Theraplay®

Helping Parents and Children Build Healthier
Relationships Through Attachment-Based Play

Theraplay® is a structured play therapy for children and their parents. The goal of Theraplay® is to enhance attachment, self-esteem, trust in others and joyful engagement. The sessions are fun, physical, personal, and interactive, and replicate the natural, healthy interaction between parents and young children. Because of the focus on developing a healthy attachment between the child and caregiver, Theraplay® is ideal for working with foster and adoptive Families.

The process of Theraplay® is quite different from traditional child therapy where the child is invited to take the lead in expressing himself through play, art or other means. In Theraplay®, the therapist takes the lead and decides which activities will happen and sets the pace for the session while taking into account the needs of the child. Parents or other significant caretakers are involved in this process and are asked to extend the therapy with activities at home. The Theraplay® activities are intentionally simple and regressive. The simplicity allows the full impact of the process to be felt by the child. Theraplay® activities aim at creating a sense of closeness between child and parent, which is attained through activities in which the child experiences the adult as creating the structure (the rules, etc.) and also nurturing the child. The goal of therapy is that the child be more at ease with adults and other children, have less of a need to stay in charge, and be more spontaneously able to experience and express her feelings.

Psychopathology results when early and on-going experiences lead to a negative sense of self. Many foster and adoptive children today have been prenatally exposed to drugs and alcohol or have experienced abuse and/or neglect which leads to attachment difficulties. Often, behavior problems in older children can be traced back to their beginnings in insecure attachment and in the concomitant negative views of themselves and the world.

Because the roots of development of the self, of self-esteem and trust lie in the early years, it is essential to return to the stage at which the child’s emotional development was derailed and provide the experience which can restart the healthy cycle of interaction. Activities are geared to the child’s current emotional level rather than to chronological age. Parents are encouraged or taught how to respond empathetically to their child’s needs. The goal of treatment is to change the inner working model of the self and others from a negative to a more positive one.

Dyadic Developmental Psychotherapy

Developed by Daniel Hughes, PhD

Some children will not respond to Theraplay® alone. Children with deep shame can benefit from a treatment model that is complementary to Theraplay®. This model is called Dyadic Development Psychotherapy. DDP is a treatment approach to trauma, neglect, loss, and/or other dysregulating experiences that is based on the principles derived from attachment theory and research. Frequently, a person’s symptoms are his/her unsuccessful ways of regulating frightening or shame-based memories, emotions and current experiences.

DDP involves creating a safe environment in which the client can begin to explore, resolve and integrate a wide range of memories, emotions and current experiences that are frightening, stressful, avoided or denied. Safety is created by insuring that this exploration occurs with nonverbal attunement and with reflective, non-judgmental dialogue, along with empathy and reassurance. The primary therapeutic attitude demonstrated throughout the sessions is one of playfulness, acceptance, empathy and curiosity (PACE). As the process unfolds, the client is creating a coherent life-story or autobiographical narrative, which is crucial for attachment security and is a strong protective factor against psychopathology. Therapeutic progress occurs with the joint activities of co-regulating affect and co-constructing meaning.

Non-verbal attunement refers to the frequent interactions between a parent and infant, in which both are sharing affect and focused attention on each other in a way that amplifies the child’s enjoyable experiences and reduces or contains the child’s stressful experiences. This is done through eye contact, facial expressions, gestures and movements, voice tone, timing and touch. These same early attachment experiences, which are fundamental for healthy, emotional and social development, are utilized in therapy to enable the client to rely on the therapist to regulate emotional experiences and to begin to understand these experiences more fully. Such understanding develops further through engaging in a conversation about these experiences, without judgment or criticism.

The primary attachment figure to the child or adult is present during these therapeutic sessions.

The parent’s role is to help the child feel safe and communicate PACE both non-verbally and verbally. The parent helps the child to regulate any negative affect such as fear, anger, or any other shame-based behaviors. The primary caregiver reassures the child that their relationship is strong regardless of the issues. The parent’s role is not to criticize, lecture, nag or amplify shame. Periodic confrontation may be necessary and needs to be integrated into the overall session.

Parents are expected to openly explore, discuss, and if necessary, resolve any of their own issues from their attachment histories that may impede their child’s readiness and ability to form an attachment with them.