THERAPLAY

Report
THERAPLAY: A Child Therapy for Attachment Fostering
Ann Jernberg, 1984
The quality of early parent-child relationships can range from esteem-embracing to esteemjeopardizing.
Used two techniques: Marschak Interaction Model & Theraplay
The childs capacity for attachment is strongly determinative of later mental health.
Both infant temperament and parental behavior can serve to either enhance or inhibit he
development of this capacity in the child.
Not being heard or valued colors the kin of present or future behavior which is based in self-esteem.
If poor parenting leads to faulty self-esteem, later remedial healthy parenting is the means for
setting the record straight.
Theraplay: the theraplay therapist, like the parent:
1. Takes charge
2. Communicates the childs uniquely wonderful qualities
3. Protects the child from hurts and tenderly cares for scratches, bumps, and bruises.
4. Makes eye contact whenever possible
all these behaviors the Theraplay therapist carries out according to the individual childs underlying
needs.
For failure to attach children who are not true sociopath but only behave in sociopathic ways
because of an early attachment deficit, Theraplay can be appropriate, particularly in the case of
late adopted children, the new family bonding context being a prime example.
It is always done in a spirit of playful cheer and optimism.
It is to provide this understanding of the parent-child relationship that the ideal course of Theraplay
includes a traditional intake interview as well as the administration of the MIM, videotaped if
possible.
MIM: consists of a series of tasks which each parent separately is instructed to perform with his or
her child.
It is designed to tap the following dimension on the part of the parent: promotes attachment,
guides purposive behavior, alerts to environment, and aids in reducing stress.
On the part of the child, it taps: shows attachment, shows purposive behavior, shows alertness to
environment, and shows ability to cope with stress.
FAMILY THERAPLAY: is conducted in two adjoining rooms and in two time segments.
During the first half of the approximately 20 session Theraplay treatment course, parents do not
directly participate in their childs treatment: only during the second half.
There will be an interpreting Therapist, sitting with the parents: he/she:
1. Discusses theraplay strategies and the Theraplay rationale.
2. Calls attention to their childs keep away and other maneuvers.
3. Asks about problem area and successful coping during the week gone by
4. Gives Theraplay hints and guidance regarding the week ahead
5. Allows the expression of acceptable and unacceptable wishes, fears, and fantasies
6. Explore resistances
7. Attempts to redirect or refer for further help those marital issues which particularly at that time,
affects the child
family Theraplay need not include both parents and may include grandparents or stepparents
Although the one-way mirror and the interpreting therapist are ideal, when not available, Family
Theraplay can be conducted as follows: Parents observe their child and his/her therapist while
sitting along a wall inside the Theraplay room.
Treatment course:
1. Introduction the child meets the therapist and learns the rules of the game
2. Exploration the child gets to know the therapist
3. Tentative acceptance the child puts on the appearance of buying the package
4. Negative reaction the child openly refuses any and all efforts at intimacy
5. Growing and trusting the child begins to experience the genuine pleasure of the relationship
case of Horace
Horace was a child who needs attention in a basic physical, close, and playful way.

