Dafna Lender is training director and clinical coordinator for
the Theraplay Institute, an organization that trains teachers, social workers and
psychotherapists. Theraplay provides a structure for activities that help heal
kids' attachment problems.
HUG: First, tell me how you got involved with Theraplay.
Lender: My involvement began when I was working in a foster
care agency that had a residential component. Most kids had been adopted
previously or been in a nuclear family, and their history of abuse, neglect,
separation, loss and trauma had caused them to disrupt the place they had been
in.
We found these kids were still unprepared after two years with
us to go into a family. We were looking for some sort of method or therapy
model that would help. I was sold from the beginning, and it was transformative
for me, too. I felt I had hit on what I needed for the clients I was working
with.
HUG: I've been hearing more in the news about reactive
attachment disorder, and about failed adoptions. Is this problem increasing, or
is there simply more awareness?
Lender: We have had a huge influx of parents who call us
with these problems in the last ten or fifteen years, as societal problems get worse,
and funding for social services diminishes -- and foreign adoptions become more
common. There also is increased awareness of attachment issues. I definitely
think it's a phenomenon that's increasing in size with not enough resources.
HUG: I've been distressed by some parents' accounts of
adoptions that didn't work out. The parents seem not to understand how deeply
messed up these kids are.
Lender: Parents do try very hard, and the lack of resources
and support from the child welfare system or adopting agency can leave adoptive
parents really depressed, resentful or despairing. They may feel like they're
going crazy. An attachment therapist would help the parent put the child's
behavior's into context so that the parent does not feel that they have gone
crazy or are bad people. The attempt in the attachment community is to say
it's not all the child's fault, but not the parents' fault either.
The child is projecting all this non-conscious trauma onto
the parent. Most trauma that happens to kids is out of their awareness, because
either it happened before they were verbal and therefore have no recollection
of it, or they're defended against it, because it was such a horrible
experience.
The only way for a parent or therapist to interact or give
healing to these kids is to not to take it personally. That's a very difficult
feat and requires a great deal of work on the parents' part and a great deal of
support from a therapist. If parents sound callous, it could be because they
have not received this help.
HUG: Do you buy the diagnosis of reactive attachment
disorder, or RAD? There's no mention of this disorder on the Theraplay website.
Lender: There are a lot of problems with the diagnosis. There's
a lot of overlap with other diagnoses, and no criteria that are discreet from
others. Other people have talked clinically about attachment issues in terms of
both severity and features that are more on a continuum, and that is more
helpful clinically.
HUG: You work with both mother and father, if available.
What about the idea that mother is primary regulator of brain and affect
development in the first years?
Lender: That's definitely the case, but we don't work with
kids during that period of time. Parents typically bring kids in toward the end
of their second year, or before they start preschool. After the first year, the
father is important typically -- although this is a stereotype -- in providing
high levels of positive affect. This is important in being able to regulate
high arousal, enjoyment, joy, interest and excitement. A child needs that just
as much, so he doesn’t go berserk if he's waiting in line for the playground,
for example. It also wards against depression and creates a great bond. So we
love to focus on both parents.
HUG: There's an emphasis in Theraplay on certain special
moments of connection that lead to change. Can you talk a little bit about
this?
Lender: Those are called "now moments" or "moments
of meeting" in the psychotherapy literature. It has to do with when two people
are spontaneously sharing an idea, and they know that. It's an expansive
moment, when we shared something that was meaningful. For example, when we're playing
bubbles, and it pops right on the tip of the child's nose. There's a moment
where he's startled, and then thinks it's funny, and I laugh too, and it's
amplified. It's not something planned by me, it has to just happen.
HUG: Theraplay was developed for the Head Start program. Is
there a change in the client base in the past few years?
Lender: In the last few years, there's been an increase in
the severity of the abuse and neglect, the number of placements, and the rising
awareness of the effects of drugs and alcohol in utero. On a parallel stream, there's
also more and more focus on autism and early diagnosis, and we're known for
that, as well.
Theraplay is a registered service mark of The Theraplay Institute, 3330 Old Glenview Rd, Wilmette, IL, www.theraplay.org
