This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Monday, June 30, 2014

Matching emotional level

"I found it interesting reading that when a child is worked up in therapy, the therapist matches their emotional level and then helps them calm down. Can you give me an example of this, say, with Kitty, even if this may or may not be a regular part of her therapy? Would it be something like her, say, coming in and going on a rant about all the things she hates, how mean people are, etc, and yelling and screaming her comments at the therapist, and the therapist yelling and screaming things back? Can you elaborate a little?" - Anonymous

Matching emotional level - this is from Dan Hughes Arousal Regulation in Traumatized Children (2007).
Co-Regulating Child’s State of Arousal: Use of Self

  •  Matching Vitality Affect
  •  Match tone
  •  Match intensity
  •  Match prosody (the patterns of stress and intonation in a language)
  •  Don’t match the emotion

Match or lead the expression of affect.

When an adult matches a child’s nonverbal affective expression of his or her underlying emotion, the child often is able to experience the adult’s empathy for his or her experience and better regulate the underlying emotion. The adult’s affective communication of his or her experience of the child’s emerging experience enables the child to become aware of—and deepen—his or her own experience.

When children (and probably adults as well) give expression to their inner lives, they do so with an expression of affect that reflects both the information and energy that characterize the focus of their attention. The particular emotion associated with an event that they are describing is conveyed with a unique facial expression, voice prosody, and gestures and movements that best convey the particular meaning of that event for the child. The rhythm and intensity of the nonverbal expression conveys “how” and “how much” the event affected the child. When the adult matches that affective expression (often without feeling the child’s underlying emotion), the adult is able to convey that he or she “gets it,” and the child feels “felt.” In other words, the child experiences the adult’s experience of empathy for him or her in a way that words would never communicate alone. For example, if a child screams “I hate my dad!” in a therapy session, and the therapist replies, with the same intensity and rhythm as the child’s expressions, “You are really angry with your dad right now!” the child is likely to feel that the therapist does “get” his experience. If, however, the therapist says “you are really angry with your dad right now” in a flat tone of voice, the child is not likely to experience the therapist as “getting it.”

Along with conveying empathy for the child’s experiences, matching the affect also helps the child to regulate his or her experience. When a child experiences intense anger, that expression of anger is demonstrated by an intense affective expression in his or her voice, face, and gestures. If the child does not experience a similar response from an adult, the intensity is likely to escalate, as the child may struggle to regulate the emotion. If the child lacks general affect-regulation skills, any increase in intensity only increases the risk
of dysregulation. By matching the intensity and rhythm of the affective expression (and remaining regulated him- or herself), the adult is able to help the child to remain regulated. By finding the adult with him or her in the intense experience, and communicating with the adult about it, the child often finds him- or herself becoming less distressed and agitated.

Children may have trouble identifying an experience because it is new. They may be uncertain how to communicate it or worry that maybe they should not have it. This is especially true of children raised in circumstances where aspects of their inner lives are not seen or encouraged or when they have experienced traumatic events. In those situations, if a therapist is able to make sense of the child’s experience and take the lead in its nonverbal affective expression, the child is often able to experience it more deeply and communicate it more fully him- or herself.
            - Hughes, D. (2009). Attachment-Focused Treatment for Children. In Clinical pearls of 
wisdom. Kerman, M. (Ed.). New York: Norton. 169-181.

Ex.  Kitty's therapist matches Kitty's emotional level in pretty much every session.  When Kitty comes into a session she jumps into fight/ flight/ freeze mode pretty quickly.  Usually she gets agitated and starts venting and yelling.

The therapist stays focused on Kitty and matches her intensity, but not her anger.  Meaning if Kitty is  agitated and upset, then the therapist is empathetic and non-judgmental.  She is asks Kitty questions about what she's feeling, and by explaining her feelings to the therapist, Kitty learns to identify them for herself.  The therapist never says things like "You had every right to be angry.  She was mean to you." or "You need to calm down.  You shouldn't be mad, because she didn't mean to do that."  The therapist doesn't agree or disagree, instead she restates Kitty's thoughts and often helps her identify her feelings for her.   "You sound really angry at your sister.  She really hurt your feelings."

