International Journal of Play Therapy

© 2021 Association for Play Therapy 2021, Vol. 30, No. 2, 125–135
ISSN: 1555-6824 https://doi.org/10.1037/pla0000139

A Phenomenological Study of Theraplay Groups

Within a Middle School

Jo Lauren Weaver, Nina V. Medyk, Jacqueline M. Swank, Philip F. Daniels, and

Sondra Smith-Adcock
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

School of Human Development and Organizational Studies in Education, University of Florida

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Theraplay is an attachment enhancing, play-based intervention. We used a phenomeno-

logical study to explore the experiences of middle school students (N = 21) participating
in Theraplay groups, and found five overarching themes: (a) alternative to the lunchroom,
(b) relationships and making connections, (c) perspective taking and challenging
perspectives, (d) feelings about the group, and (e) recommendations for future groups.
We discuss the clinical implications and recommendations for future research.
Keywords: Theraplay, middle school, adolescents, attachment

Adolescents between the ages of 10 and 14
begin to desire distance from their parents, spend-
ing more time with peers. Developmentally, their
focus shifts to identity formation and establish-
ment of peer connections (Erickson, 1950). A
shift also occurs from early childhood to middle
childhood through the beginning of adolescence
that emphasizes teamwork and group cohesion
more than group information (Leman, 2015). As
children’s understanding of group dynamics and
social groups expands, so does their orientation to
knowledge as they learn groups work better when
they are cohesive (Abrams et al., 2007). With the
importance of peer group acceptance during this
developmental period, feelings of loneliness tend
to peak during this stage (Heinrich & Gullone,
2006). Additionally, with increased emphasis on
social relationships, early adolescents are learn-
ing to regulate their emotions more independently
than when they were children (Steinberg, 2008).
Young adolescents experience more negative and
fewer positive emotions than when they were
younger (Larson & Ham, 1993) . Researchers
report this is a critical time to develop emotion
regulation as it can reduce psychopathology (i.e.,
Schaefer et al., 2017). A greater ability to emo-
tionally regulate is linked to a secure attachment
style in adolescence (Shumaker et al., 2009).
Additionally, secure adolescents display greater
social competencies likely due to their advanced
emotional skills, including empathy, emotional
expressiveness, and emotional awareness
(Laible, 2007). Thus, mental health professionals
may seek an attachment-informed, emotion reg-
ulating treatment modality (i.e., Theraplay) in
working with this population.
Theraplay
Theraplay is a short-term therapeutic interven-
tion that is attachment-informed, play-based, and
modeled after the natural patterns of healthy
caregiver–child interactions (Jernberg, 1979;
Jernberg & Booth, 1999). The therapeutic process
of Theraplay emphasizes moment-to-moment
interactions that are attuned, structured, joy-
filled, and designed to help with regulation
(Munns, 2009). Clinicians use Theraplay to pro-
mote self-esteem, foster trusting relationships,
and support healthy attachments in clients and

Correspondence concerning this article should be ad-

Nina V. Medyk https://orcid.org/0000-0003-2476-6142 dressed to Jo Lauren Weaver, School of Human Develop-
Jacqueline M. Swank https://orcid.org/0000-0003- ment and Organizational Studies in Education, College of
2060-5835 Education, University of Florida, Gainesville FL 32611,
Philip F. Daniels https://orcid.org/0000-0002-1058- United States. Email: jlauren.weaver@ufl.edu
7007

