"What is Different about Residential Treatment?"

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.

Lisa

 

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Let me introduce myself. Russ and I are the parents of twelve children by birth and adoption, and sometimes more through foster care. I'm the creator of One Thankful Mom which has been as much of a gift to me as to my readers. In 2011 I became a TBRI® Pracitioner* and have lived and breathed connected parenting ever since. I'm deeply honored to be the co-author, together with the late Dr. Karyn Purvis, of The Connected Parent; it is her final written work. I love speaking at events for adoptive and foster parents. I'm also the co-founder of The Adoption Connection, a podcast and resource site for adoptive moms. I mentor and encourage adoptive moms so you can find courage and hope in your journeys of loving your children well.

50 Comments

  1. Lauren Linton
    March 13, 2013

    Thank you for this thoughtful response. It is very enlightening.

    Reply
    1. Lisa Qualls
      March 13, 2013

      You're welcome, Lauren. Thanks for reading my long post.

      Reply
  2. jtmabpark
    March 13, 2013

    Such a great question and a very comprehensive response. What an amazing program! DO they have a network of programs all around the US with this model or is it one of a kind? I pray that when we do adopt we will not need this program but I am thankful it is there for the when or if!

    Reply
    1. Lisa Qualls
      March 13, 2013

      I believe Dimples' program is independent and I personally don't know of others – although they may exist. I recently learned of a similar program for teens called CALO: http://caloteens.com/
      Dimples' program only admits children up to age 12. There are definitely other therapists who work with this model on an outpatient basis – much of it is based on the work of Daniel Hughes. You can find his website here: http://www.danielhughes.org/index.html

      I hope if others know of similar programs, they will share them in the comments.

      Reply
  3. Dolisa
    March 13, 2013

    Thank you, Lisa. My daughter is 7. We adopted her through the foster care system. She was severely neglected as a baby. She was removed at 2 and came to us at 31/2. She really struggles with attachment. She was placed in a local residential treatment but the care she was given was so bad it actually set her back. It appears your family has found a quality, well educated and highly trained facility. I will continue to follow your progress. Thank you for this post. It is very difficult to explain this decision, but you have done so in a very eloquent way.
    I think you are an amazing mom. God bless you and your family. Thank you for continuing to inspire me!

    Reply
    1. Lisa Qualls
      March 13, 2013

      Dolisa, I'm sorry your daughter experienced that. We feel extremely blessed that Dimples is where she is – it is a gift. You're right, explaining the decision is very hard – sometimes terrible – but I just can't imagine a better opportunity for Dimples.

      Reply
  4. Mary (Owlhaven)
    March 13, 2013

    I realized my stomach was in knots reading this, partly because I am imagining how hard it was for you to release her in this way, and partly because as I read, I also feel great and aching hope that this will be the step that finally allows her to begin to heal….
    Many prayers go with your entire family
    Mary

    Reply
    1. Lisa Qualls
      March 13, 2013

      Thank you, Mary. The yearning I have for her healing is painful and sometimes I fear it won't happen. What would we do? I can't let my mind run that far ahead – we live every day believing she will heal and come home.

      Reply
      1. Laurel
        March 13, 2013

        Right there with you on this . . . for our own Little Miss. Desperately hoping and praying that healing can take place and that she will be able to move home at some point. So sad. So hard. But we ARE doing what is best for our daughters . . . and what is best or our family as a whole.

        Hugs!

        Reply
        1. Lisa Qualls
          March 13, 2013

          Prayers for your daughter today too, Laurel.

          Reply
  5. Kelly
    March 13, 2013

    Thank you for being so transparent, for those of us that have lived like you have, been through it. This post gives so much light to why we had to change placements of our foster daughter we loved. As foster parents, we could not choose a path like residential treatment, our only option was to let go, and we are still healing ourselves and our children from her time in our home. I felt so guilty that we could not achieve healing for her, even after implementing all that we know on attachment, and trust based parenting.
    God has used your journey to help begin to heal me. Thank you, again… For sharing.
    And just in case *you* wanted to know what we had for dinner last night… it was pot roast. 😉

    Reply
    1. Lisa Qualls
      March 13, 2013

      Kelly, you made me smile – thanks. I'm sorry you had to go through this pain. I understand the guilt so well; I wish we could have brought enough healing to Dimples without this, but we tried, we really did, and it just wasn't enough. This environment seems to be the key; at least we hope it is. And by the way, we had french dip sandwiches and asian noodle salad 🙂

      Reply
  6. Katie Szotkiewicz Patel
    March 13, 2013

    Thank you Lisa for your explanation….I know this is hard for ya'll. What love you show for her, to walk through all of this in order for her to heal….much love and prayers to your whole family. I wait to see God's mighty hand in this story because I know He always wins!! (easy to say, but hard to walk through, I know)

    Reply
    1. Kimberly Witt
      March 13, 2013

      My thoughts exactly, Katie! Thanks for sharing the journey so we can learn along with you.

      Reply
      1. Lisa Qualls
        March 13, 2013

        I can't deny that I often wish I were not on this journey, but I'm glad we are able to help other families.

