Next Level Play Therapy: A Podcast for Play Therapy Excellence

What is Case Conceptualization in Play Therapy?

• Cathi Spooner, LCSW, RPT-S • Episode 102

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🎁 Pulled from the Vault: An Oldie but Goodie

I’m officially taking a break this holiday season — slowing down, soaking up family time, and sipping something warm by the tree. ✨

But I didn’t want to leave you hanging! So I dug into the vault and pulled out one of the most-loved livestream episodes I’ve ever done. And honestly? It’s still 🔥 relevant today.

Over the last 15+ years of supervising and training play therapists, I’ve noticed one big mistake that keeps showing up again and again…
❌ It’s the reason play therapists start feeling lost in the treatment process — unsure what to do next.
 ❌ It’s why interventions sometimes feel like they’re just not landing.

Here’s the kicker 👇🏼
 The biggest mistake I see play therapists making is not taking the time early on to gather the right information for case conceptualization.
Sounds academic, right? (Cue the grad school flashbacks 😅)

 But this one skill is what separates chaotic sessions from clinically confident ones.

In this throwback episode, you’ll learn:
 ✨ What case conceptualization really means for play therapists (in down-to-earth language).
 ✨ The goals behind it — and how it keeps you grounded when sessions feel unclear.
 ✨ Why it’s the secret to consistent, meaningful treatment outcomes.

So while I’m resting and recharging, you can hit play and get re-inspired.

Because this episode? It’s the one that changes how you see your entire play therapy process.

Join my free Facebook Community Play and Expressive Arts Therapy Playground.

Check out my free resources for mental health professionals working with children, adolescents, and families who want to integrate play therapy and expressive arts into their clinical work.

I work with individuals and agencies to develop successful strategies and meet the treatment needs of your child and adolescent clients and their families using play therapy & expressive arts.

Contact me to schedule a free 30-minute video call if you're ready to level up your skills

Cathi Spooner:

