Theraplay® and EMDR Integration
Shanon Claussen, LISW RTP-S AC is an experienced EMDR therapist, supervisor and Approved Consultant who skillfully integrates Theraplay® with EMDR in her therapeutic practice. Shanon’s innovative approach significantly enhances the therapeutic outcomes for children and adolescents undergoing EMDR therapy.
Research and Application of Theraplay®
Theraplay® is a therapist-directed play therapy that actively involves children and their parents. It is specifically designed to build and enhance attachment, boost self-esteem, improve trust in others, and foster joyful engagement. The basic assumptions of Theraplay ® are:
1) the self and personality develop out of the early parent-child interaction as outlined in Self Psychology, object relations theory, attachment theory and research on brain development.
2) caregiver empathy and sensitivity are essential to the child’s healthy development and secure attachment.
Based on the natural playful interactions between parent and child, Theraplay® sessions are structured around key relational dynamics:
- Structure
- Engagement
- Nurture
- Challenge
- Playfulness.
These sessions aim to transform a child’s view of themselves as worthy and lovable and of relationships as positive and rewarding. Recognized as a “Promising Practice” by the California Clearinghouse for Evidence-Based Practice, Theraplay® is particularly effective for children who face attachment issues or have been adopted. It is one of the rare modalities that accommodates a broad age range, from infants to teenagers. For more information on Theraplay® and available training, visit The Theraplay Institute.
The therapeutic power of Theraplay® extends to integrating trauma-informed approaches, leveraging healthy physical contact, which is vital in establishing and reinforcing attachment security. This modality addresses the detrimental effects of inadequate touch, as evidenced in studies with children experiencing neglect, underscoring the necessity for healthy, affirming physical interactions.
Research and EMDR
EMDR is a robust treatment modality for trauma, with proven effectiveness for a spectrum of issues including anxiety, depression, and attachment disorders. It helps to integrate fragmented memories by accessing and processing traumatic memories, restoring the brain’s innate healing abilities.
Integrating Theraplay® with EMDR
Combining Theraplay® with EMDR therapy provides a dual approach to treating attachment-related trauma. This integration is especially beneficial in addressing the complex needs of children who have experienced early relational traumas. The EMDR component focuses on reprocessing and integrating traumatic memories, while Theraplay® sessions build positive, nurturing interactions that reinforce the child’s sense of security and self-worth.
Application of Theraplay® and EMDR in Practice
Shanon Claussen’s therapeutic approach uses Theraplay® to establish a secure and engaging environment, where positive interactions during therapy are enhanced through EMDR’s bilateral stimulation techniques. This method strengthens the child’s adaptive information networks by reinforcing positive experiences and reprocessing negative ones within a supportive, structured setting. Shanon has developed protocols that combine these therapies to address complex developmental traumas.
Case Example for clinicians trained in both:
Phase 1. History taking/Information gathering:
‘Sal’ is a 6 year old male. His mom, ‘Sue’, is in her mid 30s. Sal has 3 other siblings: a sister (10) and 2 brothers (ages 12 and 8), and he is the youngest in the family. Sal and his siblings each have a different father. As a result, Sal has had several different male figures in and out of his life. Sal’s biological father is not regularly involved in his life.
Sal witnessed domestic violence between his mom and each of the males in mom’s life in various forms (some were physical, some verbal, etc.), including by his biological father. Sal does not feel safe at times and still wishes his father was a part of his life. About 2 years ago, Sue left Sal’s biological father and started a new relationship with a man. ‘ Kyle’ is about 8-10 years younger than Sue, which is significant because Kyle is now just reaching an age where full brain development occurs (mid 20s).
Mom is at times unsure of Kyle’s commitment level to her and the children. Kyle demonstrates fear and anxiety to commit to the children and mom long term. Kyle talks to mom and the children about getting married to Sue, but will not propose or show signs/behaviors that indicate he truly wants a long term commitment.
Sue has not been able to be emotionally present/stable for Sal or his siblings since their birth due to her upbringing and past abuse. She does report she wants a good relationship with Sal and his siblings. Sue reports a lack of attachment with her parents growing up, sharing that she was abused by them physically, mentally and emotionally. Her upbringing and past abuse interferes with Sue’s ability to parent positively, have a good relationship and attach positively to the children.
Sal engages in negative behavior to get attention, and verbalizes a longing to be close to his mom, as well as to be close to his biological father who is not involved in Sal’s life. Sal acts out negatively at school as well. Symptoms of his diagnoses of ADHD and PTSD interfere with positive relationships at school, at home, as well as with his ability to focus and do well at school academically. Theraplay ® and EMDR interventions are both being utilized to help Sal work through past trauma and improve his relationship with his mother so he can have a healthy level of attachment, as well as to enable him to be successful academically and socially at school.
Phase 2. Preparation (Resourcing):
Therapist starts out with utilization of a Theraplay ® intervention: Therapist directs Sal and his mom Sue to sit across from each other on the floor, in a “criss-cross applesauce” seating position.
