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Helping children and families address and prevent sibling abuse

By Diane M. Stutey February 28, 2017

Counselors play a fundamental role in the well-being of children and adolescents, including serving as advocates against abuse. We are trained to assess and intervene if clients are experiencing sexual, physical or emotional abuse or neglect. Children are a particularly vulnerable population given their size, power status and general lack of knowledge about how to protect and defend themselves against such threats.

Unfortunately, the abuse of children by adults continues in today’s society, even though it is illegal. Yet abuse of children by adults may not be as prevalent as other forms of abuse that children experience. For instance, they might suffer physical or emotional abuse from other children or peers, which is commonly referred to as bullying.

A less frequently explored form of peer-to-peer violence is sibling abuse. In the past, sibling abuse, which was often mislabeled as “sibling rivalry,” was considered to be a normal rite of passage that most children experienced. Today, many researchers posit that sibling abuse may be more prevalent than other types of family violence.

In 2007, Mark S. Kiselica and Mandy Morrill-Richards reported in the Journal of Counseling & Development that up to 80 percent of children may experience some form of sibling maltreatment. In 2010, Deeanna Button and Roberta Gealt reported in the Journal of Family Violence that 3 to 6 percent of children experience severe physical abuse (which may include the use of weapons) by a sibling. In addition to potentially being the most prevalent form of abuse for children, sibling abuse is often the least reported and least researched form of family violence.

As a former school counselor and elementary teacher, I was very surprised when I first learned about the possible high rates of children experiencing maltreatment by a sibling. I was researching the topic of teen dating violence for my dissertation, and one of the articles mentioned the possibility that teenagers who enter into violent dating relationships might have experienced violence with a sibling as a child. I knew there was a link between child abuse and dating violence, but I had never considered that sibling violence might also be a precursor. I became very curious about sibling abuse and ultimately changed the focus of my dissertation to examine school counselors’ attitudes and beliefs about sibling abuse.

Initially, I wondered if other counselors had already learned about sibling abuse; perhaps this was something I had simply missed during my training on child abuse and neglect. However, as I examined the literature on sibling abuse, I found that only one article had been published in the counseling literature on sibling maltreatment (the article by Kiselica and Morrill-Richards). My dissertation findings confirmed that school counselors were often unaware of sibling abuse and received little to no training on the subject, meaning that it might continue to go unaddressed. It seemed imperative to me that our field needed to start a dialogue and research around the topic of sibling abuse, especially as I continued to learn about the negative psychological ramifications associated with it.

Consequences and complications

Through my review of the literature, I discovered that children who suffer from sibling abuse experience myriad negative consequences over time. Many of these harmful side effects are similar to those faced by survivors of child abuse.

Survivors of sibling abuse have reported problems with depression, drugs and alcohol, sexual risk behaviors, low self-esteem, eating disorders, posttraumatic stress disorder and an increased risk of continuing the cycle of violence into their teenage years and adult lives. Counselors work diligently to prevent clients from experiencing adverse childhood experiences, but we may not be addressing sibling abuse because of a lack of awareness about this issue or a lack of reporting by clients and family members. This could result in the possibility of clients being harmed, both in the short and long term.

Further complicating this problem is the fact that there are currently no federal laws, and few state laws, to protect children and adolescents from abuse by a sibling, other than in cases of sexual abuse. So, even when counselors determine that sibling abuse might be occurring, it can be difficult to protect children from this form of abuse.

Counselors have shared that when they call child protective services (CPS) to report sibling abuse, they are typically instructed to call the police. When they call the police, they are generally told that this is a “family matter” and the counselor should contact the parents. One problem with this scenario is that sibling abuse occurs at higher rates within families in which domestic violence or child abuse is present. So, working with the child’s parents or guardians may not always be beneficial because of the presence of intrafamilial violence.

There is often a cultural silence that exists with all forms of intrafamilial violence, including sibling abuse, wherein children are told to keep family matters private. When family violence occurs, there are often threats made not to report it to anyone. So even children who might recognize that they are being abused by a sibling may not seek help because of the fear of breaking family bonds or the threat of retribution. In addition, many people normalize violence between siblings, excusing it as sibling rivalry without fully understanding the damage that can be caused both short and long term. Children may seek help from their parents, only to be told that what they are experiencing is normal or to “toughen up” or “fight back.”

Counselors can take several precautions to ensure that they are advocating for all clients when it comes to sibling abuse. First, counselors who are unfamiliar with this phenomenon should educate themselves about the topic. Sibling abuse can occur across the same domains as child abuse, including sexual, physical and emotional. Sexual abuse of a sibling is often referred to as incest and may include touching, fondling, indecent exposure, attempted penetration, intercourse, rape or sodomy. Physical abuse of a sibling might include slapping, hitting, biting, kicking or causing injury with a weapon.

Sexual and physical abuse may be the easier forms of sibling abuse to detect and report because of the physical evidence and a clear line being crossed. However, verbal or emotional abuse can occur along with or independent of sexual or physical sibling abuse. This psychological maltreatment might include name-calling, ridicule, threatening, blackmail or degradation. Abuse between siblings might also include property or pet abuse and relational aggression.

Similar to the definition of bullying, sibling abuse is viewed as a unilateral relationship in which one child uses his or her power to control and harm the other. With sibling abuse, however, the perpetrator has greater access to his or her victim. This close proximity can lead to additional layers of emotional abuse, such as damaging a sibling’s property or torturing or killing a pet.

Once counselors have more insight into sibling abuse, they can begin to integrate this knowledge into their work with clients. Elysia Clemens, of the University of Northern Colorado, and I adapted a five-step model to assess and intervene with sibling abuse. Heather A. Johnstone and John F. Marcinak developed the original model to be used in the nursing field when there was a suspicion of sibling abuse. Although our adapted model was specifically designed for implementation by school counselors, I have adapted it here to be useful to all counselors.

Our adapted model consists of counselors working with clients through five phases to assess, conceptualize, plan, intervene and evaluate for sibling aggression. Detailed information about each of the five steps can be retrieved from an article we wrote for the Professional School Counseling journal in 2014. That article includes a decision-making tree to help school counselors determine when to stop and report sibling abuse versus when to continue working with the client and family through each of the model’s five phases.

Assess for sibling abuse

In the first phase of this model, the counselor should assess for sibling abuse if there are red flags similar to those we might observe with child abuse (e.g., unexplained bruises, the child seems fearful of his or her sibling, etc.). This can be done by asking a series of questions: Is the client being hurt by his or her brother or sister? What kind of aggression is the child experiencing? How often is this occurring? Is the child afraid to be left alone with his or her sibling? Has the child reported this to anyone in the family? If so, what happened?

Remember that although it may be easier to identify and document physical or sexual violence or abuse, counselors will also want to inquire about emotional or verbal abuse. It is also important to note that the term sibling might pertain to a variety of people living in the home, including biological siblings, half brothers or sisters, stepsiblings, adoptive siblings and foster siblings. In some cases, there may also be what is described as a “fictive” sibling — a child living in the home who is not related but who assumes the role of a brother or sister.

It is important during the assessment phase for counselors to determine whether the sibling aggression would be defined as violence or abuse. If it is determined that the aggression is bilateral, there may need to be intervention on multiple levels within the family. The family may need some psychoeducation about sibling violence, including ways to intervene more effectively and provide proper supervision for all siblings.

If it is clear that there is a perpetrator and a victim of sibling abuse, then it is important to first assess how best to protect the client being victimized. Options may include reporting the case immediately to CPS, calling law enforcement or consulting with the client’s parents or guardians to determine whether they are willing to work to put a stop to the sibling abuse. Counselors will need to make this decision on a case-by-case basis. In our model, we emphasize the importance of working with the parents or guardians if at all possible. However, if the counselor assesses that the parents or guardians seem unwilling or unable to protect their child or may also be involved in intrafamilial abuse, then reporting to CPS or law enforcement would be the best decision.

Conceptualize with clients

Assuming that the parents are willing and able to work with the counselor to protect their child, the counselor will move on to the second phase, which involves helping the client and family conceptualize what type of sibling abuse is occurring. During this time, it is important to provide the family with some psychoeducation about sibling aggression. Helping the client and family understand the difference between sibling abuse and sibling rivalry is a key piece of this conceptualization.

The counselor will also want to differentiate between mild and severe sibling aggression. In the book Sibling Aggression: Assessment and Treatment, Jonathan Caspi explains sibling aggression on a continuum from sibling conflict to sibling abuse. Conflict or competition between siblings (e.g., fighting over who gets to pick the movie you watch or who has the best report card) would be considered mild sibling aggression, whereas severe sibling aggression would include violence and abuse. Examples include the aforementioned forms such as sexual, emotional and physical abuse. Counselors can also help parents conceptualize when and where the abuse is occurring and discuss ways in which providing better supervision and interventions would be beneficial.

