Vous êtes sur la page 1sur 10

The Family Journal

http://tfj.sagepub.com/

A Filial Therapy Model Through a Family Therapy Lens : See the Possibilities
Nick Cornett
The Family Journal 2012 20: 274
DOI: 10.1177/1066480712449128
The online version of this article can be found at:
http://tfj.sagepub.com/content/20/3/274

Published by:
http://www.sagepublications.com

On behalf of:

International Association of Marriage and Family Counselors

Additional services and information for The Family Journal can be found at:
Email Alerts: http://tfj.sagepub.com/cgi/alerts
Subscriptions: http://tfj.sagepub.com/subscriptions
Reprints: http://www.sagepub.com/journalsReprints.nav
Permissions: http://www.sagepub.com/journalsPermissions.nav
Citations: http://tfj.sagepub.com/content/20/3/274.refs.html

>> Version of Record - Jul 13, 2012


What is This?

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

A Filial Therapy Model Through a Family


Therapy Lens: See the Possibilities

The Family Journal: Counseling and


Therapy for Couples and Families
20(3) 274-282
The Author(s) 2012
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1066480712449128
http://tfj.sagepub.com

Nick Cornett1

Abstract
The call for family-centered therapeutic services, especially for families of young children, has come from governmental organizations, professional associations, practitioners, and families. Play therapists and family therapists are prime candidates to provide
such services, but professional research and literature suggest that practitioners within these fields tend to exclude members of
the family system. This had led some to propose filial therapy, an outgrowth of child-centered play therapy, as a means of meaningfully integrating parents and children in treatment. However, play therapists may have difficultly conceptualizing from a family
systems lens, while family therapists may struggle to see the theoretical compatibility of filial therapy with their systemic views.
This article demonstrates the conceptual overlap between filial therapy and the major family therapy models with the goal of
encouraging play therapists and family therapists to answer the call to provide family-centered services.
Keywords
play therapy, family therapy, filial therapy, family-centered child services, young children

The Call for Family-Based Services for Families With Young Children
Over recent years, there has been a resounding call for those in
the helping professions to provide family-based services for
families with young children. This call has come from governmental organizations, such as the U.S. Public Health Service
(2000), who published a national action agenda underscoring
the importance of researching, developing, and utilizing
evidence-based, family-centered treatment in addressing the
mental health of children. A similar call for involving families
in therapeutic services is evident in the ethical codes of major
professional associations (American Association for Marriage
and Family Therapy [AAMFT], 2001, 6.8; American Counseling Association [ACA], 2005, A.1.d.; American Psychological
Association [APA], 2010, 10.02; National Association of
Social Workers [NASW], 2008, preamble) and in the APAs
(2005) policy statement on evidence-based practice.
Across helping professions, practitioners have emphasized
the need for and the importance of family-centered assessment
and treatment (Perry, 2007; Pritchett et al., 2010; Reeves &
Anthony, 2009; Reinherz, Giaconia, Paradis, Novero, & Kerrigan, 2008; Tomlin & Viehweg, 2003; Wallander, Dekker, &
Koot, 2006). Research buttresses the importance of familycentered treatment in that caregiver involvement in the mental
health treatment of children is associated with better outcomes
(Bratton, Ray, Rhine, & Jones, 2005; Richards, Bowers,
Lazicki, Krall, & Jacobs, 2008).
Finally, families themselves seem to be actively seeking
such services. Research conducted by Sax (2007) reveals that

parents of children with mental health concerns desire


family-centered systems of care that provide effective helping
strategies, entail meaningful parental involvement, and
enhance support among parents. However, as Perry (2007) has
noted, there is a lack of systematic treatment methods that comprehensively address the diverse treatment needs of families
with young children. The call from organizations, professionals, and families regarding the need for family-based services
is clear, but an answer seems to be lacking.

A Problem in Common: Either/Or


Play therapists and family therapists in particular appear to be
prime candidates for providing such services given that they
have frequent contact with families of young children.
Research indicates that play therapists often encounter family
issues (Kranz, Kottman, & Lund, 1998; Ryan, Gomory, &
Lacasse, 2002; Tsai & Ray, 2011), and family therapists often
encounter families who are experiencing issues with their
young children (Doherty & Simmons, 1996; Hines, 1996). In
addition, surveys of play therapists (Haslam & Harris, 2011;
Phillips & Landreth, 1998) and family therapists (Sori &
1

Department of Graduate Counseling, John Brown University, Siloam Springs,


AR, USA
Corresponding Author:
Nick Cornett, Department of Graduate Counseling, John Brown University,
2000 W. University St., Siloam Springs, AR 72761, USA
Email: ncornett@jbu.edu

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

Cornett

275

Table 1. Integration of Family Therapy Approaches and ChildParent Relationship Therapy (CPRT)
Theory

Focus

Intervention

Interface With CPRT

Systems

Identifying
systemic
patterns
Interactional
patterns

Expanding repertoire beyond patterns

Eliciting new intrapersonal and interpersonal patterns in


parent, child, and parentchild relationship

Brief strategic

Interrupting interactional patterns


surrounding the problem behavior and
eliciting resourceful patterns
Structural
Organizational Restructuring family system with clear
patterns
boundaries, hierarchy, and reinforcing
parental/spousal subsystem
Experiential
Expression
Promoting individual and systemic growth
patterns
through encouraging greater depth of
shared expressions
Promoting differentiation (balance between
Intergenerational Family-ofseparateness and togetherness; separation
origin
of feelings and thinking)
patterns
Postmodern
Discourse
Exchange problem-saturated stories with
patterns
preferred narratives/creation of new
meanings

Focusing on strengths and resources within parents and


children; addressing problematic sequences of
interaction
Creating clear structure and boundaries in parentchild
relationship through the use of limit setting/choice-giving
in an environment of support
Encouraging increased expression through the use of play;
building the relationship between parent and child;
identification and reflection of feelings
Focusing on parents self-awareness and encouraging the
autonomy of the child through choice-giving and
returning responsibility
Attending to parents desires and hopes for their children
and their relationship; Dialoguing about parenting
experiences within a context of supportive
understanding and feedback