The therapist displays curiosity and asks questions about what Kitty says.  She stays calm and regulated (and helps Hubby or I if we get upset - which is easy to do when you're being yelled at and dealing with someone who is completely irrational). She never makes the mistake we make, which is to try to explain things rationally or ask Kitty to understand reality.

The therapist will also try to verbally get Kitty to self-regulate.  The therapist never tells Kitty to calm down (that would just triggers Kitty's need to be defiant).  Instead she will ask Kitty to notice how the emotion feels in her body. Honestly this also triggers Kitty, but I think Kitty still notices the feeling.  By staying calm and regulated herself, the therapist helps Kitty get regulated.  I do feel that this I am able to do 90% of the time.  It helps me to remember why she acts the way she does.

Kitty is really stressed about moving to Biomom's house.  Totally normal of course.  Friday night we were on a way to dinner with the family and she snapped at Bob - accusing her, and then the whole family of wanting her to leave and being happy about it.  Hubby pulled her aside to talk to her and she immediately went into fight/ flight/ freeze.  He tried to calm her down, but just couldn't.  Mostly because he's male and an authority figure.  She wanted to run.

I took over.  It took almost an hour for me to calm her down.  Some of which was me forgetting and trying to rationally to explain to Kitty why her perception of what was happening was distorted (she was worried about moving and trying to distance herself from us so it wouldn't hurt as much).  I finally got her to come inside.  She said she wasn't hungry, but I encouraged her to take food "to eat when she got hungry later."  She ended up eating happily with the cousins.  Switch flipped.

Friday, June 27, 2014

Questions to ask an attachment therapist


Of course it depends on your child's issues, but for us, we loved our attachment therapist (who also did somatic therapy) and for trauma EMDR.  Finding an Attachment Therapist -

  1.    Is it OK for me to be in the room during therapy?  You should be in the room the whole time (prevents triangulation, false allegations, and for attachment therapy you want the child bonding with YOU not the therapist).  At the very least you should be able to observe the therapy.
  2.  How much experience do you have working with kids of trauma?  The therapist needs to be experienced with kids of trauma (book learning is fine, but very few therapists "get" what it's like living 24/7 with a child with a serious mental illness or attachment issues).  Even if your child is not diagnosed with a severe mental illness or attachment disorder (like RAD), the therapist should be able to identify and treat it.
  3.   How do you handle a dysregulated child?  A good therapist matches (without joining) the energy level of the child, and then helps them regulate.
  4.   What treatment methods do you use?  (or combination of methods) Talk therapy doesn't work for trauma!  Options may be: attachment therapy, EMDR, CBT, DBT, biofeedback, play therapy, Theraplay, somatic therapy, family therapy, filial therapy...
  5.   Whose methodology do you follow? Our attachment therapist trained under Daniel Hughes. 
  6. How would you handle our child parent bashing?  There should never be any parent bashing by the therapist.  The child can be supported in venting, but the therapist should NEVER make the parent feel they are bad parents.  It's a difficult line for the therapist to walk!
  7. How do you treat complex trauma, sexual reactivity, attachment issues, aggressive behavior, animal abuse, sibling abuse...?
  8.  How do you support the parents?  Parents must be supported!  Whether from the therapist (some do half the time with the child and half with the parent), encouragement to get their own therapist, or advice on books to read or places to go for support.  Parents need advice, guidance and support.
  9. I will need advice/ support/ information on how to help my child, what do you suggest?  I had a therapist accuse me of wanting him to train me to be a therapist (we eventually fired him).  Another therapist recognized that I wanted to become a therapeutic parent for my child and continue the work we did  in therapy (or at least not derail it).  She gave me advice in one on one sessions, suggested books to read, and connected me with a local support group.
  10. What is the best way to communicate with you? I don't like to talk about my child or issues we might be having in front of the child.  Personally, I prefer to send way too lengthy e-mails or meet with the therapist alone for a little while.  
  11. What do you do if the child reports abuse?  What if the child is prone to false allegations? 

Please post any other questions you think should be asked in the comments!

