Tag Archives: & Family

Remembering Minuchin and the democratization of therapy

By Charles F. Shepard February 25, 2018

Just after lunch on a Friday afternoon in late March 2017, Salvador Minuchin gently raised his hand to address the hundreds assembled to learn from him at the Psychotherapy Networker Symposium in Washington, D.C. If any of the attendees were drowsy from their meal or the demands of the week, they did not stay that way for long. Once the crowd quieted, the then-95-year-old giant of family therapy, his body and voice diminished by age, announced that this would be his last public appearance.

This was the first memory to hit me, nearly eight months later, when I saw Minuchin on the cover of The Washington Post on the first Sunday in November. Sadness and gratitude quickly followed when I learned that he had died, at age 96, on Oct. 30.

Minuchin’s face, voice and genius are familiar to many of us who have been trained to apply family systems theory to the practice of professional counseling. Many of us were introduced to what has become known as structural family therapy during our graduate training programs. Countless instructors have shown archived videos of Minuchin seeing, naming and changing the maladaptive patterns of families seeking his expertise at the renowned Philadelphia Child Guidance Clinic (CGC).

Salvador Minuchin (Photo via Wikimedia Commons)

Certainly, this is the contribution to the field for which Minuchin is best known, and it is my preferred mode of practice and teaching. However, it was Minuchin’s democratization of psychotherapy that I have found most inspiring.

Having earned his M.D. from the University of Cordoba in his native Argentina in 1947, Minuchin immigrated to the United States to be trained in child psychiatry and psychoanalysis. Minuchin was also Jewish, and his post-doctoral training was sandwiched around a stint serving in the Israeli army to support the fledgling state. By the mid-1950s, Minuchin had begun to work as a child psychiatrist at the Wiltwyck School for Boys along the Hudson River between New York City and Albany. The school was a treatment center for underprivileged boys, many of whom had been involved with the juvenile court system, between the ages of 8 and 12. It was at Wiltwyck that Minuchin first conceived of inviting a child’s family into the consulting room as a valuable contribution to the treatment process.

At the time, this move was revolutionary. Psychotherapeutic services were available almost exclusively to elite members of society and usually focused on individuals. Minuchin himself noted in “My Many Voices” — his contribution to the 1987 anthology The Evolution of Psychotherapy — that “parents were considered, frankly, destructive to the children. If they were seen at all, they were seen individually in the ‘main office.’”

Minuchin changed this system at Wiltwyck so that not only were children seen with their parents in the same room, but Minuchin and his colleagues observed each other providing and developing a style of family therapy through one-way mirrors. This innovation led Minuchin to develop a theory of family structure, his psychoanalytic training shining as he interpreted relational moves between family members and family subsets. Once he had developed his theory, he began to collaborate with other like-minded practitioners, namely Jay Haley, who joined Minuchin in Philadelphia at the CGC in the mid-1960s.

It was here that structural family therapy proliferated. Having accepted a position as director of the CGC in 1965, Minuchin published his first book, Families of the Slums, in 1967. A dozen books, some written with various co-authors, followed, including classics such as Families and Family Therapy (1974), Family Therapy Techniques (1981), and Working With Families of the Poor (second edition, 2007). At the CGC, Minuchin and his staff emphasized working with underprivileged families of the city — to the point that they were teaching laypeople to provide structural family therapy-influenced care to their neighbors in the nearby ghettos and barrios.

Clinicians from all over the world flocked to Philadelphia to learn from Minuchin and Haley. Among these trainees were Steve Greenstein and Dave Waters. By the late 1990s, Greenstein had moved on from the CGC and landed in Charlottesville, Virginia. In this small town, home to the University of Virginia (UVA) and set in the Blue Ridge Mountains, Greenstein furthered Minuchin’s democratic vision by taking structural family therapy outside the clinic walls and into the homes of families in crisis.

Greenstein founded the League of Therapists, a private agency that primarily provided intensive in-home counseling, a Medicaid-funded service aimed at helping prevent out-of-home placement for at-risk children. Clinicians were trained to help families from a variety of different circumstances. They helped reunite children in foster care with their birth families, prevent acute hospitalization and residential treatment, and prevent juvenile detention by working with the entire family system to see, name and change maladaptive relational patterns. Waters, who was a professor in the UVA medical school when Greenstein started his project, joined as a fellow supervisor.

Clinicians, who often were residents in counseling, marriage and family therapy or clinical psychology, videotaped their sessions and reviewed their work with Greenstein and Waters on a weekly basis. At its height, the League of Therapists had 12 offices across Virginia and as many as 300 providers. Thousands of families were served until the group closed its doors in 2011. Greenstein died three years later.

Nevertheless, the work continues. Several of the counselors who worked for Greenstein continue to provide home-based family therapy in Virginia. Waters continues to supervise and teach them through video review on a regular basis.

It bears mentioning that Minuchin was not without his critics. His obituary in The Washington Post noted that Minuchin came to the forefront of public discourse as the feminist movement was gaining strength. Activists from that end of civic discourse often found him “too willing to accept and reinforce traditional gender roles and stereotypical family units.” Furthermore, many of his colleagues found his methods, which at times could range from biting humor to blatant mockery, too confrontational.

This side of Minuchin is familiar to anyone who has viewed any of his archived video footage. It came through in the video he reviewed with the March symposium attendees. During the session, he referred to the father of the client family as a “brute” and made it bluntly explicit that he, Minuchin, was the expert in the room.

The tape was from the 1980s, when Minuchin was in his 60s and approaching the end of his career. On that Friday afternoon at the symposium, he was asked to comment on his perception of himself as he watched more than three decades later. He replied that he was embarrassed. “If I had it to do over again,” he said, “I would do it differently. I would do it more gently.” And so, the next generation may be inspired to take the core principles and techniques Minuchin developed but apply them with rounder edges.

The continued development and dissemination of structural family therapy has been centralized at the Minuchin Center for the Family, located just outside Philadelphia in Woodbury, New Jersey. However, clinicians who have been influenced personally and professionally by Minuchin are all over the world. A few of us were in the room with Minuchin this past March, and the moment was not lost on us. Minuchin was not only a great developer of the theory and practice of family therapy, but also one of the great advocates for giving the underserved access to a systemic approach to counseling. May we all carry his legacy forward in our respective communities.

 

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Charles F. Shepard is a licensed professional counselor and national certified counselor in private practice and a student in the doctoral counseling and supervision program at James Madison University. He learned structural family therapy in the style of Salvador Minuchin from Steve Greenstein, David Waters and Gretchen Wilhelm. Contact Shepard at cshepard.lpc@gmail.com.

 

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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.

Parenting in the 21st century

By Laurie Meyers February 22, 2018

Remember when receipt of a coffee mug emblazoned with “Best Mom Ever” or a T-shirt proclaiming “Best Dad Ever” was enough to validate someone’s skills and aptitude as a parent? In the 21st century, it seems that the ante has been raised. In the eyes of society, parents barely qualify as competent — much less “perfect” — unless they can check off all of the following qualifications:

  • Not only attend to, but anticipate, their child’s every need
  • Orchestrate their child’s academic success
  • Provide their child with all the best experiences and most useful activities
  • Make home an oasis of peace and harmony for the family (while simultaneously prospering in their own careers)

Attendance to one’s children at all times is mandatory. No exceptions will be made for parents working two jobs just to get by, single parents or parents of children with special needs. No foolproof instruction manual will be provided.

