It addresses a gap in the literature on the treatment of trauma and chronic loss, which is a ubiquitous part of life in foster care. Relational treatment of trauma explores the ways in which these experiences arise in the therapeutic relationship and shows how to help clients build the trust necessary for forming healthier, more satisfying, and hopeful relationships.
CONTENTS
Treatment in the context of deprivation and loss 103 8 Disturbed care and disturbed moods: Pediatric bipolar disorder.
ACKNOWLEDGEMENTS
I did all my writing at home - sometimes in the quiet after my two children had gone to bed; sometimes while simultaneously trying to meet a deadline and keep the routine hustle and bustle of family life from descending into chaos. Jonas and Parker gave me first-hand lessons in the value of giving up control – in writing as in life.
PERMISSIONS ACKNOWLEDGEMENTS
Chapter nine, Infant-Parent Psychotherapy Minus One, originally appeared as Infant-Parent Psychotherapy Minus One, p. Journal of Infant, Child, and Adolescent Psychotherapy, 1:1–22.
INTRODUCTION
My personal hope is that in the chapters of this volume you will gain a deeper understanding of the inexorable connection between decisive, creative thought and the ability to hope, despite a tidal wave of failure. When dealing with a foster child, the clinician may encounter many family systems that operate within the context of the child welfare and justice systems.
Section I
Alice has been told that she needs to “talk to someone” because her behavior in her group home is so disruptive. She has been ordered to attend 10 therapy sessions as part of the plan to tackle allegations of physical abuse against her children, aged two and four.
GETTING STARTED
The experiences of the physicians who founded “The Children's Psychotherapy Project,” as A Home Within was originally called, were not much different from those of the interns described above. The physicians who founded A Home Within did so to address a number of unmet needs: that of foster youth – the need for a stable therapeutic relationship, and that of therapists in private practice – the need for a community of like-minded physicians who help them continue their work with this population (Building A Home Within: Meeting the Emotional Needs of Children and Youth in Foster Care.
A HOME WITHIN
Each consultation group is embedded in a larger network of A Home Within clinicians who work in the same community and meet in other similar consultation groups. Many of them have spent time in the foster care system and/or suffered the trauma of emotional, physical or emotional abuse.
Section II
All of them have important stories to tell about the importance of relationships in the human psyche and interactions. The two chapters that follow demonstrate the ways in which trauma is woven into the fabric of the self, giving the lie to the idea that abuse or the consequences of trauma can be treated as measured symptoms.
THE DYNAMICS OF ATTACHMENT AND TRAUMA
The chapters in this section describe the theoretical foundations for the work described in the following sections. Why then, like the children in the Boxcar story, don't they realize that they need help from adults.
RELATIONSHIPS BEGET RELATIONSHIPS
These points are critical to our discussion of the mental health needs of homeless youth. In the context of attachment theory, we can understand why these issues emerged from the research as particularly problematic for homeless youth.
HOW CAN YOU TREAT WHAT YOU CANNOT SPEAK?
Out of a conscious desire to spare the child additional pain, we would like to slam the therapist's door on the bad guys. It is the moral obligation of the adults in the child's environment to maintain the boundaries between the child and the adults and exercise control over their impulses.
GOOD GUYS AND BAD GUYS
These divisions between the people around an abused child reflect the division in the child's inner world of relationships. She was not at all interested in this headmaster sending Ruby home in the middle of the day. Perhaps, even in the quiet of the therapy sessions, Ruby's desperation, otherwise hidden behind her aggressive outbursts, surfaced.
Section III
It is also true that some children find stability in the care system; if they are immediately placed with a family that intends to adopt them and eventually does, the uncertainty about their future may last only a few months. In many cases, a few months of uncertainty in a young child's life will cause concern. But in the care system, while not exactly a cause for celebration, limiting uncertainty to a few months is often seen as a measure of success.
SYSTEMIC IMPINGEMENTS
Perhaps the insidious detriment to the psychological development and emotional well-being of children who spend significant time in the foster care system is the chronic experience of unplanned, unpredictable, and unexplained losses that are part of their daily lives. Weaving without a loom' considers the issue of identity formation in the context of the ever-changing relationships in foster care. Sometimes, as in the case of Oliver Twist or Little Orphan Annie, it is as simple as the death of the biological parents.
