In His Own Words

— Most Telling —

• “Therapeutic holding” includes hugging, embracing, restraining and provocative physical containment.

  — Troubled Transplants: Unconventional Strategies for Helping Disturbed Foster and Adopted Children (Richard Delaney & Frank R. Kunstal; Oklahoma City, OK: Wood ‘N’ Barnes Publishing, 2nd ed., 1997), p. 139

• [T]he more intrusive, restraining and provocative holding strategies used, the more close monitoring by the treatment team is required.

  — Troubled Transplants (1997), p. 166

• When held in place, [the boy] became livid and struggled against the adults — to no avail. His rage escalated quickly as he screamed louder and louder at those holding him. He commanded them to let him go, he threatened to turn them into the police, and he claimed that they were breaking his arms. The adults kept [the boy] in a “therapeutic restraint,” nonetheless.

  — Troubled Transplants (1997), p. 141

• [I]t is essential for foster and adoptive parents (and caseworkers and therapists) to be ready for such interventions. Many parents and professionals may find this approach quite overwhelming and intense — even contrary to their beliefs about helping. However for some children in placement, therapeutic holding is imperative to stimulate them to cathart, vent and then sort out what it all means afterwards. Without such extreme intervention, some children may be returned to hospital or residential settings…

  — Troubled Transplants (1997), p. 142

• While [the boy] was in a rage [while being restrained], the therapist began to insert remarks about Jay’s feelings towards his birth parents. … Initially [the boy] refused to acknowledge the remarks…though he was helpless.… Ultimately, [the boy] exploded, “Okay, okay … I hate them! …”

  — Troubled Transplants (1997), p. 142

• And so I told her this. … “I want you to start a military academy in your house. I want you to forget about the bull crap about benevolence and love and bonding and attachment and care and fairness and everything else. … Get him off that baloney about how great his birth mother is…”

  — “Healing Families” (2002)

• As with many of the unconventional strategies, it is important that the child be placed “off balance”…

  — Troubled Transplants (1997), p. 83

• Many children initially react to infantalization with embarrassment, discomfort and resistance.

  — Troubled Transplants (1997), p. 81

• Do you believe that you have memories and recollections back to a month or so of life? … Yeah, I believe it.

  — “Healing Families,” 28th NACAC Training Conference (2002) [Available from Utah Adoption Connection Lending Library, Audiotape #AT037]

— More on Holding Therapy —

• Restraining and provocative physical containment is used in severe cases where maltreated children — massively resistant and guarded — present on-going problems with passive-aggressive behavior, resistance to forming attachments to anyone.

  — Troubled Transplants (1997), p. 140

• [W]hat we attempting in the confrontive sessions with the child is to allow him to vocalize his feelings of grief, rage, depression and frustration which have been suppressed.

  — Troubled Transplants (1997), p. 95

• Whatever the cause, there are many children who need touch desperately but are too active, too withdrawn or too “unattached” to allow, let alone initiate, contact with parent figures. With these youngsters, interventions from parents can range from playful, loving hugs to more forceful, aggressive holding and restraint.

  — Troubled Transplants (1997), p. 140

• Two approaches may be appropriate … [One is] to confront his birth parents…The other approach involves therapeutic holding which might confront and address Jay’s angry feelings in the safety of the foster home setting or therapist’s office.

  — Troubled Transplants (1997), p. 141

• The “verbal eruptions” from non-verbalizing, acting-out children can provide most beneficial encounters with them. Often those encounters follow upon physical restraint.

  — Troubled Transplants (1997), pp. 142-143

• In the maddening, yet safe, embrace of his restraining foster parents, [the boy] was freer than he’d ever been to voice unspeakable rage without fear of obliterating others in the process.

  — Troubled Transplants (1997), p. 143

• [T]herapeutic holding helps us to get a grip on the child.

  — Troubled Transplants (1997), p. 142

• We advise professionals to consult their professional insurance carrier and perhaps their attorney about the potential liability issues before employing intrusive/invasive approaches in their practice.

  — Troubled Transplants (1997), p. 144

— Scatological Focus —

• Where my office is fairly near what’s called a feed lot for cattle. … And I have one little kid in session and he said, “Oh, I love that smell!” I said, “You do?” I said, “Well, I’ve always thought of you as a little shit.” Where my office is fairly near what’s called a feed lot for cattle. … And I have one little kid in session and he said, “Oh, I love that smell!” I said, “You do?” I said, “Well, I’ve always thought of you as a little shit.”

