Clinical Interventions with Birth Parents - PowerPoint Presentation

Slide1

Clinical Interventions with Birth Parents

63Slide2

Handout

#4.6 Joanne: Clinical Interventions with a Birth

Mother

How did Joanne’s experience with adoption factor into the presenting issues?What background factors are particularly relevant in relation to the presenting issues surrounding the involuntary termination of her parental rights?Do you agree with the assessment conclusions reached by the therapist? Why or why not?How would you describe the key treatment strategies used by the therapist?How important was the therapist’s adoption competence in this case?

64

Clinical Interventions with Birth Parents Slide3

Specific Clinical Interventions

Written role play

Therapeutic writing

BibliotherapyTherapeutic ritualsGroup work

65

Clinical Interventions with Birth Parents Slide4

Strategy for facilitating the birth parent’s exploration of hopes, fears, beliefs, and expectations in relation to the child and adoptive

familyClient chooses who to write to – it is

not intended that the letter will ever be

sentTherapist asks the client to:Write whatever he/she wants to that person Assume the role of the person who has received the letter, and respond in writing as if she/he were that person.Respond in writing to the response of the adoptive family member, and so on.

“Correspondence with the self.”

66

Clinical Interventions with Birth

Parents: Written Role Play Slide5

Journaling Different forms: from very free-flowing to very structured

Growing body of research: writing can have therapeutic benefits that help psychologically as well as physically

As

therapy progresses, it is useful to have the client return to material written weeks earlier to revisit those feelings in light of therapeutic progress made since then.67

Clinical Interventions with Birth Parents: Therapeutic Writing Slide6

Incorporates

appropriate books or other written materials, usually intended to be read outside of psychotherapy sessions, into the treatment regimenGoal: to broaden and deepen the client's understanding of the particular problem that requires

treatment

The problem itself The proposed treatmentCan facilitate active participation in treatment and promote a stronger sense of personal responsibility for recovery

May find relief in knowing that others have had the same problem and have coped successfully with it or recovered from it

68

Clinical Interventions with Birth

Parents:

Bibliotherapy

Slide7

Symbolic acts that provide support for people and provide an environment for expressing and containing strong

feelingsMeans of connecting the past to the present, and the present to the

future

Can provide a powerful bridge to adoption when celebrated with openness, love, and pride -- powerful message of validation The outcomes of rituals may be:A release of feelings of grief, anger and confusion toward a situation or personAbility to put memories in a safe place so that they do not interfere with moving forward

Clear definitions of family relationships People joining together in new roles

69

Clinical Interventions with Birth

Parents: Therapeutic Rituals Slide8

The entrustment

ritualRituals marking a transition from the past to the future

70

Clinical Interventions with Birth Parents: Therapeutic Rituals Slide9

Being a birth parent: Isolating experience – shame, guilt

, unwillingness to share the experience with others

“Talk

therapy” can be very beneficial, but talking within the safety of a group of other birth parents might be even more useful71

Clinical Interventions with Birth Parents: Group Work Slide10

Handout

#4.7 Donna: Clinical Interventions

72

Clinical Interventions with Birth Parents Slide11

Clinical Interventions: Children and Youth

73Slide12

Handout

#4.8 The

Good Grief Program of Boston Medical Center: What Children Need

 74

Clinical Interventions: Children and YouthSlide13

1. Understanding

: knowing what happened to the person who left and why, or knowing what situations caused the loss and why it happenedWhat are some specific considerations that we must take into account in helping children understand their losses?

75

The Good Grief ModelSlide14

The developmental stage and cognitive ability to understand the loss

The child’s unique temperament and personalityTendency for children to assume responsibility for what has happened to them

The fact that some children regress under stress

76The Good Grief ModelSlide15

2. Grieving

: experiencing the painful feelings associated with a loss Some key considerations when they think about how children grieve are:Children grieve in

spurts

Their grief can be described as sad, mad and bad77

The Good Grief ModelSlide16

Five factors that have an impact on a child’s grief response are:

Their developmental stage and cognitive ability to understand the loss (as with Understanding)Their need to re-grieve as they grow and developTheir relationship with the people they have lost

The suddenness or anticipatory nature of the loss

The secondary losses that often accompany a primary lossWe cannot rush the grieving process in children78

The Good Grief ModelSlide17

3. Commemorating

: remembering the persons, places, things that are no longer part of the child’s daily lifeCommemoration as a vehicle for

expressing

Ambiguous loss: Informal commemorations What might be some informal commemorations that we could work with a child to create to remember his/her losses?

