Trauma-Focused Theraplay, Eliana Gil, Ph.D.
Trauma-Focused Theraplay
Eliana Gil, Ph.D.

Dr. Gil
has worked in the field of child abuse and prevention since 1973.  She is a prolific author, most recently Helping Abused and Traumatized Children:  Integrating Directive and Non-Directive Approaches (2011).  Dr. Gil is a frequent keynote speaker at national and international conferences, including the 2013 International Theraplay Conference where she delivered this advice:

"I am fortunate at this stage in my career to be a mentor to many younger therapists. The greatest gift I can give my mentees is my advice to “go and get Theraplay training”. I honestly wish I had when I was thirty."

Theraplay is uniquely suited to provide substantive help in the treatment of complex trauma. The National Center for Traumatic Stress Network (NCTSN) has identified several domains to target for therapeutic intervention, among them attachment, self-image, regulation and biology.  These target areas are relevant and necessary components of trauma treatment.  

In fact, complex trauma cases need to be viewed contextually in order to advance positive outcomes.  Children will need a secure base, strong attachments, concrete guidance, support, and nurturing in order for them to utilize reparative mechanisms, address traumatic material, and have a restorative experience.

Theraplay narrows its focus on an important relationship, drawing from research on the interactions of healthy attachment.  Thus, parents and children are assessed together to identify their strengths as well as areas for improvement.  Theraplay can be deceptively simple, and yet its potential to pinpoint areas to reinforce, to stimulate, and to engender important change, cannot be under-estimated.  

In the second half of my professional career, my perspective has become more and more focused to the therapies that engage families in significant change, and those that seem less interesting to clients.  The one therapy practice that has the potential for greatest contribution in tangible ways, is Theraplay.

In this time of multiple demands and active dialogues about clinical incorporation of evidence-based practices, Theraplay shows great promise.  The research consistently demonstrate its usefulness and client reports are clear and resounding:  Theraplay works, changes occur, and those changes are visible to others, and felt deeply with our clients.

It’s not just the focus on the relationship that helps:  It’s the various levels of activity that provide parents and their children with guidance about how to have whole-brain activities, using their physical energy, movement, touch, laughter, breath, to activate the whole person, orient parent and child towards each other, and give an organic and sensory experience that produces a sense of well-being.

What we know about helping others is that a few factors are critical:  We have to get client attention; we have to motivate clients to make efforts on their own behalf; they need to feel that we care for them; and they have to see the changes that fuel them to repeat interventions.  That is, clients are most responsive to feeling successful.

Theraplay accomplishes these things:  It gets client attention immediately, partly because it’s not expectable.  I think most clients come into therapy expecting to have verbal dialogues while sitting comfortably in chairs (often without movement or breath).  Theraplay is a “doing” therapy which elicits energy on physical and emotional levels.  It’s hands-on, which invites clients to experience novelty!!

Theraplay is full of optimism and clients respond with interest.  Suddenly, parents can “see” new interactions which then allows them to visualize new options.  Many Theraplay clients have shared that after Theraplay sessions they feel hopeful.  Any therapy that allows clients to visualize and shift narrow perception, is a therapy of hope.

Dr. Judith Herman describes a three-phase model of treatment that I fully embrace.  Utilizing this model, you move sequentially through phases of treatment, completing phase goals before moving on.  The first phase of treatment is safety and security, the second addressing traumas directly, and the third affiliating with others (social reconnection).  Theraplay functions to create a sense of safety in security for the child by anchoring them in a nurturing, safe, and structured primary relationship, thus addressing attachment concerns first.  Once children establish a sense of feeling connected to one important other, the trauma work can proceed with greater ease since the emotional foundation is set.

Unhealthy relationships or those in which parents have limitations and ambivalences are not easy to repair.  Some parent-child relationships have endured many ruptures, disappointments, painful injuries, and physical or emotional distance.  The interventions to reorient distant or distrustful parent-child dyads towards each other need to be designed to bring about concrete change.  Theraplay provides real help for real issues of emotional disconnect.  It understands relational brain functioning and it engages the whole person actively.

Most of you know me as passionate about my work and know the ways I’ve immersed myself in the expressive therapies as a way to help traumatized children.  I am drawn to this work because it allows traumatized children to find legitimate forms of expression, release, healing from difficult feelings and thoughts.  I use it because it works more consistently than trying to get children to verbalize.  The bottom line is that adults over-emphasize verbal communication …  children have ample language through their behavior, their nonverbal communication, and of course, their play …  children’s natural mechanisms for expression are much more ample and interesting.

I cannot say enough about Theraplay.  You have to experience it.  You have to watch what happens to your clients when applied carefully and purposefully.  

As an integrated clinician, I am eternally grateful for this wonderful technique, deceptively simple, amazingly accessible, and tested over decades with thousands of parent-child dyads.  Its application is without bounds, and my purpose here is to encourage clinicians to think about Theraplay as a therapy of choice for trauma and its subsequent clinical issues.

Luckily for us, a international Theraplay organization is well-established and generous in their willingness to train and guide clinicians to incorporate Theraplay interventions into whatever other work they may use to assist children and their families.

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