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