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Friday, November 9, 2018

Children in Foster Care: Grief During the Holidays

It is extremely difficult for children to cope with being separated from their families at any time of the year, but it is especially difficult during the holiday season. While they may be living with a very warm, loving family, they are still very likely to miss their biological family along with the traditions and experiences they are used to having. Many children also worry about how their parents are doing without them, wanting to rescue mom and/or dad from pain.

Foster care is a very important system, designed to provide a safe harbor for children. However, many children would rather face the trauma of their biological family rather than experience separation. While their parents have made poor choices resulting in the separation, most children love their parents and want to be with them. They tend to view the foster care system as a big bully in the way of having their family together. Early in my counseling career, I was shocked to hear children beg to be back with parents who horribly abused them. Over the years I have seen the same situation over and over: children desperate to be with their parents. Age has a significant impact on their emotions, as well as the degree of neglect or abuse. Some children recognize the toxicity of the situation or hold resentment, resulting in no longer desiring relationship. The underlying issue that I see is that most children miss their biological families.

Children will commonly fret about how their parents are doing. They want to know how they are going to celebrate the holidays, if mom and/or dad miss them, and how things would be different if they were home. Some children are completely preoccupied with these thoughts, impacting their ability to focus on school work and their ability to make new relationships. It would be expected for these children to experience some depression, anxiety, and/or anger during this time. They are experiencing grief related to the loss of their family, even if it is only a temporary placement.

Foster parents can help by offering emotional support and understanding. Asking simple questions can make a world of difference for these children. Here are some examples: What does your family do on Christmas Day? What was Thanksgiving like for your family? Do you have any special memories of the holidays with your family? Who did you spend the holidays with? Do you have any holiday traditions that we could do this year? Remember, even if their experiences were less than ideal, they represent the culture that the child has been raised in and many memories are special to them. Being able to incorporate some of their family’s traditions could make them feel more at home.

It is vitally important to not view the child’s biological parents as enemies. Children pick up on this very quickly and will often be distrustful of their foster parents. If the child has a bond with their parents, honor it. It is not helpful to make any negative comments about how biological parents did things. If the child seems upset, simply show empathy. Children want a safe place. If they feel that the foster parents are trying to take the place of their biological parents, they will not feel safe. If it turns into a permanent placement, things will progress without the foster parents having to make statements about how they do things better or safer. The children will recognize it over time and appreciate it more if they do not feel pressured to choose between biological and foster parents.

As a therapist, I tend to do grief work to help children process the loss of their parents, even if it is only temporary. Creating a memory box is helpful. They can draw pictures, write letters, or put special mementos in the box. It can be full of their every day experiences, or they can draw pictures or write about their favorite experiences with their parent(s) and extended family. If a child expresses a sense of loss of not being with their parents for Thanksgiving, I would encourage them to draw a picture of what it would look like if they were home for the holiday.

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I also like to use my Journey to My New Family game. It is designed to help children process feelings related to being in a new family with new rules and expectations. It allows them to express how they feel about the changes and how the new roles have impacted them emotionally. There are so many issues that children experience as part of the foster care system, such as abandonment, distrust, trauma, and anxiety. Cognitive behavioral counseling can help children process these issues and to focus thoughts on hope. I strongly believe that emotions, thoughts, and behaviors are all interrelated. If you can fix the problems with the thoughts, emotions and behaviors will also adjust.

I hope these tips help you to have a warm, loving holiday season. Remember to be patient and offer lots of love. The kids are worth it!

Photo by George Dolgikh from Pexels

Narrative Therapy for Grief

Losing a loved one is difficult.  You expect to see them sitting there, ready to embrace you, yet they are gone.  All you are left with are the memories you have shared.  It is typical for anxiety to arise, fearful that these memories will fade and the connection to your loved one will be gone forever.

A couple of weeks ago my grandpa died.  He lived a long, full life, to the ripe age of 95 years old.  He and my grandma were married just shy of 75 years.  As his family and friends gathered for his memorial service, we shared favorite stories.  We were able to laugh and cry at the sweet memories that we shared with him.  It reminded me of how valuable those stories are in processing grief.

