Friday, February 12, 2021

Tales from Therapy

                 These real case examples are published with the written consent of the clients and their                    parents with identifying information changed or removed to preserve confidentiality. 

Allen and Andrew

Allen and Andrew came with their mother and grandmother, their adoptive parents, at age five.  We worked together for 33 sessions over two years.  Allen had been displaying separation anxiety in school, crying and clinging to his mother, relieved only in the company of his twin brother, Andrew. Their parents wanted help explaining their adoption and addressing their sometimes aggressive behavior toward each other and defiance of parents. They could not be apart nor sleep in their own beds, they screamed in the car refusing to go into stores, and they demanded their electronic toys and could throw hours-long tantrums.

            The boys were named Jerry and Joseph by their 18-year-old biological mother Kathy.  The twins each weighed about five and a half pounds at birth.  They were healthy.  Kathy cared for them for three weeks at her mother’s home then took them back to the hospital for a check-up.  That’s when their mother admitted using drugs and alcohol and the infants were removed from her care, deemed to be underweight.  Child welfare services placed the twins in the home of a foster parent then moved them six months later to their adoptive home.

            Their biological mother herself had been adopted.  Kathy and her sister were abandoned on the streets of Tijuana and placed in separate orphanages.  At the age of six Kathy was separated from the children with whom she was raised in the orphanage and moved to her sister’s shelter.  From there they were adopted by a San Diego couple.  At the age of 12 the sisters were removed from the adoptive home because the adoptive father had molested one of their friends.  He was convicted and sentenced to prison and they were reunited with their adoptive mother.  At the age of 16, Kathy gave birth to a boy who was subsequently removed from her care and adopted.

            Allen and Andrew are the smartest, funniest, most articulate, caring boys you will ever meet. They come up with the most meaningful and thoughtful things to say and they are interested in everything and everyone around them.  They are hard to say no to.  Their mother, Diane, had wanted children but never married.  So, she and her mother, Claire, decided to adopt together.  Diane is the breadwinner, and Claire is the stay-at-home parent.  They each have a sense of humor and plenty of support from family and friends.  But they do come from two different generations.  Diane’s focus was on making the boys happy.  Claire needed them to mind her.  So, whether it was bedtime or chore time there was a lot of whining and pleading, sometimes also by Allen and Andrew.

            In the first few sessions as I learned more about the boys and they became more comfortable in the therapy room and with me, we explored their personalities and strengths.  We played games and explored the topic of adoption in general with books.  At that point, the boys understood little about their own biological history and assumed their lives started in the twin cribs they shared as infants, constantly hungry and eating and growing, until they could crawl out of one crib into the other and sleep together.  We drew out their “placement map” and identified the people and places in their lives including their biological mother, the unknown father they named “Bill”, and the older brother who went to another adoptive home.  To help with the story, Diane had pictures of the boys and their mother and even found pictures of their brother.

            It took no more than a dozen sessions for the boys to be able to tell their own story and identify all the feelings associated with leaving and moving and finding a forever family.  They became very familiar with the routine of the room: asking for toys and games before playing with them; excusing themselves to insert comments into adult conversations; accepting choices about how to leave the room, all planned attachment therapy interventions. They were totally obedient and compliant until they could stand it no longer and needed to take charge.  It was the smallest of requests from Mom, “Shake Mike’s hand and say goodbye.”  Nothing.  Andrew looked at Allen and the test of wills was on. 

            Allen looked at Mom and said, “Come on, let’s go.”  “Shake Mike’s hand.”  “No”.  First Allen and Andrew began begging to go home.  In the moment they did not realize that the door was unlocked and nothing kept them from walking out of the room, taking the elevator or stairs down, and walking to the parking lot.  Instead, Allen begged his mother to go then ordered her to get up and leave with them.  Andrew watched and then joined in, looking at me and his parents dead in the eye and began to tear the room apart.  The twins pulled toys out of the cabinet, dumped puppets out of an ottoman, tried to overturn a coffee table until the wheels came off.  First, Diane then Claire pleaded with their sons to stop.  “All you have to do is shake Mike’s hand.”  “Boys, stop tearing up the room.”  The more the parents bargained the bigger the show became. “You’re ruining my life!” said Allen.  “You don’t love us!” cried Andrew as the boys writhed on the floor.  With an “evil eye” toward me they moved toward my laptop and shelves as if preparing to do damage but did not.

            Feeling fairly safe myself and with no pressure to clear the room for another client, I knew the boys were inviting me into their world and I was seeing what the parents experienced frequently.  My attention, then, turned not to the twins but to their parents and their attempts to stop the show.  I reassured Diane and Claire that I was not judging them or the boys and that we had plenty of time to work through this together.  I encouraged Diane to stop responding to the twins’ cutting remarks and to stay calm and focus on her smart phone.  I gave Claire a book and told her to relax and at least pretend to read and ignore what was going on.  It is important here to say I did not suggest the parents leave the room or threaten consequences in any other way.  This is what happened when the children did not want to leave the car to go into a store, and it happened when the parents took away electronics to direct the kids to chores or bed.

