Theraplay: Helping parents and children build better relationships through attachment-based play (Second Edition)

by Ann M. Jernberg and Phyllis B. Booth. San Francisco, Ca.: Jossey-Bass Publishers: 1999: 434 pp.:$37.50 (paperback).

Reviewed by Ivan B. Inger and Jeri Inger

Theraplay, originally authored by Ann Jernberg and published in 1979. is in its Second Edition. Ann Jernberg died in 1993, and Phyllis Booth, listed as second author, has undertaken the major revisions of this edition with the contributions of others at the Theraplay Institute.

Ann Jernberg was Director of Head Start Psychological Services, founder, inspiration, and synthesizer of the concepts and methods that have become known and widely applied as Theraplay. Theraplay was an attempt to find a straightforward way of helping young children and parents with attachment and developmental difficulties, within a safe, nurturing environment. It was also a populist effort to train Headstart workers to identify and respond to the mental health needs of their child clients.

This edition was undertaken to incorporate changes in child development theories and to update practitioners about the revision and expansion of treatment methods. This edition also addresses current thinking and treatment of childhood autism, and what has become the delicate and controversial issue of touch in the treatment of children.

What is Theraplay and how does it relate to systemic family therapy theories and practices? Theraplay is an ideology and methodology that creates a bridge between family therapy and individual therapy.

Theraplay is a form of play therapy that directly includes parents and significant others in the therapeutic experience. Clients are engaged in a highly structured, interactive process with the therapist who takes charge, carefully plans, structures sessions, and, "…does all in her power to entice the child into a relationship." The therapist, using nurturing touch, remains firm in the face of resistance and engages in interactive, physical, play. The therapist initially takes on a parental role, but soon brings in the parent(s) and makes the transition toward the parent(s) taking over the Theraplay relationship. This is a form of reenactment psychotherapy, in the best tradition of Gestalt Therapy, Psychodrama, Structural Family Therapy and others that are designed to bring a new form of interacting into the daily lives of an individual and/or family.

Theraplay has much in common with instrumental family therapies, such as Structural Family Therapy and several Strategic Family Therapies, including Solution-Focused Therapy, Object Relations Family Therapy, and some Postmodern Narrative Therapies. One of the common aspects among these therapies pertains to the role of the family therapist as an active interventive participant in the interview bringing preconceived templates of ideas and reenactments of situations into the therapy room.

The confluence of Theraplay and instrumental family therapies is found in their attempts to integrate intrapsychic and interpersonal aspects of individual development and family relational patterns. These instrumental family therapies mentioned above contain efforts to create therapeutic experiences that attend to the interface between the inner world of the individual, and the outer world of others. One of the crucial aspects of these attempts at integration concerns the attitude of therapists about their place in the therapeutic process. The history of family therapy is replete with examples of the therapist as the conductor who directs the interaction in therapy using her template to understand family dynamics and to promote change according to that template. This includes Postmodern therapies, which profess collaboration, while the subtext of what is desirable and undesirable change remains in the hands of the therapist.

Theraplay's foundation stone is the parent-child-therapist triad, with the latter as the medium through which that relationship can change. Theraplay accomplishes this, not through traditional psychotherapy modes of treatment, but through nontraditional participation of the therapist. This too, has been a hallmark of some family therapies whose methods represent efforts to move away from traditional models.

Theraplay emphasizes concrete experiencing as the way to bring about relationship change. Theraplay therapists do not look to symbolic meanings as explanations of relationships. This may sound familiar to many family therapists who work in the "here-and-now mode," who emphasize the importance of the family unit being in charge of the therapeutic process, and who see symbolization (as used by psychopathology models) as part of an oppressive hierarchical structure. Yet, there is an element, even in those Postmodern Family Therapies, of the therapist as the instrument who creates the context and direction for change, much like Theraplay which is highly structured to enhance the attachment between child and parent.

By studying this interesting method, family therapists can expand their ideas about children and ways of relating to them therapeutically, thus, incorporating Theraplay's ideas and methods into their practices.

This book, especially its way of linking theory and practice at the level of concrete interaction, is worthy of study and admiration. It is a pioneering effort similar to the efforts of many pioneers in the field of family therapy: risks that have been worth taking in the face of the skeptics.