 The therapist has also gently begun the process of urging them to do at home some nurturing and
playfully intrusive activities wit Horace and to omit question marks, apologies, and legalistic
discussions.
In the course of the Theraplay belated-bonding program, attachment emerges as the parents are
taught to playfully infantilize their child even though he or she may be chronologically of school
age.
A Practical Approach to Implementing Theraplay for Children with ASD
Simeone-Russell, 2011
Theraplay is a form of therapy that uses elements of play therapy to assist children in forming
better attachment relationship with others.
It rests on the assumption that a powerful, therapeutic attachment relationship can be developed
between the therapist and child.
The assumption is that the child can develop a healthy attachment relationship with the therapist.
GOAL: for children to develop healthy attachments and feel the security that comes from this
development, which will in turn allow them to securely explore the world and develop into who they
want to become.
Results from the 2007 National Survey of Childrens Health suggest that approximately 110 per 10,
000 children aged 3 to 17 are diagnosed with ASD, totaling an estimated 673, 000 children that
have been diagnosed with this condition.
Theraplay is said to be effective in dealing with children with ASD. It mentioned studies by Wettig,
Franke and Fjordbak (2006), Wettig, Coleman and Geider (2011), and Siu (2009). These studies
demonstrate support for the effectiveness of Theraplay, however it suggested that further research
should be done in order to show the effectiveness of Theraplay in a classroom setting.
Group Theraplay in a classroom setting: it can be implemented with multiple children in a classroom
setting with a mental health professional and teacher present. By doing so, not only do children
with ASD benefit, but the rest of the children in the classroom are also able to participate in the
group.
Theraplay can be integrated into the classroom in order to help the teacher facilitate childrens
needed emotional and social development, as well as foster nurturing relationship with each child.
A Practical Approach for Group Theraplay in a Classroom Setting: Theraplay can be used with a
mental health professional and child, in a small group of children or even with a classroom of
children.
It is important to note that school counselors and other mental health professionals that work in a
school setting may be responsible for serving several hundred children.
It is recommended that MHPs and teachers receive Theraplay training through a certified training
from The Theraplay Institiute in Chicago; specifically the Group Theraplay training class, which can
be completed in one day.
It would appear that a kindergarten classroom is an ideal setting to implement Group Theraplay.
Group Theraplay in a kindergarten classroom would allow the MHPs and the teacher to work with
children with ASD on engaging and interacting with peers, as well as creating healthy relationships
between the children and teacher, thereby enhancing childrens attachment to the teacher.
Goals: developing sense of self, recognizing others as separate form themselves, and developing
trust with others.
Supplies that can be used: sensory balls, bubbles, lotion, cotton balls, blanket, newspapers, and
small crackers.
Permission form: need to sent home to the parents of the children participating in the group.
(purpose and goals of the session; time frame)
Proposed plan: Tuesdays and Thursdays at the end of the school day for 30 mins for 10 weeks,
resulting in 20 sessions.
Ethical Considerations: confidentiality, counseling relationship, group work
Parents are informed about the group and the goals of the group, provide permission form, and
provided with contact information, educating staff members and parents on the purpose of the
touch.
By providing Group Theraplay, the MHPs is able to help mainstreamed children with ASD to form
healthy attachments to their teachers. Children with ASD can work toward academic and
developmental success in the classroom setting, development of supportive relationships with
teachers and the mental health processional, and improvement in social interactions with peers.

 ENGAGEMENT ACTIVITIES: enable children to gradually ease into interacting with other while slowly
and methodically learning appropriate social response.
NURTURE ACTIVITIES: allow children with ASD to feel taken care of, valued, accepted and loved.
CHALLENGE ACTIVITIES: provides the ability to explore new things and to be successful in those
attempts.
Overall, children with ASD would ideally be able to build trust with those participating in the group
and work on changing maladaptive behaviors that are impeding their success in forming healthy
relationships with others.
Group Theraplay gives the teachers a tool to use as they focus on developing a healthy attachment
between the self and the children with ASD.

Evaluating the Effectiveness of Theraplay in Treating Shy, Socially Withdrawn Children

Wettig, Coleman, & Geider, 2011
Shyness has been related to a temperament style associated with behavioral inhibition, identifiable
in infancy and early childhood with physiological, cognitive and behavioral issues.
There are neurobiological, neuropsychological, cognitive and physiological factors in extreme
shyness.
Treatment at younger ages for social withdrawal, shy behavior and anxiety can successfully
promote improved social adjustment and school functioning and may reduce the risk of more
serious mental health problems. Treatment of childhood separation anxiety and general anxiety
successfully has been shown to improve both academic and social functioning.
The characteristics of Theraplay seem particularly well matched for treatment of children with
exceptional shyness and social anxiety. It has the potential to improve communication, as well as
affective and social variables that impact social confidence.
THE HYPOTHESIS OF THE STUDY WAS THAT CHILDREN RECEIVING THERAPLAY WHOULD
DEMONSTRATE REDUCTION IN SHY BEHAVIORS, SOCIAL WITHDRAWAL, AND SOCIAL ANXIETY AS
MEASURED BY A STANDARDIZED BEHAVIORAL RATING SCALE AND THAT THEY WOULD
DEMONSTRATE BEHAVIORAL RATINGS CLOSER TO THOSE NORMAL CONTROLS.
First study: examining the effects of Theraplay with a homogeneous group of children selected from
a single institution and delivered by a single, very experienced clinician.
Second study: draw subjects from multiple centers using multiple Theraplay therapists. This allowed
for demonstrating generalizability of the therapy across conditions.
METHOD
Study 1: Controlled Longitudinal Study (CLS)
Participants were selected from an initial pool of 60 consecutive children reffered to a single medical
center in Germany for evaluation and treatment of developmental language delay and behavioral
disorders. It was based on having a dual diagnosis of language and behavioral disorder.
22 children were diagnosed with clinically significant social anxiety and language disorder.
Age range of 2 yo 6 mos to 6 yo 11 mos, with an average of 4 yo 1mos.
Study 2: Multicenter Study (MCS)
Participants were selected from a pool of 333 patients to nine separate medical centers across
Germany and Austria for treatment of behavioral disorders and language delays.
167 children were diagnosed with clinically significant social anxiety and language disorder.
Age range of 2.5 yo to 6 yo 11 mos, with an average of 4.5 yo.
Measure: Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP-D)
Why: ease of administration and it was already used as part of basic documentation for all children
in pediatric and psychiatry clinics across Germany and Switzerland
CASCAP-D shyness are timidity, inattentiveness, uncooperativeness, overadapting/conformity,
socially withdrawn.
Treatment setting: CLS therapy room with an observation room alongside, with one-way mirror.
Treatment setting: MCS therapists regular therapy room
Treatment Procedure: CLS single certified Theraplay conducted sessions directly with the child.
The therapist maintained credentials consistent with German laws and was certified in Theraplay
through rigorous training.