Another key component to the conceptualization phase is to help the family gather more information about the goals and misbehavior of the sibling perpetrator. It is important to put mental health services in place for both the victim and the perpetrator of sibling abuse. The sibling perpetrator may have also experienced abuse or neglect of some kind, or the child may have some underlying mental health issues that need to be addressed.

In addition, other siblings in the family may have witnessed the abuse without experiencing it firsthand. It is important to work with the parents or guardians to ensure that these siblings who were not targeted also receive counseling services if necessary. The counselor can help the client and the family to conceptualize each of their roles in promoting better and healthier sibling interactions.

Plan for safety

Initially, parents or guardians may be unaware that sibling abuse is occurring in their home. One of their children might have complained about a sibling’s behavior, but the parents or guardians may not have realized the magnitude of the situation or didn’t possess the awareness that it went beyond normal sibling rivalry. During the conceptualization phase, the counselor works with the client and family to increase this awareness. With this knowledge, the family can start putting a safety plan in place. 

It is important for counselors to work with their child clients to create plans that ensure they are safe and being properly supervised in the home. As counselors, we may be working with multiple family members throughout this process. Our work may include counseling the sibling victim, sibling perpetrator and nontargeted siblings, as well as consulting with the parents or guardians.

It is also critical for all members of the family to have input on the safety plan and for the counselor to ensure that they understand their role in the plan. If it is determined that the sibling abuse is occurring during a certain time of day or in a particular place, the counselor will want to address this in the plan. For instance, if the sibling perpetrator shares a room with the victim, the counselor should explore with the family how this might be escalating the problem and creating an unsafe and unsupervised environment. Part of the safety plan might include setting aside a space in the house where the sibling perpetrator is not allowed to go, thus ensuring that the victim always has a “safe zone.” In addition, if weapons such as belts, knives or other objects have been used to inflict sibling abuse, then removing or restricting access to these objects is another element to address in the safety plan.

Choose interventions

Once the family is able to conceptualize the sibling abuse that has been occurring and has a safety plan in place, the counselor can work with the family to implement additional interventions. Sometimes, simply providing a greater level of awareness of the sibling abuse and establishing safety boundaries within the home might put an end to the abuse, making these additional interventions unnecessary. However, this will more likely be the case if no other forms of family violence are present and if the sibling abuse that occurred was milder in nature.

In instances in which intrafamilial violence may exist or the sibling abuse is more severe, it is important for the counselor to address the long-term impact of sibling abuse on the child victim, the sibling perpetrator, the nontargeted siblings and the family. Counselors can look at interventions that might help young children or adolescents break the cycle of abuse. There are no evidence-based programs for sibling abuse at this time. However, one way for counselors to help these clients is to explore evidence-based programs that have proved effective in working with children and abuse, including trauma-focused cognitive behavior therapy, game-based cognitive behavior group therapy and play therapy.

In addition, counselors may want to recommend some parenting programs aimed at preventing child abuse and neglect, such as the Incredible Years parents training program, SafeCare and Project 12-Ways.

Evaluate if the plan is working

A key component of the evaluation process is for counselors to consult and collaborate with other professionals. As previously mentioned, the five-step plan discussed in this article was originally designed for school counselors. One piece of advice we give to school counselors is to work as part of an interdisciplinary team within the school setting to help sibling victims and perpetrators. This may include working with school administrators, teachers, nurses, social workers or psychologists. In addition, school counselors can seek permission from the parents or guardians to consult with outside counselors who may be providing services to their students outside of the school setting.

It is just as imperative for clinical mental health counselors to consult with school counselors regarding sibling abuse that is occurring in families. Establishing and maintaining an ongoing dialogue between mental health professionals is essential to evaluating if the family’s safety plan is working and if the client feels safe and supported.

In addition, counselors will want to continually evaluate with the client and the parents or guardians regarding whether the safety plan is working and if the sibling abuse within the home has stopped. Counselors should recognize that it might take some time for sibling aggression to stop completely. However, during this transition we want to ensure that the sibling victim is feeling safe and that the parents or guardians are providing proper support and supervision. At any point within these five phases, counselors can report sibling abuse to CPS or law enforcement. Although there are no federal, and few state laws, to protect children from sibling abuse, parents and guardians can be reported to CPS for parental neglect if they fail to provide proper supervision for their children.

Summary

Sibling abuse occurs more often than is reported and can cause serious ongoing psychological damage. Counselors can play an instrumental role in helping their clients acknowledge and put a stop to sibling abuse. Utilizing the five-step plan discussed here is one way for counselors to assess and intervene on behalf of child and adolescent clients who are experiencing sibling abuse.

In addition, counselors have the ability to increase awareness about the topic of sibling abuse in their communities and schools. We can educate those around us about sibling abuse, collaborate with others in the mental health and social services fields to better define what constitutes sibling abuse, and advocate for state and federal laws to protect children from sibling abuse.

There are several excellent resources for counselors and parents who want to learn more about ways to address and intervene with sibling abuse. I have listed a few of them here.

  • Sibling Abuse Trauma: Assessment and Intervention Strategies for Children, Families and Adults by John V. Caffaro and Allison Conn-Caffaro (1998)
  • Sibling Aggression: Assessment and Treatment by Jonathan Caspi (2012)
  • Sibling Abuse: Hidden Physical, Emotional, and Sexual Trauma by Vernon R. Wiehe (1997)
  • What Parents Need to Know About Sibling Abuse: Breaking the Cycle of Violence by Vernon R. Wiehe (2002)

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Diane M. Stutey is an assistant professor of counseling and counseling psychology in the School of Applied Health and Education Psychology in the College of Education at Oklahoma State University. She is a registered play therapist supervisor, licensed professional counselor, licensed school counselor and national certified counselor. Contact her at diane.stutey@okstate.edu

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Fostering a brighter future

By Bethany Bray February 23, 2017

In fall 2015, there were 427,910 youths in foster care, according to the most recent statistics available from the U.S. Department of Health and Human Services, marking the third consecutive year that this number has increased nationwide. Of those youths, 61 percent were removed from a home because of neglect and 32 percent were removed because of a parent’s drug use.

Given those statistics, it’s not surprising that many of the youths in foster care have trauma histories, but the process of being removed from a caregiver is traumatic for a child in and of itself, says Evette Horton, a clinical faculty member at UNC Horizons, a substance abuse treatment program for pregnant women, mothers and their children at the University of North Carolina School of Medicine in Chapel Hill. “Any kind of separation from your primary caregiver is considered trauma, no matter what the age of the child,” says Horton, a licensed professional counselor supervisor (LPCS), registered play therapy supervisor and American Counseling Association member.

For youths in foster care, attachment and trust issues, stubbornness, defiance and a host of other behavioral problems are often a result of the trauma they experienced in — and associated with the removal from — their biological homes. “The best foster families don’t take the child’s behaviors personally or as any kind of statement about them or their parenting. The kids are just coming in with what they know,” Horton says. “The best foster parents I’ve ever worked with understand that what the child does, it’s not about them [the foster parents]. The best foster families understand that [the child] is coming in with skills that they’ve developed to survive.”

Stephanie Eberts, an assistant professor of professional practice at Louisiana State University, agrees that addressing trauma should always be on the minds of counselors who work with children and families in the foster care system. “The behaviors that [these children] are showing, a lot of them make [the child] very unlikable. If we as adults can see past that, we can help the children. If we can’t, then we sometimes perpetuate the cycle they’ve been caught up in,” says Eberts, an ACA member with a background in school counseling. “It’s really important for us as counselors to help these children heal from that break they’ve had from their caregivers, the trauma they’ve experienced and the break in attachment.”

To that end, Horton says that counselors’ skills and expertise with children and families — as mediators, relationship builders and client advocates — can be integral to improving the lives of children in foster care, while also supporting their foster families and biological families, as appropriate.

“Counselors shouldn’t underestimate their power to advocate,” Horton says. “Judges, lawyers and guardian ad litems aren’t trained to understand what the child needs, socially and emotionally, and we are. You shouldn’t underestimate the power of your words and your voice to impact a vulnerable child. A child who has been put in this unbelievably complex situation needs someone to speak on behalf of his or her mental health needs.”

Ground rules for practitioners

Horton oversees the mental health treatment of children, ages birth to 11 years, whose mothers receive substance abuse treatment at UNC Horizons. Through her work, she has the opportunity to see both sides of the foster care coin. In some cases, a mother is able to make the progress needed to be reunited with her children who have been in foster care while she was in treatment. But Horton also sees mothers who are unable to maintain their recovery. In cases in which a child is being put at risk by the mother’s substance abuse, Horton must file a report with child protective services (CPS). Throughout her career, she has assisted biological families, foster families and children with the transitions into and out of foster care, and also worked with the court system and CPS.

