Adapting the Environment

Adapting the Environment

ENVIRONMENT

HEALING ENVIRONMENT

 

Special Environmental Considerations for children with early trauma

In preceding chapters, we informed the reader about the impact of child trauma and how to develop a supportive team.  Once the team is in place, we must turn our attention to creating a healing environment.  This unique environment must be thought of as a “Secure Base” for supporting attachment, emotional regulation and thereby promoting developmental maturation.  The healing environment must: provide attachment opportunities, demonstrate unconditional acceptance, encourage developmental maturation, and identify stressors and either remove them or help the child to increase their stress tolerance.

The environment: Using the trauma lens to create a healing home

As referenced in earlier chapters, children with a history of early trauma and attachment disruptions were forced to attempt to control their environments in order to maintain safety, reduce their anxiety and meet their own needs.  Integration into new placements can be enormously difficult.  Many times the first few months a child is placed in the home may be peaceful and pleasant—the proverbial calm before the storm.  Over time, the impact of the early trauma becomes more apparent as maladaptive behaviors increase.  Foster and adoptive parents may be blindsided when the behaviors erupt. 

We (FH and JM) do trainings we call “Creating a Healing Home.”  We illustrate the fear and anxiety experienced by a child when integrating into a new family.  We distribute a wrapped piece of chocolate candy to all attendees.  As they begin to express their appreciation for the treat, they are instructed to unwrap the candy and find a stranger in the room to whom to feed the candy.  An overwhelming sigh is always heard in the room.  Usually, men are more shocked than women, probably because of women’s greater inclination to nurture.  Then we begin building empathy for the child’s experiences by describing in great detail the move to a “foreign” environment.

This foreign environment consists of different parents, siblings, customs, language, food, odors and values.  These strangers violate the child’s privacy by offering to bathe the child and tuck them in at night.  The parents instruct, direct, touch and soothe the child.  The child is told by the ones who removed them away from the prior placement or birth family that these strangers are safe.

It is understandable that children in the foster and adoptive systems experience anxiety and fear.  To compensate (but often overcompensate), many foster or adoptive parents try to comfort children with material possessions, activities and services.  The children are kept busy and expected to appreciate the good things the family furnishes.  For healing to occur, though, the home environment must be a “Secure Base” (Ainsworth) carefully designed and implemented.  Kinniburgh, Blaustein and Spinazzola (2005) specified two goals in “attachment-focused interventions: building (or rebuilding) healthy attachments between those children who have experienced trauma and their caregivers; and creating the safe environment for healthy recovery” (p. 426).  This new environment must have well-defined structure and limits in order to provide opportunities for healing.  The parents’ paradigm shift allows them to see the child through the trauma lens and act accordingly when designing the environment.  These parents will be more flexible, attuned and developmentally engaged with their child, thus giving the child more opportunities for healing with relational, emotional and developmental maturation.

The environment as a Secure Base

As mentioned in earlier chapters, the secure base gives children the foundation and freedom to explore the world with implicit and explicit knowledge: the family will welcome them home and provide comfort if needed.  The environment must support the secure base by providing structure, nurturance and challenge.  Structure is comprised of the daily routines and rituals parents develop and use to give order to family life.  Nurturance is relational responsiveness, unconditional love and intimacy.  Challenge is the parent’s influence in addressing, reframing and restructuring the child’s negative belief system.  Each demonstrates parental security via trust, reliability, sensitivity and physical and emotional availability.

The Secure Base is strengthened by structure.  Children with early trauma need routines and rituals to give order to their lives.  Many times, previous homes were chaotic and unpredictable.  Meals, bedtimes and even school attendance may have been erratic.  Young children may have had to gather food for themselves and siblings.  They may have needed to beg from neighbors, stolen from stores and solicited food from school staff.  One child reported taking cat food from a neighbor’s porch for her and her sister to eat.  A five year old child remembered fixing food for her two younger siblings and being yelled at by her mother when she burned the food.  Small wonder these children tend to have “food issues.” 

