96 I. PLAY THERAPY THEORIES AND APPROACHES initially presented. What were his or her feelings and experiences at that time? What were his or her apprehensions and fears? The final doll represents the child during the termination stage. After discussing the first doll, the final doll is discussed. How has the child changed and grown? What kinds of experiences have facilitated this growth and change? The child and thera- pist explore what the child continues to need and how those needs will be met. The strengths and resiliency of the child are em- phasized. The child also processes how the therapeutic relationship has changed his or her perceptions of self and others in the re- lationship. The dolls between the first and last are also discussed and influential expe- riences during the therapy are written on the middle dolls. Clinical Case Example Spencer's parents, Joseph and Kari, met initially with the therapist to discuss de- ployment concerns, including how Spencer would tolerate the upcoming change. While meeting, the therapist gathered as much detailed information about the deployment as possible in order to use the information later while acting out with Spencer, age 4, the probable experiences related to his dad going to Afghanistan. His parents were able to give critical information about where and when the family would engage in activities related to deployment. Joseph indicated that he would be dressed in his Army com- bat uniform. They would interact with other families who were involved in deployment at the same time and others who would have parents returning at various times during the upcoming year. The family would give their final goodbyes before his father would board the bus carrying his unit. Spencer's parents felt that he would have difficulty at various times during the week leading up to the deployment and specific nurturing and reassuring activities were planned to con- nect with him during those times. The therapist made available toys that reflected the deployment, including toy buildings (shoeboxes with signage related to Army base buildings typically utilized by families). Soldier dolls and puppets al- lowed for Spencer to engage in play related to his father's deployment. He and his fam- ily brought supplies (boots, Kevlar, camel backs, etc.) that were commonly seen by Spencer when his father would pack for ex- tended leaves. During the play, Spencer and his therapist acted out the scenario that his parents had articulated would be expected on the final days before deployment. The details of the specific events, including gatherings with extended family and other families in his father's unit, were enacted. His father and mother came in to sessions, and he showed them some of the scenarios. His parents noted his feelings and thoughts in the play scenarios and how similar they were to how he had felt during his father's previous deployment. Spencer was able to explore feelings of abandonment and loss, and his parents as well as his therapist were able to "hear" his perceptions. His anger and sadness were understood through his play, not as an expression that needed to be "changed" but rather as one that was ac- ceptable and therefore he was acceptable. As he was accepted in his expressions, Spencer was able to explore the beliefs re- lated to his feelings. Was he unworthy of his dad's love and consistent involvement? Was his dad going to return to him? Was his dad's leaving related to him or his be- havior? What did the changes mean to him and about him? These themes were beyond the "words" of a child; however, they were not avoidable in his play. He was able to de- pict through play the thoughts that needed exploration. As the therapist was able to put words to the play (or at times staying within the play if that seemed necessary), he was able to process his fears and the loss. In this way Spencer was supported in his feelings, and his parents were able to appreciate that he needed to express the loss he felt. ed aps a TA SF in mc de st n a ta j y K T T J ( 6. Cognitive-Behavioral Play Therapy In addition to using the initial therapy for stress inoculation, Spencer was also able to use the therapy throughout his father's deployment to continue to process the day- to-day experience of being the child of a de- ployed parent. He and his father discussed ways they would communicate, including Skype, during his deployment. His family members participated in a session during which each used a puppet to represent a dif- ferent family member. Each was supported in how he or she viewed the others and in how each member felt, and the strengths of each family member were discussed. Spencer's parents expressed appreciation for acting out the scenarios in play, as they indicated that this afforded them a deeper understanding and appreciation of the ex- perience. Conclusion CBT must be adapted for utilization with children due to cognitive and verbal limi- tations as well as interests. Children com- municate through play significantly more information than they do through ver- balization. Play can be used to facilitate children's self-expression and to provide a developmentally appropriate means of teaching a skill that may not be understood through verbal-only communication. Play in CBPT allows the child to express feel- ings, thoughts, and perceptions. mental, and theoretical aspects. M Harper & Row. Beck, A. T. (1970). Cognitive therap and relation to behavior therapy Therapy, 1, 184-200. Beck, A. T. (1972). 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