What Do Kids Need From Therapy? - Weekend Wisdom

Question: I’m an intern therapist working with kids involved in DHS and the foster system. Could you guys talk about what a kid in the system needs from therapy? Or like what helped them, what didn’t, what they needed in that space that their therapist didn’t provide?

Resources:

• Trauma-Informed Therapy: Finding the Right Fit for Your Family
• Therapists: Parents Should Be With Their Kids for Adoptive or Foster Therapy Sessions
• Finding an Adoption Competent Therapist

Transcript

Please pardon any errors, this is an automated transcript.

Welcome back to Weekend Wisdom. I'm Tracy Whitney, the content director for creatingafamily.org.
We bring you this short weekly podcast to answer the practical questions and concerns and dilemmas
that adoptive foster and kinship families face in their everyday life. If you have a question that
might fit the Weekend Wisdom format, we would love to hear from you. You can send them to info at
creatingafamily.org with Weekend Wisdom in the subject line. And we will add you to the queue and
work on an answer that can strengthen your family. Today's question is a little bit of an outlier
for us. We actually heard from a listener who is studying to become a therapist. I love the
initiative and interest that this question represents. And I think we've pulled together some
pretty practical information to help not just this young person who's learning how to become an
effective therapist, but also to help families who might be listening and considering therapy for
their kids. Here's the question. Hello, I'm an intern therapist working with kids involved in DHS
and the foster system. Could you guys please talk about what a kid in the system needs from
therapy? What helped them, what didn't, what they needed in that space that their therapist maybe
didn't provide. And this comes from Mount Pleasant, Iowa. So thank you, Mount Pleasant,
for writing in. It's great to hear from you and to know that you are already thinking about what
the kids in foster care need from their support circles. It's very common for parents and
caregivers to assume that therapy will automatically help their kids or fix their kids. Parents and
caregivers tend to seek therapy for their kids to learn better behavior strategies,
coping tools, learning how to manage big emotions, and to heal damaged relationships.
And that's all great. The truth of the matter is that therapy only works when it's a good match
between what the kids need and what the therapist can do to support the experiences that the child
has had from things like trauma, loss, and disrupted attachment. So we need to kind of frame the
conversation in two different parts. First, Part that we want to tackle is that kids in foster care
or adopted from foster care have specific needs from the therapy experience. And then we would
address what the parents and caregivers should be looking for in an effective therapy relationship,
including maybe some red flags that they should be alert to. So the first thing that kids need in a
therapeutic relationship is tools and connection that will strengthen the parent-child
relationship. Kids who've experienced wounding in relationship need to heal in relationship,
not in isolation. And even if a foster child is not able to be currently in a relationship with
their birth parents, they still need a parent relationship where they can learn how to feel safe,
where they can learn how to trust and learn that grownups are and can be safe. So a therapist who
is working with a child in a foster care relationship can involve the foster parents,
but also the birth family if they are safe and accessible. Including all of those safe adults in
this process can help the child heal the wounds that happened in those relationships. When
caregivers are involved in a child's therapy process, both the child and the adult can learn new
ways to heal and can learn new ways to interact with each other that can help mitigate the impacts
of the trauma that they previously experienced. Kids can see these adults learning new skills and
new ways to respond, and the adults can learn what makes the child feel safe. The primary
attachment focus then is turned toward the parent-child relationship, whether that's turning the
child toward the foster parents or turning the child toward the birth parents if reunification is
still on the table. And it sets up this pattern of repetition that tells the child's brain and the
adult's brains that Connection is safe and trustworthy and reliable and can go towards healing that
previous wound. So what then should foster parents look for in a therapeutic relationship?
So foster parents should consider looking for a therapist who includes the caregivers in sessions,
who offers practical guidance and opportunities to practice in the sessions,
and focuses on the connection and safety between the parent or caregiver and the child rather than
just on actual behavior. So if the foster parents are supporting the birth parents as well,
then they could also consider how the therapist will welcome or include the birth family in those
sessions. And what might be a warning sign that this therapist isn't a good fit? Well,
one warning sign would be a therapist who only wants to work with the child and shuts out or
excludes birth parents or foster parents from the process. Another warning sign might be a
therapist who is unwilling to communicate with all parties and keep everyone in the loop when a
parent or a caregiver is not in a session with a child. And then another warning sign would be a
therapist who presents themselves as somebody who will fix this child for you. So let's move on to
the second thing that kids need in a therapeutic relationship, foster kids in particular for this
listener's question. Kids need therapists who understand trauma and attachment.