 Session structure was similar across children and lasted 30-45 mins.
Initial sessions were conducted with the therapist-child. Parents are observing and receiving
feedback from the cotherapist. Subsequent sessions increasingly involved the parents to improve
the parent-child interactions and practice skills to be generalized to the home.
The transition of parent from observer to active participants in play was gradual starting with
participation in one or two activities and increasing to full participation.
Timing and degree of participation were individualized, based on parent learning curve, comfort
with the process and demonstration of confidence and competence.
Treatment procedure: MCS postgraduate trained and certified Theraplay therapists. A certified
Theraplay trainer-supervisor ensured treatment integrity across sites.
Initial assessment and evaluation in early sessions were used to guide the choice of activities to
specifically address the child needs and clinical concerns. Therapist has a planned set of activities
and clear rules and boundaries.
Activities were designed to promote social engagement, keeping interaction focused on the
relationship between the therapist and child and later between the parent and the child.
The therapist offers activities which promotes self-esteem, feelings of competence, and self-efficacy.

 Therapeutic activities were chosen depending on the developmental rather than chronological age.
Movement games, singing, feeling the child, racing, bubble blowing, catching balloons or feathers,
patty cake clapping, among others.
Both CLS and MCS required an average of 18 sessions.
RESULTS AND DISCUSSION
Both studies were consistent in demonstrating significant improvements in shy behavior after a
course of Theraplay treatment. The improvements in attention, cooperation, assertiveness, social
withdrawal, and trust.
Findings:
1. The improvement in the clinical subjects in the MCS was similar to that of subjects in the CLS,
despite the fact that MCS was carried out by 14 therapists in nine institutions across Germany and
Austria. This suggests that Theraplay is highly replicable across settings and therapists with proper
training.
2. Although starting out significantly different from normal controls, many of the symptom domains
normalized during the course of therapy, suggesting a clinically significant improvement in addition
to statistically significant change.
3. The gains were sustained over time based on the 2-year follow-up from the CLS. It is likely that
improved social skills are self-maintaining given natural social contingencies.
4. There was an improvement in the childrens receptive language abilities even though this was
not the direct aim of the therapy. A possible explanation for language improvement is the intensive
modeling and practice of social interaction. A second explanation is that decreased social anxiety
facilitates increased attempts at verbal communication with other adults and peers in daily life.
5. A fifth point of relevance is the relatively short time required to achieve lasting therapeutic
effects. An average of 18 sessions was needed to achieve improvements, although some children
required longer courses of treatment. Cost of any medical treatment and time involved can present
barriers to treatment participation.
6. it is important to note the young age of the participants. Theraplay is considered a
developmental therapy (Jernberg & Booth, 1999), a therapy that can be applied across the age
span and adjusted for the developmental needs of the client.
Theraplay in the Chinese World: An Intervention Program for Hong Kong Children with Internalizing
Problems
Siu, 2009
The primary objective of this study was to evaluate the effectiveness of Theraplay on reducing
internalizing problems among young children.
Externalizing problems: acting out behaviors, such as aggression ad delinquent behaviors
Internalizing problems: withdrawn behaviors and somatic complaints, often unnoticed,
Internalizing problems tend to affect various social and school activities, that usually hinder
childrens readiness for learning, can increase the risk for suicide attempts, can develop into
psychiatric conditions such as depression and anziety, WHICH IS WHY EARLY INTERVENTION IS
IMPORTANT.
Penn Optimism Program and Coping Koala Program are some of the interventions used in reducing
or preventing childhood internalizing problems. They are mostly Cognitive-behavioral in nature.
The power of play has been recognized as part of the intervention process and it can be an
important way to enhance childrens socioemotional developments.
It was hypothesized that: compared with a waitlist control group, this study reported that
adolescents who received interpersonal psychotherapy have a significantly greater decrease in
depressive symptoms and an improvement in social functioning.
Healthy interactions allow both to experience the compfort of intimacy and to develop selfconfidence.
STRUCTURING ACTIVITIES: set to ensure childrens physical safety and emotional security
CHALLENGING ACTIVITIES: challenge the child to take a step forward and to enhave feelings of
competence
ENGAGING ACTIVITIES: increase a childs experience of her or himself as a unique individual
NURTURING ACTIVITIES: provide a calming, soothing, reassuring effect on the child. They help
children meet their needs for physical contact and caring in a positive context.

