Monday, November 27, 2006

Restorative Relationships for Foster Care Alumni

As adults, it is possible to restructure negative relational patterns laid down in childhood.

The adult brain is able to adapt and improve its functioning under the right conditions. It has plasticity, which means that existing neurons are capable of taking on new jobs in order to help individuals adapt to changing circumstances.

Although early structural and chemical patterns might predispose a person towards anger anxiety or depression, the human brain is capable of adapting psychologically to new situations.

Restorative relationships
Relationships can be destructive -- but they can also be restorative. Problems that were created through damaging relationships can be resolved through healing relationships.

At one time, certain responses helped you to survive. Now, those same unconscious reactions undermine your ability to maintain intimate relationships.

You basically have to create a new pathway in your brain. New behaviors will lead to new brainwave patterns -- but these connections will only become stronger if they are frequently used.

Reroute old reactions into a new response:
-If your habitual response is emotional secrecy, you might have to "build the habit" of putting emotions into words.

-If your habitual response is anxiety, you'll need to identify what triggers anxiety, and try to put into words what triggers that anxiety: What are you thinking about that triggers those emotions?

Hendrix, Harville and Helen LaKelly Hunt. Receiving love: Transform your relationship by letting yourself be loved. Atria Books, 2004.

Sunday, November 26, 2006

It seems familiar, but it isn't really...

The battle is over, but self-vigilance is still constantly enforced...

Three features of post-traumatic stress disorder are particularly damaging to intimacy:

1.) Avoidance: Feelings of detachment and estrangement from others can lead to self-imposed isolation. I am different from others / I can only trust myself.

2.) Hyperarousal: An overdose of adrenaline can lead to increased irritability and outbursts of anger. I must protect myself; I am in danger.

3.) Re-experiencing: Intrusive recollections of past trauma tend to occur even after true danger has receded. They may be an attempt to process the experience. Suddenly, I find myself back where it all began... Can I never escape from this type of experience?

Self-isolation can be motivated by a desire for safety - but in fact, often makes a person more vulnerable. Without a support network, a person has less physical and emotional resources. Also, it is easier for human predators to take advantage of isolated individuals.

A moment of personal disclosure:
When I first married my husband, there were moments when I felt threatened to my very core. The first year of marriage is often the most difficult, and I became fully aware during our honeymoon that I had married a fallible person, who might possibly hurt me.

In my mind, the first half of my life was checkered with events that had made me feel powerless and out of control. It was only after entering college and being legally emancipated, that I had taken control of my life and created an atmosphere of stability and safety.

In college, graduate school and the workplace, I'd established a circle of friends. But, I had always tried not to be overly emotionally dependent upon them. Whereas, in marriage, by yoking myself to another person, I had allowed myself to become vulnerable.

This was an incredibly scary realization for me.

I wish that I had been better prepared for the experience. However, since we can't undo the past, and my husband and I are still happily married, my goal is for other people who age out of foster care to feel better prepared to navigate what they might experience in terms of their fear of dependence on someone.

Think about it:
If the very first emotional / physical support systems of your life disappoint you, the logical response might very well be to depend upon yourself.

This will often get you through the short-term, and ensure your physical survival.

But, if at some point, you want to commit to another person, to love and be loved by them, that might be hard. Because, in loving them, you are vulnerable to them... and that means that they can hurt you.

Since they are human, there will undoubtedly be moments when they disappoint you. And at those times, having them fail you might bring to the surface the memories of every other time that someone from your past has failed you.

But something is different... can you guess what it is?

Saturday, November 25, 2006

Impact of Trauma on Intimacy

My previous blog entry referred to foster care alumna, and how they (we) experience post-traumatic stress disorder at a rate twice that of Vietnam war veterans.

Research also indicates that the ability to relate to other people is altered by personal exposure to trauma.

Truama often causes the "wires" of human interaction to become crossed. This impact is felt most deeply in intimate relationships -- but also has a "ripple effect" which affects every other relationship in that person's life.

In that sense, the trauma continues to harm the person, and infect/affect every person in their life who tries to love them.

Trauma can be a singular event, or the build-up of multiple experiences. Singular events tend to create an immediately obvious reaction, while multiple traumatic exposures can accumulate over several years before revealing themselves. Studies have shown that natural disasters generate less of an emotional impact than interpersonal trauma.

Common features found in traumatic events include:
-Sudden, dangerous, and often life-threatening turn of events
-Feelings of helplessness and loss of control
-Disruption of personal routine; loss of what was familiar
-Unresolved uncertainty over the future

I would argue that, for most of us, foster care created an accumulation of multiple interpersonal traumas.

