Tag Archives: Children & Adolescents

Children & Adolescents

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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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.

The Social Adventures and Experiments of  Tommy Joe Peterson

By Brandon S. Ballantyne February 7, 2017

The idea of this therapeutic short story is to creatively illustrate the various dilemmas that occur from the perspective of a socially awkward young man, Tommy Joe Peterson. Through the story, the reader is able to gain perspective on the thought process and problem-solving skills of this uniquely talented 11-year-old boy.

Whether this fictional story is read by a child or read to a child by a teacher or counselor, the discussion questions included at the end are aimed at facilitating reflection and interpersonal growth. I believe that discussing the responses to the discussion questions will allow for improved awareness and insight into real-life dilemmas and help children to improve their problem-solving skills in a creative, narrative manner.

The target population for my therapeutic short story consists of teachers, parents, therapists and children of elementary through middle school age, particularly those with a mental health diagnosis similar to or consistent with autism spectrum disorder or social anxiety.

Friendship

Hello, my name is Tommy Joe. I am 11 years old. And in my mind, I am not just a boy. I am the world’s most coolest teenage superhero in my school. Well, at least I pretend to be.

Let me tell you about the time I almost saved my friend William from a flying plate of steaming hot lasagna in the cafeteria. Oh, and just so you know, William is only a few months younger than me. This is what happened …

The day started out just like any other day. I woke up at 6:37 a.m. I always wake up at that time to ensure that I get as many cartoons in as I can before I leave for school at exactly 8:02 a.m. I like the superhero cartoons. Batman is obviously the best, and I think I am like him in some ways. Although most adults say I am socially awkward, whatever that means. Clearly, they do not understand my abilities.

Anyway, after my cartoon time, my mother prompted me to participate in what she calls “activities of daily living.” She is a nurse, and I hear those types of phrases all the time. I have gotten used to it. This is the part of my morning routine during which I brush my teeth and comb through my brown wavy hair. I usually place some deodorant under each armpit, but not a lot. I typically do not like the texture, but I tolerate it enough to get at least a little bit of scent on me. Every good superhero needs a scent — at least that is what my mother tells me.

It was almost time to leave for school, so I slipped on my Velcro shoes and placed my bright red turtleneck on so it fit nice and snug, just the way I like it. I refuse to wear anything else but that red turtleneck. I feel most like a superhero in that shirt. Some people tease me for this. They clearly do not understand my abilities.

The bus ride to school is short. I live only four blocks from the school. And as a fifth-grader, riding the bus is the cool thing to do. On that day, the older kids were making fun of the way I was dressed. They always do. They also make fun of the way I only spray certain sections of my hair. You see, only some sections of my hair get messy, so there is no need to hairspray it all down. Only certain sections need a touch-up.

I do not think that the other kids understand my perspective. I don’t mind though. Life can be hard for a superhero like me. Clearly the other kids on the bus do not understand my abilities. And anything is better than riding to school with your parents, although my mother does listen to good music. But that is beside the point, and I do not want to ramble on, so let’s get back to the story of how I almost saved my friend William from an extremely steaming hot plate of lasagna.

I meet my friend William at the same spot every day before going into school. Every superhero needs a sidekick, and William is mine. William is shorter than me, and he refuses to be called Billy. He thinks that William is more formal, and he likes that. He has red curly hair and orange glasses. I do not really know where he got those glasses, but I like them. His glasses usually slip down to the end of his nose, and he has to spend most of the day adjusting and readjusting them. We have every class together. Every superhero needs a sidekick, and at least William understands my abilities.

The day was pretty boring until art class. It is like that every day. William and I count down the minutes leading up to our fourth-period art class. For us, it is more than just art class. It is a time for us to create new supercool superhero ideas. And on this day, the topic of class was “favorite transportation.” This was a perfect topic for superheroes like us.

