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The Child Who Is ‘Stuck’
INTRODUCTION: A major function of parenting is the creation of an environment which allows the child to achieve his full potential in all areas of development– physical. cognitive, and psychological. Although developmental gains in these three areas are usually intertwined, physical development is frequently a precursor to cognitive and psychological development. However, gains in these latter areas, in turn, affect future physical development. In general, if there are delays in one area of development, they affect the other major areas. Once the child becomes “stuck” in terms of development in any of the three major areas, continued growth and change are likely to be affected in the other areas as well. The child’s growth and change are functions of the interactions between him, close family members, particularly parent figures, and his environment. Problems in any of these three variables can interrupt the normal progression of development. Most children who enter the child placement system for whatever reason will experience problems in continued growth and change along the usual lines. If the child has had normal development in all spheres and has had a normal family life up until the time of placement (in this case we might presuppose that a crisis in the family led to the placement) the separation from the family is likely to cause an interruption in the usual progression of change and growth. More commonly, there have been major problems prior to the child’s entering the child placement system. These may have been initiated by conditions inherent in the child from birth or stresses within the family. In either situation an environment which meets the child’s needs has not been provided. Once a problem starts in either of these areas we again find that this, in and of itself, influences the other area. A child’s reactions will influence parental behaviors; parental behaviors influence how a child reacts. Cyclical reactions, rather than linear reactions are common in families. Environmental factors tend to modify the behaviors of both adults and children. Thus, we can see that the child who enters the child placement system is particularly likely to be “stuck” in one area or another in the normal progression of developmental functioning. This, as we noted earlier, is likely to affect the other major developmental areas to one degree or another. Those of us who work with such children in any capacity are responsible for identifying the problems and for attempting to see that an environment is created which will optimally meet the child’s present needs so that he can become “unstuck” and can again be available for continued growth and change in all areas. It has been our experience that once the child enters the child placement system it is important to identify how and where he is “stuck” as well as why this has occurred. Answering the “how”, “why”, and “where” will tell us what we must do to help free up the child for further healthy growth and change. Four Ways Children Become “Stuck” 2. He may have developed abnormal (or maladaptive) patterns of behavior. 3. Unresolved separation issues may cause the child to become “stuck”. 4. Misperceptions, either on an organic or psychological basis, can be very potent in terms of hindering the usual progression of growth and change. In all of these situations, the child’s energies seem to go into coping with the problems, leaving little energy available for continued growth and change. It is not uncommon to see children caught in the same patterns for many years. We frequently see children who, years after the separation from birth parents, continue to be frozen at the level of psychological de-velopment which should have been present at the time of the separation. For example, an eight or nine year old may still be involved in the autonomy battles which are usually resolved during the toddler years, or a seven year old may continue to depend on externally supplied safety and security, rather than learning any measure of self-control. Following moves it is not unusual to see periods of regression in functioning. This is true for all people, but it is more noticeable both in the child who has had many moves and in the one who already shows evidence of delayed or abnormal development. How Do We Help the Child to Become “Unstuck”? In my work in residential treatment, I learned that it is the day to day living situation that is the real therapeutic tool. This can be adapted to the foster care and adoptive systems by recognizing that there are similarities between these two situations and residential treatment. In each case, the child has been removed from an environment which has promoted, or at least has not interrupted, the development of problems, and has been placed in what is, hopefully, a corrective environment. If we realize this, then therapists can recognize that their role in the helping process is to become experts at identifying how and where the child is “stuck,” and then to work with the new family to create strategies for providing optimum stimulation for continued growth and change within their family structure, thereby helping the child to become “unstuck.” This is the same role as that of the consultant in a residential treatment center. The consultant is expected to take the input given by the history, formalized testing, and the day to dayobservations of the child care workers, and then to identify what the child is telling us abouthis needs. The consultant is then further expected to help the child care workers develop a plan for implementing new learning for the child in the course of he day to day living situation. When therapists work with adoptive or foster families, the role is the same. They need to identify what the child’s developmental needs are, what new, or corrective learning experiences he needs, what his misperceptions are, and then help the family develop a plan for day to day remediation. This plan must fit with overall family functioning and needs. It will, of necessity, vary from family to family because each family is a unique system. THE FOUR PROBLEM AREAS Developmental Delays: Our job is to identify the developmental levels at which the child is functioning and then to help the family create an environment which is congruent with those levels rather than his chronological age. In order to do this, we must be knowledgeable of the normal developmental