ATTACHMENT THEORY and Theraplay® | PHYLLIS BOOTH, LMFT, LCPC, RPT-S & SANDRA LINDAMAN, MA, MSW, LCSW, LISW T
heraplay® is an evidence-based, relationship-focused play therapy that integrates current theories of attachment, physiological state, affect
neurobiology. It offers an understanding of the power of face-to-face synchronized, reciprocal play.
Basic Tenets Theraplay is modeled on the responsive, attuned, co-regulating, and playful patterns of interaction between caregivers and their babies that lead to secure attachment and life-long social-emotional health. We incorporate Bowlby’s (1988) suggestion: “The pattern of interaction adopted by the mother of a secure infant provides an excellent model for the pattern of therapeutic interaction” (p. 126). Theraplay assessment and treatment looks at strengths and challenges in four dimensions of caregiver-child interaction: structure, engagement, nurture, and challenge (Booth & Jernberg, 2010). The focus of treatment is the relationship itself; caregivers are an essential part of the process so that they can carry on the newly developed patterns of interaction at home. In sessions, the therapist initially guides the interaction. Progressively, caregivers take the leadership role. Regularly scheduled caregiver-only sessions allow for additional reflection and problem solving. Theraplay may be combined or sequenced with other modalities for complex problems.
Theraplay stimulates the healthy development of the emotional brain from the bottom up, working within subcortical systems of safety and defense (Porges, 2011), affect regulation (Schore & Schore, 2008), and play, care, and joy (Panksepp & Biven, 2012). Three key elements are social engagement offered by the therapist; face to face, synchronous, rhythmic, and reciprocal play; and the provision of direct nurturing via positively attending to the body, soothing, and feeding (Lindaman & Mäkelä, 2018). Theraplay sessions are designed to contain alternating sequences of up-regulating play and down-regulating care within the child’s window of tolerance and optimal arousal (Siegel, 1999). These processes also apply to group Theraplay, where the focus is on leader- child and child-child relationships (Siu, 2009, 2014; Tucker et. al., 2017).
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www.a4pt.org regulation, and interpersonal
Psychopathology and Client Dysfunction Theraplay is helpful for children, from infancy (Salo, Lampi, & Lindaman, 2010) through adolescence (Robison, Lindaman, Clemmons, Doyle- with caregivers, other children, and other adults. Their caregivers often express dissatisfaction with
the caregiver-child relationship. This
relationship dysfunction arises out of inadequate or negative experiences that disrupt/interfere with the sense of safety and connection that is essential for healthy family development. The source of the disruption may stem from the child, the caregivers, or from stressors in the family environment. For example: attune to the child (Hiles Howard, Lindaman, Copeland, & Cross, 2018).
• Children placed in foster or adoptive families have sustained loss and very probably neglect and abuse that interfere with trusting new caregivers and forming new attachments (Weir et. al., 2013).
• Caregivers may have their own childhood trauma and attachment insecurity, mental health issues, substance abuse, and/or marital responsive, and sensitive to the child (Norris & Rodwell, 2017).
• Life stressors ranging from typical family issues of divorce, sibling birth(s), and moving homes to overwhelming experiences of medical trauma, domestic or community violence, displacement from one’s country of origin, and natural catastrophes disrupt family life and the security that caregivers desire for their families (Bennett, Shiner, & Ryan, 2006; Cort & Rowley, 2015).
Treatment Description The Theraplay treatment process begins with an assessment, including a detailed intake interview with caregivers, observation of caregiver- child interactions via the Marschak Interaction Method (MIM), and a collaborative discussion of the MIM experience with caregivers (Booth, Christensen, & Lindaman, 2011). Next, the therapist plans treatment, employing the dimensions, and has a reflective and practice session with the caregiver.
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