Received 12/03/09Revised 05/17/10

Accepted 06/25/10

Rest Practices

Play Therapy in Elementary Schools:A Best Practice for Improving AcademicAchievementPedro J. Blanco and Dee C. Ray

• T h i s pilot study of 1 st graders who are academically at risk examined the effectiveness of child-centered play therapy(CCPT).The experimental group received biweekly, 30-minute play therapy sessions for 8 weeks. Findings indicated thatthese 1st graders participating in CCPT (n = 21) demonstrated a statistically significant increase on the Early Achieve-ment Composite of the Young Children's Achievement Test (Hresko, Peak, Herron, & Bridges, 2000) when comparedwith children in the control group (n = 20). Results support using CCPT as an intervention for academic achievement.

The need for mental health services for children has beenlabeled a crisis in the United States, with more than 20% ofchildren and adolescents experiencing mental health problems(Committee on School Health, 2004; Mellin, 2009). Although75% to 80% of children and youth who need mental healthservices do not receive them (Kataoka, Zhang, & Wells,2002), evidence suggests that if children obtain help, theyare most likely to receive mental health services in the schoolsetting (Foster, Rollefson, Doksum, Noonan, & Robinson,2005; Rones & Hoagwood, 2000). In schools, children canbe identified, assessed, and provided mental health servicesfrom a prevention and intervention perspective. The AmericanCounseling Association, American School Counselor Associa-tion (ASCA), National Association of School Psychologists,and School Social Work Association of America (2006)jointly called for interventions based on evidence to addressthe mental health needs of children in schools.

Young children are especially susceptible to the linkbetween mental health issues and academic achievement.Expulsion rates among preschoolers are higher than those forschool-age children and are partially attributed to lack of atten-tion to social-emotional needs (Gilliam, 2005). Elementary-school-age children are more likely to be unhappy at school,absent, suspended, or expelled (National Center for Childrenin Poverty, 2006). In the Columbia University TeenScreenProgram (2009), it is suggested that the No Child Left BehindAct of 2001 created an environment in which mental healthneeds might go unobserved and unmet because of heightenedacademic pressure. There is an urgent need for interventionsthat affect both mental health and academic achievement.

Child-centered play therapy (CCPT) is one possibilityfor providing a mental health program in schools. CCPT isdefined as a dynamic interpersonal relationship between achild and a counselor trained in play therapy who providesselected play materials and facilitates the development of asafe relationship for the child to fully express and exploreself through the child's natural medium of expression—play(Landreth, 2002). CCPT is based on the philosophy of CarlRogers (1942) and his person-centered approach to counsel-ing adults. Virginia Axline, a pupil of Rogers, applied the useof play and nondirective therapeutic principles in her workwith children, thereby popularizing the approach in the fieldof psychotherapy (Axline, 1947b). Axline (1947b) developedeight basic principles to use as guidelines for nondirective playtherapy. These principles are the establishment of a caring re-lationship between the therapist and the child; full acceptanceof the child for who he or she is; creation of a free atmospherein which the child feels capable of expressing a range of emo-tions; recognition and reflection of the child's feelings; respectfor the child's ability to internally solve difficulties and provi-sion of opportunities to establish responsibility; allowance ofthe child's leadership in play sessions; understanding of thegradual process of therapeutic change; and, finally, provisionof therapeutic boundaries only when necessary.

Axline (1947b), Moustakas (1953), and Landreth (2002)asserted the belief that children have the innate capacity to de-velop self-actualization through self-direction when providedan atmosphere that is fully accepting of each child. The focuson the child's innate tendency to move toward growth andmaturity and a deep belief in the child's ability to self-direct

Pedro J. Blanco, Department of Counselor Education, Delta State University; Dee C. Ray, Child and Family Resource Clinic andDepartment of Counseling and Higher Education, University of North Texas. Pedro J. Blanco is now at Department of Counseling,Texas A&M University-Commerce. This research was supported in part by grants from Chi Sigma lota and the Dan Homeyer Foun-dation. Correspondence concerning this article should be addressed to Pedro J. Blanco, Department of Counseling, Texas A&MUniversity-Commerce, PO Box 3011, Binnion 212A, Commerce, TX 75429-3011 (e-mail: pj_blanco@tamu-commerce.edu).