As an aftermath of sexual abuse, victims often avoid intimacy and trust. Feelings of guilt, shame and inadequacy become linked with sexuality, tainting it and robbing it of beauty or joy.

Problems with intimacy can be caused/exacerbated by traumatic events of a nonsexual nature. Studies reveal that combat veterans often become secretive and emotionally withdrawn.

Although the circumstances of traumatic events differ, the impact on survivors and their partners and the damage to their level of intimacy are similar. This includes accident victims and parents who lose a young child.

Mills, Bo and Gordon Turnbull. Broken hearts and mending bodies: The impact of trauma on intimacy. Sexual and Relationship Therapy, Vol. 19, No. 3, August 2004.

Friday, November 24, 2006

Cyanide and Happiness cartoon

Foster Care & Post-Traumatic Stress Disorder

According to an April 6, 2005 study of foster care alumni, former foster youth suffer post-traumatic stress disorder at twice the rate of United States war veterans.

The definition of PTSD is "a condition in which victims of overwhelming and uncontrollable experiences are subsequently psychologically affected by feelings of intense fear, loss of safety, loss of control, helplessness and extreme vulnerability. "

After suffering a traumatic event, survivors believe (either on a concious/unconcious level) that if they are vigilant enough, they will be able to recognize the warning signs and avoid future traumas.

Researchers from Harvard Medical School, the University of Michigan and Casey Family Programs reviewed case files of 659 adults in Washington and Oregon, ages 20 to 33, who had lived in foster care between 1988 and 1998. They interviewed 479 of them.

It was the first significant study of how former foster children fare over a long period of time. Results demonstrated that foster care alumni were especially vulnerable to post-traumatic stress disorder.

Peter Pecora, director of research for Casey Family Programs, said that a fourth of those studied reported symptoms of the disorder -- twice the rate of U.S. war veterans.

"It is a dramatic finding," he said, adding that national studies show that 12 percent to 13 percent of Iraq war veterans and 15 percent of Vietnam war veterans suffer from the disorder.

Post-traumatic stress disorder occurs in some people who experience or witness life-threatening events, such as violent personal assaults, military combat or serious accidents. They often relive the trauma through nightmares and flashbacks, and feel detached or estranged.

Wednesday, November 22, 2006

Foster care: Overcoming mistrust with mentorship

What I like best about M. H. Coleman's thesis is that she went to foster care alumni in order to ask them, "What, if anything, could have been done to foster your sense of trust and security?"

Participants in this study were contacted through Virginia's Independent Living Program and the National Foster Parent Association.

Here is how they responded:
For all participants, building trust was a struggle. In each placement that they entered, one of the first questions that they asked themselves was which (if any) adult in that home could be trusted.

Each participant underscored the significance of caring adults. They remembered adults who had read to them. They remembered adults who made them feel safe. They remembered who had held their hand or hugged them when they were upset.

These were trust-building behaviors. Going for a walk with the child and asking them how they felt or what they thought about things... Taking an interest in them and their abilities.

This caring adult did not have to be a foster parent or group home staff member. As long as there was one caring adult for the child to forge a trusting relationship with, it did not matter if the child lived with them.

A personal note from Lisa:
I remember Kathy Jo. She climbed trees and waded in creeks with me, when I was a child and my mother was dying of cancer. I remember how she visited me in group homes after my mother died and my father abandoned me. At Christmas, I often felt very alone -- but I remember the Christmas that Kathy Jo took her family to visit me in my current placement.

Kathy Jo had four children of her own. She never sought my custody. But, when I came home from school and checked my mailbox at the group home, I often saw a letter, reminding me of her love.

Every foster child needs a Kathy Jo in their life --- especially those who are in residential facilities such as group home placements. When you lie in bed at night and wonder what to live for, it helps to know that somebody loves you and (like the sitcom "Cheers") knows your name.

Coleman, Michele Harryette*. A chance for change: The role of trust in foster care. Virginia Polytechnic Institute and State University, Blacksburg, VA, May 2000.

Trust vs. Mistrust, and the impact of foster care

To fulfill the requirements of her Masters in Family & Children Development, Michele Henryette Coleman wrote a thesis in May 2000, called "A chance for change: The role of trust in foster care."

As mentioned in my previous blog entry, the first stage of Erickson is "Trust vs. Mistrust."

