this workshop was created and copyrighted by a child’s...

Presented by © A Child’s Song (2015)

This workshop was created and copyrighted by A Child’s Song.

Any use or duplication of this material is prohibited.

Andrea Chatwin, MA, CCCFounder and Director of A Child’s SongAndrea holds a master's degree in Counselling Psychology and has extensive experience as an Early Childhood Clinician. She specializes in attachment and trauma, particularly focusing on children who have had caregiver losses and placement disruptions. Andrea has also worked overseas in orphanages and studied the effects of abuse, neglect and developmental trauma on children of various ages. She is a proud adoptive parent of a Haitian‐Canadian child and has therefore experienced firsthand the unique challenges of parenting through adoption. Andrea founded A Child's Song as a result of her passion for supporting adoptive families in developing strong parent child connections.

© A Child’s Song (2015)


Therapeutic Interventions for Adoptive Families: Using a modified version of the Watch, Wait and

Wonder in strengthening the parent‐child relationship.

Brief Review of Relevant Research

Understanding the Experience of the Adoptive Parent and Adoptee in Therapy

Introduce Modifications for Adoptive Families

Explore Common Themes and Outcomes

Understand Resistance and Therapist Interventions


Learning Objectives

ACS therapists have a background in early childhood mental health.

We originally used WWW with high risk biological parent child dyads and had good outcomes.

Clinical population shifted to primarily adoptive families needing parent‐child interventions.

Differences in adoptive parent‐child dyad suggested need for modifications.


A Child’s Song’s Relationship with WWW

Limited research on WWW for adoptive families

General research on WWW supports its usefulness as a tool in assisting parent child relationship

Research suggests the need for thoughtful modification within specialized populations

WWW proven effective in other specialized populations with modifications (Borderline mothers, post partum mothers, child trauma)


Brief Research Overview

Introducing Mario and Mom

Mario is two and a half years old, placed six months ago with his adoptive parents.

Mario’s birth mother had a stressful pregnancy and a traumatic delivery.

Mario went home from hospital to his foster parents, remained there until adoption.

His transition to adoptive home was two weeks.

Six months post placement his mom was concerned that the transition was not going well for either of them.


Mom’s Concerns for Mario’s Adjustment

Angrily refused physical contact or comfort from mom

Would only go to bed for father

Stared off into space frequently

Screamed tantrums several times a day

Mom reported increased anxiety since placement

Mom reported feeling unsure what Mario needs.

Mom was surprised and confused by anger to Mario.


Considerations in Adoption Services


Adoption Competent Services Brodinsky, 2013

Requires a complex understanding of emotional, psychological and relational issues in adoption

Gives careful consideration to adoption in clinical assessment and decision making

Demonstrates clinical competence in the areas of attachment, trauma, grief and loss

Understands the importance of adoption language

Must not get in the way of parent‐child relationship


Adoptive Families Seeking Therapy

Concerns that Bring Adoptive Families to Therapy:

Worries about parent‐child attachmentChild’s behavior is confusing or unmanageableChild is highly agitated and distractedParent is unusually triggered by the child’s behaviorsParent worries about child’s mental healthImpact child is having on marital/familial relationshipsChild has difficulty in social settings/peer relationships


Importance of Early Intervention

Openness to intervention at placement is similar to that of pregnancy and post birth openness.

Adoptive parents initially feel less responsibility for child’s behaviors.

Prevents relational patterns from being entrenched.

Prevents parents from reinforcing negative beliefs.


The Adoptive Parent Child Dyad

Early Brain Development

Attachment Formation Post Trauma

Timing of Placement

Disconnect from Child’s Early Experiences


Experience of the Adoptive Parent

Overwhelmed by intensity of relationship.

Struggle to comprehend child’s previous experiences.

Worry about future implications of current behaviors.

Repeated rejection can lead to parent shut down.

Mother’s early experiences can create blind spots.


Experience of the Child

You don’t know me.

I don’t know myself.

I don’t trust you. I don’t trust caregivers.

I can’t predict your responses.

I don’t like that everything is different.


Introducing Watch, Wait and Wonder

WWW is a parent child play intervention that enhances the parent's sensitivity and attunementto the child's experiences.