William and I decided to create a spaceship. This was no ordinary spaceship. This was a supercool spaceship that William and I had imagined ourselves using to explore the outermost limits of our galaxy — beyond the black holes, red dwarfs, supernovas and solar flares.

By the way, space is my other supercool area of interest. William is mostly indifferent to the idea of space travel, but every superhero needs a sidekick, and because of that, I think he would come with me anyway. I guess the only problem would be if William gets motion sickness. I wonder if he gets sick in the car? To tell you the truth, I do not really know how William gets to school each day. I have never been in a car with him. Quite frankly, I only see him at school. Oh well, I do not want to ramble. Let’s get back to the story of how I almost saved William from an extremely overwhelming, steaming hot plate of lasagna in the school cafeteria.

Before describing the scene that would be about to take place in the cafeteria, it is important for me to be able to tell you how our art project turned out. William and I made a spaceship using cardboard, paint and a whole lot of glue. The spaceship was red, just like my turtleneck.

William is exceptionally good at folding cardboard, so I gave him the job of working on the wings. William attached long, narrow wings that seemed as if they would touch the ceiling. We carefully added glue to all the areas that needed to be held together, and then we added more glue, and then more glue, and then one last coating of glue to ensure that this spaceship could tolerate the astronomical elements that space travel would bring to the table. Every good astronaut needs a sidekick.

Our hands were sticky from the glue. It was hard for us to pull our fingers apart. But our spaceship was complete. William and I carefully placed the spaceship in our art closet to dry.

The bell rang for lunch. We hurried out of the classroom without cleaning up the rest of our materials. This was necessary because we need to get to lunch early so that we can sit at the table in the left corner — the one by the ice cream cooler. I like ice cream sandwiches, and it is important to be next to the cooler so that I can get two of them before they sell out. Every superhero needs his energy, and I just happen to get mine from ice cream sandwiches.

William prefers pizza, but they do not always have that. I once had the idea of putting my ice cream sandwiches on my pizza, but I have not been able to convince William to try it with me. And as a superhero, you need your sidekick to be on board before trying anything new. But that is for another story. Let’s get back to this one. I don’t want to ramble.

William and I entered the cafeteria and at a casual but fast pace assumed positions at our table by the ice cream cooler. The cafeteria was loud and chaotic as various students attempted to jockey for position in the lunch line. The teacher on duty was obviously struggling to keep order. I could tell by the look on her face. I did not have this teacher for class, but any good superhero can tell when another person is in obvious distress. I wish I could have helped her, but I needed to remain in position at my table.

This was partly due to the fact that the ice cream cooler is positioned just outside the kitchen, and as kids pass through the lunch line, they typically select their favorite ice cream product to complete their tray. William and I do it backward — we wait for a break in the line, and then we purchase our desserts first. Most kids do not think of going to the ice cream cooler first because it is positioned at the end of the line. Being the most supercool superhero that I am, I had developed this approach early last year. William agreed with me, although he typically does. William is a great sidekick.

The time was right. William and I stood up to go make our selection. I always purchase two ice cream sandwiches. William typically purchases the Italian ice. At least I think he does. Anyway, it was at that moment when we stood up that I began to notice an increase in chaos in the far right-hand side of the cafeteria. I quickly glanced over, and before picking out my ice cream, I noticed a food fight taking place. It was on the other side of the cafeteria, but it appeared as though it was escalating rapidly.

I needed to get my ice cream. I reached down and realized that I could not pull my fingers apart to grab it. Oh no, it was my worst nightmare. My fingers had been glued together from working on our spaceship in art class. It seemed that the harder I tried to pull them apart, the more they seemed to be glued together.

I had one dilemma with not being able to literally pick up my ice cream sandwich, and another dilemma with the rapidly growing food fight that was moving across the cafeteria like a tidal wave. I had to make a decision. I either needed to take cover and sacrifice my ice cream sandwich, or I needed to take the chance of being hit by food and attempt to grab my ice cream with my glued-together fingers. I had to think quickly.