Foster and adoptive parents have received training to know that their kids are vulnerable and are
carrying the weight of grief and fear and attachment and multiple placements and so on. They know
that their kids' behavior looks like defiance or control, and it's often instead survival or coping
under the surface. They know that kids' behavior strategies are shaped by kids' earlier life
experiences.
That's information you get when you're training to become a foster parent. However, therapists who
choose to work with parents or caregivers should also know that information. They should have
working knowledge of what trauma is and how it impacts not just the developing brain,
but then the behaviors and where behaviors are coming from. They should be able to look at behavior
as a communication of a need. They should not be just focused on fixing behavior.
Kids need their therapists to see their behavior through the filter of what does this child need
right now and what skills might this child be lacking because of previous trauma or neglect or
abuse. And they need to... that to the child,
to assure the child that the child is not bad, the child is not broken, the child is behaving in a
way that helped them survive before, and so now they can learn new survival strategies when they're
in a safe and healthy place, and that that's what they're there to help the child do. So keeping
that in mind, then what should foster and adoptive parents look for in a therapist? Again,
They should look for a therapist who understands that behavior is communication. They should also
prioritize emotional safety, therapists who create safe spaces,
not just in the sessions, but then teach parents and caregivers how to create safe spaces that the
child can participate in that process of creating and taking advantage of and learning how to
settle into safe spaces. They should also offer plenty of opportunities for a child's grown-up.
to learn how to be safe and see like that practicing happening in those sessions.
And then... the red flags or yellow flags that parents and caregivers should be cautious about?
They should, of course, be very cautious about any therapist that focuses mainly on compliance or
consequences or very quick behavior changes without getting at the root of what's going on.
They may not be the right fit for this child in this season.
the adults are or are not present, is this therapist pushing the child to discuss their trauma
before trust has been established? That's a big one when you're trying to look at behavior through
the lens of trauma. Kids need to be able to trust that they're safe to disclose and process what
they've experienced. The third thing that kids need from therapy is to understand,
they need therapists who understand the realities of foster care and adoption. In your training,
Mount Pleasant from Iowa, you may be learning about the common issues that foster kids experience
as a result of their connection to the foster system, things that brought them to the foster system
that may have very negative impacts on their behavior and their coping skills. So these kids are
dealing with issues like loyalty conflict and identity questions and survival brain behaviors,
as we've mentioned earlier. They're dealing with parentification. dealing with grief related to
their birth families and losing that culture, that familiarity, even if it was painful,
it was familiar. A therapist who may not understand all of those layers may not be able to
successfully get at the root of those things, and they can unintentionally increase a child's shame
or confusion about where they came from, where they are now, and where they're going. Whatever you
can do, Mount Pleasant to boost your own understanding of these issues will make you a better and
more qualified therapist to support kids who've experienced foster care and all the losses and
challenges that come with going into the foster care system and living through multiple placements.
So then let's turn to what parents should look for in a therapeutic relationship. Parents and
caregivers need to make sure that their therapist has at least a summary going into their first
session, has at least a summary of what this child has already experienced. Look for a therapist
who asks about that context and makes room for the child's full story.
Look for a therapist that's acknowledging the losses and is comfortable discussing issues around
birth families and grief and identity. This child deserves to be supported by professionals who
respect the child's past while supporting their present relationships and the hope for healing.
Often parents and caregivers will only know that by participating in a few sessions together,
and that's kind of a hard thing to work through because you might not know that it's not a good fit
until you've been a couple sessions in. Even if that is the case and you feel like after two or
three sessions, parents, that this is maybe not a good fit, it's totally okay to step back and
reconsider. In light of that, then what are the warning signs that a parent or caregiver should be
thinking about? Well, a parent should be thinking about... how the therapist handles a child's
history, how they receive it. Do they avoid talking about it? Do they treat the child as if they're
kind of a clean slate or as if this new foster placement or this new adoptive placement is the
chance for a brand new start? If they are minimizing the child's grief or treating foster care or
adoption as irrelevant to the child's emotional state or behavioral state.
Those are all red flags. There's no harm in starting out with a therapist who might feel like a
good fit and then stopping and reassessing as that relationship unfolds. And the fourth thing that
kids need from their therapists, especially kids in the foster and adoptive placement situation,
is that Their therapy should improve their daily life experience. It's crucial that our therapists