For counselors unfamiliar with the complexity of the foster care system, Horton stresses that practitioners must be very careful to identify who, exactly, is their client. This in turn will dictate with whom a practitioner can share information, to whom they have consent to talk and who needs to make decisions and sign paperwork on behalf of a minor client. For children in the foster care system, the legal guardian is often CPS. This can become even more complicated for practitioners when a child is returned to the biological parent’s home on a temporary or trial basis. In such instances, CPS still retains custody of the child, Horton explains.

“These are very, very complicated cases, and you need to support yourself,” Horton says. “Make sure you are careful, regardless of how well-trained you are. These cases are tough — really tough. Do not hesitate to work with your supervisor [and] peers and get support.”

Eberts suggests that counselors working with families and children in the foster care system educate themselves by reading the client’s case file thoroughly and collaborating with caseworkers and the biological family (if possible) to find out more about the child’s background. If details are missing from the case file, particularly about the circumstances of the child’s removal from the biological parent, counselors should attempt to speak to a caseworker or other official who was on-site as the removal happened, Eberts says.

However, Eberts notes, practitioners should also be aware that case files often contain details that can spur vicarious trauma. “Reading some of the children’s files can be really heartbreaking. That self-care piece that we talk about so much with counselors is really, really important [in these cases],” she says.

Counselors as translators

One of the most important ways that counselors can support foster parents and improve the lives of children in foster care is to “translate” the children’s behaviors for those around them. This includes explaining what a child’s behavior means and what motivates it, and then equipping both the child and the parents (both foster and biological parents, where appropriate) with tools to redirect the behavior and better cope with tough emotions.

Eberts shares a painful example she experienced while working as a school counselor. A young student told her foster parents that she didn’t want them to adopt her. Stung by the girl’s pronouncement and taking her words at face value, the couple returned her to the foster care system for placement with another family.

“These kids have experienced a lot of loss and abandonment,” Eberts says. “[This child] was just testing her potential adoptive family — testing whether or not they were going to abandon her. The behaviors [these children display] are often protective.”

Children in the foster care system often present behaviors associated with trauma, Horton says, including:

  • Attachment issues
  • Behavioral issues
  • Nightmares
  • Anxiety
  • Separation anxiety, including trouble being alone
  • Developmental delays, including being behind in speech, language and school subjects
  • Tantrums
  • Trouble sticking to routines (as Horton points out, children in foster care often come from homes in which structure and rules were limited or nonexistent)

Despite their good intentions, foster families may not always understand a child’s behaviors, and adults may interpret a child’s symptoms of anxiety as defiance. For example, the foster parents of a child who refuses to eat vegetables or who puts up a nightly struggle over going to bed may feel the child is being stubborn or testing their authority. In reality, Horton explains, the child may never have been fed vegetables or slept alone before. Misunderstandings can be further compounded when a child comes from a different culture or socioeconomic background than his or her foster family, she adds.

Sarah Jones, an ACA member and doctoral student in counseling and student personnel services at the University of Georgia, agrees. Jones and her wife are foster parents. Over the past five years, they have had 20 different children, all under the age of 7, stay in their home. Jones says the vast majority of children she has seen in the foster care system in Georgia have come from low socioeconomic backgrounds. It is common for these children to present insecurities about food, shelter and other basics, she says.

Foster parents and counselors alike “can give [these children] a glimpse of what the world can be. It can be a place where there is enough food, where there is enough love,” says Jones, who presented on narrative techniques with college students in foster care at ACA’s 2016 Conference & Expo in Montréal.

At the same time, Jones stresses that counselors should avoid assigning blame to the biological parents, the child or a system in which caseworkers are vastly overworked and underpaid. Jones thinks of it this way: The moment when a child is removed from his or her home is the low point for the biological parent or parents, but things will not necessarily stay that way.

“It’s like we’re taking a snapshot of someone in their worst-case scenario and making generalizations for their entire lives. … Sometimes we equate that to [these parents] not loving their kids, but sometimes love is not enough,” Jones says.

Counselors should also be aware that CPS usually tries to exhaust every possibility of having children placed with a biological family member before they are placed in foster care, Jones says. In some cases, children in foster care have parents and relatives who have died, are incarcerated or involved in other situations that make them unable to care for their children. “To be in the foster system, it’s not a problem that can be fixed in six months [or a short period of time],” she says. “It means that the biological parents don’t have a network that could take the child.”

Responding effectively

B.J. Broaden Barksdale, an ACA member and LPCS in Katy, Texas, has worked with children and families in Texas’ foster care system for 18 years. Initially she did home monitoring and assessment of foster families and then transitioned into working as a therapist with children and families in the system.

The behavioral issues with which children in the foster care system often struggle can be accompanied by tantrums, outbursts and emotional flare-ups, Barksdale says. She likes to use trauma-focused cognitive behavior therapy and the Trust-Based Relational Intervention (TBRI) to provide these children and their families with tools for better functioning.

TBRI’s four-level response method helps caregivers to redirect the child’s behavior while maintaining a connection and using the least severe response possible, Barksdale says. Counselors can use this method in their own work with foster children and in coaching parents and caregivers on how to use the method at home.

Level one: Playful engagement. To start, a caregiver or other adult should remain playful and light with the child. For example, if the child comes home from school, slams the door and drops his or her backpack on the floor, a caregiver could respond with, “Whoa! What’s this?” or some other lighthearted remark, Barksdale suggests. Then the child could be given a do-over. Or, if a child makes a demand of an adult, such as “Give me that!” the reply could be, “Are you asking or telling?” If the child doesn’t have the right words to ask appropriately, a counselor or parent can phrase the question and have the child repeat it. Regardless, Barksdale says, the key is to maintain a kind, playful tone and to redirect the child to keep the situation from escalating.

Level two: Structured engagement. If a child does not respond to an adult’s initial playful response, the next step is to offer choices. If a child is refusing to go to bed, give the child a voice and ask what would help him or her get to bed on time. For example, “How about turning off the TV 30 minutes earlier? How can we compromise?” This empowers the child to choose, avoids a power struggle and teaches the child compromise and conflict resolution, Barksdale says.

Repetition and consistency are key, she says. “The repetition is retraining their brain. … Giving them choices helps them learn to make choices,” Barksdale says. “And once they do it, praise the heck out of them. Try to always find something to praise, even if it’s as small as coming home without slamming the door. It’s all in how you say it — ‘We don’t hurt the dog’ instead of ‘Haven’t I told you not to do that?’”

Barksdale emphasizes that the adult should also consider the bigger picture of the child’s day. Has the child been overstimulated or particularly busy? Does the child need some quiet time, a drink or a snack, or something else?

Level three: Calming engagement. If a situation escalates to this level, the child should be given time to pause, cool off and think things through. Barksdale encourages foster parents to designate a space in the home for this very purpose. It should be a safe, comforting space where a child can spend time alone, relax and be quiet while an adult is nearby, she says.

Level four: Protective engagement. When a situation escalates to the possibility of violence, a caregiver can use accepted restraints to calm the child (but only if trained to do so through the foster care system or another agency). The adult must stay calm and reassuring and should remain with the child until he or she is calm enough to talk through the situation.

“These kids are combative about authority, hypervigilant and don’t trust anyone,” Barksdale says. “You have to teach them what they have never learned. You have to be compassionate and get them to trust you. If you don’t build that trust, that felt safety, you can’t move forward.”

In addition to providing consistency, it is essential to address behavioral issues immediately as they unfold, Barksdale says. Through TBRI, she uses the acronym IDEAL to teach this to parents:

I: Respond immediately.

D: Directly to the child, through eye contact and undivided attention, with a calm voice. Barksdale says she often gets down on the floor with younger children to better connect and because it makes her appear as less of an authority figure.

E: In an efficient and measured manner, with the least amount of firmness required.

A: Action-based, by redirecting the child and providing a do-over or giving the child choices. This could include role-play, in which the adult acts out two responses that the child could choose, one of which is inappropriate.

L: Level the response to the behavior, not the child. Criticize the behavior as being unacceptable, but not the child, Barksdale explains.

“You want to give them voice and build trust,” she says. “If they understand that you’re trying to be in harmony with them, they engage. Remember that these kids may have had no relationships, no attachment, since birth. … If there’s relationship-based trauma [in the child’s past], that can only be healed through forming healthy relationships.”

Eberts agrees, noting that counselors should consider the backgrounds of the children they are working with and the reasons they were removed from their biological homes. Counselors can then use that information to identify the child’s major needs.

For example, Eberts worked with a foster family that included an 8-year-old boy who was placed in foster care when he was 2. His biological parents had issues related to drug use and were running a methamphetamine lab in the home when he was taken from them. The boy was prone to outbursts that sometimes became violent.

“For the first two years of his life, he was not getting the kind of attention and care that he needed,” Eberts says. “We used that information to help his foster parents understand that when he needs something, he won’t ask for it in a way the foster parent might expect. … He did not have the attachment needed to connect with other people.”