At that moment, I noticed a red substance flying through the air toward William. I saw it out of the corner of my eye, so it was hard for me to tell what it was. But as it flew through the air, I realized that it was a piece of lasagna. It was hot. I could see the steam coming off of it as it whizzed past the heads of various students.

At this point, even the teachers were taking cover. Mr. Jones was under the table, and Ms. Sprockett was hiding behind the soda machine. The flying lasagna was coming our way, and based on my superhero calculations, it was heading directly toward William.

Everything was moving in slow motion. William was frozen in fear. He needed me. I quickly lunged in his direction and raised my hands in an attempt to take most of the blow from the flying lasagna. Every good superhero occasionally makes sacrifices for his sidekick — at least Batman did.

The only problem was that my fingers were still glued together. The lasagna not only hit my arms, covering me in sauce, but it also smothered William. He had sauce and cheese all over him. And the worst part of it was, I didn’t even get my ice cream sandwiches. The last thing I remember was William tasting the lasagna that was dripping off of his cheeks. William is always good at embracing chaos.

I guess even the best superheroes sometimes have trouble rescuing others. But William and I are still friends. He has forgiven me, and there are no hard feelings between us. I guess what I have learned from this situation is that every superhero needs a sidekick. I do not know what I would do without William. He is my best friend. But maybe next time, I won’t use so much glue.

 

Therapeutic discussion questions 

  • According to Tommy Joe, every superhero needs a sidekick. Who is the sidekick in your life? Who do you feel supported by? Who listens to you when you talk?
  • What makes someone a friend? What makes you a friend? What types of things do friends do for one another?
  • Discuss a difficult situation that a friend helped you with. What did they do to support you?
  • Discuss a difficult situation that you helped a friend with. What did you do to support them?
  • The glue on Tommy Joe’s fingers makes it difficult for him to rescue William and pick up his ice cream sandwiches. What should Tommy Joe have done prior to going into the cafeteria that would have made it easier for him to help William?
  • What is a goal you have in your life? What is an obstacle you face in your life? How can you plan ahead to make accomplishing your goal easier?
  • What can your sidekick do to help you reach your goal?
  • If you were Tommy Joe, what would you have done differently in the story? How would making different decisions have affected the outcome of the story?
  • Is there another way the story could have ended? If so, I would love to hear your version.

 

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Brandon S. Ballantyne, a licensed professional counselor and national certified counselor, has been practicing clinical counseling since 2007. He currently practices at Reading Health System in Reading, Pennsylvania, and Advanced Counseling and Research Services in Lancaster. He has experience working with both adolescent and adult clients struggling with moderate to severe depression and anxiety. He has facilitated many unique interventions and group modalities in the area of addressing relationship conflict and negative thought patterns. Contact him at ballantynebrandon@yahoo.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.

 

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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.

The Counseling Connoisseur: Nature-informed counseling for children

By Cheryl Fisher October 13, 2016

“Once there was a tree … and she loved a little boy” — from The Giving Tree by Shel Silverstein

 

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I recently returned from a wonderful week in Nova Scotia featuring painted clapboard cottages against blue skies and a seascape of majestic hills and swirling tides. With a history rich in forts, fur trades and complex propriety, Nova Scotia also affords miles of pristine trails for the avid (and not so avid) hiker.

On one such hike, I ventured up Cape Split, which offered a spectacular view of the Bay of Fundy following a two-hour uphill jaunt. The inland path was lush with evergreen and paved in centuries-old rocks. Snarled roots from ancient maples protruded from the narrow trail, and patches of mud provided slippery terrain. At times the trail seemed endless and unforgiving. However, just at that moment when body and morale were failing, the forest opened to a grassy knoll that blanketed the age-old rock formation overlooking the (now) returning six-foot tides of the Bay of Fundy.