progression. It is usual for children in the child placement system to evidence uneven levels of development. These children usually show some areas of delays while other areas approach more normal development. Our goal is to identify the areas of delay and use the areas of strength to effect the remediation process. Delays in language development are very common in the preschool age child in placement. Gross motor delays are less common, and are frequently less severe, but it is not unusual to see preschoolers who are six to twelve months delayed in terms of gross motor development. Fine-motor delays and those in perceptual motor integration are also common occurrences.Some children in placement are functioning at much earlier levels in terms of interpersonal relationships. A seven or eight year old child may only be able to play alongside peers rather than share and take turns–a skill which is usually attained by age four. Fears and worries that are normal at earlier ages frequently persist long beyond the usual age in the child in placement. In addition, such fears may have unusual intensity, which leads to interference with the child’s day to day functioning. If we are to help the child to continue to grow developmentally and follow the usual developmental pathways, then we must help those who live with the child create an environment that on a day to day basis not only meets earlier developmental needs, but also provides adequate stimulation for continued growth. Maladaptive Patterns: When maladaptive patterns of behavior are present, we need to both recognize the pattern, and also become aware of how such patterns originate so that we can focus on creating an environment which provides a healing experience for the child. These children need to have opportunities to relearn more normal patterns of adult-child relationships. We must always remember that it is more difficult and time consuming to relearn something than to learn it correctly the first time. In most of these cases the child has not had an opportunity to live in a family where the adult-child relationships are to the child’s benefit and this then becomes a critical factor in the new environment. Two very common maladaptive patterns are seen in abused children. These children have learned to expect that this is the usual parent-child relationship. They may psychologically defend themselves either by withdrawing and avoiding adult-child interactions, or by asserting themselves so that they control the relationship and what happens to them. When such children enter new living situations it is not uncommon for them to try to recreate the same adult-child relationship. In the case of the child who asserts his autonomy in an inappropriate manner, it is important that we understand that this in no way means that the child likes physical pain, but rather, that he wants to check out his perceptions of adult-child relationships. Such children move into new situations and behave in ways that seem to invite further abuse. They seem to be “asking for it” and may even seem to be “relieved” if they can get an adult to again use excessive physical discipline. The child’s desire to recreate the situation is aimed at confirming his own ability to perceive his environment accurately, rather than a desire to be physically hurt per se. Adults who live with these children must realize that every time they are provoked to excessive discipline, they are reinforcing the maladaptive pattern. The corrective learning experience requires that the adult-child relationship be non-abusive. This particular maladaptive pattern is commonly complicated by a misperception as to how love is shown by parents. Some children who have been abused, but who also have been loved by their families of origin, get these two interwoven, and they think that “if a parent really loves he, he will hit me. If the child has that particular misperception it is important that we know it so that special strategies can be developed to separate these two things. We want the child to learn to feel loved without being abused. A second common maladaptive pattern is seen in children who have been sexually abused. In the most common type of sexual abuse, father-daughter incest, the child learns “this is the way fathers and daughters interact.” When such a child enters an alternative living situation, she may continue to behave in the way she was earlier taught. She tries to keep up her half of the relationship. Substitute parental figures may comment, “no wonder this child was sexually abused; she is seductive and wants it”. Again, we must understand that the child wants to reconfirm her perceptions of the world, and that, like all normal people, she desires physical closeness. These needs must be separated from the girl’s actual behavior, and she must be taught that in most families father-daughter relationships are different. She needs to learn that she can be physically close to a male parent in a non-sexual way. Again, the day to day caregivers need to be aware of how the earlier pattern was learned and they need help in developing a strategy for re-education. Clearly, encouraging the child to stay away from the parent of the opposite sex will not provide for healthy relearning. Again, the focus must be on teaching the child about the more normal parent-child relationships. In general, the parent of the same sex as the sexually abused child is in the best position to take on the active teaching role as to what is appropriate in terms of interactions with the parent of the opposite sex. If a child with maladaptive patterns is able to get adults to behave toward him in the same way as in his past environment, then we have failed in the task of therapeutic re-education. Separation Problems: Some children seem to invest all of their energies in relationships that are no longer part of their day to day lives. This means there is little energy available for perceiving what is going on now, processing it, and using current relationships for continued growth and change. As time goes on, the energies are diverted to a fantasy relationship–an “if only I were with…. things would be this way.” This, of necessity, is fantasy as no one can insure what would occur if previous relationships were ongoing. As the interval increases between the time of separation and the present, there is even less likelihood that the fantasy bears much resemblance to reality. From this viewpoint, the most difficult separations, are those where