Tag Archives: & Family

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.

Bringing the family counseling perspective into schools

By S. Kent Butler, Tony D. Crespi and Mackenzie McNamara May 8, 2017

Children in schools today come from increasingly diverse and complex families. As illustration, more than 1 million families are impacted annually by divorce. In fact, approximately 13.7 million single parents are raising 21.8 million children, and 1 in 3 Americans are stepparents, stepchildren, stepsiblings or part of a stepfamily. Furthermore, according to a 2009 article published in the journal Family Relations, it is estimated that only 31 percent of fathers who no longer live with their children maintain weekly contact with those children. It is easy to conclude that the issue of divorce alone has a profound impact on many millions of children in the U.S.

Now imagine that a young student and her mother walk into the professional school counselor’s office on a Monday morning. Mom explains that she and her husband are pursuing a divorce — he recently told her that he’s been having an affair and has decided to move in with his girlfriend. The daughter acknowledges feelings of depression and admits to having angry outbursts at home. Mom says she is concerned because her daughter’s grades have been dropping.

Considering the large number of children and adolescents coping with parental divorce, it’s not surprising that this fragmented family came to the school counselor’s office. In fact, it’s a good thing. Both daughter and mother need someone to talk to, and schools are a natural access point for services. However, many professional school counselors are not trained in family dynamics and are not familiar with key tenets that impact family counseling, so they may not know how to proceed.

A sample case

Susie is 15. A high school freshman, she knows only that her father left the house two months ago to move in with his girlfriend. Susie’s parents had been together for 16 years, getting married shortly after college.

Susie’s father hasn’t called since leaving. Susie is unaware that her father told her mother that although he loves Susie and her younger sister, who is in seventh grade, he hasn’t missed seeing them in the least. Mom decided not to share this comment with the children, but she does confide this secret to you, the professional school counselor.

Sitting in your office, Susie suddenly looks up and exclaims that she is scared she will have to move and change schools. She also says that she’s having a really tough time paying attention in class and explains that her grades are slipping. “I hate my dad for doing this!” she yells.

Suddenly, Susie starts shaking and breaks down in tears. After a few minutes, Susie tells you that she is spending a lot of time with her boyfriend, partly to stay out of her house. She acknowledges feeling depressed. After pausing for a moment, she looks at her mom and states, “I really hate Dad. His girlfriend is so young. She’s in her 20s. She’s not much older than me!”

Academically, Susie has been an A and B student, but her grades have fallen since her father left. Her mother acknowledges that things are tough at home and reveals that she didn’t learn about her husband’s affair until the day he moved out. “I really don’t know what’s going to happen,” she tells you. “I know we’re getting a divorce, but beyond that I just don’t know.”

Your school doesn’t have a social worker. However, you have a colleague who has been studying family counseling, so you knock on her door to ask for a consultation. After sitting down, you share a few thoughts.

You note that, fundamentally, Susie needs someone to talk to about these issues. Acknowledging that you are speculating, you openly wonder what type of impact the obviously poor communication in Susie’s family is having on her. After all, her father has not called in two months, her mother was completely unaware of the affair and her mother is keeping the father’s confession of not missing his kids a secret. These facets alone highlight poor family communication. In addition, Susie is scared that she might have to move and change schools. Clearly the issues are widespread.

Risk points

Here are some risk points to consider as you work with Susie:

  • Parenting after a divorce differs significantly from parenting prior to
    a divorce.
  • Single-parent families in the United States are increasing.
  • Children of divorce have more mental health problems in comparison with their peers.
  • Suicide is the third-leading cause of death among U.S. youth.
  • Brain regions responsible for decision-making are not fully developed in youth.
  • Changes in family structure can have an affect on school grades.
  • Anxiety, depression and behavior problems are elevated after divorce.
  • Children of divorce often feel a sense of instability.

An understanding of these risk points is essential for moving forward with children and families because the risk points can provide direction for the work that needs to be done. For example, knowing that mental health symptoms are elevated following divorce and impulsive decision-making is greater among youth, you should assess Susie’s level of safety. In this case, Susie also makes many “red flag” statements.

These are things that counselors know how to address but might not always consider without an awareness of the data. In addition, parents can become defensive, or they might blame themselves for their children’s difficulties. For this reason, it is imperative to educate parents on these risk points. It is also important to realize that family issues may require clinical supervision.

Supervision around work with families 

Susie is not alone. As your colleague notes, Susie is one of many children and adolescents who are coping with family stressors. With the prevalence of so many family issues, a growing number of states have enabled licensed marriage and family therapists (LMFTs) to work in the schools. Connecticut, New Mexico, Maine, Texas and Illinois have passed specific laws to allow LMFTs to work in schools, whereas Massachusetts allows LMFTs to work under a general mental health designation.

Schools clearly represent an important access point for mental health professionals. But with only six states utilizing LMFTs in schools, it is extremely important for professional school counselors and their supervisors to know how to manage these situations with families.

As you ponder your next meeting with Susie, you need information. Direct supervisors are often part of the structure of many agencies, but professional school counselors might need to seek support from a colleague with training in family counseling. Such supervision might come from a guidance director, a school psychologist, a consulting psychologist, a marriage and family counselor, or a local family agency.