Bedtime routines may have been nonexistent.  The child may also have been abused during the night or in the bathroom.  Consequently, nightly baths, bedtime stories and tucking in may be scary and strange to many foster and adopted children.  Children may be oppositional to “being told what to do” because they are fearful or have learned to set their own bedtime, eat when they wanted to or when they could find food, and go to school if desired.  This can easily set the child and parents up to wrangle for control. 

Examples of structural problems

Not enough structure:

Smith family:

James and Lori adopted two year-old Sandy later in life.  They were so happy to finally be parents that they indulged her with all her wants and desires.  Sandy never had to ask for anything.  Even her language was delayed due to her parents’ “over-attunement.”  When her peers were learning their self worth to the family by completing chores and basking in the joy and approval of their parents, she slept late and demanded that her mother meet her needs.  She experienced herself as fearful and burdensome.  Her activities consumed the family’s expendable income.  As a teen, Sandy became even more demanding, responding with aggression when her parents were noncompliant.  Both James and Lori individually struggled at times with worries about “spoiling” Sandy, but they never seemed to agree about when to say “no.”  In every situation either James or Lori would act to avoid the fear that Sandy would erupt aggressively.

Treatment goals.  In this case structure needed to be increased.  Parents need to determine and set firm boundaries and limits.  James and Lori need to increase ways in which Sandy can contribute to the family effort through chores.  They can also foster her development of self-control through such simple interventions as urging her to use “I” statements.

James and Lori admitted that they lacked control of their home.  They gave in to Sandy’s demands, thereby not teaching her how to live effectively within a family system.  They agreed to concentrate on building a unified stance to keep Sandy from “triangulating” them—playing one against the other.  Through their effort, a plan unfolded to set rules and define chores, privileges and responsibilities for their daughter.  They were able to hold firm to boundaries and withhold privileges unless earned.  (They would still grant privileges occasionally just as a gratuitous expression of affection.)  They would listen to her demands, but did not give in to them.  Following through with firm boundaries was very difficult.  But Sandy eventually realized that James and Lori would not tolerate aggression or destruction of property when they called the police after she broke their front door. 

When James and Lori lapsed and failed to “follow their own rules,” they apologized to Sandy and explained their motivation for lapsing with the rules (usually fear of her retaliation).  As Sandy began to experience the security of reliable structure, her trust in her parents grew and the demands decreased.

Too much structure

Jones family:

Lisa and Danny began fostering children soon after they were married.  They learned to set firm rules for all the children.  Upon placement, a child was given a toiletries basket, four sets of clothing, and housing rules with a time chart.  The family scheduled bathing, eating, homework, chores, and free time.  Weekend schedules did not include homework.  When Lisa and Danny decided to adopt four year old Cory, they did not change their routine.  Over time, Cory’s behavior problems arose and increased.  Knowing that he came from a placement without strong directive parenting, Lisa and Danny added more rules to clarify and assist Cory in his recognition of the value of caring, involved parents. Of course, there were consequences for breaking rules. They joyfully anticipated the time when Cory would finally wake up to the fact that they cared and were here to keep him safe and provide the best for him. When that happened?  They reasoned, “He would stop senselessly violating our every effort to provide for his needs.” But that time never came. No matter how much Cory lost, he continued to blame them. Cory was getting angrier all the time, and his ability to make “good” choices actually seemed to decrease.

Treatment goals.  In this case Lisa and Danny would need to decrease structure.  They maintained most of the rules, while negotiating with Cory about some of the less important ones.  They were able to increase intimacy with Cory.  Together with him in reflective dialogues, they explored his fears about connecting to them.  They learned new ways of interacting with Cory with fewer demands and increased close proximity.  They even decided to have fun times together, whether “rules” were being broken or not. They did this because having those “fun times” was actually a big part of why Danny and Lisa became foster parents in the first place.

