Parent #1: It’s already December. We need to decide about Christmas and you had Johnny last year. Why do you think you should have him again this year?

Parent #2: You know how important Christmas is to me. I’ll take him to my parents and he’ll have all his cousins around. Why should he miss out on the big Christmas celebration my parents always have.

Parent #1: Because I want to spend Christmas with him too. Why should I lose out on time with him because it’s not a BIG celebration. Johnny needs to learn about all different ways of celebrating Christmas.

Dividing up the holidays in divorced or separated families is difficult enough when you sit down and plan it out in advance. When you try to make it work on an ad hoc basis, it can be excruciating for you and even worse for your children who feel fought over and then responsible for the next fight you have with them being the main attraction. (more…)

Are you tired of intense and destructive marital arguing and want it to stop? Do you need some space to think about things more clearly? Are you thinking about a separation but are not sure how to pull it off without making things worse? Do you feel like you just need a break from all the tension?

It might be time to separate—either formally, legally, or “in-house.” In an effort to save a troubled marriage, a separation can be useful if done with agreement between both spouses and a high degree of respect (even when you are angry). A separation does not signify that a divorce is inevitable. It is a time to get clarity about the direction your relationship should take.

In Lee Raffel’s book Should I Stay or Go?, she reviews specific steps couples can take that will enhance the probability that their marriage will be saved. She refers to this as a Controlled Separation. She tells stories of couples who have successfully separated in order to repair the relationship, learn new skills, and enter back into the relationship with a new mindset and optimism. Both partners need to be committed to change, compromise, and self examination. The reward is a much improved marriage and avoidance of painful and costly divorce.

This article is not about the legal or financial aspects of separation but is about the psychological and emotional issues and how to stay focused on getting a good outcome for an “in-house” separation. The two of you need to agree on why you are taking the separation and how long it will last. You need to both recognize that your marriage is on the brink and drastic changes are needed. Keep an open mind. Slow down the decision making. Other issues that need to be resolved—what part of the house is his or hers. Are you going to tell family or friends? Do you continue splitting chores up between the two of you in the same way. If the holidays are coming up, do you attend as a family? Are you going to be sexually intimate? Do you eat dinner together? Do you talk to each other when you pass each other in the house? This is not a license to see other people outside the relationship.

The following are some reasons that couples cite for taking a controlled, in-house separation:

• A stop to the fighting
• A time to cool off
• Time to determine your next course of action
• An opportunity to see how you feel about the relationship
• Time to reflect on your responsibility in making the marriage go sour
• You don’t have the money for a formal separation

If you think you would benefit from an in-house separation, both you and your spouse will need to act in good faith as you call this truce. Your first step is to establish some ground rules that the two of you can agree on. Establish a time frame—1 to 4 weeks—at which time the two of you will renegotiate. Make an attempt to understand the reasons your spouse wants a separation. If you do not want a separation, be clear about your concerns that things may get worse. These should all be written down which will help you stay focused. Get marriage counseling if you feel you can’t manage the details of a separation on your own. GoodTherapy.org offers lists of therapists in your area.

Separation is a serious thing not to be entered into lightly. It will not fix everything on its own. It is a tool to be used to bring healing to the relationship.

The “empty chair” technique is one of my favorite anger tools to use with clients. When I first explain the idea and how it works, I tend to hear people say, “I don’t want to look stupid.” Too often, we spend so much time worrying how we will look to others and what they will think of us—but I digress. In this technique, we want to imagine the person we are angry with and use our minds to essentially “put them” in a chair facing us. This is our opportunity to speak directly about what we feel, with absolutely no concern about how the absent target will respond.

Too often, clients will tell me they worry about the target’s response if they do share their feelings. They worry about possible retribution or intensifying the target’s response if they get too upset. Another concern for some people is that they will hurt the target’s feelings and push them away. For instance, a client wanting their parent’s approval may fear that if they express their anger with their parent, their parent will only reject them further or maybe totally disappear from their lives.

This exercise seems like it should be a piece of cake, and yet the resistance to it is amazing. Clients are embarrassed to share, concerned what I or others may think. I remind them that these fears may be related to the fact they are not used to sharing in the first place—so it makes sense that they might not be comfortable at first. Others will find themselves “stuck,” not knowing how to start or what to say. In these situations, I might help them start by taking a few of their past statements about the target and modeling the technique. I then ask the client what I am missing, allowing them to continue. In my “sharing” aloud, I might be loud and even boisterous, modeling that it is okay to express what they are truly feeling.

Once the client starts sharing, pent-up frustration seems to easily spurt out. Ironically, what I tend to hear is clients’ surprise that they had so much to say. I remind them that once they allow themselves to be comfortable sharing, they are allowing thoughts and feelings that have been stuffed for years to get their due and be released.

