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What Are Best Practices in Play Therapy for Clinical Decision-Making? · Next Level Play Therapy: A Podcast for Play Therapy Excellence

• 0:02
  Cathi Spooner: Welcome to Next Level Play Therapy.
• 0:02
  Cathi Spooner: 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.
• 0:21
  Cathi Spooner: I'll discuss practical tips and ideas so you can transformative experience for your young clients real difference in their lives.
• 0:31
  Cathi Spooner: 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.
• 0:42
  Cathi Spooner: Hey there.
• 0:48
  Cathi Spooner: Good morning.
• 0:48
  Cathi Spooner: 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.
• 1:09
  Cathi Spooner: 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.
• 1:20
  Cathi Spooner: 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.
• 1:38
  Cathi Spooner: 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.
• 2:00
  Cathi Spooner: These, they, they can be challenging.
• 2:05
  Cathi Spooner: I work in, uh, over the years, have worked in community health and some of the more, uh, like residential working in homeless shelters.
• 2:18
  Cathi Spooner: So in my mind, when we're using play therapy, it would the research says about clinical decision making.
• 2:30
  Cathi Spooner: 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.
• 2:44
  Cathi Spooner: 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.
• 2:59
  Cathi Spooner: I stream live every week into Instagram.
• 3:03
  Cathi Spooner: I live stream into my Facebook group for child adolescent therapists using play an expressive arts therapy.
• 3:13
  Cathi Spooner: 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.
• 3:26
  Cathi Spooner: 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.
• 3:38
  Cathi Spooner: Um, so you do have to answer all the questions.
• 3:40
  Cathi Spooner: 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.
• 3:56
  Cathi Spooner: In my Facebook group.
• 3:58
  Cathi Spooner: 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.
• 4:13
  Cathi Spooner: 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.
• 4:23
  Cathi Spooner: So I'm Cathi Spooner.
• 4:25
  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.
• 4:37
  Cathi Spooner: And I love using play therapy and expressive arts play I use expressive arts uh, with a play therapy lens.
• 4:44
  Cathi Spooner: And so I find that's a really, really effective way to especially family play therapy.
• 4:52
  Cathi Spooner: 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.
• 5:07
  Cathi Spooner: 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.
• 5:23
  Cathi Spooner: So those of you who have access to university libraries.
• 5:26
  Cathi Spooner: If you wanna check it out, you can check it out.
• 5:32
  Cathi Spooner: 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.
• 5:51
  Cathi Spooner: 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.
• 6:34
  Cathi Spooner: Even post pandemic because what we're finding in mental health and adolescent mental health is that families are still struggling.
• 6:44
  Cathi Spooner: 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.
• 7:17
  Cathi Spooner: And so for that reason, I thought, well, it would be the research says about clinical decision making.
• 7:29
  Cathi Spooner: I have not found, I haven't found any information in the clinical decision making.
• 7:35
  Cathi Spooner: I think sometimes it, um, kind of gets in there, um, talking about it directly.
• 7:46
  Cathi Spooner: I think whenever you're learning a specific play you're learning is how do you, especially, you get the supervision or the consultation.
• 7:59
  Cathi Spooner: 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.
• 8:15
  Cathi Spooner: 'Cause they're gonna be different nuances and you're kind of different barriers, sometimes a little Roadblocks.
• 8:26
  Cathi Spooner: How do you navigate through that?
• 8:27
  Cathi Spooner: And so.
• 8:29
  Cathi Spooner: I don't think we necessarily directly talk about making in and of itself.
• 8:33
  Cathi Spooner: And so when I found this research, I got really excited.
• 8:36
  Cathi Spooner: Um, and so in this, I'm gonna read a quote.
• 8:40
  Cathi Spooner: This is the research.
• 8:43
  Cathi Spooner: 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.
• 9:02
  Cathi Spooner: 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.
• 9:31
  Cathi Spooner: 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.
• 9:50
  Cathi Spooner: And so it's, it's grounded in theory.
• 9:54
  Cathi Spooner: 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.
• 10:26
  Cathi Spooner: 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.
• 10:42
  Cathi Spooner: And so we're looking at even if, like what evidence-based models are you using that are geared towards children?
• 10:50
  Cathi Spooner: 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.
• 11:15
  Cathi Spooner: 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.
• 11:39
  Cathi Spooner: 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.
• 12:01
  Cathi Spooner: 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.
• 12:21
  Cathi Spooner: 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.
• 12:45
  Cathi Spooner: 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.
