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Theraplay

Theraplay is a child and family therapy for building


and enhancing attachment, self-esteem, trust in
others, and joyful engagement.
Its principles are based on attachment theory and
its model is the healthy, attuned interaction
between parents and their children: the kind of
interaction that leads to secure attachment and
lifelong mental health.
Development of Theraplay
It was developed by Ann Jernberg in the late 1960s, during her
time as Director of Psychological Services at the Chicago Head
Start Program.
Jernberg's position involved identifying children who needed
professional care and referring them to outpatient clinics, but
as she began to realize how many children needed help, she
began working to create a treatment program that could be
implemented at the Head Start facilities.
Development of Theraplay
In order to care for the large number of children identified by
her team as in need of service, Jernberg employed
paraprofessionals who worked under the direct supervision of
licensed therapists. She chose people she felt were lively and
playful and would be able to readily engage the children.
Initially, there was some resistance to her methods, but she
provided video evidence of the effectiveness of the approach
to refute criticism.
Today, Theraplay is a widely respected therapeutic model, and
The Theraplay Instituteestablished by Jernberg in 1971
certifies, supervises, and trains therapists from around the
world in Theraplay.
The core tenets of Theraplay
Human behavior is influenced primarily by a drive to increase
kinship and connection;
An infant who is consistently exposed to positive relationships
is likely to develop inner representations characterized by a
high regard for self, a high regard for others, and a
positive, hopeful view of the world;
An infant who is consistently exposed to negative relationships
is likely to develop inner representations characterized by a
low regard for self, a low regard for others, and a negative,
hopeless view of the world;
The major contributing factor toward a child's positive
development is the maintenance of a positive relationship
between parent and child.
The core tenets of Theraplay
The activity of playful, responsive caregivers is vital to a childs
ability to develop a secure attachment, the capacity to
regulate emotions, empathy, and a strong sense of self-worth.
As an individuals perception of trust and self are rooted in the
early years of development, it is crucial to revisit the point at
which the childs healthy emotional development was
interrupted and administer the positive experiences necessary
to restart healthy, positive interaction.
Four Fundamental Dimensions
1. Structure
2. Engagement
3. Nurture
4. Challenge
Four Fundamental Dimensions
1. Structure: The parent or guardian takes the lead in the session and defines all rules and
boundaries in order to promote feelings of safety and a sense of organization and
foster the development of self-regulation in the child. This dimension is often effective
for children who display high impulsivity and a lack of focus and for parents who have
difficulty setting rules or taking the lead.
2. Engagement: The parent/guardian focuses on the child in a personal manner so the child
knows they are seen and heard in the moment. This dimension promotes joyful,
responsive companionship and helps parent and child form a deeper emotional
connection. Engagement is often effective for children who are socially withdrawn and
parents who tend to be inattentive to or disengaged.
3. Nurture: Parent and child take part in soothing, calming activities that are believed
to foster feelings of warmth, safety, and comfort. Soothing touch is a fundamental part
of this dimension, and nurture can help a child develop inner knowledge of being
special, lovable, and valued. This is most often appropriate for children who are anxious
overactive, or aggressive and parents who are harsh, dismissive, or who have difficulty
displaying feelings of affection.
4. Challenge: The child is helped to complete a fun but challenging task or take a mild, age-
appropriate risk in order to promote feelings of self-confidence and competence.
Activities are performed in an environment that is positive, fun, optimistic, and non-
competitive. Children who are shy or rigid and parents who are competitive or who have
inappropriate developmental expectations may obtain benefit from this dimension.
Who can benet?
Theraplay is an effective treatment for children of all ages,
from infancy through adolescence, but it is most frequently
practiced with children from eighteen months to twelve
years.
Theraplay is effective with a wide range of social difculties,
emotional challenges, and developmental and behavioral
problems.
Who can benet?
Internalizing behaviors such as
withdrawal, depression, fearfulness or shyness;
externalizing behaviors such as
acting out, anger, and noncompliance;
and relationship and attachment problems.
Theraplay has also been helpful in addressing the
relationshipproblemsassociatedwithregulatorydifculties,with
autism
Logistics and typical sequence of treatment