I will ask clients to continue this exercise as needed. For example, if you are in the car and thinking about a past frustration, it is okay to talk aloud as if directly to that person. “But what if someone sees me?” The fact is, other drivers will think you are just singing along to the radio. Of course, you can do this at home or while out alone on a walk. What tends to happen next is that clients will say how relieved, or even tired, they feel as the feelings are released. Furthermore, clients will often report finding it easier to share their thoughts and feelings later, with the person truly there.

When we use the empty chair technique, we can be as angry as we want. Don’t worry about how you say it; just get it out. After the steam clears, you may want to keep some of the core statements to later share in real life with the person—but now is not the time to have to worry about how it might come out later. Again, just get it out.

The onset of disabling illness or physical or sensory impairment is often accompanied by complicated grief processes, including depression and posttraumatic stress disorder. These grief processes are frequently developed in response to the concurrent losses people may experience when living with new abilities.

Most obviously, people who acquire a disability or disabling disease lose a part of their bodies and/or the functionality of parts of their bodies. Additionally, they may lose physical comfort, vigor, mobility, spontaneity, the ability to engage in certain activities, aspects of their previous lifestyles, privacy, a sense of dignity, a sense of control, a sense of efficacy/agency, a degree of independence, actual or perceived life roles, friends and other social supports, the ability to work, financial stability, their previous sense of identity and purpose, the ability to pursue previously established dreams, their previous body image, and, all in all, their previous sense of self as a whole. Therapists should be attuned to what a newly disabled person may have lost, or may perceive themselves to have lost, beyond the obvious loss of physical or sensory functionality.

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How well people adjust to this potentially staggering array of losses is usually much more closely correlated to who they have been prior to the disability, and what social, emotional, and financial resources they have available to them, than to how “severe” the impairment itself is. The huge importance of social support after a disabling event cannot be overstated; people with new-onset disabilities may realize how lucky they are to have loving people in their lives as they have never realized it before, or they may feel almost completely socially and emotionally isolated. The most difficult disabilities to deal with in regard to social support seem to be “disenfranchised” disabilities (e.g., those resulting from Fibromyalgia/Chronic Fatigue Syndrome) in which others do not quite believe.

Non-professionals wishing to support a newly disabled person can be most helpful by being available to him or her as a friend who is willing to listen and meet him or her where he or she is emotionally. Trying artificially to cheer the person up or suggest that the person does not, or will not, have losses is not helpful. Newly disabled people will “cheer up” once they have finished grieving their losses and reorienting themselves to their new situation, often with the assistance of a counselor or therapist.

Another key to successful adaptation to a new disabling condition seems to be successful identity reconstruction, a process in which therapists can be particularly helpful. This may often entail psychological, existential, and/or spiritual shifts in perspective toward valuing innate qualities (as opposed to physical or comparative ones), authenticity, and taking life slowly and savoring it. Identity reconstruction, it should be noted, is not necessarily a finite process, as some disabling conditions are progressive and require constant readjustment.

Keep in mind that a large number of the losses with which a person with an acquired disability must learn to cope are not due to the physical impairment itself but rather to limitations imposed on the person by society. Therefore, therapists should not insist that people with disabilities “accept” their condition of disablement as theirs to adjust to, rather than, say, as an invitation to fight injustice.

Ultimately, it is much more helpful for therapists to view identity reconstruction, rather than “acceptance” of one’s disability, as the end-stage of grieving an acquired disability.

“Do everything with a mind that lets go. Do not expect any praise or reward. If you let go a little, you will have a little peace. If you let go a lot, you will have a lot of peace. If you let go completely, you will know complete peace and freedom. Your struggles with the world will have come to an end.”

– Achaan Cha, A Still Forest Pool

When we practice mindfulness, when we learn to notice thoughts without getting carried by their content, and when we learn to sit with pain or discomfort, we practicing letting go. Most clients who come to see me are holding firmly onto something—their story, their fears, losses, expectations, relationships, or possessions—even when these things cause them pain and suffering. We all tend to hold those things and more. Learning to let go can be an act of release and healing.

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The major part of holding takes place in thoughts: obsessive thoughts, worries for the future and regrets of the past, thoughts that form your life philosophy and beliefs about who you are and your journey in the world. There are three ways of mindfulness practice that cultivate letting go of the grip of thoughts.

Awareness and Exploration
By bringing awareness to the content of thoughts through inquiry, one can learn to identify themes and topics that rise repeatedly, note them, and simply observe them without getting involved in their content. This “scientific” observation approach serves as a way to let go. When you are curios about the phenomenon of thoughts, you naturally are less attached to the message that the thought carries. Observing the process of how thoughts emerge, develop, rise and fall, and appear and disappear helps to neutralize identification with the content of the thought.

Focusing on the Breath, the Body, or an Object
The basic method for practicing mindfulness is to focus on the breath. When the meditator notices thoughts coming, he or she just shifts awareness back to the breath. This gentle inner action of shifting awareness serves as a practice of letting go. When one notices thoughts, the tendency is to follow, to get engaged in the content of the thought, even if this engagement brings pain and suffering. Noticing the inner activity of thinking and choosing not to get involved, but rather to reconnect with the breath, is an act of letting go. You allow yourself to let go of the thought.