            Then over the next 30 minutes the pattern became apparent.  When the parents responded in an anxious way to the boys’ behavior, the tantrum got louder and the mess got bigger.  When the parents stayed silent but present, the boys became quieter, started chatting with each other about other topics, and then, surprisingly began to work together to clean up the room and put everything back as it was before.  Andrew told Allen to help him pick up the corner of the coffee table so he could put the wheels back on.  They were working together showing that their overactive right brains and limbic systems had been calmed, and their left brain and cognitive functions could work together to solve their problem. Forty-five minutes after their official appointment had ended, Andrew came over to me, offered his hand, and said quietly, “See you next week, Mike.”  Allen, however, looked sideways at his brother as if he were a traitor to their cause but eventually did the same.  I responded, “See you next week you wonderful boys.”

            Here is what I understand about that situation.  Because of the twins’ experience of neglect very early in their lives, their subsequent removal from their biological mother, and their placements in two foster homes before they were six months old, these boys have a high level of anxiety associated with their primary caregivers, attunement to their internal states, and fear of abandonment.  This anxiety drives a level of emotional dysregulation when they feel unsafe in the situation or when their caregivers are anxious.  This dysregulation looks like defiance as they test adults and attempt to take control.  Also, object relations says that an infant does not distinguish themselves from their caregiver so removal from birth mother at weeks old leaves a sense of loss of self which can last well into adulthood. 

            It would be easy to think these smart boys know what they are doing and intend to get their way, in this case leaving the room on their own terms without following the instructions of their parents, refusing to obey.  Instead, at our core we seek a sense of safety essential for survival and for children that safety comes from parents. When children experience disruption so early in their lives their sense of safety is shattered and remains shaky even when parents are healthy, loving, and supported.  So, the behavior is a sign or symptom of anxiety.  And the goal of the parent or adult needs to be to help the child feel safe and regulated by staying calm, steady, and soothing.  When a parent gives in to their own anxiety by attempting to appease or scold the child, the parent has lost control of the situation, the child feels it, and their fear increases.  Another thing that increases with children who have been removed from first parents is their sense of shame that they are damaged and nobody can tolerate or help them.

            Now, most people and parents would not see this situation as a big deal worth spending an hour and a half to “fix”. They might find it petty to “force” a child to follow simple directions or even abusive to “make” them shake hands with an adult.  After all there are bigger and more important struggles to tackle and not enough time in the day to get everything done with kids.  Who wants to spend another 45 minutes with crying children when you can make it stop so fast by giving in.  The trouble is, this is about trust, helping children trust their parents, helping parents demonstrate their reliability so they can develop and maintain influence with a child in their small choices leading to big decisions.  Parents are responsible for behaviors that attach the child to them in a way that fosters security and healthy development.  If left unaddressed this pattern of trauma, anxiety, scolding, and acquiescing repeats from the smallest tests of will up to conflicts over chores, homework, media, drugs, friends and whether the teenager or young adult can follow the rules to safely live at home.

            The question was, did setting and keeping a boundary with quiet, compassionate, consistency pay off in increased trust in adults as demonstrated by the ability to go along with their directions and expectations?  The next session with Allen and Andrew proceeded like any other; checking in on their week, deciding on goals for the session, finishing their adoption story.  When it came time to leave, the boys stopped and considered their options.  Would they say goodbye and get on with their day or would they stay and test us more?  Andrew gave a knowing look to his mother and me, shrugged his shoulders, shook my hand, and walked out.  Allen looked betrayed.  He continued to dig in his heals and began to whine and cry.  This time I directed their grandmother, Claire, to leave with Andrew and wished them a good time together.  Allen stayed staring at his mother and me wondering what we would do.  He began to cry.  Not an angry or frustrated cry, but a desperate overwhelmed cry with real tears.  Mother Diane pulled him onto her lap.  The control battle was too much.  All of his fears and sadness came to a head.  His mother had the chance to empathize with him and offer physical comfort and support. After a few minutes, perhaps 15 not 45, he was ready to say goodbye holding his mother’s hand.  The scene has not repeated again although the boys talk about that day almost every time we see each other.

            The kind of early experiences Allen and Andrew have had leads children to a level of ongoing anxiety that most children do not have, although on any given day full of school and sports its presence is not readily apparent.  Then even infants, toddlers, and small children develop some interesting defenses to cope with their invisible but real fear of abandonment.  It takes a lot of energy to maintain that level of hypervigilance.  Also, intelligent children like the twins have an innate sense if not a full understanding that they are different from other people.  They often attribute this difference, not to the early experiences of trauma, but to themselves. Remember, young children are self-centered and egotistical, and they are supposed to be.  That means they do not see much farther than their small sphere and they attribute events to themselves.  Their sense of being deeply troubled or in trouble can be overwhelming.