125
 126 WEAVER ET AL.
caregivers (Booth & Jernberg, 2010; Munns,
2009). Researchers have found Theraplay in-
creases social interaction and relationship skills
(Francis et al., 2017; Siu, 2009; 2014; Wettig
et al., 2011) and emotion regulation (Bundy-
Myrow, 2005), and helps to decrease aggressive
behaviors while promoting caregivers’ respon-
siveness (Weir et al., 2013). Theraplay is clini-
cally adaptable for education and mental health
professionals to use with families or in group
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settings (Booth & Jernberg, 2010).
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Counseling professionals use Theraplay
groups to augment children’s secure attachment,
emotion regulation, and social learning (Booth &
Jernberg, 2010). Researchers have found positive
outcomes in using Theraplay groups with diverse
populations and age groups, including school-
aged children (i.e., Siu, 2009, 2014; Tucker
et al., 2017; Alves et al., 2018). Siu (2009)
examined the use of weekly Theraplay groups,
over an 8-week period, with students in Hong
Kong (N = 46) in second through fourth grades,
who were classified as at-risk of developing an
internalizing disorder. The researcher found par-
ticipants in the Theraplay group had reduced
internalizing behaviors (e.g., withdrawing,
somatic complaints, symptoms of anxiety/
depression) when compared to a control group,
and the children and their parents reported the
Theraplay group was effective, enjoyable, and
helpful. Siu (2014) also found increased social
skills including social awareness and communi-
cation among children with developmental dis-
abilities (n = 23) who participated in Theraplay
groups, when compared to a control group
(n = 15). The teachers in the study reported a
willingness to use the intervention during the next
school year (Siu, 2014).
Teachers may also use Therplay groups within
the classroom curriculum, such as a manualized
intervention called Sunshine Circles. Tucker
et al. (2017) examined the effectiveness of Sun-
shine Circles with preschool aged children
(N = 206), and found the children demonstrated
enhanced socio-emotional competencies. Addi-
tionally, Alves et al. (2018) piloted classroom
Theraplay with Head Start and Early Head Start
low-income minority families and found promis-
ing results in the following areas: (a) social
engagement, (b) child-initiated interactions
with caregivers, (c) improved sense of trust and
safety, (d) self-regulation, (e) increased tolerance
for new activities/people, and (f) a greater sense of
attachment between child and caregiver. Thus,
researchers have found positive outcomes in
using Theraplay with young children; however,
a paucity of research exists exploring the useful-
ness of Theraplay with adolescents in school
settings.
Theraplay With Adolescents
Though several authors have discussed the
clinical use of Theraplay with adolescents
(Gardner & Spickelmier, 2009; Munns, 2005,
2017), we found only one study that focused
on examining Theraplay with adolescents
(Robison et al., 2009). In their case study, Robi-
son et al. found promising outcomes (e.g., reduc-
tion in aggressing, positive communication,
increased confidence, enhanced well-being);
however, the case study included only one par-
ticipant. Additionally, the Theraplay interven-
tions occurred during individual sessions
within a residential treatment program. Hence,
further research is needed to explore using Thera-
play groups with adolescents within a school
setting.
With its emphasis on attachment, relationship-
building, and emotion regulation, Theraplay may
assuage the challenges of psychosocial and
attachment development in adolescence. During
this stage of development, adolescents also seek
to differentiate themself from others (Bowlby,
1973), which shifts their view of attachment from
a particular relationship (i.e., parent, caregiver) to
more internally based attachment styles. Adoles-
cents are continually developing their internal
states of mind regarding attachment both emo-
tionally and cognitively (Allen & Tan, 2016).
They become less emotionally reliant on their
parents to learn how to self-soothe and regulate
their emotions (Allen & Tan, 2016). Cognitively,
adolescents begin to form their perception of
attachment by compiling their experiences with
caregivers. Through this process, adolescents can
become increasingly autonomous in maintaining
emotional equanimity, while developing a more
consistent self-image that exists separately from
interactions with their caregivers (Allen & Tan,
2016). Adolescents also begin to include indivi-
duals other than their primary caregivers in their
hierarchy of attachment (Allen & Tan, 2016;
