THERAPEUTIC INTERVENTIONS CASE STUDY: THERAPLAY AND STORY WRITING

Theraplay is defined as a playful, engaging, relationship-centric intervention that is fun, interactive, and physical (Money, Wilde & Dawson, 2021, p.4). Theraplay is applied for persons with various psychological challenges such as developmental disorders, trauma, attachment issues, and regulation challenges (Money, Wilde & Dawson, 2021, p.4). Theraplay is based on Bowlby’s attachment theory, specifically relating to the concept of inner working models which suggests that children with attentive and pleasurable interaction experiences with their caregivers grow a healthy inner working model (Money, Wilde & Dawson, 2021, p.4). Theraplay, therefore, suggests that for children with difficult relationships with their caregivers, new positive interactions can be developed between the parent and the child to develop a positive inner working model (Money, Wilde & Dawson, 2021, p.4). Therapeutic story writing is where patients co-author life stories that convert literature into a practical application that assists persons to heal (Gu, 2018, p. 479). The interventionist assists the client by coaching them and equipping them with skills to solve their challenges through story writing (Gu, 2018, p. 479). Story writing can occur in the classroom and focuses on personal healing and story writing as a meaning-constructing exercise for the student (Gu, 2018, p. 479).

This paper will focus on the case study presented in Appendix 1. The case study involves two children, Joshua and Gabriel, aged 5 years and 7 years respectively, who have been depicting abnormal behaviour as highlighted by their teachers and the SENCO at their school. This report seeks to evaluate the impact and effectiveness of the use of theraplay and story writing for the two students in dealing with their evident attachment, developmental, social and learning challenges. Theraplay and story writing have been applied in interventions targeting these challenges, particularly in the classroom setting (Gu, 2018, p. 479; Money, Wilde & Dawson, 2021, p.4), therefore being used in this report. This report will evaluate each intervention independently and offer conclusions on their applications in the case of Joshua, Gabriel, and their family.

Interventions

Therapeutic interventions are initiatives made by individuals such as teachers to better the well-being of persons such as students who either require help but refuse it or are incapable of initiating or accepting help (Psychology Today, n.d, n.p). There are various types of therapeutic interventions that are used today including theraplay and story writing. Joshua and Gabriel’s case as shown in Appendix 1 involves two children with various special educational needs that range from the dimensions of the children’s relationships in terms of structure, nurture, engagement, and challenge. Joshua and Gabriel have challenges that impact their schoolwork, their ability to comprehend information, challenges comprehending others or expressing themselves, challenges interacting with others including fellow students and adults challenges making friends, and problems with behaviour at school and at home (Nidirect.gov, n.d., n.p). The case study identifies that Joshua and Gabriel are experiencing challenges brought about by the impacts of their mother’s prenatal depression and their parent’s separation. As Appendix 1 notes, the children depict several needs that have a wide range and scope. These challenges and needs depict the need for various interventions to cater for these needs but this report focuses on the application of two interventions; theraplay and therapeutic story writing. Theraplay and story writing offer a chance for addressing the children and their parent’s needs since they target the children’s relationship with their mother, the children’s interactions with others, their mother’s efficacy as a parent, and understanding and excelling in their new living conditions.

While theraplay and story writing offer methods of approaching the problem and meeting the children’s and their mother’s needs, there are various potential barriers that may impact the continuance of the intervention and its success in positively influencing the children to resolve their challenges. One of the potential barriers to the success of the intervention is the stigma the children and their mother may face (Aguirre, Cruz, Billings, Jimenez, and Rowe, 2020, p.3). Other students may stigmatize Joshua and Gabriel for being part of the special educational needs program, which may negatively impact their perception of the interventions and reduce their impact in dealing with their challenges (Aguirre, Cruz, Billings, Jimenez, and Rowe, 2020, p.3). The mother, who is presumed to have experienced postnatal depression, could also face stigmatization for not being a good mother, which may additionally affect her perception and reception to the interventions (Aguirre, Cruz, Billings, Jimenez, and Rowe, 2020, p.3).