            The job of a parent, to the extent possible, is to be that calm, consistent safe base from which a traumatized child can receive comfort, validation, and encouragement in exploring themselves and their world.  The job of the therapist, to the extent possible, is to support the parent and guide the dyad in managing emotions on the journey to healing and thriving.  For the therapist, it is about developing a relationship of trust with the parent so they can manage their own anxiety without shame, develop a better understanding of their child, and practice counterintuitive non-traditional methods.  The purposes are to read the child’s behavior therapeutically, help the child reduce their anxiety levels and raise their self-esteem, and improve the child’s attachment to the parent.  This more secure attachment gives the parent influence with the child in guiding them toward self-realization and healthier relationships in the future.

Donny and Henry

            Donny and Henry were eight years old when their mother Joan brought them to me to work on adoption issues.  I worked with Donny off and on for more than four years.  I worked with Donny and Henry together for a time before Henry started EMDR with another therapist to address his PTSD.  Joan’s home was the twins’ ninth placement since their removal from their biological mother at age two and their third adoptive placement including with their biological sister.  The boys had just moved in when we started working together and they were already displaying the behaviors of a difficult adjustment; lying, stealing, defiance, and tantrums. 

            Henry was the first twin born weighing not quite four pounds with Donny right behind him at five and a half pounds.  The size difference has been evident throughout their lives, Henry is the smaller brother. They lived with their biological mother for almost two years with their three older siblings until child welfare services intervened on behalf of their older sister.  After staying in foster care for two years, the twins were actually placed with the older sister for adoption.  It was during that more than two year period they were exposed to domestic violence and physical abuse along with their sister’s two younger children who were also removed.  The boys reported leaving the house as small children to get away from what was going on inside.  By the time they got to Joan’s house they were most concerned about what they would eat, how much they could play, and where their stuff would go.  They had very little tolerance for a new parent’s rules and reminders to do their homework, clean up after themselves, or go to bed on time. 

            In fact, Henry had the most difficulty going to sleep.  He would hide, stall, and scream. One day Henry came into the therapy room with his head hanging in shame.  His mother followed with an exasperated look on her face. Joan was raised by a loving mother and critical father, so being challenged by angry little boys was triggering to her.  Despite this, she was well educated, well trained, well supported, and committed to keeping these boys in the family.  She also had the help of her mother who lived nearby and attended therapy with them.   I asked Henry, “You look upset, what’s up?”  With enough time to feel comfortable in the setting he said quietly, “I kicked a hole in the closet door.”  His mother shook her head, “We had a difficult night.” She understood bedtime was difficult because of the domestic violence he experienced in his sister’s home. They had already tried different strategies to help Henry sooth at night including his mother staying in his room until he fell asleep.  She neither judged nor shamed but just asked for help. 

            I handed Henry the telephone and the yellow pages, the big book.  I suggested he could probably fix his problem with a simple call and that his mother and I would be nearby to help him.  Then we listened and watched.  Henry found the number for Home Depot.  He called and asked for the right department.  He asked about ordering a new closet door.  At one point, he turned to his mother behind him and asked if they needed someone to install the door.  His mother told him they had a family handyman.  He finished ordering the door, said thank you, and hung up the phone.  Now this nine-year-old struggled with school and homework, was easily irritated and quick to temper, and often shut down when faced with his mistakes.  The same boy spoke clearly, politely, and professionally.  He calmly conducted business in an adult-like way.  I then asked him how much the door would cost.  “One hundred twenty dollars,” he said.  “How many weeks of allowance is that?”  Henry took pencil to paper and figured out 20 weeks.  His mother and I did not need to do anything except praise his performance.  He solved his own problem.  The next week the handyman had installed and painted the new door.  This time Henry walked into the room standing tall with a smile on his face.  The bedtime tantrums decreased and the closet door was safe because it belonged to him.

            Parents often talk about the damage their adopted and traumatized children have done: holes punched in the walls; pantries emptied of snacks; parents, siblings, and pets kicked, punched, and pushed.  It can be difficult to make the connection between this kind of aggression and the child’s underlying sense of safety.  Trauma like removal from biological parents, early neglect, and exposure to domestic violence leaves children feeling desperate, overwhelmed, trapped.  In these environments it is difficult for the child’s brain and body to develop the ability to regulate themselves.  Aggression is the extreme expression of fear and dysregulation.  It also comes with a deep sense of shame that feeds more aggression.  To deal with both, it is important to help the child regulate by providing close support from the parent and to facilitate the child’s problem solving skills.  Many parents are able to do the first, but have difficulty following through with the second.  It might be easier to ignore the damage, fix it ourselves, or worse, use it as a cudgel to remind the child of their mistakes, thus increasing their sense of shame.  It takes more time and more work to hold the child accountable and teach them how to fix the damage. But the payoff for doing so is longer lasting than a simple scolding or fixing problems for them.  The key here is not to try to do the two things at the same time. 