Damp with perspiration from navigating the trail, we sat down and unloaded our backpacks, laying out a feast before us of lobster rolls and blueberry lemonade. The cool breeze from the bay mingled with the warmth from the sun. In that moment, I was sure there was nothing sweeter than communion with nature and the physical and emotional exertion and spiritual nourishment it afforded.

 

Camps and communion

For many children (and their excited parents), the end of summer signifies a return to school, studies and schedules. It is a time when we bid farewell to the lackadaisical whimsy of carefree days. Summer memories of camps, cookouts and canoes fade, making way for the cooler activities of autumn. However, for many children, summer camp did not include nature hikes, bonfires or kayaking; it involved indoor activities centered around a theme such as weight management, music acquisition or computer skills.

photo-1447875372440-4037e6fae95dResearch suggests that connecting to nature can result in reduced stress, increased energy, improved sleep, reduction of chronic pain, and accelerated healing from injuries and surgery. In particular, Peter Kahn and Stephen Kellert have argued that “a child’s experience of nature exerts a crucial and irreplaceable effect on physical, cognitive and emotional development.”

Yet modern living has insulated us from the positive ionic exchange between grass, trees, river and sky, resulting in a physical, psychological and often spiritual connection from the Earth and her creatures. According to researcher and therapist Martin Jordan in his book Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces, this detachment is associated with a variety of dis-ease, including epidemic rates of obesity and depression.

Richard Louv, author and founder of the Children & Nature Network, coined the term “nature deficit disorder” in his book Last Child in the Woods to refer to a generation of children who no longer spend time outdoors hiking, camping and otherwise interacting with the natural world. Direct contact with nature appears to benefit children physically, emotionally and spiritually.

 

Physical

Interacting with natural elements provides a varied and complex terrain and physical stimulation for children. Negotiating inclining hills or slippery declines, catching and releasing tadpoles or crickets, and chasing butterflies, for example, create opportunities for skill-building in a variety of areas, including large and fine motor skills, balance and hand-eye coordination. Most people can remember the challenge of a new skill … and the thrill of successful mastery.

 

Emotional and cognitive

According to Kahn and Kellert, a child’s experience of nature “encompasses a wide variety of emotions” and an “unfailing source of stimulation.” I remember the awe and wonder I experienced when my childhood naturalist neighbors taught me how to look for the tiny green caterpillars grazing on the cabbage leaves in the garden; then observing their transformation as they ate their way to chrysalises; and the unbearable waiting and waiting until these dormant creatures emerged into beautiful white butterflies.

More recently, I ventured into raising the threatened monarch butterfly. Still with the curiosity of a child, I planted my milkweed, purchased my microscopic caterpillars and watched in amazement as larvae transformed into J’s hanging from the top of my butterfly shelter. Sadly, a virus attacked my precious guests and killed each before they could take their first flight. I experienced genuine grief over this loss.

 

Moral

Nature provides endless teaching opportunities around issues of moral conscience. Kellert identified nine values of the natural world:

  • Aesthetic: Physically appealing
  • Dominionistic: Mastery or control over nature
  • Humanistic: Emotional bonding with nature
  • Moralistic: Ethical or spiritual connection to nature
  • Naturalistic: Exploration of nature
  • Negativistic: Fear and aversion of nature
  • Scientific: Knowledge and understanding of nature
  • Symbolic: Nature as a source of language and imagination
  • Utilitarian: Nature as a source of material and physical reward These values tend to emerge in a developmental manner, generally shifting from more self-centered, egotistical values to more social and other-centered values.

 

Nature-informed counseling

Nature-informed counseling refers to a vast array of scientifically based psychological therapies that use nature in clinical practice. Among the foundational assumptions of nature-informed counseling are that we are not machines; we are human beings who are sensual, curious and creative. We are interdependent with the full ecosystem in which we reside.