These extreme expectations, paired with the rapidly accelerating pace of modern life, present significant obstacles and pressures for parents who genuinely want to make their children feel cared for without driving themselves crazy. Many counselors are routinely helping clients respond to these and other challenges of modern-day parenting.

Parenting, problems and pride

“Always on” parenting requires a lot of problem-solving, which leaves parents focused on all the things that are going wrong, says American Counseling Association member Laura Meyer, a licensed clinical mental health counselor in Bedford, New Hampshire, who specializes in parenting issues and women’s concerns. In particular, working parents often have a difficult time attending every school function that is offered because they typically take place during the workday. This can feel like a failure, particularly for mothers, says Meyer, who is currently researching women’s parenting experiences.

As a kind of antidote, Meyer encourages clients to look for instances when they did something that made them proud of their parenting: “Maybe I wasn’t able to be there for this one particular event, but I made the costume that my kid wore in the play.”

It’s easy for parents to become trapped in the problems that they face, so Meyer encourages a solution-focused approach. For example, she has a client who is struggling with parenting a son who has intermittent explosive disorder. “She was at her wit’s end,” Meyer says. “He was kicking her [and] she was dragging him out of public venues.”

Meyer asked the woman to tell her what went well that week. At first, the client couldn’t think of anything. Then she remembered putting up a Christmas tree with her son. They had enjoyed decorating it together, and the mother took a photo. Meyer asked the client what might happen if every time that she and her son had a good moment together, she took a photo and included it in a chatbook — a social media app that allows users to generate photo books from uploaded pictures. Then they could sit down and look at the photos together each week.

The client burst into tears, saying it would make a huge difference to look at and remember some of the little victories rather than always thinking exclusively about the failures. Meyer suggested that the client could also use the photos to talk with her son about why that particular experience or day had been so good and then ask him how he had been able to remain calm.

Meyer encourages clients to use their counseling sessions as a time to stop and reflect on the quality of their relationship with their child rather than continually reacting to crises. Parents are often susceptible to getting caught up in the everyday duties of being a parent and missing out on the joy, love and upside of parenting, she says.

Helping prevent sexual abuse

Over the course of seven days in January, 156 young women and teenagers gathered in a courtroom in Michigan to recount how Lawrence Nassar, former physician for the USA Gymnastics team and Michigan State University, sexually violated them. Their stories detailed the widespread damage an unchecked predator with access to children and teenagers can wreak. Some of those who came to speak were accompanied by their parents, who were left to ask — in the words of one mother who testified — “How could I have missed the red flags?”

Most parents don’t have much accurate information about sexual predators, says ACA member Jennifer Foster, an assistant professor of counselor education and counseling psychology at Western Michigan University. Her research focuses on child sexual abuse.

In the past, most sexual abuse prevention efforts were aimed at children in the school system, she says. “This helped to create awareness, but the efforts had a major flaw in that they put the burden of stopping abuse on kids,” Foster observes.

As a former licensed mental health counselor and school counselor in Florida, Foster worked with many children who had been abused. “They would say to me, ‘I did say stop. I did say no,’” she recalls. Unfortunately, it is easy for children to be outmaneuvered and overpowered by adults and older children, so prevention efforts should focus on parents and other adults, Foster asserts.

Foster now helps educate parents about sexual predators. “I want parents to know all the scary info,” she says. This includes working to break down conventional myths. When asked to think about the profile of a “typical” predator, most people picture an adult male with a criminal record who is a stranger, or at least not someone the family knows well. Foster tells parents to picture instead the people they might invite to Thanksgiving dinner, because 90 to 96 percent of sexual predators are either family members or someone who is close to the family (the Rape, Abuse & Incest National Network puts this number at 93 percent). According to the Crimes Against Children Research Center, 36 percent are other children.

Parents don’t typically picture a female offender either, and although the reported incidence of sexual abuse by women is low, experts think that the actual rate is higher, Foster says. Unfortunately, parents are much more likely to hand over the care of their children to a woman — in a day care setting, for instance — without really knowing the person’s background, she continues.

Research also indicates a high rate of sibling-on-sibling sexual abuse, often with the use of force, Foster says. Many parents like to assume that this is something that happens only in families with lower socioeconomic status, but the truth is that it can take place in any family. Foster adds that research indicates that if child or juvenile offenders get treatment, they are likely to recover and not go on to commit the same offense again.

Foster teaches parents about some of the behavioral red flags of possible sexual predators, including spending more time with children than with peers, lacking adult friends, having numerous child-friendly hobbies and making inappropriate sexual comments about children. Foster reported a local teacher who regularly made sexually suggestive comments to his female students, such as, “If you were my daughter, I wouldn’t let you out the door in those pants because I know what I would be thinking.”

“That is such a great example of covert abuse, which was allegedly ignored by school staff when girls repeatedly complained about the teacher. That was one of multiple comments he made. They were told, ‘You’re taking it the wrong way. You misheard. You don’t know how to take a compliment.’ Then, when he had an opportunity and a student in isolation, the abuse moved to overt, with him putting his hand up her shirt.”

That student happened to be a member of a youth group Foster helps lead at her church. She believes the girl felt encouraged to disclose to her because of a pen that Foster often uses that says, “Rape. Talk about it.” Another girl in the group asked why Foster had that pen, and that gave Foster an opening to talk about the work she has done with sexual trauma survivors. After the group, the girl who had been violated told Foster about her experience. Foster contacted the school, which she says took no official action, instead simply allowing the teacher to resign.

Parents should also be wary of adults who are always putting their hands on kids or giving kids hugs, Foster says. These behaviors will often take place in front of other people because predators are testing to see if anyone notices and is alarmed by their actions. Predators also try to spend time alone with children and may give them gifts. Foster says that giving gifts can be an entirely benevolent act, but she also warns that it can be a part of the grooming process. Foster’s family has established a rule that her children won’t take gifts from anyone without first asking Foster or their father.

Foster also teaches her children that no secrets should be kept in their family (although she does distinguish between secrets and surprises). Part of the reasoning for this practice is that sexual predators often try to get children to keep small secrets. For example, “Don’t tell your mom I gave you ice cream before dinner. She’ll be mad at me!” Small secrets are a test of sorts, Foster explains. The predator is trying to gauge what a child will and will not tell his or her parents.

Predators are opportunistic — always looking for ways to be “helpful,” Foster says. They often try to come to the rescue, particularly with families in vulnerable situations, such as a family with a chronically ill child, a family that is new to town or a family headed by a single parent, she says. Becoming the family savior is part of the end goal so that they can get time alone with the children, Foster explains.

Although Foster believes that the burden of spotting and stopping child sexual abuse must be placed on adults, she says that it is still important for children to know that it is not OK for someone to touch them inappropriately. Foster likes to teach parents the language that Feather Berkower, a child sexual abuse prevention expert, uses about “body safety.” The concept is simple enough that even little children can learn it.

Body safety means that no one can look at, touch or take pictures of the child’s private parts, and children should not look at or touch another person’s body parts, Foster explains. She believes that children who aren’t taught about body safety are more vulnerable because they don’t have the language to talk about something that has made them feel uncomfortable, including actual abuse. Children should also learn the anatomically correct names for body parts, Foster says.

Foster’s son knows that everyone has to follow body safety rules. If he goes to a friend’s house, Foster also makes sure that the friend’s parents are aware that Foster’s family follows body safety rules. In addition, because of the prevalence of child-on-child sexual abuse, Foster does not allow closed doors when friends come over to play at her family’s house. She also intermittently checks in with her son about his interactions with the adults in his life by asking if he had fun with the person, what they did together and whether the person followed the body safety rules.

