We Are Now Published In German by Beltz

A different book jacket and title that translates roughly into “The Car Is Parked At The Bridge. I Am Sorry. A Father’s Search For Answers To His Daughter’s Suicide.”

With over 80 million people, Germany is the largest country in Europe.

9783407864161

The Girl Behind The Door: A Memoir By John Brooks

TGBTD-eBookCov_03-600“This book should be a wakeup call to all adoptive parents and professionals about the urgent issues adoptees and their parents face.”

Nancy Newton Verrier, attachment therapist and author

The Primal Wound and Coming Home to Self

A Marin County, California father embarks on a journey to understand what led his seventeen-year-old daughter, Casey, to take her life. He travels back to her abandonment at birth and adoption from a Polish orphanage. His search leads to a condition known as attachment disorder, an affliction common among children who have been abandoned, neglected or abused. It explained everything. The Girl Behind The Door integrates a tragic personal adoption story with information from the experts to teach other families what the Brookses learned too late.

Who should read it?

    Anyone with a connection to the adoption “triad.”
    Anyone who has lost a loved one to suicide.
    Anyone who cried through the movie Philomena.
    Anyone who knows us and wants to read our story.

Available now on Amazon in print and Kindle version. Soon to be released on the Apple iBookstore, Barnes & Noble online, Sony Reader Store, Kobo and more.

Five What-To-Do’s When Adopting Your Child

For those of you who read this blog you know that our adoption experience ended tragically with our daughter, Casey’s, suicide in 2008. I chronicle the difficulties we had in raising her and the mysteries surrounding her sometimes-extreme behavior. Yet for all of the difficulties and heartache there was far more joy in being the father of this amazing child. I simply couldn’t have been luckier to have been Casey’s dad. I never had the slightest thought of “what if,” as in what if we’d had a biological child. Still, we were shrouded in ignorance and the results were catastrophic. In my as-yet-published book, The Girl Behind The Door, I share all of my lessons learned about how to do adoption right to minimize misfires in an imperfect system of creating a family.

Here are five what-to-dos in the initial phase of adopting your child. You could also call this, Five Things The Brookses did – Now Do The Opposite. One caveat here – these assume we live in an ideal adoption world, and this world is far from ideal.

couple-meeting-with-adoption-agencyBe skeptical about adoption agencies or intermediaries who sugarcoat the downside of adoption and parenting. Both sides come to this relationship with conflicts of interest that can skew judgment. In our case nothing was known about potential pitfalls with adopted children down the road, so we went in blissfully ignorant. Adoptive parents are aching for a child while adoption agencies are in the business of placing children with families. This is a noble cause, but it also risks being compromised by pairing the wrong children with the wrong families. I know ow difficult it is for adoptive parents to challenge the “gatekeepers” when they feel so vulnerable. Just prepare for a healthy dose of skepticism and ask about how best to prepare for parenting once your child is home.

Casey Photos 1991-96_0024Once your child has been identified, find out as much as you can about her family, medical history, behaviors, and personality. This is a “no duh” suggestion, but oftentimes reliable answers are elusive. They were for us. Could we have tried harder? We’ll never know. And of course by now once you’ve seen that first photo of your child you’re hopelessly in love. So there is a natural inclination to not rock the boat and blow the deal with too many nosy questions.

n1051794010_19775_9940If you meet your child at an orphanage scope it out, take photos and videos. Again, easier said than done. I remember how petrified we were at the orphanage in Poland. We could barely speak let alone have the presence of mind to ask intelligent questions, a fact complicated by the fact that we (or I) didn’t speak Polish. We just wanted to grab Casey and race away as quickly as possible. We were shown to a visitation room but never saw any other part of the orphanage, and we were too afraid to ask at the risk of insulting the staffers (or our lawyer) and blowing the deal. If I could’ve had a redo, I would’ve wanted to see where Casey slept – the room, her bed, her playthings, other children she may have interacted with. How did she sleep? Did she rock herself? How was her eating? How would she spend the day? I know, easier said than done, but we didn’t even know to do.

Casey Photos 1991-96_0042Very important and not so obvious: Ask to take something of hers with you from the orphanage – some clothes, pajamas (even if they’re smelly or dirty), a pillow, a stuffed animal. As an attachment specialist and adoptive mother told me at UC San Francisco Medical Center, “It’s a child’s instinct to cling.” Of course we knew none of that while we dressed Casey in new, clean American girly clothes. Up till the time she met us all she probably knew was about things being taken from her – no constancy. Adoptees need that familiar attachment to the only home they’d ever know.