Sprenkle, 2004) indicate that practitioners within these fields


believe in the importance of providing services that meaningfully involve family members.
However, play therapists and family therapists have typically concentrated their efforts on either the child or parental
subsystems, leaving untapped potential that is available within
the family system as a whole. Numerous family therapists have
identified and spoken to the lack of inclusion of children in
family therapy (Botkin, 2000; Green, 1994; Johnson & Thomas, 1999; Korner & Brown, 1990; Miller & McLeod, 2001;
Raimondi & Walters, 2004; Sori & Sprenkle, 2004; Zilbach,
1986, 1989). This issue within family therapy is surprising,
given that many of the most influential family therapists, such
as Ackerman (1970), Satir (1983), Whitaker (Keith & Whitaker, 1981), Minuchin (1974), and Haley (Montalvo & Haley
1973), advocated for the inclusion of children in their
approaches. Play therapists have noted similar issues regarding
the lack of practitioners working conjointly with family members (Gil, 1994; Haslam & Harris, 2011).

learning how to apply basic child-centered play therapy skills


in conducting play sessions with their children (p. 304).
Despite filial therapy being an outgrowth of child-centered
play therapy (Axline, 1947; Landreth, 2002) and personcentered theory, proponents have provided theoretical arguments that explain how filial therapy satisfies the unique
dimensions of both play therapy and family therapy (Hutton,
2004; Johnson, 1995; Johnson et al., 1999; Kellam, 2001). For
instance, Johnson et al. (1999) provided six different arguments
for filial therapy that coincide with traditional family therapy
principles:

A Solution in Common: Both/And

Outcome research on filial therapy conducted thus far lends


credibility to these theoretical claims. In a meta-analysis of
93 controlled outcome research studies using play therapy
approaches, Bratton et al. (2005) found that filial-trained parents had a large overall treatment effect (d 1.15). This finding is even more significant when comparing this treatment
effect to that of play therapy professionals (d .72). In addition, the most rigorous outcome research studies have consistently revealed support for filial therapy in decreasing child
behavior problems, decreasing parentchild relationship stress,
and improving the empathic responsiveness of parents toward
their children (see Bratton, Landreth, & Lin, 2010). Several
researchers performing qualitative analyses of filial therapy

Family therapy and play therapy share a problem in common,


and where one is strong in terms of involving certain members
of the family the other is weak. This had led several authors to
propose that filial therapy, with its direct involvement of caregivers and children in treatment, is a solution that family therapists and play therapists can have in common in order to impact
the family system (Gil, 1994; Guerney & Guerney, 1987;
Hutton, 2004; Johnson, 1995; Johnson, Bruhn, Winek, Krepps,
& Wiley, 1999; Kellam, 2001). Filial therapy, first introduced
by Bernard Guerney (1964), is an approach in which parents of
young children are trained to be therapeutic agents through

1) Filial therapy requires family involvement; 2) Filial therapy


takes the focus off the child as the IP [identified patient]; 3) Filial therapy often leads to the parents seeing their role in the
problem; 4) Filial therapy enhances parental leadership,
strengthening the generational boundary between parents and
children; 5) Filial therapy increases differentiated relating and
reduces polarizations between parents and children; 6) Filial
therapy highlights unhelpful systemic sequences. (pp. 172173)

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

276

The Family Journal: Counseling and Therapy for Couples and Families 20(3)

have noted that parents reported improved parentchild relationships (Bavin-Hoffman, Jennings, & Landreth, 1996;
Edwards, Ladner, & White, 2007; Edwards, Sullivan, MeanyWalen, & Kantor, 2010; Foley, Higdon, & White, 2006; Garza,
Kinsworthy, & Watts, 2009; Kinsworthy & Garza, 2010; Lahti,
1992; Sangganjanavanich, Cook, & Rangel-Gomez, 2010;
Solis, Meyers, & Varjas, 2004; West, 2010; Wickstrom,
2009). In addition, qualitative studies conducted by BavinHoffman, Jennings, and Landreth (1996), Lahti (1992), and
Wickstrom (2009) have resulted in findings that are suggestive
of potential changes occurring in the family as a whole.
As illustrated through the theoretical arguments of its proponents and its growing research base, filial therapy appears to
provide a treatment context that brings about change within
children and parents, between children and parents, and
between the relationships of others in the family system. The
rationale within these conceptual arguments and the research
should encourage play therapists and family therapists to consider how filial therapy might promote the best interests of the
families with whom they work.
Two relevant issues, however, come to the forefront that
may impede the ability for play therapists and family therapists
to integrate a filial therapy approach into their therapeutic
repertoire. For play therapists primarily trained to conceptualize within a framework of the individual, the challenge in realizing the full potential of filial therapy may be limited by their
ability to find a means for framing the systemic implications of
the approach. Without a systemic framework, play therapists
may have greater difficulty in conceptualizing and working
with families and their unique dynamics.
For family therapists primarily trained to conceptualize
within a framework of the system, the challenge in realizing the
full potential of filial therapy may be limited by their ability to
see the compatibility of the components of an approach that is
still largely explained through the language of child-centered
play therapy. Without an understanding of the conceptual compatibility between family therapy and the components of filial
therapy, family therapists may struggle to see how a consistent
integration is possible.
In light of the potential epistemological issues that exist in
the utilization of filial therapy for play therapists and family
therapists alike, I present a popular model of filial therapy
known as childparent relationship therapy (CPRT; Landreth
& Bratton, 2006) and discuss its components within the lens
of several categories of approaches to family therapy: briefstrategic, structural, experiential, integernerational, and postmodern. I will also incorporate research from the field of filial
therapy that are suggestive of changes in the family system and
that appear to align with the goals of these family therapy
approaches. Although this is by no means an exhaustive coverage of either CPRT or family therapy, the following presentation provides play therapists with the opportunity to consider
filial therapy through family systems frameworks. In addition,
family therapists have the opportunity to consider how the
components of filial therapy might merge with familiar concepts from the major approaches to family therapy.