Welcome to Next Level Play Therapy. A weekly podcast dedicated to supporting the next generation of child and adolescent therapists to provide exceptional play therapy services. We'll explore all things play therapy. To elevate your work with children and adolescents using the therapeutic powers of play. I'll discuss practical tips and ideas so you can provide a transformative experience for your young clients and make a 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 children, adolescents, and families. There. Hey there. Good morning. Today I wanna talk about a term that may bring you back to your graduate school days. I heard this term when I was, this was years ago probably. 15, 16 years ago now when I was taking on a, a master's level counseling student who was doing her field placement with me, and we met with the field liaison and the field liaison throughout this term, case conceptualization and clinical decision making. That's the other one, but case conceptual conceptualization. It's kind of a mouthful. And I remember thinking. Oh, I wanna know more about what you're talking about. And I think I know, and that is such an important term. And so I was kind of hooked from there thinking about it, because to me, I like structure. I like a little roadmap to know what's going on, how to formulate my, um, understanding of what's going on with my clients, because that's what helps me get them from. Beginning, middle, and all the way successfully to the end of treatment. And this is true in play therapy as well. And so having some structure that will, um, be like your roadmap and your way of understanding what's going on with your client, to me is a really, really foundational and essential skill to have. Counseling in general, and in this case in play therapy. And so that's what I wanna talk about today. And one of the biggest mistakes that I see play therapists making, and I see it pretty regularly, which is what gave me the idea. I didn't see anything like this in the play therapy arena, like any of the play therapy trainings. And yet I know it's a foundational skill and I know from doing 15 plus years of supervision and consultation with play therapists that this is kind of, um. An essential thing that if you don't have it, you're gonna get lost. And that's one of the things I would see regularly over and over. Is that people that I was supervising, they would get kind of lost in the beginning and they weren't sure which way to go or what to do. And they were, um, not even sure really what was going on with their client. They were kind of getting started doing the individual play therapy sessions without really taking the time. To get that treatment process off to a good start and formulate their case conceptualization, because that's also, also gonna play a role in your clinical decision making. So if you're joining me live today, go ahead and post your name in the comments. I'd love to see who's here. Um, what population do you work with? What. What play therapy and expressive arts modalities are you using? And I would love to know if you, um, in any of your play therapy trainings or any of your play therapy, if you've already become an RPT, if you have had any training or courses in case conceptualization, in play therapy. Um, so post that in the comments. Let's see who's here. I'm Kathy Spooner. I'm a licensed clinical social worker and a registered plate therapist supervisor here in the United States, and I have been in the mental health field for over 30 years now, and my big passion. For being a mental health professional is to help children and adolescents and their families heal. That's what got me into the profession. And then back in the 1980s when I was a special ed teacher and I learned about this thing called play therapy, I thought, bonanza, that is it for me. And then I, uh, went on to get my master's degree, and then it took some time to find play therapy because. It wasn't really very accessible back then in the 1980s or in the early 1990s. So welcome Keisha. Working with, oh, you're getting your RPT, so Keisha's on Instagram, um, certification. Oh, you're in Maryland. So Keisha, I orig. So I'm in southern Nevada now here in the United States on the west coast, but I am from the east coast on the northern Virginia, Washington DC area. So that's awesome. I've been to Maryland many times, so that's cool. I always like connecting with, with people from the east coast. Um, yeah. So post your name in the comments. What population are you working with? I go live. I live stream every week on Instagram, LinkedIn, and in my uh, Facebook group for mental health professionals using play therapy and expressive arts. If you're interested in, you're on Facebook. It's called Play and Expressive Arts Therapy Playground. If you're a mental health professional using play therapy and expressive arts. You wanna be in the group, it's a free group. You do have to answer every single question, though. If you don't answer all of the questions, then you're not gonna be admitted into the group. I see people regularly not answer all the questions, and it kind of kills me, and I, I used to message people and say, Hey, but then I never got a response. So. So now I just make sure I tell people, make sure you answer all the questions. Um, and I'm also live streaming on my Instagram channel platform. So welcome, welcome, welcome. If you find the information useful and helpful, please feel free to like it and share it across your social media if you're interested. And on LinkedIn, it's kind of hard to see any of the replays. Um, from previous livestream episodes. So if you're interested