Fostering Success:
Addressing The Treatment
Needs of Foster Children
Presented By
Kevin R. Bochenek, MA, MS
Educational Learning Goals:
• Participants will be sensitized
to issues related to children
in foster care.
• Participants will learn about
important therapeutic themes
and ways children react to
the foster care experience.
• Participants will explore
various therapeutic issues,
aspects of treatment, and
helpful therapeutic
techniques.
Factors Influencing Development:
• Eight factors which
influence development
will be explored in the
context of how they
relate to the foster care
experience.
Factors Influencing Development:
• Heredity:
Certain aspects of
development are
influenced by biological
factors such as genes.
Factors Influencing Development:
• Level Of Environmental
Stimulation:
Enriched environments that
offer a high degree of
stimulation influences
development positively.
Healthy stimulation should
involve all of the senses.
Factors Influencing Development:
• Modeling:
Children will learn from
their role models in their
environments.
Humans are truly
“copycats”.
Factors Influencing Development:
• Family Culture:
Family values and culture
influence the child’s
personality development.
Factors Influencing Development:
• Birth Order:
A child’s birth order in
the family can influence
the rate of development
and the child’s overall
personality.
Factors Influencing Development:
• Level Of Support:
How supportive and
attentive the caregivers are
will influence a child’s
development.
Included in this area would
be whether or not the birth
was wanted, maturity of the
caretakers, and support from
relatives.
Factors Influencing Development:
• Style Of Parenting:
Parenting style can influence
certain personality variables and
overall development.
Dictator-style parents run the risk
of having children who are overly
dependent and who act out of fear.
Permissive parents may have
children who are unable to follow
basic rules and limits established in
structured environments.
Factors Influencing Development:
• Expectations:
Development is influenced
by the expectations of
caregivers and those in the
child’s environment.
Your expectations should not
be too low or high.
Diagnostic Issues:
• It is frequently difficult to diagnose foster children. It is
sometimes unclear if behaviors are part of a diagnostic
cluster or the result of coping with being in foster care.
• Some behaviors look like one diagnosis (i.e.– AD/HD)
while they may actually be something else (i.e.– anxiety).
• Substance exposure in foster care complicates diagnosing.
They can exhibit very impulsive, explosive, and labile
behavior. It is unclear if those children should be
diagnosed as AD/HD, Bipolar Disorder, or Intermittent
Explosive Disorder.
Diagnostic Issues:
• It is helpful to understand the child’s premorbid functioning and to know the
biological family’s medical and mental health
history.
• Common diagnoses: Adjustment Disorder,
Oppositional Defiant Disorder, Dysthymic
Disorder, Intermittent Explosive Disorder,
and Reactive Attachment Disorder.
Ways Children React To Foster Care:
1.
The Needy Child:
He is clingy and has
indiscriminate attachments;
likes a lot of physical
touch, does anything to
relate to you and others;
constantly wants to please
you and fears rejection; is
at risk for victimization.
• Therapeutic Goals: Teach
independence and appropriate
boundaries, teach personal safety,
and educate child on how to deal
with strangers
Ways Children React To Foster Care:
2.
The Control Freak:
This child was often
parentified; has difficulty
accepting authority and
attempts to relate to adults
as a peer; child likes to take
charge; often the child is
overly neat and organized;
does not trust that adults
will be in control; often
perceived as annoying to
adults.
• Therapeutic Goals: Help the child
explore trust issues; help child
learn to take an appropriate child
role; establish appropriate adultchild boundaries; offer clientdirected time in therapy.
Ways Children React To Foster Care:
3.
The Distant Child:
This child keeps his
distance from you;
becoming too emotionally
connected to you or anyone
is too threatening to him;
this child needs space and
time to feel close to you;
often this child never fully
unpacks at his foster home;
this child has great
difficulty sharing thoughts
and feelings.
• Therapeutic Goals: Help the child
learn to identify and share feelings;
focus on building a trusting
relationship; help the child with
communicating thoughts and needs;
help the child to engage with
others; help child label feelings to
initiate discussion and
understanding
Ways Children React To Foster Care:
4.
The Volcanic Child: This
child is like a volcano ready
to explode; he has a lot of
anger about his situation
this is frequently displaced
to others; he is often
oppositional; sometimes he
can be well-behaved for
days before exploding.
• Therapeutic Goals: Teach anger
control and impulse control; find
appropriate physical outlets for the
client; teach relaxation skills;
develop a plan to help child when
angry and involve foster parents
and/or school staff with the plan;
give a lot of support to the foster
parents.
Ways Children React To Foster Care:
5. The Avoidant Child: This
child avoids issues
surrounding foster care; child
will disagree with need for
therapy; child avoids sharing
feelings; acts as if he has two
separate worlds; often
disowns his biological family;
often acts as if everything is
fine despite hurting on the
inside.