© 2011 by the American Counseling Association. All rights reserved.

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are the main tenets that differentiate CCPT from other modelsof play therapy (Landreth & Bratton, 2006). In practice, theCCPT counselor initiates statements that reflect content andfeeling (e.g., "You're frustrated with her"); encourage (e.g.,"You figured it out"); return responsibility to the child (e.g.,"You can choose how you want it to look"); and, if needed,set limits (e.g., "Toys are not for breaking"). Typically, theCCPT counselor does not direct behavior or interpret thechild's actions or words (Ray, 2008).

Use of play in therapy allows school-age children tonaturally express emotions and experiences (Landreth, 2002;Moustakas, 1959). Landreth (2002) suggested that becauseof the unique relationship established in CCPT, the child per-ceives the playroom and the counselor as safe; the counselorin the playroom will accept and reflect the child's emotionalexpressions, thereby allowing the child to become more em-powered and accepting of him- or herself As children feelfree to accept themselves, they will hypothetically be opento accept others, including knowledge from others, such asteachers. Landreth further stated that

a major objective of using play therapy with children in anelementary school setting is to help children get ready to profitfrom the learning experiences offered.... Play therapy, then,is an adjunct to the learning environment, an experience thathelps children maximize their opportunities to leam. (p. 148)

•P lay Therapy Research and AcademicAchievement

An effort to enhance the child's ability to perform academi-cally has been emphasized since the development of coun-seling children. Play therapy as a treatment modality is nodifferent. Early studies of play therapy attempted to measureacademic improvement and successful treatment by using IQscores, reading measurements, and language development.Historical studies conducted in the field attempted to enricha child's ability to leam through play therapy. Early studies(Axline, 1949; Dulsky, 1942; Leland. Walker, & Taboada,1959; Moulin, 1970; Mundy, 1957; Shmukler & Naveh,1984) attempted to measure the efficacy of play therapy onachievement by placing a high emphasis on changing thechild's IQ score over the course of treatment. Research con-clusions from early studies of Dulsky (1942), Axline (1949),and Mundy ( 1957) and a later study by Shmukler and Naveh(1984) suggested that providing play therapy to children canhelp increase their IQ scores and thus their ability to leamin the classroom. Providing play therapy for children withlearning disabilities was also significant in improving theacademic abilities of children through improvements in motorfunctioning and teaming difficulties (Newcomer & Morrison,1974; Siegel, 1971). More recent literature (Quayle, 1991;Shechtman, Gilat, Fos, & Flasher, 1996) concerning playtherapy in schools has been noted as improving a child's abil-

ity to perform academically. However, it should be noted thatAxline ( 1949) did not conclude that play therapy increasedthe intelligence of children, but she hypothesized that playtherapy allowed the child to overcome emotional limitationsthat were hindering expression of intelligence and releasedthe child to demonstrate full potential.

In an attempt to further promote play therapy as an aidin education, many research studies offered play therapy asa suitable alternative intervention for reading enrichment.Some early studies (Axline, 1947a; Bills, 1950; Seeman &Edwards, 1954) presented positive results and suggested thatproviding play therapy could be a way to release the innerdirection of the child and minimize performance anxietyeffectively. Later studies found mixed results as further ex-perimental designs included a comparison control group, butsignificant findings were not reported in reading achievement(Boehm-Morelli, 2000; Crow, 1990; Kaplewicz, 2000). Ofthe mixed-findings studies, Boehm-Morelli (2000) reportednumerous limitations and speculated that the brief numberof sessions may have limited reading achievement results.Boehm-Morelli suggested a longer time frame for childrento experience an improvement in self-concept to activate themediating processes that affect achievement. Crow (1990),who also observed reading improvement based on a play-therapy intervention, did not find a significant differencein reading achievement between the children who attendedplay therapy and the control group. Crow concluded throughanecdotal observations that even though behaviors appearedto be changing, there was not enough time in the experimentto demonstrate an improvement in reading.

