Tag Archives: therapy

Giving trust, losing trust. Does it make a difference?

January 28th, 2019

I remember that moment when I realized that there was no way I could do this without help. I had tried every technique I knew, been patient, yelled some, loved my son with all my heart and absolutely nothing got better.  He was only six, I thought.  Maybe there is one more thing, something overlooked, that I can try?  But there wasn’t.  I had exhausted what I knew and needed help.

I took him to our pediatrician who said it was time to try therapy and maybe medications.  I made an appointment and waited. And while I waited, my son got worse.  He was anxious at school; now he hid under the desk for hours.  He was sad; now he cried often and was inconsolable, sometimes saying he wanted to die.  He was going to school intermittently; now he stopped going altogether.  That first appointment couldn’t come too soon.

Like many parents, I walked into that first therapy appointment with vague but powerful hopes.  I hoped the therapist would know exactly what was going on with my son.  I hoped he would have smart and effective things for me to try.  I fervently hoped there was a path to wellness that would be short and have regular signposts so I would know I was on the right track. I hoped I could trust the therapist, trust the steps we were taking and trust the safety net I was hearing about.

There is a bargain parents enter into when they use mental health services and it’s simply this.  You give over some decision making and in return, you are expected to trust.

For the most part, we are happy to make that bargain at first.  We long for others to “get us” and define what our children need.  We long to trust that therapists, teachers and doctors have great intentions, a mountain of relevant knowledge and a strong base of experience.  We often begin with an uncritical kind of trust.

There are many kinds of trust ranging from blind trust to a “trust but verify” stance. While some of us find it easy to give our trust, many of us find it much harder. “What are we trusting?” we wonder. Expertise, good will, an attitude of “do no harm” or a commitment to our child’s mental health?   These can vary widely.  My son has had therapists, doctors and teachers who were experienced or newbies, skilled or blundering and some had a kind of humility while others were wrapped in arrogance.  I know I’m not the only parent who has been told a certain program, medication or approach is a perfect fit only later to hear that “we’ve never met a child quite like your son before.”

I read that Suzanne Massie, an American writer, met with President Ronald Reagan and taught him the Russian proverb “Doveryai, no proveryai” or “Trust, but verify.” She advised him that the Russians like to talk in proverbs so he should know a few.  He used the phrase often during important negotiations over treaties.  It’s also a phrase I wish I’d learned far earlier.

We think that the bargain we make, giving trust in exchange for help with decisions, access and healing, will be short term.  We learn that the next set of services, the next program, the next relationship asks for the same kind of trust.  Trust is defined as the belief in the reliability, truth, ability, or strength of someone or something. Sometimes that reliability or strength comes through for us.  Other times, not so much.  That makes it harder to keep trusting.

Doubt creeps in and it stays.  And it shows in our demeanor, our attitude and our body language.  I know it did in mine.

The unexpected can happen, too.  One therapist apologized to me when staff handled my son’s very rigid obsessive eating patterns with discipline, instead of understanding at his therapeutic school.  She then made changes so it didn’t happen again.  Another time a psychiatrist told me he regretted not listening to me about a medication choice.  I’d told him that we’d tried it before and it had been useless.  He insisted and had the same results.  Saying he chose wrongly made up a lot of lost ground.

It’s also awkward that therapists and other mental health professionals know so much about our lives from the trivial to the awkward to the things that make us feel vulnerable.  Yet, we often don’t know much about theirs.  When they share something, it can help our trust return.  The psychiatrist my son had in his teens (maybe the 6th one by then) had pictures of her children and dog on her desk.  I knew she was a parent and she let me know one day that her child had ADHD.  I already liked her but I could feel a part of me relax and trust a little more.

Part of parent’s job is to make decisions for their child as well as their family.  You might consult others, but in the end you decide, adjust and live with the results.  When your child has mental health problems, you are faced with a different paradigm.  Instead of consulting, you share or give over decision making.  Instead of adjusting, you rely on others to make changes.  You still live with the results.  Most of us want to believe and trust.  Sometimes we are glad we did.  But other times, it’s hard.

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Including parents should be part of effective trauma therapy

August 2nd, 2017

Some mornings as I drive to work, my mind wanders through my family memories.  I often wonder if my life is at all like other people’s lives.  I always think about my children first and then think of the many families and young people I have supported as they needed it. At times I think about all the kinds of therapy, services, supports and various medications that I have tried out. I think of the binders filled with IEPs, treatment plans, timelines and photos that I have taken to remember it all, and wonder if I remember all the facts. It can be hard with three children.  They are all unique and different but share one  thing – trauma.

Trauma is now looked at more and more with children (and adults) and there are lots of conversations about new supports, new research and new ideas. I have tried the Trauma-Focused Cognitive Behavioral Therapy approach, Eye Movement Desensitization and Reprocessing, sensory diet , Attachment Regulation and Competency and therapy after therapy. And you know how it works best? Including the family, especially the parent.

My child has received therapy in the residential setting and the community but when I have not been taught and included in the treatment, it really hasn’t worked most effectively.  Many therapists told me to focus on my trauma and they would focus on my child . The reality has always been that my trauma has already been worked on and the PTSD that I have incurred from going through the ongoing issues with my children has been just as hard.  The reality is that the one therapy where I was included resulted in both my son’s greatest gains and his ability to maintain his skills and improve in his journey.

Trauma has turned out to be so common that it is something more and more systems are identifying and seeking better outcomes. Is anyone noticing that when you include the parent, the treatment improves? Are we making sure the skills are taught to the parent so that the approach can be done during home time, day trips, holidays at home and more? Do people see the parent as an investment or a problem?  I would love to see more outcomes that look at how including parents helps the child. I absolutely know that improvement for the child is very much tied to the connection to the parent.

An underlying piece of the onion that no one sees and no one wants to understand continues to be the things many parents and caregivers do to make it feel safe for their child. It takes patience, understanding, empathy and sometimes just someone to show that they hear the parent and see them as the expert.  It has been the one area in my children’s life that has been a mystery to figure out.

As the brain develops things change, memories change, and behaviors to deal with it change too. My oldest son and I talk now about what memories we have and how we continue to feel lucky to be able to talk about it and how we are going to deal with it. Trauma comes up when you least expect it.

For us the biggest trigger is fire.  We remember a house fire that we were in. We are triggered by seeing the burnt house we drive by, a candle burning in a house, smell of smoke, a fire alarm and at times just people lighting a grill. It comes up and each of us deal with it differently. I approach it with a mindful approach, my middle son using the Attachment Regulation and Competency approach and my oldest using the Trauma-Focused Cognitive Behavioral Therapy approach. They are all correct and all okay- but without my understanding and embracing what works for them it would not work.

I appreciate being asked about trauma and talking to people about their approaches. It doesn’t go away. It is not the last peel of the onion for us– it is actually near the outside.

My last suggestions are the following:

  1. Include parents in your treatment model- teach them and include them
  2. Ask the parent what has worked and not worked
  3. If a parent asks for assistance to get outside support for trauma, help connect them
  4. Talk about positives that are possible so that parents know it gets better
  5. Remember that it doesn’t matter how large or small – if people use the word trauma LISTEN

Let’s change trauma to something we talk about and help.

Meri Viano is our guest blogger.  She is the parent of two sons and a daughter who continue to inspire her blog posts.

 

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