or you just like YouTube, you can pop over to my YouTube channel. All of the replays are on my YouTube channel. Kathy Spooner, renewing Hearts Consulting, and you just go into the live tab and all of the replays are there. If you're in my Facebook group, you can go into the featured section and all the lives are there. It's pretty easy to find the replays on Instagram 'cause you just go into my little, what do you call that thing where you can see all my posts? Um, that's where you go. So, so let's get started. First and foremost, I would love to hear what are your questions about case conceptualization and what are your questions about how that applies? To play therapy. Like I said, this is not something I saw very often. Actually, I didn't see this anywhere when I was getting my credential for RPT back in the, um, early turn of a century. So if you have questions, post your questions, what are those? If you're joining me live. Go ahead and post your name in the comments. I'd love to see who's here. Where are you from? If you're watching the replays, go ahead post your questions. Where are you from? What po uh, population you work with, and we'll keep the conversation going. Okay? So first and foremost, so I, I did wanna say so on, if you're watching me on Instagram, I am gonna show some slides. Um, I use Streamy Yard to live stream directly into my Facebook group and, uh, LinkedIn and my YouTube channel. Um, you won't be able to see them on Instagram, but I'll make sure I describe them and, um, just so you can know what I'm talking about. Okay. So first and foremost, what. The heck is case conceptualization. Case conceptualization is a really fancy term. For, essentially you are gathering information from your clients, and this is, you wanna make sure you do this before you even get started doing play therapy. This is really that psychoso, that psychosocial. Uh, bio-psychosocial, spiritual cultural assessment that you do at the beginning. That one should take you back to your graduate school days. But you really wanna make sure you do that at the beginning because that's where you gather all of the information that you need in order to better understand what's going on with your clients. If you don't ask all of the questions, then you're not really gonna have a full understanding of. Probably what's going on with your client, because you're going to use that case formula, uh, case conceptualization, which is you gather all of the information in your bio-psychosocial, cultural, spiritual assessment, and then you're gonna analyze it and synthesize it to make sense of. Hmm. I think this is what's going on with my client because they meet all of the diagnostic criteria for this diagnosis. And so let me just say a little thing about diagnosis. I, I know there are lots of belief systems about di um, diagnosis, and I know I've heard from people say, oh, I don't do diagnoses or. I don't like doing diagnoses, so I give them the adjustment disorder because, you know, BA essentially diagnoses is, is not a good thing. I don't wanna label them. And then there are some who are kind of really strict that way. I fall in the camp of, we need to diagnose. I mean, if you were going to the doctor and you had some kind of thing going on with you, you would probably want a diagnosis to make sure your doctor was giving you the right medication. Like for example, if you went to the doctor and you had this really bad pain in your arm. You would wanna know if it's a broken arm or maybe a ligament. Those are two, two different things going on. Or you would wanna know if you've got some like internal, um, thing going on or some autoimmune disease you would wanna know because that diagnoses is gonna be linked to. Some treatment approaches. Um, and that's, that's why diagnoses is important. It's not the end all be all. I'm not in the camp where, um, you know, you have to pinpoint exactly to the right one because. Sometimes it takes it a little while to get to fully, it's like a, you know, like Shrek it, it's like an onion. You gotta peel it back in layers and you won't always know from the very beginning. But if you gather enough information in the beginning to formulate your working diagnoses in the beginning, you're gonna be staying in that information and assessment gathering mode. Throughout the treatment process because you may find out if, if you kind of get the initial presenting symptoms stabilized, you may find out, oh, there's something else that was actually feeding that we couldn't get at it until we got through that first layer of the onion, so to speak. So. Your, your gathering of the information helps you to figure out what's going on with your clients, so, so you can then figure out what treatment approach you want to use, and that does come with the diagnosis. And diagnosis is important because it helps us align with certain treatment approaches that work best with that particular. Issue that your client is dealing with. And I'm gonna talk about that, um, in a, in, in a little bit. I wanna read who's here. Um, hey, I think I'm pronouncing it. Aya, you emailed me. I was so excited that you emailed me, um, oh, in South Africa. Thank you for this topic. Student psychologist, case conceptualization is an important area of focus and not I agree. I totally agree. And I was in South Africa back in 2008. It was one of, it was such an amazing trip. So I have like a gazillion. I was in, um, Johannesburg and the Cape Town area, and then we went to Kruger National Park as well. So it was a really, I went with social workers, actually, it was a hundred social workers. I would never travel with a hundred