fostering success: addressing the treatment needs of foster children presented by kevin r. bochenek,...

Fostering Success: Fostering Success: Addressing The Addressing The

Treatment Needs of Treatment Needs of Foster ChildrenFoster Children

Presented ByPresented By

Kevin R. Kevin R. Bochenek, MA, Bochenek, MA,

MSMS

Educational Learning Educational Learning Goals:Goals:

• Participants will be Participants will be sensitized to issues sensitized to issues related to children in related to children in foster care.foster care.

• Participants will learn Participants will learn about important about important therapeutic themes and therapeutic themes and ways children react to ways children react to the foster care the foster care experience.experience.

• Participants will explore Participants will explore various therapeutic various therapeutic issues, aspects of issues, aspects of treatment, and helpful treatment, and helpful therapeutic techniques.therapeutic techniques.

Factors Influencing Factors Influencing Development:Development:

• Eight factors Eight factors which influence which influence development will development will be explored in the be explored in the context of how context of how they relate to the they relate to the foster care foster care experience.experience.


• Heredity:Heredity:

Certain aspects of Certain aspects of development are development are influenced by influenced by biological factors biological factors such as genes.such as genes.


• Level Of Level Of Environmental Environmental Stimulation:Stimulation:

Enriched environments Enriched environments that offer a high degree that offer a high degree of stimulation influences of stimulation influences development positively. development positively.

Healthy stimulation Healthy stimulation should involve all of the should involve all of the senses.senses.


• Modeling:Modeling:

Children will learn Children will learn from their role from their role models in their models in their environments. environments.

Humans are truly Humans are truly “copycats”.“copycats”.


• Family Culture:Family Culture:

Family values and Family values and culture influence culture influence the child’s the child’s personality personality development.development.


• Birth Order:Birth Order:

A child’s birth A child’s birth order in the family order in the family can influence the can influence the rate of rate of development and development and the child’s overall the child’s overall personality.personality.


• Level Of Support:Level Of Support:

How supportive and How supportive and attentive the caregivers attentive the caregivers are will influence a are will influence a child’s development. child’s development.

Included in this area Included in this area would be whether or would be whether or not the birth was not the birth was wanted, maturity of the wanted, maturity of the caretakers, and support caretakers, and support from relatives.from relatives.


• Style Of Parenting:Style Of Parenting:

Parenting style can influence Parenting style can influence certain personality variables certain personality variables and overall development. and overall development.

Dictator-style parents run Dictator-style parents run the risk of having children the risk of having children who are overly dependent who are overly dependent and who act out of fear. and who act out of fear.

Permissive parents may have Permissive parents may have children who are unable to children who are unable to follow basic rules and limits follow basic rules and limits established in structured established in structured environments.environments.


• Expectations:Expectations:

Development is Development is influenced by the influenced by the expectations of expectations of caregivers and those in caregivers and those in the child’s the child’s environment.environment.

Your expectations Your expectations should not be too low should not be too low or high.or high.

Diagnostic Issues:Diagnostic Issues:

• It is frequently difficult to diagnose foster It is frequently difficult to diagnose foster children. It is sometimes unclear if behaviors children. It is sometimes unclear if behaviors are part of a diagnostic cluster or the result of are part of a diagnostic cluster or the result of coping with being in foster care.coping with being in foster care.

• Some behaviors look like one diagnosis (i.e.– Some behaviors look like one diagnosis (i.e.– AD/HD) while they may actually be something AD/HD) while they may actually be something else (i.e.– anxiety).else (i.e.– anxiety).

• Substance exposure in foster care complicates Substance exposure in foster care complicates diagnosing. They can exhibit very impulsive, diagnosing. They can exhibit very impulsive, explosive, and labile behavior. It is unclear if explosive, and labile behavior. It is unclear if those children should be diagnosed as AD/HD, those children should be diagnosed as AD/HD, Bipolar Disorder, or Intermittent Explosive Bipolar Disorder, or Intermittent Explosive Disorder.Disorder.

