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

THERAPLAY GROUPS FOR ADOLESCENTS WITH EMOTIONAL PROBLEMS

Peggy Weber, A.C.S.W., L.C.S.W.

Sanders School Indianapolis, Indiana

The staff at Sanders School in Indianapolis has been conducting successful Theraplay groups with elementary, junior high and high school students with serious emotional problems and developmental delays. Sanders is a separate, full time public special education program and a restrictive educational environment for students with behaviors that interfere with their learning. In addition to educating students, our goal is to teach students skills that will help them manage their behavior and return to a less restrictive setting. In order to provide opportunities for learning and practicing social skills, all of the students in the school go to some type of special program or club twice a week. In contrast to the educational programs and the experiential but non-therapeutic clubs, Theraplay group combines the interactive, experiential component with specific therapeutic goals.

Many of our students have experienced gaps in nurturing due to health problems, family crises, or caregivers with their own personal issues. These students were not held as infants, sung to, cuddled, nor did they learn to trust that their needs would be met consistently. Many have experienced repeated trauma during their lives and have come to associate intimacy and touch with physical and emotional harm. Most students have previously had or are currently attending traditional counseling. While this is helpful, it does not address the entire spectrum of their needs. Many of these students are not candidates for traditional “talk therapy” due to disorders such as ADHD or Asperger’s or developmental disabilities. Many are intellectually gifted but display behaviors that interfere with achievement. Many do not believe that they can achieve, nor do they believe they deserve success. They lash out to prevent intimacy and to feel in control.

In graduate school I was taught to “start where your client is.” For many of these students, that is at the preverbal level. Theraplay addresses this level, but is a method that is more directive than traditional play therapy. It appeals to my need for structure and to my administrator’s preference for lesson plans. Theraplay also is consistent with the current notions of best practice for treating individuals with attachment disorders. While it is preferable to intervene with children as young as possible, adolescents should not be denied the opportunity for services due to their chronological age.

In order to make the group sound more appealing and dynamic to our older students, we changed the Theraplay group name to Powerplay. We still followed the Group Theraplay rules as described in Rubin and Tregay’s Play With Them: No hurts, Stick together, and Have fun. All staff and students adopted the language of those rules. The group staff consisted of the school social worker as leader with teachers and paraprofessionals working with individual students. Because our students’ behaviors were so difficult to manage, our group staff to student ratio was one to one, or one to two. Having an adequate number of playful, nurturing staff was essential to keeping things from becoming chaotic. The following is a description of the the things we learned that helped the Powerplay groups run smoothly and effectively with our fourteen to eighteen year old students.

Preparation: Before starting the groups, I oriented staff to the Group Theraplay approach, explaining the three basic Group Theraplay rules and stressing that the adult must be in charge. I encouraged staff to be playful and to accept all the behaviors presented by the students. The “have fun” rule was the hardest to follow. Classroom management is expected of competent teachers. Our school employs a comprehensive behavior management system to deal with student behaviors. To permit boisterous and non-compliant behaviors is alien to the traditional approach used by the staff. Those uncomfortable with the Theraplay concepts were permitted to opt out of group participation. It was necessary to convince all the teachers and paraprofessionals that the novel interventions of Theraplay were based on a theoretical foundation, to teach them the interventions and to allow them time to experience the reality that Theraplay works!

Description of Powerplay Groups: Students enter the group room during a general passing period. A sheet placed in the center of the room acts as an “anchor” or focal point on which we all “stick together.” Students are invited to sit on the floor, on pillows or in chairs. A typical forty-five minute session begins with an introductory, interactive activity that students join as they enter the room. Blowing/chasing bubbles, cotton ball blow, cotton ball races and the beach ball pass are good examples of entry activities. Once everyone is present and engaged in the activity, we switch to another active, engaging activty such as arm wrestling, hand stack, or modified tug of war (Stand with your back to your partner about three steps apart, bend over, reach through your legs and grab the hand the partner has put through his legs. The first one to pull the other off balance wins. Be sure to have spotters to keep it safe). This allows students an opportunity to pair up with their staff partner, engage, touch, and begin to talk to each other. I encourage staff to attend to the students and to reinforce their efforts with laughter and comments such as “Wow, you’re so strong!” Then we enter the nurturing phase by introducing a snack. Students are encouraged to get comfortable on the floor with a pillow, on a chair, or in whatever position they will tolerate. Staff feed the students the snack, engage in conversation and give them a drink. Then we bring out the lotion and powder and the students select what they want the staff to apply. We notice freckles, bumps and scars. We usually do another nurturing activity such as making handprints with lotion and powder, or looking for letter or number shapes in the lines of their palms. At this point the group usually is calm and content. If time permits we will do another group activity until the session ends, such as “make a round circle,” a group favorite and an old stand-by (I “draw” a circle on a student’s back with my finger and “color” it in, then invite another student to touch in the circle; the first student guesses who gave the touch). A typical ending activity might be to wrap a student in a sheet and present this “special gift” to the group. I find the games that I used to play with neighborhood children in the backyard are very successful in group. These games have been loved by generations of children, but our students didn’t have the opportunity to enjoy a carefree childhood--until Theraplay group!

