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The development of the child interpersonal relationship and attitudes assessment for child centered play therapy

Dissertation
Author: Ryan P. Holliman
Abstract:
The purpose of this study was to develop a parent report form instrument congruent with the philosophy of child-centered play therapy. The study sought to develop an instrument with acceptable levels of construct validity, reliability, sensitivity to clinical attitudes and relationships, and responsiveness to intervention. The Child Interpersonal Relationships and Attitudes Assessment (CIRAA) and the Child Behavior Checklist (CBC) and the Parenting Stress Index (PSI) were administered to 136 parents of children aged 3 to 10. The children of the parents sample consisted of 90 males and 46 females. Exploratory factor analysis was conducted for construct validity. Parallel analysis was conducted to determine the number of factors to retain. The factor solution explained 53.86% of the variance, which is an acceptable amount of the variance. Cronbach's alpha was conducted for total scale and all subscales. Reliability scores for the total score and subscales were acceptable, with an overall reliability coefficient of .93. A Pearson's r was conducted for concurrent validity between the instrument, the CBC, and the PSI, with Pearsons' r of .75 and .74 respectively. Paired-sample t -tests using the pretest and posttest scores of the instrument in development examined the responsiveness of the instrument to play therapy intervention at the same level as the CBC and PSI. ROC curve analysis, indicated acceptable discrimination of clinical scores and adaptive scores, with a clinical score being generated from the analysis. It is the first parent-report form developed for child-centered play therapy, and provides an efficient and philosophically consistent instrument for child centered play therapists to use in clinical and research settings.

TABLE OF CONTENTS Page

ACKNOWLEDGEMENTS....................................................................................................... iii

LIST OF TABLES ..................................................................................................................... vi

LIST OF FIGURES ..................................................................................................................vii

Chapters

1. INTRODUCTION ............................................................................................... 1 Statement of the Problem Purpose of the Study Definition of Terms

2. REVIEW OF LITERATURE ............................................................................... 6 Play Therapy Effectiveness of Play Therapy Child Assessment Play Therapy Assessment

3. METHODS AND PROCEDURES..................................................................... 67 Research Objectives Instrument Development Sample Measures Data Collection Procedures Data Analysis

4. RESULTS .......................................................................................................... 86 Data Screening Factor Retention Responsiveness to Change

v

5. DISCUSSION .................................................................................................. 103 Conclusions and Implications Recommendations for Future Study

APPENDICES ........................................................................................................................ 114

REFERENCES ....................................................................................................................... 134

vi

LIST OF TABLES

Page

1. Initial Items Organized by Factor ................................................................................... 71 2. Items Used in the CIRAA Pilot Test .............................................................................. 74 3. Items Used in CIRAA Main Study ................................................................................. 76 4. Demographic Characteristics of Participants (n = 136)................................................... 78 5. Parallel Analysis Results ............................................................................................... 89 6. Descriptive Statistics for CIRAA Final 4-Factor 30 Item Solution Rotated to Varimax Criterion with Kaiser Normalization (n = 136) ............................................................... 91 7. Inter-item Correlations for CIRAAFactor 1: Self Control ............................................... 94 8. Inter-item Correlations for CIRAA Factor 2: Interpersonal Relationships ...................... 95 9. Inter-item Correlations for CIRAA Factor 3: Coping Skills ........................................... 95 10. Inter-item Correlations for CIRAA Factor 4: Internal Locus of Evaluation .................... 96 11. ROC Curve Analysis of CIRAA with CBC Total Problems Score as Criterion .............. 99 12. ROC Curve Analysis of CIRAA with PSI Child Domain Scores as Criterion ............... 101

vii

LIST OF FIGURES Page 1. CIRAA scree plot .......................................................................................................... 88 2. CIRAA and CBS ROC curve analysis results ................................................................ 98 3. CIRAA and PSI ROC curve analysis results ................................................................ 100

