Friday, March 9, 2012

What Kind of Therapy Should We Use?

One of the questions I often hear is, “What KIND of therapy should we use to help our child?”  My answer is always, “I don’t know.”  (Real helpful, huh?)  The thing is, I don’t believe any ONE therapy will help.  Our kids’ “stuff” starts at different places and different ages.  Trauma that happens early (and often) is often much more difficult to treat therapeutically than trauma which happens when a child is older. 

When I started trying to sort through all the therapy options 4.5 years ago, it seemed everyone I knew was singing the praises of Beyond Consequences, Logic and Control (BCLC).  This method was started by Bryan Post (who calls himself “Dr.” but does not hold a doctoral degree from any accredited institution -- only an online and now defunct diploma mill, and who was disciplined by the state of Oklahoma in 2007) and Heather Forbes, LCSWC (who has distanced herself from Post and now runs BCLC without him).  I read all the BCLC books.  I read articles on Forbe’s website.  I learned techniques from other parents who’d attended her trainings.  However, some of the BCLC stuff was easily manipulated by my very smart kids.  Besides, my kids NEEDED to feel as though someone was in “control.”  They’d had to control too much in their lives, too early.  They needed the direction of an authoritative parent.  (Notice I did not use the word, “authoritarian.”  Authoritarian parenting results in rebellion and steps backward in the healing process.  Authoritative parenting lets the child know who is in charge, and gives them a sense of safety, consistency, and protection.  My kids need that.)  In short, BCLC had some things that worked, and some things that didn’t.

We have used a lot of play therapy and family therapy (and play therapy as family therapy).  These methods have helped a lot with attachment.  It is SO important to find a therapist who really knows about attachment and trauma.  Activities such as playing games and using sand trays have helped us find breakthroughs for both The Princess and Youngest Son.  For example, our therapist uses the game “Sorry” and adds some rules of her own.  If we get a “1,” we get out onto the board, but only if we say something good that’s happened since our last session.  If we get a “2,” we have to say something that concerns us.  If we get a “3” we have to say something that our family does together that we like, etc.  These games almost always never go on very long before our kids are working, without ever feeling (terribly) pressured to “go there.”  This method helps us deal with specific issues, using Interpersonal Therapy (IPT) methods.  It is the method by which I’ve learned the most in how to BE a therapeutic parent for my kids.

Cognitive Behavior Therapy is a very traditional therapy.  We use it a little bit, but only when things are going well.  When things hurt, and when a kid is dealing with trauma stored in the emotional part of their brain (amygdala), it’s nearly impossible to process things in the front part of their brain where cognition happens.  Still, it’s a therapy that has helped my kids feel as though they have some control over their lives -- when things are going well.

As I’ve written in earlier posts, for Youngest Son, Dialectical Behavioral Therapy (DBT) is the therapy that has changed his world (and ours).  However, this type of therapy would not have been possible with him even a year ago.  It is really just this school year that he’s matured enough, and has become stable enough on his medications, that he WANTS to change the way he responds to things.  Because DBT emphasizes responsibility for one’s own “stuff,” it was able to move him into a place where he could work cognitively and truly “own” his response to the things that trigger him.  It is only in recognizing that he DOES have PTSD, and that there ARE things that trigger him, that he is able to grasp hold of those triggers and change his behavior.

There are a lot of other things we’ve tried, as well, including “out-crazying the crazy.”  (Which is fun!)  We’ve even used (gasp!) traditional parenting methods in our therapeutic approach.  Like any of the above, sometimes it works and sometimes it doesn’t.  In my experience, raising hurt kids is a very fluid enterprise.

I found a PDF which may be helpful to some.  It describes various therapy methods in very basic terms and is a good introduction to the world of therapy.  You can find it HERE.  It might serve as a conversation starter when talking to a potential therapist for your family.  There are also lists of questions to ask available on various blogs and websites.  One good list is HERE.

Please feel free to share other ideas in the comments section.

1 comment:

Courtney said...

I'm so glad to hear your comments about BCLC. I've heard so many parents rave about it, but after reading descriptions I really didn't feel like it was the best choice for us.