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The Approaches to Play Therapy by the two main professional organisations

Setting the Scene
The two main professional organisations supporting play therapy are the (American) Association for Play Therapy (APT) and Play Therapy International (PTI).

There had been a co-operative relationship for many years, where PTI was an accredited APT training provider.

This was ended in August 2010 by mutual and friendly agreement because of the divergence of views about the development of the profession in a number of areas, as shown below.

The traditional model is exemplified by APT - developed in the United States by pioneers such as Axline, Landreth, Schaeffer and O'Connor

The evolutionary model is exemplified by PTI - building on the traditional model, emerging from the work of Oaklander, Mark Barnes in Canada, and subsequently developed further in the UK and internationally led by Jephcott and Thomas.


The Main Comparative Factors
The main factors to consider in comparing the two approaches are:
  1. Professional reach - PTI's approach has evolved beyond just the mental health service delivery channels
  2. Professional levels - PTI's approach has evolved to include therapeutic play by recognising a spectrum of needs and a preventative role
  3. Clinical governance - PTI's approach has moved the profession forward by making quality management mandatory
  4. Geographical coverage - PTI's development of play therapy is across the world - not focussed on one country
  5. Ethical basis of practice - PTI has evolved from a code of ethics to a set of principles that empowers the therapist
  6. Training - the basis and methods - PTI's accreditation of training has evolved to be based on evidence based competencies and a coherent approach
  7. Standards - Qualifying hours of practice, trainers and clinical supervision - PTI's standards recognise different countries' needs
  8. Evidence of the effectiveness of training and practice - PTI's proof of standards has evolved through extensive clinical outcomes research
  9. Research policy - PTI's research policies have evolved to embrace quantitative and qualitative methods and move beyond the problems and limitations of RCTs and meta-analysis studies.
The first two points account for the major divergence between the two organisations. PTI believes that they are fundamental to helping as many children, who have emotional, conduct, social and other psychological problems as possible. Point 3, is in PTI's view, also very important because quality management of our practitioners' work is essential to protect the children from unsafe or shoddy practice. Points 4 to 8 are more points of detail. Point 9 determines the pace of innovation in the profession.

Professional reach
The rationale is to help as many children as possible through all appropriate service delivery channels at the highest standards.

PTI regards play Therapy is a distinct profession using play AND creative arts therapies that can be delivered through a number of channels including :
  • Education
  • Social services
  • Community services
  • Justice
In addition to all health channels (physical as well as mental health). Play and creative arts therapies may also be an extension to existing qualifications.
APT does not regard Play Therapy as a profession in its own right, but as an extension of existing mental health professions such as : psychology and psychiatry.

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Professional levels
The rationale is that there is a spectrum of children’s needs ranging from mild, single problems to severe, complex multiple problems. In addition the therapies have an equally important preventative role.

PTI recognises that there is a need to match resources to needs to provide an efficient as well as an effective model. This requires a multi level approach. (Practitioner With Therapeutic Play Skills, Certified Play Therapist, Accredited Play Therapist) APT has a single level approach. For example it does not recognise ‘Therapeutic Play’ as a level because of the US Classification of ‘therapeutic play’ as only a nursing intervention.

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Clinical governance
Clinical governance is a term used by European health professions for quality management. Because children are a particularly vulnernable group, it is essential that this is carried out by both by the therapist and an external monitoring agency, in addition to clinical supervision (sometimes called 'consultation').

Required of all PTI and its affiliated organisations’ membership. Not required by APT - the concept of monitoring the quality of members' therapeutic work does not exist.

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Geographical coverage
The rationale is to help children in as many countries as possible through culturally adapted methods, recognising different priorities and levels of available resources and skills.

PTI operates mainly in Europe, Asia, Australasia, Canada, Africa through affiliated but autonomous organisations which PTI supports financially in their early days. APT's membership is mainly in the United States. It operates through a branch network.

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Ethical basis of practice
It is vital that the therapist is able to take safe but quick decisions inside as well as outside the playroom and to minimise the chances of complaints. Working with children has special considerations.

PTI has a mandatory ethical framework, designed for working with children. This framework uses principles which empowers and places responsibility on the therapist. APT has Voluntary Practice Guidelines - the ‘power’ is in the ‘rule book’ not with the therapist.

