Programs

Notes:

Type of services provided:

Structured play therapy for children and parents that promotes attachment, self-esteem, trust in others and joyful engagement. Theraplay is interactive and relationship based with an emphasis on strengthening the parent/caregiver-child relationship. The core components of Theraplay focus on:
• providing structure (key concepts: safety, organization, regulation)
• engagement (Key concepts: connection, attunement, expand positive affect)
• nurture (key concepts: regulation, secure base, worthiness)
• challenges (key concepts: competence, confidence, supports exploration)

Program setting:

Community agencies, hospitals/clinics, residential care facilities, adoptive homes, schools, domestic violence shelters

Length of program/number of sessions:

Typically 18-25 weekly sessions with four follow-up sessions at quarterly intervals over the next year; sessions are 30-45 minutes (shorter for younger children). There is a version of Theraplay called Group Theraplay. Group Theraplay (recommended group size 4 to 10) has been adapted as a briefer intervention for women and children in domestic violence shelters.

Type(s) of trauma/concerns addressed:

Complex relational trauma

Symptoms addressed:

Posttraumatic stress disorder, attachment and relationship problems, developmental trauma disorder, regulatory problems, attention deficit disorder, withdrawn, depressed, and other symptoms

Education level of providers:

Masters or doctoral level degree in a mental health field in the United States; varies in other countries

Additional information:

None

Unique/Innovative Characteristics:

Theraplay places a strong emphasis on enhancing attachment and strengthening the mother/caregiver-child relationship, a key protective factor for children exposed to domestic violence. There are three exploratory studies that have examined how Theraplay/play therapy can be used in a shelter setting and how the goals of Theraplay/play therapy can help to address the needs of women and children in domestic violence shelters.

Date Added/Updated:

9/11/2017

Population Adaptations:

Age range of children served:

0-18 years of age

Are parent/adult caregiver(s) included in intervention?

Yes

Ethnic/racial and other groups served:

The children that participated in the small experimental study of play therapy in a domestic violence shelter (Tyndall-Lind, 2001) included Hispanic and African American children. People from more than 50 countries have been trained since an electronic database was started in 1995 and program administrators maintain regular training and supervision in 21 countries.

Specific cultural adaptations:

Not indicated

Languages that service/resource is available:

Finnish, German, Japanese, Korean, Spanish, Swedish

Foundation:

Goals of the program/services:

The program goals of Theraplay are to:
• Increase child’s sense of felt safety/security
• Increase child’s capacity to regulate affect
• Increase child’s sense of positive body image
• Ensure that caregiver is able to set clear expectations, boundaries, limits
• Ensure that caregiver’s leadership is balanced with warmth and support
• Increase caregiver’s empathy for child
• Increase caregiver’s capacity for reflective function
• Increase caregiver’s skills to help child through stressful situations
• Increase parent and child’s experiences of shared joy

Evaluation Studies:

Has there been any evaluation?

Yes

Key evaluation results:

There are three studies that have evaluated Group Play Therapy with mothers and children in domestic violence shelters (Dodd, 2009; Bennett et al, 2006). A third evaluation study of an unspecified play therapy intervention with children and their siblings at a domestic violence is also described below (Tyndall-Lind, 2001).

Linda Dodd (2009) conducted a pre-test and post-test evaluation and qualitative assessment of Group Theraplay sessions with ten mothers and their pre-school children in a domestic violence shelter in England. The staffing for Group Theraplay was multi-agency and included workers from the shelter, a child protection worker and a psychologist. Group Playtherapy was offered on a weekly basis at local Family and Children’s Centres. Duration of the intervention was not indicated. Pre-Group, post-group scores suggested small reductions on the Parenting Daily Hassles Scale. Mothers’ and group leaders’ feedback about the intervention were positive. Mothers reported feeling that their children had enjoyed and benefited from the groups; the extra attention helped to make their children “feel special.” Mothers reported improvements in their children’s social skills, behavior and development (happier, better eating, more confident) and less violent and aggressive behaviors. Group leaders noted that the children were much calmer after the first week.