Monday, June 23, 2014


Therapeutic Parenting
"Happiness is something you decide on ahead of time.”
“Each day is a gift, and as long as my eyes open I'll focus on the new day and all the happy memories I've stored away ... just for this time in my life. Old age is like a bank account ... you withdraw from what you've put in. So, my advice to you would be to deposit a lot of happiness in the bank account of memories.”

**This is a working document.  Items in italics are being added/updated.  Constructive input is always appreciated!

a.    Preoperations Stage
b.    Magical thinking/ Distorted Reality
c.    Concrete/ Black and White Thinking 

a.     Behavior Problems
i.              Lack of Impulse Control
ii.            No Understanding of Consequences
b.    Consequences vs. Punishment
i.              Natural and Logical Consequences

a.    Structure and Support
b.    Low Tolerance/ Overwhelm
c.    Traumaversaries
d.    Role Modeling
e.    Reciprocity
f.     Teaching New Values
g.    RULES
i.         “No”
ii.            Rules should be simple and few
iii.           “Don’t”
iv.           Clear messages
v.            Fresh starts
vi.           Choices
vii.         “Okay?”
Chapter 4--    NURTURING
a.    Emotional regulation
b.    Calming techniques
c.    Holding a child
d.    Let the child know what is happening
e.    Four types of communication
f.     Greetings
g.    Positive interactions (letter parties)
h.    Compliment sandwich
i.      Speak Softly

a.    Definition of discipline
b.    Distraction/ Re-direction
c.    Praise appropriate behavior
d.    Ignore negative behavior
e.    Timeouts
f.     Time-ins
g.    Shadowing
h.    “4 Foot Rule”
i.      Fight/ Flight/ Freeze
j.      Teachable Moments
k.    “This is where you say________”
l.      “No” practice
m.   Prescribing
n.    “hmm… how are you going to handle that?”
o.    Behavior charts/ star charts
p.    Concise communication
q.    Encourage use of language
r.     The five Ps
s.    Age-Appropriate activities
t.     Waiting time/ Transition time
u.    Environments
v.    Off Limit Areas
w.   Off Limit Activities
x.    “Off Limit” People
y.    Reasons Children

Chapter 6--    ABUSE
a.    Physical
b.    Verbal
c.    Night terrors
d.    Fight/Flight/Freeze
e.    Shut down/ Dissociation
f.     PTSD - Hypervigilance

Chapter 7--    MISC
a.    Mental Illness/ co-morbid
b.    Shut down/ Dissociation
c.    Food allergies/ other physical causes for behaviors
d.    Food Issues
e.    Lying/ stealing – developmental
f.     Media
g.    Potty Training Philosophy


Therapeutic Parenting 


Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  

Food Issues – Food issues usually have nothing to do with food, hunger or even control, and tend to be more about attachment and trauma.  My daughter eats to make herself feel better (emotional eating).  My son eats lots of sweets because he has an addictive brain (he also had problems with tobacco, alcohol and drugs).  He also hoarded, probably because there was not enough food when he was a child.  This is definitely not an issue now, but their brains don't always "get" that they are safe now.

Media -  I subscribe to the “Garbage In, Garbage Out” philosophy.  I have removed anything I don’t think is GOOD for them (not just "not bad").  We purchased a Clearplay DVD player and any videos rated higher than PG must be played on that (and most PG movies benefit from it too).  We don’t allow any TV shows rated higher than PG (no PG – 14), and we completed banned certain channels.  No Cartoon Network at all (no Spongebob – too violent and rude), no shows like iCarly which is pretty much rude all the time.  Nothing on Nick at Nite.  Most of the more violent cartoons and pretty much everything on the Military or History Channels.  We even dumped ABC Family channel which played some good movies because they were advertising really inappropriate shows (Degrassi, stuff about teenage moms…).  I’ve also had the children switch to all Christian music (there are all kinds – rap, heavy metal, pop…). 

Maybe some kids can handle the innuendo, adrenaline-inducing, emotionally-triggering, violence…  mine can’t.  My kids are developmentally much younger and have very black and white thinking that makes it hard for them to understand when it is (and is not) appropriate to emulate what they see on TV.  We decided that to treat them as though they were their chronological age, or as if they are able to handle things we have recognized as triggers, is just cruel and unfair.  It is definitely hard to follow through on this!!  Most people don’t understand it, and my kids certainly don’t love it, but we’ve had fewer meltdowns and the language and attitudes have improved, for both my kids of trauma and my “neurotypical kids.”