  — “Healing Families” (2002)

• Enuresis and encopresis … That’s soft tissue pathology. That’s something they have total control over….One of my favorite stories…[A] young teen that pooped on command. His own command! … It was really hostile. … They brought the poor kid to see me. … Mom said he sure likes girls. … And so I brought him into our family session, and said, “You know, Junior, you never told me you like girls.” “Oh. Yeah, yeah, yeah, yeah. [panting]” He was a little kind of a nervous kid. And I said, “Did you know that I’m an expert at relationships between boys and girls?” No, he didn’t know that. I said, “I apologize that we’d been focused on the pooping all the time. We should have been focusing on getting you a girlfriend. Would you like a girlfriend?” He said he would love a girlfriend. I said, “I would love to find you a girlfriend. Would you like me to find you the perfect mate? … Junior, here’s what I’m doing. I’m coming to your school tomorrow. And I’m going to park myself by your homeroom door. And every girl that goes by, I’m going to smell her. And I’m going to find one who poops her pants. And if I don’t find one who poops her pants, maybe I’ll find one who likes the smell of poop. Because then you guys can really connect. You’ll be like soul mates. Toilet mates. I don’t know.” … I went the next day. I stood at the door. He was about the last one in the classroom. When he came up to me, I said, “Junior, I have to apologize to you terribly. I’ve tried and tried. I can’t find one single girl who poops her pants. But I’m willing to keep trying.”

  — “Healing Families” (2002)

— Attachment Therapy —

• The therapist and caseworker should typically take on the role of confronters of reality as a way of sparing the foster parents…that is, the therapist and caseworker should play “bad cop,” allowing the foster parents the role of comforter of the child when his feelings of pain and anguish emerge.

  — Troubled Transplants (1997), p. 93

• Teasing can be an invaluable tool in reaching disturbed children. It can engage and enliven the flat, depressed and withdrawn child, or it can taunt and provoke the controlled and controlling hostile child to ventilate underlying grief and rage.

  — Troubled Transplants (1997), pp. 130-131

• We do foster obnoxious behavior and vocalizations in the horrendously repressed, intimidated and meek child…

  — Troubled Transplants (1997), p. 103

• If you stop the child from talking about all of the negative things that have happened to her, aren’t you just forcing her to keep it inside? You would if indeed the child was sharing her hurt and pain with you. There is a difference between merely talking about pain and actually feeling it.

  — Troubled Transplants (1997), p. 102

— Requiring Eye Contact —

• …other strategies for use with withdrawn, avoidant, inadequate children … In some instances merely insisting on proximity — physical closeness — may help … by simply insisting on eye contact.

  — Troubled Transplants (1997), p. 99

— Dismissing Conventional Therapy —

• Rarely do professionals recognize adequately the child’s pathology and its damaging effect on the foster/adoptive family.

  — Troubled Transplants (1997), p. 33

• Many disturbed foster and adoptive children often fail to respond to conventional interventions. In fact, some traditional approaches may interfere inadvertently with the stability of foster and adoptive placements.

  — Troubled Transplants (1997), p. 67

— Who Needs Research or Evidence? —

• These strategies have not been researched by any statistical, controlled study. However, anecdotal reports by foster and adoptive parents and caseworkers working on treatment teams underscore the general impactfulness of inventive strategies with certain disturbed children.

  — Troubled Transplants (1997), p. 166

• And some of these kids, I’ll tell you, you spend an hour with them, you evaluated them. You come out. You tell the person, “This child’s at high risk for physical abuse.” “How do you know that?” I said, “Well, I wanted to beat the hell out of him after, you know!”

  — “Healing Families” (2002)

• My theory is that we just don’t get a real disturbed child in one generation. I think it takes multiple generations of people to produce a very sick child.

  — “Healing Families” (2002)

— Understanding Child Development —

• I find that a lot of kids who are fire bugs have been sexually abused over the years … This burning rage that kids have…

  — “Healing Families” (2002)

• How many of our children are maybe 12 going on 12 months…?

  — “Healing Families” (2002)

• What direction do we want them to grow? Up or down? Grow down. They’ve missed out on too much. They need to go back and get it again. And some of them need reparenting.

  — “Healing Families” (2002)

• Toddlers are the same as teens. And teens are the same as toddlers.

  — “Healing Families” (2002)

— Scare Tactics —

• Foster and adoptive family members can quickly fall prey to the child’s negative mental blueprint…

  — Troubled Transplants (1997), p. vi

• This history of maltreatment has almost inevitably damaged the child at a deep level psychologically.

  — Troubled Transplants (1997), p. 11

• The abused and maltreated child is often the master at finding and exploiting the foster or adoptive parents’ “Achilles heel.”

