What is Theraplay©?

Theraplay is a child and family therapy for building and enhancing attachment, self-esteem, trust in others, and joyful engagement. It is based on the natural patterns of playful, healthy interaction between parent and child and is personal, physical, and fun. Theraplay interactions focus on four essential qualities found in parent-child relationships: Structure, Engagement, Nurture, and Challenge. Theraplay sessions create an active, emotional connection between the child and parent or caregiver, resulting in a changed view of the self as worthy and lovable and of relationships as positive and rewarding.

In treatment, the Theraplay therapist guides the parent and child through playful, fun games, developmentally challenging activities, and tender, nurturing activities. The very act of engaging each other in this way helps the parent regulate the child’s behavior and communicate love, joy, and safety to the child. It helps the child feel secure, cared for, connected and worthy. We call this “building relationships from the inside out.”

Theraplay has evidence-based status. Theraplay has been rated as demonstrating “promising research evidence” by The California Evidence-Based Clearinghouse (December, 2009). The Clearinghouse rates programs on a scale of 1-5. Ratings from 1-3 indicate that the program is well-supported by research, with a rating of 1 being the highest attainable.

With a rating of 3, Theraplay has been judged to meet the following standards:

Two peer-reviewed studies utilizing some form of control have been published. The outcome data support the benefits of Theraplay. A manual is available: Theraplay: Helping children and parents build better relationships through attachment-based play, Booth and Jernberg, 2010. No empirical or theoretical evidence exists that Theraplay has a substantial risk of harming clients as compared to its possible benefits. Theraplay has also been rated as a promising practice by Washington State Inventory of Evidence-Based, Research-Based, and Promising Practices. For Prevention and Intervention Services for Children and Juveniles in Child Welfare, Juvenile Justice, and Mental Health Systems under "Mental Health". Articles are available on the Theraplay website for futher reading.

Understanding the four pillars of Theraplay©

1. Structure: The purpose of structuring activities is to organize and regulate the child’s experience. The adult sets limits, defines body boundaries, keeps the child safe, and helps to complete sequences of activities.

a. Signals: Using signals for when to start will increase the structure in any activity. Start with simple signals such as “One, Two, Three, Go” or “Ready, Set, Go”; advance to more complicated signals, such as listening for a selected word in a series, or watching for a visual signal, such as a wink or other facial movement. Signals should not be used for every activity as they can slow down the pace or become too predictable and they may take away from the lighthearted tone you want at a particular moment.

2. Engagement: The purpose of engagement activities is to connect with the child in a playful, positive way, to focus intently on the child and to encourage him or her to enjoy new experiences. At all times it is important to attend to the level of the child’s arousal and to modulate it when needed.

3. Nurture: The purpose of nurturing activities is to reinforce the message that the child is worthy of care and that adults will provide care without the child having to ask. Nurturing activities help to calm and regulate the anxious child and enhance feelings of self-worth.

4. Challenge: The purpose of challenging activities is to encourage the child to take age appropriate risks in order to foster feelings of competence and mastery. These activities are most often done cooperatively with the parent or therapist. Challenge activities also allow a child to accept structure, engagement and nurture that they might resist in more direct forms.

Rules are established as a part of Theraplay groups and family therapy sessions to communicate expectations and to structure the sessions.

1. “No Hurts”: This rule communicates the nurturing dimension of Theraplay©. Your words, affect and actions communicate that giving or receiving a hurt is unpleasant and undesirable. Regardless of whether a child denies that he or she was hurt, that the hurt does not really hurt, or expresses pleasure in or a lack of awareness of getting hurt, you should respond in the same caring manner. Take all hurts seriously. Attend to them by rubbing lotion around them, blowing on them, or responding in another caring nurturing way. Only parents may kiss a hurt. Children who hurt another child should be encouraged to take care of the hurt child through a hug, lotion or by offering a band-aid after both children have had a chance to calm down.

2. “Stick Together”: This rule communicates the structuring and interactive message of Theraplay©. Children should be encouraged (not forced) to participate in the activities and to focus on the shared experience of the group. Adults should assist the children to attend to what is happening around the circle and respond to the activity at hand. Each child should also be encouraged to voice and attend to their individual needs.

3. “Have Fun”: This rule communicates the engagement, challenge and playfulness of Theraplay©. Fun engages group members and allows them to have a break from the day that might require different responsibilities or tasks of them. This “rule” also makes space for moments of mutual joy that are experienced by both the adult and the child, reinforcing the idea that adults can be safe and fun.

The adult is in charge (the unspoken rule): Adults are responsible for giving signals to the child and making sure the directions for activities are understood. Adults should not ask permission of children (e.g., “Do you want to play this game?”) but should be receptive to the child’s refusal to participate in any given activity. Taking charge can also mean noticing when a child is hurt and caring for that child. Adults should also avoid being punitive. Instead of punishment (e.g., Stop doing that! Do you want to go home?) the adult should try to redirect the child or to structure the child. Examples include, taking a child who is hitting another child aside and saying, “Remember our rule, ‘No Hurts?’ Why were you hurting your friend? Do you have a hurt that needs to be taken care of?” Or, for a child who is grabbing a toy and not letting go, you might say, “Wow! You are holding on to that really tight! Let’s see if you can toss it to me on the count of three. Ready? One, two three!”