Narrative therapy focuses on writing the story.  It puts words to the emotions, describes the memories, and gives permanence to the experience, as you have a written copy that will withstand the test of time.  We tend to take life for granted, that we can always go back and hear the stories.  After the loved on is gone, those opportunities can be lost. However, writing out those stories is a productive way to process loss. 

At the funeral, I was talking to my dad’s cousin about his dad, my Uncle Tommy, who was my grandpa’s brother. Almost 10 years after Uncle Tommy’s death, they found an autobiography that he had written.  As they read through it, they discovered stories of his life that were a treasure to those he loved.  They were able to get it published to share the memories with loved ones and friends.  What a treasure!

I typically advocate making memory boxes during times of grief to remember the experiences that are treasured.  With children, I ask them to draw pictures and describe experiences.  With older kids as well as adults, a journal is a great way to memorialize these experiences.  The goal is to put words to the memories and the emotions.  There is a huge chasm between the brain and the heart.  Words can help connect this chasm to release the pent-up emotion. The concept of narrative therapy is putting words to the experience.

Here are some ways to use narrative therapy during your journey to healing:
  1. Write letters to your loved one and keep them in a memory box.  Add small items that remind you of your loved one and pictures.  During times of sorrow, you can open the box and look through the contents.
  2.  Make a scrap book of memories.  Use pictures and short stories in your scrap book to remember your favorite times together.
  3. Keep a journal handy.  When emotions are strong, write.  You can write about memories, current feelings, how the loss is impacting you on that particular day, or about what life would be like if they were around. Acknowledging the how life is different now due to the loss is an important part of the grief process.
  4. Create videos, songs, pieces of art, or any other creative way of communicating your love and affection.  The art will be symbolic of your experiences, allowing you to feel and heal as you look at it or listen to it.
  5. Join a grief group to share stories with people who are also healing from loss.  There is almost a compulsion to tell stories during grief.  It is your body’s way of processing the loss.  It is OK to talk about it extensively if necessary.  Finding a group of people who understand and are willing to listen can help immensely. 

Grief can be painfully slow at times.  It impacts each person differently, and there is no timeline for “getting over it.”  The goal of grief is to continue moving forward and embracing the emotions as they come. Rather than looking at grief as a series of steps you must accomplish to be through the process, remember that it comes in waves.  The shock, anger, sadness, and acceptance can come and go.  Don’t be shocked if this happens, as it is normal.  The goal is to be able to look back on the memories and smile. 
When the waves of grief come, use it as an opportunity to share the experience.  Give words to the feelings and your grief and loss can help bring healing to others if you take the time to write.  Your stories and experiences can bring joy and hope to other people who continue to struggle with the pain.

Friday, July 6, 2018

Rewards and Consequences Game Cards

One of the most common presenting problems I see in my school-based practice is impulse control issues. Most of my kiddos with ADHD and autism struggle with impulse control, but I see so many other kids that just fail to think before acting on a regular basis. I have found that it is helpful to role play with them or present situations to help them think through appropriate courses of action.

I address impulse control through many different ways such as having them do activities that require them to follow directions, games like red light/green light, and giving them choices for immediate gratification or giving them a larger reward if they wait for it. I have used the Stop, Relax, and Think game, and making Stop and Think activities.

I have also used Chutes and Ladders for years to address impulse control and discuss logical consequences for behavior. I like how the game board shows children making decisions and receiving either rewards or a negative consequences for their actions. It is a good way to open the conversation about thinking through things before acting and making deliberate choices to enjoy rewards. I created these game cards to give more depth to the game, having players answer a card with each turn. Cognitive behavioral therapy is incorporated to help children address their thoughts on these situations and to correct irrational thoughts, such as others make them do things and that they do not have control over their behavior.

These game cards can be played with other games besides Chutes and Ladders, such as Jenga, pick up sticks, or UNO. They could be played with many other games as well. They will transform the game into a play therapy tool. They are situational role cards that allow children to think of the consequences of behaviors. Some cards also address individual behaviors of the child and the consequences of their actions. Many cards focus on the social impact of impulsive behavior, which will lend these cards to being used in social skill groups or private sessions.