  — Troubled Transplants (1997), p. 155

• Central to our work with foster and adoptive families is the notion of “importing pathology.” … In effect, when a family takes on an adoptive or foster child, they often, as it were, “transplant” a diseased young shoot into their family garden. The planting…often bears bitter fruit.

  — Troubled Transplants (1997), pp. 30-31

— Parent as Co-Therapist —

• In our view, foster and adoptive parents are the key members of the treatment team.

  — Troubled Transplants (1997), p. 67

• It is essential that parents work collaboratively with the treatment team when employing the more controversial holding approaches: restraint or provocation of the child to rage.

  — Troubled Transplants (1997), p. 143

— Mother vs. Father —

• Typically the mother feels that she is the target of anger, passive-aggression and vengeance from the child, while the father enjoys a somewhat idealized relationship…

  — Troubled Transplants (1997), p. 32

• Professionals characteristically take sides with the father and child — with the father who appears more rational, available and stable…

  — Troubled Transplants (1997), p. 32

• I noticed that dad was okay with him peeing. [He was] undercutting mother, who was suffering about this little, manipulative guy. … Here’s the task. I want you to have him drink tons of water. I mean slush that kid up before bedtime. … Then I want you to have him pee on the bed … I want him to kneel on the bed and pee his pants. His pajamas. Right on the bed. And then he’s to go to sleep in it. … Do you know why you’re doing this? Well, from there on, when the kid would pee, dad would wonder…" I wonder if he’s just doing this to get to you, dad?”

  — “Healing Families” (2002)

• The “Wait ’Til Your Dad Gets Home” Strategy … The purpose could be described as extracting the mother from the thankless job of punishing and correcting her adopted son…. Without a change she cannot take on a more relaxed role….In working to reverse roles, the mother needs to force herself to not enforce rules but to wait until her husband can take that on when he gets home.

  — Troubled Transplants (1997), pp. 119-122

— Food Issues —

• The “Unending Pizza” Strategy … Sally had her dream come true. She was given pizza for breakfast, lunch and dinner…Sally was, in effect, given exactly what she wanted — total control over her diet.

  — Troubled Transplants (1997), pp. 70-72

• [If a child refuse to eat much] … parents might try sitting the child on their lap and spoon or bottle feeding the child, as if he were an infant. … [W]herein the child steals food in order to eat wolfishly in private, again use of close parent contact is crucial. In this instance the parent might site the younger child on her lap and feed him with baby utensils, insisting on eye contact between each bite.

  — Troubled Transplants (1997), p. 74

• Take for example the child who refuses seconds at the dinner table but sneaks a “midnight snack.” The compulsion to steal is deeply entrenched…

  — Troubled Transplants (1997), p. 82

— Being Scary and Unpredictable —

• About the best way to get [a child’s] attention is to throw your own tantrum. So [the parents] did … At the school. … Or you can be the parent who goes in the kitchen and starts going nuclear and yelling.

  — “Healing Families” (2002)

• “Creating A Catastrophy” [sic] seems to work well … Mrs. T., having conferred with the psychologist, was prepared for the next explosive episode … Brandon made a big scene on his birthday … Mrs. T marched of to the kitchen. In a few minutes she started talking to herself in a louder and louder voice, “Nobody appreciates what I do around here…” Just for effect, she rattled pots and pans together and closed the cabinet doors with a force. … Mrs. T’s “outburst” had a way of upstaging her manipulative son.

  — Troubled Transplants (1997), pp. 75-76

• Creating A Catastrophy [sic] … the objective of this strategy is to disrupt the child’s outburst by our outlandish, ludicrous, up-staging behavior.

  — Troubled Transplants (1997), pp. 75-77

• In one adoptive home the father would lie down on the floor next to the child and yell and scream along with him.

  — Troubled Transplants (1997), p. 77

• The “Inspector Clousseau” Strategy … Children who are inert, withdrawn, depressed and/or “wooden” emotionally…require the therapeutic equivalent of “shock therapy,” not unlike the invigorating “surprise attacks” from Kato.

  — Troubled Transplants (1997), pp. 116-117

• As [the girl] shuffled into the therapist’s room, she wore her trademark wooden expression. As usual there was no luster in her eye, no spring in her step. By previous agreement, the therapist and the adoptive mother started in on the “kinetic” exercise. First, the adoptive mother asked [the girl] to stand next to her, as she explained the fun new game. [The child] compliantly stood and listened without apparent curiosity. Then, the adoptive mother bent over and grabbed hold of [the child’s] ankles as the therapist reached for [the child’s] wrists. The two of them lifted the child off the ground… [The child’s] face remained impassive — a blank screen. The therapist suggested that they begin the swinging … higher and higher … she and the therapist released their grip, sending [the child] flying up, across and down onto the couch. [The child] bounced safely, but showed no expression, no reaction. … Without kinetic strategies inert children … often fail to develop reciprocal relationships with caregivers … This leaves the placement in ultimate jeopardy.