• 12:59
  Cathi Spooner: 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.
• 13:09
  Cathi Spooner: And they're all gonna be based on whatever your model is that you're using.
• 13:14
  Cathi Spooner: 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.
• 13:33
  Cathi Spooner: Excuse me.
• 13:41
  Cathi Spooner: All right.
• 13:43
  Cathi Spooner: 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.
• 14:10
  Cathi Spooner: And I would 100% agree with that.
• 14:13
  Cathi Spooner: Because evidence-based treatment is grounded And then that model is gonna require decision making to you're going to apply it.
• 14:28
  Cathi Spooner: So I thought this was really, really interesting research.
• 14:32
  Cathi Spooner: Um, and so what the, so the results of the study, so in me back up a little bit.
• 14:43
  Cathi Spooner: So in this study, they took 48 clinicians.
• 14:45
  Cathi Spooner: And they divided them into two groups.
• 14:51
  Cathi Spooner: There were, there were 14 clinicians who were in the trained, uh, group, and then 34 were in the non treatment trained group.
• 15:01
  Cathi Spooner: And so the way that the research worked was they were in both groups were given the same case vignettes.
• 15:14
  Cathi Spooner: 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.
• 15:29
  Cathi Spooner: Uh, their treatment planning.
• 15:33
  Cathi Spooner: So what we know is, um, when we're using case using clinical decision making.
• 15:39
  Cathi Spooner: 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.
• 15:59
  Cathi Spooner: 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.
• 16:18
  Cathi Spooner: And part of that is treatment planning.
• 16:19
  Cathi Spooner: 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.
• 16:46
  Cathi Spooner: 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.
• 17:01
  Cathi Spooner: 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.
• 18:21
  Cathi Spooner: If you're into those things, you wanna know those things.
• 18:23
  Cathi Spooner: Um.
• 18:27
  Cathi Spooner: 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.
• 19:01
  Cathi Spooner: Carla, so glad.
• 19:02
  Cathi Spooner: Oh, that's awesome.
• 19:03
  Cathi Spooner: I'm glad you could join us.
• 19:05
  Cathi Spooner: Hey, which reminds me, I totally forgot to say, if Uh, post your name.
• 19:15
  Cathi Spooner: 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.
• 19:30
  Cathi Spooner: Feel free to post those in the comments.
• 19:34
  Cathi Spooner: Thank you, Carla.
• 19:38
  Cathi Spooner: When I saw your post, I realized, Ooh, I forgot to ask tell people to do that.
• 19:41
  Cathi Spooner: Feel free to join the conversation.
• 19:43
  Cathi Spooner: 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.
• 20:02
  Cathi Spooner: 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.
• 20:29
  Cathi Spooner: 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.
• 21:18
  Cathi Spooner: I would read a little bit, I read a quote from the study that kind of highlights this, um, information.
• 21:23
  Cathi Spooner: So novices would be, um, uh, the, the ones that are not necessarily very proficient in doing that clinical making making process.
• 21:41
  Cathi Spooner: So Carla's asking, what does EBT mean?
• 21:43
  Cathi Spooner: EBT stands for evidence-based treatment.
• 21:47
  Cathi Spooner: 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.
• 22:15
  Cathi Spooner: The Gary Landreth version would be Child Parent That's another evidence-based.
• 22:23
  Cathi Spooner: Adlerian therapy play Therapy and Thera play.
• 22:25
  Cathi Spooner: Those are considered evidence-based by samhsa.
• 22:29
  Cathi Spooner: They've had a lot of research behind them.
• 22:33
  Cathi Spooner: Um, like a really common one pretty much a lot of know is Cognitive Behavioral Therapy, DBT therapy.
• 22:40
  Cathi Spooner: They've con they're considered evidence-based because a lot of research to back it up.
• 22:47
  Cathi Spooner: So, um, so here's my other thing about that.
• 22:50
  Cathi Spooner: 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.
• 23:12
  Cathi Spooner: 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.
• 23:28
  Cathi Spooner: 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.
• 24:05
  Cathi Spooner: 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.
• 24:48
  Cathi Spooner: Um, usually lots of generations of trauma addiction and attachment issues that they've been struggling with a, a few generations.
• 24:57
  Cathi Spooner: So that's higher acuity.
• 25:00
  Cathi Spooner: Hey, uh, I. I hope I pronounced your name right.
• 25:02
  Cathi Spooner: Ro Aya from South Africa.
• 25:07
  Cathi Spooner: I'm so glad you're joining us.
