Treatment includes caregiver-child-therapist weekly sessions and regular caregiver-therapist reflective and practice sessions. Theraplay therapists plan each session to provide a sequence of positive and co-regulated experiences. Weekly sessions are 40-50 minutes long. A typical session sequence follows: • The therapist, caregiver, and child enter the treatment space in a pleasant, connected way (e.g., holding hands and taking big steps to pillows on the floor).
• The therapist sits across from child and caregiver, notices their special personal features, and, with the caregiver’s help, attends to any “hurts” the child may have.
elbows)
• Down regulating, caring activity (e.g., making powder handprints) • Upregulating activity (e.g., caregiver’s arms)
jumping off a stack of pillows into
• Additional sequences of up- and down-regulating activities based on the child’s window of affect tolerance
• Down-regulating soothing activity (e.g., sharing a food treat, drink, song)
• Exit with caregiver and child connected (e.g., piggy-back ride to the door)
This sequence creates opportunities for many joyful and quiet moments of physical and affective synchrony, as well as interactive repair if the therapist or caregiver mis-attunes to the child. Over time, the therapist creates experiences at the edges of the child’s window of tolerance to expand emotional regulation and resilience.
Therapy Goals and Progress Assessment The goals of Theraplay treatment are to create a responsive, attuned, regulated, and supportive relationship between the child and caregivers that provides the sense of safety, connection, and empathic behaviors associated with presenting problems.
Progress is measured by observing the following changes in interactions during sessions: The child is better regulated with fewer instances of defensive arousal or withdrawal, seeks playful interaction with and comfort from the caregiver, and is able to explore and reach out to the world. Caregivers recognize signs of child distress and respond in calming/regulating ways and are able to reflect on their experience. The interaction between child and caregivers is characterized by attunement, synchrony, moments of meeting, relational repair, and shared joy. Formal assessment is made via pre- and post-MIMs and using standardized checklists of child behavior and caregiver stress.
Therapeutic Powers of Play Theraplay’s accepting, responsive, co-regulating therapeutic relationship with both caregiver and child provides a reparative experience leading to a more positive view of self, others, and the world that addresses many of Schaefer and Drewes’s (2014) therapeutic powers of play. We create a safe and supportive relationship between child and caregivers, which leads to secure attachment and puts psychological development back on
track. Our empathic interactive repair of mis-attunements and reflection on the meaning of the child’s behaviors, supports the development of the child’s empathy. Our focus on co-regulation and on strengthening social engagement helps the child to become more self-regulated and resilient. Our provision of soothing care and shared joyful play leads to shared positive emotions and builds the child’s sense of worthiness, social competence, and self-esteem. We create stress inoculation by helping children and their caregivers to enter and stay within a window of safety, social engagement, and optimal arousal. Caregivers learn how to provide stress management for themselves and their child. Additionally, Theraplay facilitates self-expression by responding to non-verbal and verbal emotional signals that are the foundation for more complex forms of communication.
Summary Theraplay provides the face-to-face, reciprocal, joyful, and caring co- regulating interactions characteristic of secure attachment. The focus on the caregiver-child relationship gives the caregiver new tools and a deeper understanding of the child, creating a new meaning of togetherness and supporting the child’s healthy development.
References Bennett, L. R., 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 Service, 44 (10), 38-47.
Booth, P. B., Christensen, G., & Lindaman, S. (2011). Marschak Interaction Method (MIM) Manual and Cards (Revised). Evanston, IL: The Theraplay Institute.
Booth, P. B., & Jernberg, A. M. (2010). Theraplay: Helping parents and children build better relationships through attachment-based play. San Francisco, CA: Jossey-Bass.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.
Cort, L., & Rowley, E. (2015). A case study evaluation of a Theraplay intervention to support mothers and preschool children following domestic abuse. Debate, 156, 33-41.
Hiles Howard, A. R., Lindaman, S., Copeland, R., & Cross, D. R. (2018). Theraplay impact on parents and children with autism spectrum disorder: Improvements in affect, joint attention, and social cooperation. International Journal of Play Therapy, 27, 56-68. doi:10.1037/pla0000056
Lindaman, S., & Mäkelä, J. (2018). The polyvagal foundation of Theraplay treatment: Combining social engagement, play and nurture to create safety, regulation and resilience. In S. Porges & D. Dana (Eds.), Clinical applications of polyvagal theory (pp. 227-247). New York, NY: Norton.
Norris, V. & Rodwell, H. (2017). Parenting with Theraplay. London, UK: Jessica Kingsley. Panksepp, J., & Biven, L. (2012). The archaeology of mind. New York, NY: Norton
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York, NY: Norton.
Robison, M., Lindaman, S., Clemmons, M. P., Doyle-Buckwalter, K., & Ryan, M. (2009). “I deserve a family”: The evolution of an adolescent’s
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