The information in this program outline is provided by the program representative and edited by the CEBC staff. The Theraplay program has been rated by the CEBC in the area of: Infant and Toddler Mental Health (0-3).

• Types of Maltreatment: Physical Abuse, Physical Neglect, Emotional Abuse, Exposure to Domestic Violence
• Target Population: Children ages 0-18 who exhibit behavioral problems and their caregiver (biological, adoptive, or foster).

Theraplay is a structured play therapy for children and their parents. Its goal is to enhance attachment, self-esteem, trust in others, and joyful engagement. The sessions are designed to be fun, physical, personal, and interactive and replicate the natural, healthy interaction between parents and young children. Children have been referred for a wide variety of problems including withdrawn or depressed behavior, overactive-aggressive behavior, temper tantrums, phobias, and difficulty socializing and making friends. Children also are referred for various behavior and interpersonal problems resulting from learning disabilities, developmental delays, and pervasive developmental disorders. Because of its focus on attachment and relationship development, Theraplay has been used for many years with foster and adoptive families.

Session structure:

• The first session is an information-gathering interview with the parents.
• The second and third appointments are observation sessions using the Marschak Interaction Method (MIM), in which the child and one parent perform a series of interactive tasks together. The MIM is a structured technique for observing the relationship between two individuals. It consists of a series of simple tasks designed to elicit a range of behaviors in the four Theraplay dimensions: Structure (key concepts: Safety, Organization, Regulation); Engagement (key concepts: connection, attunement, acceptance, expands positive affect); Nurture (key concepts: regulation, secure base, worthiness); Challenge (key concepts: competence, confidence, supports exploration).The interactions are videotaped and later analyzed by the therapist(s) in preparation for a fourth session with the parents.
• The fourth session is a planning session where the therapist(s) and parents discuss their observations of the interaction and together agree on a plan for treatment.
• Sessions five through twenty involve direct Theraplay with the family.

The essential components of Theraplay treatment are:

• It is interactive and relationship-based and utilizes innate capacities for social interaction (rhythm, affective resonance and synchrony, and mirror neuron functions).
• It provides a direct, here and now experience and utilizes now moments, non-congruence, and multiple foci of change.
• It is guided by the adult and utilizes concepts of holding environment, authoritative parenting, and resilience building.
• It is responsive, attuned, empathic, and reflective and utilizes contingency, primary intersubjectivity, attunement to vitality and categorical affects, empathy, mindfulness, and reflective function.
• It is geared to the pre-verbal, social, right brain level of development and utilizes concepts of experience-dependent brain development, primacy of right brain development in early life, and co-regulation of physical and emotional internal states.
• It is multisensory and utilizes touch and appropriate stimulation of body senses for social development, attachment, regulation of physiological development, stress reduction, and positive body image
• It is playful, but does not employ a lot of toys or props and utilizes affective synchrony and amplification of interest and joy to connect with the child.
• Parents are involved in the treatment and it strives to give parents a more positive, empathic view of their child, to have them become competent co-therapists, to teach them about appropriate developmental expectations, and to consult about behavior management.

Theraplay was designed with a child component that addresses the following presenting problems and symptoms:

• Withdrawn, depressed, fearful, shy, acting out, angry, non-compliant, Oppositional Defiant Disorder, relationship and attachment problems, Reactive Attachment Disorder, PTSD, complex relational trauma, Developmental Trauma Disorder, regulatory problems, ADHD, autism spectrum disorders, and developmental delays.

Age range: 0 – 18

Developmental Delays:

This program was developed for children with developmental delays; but has not been tested for children with developmental delays.

Theraplay was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Has a behavioral/relationship problem with their child, was not well-parented and needs to experience how being taken care of feels.

Theraplay was designed to be conducted in a group setting, and has been tested for use in a group setting.

Recommended group size:

4-10

Testing References:

Siu, A. F. Y. (2009). Theraplay in the Chinese world: An intervention program for Hong Kong children with internalizing problems. International Journal of Play Therapy, 18(1), 1-12.

Recommended Intensity:

Families typically receive 30-45 minute weekly sessions (shorter for younger children).

Recommended Duration:

Approximately a year and a half (weekly for 18-24 weeks then four follow-up sessions).

This program is typically conducted in a(n):

• Adoptive Home
• Community Agency
• Foster Home
• Hospital
• Outpatient Clinic
• Residential Care Facility
• School

Theraplay includes a homework component:

Parents use the play activities at home with their child, starting with activities that have been enjoyed during therapy.

Theraplay has materials available in languages other than English:

Finnish, German, Japanese, Korean, Spanish, Swedish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

The typical resources for implementing the program are:

Ideally, an agency would have a treatment room of approximately 150 square feet (12 x 12) or larger , with a small couch or love seat, a cabinet with doors for supplies, and two 3 feet by 8 feet gym mats. Optimally there would be very few other games/toys/furniture in order to reduce distraction. Optimally there would be an adjacent observation room with a one-way mirror to see the session. This requires some type of audio system (baby monitors are fine). Furthermore, a camcorder for recording the sessions and a computer or other mode to play back the videos is necessary. Videotaping would only be done with client's consent. It is possible but not optimal to practice the model without videotaping.

One must have a Master's or doctoral level degree in a mental health field that prepares one to provide clinical services to families and children, and one must be fully licensed to provide these services independently to complete the introductory and intermediate trainings and become a certified therapist. Individuals may earn associates status and work under competent clinical supervision, if they have not fulfilled the education level required to be a certified therapist. Supervisors and trainers must be licensed therapists for at least two years prior to entering the supervisor/trainer practicum.

It is recommended that all participants in the introductory level training have a masters or doctoral degree as above, but students will be admitted as well.

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:

• Dafna Lender, Training Director
  The Theraplay Institute
  info@theraplay.org
  phone: (847) 256-7334

Training is obtained:

The training is offered three times yearly in Chicago and on-site upon request, including open registration training at host venues.

Number of days/hours:

The Introductory Theraplay & MIM training is 26 contact hours over four days. Intermediate training is 19 contact hours over three days. The supervision practicum to become certified includes an additional 40 supervised hours.

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being