people again, and it was amazing trip. So. That's awesome. Uh, I, and I totally agree, which is why I, when I was thinking, because I do a lot of supervision now, consultation, and I have an online. Play Therapy, supervision, consultation group and program. It's called Play Therapy Academy. And in one of the things,'cause I've been supervising and consulting for about 15 years now, and what I realized is that when I'm supervising people, they don't really have some of these basic, basic case conceptualization. And what does that look like in play therapy? Foundation and so what I did in Play Therapy Academy. Is I have created a whole series of courses which are available if you're not in Play Therapy Academy. These are available just as the courses themselves, like, uh, it's a whole series called Getting Grounded in Play Therapy Excellence. And there are, um, there's probably, I think there's gonna be like definitely five. M kind of mini courses in the training. You can buy each of them separately. All of these are gonna be available in Play Therapy Academy as part of the Play Play Therapy Academy, I wanted to make sure that these courses were available to everybody who needed them, whether or not you were in Play Therapy Academy. So that's why I did it this way. So the first course that's available now in that series is called Getting Grounded in Play Therapy Foundations. And that one really lays the groundwork of what is play therapy? What are the core skills that you need? What are some of the ethical and cultural considerations you need to consider? And then the next one in the series, which is coming out in March. Is called case conceptualization in play therapy. That one is, I'm in the, um, middle of getting that one created and recorded and, and get it ready for people to purchase because I really think it's an important. It's an important topic and um, what I find when people take the time to really do that, case conceptualization, really gather all of the information, then what happens is they end up, and this is my next point, which is they get much better treatment outcomes. You know, one of the things that I've been finding, and I I always do a lot of research when I'm doing any of my. Um. Preparation for the courses.'cause I like to have the most up-to-date information. What is the research saying? And I like to put that in there. Um, so one of the things that I've been finding as I have been doing the research for case conceptualization and clinical decision making, because the second course is case conceptualization and we also look at clinical decision making in there. Is the different bias that we're all prone to bias. But here's one of the things that I found really, really interesting and I'm gonna, um, probably in the next couple of weeks, the, my live streams. I'm gonna do a little, I'm gonna talk about the, what the research has said. So some of the, excuse me, research that I found, I'm gonna. Talk about that in some of the upcoming livestream episodes. But, um, bias and overconfidence bias is for people who have been doing it for a while, play therapy and counseling. Um, with experience, they are much more prone to overconfidence bias. And that's basically, you kind of think you know what you're doing, so you don't really, um. Look at some of the details and the specifics or how it's working or not working you. And there there's a whole bunch of other kind of bias bias that is really important for us to think about. I think, I think, you know, as I've been reading through it, I've kind of realized, oh, I, I think I kind of. Do these things. I just didn't know there was a name for it. And reading through this, my thought was, oh, I, I can actually do better with this now that I'm even more aware of what it is. So I'm gonna put that one in my upcoming. Um. Upcoming training. Oh, okay. Say you're from Johannesburg. Yes. I had a really awesome time there and actually when I was in Virginia on the East coast, uh, the church that I went to at the time was really multicultural. Um, we had 27 different countries represented. That was one of the things. But the pastors, um, are from Johannesburg and their kids, so that was really cool. I feel like I have kind of a tie to Johannesburg through that way. Um. Really beautiful city. It's so beautiful. It was such an awesome trip there. Um, so one of the things that we need to think about when we are using case conceptualization, one, we have to be aware of the bias. Um, I think that's always a thing we have to keep in mind. Hey Carla, so I see you on, um, Instagram Welcome and, uh. The other thing is like, what do we do with the information is, uh, sorry, I got distracted chatting with Carla. Um, what do we do with that information? Well, in my mind we go into, um. Detective mode. So we're gathering the information, we're going into detective mode to better understand, okay, my clients are reporting these symptoms. What does that mean? So if, if you are watching me on, um, my YouTube channel, Instagram, I mean, um. Facebook or LinkedIn, you're gonna see my slides, but I'm, for those of you on Instagram, I'm gonna describe them to you. In my mind, when you are doing case conceptualization, you're re, it's like a detective. You're like figuring out where all the data is, what they mean. You're kind of analyzing them and making sense of them and figuring out how does that apply to your clients? And one of the. One of the issues, if you're in play therapy and you work with children and adolescents, the likelihood you're gonna get kids on your caseload who struggle with emotion regulation problems is super high. Like you're gonna