others have separated the childp and parental figures, whether they be birth parents, foster parents, or adoptive parents, against the will of both parties. In such cases the child rarely has permission to go and do well. Thus, he is likely to think that if he becomes close to the new caretakers, learns to love them, and does well, he will be disappointing people who were very important to him in his past. If the parents either verbally or through their behaviors are clearly indicating that they: 1) do not want the child with them, or 2) are unable to meet the child’s needs, then we are in a osition to help the child understand the separation process. We can help the child come to grips with the fact that there is nothing he can do if the parent does not want him to return home, or if the parent is unwitting to change his own behavior, and thus better meet the needs of the child. This is not easy work for the child to accomplish but it is based on reality and thus is easier to confirm and resolve than perceptions based on fantasy. In general, it is easier to help the child resolve this issue if we have the parents give the child the message directly. When we try to protect the child from this pain by acting as intermediary interpreters, it is easy for the child to focus his feelings about the separation on us. We then are sometimes put in a defensive position, and can no longer act as helpers in the resolution process because the child sees us as responsible for his plight. If the child holds us responsible for the separation, we may set the child up to “prove us wrong” by disrupting subsequent placements. In this way he is proving to us that moving him was not a good choice. If the child is “stuck” in terms of separation issues, then we must help him come to grips with reality. This may mean that we have to set up contact with past parent figures or other relatives via face to face contact, letters, or telephone. Sometimes helping a child write a letter to someone who is likely not to answer is necessary. If there is no answer, then we are in a position to help the child deal with the emotions that this arouses. If there is an answer, we can help the child deal with the written message. If we don’t allow him to write, we are in reality supporting his fantasy of, “if only my parent knew…” The strong feelings associated with the separation are then displaced on us. The child can blame us for his anger or depression. “It’s because you wouldn’t let me contact them”. Our job is not to protect the child from reality, but to help him cope with it. If parent and child have been separated for some time, and the child is putting all of his energies into the old relationship, we may have to allow him and the parent to reunite, even if we doubt that the placement will be successful on a long-term basis. This is necessary to put the situation into reality terms so that we can then help the child with the separation process on a reality rather than a fantasy basis. Obviously, we would have to insure that the child is not at risk of physical harm and we would have to be supportive to the child coping with the reality of the situation. Sometimes returning to old places can aid the child in remembering enough of the past that resolution becomes possible. If past caretakers are dead, pictures of them, or trips to the cemetery may aid in the resolution process. In therapy it is common for the most important issue to be the one about which the patient can do nothing. This issue frequently relates to separation. For example, if the child is caught in fantasies about a birth parent who is dead, and is putting his energies into thinking, “If only she hadn’t died,” the goal is to help him come to grips with the fact that this is something over which he has no control. There is nothing he can do. He does, however, have some control over how he lets her death affect his life. In many cases people put much more energy into fretting about situations over which they have no control, and avoiding those situations over which they do have control. Our job as helping people is to aid individuals in discriminating between the two types of situations and making them take responsibility for their choice as to where they put their energies. Because separation issues are a major cause of long-range problems, we need to understand that the time spent trying to minimize the trauma of moves is time well spent. Our first line of defense is preventing unnecessary moves. However, when moves are necessary, we need to know that whenever a child feels that he is part of the decision-making process, without being totally responsible, he is less likely to become “stuck” in unresolved separation issues. If we can take care in the preplacement preparation and work to conscientiously transfer behavioral gains and attachment, again we will be taking preventative measures which will lessen the likelihood of serious separation difficulties. We have little control over the circumstances leading to many of the problems that children in the child placement system exhibit. The area of unresolved separation issues is an exception. We not only have control over the circumstances surrounding moves; we also have recognized ways to minimize the trauma of moves when they must occur. Misperceptions: Children in the child welfare system are more likely to have learning disabilities and perceptual problems of an organic nature than the population as a whole. Perceptual problems may be in either the visual or auditory area. Children with these problems are also likely to be more easily frustrated and impulsive than others. Frequently, they have a short attention span and are emotionally labile. Our job in such cases is twofold. One aspect relates to helping the day to day primary caretakers create an environment which helps the child learn to deal with the frustration, impulsivity, etc. The second aspect is to work with the caretakers toward understanding how this child perceives the world, thus using adults as mediators in focusing attention and correcting misperceptions. We must learnto see and hear through the child’s eyes and ears if we are to help him build a coherent image of the world. A second type of misperception, related to magical thinking, frequently relates to moves. The child, in his striving to make sense out of the world, tries to find reasons for what has happened to him. However, the reasons on which he focuses frequently do not relate to the real reasons for the