Rosenthal & Kobak, 2010). In this way, adoles-
cents’ relationships with peers are characterized
by a gradual development of adult-like intimacy
 A PHENOMENOLOGICAL STUDY
and supportiveness. By the end of adolescence,
long-term relationships with peers serve as
attachment figures, and relationships become
varied and complex (Buhrmester, 1992). There-
fore, establishing healthy attachments with peers
is necessary for adolescent development. Group
Theraplay offers promise as an intervention to
build peer relationships as it allows members to
participate in activities based on the tenants of
secure attachment.
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The purpose of the present study was to explore
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the usefulness of Theraplay groups with middle
school students. The researchers used a qualita-
tive, phenomenological approach to explore the
experiences of the students in Group Theraplay.
The research question was: What are the lived
experiences of middle school students that
engage in a Theraplay group intervention?
Method
Researchers
Five researchers were involved in the current
study. At the time of the research, two were
counselor educators and three were doctoral stu-
dents. Four of the researchers were White females
and one was a White male. We were trained in
group Theraplay, and our theoretical lens for the
group was relational/attachment. Our clinical
experiences ranged from working with early
childhood to late adolescence in a variety of
settings, including schools, agencies and private
practices, day treatment facilities, inpatient units,
and residential facilities. We also value Theraplay
as a treatment modality.
Participants
The target population for this study was sixth
and seventh grade students. The participants
(N = 21) were from one middle school in the
southeast region of the U.S. The school houses an
academy program for technology and gifted stud-
ies. Students in the academy program take differ-
ent classes from traditional students. Participants
in this study were both traditional and academy
students. Ten students were in sixth grade and 11
were in seventh grade. Fifteen (71%) identified as
female, five (24%) male, and one (5%) did not
report gender. The age range of the participants
was 11–13 (M = 12, SD = 0.75). Regarding
127
race/ethnicity, six participants identified as Black
(29%), six (29%) White, four (19%) Asian/
Pacific Islander, two (10%) Hispanic, two
(10%) mixed, and one (5%) did not respond.
We used pseudonyms to report the data to protect
the participants’ identities.
Theraplay Group Experience
Theraplay activities are based on four essential
qualities of the parent–child relationship: (a)
challenge, (b) nurture, (c) structure, and (d)
engagement (Booth & Jernberg, 2010). In Thera-
play groups, the facilitators intentionally select
activities from each category totaling three to four
activities per session. Group sessions are gener-
ally 20–30 min in length depending on the age
and attention span of the group members.
In the current study, three doctoral student
researchers facilitated four Theraplay groups dur-
ing the students’ lunch periods. Two facilitators
lead each group. The students were dismissed
from class 5–10 min early to have extra time to
get their lunch and eat before the start of group.
The facilitators engaged the students in various
activities from the Theraplay group manual. See
Table 1 for sample activities.
In selecting the activities, we made adaptations
due to the members’ stage of development and the
group being comprised of both genders. Munns
(2005) recommends to avoid activities that may
be too intimate as sexual awareness is heightened
for adolescents. Therefore, we modified or
avoided activities involving touch depending
on the level of intimacy. The facilitators also
took this opportunity to model appropriate touch
between members, as well as between members
and facilitators. Munns (2005) also suggests
infusing additional activities from the structure
and challenge domains. Thus, we added more
structure and challenging activities to maintain
the composure and interest of group members.
Each session began by reviewing the rules: no
hurts, stick together, and have fun. The partici-
pants and group leaders enthusiastically stated
these rules together accompanied by hand mo-
tions representative of each rule. The sessions’
activities would alternate between up and down
regulating activities. For example, the leaders
would introduce an up regulating activity, such
as paper punch, followed by a down regulating
activity, such as weather report (see Table 1). All
sessions concluded with a food sharing (feeding)
 128 WEAVER ET AL.

