Theraplay

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

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

Target Population: Children ages 0-18 who exhibit behavioral problems and their caregiver (biological, adoptive, or foster)

For children/adolescents ages: 0 – 18

For parents/caregivers of children ages: 0 – 18

Brief Description

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 Children have been referred for a wide variety of problems including withdrawn or depressed behavior, overactive-aggressive behavior, temper tantrums, phobias, and difficulty socializing and making friends.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.

Program Goals:

The goals of Theraplay are:

  • Increase child's sense of felt safety/security
  • Increase child's capacity to regulate affect
  • Increase child's sense of positive body image
  • Ensure that caregiver is able to set clear expectations and limits
  • Ensure that caregiver’s leadership is balanced with warmth and support
  • Increase caregiver's capacity to view the child empathically
  • Increase caregiver's capacity for reflective function
  • Increase parent and child's experience of shared joy
  • Increase parent's ability to help child with stressful events

Essential Components

The essential components of Theraplay include:

  • Session structure:
    • First session: Information-gathering interview with the parents.
    • Second and third sessions: 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.
    • Fourth session: Planning session where the therapist(s) and parents discuss their observations of the interaction and together agree on a plan for treatment
    • Fifth through 20th session: Direct Theraplay with the family
  • Treatment components:
    • Interactive and relationship-based and utilizes innate capacities for social interaction (rhythm, affective resonance and synchrony, and mirror neuron functions)
    • Provides a direct, here and now experience and utilizes now moments, non-congruence, and multiple foci of change
    • Guided by the adult and utilizes concepts of holding environment, authoritative parenting, and resilience building
    • Responsive, attuned, empathic, and reflective and utilizes contingency, primary intersubjectivity, attunement to vitality and categorical affects, empathy, mindfulness, and reflective function
    • 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
    • Multisensory and utilizes touch and appropriate stimulation of body senses for social development, attachment, regulation of physiological development, stress reduction, and positive body image
    • 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
    • Involves parents n the treatment and 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
  • Typically provided as family therapy but has a group version available with a recommended group size of 4-10

Child/Adolescent Services

Theraplay directly provides services to children/adolescents and addresses the following:

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

Parent/Caregiver Services

Theraplay directly provides services to parents/caregivers and addresses the following:

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

Delivery Settings

This program is typically conducted in a(n):

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

Homework

Theraplay includes a homework component:

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

Languages

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).

Resources Needed to Run Program

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.

Minimum Provider Qualifications

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.

Education and Training Resources

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

    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.

Implementation Information

Since Theraplay is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Theraplay.

Formal Support for Implementation

There is formal support available for implementation of Theraplay as listed below:

The Theraplay Institute maintains a Theraplay Certification program. Professionals who have taken the Level 1 training can enroll in the supervision program which has three levels of competence. The most intensive level, with 37 hours of training, ends with full certification. The supervision portion of the training requires participants to video their sessions. Supervision is conducted online, individually and in groups, with the Theraplay Institute via a secure website.

Fidelity Measures

There are fidelity measures for Theraplay as listed below:

The Theraplay certification practicum enables practitioners to verify the fidelity of their implementation by videotaping their sessions and receiving supervision from certified Theraplay supervisors. There is a standard Theraplay session evaluation form that supervisors and students must complete at 3 levels of advancement in the practicum. At the midterm and final exam level, an additional, objective 2nd evaluator reviews students work in order to ensure inter-rater reliability.

Implementation Guides or Manuals

There are implementation guides or manuals for Theraplay as listed below:

The book Theraplay: Helping Parents and Children Build Better Relationships Through Attachment-Based Play, 3rd Edition, is the program manual. It gives the full description of the treatment and how to implement in its basic form at as well variations for specific populations such as autism, adolescents, complex trauma, adoption, and more. The manual is available at https://theraplay.org/index.php/js-books-videos-media-2.

Research on How to Implement the Program

Research has not been conducted on how to implement Theraplay.

Relevant Published, Peer-Reviewed Research

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

Show relevant research...

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.

Type of Study: Randomized controlled trial
Number of Participants: 46

Population:

  • Age — Mean=7.8 years
  • Race/Ethnicity — 100% Chinese
  • Gender — 25 Males and 21 Females
  • Status — Participants were children recruited from an elementary school whose internalizing score on the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) reached a clinical cutoff point.

Location/Institution: Hong Kong

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Potential participants were given a baseline evaluation using the CBCL/6-18 and those whose internalizing scores reached the cutoff point were randomly assigned to receive the Theraplay intervention or to a wait-list control group.  Intervention children received 8 weekly sessions incorporating a variety of activities involving physical interaction, playfulness and establishing a sense of connection.  Mothers were included in the later sessions.  At the end of the intervention, mothers again completed the CBCL/6-18.  Results showed a significantly greater decrease in CBCL/6-18 internalizing scores for the intervention group than for the control group at post-test. Limitations include lack of long-term follow-up.

Length of postintervention follow-up: None.

Wettig, H. H. G., Coleman, A. R., & Geider, F. J. (2011). Evaluating the effectiveness of Theraplay in treating shy, socially withdrawn children. International Journal of Play Therapy, 20(1), 26-37.

Type of Study: Pretest-posttest control group design
Number of Participants: 189

Population:

  • Age — 2-6 years
  • Race/Ethnicity — German and Turkish
  • Gender — 64% Male and 36% Female
  • Status — Participants were children with language disorders, behavioral problems, and shyness/social anxiety referred from German and Australian medical centers.

Location/Institution: Germany and Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study assessed the efficacy of Theraplay, a directive, short-term, attachment-based play therapy, for dually diagnosed children with language disorders and shyness/social anxiety. Participants were assigned in two waves to treatment conditions or a no-treatment control group and completed the German version of the Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP-D) at intake, post-intervention, and at 2-year follow-up for study 1 participants. Study 1 was longitudinal, with 22 children treated at a single institution by 1 therapist. Study 2 incorporated 167 subjects and therapists across multiple centers to evaluate generalizability. Results indicated that children improved significantly on assertiveness, self-confidence, and trust. Social withdrawal was reduced. Expressive and receptive communication improved. Many behaviors normalized compared with neurologically healthy controls. Improvements were maintained over a 2-year period without relapse. Limitations include a lack of randomization.

Length of postintervention follow-up: 2 years (study 1 only).

References

Bennett, L., Shiner, S. K., & Ryan, S. (2006). Using Theraplay in shelter settings with mothers and children who have experienced violence in the home. Journal of Psychosocial Nursing and Mental Health Services, 44(10), 38-48.

Booth, P. B. (2000). Forming an attachment with an adopted toddler using the Theraplay approach. In: The Signal. Newsletter of the World Association for Infant Mental Health, July-Sept, 8(3).

Robison, M., Lindaman, L., Clemmons, M. P., Doyle-Buckwalter, K., & Ryan, M. (2009). “I deserve a family”: The evolution of an adolescent’s behavior and beliefs about himself and others when treated with Theraplay in residential care. Child and Adolescent Social Work Journal, 26, 291-306.

Contact Information

Name: Dafna Lender, MSW, LCSW
Agency/Affiliation: The Theraplay Institute
Website: www.theraplay.org
Email:
Phone: (847) 256-7334
Fax: (847) 256-7370

Date Research Evidence Last Reviewed by CEBC: May 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: December 2009