A Theraplay model uses concepts from multiple Theraplay is a specific modality used with children and families that is recognized as a highly effective psychotherapy for children. Any professional working with children can use Theraplay to support healthy attachment with family members. Attachment is vital to an individual’s all-around health, making modalities like Theraplay more important than ever for children with attachment-related struggles.
Theraplay background and development
Theraplay began development when Dr. Ann Jernberg undertook the clinical directorship of the mental health program tied to Chicago Head Start. She quickly found that there were few resources or facilities for these children to obtain mental health services and extremely limited funds to assist this program.
Dr. Jernberg set out to train individuals with no professional training, like graduate students and parents, so these children could get the help they needed. The only requirements that she had were that individuals have openness, flexibility, ego strength, and the natural talent to learn and apply the therapeutic skills that she taught them. Immediate and long-term progress was documented on film, and the program was deemed a success.
From this, the Theraplay Institute was formed to train and treat families in need, and it continues on its mission today. Research is continually being undertaken to evaluate Theraplay’s effectiveness in various settings with children from different backgrounds and struggles, and the institute is always open to pairing with researchers to evaluate the system further.
Theoretical underpinnings of theraplay
Theraplay model uses concepts from multiple developmental theories, including attachment theory, self-psychology, and object relations theory.
Theraplay points to the following core principles underlying their work.
- Infants develop inner representations that mirror the relationships they are exposed to. If they have positive relationships, they learn they are lovable, people can be trustworthy and caring, and they feel safe to explore the world. If they have negative relationships, they internalize that they are unlovable and incapable, that people are unreliable, and that the world is unsafe and hurtful.
- With the above in mind, the most important part of a child developing well is the maintenance of a positive relationship.
- The need for connection drives much of human behavior, which is why primary relationships are so important to development and growth.
- Playful and responsive caregivers help the child develop secure attachment and trust. In order to overcome problems, individuals need to revisit the point where healthy development was arrested and recreate the positive experiences to correct the learned maladaptive thinking.
Steps and timeline of Theraplay
A typical Theraplay treatment regime lasts from 18-26 weeks, but if the family needs further help, treatment can continue for 9-18 months as needed. After primary treatment is completed, there are typically four follow-up sessions spread over the next year for families to check in with clinicians and evaluate maintenance of progress.
Involves the parent interview to evaluate the family’s needs as well as the appropriateness of the family for treatment and to begin to set up a treatment plan.
2 & 3
Involves observing the child and parent as they complete activities together. These are videotaped and then analyzed using the Marschak Interaction Method or MIM, which is a structured procedure that evaluates the relationship and shows strengths and weaknesses.
Involves the therapist and parents' discussion of the findings of the MIM and delineates the treatment plan for the family.
Involves the therapists teaching the parents about the different activities used in treatment, why these are going to be used, and the potential reactions that children may have to the activities. The parents are encouraged to share thoughts and concerns as well as ask as many questions as they need to understand what comes next.
6 - 25
Involves Theraplay games, activities, and interactions intended to improve the parent-child relationship. The pattern of therapy requires three sessions with the family as a whole and then a fourth session with just the parents to review goals and progress. Additionally, it is not uncommon for therapists to assign homework to the family in between sessions.
Because of the structure of the program, Theraplay is intended to involve parents and children in the sessions. While some adjustments could be made to accommodate special circumstances (e.g., a parent who is away from home periodically and cannot attend every session), in general, Theraplay is a structured program with a purpose for each session that needs to be followed.
Theraplay setting and tools
Theraplay can be used in different settings, including office settings and school settings as well as telehealth settings. In general, you need a large enough space to accommodate the activities and games you plan to use in the session.
In some cases, one therapist may be playing with the child to demonstrate the technique while the parents watch with or without another therapist explaining the process to parents, so it is important to keep in mind that some different spaces may need to be set up in the space you are practicing in. Each family and location has different needs, and flexibility is important.
Telehealth has been and continues to increase in popularity due to the COVID-19 as well as some families' difficulties in traveling to therapists for services. The Theraplay Institute offers a variety of resources for therapists wishing to provide Theraplay in a remote setting.
Theraplay involves a variety of games and activities, and the tools you use for each family may vary depending on the family. The Theraplay institute offers kits you can purchase if you want to use their specific tools.
Effectiveness of Theraplay
Theraplay is recognized as an evidenced-based treatment by the U.S. Substance Abuse and Mental Health Services Administration for internalizing problems and Autism Spectrum disorders. Additionally, Theraplay is rated as a promising practice by California Evidence-Based Clearinghouse and the Washington State Inventory.
Theraplay focuses on the child’s relationship with their caregiver. As such, if the primary problem is related to individuals outside of the family setting, Theraplay may not address those problems effectively.
Additionally, Theraplay is not considered appropriate when working with children or parents with severe cognitive deficits, as these individuals may experience limited success. Parents who are abusive or under the influence of active substance addiction are also not appropriate for Theraplay as those issues need to be addressed prior to attempting to improve attachment.
Billing for Theraplay
It would seem that billing for Theraplay would fall under Family therapy sessions, however, while the sessions are done with the family much of the time, the focus is more individualized. Much of the time, the therapist is working specifically with the parent, including during times when the children are in the room, and of course, the primary focus is on the child’s progress.
Due to this, many therapists, including The Theraplay Institute, feel that billing for Therplay should be done as an Individual therapy session, and using coding 90837/34/32 is the best practice. The Theraplay Institute bills the first two appointments under coding 90791, Initial Diagnostic Session, and the rest of the sessions under 90837, 60-minute Individual Psychotherapy.
This also allows for add-on complexity codes as needed in the case of much longer sessions or other additions.
Of course, the therapist should always thoroughly document the use of Theraplay, which phase, and which techniques are being used in order to maintain proper documentation and to keep track of progress.
Training for therapists
Theraplay offers a variety of training for therapists from how to use Theraplay virtually to how to utilize Theraplay in conjunction with other modalities like TBRI is available on their training site.
In order to work as a certified Theraplay therapist, there are a few different requirements:
First, there are educational requirements.
The Theraplay therapist must hold a master’s degree or higher in a mental health field, preferably specializing in working with children and families.
Therapists must also hold licensure that allows them to work independently. However, if you do not have licensure, you may be eligible to go up to foundational and progress further after earning your licensure status.
Therapists are required to attend Level One Theraplay and MIM and complete the four-day training or modules one through six. After which, there are supervision requirements and levels of certification recognition.
Foundational Theraplay Practitioner
- Application fee and eight supervised sessions: This level also includes 32 unsupervised sessions, which can be in-person or telehealth sessions.
- Cost: $1200* OR $400** if using an independent supervisor
Intermediate Theraplay Practitioner
- Minimum of eight supervised sessions: This level also includes 32 unsupervised sessions, of which three can be telehealth sessions.
- Cost: $1075* OR $375** if using an independent supervisor
- To go further, therapists need to complete Level Two Theraplay and MIM training, after which they can progress to full certification.
Certified Theraplay Practitioner
- Minimum of eight supervised sessions: This level also includes 32 unsupervised sessions, which must be in person.
- Cost: $1075* OR $375** if using an independent supervisor
The most beneficial site for resources about Theraplay is The Theraplay Institute. This site can answer all of your questions or point you in the direction of where to find any answer you need about Theraplay.
For those wishing to find a Theraplay-certified practitioner, you can check the status of practitioner certifications here.
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