Take risks! The things that I feared were too juvenile, intimate or downright corny have been some of the most successful activities that we have done. If the leader is playful and acts as though it is perfectly reasonable to do these activities, the kids will usually go along. The pure fun and joy of engaging in the playful activities are your best resource. The activities are winners, let them sell the program for you. My students loved to be sung to, fed and have lotion put on them. Although they initially reacted with skepticism and hesitation, they could be coaxed into having fun.

Materials: Students will not be invested in the Theraplay process if inferior products are used. Cotton balls, sheets, balloons and paintbrushes do not have to be luxury items, but they should be sturdy. Using good quality materials implies that you value the students and that they are worth something. An effective way to get students to allow staff to apply lotion is to use the products that they like. Men’s fragrances such as Tommy Hilfiger, Polo Sport, Eternity, Gucci and Nautica are very popular and the guys seek out the lotion. Students are allowed the scent they prefer. I avoid anything that might appear juvenile. I use pre-moistened towelettes, but nothing that says baby wipes. The guys make jokes about using “baby butt wipes,” but staff points out that the towlettes are not baby wipes. Name brand lotions, food, foil and construction paper are expensive. It is impractical for the group leader to underwrite the cost of all the materials. Therefore, getting financial support from the school or agency is very important. As our staff became more familiar and invested in the process, they began to bring in lotions and snacks. Everyone began to take some ownership of the process.

Sequencing: Different groups, like different children require different activities and sequencing. All group members benefit from being quickly involved in an activity when they enter the group room. Some groups that I have led needed an active initial entry activity and then a quick shift to nurturing activities. If not, they would become boisterous and out of control. Another group tolerated a mixture of both. It is best not to start with a nurturing activity. Most students need a little time to make the transition from the classroom to the group. Too much closeness too soon creates a great deal of anxiety. I usually serve the snack fairly early in the session. It keeps students from obsessing about the food and our hands are usually still clean, not smelling of lotion. I also bring large quantities of wet wipes to use before and after feeding and lotioning activities.

Always keep one or two extra activities in mind just in case you run out of things to do, or the group mood does not fit the original plan. Usually students love the Paper Punch (Staff holds up a sheet of newspaper for the student to punch through on a signal), but one group was so lethargic that I switched to a quiet nurturing activity--shaving. We put shaving cream on the boys’ faces and using popsicle type/craft sticks as “razors,” “shaved” the guys. The girls were given a “facial” with the shaving cream.

Planning and clean up take as much (or more time) as conducting the group. You will not feel like cleaning up. You will be tired. I suggest that you schedule the group session at a time when you do not have to move on to another demanding activity, or do not have to clean up completely.

Problem Solving: Plan Ahead! While you are looking for your materials or thinking up an activity, group members quickly find inappropriate things to do. Have a specific agenda for each group. In my pocket I have a piece of paper on which each activity is written. All materials are organized and packed in a backpack. This keeps it handy, but out of sight. If the students have an opportunity, they get into the pack and go through the contents, so the pack is adjacent to the leader, but away from the group.