The mother could also lack the emotional competence to engage successfully with the interventions, which would also pose a barrier to their success. If the mother had negative prior experiences with mental health professionals or her mental health literacy is low, she may also not be very receptive towards the interventions which may raise a barrier to her treatment and also impact her children’s perceptions towards the interventions (Aguirre, Cruz, Billings, Jimenez, and Rowe, 2020, p.3). Financial barriers may also become a challenge to the interventions since they may require additional funds to meet the treatment needs of the children (Goldsmith, Pellmar, Kleinman & Bunney, 2002, p.334). The interventions may also fail to accommodate some of the clients’ needs such as their cultural needs, which may result in the interventions not being fully actualized (Goldsmith, Pellmar, Kleinman & Bunney, 2002, p.335). However, despite these challenges, the children and their mother have the capability of benefiting from the interventions and improving their well-being.

Theraplay

Appendix 1 highlights Joshua’s developmental, attachment, relationship, interaction, and behavioural needs. Gabriel, on the other hand, has behavioural, interaction, and psychological needs. The mother also depicts the need for mental health treatment for her postnatal depression which is the source of some of her children’s challenges. Rosie also has the need for interaction and attachment intervention because of her feelings of inadequacy as a mother that may arise from her postnatal depression (Appendix 1). In addition, the family also needs to learn how to adjust to their new living situation and cope with it. This includes finding new ways to deal with Emma’s needs as a toddler and ensuring that her tantrums do not affect the whole family.

Theraplay involves developing new inner working models for the children so that they are able to develop better behaviours and interactions with others (Money, Wilde & Dawson, 2021, p.4). This intervention can be specifically targeted to Joshua and his mother Rosie since they have relationship issues that are part of their needs – Joshua needs his relationship with his mother to be able to foster relationships with others, while Rosie needs to feel capable as a mother. Theraplay is based on the attachment theory and suggests that if the parent and the child can develop new memories together, then they can develop better relationships and inner working models that make the child and the mother more positive about courage while exploring their environments (Money, Wilde & Dawson, 2021, p.4). The attachment theory highlights the necessity of the emotional bond between a primary caregiver and a child in their development, which is meant to give the child a perception of safety and stability from this bond, and provide room for the child to interact with others and feel like they are also responsive to them (Salisbury, 2018, p.424). This suggests that theraplay, which seeks to develop the attachment and relationship between a parent and their child, is capable of assisting Rosie to establish a better relationship with Joshua and Gabriel since both depict challenges with interacting with others (Salisbury, 2018, p.424). Through theraplay, Rosie and Joshua can engage in active play and create new memories of their relationship which would, in turn, result in the development of some feelings of safety for Joshua and self-efficacy in parenting for Rosie. Additionally, theraplay would create the foundation that would allow Joshua to interact with other children since the safety of his relationship with his mother creates a foundation that he can also have a similar relationship with his peers.

Theraplay is beneficial for the case of Gabriel in terms of his aggressive behaviour. Studies suggest the outreach theraplay provides teaches children about the safety their parents give them, that they are worthy of relationships with others, and that others are receptive to them (Salisbury, 2018, p.424, 425). This means that Gabriel’s perception that others are against him and his challenge interacting with others can be addressed by developing his feelings of worthiness when it comes to relationships and interactions with his fellow students.

Theraplay has also been found to be beneficial for students’ education attainment and success since early child development and their relationships with adults have a direct impact on it (Salisbury, 2018, p.425). The social and educational success of the children can be improved by the use of theraplay because of the positive impacts it has on their relationship with Rosie, hence resolving Joshua’s slow developmental issues and his relationship with other students. Developing a secure relationship with Joshua and Gabriel through theraplay could also be transferred to Emma, which would increase Rosie’s feelings of efficacy as a mother and caregiver. Studies suggest that theraplay has the ability to improve the relationship between parents and their children, while also reducing various internalized and externalized symptoms for the children such as their aggression, low resilience, antisocial behaviour, and ability to interact and form bonds with other children (Salo et al., 2018, p.331).