Furthermore, ecotherapy is an organic model of care that tends to the whole relationship between humans and the other-than-human. Here are several ways to incorporate nature-informed methods into your counseling practice:

1) Animal-assisted therapy: I am fortunate to be able to bring my goldendoodles to my office to be co-therapists. However, in addition to dogs, there are other smaller pets that may work more easily in your practice. For example, I had a betta fish (who was named Olive by a client) that I used with clients. Or place a bird feeder outside your window (if you are fortunate enough to have a window).

2) Horticulture therapy: There are numerous ways to integrate plants in a therapeutic manner. Have clients plant seeds and tend to their care. Or keep small pots of herbs in your office, providing an opportunity to explore aromatherapy. It is a wonderful release to pinch off a bit of rosemary, mint or thyme and inhale the calming, soothing or energizing fragrance.

3) Wilderness therapy: I have used “kayak therapy” with trauma survivors with great success. However, you may not work in a community with easy water access or even know how to kayak. Therefore, your wilderness approach might be more in line with taking clients on a walk on a trail or observing wildlife with them in a nearby lake or pond.

You can also co-create homework around nature walks. For example, I was working with a couple who seemed stuck, so I asked them to go for a walk together (without talking) and collect items along the way that reminded them of their marriage. When they returned to my office, they emptied their treasures, which included a rock (“that used to be how I saw our marriage”), a feather (“we are drifting away”) and a few twigs (“we have roots still”). After a discussion centered around the items gathered, I had the couple finish the session by using the items to create a sculpture that reflected the relationship they wanted to craft.

4) Other ideas:

  • Assess your clients’ relationship with nature. Where is their “happy place”? How often does they get to visit it? Where are their favorite memories housed?
  • Invite a family with which you are working to spend the night in a tent in the backyard and reflect on this experience in session.
  • Teach cloud spotting. Teaching clients mindfulness takes on a fun twist as you lie on your back and gaze at the ever-changing cloud formations.
  • Use transitional objects. I keep a box in my office filled with seashells, sea glass and rocks lovingly collected by my own mother when she walks the beach. I use these as transitional objects when clients might benefit from imprinting an image or experience to an object that they can carry in their pockets or purses throughout the day.

 

Ethical consideration

As with all forms of practice, ethical standards must be followed to avoid harm and litigation. So what are the ethical considerations when utilizing the wisdom of nature in psychotherapy? This depends on the extent and type of nature-informed therapy you are using. For example, the ethical guidelines for hiking a trail with a client may look a bit different than the guidelines forphoto-1469440317162-d9798b137445 planting a sunflower seed and tending to it as metaphor for self-care and growth. However, in general the following issues must be addressed.

1) Do all parties feel physically and emotionally safe? Although you may thrive sitting in a field of poppies, your client may possess strong allergies to flower pollen that render therapy outdoors a physically uncomfortable experience. In addition to allergies, the client may exhibit phobias around the outdoors that need to be understood and appeased. Temperature and air quality may also be variables to consider.

2) Framing the relationship. For some therapists and clients, an office space with a designated chair arrangement signifies a professional relationship and the tasks that will ensue. A client may feel uncomfortable with the more lax and familiar atmosphere of sitting cross-legged on a hollow log while disclosing current therapeutic issues. Trading leather chair for log stump may alter the relationship in ways that prove unsettling for either the client or the therapist.

3) Is it confidentiality compliant? I have clients who love taking a walk during therapy. Some lament that it is the only time they have for physical activity. However, if we are walking in a heavily populated area, their confidentiality may be at risk. At the same time, an area that is too isolated may not be prudent should an emergency situation arise.

4) Get appropriate training. If you do not know how to kayak, taking clients on a wilderness kayak expedition probably isn’t wise. Always get training before using any modality in therapy.

5) Informed consent. It is always prudent to have clients sign an informed consent form that stipulates the possible risks and benefits of any therapy used in session. Therefore, a specific consent form that addresses the specific type of nature-informed therapy — including possible benefits and risks — needs to be explained and signed prior to taking that walk in the woods or a stroll in the garden during session.

