by Lisa Remey MEd, LPC-S, RPT-S™, NCC, RST-C/
Play is the language of children and a means of learning, problem-solving, and making sense of their world (Landreth, 2023). It is their natural language, their laboratory, and a bridge between emotion and understanding. In play, children experiment, solve problems, and rehearse coping skills, even before they can express these concepts in words. Just as Dr. Aaron Beck’s cognitive therapy helps adults identify and reshape unhelpful thoughts and maladaptive beliefs, Cognitive Behavioral Play Therapy (CBPT) brings those same principles to children through the natural language of childhood: play.
From Cognitive Behavior Therapy to Play Therapy: A Natural Evolution
When Dr. Aaron Beck introduced cognitive therapy, he emphasized that thoughts shape feelings and behaviors. For children, however, thoughts are often embedded in stories, symbols, and play. Translating cognitive principles into the world of childhood requires both creativity and developmental sensitivity, meeting children where they are.
Dr. Susan Knell introduced CBPT, an adaptation that merges cognitive-behavioral theory with play therapy principles (1993). Her work showed that even young children can engage in cognitive change when met at their developmental level and when the therapeutic powers of play are used as the medium.
More than three decades later, CBPT is considered a seminal theory for play therapy by the Association for Play Therapy (Association for Play Therapy, n.d.). Research and practice have expanded its application across settings and diagnoses, yet the foundational ideas remain constant: children can learn to identify, examine, and replace unhelpful thoughts when the process is through play and the therapeutic relationship. Additionally, through their work with children and caregivers, therapists also aid in preventing maladaptive beliefs and cognitions from taking root.
What is Cognitive Behavioral Play Therapy?
CBPT integrates the structure and evidence base of CBT with the developmental aspects of play therapy, helping children build awareness of their thoughts, recognize connections between feelings and behaviors, and practice coping skills – all through playful experiences.
Play serves as the bridge between cognition and emotional learning. Through stories, games, art, and sand tray, children externalize their experiences and experiment with new perspectives. For example, a child might use puppets to rehearse inviting a peer to join a game or to practice what to say when resolving a disagreement. This symbiotic rehearsal becomes the seed for new cognitive and behavioral patterns.
The balancing of directive and nondirective approaches within the CBPT framework provides opportunities for psychoeducational learning, role playing, and modeling. Cognitive concepts are introduced in developmentally appropriate ways within directive and nondirective portions of sessions, bringing awareness to coping self-talk, problem-solving, and emotional regulation while maintaining a strong therapeutic alliance that allows the therapeutic powers of play to serve as a vehicle for change.
CBPT in Action
In CBPT, change occurs in what may seem like small yet meaningful moments where cognitive insight meets the safety and creativity of play. For example, during nurturing kitchen play, children might express their internal experiences through the roles and stories they create. A baby doll that becomes “scared when it’s alone” could reflect a child’s own worries about separation or safety, offering insight into underlying beliefs. As the child comforts the doll, perhaps saying, “It’s okay, take a deep breath,” or gently rocking the doll while preparing a bottle, they actively practice emotional regulation and co-regulation within the safe metaphor of play. Sometimes, frustration or anger naturally emerge; pretend spills or a baby doll that “won’t listen” can mirror the child’s real-world experiences. These moments, though seemingly simple, give rich opportunities for the play therapist to observe cognitive patterns, introduce flexible thinking, and support skill development in a developmentally sensitive and engaging way.
Parent and caregiver involvement is also an integral part of the process. By including parents in the process, the collaboration bridges the skills and psychoeducation into daily life and beyond play therapy sessions. This collaboration strengthens the therapeutic alliance and reinforces long-term growth.
Why CBPT Matters
Children today navigate a complex and fast-changing world, one that can amplify anxiety, perfectionism, and emotional overwhelm. Tools are needed that are both evidence-based and developmentally attuned.
CPBT answers those needs. It brings together the best of both worlds: the structured, measurable outcomes of CBT and the relational, expressive power of play therapy. It is grounded in research and child-focused, helping children build resilience, flexibility, and confidence through meaningful play.
A New Resource for the Field
Knell’s foundational resource was published over 30 years ago. Recognizing the need for an updated and comprehensive resource, I had the privilege of co-editing Cognitive Behavioral Play Therapy: A Comprehensive Guide to Theory and Practice. (in print) alongside Dr. Athena A. Drewes.
This text brings together international contributors illustrating what CPBT looks like in practice across settings, cultures, and presenting concerns. It explores session structure, developmental considerations, and the integration of directive and nondirective play, while providing real-world case examples that bring the theory to life.
Our goal was to create a resource that supports both new play therapists learning to apply cognitive behavioral concepts and seasoned clinicians alike. The book offers the “nuts and bolts” of CBPT from theory and research to session components and parent collaboration.
Play with Purpose
CBPT reminds us that play is not an alternative to cognitive behavioral therapy; it is an extension of it. It allows children to process their world in ways that feel safe, engaging, and empowering, meeting them at their developmental level through their natural language of play.
Every puppet story, sandtray world, play scenario, or metaphor becomes a doorway of insight. They also build an understanding of their feelings and experiences, normalizing the range of emotions while learning coping strategies along the way. Through play, children learn that their thoughts can change, and when their thoughts change, so does how they feel, act, and experience the world.
As Dr. Beck has taught us, changing our thoughts can alter our mood and perspective, in turn, making us feel better and leading to the development of adaptive thoughts and more helpful behaviors. In CBPT, these transformations begin one play session at a time, where imagination and play become the foundation for growth.
References:
Drewes, A. A., & Remey, L. (Eds.). (in press). Cognitive Behavioral Play Therapy: A Comprehensive Guide to Theory and Practice. Bloomsbury.
Knell, S. M. (1993). Cognitive-behavioral play therapy. Jason Aronson.
Landreth, G. L. (2023). Play Therapy: The Art of the Relationship (4th ed.). Routledge.
Lisa Remey, MEd, LPC-S, RPT-S™, NCC, RST-C/T is a licensed professional counselor supervisor, registered play therapist supervisor, and founder of the Bluebonnet Center for Play Therapy in New Braunfels, Texas. She is an international trainer, author, and co-editor of the forthcoming Cognitive Behavioral Play Therapy: A Comprehensive Guide to Theory and Practice. A former president of the Texas Association for Play Therapy, Lisa is known for her engaging workshops, creative interventions, and commitment to making CBPT approachable and developmentally sensitive for children. Her work blends clinical expertise, playfulness, and a deep passion for empowering children and the professionals who serve them.