You are already tired. Stuff at home is overwhelming. You decide it's time to involve a mental health professional. You sit down at your computer and type in, "child therapist near me"... within 0.82 seconds google sends you 169 000 000 results. (It's true, I just did it).
So now what?
Cause, that's not going to work!
The process of finding your first therapist, or just a new therapist can add another stressful item to your already challenging day. I have been there. I have been a foster parent for the past 6 years, spending many hours advocating for our children to get the best care possible. But, I also spent 12 years working in mental health programs that accepted government sponsored insurance programs and treated many of the communities under resourced families and then in contrast, I spent some time as a director in a for-profit treatment center with all the bells and whistles.
So here are a few tips from someone who has been there, to help you figure this all out.
First of all... let's talk about what everything means!
Social Worker This title refers to anyone who has a bachelors or masters degree in social work. Some of these individuals have focused their training on community work and advocacy & others in therapy and clinical treatment. If you are considering working with a social worker, you may want to ask about their professional license as most areas offer a provisional license for new graduates and then a full clinical license for those having practiced in the field for a few years. Asking about their license and clinical experience should be a normal question for most practitioners. And, if possible, you will want to work with someone who has their full license and a lot of experience.
Counselor: This is generally an individual that has a masters degree in counseling / clinical psychology or marriage & family therapy. There are also different levels of license with this degree (similar to a social worker), so when talking with a professional with this title you will want to ask how long they have been practicing and if they have their full clinical license or not so you can determine who is the best fit.
Psychologist: This is an individual with a doctorate in psychology. They will often have chosen a specialty they can discuss with you. Many at this level specialize in psychological testing, others in different forms of therapy, and some in both. They will all be quite experienced.
Psychiatrist: This is a medical doctor who specializes in the treatment of mental health disorders. They generally focus their attention on medication management as well as hospitalizations and have less knowledge about therapy. If you are looking for medications for your child, this is who you are looking for. Their appts are often once every 1 - 3 months and they can coordinate care with your weekly therapy provider.
Secondly... let's talk about what trauma informed means!
If you are a foster or adoptive parent and are looking for a treatment provider, it is essential that you are working with a professional that is truly trauma informed. Trauma is a bit of a catch phrase these days. Many therapists, teachers and other professionals are tossing around the word and claiming to be trauma informed, when in fact, they might not be. So checking in with your provider and determining their level of trauma training is essential for your child & family.
Some good questions to ask when seeking out a new provider could be...
What kind of certifications have you earned in the area of trauma treatment? or What workshops have you participated in that focused on trauma treatment? - The answer you are looking for is an actual certification or at least more than one workshop or grad school class. They might not be certified in a particular type, but they may have participated in a 2 day training - that would be better than nothing.
What is your modality of choice when working with children who have experienced early childhood trauma? - See below for some evidence based modalities.
What is your opinion of in utero trauma? - The answer you are looking for is an educated one that speaks to the reality of in utero trauma and it's long term effects on emotional and behavioral regulation. If they are struggling to answer this question, and you believe your child to have in utero trauma, they may not be the best provider for your family.
What percentage of your caseload is children from foster or adoptive homes or have experienced early childhood trauma? The ideal answer you are looking for is, more than 20%.
What are the main diagnosis of the clients you work with? The answers you are looking for are PTSD, FASD, Anxiety disorders, Attachment disorders (RAD or DSED), Stress disorders, or Adjustment disorders. I would be hesitant to work with someone who uses the term ADHD or especially ODD (Oppositional Defiant Disorder) or when working with children from hard places as that could demonstrate a lack of a trauma informed conceptualization.
How do you involve the parents in treatment? The answer you are looking for is that you are absolutely involved in treatment.
Now... let's talk about different kinds of treatment.
Not only are there 169 000 000 different therapists on google, but there are also about that many different styles of therapy! Ok, I might be exaggerating a little bit, but it's kinda true. There are a lot of different modalities of ways to work with families so here is a very brief overview of some evidence based strategies. They are not ranked in order of anything as many of them are very effective for different seasons and struggles. You will need to work with your child and provider to determine what is the best course of treatment for you, during this time.
Trust Based Relational Interventions (TBRI): This is an excellent form of treatment for children who have experienced early childhood trauma. TBRI uses Empowering techniques to address the child’s physical needs, Connecting strategies to build attachment and Correcting strategies to disarm fear based behaviors that require attention. The parents are coached on learning to meet the need behind the behavior, and it is very effective in building attachment in the family. This therapy pulls concepts from various other treatment models, and brings them together in a cohesive unit. It's main focus is on emotional and behavioral regulation, while building connection with the caregiver. It does not focus much on the trauma narrative. For more information on this modality you can check out their TBRI Youtube Channel, their book "The Connected Child" or their website child.tcu.edu which also includes their list of practitioners.
Dyadic Developmental Psychotherapy (DDP) is very similar to TBRI in that it focuses on the parent child relationship and attachment and therefore is also excellent for foster & adoptive families. It uses PACE... Playfulness to bring enjoyment to the relationship; Acceptance to create safety; Curiosity to get to know one another better (the story behind the behavior); and Empathy to recognize and respond to each other’s experiences. For more information you can check out their DDP Institute Youtube Channel, their book, "Healing Relational Trauma with Attachment-Focused Interventions" or their website is ddpnetwork.org, which also includes a list of certified practitioners.
