Last
month Di introduced us to Theraplay. Here she expands on the method.
Click here
if you wish to read last month’s article first.
What
is the difference between therapies?
Play
therapy
Play
therapy is child-centred and the therapist’s role is to facilitate
the child’s expression of his or her inner experience and
their view on the world through symbolic play. In this approach
the therapist sets limits on dangerous or destructive behaviour,
and the child will enter the therapy room full of toys designed
to invite the expression of feelings and act out the important themes.
The therapist role varies from quiet observer to an active follower
of the child’s symbolic play.
Theraplay
The
difference both in theoretical base and goals of treatment dictates
a very different way of interacting with the child in treatment
in Theraplay. We believe that if we are to change the children’s
views of themselves and the parents’ way of relating, we need
to initiate more active play of a type which is natural in the parent-child
relationship, but which is very different from other child therapies.
We
bring children into the room without toys so that the entire focus
is on the relationship between child and therapist. We then initiate
activities borrowed from the parent-child repertoire which are physical,
playful and surprising. We even use play on entering the play room
with the adult staying in charge, as with an early infant and mother
interaction.
Brief
outline of a session
Aim
of structure
To relieve the child of the burden of maintaining control of interaction.
Activity
The child enters the room, hop-skip-jumping with the adult holding
the child’s hand.
Alternatively,
using eye signals, the child holds the therapist’s hands and
they face each other, so that eye signals can be used to indicate
the direction and number of steps to take. For example, the therapist
may wink with the left eye twice so the child will move two steps
to the left.
Aim
of engagement
To establish and maintain connection with child and to focus on
the child in an intense way and to surprise the child and involve
him or her in an enjoyable new experience.
Activity
Checking body parts such as nose, chin, ears, cheeks, fingers. other
body parts.
Alternatively, face the child and mirror facial expressions or movements
of arms or other body parts. For children who are diagnosed with
perhaps ADHD, slow motions or various tempos should be used.
Aim
of nurture
To reinforce that the child is worthy of care and that adults will
provide care without the child having to ask.
Activity
Checking for hurts –taking notice of the child and placing
lotion around scratches and cuts and celebrating other parts such
as freckles, colour of eyes etc.
Alternatively,
feeding - presenting a small snack or drink to the child either
with the child on the adult’s lap or face to face, in contact
whilst s/he sits up or is propped up. During feeding there should
be observation of sounds and waiting for the clues as to when the
child is ready to move on for additional feeding.
Aim
of challenge
To enable the child to feel more competent and confident by encouraging
the child to take a slight risk and to accomplish an activity with
the support of an adult.
Activity
In a balancing activity the child balances on a pillow, starting
with one and increases as long as the child can easily manage. Once
the child is balanced, the therapist instructs him/her to jump into
his/her arms or down to the floor, but only when the signal is given
by the therapist.
Alternatively,
a crawling race, with the child and the therapist crawling around
cushions placed on the floor trying to catch each other’s
feet. This is good for children who perhaps have learning difficulties,
as research shows that children who missed this vital mile-stone
of crawling could develop reading disabilities.
A
blend of these components can be used, depending on the child’s
needs and areas needed to be worked upon. The therapist stays within
the proximity of the child at all times and tries to gain eye contact
throughout. If and when a child resists, the therapist works with
the resistance and will bring into the session an additional activity.
For example, if a child pushes the therapist away with their hands,
the therapist will use an activity such as push me over-pull me
up, using the child’s hands they used to resist with.
Assessment
In
developing the treatment programme, an assessment of the family
takes place in an observation room using one-way mirrors or video
linkage. This takes place over perhaps one or two sessions, depending
how many parents or carers there are within the family. During this
period the parent or carer is left in a room with their child and
given a number of play activities by the therapist, using all of
the components outlined
From
there the therapist would use the analysis of the Marschak Interaction
Method, which is designed to assess the quality of and nature of
the relationship between each parent and their child.
The
assessment would involve exploring the following :
Structure
Who is in charge - the parent or the child?
What role does the parent take - appropriate parenting role, peer,
pal, child in the parental role, school teacher?
Does the parent provide structure or direction?
Does the child accept structure or direction?
Engagement
Parent able to engage with child?
Child response to parents’ attempts to engage the child?
Does parent respond empathetically to the child?
Parent and child physically and affectively in tune with each other?
Do the parent and child match levels of stimulation to the child’s
ability to tolerate it?
Are the parent and child are able to have fun together?
Nurture
Parent provides contact by touch, physical contact and care giving.
Parents accepts taking care of him or her.
Parents recognise and act upon child’s needs for help in soothing,
calming, and reducing stress.
The child accepts parental help when needed regarding calming reduction.
The child is able to sooth him/herself.
The parents prepare child for separation.
Challenge
Activities chosen by the parent are developmentally appropriate.
The child responds to the task.
Parents make mastery appealing.
The child is able to focus and concentrate.
The child is able to handle frustration.
Parent helps the child handle frustration.
Reflective
functioning
Once
observation has taken place the therapist would analyse the video
footage and discuss with parents / carers, supported by a method
called Reflective Functioning (RF) which is based on findings from
research by Peter Fonagy, Howard Steele, British psychoanalysts
and child developmental specialists They suggests that maternal
reflectiveness mediates the relation between the adult and the child.
Attachment is what makes possible for the mother to respond contingently
.Contingent sensitive responding depends on accurate reading of
the child’s interaction and feelings and upon the mother’s
emotional availability.
This
supports the mother in reflecting upon the emotional, internal life
of her baby (even before it is born). It also enables the mother
to reflect upon her own internal affective experience of parenting,
beginning as early pregnancy, and finally it helps the mother to
understand the dynamics of her own and her baby’s affects
- as they exist internally and interpersonally - as a means to problem-solving
and the development of the sensitive response by the care giver.
For
example, in one activity which I used in observation the parent
left the room for one minute. When she got up to leave the room,
the child followed and strongly resisted her departure. When asked
how she was feeling afterwards, she responded, “He just wants
his own way. He always tries to stay in control”. The mother
then saw herself play with her child on the video. Once she had
watched the video footage, she had tears in her eyes. “He
is afraid. He doesn’t know what is going to happen. No wonder
he wanted to come with me”.
By
using reflective functioning, the mother was able to reflect on
her approach towards the child as she left the room. Working with
the parent / carers is vital part to improve relationships, as they
are the ones who work twenty-four hours a day with their child.
During
this feed-back period parents / carers will discuss and explain
their views of their child, with the intention that the therapist
will increase empathy by helping parents / carers to understand
how their child may feel, with the long-term aim of parents / carers
becoming more comfortable in stopping their child’s uncontrolled
behaviour.
Sequence
of the treatment programme
Session
1 Initial contact with the family after the referral and exploration
of the family and looking at current functioning.
Session
2 Marschak Interaction Method (MIM)
Session
3 Feed back to parents / carers on observation of areas of good
interaction and difficulties and proposed treatment programme via
observation of video footage.
Session
4 onwards Usually takes place weekly, for a period of 50 minutes
depending on the individual needs of the child; in some cases they
could perhaps last for five minutes .
Over
the twelve sessions, the therapist initially works with the child
to gain a better understanding of what is taking place within the
child. Gradually the parent (usually the mother) enters the room
with the therapist, with the view that the therapist will support
their interaction. The father then enters the room and works with
the child. Later, both parents enter the room, supported by the
therapist.
Footnote
The family also does homework on a weekly basis. At the end of the
treatment programme there are four reviews over the year. To date
I have just concluded working with many families, with remarkable
results with the individual children and families as a whole.
Any
further inquires : Contact DiGower @aol.com
