Wedding Systemic Practice and Theraplay

1. Wedding Systemic Practice and Theraplay Christian Elliott Therapeutic Social Worker – Horizons, Derbyshire

2. 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.

3. 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

4. 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.

5. 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

6. 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.

7. 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

8. Theraplay Treatment:Using The Dimensions OfThe 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.

9. Theraplay Treatment:Using The Dimensions OfThe 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.

10. Children who are referred • Children can be referred for a variety of difficulties including: • Attachment difficulties • ADHD • Autism • Developmental delays • Anxiety And depressive symptoms

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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