasons helpful to know is that the EBT trained clinicians to organize and synthesize the information more to conceptualize what the diagnosis is and what the So, and there were significant variations between the and the non EBT trained clinicians on how they in these case vignettes and how they made So I thought I would read out of the results. I would read a little bit, I read a quote from the study that kind of highlights this, um, information. So novices would be, um, uh, the, the ones that are not necessarily very proficient in doing that clinical making making process. So Carla's asking, what does EBT mean? EBT stands for evidence-based treatment. So it's treatment that's been researched and found to So it's got evidence behind it that it's a very effective Like one of, uh, like a in play therapy, evidence-based treatment models would be child-centered play It would be Filial Therapy, um, which is SLU the gurney version of adding parents. The Gary Landreth version would be Child Parent That's another evidence-based. Adlerian therapy play Therapy and Thera play. Those are considered evidence-based by samhsa. They've had a lot of research behind them. Um, like a really common one pretty much a lot of know is Cognitive Behavioral Therapy, DBT therapy. They've con they're considered evidence-based because a lot of research to back it up. So, um, so here's my other thing about that. Like, even in play therapy that like Gestalt play or Jungian play therapy, they, at this point they research, maybe because there's not enough funding big university organization behind it doing the So that's kind of one of my thing. It's nice evidence-based treatment I think The other thing about that is there's some really good out there that maybe haven't had the research, they had funding or whatever, um, to kind of get that That's just my little caveat and my opinion. So here's the quote that I thought would be info, um, Novices are described as not having sufficient, sufficient knowledge and skills to discriminate between salient and appear to occur with non EBT trained clinicians, based on increased number of diagnoses and factors attended to V vignettes that included parent and family factors. The findings suggests that non EBT um, trained clinicians may have more difficulty organizing large amounts and family-based, given the complexity of families services in community-based mental health of multiple parent and child conte contextual risk Which is basically the meaning they have they have acuity families, they have FI families who have more They are. Um, usually lots of generations of trauma addiction and attachment issues that they've been struggling with a, a few generations. So that's higher acuity. Hey, uh, I. I hope I pronounced your name right. Ro Aya from South Africa. I'm so glad you're joining us. Thank you for breaking down the study. So well, the study highlights and supports, again, the evidence-based practices. I agree. Um, and at and at least practices that are theory determines how you apply it. But the other piece is, what they're highlighting here that training in the clinical decision making process.'Cause you can go to a training, you can get trained. But the the effectiveness of the out of the the outcomes is gonna based on clinician competency. The clinician's ability to apply it, which is going decision making process. It also in is gonna include your case conceptualization. They go hand in hand. Um, so what, what it says is, so just kind of finishing the quote here, A clinician's ability to meaningfully and create an accurate case conceptualization, treatment plan in an efficient manner can be qua critical to delivering optimal care. And I 100% agree with that. And I, I have, um, that's one of the things that we I, any of my consultation and supervision that I I think it's really important for clinicians to develop case conceptualization and clinical Then that includes in play therapy. And so I have Play Therapy Academy, which is basically consultation groups couple times a month. And then in Play Therapy Academy, I have additional These are the ones I'm in the process of developing. I have one out now, which is getting grounded in Play That's available if you're not in Play Therapy Academy, it's still available. I'll talk a little bit more about that. I'll talk a little bit more about play Therapy Academy But right now I'm in the process of developing these, Getting Grounded in Play Therapy Excellence Skills, I found is in the play therapy community, we don't have a lot of training for some of these, what the would call common elements. Some of these elements that in play therapy that different play therapy models. For example, clinical decision making and case So your play therapy model is gonna determine how you That being said, you still need to formulate that case clinical decision making to get all the way through Which is, you know, when I, when I do any of these I'm developing them, I always like to go to the research see what the research says and include that in the because I think it's really important to make sure that we've got the most up-to-date information in when we're our trainings 'cause we're passing that along. And so, um, to me that's really important in the, in we're, I mean, the training that we're providing. So I'll talk a little bit more at the end about these, One, which is the Play Therapy Academy, that's the some training in the program. But also if you, if you're not in Play Therapy Academy not in need of, uh, of play therapy, supervision, you're already in with somebody else, uh, but you want access to the courses, they're available as well. So I'll, I'll talk a little bit more about that. Um, but I do think this is important for play have these kinds of trainings to kind of hone, hone our And this, this is probably one of my superpowers I get lost without a structure. And early on in my play therapy career, I realized I got to develop a structure, a way of thinking about and navigating these cases, um, in order to be effective.'Cause the goal is for them to, um, be able to complete play therapy in the shortest amount of time, the most optimal benefits. That's the goal. Um, so what does that mean for play therapy? So I've kind of already talked about that a little thing is just to kind of a kind of tie in the the study Play therapy has evidence-based models and they have non-evidence based models. The thing is, across play therapy, if you're using play therapy, you've been trained in a specific play therapy like child-centric play therapy or um, Adlerian play or Gestalt play therapy, or Jungian play therapy, or or therapy play. You're, you're gonna use, um. When you're learning these models, you wanna make sure you're learning the principles and how they're applied. Because one of the things that I notice happens a lot, consultation and supervision for about 15 years now. One of the biggest things that I find happening is that clinicians are not thinking about how the model is And practicing and becoming proficient at, okay, maybe um, Jungian play therapy. What is Jungian theory and how is that applied with particular client at this particular time where they are All of that's decision making. So e so you're basing your decision making and you're based on your theoretical model. But there are still ways in which you need to go about your theoretical model to understand and diagnoses is, and then use that for your treatment That's gonna be true across all your play therapy models, and it's important to really hone and develop your decision making skills and your case That's an important part of the process, and for that with, and I'm developing these, these courses that about in the Getting Grounded and Play therapy Foundation All the courses are gonna be self-paced. They're gonna be online. You could take 'em in your own time zone whenever it's I wanted to make them really, really, really accessible. So just to recap for today, um, play the study provides useful information to understand the role of quality when providing mental health treatment to children, And clinicians who are trained in an evidence-based would say the evidence-based model is really about the theoretical model. And how does that, how does that, how do you apply that with each of your clients? So your, your evidence, it, your model that you're is grounded in a theory and theory drives the and that's the important piece. You're not just kind of making things up from session to session, not really grounded in any kind of theoretical and just kinda, or even if you're working with you're not using an adult model. That developmentally is geared towards adults. You're not using that with children. And then thirdly, play therapy is based in a that guides children's ability to access those powers of play for healing. So simply learning a play therapy model is not gonna be You've got to learn how to apply that model with each of your clients who are showing up in your practice, and decision making process is really, really important. So that is it for today. I am so glad you were able to join. If you're watching on the replay, I would love to know, where, what population you work with, where you So feel free to post in the replay. I would love to know what play therapy models you are So go ahead and post those in the comments as well, and Bye. Thank you for joining me on this episode of Next Level I hope you found the discussion valuable and gained new insights and ideas to support your work helping children, adolescents, and families heal. If you enjoyed this episode, be sure to subscribe to the podcast and leave a review. Your feedback helps to improve and reach more people who benefit from this information. Remember, play therapy is a powerful tool for Whether you're a new play therapist or experienced, I learning journey to unlock the potential of play in your own work in relationships. If you have any questions or topics, suggestions for I'd love to hear from you. Connect with me on social media and visit my website at Therapy Training to stay updated on upcoming episodes, Thank you once again for listening to Next Level Play Until next time, keep playing, learning and growing.