Diagnostic Issues:Diagnostic Issues:

• It is helpful to understand the child’s It is helpful to understand the child’s pre-morbid functioning and to know pre-morbid functioning and to know the biological family’s medical and the biological family’s medical and mental health history. mental health history.

• Common diagnoses: Adjustment Common diagnoses: Adjustment Disorder, Oppositional Defiant Disorder, Oppositional Defiant Disorder, Dysthymic Disorder, Disorder, Dysthymic Disorder, Intermittent Explosive Disorder, and Intermittent Explosive Disorder, and Reactive Attachment DisorderReactive Attachment Disorder..

Ways Children React To Ways Children React To Foster Care:Foster Care:

1.1. The Needy Child:The Needy Child:

He is clingy and has He is clingy and has indiscriminate indiscriminate attachments; likes a attachments; likes a lot of physical touch, lot of physical touch, does anything to does anything to relate to you and relate to you and others; constantly others; constantly wants to please you wants to please you and fears rejection; is and fears rejection; is at risk for at risk for victimization.victimization.

• Therapeutic GoalsTherapeutic Goals: : Teach independence Teach independence and appropriate and appropriate boundaries, teach boundaries, teach personal safety, and personal safety, and educate child on how educate child on how to deal with strangersto deal with strangers


2.2. The Control FreakThe Control Freak: : This child was often This child was often parentified; has parentified; has difficulty accepting difficulty accepting authority and authority and attempts to relate to attempts to relate to adults as a peer; adults as a peer; child likes to take child likes to take charge; often the charge; often the child is overly neat child is overly neat and organized; does and organized; does not trust that adults not trust that adults will be in control; will be in control; often perceived as often perceived as annoying to adultsannoying to adults..

• Therapeutic GoalsTherapeutic Goals: : Help the child explore Help the child explore trust issues; help child trust issues; help child learn to take an learn to take an appropriate child role; appropriate child role; establish appropriate establish appropriate adult-child adult-child boundaries; offer boundaries; offer client-directed time in client-directed time in therapy.therapy.


3.3. The Distant ChildThe Distant Child: : This child keeps his This child keeps his distance from you; distance from you; becoming too becoming too emotionally connected emotionally connected to you or anyone is too to you or anyone is too threatening to him; this threatening to him; this child needs space and child needs space and time to feel close to you; time to feel close to you; often this child never often this child never fully unpacks at his fully unpacks at his foster home; this child foster home; this child has great difficulty has great difficulty sharing thoughts and sharing thoughts and feelings.feelings.

• Therapeutic GoalsTherapeutic Goals: : Help the child learn to Help the child learn to identify and share identify and share feelings; focus on feelings; focus on building a trusting building a trusting relationship; help the relationship; help the child with child with communicating communicating thoughts and needs; thoughts and needs; help the child to help the child to engage with others; engage with others; help child label feelings help child label feelings to initiate discussion to initiate discussion and understandingand understanding


4.4. The Volcanic The Volcanic Child: Child: This child is This child is like a volcano ready like a volcano ready to explode; he has a to explode; he has a lot of anger about his lot of anger about his situation this is situation this is frequently displaced frequently displaced to others; he is often to others; he is often oppositional; oppositional; sometimes he can be sometimes he can be well-behaved for well-behaved for days before days before exploding.exploding.

• Therapeutic GoalsTherapeutic Goals: : Teach anger control Teach anger control and impulse control; and impulse control; find appropriate find appropriate physical outlets for physical outlets for the client; teach the client; teach relaxation skills; relaxation skills; develop a plan to help develop a plan to help child when angry and child when angry and involve foster parents involve foster parents and/or school staff and/or school staff with the plan; give a with the plan; give a lot of support to the lot of support to the foster parents.foster parents.


5. 5. The Avoidant Child: The Avoidant Child: This child avoids issues This child avoids issues surrounding foster surrounding foster care; child will care; child will disagree with need for disagree with need for therapy; child avoids therapy; child avoids sharing feelings; acts sharing feelings; acts as if he has two as if he has two separate worlds; often separate worlds; often disowns his biological disowns his biological family; often acts as if family; often acts as if everything is fine everything is fine despite hurting on the despite hurting on the inside.inside.