CPRT Within the Lens of Family Therapy


CPRT is a popular 10-session filial therapy model presented by
Landreth and Bratton (2006). Landreth and Bratton provided
the following definition of their approach:
Filial therapy is defined as a unique approach used by professionals trained in play therapy to train parents to be therapeutic
agents with their own children through a format of didactic
instruction, demonstration play sessions, required at-home
laboratory play sessions, and supervision in a supportive atmosphere. Parents are taught basic child-centered play therapy
principles and skills including reflective listening, recognizing
and responding to childrens feelings, therapeutic limit setting,
building childrens self-esteem, and structuring required
weekly play sessions with their child using a special kit of
selected toys. Parents learn how to create a nonjudgmental,
understanding, and accepting environment that enhances the
parent-child relationship, thus facilitating personal growth and
change for the child and parent. (p. 11)

In summarizing their approach, Landreth and Bratton (2006)


stated, The overall aim of CPRT is to enhance and strengthen
the parent-child relationship through improved family interactions and problem-solving strategies and through increased
feelings of familial affection, warmth, and trust (p. 11). As
evidenced in these definitions, this filial therapy approach is
inclusive in its focus on the dynamics of the parent, the child,
the parentchild relationship, and the family as a whole.

CPRT and Brief-Strategic Family Therapy


The first category of family therapy approaches, brief-strategic
family therapies, are ones that share in common an emphasis on
actively interrupting the interactional patterns surrounding the
familys problems in attempts to (1) help get them unstuck and
(2) to allow the family to utilize its own resourcefulness in
addressing its concerns. The family therapy approaches that
share these principles are Mental Research Institute (MRI)
brief therapy (Fisch, Weakland, & Segal, 1982; Watzlawick,
Weakland, & Fisch, 1974), Milan systemic family therapy
(Boscolo, Cechin, Hoffman, & Penn, 1987), strategic family
therapy (Haley, 1976), and solution-focused therapy (de Shazer, 1985, 1988). Although the approaches utilize different theoretical language and techniques, they have similar values in
seeking to initiate small, direct changes within interactive
sequences. Whereas the MRI, Milan, and strategic approaches
tend to focus on the problem-maintaining sequences of interaction, the solution-focused approach focuses on resourceful
sequences of interaction. Put simply, these approaches want
to help families do something different when they become
entrenched in unhelpful patterns of relating and exchange these
modes of relating for doing what works (de Shazer & Berg,
1995, pp. 250251).
Filial therapy models, such as CPRT, also share a trust in the
resourcefulness of the family and the importance of finding
ways to interrupt problematic interactions. By its very nature,

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

Cornett

277

filial therapy affirms that parents have within them the psychological and emotional wherewithal to make a major contribution
to the positive development of their children (Guerney, 2000,
p. 7). Guerney (2000) identified that a major task of filial therapy
is to identify and utilize strengths and build on them in therapy (p. 12). Through CPRT, therapists consistently encourage
parents to focus on the donut, not the hole (Landreth & Bratton, 2006, p. 131), to see and affirm the strengths in their children, to have a future focus, and to see their own growth
through positive supervisory feedback regarding their play sessions. All these contribute to cultivating resourceful interactions
within the family. As in the brief-strategic family therapy
approaches, there is a similar emphasis in CPRT on initiating
small changes within the familys interactions. For instance, parents only do one weekly 30-min play session, limiting the utilization of the skills that they learn for these times in order for
parents to experience success in applying new skills (Landreth
& Bratton, 2006, p. 26). In addition, parents have short, experiential homework exercises where they practice the specific skill
of CPRT for that week. Experiencing these incremental positive
shifts in behavior within the context of the parentchild relationship facilitates resourceful sequences of interaction.
Despite its heavy emphasis on building upon the strengths of
the parentchild relationship, CPRT also provides the opportunity to focus on the problematic patterns within the family. For
instance, in session 9, time is set aside for the parents and therapists to address any problematic interactions that they are still
experiencing with their children (Landreth & Bratton, 2006).
This allows parents and therapists to determine how they may
generalize the skills they learned in CPRT to interrupt these
problematic patterns. By seeking to interrupt these
problematic interactional patterns and eliciting resourceful
interactional patterns, CPRT mirrors the basic thrust of briefstrategic family therapy.
One extensive qualitative research study on filial therapy by
Winek et al. (2003) offers support for this notion that filial therapy highlights problem-maintaining sequences of interaction
between parents and children and generates resourceful
sequences of interaction. They identified behaviors on the part
of children and parents that both facilitated and inhibited progress. For example, for one of the inhibitive behaviors, they
identified that parents directiveness, such as making controlling statements, detracted from play sessions as did childrens being oppositional (Winek et al., 2003, p. 99).
Taken together, it is probable that these inhibitive behaviors
interact with one another, so that as the parent is more directive,
the child is more oppositional, and as the child is more oppositional, the parent is more directive. For one of the facilitative
behaviors, they identified encouraging in parents and following rules in children as behavioral categories that contributed to positive play sessions. It is reasonable to assume that
these problematic and resourceful interactions within play
sessions reflect possible interactions that occur outside of play
sessions. This research highlights how filial therapy may provide a means to assess and intervene within these interactive
sequences.