have. Quite a few clients, most likely on your caseload with emotion dysregulation problems. So here's the thing. They come in their, their parents are reporting. My child throws these tantrums. They can last anywhere from 10 minutes. To two hours or all day. And they get aggressive and they yell and they say mean things or they'll make these statements like, I'm gonna jump off the roof, or You just wish I was dead. All of these things are very alarming to their parents. And if they're, and I use parents and guardians kind of interchangeably. Um, 'cause some kids don't live with their. Biological parents or their adoptive parents, they may be in a different situation. So, so we have these that report. That's why they're coming. They're coming because they have these emotion dysregulation problems. But here's what we know. We know anxiety and depression can result in some emotion dysregulation problems. We know kids on the autism spectrum and kids who have sensory processing problems, they can get dysregulated. We know kids who've experienced traumatic experiences, they can get dysregulated. We know kids with A DHD who have executive function problems and emotion dysregulation. Is an executive dysfunction, uh, is an executive function. Thing. So if they're dysregulating, it might be part of that A DHD executive function, um, issue going on with them. We know could be oppositional defiant disorder or disruptive mood dysregulation disorder. We know kids who are of gifted intelligence. They may be. Struggling with anxiety, and that might result in some dysregulation. There are any number of things that can be. Underneath and causing this emotion dysregulation. And so one of the things that we're doing when we're doing our case conceptualization is asking all of the questions and getting all of the history to get a better sense of where are the roots? Like what's going on? What's causing this, where's this coming from? You know, when does it happen and why does it happen? So some of the things, so, so for emotion dysregulation, emotional vulnerability, we have autism kids on the autism spectrum, they struggle with cognitive inflexibility, social reciprocity problems. They can get overwhelmed by their sensory system. We know kids with anxiety disorder, they can have cognitive. Distortions that activate their fear. Like I've had kids say to me, um, this was years and years. Like kids have said. A lot of these I've heard multiple times from multiple clients. So it's not necessarily any one client that I'm talking about as much as I I, over the last 30 years, I've seen this a lot. Um, like some kids who have some kind of phobia, like they may worry, they walked by a table. It, it was like 20 feet away and there was. Cleaning solutions. Somehow it got in their mouth and now they're gonna die. Or they worry if they go to school while they're at school, their parent is gonna die, and then they're not gonna have anybody. And so they get dysregulated at school. They can't tolerate being separated from their parent. All of these things, um, can cause that emotion dysregulation. Um, so Carla says, when does it. Happen. How does it develop? What have you done? Yes, Carla, absolutely take care of this. What age? All of those things. Absolutely. Um, and Carla also says we also have to evaluate Yes. Parental competencies so we can do the, um, yes. The play therapy, kind of that environmental play therapy hypothesis. Absolutely, Carla, for sure. Um. And so we also have trauma. We know if their trauma gets triggered, that's gonna activate not being safe. Their, um, hypo arousal system is gonna be like off the chain. Their danger, danger, alarmed alarms are going off. We know what depression could be. Sadness, some hope, irritability. Um, crankiness. Snappiness and also mood regulation. There can be some biological. Components for the mood regulation. And so if. You know, especially with like emotion, uh, A DHD and autism spectrum and we know that that can be overwhelming and they feel like they can't really control their body and they're always getting in trouble if they're a DHD. Um, and the emotion dysregulation. People think their conduct disorder. I can't tell you how many times I have heard a little 5-year-old get diagnosed with conduct disorder. Kind of drives me crazy because when you really go there and look, it's not conduct disorder, it, the motion regulation problem is probably coming from undiagnosed A DHD or they might be on the autism spectrum. So these are, these are things we need to keep in mind, um, and when we're thinking about some of those biological components. We need to be thinking about executive function and that prefrontal cortex and higher cognitive functioning are involved with planning time, space management, cause and effect, problem solving, and the ability to stop and think. Some of this is age, like a five-year-old is not gonna be as. Um, proficient as maybe a 10-year-old or a 15-year-old. So you gotta think, like Carla was saying, those develop developmental things and also Carla said, yes, parental stress. Absolutely. The kids are like little sponges. They have to pick up on all of that. So that's some of the systemic stuff for sure. Um, any of that sensory processing, their little sensory systems are gonna get overloaded. If they're, um, if they're get kind of black and white thinking all or nothing, what's going on that they can't have some of that flexibility to shift. And we also know with kids who are in the gifted intelligence range that they have that asynchronous development meaning. They are chronologically one age, but maybe cognitively because they're much