Adoption '98: Networking for Children
May 8-9, 1998
Albany Marriott Hotel
Albany, N

Presented by Vera I. Fahlberg, M.D.
2615 Nellita Rd. N.W.
Bremerton, WA 98312
360-830-4288

"Until he can establish roots in his present relationships we need to protect his roots to the past, no matter how deformed they may be; without roots the child will die of emotional starvation." --Ner Littner, 1975

The three factors which most strongly influence the reaction to separation/loss are:

1. the intensity of the relationship being interrupted
2. the preparation vs. abruptness of the loss
3. availability of known others during the grief process

The child's reaction to parental separation will be influenced by:

1. The child's age and stage of development.
2. The nature of the attachment to those from whom he is being separated.
3. Parents' bonding to the child.
4. Child's previous experiences with separations and losses.
5. Child's perceptions of the reasons for the separation:
1. Resons need to be defined in terms of problems in relationships or in terms of unmet or conflicting needs.
2. Avoid assigning of fault or blame, but point out who is responsible for what.
3. Individuals faced with loss frequently have magical thinking about the causes of the loss and about remedies for their pain. It is important to identify both of these in children and youth and help them fit their perceptions with reality.
6. Circumstances of the separation itslef including preparation, and the attitudes of both those that the child is being separated from and of those he will be with following the separation.
1. Abrupt separations or losses are the most difficult.
2. Post separation-contacts are important in terms of resolution.
7. Child's adaptive mechanisms--temperament--"fight" or "flight."
8. Environment from which the child is moved.
9. In general, the stronger the attachments and the more precipitous the separation, the more difficult it will be to resolve the grief.

Grief Process

1. Bowlby describes the stages of grieving in the well-attached young child (6 months-4 years) as:
1. Protest--crying and attempts to recover attachment object
2. Despair--child appears preoccupied and depressed yet continues to be watchful
3. Emotional Detachment--loss of interest in caretakers
2. Elizabeth Kebler-Ross identifies five stages in the grief process.
1. Shock/denial: Most commonly seen in abrupt loss initially may show little emotion and appear mechnaical, goin through the motions; physical symptoms prominent during denial, including problems with forgetfulness and appetite and sleep disturbances.
2. Anger: Commonly displaced onto whomever is available.
3. Bargaining: Accompanied by magical, egocentric thinking; "if only I hadn't --------" or "I promise I will never -------"
4. Sadness/despair: Looking sad, withdrawn; little interest in life; may become dependent and clingy
5. Acceptance: Acceptance of what has happened; renewed energy now available for continued growth and change. For the child in foster care there is acceptance of having two sets of parents.
6. Variations in pattern: some children show no anger but move quickly to despair and seem to become "stuck" there. Others seem to become "stuck" in anger and have trouble moving to subsequent stages. Resolution involves dealing with feelings of anger and feelings of despair.
7. Grieving for what never was. The grief process for some children involves grieving for a parent-child relationship that never truly existed. Their grief involves not having a parent who was able to lvoe and care for them on a continuous basis. This form of grieving carries just as much emotional pain but frequently there is less adult support for this type of grief process.
3. Grief is about the present and the future, not about the past. Successful grieving requires: 1) a safe relationship; 2) articulation of the lost dream andd 3) creation of a new world view (Brier)

Loyalty Issues: Children in placement are frequently emotionally torn by loyalty issues. The child may believe that if he is accepting of the placement and becomes emotionally close to his subsequent caregivers that he is being disloyal to the birthparents. Likewise, he may subsequently believe that positive feelings about the birth family indicate disloyalty to the foster family.

1. Adults frequently escalate the loyalty issues for the child by putting him in binds.
2. Adults can do much to decrease the loyalty issues if they treat each other with respect and as if both sets of parents are important in the child's life.

Emotions at the time of separation are many and varied:

1. Scared, anxious, panic, terror about the unknown future.
2. Sad, lost, despair in reaction to missing people.
3. Confusion, bewilderment, numbness and disbelief are especially common when the separation has been abrupt.
4. Anger and rage may be the prominent response.
5. Powerlessness, helplessness, resignation, depersonalization all may accompany the loss of control over one's own life.
6. Guilt, rejection, jealousy of others are common.
7. Excitement, happiness and relief may occasionally be present as well.
8. Individuals may try to avoid painful feelings either by avoidance, running away, keeping very busy, or by substance abuse.

Children may perceive themselves as being given away, taken away, or as being in charge of the move. Psychologically, the healthiest situation occurs when the child believes that he ahs input into the decision making without having full responsibility for it and when there has been adequate preparation for the move.

1. Being "given away" may lead to feelings of inadequacy, incompetency, anger, sadness, guilt, and rejection.
2. Being "taken away" undermines the perceived power of all parent figures. It may lead to feelings of chronic anxiety and fear, as well as perceived loss of control over one's own life.
3. When the child has been in charge of the separation by self reporting abuse or neglect, he may feel responsible for all subsequent events in his own life and in thelives of other family members. He may develop feelings of omnipotence in terms of future adult-child relationships.