Regardless of the limitations from past research, it ispossible that relying solely on reading achievement scoresas a means of interpreting academic achievement maynot be accurate. In recent years, the focus of determiningprogress in play therapy has shifted to a more emotionallyand/or behaviorally driven component. In a comprehensivereview of play therapy research, Ray and Bratton (2010)reported that play therapy research moved from a focus onintelligence and school achievement in the early years to aconcentration on social adjustment and self-concept in the1970s and 1980s. Most recently, research in play therapyhas concentrated on disruptive behavioral problems witbno recent studies conducted on intelligence or academicachievement. Ray and Bratton questioned the focus onbehavioral problems in schools as a dependent variablefor play therapy research because of CCPT's focus on theinner world of the child.

Even though there has been a shift in focus of the dependentvariable, play therapist researchers have continued to concen-trate on schools as an appropriate setting for intervention.Several recent CCPT research studies have been conductedin elementary schools, establishing a pattern of incorporatingplay therapy in the school setting (Fall, Balvanz, Johnson,& Nelson, 1999; Fall, Navelski, & Welch, 2002; Garza &

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Bratton, 2005; Muro, Ray, Schottelkorb, Smith, & Blanco,2006; Ray, 2007; Ray, Blanco, Sullivan, & Holliman, 2009;Ray, Schottelkorb, & Tsai, 2007; Schottelkorb & Ray, 2009;Schumann, 2010). All ofthe aforementioned studies dealt withchildren's externalizing behaviors and relationships, specifi-cally attention-deficit/hyperactivity disorder, aggression, andteacher-child relationships. On reviewing 21 CCPT researchstudies conducted in school settings, Bratton (2010) concludedthat play therapy is responsive to the developmental needs ofchildren and has been successfully applied with diverse andat-risk populations in schools.

•Purpose of the StudyAlthough historical literature supports the use of play therapy toimprove academic achievement, and recent literature supportsits use to improve behavioral problems in schools, there is littleresearch to conclude that play therapy is a current and effectiveintervention for academic progress. The purpose of conduct-ing the current pilot study was to use a small but experimentaldesign to assess the effects of play therapy on the academicachievement of young children at risk for school failure. Asdiscussed earlier, previous play therapy studies are dated anddifficult to interpret in current academic culture, specificallyfocusing on intelligence and reading achievement that are onlysmall components of overall academic achievement. This studydiffers fi'om previous research because we attempted to assessmultiple categories of leaming instead of solely measuring read-ing achievement. We used the manualized delivery of CCPT toobserve the effects ofthe intervention as a possible best practicefor early elementary, school-age children.

•MethodParticipants

Participants were 43 students from four elementary schoolsin the southwestern United States. All schools were con-sidered Title I schools targeted by the state for schoolwideassistance because of high percentages of children qualify-ing for free or reduced lunch. School 1 listed 63.9% of itspopulation as disadvantaged. School 2 listed 72.5% of itspopulation as disadvantaged. School 3 listed 70.5% of itspopulation as disadvantaged, and School 4 listed 61.7% ofits population as disadvantaged. We requested that the schoolcounselors ofthe elementary schools send written informedconsents to parents or guardians of all first-grade studentsin mainstream education who have been identified as aca-demically at risk according to the school district. Studentsacademically at risk were defined by the school district aselementary students meeting one ofthe following categories:(a) the student did not previously advance from one gradelevel to the next, (b) the student did not perform satisfactorilyon an assessment instrument or did not perform satisfactorilyon a readiness test, or (c) the student is in custody or care

ofthe state department of protective services. Furthermore,the at-risk label was an indication of students in danger ofnot progressing academically and was designated as a wayof identifying students who are falling behind. We obtainedwritten informed consents according to procedures by thelocal human participants review board for 43 students.

Children were randomly assigned into treatment groupsby school according to playroom space. School 1 served 14children. School 2 served eight children. School 3 served10 children, and School 4 served 11 children. One studentfrom School 1 in the experimental group moved to School3 and received treatment there. Two students from School4, both in the control group, moved to different schools andwere removed from the study. The final participant numberof 41 represented 21 children assigned to the CCPT treat-ment group and 20 children assigned to the wait-list control(WC) group. Overall, 26 boys and 15 girls participatedin the study. Of the boys, 16 were assigned to the playtherapy treatment (PT) group and 10 were assigned to aWC group. Ofthe girls, five were assigned to the PT groupand 10 were assigned to the WC group. For the durationof the study, all participants were between the ages of 6and 7 years. Ethnicity breakdowns were as follows: sevenwere African American (four PT group, three WC group),14 were Hispanic (seven PT group, seven WC group), 19were Caucasian (nine PT group, 10 WC group), and onewas Asian American (one PT group, zero WC group).