Openness
Physical openness: Holding means tightness. Holding with your hand means that you tightened and folded your fingers. When we hold sadness, anger, hatred, worries, and more, there is a tightness and closing in the chest, belly, and jaws. Adapting a sense of openness and developing a sense of wide chest, open arms, and open face helps to let go of the inner holding and tightness.

Mental openness: Developing a wider view of a problem, and seeing the relative place it takes in the whole tapestry of one’s life, helps to let go of the sense of emergency and magnitude of whatever one holds. Assuming perspective can apply not just to one’s life, but also to the general scheme of things and the place of the individual within the society, nature, and the universe. These forms of mental openness release constant hovering over the issue and give a sense of release.

Mindfulness is not Distraction
We all know of another way to let go, usually for a limited amount of time, the way of distraction. Distractions can be helpful sometimes to ease tension, anxiety, and pain, and as long as they are not destructive, they can be used. However, distractions are not part of mindfulness, and their affect is limited, with no cumulative effect of growth.

It is important to note that in the mindfulness methods, the idea is not to ignore a problem or avoid addressing it—it is about a choice between suffering and freedom. One can still choose to deal with issues that need to be addressed, but do it from a place of non-attachment. Letting go releases the energy that was captured by holding to be used for creative and meaningful changes.

The dreams we have for our families and children are full of deep expectations, some stated but many unspoken. This is true for families that have biological children and also for families who choose to foster and adopt. We want to make a difference in the world and love a child that needs us. We want to offer support, guidance, and opportunities to our children. The most frequent thing I hear from parents is, “I just want to help.” The best foster and adoptive parents know that helping a child involves more than just “wanting to”—it involves sticking in there when times get rough.

The Critical Point

In my experience, there tends to be a critical point in the journey of foster care and adoption when parents have to reconcile the difference between their initial expectations and their family’s current reality. I consider this the critical point because this is when placement disruption is likely to occur. Those of us that have experienced this firsthand understand that there is always a honeymoon period with a new placement. This time is filled with excitement and positive thoughts about the future. Though scared, the child may be on their best behavior: they are helpful with chores, follow the rules, attempt to build a relationship and may cheerfully fulfill their parent’s requests. For new parents, the placement may feel like bliss. The parents feel good about themselves and feel like they are making a difference.

Then comes the change—sometimes occurring slowly and sometimes what appears to be overnight. All of a sudden the sweet-natured child that you have grown to care about tells you that they hate you. They may leave the house unexpectedly and not tell you if they plan on returning, leaving you to worry and search through all hours of the night. They may refuse to follow the rules and start screaming hurtful remarks when you ask them to help with the dishes. They may tell you that you are an awful parent and that they want to move out. Some children may take this behavior to another level and resort to violence upon themselves or others. They may start attacking their siblings or getting aggressive with the family pets. They may make false allegations and tell their social worker that you are hurting them when you have done nothing of the sort.

At this time, it is incredibly important to make decisions about how to improve the situation and avoid a disruption in placement. Why do the children act like this? They are scared and lonely and testing whether you are going to love the “real them”—or kick them out like every other provider has in the past. Though it can be discouraging, all hope is not lost. Remember that there are peaks and valleys in behaviors and that these challenges will lessen over time given the appropriate support.

Before, during, or after this time of turmoil, it is common to have feelings of resentment toward the child you have chosen to bring into your home. You may feel exhausted and unable to manage their emotions in addition to yours. You may feel as though you are in over your head and are not skilled enough to manage what that child needs. Instead, you might feel as though this child screaming at you is not what you signed for and you worry about the impact on the rest of your family. It is also common to worry that your other children may pick up these behaviors and all of your hard work as a parent will be lost. You may realize that being a foster parent or adopting a child is not the same as what you expected it to be. You may think that you must be a glutton for punishment to do this work and you re-examine why you thought this would be a good idea. The worst part is that you are upset with yourself for thinking these things in the first place—all you wanted to do is “help,” right?

Working Through Resentment

The first step in working through the resentment is to acknowledge, truthfully, what your expectations were going into the process of becoming a foster/adoptive parent. Sit down and write out what your spoken and secret hopes and dreams were. Be honest about this because sometimes the secret and hidden expectations are the most important as they may reflect some core personal values that you hold about yourself, your family, and the world: What was the relationship you were hoping for? How did you envision the family dynamic?

Next, make a list of things that you felt blindsided by during this process: What has happened so far that you weren’t prepared for? What were you shocked by or scared of that you have seen your child do? What are your fears?

Third, you need to remind yourself why you are doing the work you do: What is your goal in becoming a therapeutic provider? How do you feel change is made?

Finally, re-examine your family goals with your revised understanding of your foster/adoptive child in mind and create steps you need to take in order to achieve your new and redefined vision of your family.