Parent Child Interaction Therapy (PCIT) is designed with highly specified, step-by-step, live coached sessions with both the parent/caregiver and the child (ages 2 - 7). Parents learn skills and then using a transmitter and receiver system, the parent/caregiver is coached in specific skills as he or she interacts in play with the child. Generally, the therapist provides the coaching from behind a one-way mirror. The emphasis is on changing parent/caregiver child patterns and promoting healthy family functioning. For more information you can check out their website pcit.org, which includes a list of certified practitioners.
Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is for children and adolescents (ages 3 - 18) impacted by trauma and their parents/caregivers. It includes psycho education about child trauma and trauma reminders; a parenting component including parenting skills & family therapy; coaching on relaxation skills individualized to the youth and parent; cognitive coping skills inc connecting their thoughts, feelings and behaviors around their trauma while processing the trauma narrative. It can be very helpful for children struggling with trauma memories and needing a safe place to deal with their story. For more information you can check out their website tfcbt.org, which includes a list of certified practitioners.
Eye Movement Desensitization and Reprocessing (EMDR) is an eight-phase treatment where eye movements (or other bilateral stimulation) are used to help the client heal from their trauma. After the clinician has determined which trauma memory to target first, he asks the client to hold different aspects of that event or thought in their mind and to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, internal associations arise and the clients begin to process the memory and disturbing feelings in a way that helps them change their brain's perception of the event. For example, they are able to move from the theme of their story being, "I am disgusting" to "I am strong". For more information you can check out this EMDR International Association Youtube video, their website emdr.com, or emdria.org which includes a list of approved practitioners.
Neurofeedback provides positive feedback to increase desired brain activity to teach self-regulation. New patterns of brain activity tend to result in changes in thinking, emotions, and behavior. Many people’s brains have become stuck in a rigid pattern of responding. With neurofeedback, the brain can become more flexible and efficient, allowing the child to be better able to adapt to challenges in the future. People who might otherwise avoid traditional forms of therapy are often drawn to neurofeedback because it is not necessary to relive traumatic events or talk about their feelings, they simply work with brain dynamics. Research has shown that neurofeedback can help traumatized children and adults who are grossly disorganized after having been abused and /or neglected to normalize their brain waves so that they can manage their emotions, pay attention and stay focused on playing, learning, making friends and pursuing goals. This type of work is often done in conjuction with another form of therapy that will focus on the connection needed with the caregiver. For more information you can check out this Youtube video on Neurofeedback, also, check out this list of Biofeedback Certified International Alliance practitioners.
Trauma Sensitive Yoga is based on central components of the hatha style of yoga, where participants engage in a series of physical forms and movements. Elements are modified to maximize experiences of empowerment and to cultivate a more positive relationship to one's body. Unlike many public yoga classes, it does not use physical hands-on adjustments to influence a participant's physical form. Rather, it presents opportunities for participants to be in charge of themselves based on a felt sense of their own body. It is an excellent adjunct treatment model for those in one of the talk therapy models listed above. For more information check out Dr Bessel van der Kolk (author of The Body Keeps Score) discussing how to Overcome Trauma with Yoga in this Youtube video. Check out this list of Trauma Sensitive Yoga facilitators.
Again, this is not an exhaustive list. There are a lot out there. You can check out the National Child Traumatic Stress Network for more interventions they recommend. There are other good therapies like Collaborative Problem Solving and Dialectical Behavioral Therapy (DBT) that can be helpful when led by a trauma informed clinician. So, even though I know you have a lot on your plate, before you commit to a treatment provider, before you take someone's advice ... do your own research.
Now... let's be real about your situation.
If you are a foster parent your options may be limited. Your first step will be to reach out to your caseworker and see who they would like for you to contact. They may have contracts with providers they prefer, and you may not have a lot of say at the beginning. However this information may help you advocate and understand who is helping your child & how. If the treatment your child is receiving is not helpful (or even harmful) you may be able to argue for the agency to pay for more well researched forms of care.
If you are using a government sponsored insurance program (like Medicaid in the U.S.) you may also have limited options & long wait lists. I always tell parents, get yourself on as many wait lists as you can. You never know which one is going to call first. Check out lots of programs and see which ones will work for you. How long are you willing to wait? or How far are you willing to drive? It might not be practical in your situation, but perhaps this blog will help you select the best choice of your limited options.
If you are using a private insurance plan with freedom to chose your provider... you will have lots of options so hopefully this list helps you choose the best certified provider, and not just the one with the prettiest website.
I hope this helps. Just because someone on instagram says they are trauma informed, or just because someone in a Facebook group tells you a strategy that worked for their family, please make sure you are making the best choices for your child. Trauma needs to be more than a catch phrase in how we are helping our children heal. Look for providers that are certified, trained and educated in the latest trauma research. Let's be diligent in the way we help our children walk this journey towards emotion regulation & true, loving and trusting relationships.
For more personalized information on the issues raised in this blog please feel free to reach out. Let's chat! firstname.lastname@example.org