Watch, Wait and Wonder Description

Offers a space for the parent and child to work through developmental and relational struggles using play.

The parent is engaged in discussion to be reflective about the child's inner world of feelings, thoughts and desires.

Involves both parent and child, acknowledging the parent's role as central to the therapeutic process.


Watch, Wait and Wonder Outcomes

Increases parental sensitivity and responsiveness to child’s internal experiences, past and present.

Reduction in difficult symptoms (tantrums, aggression, dissociating, dysregulation).

Increased parental confidence in ability to determine their child’s need and meet it.

Decrease parent stress/dissatisfaction.


Increased Parent Awareness Outcomes

Power of play to communicate and connect.

Importance of child’s thoughts and feelings.

Previous experiences and current impact.

The parent gains insight into her own emotional responses to the child.


WWW Modifications Rationale

Parents are not intuitively connected to children they have adopted right away.

Children with early trauma and caregiver losses send mixed signals that are hard to read.

Hurt kids often evoke strong unexpected feelings in well meaning parents.

Essential to gain child’s trust and develop relational security so parental direction is accepted.


Modifications for Adoptive Families

Recognizing missing history and experience in the context of discussing parent reactions to play.

Systematic following of four steps in discussion.

Bringing attention to typical play themes for adoptees.

Supporting parents to understand the communication of their child.

Intervening when parents are consistently missing essential communication.


WWW Toy Kit Modifications

CPRT recommended additions to toy kit.

Different toy kits for different ages.

Individual adaptations based on child’s experiences.

Clinical practice issues.


Toy Kit Comparison

Doll familyMedical kitStand up family puppetsTame /wild animalsWooden blocksLarge tip truckSmaller cars and trucksPeg dolls and vehicles

Bowls and spoonsMirrorBaby dolls (AC)Stacking ContainersTwo telephonesTrain with interlocking railsBean bag chairSoft light ballDoll cot

DollhouseDoll family (ethnic)2 Baby dolls (ethnic)Baby bottle/blanketInstrumentsDoctor kitDress‐upBeanbag chairMirror

HandcuffsAnimals (wild and domestic)Wooden blocksArmy menArt materialsDishesFoam swordsMoneyOther age/child specific items

WWW Toy Kit ACS Toy Kit


Four Key Questions

What did you observe in the play time today?

What were you thinking or feeling during the _______part of the play?

What was your child thinking/feeling during the ______part of the play?

Did you feel your child was communicating something during the play?


Common Themes in 0‐3 Adoptee Play

Baby behaviors – bottle feed, baby talk Affection – child to doll, mom to doll, mom to childAggression – animal to animal, child to momAttention to mom’s body – doctor play, dress‐up, playing with mom’s hair, touching mom’s faceFamily relationships – stranger in the house, who’s mommy is it, daily routinesControl – bossing parent around, making games impossible to win, making parent eat yucky food


Common Adoptive Parent Fears

Fear of the unknown past events/experiences the child has that have not been reported.

Fear of biological parent trajectory and similar outcomes for child.

Fear of behaviors that are ‘not nice’ predicting future pathological behavior.

Fear of aggression and control seen in play.


Common Themes of Parent Discussion

Trauma is not fixable but pain can be soothed.

Big feelings need to be tolerated first by the parent so that the child is able to tolerate them.

Its difficult for parents not move away from the intensity of the feelings by distracting in play.

Feelings of anger are not the same as aggression.

Play is not real life and expressions in play are not predictions of future real life behaviors.


Impact of Adoptive Parent Trauma

Unresolved trauma almost always surfaces during Watch, Wait and Wonder.

Trauma influences what parents notice about their child’s play.

Trauma influences the comfort level parents have with different types of play.

Trauma impacts the parents ability to stay present during emotional play.


Outcomes of WWW for Mario and Mom

Mom reported increased physical contact daily.

Mom reported she was able to put Mario to bed now.

Mario initiated affection with mom.

Reduced frequency and intensity of tantrums.

Mom reported reduced anxiety symptoms.

Mom noticed increased confidence in reading cues.


Understanding Resistance

Difficult to tolerate the child’s intense emotions.