Traditional parenting and behavioral therapy hold that the problem needs to be addressed right away to be effective.  But this approach backfires with children who have experienced trauma and need help regulating themselves; the thinking brain turns off and the emotional brain is firing.  First, we must take the time to put out the fire, to calm the child, to help them regulate their bodies and emotions.  This often looks like the last thing a parent wants or is capable of doing when the child has done damage or made a scene, moving in calmly and soothing the child with voice and touch.  A parent says, “You mean the kid just threw a shoe and broke a mirror and I’m supposed to go up and hug them and tell them everything’s going to be OK?”  Yes, exactly, and that may be enough to solve the problem once the mess is cleaned up. 

However, second, is following through with the parenting and discipline intervention but only when you have a thinking brain turned on to receive the lessen.  Then the parent can build the child’s problem-solving skills to clean up the mess, repair the damage, replace what is broken, and make amends with those who have been injured.  To be effective, it requires separating the two parts of parenting; first the therapeutic joining then the discipline or teaching.  It also requires separating those two parenting interventions by time, waiting for the thinking brain to come back online, waiting hours or days.  The teaching discipline needs to be logically connected to the mistake, not cancelling the child’s soccer games because she broke the computer but developing a plan to repair or replace the computer.  Almost no situation except immediate danger needs to be addressed right away, and most situations are best addressed later when cooler heads prevail.  If we want to teach a child a lesson, we need to have their thinking brain engaged and it cannot be when they are emotionally dysregulated and triggered.

            There was another event early in the therapy experience that would have long term impact for Donny and Henry.  With county child welfare workers still involved, Julie had a connection to the twin’s teenage siblings.  The siblings were seeking contact with the brothers they had not seen in five years.  The teenage sister and brother were not old enough to take care of the twins to prevent their placement in foster care at two or ten.  The siblings were willing to meet Joan, Donny and Henry in the therapy room.  To the first session they brought gifts; photographs of Donny and Henry as infants, photographs that had been hanging on their grandmother’s wall, photographs Donny and Henry and their mother had never seen.  They each stared at the tiny faces of themselves, beautiful babies, before the events that would change their lives forever.  The moment was not only moving for their mother and me, but overwhelming to their brother and sister who were shaken by the loss they suffered in separation from their little brothers.  This connection, however, thanks to Joan, resulted in the siblings joining the family on a cruise and staying in contact with their brothers through the rest of their growing up years. 

This is the way a caring adoptive parent can help heal one of the deepest wounds of adoption, loss of identity and family culture.  Some feel that keeping adopted children connected to their biological families is confusing and even dangerous.  For some it is a source of fear, fear of losing a child they waited so long to have.  Particularly for parents who have suffered infertility, miscarriage, still birth, or child death, keeping in touch with biological family feels threatening to the relationship they have formed with their adopted child like having an ex-spouse in the picture.  They have worked so hard and waited so long to have a child that bringing the biological family into the picture is a painful reminder that their child did not start with them.  Without acknowledging the denial, they mark the beginning of their family life at the day of placement or adoption day instead of the child’s birthday.  The biological, birth, and cultural history gets buried in all the adoption paperwork perhaps to be shared with the child when they are an adult or when they ask. 

Further, they fear the child will show traits and behaviors of which they do not approve from the biological family and their influence.  In working with more than a hundred pairs of biological parents, I have only met two who because of serious mental illness or ongoing criminal behavior were too dangerous to have direct contact.  Most biological parents who have lost their children to adoption have struggled with their own trauma and mental illness, feel deep guilt and shame that they were unable to parent their children, and are wholly appreciative and supportive of the adoptive parent.  Rather, it makes parenting an adoptive child easier when an adoptive family includes biological relatives in their family tree or forest.  Connecting with biological relatives is the best way to address all adoptive issues from trauma, grief and loss to culture and identity.  It does take extra effort, like managing multigenerational or stepparent families.  Biological families are the child’s extended family and there is no competition for love or authority or legal rights.  The adoptive parents’ role and influence with the child actually grows stronger when they incorporate the biological family into the child’s life.  This contact can come along a continuum of safety from written and telephone contact to celebrations of birthdays and holidays up to shared vacations and routine meals and family gatherings.


            Annie was born to a mother addicted to crystal methamphetamine.  Her mother had lost other children to child welfare services. So, when she gave birth to Annie, she did not stay at the hospital long enough to take her home.  Annie went immediately into foster care and was placed in the home of Celia for the first year and a half of her life.  Annie’s father is an undocumented immigrant.  He and his mother wanted to care for Annie, but he was deported before he got a chance to participate in services and so the agency did not place Annie in his care.  Instead, Angelica was adopted by Jessica and David and I met her when she was four years old.  By that time she was still sleeping in the same room with her parents, was anxious and argumentative with her parents, and controlling and jealous with other children at school.

            I started with the family as I always have, interviewing the parents about their attachment styles and preparing them to participate in the therapy with their daughter.  With Annie and her parents we read books about adoption and emotions, played games and with puppets to practice expressing feelings, and explored her own journey to adoption.  As I always do I started drawing pictures, a “placement map”, of the places Annie had lived, from the hospital to her adoptive home.  But each time I started drawing her placement map, Annie would come close, grab the paper from the table, rip it up, and say, “We’re not talking about that.”  To be sure we continued working on rights and privileges and discipline, highlighting her strengths and fears, but the moment I went for the paper and colored pencils, Annie would push them away.

