Treatment Philosophy
Parent Educational Program
In 1990, I joined Evergreen Consultants and began working with families who had one or more children with RAD. While there I was trained in and worked with their method of treatment. As I worked with these families, I gradually began to adapt the program of treatment to include methods that were successful and exclude those that were not. These changes involved working more with the parents and modifying the holding process to be less confrontational. I also eliminated the use of stimulation, which I had never adopted. Gradually I created a program which put the parents at the center of helping their children recover from early trauma.
Before 1990 I worked principally in the children’s units of public mental health centers in several states for about twenty years. I used play therapy for a few months in the beginning of that work, but I soon began using family therapy as the major therapeutic modality regardless of the presenting problem. Over time I saw the most profound change in the shortest time by placing an ever stronger emphasis on teaching the parents how to help their own children. Occasionally the parents were the source of their children’s problems, which meant they needed to change what they were doing wrong. At other times, the parents needed to do something they had not been doing which meant they needed to learn how to provide something new and essential to their children and incorporate that into the family life. In both situations, working mainly with the parents produced the most permanent and profound improvement in these families. As the parents changed, they in turn were able to produce dramatic reduction and often complete resolution of their children’s problems.
In many families however, the children’s problems were not caused by the parents but by one or more of any number of outside factors. However, the parents remained the people in the family with the most motivation for change. They had the most power and they were the one’s who were legally responsible for their children, especially if their children’s problems were hurtful to others.
In virtually all situations however, I experienced the greatest amount of positive change in the shortest time by empowering the parents, increasing their knowledge and their parenting skills.
It was a small step to begin using this parental education approach with RAD children and their families. As this proved successful, I expanded the use of parent education, allowing the parents to become more capable of helping their children to attach. The parents helped their children to give and receive love, to increase their ability to trust their parents, and to learn to accept and obey not only their parent's rules but society’s rules as well.
By the end of the 1990’s I started to call this process the Parent Educational Program (PEP).
In my experience, all children with RAD began their life with one or more kinds of significant trauma. This trauma had the effect of making it very difficult for them to believe that they can depend upon their biological or adoptive parents. Being powerless and dependent is a frightening proposition when you are largely helpless to modify, escape or stop the trauma.
Most of the families with whom I have worked have one or more adopted children. Obviously, in each of these situations, their adopted children had suffered the trauma of losing the love and relationship with their biological mother and father. Sometimes a period of abuse and neglect was added to this loss either at the hands of their biological parents, orphanages or with other, often temporary, families. All of this happened before they came to live in their new, adoptive home. It is not surprising that it is very difficult for many adopted babies and children to trust that the adoptive parents are competent, reliable, and authentically loving.
The initial focus of PEP is to help parents understand their children’s trauma and the effect it has had on them. The program then tries to give the parents as many skills as possible, helping the parents learn how to teach their children to love, trust and obey. The positive effect of empowering parents was seen in virtually every family in a matter of four to six hours of beginning the program. The parents’ level of frustration, desperation, hopelessness and resentment began to dissipate as soon as the parents became more skilled. The skills which they began to learn in the first few hours quickly changed a number of their paralyzing emotions. They began to have more hope, were less discouraged, felt more in control of their family. They quickly became more optimistic that they and their children might develop a loving relationship, and they began to be less afraid because they could see a future where their children no longer had RAD.
Parents often experienced improvement in the relationships with their children very quickly. By noon or early in the afternoon of the first day, as parents began to develop understanding and skills, they started reporting to me how their children were already behaving differently. This usually involved a decrease in one or more troublesome symptoms or an increase in one or more examples of positive attachment behavior. Often this early improvement led to decreased conflict with siblings and an increased ability to play happily together. By the time the families sought treatment, the parents were extremely observant and noticed every instance and nuance of their children’s RAD symptoms. So, when they reported improvement, I could usually trust that it was both significant and valid.
Another significant change in how I work with families was made about a decade ago. I had been working with a mother and her adopted four year-old boy. After five or six two-hour training sessions in my office, the mother and I were becoming frustrated because we were not seeing progress. At that time I was working with the parents usually two hours every one to two weeks until they had been taught most of the parenting principles. After about twenty hours of training over a period of two to four months they had time to become skilled in applying these principles. During this time the parents would usually notice gradual improvement both in their skills and in their children’s symptoms.
While working with this mother and her four year-old son however, we were not seeing the common progression of desired change. The lack of progress was particularly puzzling because the mother was very experienced, motivated, open to learning, loving and disciplined. In addition the child was quite young and had only a moderate degree of trauma and moderate symptoms. So all the indicators suggested the likelihood of a very successful outcome in a reasonably short time.
Week after week however, she would return and report her experience applying her new skills at home with her child. Within thirty to sixty minutes of her returning home and applying new principles, her son started started acting differently. Her child was out of control, angry, and successfully disobedient. She was frustrated and felt like she was losing every conflict. Each ensuing day until our next meeting was a repeat of failed efforts to produce improvement and change.