 In an ideal situation, all children would experience appropriate nurturing, engaging, structing and
challenging interactions in their relationships with their parents or other primary caregivers.
The absence of Nurturing, Structuring, Challenging, Engaging activities may lead to children
exbihiting behaviors that are MALADAPTIVE.
Without the presence of these elements as healthy parent-child relationship, children are likely to
encounter difficulty forming secure attachments with others and will frequently display aggressive,
overly demanding, or socially withdrawn behavior.
Problem behaviors can be intensified by certain interaction patterns between a parents and a child.
APPLICATION OF THERAPLAY WITH CHINESE CHILDREN: First, the emphasis of Theraplay on
attachment and interdependence is consistent with traditional Chinese collectivist cultural values.
Compared with the Western culture, Chinese parents generally have higher academic expectations
o their children and exert more pressure on them to work hard and to achieve.
Second: given that the Chinese are generally less expressive twhen talking about their problems, an
approach with more focus on activity than talk may suit their cultural characteristics.
THE MAJOR PURPOSE OF THIS STUDY WAS TO EVALUATE THE EFFECTIVENESS OF THERAPLAY IN
REDUCING CHILDRENS INTERNALIZING SYMPTOMS. INTERNALIZING SCORES OF CHILDREN WHO
RECEIVED THERAPLAY WAS COMPARED WITH THOSE WHO DO NOT RECEIVE THERAPLAY. IT WAS
HYPOETHESIZED THAT INTERNALIZING SCORES OF CHILDREN WHO RECEIVED THERAPLAY WOULD
SHOW A GREATER DECREASE FROM PRE TO POSTTEST THAN WOULD INTERNALIZING SYMPTOMS
OF CHILDREN WHO DID NOT RECEIVE THERAPLAY.
METHOD: Participants, 46 children, 25 boys & 21 boys from an elementary school in an urbanized
area. Mean age = 7.84 in the Theraply group; Mean age of 7.89 in control group. Mothers of the
children are also included in the study.
Criterion for being in the group: they had reached at least a cutoff point for internalizing problems
as measured using the Child Behavior Checklist.
Measure: Child Behavior Checklist, because it is commonly used and well-validated behaviora;
rating scale. It was designed to quantify a broad range of clinically relevant behavioral and
emotional problems.
Syndromes were Withdrawn, Somatic Complaints, Anxious/Depressed, Thought Problems, Social
Problems, Attention Problems, Deinquent Behavior, and Aggressive Behavior.
PROCEDURE
- mothers of children completed the CBCL.
- briefing session on the introduction of Theraplay.
- children were randomly assigned.
- group sessions were conducted once a week by a certified Theraplay therapist.
- activities include physical interaction, playfulness and a strong sense of connection
- three simple rules: stick together, no hurts, and have fun. Fourth rule for adults: the adult is
always in charge. S
- eight weekly sessions which lasted for 40 minutes.
- when sessions are done, mothers were once again asked to complete the CBCl.
- mothers and children in the Theraplay condition were invited to provide feedback
RESULTS: Scores were calculated using a preintervention scores on each scale as covariates. Scored
indicates that the intervention group decreased significantly more form pre to post intervention
than those of the control group, even with the effects of preintervention score controlled.
Treatment satisfaction: participants gave a positive evaluation
90% of the mothers said they had fun time with their children
it reminded them of the importantce od basic beed on children and that feeding and babyish stud
are good for enhacing relationship.
They enjoyed most the cotton ball series, that consists of cotoon ball blow and the cotton ball fight.
For the children, 90% enjoyed playing games with their mothers, while 10% find that it was odd
playing with their mothers that way.
63% of the children said that the ballon between two body parts and cotton ball blow were their
most favorite.
DISCUSSION: The results suggested that Theraplay was effective in showing positive improvement
for children who are at risk for developing internatlizing problems. There was a significant difference
between the Theraplay group and the control group on CBCL internalizing scores, with the
experimental group being lower than the latter groups score.
The results of this study, together with previous studies indicate that Theraplay is an effective
intervention for children.