Child-View1Once you’re home find a qualified adoption or attachment specialist. Get your child assessed. This is especially important where there are possibilities of exposure to mental health or substance abuse problems. As I’ve said repeatedly, not every adoptee develops attachment or other troubling behavioral issues, but best to chart a plan early on with the right professional. We never did. In fact, after Casey died (after being seen by a multitude of medical and mental health professionals), I visited my GP on an unrelated matter. When I told him what happened, the first thing he asked was, “Was she ever assessed?” And he wasn’t an adoption specialist.

Indeed, many of these to-do items are wish lists in a perfect world where information is freely available and forthcoming, but if you are at least armed with the right questions, you’re far better off than we were back in the darker ages of adoption.

Holding Therapies – Are They Effective?

cranial_sacral_1Following up on last week’s blog post on the different schools of thought about attachment therapy, I’ve done more research into holding therapies. Much of what I’ve read and heard about them is negative, but I’ve also had some positive feedback. In this post I wanted to set predispositions aside for a balanced view of the subject with my usual disclaimer that I come at this as a curious layperson, not a mental health professional.

Like most people, I began my research by Googling “holding therapy.” The results were not positive. In fact, it was hard to find an article supportive of the practice. Here is a sampling of what I found in my search results. Again, I haven’t vetted any of these sites or authors, but the consistently negative tone of each result is telling.

On the site, naturalchild.org, Ms. Jan Hunt wrote an article called The Dangers of Holding Therapy. She notes that holding therapy is recommended in the book Holding Time, by Dr. Martha Welch (I’ll get to her later.) It consists of forced holding by a therapist or parent until the child stops resisting or until a fixed time period has elapsed; sometimes the child is not released until there is eye contact.

She considers this practice to be completely at odds with attachment parenting, which is above all a relationship based on mutual trust. It can be immensely difficult for a child to regain full, genuine trust after being forcibly held – regardless of the parent’s “good intentions” or the resulting surface behavior.

Even if there were an emotional “breakthrough”, it would be at a great hidden cost, as there is no way to avoid the child’s feelings of anger, frustration, resentment, and betrayal. Like spanking and all other forms of punishment, the child may appear to comply, while his deeper feelings become submerged until they can be more freely expressed. Further, where force is used, the authenticity of any “success” is forever in doubt.

As an alternative, Ms. Hunt suggests meeting the child’s legitimate needs (undivided attention, food, sleep, attention to hidden allergies, relief of family stress factors, etc.) Where force is simply unavoidable (the proverbial child running into a street), it should be kept to the barest minimum possible, and followed by gentle explanations and apologies.

On the site, bigthink.com, there was an article titled, Holding Therapy: Blowing The Whistle on Institutionalized Child Abuse in the UK. The article begins by stating that a “bizarre and potentially inhumane treatment which originated in the US” was being used on children in the UK using techniques including scheduled holding, binding, rib cage stimulation and/or licking. Similar but less physically coercive approaches may involve holding the child and psychologically encouraging the child to vent anger toward the parent with the intended purpose of making the child “regress” and attach. The induction of anger is done out of the belief that existing anger blocks attachment and must be “drained” before attachment can occur.

The therapy goes under the names of holding therapy, rage reduction therapy, re-birthing and attachment therapy. It actively induces rage and has only the vaguest background in John Bowlby’s renowned theory of attachment.

According to Professor of Psychology, Jean Mercer, in her piece, Adoption and Fostering, “holding therapy has never been shown to be safe and effective by independently-conducted systematic research designed to show results objectively. Rather than an evidence-based treatment, it is one supported primarily by anecdotes and testimonials that come from parents and therapists rather than the children who experienced the treatment.”

That’s what I heard from Dr. Marvin.

In the blog, charlydmiller.com, I read her piece titled, A Near Death Holding Therapy Survivor’s Story, about an email she received from someone who had had a traumatic experience in holding therapy. In short, the patient spoke of the same kind physical restrictions in the sessions and a lasting effect it had on her ability to trust, among other things. But these were from the 1970’s. Still, I got the picture.

Trying to play devil’s advocate, I thought about therapies that I’d experimented with that were perceived by outsiders as “bizarre and inhumane.” In 1979, I did the est training in a hotel room in Boston. Indeed I wasn’t allowed to go to the bathroom and, at one point, I had such a ferocious headache I thought I’d throw up. I raised my hand and was given an airsickness bag. It was uncomfortable but not traumatic. In fact, it was an eye-opening experience. Similarly, in the 1980’s I tried rebirthing. It sounded interesting but was kind of a let down. There was no holding other than comforting by a “facilitator” but I had trouble imagining myself in my mom’s womb, at birth or in infancy. I did my best while other people in the room were clearly having very strong reactions. I must have been doing something wrong.

