Once upon a time, not so very long ago, “service providers” in the mental health field were referred to as “psychiatrists,” “social workers,” “psychologists,” or counselors.” These designations gave some indication of the professional education and training of the people in the field. Referrals were made to people, based on their training, interests, and areas of expertise.
A referral to a “service provider” suggests that the recommendation is more about the program than the person delivering it. Indeed, in the current climate, it seems that we often lose sight of the importance of the relationship between two people—one seeking help for psychological distress and one trained to help people address and overcome emotional suffering.
Mental health is fundamentally about relationships. Human beings are hardwired to form connections; infants cannot survive without adults tocare for them. Adults depend on each other for love, companionship, shared knowledge, and connections to the networks of relationships that friends, family, and acquaintances offer. Without these connections individuals can and do fall into isolation, depression, and despair.
We learn about relationships through having relationships. Books, movies, songs, instructional materials, and psycho-educational programs can all offer glimpses into what makes relationships work or not work. But an emotional grasp of the nuances of relationships comes from actually negotiating different kinds of relationships.
Unfortunately, foster children and youth too often have not had a healthy relationship with a primary caregiver that forms the core of all other relationships. A therapeutic relationship with an experienced and skilled clinician can, over time, help them to understand and negotiate the thousands of large and small cues and responses that determine successful interactions. This comes, not from being taught about relationships but from being in the therapeutic relationship. This core connection allows for and supports the expansion of what is known—consciously and unconsciously—about relationships to a world of ever-increasing connectedness.
When we introduce foster children and youth to too many new programs offered by too many new people at one time we may easily overwhelm their fragile relational capacities and unwittingly drive them further into isolation and depression. No matter how well-intended our efforts to address the myriad needs of foster youth when they enter the system, it behooves us to remember that they are best served by developing one stable relationship with a caring adult. It is from the safety and security of this relationship that they will, in time, be able to take full advantage of the many well-designed programs intended to address discreet social and cognitive issues that threaten their capacity to build successful relationships.
Healthy relationships grow from relationships, not from programs.
By Toni Heineman
Unfortunately, foster children lose once again to politics. Virginia’s State Board of Social Services voted yesterday (washingtonpost.com) to continue its ban on adoptions by gay couples. It’s hard to know how that vote serves the children who are waiting for a loving family. Through no fault of their own, they have no family to return to. In somecases, their parents may have abandoned them or willingly relinquished them for adoption.
Many children remain in foster care because the state has determined that their parents were unable to care for them adequately and terminated the parents’ legal rights. Those children, too, are free for adoption—by heterosexual couples. No homosexual couples need apply in Virginia or 33 other states.
When states terminate the rights of parents they make an implicit promise to the children that they will provide better care for them than their parents would. Spending years—even an entire childhood—in foster care is NOT better care. Even if children remain with only one foster family, which is the exception, not the rule, they have no sense of permanency. Children need to know that they belong and that the home and family they leave in the morning will be the one they return to in the evening.
Young adults need to know that the family they grew up with will still be there, even when they leave home. It is the memories of the traditions, and the certainty of the unconditional love that allows them to leave home. Virginia has the highest rate of youth aging out of foster care in the country. Fully 32% of youth in Virginia’s foster care system leave without a permanent connection to a family or an adult to care for them.
Turning 18 may mean legal adulthood, but it does not translate into developmental adulthood. And adulthood does not mean that we no longer need the support and love and care of family and friends. Sadly, the state of Virginia has held steadfast in its position that some children are better off without a family than with a family that happens to be headed by two mothers or two fathers.
I wonder what the 1300 children in Virginia waiting for parents would say.
Maybe next time we should ask the children.
By Toni Heineman
That was the reason a clinical psychologist in her thirties gave for her parents’ divorce when she was eight years old. She “knew better.” She was smart and well educated and, as an adult, fully aware that marriages didn’t break up over a glass of spilled milk. But sometimes—maybe when she was having a restless night—she was racked with the same fear she had felt that night when she spilled the glass of milk as she listened to her parents exchange angry words. Later, when they told her that they would be divorcing, that scene flashed before her eyes. She knew what had happened; it was all her fault.