The Secure Base is strengthened by nurture.  We hear about unconditional love and acceptance, but few are tested to the extent that foster and adoptive parents are.  Many foster and adoptive mothers report that they feel abused by their children.  When mothers feel abused, they do not want to nurture their children.  One mother stated that she could not look into her child’s eyes because her anger toward her child was too strong.  Another mother refused to play a game the therapist suggested because of the child’s recent defiance.  These are not trivial difficulties, as “every positive, nurturing, attuned caregiving response that they provide for their children leaves an indelible mark on the child’s developing neural networks” (Goodyear-Brown, p. 135).  It follows that the opposite is just as true.  These two mothers are operating from a behavior/consequence model that indicates that they have not shifted in seeing their children’s behavior through the trauma lens.  Stepping back and viewing the child’s behavior with the trauma lens, they would see a clear link between their child’s maladaptive behavior and their history of early abuse. 

Therefore, the paradigm shift is essential before nurturing activity begins.  The Creating a Healing Home model uses nurturing actions which far exceed the norm.  Love, care, intimacy, touch and affection must occur every day and not be dependent on good behavior.  If a parent cannot or will not nurture their child, interventions that create more empathy for the child must be developed and the parent’s own trauma history be explored.  Until the block in nurturance is thoroughly understood, interactions with the child may promote the parent’s belief that “this child is unlovable” and the child’s that “this parent cannot be trusted.”

Parental care, nurture and unconditional love begins the healing process by building or rebuilding healthy connections between parent and child.  Parents must have the internal strength and insight to continue these potentially painful interactions.  Children may not easily accept nurture, may resist, and avoid intimacy.  Remember the training illustration wherein we ask the audience to accept candy from a stranger?

The Secure Base is strengthened by challenge. 

-challenging the child’s negative belief that this mother cannot be trusted, by suggesting and acting upon the belief that this mother can be trusted

-challenging the child’s negative belief that he is unlovable by suggesting and acting upon the belief that this child is lovable

Security comes when our internal beliefs match our external world.  Given that children with early trauma have developed an internal belief system of “I am unlovable, adults cannot be trusted, and the world is unsafe,” the naturally safe environment supplied by foster and adoptive homes in itself will provide no relief from that belief system and ironically can contribute to the child’s fear.  Children living with constant fear learn early to insulate themselves from the fear and anger.  This self-protective process occurs so often and so quickly that children will lose the ability to feel fear.  They report that “things just make them feel mad.”  Before the child can begin to experience security in a safe adult-led home, both the internal beliefs and the fear that they generate need to be labeled and challenged. 

Brown family:

Sandy explained to Lucy, her teacher, “It makes me mad that they give me all these rules!”  Lucy asked, “which rule?”  Sandy responded, “All of them!”  Sandy said that she was feeling very angry when asked to play in her room for an hour while mom and dad worked on taxes.  Lucy questioned, “What was the problem with being in your room?”  Sandy proclaimed, “I just don’t like being in my room!”  A surprised Lucy knew that Sandy’s toys and video games were in her room, and that she liked being alone.  “Why were you mad?” she wanted to know.  Her anger mounting, Sandy responded, “I just don’t know.  I don’t like it in there!”  Sandy was acting on her belief that these parents cannot be trusted.  She shared the confusing explanation to her teacher that she did not like parental rules or being in her room.  Her underlying emotion was fear of having rules and of adults trying to control her.

Staging an intentional environment for recovery

Lack of intentionality.  Parents bring children into their home through birth, foster care, and/or through the adoption process.  The resulting home environment is rarely constructed intentionally, but instead is often developed “on the fly,” instinctual and driven by parental needs.  Examples of reasons people have children include “That’s what people do,” “My biological clock was ticking,” “My mom said it is time to be a parent,” and “I was lonely.”  Without a sustainable motive for beginning or adding to a family, how can there be intentionality in its creation?

Internal and external pressures may influence the home environment.  Each partner carries their internal parenting models and is driven to reproduce or correct it.  The rules, possessions, activities and personal interactions become subservient to that intent.  A parent may unconsciously or consciously attempt to enforce their model on the other.  One parent may not support the other.  Marriages can be destroyed if parenting models are not merged or intentionally developed. 