            It got to the point that she would give me the “evil eye” as soon as she came through the door, fold her arms in front of her, and go sit behind the sofa refusing to participate.  I continued the conversations with Jessica and David.  Talking about the child instead of at the child can sometimes keep the child from going into defense mode and allow them to take in information indirectly without being overwhelmed by it.  Annie’s hypervigilance meant she was listening to the conversation from behind the couch.  She was participating in therapy in the only way she could feel safe.  I directed my question to her parents, “Why do you think the biological mother left the baby at the hospital and never came back?”  From behind the couch, the little voice whispered, “I think the baby cried too much.”  Her parents’ eyebrows rose.  My jaw dropped.  No wonder she did not want to talk about it. Similarly, I once had a 67-year-old woman who had confirmed her adoption after her parents died say, “It makes me wonder what was wrong with me.” As with most adopted people, particularly children, Annie blamed herself for her mother abandoning her.  No wonder she was so defiant when her parents corrected her and controlling with peers.

            Annie had opened the door to her inner world and our work had just begun.  We accepted, normalized, and validated her feelings, “I’m damaged goods.”  We can agree with the feeling and not the fact.  We used her considerable four-year-old intelligence to explore other points of view, other perspectives, other children’s experiences.  We role played her situation, putting her in charge of the play.  I played her birthmother so that she, and her parents on her behalf, could ask the questions she needed answered.  We could not change the story.  We would not have all the answers. In fact, between sessions she would often have break downs and blow ups related to the heavy emotions.  But she and her parents also had moments of understanding and connection when she shared her confusion and sadness and accepted her parents’ nurturing care.  She corrected the thought that is was her fault, however the deep sense of loss and shame would occasionally come back especially when she made a mistake or suffered failure.

 What we did not do is give up because it was too difficult to talk about; because she was not willing to do it; or because the story would make her sad.  Her first foster mother refused to talk about Annie’s removal and adoption because she thought she could not handle it or did not need to know.  Other parents say their children never ask, never think about it.  That is denial.  Most parents do not want to do this work because they cannot handle it themselves.  They need to know that going on this difficult journey with their child will bring them closer, make them more trusted, give them influence with their child.  What children don’t know, they make up.  What they make up is worse than the trust.  And what they make up that is worse than the trust is their fault.  Annie’s parents learned they could not leave her to suffer in silence holding on to this mistaken image of herself.  They could hold her strong emotions and lead her through it.  In time, Annie would tell her own story and she put the responsibility in the right place, squarely on her biological mother who had used drugs and walked away.  She began accepting her parents’ direction and guidance, and she began to let other children be in charge on the playground.  She did have friends over to put on a talent show at her house, for which she was the director.  Sometime later she began to decorate her new room and sleep in her own bed. 

            Whether from abandonment or multiple placements, children can develop a form of relational Post Traumatic Stress Disorder in which forming new relationships and trusting adults brings heightened anxiety with all the associated symptoms; avoidance, hypervigilance, flight, fight, freeze, appease.  Just like treating traditional PTSD, for example if someone is afraid of the water because of an incident, the plan includes establishing calming techniques, developing skills like emotional regulation or, from the example, learning to swim, and approaching and facing the triggering material a little at a time until it can be tolerated and mastered.  For water, learning to breath and swim, then touching, walking, wading, paddling, and finally swimming.  For Relational PTSD in a child, using the parent as a safe base and emotional grounding, developing an emotional vocabulary and regulation skills, and reviewing the trauma history until the child can understand and tell their own story without shame.  This requires revisiting the trauma history again and again through the years as brain development allows the child to understand in successively more sophisticated ways.


            Jewell spent her first six years with her mother, Nickie.  Her mother did not identify her father, but Nakala was raised by her mother and her mother’s partner, Kelly.   Jewell was old enough to remember and describe her time with her mother including dresses and toys and birthday parties.  But she also recalled being hit when she misbehaved and locked in her room.  At one point, Jewell’s mother sent her to a child therapist to get her to behave.  In therapy, Jewell revealed the emotional and physical abuse she had experienced.  Since the therapist was a mandated reporter, child welfare workers were soon knocking on the door.  Instead of accepting parenting classes or other services, Nickie and Kelly drove Jewell to the children’s shelter and dropped her off telling her they would return for her.  They never did.

            Jewell was placed for adoption quickly because her mother refused reunification services.  She had only one placement, the home of Latrece and Robert with their two teenage sons.  At first she enjoyed the attention of being youngest and the only little girl in the home.  Then she began to miss her mother terribly and some of the treats her mother used to give her to make her mind.  Jewell began to sneak around the house at night, get into the cabinets and refrigerator and eat up the chips and cookies.  Then, when confronted with the evidence she would lie about her behavior.  Otherwise, Jewell did great in school, made many friends, and enjoyed playing sports.  Toward middle school Jewell began to seek out other attention by going on line.  By the time I met her, all electronics including school tablets were off limits, but she still found ways to borrow other devices to post pictures of herself in clothes that were not the school uniform.