Most parents are also in the dark about how to keep their children safe online, Foster says, but they need to be aware that sexual predators often use online means to target children. Perpetrators often develop social media accounts and profiles, posing as someone who is the same age as the child or adolescent they are targeting and then revealing their true age later. After earning the young person’s trust, the predator may attempt to entice the child or adolescent to meet in person and move their encounters offline.

Foster recommends that families confine technology use to open spaces such as the TV room or kitchen. Parents can make use of tracking tools, but they should also have an open dialogue with their children about their online activity, Foster says. She also advises that parents find out what kind of technology rules other parents have before allowing children to go to their friends’ houses.

As a whole, Foster says, a higher level of vigilance against sexual abuse is required. She notes that most parents are good about discussing safety with their children when it comes to looking both ways before crossing the street, using a helmet when riding a bike or always wearing a seatbelt in the car. But more children are sexually abused each year than are hit by cars, and relatively few families take active steps to prevent that from happening.

“When it comes to child sexual abuse, adults need to take on the responsibility to create safe homes and communities,” Foster says. “Counselors [can] give them the tools they need.”

No longer partners but still parents

“Divorce changes kids’ lives [and] usually not in good ways,” says Kristin Little, a licensed mental health counselor whose Seattle-area practice includes a focus on counseling families that are navigating divorce or separation. “However, kids can manage even difficult divorce changes if well-supported and protected from the most harmful effects of conflict [such as] loss of confidence in their parents’ ability to lead, loss of stability in home/school life and loss of relationship with either or both parents.”

Little says the most essential thing that mental health professionals can do when counseling parents who are separated, divorced or in the process of divorcing is to introduce the idea of the separation of “adult mind” and “parent mind.”

“Parents can be experiencing a high level of anger or sadness while their marriage is ending. This is normal and expected and may be important for them to explore individually,” she says. “However, they continue to be parents and need to separate their own adult experience and reactions from their parenting roles. Giving parents the permission to feel, yet reminding them that they have the responsibility to attend to parenting needs, make important decisions, [and] see and respond to their children’s needs and feelings as separate from their own, is vitally important.”

ACA member Kimberly Mason, a licensed professional counselor (LPC) in Madisonville, Louisiana, who specializes in family and relationship issues, says that many parents have difficulty managing their anger, guilt and shame, and setting aside their conflict while parenting. To better shield their children from strife, she gives the following recommendations to parents:

1) Have ground rules for communication. Parents should not berate each other or argue in front of their children. If necessary, they should go to a private area to work out their conflict.

2) Each parent should seek individual counseling to work through his or her own issues. This can help limit the level of animosity and frequency of arguments that may occur in the home.

3) Model mutual respect for each other in front of the children. Each partner should also talk to family members and friends and ask them to refrain from saying negative things about the other partner in front of the children.

Parents who are facing divorce or separation are often terrified, which can override their ability to collaborate and make decisions, Little says. They may seek safety by sticking to past patterns of interacting and relying on assumptions about roles or capabilities that they held during the marriage or relationship, she explains. They often have difficulty envisioning change.

“This can result in one parent insisting that they are more experienced than the other and thus deserving of more time, which inevitably triggers fear and anger in the other parent and results in what we often see as a tug of war that rarely serves the kids’ or parents’ needs,” Little says.

Counselors can be a neutral “referee” of sorts for parents, steering the conversation away from who is wrong or right and instead toward developing a working co-parenting relationship that focuses on the future, she says.

ACA member Monika Logan, an LPC in Frisco, Texas, has a practice that focuses on divorce and parenting issues. She says that parents need to learn to form a more businesslike relationship by setting aside their emotions toward each other. Parents can begin to do this by “working on their own feelings related to the separation or divorce and developing a support network,” she says.

Little agrees with encouraging that approach. “[It] allows them to get the important job of parenting done,” she says. “It is essentially undoing the patterns, dynamics and practices of the marriage to allow for a renegotiation of how they will interact [and] the tasks they will agree to in the new co-parenting relationship.”

Each partner must agree to the new “business” guidelines or they won’t work, says Mason, who is also a core faculty member at Walden University. They must commit to putting their children’s needs above their own and making joint decisions. Compromise and consistency are also essential. The parents must be willing to back each other up when making decisions so that the children will still view them as a team, she emphasizes.

“Contrary to what some people describe, healthy co-parenting can be anywhere along the spectrum from parallel parenting — having little contact and overlap between homes and parents — to how co-parenting is usually thought of — frequent collaboration and interaction,” Little says.

There is no one-size-fits-all approach to co-parenting, she says. A counselor’s job is to help parents craft a plan that works for each partner, minimizes conflict and, most important, meets the needs of their children.

Coming to terms with coming out

As the LGBTQ (lesbian, gay, bisexual, transgender and questioning or queer) community has gained greater acceptance during the past 10 to 20 years, it has become more common for young people to come out to their parents, says ACA member Misty Ginicola, an LPC in West Haven, Connecticut, whose practice specialties include LGBTQ issues. She adds that those who come out are also often taking that step at younger ages than in the past — for instance, as middle schoolers rather than as teenagers.

How parents react to that decision is incredibly important to the mental health of the child. Ginicola, the lead editor of the ACA-published book Affirmative Counseling With LGBTQI+ People, has witnessed parent reactions in her practice that ran the gamut from accepting yet concerned to completely opposed and voicing a desire to “fix” their child. She tells parents looking to “cure” a child that counselors cannot, either from an ethical or a practical standpoint, change someone’s sexual/affectional orientation. However, Ginicola does try to address the concerns of all parents who come to her for help, whether they are “affirming” parents (who are supportive of their child’s orientation) or “disaffirming” (those who reject LGBTQ status).

Even parents who are supportive of the LGBTQ community may have problems adjusting to their own child coming out, she says. They may ask if the child is “sure” or, if a child comes out as gay or lesbian and then subsequently shows interest in someone who is other gendered, they may say, “Oh, so you’re really not [gay or lesbian],” Ginicola reports. These kinds of reactions often spring from parents’ fears that their child will be bullied or belittled or face other hurtful consequences, she says.

However, Ginicola explains to parents that when they ask those kinds of questions or make those kinds of statements, what their children actually hear is that something is wrong with them. Children are very vulnerable when coming out. In fact, the risk of suicide is highest during the coming-out process, but research shows that having supportive parents reduces this risk by half. So, it is crucial for parents to strive to always communicate support and to be willing to admit and apologize when they have said the wrong thing, Ginicola emphasizes.

Ginicola also teaches parents that although they cannot keep their children from being bullied, they can help them cope by building and reinforcing their self-esteem, teaching them good social and emotional skills, and ensuring that they have allies such as friends, teachers and school counselors in place.

One of the ways parents can help build their children’s self-esteem is by helping them find places where they will be accepted through whatever interests and activities they enjoy, Ginicola says. She cautions, however, that parents must take it upon themselves to ensure that these places are safe and not an environment in which their child will be rejected or targeted.

Parents should also talk to their child’s school to confirm that it has sound anti-bullying policies in place, Ginicola says. Most important, parents must make sure their children understand that there is nothing wrong with them and that they are not the problem, she emphasizes.

