Monday, April 29, 2013

Putting Together Your Support Team: Picking A Good Counselor

 by John

Those of us who work with troubled kids, either within the foster care system, or privately, know just how important it is to have a good support team.  Finding a therapist or counselor is vital and, just like finding the right doctor, shopping around to find the right fit is vital.
When looking for a counselor to help you work through issues with your RAD, ADHD, or other behaviorally challenged child, there are a lot of important factors to consider. First, find a certified and qualified therapist or counselor who is (hopefully) experienced or specially trained in the treatment of the issues your child is facing.  Get referrals if possible from other parents from your local support groups.
Once you get that far, it really comes down to a personal response to the counselor and whether or not you can work together. Here are some things to consider from my own experiences working with kids and counselors in the foster care system.

How to Pick a Good Counselor
1.     Find someone you like, not just someone the child likes.
2.     Find someone you can trust.   A good counselor will want to know how you were brought up and some of your personal history; so, they can understand where you are coming from.  In order to do that, you’ll need to trust the counselor and be able to open up on a personal level with them.
3.     Find a counselor who is ready to hear you and the problems you’re having in the home.   A successful working relationship will mean that the child’s counselor will discuss the child’s progress and incidents with you, troubleshoot behaviors and work through the behavioral triggers (actions and reactions) with you for the betterment of the child.
4.     Find counselor who is knowledgeable in the field and who knows the latest techniques and skills that work with children with issues like your child’s. For instance, if your child has an attachment disorder, you’ll want a counselor trained in attachment disorders or RAD, who knows all the latest treatment options and approaches, and has numerous resources and approaches to call upon during sessions.                
5.     Look for an innovator.  Find a counselor who will try to find ways around your child’s problems like RAD or ADHD and challenge your child instead of coddle them or make excuses for their behavior.
 What is a Bad Counselor?
1.      A counselor whom your child likes and you don’t.  Your child will sense that you don’t like the counselor and will use this against you in some way. (Play adults off each other.)  I have had it happen to me many times. 
2.      If the child sees the counselor as someone who has power over their parents, that is not a good thing. Some counselors see themselves like that to. If you get that type of feeling, run as fast as you can, because it is hard to stop a counselor who will try to use their power over you and make all the issues with the child, your problems, not theirs or your child’s.  There should not be a power struggle between the parent and the counselor. It should be viewed by both parties as a partnership that works together toward the agreed upon goals for the child.
3.     If you feel that you cannot trust the counselor in some basic way, be it keeping appointments, being straight with you about goals and discussions with the child etc, the relationship will not work.  Kids can feel that you don’t trust them, so they will not trust them either.
4.     A counselor that has the child come into his or her office and has you wait outside until the session is over is not someone you want to work.  A good counselor will involve the parent in sessions, as the parent is the one who works on issues 24/7 and must show the child that they have 100% trust and collaboration with the parent by involving them in the counseling sessions as well.
5.     If you come to a counselor for advice on an issue, and they simply ask you what you are doing already, and have no other advice to offer… find a new counselor.  They might be good for venting, but if they cannot offer you any information on new techniques or treatments, you are wasting your time and money.

6.     If a counselor gets stuck on a diagnosis and has a “give up” attitude, move on.  They might be able to tell you what is wrong with your child and why you can’t help them because of their diagnosis, but they don’t push to help the child.   Instead, they try to get you to give up on the child and to accept that they can’t get any better.  I found that a diagnosis could change because children can grow and change. If you give them a chance, and try to change them with small steps, there is always hope.

 Most of the time, children surprise me by how successful they are.  God always surprises me on how he works through us, to help kids.  Most of the time, I am looking back at how we were able to help the child be successful and smile, because I know it was not us, but Gods helping hand that guided us. There is a rainbow in every storm, you just have to look for it and you will find what you need to help the child… and that is your pot of gold. Thank you God. 