Eberts worked with the child on building connections with people and trusting that his needs would be met. She used play interventions to help the child learn to express himself, identify emotions and process his frustration. Eberts also equipped the foster parents with tools to de-escalate his tantrums, including recognizing the cues the child gave leading up to his outbursts, and calm, consistent methods for responding when outbursts took place.

“He was very challenging, but things did get better,” Eberts recalls. “It was hard work and took a long time. [The foster mother] had to work on herself quite a bit to understand when he was starting to escalate and how to de-escalate him [by] using a calm voice and helping him to self-identify emotion … in a way that wasn’t combative or defensive. He wasn’t student of the year by the end of the year, and he still struggled with attachment, but the skills that the foster mother had learned helped a great deal. He was on the road to having a much better life experience.”

“He was violent because he was sad and he didn’t know what to do with it,” Eberts says. “These are kids who have so many emotions, they don’t know what to do with them. They don’t know how to express them.”

Tips for helping

Counselors can keep these insights in mind when working with children and families in the foster care system.

Regression is common. For children who have experienced trauma and instability, progress will often be accompanied by spurts of regression. For example, a child who is potty trained may suddenly start having accidents when moved to a new foster home, Horton says. Counselors should coach foster parents not to get discouraged if a child regresses.

“Help the family understand that this will pass. It’s part of the road,” Horton says. “We have to remind people that this is actually common. It’s all very new and confusing to [the child]. All of us regress when we’re under stress, and kids do too.”

Regression can also be expected when children in foster care phase into a new developmental stage, such as the onset of adolescence, Eberts says. “The trauma that they’ve experienced in life has to be reprocessed at every developmental milestone,” she explains. “When they hit adolescence, they’ll have to reprocess it from an adolescent perspective, then as a young adult. So if an 8-year-old makes progress, they can and will regress when they hit 12. They’re processing things from a different developmental perspective.”

Meet children where they are. Many children in the foster care system will lag behind their biological age developmentally, from emotional maturity to speech skills. Counselors should tailor their therapeutic approaches to a young client’s level of development, not the age on his or her file, Eberts says.

“A child who is 10 may still be a great candidate for play therapy because, developmentally, he is really around 7 years old,” she says. “The intervention has to be aligned with the child’s developmental age.”

Keeping that in mind, the expressive arts and tactile interventions such as sand trays and art, dance and movement therapies — in other words, methods other than talk therapy — can be particularly useful with children in the foster care system, Eberts says.

“Keep in mind that you have to meet the child where they are developmentally. That is the most important thing,” Barksdale says. “Expectations for a child who has experienced trauma need to be realistic.”

The importance of structure and routines. If children are coming from a background ruled by instability, it is helpful for counselors to work with foster families on establishing routines and clear expectations. “Make sure there are as few surprises as can be,” Jones says.

For example, it can provide a sense of security for the family to have a movie night every Saturday or to eat dinner together at the same time each evening. Nighttime can be particularly troubling for foster children, so establishing an evening routine and sticking to it — such as brushing teeth and then reading a book together — can be helpful, Jones adds.

Horton suggests that counselors work with foster families to create and post a list of age-appropriate house rules and a daily routine or calendar. If the foster child is too young to read, these lists can be illustrated with pictures. This becomes even more effective if the counselor has access to both the foster and biological families so that the lists can be posted in both homes, Horton says. When possible, the same can be done with a compilation of photos of the child’s biological and foster families, she says.

Prepare for transitions. Transitions both large and small, whether they encompass switching schools or simply transitioning from playtime to bedtime, can be hard for children in the foster care system. Counselors can suggest that foster parents provide plenty of gentle, advance notices that a transition is coming, such as 30 minutes, 15 minutes and five minutes before a child needs to finish playtime to go grocery shopping with the family, Barksdale says.

Established routines can also help in this area, she adds. “Bedtime should be at the same time every night if at all possible. If done repeatedly, the child knows what’s coming next. It helps with comfort, consistency and felt safeness,” Barksdale says. “The one-on-one attention helps with relationship-building, and once trust is built, it’s easier to redirect the child.”

Goal setting and journaling. In the counselor’s office, engaging in dialogue journaling and goal-setting exercises can be helpful for youths in the foster care system, Jones says.

In a dialogue journal, the client and counselor write messages back and forth (younger clients may draw instead of write). The journal can help spark conversation and get the client thinking in between sessions. “A lot of times they don’t know how to talk about their past,” Jones says. “[Through the journal], they can talk about something that happened in their life. Maybe it’s, ‘I wasn’t able to have dessert because I didn’t finish my broccoli.’ Then you can transition into a conversation about how that is different from their past home.”

Goal setting can also be a useful way to connect the past, present and future with young clients, notes Jones. For example, a counselor might work on building a young client’s social skills by encouraging the client to set a goal of talking to one new person at school in the coming week. The counselor would talk through the steps the child could take to achieve the goal and ask the child how he or she made friends in the past at previous schools. “You’re showing the child that they already have those skills,” Jones says. “They just need to use them in a new place.”

The power of pictures. Horton often creates picture albums for her young clients who are transitioning between foster care and home placements. She contacts adults the child is acquainted with to ask for photographs of biological relatives, foster family members and other important people in the child’s life. She looks at the book with the child at every counseling session because it serves both as a conversation starter and a way to remember loved ones, she says.

“Sometimes we have to help create the story that helps the child make sense of what happened,” Horton says.

Coping tools and self-regulation. Many children in the foster care system can be flooded with anxiety and strong emotions, including anger, Horton says, which can make self-regulation exercises, from mindfulness to breathing exercises, particularly helpful. Horton often brings bubbles to counseling sessions. She shows the children how to make big bubbles — which also teaches them how to take slow, deep breaths, she says. In the case of another young client, self-regulation included getting outside. His foster family had a trampoline, and they would all go outside and jump together. This made a difference because rather than just shooing him out the door, they stayed with him to work through his anger as they jumped, Horton says.

Barksdale uses a tool in session that serves as a jumping-off point to talk about self-regulation with clients. It is a wheel with an arrow that clients can move to different colors to indicate how they are feeling. “If you’re feeling blue and tired, what can you do? Get a snack or drink some water. If you’re in the red and really hyped up, what can you do? Count backward and breathe,” Barksdale says. “If you’re feeling anxious and tense, what does your body feel like? Learn to identify that.”

Be honest and talk it through. Be honest with the child while also giving him or her the space to process what is happening, Jones says. “For a few weeks, it feels [to the child] like you’re on vacation and you’re at someone else’s house. As they start to feel more comfortable, the feelings start to come. With that ease also comes an onslaught of feelings about what they’re giving up and missing,” Jones says. “It’s important to recognize how difficult it is, but at the same time saying, ‘You are not alone.’”

“Tell them, ‘There are a lot of people who love you, and they’re doing the best they can right now,’” she says. “We [Jones and her wife] really believe in talking about what’s happening.” Jones says it is important for counselors and foster parents to “talk about how your family is dynamic, and this is what’s happening right now.”

When it’s time to let go

As a foster mother, Jones is all too familiar with working to form bonds and relationships with children in her care despite knowing that they may soon transition back to their biological families. This break can be quite painful for foster families, she says.

“It’s important for counselors to give families a space to grieve,” Jones says. “There was a period of time when our family had two significant losses back to back. A child we had from birth transitioned to her mother after 16 months. Then, less than three months later, a child transitioned from our home into her father’s home and, less than one week later, died from natural causes. The grief associated with these experiences impacted every member of our family — even our dog was acting depressed. My counselor gave me a space to experience very big and painful emotions, then eventually helped me make meaning from my experiences.

“Reminding foster parents that the amount of pain they are experiencing is likely equal to the amount of love given to a child in need is also a powerful reminder. It hurts because it mattered, and if it mattered to us, it likely made an impact on a youth’s life. And that’s why we work as foster parents — and as counselors.”

 

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Related reading

See Brian J. Stevenson’s article “Developing a Career Counseling Intervention Program for Foster Youth“ in the June issue of the Journal of Employment Counseling: http://bit.ly/2r6gFUj

 

 

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Foster care: By the numbers

  • For 2015, the median age of the youths in foster care was 7.8 years old. The median amount of time in care was 12.6 months and the mean was 20.4 months; 53,549 children were adopted with public child welfare agency involvement.
  • Between 2014 and 2015, 71 percent of states reported an increase in the number of children entering foster care. The five states with the largest increases were Florida, Indiana, Georgia, Arizona and Minnesota.