Unfortunately, the reality is that although acceptance for those who identify as LGBTQ has grown tremendously, they are still at increased risk for experiencing violence, meaning that parents need to talk to children who have come out about safety, Ginicola says. Specifically, children should be careful about who their friends are and make sure that they attend parties and other social events with people who are affirming, she says. Parents should also caution children who are not fully out to be very careful about whom they tell, not because there is anything wrong about telling but because sometimes it can be unsafe, Ginicola says.

Open communication is also essential. Children need to know and trust that they can tell their parents anything, Ginicola says. It is particularly critical that children understand the necessity of informing their parents about any instances of bullying, violence or other actions that threaten a child’s safety, she says.

Counselors must also prepare parents for the rejection that they will experience, Ginicola points out. For example, it is possible that family members might say hurtful things about a child who has come out and question how the parents are raising the child, she says. Community members may also weigh in with their own judgments, which Ginicola has experienced personally, including when a neighbor called child protective services because Ginicola lets her nongender-conforming son wear pink shoes to school. Nothing came of the neighbor’s call, but “it’s scary to realize that while I am getting the rejection for him now, someday he will receive that,” she says.

In some cases, parents may lose a whole community in which they previously felt secure and safe, Ginicola says. For example, in the African-American community, the church often serves as the main safe space for its congregants, but many churches are not affirming of LGBTQ individuals. By choosing to support their children who identify as LGBTQ, the parents may lose an essential source of support.

In cases such as these, Ginicola helps her clients process their grief and encourages them to seek alternative sources of support, such as other parents who have gone through similar experiences. She is also able to recommend online and local groups to which parents can turn. Ginicola also provides validation for the parents, emphasizing that it is the culture that is the problem, not the parents themselves. Another part of the service that counselors can provide these clients is to make sure they are practicing good self-care, she adds.

Ginicola also sees parents who are totally unsupportive of their child’s LGBTQ status. She acknowledges walking a fine line with these clients. Although she doesn’t want to support their beliefs, she tries to identify a way to reach them so that they don’t instead go find a therapist who is willing to attempt to “change” their child.

“[It requires] the same principles that underlie work with any parent that is potentially destructive to a child,” Ginicola says. “[It’s] a delicate balance of keeping them feeling validated without promoting harming their child.”

She starts by probing for what is at the root of the parents’ nonaffirming stance. “Let’s say it’s religious beliefs. You [as the counselor] can’t start quoting Bible verses,” Ginicola says. “That’s not our place, and they’re not going to listen to us anyway because we’re not within their religious group.”

Ginicola validates parents by saying she can see that it might be difficult to feel caught between two conflicting forces — the instinct to love and support their child versus their belief in a religious tradition that rejects their child. Rather than attempting to challenge their religious beliefs, she looks for inconsistencies and discrepancies that she can point out.

“I might say, ‘I’m hearing you say that in your faith you are supposed to love and support your child but also hearing that this [coming out] is something you can’t support. How do you feel about that conflict?’”

Ginicola tries to get these clients to a point at which they are willing to join local or online support groups and talk to other parents who have gone through the same experience. She reasons that these parents will be the best source of support and advice on coping with the conflict of belonging to a faith tradition that does not affirm LGBTQ identity and culture, yet wanting to support a child who is LGBTQ.

Sometimes parents are unwilling to let go of whatever beliefs are informing their anti-LGBTQ stance. In these situations, Ginicola lets them know that they are choosing a dangerous path. When families utterly reject children who come out as LGBTQ, the risk of suicide is exponentially increased.

“At some point,” Ginicola observes, “they have to ask themselves, do they want a gay son or a dead son?”

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Stepping In, Stepping Out: Creating Stepfamily Rhythm by Joshua M. Gold
  • Casebook for Counseling Lesbian, Gay, Bisexual, and Transgender Persons and Their Families edited by Sari H. Dworkin and Mark Pope
  • Youth at Risk, sixth edition, edited by David Capuzzi and Douglas R. Gross

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Divorce and Children” by Elizabeth A. Mellin and Lindsey M. Nichols
  • “Parenting Education” by Carl J. Sheperis and Belinda Lopez

ACA divisions

  • Association for Child and Adolescent Counseling (acachild.org)
  • International Association of Marriage and Family Counselors (iamfconline.org)

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@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.

Giving children a voice in addiction recovery

By Bethany Bray December 4, 2017

When treating clients struggling with substance abuse, Lindsey Chadwick would like her fellow counselors to keep in mind the toll that addiction takes on children. Addiction affects the whole household. Children feel the effects differently — but as acutely — as adults, says Chadwick, a licensed professional counselor and manager of the children’s program at the Betty Ford Center, part of the Hazelden Betty Ford Foundation, just outside of Denver, Colorado.

“Simply being aware [of the fact] that kids are affected by addiction is a huge piece of the advocacy work that we do,” says Chadwick, a member of the American Counseling Association. “Even if a counselor is working [in addictions] with adults, be thinking of the kids. They are a big part of their grown-ups’ recovery. They matter. Take into account what the kids have to say.”

Chadwick and her colleagues run a program for children, ages 7 to 12, who come from addicted homes. The child’s “grown-up,” a parent, relative or caregiver, receives treatment simultaneously through the Betty Ford Center’s programming for adults. The children come for an intensive, four-day workshop that focuses on coping skills and education on what addiction is, and – most importantly – that it’s not their fault, says Chadwick.

“Most of all, we try and help them have fun and be a kid. They are often caught up in very grown-up situations at home,” says Chadwick.

Children from homes where  addiction is present often  take on roles they’re too young to play, such as caring for younger siblings or being a peacemaker or mediator in the home, she

Lindsey Chadwick at work in the children’s program at the Betty Ford Center just outside of Denver, Colorado.

explains. At Betty Ford, Chadwick and her colleagues do a lot of role-play, sharing activities and psychoeducational games with the children, as well as non-therapeutic games, snacks and swimming at a nearby pool.

“For the most part, on the surface, our kids look like any other kids,” says Chadwick. “But we see a lot who are struggling with anger toward their grown-up or family members. We see a lot of very anxious and nervous kids who have taken on a lot of adult roles because they needed to.  Some of our kids have also experienced abuse and neglect. Addiction is an equal-opportunity disease, so we see it in all kinds of families.”

Children who come through the program often struggle with perfectionism, an extreme focus on maintaining control and “not making waves,” says Chadwick. Also, children who come from addicted homes often experience loneliness and guilt or feel like their family is not as good as others.

Many children feel like the addiction is somehow their fault – a message they focus on reversing, says Chadwick.

“We teach them that many people go through what they’re going through,” she says. “We want them to really learn their strengths. Despite the addiction, it doesn’t mean that they can’t love their family, or that other things [in their life] aren’t going well.”

In households with addiction, feelings and problems are not usually talked about or addressed. This unwritten “rule” of not talking about struggles or emotions is passed from older to younger generations, Chadwick says. At Betty Ford, they work to undo those patterns, teaching children to express what they’re feeling – with an aim to keep them from falling into addiction when older.

“A lot of our kids don’t have the language [to express the struggles of addiction]. We try to give them the language to talk about what’s going on, to identify what’s wrong and tell someone,” says Chadwick. “… We give them the space to know that they matter, and it’s OK to let things out.”

In addition to talking to express themselves, they teach the youngsters nonverbal ways to let out their emotions, such as drawing, physical activity and other self-care activities. They also identify who is safe to talk to (i.e., a counselor, trusted adult or peer) and when. “Addiction sometimes confuses that for them,” explains Chadwick.

“We have kids who come in, and they’re angry, sad or mad, and they don’t want to be here,” she says. “On the last day [of the program], they’re happy and smiling – they’re a kid again. It’s such a wonderful transformation to be a part of.”