• Therapeutic Goals:Therapeutic Goals: Help the child to Help the child to explore his feelings; explore his feelings; develop a trusting develop a trusting therapeutic therapeutic relationship over relationship over time; be there for the time; be there for the client and do not push client and do not push too hard during the too hard during the initial stage of initial stage of therapy.therapy.


6.6. The Manipulative The Manipulative Child: Child: Because of his Because of his experiences with experiences with neglect, this child neglect, this child often uses people to often uses people to get his needs met at get his needs met at any cost; can be any cost; can be charming; will strive charming; will strive to gain your trust and to gain your trust and then will do then will do something to break something to break that trust.that trust.

• Therapeutic Goals:Therapeutic Goals: Teach about the Teach about the importance of honesty importance of honesty in relationships; in relationships; confront confront manipulation; assist manipulation; assist child in finding ways child in finding ways to get needs met to get needs met appropriately; help appropriately; help child to develop child to develop genuine relationshipsgenuine relationships


7.7.The Anxious Child:The Anxious Child: This child is very This child is very cautious; often cautious; often functions like “a deer functions like “a deer in the headlights”; in the headlights”; often worried about often worried about punishment or punishment or disappointing adults; disappointing adults; fears & worries tend fears & worries tend to be reality-based.to be reality-based.

• Therapeutic Goals:Therapeutic Goals: Offer a lot of Offer a lot of reassurance; help reassurance; help the child to know the child to know what is coming what is coming next; avoid next; avoid surprises; teach surprises; teach relaxation relaxation techniquestechniques

Five Essential Therapeutic Five Essential Therapeutic Themes:Themes:

• Eliminating Eliminating ResponsibilityResponsibility

• Building Self-WorthBuilding Self-Worth• Believing In Believing In

YourselfYourself• Maintaining Maintaining

ConnectionsConnections• Developing A Developing A

Future OrientationFuture Orientation

Therapeutic Issues:Therapeutic Issues:

• Feeling differentFeeling different• Enormous sense of Enormous sense of

grief and lossgrief and loss• Am I worthy of Am I worthy of

love?love?• Need for controlNeed for control• Feeling responsible Feeling responsible

for younger siblingsfor younger siblings

Therapeutic Issues:Therapeutic Issues:

• Learning to trustLearning to trust• Learning to be a kidLearning to be a kid• Anxiety– What is next?Anxiety– What is next?• Fitting inFitting in• Caught between two Caught between two

worldsworlds• Dealing with Dealing with

disappointmentsdisappointments• Aging outAging out• Coming to termsComing to terms

Aspects Of Treatment:Aspects Of Treatment:

Support To The Foster Parents:Support To The Foster Parents: A primary goal of therapy for foster A primary goal of therapy for foster

children is to offer support to the foster children is to offer support to the foster parents in order to preserve the parents in order to preserve the placement.placement.

Support includes involving foster parents Support includes involving foster parents in the treatment process, conducting in the treatment process, conducting family therapy, offering parenting family therapy, offering parenting suggestions, allowing foster parents to suggestions, allowing foster parents to vent, and to offer phone calls or e-mails vent, and to offer phone calls or e-mails in between sessions.in between sessions.


The Therapeutic Relationship:The Therapeutic Relationship: It is essential that the therapist take adequate time to It is essential that the therapist take adequate time to

develop a trusting therapeutic relationship.develop a trusting therapeutic relationship. The child should be clear on confidentiality policies.The child should be clear on confidentiality policies. It is often helpful when you want to share information It is often helpful when you want to share information

about a session to get the child’s permission or have the about a session to get the child’s permission or have the child tell the other party.child tell the other party.

The therapist must be sure not to put herself in a The therapist must be sure not to put herself in a situation in which she attempts to rescue the client. situation in which she attempts to rescue the client. Some children will try to manipulate the therapist to get Some children will try to manipulate the therapist to get their needs met.their needs met.

Therapeutic relationships with foster children can be Therapeutic relationships with foster children can be intense.intense.

The therapist provides a corrective relationship.The therapist provides a corrective relationship.