CPRT and Structural Family Therapy


Another major family therapy approach, structural family therapy (Minuchin, 1974; Minuchin & Fishman, 1981), emphasizes
the role of the organization of the family. Within this approach,
healthy family systems that promote the growth of its members
have the following elements: a generational hierarchy, a coalition between parents, and clear boundaries (Gehart & Tuttle,
2003, p. 36). The parental unit, as a unit of significant influence
in the family, should provide leadership for growth and development of the child (Hanna, 2007, p. 10). In addition, healthy
families have flexible boundaries between its members that are
neither too diffuse, fostering enmeshment, nor too rigid, creating distance. Thus, a major task of structural family therapy is
to use a familys interactions to assess their structure and to
strengthen and clarify structure and boundaries as needed
(Gehart & Tuttle, 2003, p. 27).
Because of its roots in child-centered play therapy, filial
therapy has to challenge misconceptions that it proposes that
the familys world should revolve around the child (Kellam,
2001). What may come as a surprise to many is that filial therapy actually incorporates a heavy component of behavioral
approaches that encourage parents to assume the role of providing structure for their children (Guerney, 2000, p. 10). For
instance, in CPRT, parents learn to utilize choice-giving with
children. In this technique, parents are encouraged to present
choices to their children that provide opportunities for the child
to make decisions while ensuring that parents still maintain
control of what constitutes acceptable choices. In addition to
choice-giving, parents learn the skill of limit-setting. With
limit-setting, parents learn how to respond to problem behavior
by acknowledging the childs wishes, communicating clear and
consistent limits, and targeting alternatives for the child to
choose. During play sessions, parents let the child lead
(Landreth & Bratton, 2006, p. 203) while maintaining basic
control of the structure of sessions. Through weekly discussions and videotaped play sessions, CPRT provides therapists
with the opportunity to see and use the interactions between
parents and children as a means to assess their family structure
and encourage parents to utilize their skills to build relationships with their children that promote a more optimal family
structure (Kellam, 2001). These structuring skills allow for the
developmentally appropriate participation of children while
maintaining parental hierarchy. In addition, these practices
reinforce clear structure and boundaries in the family system,
which contribute to an environment of consistency and safety
for family members. Clear structure helps families avoid the
lenient interactions characteristic of family boundaries that are
too diffuse and the authoritarian interactions characteristic of
family boundaries that are too rigid.
In her qualitative study of the systemic changes of using the
CPRT approach, Wickstrom (2009) identified several changes
reported by parents that are suggestive of adjustments in family
organization and structure. For instance, parents in this study
indicated experiencing the following gains: improved marital
relationships and coparenting, increased sense of shared power,

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

278

The Family Journal: Counseling and Therapy for Couples and Families 20(3)

increased awareness of their level of influence in their relationships with their children, and creating developmentally appropriate equality with children. Bavin-Hoffman et al. (1996) also
found in their qualitative study of 20 married couples who participated in CPRT that participants reported improved partner
communication and increased unity within the marriage. In
an ethnographic study of the process and effects of CPRT,
Lahti (1992) too reported the finding of improved marital relationships and increased communication. Winek et al. (2003)
found that some of the behaviors of parents that facilitated play
sessions were when they set limits, redirected children toward
appropriate behaviors, and joined in the fantasy play led by
their children. Parents tended to inhibit play sessions when they
were too directive, threatening, or did not enforce limits. These
findings demonstrate how filial therapy can assist families in
establishing appropriate parentchild hierarchies, foster the
development of parental coalitions, and facilitate clear boundaries that allow for developmentally appropriate interaction
between parents and children.

CPRT and Experiential Family Therapy


The experiential family therapy approaches of Carl Whitaker
and Virginia Satir both share an emphasis on facilitating growth
within the family through creating shared experiences of expression (Gehart & Tuttle, 2003; Satir, 1983; Whitaker & Bumberry,
1988). Experiential family therapists use themselves to model
and facilitate this depth of communication between family members (Gehart & Tuttle, 2003; Hanna, 2007; Satir, 1983; Whitaker
& Bumberry, 1988). Hanna (2007) stated, Experiential family
therapists focus on subjective needs of the individual in the family and facilitate family interactions that address the individuality
and self-esteem of each member (p. 17). There is a strong
emphasis within experiential family therapy on individuation
within a context of belonging in the family (Whitaker & Bumberry, 1988). Whitaker and Bumberry (1988) argued, the central issue is to focus on expanding the significance of experience
and broadening the horizons of life . . . If we can aid in the
expansion of the symbolic world of the families we see, they can
live richer lives (p. 75). In order to facilitate this symbolic
expression and understanding within families, Keith and Whitaker (1981) actually contended for the inclusion of play within
family therapy.
In identifying the features of the CPRT approach, Landreth
and Bratton (2006) highlighted the central importance that the
use of play has in creating a means for symbolic expression
between parents and children. Through play, the authors noted
that families have a communication medium that provides
an opportunity for the expression of feelings, needs, wants,
wishes, fantasies, experiences, and thoughts (p. 16). Learning
and utilizing the foundational CPRT skills of identifying feelings, reflective responding, and esteem building only further
enhances the depth and breadth of expression between parents
and children. Parents learn to be with their children, implicitly communicating the messages I am here, I hear you,
I understand, and I care (Landreth & Bratton, 2006,

p. 84). The group process component of CPRT allows parents


to also have the opportunity to express themselves within a supportive context created through the modeling of the therapists.
CPRTs emphasis on building the relationship between the parent and the child ensures that there is a sense of belonging that
is pivotal for individuation to occur.
The research appears to support the notion that CPRT leads
to new and beneficial expressions between parents and children. For instance, multiple research studies involving CPRT
have demonstrated that filial therapy leads to increases in parents acceptance of their children (Bratton & Landreth, 1995;
Chau & Landreth, 1997; Costas & Landreth, 1999; Harris &
Landreth, 1997; Kale & Landreth, 1999; Landreth & Lobaugh,
1998; Lee & Landreth, 2003; Tew, Landreth, Joiner, & Solt,
2002; Yuen, Landreth, & Baggerly, 2002). In addition, multiple
studies have demonstrated that participation in CPRT increases
parents empathic behaviors toward their children (Bratton &
Landreth, 1995; Carnes-Holt, 2010; Chau & Landreth, 1997;
Costas & Landreth, 1999; Ferrell, 2004; Glover & Landreth,
2000; Harris & Landreth, 1997; Jang, 2000; Kidron, 2004; Lee
& Landreth, 2003; Smith & Landreth, 2003; Yuen et al. 2002) .
Winek et al. (2003) found that parents facilitated play sessions
by demonstrating behaviors of acceptance and encouragement,
and children facilitated play sessions by expressing emotions.
In addition, these researchers found that initiating affection and
feelings of connection between parents and children facilitated
play sessions. CPRT-trained parents, through qualitative studies, have consistently reported an increased awareness of the
feelings or needs of their children (Edwards et al., 2007; Foley
et al. 2006; Kinsworthy & Garza, 2010; Lahti, 1992; Solis et al.
2004; Wickstrom, 2009). Taken as a whole, these findings from
research suggest that filial therapy helps to initiate interactions
involving emotional expression in the parentchild
relationship.