Misinterpreting the child’s play.

Feels rejected by child in play.

Disappointed in content of child’s play.

Worry that the child play shows he is ‘damaged’ by previous experiences.

Less common in children between ages of 0‐3.

Tiredness during playtime.

Disruptive behavior during discussion.

Depends on child’s felt security in the environment.

Parental response to this determines recovery.

Parent Resistance Child’s Resistance


Working With Resistance

The therapist can apply WWW with parent in discussion.

Watch for the experience of the parent.

Wait for the parent to understand the process and discuss their experience.

Be aware of your own anxiety when parent discounts or denies the processing of the child.

Wonder (out loud) what it must be like for parent.

Offer empathy for how difficult it is to be present with your child while they are grieving.


Therapist Intervention

Required more frequently with parent‐child dyads that do not have common experiences.

Therapist sensitivity to the child’s level of distress.

Identify specific themes in child’s presentation based on common adoptee concerns.

Providing template for how to respond to child’s behaviors based on level of trust.

Modeling empathy by response to parents distress. © A Child’s Song (2015)

Counter‐indications

Pre‐existing marital distress

One parent does not support the therapy

Significant maternal distress or preoccupation

Severe mental illness

Scheduling conflicts *


A Child’s Song Adoption Services

Pre‐placement Consultations

Transitioning Services

Post Placement Services

Parent Child Attachment Therapies

Individual Therapy

Educational Workshops and Trainings


References

Barth, P. Richard et al. (2005). Beyond attachment theory and therapy: Towards sensitive and evidence based interventions with foster and adoptive families in distress. Child and Family Social Work, 10, pp. 257‐268.

Brodinsky, David M. (2013). A Need to Know: Enhancing Adoption Competence among Mental Health Professionals. The Donaldson Adoption Institute. Retrieved on April 19, 2015 from http://adoptioninstitute.org/old/publications/2013_8_ANeedToKnow.pdf

Chen, Helen & Lee, Theresa (2013). The Maternal Infant Dyadic Relationship: Looking Beyond Postpartum Depression. ASEAN Journal of Psychiatry. Retrieved on April 19, 2015 from http://www.aseanjournalofpsychiatry.org/files/journals/1/articles/155/submission/original/155‐485‐1‐SM.pdf


References

Newman, Louise & Stevenson, Caroline (2005). Parenting With Borderline Personality: Ghosts from the Nursery. Clinical Child Psychology and Psychiatry. Retrieved on April 19, 2015 from http://www.in‐support‐of‐natashaakaev.com/resources/Parenting%20%26%20BPD.pdf

Stepp, Stephanie D. et al. (2012). Children of Mother’s with Borderline Personality Disorder: Identifying Parenting Behaviors as Potential Targets for Intervention. Personality Disorders: Theory Research and Treatment, Vol .3, No. 1, pp. 76‐91.

Tomlin, Angela M & Viehweg, Stephan A. (2005). Infant Mental Health: Making a Difference. Professional Psychology: Research and Practice, Vol. 34, No. 6, pp. 617‐625.


References

Vallance, Denise (2004). Watch, Wait, & Wonder: Enhancing Attachment and Resolving Adjustment Difficulties with Your Young Adoptive Child. Homewood Bound: The Caring Home for Orphaned Children Newsletter. Retrieved on April 19, 2015 from http://chocadoption.com/CHOC_Info/february2004.pdf

Van Horn, Patricia & Lieberman, Alicia, F. (2009). Using Dyadic Therapist to Treat Traumatized Young Children. Treating Traumatized Children. Retrieved on April 19, 2015 from http://books.google.ca/books?hl=en&lr=&id=6Q99AgAAQBAJ&oi=fnd&pg=PA210&dq=modified+Watch+Wait+Wonder&ots=uWiE1reBL0&sig=qlDcCLJwxOhFFMHihVG5juvdCWY#v=onepage&q&f=false

Zilibowitz, Micheal. Watch Wait and Wonder: A Modified Version (Powerpoint). Retrieved on April 19, 2015 from http://www.earlyyears.org.au/__data/assets/pdf_file/0017/155213/Zilibowitz_Michael.pdf



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