Originally published in the The Theraplay® Institute Newsletter of Winter 2008

Theraplay With Adolescents

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Brijin Gardner, LSCSW, RPT-S and
Mary Spickelmier, LSCSW, RPT-S

Leavenworth, KS

Adolescence is a wild ride for everyone involved. It is filled with tumultuous friendships, power struggles with parents, preoccupation with social status at school, self-esteem issues, testing limits and rules, along with a menagerie of other difficulties acquired along life’s journey. Providing therapy to teen-agers is a challenge, to say the least, but, believe it or not, adolescents want adults in their lives, especially adults who treat them differently than “other” grown-ups. Theraplay can provide great results with this difficult population if you have a dab of creativity, lots of patience and a generous understanding of what teenagers are experiencing.

Clients, Setting, Rationale for Theraplay & Treatment Goals

Brijin Gardner applies Group Theraplay with young adolescents in the public school setting. Most of her clients are boys in middle school and high school between the ages of 12 – 16 with various mental health diagnoses such as bi-polar, ADHD, ODD, Mental Retardation, RAD, Autism and depression. Students referred to her groups have Individual Education Plans (IEPs) to address various social, emotional and behavioral goals such as: improving peer and adult relationships, promoting more spontaneous and positive interactions, increasing ability to work with others, attending to directions, and complying with adult requests. Brijin implements her groups in the school setting without a co-therapist; some groups utilize the special education teacher and paraprofessional. The Theraplay groups are closed and last from 9-12 sessions with an average of 4-5 students. Before initiating a Theraplay group, Brijin meets with each student 4-6 sessions individually to assess their fit for the Theraplay Group.

Mary Spickelmier uses Theraplay techniques in her Juvenile Offenders Program (JOP), for adolescents between the ages of 13 to 18 years. Her referrals for the group come from local diversion and probation officers, as her clients have broken the law and are charged with various criminal acts ranging from theft to battery. She conducts open ended groups ranging from 12 to 20 sessions based on the clients’ needs. Mary divides the groups by gender with an average of 6 to 8 adolescents in each group, and provides the services in her private practice office without a co-therapist. Mary utilizes several Theraplay techniques within the JOP program and blends cognitive behavioral pieces to help process activities.

Although our settings and populations are vastly different, we have both found the applications of Theraplay to be valuable and effective in our work with adolescents. We hope that this article will encourage more therapists to attempt to go outside of their comfort zone of working with primarily younger children. However, realizing that many therapists struggle using Theraplay techniques with this tough-to-reach population, we have developed the following suggestions to use while working with adolescents.

Tips for Working with Adolescents

Have Clear Rules & Use Teen Culture

When working with adolescents it is imperative to employ clear rules and structure within the groups. Brijin uses the three rules of Theraplay to open every group: No Hurts, Stick Together and Have Fun. At one point the middle school students modified the rules to better fit their lingo: “Zip it, Stick it, Give ‘em props…. Awww Snap”. To better understand this version of the group rules: “Zip it” implies being quiet, listening to the adult; “Stick it” means sitting together in the group, not leaving, following the rules, participating in the games, and “Give them props” suggests that only positive language is used, no put-downs to each other. Loosely translated, they maintained the rules but created their own spin and identity.

Sessions are carefully planned and utilize variations on tried-and-true Theraplay games by infusing them with teen culture. Always plan for more activities than you think you will need; it’s fun to see which games the groups latch onto and enjoy.

Keep in Mind Developmental Stages

An important piece to consider and reflect upon while planning and implementing group sessions are the developmental stages of each client. Many of Brijin’s students have developmental delays; allowing her more freedom to use pure Theraplay techniques, while Mary’s clients are typically older and more resistant to many of the nurture and engagement activities. When utilizing Theraplay with adolescents, we have both found that there is more verbalization and communication that happens between the therapist and child than with younger children. This can be in the form of tracking responses or, in Mary’s case, actually having a conversation to process what the activity felt like.

It is crucial to recognize and reflect on the possible sexual / developmental issues taking place, especially when working with young men. When clients make innuendos about clothing or appearance, using humor to diffuse these potentially difficult or embarrassing situations has been helpful in Mary’s setting; inside jokes have emerged that have helped bring the group closer. The therapist’s awareness of the adolescent’s personality, sensitivities, vulnerabilities and hidden strengths allow her to help create an environment that facilitates rapport and group cohesiveness.

Relationship is Key

The therapist’s relationship with the adolescent client is the main ingredient to successful treatment. A big difference we have noticed in using Theraplay with different age groups is what draws in or engages the client. Younger children are drawn into Theraplay by the activities and games, and the therapeutic relationship evolves. However, with adolescents it is the relationship between the therapist and the adolescent that is key for engaging them in the activities, rather than the activities themselves. When implementing Theraplay groups with adolescents, the therapist must maintain a heightened awareness to meeting and matching the needs of each client. It takes a great deal of trust for an adolescent to regress and allow someone to nurture them. Theraplay with adolescents can provide meaningful and different relationships for teens as there is no interpretation of motives or behaviors spoken between the therapist and adolescent.

