Therapists in Anacortes, WA
CradleStone, LLC
Counselor, MS, MAC, LMHC, SUDP
Verified Verified
Anacortes, WA 98221
Are you alone and feeling no support? Is your teenager struggling to be part of your family? Whether your teen is acting out through high-risk behaviors or isolating through technology, your family is probably feeling the strain. When you aren't sure how to help your teen or what they truly need, it can feel overwhelming and hopeless. I'm here to support you, your teen, and your family so you can move through your challenges together. Individuals seeking help with depressive or anxious feelings can find solutions through me as well.
Are you alone and feeling no support? Is your teenager struggling to be part of your family? Whether your teen is acting out through high-risk behaviors or isolating through technology, your family is probably feeling the strain. When you aren't sure how to help your teen or what they truly need, it can feel overwhelming and hopeless. I'm here to support you, your teen, and your family so you can move through your challenges together. Individuals seeking help with depressive or anxious feelings can find solutions through me as well.
Denise Miller
Counselor, MA, LMHC
Verified Verified
Anacortes, WA 98221
Waitlist for new clients
I take a holistic approach to counseling, with an emphasis on mind, body and spirit in relationship to self and others. I specialize in trauma informed practices utilizing modalities such as EMDR, CBT, DBT, and family systems therapy.I am a Children's Mental Health Therapist and a Minority Mental Health Therapist with experience working with Native American, Hispanic and African American and LGBTQ populations.
I take a holistic approach to counseling, with an emphasis on mind, body and spirit in relationship to self and others. I specialize in trauma informed practices utilizing modalities such as EMDR, CBT, DBT, and family systems therapy.I am a Children's Mental Health Therapist and a Minority Mental Health Therapist with experience working with Native American, Hispanic and African American and LGBTQ populations.
Melissa Street
Counselor, MS, LMHC
Verified Verified
1 Endorsed
Anacortes, WA 98221
Not accepting new clients
Hello there! I have been working with children, adolescents, young adults transitioning into adulthood and families since March of 2019, and I have experience working with trauma, anxiety, depression, as well as parenting. Being a nerd at heart, I enjoy connecting with clients over video games and movies with therapeutic approach to help meet their goals in a way that impacts them through their interests.
Hello there! I have been working with children, adolescents, young adults transitioning into adulthood and families since March of 2019, and I have experience working with trauma, anxiety, depression, as well as parenting. Being a nerd at heart, I enjoy connecting with clients over video games and movies with therapeutic approach to help meet their goals in a way that impacts them through their interests.
Online Therapists
Annie Sturtewagen
Counselor, MA, LMHCA
Verified Verified
1 Endorsed
Puyallup, WA 98372
She loves working with children in play therapy, music and art therapy.
Accepting New Patients In Person and Telehealth children, teens, and couples. She received their master’s degree in clinical mental health counseling at Northwestern University in June of 2023. Annie's past clinical experience includes working with a variety of clients at a community mental health agency dedicated to reaching underserved populations. Prior to becoming a licensed mental health counselor associate.Annie worked as a board-certified music therapist at a state psychiatric hospital for six years. Annie utilized a variety of expressive arts and therapeutic activities in both individual and group therapy settings.
She loves working with children in play therapy, music and art therapy.
Accepting New Patients In Person and Telehealth children, teens, and couples. She received their master’s degree in clinical mental health counseling at Northwestern University in June of 2023. Annie's past clinical experience includes working with a variety of clients at a community mental health agency dedicated to reaching underserved populations. Prior to becoming a licensed mental health counselor associate.Annie worked as a board-certified music therapist at a state psychiatric hospital for six years. Annie utilized a variety of expressive arts and therapeutic activities in both individual and group therapy settings.
Therapeutic Mind Group, PLLC
Clinical Social Work/Therapist, LICSW, MSW
Verified Verified
Everett, WA 98201
Tito Maltos, MSW, LSWAIC, MHP, has been working as a therapist for the past 2 years providing therapeutic support including psychotherapy, CBT, DBT, and play therapy to clients and their families experiencing concerns with themselves including mood and substance concerns, interactions with family members, their community/school, and/or the legal system.