more advanced. If they're intellectually gifted, they may be maybe in second grade. But cognitively, they may be more like in third grade. So you got a little, uh, kindergartner or first grader doing kindergartner or first grade work, but their little brain can do third grade work or maybe even fourth grade work. They are bored out of their minds. Um, it's kind of hard. They get frustrated. It's really, you know, think about a job that I remember, a job I had. I just. Stood at the cash was when I was a teenager, stood at the cash register all day long and it was like a super duper slow store. It was like an eight hour day standing there doing nothing all day long. I thought I was gonna lose my mind. It's the same for kids who are gifted. They, and especially if they have some emotional intensity to them that, um, these are all things that can be underlying and it's important to. Um, consider and do all of that information gathering in the beginning to really understand what's going on. Because when you understand what's going on, then you're gonna be able to use interventions and a treatment approach that's gonna help you get the results that you need. And one of, like Carla was saying, yes. Family. Um, we need to work with the whole family. Carla and I are totally in sync on this. We've chatted about this a few times. Actually, Carla took my training on family plate therapy. Um, oh, I think that was back in October, which is where we met, which was really cool. That was a live webinar. I did, I am gonna do that one again and I'm not sure when, in 2023. Um, that's exactly, we need to really understand systemically what's going on, and I, I am a huge proponent if your case conceptualization does not include looking at child in context. And working with parents and, and integrating parents into the play therapy process, then you've missed a big piece of what needs to happen, and that's part of that case conceptualization in my mind. When I'm conceptualizing what's going on with my clients, I'm also conceptualizing. How parents or guardians need to be involved and what is that gonna look like? And it, that decision making is how it changes over time. But all of those are really important. And if you skip that case conceptualization part. Then you are kind of operating without a roadmap and you're just kind of, um, doing things hoping they work. And sometimes they, they probably will work until you get a challenging case that's not super easy, then you're gonna be probably lost if you haven't gotten your case. You know, done that initial legwork of gathering all of the information. So that is it for today. Um. I'm gonna do a little recap and then I'm gonna tell you a little bit about some of the courses, like I mentioned, play Therapy Academy and this Getting Grounded in Play Therapy. Excellent series that I have going on right now. Um, first and foremost, what is Case Conceptualization? It is essentially taking all of the information, uh, about, um. What's going on with your clients? Some of that social history you wanna make Sure. Um, gathering any cultural history. It's really important, I think, also to gather some of that spiritual. History.'cause sometimes that might be part of the problem, but sometimes that might be a, a resource for the family.'cause during this case, conceptualization, we're identifying resources as well because we wanna help our clients access those and support those. And when you, when you take the time to do that information gathering and do that case conceptualization. Then that plays into your treatment planning about what needs to happen, how it needs to happen. What kind of play therapy modalities are you gonna use? Who's gonna be involved in the treatment process? And then you lay out your plan in order to get started. The clinical decision making, which we didn't talk a lot about this time, and I'll, I'll, I'll talk about that in some upcoming lives, is how you kind of stay in, in detective, clinical detective mode throughout the change process and do that decision making as you go along. Um, so a Facebook user says, I had a look at your courses. Love to do them, like some guidance on how to become an RPT in South Africa. You know what, um, post, you can either message me or post in my Facebook group. I will get back to you and I'll, um, we can chat about that. Um. So that is it for today. If you found the information helpful, please liken it and share it across your social media. You can always find all the replays to my live streams and on my YouTube channel. I have a bunch there. Um, replays on my YouTube channel. Kathy Spooner renewing hearts. Consulting. If you're in my Facebook group, go up there in the featured section. You can find 'em all there. All right. If you have any questions, feel free to post them in the comment, and I will see you next week. Bye. Thank you for joining me on this f. Of next Level play therapy. I hope you found the discussion valuable and gain 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 can benefit from this information. Remember. Play therapy is a powerful tool for healing and growth. Whether you're a new play therapist or experienced, I encourage you to continue your learning journey to unlock the potential of play in your own work in relationships. If you have any questions or topics, suggestions for future. I'd love to hear from you. Connect with me on social media and visit my website at Renewing Hearts Play Therapy Training to stay updated on upcoming episodes, trainings, and resources. Thank you once again for listening to Next Level Play Therapy. Until next time, keep playing, learning and growing.