Table 1
Theraplay Activities

Theraplay
domain Activity Description

Structure Pass a hand-shake Opening activity where each person adds on to the hand-shake as it is passed
Foil toss Group members stand in a line and toss foil balls into containers
Engagement Peanut butter and jelly Leader says “peanut butter” and the group replies “jelly” mirroring voice tone
Telephone A message is whispered to each person. Last person say message aloud
Nurture Hand massage Leader massages each participates’ hands with lotion
Weather report In pairs, make movements of a “weather report” on partner’s back
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Challenge Blanket balloon bop Keep balloons floating within perimeter of a blanket while more are added
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Paper punch In pairs, take turns holding a newspaper and partner punches through it

activity, which serves as a nurturing experience Data Collection

designed to facilitate an emotional bond between
the facilitator and the child. This involved the
facilitator placing a small cracker, piece of fruit,
candy, or other approved food into the students’
hands. Group facilitators also added an element of
challenge and mindfulness by suggesting the
students “guess the flavor” of the food, which
evoked the use of their senses in the present
moment.
Procedure
Following approval from the institutional
review board, we began recruiting students
from referrals made by the school counselor.
The school counselor selected students who ex-
hibited social, emotional, and/or behavioral dif-
ficulties based on counseling and discipline
referrals made my teachers and administration.
We discussed the study and the group interven-
tion with these students, and they expressed
whether they wanted to participate in the project.
For those who wanted to participate, we obtained
informed consent from their caregivers and then
formally obtained student verbal assent before
beginning the groups. We conducted four groups
with students during the 2018–2019 academic
year, each lasting 10 weeks. After the last group
session, four of the researchers helped conduct
interviews and focus groups, lasting approxi-
mately 15–25 min, during the students’ lunch
periods. We then transcribed the recordings
and analyzed them for themes. Students also
completed a demographic questionnaire about
gender, age, race/ethnicity, and grade level.
We collected data through a demographic ques-
tionnaire and interviews and focus groups. Each
group member participated in either an individual
interview or a focus group. The semi-structured
interviews and focus groups were centered on
exploring the students’ experiences participating
in the Theraplay group. Questions related to their
interactionswithothergroupmembers,theirfavorite
and least favorite activities, learning about oneself
and others, and recommendations for future groups.
Data Analysis and Verification Procedures
We followed the phenomenological method
discussed by Moustakas (1994) to analyze the
data. We transcribed the interviews, and reviewed
them individually. During the process of horizo-
nalization (Moustakas, 1994), we identified sig-
nificant statements of students’ experiences in the
Theraplay groups. We combined individual sig-
nificant statements, and organized them into clus-
ters of meaning and themes. Then, we met together
and using an iterative and inductive procedure,
discussed the data, and continued the process of
horizontalization in weekly meetings on an online
format (i.e., Zoom) over a period of 5 weeks until
we reached consensus on the final themes. To
strengthen trustworthiness of the study findings,
we explored researcher subjectivity (Creswell &
Poth, 2018) by discussing our biases before begin-
ning the study. Additionally, during data analysis,
the researchers used an audit trail (Lincoln &
Guba, 1985) to document the steps of the research
process in order to explain the decisions that were
made during analysis.
 A PHENOMENOLOGICAL STUDY
Findings
We identified five themes with multiple sub-
themes that emerged from the data. The first
theme, alternative to lunchroom, has one sub-
theme, break in the day. The second theme,
relationships and making connections, signifies
the relationships formed between participants
during the group. The third theme, perspective
taking and challenging perspectives, includes two
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subthemes, interpersonal skills and teamwork.
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The fourth theme, feelings about the group,
focuses on the participants’ reactions to the
group. The final theme, recommendations, refers
to participants’ suggestions for future Theraplay
groups.
Alternative to Lunchroom/Quiet Lunch
Space
The students described the group as being a
positive alternative to the typical lunchroom
experience. Sara shared, “I liked it because I
don’t like going to the lunch room, so it was one
day less that I had to go there : : : It’s a lot more
quiet [in the group] : : : . The lunch room is
really loud.” Additionally, Jamal commented,
“[I prefer] playing games during lunch instead
of having to be in a big, really loud room.”
Other students discussed wanting additional