Aspects Of TreatmentAspects Of Treatment

Three Key Issues:Three Key Issues: Consistent Consistent

therapeutic therapeutic relationship is relationship is important.important.

Treatment issues Treatment issues are complex.are complex.

Course of Course of treatment– Healing treatment– Healing takes time.takes time.


Individual Therapy:Individual Therapy: The therapeutic process is sometimes more The therapeutic process is sometimes more

important than the content.important than the content. Consistency is extremely important in therapy with Consistency is extremely important in therapy with

foster children.foster children. It is helpful to give the client some control of the It is helpful to give the client some control of the

session.session. Reducing anxiety by teaching relaxation techniques Reducing anxiety by teaching relaxation techniques

is often helpful during the initial stage of therapy.is often helpful during the initial stage of therapy. The therapist must be comfortable confronting tough The therapist must be comfortable confronting tough

feelings and issues directly.feelings and issues directly. The therapist needs to communicate closely with the The therapist needs to communicate closely with the

foster parents about the therapy process and goals.foster parents about the therapy process and goals.


Sibling Work:Sibling Work: Many siblings in foster care do not have Many siblings in foster care do not have

healthy relationships with each other.healthy relationships with each other. Working with siblings can often be Working with siblings can often be

challenging; however, it can be beneficial to challenging; however, it can be beneficial to improving siblings relationships, stabilizing a improving siblings relationships, stabilizing a placement, sharing common experiences, placement, sharing common experiences, and working on social skills.and working on social skills.

Other goals might include processing why Other goals might include processing why they came into care, expressing feelings they came into care, expressing feelings surrounding removal, discussing adjustment surrounding removal, discussing adjustment issues, discussing visitation, and developing issues, discussing visitation, and developing healthy communication patterns. healthy communication patterns.


Dyad Work:Dyad Work: Putting two foster children together to Putting two foster children together to

work on common treatment goals can be work on common treatment goals can be very useful.very useful.

A therapy dyad can be a useful precursor to A therapy dyad can be a useful precursor to placing a child in a group.placing a child in a group.

Many goals can be accomplished in the Many goals can be accomplished in the dyad including processing feelings of loss, dyad including processing feelings of loss, social skills, communication skills, and social skills, communication skills, and relationship-building.relationship-building.


Group Therapy:Group Therapy: Group therapy can be a powerful Group therapy can be a powerful

modality for foster children because modality for foster children because they can share common issues and they can share common issues and realize they are not alone.realize they are not alone.

Care should be taken in selecting Care should be taken in selecting children for a group.children for a group.

Groups could be process-oriented or Groups could be process-oriented or focus on topics such as social skills focus on topics such as social skills and anger management.and anger management.


Trauma, Loss, and Adjustment IssuesTrauma, Loss, and Adjustment Issues:: The need for trauma and/or loss work The need for trauma and/or loss work

needs to be carefully assessed.needs to be carefully assessed. Before embarking on trauma work, work Before embarking on trauma work, work

with the child at developing some basic with the child at developing some basic coping skills.coping skills.

A supportive therapeutic relationship A supportive therapeutic relationship should allow for the child to feel safe should allow for the child to feel safe discussing and exploring issues related to discussing and exploring issues related to adjusting to foster care and to particular adjusting to foster care and to particular placements.placements.


Attachment Issues:Attachment Issues: The therapist should involve the foster The therapist should involve the foster

parents in the treatment to help build parents in the treatment to help build healthy relationships and attachments for healthy relationships and attachments for the child.the child.

Therapists should be careful not to have Therapists should be careful not to have their foster child become too dependent on their foster child become too dependent on them.them.

For children who develop indiscriminate For children who develop indiscriminate attachments, it is important to discuss attachments, it is important to discuss personal safety and appropriate boundaries.personal safety and appropriate boundaries.


Self-Esteem:Self-Esteem: Stephanie Marston defines self-esteem as “a Stephanie Marston defines self-esteem as “a

sense of feeling lovable and capable. When sense of feeling lovable and capable. When those two things are in sync, a person has high those two things are in sync, a person has high self-esteem.”self-esteem.”

Help the child develop and explore their Help the child develop and explore their identity.identity.