  — Troubled Transplants (1997), pp. 128-129

— Parental Coercion —

• I think that children, at some level, to have maybe a little bit of fear of a parent is a healthy thing.

  — “Healing Families” (2002)

• [The parents] agreed to rock her daily in their arms — despite her fairly large size for a ten-year-old. They also bottle-fed her … we might help her with the clothes selection, help her button her shirt, zip her zippers and tie her shoes. These all are infantilizing strategies … We may need to actually “overdo it"…

  — Troubled Transplants (1997), pp. 128-129

• These kids don’t understand their feelings very well. So you voice their feelings for them. … To literally put words in children’s mouths is a good thing…

  — “Healing Families” (2002)

— The Trap of Reasoning —

• [The boy] was an accomplished debater by the age of eleven. A bright, verbally precocious boy, he took delight in arguing any point with anyone. And, he almost always won. His greatest and most enduring debates occurred … with the adoptive mother. This woman … had fallen into the trap of reasoning with him. … Ultimately she found herself outwitted … [the boy] sadly was … arguing himself right out of his adoptive placement. … Referred to as the “Not Now I Have a Headache” strategy, the approach relies on a “convenient” excuse to avoid an argument. … [D]on’t let him “hook” you back into explaining yourself, your points, your motives. … [With this strategy] the adoptive mother continued to grow stronger by growing weaker.

  — Troubled Transplants (1997), pp. 85-87

— “Dose of Reality” Strategum —

• A Dose of Reality” Strategy … Joint conferences between the therapist, caseworker and foster parents came to the conclusion that [the boy] should see more of his [birth] mother rather than less … to provide [the boy] with a “dose of reality” — increased contact with the true source of his anguish and bitter frustration.

  — Troubled Transplants (1997), pp. 90-93

• In some instances, increased face-to-face contacts and visitation between the [birth] parents and child provides “fodder” for the therapist and caseworker in treatment. Provided with more frequent (and lengthier) visits with his birth parent, the child receives a “dose of reality” which can be useful therapeutically whether the child can be expected ever to return home or not.

  — Troubled Transplants (1997), p. 94

— Be Afraid, Be Very Afraid —

• Sometimes [sleep problems] presents a danger to the family … [F]amilies can deploy motion detectors or other alarms to alert them to the child’s roaming.

  — Troubled Transplants (1997), p. 107

• [S]talking their prey. … These children have to come into your home. They got to watch you, they got to learn your way of living, they got to get to know you. … And they can hold that together while they’re learning.

  — “Healing Families” (2002)

• I think one of the best ways to have allegations of abuse come against you is to have a child in individual therapy…

  — “Healing Families” (2002)

— Threatening Abandonment —

• The “Line in the Sand” Approach. The unconditional acceptance may in reality frighten this child. … Sometimes it comes to this: the child must know that the placement will be in jeopardy and he may be moved — unless things change for the better … and soon.

  — Troubled Transplants (1997), pp. 107-109

• Can’t this approach throw children into a state of panic over abandonment…? Yes….The “Line in the Sand” approach should not be used as an idle threat….this approach should be used only with the sanction of the treatment team and only if it complies with relevant child statutes and regulations.

  — Troubled Transplants (1997), p. 110

— Making “Ordeals” for Children —

• On the second night [the adoptive daughter] again had her fears, and was allowed into her mother’s bedroom. Immediately the “prayer vigil” began and stretched on for a full hour, with [the child] complaining about the reading and miserable about the memorization work….Not surprisingly, on the third and following nights, [the child] remained in her bedroom all night. … [I]t was necessary to find a way to turn [the child’s] “ideal” (getting into bed with her mother) into an “ordeal” and to allow Liz to have what she wanted, but to provide it on other, unbearable terms. …. Although successful treatment of [the child’s] broad psychological problems was not accomplished by means of this “prayerful” strategy, it provided the adoptive mother a sense of competence and some nights of uninterrupted sleep.

  — Troubled Transplants (1997), pp. 105-106

— Nobody Promised Fair —

• Be “mom-nipotent." … And we simply say to the child, “… You did this. That’s my belief. Here’s your consequence.” And we move on. At times, we might be wrong about it. But you know what my thinking about it is? These kids have gotten over us SO much that it kind of evens it up a little bit. … You don’t worry about the fairness thing.