79The Good Grief ModelSlide18

4. Going

on: The child learns that the pain of grief subsides and the legacy of their loved ones lies within themselves Going on involves a transformation over time. Children maintain an inner connection with those they have lost

Connection

and memory of the people they have lost depends on our willingness to help them integrate this loss within themselves.80The Good Grief ModelSlide19

Unresolved

separations will interfere with formation of new relationshipsNew attachments are not to replace old onesWe can free children from the past by providing a process to grieve past losses

Children fear re-occurrence of pain of losses and avoid intimacy

Adults who show support of child’s emotions as the child copes with grief support the development of new attachmentsAdoptive parents must accept that loyalty issues will exist but that children can love more than one person81

Guiding PrinciplesSlide20

Life Books

Loss Box W.I.S.E. Up

CASE’s Teen Treatment Model

Individual TherapyGroup TherapyWritten Role Play

Clinical Interventions with Adopted Children and Youth

82Slide21

Life Books

83Slide22

What it isHow a loss box is made

A loss box made by a teenat the Center for Adoption

Support and Education

The Loss Box 84Slide23

What are your thoughts about the loss box as a way of helping young people identify and acknowledge their losses?

The Loss Box

85Slide24

During the middle childhood

years: children encounter questions from school mates about adoption -- may trigger additional feelings of grief and loss.

What

might be some questions from school mates that could trigger these feelings?  86

W.I.S.E. UpSlide25

Who is your real mother? How come she didn’t keep you?

Don’t you want to find your real mother?I hear you were left in an orphanage. What was wrong with you?Is your mother a prostitute?

Do you have a dad? Where is he? How come he didn’t marry your mother?

I hear that all kids in foster care were abused. What happened to you?How do you know what you will look like when you grow up?How can that be your mother? Her skin isn’t dark like yours.How much did your parents pay for you?Is your real mother a drug addict?

87

W.I.S.E. UpSlide26

Developed by the Center for Adoption Support and

Education for younger childrenW.I.S.E. Up the Owl leads young readers through the book with questions about feelings, different ways the topic of adoption is brought up by peers, and how to handle situations as they

arise

The letters in WISE stand for the four options children have for responding to questions and comments about adoption:W Walk away or ignore what is said or heardI It’s private and I don’t have to answer it

S Share something about my adoption story

E

Educate

others about adoption in general

88

W.I.S.E. UpSlide27

The W.I.S.E Up! Powerbook can be ordered from the Center for Adoption Support and Education Store at: http://www.adoptionsupport.org/pub/index.php

89

W.I.S.E. UpSlide28

Childhood grief is often based on different issues that those that impact adolescents and adults.

Donna O’Toole, author of Helping Children Grieve and

Grow:

“Especially for children a loss may be based on safety, comfort, and familiarity rather than on what adults speak of as love or affection.”Six categories of childhood loss:Relationship loss (usually people and animals)Loss of objects that give comfort (toys, blankets, clothing)

Loss of a secure, familiar environmentLoss of self (ways of being and doing that define us uniquely)Loss of skills, abilities, and competencies

Loss of familiar habits and

routines

90

Clinical Interventions with Young Children and their Adopted ParentsSlide29

Theresa Anderson:

“You can’t take a child from home, put them on an airplane, cross the world, surround them with thousands of people at the airport, have them met by strange people, smells, textures, food and voices, and not expect them to be traumatized.” Donna

O’Toole: Children

do not tell us they are grieving. We must look at what they say and do. 91Clinical Interventions with Young Children and their Adopted ParentsSlide30

Possible reactions:

When

children feel overwhelmed by intense feelings they may naturally make their world safe by distancing themselves physically and emotionally, by pretending or by denying the reality of the loss.

92Clinical Interventions with Young Children and their Adopted Parents

Anger

Sadness

Hyperactivity

Changes

in appetite

Hoarding food

Clinginess

Inappropriate

emotional response

Headaches

Difficulty making decisions

Repressive behaviorsSlide31

Handout

#4.9 C

ase

Example: SaraAs the therapist for Sara and her family, how would you have supported Sara’s parents in revealing the adoption story to her?What interventions might you use with Sara as she attempts to absorb these new losses on top of the existing losses?

93

Clinical Interventions with Young Children and their Adopted ParentsSlide32

Handout

#4.10 Examples of Feeling Charts

94Clinical Interventions with Young Children and their Adopted ParentsSlide33

Two books recommended by the C.A.S.E. therapist are:

The Invisible String

Twice

Upon a Time 95

Clinical Interventions with Young Children and their Adopted ParentsSlide34

3. How might you work with Sara’s parents in helping them help Sara as she experiences the disbelief, anger and sadness at learning her adoption story?

96

Clinical Interventions with Young Children and their Adopted ParentsSlide35

97

C.A.S.E.’s Teen Treatment Model

Involves

the teen in individual and group therapy, the family in family therapy and parent support and education. Slide36

98

C.A.S.E.’s Teen Treatment Model

Individual Therapy:

The therapist:Provides a safe place for exploration of adoption issuesGive permission to the teen to grieve lossesValidates the teen’s sense of confusion as he/she moves to consolidate a sense of self

Educates the teen to developmental issues in adoption Slide37

Handout #4.11

David

What

factors have contributed to David’s complicated grief?As the clinician, how would you begin your work with Marla and David?What are some clinical interventions that you would consider as you complete the assessment and begin the development of the treatment plan?