activities during their lunch period. Courtney
remarked, “I just wanted something to do dur-
ing lunch because I feel like lunch is a waste
of time.”
Break in the Day
The students discussed the group as being a
respite from the academically focused school day.
Fred commented, “You get to do stuff in school
besides just sitting at your desk, and listening to
your teacher : : : You get to do stuff not school-
related. Everything is school related these days.”
Jackson stated, “It was a break from all the work
and having to deal with teachers.” The students
also discussed their mood related to having this
break in the day. Sara shared, “[I’m] happy while
I’m in here, but whenever I leave I feel unhappy
because I have to go to math class.” Finally, the
students discussed needing time outside the class-
room, while not wanting to spend additional time
in school. Lesley commented, “I hate how middle
school doesn’t have a time where we could all go
129
outside. But yeah, it’s also a waste of time because
you don’t want to spend more hours in school.”
Relationships and Connection
The students conferred on the relational effects
of the group. The middle school has a magnet
program, and students enrolled in this program
are referred to as “academy kids”. Oftentimes, the
“academy” and “regular” students do not receive
the opportunity to interact due to their different
course schedules. Fred explained, “Academy
students are fun : : : I didn’t actually ever get
to talk to [them] : : : I have regular classes : : : . I
don’t really know any of them because of the
[different] tables that we sit at [during lunch].”
The participants developed relationships with
those outside their social and classroom environ-
ments. Jamal shared, “I feel more connected.”
Additionally, the students discussed being able to
better trust their peers. Sara commented, “It made
me feel like the people around me I could trust in
the cafeteria. I’ve seen people gossiping and stuff
like that, and then here we were just playing.”
Perspective Taking/Challenging Perspectives
The students described their evolving perspec-
tives of others as a result of the group. Derrick
shared, “A lot of people are funny : : : more
friendly : : : Before I didn’t know [them] and I
thought they were being mean or something.”
Megan echoed this perspective, “[Regarding]
someone in this group, I thought they didn’t like
me, but it turns out it was me overreacting : : :
I don’t have a bad relationship after all.” The
students also discussed the value of getting to
know their peers. Yolanda remarked, “I learned
that when you hang around people for a longer
amount of time, and you get to know them, it’s kind
of like they’re a different person.” Cedric added, “I
like learning about new people especially if they’re
like the type of people I would hang out with : : :
[The group] teaches me that not everyone is the
same so be more careful if they’re sensitive or
something.”
Interpersonal Skills
The students discussed the interpersonal skills
they developed during the group. Jason re-
marked, “Good personality : : : Don’t say
mean things to others. Don’t talk back to a
 130 WEAVER ET AL.
teacher.” Sara shared, “I learned how to talk to
people a lot better.” Additionally, Lori commented,
“[I learned] how people react : : : be careful of their
feelings : : : [If you] break bad news : : : not
blurting it out or not showing any emotion : : :
Sometimes they had arguments. [The facilitators]
would : : : tell them what not to say, and what to
say, and how to say it.”
The group also challenged the students to get to
know each other. Regarding conversing with her
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peers, Yolanda shared, “I feel more open; I know
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how I talk to people now : : : My friends would
always have to introduce me to new people : : :
because I’m really shy : : : But now I can talk to
people without being that shy.” Additionally,
Jackson commented, “Sometimes I’m just too
shy to come up to anyone but this group kind
of made me : : : I met new people and it was a lot
easier than I thought originally.”
Teamwork
The students discussed how the group gave
them the opportunity to work together as a team.
Sara commented, “Teamwork : : : we had to trust
the other person. I remember that day where
someone had to be in the middle of the blanket
: : : If someone would have let go, that person
probably would have fell.” Additionally, Jamal
shared, “With the activities, we were like able to
work together : : : we had to work out what we
were doing or else we couldn’t do it : : : If we
didn’t interact with each other we wouldn’t know
what to do.” The students also conferred on
different ways they had to learn to work together
as a group to be successful. Lori commented, “That
[activity without talking] was fun too because
we had to gesture towards each other : : : We
need to work together without like yelling : : :
We were interacting with each other in different
ways : : : that would help if I did that with my
siblings.”
Feelings About the Group
The students described their reactions to the
various activities and the group overall. Sharon
commented, “The activities : : : the groups : : :