Home environments are also subject to external pressures.  Television portrays ideal and fantasy versions of family life.  Movies create idealistic expectations of how children should behave.  Peers pressure the child to fit into their groups.  Parents may measure success by children’s performance outside the home.  Adoption and foster care agencies enforce directives and requirements that must be followed for the child to remain in the home.

Intentionality.  Our Trauma Lens model is intentional and derived through seeing the child’s behaviors, development and emotional regulatory systems through the trauma lens.  It addresses deficits with interventions that encourage growth.  If parents proceed trying to parent their traumatized child as they parent healthy birth children, the child’s behaviors are most likely to worsen.  During my (FH) parenting experience I termed it “parenting backwards,” because it seemed that strategies that worked with my birth children had the opposite effect with my adopted son.

Staging.  Trauma psycho-education must evoke a paradigm shift in the parents for them to be successful.  Through this new paradigm, a healing environment will be designed and executed.  This environment will not be static and adjustments must occur as the parents attune to their child’s needs.  The process is similar to staging a theater production with props, cast and a script that balances structure, nurture and challenge of old beliefs.  The performance is dependent on each element.  Choose cast, script and props carefully, as they are the family possessions, the relationships and the daily interactions. 

Daily family life is the production.  As with any play or performance, the actors and performers practice frequently with many errors.  They don’t stop and collapse under pressure, but continue to perfect their roles.  Parents must realize they have the same opportunity as actors in a production. They will fail at times, but their children will give them many occasions to practice their roles and perfect the production.  On the road to relational recovery the child must spend time with the family.  The production section will offer ideas to increase family time. 

Specific ways are suggested to script relationships, possessions and activities so as to minimize excesses and create a balance in each.  By thus intentionally adapting the environment as with a production, disruptive behaviors may be avoided and attachment bonds strengthened. 

  1. The characters

The main cast of characters is the child and the primary caregiver (usually mother) who replicate an infant’s early experience.  Mother is the first responder, attuned and emotionally activated by the infant’s cues.  Attachment is about building a relationship.  The parents will need guidance to maintain a balance of “normal” life while being a therapeutic parent.  Activities must include mother more frequently than not, but not exclusively.  Families usually include another parent, siblings and extended family. 

All family relationships will be stressed during the therapeutic process.  The parents’ relationship reveals the strength of the secure base.  Mother will rely on her partner’s support.  Siblings will expect assistance when treatment focuses on attachment building between parent and child.  The siblings may feel left out and that the world is not fair; their world seems to center on the child with the worst behaviors. 

Respite for the family, especially mother, is necessary.  Parents may be hesitant to use respite because they fear later “payback” for sending the child away.  But they need the rest to recover and sustain their therapeutic stance.  Respite must be encouraged for the family’s health.  The best respite provider is well-trained and provides two different types: restrictive and reward. 

A restrictive respite offers limited activities and distractions.  This respite provider offers quiet activities in which the child must occupy their self.  A reward respite is used as a positive encouragement to give everyone a rest from the hard work they are doing in therapy.  The child is able to relax in a less intimate setting.  All respite providers must redirect the child back to the parents by stating that all good things during the visit come from the parents.  They compliment the child for hard work well done and predict more success for the child.

Jones family:

Birth children Sara, Andy and Lane were happy to have another brother, Cory, in the family.  Cory was four years old when he joined them after six changes in foster placements.  The first summer was fun, with many activities and vacations.  But as soon as school began, problems began also.  Cory refused to bathe, sleep through the night and eat regular meals with the family. 

The parents began adding services to help Cory with his daily tasks.  Cory had a special one-on-one aide who came three days a week.  Cory had a weekly therapy session and a monthly doctor’s appointment.  His caseworker visited every week.  The children’s mother had to go to all the appointments and meetings.  It seemed like she was never home or had time for them.  Cory was the one causing trouble, but he was the one getting all of mother’s time.  The family needed help!