Our uncertain times has likely increased stress and the “What if’s” into your or a loved one’s life. The constant change and uncertainty can foster stress and other emotional reactions. This may look/feel like feeling isolated, frightful, irritable, outraged, sad, guilt or even exhibiting maladaptive behaviors (e.g., substance use, risky behaviors, eating habits, sleeping habits, etc.). While there’s no one-size-fits-all approach, having a harm-reduction approach, focusing more on what we can control and less on what we can’t, decreasing stress, reducing your triggers and focusing on our strengths and supports can help.
Tito Maltos, MSW, LSWAIC, MHP, has been working as a therapist for the past 2 years providing therapeutic support including psychotherapy, CBT, DBT, and play therapy to clients and their families experiencing concerns with themselves including mood and substance concerns, interactions with family members, their community/school, and/or the legal system.
Our uncertain times has likely increased stress and the “What if’s” into your or a loved one’s life. The constant change and uncertainty can foster stress and other emotional reactions. This may look/feel like feeling isolated, frightful, irritable, outraged, sad, guilt or even exhibiting maladaptive behaviors (e.g., substance use, risky behaviors, eating habits, sleeping habits, etc.). While there’s no one-size-fits-all approach, having a harm-reduction approach, focusing more on what we can control and less on what we can’t, decreasing stress, reducing your triggers and focusing on our strengths and supports can help.
Sara Jerome
Clinical Social Work/Therapist, LICSW, CMHS, MSW
Verified Verified
Bellevue, WA 98007 (Online Only)
Approaches can range from the expressive techniques of play and art therapy to concrete skill-building using cognitive behavioral therapy (CBT).
Website: ghostsandangels.org I provide mental health therapy for children ages 0 to 12 experiencing stress, transitions, the effects of trauma, and other emotional and behavioral needs. I work virtually with clients in Washington State using evidence-based practices and creative, child-centered activities. I also offer therapy to parents & caregivers who want to reduce the stress of parenting and increase the connectedness they share with their child. This form of therapy can be particularly supportive to cycle breakers: parents with stress and trauma themselves who are working to change the generational patterns in their families.
Approaches can range from the expressive techniques of play and art therapy to concrete skill-building using cognitive behavioral therapy (CBT).
Website: ghostsandangels.org I provide mental health therapy for children ages 0 to 12 experiencing stress, transitions, the effects of trauma, and other emotional and behavioral needs. I work virtually with clients in Washington State using evidence-based practices and creative, child-centered activities. I also offer therapy to parents & caregivers who want to reduce the stress of parenting and increase the connectedness they share with their child. This form of therapy can be particularly supportive to cycle breakers: parents with stress and trauma themselves who are working to change the generational patterns in their families.
Shadow Play Therapy PLLC
Counselor, MA, LMHCA
Verified Verified
Tacoma, WA 98408 (Online Only)
Waitlist for new clients
No matter your age, how will you return to play? With a lifelong commitment to studying ableism, I’m always wondering how to build accessibility for all kinds of folks.
Informed by liberating-direct-action with workers, survivors of mental health incarceration, and skilled professionals, I value lived-experience just as much as highfalutin philosophy. I believe in the universal human drive to transform + heal through caring community connections, self-awareness, access to dreams by way of meeting basic needs, and the responsibility to recover personal and collective strengths. Healing of the self is healing of communities, and ultimately our interrelated societies. In place of paternalism, I offer avenues for developing your self-trust.
No matter your age, how will you return to play? With a lifelong commitment to studying ableism, I’m always wondering how to build accessibility for all kinds of folks.
Informed by liberating-direct-action with workers, survivors of mental health incarceration, and skilled professionals, I value lived-experience just as much as highfalutin philosophy. I believe in the universal human drive to transform + heal through caring community connections, self-awareness, access to dreams by way of meeting basic needs, and the responsibility to recover personal and collective strengths. Healing of the self is healing of communities, and ultimately our interrelated societies. In place of paternalism, I offer avenues for developing your self-trust.
Melissa Lowe
Clinical Social Work/Therapist, MSW, LICSW
Verified Verified
1 Endorsed
Puyallup, WA 98371 (Online Only)
she has experience in trauma, CBT, DBT, Motivation Interviewing, and will be using play therapy as some of her many skills and tools to work with her patients.