they were fun to do and stress relieving.” Yo-
landa echoed this perspective, “They [activities]
helped me relax : : : they taught me, they helped
me be calm.” Jackson also described the group as
“fun, relaxing, relief.” Additionally, Megan
discussed how the activities helped with other
aspects of the school day in remarking,
“If there’s a test on that day and there’s anxiety
about the test : : : a lot of stress about it : : : the
games helped.” Furthermore, in discussing spe-
cific aspects of the group that were stress reduc-
ing, Cedric commented, “snacks calm me down
: : : I have to sit still. It makes me feel really
chilled out.”
Students also discussed experiencing anger, as
well as a release of anger. Courtney stated, “I got
very angry [sometimes]. When we were doing the
toss up the blanket with all of the stuff on it and we
would drop it, and everyone was just joking
around, I got really angry.” In contrast, Jason
shared, “I liked paper punch : : : just letting your
anger out.”
The students also shared their aversions to
some activities, particularly the lotion hand
massage. Liz remarked, “I didn’t really like
the lotion hand massage. I don’t feel comfortable
with people touching me like that : : : rubbing
my hand : : : it was awkward : : : weird because
it was my hands : : : I didn’t like it.” Sam also
shared, “I didn’t like the lotion hand massage
thing. I just get all weird when I know it’s
someone else’s hand. It was uncomfortable
: : : and the feeling of the lotion after. It
was gross.”
Recommendations
The participants shared recommendations for
future Theraplay groups. Regarding time re-
straints, Jasmine commented, “We should have
a lot more time : : : some people were slower at
eating and then they had to hurry : : : Sometimes
you didn’t actually even get to play the game or
finish : : : We had to rush : : : We didn’t really get
to learn a lot.” The students also discussed having
the group at other times. Liz remarked, “I wish
this could be a club for club day, but they stopped
their clubs.” Henry shared, “I think it should be a
choice to have like therapy as one of your elec-
tives.” The students also discussed the selection
of group members. Concerning gender, Yolanda
shared, “All girls : : : sometimes boys and girls
like some things differently. I don’t really like to
interact with boys.” Additionally, Derrick stated,
“It would be even better if the people I knew did it
too because I can hang out with them.” Courtney
also commented, “[Include] more people, just to
see how we can all work together.”
 A PHENOMENOLOGICAL STUDY
Discussion
The current study focused on the experiences
of adolescents participating in a Theraplay group
in a middle school setting. This is the first known
study to explore the use of Theraplay groups with
adolescents. We found five themes and three
subthemes.
The first theme, alternative to the lunch room,
described the participants’ appreciation for being
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able to spend lunch in a location other than the
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cafeteria. The subtheme, break in the day, could
be akin to a recess period students receive in
elementary school. Researchers point to the cog-
nitive, emotional, and social benefits of recess for
younger children (London et al., 2015). There are
also benefits of structured recess, including the
development of interpersonal skills for conflict
resolution, and anecdotally reported behavior and
attention improvements in the classroom (Council
on School Health, 2013). When engaging in
Theraplay, students may receive similar benefits
in terms of a break during the academic day, and a
time to connect with peers outside the classroom.
The second theme, relationships, is central to
Theraplay’s attachment framework (Booth &
Jernberg, 2010). Theraplay is designed to engen-
der healthy relationships and attachment tradi-
tionally between child and caregiver (Munns,
2009; Booth & Jernberg, 2010). Researchers
report Theraplay enhances children’s relationship
and social interaction skills (Francis et al., 2017;
Siu, 2009; 2014; Wettig et al., 2011). In the
current study, we found participants expressed
fostering relationships with their peers, which
promotes psychosocial development (Erickson,
1968), as adolescents become inclined to bond or
form attachments with their peers (Buhrmester,
1992). Relationships, specifically friendships,
become paramount to the maturation process.
Weekly Theraplay groups provided an opportu-
nity for the students to form meaningful relation-
ships with individuals outside their social and
academic circles.
The third theme, perspective taking and chal-
lenging perspectives, describes the students’ per-
spective on developing social-emotional skills as
they began to take on the viewpoints of other
students. Perspective taking is considered the cog-
nitive component of empathy development (Davis,
1983), and perspective taking, or empathy develop-
ment, facilitates social connections (Galinsky et al.,
2005). Additionally, perspective taking involves
131
development in epistemological understanding
from objective and subjective to mixed or intersub-
jective orientations of knowledge (Kuhn et al.,