In her thesis, Michele's hypothesis was that many children entering foster care had learned by experience to mistrust to their biological families, and had learned to keep adults at a distance. Because of this, foster parents might find it more difficult to build trust with these children (reactive attachment disorder).

Coming at it from an outside perspective, Michele's primary concern was the perceived complexity of the child's behavior, including coping behaviors such as:

- anger
- oppositional behavior
- the need to be in control
- the avoidance of intimacy
- provocative behaviors

Michele noted that within the child's first home, such behaviors might have been vital in order to maintain physically survival, but that they might later prevent a child from adapting to a new caregiver.

- A child might seek negative attention, rather than positive attention.
- A child might be conditioned to avoid direct expression of feelings; to fear vulnerability
- Feelings might be expressed indirectly, in ways that undermine the placement

This might sabotage foster care placements, because foster parents desire a certain level of closeness and reciprocity.

Attempts by the foster parent to bond might elicit memories of abuse and be viewed by the child as a threat. When a child withdraws, the foster parent might feel rejected and discouraged: I just can't reach her.

Please note: All of this assumes that the child has been placed in a safe and healthy foster placement. This is not always the case. Sadly, while some foster homes provide healing, others deepen the damage. I would argue that some mistrustful behaviors might be born in an unsafe foster home.

However, the best foster parents out there are those who are in it for the right reasons. They are hoping to make a difference in the life of the child. They want to contribute to healing and growth.

But even the most well-meaning foster parents might be alienated if they just don't feel like they can make a difference in that child's life.

How this relates to stage #6, Intimacy vs. Isolation: The same behaviors that help a person survive in foster care might later on sabotage intimate relationships.

Coleman, Michele Harryette*. A chance for change: The role of trust in foster care. Virginia Polytechnic Institute and State University, Blacksburg, VA, May 2000.

*Married name: Michelle Coleman Sharp

Tuesday, November 21, 2006

Foster Care & Erickson

Erickson's 8 stages of development are:

1.) Trust vs. Mistrust: (Birth-18 mos.) If the child is nurtured, and loved, he/she develops trust and security and a basic optimism. If not, the child's response is distrust and insecurity. "Is the world a safe place?"

2.) Autonomy vs. Shame/Doubt: (18 mos- 2 yrs) Building on stage #1, a child learns to be sure/unsure of his/her personal abilities. "Can I succeed in this strange, new world?"

3.) Initiative vs. Guilt: (3-6 yrs) A child learns to imagine, cooperate and lead - or to be fearful, dependent and withdraw. "Watch me!" or "Don't look at me."

4.) Industry vs. Inferiority: (6-12 yrs) Confidence based on prior success vs. feelings of defeat and inferiority based on prior failures. "I can/can't make a difference!"

5.) Identity vs. Role Confusion: (12-18 yrs) During this stage of life, it is normal for teenagers to experiment and to try on various roles. "Who am I? " and "What does it mean to be a man/woman?"

6.) Intimacy vs. Isolation* (19-40 yrs) Arguably the most important stage for a foster care alumni. "Will I be alone for the rest of my life - or will I find someone to love me?"

7.) Generativity vs. Stagnation (40-65 yrs) Like anything in nature, a person either contributes to the world around them, or withers up in despair. "Will I make a difference in this world before I die?"

8.) Integrity vs. Despair: (65-death) Looking back at life, an individual either does or doesn't see something to be proud of: "Did I make a difference in the world?"

*As I mentioned, Stage #6, Intimacy vs. Isolation" is arguably the most important stage for someone who has grown up in foster care.

I say, "arguably," because stage #1 sets the stage for future development.

Monday, November 20, 2006

Don't let the door hit you on your way out

Rather than pathologizing the behavior of foster youth, it's important to consider the situation from their perspective:

A study of 20 male foster youth, between the ages of 8-17 years old, in a Texas residential facility, the Gardenville Residential Treatment Center, revealed that attachment issues had contributed to their conduct disorders.

Whenever a placement disruption occured, and a young man was forced to relocate, he would act out in various ways. This might take the form of theft, lying, violence, sexually acting out or substance abuse.

It was determined that each young man was responding to rejection by actively trying to alienate other people, in order to sever current relationships. These young men had internalized a view that the world was hostile, so their response to repetitive abandonment was to act out.

You don't want me? Fine - I don't want you, either!

The researchers came to two conclusions:
1.) Caseworkers shouldn't be surprised by antisocial behavior from youth diagnosed with conduct disorders when facing transitions.