 

Conclusion

Nature provides endless opportunities for metaphors, messages and meaning construction. Incorporating nature-informed approaches into our practices is not only creative but also clinically sound. It is as easy as taking the time to reflect on the sights, sounds, and smells just outside the door.

 

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For more information:

  • Ecotherapy: Healing With Nature in Mind by Linda Buzzell and Craig Chalquist (2009)
  • Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces by Martin Jordan (2014)
  • Children and Nature: Psychological, Sociocultural and Evolutionary Investigations by Peter H. Kahn and Stephen R. Kellert (2002)
  • Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder by Richard Louv (2008)

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Cheryl Fisher

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is currently working on a book titled Homegrown Psychotherapy: Scientifically-Based Organic Practices, of which this article is an excerpt. Contact her at cy.fisher@verizon.net.

 

 

 

 

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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.
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Behind the Book: Partners in Play: An Adlerian Approach to Play Therapy

By Bethany Bray October 10, 2016

It’s often said that play therapy reaches young clients through their own natural “language” of play. When combined with tenets of the Adlerian method, play therapy becomes a tool for the therapist to build an egalitarian relationship with the client while focusing on the individual and photo-1473662711507-13345f9d447chis or her dynamics with others, according to Terry Kottman and Kristin Meany-Walen, co-authors of Partners in Play: An Adlerian Approach to Play Therapy.

“The Adlerian belief in the ability to make new choices and to reinterpret situations provides a vehicle for play therapists to work with children to get out of their boxes, change their lifestyle patterns, increase their social interest, make shifts in the goals of their behavior and a host of other forums for determining their paths,” write Meany-Walen and Kottman in the book’s second chapter. “One of your primary responsibilities as an Adlerian play therapist is to discover how each child expresses his or her special and wonderful self and to convey a sense of celebration in his or her uniqueness to the child, parents and other people who interact with him or her. Sometimes the child expresses uniqueness in a way that others do not appreciate.”

Meany-Walen, an assistant professor of counseling at the University of Northern Iowa, and Kottman, who runs a play therapy counseling, training and workshop center in Cedar Falls, Iowa, are both licensed mental health counselors and registered play therapists.

The third edition of Partners in Play was published earlier this year by the American Counseling Association.

 

Q+A: CT Online contacted Kottman and Meany-Walen recently to learn more about this unique approach. Their responses are co-written, except where noted.

 

Your book focuses on Adlerian play therapy, which combines play therapy techniques with the Adlerian method. Why do you think they are a good fit? Why does that combination work to help young clients?

Adlerian psychology has a clear and easy-to-follow way to conceptualize clients and figure out what is “underneath” the presenting problem. Before the development of Adlerian play therapy, there was no precedent for working with individual child clients, nor was there a precedent for using play as a treatment modality using Adlerian psychology. We believe that combining Adlerian psychology with play therapy was a logical way to capitalize on the Adlerian methodology for conceptualizing and developing a treatment plan [while] at the same time using play, the “natural” language of children, to communicate with them.

 

What are some key takeaways that you want counselors to know about this topic?

We want counselors to learn about the myriads of ways of using play, art techniques, sand tray, active games, movement and dance, bibliotherapy and therapeutic storytelling as a vehicle for helping children, adolescents, parents and family members to grow in positive directions. We believe that the four-phase model of Adlerian or Individual Psychology — building a relationship with the client, exploring the client’s lifestyle, helping the client gain insight into his or her lifestyle, and learning and practicing new skills — is an amazing vehicle for working with clients. We value the systematic way Adlerian counselors conceptualize clients — looking at assets and strengths, interpersonal dynamics, intrapersonal dynamics (like personality priorities, Crucial C’s*, goals of misbehavior, mastery of the life tasks), problem-solving skills, self-defeating thought patterns and so forth — as a way to determine the best way to decide on the direction and structure of the therapeutic process.