 It can also enhance mother-child relationships, as it gives more oppotunitites for mother child dyads
to interact and have fun through playful activities.
Children with internalizing problems tend to keep things to themselves and are less verbal in talking
about their problems. The positive attention given to children through Theraplay could help to
create a perception in children that they are lovable and valued.
Results of this study also imply that Theraplay works well for Chinese children and their families.
Interpersonal harmony is an important is an important characteristics of Chinese communications.
As Theraplay is an action-based type of therapy and its focus is more on activities than talk,
Chinese people may find this approach less intrusive.
Collectivist cultural values emphasizes togetherness of the Chinese coincides with Theraplays
core focus on attachment and interdepence.
LIMITATION: only based on the mothers report
Effectiveness of Group Theraplay on Enhancing Social Skills Among Children With Developmental
Disabilities
Siu, 2014
Researches on school-based play therapy has shown it to have potential in reducing internalizing
and externalizing behavior, increasing self-concept, improving social skills, increasing academic
achievements and skills and decreasing ADHD symptoms, aggressive and disruptive behavior.
PT CONDUCTED BY TEACHERS: teachers are significant people in childrens lives. Research suggests
that teachers are acapable of acting as therapeutic agents during play therapy sessions.
All of these studies demonstrated that the ways teachers relate to children have a noteworthy
effect on the childrens success in school.
Teachers who practice Group Theraplay in schools are able to work with children of varying abilities
and help them engage and interact with their peers to create healthy relationships and enhance
attachments between students and teachers.
CHARACTERISTICS OF CHILDREN WITH DD. Development disabilities is a clinical term used to
describe significant lag in the achievement of developmental milestones in two or more domains
(fine motor, cognition, speech, language, social skills)
GROUP THERAPLAY strives to increase the sense of connection and belonging among group
member. Group Theraplay is guided by a simple set of rules based on these actions. A leader is
always in charge of the group.
Lasts 30 minutes. Activities such as increasing the childrens comfort with eye contact, developing
trust or enhancing self-control, and group cooperation.
The purpose of this study is to expand Azoulays 2000 study from working with individual children
with DD to working in these children in a group format.
THE GOALS OF THE STUDY WERE: A, TO TEST THE EFFECTIVENESS OF A SCHOOL-BASED GROUP
THERAPLAY PROGRAM IN INCREASING THE SOCIAL SKILLS OF CHILDREN WITH DD WHEN COMPARED
WITH A CONTORL GROUP. AND B TO EXPLORE TEACHERS ATTITUDES TOWARD APPLYING A PLAYBASED APPROACH IN A SOCIAL-EMOTIONAL CURRICULUM WHEN WORKING WITH SEPCIAL NEEDS
CHILDREN.
METHOD: 38 students: 35 boys, 3 girls from a special needs school. Mean age of 10.34. The
participants were reported by the teachers as being extremely poor at initiating interactions wth
others, expressing themselves, working cooperatively with others and following rules in games and
activities.
MEASURES: Social Resposiveness Scale (SRS) developed by Constantino and col in 2003 and notes
from teachers, containing reflections on their understanding of the program, their roles in
understanding and aiding the students social emotional development and their skills in conducting
the program.
PROCEDURES: Teachers rated the students in terms of their responsiveness to the environment and
their relationships with the people around them using a screening tool.
Major factors described in the questionnaire included attention and regulation, forming
relationships/mutual engagement, intentional two-way communication, complex gestures, and
problem solving, the use of symbols to express feelings and thought and connecting symbols
logically to express the self.
Teachers who participated in the program had introductory training in both Theraplay and Group
Theraplay.
THE GROUP THERAPLAY PROGRAM:
Welcome activity, checkup, activities based on the four Theraplay actions and arranged to meet the
specific goals of the session, food sharing and a closing activity.