Which brings me back to Dr. Martha Welch and her 1989 book, Holding Time. Surely this would shed a positive light to balance my report. According to childrenintherapy.org, she was a clinical professor at Columbia with all sorts of impressive credentials and associations. Unfortunately, in 2003, the Acting Chairman of Columbia’s Psychiatry Department distanced himself from her work. “…Dr. Welch does not utilize bonding therapy or related techniques in her work as part of the Department of Psychiatry. Her efforts here are devoted to non-clinical research. Her work on bonding therapy is conducted outside of her departmental activities.”

The site notes that the first (and to date) only published research on Holding Time appeared in 2006 as a pilot study. Among other questionable things in that research, Welch and her associates used Elizabeth Randolph’s un-validated Attachment Disorder Questionnaire (RADQ) for outcome measures. Meanwhile, Holding Time has been embraced by the “gay-to-straight” movement, probably not the best of endorsements, particularly in light of the controversy surrounding Rep. Michelle Bachman’s husband, Marcus, and their “war” on homosexuality.

So much for me trying to be “Fair and Balanced.” I’m still puzzled by those who claim positive results from this controversial practice and invite any of my readers to point me toward something that supports their viewpoint.

My Enlightening Interview With An Attachment Expert

Apologies go out to my readers for my lack of postings these last couple of weeks.

IMG_0481My wife and I have been swamped moving back into our home – a 1917 cottage on a hillside above Fairfax, California – that has been under renovation for the past six months. On top of that, I just got a new job after being out of the market since Casey’s suicide. Yes they still hire geezers like me out there, amazing as that seems. So the last few weeks have been like fighting off a water cannon.

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dr_marvinThis week I want to share more of my research into different schools of thought over attachment theories and therapies that I learned in an interview with Dr. Robert Marvin. Dr. Marvin is the Director of the Mary D. Ainsworth Child-Parent Attachment Clinic at the University of Virginia Medical Center. He began his career as a research associate with Mary Ainsworth – an early founder with John Bowlby of attachment theory – at Johns Hopkins. For the next four decades, his work focused on attachment research, developing assessment tools for families of foster and adopted children, and intervention with families experiencing varying forms of disrupted relationships and separation.

He talked at length about two groups of professionals who’d worked with children suffering attachment-related difficulties. One group emerged in the 1980’s, comprised primarily of clinicians, who took a behavioral approach to the mysterious disorders observed in children from foster care and orphanages. They developed a group of therapies, most commonly called holding therapies (where the therapist and/or parents literally hold the child in an embrace), but also known as rage reduction, rebirthing and attachment-parenting therapies. Their goal was to regress the child to an earlier age and then bring her back a whole person. Marvin believed that the mistake the clinicians made was to focus on the child’s undesirable behavior as something she did deliberately. Consequently, it had to be to controlled. But their work turned out to be coercive and controversial. These physical forms of therapy sometimes resulted in serious damage to children, including eight deaths, and landed some practitioners in prison.

The second group was comprised of researchers, academics, medical school clinicians and adoption agency staffers whose work was grounded in the Bowlby-Ainsworth theory of attachment. Since the 1950’s, they’ve compiled a huge body of peer-reviewed research, which has been used in the assessment and treatment of children and families with a variety of challenges from disrupted homes.

Marvin’s work rejects the notion that the child’s undesirable behavior (such as rages and tantrums) is deliberately aimed at tormenting those around her. Rather, it’s based on the premise that the child lacked an early parenting partner who could’ve helped her co-regulate her distress. Left without any soothing skills, she’d blow up when upset.

He observed over the years that children neglected in Eastern European orphanages hadn’t had the thousands of interactions that parents and babies have every day, so their brains didn’t develop in the same way as “normal” babies’ brains. He believes that orphanage practices that discourage attachment with caregivers – for fear that the child will suffer when faced with letting go – are more harmful than not allowing the child to attach at all.

“We now know that if the child is adopted within the first year, the adverse effects of institutionalization are not too difficult to treat.” He explained. “But for a child like Casey, adopted at fourteen months, there’s already been a fair amount of psychological and brain development damage that leads to very unusual behavior.”

“This information still hasn’t fully made its way into the mainstream.” He said. “Only in the last few years have we come to realize what’s happened to these kids and how to intervene.”

He went onto tell me that some adoptive parents seemed to know intuitively or trip over the right way to parent these children. Many didn’t, but it wasn’t their fault. He heard from many parents, feeling unloved and exhausted from their efforts to “fix” their child, who felt they had no choice but to hand the child over to a professional. But Marvin claimed that it’s the parents whom the child loves, even though she may not act like it, and it’s the parents who need to lead the child back to a normal developmental pathway.

I came away from this interview with a pretty negative impression of holding therapies, but I talked to other professionals who were not so dismissive of the practice. I’ll look at this further in an upcoming post.

