More threads by David Baxter PhD

David Baxter PhD

Late Founder
What is Theraplay?
Theraplay Institute

From the beginning the Theraplay? approach shared many assumptions with interactional theories of development, particularly those of Self Psychology and Object Relations theory. Over the thirty years of its clinical practice, an increasing body of research in the fields of early brain development and attachment theory has given further support to many of Theraplay's tenets.

The Theraplay approach assumes that the primary motivating force in human behavior is a drive toward relatedness. Personality development is essentially interpersonal. The early interaction between parent and child is the crucible in which the self and personality develop.

The playful, joyful, empathic, attuned responsiveness of caregivers is essential to the development of a strong sense of self, feelings of self worth, and secure attachment. The capacity to soothe and nurture oneself in later life depends on early experiences of being soothed and nurtured.

When things go well in the relationship, the infant develops an inner representation of himself as lovable, special, and competent, and able to make an impact on the world; of others as being loving, caring, responsive and trustworthy; and of the world as a safe, exciting place to explore. In other words, he begins a process of learning about himself and the world which is positive and hopeful and which will have a powerful influence throughout his life.

Psychopathology results when early and ongoing experiences lead to a negative or inadequate sense of self. In the absence of positive and responsive interactions, the child learns to view herself as unlovable and incompetent, to view others as uncaring and untrustworthy, and the world as unsafe and full of threat. In other words, within an insecure attachment, the process of learning about one's self and the world becomes negative and hopeless. Many behavior problems of older children can be traced back to their beginnings in insecure attachment and in the concomitant negative views of themselves and the world.

The Theraplay approach assumes both that change is possible and that the essential ingredients of change lie in the creation of a more positive relationship between a child and her parents. Because the roots of development of the self, of self esteem and trust lie in the early years, it is essential to return to the stage at which the child's emotional development was derailed and provide the experience which can restart the healthy cycle of interaction. Activities are geared to the child's current emotional level rather than to chronological age. Parents are encouraged to respond empathically to their child's needs. The goal of treatment is to change the inner representation of the self and others from a negative to a more positive one.

How Theraplay? Differs from Non-Directive, or Child-Centered, Play Therapy
Theraplay is a dyadic psychotherapy for two individuals: the child and her caregiver. The main focus of the therapy is to improve the relationship between adult and child through direct interactions between the two individuals.

Non-directive play therapy does not put front and center the in-vivo interactions that occur between parent and child. Rather, non-directive play therapy typically invites only the child into the treatment room to use materials and objects to manipulate and to transfer his feelings onto, which the therapist then interprets.

In Theraplay there are no materials that mediate the development of feelings. It is the therapist and parent who are the ?play objects?, the most enticing things in the room. In Theraplay the parent, with guidance from the therapist, plays engaging, exciting, attuned and nurturing activities that use the parents? facial expression, voice, rhythm, touch and physical presence as the modalities by which to elicit feelings from the child. Theraplay, therefore, gets right to the heart of the child?s issues vis-?-vis himself, his caregiver, and the world. The child?s feelings are then attuned to by the parent so that the parent can provide the most appropriate response--one that responds to the underlying need that is motivating the child?s behavior. Theraplay, then, is an intervention which has an immediate impact on the parent-child dyad, and progress can be made quickly.

Another aspect of Theraplay that sets it apart from non-directive play therapy is that the therapist explicitly guides the parent in the activities: to notice the child?s expressions; to go slower or faster in a game to match the child?s need; to touch the child in a way that?s nurturing but not overstimulating. In other words, Theraplay therapists act as in-vivo coaches for parents to point out ways to improve interaction patterns. Not only is this done in the therapeutic moment, but also, each session is taped so that the therapist can go over the session with the parent at a later date and point out an interaction sequence from which the parent can learn new behaviors.

An additional unique feature of Theraplay is its focus on non-verbal communication. The use of voice, facial expressions, gestures, posture, eye contact, and rhythm communicates directly with a child?s right brain, that part of the brain which processes relational information, but which is non-verbal. It is accurate to say that Theraplay works on a ?gut? level, imbuing safety and meaning into relationships through non-verbal communication sequences.

Because Theraplay works in the ?here and now? at the pre-verbal, pre-symbolic level, it benefits children who are not developmentally or emotionally prepared for non-directive play therapy. For example, Theraplay can help children with Autistic Spectrum Disorders because the child is not expected to be able to comprehend the therapist?s comments and interpretations. Rather, the Theraplay activities helps the child with a Pervasive Developmental Delay to engage more actively with the world around him or respond more appropriately to structured situations.

For the same reason, Theraplay is more effective than non-directive play therapy for children with pre-verbal trauma. Trauma, such as neglect which occurs before the child can speak, remains in the non-conscious realm of the child?s brain, and cannot be readily addressed by talk or symbolic therapies. Because Theraplay directly replicates relational experiences that provide what the child has needs but has missed, neglected children can integrate these new experiences more effectively in Theraplay than non-directive therapies.

Theraplay helps children with oppositional behavior or very strong repressed anger as well. In Theraplay the adult is in charge--structuring the treatment, attuning and adjusting to the needs of the child, providing nurture and challenge. In this way, the child who is accustomed to being bossy and controlling has her familiar defense mechanisms challenged. An oppositional child usually believes that the world is an unsafe place, and he cannot count on anyone to take care of him. Theraplay?s directive model challenges these assumptions. The therapist maintains control, gently but assertively using Theraplay activities to change the child?s view of himself and the world. In non-directive play therapy, the therapist would not usually make a direct challenge to the child?s defense mechanisms, making progress slower and less probable.

David Baxter PhD

Late Founder
Attachment disorder

Attachment disorder refers to the failure to form normal attachments with caregivers during childhood. This can have adverse effects throughout the lifespan. Clinicians have identified several signs of attachment problems. Attachment problems can be resolved at older ages through appropriate therapeutic interventions. Reputable interventions include Theraplay and Dyadic Developmental Psychotherapy.

Reactive attachment disorder
Reactive attachment disorder, sometimes called "RAD", is a psychiatric diagnosis (DSM-IV 313.89, ICD-10 F94.1/2). The essential feature of Reactive attachment disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with gross pathological care.

Dyadic developmental psychotherapy
Dyadic developmental psychotherapy is an evidence-based treatment approach for the treatment of attachment disorder and reactive attachment disorder. Children who have experienced pervasive and extensive trauma, neglect, loss, and/or other dysregulating experiences can benefit from this treatment. Dyadic Developmental Psychotherapy is based on principles derived from attachment theory.

Theraplay is a play therapy which has the intention of helping parents and children build better attachment relationships through attachment-based play. It was developed in 1967 by the Psychological Services staff of a Head Start program in Chicago. Theraplay is based on model of healthy parent-infant attachment and interactions.


Thanks for posting this, David. (Curiosity got the best of you, did it?!)

This is what I'm starting in a couple weeks. While Theraplay is designed for children and used primarily with children, there have been some successes with adults as well. Hopefully I'll be one of them. It's a bit harder with adults because we don't have that caring parent to go home with and have them finish what has been started in therapy. Theraplay usually lasts for about 18 sessions of 30 minutes each, so after that, I'm not sure where I'll be. I've heard from other adolescents and young adults that they were first approached with EMDR (same as me) and found EMDR much less scary after a few sessions of Theraplay. I told my therapist I *might* be open to it after Theraplay, because hopefully my guard will be greatly decreased from where it is now.

Anyway, it should be interesting. Yes I'm scared, but I'm also looking forward to it immensely!
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