Materials used include bubbles, lotion, cotton balls, stickers, newspapers, and a light snack.
These joyful moments encourage the children to relate to each other and be part of the group.
Rules: NO HURTS, HAVE FUN, AND STICK TOGETHER
The focus of the activities is to keep the children engaged and having fun.
NO HURTS, encourages them to be nice to one another and enjoy being together
HAVE FUN, encourages them to learn in the most relaxed atmosphere.
STICKING TOGETHER, to achieve a common goal.
Children whoo have a positive experience relating to others in the group are more likely to transfer
their skills when interacting with people outside the session.
DATA COLLECTION: obtained form two teachers who are blind to the program. Teachers completed
the SRS. Two teachers serve as the leader and the facilitator.
RESULTS: generally, the students were more aware of one anothers presence, but did not reach a
point at which they cared for and worked cooperatively with one another.
Feedback from teachers were analyzed in three stages.
In general, four teachers found the program time-consuming and exhausting, partly because they
had to change their mode of daily interaction with the students.
They have to work particularly hard to be intentionally accepting and positive as well as being
playful while taking the lead to run the group.
Once this teacher-student relationship was secured, student wrere a lot more willing to follow the
teachers instructions and enjoy the fun times with the whole group.
DISCUSSION: The teacher-conducted programa slo helps children with DD to form healthy
attachments to their teachers and develop positive relationships with their peers.
Through structuring, the children with DD were provided with safety and predictability. This element
could have enabled children to feel secure and relate to the environment. Only when they felt a
sense of security and acceptance could they start exploring and getting to know others.
Engagement activities facilitated positive interactions with their teachers and peers.
Toward the progress at early, middle and end of the program, the children became more
intentionally accepting and positive toward one another. They were also willing to follow
instructions, to work cooperatively with their groupmates when playing games and enjoy
themselves in the sessions.
Nurturing activities enabled the children to feel looked after anad accepted. Because of their limited
abilities, children with DD may endure rejection by others.
Challenging activities provided students the opportunity to experience success.
The more positive experience children have in working with others and th more comfortable they
are in attending to and caring for one another, the more successful they are in social relationships
and interactions.
It provides a learning opportunity for children with diverse abilities and promots additional skills and
idas for the teachers who are building caring and warm relationships in classroom to support
healthy interactions.
LIMITATIONS: small sample size
Programs such as Group Theraplay could serve as an additional option for special schools in
improving the social and emotional development of students with diverse abilities.

Whole Family Theraplay: Integrating Family Systems Theory and Theraplay to Treat Adoptive Families
Weir, Lee, Canosa, Rodrigues, McWilliams, Parker, 2012
Family therapy and play therapy are two treatment modalities that both have histories of
demonstrated efficacy.
Structural Family Therapy, Bowenian Family Systems Therapy, Narrative Family Therapy, multiple
Behavioral Family Therapy approaches including Parent-Child Interaction Therapy, and SolutionOriented Family Therapy have all had studies indicating that these models are effective in the
systemic treatment of adoptive families.
Multiple models of play therapy such as Filial Family Play Therapy, Dyadic Developmental
Psychotherapy, and Theraplay have been shown to be effective with adoptive families.
The integration of theories of therapy treatments are call zeitgeist of our time. (Lebow, 1997)
The integration of family therapy and play therapy has wide practical applications for clinicians in
the counseling, marriage and family therapy, psychology, and social work fields who specialize in
working with adoptive families.