By doing these exercises you will gain insight into areas that you need help with in order to reconcile your feelings and get back on track with creating a therapeutic environment. You may identify areas or skills that could benefit from trainings, behavior coaching, support groups and/or therapy. You may also come to realize strengths in yourself that you never knew you had and may recognize your positive characteristics that led you to this challenging work in the first place. Remember that it is normal to feel resentment and that you are not alone. Most importantly, use these feelings to work toward being the therapeutic parent you are able to be.

The first in a series of articles dedicated to understanding, appreciating, and coping with our anger.

“Sticks and Stones.” I am sure most of you have heard this saying and think you know the ending. It is said to go “sticks and stones may break my bones but words will never hurt me.” I think our parents taught us this, thinking it would help us ward off teasing by others. Unfortunately, this misguided saying is far from true. You see, in reality, sticks and stones may break my bones but WORDS CAN DO SERIOUS DAMAGE. Broken bones heal and yet harmful words may stick with and haunt us.

Many clients come to me struggling with their anger and just want to “fix it.” They hope a few tools will do the trick. Sometimes, this is all it takes. More often though, it is not that simple. As we delve into a quick history, it becomes clear that their anger has been around for a long time. In fact, it has grown over time. Realistically, we cannot expect life-long patterns to be broken overnight. I firmly believe it is valuable for me to help clients understand where their anger comes from. For most of us, anger is directly related to deep-seeded pain from growing up, and I want to help look at sources of pain throughout our lives.

When clients bring up how:

1) their parents weren’t there for them
2) their parents handled their own anger inappropriately
3) they were never taught or encouraged to communicate their feelings
4) they don’t show sadness and believe tears are a sign of weakness

I know how that translates into unresolved sadness and pain which, if not expressed, tends to come out as to anger.

I tend to hear people say “if I don’t think about it, the thoughts/feelings will go away.” This is not the case. In fact, stuffing our feelings will only last so long. Like a volcano, when we stuff our feelings and hold them down, they will eventually erupt or leak out. Exploding over someone spilling something or cutting in front of you, and then not understanding why you are getting that upset, is a problem. When I hear how angry someone gets over “nothing,” I want to look at where the anger is really coming from.

Our anger does not just appear out of thin air. More often than not, when we focus on how the anger has come to be, I can help clients grasp at least a few deeper issues within their past that may be tied to current anger. Of course, I am always wanting to explore with them how their denial of sadness and pain (to generalize, something that, especially we guys, don’t like to show) may have found a way into anger (a feeling we guys may be more expected and comfortable showing).

Too often, clients believe others are “making” them angry. Thinking about your anger (feelings, thoughts, actions, etc.), this in indeed yours. Own it! No one makes us do anything unless we decide to do it. No one makes me sad, happy, angry or anything. The other person can do something, that I may not like, and then I get to choose how I want to respond. Yes, at times, someone’s behavior will lead me to feeling upset but, again, I decide if this will happen. I am indeed in control. Why give up yours? Own your feelings. This will help you understand how many choices you have and how to next respond (or not).

It is important for me to normalize client’s anger. Typically, when I ask people if anger is bad, the answer I hear is “YES.” No, I say. Anger is a normal feeling. It is just what we do with anger that can be positive or problematic. Be clear on this; we all get angry. We all get happy, sad, anxious, etc. sometimes. Feelings are a normal part of our existence and we need to express them.

Upcoming articles here, will focus on not only how to face our pain and best express it, but also on tools to best cope with painful feelings and the anger we may have inside. To start, though, I want to highlight how imperative it is to learn how to calm both the mind and body. One of the best ways to do this is via a commonly used tool known as deep-breathing. Sounds simple but you would not believe how we may fail to take the necessary full breaths, especially under stress.

Taking a slow, deep breath through your nose, holding it a second or two, and then slowly expelling the air through your mouth should not be just a few second process. When we focus on this and take the time needed, it will be difficult to be angry as it helps stop the racing thoughts that tend to go hand-in-hand with anger. Again, this is not a race. Just the opposite. Calmly breathing helps the body and trains our minds to slow down. Furthermore, we don’t want to wait until we are upset to do this. The more we are calming ourselves during the day, the less likely we are to get hyped up in the first place. Try practicing this a few times daily and get ready for more next month.

Ten years into being trained in eye movement desensitization and reprocessing (EMDR), I am still amazed by its ability to transform a life filled with trauma, anxiety, and hypervigilance into one of presence, mindfulness, and relief. Clients and clinicians often find themselves confused about EMDR, and I would like to address what is meant by symptom-based and eight-phased trauma treatment.

Symptom-Based Protocol
EMDR is a treatment modality that is research driven and well known for its ability to reduce symptoms associated with posttraumatic stress (PTSD), and your therapist may recommend it to relieve your symptoms associated with PTSD. EMDR clinicians around the world are finding, in clinical practice, that it is also effective for addressing an even wider range of symptoms, especially those rooted in the events of the past.

With this in mind, EMDR is what you could call a symptom-based protocol. This means that EMDR therapists focus on how your present experience is rooted in old stuff, even things that you think that you are over. We look at how the symptoms you have in the present mimic, or cluster, around those events in that past.

