How to Select a Therapist to Treat Children with Disorders of Attachment and Trauma
Treating adopted and foster children is a very technical and specialized area requiring significant training and experience. It is vital that in selecting a therapist for your child that you select one with the competence and expertise to help you and your family. Just as you would want to go to a Board certified cardiologist for heart trouble rather than a general practitioner, you will want to see a therapist with training, experience, and expertise in helping families with adopted or foster children.
One example of why specific training and expertise is necessary is that a significant majority of my patients have a prior diagnosis of Attention Deficit/Hyperactivity Disorder, Conduct Disorder, or Oppositional Defiant Disorder and have received several months to years of treatment, with little or no improvement. This is because many of the symptoms of reactive attachment disorder and other disorders of attachment are identical to the symptoms of attention deficit disorder and oppositional defiant disorder.
In addition, Bipolar disorder I occurs as a comorbid condition in fifty to sixty percent of the children with a history of significant abuse or neglect (John Alston, MD, 1999). Dr. Ronald S. Federici in his book, Help for the Hopeless Child, describes several criteria that are essential for a professional to meet if that professional is to be of value to an adoptive or foster family: The therapist must have actual “combat experience” working with these families. This work should be the therapist’s primary area of practice, not merely one of several. (A good rule of thumb is that this should be at least 30 to 50% of the person’s practice).
Specific training from an institute or school that specializes in child development and treatment, focusing on treating traumatized children. (Examples include training at a recognized center such as The Center For Family Development, Dr. Daniel Hughes summer programs at Colby College, the Theraplay Institute in Chicago, and programs offered by the Association for the Treatment and Training in the Attachment of Children). uses a variety of interventions and methods including books, articles, and other adjunctive materials. Has relevant personal experience.
Other important criteria to consider include expertise as demonstrated by publications and training of other professionals. Finally, a family-focused approach is nearly always necessary. The mere fact that a provider may have see a hand full of cases in which a member may have been adopted does not make that provider an expert in adoption, attachment, and bonding issues and the treatment of these families.
What are some specific questions to ask? What specific training do you have in working with adopted and foster children? What percentage of your practice is with adopted and foster children? Do you belong to a relevant professional organization such as: Association for the Treatment and Training in the Attachment of Children.
A good place to look is on their listing of Registered Clinicians at www.attach.org What advanced certifications, Diplomate status, or Board status do you have in working with adopted, foster, and trauma-attachment disordered children? What specific training and certifications do you have in working with children with trauma-attachment issues? Have you published or done any professional training in this area? For how many years have you been treating adopted and foster children? Why did you begin to do this work as a substantial part of your practice? What was the last professional workshop or conference you attended having to do with treating families with traumatized adopted or foster children? How long was the training? Do you use an approach that is supported by empirical evidence?
A very important factor in selecting a professional is that you should feel comfortable with the person. The professional should be attending specifically to you and your unique situation and not offer pat or canned solutions. If you don’t feel comfortable with the person or confident in their approach, you should probably get a second option. Another very important factor is that the professional should not make you feel to blame for the situation. You did not create the difficulties your child is experiencing.
Children with trauma and attachment difficulties come to you with a history that is not of your making. However, you are responsible for creating the healing environment necessary for your child. A professional who makes you feel to blame for the situation probably does not have a good understanding of how traumatized children affect a family. Two of the most important things an adoption therapist can do for you are to provide you with the support and tools necessary to heal your child. Finally, a good rule of thumb is that is you don’t see some movement in ninety days, and then you should question the diagnosis and think about getting a second opinion about diagnosis and treatment. Not that the problem will be solved, but it is reasonable to expect to see some changes as the result of treatment.
WWW.Center4FamilyDevelop.com WWW.ATTACh.org Creating Capacity for Attachment, edited by Dr. Arthur Becker-Weidman & Deobrah Shell