            Latrece and Robert were trained parents and they had the time to give Jewell.  The adoption was finalized quickly but the pain of abandonment was just beginning to surface.  As we explored adoption in general and her story specifically, Jewell went along with the program.  As her attention-seeking behaviors became more serious, she accepted the consequences and limits her parents set.  It was helpful that her mother is a technology company executive and knew her way around the parental controls on telephones, laptops, tablets, and social media apps.  But there was nothing they could do about the most painful part of their daughter’s story, she had been abandoned.  To their credit they stayed in touch with Nickie and Kelly.  They knew that Nickie was going back to school to become…a therapist . . .  and that Kelly missed Jewell.

            Jewell desperately wanted contact with her biological mother.  As time went on, she accepted that she would be growing up with Latrece and Robert.  But she held out a dream that she could have a big birthday party and invite her mother to attend.  On line, Nickie was polite to her parents and wished Jewell well.  At one point, with success in school, with friends, and the basketball team fueling her self-confidence, Jewell decided she would write 10 questions to her biological mother starting with why she dropped her off at the shelter and never came back.  Latrece intercepted Nakosha’s answers just as our next therapy session was starting.  Did Jewell want to see the answers?  Should Latrece share them?  How would Jewell react?  Could we help her?  After months of working together we had a sense of comfort in the room.  These questions were central to Jewell’s journey to healing and would determine whether future contact was possible.

            As she had from the start Nickie blamed Jewell; for misbehaving and causing problems at school; for telling the therapist and bringing child welfare workers to her door; for making her and Kelly’s life so difficult.  Her mother wrote her that when Jewell was ready to apologize they could talk.  Silence. Then, this nearly teenage girl, who up to this point had so fiercely hidden her feelings and put on a happy face and pretended to like her life, began to weep.  There was nothing to say.  Robert wanted to make it better but I directed him to squeeze in to the loveseat next to his daughter and his wife.  Nickie collapsed into their shoulders and she cried.  Silence.  There was nothing to say, nothing to do, except hold the space for this powerful expression of grief.  We did nothing else the rest of the session. 

            Many people might ask, “Why do you want to make a child cry?  Why does an adopted child need to talk about this stuff?”  The answer is because they are thinking about it and acting it out most of the time, alone.  The feelings come out in the strangest ways, from eating to sleeping to toileting troubles.  The thoughts are coming out in all kinds of disruptive behaviors from simple defiance to destruction.  Crying is a healthy expression of emotion, right?  Can crying not be cathartic? Likely the most important skill an adopted parent can have or learn is managing grief and loss.  We run the funeral home.  You cannot get to adoption except through loss; the child loses their first parents, the biological parent loses their child, the adoptive parents lose their ideal child.  We have to know how to navigate through this swamp of sadness by creating space and rituals to mourn.  And sometimes you have to prime the pump by reading books, watching movies, playing music or showing and telling the child the truth.  It is like lancing a boil, massaging the sore spot, releasing the pain in order to allow healing.

Saturday, June 23, 2018

5 Ways to Deal with Stress, Sadness, and Trust

The two things common in traumatized children…always there…are high anxiety and a negative view of the world.

That means the brain is pumping out the stress hormones, adrenaline and cortisol, day and night, which means it’s only a matter of time before we see the volcano erupt, not to mention trouble sleeping, eating, learning, along with the very serious long term health effects like heart disease and stroke. This we have to tackle head on. It’s not enough to say “calm down”. We’re not going to wait for our engine to explode to fix the radiator. Daily we have to let off some steam and lower the temperature.

1. Breath and Move

Now start by sitting in a comfortable relaxed position and let’s breath. Focus on the breath as we take in that healing oxygen deep into the diaphragm, a belly breath, sending the good stuff to every cell of our bodies, then without holding it, exhale and send that stress right out of the body. Repeat.

Next, if you are able please stand, let’s raise our arms in the air and reach for the sky. Now out to the side and reach for the walls. The reason we move is that stress and trauma are held in the body. Next assume the superhero position, hands on hips, chest out, head up. Don’t be small, show your power. Now touch your knees and take a bow. How do you feel?

2. Re-write the ending.

We can’t get through life without grief and loss, everybody’s got it. Perhaps the benefit of maturity is that we’ve made it through a few losses and we’re getting better at it. But sometimes there’s a pile-up of loss. Sadness and anger about what happened to our children. Guilt and shame about what happened to their parents. Regret and resentment at losing that deposit at Case de Mucho Dinero where we had planned to spend our Golden Years by the sea. So much seems out of our control. We can’t change what happened. But we can change the ending. We are the authors of our own lives and we can re-write the last chapters. There’s a new movie out now starring Shirley McLaine called The Last Word in which she plays a not-so-nice older woman who wants to make sure her obituary is positive. So she hires a writer who has a hard time finding anybody to say anything nice about her. I challenge you to do the same: write your obituary, write your eulogy, or if you’re not ready for that, write the speech your friends will give to celebrate your 80th birthday…or the next birthday ending in zero. The story can’t help but highlight the ways you’ve overcome your challenges and made lemons into lemonade. Ask your friends for quotes. Give it a title. Like an epitaph. “She went kicking and screaming, just like her kids.” “He left a fortune, working taxpayers.”