Psychoeducation activities at the Betty Ford children’s program also involve a cartoon character named Beamer. He stars in a series of books that the Betty Ford Center uses in their children’s program.

Both of Beamer’s parents struggle with addiction, and one is in recovery, and the other is not, explains Chadwick. Beamer navigates the ups and downs of living in a household coping with addiction in each of the books.

“Kids really love Beamer because they’ve never really seen a character that’s going through the same things as they are,” Chadwick says. “It’s very validating to learn that they’re not alone. They relate to him. A lot of the situations he’s been in, they’ve been in – his struggles at school and interactions with family. It gives them a vehicle to talk about it as well, and helps them feel more comfortable.”

Betty Ford counselors sometimes encourage the children to write Beamer letters as a therapeutic tool, adds Chadwick.

All families who go through recovery programs at the Betty Ford Center are referred for therapy in their local area. They are also invited back for weekly follow-up programming and support groups.

Chadwick has worked for nine years at the children’s program at the Betty Ford Center. In addition to Chadwick’s program in Colorado, Betty Ford also offers children’s programming at centers in Dallas and Rancho Mirage, California.

“I grew up in a family where addiction was a problem for multiple generations. I saw things that I shouldn’t have as a kid. I’m happy to give back to these families,” says Chadwick. “It’s so amazing, as a therapist, you get to work with the kids on their level and have so much fun throughout the day, but also help focus on recovery … It’s really amazing to watch these families heal. The adults in the [Betty Ford Center] program really want what’s best for their families, and it’s wonderful to be part of that process.”

 

 

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Find out more about the Hazelden Betty Ford Foundation’s children’s program at hazeldenbettyford.org/treatment/family-children/childrens-program

More information on the “Beamer” character and materials can be found at mybeamersworld.com

 

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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 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.

 

 

Viewing fathers as attachment figures

By Ashley Cosentino September 5, 2017

The role of fatherhood has changed over the years. Hundreds of years ago, the father was the most important parent for raising the children, then he became the breadwinner, and today an expansive volume of research details a general lack of involvement by fathers in their children’s lives. Plenty of fathers want to be a part of their children’s lives and do whatever they can to stay involved. However, many fathers encounter barriers created by myths that limit, or in some cases prevent, their ability to engage with their children.

Many people may believe some common myths about fathers. These myths include:

  • Fathers are not interested in being involved.
  • Fathers do not have the capability to be involved.
  • Fathers are harmful if they are involved.
  • There is little to no effect if a father is not involved (or, relatedly, the hassle of dealing with the father is worse than any negative effects that his lack of involvement might have on children).

In reality, both fathers and mothers are important, and not just as a means of feeding, bathing and sheltering their children. Their importance extends beyond meeting the family’s physical and safety needs.

All of us likely know someone who has either grown up with a single parent or been a single parent, or perhaps we fall into one of those categories ourselves. A faulty assumption that people often make is that married fathers are always present, whereas divorced fathers (or unmarried fathers) are always absent. This assumption is based on the faulty idea that a father is only involved if he is present in the home and that when a man doesn’t live with his child, the father then becomes disinterested.

Research has shown that children who grow up without consistent father involvement commit more crimes, become teenage parents more frequently and are unemployed more often than are children who grow up living with both of their biological parents full time. This is regardless of the parents’ race, educational backgrounds, whether they were married at the time of their children’s births or if a parent remarries. According to the research, children growing up without father involvement were also found to perform more poorly in school, use drugs more frequently and have other social problems even when controlling for generally lower income.

The prevalence of single fatherhood has doubled in the United States throughout the past decade, and the number of nonresident households is growing. A residential household is the parental home where the child spends the majority of his or her time, whereas a nonresident household is the home where the child stays when spending time with the other parent. Escalations in divorce and nonmarital reproduction during the past 30 years have preceded escalations in the percentage of children living separately from their biological fathers. Between the 1970s and 2000, the percentage of children living with a single parent grew from 12 percent to 20 percent. In 2002, 69 percent of children younger than 18 lived with both biological parents, whereas 23 percent lived with their mother and 5 percent lived with their father. Fifty to 60 percent of children born in the 1980s and 1990s lived with only one parent for at least a year before reaching age 18.

These statistics help to illustrate the lack of attachment that many children have with their fathers. An attachment is characterized by intense feelings of intimacy, emotional security and physical safety in association with an attachment figure. Attachments are significant throughout one’s life, and they can vary over time. When established in early childhood, attachments can continue, but new ones can also be formed during later childhood or in adulthood, and current attachments can be reinterpreted with new perspective and conditions. The goal of attachment is to have a secure relationship with several caregivers to improve normal social and emotional development.

John Bowlby established attachment theory in the 1950s and 1960s as an addition to psychoanalytic theory. Attachment theory is a secure base from which to explore close relationships that can accommodate an extensive variability of methods and findings. Attachment theory proposes that affectional bonds are essential to the survival of humans. It has a protective function (e.g., a mother keeping her child safe in times of danger) and an instructive function (e.g., a mother providing a secure base so her child can explore the surroundings). Attachment occurs if there is closeness and active shared interaction between the child and the attachment figure. Attachment theory is the prevailing theory for understanding early social development in children.

Attachment styles

Mary Ainsworth and her associates experimentally defined three subgroupings of attachment associations: secure, anxious-avoidant and anxious-resistant (or ambivalent).

Secure attachments: A secure attachment is categorized by passionate feelings of intimacy, emotional security and physical safety in the company of an attachment figure. Features that accompany a secure attachment include remarkably good communication abilities, the use of productive coping tactics and the capability to assimilate inconsistent emotions, normalize negative emotions and resolve conflicts cooperatively and constructively. Secure children show little anxiety when separated from a caregiver and develop a sense of self-worth and belongingness. Secure attachment relationships provide a safe base from which to explore the world and an affirmative model of self in relation to others.

Insecure attachments: Insecure attachment relationships occur as the result of trauma or neglect. They create noteworthy shortfalls in the child’s development of self and his or her capacity to relate to others. These effects can have enduring negative psychological concerns such as not being able to compromise or form meaningful relationships. Forty to 45 percent of children in the United States and Great Britain are classified as insecurely attached based on research done in both countries.

Children with anxious-avoidant attachments are characterized by their insignificant need to receive physical contact from their parent(s) when united after a separation. Anxious-avoidant children use defense mechanisms such as having a low need to accept physical contact from caretakers. As adults, people who are anxious-avoidant withdraw in relationships and are emotionally distant.

Children with anxious-resistant (ambivalent) attachments demonstrate a lack of inclination to explore, a lack of precociousness and a lack of self-protection, while also showing intensification in irresponsibility and accident proneness. These children are characterized by intense misery at their caretaker’s parting and an inability to be pacified upon return of the caretaker. Children with an anxious-resistant attachment style appear to show infrequent amounts of inner conflict concerning the apparent physical and emotional accessibility of their parent. Research on the concerns of this attachment style signifies that anxious-ambivalent children experience developmental interruptions that are not typically experienced by securely attached children.

A fourth type of attachment, disorganized, could also be added. Disorganized attachment is a combination of anxious-avoidant and anxious-resistant. Regardless of the attachment style, children create an attachment blueprint for future interactions that will guide them throughout their lives.

Fathers as attachment figures

Bowlby’s original construction of attachment theory proposed the role of the father as ambiguous, but he later recognized that fathers are imperative as attachment figures. Bowlby’s philosophy about the role of fathers as attachment figures developed over time with the publication of applicable research findings.