        Reply
    2. Lisa Qualls
      March 13, 2013

      Thank you for the question, Katie. I'm glad you gave me an opportunity to process this through writing my answer. I think it will answer questions for many of my readers.

      Reply
  7. Eileen
    March 13, 2013

    Reading through this took me back to when I was in college and my teenaged sister was in a residential treatment program. After an initial period of time, we would visit her once a week and it was all VERY structured. What I recall feeling the most, and I would think this will be what your other children are going through, were conflicted emotions of hope that she'd come home healed (which I'd quickly try to squash down because I'd had hope too many times before) and fear that she'd come home (which brought with it terrible guilt). I wanted her home and yet as much as I hated to admit it, I didn't.

    It was a hard, hard time, but I do know that not only did my sister need to be away, we needed her to be away. We needed a break.

    Reply
    1. Lisa Qualls
      March 13, 2013

      Thank you for sharing your perspective as a sibling, Eileen. Our kids have such conflicted emotions, they miss her, they are afraid of her, they want her home, and some never even ask about her. We have been talking about a phone call with some of the girls, and when it came up this week, I told her therapist that I didn't have the emotional strength for it right now. The girls are going to need a lot of support before and after, and I need to provide it.

      Reply
      1. Laurel
        March 13, 2013

        Our phone calls with the siblings have gone very well They are short. The kids ask questions about school and other activities. Little Miss gives short answers. We believe the phone calls have been good for all of the kids, Little Miss included. One small step at a time towards healing.

        Reply
  8. Sadee
    March 13, 2013

    I want to keep trusting Jesus and taking steps forward in life to trust Him…and I don't have kids yet so I don't mean in parenting! 🙂 But reading your journey is so, so lifegiving. Thank you for being so brave to trust us with your story. I'm praying for you guys this morning! And I am so, so hopeful for all of you!!!

    Reply
    1. Lisa Qualls
      March 13, 2013

      "Trust and Obey" – that seems to be a key part of the foundation for me in trusting Jesus. Thank you for praying for us, Sadee.

      Reply
  9. oldqueen
    March 13, 2013

    Hoping all that you are gleening from this experience and what you share with us will help in far reaching ways. Please keep us informed. We all need the help.

    Reply
    1. Lisa Qualls
      March 13, 2013

      We are going to visit Dimples soon and will be attending a four hour training on attunement as it is used in this therapeutic model. My pride says, "I know all about attunement!" yet I know that I can learn more, much more. I'll be sure to keep writing and sharing.

      Reply
  10. Donna
    March 13, 2013

    Praying for healing for you all in this process. Your openness is refreshing and enlightening for so many. I refer many hurting families to your blog for information. God is using you all in this process.

    Reply
    1. Lisa Qualls
      March 13, 2013

      Donna, it was great to see you at Refresh – we are grateful for your prayers.

      Reply
  11. Laila
    March 13, 2013

    Thank you for this informative post. Praying for Dimples. you and your family.

    Reply
    1. Lisa Qualls
      March 13, 2013

      So thankful for your prayers, Laila.

      Reply
  12. Laurel
    March 13, 2013

    Thanks so much for this post. Can I share it (with links)? It lays out so clearly much of the reasons that our Little Miss is also living at a Residential Care Facility.

    While we do believe it is the best place for our daughter at this time, it is also best for ALL of us. Do not be hesitant in saying, "This is best for the family. This is best for our other kids. None of us could continue to live with the stress and fear." Oh how I pray that the Lord will remove the guilt from your heart, and help you to KNOW that this is HIS best for Dimples at this time.

    While I am oh.so.sad. that I could not bring the healing our Little Miss desperately needs, I know that we did all that we could for her. And . . . you were able to do a hundred times more for Dimples than we had the resources to do for Little Miss. But, it is not for lack of love . . . or desire . . . or doing all that we could for our daughters. No. Sometimes we must release our children so that the Lord can bring healing to their lives before they can return to us.

    Keep loving . . . keep sharing . . . keep seeking the Lord's wisdom as you parent each and every one of your children. They all need their Mama.

    Laurel
    mama of 12

    Reply
    1. Lisa Qualls
      March 13, 2013

      Laurel, feel free to share the post as you like. I feel sure that Dimples is where she is meant to be – it is sad for me, this is not the way I ever imagined my life as a mother would look, but I accept it. I'm glad your sweet girl is doing well.

      Reply
  13. SleepyKnitter
    March 13, 2013

    WOW. Thank you! It is good to know more about what Dimples is experiencing — that helps us “pray more intelligently” for her, as a friend of mine likes to say.

    Thank you also because this post brings me great relief regarding our daughter whom we had to re-home last spring. Every once in awhile I begin to worry over whether we should have placed her in this kind of “ranch” instead of in a second family, enabling her to continue being a member of our family and not experiencing the rejection of re-homing, but in reading your description here I realize the ranch is really not at all what she needed in her circumstance. She had not been through intense trauma in life (other than what living in our family was like for her, I guess), and she had relatively normal, healthy relationship skills (normal for post-institutional life, anyway). What she truly needed was a second chance with a new family whose situation was closer to her emotional needs, and that’s what she received and she is doing very well. Reading your post brought me relief that I can only imagine at this point will be long-term. Thank you!