CHAPTER 1 INTRODUCTION The first use of play in mental health interventions dates to the case of Little Hans (Freud, 1909/1959). Play continues to be widely used for children experiencing a variety of difficulties stemming from domestic violence, chronic illness, and adjustment difficulties (Jones & Landreth, 2002; Kot, Landreth, & Giordano, 1998; McGuire, 2000). Play therapy has been studied in treatment with a wide range of mental health diagnoses, such as conduct disorder, separation anxiety, depression, attention deficit, and various other disorders (Brandt, 1999; Milos & Reiss, 1982; Ray, Schottelkorb, & Tsai, 2007; Seeman, Barry, & Ellinwood, 1964). Widespread use alone does not substantiate claims of the efficacy of particular therapeutic interventions, and an intervention needs to be examined for the ability to reliably produce results in research settings. The American Psychological Association (APA, 2008) produced a report on the role of empirically validated treatment in psychology and outlined criteria for empirically validating treatments. APA’s criteria for categorizing a treatment as well-established have the following requirements: a treatment manual for the intervention, a well-specified client sample, and two good group-design studies conducted by different investigators demonstrating efficacy by determining treatment to be superior to a placebo or equivalent and to an already established treatment using appropriate statistical power. Additionally, a treatment may meet the criteria through a large series of single-case design studies and comparing those results with the results of another established treatment. Probably efficacious treatments require one of the following: (a) two studies indicating a treatment, which is more effective than wait-list control groups; (b) two studies, that utilize good group design, have a treatment manual, and have a clearly specified 1

client sample; (c) two good studies that may have a flawed heterogeneity of client samples; or (d) a small series of case designs otherwise meeting the criteria for well-established treatments. Play therapy does not currently meet the requirements set forth by the APA for well-established or probably efficacious treatments. To further child-centered play therapy (CCPT) research, an instrument that is theoretically compatible and developed specifically for the assessment of play therapy efficacy and progress is needed to help enhance future research studies. Researchers conducting studies of play therapy use a variety of different instruments, such as the Child Behavior Checklist (CBC; Achenbach & Rescorla, 2001), the Child Depression Inventory (Kovacs, 1992), the Attention Deficit Disorder Evaluation System (McCarney & Arthaud, 2004), and the Piers-Harris Self-Concept Measure (Piers & Herzberg, 2002). Often multiple measures are used to determine the outcome of play therapy (Post, 1999; Ray et al., 2007). None of the instruments currently used in play therapy assessment were specifically designed for use in evaluating play therapy. Assessing an instrument’s role in identifying constructs and data collection constitutes a vitally critical activity for the researcher (Heppner, Wampold, & Kivlighan, 2008). The establishment of a standard measure of assessment for CCPT is important for future research. Statement of the Problem Currently, CCPT research has no assessment instrument to measure the effectiveness of the mental and emotional factors that match the objectives of CCPT. One of the many problems with child psychotherapy research is the use of global outcome measures (Kazdin, Bass, Ayers, & Rodgers, 1990). Kazdin (2005) stated that some of the complexities surrounding evidence- based assessment include the lack of a “gold standard” to differentiate functional and dysfunctional behavior, the use of multiple measures to capture complex facets of clinical issues, 2