Although we would examine in detail the events of the previous week or two since our last meeting, I could never clearly understand how and why things were not working. Finally, during our sixth meeting I said to her, “I wish I could be a mouse in the corner in your house and see where things go wrong.” The mother replied, “Oh, would you?” And I said, “Would I what?” She said, “Would you come to my home and see what happens?” Pausing for a moment, because I rarely worked in someone’s home, I said, “Yes.”
While I knew the little four year-old boy was very intelligent, what I saw at their home was indeed remarkable. Within minutes of his mother applying the new principles she had just learned, he was able to intuitively and intelligently develop one or more new strategies to regain control. These new strategies often were in the form of new symptoms which were sufficiently different that it confused the mother. She did not know what to do when he did something he had never done before. Consequently, her son quickly regained control of the mother-child relationship and successfully defeated her attempts to bond. Once I was in the home, I could see what he did, and then I could show his mother what was happening as well as teach her what to do in response.
During the four hours in her home, we repeated a cycle four to six times. The mother would apply the principles and her son would resist by devising new strategies. I would give her new suggestions on how to apply the parenting principles we discussed to his new found response so the mother once again regained control. He would quickly try to counter her response, and once again I would coach the mother on how to respond in a way congruent with the core principles. Within an hour we exhausted his repertoire of new strategies and symptoms. By then the mother was becoming more astute and skilled. Her son became more frustrated as he no longer knew how to oppose her and regain control.
For the first time the mother experienced being completely in charge of her relationship with her son. Consequently, she was able remain loving while her son went through multiple efforts to regain control. He experienced her as the more powerful person while she remained a consistently loving mother. He could be a four year-old, dependent little boy counting on his mother to be in control and provide him the safety he needed. She knew how to counter his efforts to push her away emotionally or to gain control of the relationship behaviorally. She remained strong and loving.
For the last two hours of our in-home meeting, he alternated between playing with her or by himself and doing various tasks that she assigned to him. When he became oppositional or aggravating either during play or work, she successfully put a loving limit around him. This helped him learn to become more obedient with less and less resistance to any of her standing rules and immediate directives. He became calmer, happier and began to enjoy his accomplishments. He appeared to actually like having a more loving, cooperative relationship with his mother. I was surprised how much he could let himself enjoy his mother being the parent and he being the child. Possibly for the first time in his life he did not have to feel his safety and survival could only be accomplished by being in control and having most of the power.
From that time on I began to make every effort to only work in the homes of the families that came for help. The repeated experience was that I could more quickly and thoroughly teach the parents the knowledge and skills they needed in a much shorter period of time. For about the last ten years I have only worked in the families’ homes, usually working three seven-hour days when there is one child and four or five days if there are two or more children with RAD.
As a result I have moved away from all individual therapy in any form with children who have RAD. In my experience the core effects of RAD within the child rendered most, if not all, individual talk therapies ineffectual. Many other forms of therapy such as speech therapy, learning disability therapy, occupational therapy, etc. were either tediously slow to show progress or they appeared to be ineffectual. This seemed to happen because children with RAD often change all therapy experiences into control battles, either overtly or subtly. Once RAD children have made significant progress in attaching, they then can take advantage of any remaining therapy and work with versus against the help they need.
For about fifteen years I have transitioned entirely to working in a parent educational or training model designed to give the parents both the information and the skills needed to best help their children. This Parent Educational Program helps parents help their children accomplish three major changes:
- The children become more capable of giving and receiving love.
- The children accept their dependent state as children hence their need to have parents who are in charge and take care of them.
- The children learn to accept the rules that govern life within the family and society.
The overall goal is to teach the parents how to help prepare their children for responsible, loving, happy, healthy and law-abiding adult life. Stated a different way, the goal could be summarized as teaching the parents how to help their traumatized children learn to live within the core principle of the Golden Rule, to treat others as one would like to be treated.
Holding Therapy
In 1990 I was introduced to holding therapy as it was taught and practiced at Evergreen Consultants. In my opinion the core definition of holding therapy is simply this: holding therapy means a therapist is holding a child. While people often write about holding therapy as a uniform, singular process conducted in the same way by everyone, in reality most therapists modify the original process to fit their therapy philosophy and style. I learned the Evergreen holding process thoroughly and practiced it for one to two years without what was known as stimulation.
Within one or two years I began, like other therapists I knew, to modify the process. I attempted to make it a less confrontational and a more gentle process. As part of my making changes to the treatment model I moved towards PEP thus placing an ever increasing amount of the healing of children with the parents or within the parent-child relationship. Eventually these changes led me to conclude that children with RAD could be helped much more thoroughly and quickly by teaching the parents how to heal their own children. This process brought a natural end to my use of holding therapy.
Since the late 1990’s I have not practiced holding therapy, do not recommend the use of holding therapy to families, nor do I support the use of holding therapy in any of its various forms.