Shortly after we took Dimples to her school, I offered to answer any questions people might have. I got several, and then let them sit in my inbox; today I’m going to tackle one.
Katie asked me,
I am wondering what kind of therapy y’all are doing with Dimples, specifically, what is different about the residential treatment facility. It seems like y’all were already on the cutting edge for therapies for her, so I am wondering what more this new facility can offer? Or is it just the ability to work on what she was already doing (emdr for example) in an environment where she has no distractions?
As I answered this question, the post got too long and I had to delete a large section of it. Here are my condensed thoughts.
1. Her world has become very small. She lives in a cottage with seven other children and two to four staff are present during all waking hours (one at night).
2. Treatment is based on a relational developmental model and the staff is well trained.
3. Milleu therapy is essential for a child like Dimples. Every moment of her day is immersed in the therapeutic environment. Every decision, from the interactions with other children, to the time spent reading aloud at night with a counselor, is rooted in achieving therapeutic goals for Dimples. Russ and I were very impressed with this on our last visit; I believe this one thing is going to be key for Dimples. We could have the best therapist in the world, but one hour each week cannot compare to “every waking moment.”
4. Dimples’ therapist is a daily (M-F) part of her life. Each cottage has its own therapist, which means the caseload is eight children. While the therapist has individual appointments each week with the children, she also facilitates group sessions with the cottage and is simply a presence in Dimples’ day. Additionally, all staff must keep notes for their shift, so the therapist is aware of what has been going on with Dimples all day – in school, at breakfast, etc. When we had a family session during our visit, there was not one moment wasted on settling into the appointment, there were no subtle things to sort through. We jumped right in.
5. Dimples’ school is on campus, only a few steps away for the cottage. Her teacher is part of the therapeutic team and is 100% engaged in the plan. We all know how frustrating it can be to be working hard with a child only to have some of that work undone by well-meaning teachers who spend many, many hours with our children each week.
6. Since being with family is unbearable for Dimples, the program is giving her a break from actually being with us, while at the same time simulating a more generic family environment to allow her to work through her challenges of family life. For instance, there is a child in her cottage that she is beginning to have conflict with. The girl is close to her age and we hope that she will gain some strategies for living with her own sisters.
7. The goal is that Dimples will begin to form some attachment to her “special staff”, one male and one female, which will then transfer to Russ and me. To be perfectly honest, this is where I struggle. I am giving it all I have to want this to happen because I believe in the therapeutic model, but I just have to say that this stinks. Do I really want my child who has no attachment to me to attach to someone else? No, I really don’t. But if it will bring about healing and teach Dimples to trust and attach to someone, in order to allow her to attach to me, then I have to swallow every bit of pride and pain, and pray for it to happen. In an ideal world, this middle step of attaching to a staff member would not be needed because I would go to treatment with her. Of course, that simply isn’t possible, so this is the best we can do.
8. When a child lives in an environment where she can harm people and control them with maladaptive behaviors, she becomes even less healthy and more damaged. We’re giving Dimples, and our entire family, time to heal. When she returns home, it will be a fresh start, with new structures and routines, new skills for communication, and very high expectations for her behavior. Additionally, she will, by God’s grace, have her own bedroom and bathroom, which will simulate the cottage environment and allow her to continue in some of the patterns for life she has learned, including how to be take care of herself, and not have the continual stress of being with siblings which is so challenging for her.
9. Lastly, she is safe; she cannot harm herself or anybody else. When children who are extremely wounded are able to hurt others either physically or emotionally, it only damages them more. Raging is not cathartic, it is damaging to the child. Being so dysregulated that your brain is in constant fight/flight/freeze mode, is harmful to the body, mind, and spirit. Living in a family that has little joy and is walking on eggshells is not healthy, nor is the desire to constantly be away from the family that gives you so much discomfort.
Dimples, and every member of our family, has to go through this pain, we have to work hard to find healing and a new way of living together. There are events that need to be processed with a therapist. Dimples is not doing this work alone – we have family therapy, and in time, we’ll take some of the children with us to do therapy with Dimples.
I could go on and on, because I think about this often; thank you, Katie, for such a great question.