and the necessity of involving multiple respondents (i.e., parents/caretakers, teachers, counselors, etc.). There is a considerable lag between progress achieved in research on child psychotherapy outcomes and progress achieved in research in adult psychotherapy outcomes. One of the reasons for this divide is the lack of an instrument with sufficient psychometric properties to regularly measure clinical progress and outcomes (Faust & Burns, 1991). Kazdin (2005) emphasized that treatment goals specify the constructs which selected measurements should assess. Landreth (2002) did not identify overall goals for CCPT but stated the following: The objectives of child-centered play therapy are to help the child do several things: (1) develop a more positive self-concept; (2) assume greater self-responsibility; (3) become more self-directing; (4) become more self-accepting; (5) become more self-reliant; (6) engage in self-determined decision making; (7) experience a feeling of self-control; ( 8)become sensitive to the process of coping; (9) develop an internal source of evaluation; and (10) become more trusting of himself. (p. 88) Rather than having one specific instrument to measure all of the constructs identified by CCPT philosophy, researchers have used different measures for each different construct (Baggerly, 2004; Fall & McLeod, 2001; Post, 1999; Ray et al., 2007). For the quality and quantity of research on CCPT to improve, a psychometrically sound instrument to measure the factors that play therapy is purported to affect must be developed in a philosophically consistent manner. Purpose of the Study Several objectives were met through conducting of this study. The first objective was to develop an assessment instrument to assess the effectiveness and therapeutic progress of children participating in individual CCPT sessions. The second objective was to establish reasonable reliability and validity for an instrument that is usable and accepted in a wide range of applications. The third objective was to provide a tool for CCPT researchers to establish a global 3

instrument of CCPT efficacy that allows play therapy to be more easily researched. The fourth objective was to produce an instrument with clinical utility that provides CCPT practitioners with accurate and timely information about their clients’ progress. Definition of Terms Child-centered play therapy (CCPT) is defined by Landreth (2002) as follows: A dynamic interpersonal relationship between a child (or person of any age) and a therapist trained in play therapy procedures who provides selected play materials and facilitates the development of a safe relationship for the child (or person of any age) to fully express and explore self (feelings, thoughts, experiences, and behaviors) through play, the child’s natural medium of communication, for optimal growth and development. (p.16) Child-centered play therapy (CCPT) expert is defined as a mental health professional who holds a doctoral degree in a mental health discipline, possesses graduate level training in CCPT, and contributes regularly to professional literature in play therapy. Communalities refer to the total amount of variance in each item that is explained by the extracted factors in exploratory factor analysis. Concurrent criterion validity is the degree to which the measure to be developed can be empirically associated with other standard measurements that were administered at the same time (Springer et al., 2002). Construct validity is the theoretical relationship that one variable holds to other variables which may be determined through convergent and divergent validity analysis (Springer et al., 2002). Content validity can be defined as the degree to which items in an instrument represent the complete domain of items that would define a given construct (Springer et al., 2002). Internal consistency is defined by Springer et al. (2002) as the degree to which questions are correlated to one another. 4

Sensitivity is defined as the ability of instrument to identify true positive cases, determined by calculating the, number of true positive (TP) decisions/number of actual positive cases. Specificity is defined as the ability of an instrument to identify true negative cases, determined by calculating the number of true negative (TN) decisions/ number of actual negative cases (Metz, 1978). 5

CHAPTER 2 REVIEW OF LITERATURE Play Therapy Play Therapy History One of the first people to advocate for the study of play with children was Rousseau (Lebo, 1982). Rousseau viewed children as more than miniature adults; he viewed childhood as a time of development and growth. He saw great value in children’s play and games. He encouraged teachers to enter the world of the child to understand their pupils and become proper companions in their pupils’ play. However, Rousseau’s views on play were concerned with the role of the teacher, and he did not emphasize the therapeutic implications of play. The first instance of play being used in the context of therapeutic intervention was Sigmund Freud’s case of Little Hans (1909/1955). Freud did not treat Little Hans directly, but he asked Hans’s father to describe his play to gain insight into Hans’s unconscious concerns and conflicts. These insights aided Freud in making parenting recommendations to Hans’s father. Sigmund Freud believed repetitive play has foundations in unconscious concerns and has a role in mastery and abreaction. The incorporation of play into therapy was achieved when Hug-Hellmuth (1921) utilized play by visiting children’s homes and participating in their play in a nondirective manner. Hug- Hellmuth’s writings indicated no specific techniques for use in home visits. However, Hug- Hellmuth emphasized the importance of the material in children’s play as a way to uncover intrapsychic conflicts. With the advent of Klein’s (1960) formulation of the principles of infant analysis, play in child mental health services gained a set of fixed rules. Klein believed the child’s superego was 6