Number of children in foster care in the U.S. on Sept. 30

2015: 427,910

2014: 414,429

2013: 401,213

2012: 397,301

2011: 397,605

Reasons for removal from a home and placement in foster care (2015)

Neglect: 61 percent

Drug abuse of a parent: 32 percent

Caretaker’s inability to cope: 14 percent

Physical abuse: 13 percent

Child behavior problem: 11 percent

Inadequate housing: 10 percent

Parent incarceration: 8 percent

Alcohol abuse of a parent: 6 percent

Abandonment: 5 percent

Sexual abuse: 4 percent

Drug abuse of the child: 2 percent

Child disability: 2 percent

Reasons for discharge from the foster system (2015)

Reunification with parent or primary caretaker: 51 percent

Adoption: 22 percent

Emancipation (aged out): 9 percent

Guardianship: 9 percent

Living with other relative(s): 6 percent

Transfer to another agency: 2 percent

 

Source: U.S. Department of Health & Human Services Administration for Children & Families, acf.hhs.gov

 

 

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To contact the counselors interviewed for this article, email:

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

A systemic perspective for working with same-sex parents

By Amanda C. DeDiego September 28, 2016

According to census data, there were roughly 125,000 same-sex couples raising approximately 220,000 children in the United States in 2010. Since that time, increasing numbers of same-sex couples have declared committed partnerships, capturing the attention of policymakers and bringing the issue of legal recognition of same-sex partnerships to the forefront of politics.

In 2015, the U.S. Supreme Court heard the landmark case of Obergefell v. Hodges and ultimately declared it unconstitutional for any state to deny marriage licenses to same-sex couples. In doing so, the Supreme Court said that rights historically awarded to married partners, including adoption rights, must be extended to same-sex couples. Although state legislation traditionally branding-images_twodadsdetermines specific limitations to adoption rights awarded to married couples, under Obergefell v. Hodges, said spousal rights must apply to all couples equally.

This past summer, a federal court judge ruled adoption by same-sex couples legal in all 50 states. However, judges who make decisions to award parental rights can still create more stringent guidelines or additional hurdles for same-sex couples. So although this ruling is monumental in taking strides toward equality, it does not eliminate subtle discrimination experienced by same-sex couples seeking adoption rights.

As institutional and legal barriers to same-sex marriage and parenthood continue to diminish, counselors are increasingly called on to provide support for same-sex couples who are establishing legally recognized families. CACREP (Council for Accreditation of Counseling and Related Educational Programs) accreditation standards require programs to provide counseling students with training for supporting various issues in diverse relationships and families. However, more training and awareness are needed to properly prepare counselors to offer support specifically for same-sex couples and families.

For many years, same-sex couples could not find appropriately trained counselors to provide family and couples therapy. Now same-sex couples feel welcomed and have more referral options for counseling, but counselors still often lack specific training in best practices for supporting these couples and families headed by same-sex parents. Considering the systemic influences that affect same-sex couples, a counseling approach that also considers the systemic context is ideal.

Structural family therapy

Structural family therapy (SFT), developed by Salvador Minuchin, offers a means for counselors to address systemic issues in various contexts. The SFT approach is empirically validated and offers a map for counselors to conceptualize a family system on the basis of the roles the family members play. In addition to examining the family as a system, SFT takes into account the greater societal contexts that have an impact on the family.

Minuchin based his theory on the assumption that each family member plays a role within the family. Using Minuchin’s therapeutic approach, a counselor observes patterns in the family’s interactions to determine the hierarchy within the family system. Subsystems such as spousal, parental and sibling may also be present within the family. Any imbalance in the power, boundaries or roles within the family represents dysfunction in the system.

The goal of SFT is to adapt the structure of the family to the needs of its members to improve the function of the family system. This goal is accomplished in three phases:

1) Joining with the family

2) Enacting interactions within the therapy environment to observe family member roles

3) Creating unbalance to expand current roles, introduce boundaries and accommodate the needs of the family members in the system

As part of the SFT process, the counselor “joins” the family system to correct dysfunction. Minuchin described “joining” as the process of the counselor being accepted by the family to create a therapeutic bond. The trust gained in the joining process creates a therapeutic system that lasts the duration of the counseling relationship. The counselor works to help the family establish clear roles, while deconstructing power within the family system and subsystems. The goal is to create a functional hierarchy that meets the needs of family members.

One advantage to using SFT with same-sex parents is that this approach considers larger systemic influences on the family. Counselors working with same-sex couples may need to address unique systemic challenges. Thus, it is important to raise awareness in the counseling community about such issues so that we can address biases, practice awareness of issues facing the population and have a broad societal view of the family system and societal challenges impacting families with same-sex parents.

The road to parenthood

Traditional conception of children is not an option for same-sex couples. Thus, the road to parenthood for these couples is often emotional, complicated and challenging.

Some of these couples may already have children from previous relationships. SFT provides guidelines for work with blended families, but in many respects, same-sex couples have unique challenges in establishing family systems. In the past, many states would not recognize the adoption of children within same-sex partnerships. For same-sex partners with children from previous relationships, this meant that only the biological parent was able to serve as the legal guardian of these children. This created stress and conflict within relationships because the biological parent’s current partner was left without any legal rights as a parent. Not having legal guardianship of a child can cause same-sex partners to feel unclear about their parental identities. In turn, this may result in conflict within the partnership or struggles to establish a parenting relationship with children.

Egg donation and surrogacy: Not all couples have biological children from previous relationships, but the issue of legal co-guardianship is persistent regardless of how same-sex partners become parents. Same-sex couples may choose to pursue parenthood through surrogacy or through in vitro fertilization using a sperm or egg donor. In both cases, couples must choose which partner will be allowed to have the biological identity as the child’s parent. Because state laws have not always recognized the adoption rights of same-sex couples, the biological parent of the child often maintains all legal rights of guardianship.

Considering recent court rulings, the nonbiological parent may now seek status as a legal guardian. However, this parent may have experienced a lack of power in the family for some time because he or she was previously unable to identify as either a biological or legal parent.

Additionally, decisions must be made regarding the degree to which surrogates or sperm/egg donors will be included in and involved with the family. Thus, these family systems will potentially have multiple layers and subsystems, meaning that the same-sex partners may experience additional stress as they navigate choices concerning the level of connection to donors and surrogates.

Traditional adoption: The Supreme Court ruling in Obergefell v. Hodges acknowledged the possibility of same-sex couples facing continued institutional barriers, specifically naming instances of adoption agencies affiliated with religious organizations denying child placements for these couples. This past summer, a federal judge ruled a state ban on same-sex marriage to be unconstitutional, thus eliminating some systemic barriers to parenthood. Although overt discrimination in denying same-sex couples opportunities for adoption was eliminated, subtle discrimination that reinforces heterosexist standards of parenthood can still force same-sex couples to face stigma and additional stress during the adoption process. Same-sex couples have traditionally encountered legal obstacles, high standards for approval and long waiting periods to become adoptive parents. Historically, these institutional barriers have been substantial, causing many same-sex couples to turn to the foster care system in their pursuit of parenthood.

Foster to adopt: Foster care agencies often permitted same-sex couples to serve as foster parents, but there was always the question of whether the court system would subsequently deny these couples the option to legally adopt. This was often confusing and emotionally distressing for couples hoping to start families and gain the identity of parents. The Supreme Court has addressed these legal barriers, but it is unclear at this point what institutional and social barriers will remain for same-sex foster parents seeking legal adoption.

Additionally, same-sex couple foster parents may experience a lack of institutional support in preparing foster children for placement with a gay or lesbian couple. Thus, the adjustment to the placement can be more stressful for both the couple and the child. Couples may also experience subtle discrimination and a lack of sensitivity regarding pronoun use in record-keeping (for example, suggesting a father and mother caring for children, as opposed to two mothers or two fathers).

Systemic challenges

In addition to the typical stresses associated with blended families or adoptive parenting relationships, same-sex couples often feel that they must fight to gain recognition in their identities as parents, both legally and socially. This can create high levels of stress within these partnerships.

In 1979, Urie Bronfenbrenner discussed various social and political systems that influence individuals as members of society, including those individuals navigating marriage and parenthood. In addition to considering the legal and institutional challenges faced by same-sex couples in gaining identity as parents, counselors using SFT must consider the influences of the societal systems to which these clients belong. Unfortunately, discrimination and systemic challenges are still present after same-sex couples become parents, and counselors may need to help families navigate additional systemic challenges in raising children.

Institutional and legal challenges: Same-sex couples have long faced institutional barriers in gaining validation and recognition of their partnerships and marriages. Obergefell v. Hodges awarded the right to marry to same-sex couples and extended historically implied rights to same-sex couples who marry. However, states reserve the ultimate power to choose which rights to award (and to what degree) to married couples, including taxation, sharing of property and legal adoption. These discriminatory barriers exist beyond the courts. Among the institutional challenges that present struggles for same-sex couples attempting to establish family systems are division of work, parental leave and guardianship rights in caring for children.

Same-sex couples may experience challenges in deciding how to adapt their work schedules when raising children because of less employer flexibility, especially in the case of gay men. Thus, one partner may become the “breadwinner,” establishing greater financial power within the relationship. Given that legal adoption is not always permitted for nonbiological parents in a same-sex partnership, gaining access to a child’s medical or school records may also be a challenge.