2000). This intersubjectivity contrasts a solipsistic
way of thinking, thus moving through these orien-
tations of knowledge underlines an ability to under-
stand others’ thoughts and emotions (Rochat et al.,
2009). Hence, older children become increasingly
socialized in their thinking through peer interac-
tions, resulting in collaborations built on under-
standing and coordinating perspectives.
The subtheme, interpersonal skills, underlines
previous research findings related to the positive
effects of Theraplay on social interaction (Siu,
2009; 2014; Wettig et al., 2011). The students
discussed overcoming “shyness” and reluctance
to interact with others, as the Theraplay group
activities intentionally required them to engage
with others (Booth & Jernberg, 2010). For some
students, the activities were both engaging and
challenging for them. Additionally, students
became aware of how their behaviors affected
others, indicating social-emotional learning,
which is consistent with previous research find-
ings with younger children (i.e., Tucker et al.,
2017). With an increase in social interactions, the
students experienced the benefits of social ex-
changes, reporting the development of interper-
sonal skills. The subtheme, teamwork, suggests a
sense of trust-building with their peers and work-
ing together in the activities. As the focus shifts to
establishing peer relationships in this develop-
mental stage, group cohesion and teamwork also
become an area of focus (Leman, 2015). Partici-
pants acknowledge the necessity of working
together in order to complete the activities.
In the fourth theme, feelings about the group,
students conveyed their reactions and emotional
responses to the group activities. The students
primarily identified the group as stress relieving,
and, at times, uncomfortable and frustrating.
Relief from stress ranged from anxiety reduction
to release of anger through the activities. Re-
searchers support the use of Theraplay activities
to reduce children’s stress levels (Francis et al.,
2017; Salisbury, 2018). The anger experienced
during some of the activities underlies the chal-
lenge domain of Theraplay, as some of the activi-
ties were difficult to accomplish (e.g., blanket
balloon bop), yet, bring a sense of mastery
when completed (Booth & Jernberg, 2010).
Feelings of discomfort typically arose from
using physical touch involving lotion. However,
 132 WEAVER ET AL.
the students did not report disliking other activi-
ties that required physical contact (i.e., hand
holding) with their peers, suggesting a preference
for this type of interpersonal touch. Thus, profes-
sionals may want to explore the use of touch
through other activities, when students are not
comfortable with lotion, as touch is essential to
nurture, a core component of Theraplay (Booth &
Jernberg, 2010).
The final theme included recommendations
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
about the group occurring during the school
This document is copyrighted by the American Psychological Association or one of its allied publishers.
day and who should be included in the group.
Students expressed wanting more time in the
groups insofar that some wanted Theraplay to
become an elective. Integrating Theraplay into
the school curriculum could resemble the Sun-
shine Circles conducted in the classroom with
younger, elementary-aged children (i.e., Tucker
et al., 2017). The students’ recommendations for
group members reveal varying levels of peer
collaboration. One student wanted to gender
the groups into boys and girls, while another
thought the groups would be improved if every-
one was already friends. Another student wanted
to increase the number of people to see if the
group cohesion could extend with additional
members, suggesting a desire for more peer
connection.
Theraplay is a treatment modality designed to
enhance attachment and emotion regulation
(Booth & Jernberg, 2010). In this study, the
themes of relationships and perspective taking,
and the subthemes of teamwork and interpersonal
skills underline the strengthening of participants’
attachment and emotion regulation. These themes
highlight an increased ability to meaningfully
engage with peers and to perform relationship-
maintaining behaviors, including the ability for
emotion regulation. These prosocial behaviors
indicate a greater level of social competence,
which is linked to secure attachment (Allen &
Tan, 2016).
Limitations and Recommendations for
Future Research
In considering limitations of the study, three
out of the four interviewers/focus group facilita-
tors were also the group facilitators, which may
have influenced what the participants shared
about their experiences. Additionally, inter-
views/focus groups occurred during lunch, which
defined the time allowed; however, based on the
experience of the researchers, the participants
appeared to have sufficient time to discuss their
experiences. Further, although the participants
were diverse regarding racial and ethnic groups,
there was not much diversity regarding gender,
with the majority of participants being female.
Future research may focus on addressing the
limitations of this study, such as having the inter-
views and focus groups facilitated by individuals