already developed. Klein’s interventions in child analysis consisted of making direct interpretations to the child to reduce anxiety caused by an inappropriately severe superego. Klein utilized play because it allowed direct access to the unconscious for the child. In Klein’s view, free play with a selection of toys and dialogue was analogous to free association with adults. Klein believed play to be a natural medium of expression for children whose cognitive capacities were not adequately suited for expressing the complexities of the thoughts and feelings they experienced (Klein, 1960). In contrast to Klein, Anna Freud (1946) used play in a different manner. Anna Freud realized that the foundational techniques of traditional analysis, such as dream interpretation and free analysis, were completely foreign to children. She was aware that children were usually unwilling participants and were brought to analysis by their parents. Thus, Anna Freud used free play, the natural medium of communication for children, to establish a therapeutic relationship. Once the relationship had been established, she shifted to techniques such as dream analysis and other such verbal interchanges typically used in adult psychoanalysis (A. Freud, 1946). In the late 1930s, structured play therapy and release play therapy developed from some notable practitioners, such as Levy (1938), Hambridge (1955), and Solomon (1938). Structured play therapy consisted of three major tenets that were shared among different practitioners: (a) a psychoanalytic framework, (b) at least a partial belief in the cathartic value of play, and (c) the active role of the therapist in determining the course and focus of therapy (O’Connor, 1991). Levy developed a technique, called release play therapy, for children experiencing a specific traumatizing event. In release play therapy, the child is given a limited selection of toys, with the goal being to recreate the traumatic event. Levy believed that through repetitive play of a traumatic event, a child would assimilate associated negative thoughts and feelings. Like Levy, 7

Hambridge directed children to act out traumatic events; however, Hambridge was more directive than Levy. Hambridge directly recreated the event to aid the child’s abreaction after the initial relationship-building phase in therapy and then allowed the child free play to recuperate from acting out the trauma. Solomon developed active play therapy to be used with impulsive/acting out children. Solomon postulated that helping a child express anger and fear through play would result in abreaction because the child could express feelings without consequences. The therapist’s role involved targeting socially appropriate behaviors and separating anxiety over past trauma and present-life situations (Solomon, 1938). Relationship therapy evolved many of the play techniques developed from the philosophy of Otto Rank, who emphasized birth trauma in development (O’Connor, 1991). Rank emphasized relationships between the patient/therapist and the patient’s life in the here and now. Major theorists of the relationship therapy movement included Moustakas, Taft, and Allen, and they focused on the relationship of client/counselor, its safety, and its applications to other interpersonal interactions. According to Lebo (1982), while relationship therapy started as a movement in its own right, it has since merged with the nondirectional/client-centered attitude that has arisen in play therapy. Child-Centered Play Therapy In the 1940s, Rogers developed the client-centered approach to therapy which evolved from his experiences working with children and their parents (Raskins & Rogers, 2005). Axline (1947), one of Roger's students, adapted the client-centered approach to work with children and calling it play therapy. According to Axline, play therapy is a therapeutic environment in which a child uses play. Play is the natural medium for children to express themselves just as adults express themselves through talk. Axline’s approach involved the use of a playroom, which 8

served as a stable environment for weekly play therapy sessions. Axline developed relationships with children, and she communicated empathy, unconditional positive regard, and genuineness. Axline’s nondirective method was based on the assumption that children have the ability to solve their own problems, but that their forward-moving process makes movement toward mature behavior innately more desirable than immature behavior. Play therapy results in children being given a permissive environment in which they are able to explore and grow at their own pace (Axline, 1947). Axline (1947) outlined eight principles of conducting play therapy with children, including the following: (1) a warm relationship is established; (2) there is unconditional acceptance of the child; (3) permissiveness in the relationship that allows the child free expression of feelings; (4) the therapist is alert to the child’s expression of feelings and reflects them to the child in such a way that he or she gains insight; (5) the therapist maintains a respect for the child’s ability to solve problems and promotes decision making and responsibility in the child; (6) the therapist does not attempt to direct the child’s action or conversations; (7) the therapist does not attempt to hurry the child along and recognizes the gradual process of therapy; and (8) the therapist only establishes limits that are necessary for anchoring the child to reality and instilling awareness in the child of his or her reasonability in the relationship (Axline, 1947). Ginott (1975) was a therapist whose contributions of limit setting in play therapy have played a major role in CCPT. Ginott is notable for his contributions to limit setting in play therapy (O’Connor, 1991). Ginott believed that limit setting helped reestablish children’s views of themselves in relation to adults as people and as children who are protected by adults through limit setting. According to Ginott, children who manifest acting-out behaviors demonstrate a lack of trust that adults do act consistently and feel the need to test limits with adults. Ginott believed 9