Tuesday, April 23, 2013

"Am I The Only One Afraid My RAD Child Will Kill Me?" Q&A with FPR

Anyone who has worked with a child with reactive attachment disorder or the like, may have had this thought at one point or the other. I certainly have, and have had the passing thought about how I might have to defend myself or escape a dangerous situation.

One of our readers had the same thought, and I wanted to share the conversation, (with the editing out of any personal information of course) in the hopes that it might start a conversation, give some hope, or at least let others who have kids with attachment disorders know they are not alone with their fears and should not feel guilty for those thoughts.
Read on:

Question to Fosterparentrescue:  

Am I the only one that fears one day my child may try to kill me because of RAD? That no matter what I do to love and give structure and therapy, that the emotional and psychological damage may be permanent?
 I worry I adopted 3 future sociopaths. Don't get me wrong, I dearly love my kids! And there are times they are great, and we see progress, but the bad days, or the don't sleep for 2 days, or raging tantrums that last for hours to days, those are the days I worry. The looks of hatred from my 8 year old, the cold stare from my 12 year old, make me think one day when they are bigger and stronger than me they will try to kill me. Tell me I'm over reacting.

Answer from John- FPR: 
Well, this is a normal thought for those of us who work with RAD kids, and you need to pray that the Lord opens their heart to you.. because the love that they will have for you is what will save them.

Do you see any compassion towards you from them? I kind of went through this myself with my one RAD child that I just let go to another facility (I talk about it in my blog posts "Knowing When to Let Go,") Keep records on their behaviors if you really don't feel safe or if they are acting aggressively towards you, you'll need it later on down the road because you do have options if it gets to that point.

When you keep records you can see whether or not their behaviors are really getting better or worse. Keep track of their behavior at school as well.

I do relate to what you are saying. If you adopt RAD children, you really have to have Faith. Do you have a counselor involved? You need one for you and the kids. Having support is vital, especially when dealing with RAD kids because they can be so manipulative.
Have you read our blogs on the house rules and building trust with RAD kids? I can send you links if you need it, or you can just search on the blog for them. I have worked a lot with RAD kids,... some success, some not, I am here for you though.... always. and thanks for bringing this up, I think a lot of people feel this way.. I know I have expressed this same thought myself.

Response from reader: 
 we had talk today with my sons therapist today about the behaviors still being a very big issue in the home. we expressed our concern over the trauma to us all from his behaviors, the exhaustion, and the lack of progress (not due to her lack of competence, but to his severe lack of trust and his type of RAD). she said with his age (8) it would be very hard to find a residential placement for him, and there would need to be all other options exhausted first, and there would need to be a certain requirement of behaviors before he would be accepted (like setting fires, sticking firecrackers in animals rear ends, and harming himself or others). she recommends intensive in-home therapy, and feels with his specific history and behaviors a certain theraputic approach would be the most effective. He is "disorganized", "inhibited" (in his dis-regulation, not in his behaviors towards others), and he plays 3 roles, the victim (least of the 3), the perfect adorable child (public personality) and the role reversal controlling (behavior at home, and most dominating behavior). she feels the most effective theraputic approach is the circle of security. she is going to look for the right person to take this on.
i feel a small sense of hope, she said with his type of RAD that 85% of the children can be healed and form proper attachment, when just 20years ago that number was very low and there wasn't considered to be effective treatment.

Response from FPR: 

Glad that you have hope, and he is still young enough that you have a chance, I agree. I have had success with kids when I started at 6... so, you are still in there. If you have read some of our blogs about working with RAD kids, you know you have to take him back to infancy as far as his dependency on you.. and work your way back up from there, in order to build the trust he should have had from the beginning. Good luck to you, and keep us informed on how you are doing....