Accepting New Patients via telehealth/telemedicince. Seeing children, adults, and families. Those in my practice also can see couples. Melissa Lowe received her Masters in Social Work from Boise State in Idaho and holds an Associate License for Clinical Social Work. As a social worker, Melissa has over 15 years of experience working with children and families. She started out as a nanny before working crisis work in the school, assisting in the prisons, helping families, and at our local hospitals.
she has experience in trauma, CBT, DBT, Motivation Interviewing, and will be using play therapy as some of her many skills and tools to work with her patients.
Accepting New Patients via telehealth/telemedicince. Seeing children, adults, and families. Those in my practice also can see couples. Melissa Lowe received her Masters in Social Work from Boise State in Idaho and holds an Associate License for Clinical Social Work. As a social worker, Melissa has over 15 years of experience working with children and families. She started out as a nanny before working crisis work in the school, assisting in the prisons, helping families, and at our local hospitals.
Amy Barker D'Alessandro
Counselor, LMHC
Verified Verified
5 Endorsed
Shoreline, WA 98133 (Online Only)
Waitlist for new clients
Amy Barker D'Alessandro, Adoption and Trauma Therapist, offers specialized counseling, coaching, consulting, supervision, and public speaking services. Amy holds a Masters degree in Counseling Psychology, is a fully licensed Mental Health Counselor (LMHC) in Washington state, and is trained in Relational Psychotherapy, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Attachment Focused Therapy, Filial Play Therapy, and Sand Tray Therapy. She currently works with individuals of all ages, families of all kinds, general counseling clients, and several monthly groups, ongoing retreats, and events.
Amy Barker D'Alessandro, Adoption and Trauma Therapist, offers specialized counseling, coaching, consulting, supervision, and public speaking services. Amy holds a Masters degree in Counseling Psychology, is a fully licensed Mental Health Counselor (LMHC) in Washington state, and is trained in Relational Psychotherapy, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Attachment Focused Therapy, Filial Play Therapy, and Sand Tray Therapy. She currently works with individuals of all ages, families of all kinds, general counseling clients, and several monthly groups, ongoing retreats, and events.
Suenia Villagerardo
Clinical Social Work/Therapist, LCSW, CEAP, EMDR
Verified Verified
1 Endorsed
Seattle, WA 98122 (Online Only)
I use clay, drawing, writing, movement, dance and sand play to access deep feelings.
Virtual Sessions Only. I work well with anyone who seeks therapy and is ready to work on themselves. I have worked with about every population, culture and age group. Issues that I am best suited to treating include a wide variety of disorders, childhood trauma, addictions, domestic violence, parenting/bonding/interpersonal relationships. I certified in EMDR and expressive arts therapy. I like to offer different forms of expression to my clients in the healing arts. I also give plenty of skill building tools and homework so clients can maximize their progress outside of the weekly sessions. I speak Spanish fluently.
I use clay, drawing, writing, movement, dance and sand play to access deep feelings.
Virtual Sessions Only. I work well with anyone who seeks therapy and is ready to work on themselves. I have worked with about every population, culture and age group. Issues that I am best suited to treating include a wide variety of disorders, childhood trauma, addictions, domestic violence, parenting/bonding/interpersonal relationships. I certified in EMDR and expressive arts therapy. I like to offer different forms of expression to my clients in the healing arts. I also give plenty of skill building tools and homework so clients can maximize their progress outside of the weekly sessions. I speak Spanish fluently.
Chelsea Clemens
Counselor, MA, LMHC
Verified Verified
Tukwila, WA 98188
My joy as a therapist comes from working with kids, teens, and young adults (ages 5-25) who struggle to manage their thoughts, feelings, and behaviors. Kids, just like adults struggle to manage their emotions, however, unlike adults, they don’t quite have the developmental skills yet to communicate what they are experiencing. I utilize multiple therapeutic approaches to creatively approach each client and session based on the needs presented. I especially enjoy incorporating art and play into my sessions, which helps build on the normal communicative processes of kids that are not limited by traditional talk therapy.
My joy as a therapist comes from working with kids, teens, and young adults (ages 5-25) who struggle to manage their thoughts, feelings, and behaviors. Kids, just like adults struggle to manage their emotions, however, unlike adults, they don’t quite have the developmental skills yet to communicate what they are experiencing. I utilize multiple therapeutic approaches to creatively approach each client and session based on the needs presented. I especially enjoy incorporating art and play into my sessions, which helps build on the normal communicative processes of kids that are not limited by traditional talk therapy.