Therapist can see Sal smiling to get special time with his mom Sue, sitting close to her. Therapist says to Sal, “You look happy with your mom sitting close by you. Where to you notice feeling happy in your body?” Sal replies, “In my head and belly.” Therapist applies BLS (about 6-8 slow, short sets).
Therapist asks Sal if he notices a pleasant feeling, he confirms yes (As with EMDR protocol and resourcing, we want to make sure the client is not having any disturbing feelings/sensations/experiences when resourcing is occurring).
Therapist continues to be attuned to what Sal is feeling throughout the session and strengthens all times where the child and the mother have positive interactions and/or are experiencing positive feelings with each other, such as happiness or joy,to prepare Sal for later EMDR phases.
As Sal, or any child, continues to play during Theraplay ® activities, therapist notes times the child is experiencing joy, is proud of himself, is able to master a game, able to work through difficult emotions (such as frustration, anger, joy) and “taps in” each of these feelings. If possible (I prefer it this way), the parent is asked to “tap in” the positive traits and abilities of the child to strengthen them.
Homework can be given to the parent to help “tap in” any time the parent witnesses the child experience something positive (did a good job, was able to master something difficult, made a good choice, etc.)
To create the safe/calm/happy place, the therapist can ask the child to think about a place he feels calm and good inside to create a safe/calm place. The child will describe (or can draw) the place. The calm/safe place protocol should be followed to create it.
Phase 3 Assessment:
Assess the target for EMDR processing by stimulating primary aspects of the memory:
Therapist assists the family to decide targets to reprocess in EMDR. Standard EMDR protocol should be followed. The Negative Belief and Positive Belief (Kiessling) should be identified, as well as the SUD and VOC. Emotions experienced should be listed and the therapist should find the location for disturbance in the body.
Sal had difficulty coming up with specific examples of times he has not made good choices, but was able to identify a time at the bus stop, at school, and at home where he did not make good choices. Therapist will target each of these times in the Desensitization phase.
Phase 4: Desensitization:
School, Home, and Bus Stop were all reprocessed with the NC “I am not making good choices” and the PC “I am able to make good choices” for all three. Sal reprocessed each target quickly and completed all 3 targets in the same session. Therapist had Sal and Mom sit by each other.
Therapist asked Sal to bring up each target, the NC, to notice the location in the body, and coached mom on speed and number of sets to help Sal “tap out” the messed up feelings until his SUD reduced to zero.
Narrative techniques from Joan Lovett’s book Small Wonders: Healing Childhood Trauma with EMDR (2007) or learning story telling techniques from Ana Gomez through Agate Institute child EMDR training can be used to have the parent tell the story while the child processes the disturbing event/memory, or the child can tell the story when the parent is not present.
For example, the therapist can have Sal tell the story on the bus where he did not make a good decision while BLS is applied by the parent or the therapist. Whether the parent or therapist does the tapping will depend on what best meets the needs of the child and parent.
The parent may not understand how to apply the tapping, or may not want to. In addition, the child may or may not want the parent to do the tapping. In some cases, the child may tap on their own body during this phase or the therapist may use alternate tactile BLS such as the ‘buzzies’ from Neurotek EMDR equipment.
Theraplay ® techniques can be used in between BLS sets to titrate the work. If a child has difficulty reprocessing for a long period of time, 2-5 minutes of reprocessing can be done, followed by a Theraplay ® technique such as balloon volley or bubble popping.
These techniques can be used to soothe and ground the child. Blowing bubbles and popping them can be a form of deep breathing when instructed to use the diaphragm, and the touch of the bubbles can assist the child with staying grounded and in the present while eliciting the sense of touch. Other activities such as “feeding” assists the child on many levels with building the relationship and taking care of needs related to nurture.
Phase 5: Installation:
Utilize EMDR protocol. You can use play therapy techniques for this phase as well.
Phase 6: Body Scan
Utilize EMDR protocol to clear body scan. Can use play therapy techniques like a magic wand or Ana Gomez’ Feeling Finder magnifying glass (www.anagomez.org) to scan the body to “find” the disturbance in the body.
Phase 7: Closure
Follow EMDR protocol. Therapist can review container or calm place, or engage child in another resourcing technique at the end of the session.
Phase 8: Re-evaluation
Follow EMDR protocol. Therapist can have the child draw how the situation feels or looks to them now.
Shannon Claussen, LISW RTP-S AC
In summary, Shanon’s integration of Theraplay® and EMDR offers a dynamic and effective approach to treating children and adolescents with trauma. Her work not only facilitates deep healing but also empowers clients to establish healthier, more joyful relationships.
For those interested in learning more about integrating Theraplay® and EMDR, or to schedule consultation, Shanon can be reached at shanonclaussen@gmail.com
.
Resources
The Theraplay Institute. The Theraplay Institute. California Clearinghouse for Evidence-Based Practice
Parnell, Laurel. Tapping In: A Step by Step Guide to Activating Your Healing Resources Through Bilateral Stimulation. 2008: Webb, Sandra. Sandra Webb Counseling.
Gomez, Ana (2024) Agate Institute Master Class with Ana Gomez: The Stroy Making Protocol
Bonnie Mikelson, LISW