CPRT and Intergenerational Family Therapy


The intergenerational family therapy approaches, such as
Bowens family systems theory (Bowen, 1985; Papero,
1990), conceptualize families and their problems in terms
of psychological dynamics passed from generation to generation (Hanna, 2007, p. 14). In order to prevent unhealthy family dynamics from inhibiting the functioning of its members,
intergenerational family therapists seek to help family members grow in their insight regarding the patterns within their
family of origin and promote each members level of differentiation. Differentiated individuals have the ability to understand
the separation between their feelings and thinking and clearly
distinguish self from others (Gehart & Tuttle, 2003, p. 152).
Through being able to manage their thoughts and emotions and
maintaining a sense of self, intergenerational family therapists
believe that family members can achieve relationships that support a healthy balance of togetherness and individuality (Gehart
& Tuttle, 2003).
Filial therapists acknowledge the intergenerational nature of
family dynamics. For instance, Guerney (2000) noted, Parents

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

Cornett

279

frequently discover personal emotional baggage in trying to


relate to their children as prescribed in the play sessions
(p. 8). Landreth and Bratton (2006) echoed this notion in
describing how filial therapy often reminds parents of emotional wounds and issues with their own parents that have been
pushed aside over the years (p. 18). Through the filial therapy
process, parents have the opportunity to gain insight into these
personal issues that interfere with their relating to their children
as change agents and this processing of personal issues facilitates . . . inner growth (p. 18). In CPRT, therapists and parents
process the following rule: Be a thermostat, not a thermometer
in your childs life (Landreth & Bratton, 2006, p. 134). Parents
are encouraged to respond rather than react and recognize that
their childs feelings are not [their] feelings (Landreth & Bratton, 2006, p. 134). This principle in itself supports the differentiation of both parents and their children as they learn to
distinguish their thoughts and feelings and maintain a healthy
degree of self-other distinction. In addition, through the utilization of the skills of returning responsibility, choice-giving, and
limit-setting, Landreth and Bratton (2006) highlighted how parents can provide opportunities to encourage their childs selfdirection, self-responsibility, and self-reliance (p. 12).
Several researchers have found that CPRT-trained parents
have reported feeling less responsible for or controlling of the
behavior of their children (Kinsworthy & Garza, 2010; Lahti,
1992; Wickstrom, 2009). In addition, Wickstrom (2009) found
that parents reported decreased reactivity and rescuing behaviors. Winek et al. (2003) identified that parents selfawareness regarding how their thoughts and feelings influence
their behaviors facilitated play sessions. In addition, children
who demonstrated self-reliance and problem-solving behavior,
as well as the ability to calm themselves, facilitated play sessions. Beckloff (1997) discovered that parents trained in CPRT
made statistically significant gains in recognizing and accepting the independence of their children who were diagnosed
with developmental disorders. Multiple research studies have
indicated that CPRT often lowers parentchild relationship
stress (Bratton & Landreth, 1995; Ceballos & Bratton, 2010;
Chau & Landreth, 1997; Costas & Landreth, 1999; Kale &
Landreth, 1999; Kidron, 2004; Landreth & Lobaugh, 1998;
Lee & Landreth, 2003; Sheely & Bratton, 2010; Tew et al.,
2002; Yuen et al., 2002). These research findings demonstrate
how filial therapy might promote a healthy sense of individual
identity for both parents and children, an increased awareness
of family-of-origin issues, and opportunities for the development of self-awareness.

CPRT and Postmodern Family Therapy


The postmodern family therapy approaches, such as narrative
therapy (White & Epston, 1990) and collaborative therapy
(Anderson, 1997; Anderson & Gehart, 2007; Hoffman,
1993), emphasize how language significantly influences how
people experience reality and their problems. Within these
postmodern approaches, narratives or conversations provide a
way for people to construct multiple meanings from their life

experiences. Despite the possibility for generating multiple meanings, individuals tend to have problem-saturated narratives that
preclude talking about concerns in other ways (Gehart & Tuttle,
2003, p. 214). Postmodern family therapists, because of their
belief that problems are a reflection of language, believe that
people are separate from their problems and the person is not
the problem (Gehart & Tuttle, 2003, p. 215). Through conversations, postmodern family therapists aim to co-generate new meanings with family members that promote their preferred
narratives and the construction of new possibilities.
Through the group-processing component of CPRT, parents have the opportunity to share their problem-saturated
narratives within the context of a supportive group environment. Landreth and Bratton (2006) noted, It is common
that the discussion of relationship skills elicits parents current and/or long-standing intense feelings and reactions
about their children. Parents need time to process these feelings (p. 49). At the same time, CPRT also emphasizes that
the problem is not the problem, and therapists are
encouraged to keep the focus on the relationship between
parents and children rather than spending time focusing on
the problems that parents talk about (Landreth & Bratton,
2006, p. 201). This intentional redirection of the conversations away from problems and toward the possibilities of the
parentchild relationship represents an opportunity for new
meaning making, perceptions, and experiences of reality to
occur. For instance, in the first session, parents are asked
what they would like their children, when they are adults,
to remember most about their relationship with them. In
addition to exercises like these, Landreth and Bratton
(2006) encourage therapists to close filial sessions with a
motivational poem, book, or story, which stimulate renewed
meaning for parents. Because play is a means of communication and parents are verbally active in the way they track,
reflect, and respond to their children, the play sessions can
also be seen as a means for creating new conversations and
narratives between parents and children.
The qualitative studies of filial therapy by Winek et al.
(2003) and Wickstrom (2009) offer evidence that parents leave
filial therapy with new meanings about their family issues and
relationships and new ways of communicating with one
another. For instance, Wickstrom (2009) found that filial therapy challenged parents dominant discourses: that prizes
quick results over the process of relational change (p. 204),
regarding the polarization of gender roles (p. 202), and
regarding their expectations for themselves as parents
(p. 204). Winek et al. (2003) identified that parents narrating, verbally reflecting the childs behavior or feeling in the
moment, helped in facilitating play sessions with their children, which gives credence to the idea that play sessions within
themselves provide new means for communication between
parents and children (p. 97). In addition, one of the most common findings in qualitative studies regarding changes in the
parentchild relationship is improved parentchild communication (Bavin-Hoffman et al., 1996; Garza et al., 2009; Lahti,
1992; Solis et al., 2004; West, 2010).