moves. If he continues to function as though his sense of cause and effect or magical thinking is true, he may develop further problems. For example, when a child has been moved, he frequently holds himself responsible because of egocentric thinking. He may try to make sense of the situation by hooking together unrelated facts as cause and effect. This may be done either on a conscious, or unconscious basis. He is likely to think, “if only I hadn’t . . . . everything would have been fine.” If his “if only” is not reality based, it will not serve him well, and may lead to ongoing problems as he tries to check out his misperception. For example, a child who is moved shortly after getting a new baby enters the family may assume that this child’s arrival was the cause of his leaving, when indeed it was not the cause. On the other hand, he may develop feelings of responsibility for the separation because of magical thinking of the “wishes make things come true” type. For example, the young child who was angry at an adult immediately prior to a move may perceive his anger as the cause of the move. Careful attention to the child’s verbal and non-verbal messages near the time of moves often provide indications as to the child’s particular mode of magical thinking. Perceptions in the present may tap into old memories on a subconscious basis and lead to continuing behavioral problems. Again, this needs to be seen as the child’s healthy strivings to make sense out of his perceptions. Problems may occur because the child believes old parental messages as absolute truths. For example, if a previous parent has repeatedly said, “You are a bad boy,” or, “I’m going to leave you if you don’t stop crying,” the child may internalize these messages and continue to act as though they were absolute truths. Threats of abandonment are particularly harmful to young children as they are usually made by parents who hold the child responsible for the problems. The threats are commonly made in a way that the child becomes responsible for the adult’s behavior. For example, the parent who threatens a child having a temper tantrum in a store by saying, “if you don’t stop your tantrum, I will leave you here,” is insinuating that the child holds total responsibility for the adult’s behavior. There is no acknowledgement of the reality that the adult has many options and is responsible for selecting one. Our job is to help unravel the child’s misperceptions and/or magical thinking, and to correct them, either during one-to-one work with the child, or through subsequent day to day interactions. Usually an approach that takes both courses is the most productive. TOOLS FOR IDENTIFYING HOW THE CHILD IS STUCK: The Lifebook is a very potent tool for helping to identify how and where the child is “stuck.” As a Lifebook is completed or reviewed, there are opportunities to identify strong feelings about past events, including separations, and to correct misperceptions. The Lifebook provides us with opportunities to finish up separation issues or to recognize what kind of contact with people or places from the child’s past might be useful to this particular individual in resolving old issues. It gives us opportunities to see how maladaptive patterns developed, and to share this with the child. Working on the Lifebook is a way to identify misperceptions and/or magical thinking so that we know what it is we need to clarify in order to help the child. To help the child who is “stuck” it is frequently necessary to get down to “picky” facts. As we do this, both misperceptions and underlying feelings become evident. It is usually necessary to separate feelings from behaviors, accepting the former and confronting of the latter. We need to open up choices for the child, and help him become responsible for his own actions. What can he do in the future if he has these same old feelings? We need to actively teach him alternative ways of expressing feelings. To do this well, we must incorporate his current caregivers in the therapy. If we don’t, we run the risk of teaching him a way of expressing feelings which is not acceptable to them, and which will lead to further lack of acceptance. We must focus on helping the child and family make sense of how the child got to where he is. This, in and of itself, raises self-esteem and says, “You are basically a perceptive, sensible person.” We can then engage the child in making use of these same qualities in the here and now, and have him become an active participant in deciding what he wants in the present and future, and how he is going to go about getting it. If we can help the child and family make sense of behaviors which do not serve him well, it is easier for him to relinquish the behaviors and easier for the family to see the health in the child. The job is to help all see that once these behaviors were adaptive and served a useful purpose, but that currently they are maladaptive and serve no useful purpose. If we can put the behaviors in a framework that says once they were useful and made sense, it is easier to give them up than if the implication is “they never were useful; you always were abnormal.” In this case the child has only two choices–either to agree with us and continue to be abnormal, or to disagree and keep up the old behaviors, trying to make them more useful in terms of secondary gains. Our job is to open up choices for the future and to always hold the individuals with whom we are working, whether they be adults or children, responsible for making their own choices and responsible for the consequences of their actions. This is the way we help them out of the position of feeling powerless over their own lives. At the same time, we raise self-esteem by helping people take responsibility for their own decisions, and by helping them change in such a way that they feel accountable for the positive changes. Our job as helping adults needs to always be aimed at helping individuals make sense of their lives through understanding their past, correcting misperceptions, opening up choices for the future, and holding them responsible for their actions. Our goal is not to save individuals from the pain of reality, but to help them cope with it. Our job is not to make unilateral decisions for them. It is to help them make decisions which make sense and give them the feeling of power over their own lives which enhances both their self-control and their self-esteem.
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