Food is a favorite. Getting students to consume food is not difficult. Most adolescents are perpetually hungry and devour anything that is available. Popular items are Chex Mix, Gummi Bears, Goldfish, pretzels, caramel corn and cookies. If a student requests a particular or favorite snack, it usually appears on the menu in the future. I’ve even baked snicker doodle cookies upon request. Students feel heard, respected and nurtured if their requests are honored. Avoid, however, Skittles, raisins, grapes and other small snacks. They are too tempting to throw. Some students don’t like certain snacks and are allowed to pass. Cups of liquid can be disastrous; they are too easy to spill or throw. Individual plastic drink bottles that come in packs are appealing to students, are tidier, and (while feeding closely resembles sucking from a bottle) are appropriate for high school students to consume. Many students lie down on the pillows to be fed their juice. Some students who are very uncomfortable with feeding may withdraw or become aggressive. Some insist on holding their own food. We try to hold on to it too. If necessary, we will hand it to them, or break it into bite sized pieces. We try to be sensitive to their needs and make accommodations, but always to remain engaged in the feeding process. To date, only one student has consistently refused food and lotion.

Initially, I attempted to match staff with students. Although structure is very important, we learned that letting those matches happen spontaneously was the best practice. Staff and students instinctively gravitated to their partners. For example, a staff member may have rapport with a particular student and be matched with him, only to find out that another student seeks him out and the original student is content to pair with another staff member. Sometimes a staff member was assigned to a student in her class only to realize that the student wanted a “break” from contact with her. Another teacher and student really hit it off because of a mutual interest in Great Danes that was discovered when the student wore a T-shirt with a Great Dane on it and learned that the teacher owned three of the dogs.

As the group leader, I had the dual task of monitoring the students’ behaviors and the staffs’ response. Occasionally staff would be applying lotion and not attending to the student but chatting with other staff and students. I handled this by modeling attentive behavior in a rather obvious way and the staff was reminded of their task. Preparation of the staff is essential. In one group that was begun without the orientation of all staff participants the tendency was for staff to redirect the students’ behaviors rather than accept them. It significantly interfered with the Theraplay process. I wish to emphasize, however, that with proper information and support, most staff members have been excellent group co-facilitators.

Outcomes: We found that students do not want to leave at the end of the nine-week session. Most kids want to stay with Powerplay and some have attended a second nine-week Powerplay session. We also learned that the staff and students who participated in a Powerplay group had much better rapport. Staff could see a unique, softer side of students that was not usually visible. Students were more willing to listen to staff members that had been in the group. This occurred even if the staff member was not that particular student’s partner. An unplanned fire drill interrupted one group, and things were chaotic upon reentering the building. Two students were caught stealing juice. The Tommy Hilfiger lotion was missing, but the theft was not observed by staff. At the next group session students wanted Tommy lotion, and staff explained that it was not available. Several students privately told staff who had the lotion (because they wanted to use it during a group) and that student was confronted privately and returned the lotion. The power of the group enabled the students to address the theft that deprived the group of something valued. As the school social worker, I have found the Theraplay participants more accepting of traditional social work interventions (crisis intervention, mediation, problem solving, etc.) than they had been before.

Some students blossom in Powerplay and respond in ways that are profoundly touching. Our ending sessions are big celebrations with staff making yarn and construction paper necklaces specifying unique characteristics of the participants. We use glitter and confetti and sprinkle it on each student somewhat like a ticker tape parade. One angry student who was hostile most of the time picked up the confetti and proceeded to spontaneously “honor” each staff member by individually recognizing their unique characteristics. Staff members who were not Theraplay participants were incredulous upon hearing this!

Summary: While attending my initial Theraplay training, I asked many questions about using this technique with adolescents. Trainers were candid about the fact that it is used predominantly with younger children, but they were supportive and enthusiastic about my plan. I saw a videotape of a Theraplay therapist working with a man in his twenties. The therapist said something that inspired me: “I have to attend to my client and anticipate his needs so that I am more interesting than any game, toy, book, or video.” While it is challenging to implement, I believe this philosophy to be a very caring one. Sanders school is an environment that permits me to try new things and is supportive of taking risks. The staff is dedicated, open-minded and very child oriented. I wasn’t particularly satisfied with the things I had been doing up to that point. I decided that I couldn’t lose by trying a Theraplay group and I just might win. If the students refused to comply, acted out, or disrupted the program, we had a system in place to respond to those behaviors. Our students regularly behave in that manner, so no one would blame me. If, on the other hand, students responded in ways that I suspected they might, we would have a new tool in our repertoire of interventions for students--and I was right! I just hope that I have the energy to keep up with the rather demanding regimen of a regular Powerplay group--it is not for the sedentary!