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Polyvagal Theory Principles and Theraplay®    
Illustrating Applications to Play Therapy/Child Psychotherapy through Theraplay Assessment, Planning and Treatment Examples

Trainer: Sandra Lindaman, MA, MSW, LCSW, LISW-CP

Would you like to understand Polyvagal Theory (PVT) better and know how it can help you in your work with children and caregivers? Most presentations about PVT focus on adult treatment, despite the fact that it is early experiences that create the felt sense of safety or defense. It is critical for all play therapy child and caregiver clients to feel safe and to be able to co-regulate; this is especially true for clients who have sustained trauma. This presentation will clarify the main points of PVT, show you the impact of physiological state on the child and caregiver client and detail how PVT concepts can be used more intentionally to strengthen your play therapy. Video and literature clinical examples of clients with presenting issues of medical trauma, traumatic loss, orphanage care and adoption, dysregulation, autism, selective mutism, and parenting difficulties will illustrate Theraplay assessment, planning and treatment advice. 

PVT has been described as an important component in play therapy (Kestly, 2016, Daniel, Masters & Donovan, 2018). The play therapy model used in illustrations in this presentation is Theraplay®, one of nine clinical theories recognized as foundational to play therapy practice (Booth & Lindaman, 2019). Theraplay consists of four components:  Establishing safety and arousal regulation, Enhancing caregiver-child attachment, Working directly with the caregivers and the Practitioner’s use of self (Lindaman, Hong, Maxonight & Peacock, 2020). This combination of therapeutic actions has been shown to be effective in working with children and caregivers (Salo, et.al., 2020). This presentation will focus on the first component of establishing safety and regulation. As noted above, it is critical for all Theraplay child and caregiver clients to feel safe and to be able to co-regulate. The actions suggested by PVT are consistent with the modifications of Theraplay already suggested for clients with trauma (Booth & Jernberg, 2010). The PVT concepts offer an additional, helpful lens through which to assess, plan and treat clients. There is a strong coherence between 1. the physiological safe states described in Polyvagal Theory: social engagement, polyvagal play, rest and digest, and movement between these states and 2. Theraplay’s focus on social engagement (Engagement), reciprocal and physical play (Challenge/Play), nurturing care (Nurture) and guided movements between play and care activities (Structure) (Lindaman & Makela, 2018). This presentation will fill in the details and value of this coherence, describing what  PVT means by “safety”; the development and action of the social engagement system; PVT’s recommended progression from social engagement to proximity to touch and then to trusting relationships; the value of states of “polyvagal play/dance” and “rest and digest/intimacy”; and the development of regulation and resilience.

Pre-Reading (if possible)

Porges 2015 a and b in BIBLIOGRAPHY

Lindaman, S. & Mäkelä, J. (2018). The Polyvagal Foundation of Theraplay Treatment: Combining Social Engagement, Play and Nurture to Create Safety, Regulation and Resilience. 

S. Porges & D. Dana (Eds.) Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal Informed Therapies. NY: W.W. Norton & Company.

LEARNING OBJECTIVES

1. Describe six physiological states described in Polyvagal Theory and their significance for play therapy.
2. Describe how the sequence of a play therapy session can be planned and carried out to maximize client safety, social engagement and regulation.
3. Describe the 4 components of the Theraplay model and how PVT concepts influence these Theraplay process components.
4. Describe how the observations of dyadic Structure, Engagement, Nurture and Challenge routinely made in the Theraplay assessment of caregiver-child interaction (the Marschak Interaction Method) also correspond to PVT concepts of safety, social engagement, arousal status, proximity and contact, polyvagal play, soothing, and co-regulatory abilities.
5. Describe PVT related responses to 4 possible problems in Theraplay treatment: retraction of the client’s social engagement system, client active or frozen mobilization, client shut down, client rejection of nurture.

AGENDA

9:00-10:30 Lecture & Video about the following PVT concepts and how they appear in treatment: neuroception, safety and defense, the social engagement system (SES), the progression from SES to trusting relationships, the state of polyvagal play/dance, the state of rest and digest/intimacy, passive and active phases of treatment, moving between states, and the four components of Theraplay.  Still photos and video of non-clinical caregiver-child dyads and 2 clinical examples of Theraplay assessment and treatment planning will illustrate the above.

10:30-10:45 BREAK

10:45-12:00 Lecture, video and clinical stories about using PVT concepts in the Theraplay treatment planning, and problem solving in treatment sessions for a third clinical example. 

12:00-12:15 Questions and answers with the participants.

BIBLIOGRAPHY

Salo, S., Flykt, M., Mäkelä, J., Lassenius-Panula, L., Korja, R.,Lindaman, S. & Punamäki, R-L. (2020): The impact of Theraplay® therapy on parent-child interaction and child psychiatric symptoms: a pilot study, International Journal of Play, DOI: 10.1080/21594937.2020.1806500

Booth, P.B. & Lindaman, S. (2019). Attachment Theory and Theraplay. PlayTherapy, 14,1,14-16.

Daniel, S., Masters, A. & Donovan, K. (2018). When pediatric medical trauma presents as Asperger’s Syndrome: Polyvagal explanations and Polyvagal therapeutic play. In S. Porges & D. Dana (Eds.), Clinical Applications of The Polyvagal Theory (pp. 248-269). New York, NY: W.W. Norton & Company, Inc.

Flores, P.J. & Porges, S.W. (2017). Group psychotherapy as a neural exercise: Bridging Polyvagal Theory and Attachment Theory. International Journal of Group Psychotherapy, 67 (2), 202-222.

Kestly, T.A.  (2016). Presence and Play: Why Mindfulness Matters. International Journal of

Play Therapy. 25(1), 14-23.  

Muris, P & Ollendick, T.H. (2015). Children Who are Anxious in Silence: A Review on

Selective Mutism, the New Anxiety Disorder in DSM-5. Clinical Child and Family

Psychology Review, 18(2), 151-169.

Porges, S. W. (2015a).  Making the world safe for our children: down-regulating defence and up-regulating social engagement to ‘optimise’ the human experience. Children Australia, 40, pp 114-123.

Porges, S. W. (2015b) Play as a neural exercise: Insights from the Polyvagal Theory. The Power of Play for Mind Brain Health, 3-7.