Potty Training Philosophy –It is better for children to switch straight from diapers to underwear when they have all of the signs of readiness (Showing an interest in the potty.  Able to take own clothes on and off.  Staying dry for an hour or so - Children who are not physically ready will “dribble” all the time, rather than hold the urine).


Therapeutic Parenting 


Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  

Physical Abuse - Children should NEVER be physically forced or restrained in any way (except VERY brief restraint in emergency circumstances if unavoidable to prevent the child from harming themselves or others).  This includes holding the child in any way so that he or she cannot move, or placing your legs over a child to force them to lie still during nap.  You must not withhold food, drink, or the restroom.  You should avoid withholding any part of the regular day, such as a planned activity, game, or art project. 

Verbal/ Emotional Abuse has been shown to cause more severe long-term damage than physical abuse!

  • ·         Shaming - Shaming should be avoided at all costs (our kids do enough of this to themselves).  
  • ·         Criticism - Criticism should never be public or demeaning, embarrassing or humiliating.  Walk up to the child and talk to him or her softly - preferably away from the group, or just use eye contact or a subtle gesture (when my children get loud or hyper, I hold my hand out flat and lower it – signifying lowering the volume.  At first I also said “Please take it down a notch”).
  • ·         Belittling – these are subtle ways of ridiculing a child.  They can be any question that you don’t expect an answer to – ex.  “How many times do I have to tell you?”  “What do you think you’re doing?” “Do you ever listen?”  “Helllooo!”
  • ·         Avoid Threats – A threat is any consequence we say is going to happen, when we know it really won’t.  If you’re not going to follow through it’s a threat, and threats give away your authority and credibility as do repeating an instruction, and giving warnings and not following through.  It can seriously damage the child’s trust.

Shut down/ Dissociation - A child may shut down her physical and emotional sensations as a reaction to not getting her needs met as a child and to protect herself from perceived future harm.  Surprisingly the two are linked.  To get our child's physical (and emotional) sensation back, we worked on it from both sides - physical (neurofeedback and somatic therapy) and emotional (attachment therapy and providing a safe, structured, nurturing environment).  


Therapeutic Parenting 


Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  This particular chapter came from a preschool teacher training I gave while working as a director at a large private preschool.


Definition of discipline- the act of teaching children what is expected of them.
Distraction/ Re-direction is an important tool with little ones.  Find a different activity or something to focus on that distracts from the event that is causing STRESS..

STRESS can be triggered by - feeling unsafe, boredom, anxiety, HALT – Hungry, Angry, Lonely, Tired…).  Remember this is PERCEIVED safety (the child feels unsafe even though there is no longer any reason for them to feel unsafe).

Redirection- three steps
1. State the rule (positively)
2. Redirect ( give choices)
3. Praise appropriate behavior.

