Senior members of our community share the knowledge and expertise they have gained through their many years of work in mental health.
• Long-Term Mental Health Treatment of Adolescents in Foster Care, June Madsen Clausen, Toni Heineman, Alexandra S. Garber, Journal of Child & Adolescent Trauma (under review)
• For As Long As It Takes: Relationship-Based Play Therapy for Children in Foster Care, Toni Heineman, June Madsen Clausen, Saralyn C. Ruff, Wendy Von Wiederhold, Psychoanalytic Social Work, 2012
The trauma of child abuse is magnified for children placed in foster care. The disruption, disorganization, and discontinuity experienced in foster care further extend the trauma of abuse. Effective treatment of foster youth must prioritize the basic need for children to experience continuity, stability, and permanency in attachment to a healthy adult(s). Short-term, symptom-focused interventions are inappropriate for this population of ethnically diverse, socioeconomically disadvantaged, underserved, multiply traumatized youths with complex psychiatric comorbidity. We describe a long-term, psychoanalytically oriented, relational play therapy intervention for foster youth and present initial empirical results describing the impact of this approach. Taylor Francis Online.
• Relationships Beget Relationships: Why Understanding Attachment Theory is Crucial to Program Design for Homeless Youth, Toni Heineman, California Homeless Youth Project: Voices from the Street, 2010.
Much as we might like to idealize the lives of homeless youth1, imagining them, like the characters in The Boxcar Children (Chandler Warner, 1989), living happily and cooperatively – independent of parental demands or supervision –the real lives of homeless youth are not exciting, fun, or romantic. Without adults to help, support and protect them, these young people often live a grim, frightening, and dangerous existence. Why then, don’t they, like the children in the Boxcar story, come to recognize that they need help from adults? Why do some seem unwilling to accept our offers of food and shelter? Why do some fail to take advantage of the programs we create to help them improve their health, education, and general well being? If it is because we have not understood or given them what they need, why don’t they simply come forward and tell us what we can do to help them? Until we can answer questions such as these, homeless youth will continue to suffer, despite our genuine concerns and well-intended efforts to help them come in from the cold. Click to download.
• The Network is Down’: Building an Alternative Network to Address the Multiple Disruptions in Clinical Work with Foster Children and Youth, Toni Heineman, Journal of Infant, Child, and Adolescent Psychotherapy, 2008.
Clinical work with children in foster care sometimes feels as difficult as trying to sustain contact through an unreliable Internet network. The network in which the child lives can be disrupted at any time, without warning or explanation. Connections are broken and sometimes reappear with the same unpredictability. In this context it is essential that the therapists have a network of support to contain the anxiety, frustration, and sadness and to share success, for the network can disappear as easily in good times as in bad. A HomeWithin is an organization that builds those networks for clinicians. It is a non-profit organization that embodies the belief that we must and can provide lasting, caring relationships for children in the foster care system and that providing supportive relationships for clinicians is the key to their success with the children. It is the only national organization devoted exclusively to improving the emotional wellbeing of foster youth. By insisting that children must have a single, experienced therapist to work with them “for as long as it takes,” we begin to create an atmosphere that provides and protects relationships. Taylor Francis Online.
• Infant Parent Psychotherapy Minus One - Working in the Foster Care System, Toni Heineman, Marian Birch (Ed.), Finding Hope in Despair: Clinical Studies in Infant Mental Health, Zero to Three Press, 2008.
• Helpless Before God: A Commentary on ‘a Gift From God, Toni Heineman, Marian Birch (Ed.), Finding Hope in Despair: Clinical Studies in Infant Mental Health, Zero to Three Press, 2008.
One of the most difficult challenges faced by infant mental health professionals is that not all cases have happy endings. Most case studies describe successful interventions, leaving few resources to help professionals deal with cases that can feel like "heartbreaking failures." Whatever the cause-an abrupt end to therapy or an unsuccessful case can leave a professional with feelings of confusion, despair, and even anger. Finding Hope in Despair uses a unique format to present a series of detailed case studies of interventions that were not successful. The author of each case study provides the facts of the case and, even more important, reflects. Barnes & Noble
• Weaving Without a Loom: Creating a Self in Foster Care, Toni Heineman, Journal of the Northern California Society for Psychoanalytic Psychology, 2007.
We know from theory, research, and common sense that stability and consistency in relationships promote children's healthy development. Unfortunately, the foster care system often fails to provide reliable, sustaining relationships. The propensity of the system to look to the external world for explanations and solutions to problems too often overlooks the child's internal distress. When we suggest to unhappy or anxious children that their feelings can be relieved by a change in the environment, we insidiously undermine and disavow the fundamental importance of the child's internal world as a source of pleasure, pain, upheaval, and regulation. Moving children from one “placement” to another when problems arise is a primary response of the foster care system. In the following, I will explore the potential impact of this philosophy on identity formation. Click to view.