3.  Play every day.

Attachment is hard to do with a child or teenager who doesn’t much trust you or anyone for that matter. This is like dating in old age, after divorce. It’s going to take some time. You’ve both been around the block and you’ve both been hurt. Neither of you is willing to put up with much funny business. But you are going to have to lead this dance. So, take it slow and keep it simple. Date your child. Create meaningful moments. Stop talking, except for those funny stories about the old days. And do…hair, nails, drawing, gardening, reading. Have your child teach you how to program your smart phone or to download music. Teach them how to make your favorite family recipe passed down to you. Cheap and simple. Silly is the pathway to solid relationship. Play is a child’s main job, the way they learn. It is more important than discipline. Playing with them will allow you to gain the influence you need to direct and teach them later.

4. Run a tight ship.

As we said, trust is in short supply. So many people have let our kids down. And, if we expect to trust our children, we have to be trustworthy. Do what we say. Don’t make promises we can’t keep. We need to run our homes like facilities, predictable, consistency, structure, beyond anything you think is necessary. Breakfast, lunch, and dinner on the clock, playtime and bedtime scheduled. Also, give children choices, but from a limited number of options. Red shirt or blue shirt. Shower or bath. Eggs or cereal. Keep it routine, simple, no changes, no surprises. We often feel so bad about what happened to our children we want to make it up to them by providing all of these enriching experiences, like the Sea World and Disneyland. They don’t need it and they can’t handle it. What brought them into care was the lack of basic needs, everyday care. Food, clothes, shelter, doctor, school, play. Done! If that’s all you do for 18 years, you have done your job. Now if a play or musical or a road trip to see the desert flowers is important to you, then get a babysitter, call a friend, and go yourself. You and your kids will be happier when you return. They can buy their own ticket when they’re adults. No harm, no foul, no guilt!

5. Communicate care then concern.

Certainly, there are going to be some big challenges, like family conflict, complicated diagnoses, and financial concerns. For the rest of the family who are not parenting your children, including your children who lost their children, be firm. You are not responsible for what happened. The only choice you made was to say yes to the social worker. This is where you turn on the broken record or just shut the door or hang up the phone.

You might get really caught up in the alphabet soup of ADHD, PTSD, ODD, but stay focused on the most important letters… K. I. D. A child is not a diagnosis. Your boy is creative. Your girl is energetic. Your teenager, soulful. Stand back and admire just how unique they are. Find out who that strange kid is, and celebrate the weirdness. Defend the child against those who would label and limit them. Don’t be in a rush to have the child be self-sufficient. Let them be dependent, parent from their developmental not their chronological age. And when they make one or more of their big mistakes, engage don’t enrage. Stop the temptation to lecture. Lead with love not fear. Don’t react, respond. Regulate then reflect. Practice these one-liners.

1. She wants to watch television. You say, “Sure, as soon as your room is clean.”

2. He walks in at two in the morning not sober. You say, “I’m so glad your home. I was worried about you. See you in the morning.”

3. She climbs into the car after school angry with friends. You say, “It looks like you’ve had a rough day. I’m here if you need to talk.”

4. He hands you a report card full of low grades. You say, “I have confidence that you will figure it out. Let me know how I can help.”

5. She threatens to run away from home. You say, “I would be sad if you did that. What would be best for you?”

Finally, you would never think of fixing your own car, taking out your own gallbladder, or roofing your own house. We have people. This is your community. And this is not your typical situation. This is Red Cross parenting. Nobody expects you to be experts. No one can do it alone. That’s not to say that you send the kids off to the therapist like dry cleaning. Or throw up your hands and let others decide. You’re the anchor of this family, you’re the captain of this team. Your kids need you to lead. They’re not renters or roommates. You’re not going to be able to contract out this job. You will need some friends, some babysitters, a back-up plan, some good teachers, a understanding doctor, a good therapy, a skilled psychiatrist, a support group, and some classes. Look up the county’s Foster, Adoptive, Kinship Care Education Program and attend the free classes. Old dogs can learn new tricks. Learning keeps us young. We’re in for a rollercoaster ride instead of rocking chair, time to enjoy the ride.

Relative Caregivers Self Care

  • Taking care of you will help your child
  • Taking care of you will help you parent
  • Your child needs you to take care of you
What we face:

Child trauma: This is not the child you thought you knew.  Take tame to become reacquainted with the child.  With a sense of curiosity and wonder, ask "who is this kid?"

Off-time parenting: This was not your plan nor your first choice.  You're going back in time instead of retiring.

Grief and loss: Some mad/sad stuff happened to get us here.  It will take some time to mourn before moving on to the next chapter.