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Monday, April 15, 2013

Therapeutic Approaches for RAD and Attachment Disorders: DBT: Dialectical Behavioral Therapy

DBT has been around since the 1980's and has been used primarily with borderline personality disorders, however, its approach is ideal for dealing with many of the issues children with attachment disorders have. Generally speaking, it is used to help individuals who have extreme reactions to situations and take a long time calming down.

DBT, when used with RAD kids or those with other types of attachment disorders, teach children how to cope with their internal thought processes and develop strategies to deal with their reactions in high stress situations. This process can be successful with kids if they do not have any other learning disabilities and are able to understand their own triggers.

Aspects of DBT can be used by parents or foster parents and may help in some measure, even if all of the approaches or the intense counseling is not possible for you or your family. For those of you looking for a new approach, it is worth a look and discussion with your care team.

Here is some more information:
Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder. Since its development, it has also been used for the treatment of other kinds of mental health disorders.

                                        What is DBT?

Dialectical behavior therapy (DBT) treatment is a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.
People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Characteristics of DBT

  • Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
  • Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
  • Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
Generally, dialectical behavior therapy (DBT) may be seen as having two main components:
1. Individual weekly psychotherapy sessions that emphasize problem-solving behavior for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Quality of life issues and working toward improving life in general may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.
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Wednesday, April 10, 2013

Helping Foster Kids Understand Change and the Foster Process Through Art

By Diane and John

Foster children deal with changes constantly, and not usually under the best circumstances. Often traumatic and unwanted, with a history of past abuse and other confusing events, interacting with (new especially) foster kids can be difficult as trust and a mutual understanding must be developed.

First, however, helping a foster child understand that coming to your home, even for a short period of time, even though it is disruptive and difficult, can be an opportunity for growth, friendship and some happiness.

Children communicate well through art, and art therapy (or using art as a therapeutic tool) is highly effective in helping explain concepts like accepting change, trust and friendship to young minds that may not have any frame of reference.

Below is a process that can be used with children as a tool, partnered with gentle discussion, to help explain that although change may be difficult, it can lead to better things. This tower building exercise helps illustrate reasons a child cannot go home and explains the concept of working towards goals and a stronger family foundation.

Build a Tower

(Age 4- and up)

You’ll need: Lego’s or building blocks, a timer.   Divide legos up by colors

· Have a pile of 30 Red legos on the table

· Ask the child to build a tower with the red legos in 7 minutes.  Start the timer.

· When the timer goes off, you look at his structure and talk about it. Say, “This is a nice tower, nice and strong and solid.” 

· Then for the next round, tell the child he can use any colors he wants to make the tower.  He will choose 30 pieces.  Play the game again.

· Now, start talking about the red tower. The red tower represents the child’s family. Start talking about the family members and as you do, start taking Lego's off of the bottom of the tower in an uneven way.  For example say: “This red tower reminds me of your family. (Pull a brick off the bottom,) It's strong and solid, it was difficult at times, but you are a part of it. This brick is your Mom. She has problems that she needs help with, so she isn’t home right now to take care of you right?”  Pull another brick off “and this is your brother, and he is needing help too right?”  Hand the tower to the child. “Can you make the tower stand like it is now? (With the bricks from the base missing)  No?  Right? Because you need all those pieces there to make it strong and safe? If the tower falls over, it’s not safe for you right?”

· Then, start talking about the multicolored tower.  Something like this:  “This tower reminds me of your foster family and all your counselors. (Put the red brick on it)  You are here too.  (Start pointing to the different colored bricks) This would be your counselors, who are going to help you and your parents, and this is your foster brother who is going to watch out for you at school,” “and we are going to help your mom and dad too, “ (Start putting the red tower back together) so that it is safe for you to go home again.”

· If the child has questions about why he can’t go home yet, refer back to the red tower and pull bricks out from the bottom again, unevenly, as you refer to the problems that were going on in the home.  Again, ask him to stand the tower up, and again, show him how the tower does not stand and would be unsafe.  Give each brick a name, or title it with a problem or issue to help illustrate the things that need to be accomplished before the child can return to his “solid foundation.”