that limits were a key element in therapy, helping to reinforce consistency for the caregivers in a child’s life as well as allowing the therapist to maintain a positive attitude toward the child through protecting the relationship using limit setting (O’Connor, 1991). Landreth (2002) supported a child-centered approach and integrated the nondirective techniques of Axline (1947) and the limit setting techniques of Ginott (1975) into a consistent approach that included trained therapists utilizing a nondirective fashion in a playroom with developmentally appropriate materials. Landreth’s child-centered approach incorporated some of the basic relationship-building skills advocated by Axline, such as tracking, reflections of feeling, and reflections of content in the context of a nondirective and non-evaluative stance by the therapist. In addition to the methods of Axline, Landreth utilized the limit-setting philosophy of Ginott through an original model of limit setting and returning responsibility labeled ACT. ACT reminds the therapist to acknowledge feelings, communicate limits, and target alternatives. Landreth’s view of play therapy involves a trained therapist who facilitates the development of a safe relationship in which the child can express and explore feelings, thoughts, experiences, and behaviors through play. The ACT model allows for the development of self-acceptance, self- awareness, self-responsibility, and ultimately self-growth (Landreth, 2002). The evolution of non-directive play therapy first presented by Axline, and most recently redefined by Landreth, led to the intervention labeled CCPT. CCPT has recently been manualized for the purposes of moving CCPT research further toward evidence-based status (Ray, 2009). Contemporary Schools of Play Therapy Adlerian Play Therapy Adlerian play therapy is a contemporary theoretical approach to play therapy developed by Kottman (1997) that integrates Adler’s individual psychology and accepted play therapy 10

methods. Adlerian play therapy utilizes the concept that all people are born with the ability to connect with others and have a desire to move from a position of inferiority to superiority. Adlerian play therapists often conceptualize children through the four goals of misbehavior commonly manifested in children: attention, power/control, revenge, and proof of inadequacy. Often in Adlerian play therapy, the counselor helps the client move from the goals of misbehavior to more appropriate goals termed the crucial C’s: connected, capable, [feeling they] count, and courage (Kottman, 1997). Adlerian play therapy consists of four distinct stages: (a) building an egalitarian relationship, (b) exploring the client’s lifestyle, (c) helping the client develop insight into lifestyle, and (d) providing reorientation/re-education (Kottman, 2002). During the first phase, the play therapist uses relationship-building responses to form an egalitarian relationship with the client. The second phase, exploring the client’s lifestyle, involves a more directive role on the part of the therapist to discover information about the child’s attitudes, perceptions, thinking process, and feelings. The third phase, insight, involves nondirective, facilitative action on the play therapist’s part and challenging long-held beliefs about the world. The final phase, reorientation, requires the counselor to become an active encourager and teacher as the child experiments with new behaviors, attitudes, and perceptions of the world (Kottman, 1997). Cognitive Play Therapy Cognitive-behavioral play therapy is a mode of therapy in which cognitive and behavioral interventions are used within play therapy, as presented by Knell (1997). Knell identified several theoretical components of cognitive behavioral play therapy. First, she posited that all behavior is learned and reinforced; thus, if one can identify factors that reinforce and maintain inappropriate behaviors, it is possible to modify the behavior. The theoretical component of 11