However, there are various challenges that may arise that prevent the success of theraplay for the children. The roles of stigmatization, financial challenges, and discrimination may negatively impact the intervention’s success. Stigmatization could affect Joshua and Gabriel and further decline their ability to interact with other people effectively, while financial challenges may cause their mother to miss the theraplay to earn an income and take care of her children. Rosie’s postnatal depression could also be a potential barrier because of the constant sadness, withdrawal from human contact, and fearful thoughts of harming the child that results from her condition (NHS, n.d., n.p). However, the results from the various studies suggest that theraplay has a significant chance of developing a positive relationship and bond between Rosie and her children, which would provide them with the safety to foster positive relationships and interactions with others while reducing their problematic behaviours such as Joshua’s unkindness and Gabriel’s aggression.

Story Writing

Therapeutic story writing is the second intervention in this report, which focuses on patients co-authoring life stories that convert literature into a practical application that assists persons to heal (Gu, 2018, p. 479). The interventionist helps the client by coaching them and equipping them with skills to solve their challenges through story writing (Gu, 2018, p. 479). Story writing can occur in the classroom and focuses on personal healing and story writing as a meaning-constructing exercise for the student (Gu, 2018, p. 479). Story writing was introduced back then to help bypass patient resistance during counselling, and in the case of Joshua, Gabriel, and Rosie, it can be applied to reduce their resistance to positive interactions with others and the troubling behaviours of the two children (Sommers-Flanagan, 2019, n.p). The children and their mother are able to explore their lives in a context where the problems are not present such that they are able to direct the movement of their lives within the story writing context (Congdon, 2020, n.p). Studies suggest that story writing gives people a receptive state that is more trance-inducing, which means the children and their parents will be more receptive towards understanding their problems and resolving them (Congdon, 2020, n.p). According to story writing experts, the intervention will assist the children to express themselves in the stories, hence developing their communication abilities in the real world (Congdon, 2020, n.p). Writing would assist Rosie to externalize her feelings of inadequacy as a mother and assist her to understand her own strengths and weaknesses such that she would be able to reduce the feelings of inadequacy from an objective perspective based on facts (Congdon, 2020, n.p).

Therapeutic story writing allows Rosie and her children to retell their stories such that they describe their desired lifestyle. For Joshua and Gabriel, they would be able to write about their current situations and then develop creative retells of their own stories (The Write of Your Life.org, n.d., n.p). Retelling their story first clears up the children and their family’s current situation, then allows them to identify what they would like to improve or change (The Write of Your Life.org, n.d., n.p). Separating the problem from being internal to an external one will also assist Rosie to move from being defined by her shortcomings as a mother (Clarke, 2021, n.p). It would also allow her to deconstruct the issues and understand why she acts the way she does. The same case would apply to Joshua and Gabriel in terms of their antisocial and aggressive behaviours respectively (The Write of Your Life.org, n.d., n.p). Using techniques such as age-appropriate stories, looking for positive images within the stories, clarification of the exact dimensions of the story, and creativity while writing the story could provide beneficial impacts on the children and family’s needs. However, similar barriers as with theraplay may apply, while additional ones such as challenges accepting the truths about one’s weaknesses and the challenge to separate one from their challenges may also be a barrier to its success in this scenario (Clarke, 2021, n.p).

Conclusion

Joshua has challenges interacting with others and is often alone and mean to others when they try to initiate contact with him. Joshua also has developmental issues that are manifested in his language skills that are lower than that of his peers. Joshua is also noted to be quite unkind while at home. Gabriel on the other hand is hyperactive and also has challenges interacting with others because he thinks they do not like him or are against him. He is however quite caring and mature at home. Their mother suffers from postnatal depression after giving birth to Joshua, which has impacted their relationship and her efficacy as a mother.

Theraplay and story writing suggests significant potential for improvement for their case. Theraplay has the impact of developing a better relationship between Joshua and Rosie, which would be based on developing new memories that increase his feeling of safety and worthiness for interacting with others. This would result in better interactions with his fellow students and better adherence to his mother’s instructions at home. Additionally, this would improve Rosie’s feelings of efficacy as a parent and improve their relationship. For Joshua, theraplay would also have the same impact on safety and worthiness, which would reduce his feelings of inadequacy and his peers are against him. It would also assist him to develop healthy interactions and relationships with them while reducing his aggression.