    We did check into these ranch-type settings very briefly at one point last spring (just enough that at that time we didn’t think that was the right approach for our daughter, though we had since forgotten why we didn’t feel it was right), and we do have some realization as a result of what a tremendous personal sacrifice and commitment on your part that this approach requires. We continue to pray for you regarding the many types of resources you need to be able to do this. Blessings as God continues to heal Dimples and the rest of your family.

    Reply
    1. Lisa Qualls
      March 13, 2013

      I'm so glad this gave you some clarity and relief. Our children and situations are all so unique, we have to seek God's will knowing it will look different for everyone. It is wonderful that your daughter is doing well in her new family.

      Reply
  14. Ruth Carlson
    March 13, 2013

    Hi Lisa, have you heard of Karyn Purvis and her work?
    She has written a book called "The Connected Child".
    I have found it to be very helpful in the area of attachment.
    Thanks for sharing your story with the rest of us!

    Reply
    1. Lisa Qualls
      March 13, 2013

      Hi Ruth, thanks for mentioning Karyn Purvis. She is a lovely person and a gift to the adoption/fostercare community.

      Reply
  15. Chris
    March 13, 2013

    Thank you for explaining it. I often wondered how a residential program will enable a child to attach to parents that are not present. But the set up you describe makes sense. I especially like that they are doing work together with you and her. So many programs seem to just work on the child and I wonder about that.

    Reply
    1. Lisa Qualls
      March 13, 2013

      I knew so little about residential treatment before this winter, but it's amazing how much you can learn in a short period of time when you need to. I'm glad the post was helpful.

      Reply
  16. Blessed
    March 13, 2013

    That sounds so amazing! Oh, how I pray that Dimples can stay as long as she needs, and that she heals.

    I just yesterday found an amazing blog–reminds me a little of yours–and I don't see it on your favorite blog list: http://everybitterthingissweet.com/2013/03/iamthe… I encourage you to go read today's entry. It is a great example of the kinds of writings and subjects the author tackles.

    Reply
    1. Lisa Qualls
      March 13, 2013

      Thanks for the recommendation – I'll take a look.

      Reply
  17. Tricia
    March 13, 2013

    Very enlightening and interesting. Thanks for sharing!

    Reply
    1. Lisa Qualls
      March 13, 2013

      You're welcome, Tricia.

      Reply
  18. Emily
    March 13, 2013

    Praying for you today. Love you.

    Reply
    1. Lisa Qualls
      March 13, 2013

      Thanks, love you too.

      Reply
  19. Mavis
    March 13, 2013

    This blog is part of my pre-adoption education. We are looking forward to picking up our almost 3 year old from Vietnam. Thanks for laying it all out here to help so many! God bless you!

    Reply
    1. Lisa Qualls
      March 13, 2013

      Mavis, how soon will you be traveling? I'm glad my blog hasn't scared you away and that you are open to learning so much. Thanks for reading and commenting.

      Reply
      1. Mavis
        March 15, 2013

        Scared me away? It's a God given dose of what the reality can be! We don't do this for a free ride of cuddles and laughs, we do this because God has given us a calling and enough love in our hearts to carry it through. I'm counting on it!

        Reply
        1. Lisa Qualls
          March 15, 2013

          It's the calling that helps us press on – and the strength that God gives when we have none. Thanks, Mavis.

          Reply
  20. mrsungeek
    March 13, 2013

    Oh Lisa! Hugs! I pray that healing will come to your family!

    Thanks for writing. I'm sure it will be a help to many people.

    In reading the comments, I am again amazed at the loving support that is here! It is a reminder that we aren't alone. There are those who understand and have walked similar paths. And there are others who don't, yet pray and encourage. I wish I could give a big hug to each one of them!

    Reply
    1. Lisa Qualls
      March 13, 2013

      I can't tell you how thankful I am for the kind and supportive friends who read my blog. I feel surrounded by so much love and concern for Dimples and our family.

      Reply
  21. Kylaney
    March 14, 2013

    Lisa,
    Thank you so much for your compassionate post. We are at this decision point with our 14 year old son adopted from Russia. While he has decided to disdain us, we are still his parents and know that our current situation is not good for him. I'll email you since I need some guidance in getting our son the help he needs.

    Reply
    1. Lisa Qualls
      March 14, 2013

      Kylaney, I'm so sorry. I can imagine how much pain and tumult you've gone through to get to this point. Please email me; I would be happy to talk to you.

      Reply
  22. Jennifer
    June 1, 2013

    Thank you for this post. My parents are foster parents to several children. A child that we had for over 5 years was placed back with his birth family over 3 years ago. We received a call out of the blue in Feb about him. We now get daily 10 minute phone calls and depending on his behavior, a weekend visit. As we are the only family willing to claim him, it is heartbreaking. Sending your family love and prayers.

    Reply

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