 Because adoptive families may disproportionately experience issues relating to attachment, non
coercive attachment-based treatments logically offer promise for clinical efficacy.
Attachment therapies are defined as the coercive disreputable treatments that can be harmful to a
child, a treatment that all ethical clinician should avoid.
For the most part, this approach should be work well with children without attachment disorders
and even can be successful with some who do struggle to form healthy attachments. But for some
attachment disordered children, particularly those abused and experienced neglect, behavioral
approaches may have the effect of exacerbating the problem and the children might not respond to
the rewards and punishment of behavior modification systems as desired.
Coercive attachment therapy models may be termed Holding Therapy, Rebirthing Therapy, or
simply Attachment Therapy: they have been controversial models of treatment, in some cases have
led to the harm or death of children, and have been warned against in the ethical guidelines of
many major mental health professional associations.
Among the non-coercive attachment play therapies, Filial Family Therapy, Dyadic Developmental
Psychotherapy, and Theraplay have been most studied.
In adopted children, Theraplay helps to reduce some of the internal attachment models they gained
in their previous abusive environment and helps them to produce new healthy internal attachments
models with their adoptive families.
When parents and children interact in playful ways that balance four key dimensions of attachment,
children and parents will develop more secure attachments leading to several beneficial outcomes.
THERAPLAY WAS CHOSEN AS THE BEST MODEL TO INTEGRATE WITH FAMILY THERAPY MODELS FOR
THREE PRIMARY REASONS:
FIRST, THE DIRECTIVE NATURE OF THERAPLAY IS MORE CONDUCIVE TO THE DIRECTIVE POSTURE OF
CLASSICAL FAMILY SYSTEMS MODELS. DUE TO THE DIRECTIVE NATURE OF MANY OF THE FAMILY
SYSTEMS MODEL, THE DIRECTIVE STYLE OF THERAPLAY SEEMED THE BEST THEORETICAL FIT TO
INTEGRATE FAMILY COUNSELING AND PLAY THERAPY APPROACHES.
SECOND, THERAPLAY WAS NO LONGER HISTORY OF TREAETMENT AND SLIGHTLY LONGER HISTORY
OF EMPIRICAL TESTING FOR EFFICACY THATN DDP. FINALLY, THE PRIMARY INVESTIGATOR OF THIS
STUDY HAD PRIOR TRAINING IN THERAPLAY AND HAD FORMED A COLLABORATIVE RELATIONSHIP
WITH THE THERAPLAY INSTITUTE AND WAS DESIGNATED BY THEM AS A UNIVERSITY-BASED
THERAPLAY RESEARCHER.
In developing WFT, we anticipated working with parents, the adopted child, their siblings and
anyone else residing in the home who is part of the family system. We drew upon traditional
Theraplay, group Theraplay, preschool childrens play, and several models of family systems theory,
noting the different types of playful interaction among whole families.
Sample: 12 adoptive families from the local community.
Recruitment of participants: through advertising through local public child welfare agencies. WFT is
for free.
Five task:
1. Play with hats with your children/child
2. Play a familiar game with your family
3. Play a fame of stacking hands. Be sure to lead the family in going up and down, fast and slow.
4. Lotion your child
5. Feed your child a snack
Result:
Despite several measures showing the possibility that WFT was helpful to adoptive families, very
few items from these measures were statistically significant.
These findings suggest that family systematic functioning did not show a statistically significant
change after WFT treatment in terms of the total score or in the subscale measures, except for the
family communication subscale.
Discussion: these initial findings indicate that WFT is a practice model that shoes promising
potential and tentatively, we can say that I might have some level of clinical efficacy in a t least
three key areas:
Improving family communication within adoptive family systems, enhancing adult parents
interpersonal relational skills and assisting children in adoptive families to have better overall
clinical outcomes.
Although Theraplay dies not explicitly focus on verbalization in its form of play, the study found that
WFT did significantly improve family communication.
The finding that the parents interpersonal relations improved leads us to consider that WFT may
effectively assist adults in enhancing their interpersonal skills.

 The most important finding of this study is that the Y-OQ total scores for children in adoptive home
improves with treatment. The implementation guidelines that accompany the OQ and Y-OQ state:
the most reliable and valid quantitative measure of the child/adolescents condition is the total
score.
It is clear that Theraplay can be effectively be modified to accommodate who families with either
one child or multiple children in treatment together.
By including the siblings and other family members of the adopted childs family system, parents
are able to learn how to play in attachment-savvy ways with their children that are more natural to
their family context and therefore more conducive to successful implementation at home.
By expanding traditional Theraplay to include the entire family system, we were able to help the
adoptive family integrate therapeutic play into the natural context of the entirety of the family.
The fact that none of the families dropped out and all the families utilized the services offer through
at least 12 sessions says much about the usefulness and benefit that they ascribed to WFT in their
lives.
Limitation: lacks a control group and small sample. It also has an inability to extrapolate the
findings to other adoptive families due to small sample size.
CONCLUSION
WFT is an integrative model developed to work with adoptive families by including siblings and
other members of the family system in a holistic systemic context.
By integrating family systems theory with Theraplay, WFT enhances quality parent-child
attachment and sibling relation and improves overall behavioral functioning and subjective
emotional experiences of the children within the adoptive family system.
It also appears to improve family communication and the interpersonal role of the adults.