Help the child to value their personal history Help the child to value their personal history instead of being ashamed of it.instead of being ashamed of it.

Help clients develop mastery and competency, Help clients develop mastery and competency, in both subtle and grand ways.in both subtle and grand ways.

Aspects Of Treatment:Aspects Of Treatment:Coping Skills:Coping Skills: Getting needs met Getting needs met

appropriatelyappropriately Identifying, exploring, Identifying, exploring,

and sharing feelingsand sharing feelings Tolerating distress and Tolerating distress and

reducing anxietyreducing anxiety Communication skillsCommunication skills Anger management Anger management

skillsskills Impulse control skillsImpulse control skills Problem-solving skillsProblem-solving skills Self-soothing skillsSelf-soothing skills Self-care skillsSelf-care skills


Social Skills:Social Skills: Teaching social skills is critical in helping Teaching social skills is critical in helping

children develop appropriate social skills.children develop appropriate social skills. The Boys Town model of breaking social The Boys Town model of breaking social

skills down into component parts and skills down into component parts and preventative & corrective teaching are preventative & corrective teaching are valuable ways to approach social skills.valuable ways to approach social skills.

Social skills training is most valuable with Social skills training is most valuable with the support of a reinforcing environment.the support of a reinforcing environment.

Role plays are helpful in helping clients Role plays are helpful in helping clients learn social skills.learn social skills.


Teaching Values:Teaching Values: Because of placement changes and disruptions, Because of placement changes and disruptions,

children in care may get minimal training in the children in care may get minimal training in the area of morals and values.area of morals and values.

The therapist and the foster parents need to play The therapist and the foster parents need to play a critical role in teaching values such as the a critical role in teaching values such as the golden rule.golden rule.

Rosen (1998) suggests the importance of training Rosen (1998) suggests the importance of training children in out of home placements in altruism, children in out of home placements in altruism, empathy, generosity, respect for others, and empathy, generosity, respect for others, and right & wrong.right & wrong.

Foster children need to learn to take Foster children need to learn to take responsibility for their actions.responsibility for their actions.

Aspects Of Treatment:Aspects Of Treatment:Processing Of Permanency Goals:Processing Of Permanency Goals: Children in foster care should be aware of their Children in foster care should be aware of their

permanency goal.permanency goal. The therapist should allow ample opportunity for the child The therapist should allow ample opportunity for the child

to discuss her goal and explore feelings surrounding the to discuss her goal and explore feelings surrounding the goal.goal.

If the goal is adoption, all of the child’s feelings If the goal is adoption, all of the child’s feelings surrounding adoptions should be explored. surrounding adoptions should be explored.

If the goal is termination of parental rights, the therapist If the goal is termination of parental rights, the therapist must establish a safe place for the child to explore his must establish a safe place for the child to explore his strong feelings related to the issue.strong feelings related to the issue.

If the goal is reunification, the therapist should work If the goal is reunification, the therapist should work closely with the biological family and help the child closely with the biological family and help the child develop realistic expectations.develop realistic expectations.

If the goal is independent living, this should be If the goal is independent living, this should be incorporated into treatment. The therapist should be one incorporated into treatment. The therapist should be one of many preparing the child for independence.of many preparing the child for independence.


Reunification Work:Reunification Work: If the goal is reunification, active steps should be If the goal is reunification, active steps should be

taken to assist with the process.taken to assist with the process. Family therapy is essential to prepare for Family therapy is essential to prepare for

reunification. It should be scheduled as frequently reunification. It should be scheduled as frequently as possible.as possible.

The therapist and foster parents must take a The therapist and foster parents must take a nonjudgmental and supportive posture towards the nonjudgmental and supportive posture towards the biological family. biological family.

It is important to remember that most parents who It is important to remember that most parents who abuse/neglect their children do love them.abuse/neglect their children do love them.

Ideally, the foster parents could be coached by the Ideally, the foster parents could be coached by the therapist to provide parent training for the family.therapist to provide parent training for the family.


Reunification Work:Reunification Work: Biological parents can be taught to give Biological parents can be taught to give

supportive messages to their children supportive messages to their children regarding their behavior in the foster home.regarding their behavior in the foster home.

