What is Theraplay?

Ulrike Franke Theraplay is an interactive and playful short-term therapy. The therapeutic treatment is conducted by trained and certified therapists, and can be applied to infants, toddlers, preschool children, adolescents, adults, or the older ones who are experiencing attention deficit disorders, social interactive, communicative or attachment disorders. In the German speaking countries Theraplay focuses first and foremost on toddlers and preschool children with dual diagnoses of emotional or social interactive impairment and developmental language disorders. Theraplay is practiced in either individual or group therapy. Theraplays History Theraplay is a therapeutic intervention method, which was developed in the 1960s within the Head Start Project in the United States to give socially deprived children an improved prospect on life, while reducing the federal cost for treating emotionally and socially disordered children. The Chicago psychologist Ann M. Jernberg, Ph.D. (1979) accepted the task of developing an adequate therapeutic method. At that time, conventional therapeutic measures could only reach a fraction of needy children. Therefore she designed a therapeutic method choosing eclectically proven methods combining with her own knowledge out of hundreds of observed mother-child relationships. This new method was effective in spite of being a short-term and cost effective treatment which had to be conducted reliably by trained individuals, not necessarily academic people or clinical psychologists. The intervention is based on a good mother-child relationship(Jernberg, 1979; Jernberg & Booth, 1999). Behavioral patterns within such a relationship were observed to learn what is needed by a healthy child so that this could be implemented with a child in therapy. To do this, she focused on natural patterns of behavior between parents and their young children for her model. She observed a large number of well-functioning child-parent-relationships and identified four effective criteria of interpersonal behavior: structuring; challenging; engagement; as well as nurturing. The short-term play therapy, Theraplay, was born. Theoretical Ground-Work of Theraplay The four criteria of effective nurturing, structuring, challenging, as well as engagement appear to be very important in the early childhood development of social skills. In the past decade, research has expanded our understanding across fields. For example knowledge acquired from the Attachment Theory (e.g., Brisch, 1999) has shown what contribution Theraplay has had on the treatment of attachment disordered children. Furthermore Winnicotts idea of a good enough mother (1971, 1985), John Bowlbys insight on childrens need to attach (1969), as well as adequate behavior of their mothers, found their way into the Theraplay philosophy (Jernberg & Booth, 1999; Booth, 2003). In addition, research done by Tiffany Field (2001) on the importance of touch within the parent-child-

relationship strengthened Theraplay therapists to touch children in a kind, loving, healing, and soft or activating manner just as their parents do. Research data within interpersonal neurobiology (Hughes, 1997; Schore, 1994, 2003; Siegel, 1999, Siegel & Hartzell, 2004) confirm the importance of giving children a solid emotional foundation by means of interacting with them appropriately, as this is the only way the hippocampus, pre-frontal, and orbito-frontal cortex of the right (primarily emotional) hemisphere of the brain can develop into a good foundation to integrate and to build a network of various regions of the brain. Playing, especially interactive games is a useful means of regulating affect, balancing between tension within the interaction and the muscle tone of the body (Kayser & Kayser 2001). This is an important fact when communication is impaired in young children (e.g., developmental language delay or impairment). Researchers like Stern (1985) or Papouek et al. (2004) verify Theraplay therapists use of sensitive and empathetic methods when treating children. Theraplay Setting (e.g. individual therapy) The therapist and the child are in a room with very little distraction. There are only a few useful materials in place. Both are seated on a mat, with the child seated either on a flexible and warm pillow, or on the therapists lap or on a cushion in front of the co-therapist. This kind of setting facilitates the relationship process. Figure 1: A therapist (covered by the shown far shot) in the Theraplay setting with a child on the lap of her co-therapist Parents or care takers observe the Theraplay treatment of their children, either by looking through a one-way screen or watching a video recording of the therapeutic session taking place. Afterward, in the parent-therapist consulting meeting, certain parts of the video are shown, explained, clarified and questions are answered. Indications and Contraindications Theraplay has been especially reliable when treating children suffering from socio-emotional disorders. These include attention deficit disorder; attachment disorder; emotional disorders such as shyness, withdrawnness and anxiety; social interaction disorder, or behavioral disorders such as a lack of willingness to cooperate; oppositional defiant behavior or aggression; and pervasive developmental disorders within the autism spectrum. Since children are strongly motivated to open up, and show interest in social relationships while reducing symptoms of behavioral disorder (e.g. inattentiveness, a lack of willingness to cooperate, opposing defiance or aggressiveness). Theraplay has been extremely reliable in German speaking countries when used as a complementary therapy in preparing developmental language disordered children for speech and language therapy. Such children are motivated to get interested in social interaction, and to reduce symptoms of inattentiveness, oppositional defiance, aggressiveness, and to improve their ability of social mutuality. Theraplay has shown to be contraindicated in children involved in a symbiotic relationships with one