Children, particularly young children, have very little actual control over the events in their lives. Adults tell them when to wake up and when to go to sleep; they decide which clothes and food and toys and activities are suitable. Even when they want to be in charge, children don’t have the skills or the resources to manage their lives. So they pretend. They can be mommy or daddy – a teacher, shopkeeper, policeman, movie star, prince or princess – just by the power of imagination, sometimes aided by a few props.
The world of fantasy knows no bounds. The magic that allows for wishing on a star is the same that gives spilled milk its destructive powers. Magical thinking leaves children convinced that their actions – or sometimes just their thoughts – can control adults’ behavior.
If bad thoughts or behavior can lead to catastrophic consequences, then it follows that good thoughts or behavior can make the world right again. Children who believe that they are responsible for their own misery may decide to take matters into their own hands. We wouldn’t be surprised to hear that the little girl who held herself responsible for her parents’ divorce suddenly announced that she no longer liked milk, having decided—without telling anyone—that drinking it just wasn’t worth the risk.
When we disrupt children’s lives, we are often quick to reassure them, “This is not your fault,” before asking them how they make sense of what is happening to them. If we stop to ask and are willing to wait patiently for the answers, we might learn the particular ways in which children explain their parents’ divorce, a parent’s failure to visit at an appointed time, or one of the many disappointments that we knowingly and inadvertently cause children.
“There’s no use crying over spilled milk,” may just miss the point entirely.
By Toni Heineman
Rejection hurts. That’s hardly a surprise to anyone who has been shunned by a friend, ostracized from a group, mocked by a co-worker, or been the one left behind at the end of a romantic relationship. The surprise comes from research recently published in the Proceedings of the National Academy of Sciences demonstrating that social rejection stimulates the same parts of the brain as physical pain.
In other words, under some circumstances the brain does not differentiate between emotional and physical pain. This finding should stop us dead in our tracks when we think about the impact of –repeatedly– moving foster children from one home to another.
When young children are taken out of a familiar foster family they are exceedingly likely to experience that event as a rejection.
Regardless of the explanations offered, it hurts—just as if we had inflicted physical pain.
We would never condone inflicting deliberate physical abuse on foster children—in fact, we remove children from the care of foster parents if they physically mistreat children. Yet, we repeatedly create situations in which foster children will experience the pain of rejection.
We assign them to one caseworker, knowing that we will move them to another when their legal status changes. We place them in emergency foster care, knowing that they will be moved to a more stable placement after a short time. We refer them to a clinic for psychotherapy knowing that they will be seen by an intern who will leave them after a few months.
From the egocentric viewpoint of children, every one of these losses will be experienced as a rejection of their own making. Foster children no more believe that they have not caused these rebuffs than the spurned lover who is told, “it’s not you, it’s me.”
All children need to know that adults will keep them physically and emotionally safe. When we create programs to serve foster children we must remember that, from the perspective of the child’s brain, repeated losses are the intolerable equivalent of physical maltreatment.
Please support the therapists who volunteer their time through A Home Within so that foster children do not have to endure the pain of losing one therapist after another.
By Toni Heineman
We brought Guinness home from the shelter about two years ago. In preparation for his arrival, I bought a gate to put at the head of the stairs from the deck to the yard. I had in mind that he, like our previous dog, would like to be outside, but I didn’t want him to have access to the neighboring yards. About two weeks ago, he ventured off the deck on his own, finally brave enough to go exploring without a human companion.
We know almost nothing about the first eighteen or so months of Guinness’s life. We know that he was in a shelter in Mendocino before he moved to the SPCA in San Francisco. Obviously, he started out someplace. That makes our home the fourth place he has lived.
“Frantic” best describes Guinness when he first arrived. Every time someone came into or left the house he jumped, pounced, and madly twirled in circles. Our efforts to calm him only added to his excitement. In the park, he enthusiastically approached other dogs; his boisterous play sometimes becoming aggressive. He was never hostile toward new people and never shied away from strangers.
It took him months to settle down. We didn’t know if he was, by nature, a frantic, boisterous dog that sometimes got carried away and played too rough, or if he just needed consistent love and discipline.
Fortunately, we now know that he is, by nature, a sweet and even-tempered animal who expects little more from life than a smile, a few scratches, the occasional biscuit and regular walks in the park. Now, he approaches other dogs with either caution or a friendly wag of the tail to invite them to run with him in endless circles through the park.