Bennett and colleagues (2006) described experiences with Group Theraplay, called the Family Connections Program, with women and children at a domestic violence shelter in St. John’s, Newfoundland. The Theraplay groups were facilitated by faculty from a nursing school and children services staff members at the shelter. The length of the intervention was six weeks with two weekly sessions (90 minutes in length); the first weekly session was for children and the second weekly session was for mothers and children. Program content was expanded to address the needs of children exposed to violence. Adaptations included adding content on learning about violence and being able to discuss worries, concerns and feelings about violence.

Fifteen children and 10 mothers participated in the first implementation. Key questions addressed as part of the evaluation included concerns related to respect for personal boundaries and mothers’ authority, concerns related to structure and competitiveness and concerns related to balancing fun activities and serious discussion. Overall, these concerns did not pose barriers to implementation. With regard to structure, original concerns about changing membership from week to week did not prove to be problematic. Both mothers and children looked forward to the groups and valued this as quality time. Activities were modified to meet the essential needs of women and children. One example of this was adding a discussion with the children about how to keep safe when violence occurred which had not been part of the original content.

Tyndall-Lind and colleagues (2001) evaluated intensive group play therapy with siblings exposed to domestic violence. Children, ages 4-10 years old with a sibling no more than three years apart in age staying at an urban domestic violence shelter participated in the experimental group. There were two comparison groups: children who received individual play therapy and children who remained on a waitlist control group and received no intervention in a study by Kot (1995). Children who volunteered for the experimental group in this study received 12 sessions of play therapy over a period of 12 consecutive days (45-minute sessions). The play therapy was led by master’s and doctoral level counselors.
Children in the experimental group, compared to the no intervention comparison group in the Kot study, had significant reductions in total behavior problems, externalizing and internalizing behavior problems, aggression, anxiety and depression and significant improvement in self-esteem. Intensive sibling group play therapy was shown to be as effective as individual play therapy in the Kot study.

Two controlled studies of Theraplay were conducted in Hong Kong by A.F. Sui (2009, 2014). In the 2009 study, children in grades 2-4 were randomly allocated to 8 weeks of Group Theraplay or a wait-list control group. At the end of the intervention, children who participated in Theraplay significantly had fewer internalizing problems compared to the waitlist group.

In another study by Sui (2014), children with developmental disabilities participated in a year long Group Theraplay program. Students receiving Theraplay had significant improvement in social communication in comparison with a control group.

Is there an evaluation currently in progress or planned?

Not indicated at this time.

Publications about the program:

The following three publications evaluated Theraplay or play therapy with children exposed to domestic violence:

Dodd LW. 2009. Therapeutic Groupwork with Young Children and Mothers Who have Experienced Domestic Violence. Educational Psychology in Practice, 25(1), 21-36.

Bennett LR, Shiner SK, Ryan S. 2006. Using Theraplay in Shelter Settings with Mothers and Children Who Have Experienced Violence in the Home. Journal of Psychosocial Nursing, 44(10), 39-48.

Tyndall-Lind A, Lanneret GL, Giordano MA. 2001. Intensive Group Play Therapy With Child Witnesses of Domestic Violence. International Journal of Play Therapy, 10(1),53-83.

Two controlled studies evaluating Theraplay in Hong Kong are:

Siu, A.F.Y. (2009). Theraplay in the Chinese world: An intervention program for Hong Kong children with internalizing problems. International Journal of Play Therapy, 18(1), 1-12.

Siu, A.F.Y. (2014). Effectiveness of Group Theraplay® on enhancing social skills among children with developmental disabilities. International Journal of Play Therapy, 23(4), 187-203.

Go to the following link for a list of other publications about Theraplay:
http://www.theraplay.org/index.php/theraplay-research

Rated/Reviewed by Evidence Based Registries:

NREPP: SAMSHA’s National Registry of Evidence-Based Programs and Practices
California Evidence-Based Clearinghouse for Child Welfare

Training Contact:

Dafna Lender, Training Director: DLender@theraplay.org

Training Notes:

Training manuals/protocols:

Yes many resources available including a textbook, videos, handbooks, flip cards of activities

Availability of Training:

Yes, offered three times annually in Chicago and on-site upon request. Contact Dafna Lender, Training Director

Languages that training/resource is available:

Not specified