Trauma is tricky and can disguise itself as many things. An EMDR therapist will review your symptoms and review how your current thoughts, emotions, beliefs about yourself, and physical sensations may be related to disturbing life events and traumas from the past. Depending on when your EMDR therapist was trained, he or she may have different ways of asking you to prioritize and list what events are still contributing to your symptoms.

Even though you may not believe that those events from the past are really a big deal, they are still locked in your nervous system in what is termed a state-dependent form. Often, they are not completely processed and healed, like a record stuck in a groove. As time progresses, the record turns; it still plays, but the disturbance repeats itself over an over again, until the scratch is healed.

An Eight-Phased Treatment Model
Often mistakenly viewed as an intervention, EMDR is an inclusive treatment modality, one that includes eight comprehensive treatment phases. Each phase is a unique and necessary part of the approach. It is imperative that your EMDR therapist walk you through each of the eight phases. While they can be circular, and you may go back and forth between them, each phase will help you as you complete the therapy. The eight phases include history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. Unfortunately, EMDR has become known primarily for its desensitization phase, which is what people often confuse as the sole part of the therapy.

With this knowledge, those of you who are seeing an EMDR therapist can inquire where you are in the process, what phase you are in, or how you will prioritize the events from the past to work on them. You can also find out what symptoms you are focusing on and how the past relates to them. I often find that the more my clients know about each phase, the safer they feel and the more they feel they are part of the process.

If you have general questions about EMDR, please post them. Keep in mind that I can’t speak about your clinical work or therapy or provide clinical advice. I will try to cover your questions about the treatment in future blog posts.

It is common for children and adolescents in foster care and adoptive situations to exhibit challenging behaviors, some of which can be severe. It is equally common for parents providing care to these children to become upset and overwhelmed by what they see.

Before parents reach the point where they themselves may have a behavioral episode, I always remind them to remember the environment that their child came from. By remembering what this child was experiencing during their formative years, we can better understand the behaviors we are seeing now.

Understanding a Child’s History

Most likely, a child entering foster care is coming from a situation that may have consisted of severe neglect, physical abuse, sexual abuse, orphanage care, parental mental health issues, parents with addiction problems, or ongoing abandonment, to name a few. As a result, it makes sense that we see similar behaviors in children that they most likely experienced from their parents. These include:

• Withdrawn or depressed mood
• Lack of understanding regarding consequences
• Physical aggression towards others or animals
• Sexually acting out
• Anger
• Lack of impulse control
• Difficulty connecting with others
• Property destruction
• Emotional sensitivity
• Self-harm

Because these children did not have a comforting, loving, and secure environment as their “stable base,” they can appear lost, distrustful, and angry. These children are not “bad” or “damaged” like they may appear initially. Instead, they are simply having a normal reaction to the negative past experiences of their lives. Because of this, it is important to have a clear understanding of your child’s history in order to better understand what you are seeing now.

By gaining a deep understanding of your child’s experiences, you will be more competent as a parent and better able to work with the child in a calm and therapeutic manner. The good news is that these children can and will change with the security, warmth, and structure they can receive from a positive and therapeutic parent.

Creating a Therapeutic Environment

One of the most common burnout factors I experience with parents is lack of emotional reciprocity from the child, accompanied by destructive and targeted behaviors. We must remember that children and adolescents often “act out” when they are scared. This doesn’t necessarily mean they are scared of their foster parents, but it could mean they are terrified of being in a new environment and not knowing what to expect next.

Based on their history, it could make sense that the child would expect the worse and view everyone in their life as a potential threat. At that point, it doesn’t matter whether their foster or adoptive parent has the best intentions, a nice house with their own room, supportive siblings, or the best pet. What matters in that moment are the parent’s skills to create a therapeutic environment for that child to be able to succeed and thrive.

What does it mean to have a “therapeutic environment?” It does not mean you have a perfect family without any natural conflict. Instead, therapeutic in this context describes the positive and directed manner with which the parent is able to respond to situations. It is the response that determines the success of the intervention. In order to have an appropriate response, the parent must be self-aware enough of their own triggers and issues to be able to know whether they are responding to their children’s behaviors out of their own insecurities and fear or out of intentional positive parenting that will benefit the child.

This process of self-awareness can be quite a feat in itself. It is a critical step for parents to undertake when working with children that have trauma histories and need a little extra support. It may be necessary for the parent to take a self inventory of their own issues, parenting values, and childhood experiences that impacted who they are today. By taking this inventory, the parent can self-reflect on what responses they received from their own parent when they had a scraped knee, perfect report card, or just a bad day. By taking a self-inventory, the parent can understand where their own gut reactions come from in stressful parenting situations, and where some of their own learned behavior may have been developed.

Therapeutic parenting is about setting firm boundaries in a manner that is gentle enough to appeal to the child’s emotional needs and developmental stage, and strong enough to ensure felt security.