The infant-father attachment turned out to be prevalent while Bowlby was working on his second, more clearly defined version of attachment theory, published in 1969. He found that the father’s reactions to the child form the pattern of the child-father attachment relationship. Bowlby’s son, Richard Bowlby, who has also lectured and written on attachment theory, has said that he suspects his father’s initial concentrated focus on mothers and their attachment role may have ended up prejudicing subsequent research and distorting cultural values.

Bowlby added fathers as significant attachment figures because two distinct attachment roles seemed to exist for two separate but equally important functions for a child’s development. One attachment role is to deliver love and security, and the other role is to participate in exciting and challenging practices. In other words, the bond of attachment is more than keeping children safe from danger, which is often seen as the mother’s role. Attachment is also a bond that promotes exploration and gives confidence to venture forth, which is often the father’s role.

For children to grow into proficient adults, it is recommended that they first need to develop psychological security, which consists of both secure attachment and secure exploration. Researchers have defined this as confident, attentive, eager and resourceful exploration of materials or tasks, especially in the face of disappointment. Secure exploration implies a social orientation, particularly when help is needed.

Understanding the difference between secure attachment and secure exploration helps us see how fathers have a distinct impact on the raising of children. A father’s behavior should create a feeling of safety for the child as the child explores new understandings. These instances will allow the father and child to become familiar.

Humans have an instinctive need for enjoyment, discovery and a sense of achievement. Bowlby considered play to be an important aspect of the father-child relationship. The role of father-child play is alleged to be critical for child development and adds to the expansion of attachment relationships. A father’s role becomes noticeable in child development later; consequently, the impact of father involvement may be progressively more important and observable as the child grows older. A father’s awareness of his child’s exploratory behaviors will contribute to the child’s sense of safety during difficult tasks and increases the chances for the child to focus, follow his or her curiosity and master new talents in an emotionally unhindered way.

Parents’ roles: Separate but important

Both parents are considered attachment figures in attachment theory, and the child-father attachment is autonomous from the child-mother attachment. Whereas mothers are commonly involved in caregiving and providing emotional refuge, fathers are particularly involved in play and exploratory undertakings. Healthy development depends on a child’s positive attachment to both parents because the parents provide separate but equally important secure bases for the child’s attachment needs.

In families in which two parents are raising children, one parent serves as the main attachment figure for providing a lasting secure base and refuge for safety in periods of distress, whereas the other parent serves as the primary attachment figure for providing opportunities for exploration and excitement. There are fluctuating amounts of commonality between the two attachment roles; however, each parent will offer one type or the other. Scholars have established that individuals who excel in social situations as young adults typically had mothers who delivered a stable secure base and a positive model for intimate relationships within the family and fathers who shared in exhilarating play and interactive encounters.

To optimize the chances of a child being successful, two distinctive systems need to be in place: a secure base for the child to come back to when the action ends or goes wrong, and a trustworthy confidant to show the child the way. Children can use their parents as a secure base in diverse ways, and each parent can attend to a child’s needs differently. For instance, fathers generally take part in more physical play, inspire more risk-taking and induce a greater assortment of excitement and stimulation in play than mothers do. Fathers typically encourage competition, challenge, initiative and independence. Parents who compete for their child’s love and devotion are more likely to have offspring who are insecurely attached to both parents.

Little is known with certainty about the behavioral correlates of secure child-father attachment. Measures of this attachment should include the assessment of warm, supportive and sensitive challenges during joint play. These are indicators of an activation relationship. If we begin to view men as primary attachment figures, a change might take place in the importance we ascribe to fathers.

Need for father involvement

The issue of fatherlessness is discussed in many books and articles, but it is primarily prioritized as a financial problem. These children are considered worse off because they may not have the same level of monetary resources that can give them a better life. Most of the initial early research concentrated on the regularity of contact with the father and payment of child support. The financial assistance of fathers is unquestionably a vital resource for children in all forms of families. However, if children truly are to “profit,” fathers also need to be obtainable and involved in their children’s lives.

There is a need to reevaluate the significance of fathers and to recognize that their worth in their children’s lives is equal to that of mothers. Regardless of the eminence of the mother-child bond, children who are close to their fathers are happier, more fulfilled and less anxious. According to the research, it is important to position the father within the larger context of family relationships. When nonresident fathers maintain parentlike contact, partake in an assortment of activities with their children and spend holidays together with their children, the children’s welfare is sustained. Positively involved fathers reduce their children’s probability of externalizing and internalizing difficulties, limit children’s school failures and avert children’s self-image problems during puberty. The social interactions between fathers and their children who are raised by a single parent are important predictors of healthy functioning in children in both cognitive and behavioral realms.

The transference of social capital between nonresident fathers and their children is calculated by the quality and quantity of involvement. High-quality father involvement is essential for children’s security because fathers who cultivate close relationships with their children are more effective in observing, teaching and communicating. When children sense love and care from their fathers, their sense of emotional security is reinforced. Emotional security helps children cope with stress and makes them less susceptible to anxiety and depression. When both parents are involved, children are more likely to respect and obey parental rules and imitate parental behavior.

Studies of nonresident fathers often indicate positive correlations between father involvement, regular payment of child support and children’s behavioral adjustment, psychological welfare and academic achievement. Frequency of noncustodial father visits has been found to be linked to greater academic achievement, self-esteem, social competition and overall well-being of children. Father involvement is also positively related with children’s social capability, internal locus of control and capability to empathize. A father’s involvement in making key decisions that impacted his children also led to grown children looking to him for support. A longitudinal study of 12th-graders in divorced families found that children with recurrent contact with their fathers received more guidance and provision and were less depressed.

According to the literature, the lack of a father in a child’s life can have damaging effects on both boys and girls. Male and female adolescents from divorced and remarried families exhibit higher rates of conduct disorders and depression, and they are more likely to become teenage parents.

Boys whose biological fathers do not live with them have increased chances of conduct problems and acting out more frequently at home or school, whereas girls are more likely to become depressed. Many researchers believe that boys respond longer and further to the separation from their father attachment figure. Boys, more so than girls, can suffer from lack of contact with a father attachment figure, causing them to struggle in school.

Bowlby’s attachment theory presents that both parents are needed as attachment figures in a child’s early development. We have a long way to go before our society considers fathers to be just as important as mothers, but each step is a step closer. A successful future depends on children having secure relationships with their fathers. This means fathers being able to see their children often and being regarded as more than just financial support. Fathers are attachment figures who challenge their children and are right there with their children to explore the scary world ahead of them.

 

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

Ashley Cosentino is an assistant professor in the Counseling Department at the Chicago School of Professional Psychology. She is a licensed clinical professional counselor and a national certified counselor. Contact her at acosentino@thechicagoschool.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.

 

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Through the child welfare kaleidoscope

By Sheri Pickover and Heather Brown June 27, 2017

The amazing feature about kaleidoscopes is the endless, ever-changing scenes and complex patterns they reveal to anyone who takes the time to look. The gentlest of rotations invites a new and oftentimes completely different perspective on the same set of colorful shapes.

Working with children, adults and families involved in the child welfare system is not so different. A vast array of interplaying events, reactions, concerns and characteristics make up a mosaic of factors that drive a counselor’s assessments and interventions. Any counselor who has worked with one or 100 cases involved in foster care understands how complex and overwhelming it can be to help this population. However, in using the metaphor of looking through a kaleidoscope, we are reminded of how one gentle turn of our focus can change our perspective of the case at hand in a way that will continuously drive more attuned, meaningful interventions. Knowing that the myriad shapes exist before, during and after our treatment with these clients, we can more easily remain open both to seeing and making sense of our clients, the child welfare system and its players, as well as our own experiences of these cases.

