Critically discuss two types of psychological interventions to improve wellbeing for looked after
children.
Looked after children were described by the Department of Health (1989) as children in public care,
involving those in foster or residential homes and those who have been adopted or remain with
their biological parents but subject to a care order. The well-being of these children is of the
uttermost importance. Ryff and Singer (2008) came up with the core dimensions of psychological
well-being consisting of; self-acceptance, purpose in life, environmental mastery, positive
relationships, personal growth and autonomy. As a result, intervention may be required for looked
after children to focus on these, as they are prone to mental health problems and emotional and
behavioural difficulties (Meltzer et al, 2003). Therefore, interventions such as Theraplay and Dyadic
developmental psychotherapy are necessary to ensure they receive the support they require.
Considering the trauma issues, such as abuse among looked after children, mental health problems
are more prevalent in these children (McMillen et al, 2004). Leslie et al (2004) reported that 50-80%
of foster children require clinical treatment. Therefore, treatment is often required to improve their
wellbeing and help them develop missing qualities such as attachment. As a result, both Theraplay
and Dyadic developmental psychotherapy are based on principles of the Attachment Theory, as
attachment in early life leads to healthy future development (Bowlby, 1958). From this children form
their Internal working model that consists of expectations of themselves and others which forms the
foundation for future relationships (Pietromonaco & Barrett, 2000). Mary Ainsworth’s (1970)
attachment styles consisting of secure, resistant and avoidant attachments, have also contributed to
the development of these interventions (Main & Solomon, 1990). Research has found that a secure
attachment is linked to prosocial development (Levy & Orlans, 2003) as it leads to them trusting
their caregiver and self-soothing, knowing the caregiver will return.
Therefore, the main objectives of Theraplay is to improve the child’s self-confidence, their self-
esteem and their independence whilst improving their social skills and willingness to interact with
others including their caregiver (Franke, 1999). As looked after children often experience trauma
(Troutman, 2011) Theraplay can be viewed as the ideal treatment as it promotes healthy
relationships. Theraplay can be used to treat several disorders in looked after children including
attachment disorders, ADHD, aggressive behaviours and social disorders. It is used in settings such as
schools, mental health facilities, homes and hospitals.
Once they begin Theraplay, the parent and child are often assessed using The Marschak Interaction
Method (MIM). It is a structured observation technique that is used to assess the quality and nature
of the relationship between the adult and child. The adult and child are observed interacting with
, one another as they perform several tasks based on the difficulties they need to address. The MIM is
comprised of four dimensions which represent important elements to develop a secure attachment
(Ainsworth, 1970). These dimensions include; structure, engagement, nurture and challenge and are
used to determine differential attachment between the child and guardian (Brayman, 2016).
Structure tasks are designed to assess the guardian’s ability to take control, set boundaries and
provide a safe, orderly environment for the child as well as the child being willing to accept that
structure. Secondly, engagement tasks assess the adult’s ability to encourage interactive
engagement that is suitable to the child’s developmental and emotional level. Thirdly, nurturing
tasks assess the adult’s ability to respond to the looked after child’s needs for nurture and recognise
their stress. It also observes the child’s ability to accept this and go to the adult for comfort. Finally,
challenge tasks are used to assess the adult’s ability to help the child’s development and to set
appropriate expectations. They are also observed on their celebration to the child’s achievements
and the child is assessed on their ability to respond to the challenge. This then contribute towards a
practitioner’s recommendations to guide Theraplay intervention to ensure the development of a
secure attachment.
Once assessment is complete, feedback is giving to the guardian, followed by the therapist
interacting with the child whilst the guardian and another therapist observes. The parents are then
encouraged to join and try the playful techniques at home. It is an interactive therapy and so the
therapist leads the sessions and interacts in playful ways with the child, encouraging eye contact and
communicating verbally and non-verbally. Nurturing gestures such as physical contact during play
are used to improve attachment behaviour (Jernberg & Booth, 1999). The therapy often lasts for 18
sessions on average, of 30 minutes each, depending on the type of problem that is being treated.
The methods used by the therapist gives the child the means to develop and improve gradually
through play by guiding the parent and child through activities and interpreting the child’s thoughts
and actions (Wettig et al, 2006). Playful challenges are implemented to help the child develop self-
esteem and competency. They help improve looked after children’s wellbeing by teaching them to
release frustration in a safe and controlled way, using tug of war, pillow fighting and arm wrestling
(Jernberg, 1984). Engaging activities are also used to give them a sense of their social world by using
activities such as peek-a-boo, hiding and finding object or other surprising activities (Jernberg &
Booth, 1999). A third set of activities focus on nurturing in order to express to the child emotional
acceptance. This improves their wellbeing by providing them with comfort and security through
soothing, calming and reassuring the child (Jernberg & Booth, 1999).