Over the time he has been with us, we have concluded that he was not abused, but clearly neglected and desperate for love and attention. With consistent discipline, we have convinced this 88-pound creature that he is not, as he once thought, a lap dog.
Not surprisingly, as we have adjusted to Guinness and he to us, I have thought many times about the uncertainties foster parents and children face as they learn to know and trust each other. Guinness had no reason to expect that we would treat him well; and we didn’t know if he could become the companionable pet we wanted.
In my work as a clinical psychologist and Director of A Home Within, I repeatedly remind people that it takes a very long time to build relationships. As someone who adopted an animal who had been abandoned, I have consistently been surprised at how long it took for him to feel securely at home. He is a constant reminder that even if we could hurry love, you can’t hurry trust.
By Toni Heineman
On this the tenth day of National Foster Care Month we are launching a celebration of ten years of service to the foster care community. From a small group of therapists working only in the San Francisco Bay Area, we have grown to a network of private practice clinicians working in fifty large and small communities across the country. Because of the dedication of these social workers, marriage and family therapists, professional counselors, and psychologists, well over a thousand children, youth, and young adults have received long-term, individual psychotherapy at no cost to them, their families, or the agencies responsible for their care.
The length and depth of treatment we offer is what makes A Home Within
different from most of the therapy foster youth receive. While we have seen positive changes in some aspects of foster care over the last ten years, there has been unfortunately little improvement in the mental health services available to youth in the foster care system.
An important impetus for the creation of A Home Within was our recognition of the destructive impact on foster children who repeatedly lost important relationships when the interns they were seeing in therapy graduated or moved on to a new clinic. Unfortunately, this continues to be the rule, rather than the exception.
Another aspect of mental health care that hasn’t changed is the frequency with which the emotional pain of foster youth is met with medication. “All I wanted was someone to talk to and what I got was pills,” is a comment we heard too often ten years ago, and one we hear even more often today.
It’s often said that the ultimate goal of every non-profit is to put itself out of business. It would, indeed, be a joyous occasion if I were writing to tell you that on our tenth anniversary we were closing our doors because what we offer is no longer needed. Instead, I’m writing to tell you that we intend to keep doing more and better of what we have been doing for the last ten years—offering high-quality, pro bono mental health services that create and strengthen the relationships of current and former foster youth and those who care for them.
Last year we provided over $1.2 million in pro bono professional services. We intend to do more this year and every year after that—“for as long as it takes.” I hope that your interest and support will continue and grow with us over the next ten years.
By Toni Heineman
The recent failed attempt to pass a bill that would open California’s dependency courts to the public, highlights the complexity of simultaneously trying to protect the rights and privacy of children in the foster care system. As courts across the country are moving to allow the public to attend hearings concerning the lives of foster youth, it’s imperative that we consider the gains and losses of tipping the balance toward a maintenance of the status quo or toward revamping the current system.
Dependency court hearings are part of the process of determining the future of individual foster children. Those in favor of opening dependency courts argue that closed hearings allow courts to operate without accountability when making life-altering decisions for an extremely vulnerable group of children and adolescents.
However, these hearings may also include reviews of children’s histories, including details about the abuse or neglect that resulted in their being removed from their parents’ care. Those opposed to open hearings argue that the privacy of this vulnerable group will be compromised by allowing public scrutiny.
Protecting children in foster care is not easy. It is hard enough just to provide physical protection. Neglectful or abusive foster parents slip through the cracks of the vetting process. And, unfortunately, victimized children who have been placed in a foster family may victimize other children placed with the same family. When these instances of failure to protect come to light, we are understandably outraged, wondering how “the system” could have allowed such failures.
For better or for worse, there is no “system”–just a collection of people charged with caring for children who have no stable family to care for them. The legal and psychological issues facing those working to protect foster children are enormously complex and rarely offer simple “either/or” solutions. The lives of these children are difficult to comprehend. It is even more difficult to figure out how to address their many, often contradictory needs. The courts and the supporting characters—social workers, attorneys, advocates, foster parents, therapists, pediatricians—to name a few, often must craft delicately balanced solutions.
We need to protect children’s privacy AND we need to know that those charged with their care are working responsibly, ethically, and within the law to promote the best interests of children in foster care. This is not an easy task; it will most likely require a delicate balance between sometimes competing needs.