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Training - basis, methods and qualifying hours of practice
Rationale - play therapy training:
  • Must be evidence based. Learning objectives must be based on competencies, which are derived from the evidence base and delivered through standardised, coherent training programmes.
  • Must recognise that all children are different and react favourably to a wide range of intervention medi
  • Must include competencies that enable practice to take place and be managed as well as the therapeutic one
  • Trainees should experience the processes that the children will undergo and identify any personal issues that could prevent safe, effective therapy.
  • The clinical practice hours required whilst under training should be sufficient to provide experience of dealing with typical problems and situations. The amount of hours required should not discourage new entrants to the profession.

PTI accredited courses must be based on a detailed set of specific competencies that are derived from practice based evidence. They train in the therapeutic use of a wide range of media as well as a theoretical core and enabling competencies.

Programmes are coherent, consistent and complete in themselves to provide a formal qualifications. This compares to the use of a points or credits system.

All approved play therapy and therapeutic play courses are accredited by a university at post graduate level.

The PTI programmes make it easier for an employer or others to identify a successful trainee’s skills, instead of having to find out about a plethora of ad hoc short courses which do not add up to a coherent programme of training.

PTI accredited course content must be in the ratio of 70% experiential and 30% theoretical. This ratio ensures that any personal issues that the trainees may have that will hinder safe practice are flushed out enabling them to be dealt with.

PTI requires 200 practice hours, whilst under training, to provide threshold certification as a Play Therapist (100 hours for a Practitioner With Therapeutic Play Skills). 450 total hours are required to distinguish a higher level of experience as an Accredited Play Therapist.

Extensive research, based on over 6000 cases shows that these standards are effective.
The APT training approach uses a credits method. Training providers are approved, but not the individual courses. Only the theoretical core is consistent.

As a result an individual may accumulate sufficient points or credits for qualification as an APT Play Therapist but their skills and experience that they have acquired this way will be different, perhaps substantially, to others who have acquired their skills from completely different courses.

Many courses offered by APT approved providers are not accredited by a university and are therefore not at post graduate level, although this is sometimes claimed.

APT has no recommendation or standard on this point.

APT requires 2000 practice hours. This is based on United States requirements for mental health practitioners. In PTI's view this is only neccessary if there no coherent course to qualify as a Play Therapist.

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Standards - Qualifying hours of practice, trainers and clinical supervision
Trainers must have practical, practice experience, be able to hold the processes of the participants arising out of the experiential exercises as well as good training techniques and appropriate academic qualifications.

Clinical supervision is required for quality management and safety, at a high level whilst training, then at a lower level throughout a practitioner’s career.

PTI encourages a mix of trainers’ experience relevant to the subjects being taught. A Masters degree is desirable but not essential. The crucial skill is being able to deal with the emotions arising from the experiential work from individuals and the group.

PTI standards require 1 hour of clinical supervision for every 6 hours of practice, whilst training. 1.5 hours per month whilst practising once qualified.
APT insists that all trainers must have a Masters degree, regardless of other specific subject experience or training effectiveness.

APT do not require clinical supervision once a practitioner has qualified.

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Evidence of the effectiveness of training and practice
All training courses must be thoroughly evaluated, especially looking at job performance, after training.

PTI uses a four level evaluation model of the of training for all accredited courses. As an example see the very detailed APAC Annual Quality Report for 2009/10. This is supported by PTI's continuous programme of clinical outcomes based on over 6000 case measures. APT uses a single level model of the evaluation of training for a sample of courses. There is no programme measuring clinical outcomes.

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Research policy
Research policy must encourage the development of new methods of working and improve systemic factors. It must take into account the difficulties of individual practitioners conducting large scale research. It must use a therapy research cycle that recognises the stages of efficacy, effectiveness and efficiency in applying new methods.

PTI's research policy is based upon Pragmatic Psychology principles which enable the linking of single case study methods to PTI's large scale quantitative database. This provides a researcher with more 'leverage' for their studies.

PTI recommends the use standardised measures, that are available worldwide at no or little cost and the use of the PTI taxonomy of children's conditions.

PTI encourages and carries out its own research into systemic factors in a number of countries as well as into therapeutic aspects.
APT has no clearly defined research policy; has mainly published meta-analysis and small scale case studies; has no standardised measures or taxonomy and published little systemic research.

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