I recently posted a blog with some information on working with foster kids who threaten to hurt themselves or are suicidal. I have been working with a child like this and it has been a delicate balance that I have been struggling with. I wanted to share my journey with all of you, in hopes that you might give some advice, or perhaps learn something from my struggles.
I got this foster child we will refer to as Mary as a young teen, with a history of self- abuse and a recent suicide attempt.
After release from the hospital Mary came to my home in a delicate mental state. Although she was receiving some counseling, after a few days in my care, she seemed to be adjusting well to my home and the other children. She had a "boyfriend" at the time, whom she relied on heavily, but there was no physical intimacy between them. I allowed continued, monitored interaction as I felt it was necessary for Mary to have some support and a sense of continuity in spite of the new living situation.
I admit, I was nervous about Mary's history and although I usually go into "Jesus Mode" with my incoming foster kids, learning their history and gaining their trust, ( Read more about Jesus Mode in " Tantrums and Trust Disorders" ) I just didn't know how hard I could push Mary, how strict I could be with her regarding following house rules and how much I needed to restrict her. I felt like I needed to coddle her a bit more at the beginning, as she had extreme self-worth and self-esteem issues, was extremely sensitive to redirection or correction and quickly fell into "dark moods" and depression that worried me.
I spent a few weeks attempting to build Mary's self-esteem, confidence and self-worth. I gave her opportunities to feel part of a family unit, to express her self and feel safe within boundaries. I spent a great deal of time counseling Mary and building a trust bond with her.
During this time however, I saw Mary becoming more manipulative, using her depression as a way to get her way. I was worried about this. Was I seeing this correctly? Could I correct this behavior? If I began to set stricter boundaries, what would happen? Would she retreat into self-harm?
I had a heart-to-heart with Mary one day when she was trying to push her limits. I told her that it didn't seem like I could make her happy in my home. No matter how much I did for her, it seemed like she needed more and more to make her happy. That was not going to work for me. We talked about all of the things I felt, the manipulative behavior, and I was straight with her, outrightly telling her I felt manipulated. I am not one to beat around the bush. She didn't have much to say.
Diane, my co-author and I consulted on all of this and came to the conclusion that it was a good time to start setting some boundaries and making trust a two-way street. A common practice amongst therapists is to make a contract with patients who have suicidal tendencies. The contract is a promise from the patient to the counselor that the patient will not harm themselves. Creating a contract like this between Mary and me would be a great start in building trust between us and removing part of my fear. It would also give me an opening to discuss how I would need to begin putting some boundaries on Mary, and begin treating her like more of the family. During this discussion Mary officially moved from her "Jesus Mode" status to a more regular member of the household.
It's difficult to know when it's right to move a child forward, but I guess instinct and experience must be relied upon, as well as consulting with your treatment team. You, as primary caregiver though, know the child the best, and must do what is best of the child and the family unit.