Mother consulted a specialized team for assistance. She was given literature to help explain to the children why Cory acted like he did.  The children were asked to be sad for Cory because of his history, but to hold to firm boundaries with him.  Mother was directed to use a “reward” respite for Cory once a month.  If Cory’s behaviors were too extreme, he went to a “restrictive” respite.  The birth children were allowed to go to their grandparents’ home for special times without Cory.  As the children found relief from the Cory’s daily behavior problems, they became more accepting of Cory.

Beware of times when mother is excluded from activities.  The child may feel unsafe, especially when anyone suggests that mother cannot be trusted, is too tired or not willing to participate.  The child can perceive negative intentions simply by father’s innocuously saying, “Your mom will not deal with this behavior.  So I will take you to practice.”  Other well-meaning friends or family members may state that the child should spend the weekend with them because, “The child should have more fun and give everyone some rest.”  This may produce a “pseudo-feeling” of belonging and safety that interrupts the need to attach to mother—that is, to lower the child’s innate motivation to heal.  “If I can do this without Mom, why do I need a Mom?”

Characters: Focus on primary relationships to avoid confusion for the child and activation of their hyper vigilance.  Eliminate non-supportive relationships and reduce the number of people interacting with the child by combining as many roles as possible.  Consider the relative necessity of social workers, therapists (mental health, speech, physical, occupational), behavior specialists, caseworkers, early intervention teams, respite workers, doctors, and teachers.

Jones family:

When Cory joined the family at four years of age, his speech and motor skills were delayed because of neglect in his birth home.  His birth parents rarely interacted with him, keeping him in a crib most of the day.  Lisa and Danny gladly accepted all the professional help offered.  They arranged weekly appointments with speech, occupational and physical therapists.  During the appointments, Cory was lively and playful with each professional, but on the way home he cried and kicked the back of Lisa’s car seat.  Lisa was always happy to put him to bed after therapy.  But she began to notice that Cory was pleasant with others and angry with her.  She felt jealous of each therapist, wishing he would be as joyful with her as with them. 

A team meeting was held to determine ways to decrease time between Cory and therapists.  The speech therapist provided interventions for the parents to use with Cory and offered to check in with the family monthly.  The occupational and physical therapists combined their treatment goals to enable Cody and Lisa to have one appointment per week.  During the sessions, the therapist directed Lisa in motor skills interventions with Cory.  He began to enjoy her presence in session and also while doing the therapeutic activities at home.

Therapeutic attitude.  Parenting a child with early trauma is energy-draining in the process of ensuring safety and steering the child into more productive pathways.  It feels like a constant battle for control.  Parents must redefine their roles and take ownership of what they can control.  Old paradigms infer that the parent’s role is to control their children.  The new paradigm states that parents control their home, and children learn to adapt to the family rules.  Parents control “if and when” they take their child to the park, purchase the “needed” new shoes, and in short create and supply the child’s world.  All good things come from the parents.  All of this is within the parents’ control.

As parents regain their personal power, they develop a “therapeutic attitude” because they know who controls “when, how, and what” things are accomplished.  They cannot be coerced or threatened to provide good things.  They will base their decisions on their energy level, the child’s reciprocity, or maybe just because they are “great parents” and decide to treat the child to the park.  Using the Trauma Lens Paradigm Shift, they know why their child behaves as they do and know how to address those behaviors.  They feel confident.

Knowing the parental role and power and the impact of trauma does not mean that parenting comes easy.  Therapeutic parenting is hard work, always challenging, and requires much thought.  It is impossible to always be therapeutic with the child.  Adequate respite, even for an hour, is vital to refocus on the task.  It is important to explain the temporary separation to the child to decrease fear of another abandonment.  These messages are delivered with loving calmness.  Needless to say, sarcasm or blame reinforces the N-IWM.

Examples of hurtful statements: “You have been so bad lately.  I cannot take it anymore.  You are going to stay with the respite family.”  “I cannot stand you anymore.  You are going away for a while.” 

Examples of helpful statements: “I need time to restore my outlook.”  “I am gaining control over myself.”  “I will take some time for myself.”