Given that each turn of the kaleidoscope brings a new feature into view, we have some idea of the shapes that are there: neglect or abuse, histories of mental illness and substance abuse, court involvement, grief and loss, trauma and attachment. One element might stand out from the others at different times during treatment, but all are present in the kaleidoscope, and we should always acknowledge them throughout the course of treatment even when they don’t dominate our view.

In this article, which is based on our book Therapeutic Interventions for Families and Children in the Child Welfare System, we will provide an overview of six perspectives, or “turns of the kaleidoscope,” to take with these cases. These perspectives focus on specific considerations and guided structure to drive effective intervention and counter burnout when working with this population.

First turn of the kaleidoscope: Client worldview

When a client is involved in the child welfare system, instead of beginning treatment with assessment, start with a curiosity about the client’s worldview (whether that client is a child or an adult) and a desire to understand that worldview better. This process builds empathy for the client and reminds counselors to evaluate possible motivations for the presenting behavior concerns. What is it like to be a child in foster care? What is it like to have your child removed from your care? What it is like to care for a child you don’t know in your home?

Many factors influence the worldviews of children in foster care:

  • Exposure to traumatic events such as being removed from their homes and the abuse or neglect that prompted removal
  • Shame and guilt related to blaming themselves for the removal
  • Their attachment style with their family members
  • Grief from multiple losses (home, school, friends, neighborhood)
  • A sense of constant chaos and a fear of what will happen next that is beyond their control

Children in foster care wonder if they will ever be safe, and if a child has experienced frequent foster home place disruptions, this fear only intensifies.

Birthparents’ worldviews begin with the helplessness and hopelessness that humans feel at losing their children. Grief and loss are compounded by judgment from family, friends, court personnel, therapists and case managers. The reason for removal, such as ongoing substance abuse, their own history of trauma or attachment issues, possible mental illness, poverty or a lack of educational opportunities, is further complicated when their family enters the child welfare system. Often viewed as resistant or unwilling to accept responsibility for their actions, these birthparents often feel alone and angry and use their energy to defend themselves against the onslaught of judgment.

Ironically, foster parents’ worldviews may also begin with helplessness. Although they receive training and support, sometimes it is not enough to counteract the effects of caring for a child in their home who is angry, traumatized, grieving and filled with anxiety. In fact, the experience of foster parents can be similar to that of the child’s birthparents in that they are quickly judged and required to abdicate control in their home to the child welfare rules and a series of child welfare workers. Foster parents are also asked to love a child and then let that child go, so they struggle with attachment, grief and loss issues on a constant basis.

Second turn: Counselor worldview

As counselors, what we see in others is often influenced by our own family histories, personal values and clinical experiences. These issues rise up early in the child welfare system, where counselors are often novice professionals just starting out, and they are given clients with chronic treatment issues who have often seen myriad other professionals.

Meanwhile, the pressure from the systems and individuals involved is often overwhelming. Counselors often feel responsible to “fix the kid” or “fix the family,” and this pressure can lead to countertransference, ethical violations and burnout. These children and families often exist in chaos, and counselors can easily be pulled into that chaos by a system that expects miracles but provides minimal support. The child welfare kaleidoscope can become a series of fast-approaching shapes, constantly spinning with what appears to be little direction, or it can become stuck, making it difficult to move or view another shape.

Counselors must always be on guard against the creeping sense of helplessness and the compassion fatigue that can occur when working with this population. Counselors must also combat the countertransference that can force the kaleidoscope to become stuck on one shape or color. Seeking qualified supervision with professionals who are experienced with this population can make a world of difference. Making self-care practices a necessity rather than a commodity will help protect counselors against compassion fatigue.

When working with this population, counselors can be pulled toward feeling pity or overwhelming sympathy for these clients. On the other side of the coin, they can find themselves judging or feeling angry with these clients, either for how the adults behave toward their children or how the children seem ungrateful toward the adults. These are all ineffective responses, both for the counselors and for their clients.

Using the metaphor of a bridge, remember that to stand in empathy is to stand on the rickety, scary bridge over raging waters to allow ourselves to feel what our clients feel. Either side of the bridge — pity or judgment — feels “safer,” but they both lead to ineffective therapy and further harm to the client. Closely evaluating your own personal values before beginning this work and knowing the child welfare laws in your state will provide necessary support to curate an empathic, realistic perspective on your cases.

Working with children in foster care also can be a minefield of ethical issues. Confidentiality can be complicated depending on the referral source and the child’s legal status. For example, the birthparent of a temporary ward of the court still possesses legal rights and must be consulted over treatment issues. At the same time, the child is placed in foster care, and foster parents need to be made aware of important issues that might impact the child in their home. The court might subpoena therapy files, and caseworkers also require treatment updates and recommendations. Each of these possible breaches is relevant to informed consent with this population.

The issue of mandated reporting can also become a prominent part of treatment. Children may disclose abuse in the birth home, foster home or both. Managing the ongoing relationships with birthparents and foster parents when required to report suspected abuse or neglect requires counselors to be honest, forthright and empathetic at all times.

Finally, facing clients with complicated trauma, grief and attachment histories can become demoralizing for counselors because they rarely see the type of progress that allows for professional satisfaction. The potential for experiencing vicarious or secondary trauma responses is also high. Counselors working with this population should engage emotional support from peers, supervisors and even their own counseling. These actions can help heal emotional wounds, keep the work in perspective and prevent the type of burnout that ends up hurting rather than helping clients and counselors alike.

Third turn: Assessment

Assessments with clients involved in child welfare must be understood as living documents of sorts. After all, anything captured at one particular time can be expected to shift because of the unstable nature of so much that influences the client’s life in profound ways. Counselors should obtain ongoing strategic updates on the child’s behavior, emotional status and the status of the relationship with the birthparent, then adjust goals accordingly. For example, try to find out when a placement transition or court-ordered change in permanency status takes place, when the client experiences an additional loss or traumatic exposure, or when the client newly acknowledges a past traumatic exposure.

Counter to the tendency of many counselors to see the concerns of each case first, this population greatly benefits from intentionally identifying their strengths during the assessment process. Children and adults who are involved in the child welfare system often possess amazing resilience, creative coping skills, abundant humor, deep love and extraordinary courage.

Beyond just accounting for strengths, effective assessment looks around the kaleidoscope, gaining information on all aspects of clients’ lives, not just the current presenting problem. Clients in the child welfare system often get viewed through one shape in the kaleidoscope — their behavior. As a result, trauma, grief and attachment concerns often get lost in the desire to stop the current behavior and the pressure felt to “fix the child” or “fix the parent.”

Assessment of the child begins by listening and watching: listening to a child’s stories, listening to the reports of both the foster parents and the birthparents, and watching how the child plays and interacts with you, other siblings and adults. Attachment style will be evident by whether the child seems angry or withdrawn from adults, or whether the child clings and appears fearful. The child’s response to trauma will be evident through sleeping patterns, the way the child eats and the level of fearfulness the child exhibits at home and at school. Educational information and potential medical concerns also may be highly relevant to interventions.