To use in sessions, choose a game to play with the client or group. Each turn, the child will select a card and read the prompt. Allow the child time to discuss their thoughts about the situation. For a group, it is helpful to allow members give feedback to one another. Allow the person who drew the card share their ideas first.

You can also find our games on Amazon, Ebay, and Teachers Pay Teachers 

My Life Game Cards

When I first began working in the counseling field, a coworker discouraged me from playing the Game of Life with clients, stating it reinforces traditional family and would make them feel that they must have children and take a certain journey through life. At the time I disagreed, thinking it could open the door for discussion. So I shelfed the idea. Since that time I have been debating on how to use the game without taking a judgmental stance. I decided the easiest way would be to replace the "action" cards with cards that explore values, goals, and career exploration. The cards allow the client to give voice to their opinions on matters of marriage, having children, and career options. This game would be best used with middle school or high school students, but may also be beneficial with mature higher elementary-aged children.

As with most games, this will allow you as a therapist many avenues to explore. You can use it as a diagnostic tool to listen for strong opinions, worries, or apathy. These questions are designed to start discussion about basic values and goals for the future. When discussing how they envision their future family life, it will open the door to discuss how their current family situation has led to those desires. It can also flag possible triggers that may need to be addressed.

One goal I had in mind when making this game it to help clients develop an internal locus of control. I hear so frequently how they feel out of control and believe they are at the mercy of others. The questions in this game will help them identify how they can gain control through their every day decisions.

I hope you enjoy this new resource, and don't hesitate to let me know how it works in your sessions. You can find the cards here:
You can also find our games on Amazon, Ebay, and Teachers Pay Teachers

Sunday, June 24, 2018

Working Past the Marriage Slump

The early years of marriage can be so exciting!  You are on a new adventure with your spouse, learning each other, devoting your time to one another.  The first year is full of new experiences and goals as you set out to create traditions for your new family.  Your extended family is generally patient during the first year as you learn to make room for both sides of the family. You are still on the high of new love and the little irritations do not yet get under your skin. 

As time passes by the high of new love starts to fade and the reality of life sets in.  Responsibilities steal your time for romance. The toll of balancing work, friendships, family relationships, and children puts a strain on every relationship. Eventually you find yourself in a slump.  You realize that the person who once made your heart flutter now makes you feel sick to your stomach.  The irritating habits stand out and grate on your nerves.  You recognize that there is nothing new to the conversations you have with your spouse.  There are no new stories, nothing new to discover.  Things start feeling dull. When you realize that the love you once felt has dwindled and you are not longer satisfied with your marriage.  What do you do?  Is it time for divorce?

Feelings of dissatisfaction in your marriage can be scary.  Most people fear staying in the marriage and feeling this dissatisfaction for the rest of their lives.  I believe this situation often prompts divorce.  I want to encourage you to hang on a while. Life is a roller coaster.  It is full of ups and downs which will leave you in a tailspin.  It is normal to experience periods of dissatisfaction in your marriage.  It is not cause for concern, but a call to action.  It can change, but it requires work.

One reason the marriage drifts into a slump is when the couple is distracted and do not make time for each other.  This could include having children who require constant care, a demanding job, or too many hobbies.  It could be anything.  If there is not a deliberate decision to make time for the marriage, the marriage will suffer.  It can take a while for the emotional toll to hit, but it will come if the marriage is neglected. 

Another reason the marriage can hit a slump is due to disagreements on how to live life.  Are you and your spouse at odds about how to spend/save money?  Do you have a difference of opinion on religion, politics, or parenting styles?  These need issues definitely need to be addressed to find common ground. It is possible, but it takes work!

The main point it would like to make is that emotions cannot be trusted. You may feel angry, rejected, and alone.  You may feel like your spouse is your enemy and that the relationship is beyond hope.  I encourage you to hang in there.  Emotions can change almost instantly.  Be willing to devote some time into addressing the problems and see what happens.  Life has a normal ebb and flow, many ups and downs.  Marriage is no different.  So you’ve hit a slump, it’s OK. 