  — “Healing Families” (2002)

— Sensitive Parenting Methods —

• The “Steal Thyself Blind” Strategy … [The boy] was challenged to find the hidden items without being caught in the act of “stealing.” According to the rules, if he were caught, the items were returned to the parents.

  — Troubled Transplants (1997), p. 82

• The “Sargeant [sic] Carter Approach”. … Sargeant [sic] Carter exhorted his troops … "I can’t hear you!" … With the passive/withdrawn or unresponsive child there is a need to help him to “come alive” … [T]he parents were directed … to play verbal “hard-ball”.

  — Troubled Transplants (1997), pp. 95-97

• Assuming the role of loving “therapeutic parent” may reduce the tendency for parents to both pressure themselves to “feel loving” towards the child and to expect reciprocal warmth and acceptance from the child.

  — Troubled Transplants (1997), p. 150

• You can have fun with stealing and lying. … I will often use things like trinkets that the child likes. And tell the child after school, “When you come home, we’ve hidden six of these things around the house. Your task is to find one or all without us seeing you. If you can sneak around us and find one without us seeing you going for it, you earn it. But if we catch you, you’re going to jail.” And then you make your little jail in the corner of the room. You’ve redefined stealing.

  — “Healing Families” (2002)

• A game that I play a lot with families … is “Pretend You Love Me.” … [The parent says] “From six to eight o’clock tonight, you’re going to pretend you love me. And we will pretend we love you and we’re close.” … And you have two beautiful hours. And at 8 o’clock, you say, “STOP! You need to go back and be the creep you are…

  — “Healing Families” (2002)

• Protecting the Nuclear Family … Careful, strategic, periodic use of respite care may provide the family with a well-deserved “holiday” from the disturbed foster or adoptive child.

  — Troubled Transplants (1997), pp. 150-151

• If you have a child who’s really sick, you can be creative. You can have them lie better. You can tell, “Johnny, tell us about what you did today and please lie.”

  — “Healing Families” (2002)

• [P]repare them a runaway bag. “You know, John, you run away a lot lately. We’ve gotten something special for you from L. L. Bean. It’s a running bag. In it is a small, wooden dowel to fend off attackers. There’s a couple dollars. Some DEET. A rain poncho. when it rains. A little blanket when you get cold at night … And it will be right by the door.” And then the parents keep repeating it. “You know, John, the runaway bag is by the door.”

  — “Healing Families” (2002)

— Belittling Children —

• [T]he average child who has come into care with a tough background has about much depth as a table top.

  — “Healing Families” (2002)

• [The boy], a dangerous, lurking character, looked like a ten-year-old “Quasimodo.”

  — Troubled Transplants (1997), p. 140

• [The boy] was a mixed type adopted child whose mealy-mouthed mumblings interfered with incorporation into the family.

  — Troubled Transplants (1997), p. 98

• One noteworthy symptom of the seriously troubled child is a cockeyed, stunted understanding of feelings.

  — Troubled Transplants (1997), p. 112

• The child doesn’t care about relationships. … [He is] a human emotional cadaver.

  — “Healing Families” (2002)

— Even Being Good is Really Bad —

• I recently just evaluated a little kid … [for] the Department of Human Services. … She’s four years old. Little Maya. And they said, “She is the most wonderful girl. She’s a sweetheart. We love her. Everybody likes her … And we want …[a] psychological assessment.” … And I evaluated Maya. She was charming. She had great listening skills. … I think I talked about my problems for most of the hour. … Maya is one of my sickest patients. And everybody in the office loves Maya. But Maya should not be healthy. And Maya shouldn’t look healthy. … And in her case, I’m trying to convince everybody how rotten she is.

  — “Healing Families” (2002)

— Demonizing Birth Parents —

• Some children placed with foster or adoptive families have been so injured and damaged by their abusive pasts that they are simply “Family phobic.” These unfortunate victims are too traumatized, their selfhood annihilated by parents who committed “soul murder” on them…. While some of these “injured” children may eventually be ready for placement in a family, they need more intensive care first.

  — Troubled Transplants (1997), p. 157

• Neglectful [vs. abusive and sexually exploitive] families — possibly the most dysfunctional of all families and those who may leave the deepest “invisible scars” on the child…

  — Troubled Transplants (1997), p. 46

— Professional Preparation —

• I started off as a school teacher in junior high. … Eventually I was chief of psychology of a maximum security prison.

  — “Healing Families” (2002)

— References and Related Publications —

• Works by: Foster Cline, Vera Fahlberg, Ken Magid, Carole McKelvey, Martha Welch, Jay Haley.

  — Troubled Transplants (1997)