Allow the child ample time to discuss the changes in his life and the things that will be accomplished during his foster care stay.  Leave the towers in place as a visual reminder and refer back to them if necessary later to help explain progress and setbacks along the way. 

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Diane Steinbach is an art therapist and the author of: Art As Therapy: Innovations, Inspiration and Ideas:, Art Activities for Groups: Providing Therapy, Fun and Function and A Practical Guide to Art Therapy Groups

Wednesday, April 3, 2013

Disrupted Adoptions, RAD and "The Ranch"

Reactive Attachment Disorder is something we talk about a lot here because it is one of the most difficult behavioral issues foster, adoptive and bio parents deal with.  Children with this disorder are the most difficult to reach and often the most misunderstood.

Many times RAD goes undiagnosed for a long time, so foster or adoptive parents take on a very difficult situation without proper training or education.  The results of this can be disastrous.

I came across this very interesting article from ABC News 20/20 news about foreign adoptions. I encourage you all to read it. At the end of the article they talk about a program called The Ranch which is a placement option for RAD kids. They talk a little about some of the techniques the center uses with their kids, which you all may find useful. Many of the techniques are the same ones we discuss here.  Check it out:

From Russia With Love -- Dealing With Difficult Adoptions

After years of failed fertility treatments, Tanya and Mike Mulligan warmed to the idea of foreign adoption after seeing an ad in the newspaper touting a Russian program.
The couple wanted to adopt older children who wouldn't require the late-night feedings, teething and potty training of an infant or toddler, and in July 2004 they traveled to a remote Russian orphanage to adopt two sisters, Margarita, then 11, and Elena, 8.
The adoption agency appeared to have found a perfect match for the couple, right down to the blond hair that the sisters had, just like the Mulligans.
"What we were told prior to the adoption was that they came from a loving family," said Tanya Mulligan, a nurse in Tampa, Fla., who was then in her early 40s.
Once in the United States, Elena quickly embraced her adopted country and culture, watching "Finding Nemo" dozens of times to learn English. But Margarita was a study in contrasts.
Less than a week after leaving Russia, the 11-year-old began to show troubling behaviors, losing herself in fits of rage for hours.
"She started having a meltdown and crying, and we couldn't figure out what was going on," Tanya Mulligan said. "She was running around the house and wailing."
Her adoptive parents didn't speak Russian and Margarita understood very little English. She was crying, out of control and because of the language barrier, there was little her parents could do, they said.
Mike and Tanya Mulligan.
Courtesy Mike and Tanya Mulligan
Eventually, Mike Mulligan picked up a video camera and began filming Margarita's behavior, wanting to show Margarita's therapist and other family members how chaotic their lives at home had become.

Foreign Adoption: Family Struggles

As the Mulligans learned more about their daughters' pasts, they say they learned the girls' upbringing was far from the description of a loving family.
The Mulligans said the sisters' biological mother was an alcoholic and a prostitute who left the girls and their baby brother with their grandmother, who, they say, routinely abused them.
"Elena apparently got the brunt of it," Tanya Mulligan said. "[The grandmother] used to take her and swing her around the room and smash her face into the wall."
Tanya Mulligan said the girls told her about one night when their grandmother kept hitting their baby brother with her cane until he stopped crying. The police came the next day and the girls were sent to the orphanage. They never saw their baby brother again and seemed traumatized by his disappearance.
Wanting to give their daughters a new brother like the one they missed so much, the Mulligans -- who always wanted a son -- adopted a 4-year-old Russian boy named Sasha shortly after adopting their girls.
Margarita and the boy, whom the Mulligans renamed Slater, were eventually diagnosed with reactive attachment disorder, or RAD, a common diagnosis for many children adopted from foreign orphanages where they were sometimes neglected and abused. Children with RAD have difficulty bonding with their new families and often act out.

Read more:

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