2.) Moving children from placement to placement might be more damaging than allowing them to grow up in a stable institution.

Penzerro, R. M. & L. Lein (1995). Burning their bridges: Disordered attachment and foster care discharge. Child Welfare, Vol. 74, Iss. 2, pp. 351-366.

Avoidant/ambivalent attachment style can sabotage adult relationships

People who receive little love as children often learn to defensively devalue love as a reliable resource as adults.

A study based on abusive child relationships and difficulty establishing supportive love relationships in adulthood looked at three potential factors:

1.) Attachment style
2.) Self esteem
3.) Relationship attributions

It was found that attachment issues, particularly "avoidant/ambivalent" attachment style played the greatest role in relationship difficulties.

The avoidant ambivalent attachment style develops when a child repeatedly cries out for help and the caregiver consistently fails to alleviate his or her discomfort. As a survival mechanism, this child withdraws and gives up trying to have his or her needs met.

As adults, such people are likely to become distant marital partners, shying away from emotional investment in romantic partners. They are often critical of any neediness in their spouses. Instead of going to their partners for support, they withdraw when in emotional distress. These adults have the highest rates of broken relationships.

Participants who had experienced child abuse were found to be six times more likely to experience relationship difficulties as an adult.

McCarthy, G., & Taylor, A. (1999). Avoidant/Ambivalent attachment style as a mediator between abusive childhood experiences and adult relationships. Journal of Child Psychology and Psychiatry, 40, 465-477.

Sunday, November 19, 2006

Quotes from Jean Mercer about attachment

Jean Mercer is a professor of psychology in the Division of Social Behavioral Sciences at Richardson Stockton College. She is also president of the New Jersey Association for Infant Mental Health.

Here's what she has to say about attachment issues and foster/kinship care:

*"Foster care programs need to take into account attachment issues, such as the need for familiarity, consistency and continuity of care. Frequent changes of placement do not give necessary support to early emotional development."

*"Along the same lines, foster care placement needs to involve permanency planning: the attempt to guarantee a secure, long-term placement for the child as soon as possible, rather than an open-ended arrangement without a sense of a secure home."

*"Attachment is an issue in kinship care, just as it is in other foster care placements... the genetic relationship is no substitute for the experience of a familiar relationship, and movement in and out of kinship care needs to be planned as carefully as any other care."

Mercer, Jean (2006). Understanding attachment. Connecticut: Praeger Publishers.

Saturday, November 18, 2006

Properties of childhood attachment

According to Weiss (1991), the key properties of childhood attachment are:
1.) Proximity-seeking:
The child desires to be in close physical proximity to the attachment figure. I want to be near you.

2.) Secure base: The child derives comfort and security from the attachment figure. When I am near you, I feel safe and protected.

3.) Separation protest: The child protests being separated from the attachment figure. Please don't take me away!

4.) Elicitation by threat: When feeling threatened, the child will seek out the attachment figure as a source of security. I'm scared -- help!

5.) Specificity of attachment: That person provides security that others cannot. I want you to comfort me - not anyone else.

6.) Inaccessibilty to conscious control: Attachment feelings continue, despite recognition that an attachment figure has become unavailable. I know he will never love me - but I still want him to...

7.) Persistence: Attachments can persist in the absence of reinforcement. He never calls; he never writes -- but I still want his approval.

8.) Insensitive to experience: The child will often continue to link security with the attachment figure, even if he/she is neglectful or abusive.

What does this mean to the foster child?
Entering foster care often separates children from their primary source of comfort or security.

Even if their biological parent was/is neglectful or abusive, the child might still have an internal desire to seek comfort from that person.

This is assuming that a bond was formed between parent and child in the first place. Each individual case is different. Custodial decisions should take attachment issues into account -- but the overarching concern must be physical safety.

A personal note
Although my father gave me up when I was 12 years old, and allowed me to linger in foster care until I started college at age 16... for years, I continued to hope against hope for his approval.

I excelled in high school, hoping that if I were smart enough, I might be worthy of love. When I took part in Junior Miss, school plays, art competitions and competed for All-State Chorus, there was still a part of me longing to see his face out in the audience. I never did.

I now know why. When you give someone up, it's truly better for you if they fail. Because their failure proves you right in your choice to reject them. But if they succeed, as I did, that means that you deliberately gave up somebody valuable. It means that they are worthwhile to others, although worthless to you.

My father has never been strong enough to face that fact.

And now, at age 33, after all these years, I no longer long for his approval.

Foster Care Alumni of America postcard project