The Principle of Therapeutic Play
The Principle of Reciprocal Play Therapy (RPT)
Mifne's therapeutic approach is based on John Bowlby's Attachment Theory. Daniel Stern, a psychoanalyst, points out the importance of the primary caregivers' reference to the inner and subjective world of the infant. Therefore, the goal of the treatment is to strengthen the inherent abilities of the infant and his confidence. The treatment is carried out using a reciprocal play technique (RPT) which encourages the infant to discover the pleasure inherent in bonding, the development of the sense of self, and the pleasure inherent in human connection. It recognizes that the interaction between the infant and parent during play, as having a great contribution to the development of the self, this despite the fact that most of the interactions between parents and babies also occur during other situations (Bergman & Lefcourt, 1994).
Play is seen as an integrative approach that sees it as an expression of both cognitive and emotional processes. (Greenspan & Lieberman, 1994).
The theories that saw play as an important interaction for the development of the self refer to two aspects of play in this context:
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Playing is the optimal situation for the baby to discover his self.
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Playing is the optimal situation to unlock the capacity for representation and symbolism
Building a Relationship with the Infant
The purpose of RPT is to increase the toddler's curiosity and involvement as a source of pleasure, to enable the building of trust, and to increase the child's motivation for involvement in interpersonal interaction. At the beginning of treatment, the infant's initiatives will guide the therapist's responses to him/her. Gradually, a bond should be established between the child and the therapist.
The infant undergoes intensive treatment, one-on-one with a parent or therapist, or both, every day, including weekends. The number of hours of treatment is determined by the level of the child's developmental function.
Reciprocal play therapy requires an environment with a reduction of distracting stimuli because in many cases, the child cannot contain excess stimuli.
RPT in Four Stages
1. Attractive Play
In order to attract the infant's attention, the therapist should adjust to the infant's pace, in order not to overwhelm him/her. And at the same time, play with the therapist should be interesting with a balance between passivity and activity. Repeating this activity and expanding on it, sows the seeds from which trust in the person providing the pleasure grows, and serves as a lever for involvement.
2. Sensory Play
Children with autism are hypersensitive. Observing and understanding a child's sensitivities is a basic condition for gradually regulated feeding, hugging, massaging or holding the baby in such a way that he is physically comfortable, and is critical to his adaptation.
3. Emotional Play
This includes games of hide and seek, play with physical contact, playing with dolls that enables learning and acquiring discrimination of others and empathy, delaying gratification, as well as processing content from the child’s daily life and inner world. Sometimes all this leads to a first smile or a cry of excitement.
4. Cognitive Play
This is focused on the development of basic skills such as searching for a favorite object, putting a cube in a box, etc. It is a process that is built step by step and strengthened by the combination of all developmental factors. At this stage, emphasis is also placed on the variety of games and prevention of repetitive behavior which characterizes autism.
These four phases are not necessarily in chronological order.
The Treatment Room
The infant undergoes intensive therapy that mostly takes place in the treatment room equipped with simple toys. Every object found in the room can be used as a learning experience. The objects are adapted to the age of the infant and the level of interest he shows. Reciprocal play (RPT) requires minimizing distracting stimuli that may interfere with the infant's ability to focus.
The treatment room is equipped with a large one-way mirror that allows therapists and parents to observe throughout the treatment hours. The therapy team observes the infant and consistently records his/her behavior through video recording and charts.
The therapists are trained in RPT but the different experiences and personality of each therapist naturally leads to distinctiveness between them. The goal is to raise the infant's motivation for reciprocity by looking for ways to increase his involvement through the satisfaction of pleasurable experiences. The infant's initiatives guide the therapist's reactions to him. Gradually, a bond is formed between the infant and the therapist. The premise is that the infant's sense of security and comfort will lead to a reduction in stress and the possibility for the growth of trust in the adults who are with him. Over time, the infant usually begins to demonstrate his abilities for showing his preferences for people, especially for members of his family.
The infant’s parents are present throughout the treatment and observe the therapeutic hours. At certain times of the day, the parents play with their infant the treatment room and, with the help of feedback and guidance, acquire the skill of observing their infant's behavior patterns and play skills that match his needs.
The younger the infant, the faster development in play is observed.