In addition, same-sex couples often face challenges simply in finding a residence for their families. Research shows that landlords have traditionally assumed that same-sex couples will be troublesome tenants. Given limited choices for renting property, one partner may then become the legal owner of the couple’s purchased property. Particularly if this partner is already identified as the breadwinner of the family or the biological parent of the couple’s child, this situation can create a further imbalance of power within the parental subsystem.

Social challenges: Beyond institutional challenges, same-sex parents also experience subtle discrimination in social groups. Same-sex parents may not feel that they fit within traditional parenting roles and thus may not feel as accepted in social groups with heterosexual parents. Socially, same-sex parents can be the targets of hypercriticism for their parenting decisions by heterosexual parents.

Criticism and rejection are not isolated only to social groups. Families of origin may also express disapproval of same-sex couples becoming parents. Ultimately, same-sex couples may feel like outsiders in both social and familial groups, thus creating another source of conflict within the partnership.

Given that they are raising children in a heterosexual-centered society, same-sex parents may lack role models for navigating decisions as parents. When combined with social invalidation, this can leave same-sex parents feeling alone and lost.

Finding social support provides comfort for parents and children who are experiencing hyperawareness of the dominant heterosexual culture. Thus, same-sex parents often seek to create a new “family of choice” for social support. Same-sex parents often worry that their children will be subjected to heteronormative standards and social expectations in school. Children who have same-sex parents may experience discrimination or bias in social groups. Having the social support of other same-sex couples makes it easier for parents and their children to cope with discrimination and heterosexual norms.

Considerations for practice

Under SFT, the counselor joins with the family, becoming a part of the system instead of being a bystander to the process. Once this happens, the counselor will address issues of power, hierarchy, boundaries among family members and rules within the family system. The focus on family roles allows the counselor to adapt to the family system beyond traditional gender roles, which makes SFT ideal for work with same-sex couples and their families. Same-sex couples lack the traditional “mother” and “father” role within the family, so couples establish parenting identities based on their unique family system.

To determine the structure of the family system, a counselor must observe patterns of behavior among family members. In many cases, the lack of traditional gender roles among same-sex couples creates opportunities for greater balance in home and work responsibilities and egalitarian roles in parenting. Same-sex couples often experience greater fluidity and equality in parenting responsibilities than do heterosexual couples. Thus, decision-making in distribution of power within the partnership becomes more intentional.

The more gender-fluid roles of parents in same-sex families may challenge a counselor’s fundamental views of family. Thus, a counselor working with a same-sex couple must be aware of personal biases, or else the counselor may project gender labels onto family members. In addition, in recognizing one parent as more nurturing, it would be important not to automatically project onto the other parent the label of disciplinarian, especially considering the complementary function of parents under SFT. Instead, realize that gender fluidity in parenting roles means that same-sex parents may be sharing aspects of roles as both nurturer and disciplinarian.

In part because families with same-sex parents may not always receive support from biological family members, it is common for these parents to include neighbors or other social supports in their definition of the family system. The SFT approach allows for a more flexible definition of family. Thus, same-sex parents can invite social supports beyond the biological family to participate in family therapy. A large piece of SFT involves examining the authority exercised with children. This provides the counselor with insight regarding the hierarchy within the family system. Remembering that social supports may become an influential part of same-sex families, the counselor should remain open to considering the authority of nonparental figures within the family system.

Counselors must practice awareness of societal influences on families because these challenges often affect the balance of power within the family. Although societal issues may not be the presenting issue within the family, the influence of societal systems is always present. Additionally, counselors must practice ongoing reflection to be aware of biases in their work with this population. Working to eliminate subtle discrimination in the counseling environment — for instance, by creating gender-neutral intake forms — can create a welcoming environment for same-sex couples and their families.

Conclusion

SFT provides a framework to conduct counseling that considers systemic influences on families with same-sex parents. Recognizing the systemic and social barriers that same-sex parents face is a huge first step. Counselors must be aware of their own biases regarding their views of families when working with same-sex parents. In joining with the family system, counselors should be cautious not to assign gender roles to family members. Counselors also must be open to including social supports outside of the immediate family in the counseling relationship.

By practicing awareness of systemic barriers facing same-sex couples and being open to unique family systems, counselors can provide much-needed services to these now legally recognized partners who are navigating the road to parenthood and parenting in a heteronormative world.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Amanda C. DeDiego is an assistant professor of counseling at the University of Wyoming. She is a national certified counselor and has clinical experience in school, grant program, community and private practice settings with diverse client populations. Contact her at adediego@uwyo.edu.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Behind the Book: Stepping In, Stepping Out: Creating Stepfamily Rhythm

By Bethany Bray August 30, 2016

It can take anywhere from four to seven years for a stepfamily to successfully blend, according to Joshua M. Gold in his book Stepping In, Stepping Out: Creating Stepfamily Rhythm.

The formation of a stepfamily is “uncharted water for everyone,” he says. Not only do parents and children each carry the dynamics and histories from their previous family arrangements but also face a myriad of societal stereotypes that often paint stepfamilies as dysfunctional.

“What must become clear to clinicians is that the old myths of the stepfamily drastically interfere with effective clinical understanding and therapeutic assistance to these family constellations,” writes Gold, an American Counseling Association member and professor in the Branding-Box-Stepping-in-outcounselor education program at the University of South Carolina. “Therefore, clinicians must educate themselves beyond comparisons with nuclear families to truly appreciate the unique strengths and challenges in working with a family system whose numbers are predicted to become the dominant family form in the United States in the 21st century.”

Gold is a stepparent himself and says that his “lived experience” contributes to his professional focus on stepfamily dynamics. He is also a member of the International Association of Marriage and Family Counselors, a division of the American Counseling Association, and is a contributing editorial board member of IAMFC’s journal, The Family Journal.

 

CT Online recently contacted Gold for a Q+A about his new book, which is published by the American Counseling Association.

 

In your opinion, what makes professional counselors a good fit to work with stepfamilies?

To my mind, there are several facets to being a good fit to support stepfamilies. I believe that a foundation in systems thinking is a critical part of family intervention. Each family member brings unique resources to counseling to help the family function more successfully, and the clinician must have the orientation and skills to facilitate their emergence. Implicit in that statement is a focus on a wellness model of stepfamily functioning, which entails understanding the stages of stepfamily evolution, a capacity to legitimize stepfamily struggle within a developmental, rather than pathological, context and a deep appreciation for the characteristics and dynamics of stepfamily life.

In addition, a strong clinician would be able to recognize external family members whose input is critical to stepfamily progress and be sufficiently adept to invite the stepfamily to encourage their participation in whatever mode may be feasible. I also think that sensitive clinicians understand the interaction of ethnicity and sexual orientation with stepfamily life and are prepared to embrace the stepfamily’s experience of self and of the larger society. Clinicians must be prepared in all cases to understand any personal biases or societal misperceptions about stepfamilies that may interfere with the efficacy of their interventions.

 

Your focus in this book is helping stepfamilies through the use of narrative therapy. Why did you choose that particular method? What makes narrative therapy a good fit for working with stepfamilies?

I believe that any marginalized group in society experiences definition through the social lens of dominant social structures. So, for example, in terms of family functioning, all other family constellations may be compared in membership, roles and perceived success to the nuclear family ideal. This comparison leads to perceptions of deficiency or inherent dysfunction based on oft-repeated, yet perhaps unfounded, social narratives. These perceptions focus attention not on how the family is succeeding but rather on ways in which it fails — if not soon, then sometime in the foreseeable future. This expectation of dysfunction, member unhappiness and marital dissolution may create a self-fulfilling prophecy within the stepfamily.

Narrative therapy seeks to identify and evaluate the validity of these social myths based on the lived experience of the client. By recognizing the negative lens through which the family has viewed itself, members have the opportunity to create more positive expectations of their stepfamily life and then to interact with each other reflective of those expectations.

 

It’s predicted that the stepfamily constellation will be the most common family form in the U.S. by 2020. Do you think the counseling profession, as a whole, is aware of or ready for this demographic shift?

I believe there is not an area of counseling which has not already felt this shift. For example, any school counselor could recount, just looking at a child’s folder, the new names and addresses added to the roster and the names of new individuals permitted to [interact] with the school on behalf of that child. Any family-focused clinician or mental health professional who conducts a social history of a child presenting in pain would identify the number of stepfamilies in one’s assigned caseload. I also believe that the profession’s commitment to client welfare and provision of ongoing professional development training, in multiple venues, ensure the availability of continual upgrading of clinical skill.

What becomes important, to my thinking, is whether a clinician faced with a stepfamily situation ponders the extent to which that family constellation can be activated to help the individual presenting [with] pain to overcome that life challenge. While stepfamily life may or may not contribute to the presenting issue, I am of the opinion that stepfamily members can contribute to its resolution.