While foster parents are assisting with While foster parents are assisting with parent-training, the therapist can work on parent-training, the therapist can work on communication, problem-solving, and communication, problem-solving, and coping skills within the family.coping skills within the family.

Solution-focused work is helpful in Solution-focused work is helpful in conducting reunification work.conducting reunification work.


Reunification Work:Reunification Work: Often the therapist will need to redirect the Often the therapist will need to redirect the

family back to the reason for the removal to plan family back to the reason for the removal to plan for the future. Biological parents often minimize for the future. Biological parents often minimize the circumstances surrounding the removal.the circumstances surrounding the removal.

It is often helpful for the child’s individual It is often helpful for the child’s individual therapist to be the family therapist as well. The therapist to be the family therapist as well. The therapist is a bridge between the biological therapist is a bridge between the biological family and the foster family.family and the foster family.

The treatment team should be in place prior to The treatment team should be in place prior to the day of reunification. It is important for the day of reunification. It is important for therapeutic relationships to be established so therapeutic relationships to be established so the biological family will be more inclined to the biological family will be more inclined to commit to services.commit to services.

Helpful Therapeutic Helpful Therapeutic Techniques:Techniques:

• Letter writingLetter writing• Journal writing in Journal writing in

between sessionsbetween sessions• Nondirective play Nondirective play

therapytherapy• Directive play therapyDirective play therapy• Use of toy phoneUse of toy phone• Creating a memory boxCreating a memory box• Creating a photo albumCreating a photo album• Empty chair techniqueEmpty chair technique


• Creating stories and Creating stories and metaphorsmetaphors

• Puppet play with Puppet play with foster child puppetfoster child puppet

• Teaching clients Teaching clients something in session something in session to build to build competenciescompetencies

• Play with animal Play with animal families, dolls, or families, dolls, or puppetspuppets

• Use of art therapyUse of art therapy


• People who care People who care about me activityabout me activity

• Body drawingBody drawing• Celebration ritualCelebration ritual• Positive self-Positive self-

statement journalstatement journal• Taking care of a Taking care of a

baby doll or stuffed baby doll or stuffed animalanimal

• Mapping out history Mapping out history and placementsand placements

Lessons Learned From Lessons Learned From Foster Children:Foster Children:

• CarlCarl: Repeated re-: Repeated re-telling of abuse story telling of abuse story is not therapeutic.is not therapeutic.

• NicholasNicholas: Abused kids : Abused kids are hungry for a are hungry for a corrective experience.corrective experience.

• JasonJason: Some foster : Some foster children are eager to children are eager to push others away push others away before they pulled before they pulled awayaway

• Jacob & JaxsonJacob & Jaxson: : Unresolved anger can Unresolved anger can lead to time in jail lead to time in jail


• FelicityFelicity: Kids can : Kids can teach adults.teach adults.

• TylerTyler: Healing and : Healing and moving on takes time moving on takes time and the power of a and the power of a loving family.loving family.

• AnthonyAnthony: Fitting in at : Fitting in at all costs is important all costs is important to many foster kids.to many foster kids.

• JoeJoe: Unconditional : Unconditional acceptance leads to acceptance leads to healing.healing.


• StefanoStefano: Foster : Foster children are quick to children are quick to be accused.be accused.

• JonathanJonathan: Kids can be : Kids can be quite resilient.quite resilient.

• JustinJustin: Relationships : Relationships can help to get through can help to get through a crisis.a crisis.

• GermancyGermancy: Don’t : Don’t assume a foster child assume a foster child has picked up basic has picked up basic social graces. Pre-social graces. Pre-teach to foster teach to foster children.children.

Someone Else’s ChildSomeone Else’s Child

Be there for me…Be there for me…

I am someone else’s I am someone else’s child.child.

Won’t you be there for Won’t you be there for me?me?

If not you, then who?If not you, then who?

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fostering success: addressing the treatment needs of foster children presented by kevin r. bochenek,...

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childs development

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rate of development

childs personality development

certain aspects of development

foster care experience

biological factors

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