Praise- praising appropriate behavior reinforces the behavior.  Be specific in your praise. Avoid the terms “good girl” and “bad girl” – young children internalize these terms (and often start thinking of themselves as “bad.”).  Praise the behaviors as specifically as possible.  Be aware that some children of trauma cannot handle praise.  “I like the way that you cleaned up the blocks, Missy.  They look nice and neat.”
Ignore negative behavior when it is an attention seeking behavior and it is safe to do so, especially when it occurs during a meltdown/ tantrum.
Timeouts are often ineffective.  Use sparingly and only with children 2.5 years and older.  These should be short.  Usually 1 minute per year of child (ex.  3 minutes for a 3 year old).
- Time-ins work better for children of trauma.  Most children of trauma are not able to regulate their own emotions.  They need parents to help them.  The biggest calming technique I have is to stay calm myself (if I can't then I switch out with another adult who can).  Speak to the child in a quiet, calm voice and breathe loudly, slowly and deeply (sometimes wish I had a Darth Vader mask!) – this helps the child slow their heart rate and calm down, regulating emotions.  Sometimes it’s better not to interact with the child if this is escalating the dysregulation – in this case I often sit nearby, not looking at or talking to the child and just breathe loudly and deeply – trying not to engage.
- Shadowing – Have the child stay close to you and follow what you do or you stay close to them.  It is not a punishment- it’s an opportunity to help the child regulate safely.  To get compliance it can even be presented to the child as a reward.  “You can be my special helper and help me pass out snack.”
“4 Foot Rule” – used when the child is dysregulated, threatening harm to themselves or others, being intimidating and/or aggressive… The "4 Foot Rule" means the child must be within (approximately) 4 feet of a caregiver at all times (usually just means line of sight).  If I know she can't hurt herself (like if she's holding the door shut so can't hurt herself without moving away from the door), I might sit outside the door.
Fight/ Flight/ Freeze – Avoid trying to talk to discipline a child who is dysregulated and/or in fight/ flight/ freeze mode – they won’t hear you anyway.  You need to get them regulated first.  A child in fight/flight/ freeze mode is “thinking” with the reptilian part of the brain (survival!).  The rational part of the brain just isn't online!  Holding a child responsible for what happens in the middle of rages is pointless- it’s better to just move on after it's over and try to figure out what triggered it so you can avoid it in the future.
“Teachable moments” – in the moment opportunities to guide the child rather than out of the blue lectures.
“This is where you say'________'” - Giving our children the words they need to get what they want. I try to give them the words they'll need to use in the future.  I know they won't learn it from one repetition, but they will at least learn to use words like "Please" "Thank You" "Yes, Ma'am"   Ex.  If my child is begging for a toy and won't stop, then I might say, “This is where you say'Someday I would like to have that stuffed  animal.”  No, it doesn't stop the whining, but eventually it helps.
Behavior charts/ star charts – do not work with children of trauma.  The reward is usually too far away to be connected with good behavior and many children will sabotage good behavior to give themselves control of what they feel is inevitable failure.  Plus many children have significant impulse control issues.
Concise communication – long lectures, long timeouts, and public reprimands don’t work - kids tune you out (think how adults sound on Charlie Brown movies).  One word per age of the child is usually appropriate (ex. 3yo.  “Use walking feet.”  “Use your words.”)
Encourage use of language – frequently young children act out because they don’t have the words to express their feelings.  Identify their emotions for them, give them the words they need, and encourage them to use them.  “I can see it made you sad and mad when your friend took your toy.  Can you tell him what you want him to do?” (Pause to allow child to try on their own)  “Hmm… maybe you could try telling him, ‘John, please give me back my toy.’”  As children get older they can “work it out for themselves,” but they have to be taught the right way first or they can quickly become victims/bullies.

Proper Planning Prevents Poor Performance!
The five Ps.  Flying by the seat of your pants can lead to disaster and meltdowns.  Try to be aware of whether or not the child feels hungry, tired, ill, unsafe, or stressed!). Have a tool box full of planned activities, little songs, games... doesn’t have to be snacks, art projects or toys to keep them busy (but those are good to have too!).

Age- Appropriate activities – This refers to developmental age, not just number of years they’ve been alive.  Be sure that the individual differences, interests and abilities of each child are taken into account.  Each child has a different personality – get to know your child and learn to recognize “warning signs/triggers” - you will be able to avoid many undesired behaviors this way.
Waiting time/Transition Time – Children become bored, restless and mischievous if expected to sit or stand with nothing to do. A child can only wait 15-30 seconds!  Have a little plan in your head of things to do.  Use transition games or songs for each activity change.
You must be enthusiastic or these won’t work!  

  • Teach them finger alphabet or signs.
  • Do fingerplays, nursery rhymes or actions songs (try making them fast or silly!)
  • Play Simon Says.
  • Talk to them!  Tell them silly things about your day.