psychopathology is also important in cognitive behavioral therapy, consisting of three components (a) cognitions influence feelings and behavior, (b) beliefs and perceptions influence how one perceives events in life, and (c) most people experiencing problems are currently experiencing distorted or irrational thoughts (Knell, 1997). Cognitive play therapy consists of the following four phases: (a) assessment, (b) introduction/orientation to play therapy, (c) middle stages, and (d) termination (Knell, 1997). Assessment involves the use of clinical interviews, observations, assessment instruments, and other informal assessments to determine the child’s level of functioning, development, and perception of the problem. Introduction/orientation to play therapy involves giving the child a clear, nonjudgmental explanation of the presenting problem and explaining the play therapy process (Knell, 1997). This process also includes initial feedback, treatment planning, and determining the role of parents in therapy. The middle phase utilizes cognitive-behavioral interventions to teach the child new coping strategies to help him/her generalize newly learned behaviors to situations and environments outside the playroom. The termination phase includes talking with the child about plans for handling situations after termination and reinforcing the changes that have been made (Knell, 1997). Gestalt Play Therapy Gestalt play therapy is based on principles of Gestalt therapy as adapted by Carroll and Oaklander (1997). Gestalt play therapy incorporates four major theoretical constructs: (a) the I/Thou relationship, (b) organismic self-regulation, (c) contact-boundary disturbances, and (d) awareness/experience. The I/Thou relationship is based on the works of Buber (2008) and involves the meeting of individuals in a relationship with a sense of equality and as little of a power differential as possible. This relationship is characterized by complete honesty and lack of 12

pretenses as the therapist honestly engages the child. The therapist is careful not to lose his/her boundaries while actively engaging the child and his/her world (Carroll & Oaklander, 1997). Organismic self-regulation refers to the organism seeking out methods of achieving and maintaining homeostasis in Gestalt play therapy (Carroll & Oaklander, 1997). As the environment around individuals changes, so do their needs and their methods for achieving those needs. As catastrophic events occur in a person’s life, he/she may react differently in trying to meet his/her needs. Although these strategies are not always effective, he/she continues to seek ways to meet these needs (Carroll & Oaklander, 1997). Contact-boundary disturbances occur as individuals try to make contact with others and the environment at the boundary of self (Carroll & Oaklander, 1997). Disturbances can occur when people direct energy toward the self that they would like to direct towards others (retroflection); when people run away from strong feelings (deflection); when people merge views or beliefs with someone else to the point of denying own feelings (confluence); when people deny personal experiences and attributing them to others (projection); or when people take in conditional or negative messages from others (introjections). As therapy progresses, children develop an increased awareness of their experiences and self in play sessions (Carroll & Oaklander, 1997). Gestalt play therapy has seven major phases: (a) develop I/Thou relationship, (b) evaluate and establish contact, (c) strengthen child’s sense of self and self-support, (d) encourage emotional expression, (e) help the child learn to provide self-nurturing, (f) focus on the child’s process, and (g) finalize the therapy (Carroll & Oaklander, 1997). Establishing the I/Thou relationship requires the therapist to provide genuine respect as the therapist lets go of all expectations, entering fully into the world of the child. In the contact phase, the therapist allows 13