who were not the group facilitators, having more
male participants, and lengthening the group
sessions. Additionally, due to the limited research
on using Theraplay with adolescents, researchers
may seek to replicate this study to further explore
the phenomenon of adolescents experiencing
Theraplay groups. There is also a need for inves-
tigating the effectiveness of the intervention. This
may include investigating some of themes re-
vealed in this study, such as the use of Theraplay
to foster the development of interpersonal skills
and relieve anger, anxiety, and stress. Research-
ers may use a quantitative approach to examine
further explore these constructs in relation to
Theraplay to promote the generalization of these
findings.
Implications
The present study involved facilitating groups
during lunch. This may be an ideal time for
therapeutic interventions because, as revealed
in this study, students may want to avoid the
loud lunchroom. Additionally, using lunchtime
eliminates the dilemma with students missing
academic time by taking them out of class. How-
ever, having groups at lunch also presents chal-
lenges, such as limited time to both eat and engage
in the group activities. One strategy is to ask
teachers to let students out of class a few minutes
early and have permission to be a few minutes late
to their class after lunch. The difficulty students
discussed related to being present in the lunch-
room also present the need for further exploring
strategies for improving the lunch experience for
middle school students, such as offering various
locations to eat lunch (e.g., outside at picnic
tables, within classrooms in small groups).
Students also expressed wanting to have the
option to attend counseling as an elective, as well
as Theraplay being offered as a school club.
Theraplay groups could be a cost and time effi-
cient form of counseling services for students, as
 A PHENOMENOLOGICAL STUDY
they can be led by both mental health profes-
sionals and teachers with Theraplay training.
School counselors and other mental health pro-
fessionals working within the school may brain-
storm strategies for offering Theraplay or other
activity groups within the school to address vari-
ous student concerns (e.g., stress and anxiety)
and facilitate the development of interpersonal
skills and emotional regulation. For example,
school counselors or school-based mental health
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
counselors could facilitate Theraplay groups for
This document is copyrighted by the American Psychological Association or one of its allied publishers.
students who struggle with fostering or maintain-
ing peer relationships. Another example is tea-
chers presenting Theraplay activities in the
classroom. These activities could be daily,
weekly, or as needed in the classroom. Teachers
may select a daily activity from a different Thera-
play domain, conduct a weekly group with activ-
ities from each domain, or introduce an activity
before a specific event (e.g., testing). Addition-
ally, teachers may wish to focus on a particular
domain if they think students need to improve in
that area. For example, students appearing with-
drawn and disengaged may benefit from activities
found in the engagement domain. Conversely,
students with difficulties following instructions
may benefit from activities in the structure
domain. Teachers may also introduce other ther-
apeutic techniques (i.e., mindfulness) to provide
students with healthy coping skills.
In using Theraplay, and other therapeutic activ-
ities, professionals should consider the use of
touch. It is unknown if the participants in this
study felt uncomfortable with being touched, or
being touched specifically with lotion. Therefore,
it is crucial to explore feelings related to touch in
using activities with and without lotion. Facil-
itators may wish to discuss the use of touch in
these activities before the group begins, and allow
space for members to privately disclose any
unease with touch from the facilitator or other
members. The facilitator may also remind mem-
bers that they can withdraw from an activity if it
causes them discomfort. Additionally, facilitators
should also consider adolescent sexual develop-
ment in selecting activities with touch, especially
in groups with members of both genders (Munns,
2005). Before using Theraplay, it is also impor-
tant to obtain training in the intervention. Addi-
tionally, if integrated within a group, it is crucial
to also have training in group facilitation.
This study explored the experiences of middle
school students participating in Theraplay groups.
133
The themes revealed various positive effects of
Theraplay and recommendations for future groups
from students’ perspectives. Based on these find-
ings, Theraplay groups may be a useful addition to
a middle school curriculum to develop social
skills, facilitate peer connection, promote emotion
regulation, and promote healthy attachments and
expression of emotions.
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Received March 5, 2020
Revision received May 15, 2020

ily Theraplay: Integrating family systems theory Accepted June 24, 2020 ▪
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