Parental reaction to separation. Parents whose children are in placement will have a variety of feelings, ranging from shame, failure and guilt to feelings of sadness and loss, loss of control and anger.

1. Like children at the time of separation parents are likely to experience the common sequential response to loss--shock/denial, anger, bargaining, despair, and finally acceptance.
2. The parents' behavioral expression of their underlying feelings may lead us to think that they are uncaring when in reality they may be inappropriately expressing understandable emotions.
1. Drugs and/or alcohol may be used to dull their senses and decrease pain.
2. During the shock and denial phases of grief, forgetfulness is common; this may be manifested as forgetting to show up for visits or for other appointments.
3. Avoiding visits may be an attempt to avoid either their own or the child's pain. When a parent is self-blaming (s)he may feel (s)he has nothing to offer the child and may tell the child to "just forget me."
4. Feelings of anger may be displaced onto agency personnel, foster parents, or the child.
5. Current separations tend to tap into feelings related to past separations. Many of the birthparents whose children enter care themselves had a series of separations and little support for dealing with the feelings associated with those losses.
6. When parental behaviors seem unhelpful, it is important that the caseworker spend time ascertaining whether these behaviors are part of a long term pattern in terms of interacting with the child or if they are a response to the feelings generated by the separation per se.

Foster family reactions to separation

• Foster parents are expected to develop strong enough attachments that the children they foster can continue to change and grow; they then are expected to transfer those relationships as children leave their homes.
• If they have become attached to the foster child, the foster parents, too, will go through the grief process when the child leaves their home
1. Different members of the foster family may have differing primary emotions about the child leaving. For example, if there have been severe problems during the palcement, the foster parent might feel relief, followed by guilt while one of their children may feel primarily sad--or vice versa.
2. Their feelings will be affected by the amount of input they feel they had into the decision making.
3. Under the best of circumstances, although the foster family may be anxious or apprehensive about the child's future, they may also be happy for the child.
• Foster family members also need to have emotional support in sorting out their feelings.
1. Without this their feelings are likely to become destructive either to the child who is leaving, to the placement agency, or to themselves.
2. By providing emotional support we are modeling ways that the foster parents can help both their foster child(ren) and their birth child(ren) cope with separation and loss.

Minimizing the trauma of separations and losses

1. By adequate preparation. Although many moves into the system are emergency in nature and do not allow for adequate preparation, once a child has entered the foster care system everyone needs to be committed to avoiding precipitous separations.
1. Preplacement visits diminish the fear of the unknown; facilitate the grieving process; provide opportunities to transfer attachments and opportunities to establish postplacement committments.
2. Frequency and duration of preplacemnt visits should be dependent upon the child's age and the strength of the current attachments.
2. Involvement of both the child and his parents in the decision making process.
1. This decreases feelings of helplessness and loss of control.
2. It is easier to get a committment toward a successful separation when everyone feels that they have input into the decision making process.
3. Although it is important that the child and parents have input, decision making rarely lies totally in their hands.
3. Mechanics of the moving process should be aimed at transferring attachments. In this process in general actions speak louder than words.
1. Caretaking methods can be transferred.
2. Permission to go, do well, and develop new relationships is an important aspect of minimizing the long term effects of parent separation and loss.
3. The mechanics of the moving process can be used to facilitate the formation of new attachments.

Purpose of post-placement visits.

1. Assessment of attachments, and identification of family dynamics.
2. Minimizing the trauma of separation. Sharing information and consistent visits are the two most potent methods of facilitating the grieving process and minimizing loyalty conflicts.
3. Strengthen attachments. When the goal is to return to the birth family it is important that attachments to the birth parents be maintained and strengthened.
4. Family therapy. Changes in family interactions cannot occur if there is no contact between family members.
5. Reintegration into the birth family is unlikely to be successful without extensive visiting prior to the replacement.
6. Even when the child will not be returning to a birth or foster family there may be very good reasons to support post-placemnt contact.

Separation problems can interfere with new attachments.

1. The child's emotional energies may be tied up in past relationships so that he is not free to make use of a new environment and its relationships even if they are healthier.
2. It is important to separatne between separation problems and attachment problems. Both may lead to similar behaviors. However, in general, with adequate treatment the prognosis is better for resolution of separation problems than for the treatment of true lack of attachment.
3. Facilitation of the grieving process helps the child become more available for making use of the benefits provided by the new attachments.

Even with optimal support, parental separation and loss issues will periodically resurface throughout an individuals lifetime. There are some predictable ages and stages of development during which the effects of earlier losses may resurface, need to again be grieved, and reintegrated into the continually developing sense of self.

1. Ages 8-9 concomitant with the major leap in cognitive thinking.
2. Early adolesence when the teen must psychologically separate from all important parenting figures, past and present.
3. Late adolesence when emancipation retriggers emotions related to separation and loss.
4. When one is parenting children of the same age as the adult when he/she experienced parental separation/loss.
5. In mid-life.
6. In late life.

Rev. 6/23/98 md