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

280

The Family Journal: Counseling and Therapy for Couples and Families 20(3)

Summary and Conclusion


Despite the conceptual congruence and therapeutic rationale
for working with the entire family system, play therapists and
family therapists share a common problem in their propensities
to focus on certain subsystems of the family. Each field faces
pragmatic difficulties in finding consistent means to incorporate family members. As a result, practitioners often divide the
family system or exclude members altogether from treatment,
diminishing therapeutic potential.
In filial therapy, play therapists and family therapists have a
common solution that allows them to incorporate adults and
children in efficacious treatment. Guerney (2000) referred to
filial therapy as a remarkably robust approach (p. 13), and
the validity of this perspective is evident in examining its
numerous components and its range of application. As demonstrated through the lens of family therapy, filial therapy provides a way to assess and intervene dynamically within
family interactions. In examining filial therapy through systems frameworks, therapists trained predominantly in play
therapy can find a helpful means for conceptualizing the systemic nature of their work. For practitioners primarily trained
in family therapy, the systemic relevance of the filial approach
might come as a surprise, given the theoretical framework from
which the approach stems. Filial therapy honors the importance
of the child subsystem, the parent subsystem, and the overall
family system while providing the developmentally appropriate means to address these populations. Through the utilization
of play in the context of working with children and discourse in
the context of working with adults, filial therapy creates a relevant context for therapeutic interaction with the family system
as a whole. See the possibilities.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References
Ackerman, N. (1970). Child participation in family therapy. Family
Process, 9, 403410.
American Association for Marriage and Family Therapy. (2001).
Code of ethics. Retrieved from http://www.aamft.org/imis15/
Content/Legal_Ethics/Code_of_Ethics.aspx
American Counseling Association. (2005). ACA code of ethics.
Retrieved
from
http://www.counseling.org/Files/FD.ashx?
guidab7c1272-71c4-46cf-848c-f98489937dda
American Psychological Association. (2010). Ethical principles of
psychologists and code of conduct. Retrieved from http://www.
apa.org/ethics/code/index.aspx
American Psychological Association, Task Force on Evidence-Based
Practice. (2005). Report of the 2005 Presidential Task Force on

Evidence-Based Practice. Retrieved from http://www.apa.org/


practice/resources/evidence/evidence-based-report.pdf
Anderson, H. (1997). Conversation, language, and possibilities: A
postmodern approach to therapy. New York, NY: Basic Books.
Anderson, H., & Gehart, D. (2007). Collaborative therapy: Relationships and conversations that make the difference. New York, NY:
Routledge.
Axline, V. (1947). Play therapy: The inner dynamics of childhood.
Cambridge, MA: Houghton Mifflin.
Bavin-Hoffman, R., Jennings, G., & Landreth, G. L. (1996). Filial
therapy: Parental perceptions of the process. International Journal
of Play Therapy, 5, 4558. doi:10.1037/h0089109
Beckloff, D. R. (1997). Filial therapy with children with spectrum
pervasive development disorders (Publication No. AAT
9816128). Retrieved from ProQuest Dissertations & Theses
Database.
Boscolo, L., Cecchin, G., Hoffman, L., & Penn, P. (1987). Milan systemic therapy. New York, NY: Basic Books.
Botkin, D. R. (2000). Family play therapy: A creative approach to
including young children in family therapy. Journal of Systemic
Therapies, 19, 3142. Retrieved from EBSCOhost.
Bowen, M. (1985). Family therapy in clinical practice. New York,
NY: Jason Aronson.
Bratton, S. C., & Landreth, G. L. (1995). Filial therapy with single parents: Effects on parental acceptance, empathy, and stress. International Journal of Play Therapy, 4, 6180. doi:10.1037/h0089142
Bratton, S. C., Landreth, G. L., & Lin, Y. D. (2010). Child parent relationship therapy: A review of controlled-outcome research. In J. N.
Baggerly, D. C. Ray, & S. C. Bratton (Eds.), Child-centered play
therapy research: The evidence base for effective practice. (pp.
267293). Hoboken, NJ: John Wiley.
Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of
play therapy with children: A meta-analytic review of treatment
outcomes. Professional Psychology: Research and Practice, 36,
376390. doi:10.1037/0735-7028.36.4.376
Carnes-Holt, K. (2010). Child-Parent Relationship Therapy (CPRT)
with adoptive families: Effects on child behavior, parent-child
relationship stress, and parental empathy (AAT 3417739).
Retrieved from ProQuest Dissertations and Theses Database.
Ceballos, P. L., & Bratton, S. C. (2010). Empowering Latino families:
Effects of a culturally responsive intervention with low-income
Latino on childrens behaviors and parental stress. Psychology in
the Schools, 47, 761775.
Chau, I., & Landreth, G. L. (1997). Filial therapy with Chinese parents: Effects on parental empathic interactions, parental acceptance
of child and parental stress. International Journal of Play Therapy,
6, 7592. doi:10.1037/h0089409
Costas, M., & Landreth, G. L. (1999). Filial therapy with nonoffending parents of children who have been sexually abused. International Journal of Play Therapy, 8, 4366. doi:10.1037/h0089427
de Shazer, S. (1985). Keys to solution in brief therapy. New York, NY:
Norton.
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy.
New York, NY: Norton.
de Shazer, S., & Berg, I. K. (1995). The brief therapy tradition. In J. H.
Weakland & W. A. Ray (Eds.), Propagations: Thirty years of

