By Marshall Lyles, LPC-S, LMFT-S, RPT-S | EMDRIA Approved Consultant and Anne-Marie Brown, LCSW, MCAP, CIP, ICADC
EMDR offers hope and healing to trauma victims of all ages and from all walks of life. Some situations, such as treating children in a child welfare system, however, can complicate EMDR treatment. While working within a child welfare system may seem daunting, several characteristics and skills will improve an EMDR clinician’s success and therapeutic outcomes.
Install qualities in yourself that facilitate safety.
At the top of the list, clinicians can help themselves by possessing a flexible personality and ability to swiftly adjust to changes. Unfortunately, children in the child welfare system often experience placement disruptions. Case managers may be frequently replaced. Group homes may be inflexible in their scheduling. Court hearings can occur with little notice. While keep boundaries firm is imperative, child welfare can be fluid. As a therapist, adapting to sudden changes is vital and can serve to maintain relationships with those in the dependency system as well as reduce the therapist’s anxiety.
Being flexible feels more possible when a clinician possesses a solid foundation in EMDR/AIP theory and treatment planning. Staying flexible may require reviewing EMDR basic training with regularity as well as seeking advanced EMDR continuing education. When therapists are solidly grounded, they can more easily know when to adapt and when to advocate. And flexing with the system keeps therapists less stressed, which then translates as safety to the clients.
Second, tremendous help comes from understanding each player involved in a child welfare case as many roles exist, and each role often has different goals and agendas related to the case. In order to influence the system to be a safer place for the child to heal, the EMDR therapist needs to stay mindful of those differing agendas. For example, while a clinician may need to share concerns related to a child’s sexualized behavior with a caregiver or case manager, providing that information to a juvenile probation officer may not always be in the child’s best interests. Similarly, although a judge or magistrate may request details about the clinical work accomplished in session, clinicians know that clients need the stories of their traumas guarded. Enough detail should be disclosed to serve the client’s needs and meet legal obligations, but boundaries are often easier when pre-contemplated.
Children in the child welfare system have suffered a significant loss of power, which adds to the complexity of their traumas. EMDR clinicians can return some of that power by knowing how to prepare a client when spoken or written disclosures to other adults are required and by being concise with those disclosures. Knowing the roles of the parties involved informs the structure needed for communication, which helps clients feel safer about addressing the hard parts of their stories.
Another ideal quality to possess as an EMDR clinician working within child welfare is the ability to collaborate and communicate without bias. EMDR treatment planning emphasizes the establishment of safe resources. For example, children who have been traumatized prior to, and oftentimes within, the child welfare system typically have quite different lived experiences from their therapists. Part of establishing safety requires the EMDR clinician to maintain awareness of when differences or biases affect felt safety. Then, they must have the ability to admit when a mistake is made, to ask for help or feedback, or refer out for additional services when in the best interest of the client.
Also, bias and judgment can more easily sneak into a therapist’s frame of mind when burnout or vicarious traumatization become a factor. Increasing self-compassion aids a therapist in speaking compassion to clients. While often difficult to internally monitor, clients from the child welfare system need their EMDR therapists to care about their trauma, help organize their experiences, and believe in their innate healing potential. These clients do not need their therapists to judge, aloud or silently, the members of the their system. Staying aware of person-of-thetherapist dynamics represents one important aspect of keeping felt safety an option in therapeutic relationships.
Remember the ENTIRE system.
Even when in full possession of strong EMDR clinical skills and relational attributes, clinicians can have difficulty navigating the number of individuals involved in a child welfare case and, oftentimes, they can forget to communicate with key people. In order to provide the most appropriate trauma informed care, clinicians should familiarize themselves with the child’s system, remembering that every case has its own nuances. Here are some questions on which to reflect when considering needed systemic involvement:
- Where are the biological parents? Have their rights been terminated?
- Do they still have any contact with the child? Is it appropriate, or is clinical assistance needed?
- Does a child have both biological family and a foster family?
- Does the foster family hope to adopt?
- Who does the child perceive as their support system?
- Who is named in existing child welfare documents as involved parties?
- Have requirements about goals or communication of therapeutic progress been set by other parties involved?