Variations of Attachment

I refer to attachment disorders in the plural because they come in many forms and degrees. To confuse things further, reactive attachment disorder (RAD) and attachment disorder are often used interchangeably, at least to the layperson. In this post I’ll try to clarify things. Bear with me here.

Attachment disorder is a broad term used to describe mood, social and behavioral disorders arising from a failure to form normal attachments in early childhood.

Reactive attachment disorder (RAD) refers to a severe disorder affecting children characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way.

Even after seeking clarification from interviews with experts, I failed to see much difference between the two, so I just stuck with the broad term attachment disorder to avoid confusion.

There are four main types of attachment:

1. Secure: The child uses its parents as a secure base from which to explore the world. If the parent leaves, the child becomes upset, but is happy and easily comforted when the parent returns.

secure2

2. Anxious-ambivalent: The child explores little, preferring to remain close to the parents. He or she becomes highly upset when the parent leaves, and resists interaction with the parent upon his or her return.

ambivalent2

3. Anxious-avoidant: Similar to the anxious-resistant type, but the child does not appear to behave much differently around the parents than he or she would around strangers.

avoidant2

4. Disorganized: For those children whose behavior cannot be described by the three main attachment types.

disorganized2

There might even be a fifth type of attachment known as Oppositional Defiant Disorder, an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.

Attachment Versus Bonding

n1051794010_19776_381_2For years after adopting Casey, we focused our parental attention on bonding with our child. Certainly a nurturing and loving environment at home would erase the past; nurture would triumph over nature. But bonding was only a piece of the attachment puzzle.

The website, helpguide.net, has a good article on the difference between bonding and attachment which is summarized below.

As a parent or primary caretaker for your infant, you can follow all the traditional parenting guidelines, provide around-the-clock care for your baby, and yet still not achieve a secure attachment. You can tend to your baby’s every physical need, keep them safe and dry, provide the highest quality nourishment, and ensure they get all the sleep and mental stimulation they need. You can hold them, cuddle them, massage them, or even sleep with your infant without creating the kind of attachment that fosters the best development for your child. How is it possible to do such a good job of meeting a baby’s physical needs and yet have a child that does not have a secure attachment?

Casey 1990's_0039

The bond of love differs from the attachment bond

The infant’s need for survival and the parent’s need to care for their offspring create a bond of love between parent and child. However, an infant needs something more than love and caregiving in order for their brain and nervous system to develop in the best way possible.

The difference between bonding and a secure attachment
Bonding:
  • Refers to your feelings for and sense of connection to your child that begins before birth and usually develops very quickly in the first weeks after the baby is born.
  • Is task-oriented. You plan and attend to your baby’s regular needs such as changing diapers, feeding, and bathing.
  • You maintain your regular adult pace while attending to your infant. For example, you hurry to change the baby’s diapers so it will be done in time for you to make an important phone call.
  • You as the parent initiate interaction with your baby. For example, you want to get a cute photo of your baby laughing so you initiate play time.
  • You focus on future goals by, for example, trying to do everything you can to have the smartest, happiest baby.
  • You concentrate on planning, reading about, and talking about what your baby needs.
  • Is a process that can include many people—all those who care for your infant.
Secure Attachment:
  • Refers to your child’s emotional connection with you (as primary caregiver) that begins at birth, develops rapidly in the next two years and continues developing throughout life.
  • Requires you to focus on what is happening in the moment between you and your baby. Your infant’s cues tell you that he or she feels unhappy, for example, and you respond.
  • You follow your infant’s slower pace and take the time to decipher and respond to your baby’s nonverbal cues that communicate, for example, “I’m in no hurry, I just want to explore you and me.”
  • Your infant initiates and ends the interaction between you. You pick up on your baby’s nonverbal cue that he or she is exhausted and needs to rest, so you postpone taking a cute photo and stop trying to engage the baby in play.
  • You focus solely on the moment-to-moment experience, just enjoying connecting with your baby.
  • You concentrate on the emotional interchange that occurs between you and your baby.
  • Happens with only one person at a time—namely, the primary caretaker.
Why so much confusion about bonding and attachment?

The words bond or bonding are commonly used to describe both caretaking and the emotional exchange that forms the attachment process, even though they are very different ways of connecting with your baby.

  • One is a connection based on the care a parent provides for an infant, while the other is based on the quality of nonverbal emotional communication that occurs between parent and child.
  • Both types of parent-child interaction can occur simultaneously. While feeding or bathing your baby, for example, you can also build the emotional connection by recognizing and responding to your baby’s nonverbal cues.

Before experts understood the radical changes going on in the infant brain during the first months and years of life, both the caretaking process and the attachment process looked very similar. Now, though, they are able to recognize and painstakingly record an infant’s nonverbal responses to highlight the process of attachment.