Carol Medlin
Licensed Professional Counselor Associate, MEd, LPC-A
Verified Verified
1 Endorsed
Seattle, WA 98101
I also help children navigate their behavior and feelings through play therapy and skill building.
I work with all age groups, from children to adults. I help adults and teens with depression, anxiety, and life transitions. I use futuristic planning and goal setting to address challenges you are currently facing. I believe in using strengths the individual already possesses and working as a team to assist an individual in reaching their therapeutic goals.
I also help children navigate their behavior and feelings through play therapy and skill building.
I work with all age groups, from children to adults. I help adults and teens with depression, anxiety, and life transitions. I use futuristic planning and goal setting to address challenges you are currently facing. I believe in using strengths the individual already possesses and working as a team to assist an individual in reaching their therapeutic goals.
Rion Lee Tisino
Clinical Social Work/Therapist, LICSW, CMHS, SUDPT, EMMHS, MHP
Verified Verified
1 Endorsed
Gig Harbor, WA 98335
TFS provides group therapy, social groups, protective parenting, father engagement services, anger management assessments, children and teen counseling, individual counseling, and family support services, utilizing Cognitive Behavior Therapy, Art-Play Therapy, Triple P framework, Behavior Modification techniques and Solution-focused approaches.
As I thought of the mission for Tisino Family Services, I thought of strength's-based. TFS facilitates children, youth, adults, and families back into the arms of what family means. One important goal of TFS is to reduce recidivism and teach preventative steps for sustaintainability. So often, I see individuals dealing with unmitigated trauma, self-identified barriers, and generational disadvantages without coping skills. This mission implements practical skills with persistence that capture the attention of specialized techniques that provides significant breakthroughs of unstable mental health and increase healthy living.
TFS provides group therapy, social groups, protective parenting, father engagement services, anger management assessments, children and teen counseling, individual counseling, and family support services, utilizing Cognitive Behavior Therapy, Art-Play Therapy, Triple P framework, Behavior Modification techniques and Solution-focused approaches.
As I thought of the mission for Tisino Family Services, I thought of strength's-based. TFS facilitates children, youth, adults, and families back into the arms of what family means. One important goal of TFS is to reduce recidivism and teach preventative steps for sustaintainability. So often, I see individuals dealing with unmitigated trauma, self-identified barriers, and generational disadvantages without coping skills. This mission implements practical skills with persistence that capture the attention of specialized techniques that provides significant breakthroughs of unstable mental health and increase healthy living.
Port Gardner Counseling and Services
Clinical Social Work/Therapist, LICSW
Verified Verified
Everett, WA 98201
Waitlist for new clients
I get kids to identify and talk about their feelings and their deepest vulnerabilities through talk, play and storytelling.
My clinical focus is children and teens in their families. My work with families is through an attachment lens. With the goal of helping families grow in relationship with each other so that emotions can be experienced in a new, meaningful and healing way. I help caregivers shift their perspective on their child's tantrums, meltdowns, and testing/defiant behaviors to grow the caregiver/child relationship to a secure and safe training ground. The child will learn to trust their emotions and through this practice grow into teens and adults who can set boundaries, trust their gut and take healthy risks as their sense of self grows.
I get kids to identify and talk about their feelings and their deepest vulnerabilities through talk, play and storytelling.
My clinical focus is children and teens in their families. My work with families is through an attachment lens. With the goal of helping families grow in relationship with each other so that emotions can be experienced in a new, meaningful and healing way. I help caregivers shift their perspective on their child's tantrums, meltdowns, and testing/defiant behaviors to grow the caregiver/child relationship to a secure and safe training ground. The child will learn to trust their emotions and through this practice grow into teens and adults who can set boundaries, trust their gut and take healthy risks as their sense of self grows.
Kim Bourgette
Counselor, MA, LMHC
Verified Verified
2 Endorsed
Silverdale, WA 98383
I utilize TF-CBT, play therapy and art therapy with children and adolescents.
I am currently accepting new clients ages 7 years and up. For many years now, I have been working with survivors of sexual assault, sexual abuse, and domestic violence, and all of the post traumatic symptoms that are experienced in the aftermath of trauma. My hope for your therapeutic process with me is that you experience personal growth and self-compassion, as well as gaining skills to cope with, and manage symptoms of anxiety, depression and other issues that create difficulty in living your best life.