who are working with our kids understand that relationship dynamics show themselves differently in
a session than they do at home in regular everyday life. Most therapists understand that.
And of course, then the therapy needs to feel supportive, safe. trustworthy,
all of that, but it also needs to offer tools to handle the everyday life experiences when the pace
of life is different than it is in the office, when families are feeling rushed and pressed on by
all of the demands of the world around them, how to handle things at school, how to handle things
when kids are feeling triggered. So making progress with a family can look like this child's adults
understanding the child better. It could look like the adults feeling equipped to respond
differently than they have in the past. It could look like the child feeling safe to explore deeper
trust and deeper connection and regulation with the grownups in their everyday life, whether that's
just the foster parents or the foster parents and the birth parents. And it could also look like
reports at... next session of some joyful nourishing moments from both the child and the caregiver
that maybe they weren't able to report before. This is kind of one of those situations where you
have to be in it for a little while. And that could, again, be an uncomfortable situation where you
have to stop and assess, is this really a good fit? You'll know it's a good fit when you leave your
sessions with good ideas and language and strategies that help you feel supported to try new ways
of interacting and helping the child address challenging behaviors. You'll know it's a good fit
when the child leaves feeling supported and encouraged and hopeful about new strategies.
So over time, the family's stress becomes more manageable because you've found a therapist who is a
good fit and is focused on helping you with all of those things. So in light of that,
then parents and caregivers should be cautious about therapy that stays stuck at kind of just the
place of venting or talking about issues without any actual measurable change happening at home,
kind of just rehashing the same things every time you come to session. You should be cautious about
parents and caregivers not understanding what the goals of therapy are. I think it's really
important to work with your therapist to set goals and then check in with each other,
therapist to parent, therapist to child, parents and child, about how you feel about the goals and
what's been achieved thus far. And anytime a family member leaves sessions,
consistently feeling blamed or like they're the bad one or they're the broken one,
instead of feeling supported and encouraged to try new things, that's something else to be cautious
about. So in summary, Mount Pleasant, the kids who you are working with now as an intern and who
you may someday be working with need these three things, these four things, I'm sorry, from a
therapy relationship. number one they need to know who the safe adults are number two they need
adults parents and professionals who will understand trauma and its impacts Number three,
they need therapists and professionals who understand what they experience as an adopted or foster
person. And number four, they need tools and hope that they can heal and thrive from the trauma and
its impacts that they've experienced. Meeting those needs as their therapist is a high calling,
and it will take time for you to learn and for them to feel safe learning with you. You need time
to learn and practice and figure out how you can become that safe space. need time once you're in
these sessions with them to trust you, to build and feel hope again, and to feel supported and able
to trust their parents and their caregivers. They also need time to practice the skills that you
are investing your time in teaching them. Kids like to learn. Most kids have an innate desire to
learn and improve and please the adults around them. And you're just going to be working to
facilitate spaces where everybody in the therapeutic relationship wants to do that together.
And hopefully, parents and caregivers, this information was also helpful to you to understand what
kids need in therapy and what to be on the lookout for from a therapeutic relationship.
Look for someone who's moving at your child's pace and is supporting this emotional process of
healing without forcing it. Therapy is not just about finding a professional that your child likes,
although that is certainly a bonus. It's not about finding someone who can fix your family.
It's about finding someone who helps your child feel safe in their relationships at home so that
they can explore what they've experienced and learn better strategies. to express what they've
experienced and better strategies for behaving and coping with all the big feelings that those
experiences may bring up for them. When a therapist, like the one that Mount Pleasant is training
to become, works with a family and is strengthening the connections within their family by the
tools and practical strategies that they offer, that's when real healing can begin. Thanks again,
Mount Pleasant, for your question. I hope that this helped by taking the approach of understanding
what kids need and then what parents and caregivers should be looking for and then what parents and
caregivers should be cautious about. I hope that approach helped you think through what you can do
to be the safe professional in those relationships. And parents and caregivers, I hope this was
helpful for you as well. I would love for you to leave us a note in...
the show notes or the link that offers us space to respond wherever you're listening today to let
us know how we did. Let us know what questions you have or where you are in your therapeutic
journey. And I hope to hear from you soon. Thanks so much. And I'll talk to you next week.