 

In your experience, do stepfamilies often seek out counseling on their own, or are they more likely to come to counseling in a roundabout way, such as referral from a school counselor?

I believe that family counseling is constantly challenged to expand the focus on counseling from the identified client to the entire family. This therapeutic intent can probably best be accomplished by focusing on assignment of blame or responsibility for current stepfamily dysfunction to identifying potential resources within differing stepfamily relational schema.

This situation of “roundabout counseling” is no different in stepfamilies, except where counselors can provide resources to ongoing stepfamily support communities. Within those peer support systems, counselors can offer psychoeducational interventions on multiple levels: to stepfamilies as a whole, to the marital system, to the stepsibling system, to the involvement of ex-spouses, etc.

 

In the book, you stress the importance of combating stepfamily myths that members of a family may have. What would you want counselors to know about this? Why are myths a key part of understanding the stepfamily dynamic?

Societal myths influence stepfamily expectations and offer templates for role expectations of differing stepfamily members. However, these myths are imbued within social lore and espoused by social institutions as well as individuals. Therefore, stepfamily members are influenced subtly as to what to expect of others and of themselves within stepfamily roles.

From a clinical orientation, cognitive behavioral counseling, in general, speaks to the function of beliefs, thoughts and assumptions as precursors to action. From that perspective, interventions that seek to modify behaviors, such as conflict-resolution skills, step-parenting, marital communication training, etc., are overlooking attention to the attitudes which drive the actions. Narrative therapy encourages clients to identify, evaluate and perhaps reauthor dominant social beliefs in a way that results in more positive views of stepfamilies in general and each role within that family specifically.

More importantly, in a situation where the dominant myths seem to portray family constituents in negative lights, this process introduces the idea that the issue lies not within that individual but rather within the assumptions one holds about the role that person enacts in the stepfamily. By distancing the negative portrayal from a person to a social perception, the client can better author that perception based on real-life experience and interactions with that specific individual.

For example, stepchildren may view a new stepfather as aloof and uncaring, while the stepfather’s intent is to allow the children time and space to warm up to him. In this situation, it is easy to envision the emotional distance between them and the emergence of negative assumptions about each role. However, by transcending these social narratives about the role of “distant” stepfather and “unappreciative stepchildren,” the adult and children can begin to learn about each other’s gifts and capacities in more positive ways.

 

Do you think stepfamily dynamics receive enough focus in the education and training that people receive before becoming licensed marriage and family therapists? What do you want students and new counselors to be aware of related to working with stepfamilies?

I think that training programs are challenged to provide both generic and client-population-specific knowledge and skills. To my thinking, as clinicians encounter clients with whom they have not had previous experience, they hold a professional obligation to seek the knowledge and skills that have been found to be relevant for that specific client group. It is the purpose of post-graduation supervision to support each new clinician in expanding one’s generic knowledge and skill sets to ensure efficacious treatment of new and diverse client groups. The career-long expectation for professional development is founded in the understanding that any graduate program cannot prepare a clinician for every client situation. [It] must be augmented by individually determined specialized study to meet the clinical needs of one’s client populations.

In terms of preparation to work with stepfamilies, I would want students and new counselors to be aware of the wealth of current professional knowledge, as compared with self-help resources, and to honor that an admission of “not knowing” is not a sign of clinical unreadiness, but rather of receptivity to new learning.

 

What inspired you to write this book?

The roots of this work can be found in my clinical, personal and scholarly pursuits. I began providing counseling many years ago and was referred to a stepfamily support group to offer a psychoeducational workshop to normalize stepfamily challenges. Through working with stepfamilies as clients, I had recognized how dissimilar their family challenges were to those experienced by nuclear families, and had dedicated myself to learning what was known about stepfamilies in hopes of offering better clinical service.

Even then I intervened from a systemic perspective and saw the symptom bearer as the “voice” of family pain, requiring systemic change to allow the family to become unstuck. However, before I could intervene effectively, I needed to develop conjointly with the family an orientation toward healthy stepfamily functioning.

From personal perspective, I co-created a stepfamily over a decade ago, [composed] of two teen stepdaughters, their mother and a 6-year-old mutual child. That life experience has provided me with a reality-based template through which to evaluate my thinking and relationships as a husband, stepfather and father. That personalized learning has proven invaluable to continually reinforce the maxim that there is a gulf between theory and lived experience, and both are critical components of deeper and more profound understandings.

From a scholarly perspective, I trace my current book to my clinical experiences in my predoctoral days, my doctoral dissertation focusing on stepfamily marriages and then subsequent publications dealing with differing aspects of stepfamily life and growth. Driven by the identified failure rate of stepfamilies, plus the ongoing escalation in their numbers, I wanted to present to the profession what I hoped would be a useable and understandable treatise about how to help these families become more successful.

Finally, I hoped to contribute to the helping professions a guide for clinicians who work with stepfamilies, and for stepfamily members themselves who wish to analyze their unique family strengths and challenges.

 

 

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Stepping In, Stepping Out: Creating Stepfamily Rhythm is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222

 

 

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Stepfamily statistics

  • Approximately one-third of all weddings in the United States today create a stepfamily.
  • It’s predicted that stepfamilies will be the most common family form in the U.S. by the year 2020. An estimated 9,100 new American stepfamilies are created each week.
  • Thirty-three percent of all Americans are in a stepfamily relationship, including an estimated 10 million stepchildren under the age of 18.
  • The divorce rate for remarried and stepfamily couples varies but is at least 60 percent. At least two-thirds of stepfamily couples divorce, and divorce occurs more quickly in stepfamilies than first marriages.
  • About 46 percent of U.S. marriages today are a remarriage for one or both partners, and about 65 percent of remarriages involve children from the prior marriage, thus forming a stepfamily.
  • Four recent U.S. presidents were members of stepfamilies: Barack Obama, Bill Clinton, Ronald Reagan and Gerald Ford.

Source: Stepping In, Stepping Out: Creating Stepfamily Rhythm

 

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Counseling babies

By Evette Horton July 27, 2016

“There is no excuse for our society’s not putting scientific knowledge into practical use. … We must remember — the first few months of life are not a rehearsal. This is the real show.” — Irving B. Harris

 

A casual conversation on any given day:

“Oh, you’re a counselor! For what ages? I have this friend who …”

Me: “I work with infants and young children. I specialize in infant mental health.”

“Infant mental health? Like counseling babies? Ha! Do they lie on your couch?”

Me: “Yes, I do counseling with infants and their caregivers. Actually, what happens to infants in the first few years of life can have a big impact on their future development. The babies don’t lie on a couch and tell me their feelings, but they do have social and emotional needs.”

“Huh, who knew? So how do you do counseling with a baby?”

The term infant mental health originated in Britain, where much of the foundational research on infant social development began. Researchers such as John Bowlby, Mary Ainsworth and Donald Winnicott introduced us to the importance of our first social relationship: the infant-caregiver relationship. Infant mental health generally refers to the promotion of social and emotional development in infants and young children ages birth to 3 years. Sometimes the term early childhood mental health is used to expand the age range up to 5 years. To infant mental health providers in the field, the terms are interchangeable, and for this article, I will use the standard term infant mental health.

As the collective knowledge of child development and neuroscience expanded on the British researchers’ foundational work, the infant mental health movement grew stronger and spread throughout the world. Rigorous empirical studies from interdisciplinary groups of researchers conclusively determined that what happens in an infant’s early life can have a profound impact on his or her adult development.

Brain growth and adaptability

There are several core concepts in infant mental health that come from decades of research and inform our practices. First, neuroscientists have discovered that an infant’s brain grows remarkably fast in the first few years of life, making an estimated 700-1,000 new neural connections every second. Pat Levitt, science director of the National Scientific Council on the Developing Child, summarized thousands of studies on brain plasticity into one graph to show how adaptable a young child’s brain is to growth experiences in the first few years of life.

These findings propelled the early intervention movement, a service for children ages birth to 3 years with identified developmental delays. Infant mental health providers of all disciplines, including speech and language therapists, physical and occupational therapists, counselors and pediatricians, found that they could make huge developmental gains for an infant with developmental delays if they could provide their intervention services during the infant’s first few years of life. Getting these services early better prepared the infant for later academic and social success.

CDC Core Story FINAL

For example, when I was a school counselor in an elementary school, I was responsible for coordinating the arrival of several new kindergartners who had received early intervention services as toddlers and preschoolers. Throughout the summer, I read their Individualized Education Programs and histories and knew what their educational and social goals were. I felt like I knew these children already, so when school started, I assumed I would be able to go to their kindergarten classrooms, identify these children and see how they were doing. When I arrived, however, I could not pick the identified children out from all the other new kindergartners in the classroom. I had to ask the teacher and double-check my list. The children were doing amazingly well.