• 25:10
  Cathi Spooner: Thank you for breaking down the study.
• 25:11
  Cathi Spooner: So well, the study highlights and supports, again, the evidence-based practices.
• 25:16
  Cathi Spooner: I agree.
• 25:19
  Cathi Spooner: Um, and at and at least practices that are theory determines how you apply it.
• 25:25
  Cathi Spooner: But the other piece is, what they're highlighting here that training in the clinical decision making process.
• 25:33
  Cathi Spooner: 'Cause you can go to a training, you can get trained.
• 25:37
  Cathi Spooner: But the the effectiveness of the out of the the outcomes is gonna based on clinician competency.
• 25:51
  Cathi Spooner: The clinician's ability to apply it, which is going decision making process.
• 25:57
  Cathi Spooner: It also in is gonna include your case conceptualization.
• 26:01
  Cathi Spooner: They go hand in hand.
• 26:06
  Cathi Spooner: 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.
• 26:32
  Cathi Spooner: And I 100% agree with that.
• 26:34
  Cathi Spooner: 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.
• 26:57
  Cathi Spooner: And so I have Play Therapy Academy, which is basically consultation groups couple times a month.
• 27:04
  Cathi Spooner: And then in Play Therapy Academy, I have additional These are the ones I'm in the process of developing.
• 27:12
  Cathi Spooner: 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.
• 27:23
  Cathi Spooner: I'll talk a little bit more about that.
• 27:25
  Cathi Spooner: 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.
• 27:50
  Cathi Spooner: Some of these elements that in play therapy that different play therapy models.
• 27:57
  Cathi Spooner: 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.
• 28:40
  Cathi Spooner: And so, um, to me that's really important in the, in we're, I mean, the training that we're providing.
• 28:51
  Cathi Spooner: 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.
• 29:01
  Cathi Spooner: 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.
• 29:20
  Cathi Spooner: So I'll, I'll talk a little bit more about that.
• 29:24
  Cathi Spooner: 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.
• 29:42
  Cathi Spooner: 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.
• 29:53
  Cathi Spooner: 'Cause the goal is for them to, um, be able to complete play therapy in the shortest amount of time, the most optimal benefits.
• 30:08
  Cathi Spooner: That's the goal.
• 30:10
  Cathi Spooner: Um, so what does that mean for play therapy?
• 30:12
  Cathi Spooner: 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.
• 30:32
  Cathi Spooner: 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.
• 30:52
  Cathi Spooner: You're, you're gonna use, um.
• 30:55
  Cathi Spooner: When you're learning these models, you wanna make sure you're learning the principles and how they're applied.
• 31:02
  Cathi Spooner: Because one of the things that I notice happens a lot, consultation and supervision for about 15 years now.
• 31:15
  Cathi Spooner: 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.
• 31:33
  Cathi Spooner: 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.
• 31:48
  Cathi Spooner: So e so you're basing your decision making and you're based on your theoretical model.
• 31:54
  Cathi Spooner: 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.
• 32:50
  Cathi Spooner: They're gonna be online.
• 32:52
  Cathi Spooner: You could take 'em in your own time zone whenever it's I wanted to make them really, really, really accessible.
• 32:56
  Cathi Spooner: 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.
• 33:25
  Cathi Spooner: And how does that, how does that, how do you apply that with each of your clients?
• 33:36
  Cathi Spooner: 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.
• 33:45
  Cathi Spooner: 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.
• 33:57
  Cathi Spooner: That developmentally is geared towards adults.
• 34:00
  Cathi Spooner: You're not using that with children.
• 34:02
  Cathi Spooner: And then thirdly, play therapy is based in a that guides children's ability to access those powers of play for healing.
• 34:14
  Cathi Spooner: 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.
• 34:38
  Cathi Spooner: So that is it for today.
• 34:41
  Cathi Spooner: I am so glad you were able to join.
• 34:42
  Cathi Spooner: 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.
• 34:52
  Cathi Spooner: I would love to know what play therapy models you are So go ahead and post those in the comments as well, and Bye.
• 35:04
  Cathi Spooner: 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.
• 35:17
  Cathi Spooner: If you enjoyed this episode, be sure to subscribe to the podcast and leave a review.
• 35:23
  Cathi Spooner: Your feedback helps to improve and reach more people who benefit from this information.
• 35:29
  Cathi Spooner: 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.
• 35:42
  Cathi Spooner: If you have any questions or topics, suggestions for I'd love to hear from you.
• 35:52
  Cathi Spooner: 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.