Theraplay® and Autism: What You Need to Know
Theraplay is a model of play therapy that was developed in the 1960s to help socially aggressive or withdrawn preschoolers in Chicago's Head Start Program. The model is based on healthy patterns of interaction, play and social communication between adults and their very young children. Recently, Theraplay has gained significant popularity as a model of intervention for children on the Autism Spectrum. Here is what you need to know:
Theraplay helps kids build natural (unscripted) social skills and fosters intrinsic joy in relating with others.
Many models of intervention for kids on the Spectrum use "social scripts" to give children words and actions for relating with others. Some models, such as Applied Behavioral Analysis or ABA, also use positive reinforcement or rewards such as stickers or candy, to motivate the child in building these scripted social skills.
The Theraplay model believes that all children have an underlying deep need and desire to relate with others. Our relational needs are part of being human. Theraplay is about awakening the child's natural joy in relating with others, in ways that feel safe and fun, while reducing the child's fear and confusion. When a child is in touch with feelings of safety and joy, she is able to engage with others more and more, and to learn from her experiences. This builds social skills and ways of relating that are more naturalistic and can evolve over time as the child grows.
Theraplay increases the child's "felt safety" with a growing range of sensory experiences.
Many children on the Autism Spectrum struggle with sensory issues, where the body is either hypersensitive or under-responsive to sensory input. This can create feelings of constant anxiety and confusion for a child.
Theraplay works to recognize the child's unique window of "felt safety" with sensory experiences, and it gradually increases that window by building on the child's strengths. For example, consider a child who is very active and competitive, but struggles with tactile input, such as lotion on the hands. A Theraplay therapist might combine an enjoyable, competitive game, such as thumb-wrestling, with a less desirable activity, such as hand lotioning. This creates a new, fun experience ("slippery thumb war") while gradually increasing the child's ability to tolerate the tactile input. Over time, the child is able to integrate the experience of hand lotioning as something that feels safe and tolerable. This allows a parent to care for a child's dry hands in winter, an important nurturing experience.
Because Theraplay deliberately uses a significant amount of touch, body movement, tactile and proprioceptive experiences, sound, verbalization and singing, and other sensory input, it is an ideal model to help kids with sensory-based issues. It bares some resemblance to Occupational Therapy in this way.
Theraplay honors the parent's role as the child's greatest source of comfort, guidance, trust, and joy.
In Theraplay, the therapist is considered a "very nice stranger" while the parent is the child's entire emotional world. For this reason, parents are in nearly every session and are regarded as "co-therapists" in treatment. Theraplay therapists work with the parent and child together to foster both the child's growth and the parent's growth, so that this special sort of play can be "taken home" and the length of treatment can be shortened. Theraplay therapists work to elevate the parent's role in treatment, often deferring to the parent, asking the parent's permission to play with the child or complimenting the parent in front of the child. Theraplay works to empower and support parents- without shame and blame.
Theraplay meets the child at her "emotional age" and offers appropriate learning opportunities, including developing the mirror neuron function.
Theraplay understands a child developmentally, not in terms of her chronological age, but in terms of her "social-emotional age." Children may get "stuck" in a level of emotional development, and it is our job as therapists and parents to meet the child exactly where she is developmentally, without requiring too much or too little.
Parents all over the world engage their infants and toddlers in similar types of attachment-based activities. Games such as peek-a-boo, horsey-back ride, and singing lullabies together are played by parents and children all over the world. The purpose of these games (as well as adequate emotional attunement) is to build the seeds of empathy: the mirror neuron function. Mirror neuron functioning is the ability of a person to look at another person and "feel" what they are feeling. Brain scans have studied people looking at others who are sad; in most cases, the viewer's brain appears in the same way that a sad person's brain might appear. The development of mirror neuron function is often "stuck" in kids with Autism and may need additional support to grow.
When a child is struggling with relational and social skills, such as eye contact, reciprocity, turn-taking, understanding the feelings or motivations of others, etc., often they have gotten "stuck" in a very "young" emotional place. Theraplay is, in some ways, a sort of emotional remediation. Using these "baby games" helps to build a sturdy foundation for complex emotional and social growth. When a child is without this sturdy foundation, including a strong mirror neuron function, they cannot build the social skills that they will need to thrive in adolescence and adulthood. Without this sturdy foundation, social skills and concepts can be taught or scripted, but the child may not be able to use the skills in a natural way. More importantly, the child may miss out on the many joys of relating with others.
Theraplay recognizes that children want to do well, but sometimes need more support to do so.
Theraplay interventions encourage parents to view their child's "bad behaviors" as signals that the child needs more help. Children are seen as inherently good and desiring to succeed in tasks their parents, teachers, and others assign to them. However, at times, their needs prevent them from success.
Theraplay works to "decode" the child's behavioral signals, meet the underlying needs, and create an environment where the child can consistently do well and feel good about himself. The child's behavior can indicate millions of things: from sensory overload, to a need for increased direction and structure, to a need for better quality sleep, to executive functioning dysfunction that causes a sense of overwhelm and helplessness in the face of homework. The Theraplay therapist and the parent work together as "detectives" to find the meaning behind the child's signals, never blaming or shaming the child in the process.
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