Asking the right questions to help
identify the right therapist.

Trying to find a competent therapist to treat and work with a post-institutionalized and traumatized child can feel like an overwhelming circumstance. Before you start this process, it is important to first educate yourself.

Take yourself through a crash course in learning some of the basics about trauma and attachment disorder in internationally adopted children. There are a number of good websites and organizations:
 
Attach-China International (is not just for those who have adopted from China).

It has a lot of great resources on its website. http://www.attach-china.org  

If your child is a PI (Post-Institutionalized) child who has been subjected to early childhood trauma and/or attachment challenges, you can click on the link from that website to join the Attach-China’s listserv. This educated group of moms (and a few Dads’) is very active and offers a wealth of information and support.

In the Attach-China files section you will find three articles that the list-owner has written about interviewing therapists for internationally adopted children with trauma and/or attachment issues. She lists some very good questions there for interviewing therapists.

Another good place to start your education on child trauma is Bruce Perry’s Child Trauma Website  http://www.childtrauma.org/

Bruce D. Perry, M.D., Ph.D., explains the circle of trust in this article: http://www.protect.org/california/sb33WhatItMeansToChildren_Perry.html
 
Some recommended books:
Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children by Daniel A. Hughes
 
While this book focuses on a composite story of a domestically adopted little girl who was abused and neglected in her pre-adoptive life, Dan Hughes teaches critically important lessons about parenting children who have experienced traumatic loss prior to adoption. The parenting philosophy shared through this book is invaluable. It educates about early child trauma. The first chapter is difficult because it describes the little girl’s pre-adoptive life, but the rest of the book is easier to read. It is ultimately an incredibly optimistic book full of hope. Dan Hughes is a brilliant therapist, who has retired from private practice and is currently traveling around the U.S. and internationally training other therapists to work with traumatized and attachment disordered children. His main focus is on foster and adopted children.  He has developed an approach to therapy called dyadic developmental therapy, which I think is the most credible, appropriate, and non-fringe way of treating many children’s struggle with trauma and attachment issues. His website is:  http://www.danielahughes.homestead.com

Another excellent book is Lark Eshleman’s Becoming a Family: Promoting Healthy Attachments with Your Adopted Child. Read in particular, Chapter 10: Therapy: How to Get Professional Help for Children with RAD. in the book by Lark Eshleman. This book is excellent resource. You may need to expand on some of the points she makes if your child is not so attachment disordered as struggling with broader trauma issues.

Another practical resource is: Adoption Parenting: Creating a Toolbox, Building Connections, from EMK Press. This hefty book is a collection of essays by adoptive parents who’ve BTDT. In particular, you might want to take a look at the essays in the chapter on therapy.

Check out the EMK Press’ website too since they have a lot of good parenting articles that you can download for free: http://www.emkpress.com  

Because you want the best for your child who may be struggling with trauma, attachment, and/or sensory issues, it is important to ask targeted questions. Don’t be afraid to “grill” the perspective therapist who may not be used to this type of procedure.  We like to think of therapists, physicians and other professionals as knowledgeable and helpful but children can be harmed by inept therapists and doctors who don’t have the expertise they need to treat complex trauma issues.

This list of basic questions was formulated based on a female child in the preschool age range who spent the first year to year and a half in an institution in China. Such a scenario lends itself to C-PTSD (Complex Posttraumatic Stress Disorder), RAD (Reactive Attachment Disorder) or attachment challenges, and SPD (Sensory Processing Disorder) from deprivation. This list is a starting point. Please adjust the questions for a particular child.

• Is the practitioner male or female? (Your child may only tolerate men or women.)
• What type of clinician: a social worker, psychologist, or psychiatrist?
• Where is their degree from and where did they do their post-degree training (with particular emphasis to trauma training).
• Does the clinician take ____ insurance?
• If so – does this cover my family?
• What kind of location or setting:
• Is it a hospital setting,  or a small medical building, a home? (Keep in mind what your child can tolerate. It could be any kind of “institutional” type of office or hospital may re-traumatize the child)
• What is the emergency contact plan during non-business hours or in a crisis?
• Is there a charge for a preliminary, face-to-face interview? If there is a charge, try to prolong the phone interview and get as much information as possible. If you do decide to meet a possible or likely candidate, you won’t be wasting your billable hour on incidental information.

When you meet face-to-face or for prolonged interviews:

1. How many internationally adopted children are currently in you practice?
2. How old are they?
3. How many of them are struggling with post-institutionalized behaviors?
4. What kinds of behaviors?
5. What is your understanding of the difference between children who were born into their families and children who were internationally adopted into theirs?
6. What is your formal and practical training in treating children in the [age] range with C-PTSD, attachment issues, and Sensory Processing Disorder (SPD) etc.
7. Where were you trained (for the specific procedure), for how long, by whom?
8. What treatment methods do you use with a young child who is struggling with trauma, attachment issues, and SPD?
9. Do you include the parent in the therapy sessions? If yes, in what way? (Parents of traumatized child should be included in treatment.)
10. Do you do any coaching with the parents? If so what kind of coaching?
11. Are you trained to do EMDR with children?
12. Do you work collaboratively with any attachment therapists/trauma therapists/sensory integration certified occupational therapists?
13. What kind of work do you do collaboratively?
14. Do you work collaboratively with any parent peer educators?
15. Do you work with any school-aged children who need Individualized Education Plans (IEPs) based on PTSD or SPD?
16. If yes, do you participate in team meetings at the school for the child?
17. Do you collaborate with any educational consultants or advocates who assist families of children with IEPs for these issues?
18. How do you get supervision?
19. How do you address your own vicarious trauma as a trauma/attachment therapist.

Often you may only have to go through a limited number of questions before disqualifying a therapist.

For example, someone could be a phenomenal trauma therapist, but have never worked with post-institutionalized, internationally adopted children. They could be peripherally qualified but may be unfamiliar with the specific related issues. This may not work for your individual child.
 
Wait before you make an appointment and absorb the interview. It may not be good to make a decision about a therapist on the spot, no matter how good they seem to be. Let the interview experience settle and then decide whether to further question a specific clinician or make an appointment.

It is a good sign if a therapist seems comfortable with the extent of your probing. Getting the right help for your child, having the determination to find the right team, should only be looked upon as doing the job a mother is supposed to do in protecting and providing for her child.

If you would like further information or have questions, please contact us.