IN SEARCH OF THE ROMANTIC FAMILY
While much has been written about family romance, this process of its decay in the emotional life of the child has received relatively little attention. During the assessment, it became clear that Vera's relationship with her mother represented a disorganized attachment. Eliot's approach demonstrates the idea of the parallel status of child and parent contained in the family romance.
WEAVING WITHOUT A LOOM
Moving children from one “placement” to another when problems arise is a primary response of the foster care system. Perhaps this is an important aspect of the underlying message in John's complaints to his social worker. Too often, this is the life of children in foster care: people disappear, and with them some of the broken threads of the story disappear.
HUNGER PANGS
Psychologically, the status of foster children parallels that of a family with no or very limited assets: no one has any money in the bank. In The Poisonwood Bible, Barbara Kingsolver writes, “The hunger of the body is completely different from the shallow, everyday hunger of the belly. Experienced M in response to the tantalizing aroma of Jimmy's food, they were "bellied" and patient.
Section IV
What if there isn't a single person the therapist can go to to learn about the child's history. If the evaluator agrees that the child would benefit from therapy, the task of finding a suitable setting or therapist usually falls to the caseworker, who may have to make several calls just to get the child on a waiting list. If, as happens, one or the other of the child's biological parents is working toward reunification and, through counsel, protests the need for treatment, the question may have to be resolved by court order, necessitating the involvement of a judicial officer. cer.
TREATMENT IN THE CONTEXT OF SCARCITY AND LOSS
Finding the "right" person to talk to about a foster child can be a daunting task, especially if, as is often the case, the adults around the child have wildly divergent ideas about what plan is in the child's best interest and equally different interpretations . of the legal mandates governing his or her care. And the therapist will greet someone who has only known the child for as long as it has taken to drive from home to the office. Of course, this only addresses the logistics, not the meaning of having so many people participating in a process that might otherwise be as simple as a parent calling to get the names of possible therapists, calling a clinician to schedule a appointment, meet with the person to describe the child and the particular concerns, and then bring the child to the appointment and introduce her to someone the parent has already met.
DISRUPTED CARE AND DISRUPTIVE MOODS
The Emergence of Pediatric Bipolar Disorder Among Children in Foster Care I have worked with children in foster care for nearly 30 years. Angie's behavior at the next group home continued to escalate, and after two weeks she was placed in a short-term treatment center. And then we see the unreasonable difficulties of trying to construct, coordinate and monitor a treatment plan for children in the foster care system.
INFANT–PARENT PSYCHOTHERAPY MINUS ONE
The status of the child's future can be as murky as the details of his past. The tasks of providing services to support reunification typically fall to the child's caseworker or a range of caseworkers, depending on the administrative structure of the foster care agency. It is not uncommon for therapists who work with young children in foster care to feel that the full weight of the child's life is on their shoulders.
LEARNING TO SAY GOODBYE
After he left, I paused to consider the significance of Benjamin leaving the bullets in the safety of the house. The events of the morning of the next session seem to provide more insight into Benjamin's concerns about the cause of his father's death. This was one of the rhythms of Benjamin's life that had been disrupted by his father's death.
Section V
We have a wide variety of psychotropic medications that can often provide rapid symptomatic relief from anxiety and depression, which often have complex unwanted side effects. Over the years of our work through A Home Within, with change swirling around us, we have maintained our fundamental belief in the power of relationships to heal, and we have gathered evidence to support our position. We have also refined our clinical approach by learning from our clients and each other what works and what doesn't.
BACK TO BASICS
I hope this chapter illustrates the triumphs, failures and complexities of providing mental health treatment to traumatized children and youth who spend time in the foster care system. In this chapter we outline the eight essential elements of RBT: 1) Engagement: being fully present in the relationship;. This chapter deals with children and young people because this volume has primarily focused on work in the care system.
THE ESSENCE OF RELATIONSHIP- BASED THERAPY
Engagement includes the expression of the therapist's personal thoughts and feelings only when such disclosures directly benefit the client. In the example above, the client's surprise and the therapist's response open the door to a different kind of relationship. Part of the environment created by the therapist and client involves acknowledging power differences that exist in the relationship.
Psychoanalytic process in the shadow of rupture: Clinical encounters with death, dead mothers, and dead mothers. A mother learns to enjoy her baby: parent-child psychotherapy and art therapy in the treatment of intergenerational separation-individuation problems. Reactive attachment disorder in maltreated toddlers. 2006), Doctor forever: Acute loss in the context of chronic loss.
INDEX