  •  The script

The script for the healing process is empathic statements, humor and encouragement.  The goal is to maintain the delicate balances of structure and nurture.  Often the script must be memorized, considering that the words do not come naturally in responding to a child who, at best, pushes the mother away emotionally.  Remember my (FH) backwards parenting experience.  Communication is more than just words.  Facial expressions, body language, tone f voice and words must be fine tuned to eliminate anger or sarcasm.  Many parents spend time rehearsing Hughes’ PACE model, which provides concrete interactional interventions to engage and interact with the child.  Goodyear-Brown (p. 140) offers SOOTH strategies.  Learning and practicing new communication skills is necessary.  The greatest benefit will be the ability to draw on this wisdom and new style of engagement in times of overwhelming stress.

Examples of scripts to practice:

  • “I” statements: Parents are wise to use statements about what they will do, rather than what their child will do.  No matter what earlier generations say, we cannot control our children (although we may be able to move them about when they are young).  We can control ourselves.  Examples of “I” statements include, “I will take you to Grandma’s when your chores are finished.”  “I give cookies to children who eat their broccoli.”  Love and Logic press has a helpful handout entitled “Turn Your Word Into Gold.” (http://www.loveandlogic.com/). 

Smith family:

James and Lori determined that it was useless to tell Sandy what to do because she was so defiant.  Their demands just seemed to give her more rules to break.  They began to use “I” statements instead.  They practiced them after she was in bed at night.  They enjoyed the time together in a strange way, while they gained new skills.  They reduced their demands as they stated what and when they were willing to act.  Sandy found it difficult to argue with them, since they were not telling her what to do.

  • Third party conversations: Children with early trauma learned to be hyper vigilant to keep safe.  They needed to know everything that was happening in their environment.  Parents can take advantage of this learned skill to help their children accept compliments.  Direct compliments may conflict with a child’s negative internal working model (“I am bad”).  Therefore, a parent may “stage” the intervention to describe to the other parent the behavior to compliment.  With the child within hearing range, one parent compliments the child and the other reacts positively.  With practice, the “listening” parent can take the cue and expound on the compliment to reinforce the praise.

Brown family:

Jane found she could not compliment Sally without escalating her negative behavior. One day while talking to her mother on the phone, Jane told her about Sally’s improvement in math.  Sally smiled as she listened to her mother’s phone call.  Sally accepted the compliment because it was not directed at her, and she did not have to respond to it.

  • Matching affect: Many children complain that they do not feel heard or that they do not have a voice.  Parents often interpret these statements as “therapy talk.”  That is, as a parroting of jargon they heard in a therapy session.  But what the child is usually saying is that they do not “feel felt.”  The parent is not having the same emotional experience as the child.  Parents are encouraged to be empathic—“walking in the child’s shoes,” and responding with like emotional intensity and depth.  By matching affect, the parent will enable the child to experience the parent differently.

Smith family:

After attending a training, James and Lori were determined to use affect matching with Sandy.  They practiced with each other.  James described his commute with heightened emotion.  Lori used her own experience of being in similar traffic in order to understand James’ traveling travails.  She responded with emotions similar to his—frustration, anger and fear.  Then James shared funny stories, and Lori matched his laughter with her own.  Somewhat to their pleasant surprise, these practice sessions increased the emotional versatility of their communication with each other.  The sessions became their favorite time in the day.  They then focused on using this skill during dinnertime with Sandy.  At first Sandy was disturbed by the change in her parents. She tried to make them stop; “they weren’t being real”, or “stop acting like therapists”. But the parents were not deterred, and they actually seemed to enjoy more deeply sharing their day. Eventually they noticed that it was not taking an effort any more, and the interaction was almost automatic. Lori reported feeling “gyped” when it didn’t happen for some reason. Sandy became more emotionally attuned to her parents and felt closer to them.  Dinnertime became a pleasurable experience for all.

  •  The props

Traumatized and abused children tend to come from environments that lacked physiological and safety provisions.  Many naïve foster and adoptive parents presume that the children will be thankful for their new abundance and express appreciation for the changed lifestyle.  These children may not have a template for how to interact in an abundant environment, or even find it valuable.  This is often the first clash between the child’s and parents’ belief systems (child’s: “I am unlovable and my parents can’t be trusted.”  Parent’s: “This child is lovable and I can be trusted.”).  The natural parental impulse to provide relationship, activity and possessions for their child must be held in check at first.  To minimize conflict, the environment must be adapted.  The props for this production cannot be costly or cherished pieces that could be damaged or destroyed. 