• Therapeutic Goals: Help the child
to explore his feelings; develop a
trusting therapeutic relationship
over time; be there for the client
and do not push too hard during
the initial stage of therapy.
Ways Children React To Foster Care:
6. The Manipulative Child:
Because of his experiences
with neglect, this child often
uses people to get his needs
met at any cost; can be
charming; will strive to gain
your trust and then will do
something to break that
trust.
• Therapeutic Goals: Teach about
the importance of honesty in
relationships; confront
manipulation; assist child in
finding ways to get needs met
appropriately; help child to develop
genuine relationships
Ways Children React To Foster Care:
7.The Anxious Child: This
• Therapeutic Goals: Offer a
child is very cautious; often
lot of reassurance; help the
functions like “a deer in
child to know what is coming
the headlights”; often
next; avoid surprises; teach
worried about punishment
relaxation techniques
or disappointing adults;
fears & worries tend to be
reality-based.
Five Essential Therapeutic Themes:
• Eliminating
Responsibility
• Building Self-Worth
• Believing In Yourself
• Maintaining Connections
• Developing A Future
Orientation
Therapeutic Issues:
• Feeling different
• Enormous sense of grief
and loss
• Am I worthy of love?
• Need for control
• Feeling responsible for
younger siblings
Therapeutic Issues:
•
•
•
•
•
•
Learning to trust
Learning to be a kid
Anxiety– What is next?
Fitting in
Caught between two worlds
Dealing with
disappointments
• Aging out
• Coming to terms
Aspects Of Treatment:
Support To The Foster Parents:
 A primary goal of therapy for foster children is
to offer support to the foster parents in order to
preserve the placement.
 Support includes involving foster parents in the
treatment process, conducting family therapy,
offering parenting suggestions, allowing foster
parents to vent, and to offer phone calls or emails in between sessions.
Aspects Of Treatment:
The Therapeutic Relationship:
 It is essential that the therapist take adequate time to develop a
trusting therapeutic relationship.
 The child should be clear on confidentiality policies.
 It is often helpful when you want to share information about a
session to get the child’s permission or have the child tell the
other party.
 The therapist must be sure not to put herself in a situation in
which she attempts to rescue the client. Some children will try to
manipulate the therapist to get their needs met.
 Therapeutic relationships with foster children can be intense.
 The therapist provides a corrective relationship.
Aspects Of Treatment
Three Key Issues:
 Consistent therapeutic
relationship is
important.
Treatment issues are
complex.
Course of treatment–
Healing takes time.
Aspects Of Treatment:
Individual Therapy:
 The therapeutic process is sometimes more important than the
content.
 Consistency is extremely important in therapy with foster
children.
 It is helpful to give the client some control of the session.
 Reducing anxiety by teaching relaxation techniques is often
helpful during the initial stage of therapy.
 The therapist must be comfortable confronting tough feelings
and issues directly.
 The therapist needs to communicate closely with the foster
parents about the therapy process and goals.
Aspects Of Treatment:
Sibling Work:
 Many siblings in foster care do not have healthy
relationships with each other.
 Working with siblings can often be challenging;
however, it can be beneficial to improving siblings
relationships, stabilizing a placement, sharing common
experiences, and working on social skills.
 Other goals might include processing why they came
into care, expressing feelings surrounding removal,
discussing adjustment issues, discussing visitation, and
developing healthy communication patterns.
Aspects Of Treatment:
Dyad Work:
 Putting two foster children together to work on
common treatment goals can be very useful.
 A therapy dyad can be a useful precursor to
placing a child in a group.
 Many goals can be accomplished in the dyad
including processing feelings of loss, social skills,
communication skills, and relationship-building.
Aspects Of Treatment:
Group Therapy:
 Group therapy can be a powerful modality for
foster children because they can share common
issues and realize they are not alone.
 Care should be taken in selecting children for a
group.
 Groups could be process-oriented or focus on
topics such as social skills and anger
management.
Aspects Of Treatment:
Trauma, Loss, and Adjustment Issues:
 The need for trauma and/or loss work needs to
be carefully assessed.
 Before embarking on trauma work, work with
the child at developing some basic coping skills.
 A supportive therapeutic relationship should
allow for the child to feel safe discussing and
exploring issues related to adjusting to foster
care and to particular placements.
Aspects Of Treatment:
Attachment Issues:
 The therapist should involve the foster parents
in the treatment to help build healthy
relationships and attachments for the child.
 Therapists should be careful not to have their
foster child become too dependent on them.
 For children who develop indiscriminate
attachments, it is important to discuss personal
safety and appropriate boundaries.
Aspects Of Treatment:
Self-Esteem:
 Stephanie Marston defines self-esteem as “a sense of
feeling lovable and capable. When those two things are
in sync, a person has high self-esteem.”