Couples who persevere past the slump realize that their relationship has become stronger.  They develop a deeper sense of trust. Rather than the thrill of new discovery that you felt early in the relationship, the deep knowing of your spouse becomes a comfort.  Instead of talking about past stories and learning about each other like you did early in the relationship, you recognize that all the stories are now about your life together. You start to find comfort in the predictable nature of your relationship because you know you can depend on your spouse to always be there. Even sex becomes better with time because fear is gone. Over time you no longer worry about your insecurities because everything in the relationship has been exposed.

There are steps you can take to renew the love and passion in your relationship.  Here are some things to try:
  •          Make consistent time to spend with your spouse.  I would recommend no less than 30 minutes per day without distraction so you can talk.
  •        Go on a date at least once per week.  If you have young children or are tight on finances you may have to be creative, but you can make it work!
  •          Get physical. Skin on skin contact will cause your body to release oxytocin, the bonding hormone.  Without it, you will continue to feel emotionally separated from your spouse.
  •         Make a plan to address different values.  Most premarital workbooks will include how to discuss finances, communication, work/life balance, parenting, etc.  If that is not enough, consider seeing a marriage therapist.
  •         Readdress expectations of one another.  When a couple first marries, they will usually figure out how to divide responsibilities.  As time goes on roles change which leads to a need to readdress expectations.  The addition of children makes this a frequent necessity. As the children grow they can start to take on some of the responsibilities.
  •          Seek counsel from an older, trusted couple.  Find a couple that you respect and admire and ask for their help.  They will be able to impart wisdom and encouragement.  I’m sure they will also testify to ups and downs in the marriage and to hold on for the ride!

Friday, April 13, 2018

Privacy Please

A conversation with one of my clients prompted to me to write an article about whether or not you have to open up and share what is going on to benefit from counseling. I think there is a preconceived idea of a person lying on the couch as the psychotherapist probes the person’s brain during counseling.  It provokes feelings of vulnerability and insecurity.  This is far from the normal counseling experience. When a person walks through the door into the counseling room, they are fully in charge of what they share, how they share it, and on their own terms.  With this being said, being dishonest will not result in progress in counseling.  However, it is quite possible to experience huge growth through counseling without having to share your deepest darkest feelings.

Many years ago I worked with a child whose father had recently passed away.  This child was falling behind in school, had huge anger outbursts, and was suffering from depression.  He wanted to feel better, but by nature was a private person.  He did not want to tell people what he was feeling, what he was thinking, or even how he was doing.  I made a deal with him that if he would learn techniques in counseling, he could do them at home on his own and would not have to share his feelings with anyone. I taught him thought stopping and replacement techniques, coping skills, and how to journal.  He also took the time to make a memory box.  Within four months he had a complete turnaround, doing very well in school, was happy again, and was getting along well with his grandparents.

This is experience made a huge impact on me as a therapist.  It is not necessary for people to verbalize all their emotions to make progress.  Since that experience, I have worked with several other people who are generally more private about their emotions.  I have found that they need a coach, someone to provide a framework for them to work from.  Instead of processing all of the emotion in the counseling room they learn the skills and are able to get feedback. A session would generally consist of the client asking questions, discussing the situation in a general manner, and spending time doing psychoeducation.  I also try to role play, using made up scenarios rather than making them discuss their personal experience. 

Saturday, April 7, 2018

Anxiety Curriculum for Children

Counseling groups can be hugely productive, but also completely exhausting.  It helps to go in prepared with a lesson and supplies ready to go.  With so many different needs, having a curriculum for each need can be a helpful tool to have on hand.  

It is my goal to produce several more groups this summer.  I have ideas for impulsive, disruptive behavior.  You might want to sign up with your email for alerts so you don't miss out!  

Anxiety is a common problem in my counseling room.  Many children come in feeling overwhelmed and alone in their distress.  I try to normalize their feelings and we quickly get busy learning coping skills and how to combat negative thoughts.  This curriculum takes you through several steps to address anxiety in children. 

My goal is to help them understand why they are feeling out of control and to give them skills to regain control over their emotions.