Basic Parenting Skills for Adopted and Foster Children

These basic therapeutic parenting skills are important in successfully responding to situations, as well as being proactive:

• Calm tone and facial expressions
• Use of positive rewards for desired behavior
• No use of sarcasm, physical punishment, or other negative measures
• Understanding and open attitude
• Clear rules and expectations
• Implementing firm structure and boundaries
• Consistency in rule-implementation and consequences
• Follow through, follow through, follow through every time

Therapeutic parenting is about setting firm boundaries in a manner that is gentle enough to appeal to the child’s emotional needs and developmental stage, and strong enough to ensure felt security. Following through with what you say you are going to do is also critically important. This teaches the child that they can trust what you say. They learn by your modeling that there are consequences for choices they make. By implementing positive and therapeutic parenting techniques, the parent will feel safer in their environment and so will the child. The hard part is implementation—it is much easier said than done.

In addition, there will inevitably be times you don’t implement these techniques as you would like to. When you slip as a parent it is important to acknowledge it. Apologize if you did something wrong or explain what happened. These “mistakes” are opportunities for you to demonstrate that you are human and you accept accountability—a social skill your child will benefit from having as well.

The best thing a parent can do when their child engages in this behavior is to remain calm and consistent. By doing so, the parent creates a safe space for the child to know that despite their behaviors, they are cared about in a consistent and structured environment. It is likely that a new foster or adoptive child will not show the love and affection that a parent is seeking. It is also likely that the child may be resentful of the situation and not act or appear appreciative of the parent’s efforts. When this occurs, it is important for you as the parent to remember, “It isn’t about me.” Use this as your mantra during behavioral episodes. Your job is not to save them, but to help guide them in their own journey of growth and self-awareness.

Persevering Through the Process

In the beginning period of a placement, which can last years, it is common for there to be steep peaks and valleys of behavior, usually quite frequently for the first year, at least. However, if the parent can stick with it and persevere through the difficult behaviors, the reward can be great. Over time, with consistency and warmth, a child can build trust and a sense of security with themselves and the rest of the world. The parent will start to see more mild peaks and valleys of behaviors, until a baseline is eventually reached—not without the occasional slip up, of course!

With a greater understanding and self-awareness on part of the parent, behavior will come to be an expected and natural part of a process, which can result in a child who has the opportunity for a life they wouldn’t have been able to live before. In my opinion, witnessing that type of positive change in a growing individual is one of the most rewarding things you can do. Good luck!

Parents who are struggling with managing the behavior of an adopted or foster child may find individual or family therapy helpful. Reach out to a licensed, compassionate therapist here.

In much of our work with people, we coach and encourage them to communicate difficult feelings and thoughts to others. What I mean by difficult are a range of verbal expressions of feelings or thoughts that expose vulnerability, disappointment, and anger. Why is it so hard to communicate to others that we are hurt, scared, disappointed, angry, or upset?

People are willing to spend countless sessions discussing, venting, and complaining about how others make them feel, yet as soon as we suggest they express these feelings to the person they’re directed to, they shy away. This inability to communicate in more honest, authentic ways creates a gap in every area of life; it underlies loneliness, family, and marital problems, causes friendships to drift, creates stress in the workplace, and causes feelings of inadequacy, creating self-esteem issues.

Our aim as therapists is to convince people that these difficulties in communication are damaging and that this can be changed. It is crucial to let people in therapy know and understand that communication patterns and styles are learned and can therefore be unlearned.

The key to understanding these issues lies in a thorough assessment of relationship history: discussing, examining, and processing communication interactions with key figures in one’s past and present. Most of us have learned communication skills and lessons from our parents, siblings, teachers, and other role models. Probably parents are our most powerful communication coaches. Early on, through verbal and nonverbal means, they made clear to us what is  and what is not acceptable to say—or at least what they don’t want to hear and talk about it.

Robert Bolton, PhD, in his book People Skills, says, “We first experience the training process at an early age. Parents or parent substitutes rewarded some kinds of nonverbal behavior, like smiling, and they communicated displeasure over other kinds of nonverbal behavior, such as “temper tantrums.” When we were young, they helped us frame our first words. Then they trained us to speak in certain ways. No matter how badly you hated the annual Thanksgiving visit to your aunt’s house, you have been told, “Thank your Aunt Edith for the lovely time you had.” He goes on to say that you were taught to not interrupt adults’ talking, not to whine, not to speak a certain way to certain people, not to use certain words. Parent substitutes—relatives, teachers, babysitters—also became part of the training process. Numerous dysfunctional ways of relating include learning to be superficial, ways to manipulate others, how to hurt and bully, how to build walls, and how to talk without saying anything.

Our main jobs as therapists are to help people identify their patterns of communicating, how to relate to others, and help and guide them to make necessary changes. The main direction of the change is that it is okay and actually conducive to creating deeper, more satisfying relationships if communication is more honest and authentic. More often than not it is okay to say what one thinks. There has to be a choice—you don’t have to feel stuck.