 Help the child develop and explore their identity.
 Help the child to value their personal history instead of
being ashamed of it.
 Help clients develop mastery and competency, in both
subtle and grand ways.
Aspects Of Treatment:
Coping Skills:
 Getting needs met
appropriately
 Identifying, exploring, and
sharing feelings
 Tolerating distress and
reducing anxiety
 Communication skills
 Anger management skills
 Impulse control skills
 Problem-solving skills
 Self-soothing skills
 Self-care skills
Aspects Of Treatment:
Social Skills:
 Teaching social skills is critical in helping children
develop appropriate social skills.
 The Boys Town model of breaking social skills down
into component parts and preventative & corrective
teaching are valuable ways to approach social skills.
 Social skills training is most valuable with the support
of a reinforcing environment.
 Role plays are helpful in helping clients learn social
skills.
Aspects Of Treatment:
Teaching Values:
 Because of placement changes and disruptions, children in care
may get minimal training in the area of morals and values.
 The therapist and the foster parents need to play a critical role in
teaching values such as the golden rule.
 Rosen (1998) suggests the importance of training children in out
of home placements in altruism, empathy, generosity, respect for
others, and right & wrong.
 Foster children need to learn to take responsibility for their
actions.
Aspects Of Treatment:
Processing Of Permanency Goals:
 Children in foster care should be aware of their permanency goal.
 The therapist should allow ample opportunity for the child to discuss
her goal and explore feelings surrounding the goal.
 If the goal is adoption, all of the child’s feelings surrounding adoptions
should be explored.
 If the goal is termination of parental rights, the therapist must establish
a safe place for the child to explore his strong feelings related to the
issue.
 If the goal is reunification, the therapist should work closely with the
biological family and help the child develop realistic expectations.
 If the goal is independent living, this should be incorporated into
treatment. The therapist should be one of many preparing the child
for independence.
Aspects Of Treatment:
Reunification Work:
 If the goal is reunification, active steps should be taken to assist
with the process.
 Family therapy is essential to prepare for reunification. It should
be scheduled as frequently as possible.
 The therapist and foster parents must take a nonjudgmental and
supportive posture towards the biological family.
 It is important to remember that most parents who
abuse/neglect their children do love them.
 Ideally, the foster parents could be coached by the therapist to
provide parent training for the family.
Aspects Of Treatment:
Reunification Work:
 Biological parents can be taught to give supportive
messages to their children regarding their behavior in
the foster home.
 While foster parents are assisting with parent-training,
the therapist can work on communication, problemsolving, and coping skills within the family.
 Solution-focused work is helpful in conducting
reunification work.
Aspects Of Treatment:
Reunification Work:
 Often the therapist will need to redirect the family back
to the reason for the removal to plan for the future.
Biological parents often minimize the circumstances
surrounding the removal.
 It is often helpful for the child’s individual therapist to
be the family therapist as well. The therapist is a bridge
between the biological family and the foster family.
 The treatment team should be in place prior to the day
of reunification. It is important for therapeutic
relationships to be established so the biological family
will be more inclined to commit to services.
Helpful Therapeutic Techniques:
• Letter writing
• Journal writing in between
sessions
• Nondirective play therapy
• Directive play therapy
• Use of toy phone
• Creating a memory box
• Creating a photo album
• Empty chair technique
Helpful Therapeutic Techniques:
• Creating stories and
metaphors
• Puppet play with foster
child puppet
• Teaching clients
something in session to
build competencies
• Play with animal families,
dolls, or puppets
• Use of art therapy
Helpful Therapeutic Techniques:
• People who care about
me activity
• Body drawing
• Celebration ritual
• Positive self-statement
journal
• Taking care of a baby
doll or stuffed animal
• Mapping out history and
placements
Lessons Learned From Foster
Children:
• Carl: Repeated re-telling of
abuse story is not
therapeutic.
• Nicholas: Abused kids are
hungry for a corrective
experience.
• Jason: Some foster children
are eager to push others away
before they pulled away
• Jacob & Jaxson: Unresolved
anger can lead to time in jail
Lessons Learned From Foster
Children:
• Felicity: Kids can teach
adults.
• Tyler: Healing and moving
on takes time and the power
of a loving family.
• Anthony: Fitting in at all
costs is important to many
foster kids.
• Joe: Unconditional
acceptance leads to healing.
Lessons Learned From Foster
Children:
• Stefano: Foster children are
quick to be accused.
• Jonathan: Kids can be quite
resilient.
• Justin: Relationships can
help to get through a crisis.
• Germancy: Don’t assume a
foster child has picked up
basic social graces. Pre-teach
to foster children.
Someone Else’s Child
Be there for me…
I am someone else’s child.
Won’t you be there for me?
If not you, then who?
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