Two popular family therapy models that might help Susie are presented below.

Symbolic-experiential family therapy 

This model, derived from the work of Carl Whitaker, addresses both individual and relational patterns. It is focused on both personal growth and family relations.

Fundamentally, the therapist helps dislodge rigid patterns and stimulates flexibility using a family’s natural pull toward growth. Focusing on the present, the therapist helps people recognize their real feelings, express those feelings and move forward, individually and as a family. Key points follow.

  • The “battle for structure” involves clients (a family) “sizing up” a therapist. There is no “identified patient”; rather, the family is the therapy unit. In this model, the therapist must win the battle and control therapy. For instance, if the therapist invites the entire family and one member does not show up to the session, the therapist may refuse to meet until everyone attends. In the case with Susie, you might note that you, Susie, her mother and Susie’s sister must all attend.
  • The family must win the “battle for initiative”; this involves their decision to take charge of their lives and decisions. Is Susie committed to resolving her feelings? Will she commit to six counseling sessions? Is she willing to confront her father about calling his children? Is she motivated to initiate change?

Therapy progresses through stages:

1) Engagement: This is the “meet and greet” phase. You have already started this stage with Susie and her mom.

2) Middle phase: Families are encouraged to change through confrontations, encouragement and interventions. Can Susie’s family meet to start this process?

3) Late phase: Increased flexibility is a focus for the family. Can Susie’s family talk through how the divorce will change their life?

4) Separation: As the therapist separates, the family takes responsibility.

Symbolic-experiential family therapy often advocates the use of co-therapy, making it a great model to use with a more “senior” therapist. In this fashion, supervision can be active and ongoing as you acquire firsthand skills in family counseling.

Structural family therapy

The structural approach, typically associated with Salvador Minuchin, views problems as being rooted in family interactions. Fundamentally, if we can help change the family’s organization (structure), its members typically find that they feel better and their symptoms are often relieved. Key points follow.

  • Enmeshment or disengagement: Family members may range from those who are overly connected to those who are disengaged. Enmeshment tends to prevent growing maturity, whereas disengagement may lead a child to feel abandoned. Most families are not one or the other but have subsystems that reflect their tendencies. For example, a disengaged father who is overly involved at work may neglect the family. In response, the mother may compensate by becoming overly involved. Is Dad really connected? What is the structure
  • Boundaries: Are parental boundaries rigid or flexible? Are grandparents a resource? Can a child visit Dad at work, or does the family maintain a rigid rule against it? Can Susie ask Dad questions? What are the boundaries? What is spoken? What is unspoken?
  • Alignments: Who joins together? Are children aligned against the parents? Did a parent resent and refuse to attend a child’s sporting activities? Did a parent require everyone to attend? What are the alignments?
  • Triangulation: The permutations of triangulation in families can be abundant. A child and parent may triangulate against another parent. A parent having an affair can create a triangle with the other spouse. Will Susie triangulate with Mom against Dad? What triangles exit?

The structural model also features several stages:

1) Joining and accommodating

2) Assessing family interactions

3) Monitoring dysfunction

4) Restructuring patterns

Summary and considerations

When a student walks into a professional school counselor’s office, we are presented with a rare opportunity. When a student and parent walk in together, we are handed an even rarer opportunity.

Family counseling offers unique and engaging ways of reframing problems. Rather than blaming an individual for a particular problem, family counselors look at the family system. Perhaps a child’s acting-out behaviors allow parents to avoid looking at their relational problems. Perhaps a child’s failing grades reflect more on family anxiety and stress than on individual issues. Fundamentally, family counseling takes a larger, more systemic perspective of presenting issues.

Professional school counselors possess wonderful skill sets. They understand rapport building. They understand relational dynamics. They understand problem assessment and the utility of interventions. The connection between families and school adjustment is undeniable. At the same time, school counselors will likely find continuing education and supervision indispensable in helping families.

In our experience, students and families can often benefit from a family counseling perspective. With so many students in the schools coping with changing family structures, it is vital that we expand our skill sets. Fortunately, there are multiple platforms through which we can provide help. Some of these options include:

  • Individual counseling from a family perspective
  • Co-therapy with single families
  • School-based divorce groups with multiple children
  • Single-parent support groups

This article is intended to stimulate thinking and provide a preliminary glimpse into two prominent family counseling theories. Our advice? Be available. Be sensitive. Consider finding a supervisor who is capable of expanding your knowledge and skills in this invaluable area. Truly, children, families and the community stand only to benefit.

 

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S. Kent Butler is an associate professor at the University of Central Florida. He is a licensed professional counselor, national certified counselor and national certified school counselor. He is particularly interested in mentoring, supervision and multicultural issues in counseling. Contact him at skbutler@ucf.edu.

Tony D. Crespi is a professor at the University of Hartford. He is a certified school counselor, licensed marriage and family therapist, and licensed psychologist. He is particularly interested in family counseling and legal issues that affect supervision.

Mackenzie McNamara is a doctoral student in the counseling psychology program at the University at Albany, State University of New York. She most recently worked for New London Public Schools in Connecticut.

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.

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.