99

C.A.S.E.’s Teen Treatment ModelSlide38

Group Therapy

A social milieu for growth and emotional healing

Opportunities

to identify with other teens and normalize experiences (“I’m not alone!”)Helps teens release stigma and shameValidates for teens the universality of their

issues

100

C.A.S.E.’s Teen Treatment ModelSlide39

Research evidence: Effectiveness

of group therapy for adolescents when the therapeutic relationships in the group have relationship structure and relationship quality. Structure: The

direction of the relationship.

Vertical cohesion refers to a group member’s perception of the group leader’s competence, genuineness, and warmth. Horizontal cohesion describes a group member’s relationship with other group members and with the group as a whole.

101

C.A.S.E.’s Teen Treatment ModelSlide40

Quality

of the group relationships: how members feel with their leader and with other members (positive bond

)

by the tasks and goals of the group (positive work)the empathic failure with the leader and conflict in the group (negative relationship)

102

C.A.S.E.’s Teen Treatment ModelSlide41

“I thought I was the only one who

ever thought about what it would have been like to have been raised by my birth parents.”

A

teen in a group therapy program for adopted adolescents103C.A.S.E.’s Teen Treatment ModelSlide42

C.A.S.E

.’s Teen Treatment Model

104

Handout #4.12

C.A.S.E

. Scripted Group Schedule: Group Therapy with TeensSlide43

Can help a young person open communication.

Process: Write a letter to his birth mother/father, which can be followed by the young person composing his or her reply to the letter by imagining how his/her birth mother/father

might

respondAlso can help an adoptee prepare for meeting his birth mother/father105

Written Role PlaySlide44

Handout

#4.13

Amy

106Written Role PlaySlide45

What are your thoughts on written role play? How might you see yourself using this approach with adopted older children, youth and young adults?

107

Written Role PlaySlide46

Critical to clarify at the outset of therapy, both with the child and parents, how privacy/confidentiality of information shared by the child will be

handledGregory Keck: Parenting Adopted

Adolescents

:When parents bring an adolescent to therapy, he discusses what information will not be confidential – such as physical or sexual abuse, dangerous use of alcohol or drugs, and safety issues. There is usually an understanding that family matters are shared with the people who are involved in treatment.

108

Confidentiality and Creating a Safe Environment Slide47

Adolescent asks,

before saying something: “Will you tell my parents?” In response,

Dr. Keck says

, “It depends on what you tell me,” and then goes over what he would either need or want to share. One of the most important ethical considerations: Creating a zone of safety for clientserapist should always be aware of situations that may be beyond his/her current level of expertise. In such cases, be sure to reach out for consultation or supervision with colleagues who have more experience in this area.

109

Confidentiality and Creating a Safe Environment Slide48

110

Break Time!Slide49

Clinical Interventions: Adoptive Parents

111Slide50

Assessments of the range of losses that adoptive parents may experience is essential to our quality work with them and their families.

Dyadic Developmental Psychotherapy (DDP): focuses on assessing and addressing adoptive parents’ grief, loss, separation and attachment experiences in the context of meeting their children’s

needs

112Clinical Interventions: Adoptive ParentsSlide51

Far more work on separation and loss has been done with respect to clinical interventions with birth parents and with adopted children and youth than has been the case with adoptive parents.

Why

do you think that this is the case?

113Clinical Interventions: Adoptive ParentsSlide52

A Movie and Discussion

114Slide53

“

Families linked in adoption come in as great variety as the range of human possibilities permit. Regardless of their particular link to adoption, they must deal with the universal human needs for attachment, generativity, and coping with loss. The only certain commonality among these families is that they have undergone fundamental loss experiences beyond those that any family can normally expect. No other common experiences can be assumed for all families linked in

adoption.”

(p. 13).115

Reitz and Watson in their book The Adoptive Family SystemSlide54

To

learn more about the people featured on the

documentary: http://unlockingtheheart.com/www/index.htm

116Slide55

Summary and Closing

117Slide56

Define ambiguous loss and describe how

birth parents and adopted children and youth experience ambiguous loss.

Describe

the continuum of children’s reactions to loss Define disenfranchised grief and how birth mothers and birth fathers and adopted children

and youth experience disenfranchised grief Compare two different frameworks for

understanding birth

parents grief and loss and

describe

how these frameworks could be

utilized

in the students’ clinical practice

Our Learning Objectives

118Slide57

Define complicated grief and prolonged grief disorder (PGD) and how the DSM-V treats these conditions

Using case studies, identify at least five clinical interventions that can be utilized with birth parents in helping them with grief and loss issues and discuss how the student would use these in his/her clinical practice

Describe the four principles of the Good Grief Program

119Our Learning ObjectivesSlide58

8

Identify at least three clinical interventions that can be utilized with adopted children

and

youth in helping them with grief and loss issues and discuss how the student would use these in his/her clinical practice9 Identify, based on the stories depicted in Unlocking

the Heart of Adoption, the losses experienced by all members of the adoption

kinship network in same race

and

transracial adoption

120

Our Learning ObjectivesSlide59

The Brief Online Survey

Next Steps

121Slide60

Trauma and Brain Neurobiology

Our Next Session

122