Originally published in the The Theraplay® Institute Newsletter of Summer, 1998

Theraplay in a Residential Setting

Carol Brennan, Ph.D., L.P.C.C., R.P.T./S

The Phoenix Group, Albuquerque, New Mexico

A modified Theraplay approach has been used successfully in a residential treatment setting in Albuquerque, New Mexico with young children as well as with adolescents. Residents in this setting are admitted for a variety of reasons and with a broad range of diagnoses. While most of these children enter the residential setting directly from an in-patient psychiatric setting, many have previously been in foster or adoptive placements, while others have been unsuccessful within their biological family homes. The majority of these children are admitted with DSM IV diagnoses of Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Major Depression, Post-Traumatic Stress Disorder, or a combination of these and other diagnosed disorders.

Prior to the implementation of Theraplay techniques, a behavior modification approach had been employed with all residents, regardless of their ages. When Theraplay was used as an intervention with one little girl, the effectiveness of using aspects of engagement and nurturing physical touch soon became evident to the entire staff. Reba, five years old, had been admitted to residential treatment due to non-compliance, dangerous impulsivity, inattention, and hyperactivity. Previously, she had been seen for a few months in traditional play therapy, first as an outpatient, and then while in a hospital setting. The same therapist worked with her throughout her outpatient, inpatient, and residential treatment. Reba was extremely difficult to engage and seemed unmotivated to “connect” except to obtain special favors from adults.

After several weeks of Theraplay sessions, Reba startled her therapist by spontaneously calling to her as she was leaving, using her name for the first time and asking when she would return to see her. Seeing how effective individual Theraplay sessions were with Reba, staff members began extending and increasing their use of a few simple techniques such as initiating eye contact and placing a supportive hand on her shoulder or a pat on her back when they interacted with Reba on the unit.

As Reba’s progress became more pronounced and was maintained, staff therapists asked to learn more about Theraplay and began using Theraplay as an intervention with other children during their individual therapy sessions. The children’s parents were included when possible and support staff, such as mental health workers, were involved in some brief, informal “in-house” training about the purpose and benefits of using appropriate engaging and nurturing activities.

Staff therapists were so encouraged by the success of Theraplay interventions with individual children that they began a weekly Theraplay group of eight to ten children; two children were paired with one staff member within this group. After six to eight weeks, several group members showed a decrease in aggressive behavior and an increase in empathy with each other outside the Theraplay group.

The successful use of a few simple Theraplay techniques with the residents in this setting has led to an administrative decision to make Theraplay, rather than behavior modification, the primary intervention for children age ten and under who enter this treatment center in the future. While some staff members had an understandably difficult time shifting their thinking as well as some of their interactive behaviors with the children on the unit, some readily embraced suggestions to make consistent eye contact and to use nurturing touch when possible. A few large rocking chairs which had “disappeared” from the unit “reappeared.” Evening staff members reported that children who were rocked before bedtime were going to sleep more easily and sleeping more soundly.