Read about how Theraplay helped a family with children adopted internationally in this Good Housekeeping article

Core Concepts of Theraplay®

THE THERAPLAY® CIRCLE

Presenting the essence of Theraplay in an understandable, graphic form.

The Center of the Circle: Theraplay in Action

The center of the circle represents the essence of Theraplay in practice. Using the model of the healthy parent-infant experience the Therapist brings a mother and her child together to give them an active, here and now experience of a new way of relating. She guides them in the experience of interacting in ways that foster attachment and create joyful interaction. This direct here and now experience is a unique feature of the Theraplay approach.

The Inner Ring of the Circle: The Theoretical Basis of Our Work

At this level of the circle we look at the distinctive characteristics of Theraplay--The Core Concepts—in order to understand the theory and research underlying every aspect of our work. Each core concept is solidly supported by theory and research that underscores its importance in the interaction that leads to secure attachment and lifelong mental health.

  1. Interactive and Relationship Based: As with all attachment based treatments, the focus of treatment is the relationship itself. In order to form or fine-tune a relationship you need to do it face to face, taking advantage of the hard-wired mechanisms that support parent infant connection and interaction. Theraplay activities use rhythm, resonance, affective synchrony and mirror neuron functions to support relationship building.
  2. Direct Here and Now Experience: Change in a relationship can best be achieved by interacting affectively in the moment not by talking about or interpreting symbolic behavior. We take advantage of these innate capacities for synchronizing, resonating, and connecting, through shared emotion and physical interaction. We create moments of excitement that suddenly shift the child into a moment of joyful connection. We challenge the child’s negative internal working models by responding to his behaviors in ways that are non-congruent with what he expects, e.g. we take a child’s negative behavior and see it in a positive light, and in so doing we organize a behavior that might typically get a negative response into one that is positive, and creates a moment of shared, playful activity. Rather than talking about new meanings, we create them in the interaction.
  3. Guided by the Adult: The development of a healthy relationship requires the presence of a caring adult who can make the baby feel that he is in the hands of someone who can keep him safe and can support and guide his behavior. In Theraplay we take extra care to make sure the child feels safe at all times. We organize what could be chaotic games, for example balloon bopping, by adding a counting component. We regulate activities to match the child’s current affect state, for example by slowing down or speeding up the pace. We have clear expectations and limits in our games, but they are communicated with warmth and support. All of this provides a foundation for self-reliance and confidence.
  4. Responsive, Attuned, Empathic and Reflective: This core concept is derived directly from research into the kind of parenting that leads to secure attachment. Based upon our understanding of the child’s experience, we respond in attuned ways and help parents do so too.
  5. Preverbal, Social, Right Brain Level of Development: New understanding of brain development and of the effects of neglect and trauma on the developing brain supports our focus on meeting the child’s younger emotional needs and on finding ways to calm the dysregulated and frightened child. It supports our use of younger activities and our attention on regulation. Theraplay uses the language of the right brain through eye contact, touch, movement, rhythm and playful interaction, resulting in the creation of new patterns in the brain.
  6. Multisensory: The lively, nurturing care of a baby provides stimuli to all the senses. We emphasize active physical interaction to stimulate vestibular and proprioceptive responses as well as calming touch and soothing sensory experiences to create “cared for” feelings and positive body image.
  7. Playful: The shared joy of interactive play creates a strong emotional bond. It also programs the brain to become fully social. “I would suggest that any therapist who can capture the therapeutic moment in mutually shared play episodes will have brought the client to the gateway of happy living.” Panksepp, p 17, The Healing Power of Emotion. Theraplay activities promote optimal arousal by being exciting and fun, yet regulated. “Just plain fun” activities can result in shared joy, stress reduction and brain organization.

The Middle Ring of the Circle: The Dimensions of Theraplay

As a guide to our work with parents and children we distinguish four basic dimensions of healthy parenting: Structure, Engagement, Nurture, and Challenge. We use these dimensions to plan treatment based on the specific needs of the parent and child. Except for Structure, the core concepts are not directly identified with any one dimension but provide important scaffolding for all the dimensions. They are the prism through which we translate the core concepts into the action plan for treatment sessions.

  1. Structure: When focusing on structure we are providing a sense of safety, organization and regulation for both the child and the parents. We are attuned and sensitive to the child’s need for guidance, for regulation of his experience and for having an adult he can count on who will set limits and provide a model for appropriate behavior.
  2. Engagement: Engaging activities lead to connection, optimal arousal and shared joy. As a result of this playful, responsive interaction, the child gets a new experience of his body and of how to interact with others in a shared, synchronous manner. For this to work well we attune to the child’s level of excitement and are prepared to co-regulate the child’s experience. Shared joy is a powerful force in changing negative internal working models to positive ones.
  3. Nurture: Nurturing activities help regulate and calm the child, enhance self-worth, and provide many experiences of empathic responses to her need for comfort and reassurance. Nurturing activities are the essence of the experiences that convey to the child that the adult can provide a secure base to return to when stressed and when needing comfort. Touch is an essential ingredient in most nurturing experiences.
  4. Challenge: Challenging activities lead to a sense of competence and mastery. These activities support the child’s impulse to move forward, to master new things, while at the same time providing the support that assures him of success. Activities are carefully chosen with an awareness of the child’s developmental level and his ability to succeed. The child learns that he can branch out while always being able to count on adults to be there when he needs them.

The Outer Ring of the Circle: Our Goals

As we work with families we have a number of important goals.

  1. Our playful, attuned, here and now interaction will create positive, hopeful internal
    working models for parents and child.
  2. Our focus on co-regulation of affect will lead to the capacity for self-regulation for
    parents and child.
  3. Our adult guided, playful interaction will provide the foundation for positive social skills.
  4. Our responsive, attuned, empathic approach will create a secure attachment between
    parent and child.
  5. This secure and healthy parent-child relationship will lead to lifelong good mental health.