Instrument

The Young Children's Achievement Test (YCAT; Hresko,Peak, Herron, & Bridges, 2000) was developed to measurethe achievement levels of young children ages 4 to 8 yearswith respect to skills needed to succeed in school over fivedomains. The YCAT is a comprehensive assessment thatmeasures early academic achievement levels and can beused to monitor the student's progress. The YCAT is admin-istered by a trained examiner and requires 25 to 45 minutesto complete. The YCAT assesses an overall achievementscore in academic areas from the combination of five sub-tests. The results from the five subtests make up the child'sEarly Achievement Composite score. This composite scalereflects the child's school-related achievement across themajor areas of academic tasks. Hresko et al. (2000) furtherindicated the Early Achievement Composite is the bestindicator ofthe child's overall academic abilities. The fivesubtests are General Information, Reading, Mathematics,Writing, and Spoken Language. Children responded toquestions both orally and in writing, depending on the sub-test. The Mathematics and Writing subtests were respondedto in writing and orally. The other subtests did not includea writing component. High reliability has been establishedfor the YCAT instrument. The internal consistency, or thedegree to which the items correlate with one another, av-eraged above 0.85. The test-retest reliability, meaning the

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consistency of ratings by the same examiner over a shorttime interval, was established at 0.98. Interrater reliabil-ity, the level of agreement among independent examiners'ratings of the same child, averaged at 0.98 (Hresko et al.,2000). The calculated Cronbach's alpha for this study was.95, indicating high reliability for the current sample.

The YCAT demonstrated acceptable measures of validity.YCAT subscale and composite scores correlate as high as.99 with corresponding scores on other instruments, such asthe Comprehensive Scale of Student Abilities, the KaufmanSurvey of Early Academic and Language Skills, the Metro-politan Readiness Tests, and the Gates-MacGinitie ReadingTests (Hresko et al., 2000). These results support the constructvalidity of those YCAT dimensions. Further validity studieshave been conducted on the YCAT, thus establishing facto-rial and discriminant validity. The YCAT was specificallychosen for this study because it does not require a significantwait time needed for multiple administrations. It is possiblefor individuals taking the assessment to have a small leam-ing effect. However, participants from both the PT and WCgroups were administered the posttest 8 weeks following theinitial assessment. Because both groups were given the sametest at pre- and posttest, any slight learning effect would beaccounted for by the control group comparison.

Procedure

Once informed consent from each student's parent or guardianwas received, all children were individually administered theYCAT. YCAT administration was conducted by advanced doc-toral counseling students who were well-trained in assessmentand who had no knowledge of group assignment at pre- orposttest. Participants were then randomly assigned to one oftwo treatment groups, PT or WC. Students were scheduledto participate in either 8 weeks of play therapy or 8 weeksof no intervention during the fall semester. At the end of the8 weeks, each participant was individually administered theYCAT as a postmeasure.

PT group. Twenty-one students were assigned to the PTgroup, which consisted of 16 sessions of CCPT scheduledover 8 weeks. Children receiving play therapy participatedin two 30-minute sessions per week for a period of 8 weekson-site in equipped school playrooms. All play therapy ses-sions followed procedures according to a CCPT treatmentmanual (Ray, 2009) and were facilitated by doctoral-levelcounseling students trained in play therapy or a master's-level practitioner trained in play therapy. All therapists hadcompleted at least 42 hours in a graduate-level counselingprogram that included an introduction to play therapy, anadvanced play therapy course, and one clinical course inplay therapy. All therapists received 1 hour of weekly playtherapy supervision during the course of the study to ensurethat each therapist was following CCPT protocol. At thattime, the play therapists, with their respective supervisors

present, were required to review their videotaped play ther-apy sessions. Each play therapist's supervisor ensured thatthe play therapist was following CCPT protocol throughthe use of the Play Therapy Skills Checklist (PTSC; Ray,2009). Furthermore, a randomized check of play therapysession recordings was conducted by the research teamusing the PTSC to ensure that the play therapy sessionswere conducted using CCPT procedures.