I utilize TF-CBT, play therapy and art therapy with children and adolescents.
I am currently accepting new clients ages 7 years and up. For many years now, I have been working with survivors of sexual assault, sexual abuse, and domestic violence, and all of the post traumatic symptoms that are experienced in the aftermath of trauma. My hope for your therapeutic process with me is that you experience personal growth and self-compassion, as well as gaining skills to cope with, and manage symptoms of anxiety, depression and other issues that create difficulty in living your best life.
Mary Knight
Clinical Social Work/Therapist, LICSW
Verified Verified
1 Endorsed
Bellingham, WA 98226
The ages of my clients range from young children to gray-haired individuals like me! I am a child-centered play therapist.
Recovery is possible! I can help you in your healing journey because I have healed from my own major life traumas (abuse during childhood, domestic violence, divorce, and chronic pain). I now enjoy an active, healthy life. It is filled with joy, creativity, beauty, and love.
The ages of my clients range from young children to gray-haired individuals like me! I am a child-centered play therapist.
Recovery is possible! I can help you in your healing journey because I have healed from my own major life traumas (abuse during childhood, domestic violence, divorce, and chronic pain). I now enjoy an active, healthy life. It is filled with joy, creativity, beauty, and love.
Mindful Springs Counseling
Clinical Social Work/Therapist, LCSW
Verified Verified
Seattle, WA 98105
Our Seattle- based staff therapists have specializations in play therapy, trauma therapy (via Brainspotting and EMDR) and ketamine therapy.
Have you tried other therapists but did not seem to connect? Our staff bring mindfulness and cutting-edge healing opportunities so you have access to the deepest healing possible. From ketamine therapy to brainspotting to play therapy, the Mindful Springs Counseling staff are trained and certified in many different areas to meet the needs of our clients without bias or judgement. We want our clients to heal, move forward and transform their lives in the safest space possible, while offering real opportunity for healing and recovery.
Our Seattle- based staff therapists have specializations in play therapy, trauma therapy (via Brainspotting and EMDR) and ketamine therapy.
Have you tried other therapists but did not seem to connect? Our staff bring mindfulness and cutting-edge healing opportunities so you have access to the deepest healing possible. From ketamine therapy to brainspotting to play therapy, the Mindful Springs Counseling staff are trained and certified in many different areas to meet the needs of our clients without bias or judgement. We want our clients to heal, move forward and transform their lives in the safest space possible, while offering real opportunity for healing and recovery.
Ying Chiao (Livia) Chen
Counselor, MA, LMHCA, IMH-E®
Verified Verified
Seattle, WA 98188
My specialty: parenting, attachment, social-emotional development, emotional regulation, parent-child relationship, play therapy, infant and early childhood, children, stress, and perinatal mental health.
I love and enjoy working with children and parents! I am an early childhood educator as well as a mental health therapist. I offer therapy services for children and their families. I provide Infant and Early Childhood mental health and development services (ages 0-6), Children mental health (ages 7-12), parents, and perinatal mental health, and Adults (age 18 and above). I have worked with children and families for more than 6 years in a wide variety of settings, including schools, private daycare centers (infant/toddler/preschool/kindergarten), and community mental health clinics.
My specialty: parenting, attachment, social-emotional development, emotional regulation, parent-child relationship, play therapy, infant and early childhood, children, stress, and perinatal mental health.
I love and enjoy working with children and parents! I am an early childhood educator as well as a mental health therapist. I offer therapy services for children and their families. I provide Infant and Early Childhood mental health and development services (ages 0-6), Children mental health (ages 7-12), parents, and perinatal mental health, and Adults (age 18 and above). I have worked with children and families for more than 6 years in a wide variety of settings, including schools, private daycare centers (infant/toddler/preschool/kindergarten), and community mental health clinics.
Emotesy Child and Family Counseling Services
Psychologist, PsyD, LMHC, LISCW
Verified Verified
2 Endorsed
Lynnwood, WA 98036
Our clients come to Emotesy because they are struggling with behavioral issues, school problems, difficulties controlling worries, or poor emotion regulation skills. We are a team of providers that enjoy working with children, adolescents, and families. Working collaboratively with clients, Emotesy strives to create shared goals and build skills using play therapy and cognitive behavioral therapy. We're here to help bring out the best in your child and family. Our clients leave with new strategies to help them navigate behavioral challenges and a renewed sense of hope.