Most people in therapy, even if intellectually on board with this proposition, are inherently resistant to changing this. It is important to understand and help explore this resistance. The main reason for the resistance is that people think they are protecting themselves by communicating and relating the way they do. It is crucial to acknowledge this, then explain and teach people that their particular way of protecting themselves is not necessarily doing the trick and in fact creates other dangers—disconnection, isolation, hurt, and anger. It is crucial to help them understand that there is a way to take care of themselves, even protect themselves without exposure to risk and harm.

Most people are reluctant to express their feelings and thoughts because they are concerned about rejection, anger, or alienating others. They are afraid to expose their vulnerability, and face harm. As their therapists we must find a way to show them how they are harmed by creating walls, by not letting others know them as they truly are. This  prevents them from truly being known as well as truly knowing anyone else, creating an unreal, lonely existence, often based on false assumptions.

It is also important for people to understand how these patterns of communication create distance and rupture intimacy. More often than not, unexpressed resentments, disappointments, and unfulfilled needs result in self-esteem problems. At other times people erupt with uncontrolled anger or harmful behaviors over seemingly minor infractions. Both of these situations push others away and disrupt closeness, which dysfunctional communication attempts to solve or prevent.

The Textbook of Family and Couples Therapy describes the three “most common types of couples therapy”:

1. Individual therapy;
2. Conjoint couples therapy; and
3. Combined couples therapy

In the first, a member of a couple is treated by an individual therapist, which, the textbook notes, is suitable especially for instances in which one spouse refuses to join marital therapy but a “poor choice, however, in the presence of marital disturbance and severe psychopathology…” Individual therapy for a marital problem does not give the therapist an adequately full picture of the marital interactions, nor adequate leverage to help both participants to symmetrically address their contributions to the problem. In general, because problems tend to be interactive, for one partner to make lasting changes for the better, both parties need to make changes.

In the second, “conjoint couples therapy,” both spouses are treated at the same time by a single therapist or team of co-therapists. Again, this form of treatment does not enable the therapist to see and therefore accurately diagnose the couple’s interactive patterns. Anyone can look good in individual treatment. Whole additional aspects of couples’ functioning appear once they are interacting with their partners around emotionally sensitive issues, and these are generally the issues that couples need help addressing.

[fat_widget_relationships_left]The third structure for couple treatment, “combined couples therapy,” refers to the combination of conjoint sessions that both partners attend together with ongoing or occasional individual therapy sessions for one or both spouses. That is, the therapist interweaves individual and couple sessions in a design that most meets the needs of this specific couple. “The combined treatment,” the textbook explains, “has the advantage of allowing the use of fantasies in individual sessions while providing easy access to transactional and communicational patterns” in joint sessions. Conflict resolution treatment generally employs the third of these “most common types of couples therapy.”

As described more fully in a recent article in the Journal of Marriage and Family Therapy currently available on the website of the American Association of Marriage and Family Therapy, such combined treatment offers important benefits:

One professional is in a better position to recognize, define, and point out [and thereby ameliorate] the intrapsychic and interpersonal dimensions of the symptom-problem, to be aware of the two-way street effects of one process on the other, to know areas in either process that are being avoided and impulses that are being “acted out” rather than confronted. He [or she] is able to appreciate the subtleties of the resistances and transferences and to form an integrated concept of where the individual client and the marriage is and what the client and marriage is doing in each phase of help even though each process may be conducted according to the techniques of that particular modality…

Conversely, when a person is in individual therapy with one professional and in marriage counseling with another, the two processes may go off in opposite directions. Also, resistances may go unnoticed, the transferences may become more split or diluted, and the continuity of the person’s emotional flow and life processes may become more compartmentalized.

For these reasons, conflict resolution treatment recommends the practice of asking people being treated to take a break from any prior individual therapists if they are going to enter into treatment with a conflict resolution therapist. At the same time, the therapist explains that s/he will be available at any time for either spouse to schedule individual sessions as they feel the need. I explain that in general if I am seeing one spouse individually, I like to keep things symmetrical and work also with the other; and at the same time if this is not possible for financial or other reasons, I can be flexible. I add finally that the individual sessions may be occasional, suggested by either one of the spouses or by me, and/or may be part of an ongoing weekly pattern of treatment. For people dealing with specific difficulties—for instance, when one spouse has a borderline personality pattern or is dealing with chronic depression—as many as three sessions a week, with one couple session and one individual session for each spouse, can be ideal, finances and time permitting.

Multiple research studies have demonstrated that individual therapy for a spouse in a distressed marriage may make a couple’s conflict worse, making divorce more likely. These concerns, and their import for practice, are explained in a chapter of the 2008 Clinical Handbook of Couple Therapy, as follows:

“Because we take a systems perspective and view the couple as the client, we have found that individual therapy may interfere with our couple work. We also tell clients that research indicates that the chance of divorce is greater if clients engage in individual therapy rather than couple therapy (Bray & Jouriles 1995). Therefore, we request that partners stop individual therapy during our couple treatment. There is a greater chance of dysfunctional triangulating when another therapist is involved” (p. 504).