Play therapy sessions were conducted in speciallyequipped playrooms in each school setting, and playroomswere equipped with a variety of toys specifically intendedto facilitate a broad range of expression following Lan-dreth's (2002) suggestions. All therapists were requiredto conduct treatment sessions using CCPT principles thatincluded both nonverbal and verbal skills outlined by Ray(2009): (a) maintaining a leaning forward, open stance; (b)appearing to be interested; (c) remaining comfortable; (d)having a matching tone with the child's affect; (e) havingappropriate affect in responses; (f) using frequent interac-tive responses; (g) using behavior-tracking responses; (h)responding to verbalizations with paraphrases; (i) refiectingthe child's emotions; (j) facilitating empowerment throughreturning responsibility; (k) encouraging creativity; (1)using self-esteem-boosting statements; and (m) usingrelational responses. These skills are used to convey thatthe therapist understands the child's world and sends themessage "I am here, I hear you, I understand, and I care"(Landreth, 2002, pp. 205-206).

WC group. Twenty students were assigned to the WC groupthat received no treatment intervention during the course ofthe study. Following postadministration of instruments, eachWC-group child was placed in CCPT. Play therapy was pro-vided to the WC-group children following the study to meetethical delivery of services.

Data Analysis

Following the completion of the study, we scored the pretestand posttest data by using hand scoring on the YCAT ac-cording to the manual. To determine if PT and WC groupswere statistically equal, we performed a two-factor repeatedmeasures split-plot analysis of variance (SPANOVA; TimeX Treatment Group) on the dependent variable, academicachievement, to determine if the PT group that received16 sessions of CCPT performed differently than the WCgroup did across time, which was a particular interest forthis study.

The two levels of group are defined as the experientialgroup (PT group) and the nontreatment group ( WC group).The two levels of time are pretest and posttest for the de-pendent variable. Significant differences between the meansacross time were tested at the .05 alpha level. An effect sizewas computed for each analysis using the eta-squared sta-tistic to assess the practical significance of findings.

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•ResultsResults ofthe SPANOVA (see Figure 1) indicated that thedependent variable. Early Achievement Composite, revealeda statistically significant interaction effect of Time (pretest,posttest) X Treatment Group (experimental, control), Wilks'sA = .56, F(l , 39) = 5.23,p = .03 (partial r\^ = .12); a statisti-cally significant main effect for time, F(\, 39) = 30.14, p <.01 (partial T] = .44); and no statistically significant maineffect for group, F(l, 39) = .lO,p = .75 (partial r]^ < .01).These results indicate that when grouped together, childrenwho attended CCPT and the WC group obtained statisti-cally significant higher scores on the Early AchievementComposite subscale of the YCAT from pretest to posttest.Furthermore, results from the SPANOVA interaction effectand further analysis of means indicate that the children whoattended CCPT obtained statistically significantly higherscores on the Early Achievement Composite from pretest toposttest, when compared with the WC group from pretest toposttest. The effect size of .44 for change over time indicatesa high effect size, and the effect size of .12 for interactionindicates a moderate effect size according to Cohen's (1988)guidelines.

Because the main effects and interaction effect weresignificant, a paired-samples t test was calculated foreach treatment condition to explore group performance.Results of a paired-samples / test indicated that the EarlyAchievement Composite for the treatment group revealeda statistically significant difference from pretest to posttest,/(20) = -5.01,p< .01, Ti = .56. Results of a paired-samples

Treatment• =CCPT•a = Control

82.00 —

TPretest

TPosttest

Time

FIGURE 1

Early Achievement Composite Scores FromPretest to Posttest

Note. CCPT = child-centered play therapy.

t test demonstrated that the Early Achievement Compositefor the WC group also revealed a statistically significantdifference from pretest to posttest, í(19) = -2.53, p = .02,ri = .25. Although both groups, PT and WC, demonstratedlarge effect sizes, results indicated that the PT group hadan effect size that was twice as large as the WC group's.

YCAT Subscales

Because a significant difference was found between the PTand WC groups on the overall achievement composite score,we chose to run SPANOVAs on each subscale to investigatewhether achievement changes were centered on one area. Re-sults from the four SPANOVAs conducted using the GeneralInformation, Reading, Mathematics, Writing, and SpokenLanguage subscales revealed no statistically significant in-teraction effects, which signified there was no statisticallysignificant difference between groups over time on those spe-cific subscales. As can be seen in Table 1, the mean gains werehigher for the PT group on every subscale except Writing.

