“Attachment is our limitation, not the limitation of the child.”
I heard Dr. Yvon Gauthier say this at a Child and Adolescent Psychiatric Conference and it struck me as if with physical force. What an encouraging thought!
In the teen treatment industry we often hear of the “untreatable” child. I think this is totally false. The untreatable child is just the child we haven’t figured out yet! But heaven knows I’ve run into a few in my lifetime. 
I was on a conference call yesterday and one of the participants said that her mantra is “behavior problems are indicative of unmet needs”.
When my wife and I adopted our son, Michael, who is turning 7 next month, I was nervous about whether he’d be able to attach or not. He did just fine and over time I relaxed. The truth was, I had figured out how to connect with him. Now that he’s almost seven, I still take the “temperature” of our relationship every night when I tuck him in bed, just to see if we’re still connected. Last night he wanted to cuddle three times before he’d go to sleep. I think he’s connected!
One of my former New Haven students had a child she thought was Autistic. She wasn’t connecting well with her at all, and then she was diagnosed with Autism. I suspected the diagnosis was misguided. Over time, as my young friend worked to engage her daughter in the way her daughter wanted to be engaged, this perceptive mother discovered that the child’s speech and physical abilities improved. The misdiagnosis fell by the wayside.
Contrast the relatively easy time my alumna friend had with the experience of one of my former co-workers, whose first sonmost definitely has Aspergers. After years of behavioral work, she is finally getting him to eat on his own, hug her occasionally, and so on. He’s thriving.
I realize now that attachment is not about the child’s capability. It’s about ours. The only children who can’t attach are the children whose caregivers give up trying.
This may sound like I’m blaming parents or professionals. Not so. What I’m trying to illustrate is the immense hope I feel. Think about it: we’re not dealing with a deficiency in the child, rather we’re dealing with our own lack of knowledge or skill. And we know where to get knowledge and skill: our own experience and the shared experiences of others. That’s incredibly empowering.
What challenges have you any of you had in connecting with your own children or the children you serve? What knowledge or skills have you developed that you could share here?
It’s been another fantastic few days of Family Weekend at New Haven, the residential treatment center where I work. It’s my favorite time! I love being with each family in group sessions as they work on their issues. It’s an honor.
These weekends always cause me to wonder: What is it that really causes change in struggling teens?
Scott Miller, Ph.D., (www.scottdmiller.com) and his colleagues have researched this topic ferociously over the past decade. They’ve studied over 6,000 research articles. What they came up with surprised me at first. After I thought about it for a while, though, it began to make sense.
Miller says that 40% of change is attributable to “extra-therapeutic” factors. These are things that happen outside of the therapy office. Unforeseen changes in the economy, in families, and in the environment can spur people to change. I call these things “acts of God”.
The next 30% of change can be attributed to a person’s orientation toward hope and change. Do they believe they can change? Do they have hope the change can last?
15% of change is due to the relationship the client has with the therapist.
The last 15% can be narrowed down to the therapist’s particular skill and style.
This has important implications for treatment.
Extra-therapeutic Factors
For example, the residential staff, shift changes, room changes, cats, horses, activities off-campus, intensive days, family weekends, campouts, hikes, family phone calls, and so forth, are our attempt to have some effect on the “extra-therapeutic” factors. John Stewart calls this “shotgun therapy”. We try a lot of different things to see if we can get through to a girl. Like a father said this weekend in a group session, “New Haven will even throw ‘the book’ out if it will work for a kid.” This doesn’t mean we run around willy-nilly, of course. We just try a lot of things until something works.
Hope
We try to focus on strength rather than condemning weakness. We fiercely protect a person’s ability to choose – it’s our effort to foster an internal locus of control. When a person takes me by the hand and expresses kindness to me and confidence in me – even challenges me – I am more likely to rise to the occasion because he or she has faith in me. That give me hope. Our experiential therapy approach is designed to give students successful experiences that they can point to later, when they feel down.
Relationship with the Therapist
I require each therapist to measure how well each student connects with that therapist. Every session, every student rates how well she felt the therapist did during the session. We make sure that the student/therapist relationship is a match.
Skill and Style
I welcome a wide range of skills and styles of therapy here, as long as the therapists we hire are able to be effective during family therapy. It’s my feeling that family therapy which encourages every member of the family to do his/her part is the most effective way to ensure that the change in the adolescent lasts.
So how well are you doing at taking advantage of the extra-therapeutic factors? How effective are you at instilling hope in those who feel hopeless? How much influence are you able to marshall, because of the relationship you have with those you serve? Do you possess the set of skills necessary to help the client who is seated in front of you?