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

Cornett

281

influence from the Mental Research Institute (pp. 249252). Binghamton, NY: Haworth Press.
Doherty, W. J., & Simmons, D. S. (1996). Clinical practice patterns of
marriage and family therapists: A national survey of therapists and
their clients. Journal of Marital and Family Therapy, 22, 925. doi:
10.1111/j.1752-0606.1996.tb00183.x
Edwards, N. A., Ladner, J., & White, J. (2007). Perceived effectiveness of filial therapy for a Jamaican mother: A qualitative case
study. International Journal of Play Therapy, 16, 3653. doi:
10.1037/1555-6824.16.1.36
Edwards, N. A., Sullivan, J. M., Meany-Walen, K., & Kantor, K. R.
(2010). Child parent relationship training: Parents perceptions of
process and outcome. International Journal of Play Therapy, 19,
159173. doi:10.1037/a0019409
Ferrell, L. G. (2004). A comparison of an intensive 4-week format of
the Landreth 10-week filial therapy training model with the traditional Landreth 10-week model of filial therapy (Doctoral dissertation, University of North Texas, Denton, 2003). Dissertation
Abstracts International, A, 64(12), 4369.
Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change:
Doing therapy briefly. San Fransisco, CA: Jossey-Bass.
Foley, Y., Higdon, L., & White, J. F. (2006). A qualitative study of
filial therapy: Parents voices. International Journal of Play
Therapy, 15, 3764. doi:10.1037/h0088907
Garza, Y., Kinsworthy, S., & Watts, R. E. (2009). Childparent relationship training as experienced by Hispanic parents: A phenomenological study. International Journal of Play Therapy, 18,
217228. doi:10.1037/a0017055
Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family therapists: Integrating theory and
practice. Pacific Grove, CA: Brooks/Cole
Gil, E. (1994). Play in family therapy. New York, NY: Guilford Press.
Glover, G., & Landreth, G. L. (2000). Filial therapy with Native
Americans on the Flathead Reservation. International Journal of
Play Therapy, 9, 5780. doi:10.1037/h0089436
Green, R. J. (1994). Foreword. In E. Gil (Ed.), Play in family therapy
(pp. vvii). New York, NY: Guilford Press.
Guerney, B.Jr. (1964). Filial therapy: Description and rationale. Journal of Consulting Psychology, 28, 304310. doi:10.1037/h0041340
Guerney, L. (2000). Filial therapy into the 21st century. International
Journal of Play Therapy, 9, 117. doi:10.1037/h0089433
Guerney, L., & Guerney, B.Jr. (1987). Integrating child and family
therapy. Psychotherapy: Theory, Research, Practice, Training,
24, 609614. doi:10.1037/h0085758
Haley, J. (1976). Problem-solving therapy: New strategies for effective family therapy. San Fransisco, CA: Jossey-Bass.
Hanna, S. M. (2007). The practice of family therapy: Key elements
across models (4th ed.). Belmont, CA: Thomson.
Harris, Z., & Landreth, G. L. (1997). Filial therapy with incarcerated
mothers: A five week model. International Journal of Play Therapy, 6, 5373. doi:10.1037/h0089408
Haslam, D. R., & Harris, S. M. (2011). Integrating play and family therapy methods: A survey of play therapists attitudes in the field. International Journal of Play Therapy, 20, 5165. doi:10.1037/a0023410
Hines, M. (1996). Follow-up survey of graduates from accredited degreegranting marriage and family therapy training programs. Journal of

Marital and Family Therapy, 22, 181194. doi:10.1111/j.17520606.1996.tb00197.x


Hoffman, L. (1993). Exchanging voices: A collaborative approach to
family therapy. London, England: Karnac.
Hutton, D. (2004). Filial therapy: Shifting the balance. Clinical Child
Psychology & Psychiatry, 9, 261270. doi:10.1177/135910450404
1922
Jang, M. (2000). Effectiveness of filial therapy for Korean parents. International Journal of Play Therapy, 9, 3956. doi:10.1037/h0089435
Johnson, L. (1995). Filial therapy: A bridge between individual child
therapy and family therapy. Journal of Family Psychotherapy, 6,
5570.
Johnson, L., & Thomas, V. (1999). Influences on the inclusion of children in family therapy: A brief report. Journal of Marital & Family
Therapy, 25, 117123.
Johnson, L., Bruhn, R., Winek, J., Krepps, J., & Wiley, K. (1999). The
use of child-centered play therapy and filial therapy with Head
Start families: A brief report. Journal of Marital & Family Therapy, 25, 169176.
Kale, A., & Landreth, G. L. (1999). Filial therapy with parents of children experiencing learning difficulties. International Journal of
Play Therapy, 8, 3556. doi:10.1037/h0089430
Keith, D., & Whitaker, C. (1981). Play therapy: A paradigm for work
with families. Journal of Marital and Family Therapy, 7, 243254.
Kellam, T. (2001). Filial therapy: A family systems intervention. Family TherapyThe Journal of the California Graduate School of
Family Psychology, 28, 6371.
Kidron, M. (2004). Filial therapy with Israeli parents (Doctoral dissertation, University of North Texas, Denton, 2003). Dissertation
Abstracts International, A, 64, 4372.
Kinsworthy, S., & Garza, Y. (2010). Filial therapy with victims of
family violence: A phenomenological study. Journal of Family
Violence, 25, 423429. doi:10.1007/s10896-010-9303-y
Korner, S., & Brown, G. (1990). Exclusion of children from family
psychotherapy: Family therapists beliefs and practices. Journal
of Family Psychology, 3, 420430. doi:10.1037/h0080555
Kranz, P. L., Kottman, T., & Lund, N. L. (1998). Play therapists
opinions concerning the education, training, and practice of play
therapists. International Journal of Play Therapy, 7, 7387. doi:
10.1037/h0089419
Lahti, S. (1992, February). An ethnographic study of the filial therapy
process. Dissertation Abstracts International, A53, 2691.
Retrieved from PsycINFO database.
Landreth, G. L. (2002). Play therapy: The art of the relationship
(2nd ed.). New York, NY: Routledge.
Landreth, G. L., & Bratton, S. C. (2006). Child parent relationship therapy: A 10-session filial therapy model. New York, NY: Routledge.
Landreth, G. L., & Lobaugh, A. (1998). Filial therapy with incarcerated
fathers: effects on parental acceptance of child, parental stress, and
child adjustment. Journal of Counseling & Development, 76,
157165.
Lee, M., & Landreth, G. L. (2003). Filial therapy with immigrant Korean parents in the United States. International Journal of Play
Therapy, 12, 6785. doi:10.1037/h0088879
Montalvo, B., & Haley, J. (1973), In defense of child therapy. Family
process, 12, 227244. doi:10.1111/j.1545-5300.1973.00227.x

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013

282

The Family Journal: Counseling and Therapy for Couples and Families 20(3)