Parenting from the inside out:  Who are you?  You are not just a grandparent or relative caregiver.  You are a person first, a partner second, a part third, and then there's friend, neighbor, citizen.  Let's get our priorities straight.  These children cannot be the center of our lives.  It's not good for them and it's not good for us.  When we keep parenting in it's place and focus on ourselves we are modeling and teaching what we want our kids to become.  Whole and healed.  This is about perspective, not perfection.

This is a marathon not a sprint, with the finish line in sight we know it takes patience and perseverance not speed.  There have been some ups and downs on this course that take grit and guts.

This is a road trip not a racetrack.  We're not driving in circles ad we're not her to win trophies.  We prepare for breakdowns and flats.  We stop for the roadside attractions and weird food.  We get los and off course before backtracking and correcting our route.  And sometimes we wind up in places we never thought we'd see.  Like planning for California and winding up in Kansas.  And it's only in retrospect that we see the value in our journey.  

Monday, February 20, 2017

Understanding Military Veterans

     Working with military veterans over the last three years has been a rewarding learning experience.  I have worked with more than 50 veterans, both men and women, from 23 to 90 years old, who have served in the Army, Navy, and Marines in conflicts ranging from the Korean War and Desert Storm to Operation Iraqi Freedom and on bases throughout the world during peace time.  Some have served for between three and five years.  Others have served careers of 10 or 20 years or more.  Certainly all of those veterans have experienced traumatic events but it would be incorrect to assume that all of them have post traumatic stress disorder.  In fact, they have experienced everything from depression and social phobia to relationship conflict and parenting concerns.  As we have worked on those challenges I have discovered three factors that influence a veteran's experience of their active duty as well as their readjustment to civilian life after service. Those factors are childhood and family experiences, meaning and motivation for service, and conditions and reasons for discharge or retirement.
     If a service member has grown up in a nurturing, responsive family with adequate resources and support, it contributes to their emotional regulation and positive sense of self.  This establishes a foundation or safe base from which to explore the world.  Positive family relationships provide a source of resilience for service members.  They are patterns for successful relationships developed with other soldiers and sailors that contribute to unit cohesion and teamwork.  They also provide a sense of safety and coping when service members face conflict and traumatic experiences on deployment and in combat.  These early childhood and family experiences cannot prevent post traumatic stress or even injury but may prevent it from becoming a disorder and contribute to healing and recovery.  On the other hand, if a service member grows up in a chaotic or abusive environment marked by parental conflict, lack of resources, violence and separation, they are predisposed to post traumatic stress disorder if they do not already suffer from it.  Their lives are marked by high stress and emotional dysregulation, negative core beliefs and low self esteem.  This makes them particularly vulnerable to the inevitable new stressors of military service.  Rather than inoculating the member against the impact of sleep deprivation, high alert duty, and battle, childhood trauma leads the member to be overwhelmed by military service to the point of developing disorders and disabilities.
     Ironically, so much about military service makes it attractive to people who have experienced childhood trauma.  It offers consistency and structure, a sense of belonging and importance, and the basic needs of food, clothes, shelter, and medical care, just like a functioning family.  Foster and adoptive youth, juvenile delinquents, their parents and advocates often see military service as an attractive option because they perceive it will teach the youth responsibility, lead to a successful career, or reverse a downward spiral. However, these traumatized youth take their underlying hypervigilance and negative core beliefs into a high pressure environment and challenging culture in which individuals are tested to form a fighting force.  Some succeed and achieve while others fail and suffer.  Those who survive basic training and go on to successful service develop relationships with officers and unit members who care for them and watch out for them much like a parent, brother, or sister.  They find the support to develop the resilience to survive isolated deployments and dangerous and deadly events.  They often continue these bonds into post service life.  Those who are not able to develop those relationships often find themselves cut off, targeted, and mistreated, some to the point of harassment, physical and sexual abuse.  Deployments themselves are overwhelming, and sometimes their coping skills including defiance, substance use, and violence get them discharged, reinforcing their childhood script.  They often leave service more traumatized and alone than when they joined.
     When a young man or woman signs up because they see a cause bigger than themselves, such as patriotic duty, or even for education and career opportunities, they are likely to be more successful than the youth who is avoiding the next life stage or escaping from a deprived environment.  The first is likely to find or make meaning from the experience while the second is prone to existential crisis.  The meaning of service is most important in the adjustment back to civilian life.  Adjustment is determined, in part, on how the service member is discharged.  An honorable discharge after a planned period of service or a long career lends itself to closing an important life chapter and starting a new one.  A conditional discharge based on behavior or an abrupt release due to disability or injury leads to a bumpy landing and an extra period of grieving.  If the service member is also dealing with the mental and physical effects of duty, they are likely to experience a pile up of post traumatic stress that started long before they joined.  Just as family support contributes to meaningful service it can also help heal the bodies and minds of veterans. So whether the veteran is young or old, whether they are working through post traumatic stress or relationship issues, I make sure I ask about their childhoods, their reasons for joining the military, and the conditions under which they discharged. 

Tuesday, July 26, 2016



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