the child to establish contact with the therapist and the materials. The therapist provides play and art experiences to encourage contact if the child exhibits difficulty making contact with the therapist (Carroll & Oaklander, 1997). Therapists help strengthen the sense of self through activities designed to stimulate senses, increase awareness of body, and help children cognitively define who they are by talking about their attitudes, beliefs, and opinions (Carroll & Oaklander, 1997). In the phase of encouraging emotional expression, aggressive energy is important. Aggressive energy is defined as the energy needed to promote action. Children in play therapy often use aggression with abundance, resulting in difficulty in interpersonal interactions. Children can also suppress aggression, resulting in overly passive behavior. Through play, storytelling, dance, art, and sensory awareness activities, children become aware of their emotions and can express them. The counselor helps children focus on their processes through using sensory awareness exercises and persuading the client to pay attention to feelings as they experience certain emotions or engage in certain behaviors (Carroll & Oaklander, 1997). Finalizing therapy occurs when children have worked through the aforementioned stages as their developmental level allows. The overall goals of Gestalt play therapy are to restore the child’s sense of self and enable the child to accept previously unacceptable parts of the self, learn to support the self, and be able and willing to experience pain and discomfort. Effectiveness of Play Therapy In 2005, Bratton, Ray, Rhine and Jones conducted a meta-analysis of 93 studies examining the outcome of play therapy with a wide range of clients. Bratton et al. determined through the meta-analysis of play therapy (which included a variety of different approaches) that the mean effect size of play therapy clients was .80 for children. Children receiving play therapy 14

performed an average of three-fourths of a standard deviation better on standardized instruments than children not receiving play therapy. For the purposes of developing an instrument to measure the efficacy of CCPT, Bratton et al. recognized the importance of exploring the areas in which play therapy has proved effective and the methodology of studies. Examination of play therapy studies provides important insights in the development of standardized instrumentation for CCPT studies and may improve CCPT research. Bratton et al.’s meta-analysis explored the effectiveness of play therapy with a wide range of difficulties, including aggressive behaviors, emotional maladjustment, and locus of control, which are discussed with more specificity in the following section. For the purposes of presenting CCPT, only a few studies are presented in depth. Attention-Deficit/Hyperactivity Disorder (ADHD) Ray et al. (2007) conducted a study to determine the effects of CCPT on ADHD behaviors and teacher stress when applied to children identified as exhibiting ADHD behaviors. Sixty were children recruited from a Title I elementary school in the southwest United States. Thirty-one of the children participated in the CCPT treatment group, and 29 children participated in the reading mentoring group. Children in the play therapy group received 16 sessions of CCPT provided by a therapist trained at the graduate level in CCPT procedures; children in the reading mentoring group received reading mentoring (either a child reading to the mentor or the mentor reading to the child) for 16 weeks. Children were pretested with the Index of Teacher Stress (Abidin, Greene, & Konold, 2004) and the Conners Teacher Rating Scale (Conners, 2001). The Index of Teacher Stress scale for ADHD as well as the Conners Teacher Rating Scale total ADHD score indicated that the groups improved an equal amount over time. Scores relating to emotional liability, anxiety, and student characteristics that caused stress in the student-teacher 15

Full document contains 149 pages
Abstract: The purpose of this study was to develop a parent report form instrument congruent with the philosophy of child-centered play therapy. The study sought to develop an instrument with acceptable levels of construct validity, reliability, sensitivity to clinical attitudes and relationships, and responsiveness to intervention. The Child Interpersonal Relationships and Attitudes Assessment (CIRAA) and the Child Behavior Checklist (CBC) and the Parenting Stress Index (PSI) were administered to 136 parents of children aged 3 to 10. The children of the parents sample consisted of 90 males and 46 females. Exploratory factor analysis was conducted for construct validity. Parallel analysis was conducted to determine the number of factors to retain. The factor solution explained 53.86% of the variance, which is an acceptable amount of the variance. Cronbach's alpha was conducted for total scale and all subscales. Reliability scores for the total score and subscales were acceptable, with an overall reliability coefficient of .93. A Pearson's r was conducted for concurrent validity between the instrument, the CBC, and the PSI, with Pearsons' r of .75 and .74 respectively. Paired-sample t -tests using the pretest and posttest scores of the instrument in development examined the responsiveness of the instrument to play therapy intervention at the same level as the CBC and PSI. ROC curve analysis, indicated acceptable discrimination of clinical scores and adaptive scores, with a clinical score being generated from the analysis. It is the first parent-report form developed for child-centered play therapy, and provides an efficient and philosophically consistent instrument for child centered play therapists to use in clinical and research settings.