Transcript THERAPLAY - The Derbyshire Branch of AFT

Wedding Systemic Practice and
Theraplay
Christian Elliott Therapeutic Social
Worker – Horizons, Derbyshire
Horizons
A multidisciplinary service made up of Clinical and
Educational Psychologists and Therapeutic Social
Workers that specialises in providing training,
consultation and therapeutic interventions to adopted
children, children in care and the networks that surround
them.
Horizons offers attachment based therapies such as
Dyadic Developmental Psychotherapy and Theraplay.
Horizons is based at The Hub, South Normanton and
covers the county of Derbyshire.
Horizons is a Derby City Hospitals NHS Foundation
Trust service.
History of Theraplay
Ann Jernberg, a Psychologist, founded
Theraplay in 1967 in Chicago as part of
the Headstart program in Schools.
Became a Registered Trademark in 1976
Expanded to United States and Canada
and later to Australia, Finland, Germany,
Israel, korea and South Africa
What is Theraplay?
Theraplay is:A short term structured play therapy for children,
young people and their carers and parents
Interactive, play, focused and fun.
It is modelled on the natural, healthy parent-infant
relationship.
Theraplay’s goal is:To provide a corrective emotional and behavioural
experience to enhance attachment, self esteem, trust
and joyful engagement with carers.
To enable parents/carers to continue their own health
promoting interactions beyond the therapy room.
Theraplay is not simply a set of techniques but a way
of relating to children that is positive, playful and
enriching.
The Basic Assumptions Of Theraplay
Theraplay has developed an increasing body of
research into the fields of child development,
attachment theory and Brain development that
support Theraplay’s tenants.
The primary motivating force in human
behaviour is a drive towards relatedness
The early interaction between parent and child in
which the self and personality develop.
A secure attachment process builds healthy
emotional and behavioural development
Distinctive Characteristics Of Theraplay
Theraplay is modelled on ‘good enough’ parenting, the
kind that leads to a secure attachment
‘Treatment’ involves emotionally attuned, interactive,
physical play.
Nurturing touch is an integral part of the interaction.
The Theraplay therapist remains firm in the face of
resistance.
The focus is on the here and now.
‘Treatment’ is geared to the child's emotional level.
The Theraplay therapist takes charge
Parents are actively involved in the treatment and
supported by their own interpreting therapist
The therapists and parents work together to engage the
child in a healthier relationship.
Theraplay Program: Using The Dimensions Of
The Early Relationship As Compensation
Four identified dimensions that prevent the
development of a healthy relationship
Inadequate structure in daily experience
Too little personal engagement
Insufficient empathic nurturing touch
And failure to provide the right kinds of
challenge
These are the dimensions of Theraplay
Theraplay Treatment:
Using The Dimensions Of The Early
Relationship As Compensation
STRUCTURE:
Useful for overactive, undirected, over-stimulated, controlling
children. The fact that the therapist is in charge is reassuring,
teaching the child to be in control of self, addresses inner/outer
disorder.
ENGAGEMENT:
Essential for all children. Useful for withdrawn, avoidant of
contact or too rigidly structured children. Child is focused on in an
intense personal way to make an attuned connection. Goal is
child is ‘seen’ and ‘felt’. Child is shown surprises can be fun and
enjoyable.
Theraplay Treatment:
Using The Dimensions Of The Early
Relationship As Compensation
NURTURE
Useful for overactive, aggressive or pseudo mature
children. Meets with child’s younger needs, helps the
child to relax and let themselves be taken care of,
builds inner representation that the child is valued and
loveable.
CHALLENGE Useful for withdrawn, timid or rigid children. Enables
child to take appropriate risk to promote feelings of
confidence and competence. Activities are fun and
require a partnership.
Children who are referred
Children can be referred for a variety of
difficulties including:
Attachment difficulties
ADHD
Autism
Developmental delays
Anxiety And depressive symptoms
Theraplay Supports
Children with….
With drawn and unhappy children become more
outgoing and self-confident.
Overactive and aggressive children become more
calm and cooperative.
Children benefit from more loving, nurturing and
attuned care giving.
How to engage and enjoy intimate attached
relationships.
Children benefit from being understood.
Theraplay Supports
Parents/Carers with……
How to take charge without humiliating or being drawn
into coercive interactions
How to stay with the child when they are angry and
upset
How to engage children in a more loving, nurturing
relationships
How to use appropriate touch as part of tender nurturing
caregiver
How to challenge to build competence and self esteem
How to side step behaviours with the sheer fun of joyful
play
How to enjoy their children
What's Behind These Theraplay
Activities: A Window Into Attachment
Through the Theraplay assessment, the Marschak
Interaction Method (MIM), Theraplay activities are
matched to specific child/carer relationships and targeted
at developing areas in the dyad which might act as
barriers to attachment.
The type of Theraplay activities offered will relate to the
attachment pattern of the child and carer.
Attachment patterns/Internal working models
- Secure attachment
- Insecure avoidant (dismissive)
- Insecure ambivalent (preoccupied)
- Insecure disorganised
Attachment Narrative Therapy Dallos & Vetere
Internal working models – attachment as a set of beliefs,
expectations, stories we have about ourselves and
others, influenced by our close relationships, family,
community, wider societal factors (Social
Constructionism)
Narrative approaches - move to assessing attachment
through the content and structure of the stories people
tell about their lives
Narrative – ability to tell coherent stories about our lives
is shaped by our attachment experiences in families
Attachment Narrative Therapy Dallos & Vetere
ATTACHMENT STYLES DETERMINES FAMILY
COMMUNICATIONAL RULES
– SECURE: Expression of feelings met by acknowledgement,
reflection and negotiation – semantic and emotional
responses
– DISMISSIVE: Communication of feelings met by injunction
to suppress feelings, avoidance, rejection – semantic
responses
– PRE-OCCUPIED: Symmetrical escalating expressions of
feelings, mutual accusation, blaming – emotional response
FAMILY PATTERNS - Parents may differ in their styles , e.g.
mother avoidant/dismissive , father ambivalent/pre-occupied
Corrective and Replicative Scripts
John Byng Hall
Families make comparisons across generations,
scripts repeated of altered.
Therapy focuses on positive frames in that we
can construe the intentions of the parents
positively, i.e. they have tried to repeat what was
good or correct from their own experiences of
being parented. This can then lead to a
‘discussion’ of whether these attempts have
been successful or not, and possibly how they
might be altered, strengthened, elaborated etc.
To the same ends - ANT &
Theraplay?
Theraplay’s focus is on building relationships, new ways
of interacting, through actions, through play. Underlying
philosophy - medical explanation re neurobiology of the
brain i.e emotional attunement, non-verbal, face to face
emotional communications involving rhythm, eye contact
etc said to access right brain structures.
ANT focuses on enabling parents, carers and children to
develop healthier relationships through co-constructing
new narratives and discourses. This is done through
experiential, relational, techniques such as enactment,
role play, genogram’s, time lines, Internal other
Interviewing, mapping relationships, scaling and circular
questions etc
Applying Systemic Approaches in
Theraplay
Collaborative, ‘non-expert’, second order
approach e.g study MIM together and
jointly prepare assessment & decide on
dimensions with carers/parents
Curiosity, Neutrality and Hypothesising in
Theraplay
GRACE Awareness
Involving other significant relationships
and wider system