Remember that the child’s nature is to push the family away and recreate what is familiar to them internally and externally, namely a chaotic environment and distant, abusive or neglectful relationships.  Until the child develops a positive belief system and healthy emotional regulation, they will be prone to damaging or destroying possessions.  So irreplaceable and costly items should be removed and stored.  What better way to push mother away than to break her favorite lamp, vase or jewelry?  Other family members may also be targeted, and so their possessions must also be secured and firm boundaries established. 

There is great value in limiting the quantity and quality of the traumatized child’s personal belongings at first.  The child is easily overwhelmed with all the choices of toys or clothes, and picking and choosing can become a virtual battlefield.  The child may destroy anything of value under the influence of their negative core beliefs.  By staging a minimal environment, parents can give the child’s chaotic inner world opportunities to calm down, with reduced trauma triggers.  As Goodyear-Brown points out (2010, p. 143) one of the parent’s responsibilities is to “be proactive in scanning the environment for anything that may spike the child’s posttraumatic anxiety.”

Lewis family:

Bob and Deana were first time parents of newly placed six year old Samuel.  They wanted Samuel to integrate into their home without needing to adapt the environment.  Both believed that a child will comply when they know the rules, and will be thankful for their nice home.  On Samuel’s second day in their home, they outlined for him how he was expected to behave, the family rules and his boundaries.  Although the first week went well, Samuel began to “forget” the rules and what he was not allowed to touch.  By the second month Samuel had gone from “forgetting” the rules to telling Deana that he did not care about their rules.  In the third month Samuel broke Deana’s valuable figurines and rummaged through Bob’s desk.  Bob and Deana did not know how to make him respect their property.  The family had begun the Downward Spiral.  The family therapist referred them to a developmental specialist. 

The developmental specialist advised Bob and Deana to assess Samuel’s emotional age and prepare a corresponding environment.  After some reading on child development Deana determined that Samuel demonstrated toddler behaviors.  They simplified their home, removing costly items and adding toys and activities to engage Samuel.  They actually had to teach him to play.  Bob and Deana’s relationships with Samuel then began to deepen.  He began to emotionally mature and became respectful to the family’s possessions as he watched Bob and Deana model how to care for their belongings.

Limit props to decrease stress.  Specifically, limit the number of toys, clothes, books and furniture.  The first rule: don’t buy anything for the child that is not absolutely necessary.  Parents’ inclination is to rush out and buy everything for this “poor orphaned child,” out of a desire to shower them with glorious presents as proof of their loving kindness.  But parents must visualize first losing connections to one’s birth family, then being moved from family to family, and now facing placement wit still a different family.  We must try always to see the world through the child’s lens.  What is the most important thing for the child?  Is it really a possession?

Brown family:

Sally, who just moved to her fourth foster family, relentlessly talked about the American Girl doll she had to leave at the previous home.  “The doll cost a hundred dollars,” Sally declared.  Jane wanted to order her a new doll to make up for the loss.  She thought it would ease Sally’s pain.  She failed to notice that Sally was not saying she missed the family who bought the doll.  If we were Sally, what should we grieve?  A possession?  These children have a relationship deficiency that another possession will not remedy. 

Many children have unknown “trauma triggers” that instill fear and anxiety.  In the past, the child’s toy may have given the caregiver a means to punish the child.  The toy may have been taken away and used against the child or destroyed out of anger.  Some children were “groomed” with toys by sexual predators.  Such memories may trigger feelings of discomfort or outright fear of the new caregiver.  If the environment must be adjusted after the child already has too many possessions, these traumatic memories can become activated with accompanying emotional dysregulation.  Extra precautions must be used in this process.  Ways to manage this are addressed later.