In addition, the amount and type of losses the child has endured and the child’s grieving process matter greatly. Taking session time to normalize the child’s reaction to removal from the home and any subsequent placements can have a significant impact on the child’s adjustment efforts. Finally, after examining and prioritizing behavior problems and building an understanding of what is driving them, work with the families to create a realistic and achievable plan that focuses on one or two concerns at a time. Using this approach, the counselor can keep the many parts of the client’s kaleidoscope in mind while knowing that trying to work on everything at once would be ineffective.

One common challenge in working with this population is the tendency to turn therapy into nonstop crisis intervention sessions, responding to the complaints of foster parents or case managers rather than holding steady to the set treatment plan. Although crisis management is necessary at times, learn to determine what is truly a crisis (e.g., suicidal ideations, homicidal ideations, an immediate risk of removal) and what qualifies as an ongoing complaint (e.g., trouble in school, acting out in the foster home). Holding focus on just two or three shapes at a time prevents therapy from turning into a nonstop process of confronting the child.

Fourth turn: Treatment

Beginning treatment for any primary concerns with this population must focus on giving the child and family space to feel safe and comfortable. For example, get on the child’s eye level, allow the child to move freely throughout the room, and be clear and open about what therapy is and is not. Because treatment is often specific to the needs of the child, be sure to research and seek training in specific interventions related to trauma, attachment, grief and loss, or behavior issues. The following brief case studies illustrate an intervention for each treatment issue listed above.

Trauma: A 15-year-old girl came into care for the second time in her life because of allegations of sexual abuse by multiple family members. She barely was eating or sleeping and kept her body and hair covered with multiple layers of clothing at all times. The counselor took time to connect with her in simple ways that she could handle — drawing, listening to a song she liked, smelling a favorite hand lotion, updating her on the status of her many siblings and naming how much had changed since she had come into care and how normal it would be to feel overwhelmed. Creating this routine of predictable, soothing interactions built a sense of psychological safety in the therapy space. From there, the counselor helped her learn how to lower her arousal enough to open up about her inner world. This allowed her to begin the long and life-changing intensive trauma treatment process that had previously been inaccessible to her.

Attachment: The counselor used a metal Slinky as a transitional object with a 7-year-old boy who refused to enter the counseling room. The counselor brought out the Slinky, and the boy played with it as he ran around the waiting room, not responding to verbal prompts or directions. When he stopped, he and the counselor would go and walk the Slinky up and down the stairs. After three sessions, the counselor stated that to play with the Slinky, the boy had to enter the counseling room. He was able to enter for a short time in the first week and stayed for the entire session from that point forward.

Grief and loss: An 11-year-old girl had witnessed her mother die of breast cancer in her home. The child had limited verbal skills and would draw pictures of herself jumping rope with her mother in the sky. Using her art, the counselor encouraged her to draw herself as she currently felt. She drew herself crying with her mother in the sky. As treatment progressed, she could draw herself smiling as she jumped rope, and this action was identified as showing her mother that she was coping. The counselor arranged to have the pictures sent to her mother in a balloon so that her mother could see she was starting to cope.

Behavior modification: A 10-year-old boy acted out constantly and did not respond to normal punishment. The counselor created a “caught being good” plan. The child received a star for every positive behavior and a check for every unwanted behavior. To earn his reinforcing reward — an allowance — he had to be good only one more time than he was bad. The counselor encouraged the foster parent to set the child up to win the reward, so he gained stars for stopping in the middle of acting out or for flushing the toilet. He received lots of verbal praise for the stars and no verbal response for the checks.

Fifth turn: Engaging adults

Perhaps the greatest challenge for counselors working with children in foster care is finding a way to also work with the myriad adults involved in the system. These adults include birthparents and any involved relatives, foster parents, caseworkers, casework supervisors, attorneys, educators and medical professionals, to name a few.

It’s easy to become stuck in silo thinking, focusing only on the therapeutic process in your sessions and becoming frustrated when others do not support or engage in the treatment. During this turn of the kaleidoscope, counselors can remember to picture the colors and shapes of all the other involved adults, including these adults’ own histories of trauma and their own feelings of helplessness and frustration. This will help counselors keep empathy at the forefront of all interactions, thereby avoiding blame and patterns of disempowering, ineffective interactions.

Reframe engagement as something the counselor is responsible for rather than it being the responsibility of the other adults in the child’s life. In other words, counselors need to take on the mindset that it’s our job to work with them, not their job to work with us. That way, if they don’t engage or respond to our efforts, it becomes our responsibility to try different engagement interventions. Trying different approaches might engage an adult who otherwise would not work with the counselor.

For example, focus on asking birthparents and foster parents for help with treatment. Identify the birthparent as the expert on her or his child. Even if you do not use the advice or data the parent gives you, the act of asking is often enough to engage the parent.

Another engagement technique involves remembering to praise something about the child and attribute the behavior to the parent. For example, “Your child has such good manners. It’s clear you spent time teaching him.”

Finally, remember to validate foster parents and birthparents whenever possible: “I wonder if you feel judged and belittled by having all these other adults tell you how to raise your child” or “People expect you to just deal with serious problems and don’t listen to your expertise.”

If collaboration with other professionals proves difficult, remember to empathize with their frustration over the many cases they have and the stress of their workload. Attempt to find compromises, such as shifting your schedule or using encrypted email to keep information flowing. Collaboration helps children in foster care in many ways. For example, it keeps these children from having to repeat stories over and over again. It also guards against having their needs fall through the cracks because everyone assumes that someone else is getting a task accomplished. Collaboration also sends a message to these children that they matter and that the adults in charge of their lives are making decisions together.

Final turn: Self-care

We already touched on this topic under the “counselor’s worldview,” but it bears repeating. Self-care cannot be viewed as a luxury when working with this population. It is a necessary set of supports and adaptive coping skills. Self-care is subjective, not prescriptive, so it should involve whatever works for the counselor.

At bare minimum, counselors should seek peer and professional supervision with others who have experience working within child welfare so that counselors can both vent and get validated. Remember that by nature, these cases are heavy with deep psychological wounding that will bring out countertransference one way or another. Building awareness and tending to your own reactions rather than trying to fight or minimize them will only make you a better counselor and person.

Professional development support, training and consultation around specific troubling cases or treatment concerns, such as sexual abuse reenactment, severe posttraumatic stress disorder or deep attachment insecurities, can make a significant difference in supporting feelings of competency and utilizing best practices for the challenges these cases will present. Give yourself permission to notice any signs of depression, anxiety, grief and secondary or vicarious trauma in yourself, and then seek professional support.

It’s also important and helpful to remember that working with clients with complicated trauma and attachment histories can become disheartening because the counselor rarely sees the type of progress that allows for professional satisfaction. Find ways to keep the work in perspective and balance work-life demands. Take time to seek joy and pleasure in life to prevent the type of burnout that ends up hurting rather than helping clients.

 

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

Sheri Pickover, a licensed professional counselor, is an associate professor and director of the counseling clinic in the University of Detroit Mercy’s counseling program. She has been a counselor educator for 13 years and worked in the child welfare system for 20 years as a therapist, case manager, foster home licenser and clinical supervisor. She currently teaches courses in trauma, human development, assessment and practicum. Contact her at pickovsa@udmercy.edu or childwelfaretherapy.net.

Heather Brown is a licensed professional counselor and art therapist in private practice in Detroit. She has more than 15 years of experience working with youth (both in and adopted out of the child welfare system), parents and professionals as a program developer, therapist, trainer and supervisor. Contact her at BrownCounselingLLC@gmail.com or BrownCounseling.com.

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.