Manual Write up by Theraplay by PgvNXP5


									  Portions of this poster are from an article published in The Theraplay Institute
                             Newsletter Winter 2004-05

For more than four years (1991-1995), the small country of Croatia suffered
through a “backyard” war—one in which virtually the entire population of 4.5
million was exposed to the horrors of battle, death and destruction. Relief efforts
usually begin with physical reconstruction and rebuilding economic stability. But
what can be done to heal such massive emotional trauma—when even the
mental health professionals are emotionally fragile? Who will help the children to
feel safe again, and how will they learn to trust?

Bob Patterson, a physical therapist by profession, heard about the plight of the
children at his local Rotary Club meeting in Lancaster, Pennsylvania, and
decided to do something about it. He contacted Lark Eshleman, Ph.D., founder
of the Institute for Children and Families (ICF), a leading center for treating
children who suffer from early trauma, and proposed that she develop a program
to help these children. Lark decided to interrupt her doctoral dissertation work
and tackle the project.

The challenge was daunting. The program needed to be inexpensive, easily
instituted without an army of trained professionals, and require minimal time and
working space. While Lark worked on program development, Bob went to work
securing local, regional and international grants from Rotary International, and
succeeded in raising over $450,000 for the project.

Traumatized children need to regain their sense of trust in others and to feel that
it IS possible to be safe again. Lark, who is Theraplay-trained, worked on an
approach that would help establish trust, first and foremost, to prepare the
children for emotional and cognitive understanding of their pain. Phyllis Booth
calls the resulting program, “a very nice protocol of increasingly intimate activities
that adopts a gentle and careful approach to making the child feel safe and able
to form a trusting relationship.”

The program is designed to train community volunteers who are then supervised
by mental health professionals. Each volunteer commits to working with one
child over ten sessions, each carefully scripted. The volunteers are coached on
how to approach each session:

       *Don’t make assumptions about how your child should react
       *Move slowly with a quiet assurance of being in charge
       *Be confident, firm, but gentle
       *Maintain as much contact as possible
       *Be prepared for the sessions and stay focused
      *Be positive and accepting
      *No one can hurt anyone during these times together
      *Check-up and nurture
      *Stick to the script, only substituting culturally appropriate songs and
       games as directed

Theraplay practitioners will find this approach very familiar! The sessions begin
with other Theraplay activities such as checking up and taking care of hurts.
Games and activities include such standards as jumping on signal; Row, Row
Your Boat; hand-tracing, and nurturing feeding. Examples of other, less familiar
activities can be found in the box below.

The sessions are structured to have a combination of one-on-one activities
between the volunteer and child, and small group activities with games like
Hokey-Pokey. The final session is a celebration of the progress made and a
reinforcement of the trust established.

In October of 1997, Lark traveled to Croatia in search of a mental health
organization there to partner with her. She met up with a group that was already
working with adults and looking for a program to help children. Having
established this contact, funding was finalized and a pilot project began to take

A professor at the University of Zagreb was looking for ways to get her social
work students involved in the “real world” problems facing the country. The
University was located near an orphanage in Zagreb, and a group of advanced
students were matched one to one with about 40 children from the orphanage to
run the pilot program.

The children all exhibited post-trauma symptoms such as avoidance of actual
intimacy, provocative behavior, and eating/sleeping disorders. Some were “real”
orphans, many who had been with one of their parents when they died or were
killed in the war. Others were “given” to the orphanage by parents who were
emotionally unable to care for them. Still others were there because their
parents reported that they were ”wild and unparentable.” Only children who
could function within the guidelines of the program were accepted; the others
were referred for individual therapy.

The pilot program began in June 1999, and, happily, lead to expected positive
behavior changes in the children—smiles where there had been none;
acceptance of comfort and nurture which had been impossible before. In fact,
using the Child Behavior Checklist, the Randolph Attachment Disorder
Questionnaire, and descriptive behavior interview with the orphanage caregivers
given prior to intervention, the pilot group measured significant positive changes
in almost every child after the pilot program, and again when they were re-visited
one year later.

One of the “unmanageables”, 5-year old Stravko, was reunited with his mother
and siblings, doing well three years later. Another little girl, Nina, began to speak
again after months in the orphanage without talking except to scream when
anyone tried to touch her. She was successfully adopted by an Italian family.

An unexpected positive result was that almost all of the volunteers reported and
exhibited emotional healing as a result of being in the program. The only change
Lark reports making to the pilot program was adding group conversations for the
volunteers to discuss how their experience had helped with their own recovery.

The program has been translated into Russian, Serbian, Chinese and currently
Romanian. Though Lark is unsure if the project has been duplicated, she did
spot her manual in a photo taken in Kosovo that was published in the New York
Times, and she has presented the work to SOS Children’s Villages and TOUCH
Family Services in Singapore. The program is designed to be replicable in other
cultures and applicable to other traumatic situations, such as natural disasters
and terrorist attacks.

Lark confirms that “Theraplay principles are at the heart of helping the healing of
the affected children in this program”. She uses Theraplay at ICF as part of her
own Synergistic Trauma and Attachment Therapy (STAT™), which combines a
variety of ways to promote healthy development, healing and attachment.

You can reach Dr. Eshleman regarding permission and protocols to use the
program, Healing Emotional Trauma: Treating the Wounded Child, through
her website:, or by emailing her at . Also available there is her book: Becoming a
Family: Promoting Healthy Attachments with Your Adopted Child. (Taylor
Publishing Company.)

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