Theraplay Activities that WORK with Adolescents

Structure:

Hello & good bye handshakes are standard part of structure that Brijin uses in her sessions. Students pair up each week to create daring, silly and creative handshakes that go all the way around the circle. They range from karate chops to mini-hello and good-bye raps to very complicated sequences of fist bumping, thumb wrestling or finger zapping. A favorite greeting used by Brijin’s high school group is “H-to-the-ELLO” and “G-to-the-OODBYE”! This greeting is passed around the circle at the beginning and end of each session.
Check-ins and observations are important components for adolescents; with changing bodies and increased peer importance along with social stereotypes, kids need to know that we notice, care and remember things about them. During sessions we observe scabs, scars, ear /nose piercing or jewelry. One group of boys even had a “whisker watch” to see who needed to shave. Many groups create their own culture and comfort zones, helping to normalize some of the “weird” things happening in their bodies and life during adolescents.

Nurture:

FOOD!!! Especially with boys, work in 2-3 activities per session with food such as Loudest Crunch (with chips), M&M or skittle color guess. The therapist feeds each client during these games. Always consider eating issues (especially with teenage girls) when selecting your feeding activities.
Spa Day. Mary helps her girls give and accept nurture via a Spa Day by playing relaxing music, having scented lotions and eye masks. The girls in her groups take turns giving one another hand massages as they relax in bean bag chairs. After they have all experienced the Spa, they process the experience.
A nurturing technique Brijin created called “K.C. Ink” taps into the interests of her teenage boys. Several boys mentioned watching popular reality television shows, like L.A. Ink and Miami Ink (both about tattoo parlors). Many adolescents are intrigued by the taboo of body art and piercing, in hopes of tapping into this interest in a safe way, Brijin uses paint brushes and her finger tips to create pretend (yet intricate!) tattoos. The students pick where they want the “tattoo” along with the design they want. This is a great way to give a mini massage on a back, arm and neck.

Engagement:

Use teen culture to enhance the traditional techniques. Watch MTV once in a while, play a Gameboy video, get on the internet to visit Myspace.com, or even go to a teen movie. You do not need to identify (or fully understand) everything you experience; just be aware of what your clients are culturally soaking in. Become aware of what is important and influential to teenagers today. We wouldn’t want you to be “old school” when working with this hip and hyper-techno population!
Use MUSIC as a game or infuse current music into traditional Theraplay games. Most teens like to download, listen and lose themselves in their favorite music; pay attention to the phone ring-tones and artists your clients mention to tap into their interests. Music can be infused into traditional Theraplay games like hot-potato and London Bridge. iTunes is a favorite place for kids to download music.
Human Tangle / Human Knot; this traditional game successfully engages students and holds a lot of challenge. Each student extends his hands to the center of the circle and grabs onto two other hands. The object of the game is to untangle the mess of hands and unwind the group back into a circle. Brijin has found using words like “take hold or gently grip” a hand in the center of the circle is better received by teenage boys then saying “hold hands”. Maintaining sensitivity to language and stereotypes within teen cultures helps facilitate smoother sessions

Challenge: ACTIVE GAMES with LOTS of movement, here are some favorites!

Get creative! Look into team building, adventure therapy, and “ropes course” games that provide more challenge for older kids.
Balloon Bag Bop is a favorite activity for all ages. Take a BIG trash bag, fill it with balloons and tie it off at the top when it’s almost bursting. There are SO many games you can create with this bag-o-balloons! Some of Brijin’s favorites: using the balloon-bag as a welcome activity where each student bops the bag 3 times while the group says the person’s name each time they hit it. Another fun one with the bop-bag is called, World Record Breaker. The students are standing up and make a circle; the therapist sits in middle of the circle. The goal is for the balloon bag to stay in the air without touching the floor (and without kids jumping on top of each other!). This technique was modified from a book called Quicksilver by Karl Rohnke (1987).

The use of Theraplay techniques and Theraplay groups with teens has proven to be effective in reducing verbally aggressive encounters within the group setting as well as physical aggression in the classroom (per teacher report and clinical observations). In the school setting, there is a waiting list of referrals made by teachers who have seen and felt the positive effects of Theraplay. There have been occasions when teens enter the group with ongoing conflict with another group member. By the end of 12 sessions the conflict has been tremendously reduced and in some cased completely alleviated. The teens that receive Theraplay groups (when compared other directive technique groups we provide) appear to be more cohesive, enjoyable and have increased positive regard for peer members after 5-6 sessions. We have found that Theraplay allows us to establish meaningful relationships that foster change within this difficult to reach population.

We hope you will give these ideas a try… be brave and take a risk; the adolescents we see in therapy are doing the exact same thing with us. Shake your tail-feather, get your groove on, have a good laugh, explore a new (teen) culture, and redefine the type of Theraplay you are doing.

The authors are both Theraplay practicum students and presented at the 3rd Annual International Theraplay Conference in Chicago this July. They are writing a chapter on Theraplay with Adolescents for a new book, edited by Dr. Evangeline Munns.