How would you begin to think about protecting BOTH rights AND privacy for foster children?
By Toni Heineman
The federal budget is settled—at least for the moment. But when the battle begins anew, the political fortunes of the Obama administration and Congressional leaders John Boehner and Harry Reid are likely to dominate the news. With unfortunate predictability, politics distracts our attention from the very real human consequences of the activities on Capitol Hill. We are expecting unprecedented reductions in spending for programs that serve the most vulnerable of our citizens.
Some cuts are obvious and immediately evident—when there are fewer beds in homeless shelters, the lines of people waiting to get in are likely to be longer—at least for a while. But they may, over time, get shorter, because those in need of shelter no longer bother to wait in line, only to be turned away.
Loss of hope is hard to measure.
By Toni Heineman
This was the title of our very provocative conference in San Francisco last Saturday that focused on the psychodynamic treatment of children and young adults suffering from Asperger’s Syndrome. We repeatedly heard from the presenters about the complex reactions of both the patients and their families when they failed to find a way to connect to each other.
In introducing the panel, Katharine Gould, psychoanalyst and Clinical Director of A Home Within’s Chicago chapter, reminded the audience that foster children are among those that suffer most from being unfound. Many of them wait for weeks or months or years in the hope that someone will care enough to find them.
Do you remember playing hide-and-seek and how the excitement of waiting to be found was tinged with the anxiety of not being found? Being found too quickly made the game boring; waiting too long meant that anxiety overtook excitement.
For foster children, there is little excitement in waiting to be found—waiting for someone who will want to get to know them. Sometimes they emerge from hiding too quickly, attaching themselves to anyone who appears in their world, unable to take the time to get to know the person or form a real relationship. Sometimes they won’t come out of hiding at all, afraid to believe that there might be someone who really does want to know them. It takes courage to believe that someone will take the time to find out who they really are, hidden behind the barriers they have created to protect themselves.
For children suffering from Asperger’s Syndrome, the barriers to relationships have their beginnings in neurophysiology. For foster children the barriers to relationships have their beginnings in loss. Sometimes it’s not clear how these groups of unfound children experience their lack of relationships; for those working to find them, the pain can be almost palpable.
By Toni Heineman
When you stop to think about it, musical chairs is a curious activity for entertaining children.
In case you don’t remember—or never played it at a friend’s birthday party—a group of chairs, numbering one fewer than the number of players, is arranged in a circle, seats facing out. As the music starts, the children walk around the circle, often jockeying to keep as close as possible to a chair. When the music stops, everyone rushes to grab a seat. If two children land on the same chair, only one can ultimately claim it; the loser might be physically weaker, or less tenacious, or more polite, or more timid. For whatever reason, a child without a seat is removed from the game along with one chair, thereby insuring that when the music begins and then again stops, one more child will be eliminated from the game. Eventually, one child is left with the sole remaining chair.
One does wonder for whom, exactly, this game is supposed to be fun.
Is it fun for the child, sitting alone on the only available chair? Is it fun for the children who weren’t quick or clever or strong enough to stay in the game? (We might imagine that those eliminated early began to play among themselves, perhaps enticing others to “lose” in order to join in less anxiety-provoking activities.) Nicholas Kristof writes about trying to introduce musical chairs to a group of Japanese school children at his son’s birthday party (NYT March 21, 2011).
“Disaster. The children, especially the girls were traumatized by having to push aside others to gain a seat for themselves.” The children at that party changed the game into one of collaboration and cooperation. No doubt something that those among us with a competitive streak wouldn’t even classify as a game.
Unfortunately, as Kristof points out Americans can be pushy. “We sometimes treat life, and budget negotiations, as a contest in which the weakest (such as children) are to be gleefully pushed aside when the music stops.” When the music finally stops at the end of current fiscal negotiations at the federal, state, and local levels, we are likely to find that, foster children are among those most profoundly affected by budgetary musical chairs. They may find that, not only their chairs have been eliminated, but that there are fewer seats for those charged with their care. Budget cuts often mean that the seats once occupied by foster parents, caseworkers, and supervisors are eliminated. When these people lose their jobs, who will care for the 500,000 children in foster care?
By Toni Heineman