Story writing could assist the clients to retell their stories such that they are able to identify their strengths and weaknesses and how they would like to change them. This would also assist them to externalize their problems and separate themselves from them such that they are able to deconstruct their issues and generate unique outcomes. While there are various challenges that may arise, both interventions seem to fit the needs of the clients and collectively resolve most of their challenges from a relationship point of view, which is the main challenge in the case study. Therefore, theraplay and story writing are feasible and beneficial interventions for this scenario.

References

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Appendices

Appendix 1: A case study

Joshua, age 5, and Gabriel, age 7, are attending a primary school in the Basildon area in Essex, they started 6 months ago. Joshua and Gabriel live with their mum, Rosie, their little sister, (1-year-old) Emma, and their grandparents Marc and Joseline. Rosie and the children used to live in Birmingham with Mason, their father, but Rosie and Mason separated just before Christmas 2020, and Rosie and the children moved to her parents’ two-bedroom townhouse in Basildon. Prior to the move, the children had had limited contact with their grandparents. Rosie shares a room with the children. Rosie works at the local supermarket and alternates between the early and late shifts. The children are dropped off and picked up at school by their mum or their grandparents, and often attend breakfast club or after school club. There is no legal arrangement regarding the children’s care, but the children tend to see their dad every other weekend. Dad comes and picks them up and they travel to Birmingham where they spend the night in their old house, with dad’s new partner, before returning to their mum on Sunday evening; for the last three months, the children have seen their father 3 times.

They started their new primary school in the middle of the second lockdown in January 2021. Joshua started in reception class and after 3 months is described by his teacher as a quiet child, whose speech and language appears delayed compared to his peers. Joshua often engages in solitary play and spends long periods of time sorting out the small cars and rolling them in different areas of the classroom or playing in the sand tray and water tray in the outdoor classroom. If other children or adults join in in his play, Joshua will push them away saying “mine” or, for example, will take the cars and move away from the children or adults. Gabriel is in Year 2 and is described by his teacher as loud and demanding of attention. He is keen to make friends but has difficulties interacting with his peers. Gabriel often thinks the world is against him and that nobody wants to be his friend. He can also be quite aggressive towards his peers, as he thinks they are mean to him. Gabriel is often tired and finds it hard to concentrate. The school SENCO, alerted by both teachers, arranged a meeting with mum. Mum explained that since the birth of Joshua she had been feeling overwhelmed and inadequate in her role as a mum, and that she lost her job soon after her maternity leave ended. She said that the way she was feeling had an impact on her relationship with her partner who was quite cross when she lost her job and, soon after this, he spent less and less time at home. When she accidentally became pregnant with Emma, their relationship broke down as he confessed to having an affair and she eventually moved in with her parents, where she feels very lonely. Mum also mentioned that her little girl’s sleeping pattern is affecting all the family, including the grandparents, and that the little girl is a difficult child and gets very upset at drop off time, at the nursery she attends when whilst she is at work because she is very clingy. Mum says that Joshua is not very kind at home and often has tantrums, whilst she describes Gabriel as being mature, always there to console her and often looking after his two younger siblings so that she can rest and so that they don’t get into trouble with their grandparents.

The SENCO is concerned that mum has been suffering from postnatal depression and worries that the children’s development and wellbeing have been affected by this, in addition to the difficult situation around the relationship breakdown. Mum has agreed for the SENCO to begin an Early Help Assessment, to allow for a multi-agency response from health visitors, social services, GP and family support workers, to provide appropriate support for the family. The SENCO has also agreed with mum that Gabriel can begin to take part in story writing therapy at school, to support him in expressing his feelings and worries and promote his self-confidence and positive behaviour. The SENCO has also agreed with mum, that both she and Joshua could take part in Theraplay sessions, with the aim of supporting mum to find ways to engage with Joshua, encouraging her to regain a sense of adequacy as a mum and helping to build and strengthen Joshua’s attachment and relationships with her and with other adults in his life, in addition to improving Joshua’s ability to interact and play with others.