During the often-experienced chaotic moments of seeing clients from a child welfare system, such as trying to find a private space for a school-based appointment or having a client brought late because multiple individuals were involved in scheduling and transportation, it can become easy to overlook what a healing child is needing from their parenting subsystem. Caregivers, relative or non-relative, living with the child or not, need to know how to speak safety after EMDR appointments. Biological parents are often left out of therapy or updates on the child’s progress simply because the child is no longer in their custody. However, being left out detracts from their role as parent and neglects the development of the parents as an eventual safer place. Whatever the reason for child welfare involvement, the clinician’s assumption should be that many case outcomes are possible. This means that multiple caregivers may need education and support for continuing the child’s healing journey. A village mentality is needed.
Clinicians working with children and families in the child welfare system should also be apprised of the various other systems playing a role for the child or family. Each of these systems may carry different sets of requirements and expectations that could impact therapy. For example, a child with delinquency charges may have a certain treatment plan via juvenile justice. The clinician needs an awareness of these goals so that the child does not seek termination of probation, only to discover that they have not yet completed their court-ordered 12 weeks of anger management.
Even the most effective of EMDR treatment can be problematically impacted when clients feel let down by the adults involved in their case are not communicating – school staff, medical providers, for starters, and the list goes on. Due to the complexity of cases in the child welfare system, much of the EMDR clinician’s treatment must consider the other moving parts in the client’s life.
Oftentimes, however, key players within both the judiciary and the child welfare system may make clinical recommendations that are not EMDR (or even trauma) informed. As a result, the clinician must establish and maintain their role as clinician. Also, many members of these systems may not be knowledgeable about the help EMDR offers. A therapist needs to perfect an elevator pitch that can be customized for a variety of non-therapeutic professionals. Know what EMDR research offers so that information can be delivered and boundaries can be set with conviction and clarity.
Bring power back to the child.
One of the most important aspects of working with children and families involved in the child welfare system is empowering the child. Too often a child is removed from their caregiver without explanation, moved to a new home, enrolled in a new school, in a new neighborhood, with few belongings, no friends, and little to no contact with their natural support system. How frightening this must be.
One of the clinician’s primary roles is to engage the child and establish a sense of safety while developing their locus of control. In the course of an EMDR treatment plan, this likely means returning to Phase 2 with frequency. Be prepared to offer touchstones to security and to handle contaminations in previously-identified safety resources. The process is required for a child who may have less internalized co-regulation and multiple experiences of powerlessness.
In general, children often have minimal control over their lives. However, children in the child welfare system have even less control. Simple tactics to utilize when working with children include keeping them apprised of treatment team outcomes in a developmentally appropriate manner, inquiring what they know about their removal and why they were removed, and validating their emotions.
It is also crucial that clinicians not demonize biological caregivers. They can simply state, “Your mommy and daddy love you so much, but they didn’t always know how to be safe mommies and daddies. Sometimes, they didn’t know how to keep you safe, and this was scary. A lot of people want to help make sure you and your parents are always safe. It’s scary to not know what will happen next, but I’m here with you now, and we can learn to feel safe together.”
When reprocessing traumas, trust the child’s perspective. Allow the child’s mind to lead in the healing. The therapist is tasked with cultivating and continually monitoring the proper relational context but not with making meaning for the client.
Even EMDR clinicians who believe in the “stay of the way of healing” principle can fall into a rescuer stance in the presence of these tragic stories. And, as controversial as it may be to other voices involved in a child welfare case, the client needs choice in the pacing of their EMDR work. The ultimate responsibility is to the client. Safety can be compromised when a therapist becomes overly preoccupied with the expectations of therapeutic outcomes from others.
Serving clients involved in the child welfare system can be complicated, overwhelming, and time-consuming. This is true, but it is not the only thing that is true. EMDR offers a perspective on healing traumas that can empower all involved to retake some control in making meaning of the hard moments in life. For those in the system, EMDR therapy can change their lives and the lives of their future generations. The child welfare system needs informed EMDR therapists to help make healing a possibility for far too many children who did not choose to be where life has brought them.
Marshall Lyles, an EMDRIA Approved Consultant, has over 15 years of practice in family and play therapy. He regularly teaches on trauma, expressive therapies, and attachment-informed family work around the globe.
AnneMarie Brown is Director of the Childhood Trauma Response Program at the Center for Child Counseling in South Florida. She is an EMDRIA and TF-CBT Certified Therapist, EMDR Consultant in Training, and Qualified Supervisor for addiction professional candidates.