Infant Filial Therapy – From Conception to Early Years: Clinical Considerations for Working with Whole Family Systems

Kate Renshaw and Judi Parson


Filial therapy is a long-established therapeutic intervention for working with children and families in Play Therapy (Guerney, 2000). Play Therapy metaanalyses have found Filial Therapy to be the most effective Play Therapy intervention for children and families (Bratton, Ray, Rhine & Jones, 2005; Lin & Bratton, 2015). Training parents in therapeutic play skills and supporting them to undertake their own special play times with their children can be applied to families with children of all ages. Typically, Filial Therapy publications have focused on target children referred between the ages of 3 and 10 (VanFleet, 2005). Some publications have focused on including adolescents in Filial Therapy, but few to date that consider infants. In their clinical experience, the authors have applied Filial Therapy from pre-birth to late adolescence. Trained Filial Therapists are well placed to adapt this approach to work with whole family systems. A whole family systems approach has led the authors to include family members ranging from conception to 3 years of age in Filial Therapy interventions. It is the authors’ experiences that including this age group in Filial Therapy enables parents to incorporate therapeutic play skills from conception. Filial Therapy in pregnancy, infancy and the early years combines both relationship enhancement and the therapeutic powers of play to enhance attachment relationships and support neurobiological development.

This chapter outlines the clinical considerations for Filial Therapists when planning and delivering interventions with expectant parents, infants and very young children up to the age of 3 years. Important aspects covered include: how to plan with parents for the inclusion of infants in Filial Therapy; toy choice and playful interaction ideas; and how to support parents to transfer and integrate Filial Therapy skills into day-to-day parenting. A composite case example will illustrate a Filial Therapy intervention with a whole family system, including an infant. Finally, future implications for researching Filial Therapy from conception through to infancy will be explored.

Filial Therapy

Filial Therapy is a highly specialized parent-child therapeutic approach originally developed by Bernard and Louise Guerney in the 1960s (Guer- ney, 2003; Guerney Sc Ryan, 2013). Whilst there are various models of Filial Therapy available, such as Child-Parent Relationship Therapy and Group Filial Therapy (see Thomas, 2018), this chapter is based on the Filial Therapy as proposed by VanFleet (2005). VanFleet adapted traditional Group Filial Therapy for work with individual families (Thomas, 2018). The authors are both trained in and practice the VanFleet individual family model of Filial Therapy.

Filial Therapy is described as effective across a “variety of populations, family structures, and presenting concerns” (Cornett Sc Bratton, 2015, p. 128). Attractive features of Filial Therapy include being cost-effective, short term and preventative of future mental health difficulties (Bratton, Ray, Rhine, &C Jones, 2005). In 2015, Cornett and Bratton reviewed the literature from the previous 50 years of Filial Therapy and concluded that:

Parents can serve as therapeutic agents in the lives of their children, that parents and children can experience significant positive changes in filial therapy, and that changes in the parent-child relationship can serve as a potent initiator of that growth.

(p. 129)

Ryan and Bratton (2008) argued for parental inclusion in therapeutic service provision for very young children. They also strongly recommend Filial Therapy as the most appropriate therapeutic modality for young children. Glazer (2008) has also reported therapeutic success when using a Filial Therapy approach with an infant. The American Academy of Pediatrics (AAP) recently published a clinical report offering guidance that details the power of play for enhancing a child’s development with a special focus on child-led play and parental engagement in play (Yogman et al., 2018). Reports such as this will help to facilitate referrals for Filial Therapy for families where play may be therapeutically integrated.

Filial Therapy has been described as the most effective type of Play Therapy, with the strongest treatment effect size (Bratton, Ray, Rhine & Jones, 2005). The most recent meta-analysis of Play Therapy research reconfirmed the benefits of parents’ involvement in the therapeutic process (Bratton & Lin, 2015). Parents’ experiences of Filial Therapy were studied by Foley, Higdon & White (2006); they found that parental stress decreased, and the parent—child relationship became more enjoyable. Cornett &c Bratton (2015) also described benefits to parents, such as improved attu- nement to children’s feelings and needs and a decrease in parental stress.

While further research is required for the different filial models as well as diverse populations, the science of Filial Therapy also integrates clinical wisdom with other theoretical knowledge and philosophical points of view. For example, the recent neurobiological research combined with attachment theory forms the basis for modern attachment theory (Schore, 2017).

Neuro-bio-psycho-social Approach

The last several decades of neuroscience research have yielded rich information for researchers and clinicians working with children and families. Filial Therapy as practiced today by the authors is a neuro-bio-psycho- socially informed approach whereby the therapists draw on this holistic view of the individuals and the family to personalize optimal conditions (Ryan &C Wilson, 1995). Growth and healing are activated and modulated by the Filial Therapist to enhance the therapeutic relationship through the therapeutic powers of play (Schaefer & Drewes, 2014).

Systemic Practice

From the early days of Play Therapy, Virginia Axline (1969) described parents included in the Play Therapy process as indirect participants, who although not directly involved in clinical sessions were a crucial part of the therapeutic process. Play Therapy and Filial Therapy have been informed by general systems theory, family systems theory, systemic psychology, family psychology, and social ecology theory (Ferguson & Evans, 2019; Fiese, Jones & Saltzman, 2019). Systemic thinking sits alongside the neuro- bio-psycho-social as well as ecological considerations within the practice (Hayes, O’Toole & Halpenny, 2017) of Play Therapists. This knowledge of systems thinking is the cornerstone for the inclusion of parents in Play Therapy as part of the therapeutic alliance and in Filial Therapy as the “primary change agents” (VanFleet, 2005, p. 1).

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