•DiscussionResults of this study help to highlight the benefit of CCPTwith students at risk of academic failure. As previouslyreported, the YCAT assesses the early academic achieve-ment levels of young children using five domains; GeneralInformation, Reading, Mathematics, Writing, and Spoken

TABLE 1

Mean Scores on the General Information, Reading,iVIathematics, Writing, and Spoken Language

Subscales and Eariy Achievement Composite onthe Young Children's Achievement Test

PT Group WC Group(n = 20)

Variabie

General InformationMSD

ReadingMSD

MathematicsMSD

WritingMSD

Spoken LanguageMSD

Early AchievementComposite

MSD

Pretest

89.9510.56

85.7112.50

89.7610.44

88.5211.31

84.7617.74

82.8613.71

Posttest

92.488.20

95.3310.95

94.7611.22

92.2411.73

90.0515.37

90.1412.50

Pretest

90.3010.81

84.1510.08

87.959.40

89.308.42

88.9018.87

83.7012.31

Posttest

89.5512.04

90.3012.67

89.3513.34

93.8511.96

89.6017.99

86.7014.85

Note. An increase in mean scores indicates improvement in achieve-ment. PT = piay therapy treatment; WC = wait-list control.

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Language. From these domains, an overall achievementscore identified as the Early Achievement Composite, thebest indicator of the child's overall academic abilities, canbe computed (Hresko et al., 2000). Results of the analysisindicated that from pretest to posttest, students who par-ticipated in the PT group scored statistically significantlyhigher on the Early Achievement Composite of the YCATwhen compared with students who were placed in the WCgroup. In analyzing post hoc group effects, we found thatthe treatment group effect size for the CCPT interventionwas twice as large as the control group effect size for theEarly Achievement Composite, indicating the practicalsignificance of the study's findings. On the basis of meanscores from pretest to posttest on the Early AchievementComposite, the PT group had a 7.28 point increase in theirmean scores compared with a 3 point increase for the WCgroup. Helpful clinical significance of findings for CCPTtreatment indicate that 36% of the children, as compared with29% of children in the WC group, improved from at risk ofacademic failure to one of normal functioning following theirparticipation in CCPT. These results provide a foundation forfuture controlled studies measuring the impact CCPT mayhave on academic achievement. Although it is noted that bothgroups improved over time, children participating in playtherapy demonstrated statistically significant improvementover children who did not.

The findings related to overall academic achievement aresimilar to those of Quayle (1991) and Shechtman et al. (1996).Quayle specifically noted improved self-confidence in childrenwho received CCPT, which as reported by the students' teachersled to significant improvements in leaming skills and participa-tion. Shechtman et al. further noted increased academic per-formance in children may be rooted in the child's ability to beintrinsically motivated. Because CCPT is based on the creation ofa free atmosphere in which the child feels capable of expressinghim- or herself, with a therapist who honors the child's ability tointemally solve difficulties, it may be likely that the children inthe experimental group began developing the ability to self-directand accept responsibility as a result of attending CCPT sessions.Thus, the students may have begun seeking positive solutions toacademic problems (Carmichael, 2006).

In summary, it appears there was a cumulative effect ofscores for each individual subtest in every academic area forchildren receiving CCPT. The treatment group performedbetter on four subscaies of academic achievement leadingto an overall statistically significant increase on the EarlyAchievement Composite score compared with the controlgroup. It is possible that children attending CCPT weremore open to learning overall. This effect may result fromthe child-centered play therapist's facilitation of a warm,caring, accepting relationship. Theoretically, the permissiveenvironment gave the child freedom to develop internal cop-ing strategies and responsibility for his or her actions at hisor her own pace. Landreth (2002) suggested.

Risk taking, self-exploration, and self-discovery are not likelyto occur in the presence of threat or the absence of safety. Thepotential learning experiences available in play therapy aredirectly related to the degree to which the therapist is success-ful in creating a climate of safety within which children feelfully accepted and safe enough to risk being and expressingthe innermost totality of their emotional being, (p. 90)

Because of this relationship, the child's innate capacity toperform well academically is released.