 

* The Crucial C’s are one method that Adlerians use to conceptualize clients. They were developed by Amy Lew and Betty Lou Bettner, who suggest that all people need to have courage (the willingness to try new things without a guarantee of success), connect (the desire and ability to build relationships with other people), be capable (the belief that they are able to master ideas and skills) and count (the belief that they are valuable and special without having to earn love or worthiness).

How does Adlerian play therapy fit with your personality and style as a counselor? What made you want to specialize in this area?

I (Terry) am a very encouraging and exuberant person. Adlerian play therapy reflects my personality by being positive and playful. I was drawn to Adlerian psychology because it is so focused on the strengths of the client, which is exactly what I wanted to do when I became a counselor. I love playing, have always loved playing and had spent my whole life working with children in some capacity. When I was in high school, I worked part time in a pediatrician’s office. When I was in college, I taught swimming lessons to young children and volunteered in an after-school program for children who came from low-income families. I got my first master’s degree in elementary teaching and my second master’s degree in special education. I loved working with children in schools. It was a natural transition for me to work as a school counselor and to become a play therapist.

Adlerian play therapy was also a natural fit for me (Kristin). I had often considered the experiences of my youth, and my perceptions of those experiences, as instrumental in shaping who I was as an adult. I explored many different counseling theories, and Adlerian psychology was most consistent with how I understand people and how I want to work with them. The systematic way of understanding people’s ways of belonging and operating in the world, from an Adlerian perspective, helps me to feel organized and productive, both of which are important parts of my lifestyle.

By happenstance, I took a class from (co-author) Terry Kottman where I began learning about the value and art of play therapy. I started to use some of the play therapy concepts with my own child, who was 8 years old at the time. I noticed drastic improvements in his mood, his behaviors and our relationship. I wanted to help other children and families in the same way.

 

One of the things that prompted you to write the first edition of this title (in 1995) was a rising interest in play therapy. Two decades later, is the field still growing?

Yes, it is. The field of play therapy continues to grow, with the Association for Play Therapy growing from 3,346 members in 1998 to 6,166 members in 2015, increasing at the rate of about 1.5 percent each year. There is a wider understanding of the importance of credentialing of play therapists (registered play therapists, or RPTs) among mental health professionals and with the public.

 

What is one thing you wish you knew about play therapy as a new counselor? What advice would you give to recent counseling graduates who are starting out and are interested in play therapy?

I (Terry) wish I had known that play therapy was not just for children — that teens, adults and members of families can also benefit from using play therapy skills and techniques (including art techniques, sand tray, active games, movement and dance, bibliotherapy and therapeutic storytelling) as a way to express themselves, explore their issues, gain insight, and learn and practice new ways of communicating, solving problems and interacting with others.

The advice I would give recent counseling grads who are starting a career in play therapy is to obtain really good training in play therapy. I believe it is essential to explore the different approaches to play therapy and find one that fits with your personality and what you believe about how personalities form and how people change. After that, find training that includes being observed with children and getting feedback about your skills and abilities.

 

What prompted you to create a third edition of this title? What new information will readers find?

The counseling field continues to evolve as we make discoveries and learn from our experiences. We wanted to provide updated information about play therapy, counseling and how the two merge. Since the last edition, we have seen an increase in the importance of evidence-based treatments and research. In the current edition, we include information about some of our ideas of researching Adlerian play therapy as well as published accounts of Adlerian play therapy. We also included various resources for readers such a list of activities to use with children and informal assessments to use with children, parents or teachers.

 

In addition to your book, what resources would you recommend for counselors who want to learn more about play therapy?

For beginning play therapists who want to know about play therapy skills, another book I (Terry) wrote that is published by ACA would be a good resource: Play Therapy: Basics and Beyond (second edition). Another excellent resource is the website of the Association for Play Therapy (www.a4pt.org).

 

 

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Branding-Box-Partners-in-PlayPartners in Play: An Adlerian Approach to Play Therapy 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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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.