• Disrupted Care and Disruptive Moods: Pediatric Bipolar Disorder in Foster Care Children, Toni Heineman, Sharna Olfman (Ed.), Bipolar Children: Cutting Edge Controversy, Insights and Research. Praeger, 2007. Barnes & Noble
• Building a Home Within: Meeting the Emotional Needs of Children and Youth in Foster Care, Toni Heineman, Diane Ehrensaft, Brookes Publishing Co., 2006
All children need stable, lasting relationships with caring adults to ensure their healthy emotional, cognitive, and social development. But for children and adolescents in foster care, these essential relationships are often absent. This book presents a proven solution based on over 10 years of groundbreaking work by the Children's Psychotherapy Project (CPP): When young people work with the same therapist for as long as they need to, they'll make better progress toward developing strong, healthy relationships and hope for the future. More than a dozen experts from the CPP give psychologists, social workers, counselors, and program administrators a complete, research-supported introduction to this successful "one child, one therapist, for as long as it takes" model as they share their triumphs and challenges. Through the lessons these therapists learned as they donated their time to weekly psychotherapy sessions, readers will gain new insight on how to build positive relationships with children. They'll learn how to address various aspects of foster care. Available from Amazon.
• Spokes in the Wheel: The Multiple Relationships of Children in Foster Care, Toni Heineman, Kelly Abrams, Sheryl Dicker, Julie Stone, Zero to Three Journal, 2005.
This article presents a case study of two brothers' protracted journey through the foster care system, and highlights the numerous challenges they face in their ability to form strong, healthy attachments to significant caregivers. Commentary from a clinical supervisor reveals how the professionals who are working with children in foster care are better able to support the children with whom they work when they receive supportive supervision. A lawyer who directs the New York State Judicial Commission on Children emphasizes how the judicial system must also ensure that the needs of young children are placed at the center of decision making in juvenile court cases. Click to view.
• Not for Love or Money”, Toni Heineman, Journal of Infant, Child and Adolescent Psychotherapy, 2002.
Before turning to Dr. Altman's thought-provoking presentation of his work with Geraldine, I'd like to address some of the issues he raises at the end of his remarks. Obviously, questions of financial and emotional gratification are inherent in the structure of any therapeutic relationship. Certainly we are also aware of the complex interplay of perpetrator/victim that informs the transference-countertransference paradigms in our treatment of children who have been neglected or abused. However, Dr. Altman suggests that the particular structure of The Children's Psychotherapy Project may bring some of these questions into sharper than usual relief, and I think we can productively use this opportunity to consider them. Click to view.
• Hunger Pangs: Transference and Countertransference in the Treatment of Foster Children, Toni Heineman, Journal of Applied Psychoanalytic Studies, 2001.
In working with children, clinicians are often confronted with physical as well as psychological hunger - demands for real along with symbolic feeding. Foster children, who have suffered actual neglect and deprivation, often stir powerful and primitive feelings about the place and importance of the real and the symbolic in psychotherapy. These parentless children explicitly and implicitly announce that they need a family, not a therapist. In response, the therapist, particularly the young and inexperienced clinician, may devalue the therapeutic relationship and unconsciously move into a parental role, feeling that without the protection of a family the child will inevitably fall into the enormous emotional, economic, and systemic cracks in the world of foster care. Clinical material illustrates these points. Springer Link.
• Beginning to Say Goodbye: A Two-Year Old Confronts the Death of His Father, Toni Heineman, Journal of Infant, Child, Adolescent Psychotherapy, 2000
• The Children’s Psychotherapy Project, Toni Heineman, Diane Ehrensaft, Journal of the Northern California Society for Psychoanalytic Psychology, 1996
• Gender Born, Gender Made. Raising Healthy Gender-Noncomforming Children
In Gender Born, Gender Made, Diane Ehrensaft offers parents, clinicians, and educators guidance on both the philosophical dilemmas and the practical, daily concerns of working with children who don’t fit a “typical” gender mold. She debunks outmoded approaches to gender nonconformity that may actually do children harm. And she offers a new framework for helping each child become his or her own unique, most gender-authentic person. Click for more information: http://genderborngendermade.com/ “Gender Born, Gender Made brings to our homes, schools, and clinicians’ offices a wealth of ideas and tools that will prove invaluable as we move toward a more empathetic, just, and inclusive society.” From the foreword by Edgardo Menvielle, MD, MSHS. Available from Amazon.
• The Abused Child: Psychodynamic Understanding and Treatment, By Toni Vaughn Heineman - Guilford Press (1998) IBN 1572303751
Capturing the complexities of working with abused children, Heineman explores the intrapsychic worlds of these youngsters and examines many of the paradoxes and complications encountered when treating them. The book traces the interplay of neurobiological and psychological facets of behavior to show how abuse derails normal development and how psychodynamic psychotherapy can reestablish emotional connections. Chapters highlight special issues involved when working with children who have been physically, sexually, and emotionally abused, exploring memory and disclosure, dissociation and externalization, and the relationship between action and spoken language. The book also addresses important factors in understanding and working with parents and caregivers and reviews such relevant legal issues as the process of court-ordered evaluations. Throughout, clinical vignettes illustrate the practical applications of concepts and theories discussed. Available from Amazon.