parent, or if the child stems from such a different cultural background that Theraplay does not apply family principles. Furthermore, the success rate is weakened when parents of the suffering child do not trust or are skeptical of the therapeutic measures, and go against therapeutic activities. Apart from that, Theraplay is not indicated once the disorders are treatable by behavioral or cognitive therapy. Methods of Theraplay The goals of Theraplay treatment depends on the specific disorders of each child, and the childs individual and social development needs. In a clear structured game situation the Theraplay therapist bonds with the child creating a positive interaction that is fun for the child. The childs resulting trust enables the therapist to establish a relationship based upon the childs growing selfesteem. Each child is offered an individual relationship and playful challenge, according to what the child needs and not what the child desires. The therapeutic scheme is, on one hand, a ritual that mediates a feeling of security und peacefulness. On the other hand, games give the child an adequate structure according to his or her developmental (not chronological) age, stimulating the child as well as challenging to enhance self-esteem. Duration of Theraplay The average duration of therapy, or the number of therapy sessions, strongly depends on the type of disorder, the childs characteristics and age, parental support and participation as well as the defined goal. So far the statistical average accumulated over all disorders treated with Theraplay is from 18 to 20 sessions, and about 25 to 27 when treating autism, in orderto reach the defined goal. One session effectively takes 30 minutes (not including preparation and follow-up evaluation time) and takes place once a week. References Bowlby, J. (1969). Attachment and Loss. Vol. 1: Attachment. London: Hogarth Press Field, T. (2001). Touch. Cumberland: Bradford Books. Franke, U. (2001). Erfahrungen mit intensivem Theraplay. In: Schwierige Kinder 25, 2001. Hughes, D.H. (1997). Facilitating Developmental Attachment. Northvale, N.J.: Jason Aronson, Inc. Jernberg, A. M. (1979). Theraplay. San Francisco: Jossey-Bass Inc. Publishers. Jernberg, A.M., and Booth, Ph. (1999). Theraplay. Helping Parents Build Better Relationships Through Attachment-Based Play. San Francisco, CA: Jossey Bass Kayser, A. und Kayser, E. (2001). Spiel, Spielen, Therapie. Idstein: Schulz-Kirchner Verlag. Papoucek, Wurmser und Schieche (2004). Regulationsstrungen der frhen Kindheit im

Entwicklungskontext der Eltern-Kind-Beziehung. Bern: Hans Huber Verlag. Schore, A. N. (1994). Affect Regulation and the Origin of the Self. The Neurobiology of Emotional Development. Hillsdale, N.J.: Lawrence Erlbaum Ass., Publishers Schore, A. N. (2003). Affect Dysregulation and Disorders of the Self. New York, N.Y.:W.W. Norton &

Company, Inc. Siegel, D. S. (1999), The Developing Mind. Toward a Neurobiology of Interpersonal Experience. New York, N.Y.: The Guilford Press, Guilford Publications, Inc. Siegel, D. S., and Hartzell, M. (2003). Parenting from the Inside Out. Penguin Group, Inc. Stern, D. (1985). The Interpersonal World of the Infant. A View from Psychoanalysis and Developmental Psychology. New York, NY.: Basic Books, Inc., Publishers Winnicott, D.W. (1971). Playing and Reality. London: Tavistock Winnicott, D. W. (1985). Kind, Familie und Umwelt. Mnchen: Ernst Reinhardt Verlag.