Those students who had received early intervention services continued to thrive throughout their time in my elementary school. Interestingly, the kindergartners who arrived without any history of early intervention services, but later were determined to have emotional, social or other developmental delays, were the students who struggled the most during their elementary school years.

I had learned, firsthand, how early intervention services could harness the power of the developing brain during a child’s first few years of life and how children who had missed that opportunity for early intervention took much, much longer to catch up.

The caregiver connection

A second core concept in infant mental health involves the research finding that infants develop in their relationships with their caregivers, including parents, foster parents, adoptive parents and child care providers. In 1947, Winnicott famously said, “There is no such thing as a baby. … If you set out to describe a baby, you will find you are describing a baby and someone.”

In other words, to learn, grow and thrive, infants must depend on their caregivers. Without a caregiver’s consistent, sensitive attention and interaction, infant brains do not develop to their optimal capacities.

The Center on the Developing Child at Harvard University describes this concept as a serve-and-return interaction in which the back-and-forth social interactions between the caregiver and infant help build the infant’s brain architecture and promote healthy development. Infant mental health counselors work with the infant and the infant’s primary caregivers to help the caregivers hear, see and understand the infant’s fundamental social and emotional needs.

To see what serve-and-return interactions look like and how a lack of these interactions can affect an infant, watch Ed Tronick’s widely viewed “still face” experiment video (youtube.com/watch?v=apzXGEbZht0). Tronick is a pioneer in the field of infant mental health and has been conducting still-face experiments for decades.

In the experiment, we watch a mother first use serve-and-return interactions to engage with her infant. Then the mother withholds her serve-and-return interactions for two minutes to see how the infant responds. In that short time, we can clearly see that the infant experiences distress, and researchers have found biological markers that confirm the distress the infant feels when these back-and-forth interactions are stopped.

Why does this matter? As we see in the video, the infant and mother quickly reconnect and delight in each other. One two-minute experiment is not sufficient to cause long-term damage to the infant’s development. But if the mother’s interaction had been withheld for a sustained period of time, this lack of interaction might have had a negative effect on the infant and the infant’s relationship with her caregiver, such as in instances in which a caregiver has clinical depression or a substance abuse disorder.

In such a situation, an infant mental health counselor would work with the caregiver’s mental health provider and doctors to help the caregiver notice the infant’s need for engagement.

Toxic stress

The third core concept important in understanding infant mental health is toxic stress. The Center on the Developing Child at Harvard University describes toxic stress as long-lasting environmental stressors, such as in cases of child maltreatment, that over time cause damage to the infant’s developing brain.

All infants and young children experience stress, but when the stress is prolonged and not attenuated by nurturing caregivers, it causes reductions in neural development. In such cases, infant mental health counselors are called in to conduct social and emotional assessments to determine if any social or emotional delays are present. If delays exist, the counselor works with the infant and his or her caregivers on the maximal ways to reduce the infant’s stress and return the child to a healthy developmental path.

For example, an infant mental health counselor might be needed when an infant or young child experiences an extended separation from a primary caregiver, such as in cases of foster care placement, extended caregiver hospitalization or caregiver incarceration. These types of separations from primary caregivers can be traumatic to infants and young children and may cause heightened stress responses.

Consider an 18-month-old male child separated from his mother so she can attend a drug treatment program. During the separation, the current caregivers notice an increase in the child’s sleep disruptions, tantrums and separation anxiety. During this difficult transition, the infant mental health counselor is called in to help the child manage his stress. The counselor also helps the caregivers better understand and manage the child’s newly developed symptoms in ways that are sensitive to his trauma history. When the mother and the now 2-year-old reunite, an infant mental health counselor might be called in to help reconnect and repair the relationship between the child and his mother, help the mother understand how the child was affected by the separation and help the mother respond to her child’s attachment needs.

The research on toxic stress is robust and has applications to many dimensions of public health. The Centers for Disease Control and Prevention-Kaiser Permanente Adverse Childhood Experiences Study, conducted by Vincent Felitti, Robert Anda and colleagues and first published in 1998, asked more than 17,000 adults about their childhood experiences. The researchers found that the more adverse experiences the adult participants reported having as children, the more at risk those adults were for physical, social and economic difficulties, including heart disease, chronic obstructive pulmonary disease, depression, substance abuse, intimate partner violence and so on. Thus, intervening in an infant’s life may have profound impact not only on the infant’s current mental health but also on his or her future mental and physical health.

This finding has led to further research by economists, including Nobel Memorial Prize-winning economics professor James Heckman, who have determined that the more we invest in services for infants and young children, the bigger the return on our investment (see heckmanequation.org/content/resource/why-early-investment-matters).

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Infant mental health competency

Becoming an infant mental health provider frequently requires post-degree specialty training to understand and incorporate these three core infant mental health concepts, as well as several other concepts and evidence-based practices. According to a 2009 article on competencies for infant mental health therapists written by Herbert Quay, Anne Hogan and Keith Donohue, counselors working with this age group need to have an understanding of:

  • Both normal and atypical social-emotional, cognitive and physical development in the first three years of life, including brain development
  • Attachment theory and what it looks like in the first three years of life
  • The tools for assessment and intervention
  • How parenting/caregiving behaviors affect early childhood development

Courses and workshops are available that can help interested counselors become competent in infant mental health. In these courses, counselors will learn about the variety of valid tools used to assess infants of all ages and stages and the evidence-based clinical interventions for working with this population, including Child-Parent Psychotherapy and Attachment and Biobehavioral Catch-Up. Several states offer certificates of competency in infant mental health, and international conferences and journals address research topics in this area of practice.

What all counselors need to know

By this point, readers are probably thinking, “This is interesting, but how does this relate to my work as a professional counselor?”

Although not every counselor is interested in becoming an infant mental health specialist, every professional counselor should at least become informed about the broad core concepts. For example, every professional counselor should understand that:

  • The brains of infants and young children ages birth to 3 years are in a delicate developmental position that may benefit from or be inhibited by factors occurring in their immediate environments.
  • Infants and young children have social and emotional needs and can have mental health issues just like older children, adolescents and adults.
  • There are evidence-based interventions to preventatively and positively impact these mental health issues.
  • If a client has an infant or young child in the family, it is possible that the infant or young child may need a social-emotional assessment from a qualified infant mental health counselor.

For example, perhaps you are a substance abuse counselor working with a client who thinks that his or her children are too young to be affected. Or perhaps you are a school counselor and notice that a family with which you work is struggling because the father has just been incarcerated and you know there is a newborn in the home. Your job may not be to work with the infant or young child directly, but you can let the family know that research speaks to how infants and young children can be affected by such events. You can also let the family know that counselors are available to work with the infant or young child and family to ensure that the child is meeting his or her social and emotional developmental milestones during this time of family stress.

Finding an infant mental health counselor in your area can require some effort. The best way to begin is by seeing if your state or country has an infant mental health association. The World Association for Infant Mental Health has a worldwide list of its affiliates, or you can use an online search engine to see if your state has an independent association. Contact the association to ask for providers in your area.

Another place to look for infant mental health providers is your local pediatrician’s office. The American Academy of Pediatrics recommends that all children be screened for social and emotional developmental milestones at the ages of 9 months, 18 months, 24 months and 36 months during the child’s yearly well-child visits. Most pediatrician offices have a list of support services available to caregivers with young children. Because of the high risk of trauma in children exposed to maltreatment, your community’s child protective services office should also have a list of infant mental health providers in your area.

If you are interested in learning more about infant mental health, consider joining the Association for Child and Adolescent Counseling (ACAC), a division of the American Counseling Association. ACAC’s mission is to “promote a greater awareness, advocacy and understanding of children and adolescents, as defined as the ages from birth to adolescents” (see acachild.org). ACAC has sponsored several infant mental health workshops at the national ACA Conference and in the near future will host an ACAC conference at which infant mental health sessions will be offered.

One of the core professional values of the counseling profession as listed in the 2014 ACA Code of Ethics is “enhancing human development throughout the life span.” One of the best things about being an infant mental health counselor is that I get to see this “enhancement” of human development. In fact, my goal is to prevent future mental and physical health issues. I have seen improvements in an infant’s social and emotional development through evidence-based infant mental health interventions in as little as six weeks.

My hope is that this brief article has highlighted some important research findings for you as a professional counselor and that you will share the information about the importance of working with infants and young children with your clients, students and colleagues whenever it is pertinent. Together, professional counselors can enhance human development from day one.

 

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For more information about infant mental health, see:

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Evette Horton, a licensed professional counselor supervisor and registered play therapy supervisor, is clinical faculty in the School of Medicine at the University of North Carolina at Chapel Hill. She is a founding and current board member of the Association for Child and Adolescent Counseling (ACAC) and serves on the editorial board for ACAC’s Journal of Child & Adolescent Counseling. She is also a founding board member of the North Carolina Infant Mental Health Association. Contact her at evette_horton@med.unc.edu.

Letters to the editor: ct@counseling.org