Our clients come to Emotesy because they are struggling with behavioral issues, school problems, difficulties controlling worries, or poor emotion regulation skills. We are a team of providers that enjoy working with children, adolescents, and families. Working collaboratively with clients, Emotesy strives to create shared goals and build skills using play therapy and cognitive behavioral therapy. We're here to help bring out the best in your child and family. Our clients leave with new strategies to help them navigate behavioral challenges and a renewed sense of hope.
Carly A Cassidy
Mental Health Counselor Associate, LPCC
Verified Verified
Mountlake Terrace, WA 98043 (Online Only)
Ihave experience with play therapy and animal assisted therapy.
As a therapist, I enjoy working with young adults,teens,and adolescents. Life can be difficult and overwhelming at times. It is my goal to work together with my clients to help them take steps to deal with lifes challenges. Anxiety, depression, and Low self-esteem are real issues, and I believe that we can develop strategies to grow and love ourselves and others. Therapy provides a connection and a chance to grow and change within any circumstances you may be experiencing.
Ihave experience with play therapy and animal assisted therapy.
As a therapist, I enjoy working with young adults,teens,and adolescents. Life can be difficult and overwhelming at times. It is my goal to work together with my clients to help them take steps to deal with lifes challenges. Anxiety, depression, and Low self-esteem are real issues, and I believe that we can develop strategies to grow and love ourselves and others. Therapy provides a connection and a chance to grow and change within any circumstances you may be experiencing.
See more therapy options for Anacortes
Nearby Play Therapy Searches for Anacortes
- Arlington
- Bellingham
- Burlington
- Coupeville
- Ferndale
- Langley
- Lynden
- Marysville
- Mount Vernon
- Oak Harbor
- Port Townsend
- Stanwood
Play Therapy
Who is play therapy for?
Play therapy is generally targeted to children between the ages of 3 and 11 who have social, emotional, or behavioral difficulties. Play therapy has also been found helpful for children who have experienced physical or emotional abuse or witnessed atrocities. Play therapy is also often recommended for children who are undergoing major medical procedures or who are suffering from chronic illness; many children’s hospitals are equipped to offer play therapy on-site. Play therapy is also sometimes used for adults; creative writing, music, and art are expressive forms that can all be adapted for therapeutic purposes.
Why do people need play therapy?
Children often do not have the language skills or words to know or to express what is troubling them. Yet they often spontaneously draw or use playthings to depict scenarios that reflect problems in their everyday life. Play therapy provides children with an array of objects and play situations to act out their feelings or experiences so that therapists can get a clear picture of what children might be struggling with and help them find solutions. In addition, play therapists are skilled at helping children understand their inner experience and find words for them, necessary steps toward helping children learn to control their own behavior and come up with solutions to problems they encounter.
What happens in play therapy?
A child enters a comfortable playroom where they are free to choose the objects they want to play with. The play therapist will typically observe how they play with the toys—whether a sandbox, puppets, dolls and action figures, trucks, costumes, drawing and painting materials, or more—because such play provides clues to a child’s family and social relationships, difficulties they are encountering in the world, and what going on inside themselves. Sometimes the therapist may ask the child to use the play objects to tell a story about their family. Using the same instruments of play, therapists can help children discover more advantageous ways of thinking and behaving.
What kinds of problems do play therapists treat?
Play therapy can help children who display destructive or self-destructive impulses; children who seem angry, sad, or fearful; children who experience frequent social, emotional, family, or school difficulty. Play therapy is often of value to children who have experienced a loss or distressing family experience, who are regularly exposed to family conflict, or who have been physically or emotionally abused. Play therapy can help children who are perpetrators of bullying as well as those who are targets of bullying. It helps children learn to identify their feelings, to express them in constructive ways, and to regulate them so they can get on with the business of development.
How long does play therapy last?
Play therapy sessions may last for 30 to 45 minutes, and they usually occur weekly for about 20 sessions. Each session is tailored to the individual child and the kinds of problems they are struggling with. Play that is highly repetitive often indicates a problem requiring further exploration. Therapists typically measure progress through session-to-session changes in play behavior.