As early as Axline's ( 1947b) study, implications for educa-tion using basic principles of CCPT have been offered. Shesuggested children cannot be productive students while inthe midst of emotional turmoil. Principles such as accept-ing the child for who he or she is at the current moment andrecognizing the child's feelings may contribute to learning.When educators display this acceptance, children are free fromexpectations placed on them. This allows children to developa better sense of their current abilities in safety, without theanxiety of performance, unlike that in the classroom. Thisnonevaluative environment gives the child freedom to expresshis or her feelings without judgment. Axline ( 1947b) proposed.

It is the permissiveness to be themselves, the understanding,the acceptance, the recognition of feelings, the clarificationof what they think and feel that helps children retain theirself-respect; and the possibility of growth and change areforthcoming as they all develop insight, (p. 140)

Furthermore, perhaps providing this warm, caring, safeenvironment is a precondition for children to become eagerto learn.

Limitations and Implications for Future Research

Although the results of this study offer valuable informationregarding effectiveness of CCPT with first graders who areacademically at risk, there are limitations to this pilot studythat should be considered when interpreting results. Partici-pants in the study represented a limited range in age and wereselected from a small sample residing near a southwesternmetropolitan area. Use of a limited range of grade level anda population from a specific geographic location limits pos-sible generalizations of the anticipated results to other areas.Number of participants further limits possible generalizationof future findings. A larger scale replication study is sug-gested as a way of increasing generalizability. An additionallimitation of this study is the use of a nontreatment controlgroup. Changes found between the control group and the ex-perimental group could result from the use of an intervention,rather than if the findings resulted specifically from CCPT.The use of a treatment comparison group provides supportfor the present findings. A larger replication study including atreatment comparison group is suggested as a way of increas-ing the assurance that findings were directly related to CCPT.

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Implications for Practice

Although for this particular study the counselors providingtreatment were school-based counselors, the results offer sup-port for the training and use of CCPT for school counselorsand school-based therapists. According to the ASCA NationalModel (ASCA, 2003), school counselors are encouragedto offer responsive services, such as individual and groupcounseling, as one component of the overall school counsel-ing program. Bratton (2010) supported the use of CCPT withchildren for behavioral problems, and results from this studyindicate that CCPT might be helpfiil as an intervention forchildren who are struggling academically. CCPT can be anadditional tool for the school counselor's set of skills. School-based therapists who work as consultants might use CCPTto respond to children's emotional, behavioral, and academicneeds because of its practical delivery methods. The practiceof CCPT is conducive to the school setting because it canbe delivered in 30-minute sessions, a typical time periodfor school interventions. In addition to timing's alignmentto setting, Landreth (2002) proposed the use of a travelingplay kit for play therapists who work at multiple sites, suchas school-based therapists.

•ConclusionBecause of No Child Left Behind (2001) legislation, allU.S. schoolchildren are expected to meet certain academicstandards within their respective grade levels. However,many children with mental illness have difficulty attainingthese standards because of emotional interference withtheir academic learning. Furthermore, the President's NewFreedom Commission on Mental Health (2003) reportedthat public school system's priority is to educate all at-tending students. The report also concluded that childrenwith mental illness are the students most likely to fail ordrop out of school. At-risk students, along with studentsstruggling to perform well in school, continue to "fallthrough the cracks," making it important to continue tar-geting interventions that can assist and prevent academicfailure. Because of a strong correlation between emotionaldevelopment and academic success, development of a solidmental health program within the school is necessary tohelp promote academic achievement (Foster et al., 2005;President's New Freedom Commission, 2003). Thus, it isvital to identify and use effective mental health servicesthat benefit the emotional needs of school-age childrenalong with improving academic development.

Findings in this study indicate CCPT can significantlyincrease academic achievement for first-grade children identi-fied as academically at risk. In summary, CCPT has potentialas an effective intervention to positively affect academicachievement with first graders who are academically at risk.On the basis of an exhaustive review of literature, the presentstudy represents the largest controlled CCPT study to date

analyzing its effects on academic achievement. Because ofthe importance for counselors in the school setting to promoteacademics as well as emotional support to students, this studycontributes empirical data that support the use of CCPT withinthe school system and possibly offer a new best practice forcounselors in schools.

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