One of the most exciting advances in neuroscience is the discovery of how psychological disorders are rooted in brain development. Thanks to functional brain scans, clinicians can see that depression, schizophrenia and many other ills correlate with over- or under-active parts of the brain.
It's clear that psychotherapy isn’t just for sissies, and that people can’t heal just by bucking up and not dwelling on the negative.
Our brains evolved to learn how to love from our mothers, and, later from our fathers and other family members, in an ever-widening social circle. But loving is the result of a series of neurochemical responses based on oxytocin, and it relies on brain structures and neural connections that develop slowly in the first three years of life.
Unfortunately, in those early years, it's possible to miss the experiences that form the oxytocin response. Some mothers were themselves abused, rejected or neglected as children; they may unconsciously transmit a tendency to shut down in the face of intimacy to their children.
Babies who spend time in orphanages, foster care or intensive care may miss the amount of touch, being looked at and spoken to that's necessary to spark the development of the social brain's attachment system and the oxytocin response.
Theraplay is a structured way of stimulating the brains who missed getting the right kind of interaction, for whatever reason. In a typical course of 12 to 15 weekly sessions, it provides experiences that trigger brain activity that will lead to its healthy growth and maturity. It's been used to treat children showing withdrawn or depressed behavior, overactive-aggressive behavior, temper tantrums, phobias, and difficulty socializing and making friends, as well as learning disabilities, developmental delays, and pervasive developmental disorders. Because it focuses on developing the attachment system, Theraplay is often used with foster and adoptive families.
The system was developed beginning in 1967 by Ann Jernberg when she was director of psychological services for Chicago Head Start -- long before science understood how the early environment shapes the brain. Because there weren't many resources for kids in the program who needed psychological services, Jernberg decided to develop a system that could be used by Head Start workers in the centers.
The evolution of Theraplay took a turn toward its current focus on repair of the attachment process following co-developer Phyllis Booth's year-long training at the Tavistock Centre in London. There, Booth studied the ideas of John Bowlby, who first developed attachment theory.
It's evolved since then to focus on repairing the attachment between the child and the mother or other primary caregiver.
The activities are organized around four dimensions that characterize a healthy relationship between mother and child: structure, engagement, nurture and challenge.
Kids who haven't been able to rely on a parent or other caregiver for emotional regulation need to learn to let the adult lead. The therapist strives to remain attuned with the child, as she selects and leads the activities. This reassures the child that someone is available to take charge.
Children from chaotic homes may find any change stressful, a response that will limit their later ability to fulfill their needs. Withdrawn or autistic kids may dislike engagement with another person. The therapist focuses on the child in order to achieve and maintain a connection, moving at his own pace. The activities are designed to be engaging, showing the child that "surprises can be fun and new experiences enjoyable."
The therapy includes plenty of soothing, calming, quieting and caretaking activities to change the child's view of the world from scary to safe, predictable, warm and secure. This nurturing also fulfills the child's basic needs, reducing the level of stress chemicals, activating the parasympathetic nervous system and reminding his brain to release oxytocin.
Challenging activities mimic the way a good mother acts as a secure base from which her child can gradually explore and experiment with his environment and other people. These challenging activities are cooperative and fun, to help promote feelings of competence and confidence.
An article on the Theraplay Institute website offers a lovely glimpse into the small steps that lead to attunement between therapist and child, and then, mother and child.
A Theraplay-therapist is holding a panicky, disorganized child in her lap, checking out what a wonderful girl she is. The girl cries until, all of a sudden, the therapist beeps her nose. The child is startled and smiles. The next time, with another sound coming from the therapist’s nose, the child giggles.
Then, for three sessions she whines, cries, and turns away from all the therapist’s advances. One day, to the child’s amazement, a soap bubble pops before her finger even touches it. The therapist’s voice shows similar amazement: what happened? The child, who has forgotten to whine, pops the next bubble, and the therapist rejoices.
The next session, the child is suddenly still, absorbed by the eyes of the therapist, who attunes to every gesture and vocalization of the child, matching them to the nurture she is giving to the child’s feet; playing peek-a-boo with them, rhyming the child’s “mama” into a familiar song. Never before in her 3 years has the child been in prolonged eye contact. Now her eyes spell-bind the therapist, and her mother and me, looking from behind the mirror. Her whole countenance has changed from a frizzled rag doll look to an intense, oriented, girl of three.
Two sessions later as she is cuddled in her mother’s arms she reaches up to find the curly blond locks of her mother’s hair and starts to play with them, looking intently into her mother’s eyes. Her mother says her daughter was born to her at that moment.
Theraplay is a registered service mark of The Theraplay Institute, 3330 Old Glenview Rd, Wilmette, IL, www.theraplay.org