PLAY THERAPY WITH THE MALTREATED CHILD: IMPACT UPON AGGRESSIVE AND WITHDRAWN PATTERNS OF
INTERACTION
Barbara Mills and John Allan, 1992

Aggressive and withdrawn behaviors are seen as the predictable results of unsupportive and/or
destructive early environments.
Aggression and acting out behaviors are currently the most common reasons fro referral of young
children to mental health services.
THE FOCUS OF THIS PAPER WLL BE THE EXPLORATION OF CURRENT ATTACHMENT RESEACH AS IT
APPLIES TO THE SCREENING, TREATMENT AND MANAGEMENT OF RELATIONSHIP PROBLEMS IN
YOUNG CHILDREN.
Aggression and victim of aggression: these behaviors are two sides of the same issue of an
unsupportive or destructive early environment.
Attachment theory suggests that there is a connection between early infant-parent attachment
relationships and the childs concurrent and later image of self and patterns of young relationships
with others.
Studies linking attachment and aggression: childs early caretaking experiences have profound
effect upon ongoing relationship patterns including patterns of aggression and/or withdrawal.
Those mothers who were neglected, maltreated, abused or threatened with abandonment in their
own childhood were significantly more likely to neglect or abuse their own children.
Studies following aggressive children into school: children wo are maltreated, insecurely attached,
or come form chaotic homes are significantly more likely to show behavior patterns or aggression or
withdrawal both in preschool and into the early school years.
ATTACHMENT-BASED PLAY THERAPY: play therapists have generally recognized that a safe, trusting
supportive therapeutic relationship is the necessary and essential element to healing children. It is
only after the child feels unconditionally accepted that he or she can then begin o express the pain
and to grow beyond it.
We have found in our early sample that not only do maltreated children grown in self confidence
and social skills during the course of therapy, but they also become more able to learn and function
intellectually in the classroom environment.

GOALS: 1. To help the child bring early trauma experienced through maltreatment or breaks in
attachment to the play experience so that they can be worked through rather than acted out. 2. To
rework through the therapeutic relationship the childs maladaptive internal models of self and self
in relation to others.
Models of change: internal working models. Ego defense mechanisms. Transference.
Children move from symbolic expression of their concern and traumas to greater ability to
verbalize.
Change in the classroom tends to follow the childs success in experimenting with new ways of
interacting in therapy.
Role of teacher and the school: positive and supportive school environment can provide the
additional opportunity to not only practice new modes of relating, but also to experience a very real
social environment which is not only safe but supportive.
Creating an environment of physical and emotional safety is the essential and necessary role for
the school to play to ensure the effectiveness of therapeutic treatment and change.
Safety is created by establishing clear and consistent guidelines followed by every teacher in the
school or center.
Conclusion:
Teachers are in an ideal situation to identify children who need help. The first step is knowing that
these children are not bad, but are in need of professional intervention. Close cooperation and
planning between the counselor or play therapist and the teaching staff enables assistance that will
help both the childs inner world pain and outer world behavior.

FOSTERING THE RELATIONSHIP: A THERAPLAY GROUPP FOR ADOPTIVE ND FOSTER FAMILY

Pryzbylo

In theraplay, parents are educated on how to take charge without hurting the child, how to engage
children in a relationship, how to use touch to nurture, how to use challenge to enhance selfesteem, and how to be playful.
Many adopted children experience a disruption in the attachment process which can result in an
attachment disorder. It is an interruption of emotional connection between a mother and a child.
A child whose basic needs are not satisfied by a caregiver, feels insecure, mistrustful and unloved
have attachment disorders.
As a result, such a child has difficulty forming significant relationships in life, lacks trust, shows flat
affect, and can demonstrate oppositional characteristics.
How is theraplay group organized?
The group should include 5-6 adoptive and the children should be of similar age.
Therapists ole: to model the activities and lead the group.
Goal of the theraplay group:
Enhancement of an attachment between the adoptive parent and the child;
Creation of a sense of trust, security, and love:
Facilitation of a feeling of being taken care of;
Prevention of emotional and social problems in life.
I am here for you, I care for you, it is safe, trust me.
the relationship between he adoptive or foster parent and the child will function as a buffe for
emotional and social problems later in life.
How would we know that the child is forming at attachment with the adoptive parents?
- eye contact, seeks physical contact, obeys, imitates parents behavior, opposes parents absence,
seeks comfort during stress, trust caregiver, and accepts family rules and beliefs.