Conflict resolution treatment recommends this same policy, that is, flexible inclusion of individual and couple sessions within an overall couple treatment format with one therapist handling all the treatment components. The one exception to the one therapist rule for couples is for treatment of problems that lie outside the therapist’s areas of competence. Referral for additional specialized treatments such as neuropsychological exams, medication treatment, or addiction cessation would always be appropriate, provided the couple therapist and the additional treatment professional agree on a clear division of labor between the therapists.

What is essential however with a protocol that includes both individual and couple treatment formats is explicit confidentiality procedures. Conflict resolution therapists are encouraged to explain at the outset of treatment their policies with regard to confidentiality. Will information disclosed in one spouse’s individual session become the property of the couple? If so, then is it appropriate for the therapist to share individuals’ communications to the therapist with the other spouse? I believe not. Information shared by the couple in the presence of the couple of course is bounded by confidentiality vis-a-vis anyone other than the couple. Information shared with the therapist by one spouse must remain similarly bound by confidentiality to remain with the therapist.

With these principles, one spouse who may be having an affair is able to work on how to disentangle from the affair. The individual sessions enable the straying spouse to utilize the therapist’s in order to extricate from what can be a difficult situation. This option increases the likelihood of a positive marital outcome.

At the same time, if one spouse is having an affair, the therapist has a responsibility to clarify when the affair is revealed that affairs are a violation of the marriage contract. It is ethically important for a therapist to clarify to an unfaithful spouse that continuing to conduct therapy with a secret partner on the side is not an ethical endeavor or an option. However a therapist can help a partner who is engaged in an affair to settle their internal conflict, that is, to choose either to stay in the marriage or to leave it for the new partner.

I have found that this dilemma of having to hold confidential information with regards to an affair is a situation that does occur, but rarely. In most instances, holding individual spouses’ confidential information in confidence is relatively easy and greatly benefits both spouses. They can then enjoy the gains of both individual and couple treatment, with both aspects of this integrated treatment enhancing each other.

Dramatic activities are powerful tools when used in a family therapy setting. One such tool is called psychodrama. An example of one type of psychodrama is family sculpting. The first step involves determining who has a sense of readiness to do their family sculpting at this time. I generally ask this question to the group and then wait to see who is interested in doing work. If more than one person is interested, I encourage each person to talk about how important it is for them to do work now, versus considering a later date. Whoever has the most pressing need is then afforded the opportunity to do the sculpting.

The individual is then asked to intuitively pick an event or an occasion from their childhood to present to the group. I ask them arbitrarily to pick an event or circumstance from when they were five years old. Later in the sculpting they are asked to pick additional events from age 10 and then eventually age 15. I will say more about this later. The person going through the sculpting is asked to choose a support person to be with them throughout the psychodrama. The person chooses someone he/she feels a connection with and feels safe around. As the individual recalls the setting, and whatever happened, he/she is asked to talk about the other people involved. As the individual introduces the people involved in the original setting, he/she is asked to choose somebody to play the part(s) of those initially involved.

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This is typically the stage of the sculpting where the individual really starts to sense the realness of what is about to happen. They begin to develop a sense of who might trigger the original mannerisms or energy that people possessed in the original setting. Paying attention to who the person chooses for each role can also reveal projections that the individual may have toward other group members. That is one of the reasons it becomes very important to de-role at the end of the sculpting. Once all of the participants are chosen, the individual then places them in the room according to where they would have been in the original setting and in relationship to where the individual him/herself was in the original scene.

The person then provides information about each individual, so that the people playing the roles will have a sense of what their character might say and how they might act. They can ask questions until they feel a degree of comfort with the role. This is typically a place in the activity where I assure the participants that I have a sense of their role and I will help them if they get stuck. I also make it clear that, if what they are saying does not seem accurate or helpful, I will intervene and provide direction.

While overseeing the group I remain available to be there for emotional support for the person being sculpted. The co-therapist may be asked to play a role. If he/she is not in a role then he/she can help provide information or direction to the participants. This person also plays the important role of tracking the group and must pay close attention to anyone who gets triggered into some of their own trauma as a result of the intensity and/or realness of the psychodrama.

The individual may choose someone to play his/her part in the drama or may play the role him/herself. This is determined through discussion between the individual and the group leaders. The main criteria for the person being involved as him/herself, is generally whether he/she feels prepared to get emotionally connected with the original pain or not. If he or she is not sure of the degree of readiness, it is better to move in the direction of not having a role for him/herself.

Someone experiencing psychodrama for the first time generally does better being less connected emotionally through having someone else play their role. This also allows him/her to see how impacted he/she was by the traumatic event, from the outside. This potentially provides an opportunity to be there for his or her own hurt parts that are revealed through the sculpting process. By getting to see their internalized process be externalized, the person, in some cases, makes their first connection with these hurt part(s), and thus begins to learn to acknowledge and be there emotionally for these parts of him/herself.