Environments- Change the environment to meet your child’s needs. Set things up so you aren’t constantly saying “No,” or “Don’t touch!”  Watch for areas and activities that frequently cause problems like crowded or out of sight places.  If a child is splashing in the sink (or toilet!), add a water table or extra bath time to your environment.  If your child is throwing toys, take them outside to play with a ball.  Temporarily remove frequently fought over toys if multiples are not available.  If the child is overwhelmed in loud, noisy environments.  Try setting up individual play dates instead of attending big parties and whenever possible, leave the child at home when you need to go shopping.
Off Limit Areas – If you are by yourself or feel unable to supervise your children safely, feel free to close down/ make off limits parts of the house, backyard, playground… (sand boxes, bedrooms, play room, etc.).
Off Limit Activities – If certain activities cause a child to get overstimulated and act out (shopping, playgrounds, meals…), try to figure out what the trigger is and avoid it!
“Off Limit” People - Siblings and other children can be off limits too!  When our children were having trouble keeping their hands to themselves, we established a rule that kids could not be within touching distance of each other.  If a child had difficulty with this rule then that child needed line of sight supervision at all times.
Reasons Children “Misbehave”
Cause and Effect
Learned Behavior



Therapeutic Parenting 


Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  This particular chapter came from a preschool teacher training I gave while working as a director at a large private preschool.

Nurturing is ESSENTIAL – Always comfort upset children.  It won’t spoil them or make them more clingy and dependent – in fact it does the opposite, because the child will trust you to be there.  Children should be held frequently to build a trusting bond.  

Emotional Regulation – Young children and children of trauma frequently need help with emotional regulation (many have never learned how to self-soothe).  The child needs that from you.  You need to stay calm, use a soothing voice, and have steady, even breathing.  Eventually the child will match your level (if you are excited and angry...).

Calming Techniques – EMDR/ Tapping/ Brain Gym/ Biofeedback

Holding a child - When picking up a child, ALWAYS pick the child up by the child’s torso – NEVER an arm or other extremity, or clothing.  Be careful to bend and lift with the knees.  Children should not be tossed, flipped, or held in a manner that makes them uncomfortable.  

Let the child know what is happening - Always talk to the child about what you are doing -- before you do it, while you are doing it, and after you are done.  Always alert the child BEFORE picking the child up (using their name helps).  Let child know you are planning on picking the child up and what you will be doing next.  If the child is too heavy to lift, have them sit in your lap, or let them sit next to you with your arm around them (this can build nurturing while reducing eye contact – which can be over-stimulating and stressful if the child is not ready).

The Four types of communication – there is actually one more type beyond the usual written, verbal and body language.  Kids can actually sense our emotional state.  If they sense you are scared, angry or dysregulated then they will reflect that state.  Try to stay calm and positive using a loving, pleasant tone of voice.  If you can’t stay regulated then try switching out with a partner, taking a personal timeout, find ways to recharge your batteries, and care for the caregiver!

Greetings – Focus on being positive with a child, especially the first interaction of the day.  If you can do nothing else, at least smile!  

Positive Interactions
- Make things fun – create special memories! (ex.  Letter parties - We plan our evening around a letter.  The child helps with the shopping and planning.  If the letter is P - then we might have a Pizza Picnic in the living room wearing our PJs  and watching a Pirate movie... )
- Get down to child’s level when speaking to them - if that means sitting on the floor, then do it!
- Always speak to child with respect. 
- Pleasant tone of voice (never yell) – it is possible to be firm and still have pleasant tone.  
- Avoid yelling across a distance – go to the child and speak quietly and firmly.
- Teach children to respect other people and their belongings
- Teach children to respect other people’s work areas and products (art work, lego tower, etc)
-       Teach children to respect other people's "bubble" - "Use your gentle hands," "Keep your hands to yourself,"  "We ASK before giving someone a hug."
Compliment Sandwich – if you have to deliver a negative (try a Compliment Sandwich – positive, negative, positive).
Speak Softly – While working in childcare, I often found loud, chaotic rooms where the teacher barked out orders and spoke louder and louder to get the children’s attention… which the kids ignored (I assume the caregivers sounded like adults in the Peanuts cartoons – “Wha Wha…”).  Classrooms where the teacher spoke softly and calmly were the classrooms where the children were listening and regulated.  When a loud caregiver was trying to change the interactions, it helped to whisper, quietly inviting the children to do something interesting and then rewarding them for complying with requests. The children began paying attention to the teacher so they wouldn’t miss out on anything fun.
I strongly recommend never discussing anything you don’t want a child to hear or using inappropriate language where little ones can hear you!  Even if you are sure they are not paying attention; they are like little sponges and will mimic what they hear.