Miller, L., & McLeod, E. (2001). Children as participants in family


therapy: Practice, research, and theoretical foncerns. Family Journal, 9, 375383.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA:
Harvard University Press.
Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques.
Cambridge, MA: Harvard University Press.
National Association of Social Workers (2008). Code of ethics.
Retrieved from http://www.naswdc.org/pubs/code/code.asp
Papero, D. V. (1990). Bowen family systems theory. Boston, MA:
Allyn & Bacon.
Perry, D. F. (2007). A missed opportunity: Categorical programs fail to
meet the needs of young children and their caregivers. Journal of
Early Intervention, 29, 107110. doi:10.1177/105381510702900202
Phillips, R. D., & Landreth, G. L. (1998). Play therapists on play therapy: II. Clinical issues in play therapy. International Journal of
Play Therapy, 7, 124. doi:10.1037/h0089416
Pritchett, R., Kemp, J., Wilson, P., Minnis, H., Bryce, G., & Gillberg,
C. (2011). Quick, simple measures of family relationships for use
in clinical practice and research. A systematic review. Family
Practice, 28, 172187.
Raimondi, N. M., & Walters, C. (2004). Training family therapists to
work with children: Competence, relevance, and interest ratings in
the field of family therapy. American Journal of Family Therapy,
32, 225237.
Reeves, G., & Anthony, B. (2009). Multimodal treatments versus
pharmacotherapy alone in children with psychiatric disorders.
Pediatric Drugs, 11, 165169.
Reinherz, H. Z., Giaconia, R. M., Paradis, A. D., Novero, C., &
Kerrigan, M. K. (2008). Health-promoting influences of the family
on late adolescent functioning. Child & Adolescent Social Work
Journal, 25, 517530.
Richards, M. M., Bowers, M. J., Lazicki, T., Krall, D., & Jacobs,
A. K. (2008). Caregiver involvement in the intensive mental
health program: Influence on changes in child functioning.
Journal of Child and Family Studies, 17, 241252. doi:10.
1007/s10826-007-9163-0
Ryan, S. D., Gomory, T., & Lacasse, J. R. (2002). Who are we? Examining the results of the Association for Play Therapy membership
survey. International Journal of Play Therapy, 11, 1141. doi:
10.1037/h0088863
Sangganjanavanich, V., Cook, K., & Rangel-Gomez, M. (2010). Filial
therapy with monolingual Spanish-speaking mothers: A phenomenological study. Family Journal, 18, 195201. doi:10.1177/
1066480710364320
Satir, V. (1983). Conjoint family therapy (3rd ed.). Palo Alto, CA:
Science and Behavior Books.
Sax, P. (2007). Finding common ground: Parents speak out about family centered practices. Journal of Systemic Therapies, 26, 7290.
Sheely, A., & Bratton, S. C. (2010). A strengths-based parenting intervention with low-income African-American families. Professional
School Counseling, 13, 175183.
Smith, N., & Landreth, G. L. (2003). Intensive filial therapy with child
witnesses of domestic violence: A comparison with individual and

sibling group play therapy. International Journal of Play Therapy,


12, 6788. doi:10.1037/h0088872
Solis, C. M., Meyers, J., & Varjas, K. M. (2004). A qualitative case
study of the process and impact of filial therapy with an AfricanAmerican parent. International Journal of Play Therapy, 13,
99118. doi:10.1037/h0088892
Sori, C., & Sprenkle, D. (2004). Training family therapists to work
with children and families: A modified delphi study. Journal of
Marital and Family Therapy, 30, 479495.
Tew, K., Landreth, G. L., Joiner, K., & Solt, M. (2002). Filial therapy
with parents of chronically ill children. International Journal of
Play Therapy, 11, 79100. doi:10.1037/h0088858
Tomlin, A. M., & Viehweg, S. A. (2003). Infant mental health: Making a difference. Professional Psychology: Research and Practice,
34, 617625. doi:10.1037/0735-7028.34.6.617
Tsai, M., & Ray, D. C. (2011). Play therapy outcome prediction: An
exploratory study at a university-based clinic. International
Journal of Play Therapy, 20, 94108. doi:10.1037/a0023441
U.S. Public Health Service (2000). Report of the surgeon generals
conference on childrens mental health: A national action agenda.
Retrieved
from
http://www.surgeongeneral.gov/topics/cmh/
cmhreport.pdf
Wallander, J. L., Dekker, M. C., & Koot, H. M. (2006). Risk factors
for psychopathology in children with intellectual disability: A prospective longitudinal population-based study. Journal of Intellectual Disability Research, 50, 259268. doi:10.1111/j.1365-2788.
2005.00792.x
Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change:
Principles of problem formation and problem resolution. Oxford,
England: W. W. Norton.
West, B. E. (2010). A mixed methods approach to the experiences of
non-offending parents of children who have experienced sexual
abuse participating in Child parent relationship therapy (CPRT)
(UMI 3436580). Retrieved from ProQuest Dissertation and Theses
Database.
Whitaker, C. A., & Bumberry, W. M. (1988). Dancing with the family:
A symbolic-experiential approach. New York, NY: Routledge.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends.
New York, NY: W. W. Norton.
Wickstrom, A. (2009). The process of systemic change in filial therapy: A phenomenological study of parent experience. Contemporary Family Therapy: An International Journal, 31, 193208.
doi:10.1007/s10591-009-9089-3
Winek, J., Lambert-Shute, J., Johnson, L., Shaw, L., Krepps, J., &
Wiley, K. (2003). Discovering the moments of movement in filial
therapy: A single case qualitative study. International Journal of
Play Therapy, 12, 89104. doi:10.1037/h0088873
Yuen, T., Landreth, G., & Baggerly, J. (2002). Filial therapy with
immigrant Chinese families. International Journal of Play Therapy, 11, 6390. doi:10.1037/h0088865
Zilbach, J. J. (1986). Young children in family therapy. New York,
NY: Brunner/Mazel.
Zilbach, J. J. (1989). Introduction and overview. Journal of Psychotherapy & the Family, 5, 314.

Downloaded from tfj.sagepub.com by Nela Marinkovic on April 27, 2013