Most foster and adoptive parents want to enrich their child’s life with gifts and privileges.  They quickly realize that possessions become another source of interference in the development of relationship.  Children tend to destroy the gifts in which parents have invested time and money.  Disappointment grows into anger as the parents see their gifts destroyed.  The wedge between the parents and the child drives them further apart.  The child will not be happy with broken toys but will experience comfort as they “feel” the resulting distancing of the parental relationship.  Statements like “who cares anyway” or “so what,” delivered with complete disregard for potential consequences, demonstrate the child’s comfort.  Often the “icing on the cake” is blaming the parents for the damage: “If you would have bought a different one,” “That was never what I wanted anyway.”  Or maybe it’s the professional peering out over the top of their glasses at the parents with the judgmental observation, “I noticed all of his toys are either broken or have missing parts!” 

In short, if parents equate the child’s care of their gift with the child’s affection for them, the gift may be used as a wedge to divide the relationship.

Too many possessions

Lewis family:

Bob and Deana tended to use retail therapy to sooth their emotional distress.  When Samuel joined the family at six years old, they had a reason to buy more to make up for his deprivation.  Samuel was a difficult child to parent with all his behavioral problems.  Because of the stress of parenting, Bob’s and Deana’s buying increased.  The home quickly became filled with “stuff.”  Samuel’s possessions required him to repeatedly make bewildering decisions about what to do with his time, attention and energy.  He was ill-prepared to apply the focus, adaptability to loss (of all the things he did not choose to do at the moment), and security (that nobody would take the possession away) that were necessary to manage this “embarrassment of riches.”  He began leaving items all over the house.  He had tantrums when instructed to pick up the toys.  When other children wanted to play with one of his toys, he became aggressive.

Treatment goal: Eliminate the child’s messiness, destruction of property, aggression and tantrums related to possessions, and relieve the parents of fatigue, anger, hypervigilance and overspending; by reducing the number of possessions

Therapy focused on reducing the number of toys to a few favorites, decreasing parental purchases, increased parental time playing with the child, and parents finding new ways to handle their stress.  Parent savings increased as they reduced their need for retail therapy.  As Samuel continued to mature and gain in emotional self-regulation, he was able to handle more possessions.

Performing the production: family time to grow the relationship

In addition to the characters, script and props, relationships will only grow when the partners spend time together enjoying each other’s company.  Imagine dating but not being together or having fun with each other.  This may entail limiting “extracurricular” activities for the child, such as music or art lessons, sports or involvement in other organizations.

Jones family:

Lisa and Danny happily signed Cory up for soccer.  Cory also stated that he wanted to play the trumpet, and so private lessons were scheduled once weekly.  Danny lead the local Boy Scout troop, and Cory tagged along.  The family was active in their church, allowing Cory to be in the children’s group.  Lisa and Danny were pleased that they could offer all these opportunities.  They were fulfilling their parenting dreams by treating him like their birth children and helping make up for the deprivation he endured.

A busy summer was followed by fall with more activities.  Lisa began feeling like a taxi driver with a growing concern about Cory’s grumpy attitude.  He was demanding and aggressive when late for an activity or asked to complete chores.  They had little family time.  Cory enjoyed his time away from the family.  Lisa and Danny thought that if they explained the inappropriateness of his attitude, Cory would change.  But explaining did not work and consequences were of no “consequence” to him.  Behavior problems increased.  Lisa and Danny felt like they were in a vortex pulling them further and further away from their parenting dreams. 

Treatment goal: The therapist successfully convinced Lisa and Danny to curtail his and their involvement in outside activities until such time as their relationship was solidified.  They actually discovered with Cory an enjoyment of board games that they hadn’t even experienced with their birth children.  As Cory began to respond with some warmth to this play time with his parents, they were reminded of the “P” in Dan Hughes’ PACE acronym: Playfulness!

In the appendix you will find a host of practical suggestions for adapting the environment to the unique needs of the attachment disordered child.  Now we move on in the next chapter to broaden our lens and focus beyond the home environment to the village!

© 2021, Faye Hall. All rights reserved.

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