Participants
Settings
Sessions
Logistics and typical sequence of treatment

Participant
Parents or primary caregivers in the sessions. It can be
successful using either one or two therapists.
Logistics and typical sequence of treatment

Settings
Theraplay room is simple, functional, and comfortable. Large
oor pillows or a beanbag chair and soft toss pillows
suggestthat this is a place where you can relax and have fun.
It is helpful to have an observation room with a two-way
viewing mirror in which the parents and the interpreting
therapist can observe and discuss what is happening in the
childs session.
If that is not possible, a simple video hook up or wireless
connection can link the Theraplay room with another room
that serves as an observation room.
Logistics and typical sequence of treatment

Sessions
The basic Theraplay treatment plan is for eighteen to twenty-
four sessions. This includes an assessment period of three or
four sessions, the treatment, and a follow-up period of four to
six sessions spaced over a year.
For more complex cases, the length of treatment will be from
six months to a year.
Theraplay sessions are thirty to forty-ve minutes in length
and are typically scheduled once a week.
The Sequence of Theraplay Treatment

the three steps in the treatment process:


1. assessment,
2. treatment,
3. and follow-up
The Sequence of Theraplay Treatment
The Theraplay assessment procedure includes the following
elements:
1. Standardized questionnaires about the childs behaviors and
the parents attitudes. These are usually completed by the
caregivers before the intake interview.
2. An initial intake interview with the childs caregivers, during
which we begin to learn about the history and current
functioning of the family
3. An assessmentof the childs relationship with each parent
using the Marschak Interaction Method (MIM).
4. A feedback session with the caregivers who were involved
in the MIM sessions.
The Sequence of Theraplay Treatment
Treatment: Theraplay sessions are designed to be engaging and
fun. The therapist approaches each session with a plan based on
an understanding of the needs of the particular child.
In the moment-to-moment interaction with the child, the
therapist adapts his plan and attunes his actions to the childs
responses.
Activities within each session alternate between active and
quiet; sessions typically end with a quiet nurturing activity
including feeding and singing to the child.
The Sequence of Theraplay Treatment
Treatment:
Theraplay sessions are designed to be engaging and fun. The
therapist approaches each session with a plan based on an
understanding of the needs of the particular child.
In the moment-to-moment interaction with the child, the therapist
adapts his plan and attunes his actions to the childs responses.
Activities within each session alternate between active and quiet;
sessions typically end with a quiet nurturing activity including
feeding and singing to the child.
The nal session is an upbeat party at which the childs strengths
and achievements are celebrated. A strong emphasis is placed on
how much the child and his parents are able to enjoy each other.
At the end of treatment, the parents ll out the standardized
questionnaires again and the MIM is repeated in order to assess the
outcome of treatment.
The Sequence of Theraplay Treatment
CHECKUP SESSIONS.
Checkup sessions are scheduled at monthly intervals for the
rst three months and then at quarterly intervals for a year.
These sessions follow the pattern of sessions in the later part
of treatment with the parents joining in during the second half
of each session.
During the rst half of the session parents have an
opportunity to discuss any problems or issues that have arisen
during the intervening weeks.
When they come into the playroom they are able to
demonstrate new activities that they have enjoyed with their
child.
Theraplay is a child and family therapy for building and
enhancing attachment, self-esteem, trust in others, and
joyful engagement.
Its principles are based on attachment theory and its model is
the healthy, attuned interaction between parents and their
children: the kind of interaction that leads to secure
attachment and lifelong mental health.
References
Jernberg, Ann M. and Booth, Phyllis B.
(2009) Theraplay: Helping Parents and Children Build Better
Relationships Through Attachment-Based Play
https://www.goodtherapy.org/learn-about-
therapy/types/theraplay
https://www.theraplay.org/index.php/what-is-theraplay-3

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