Requirements for a Successful

By Nancy Spoolstra, DVM, Executive Director of ATN

One of the questions I’m most often asked by distressed parents from around the country is "What treatment options do we have?" The most frequent inquiry focuses on an "intensive", or an intense therapeutic intervention, therapy that occurs over several continuous days as a “jumpstart” toward healing.  These intensives are often VERY successful interventions, but are also very expensive, exhausting and emotionally charged.  There are as many specific approaches to an intensive as there are therapists who utilize them, each bringing their own style and combination of modalities to the mix.  But in addition to feeling comfortable with the therapist and his/her approach, there are, in my opinion, five factors that should be present for any type of intensive to have a fair chance of being successful. Those requirements include:

  1. The child must be interested at some level of consciousness in making changes in their own lives. Many therapists require that the child contract with the therapist. It is true that any good therapist can convince about any child to "parrot" the "correct" words. This is especially true for a child facing a therapeutic intervention about which they are uncertain. But at some level, the child must be sufficiently dissatisfied with their current life to have some investment in the outcome of therapy. Paula Pickle, Executive Director of ACE, defines this dissatisfaction as a "conflict" that the child must have regarding how his or her life is going. If they have no conflict, can the adults in their environment create enough dissatisfaction to encourage the child to change? I personally believe this to be especially important when dealing with older children. Very young children are often not as established as "solo acts" and are more amenable to the suggestions of the adults responsible for their care. In Dr. Welch’s approach, contracting is not required, but she does not quit until the child capitulates and acquiesces to the family.
  2. After the intensive, the day-to-day effort of reparenting a very troubled child still falls on the family. This family must be incredibly dedicated and committed to helping this child to the best of that family’s ability. It is crucial that they are not too burned out. Sadly, by the time many families get the agencies and mental health professionals to realize just how stressed the family is, it is too late to save the placement. This intensive work must be done when the family still has the energy and interest to do it!
  3. There must be a trained and available therapist locally to continue the work at home. ACE requires a hometown therapist to attend the intensive. In the case of Martha Welch’s approach, a therapist is not required to attend, but is necessary for follow-up. Again, this is not follow-up with conventional psychotherapy, but instead is attachment-oriented therapy. I know of a case where the hometown therapist was trained in attachment work specifically for the child that received the intensive. While her efforts were commendable, her lack of experience made it difficult for her to adequately support the parents after the intensive.
  4. There should be well-trained respite providers to keep the child moving in the right direction while still providing the parents with a much-needed opportunity to re-energize and recuperate from the exhaustive task of parenting a RAD child. The intensive is just a jump-start -- the real task lies with the family. Also critical to success is the establishment of a total environment that is supportive of the family and their efforts. This includes schools, the juvenile justice system, child protective services, neighbors, church family, extended family – in short, anyone and everyone who interacts with the RAD child and their family. Unfortunately, this ideal is often impossible to achieve, and also requires additional time and effort from a family already stretched beyond their capacity.
  5. There must be funds to pay for the intensive treatment and follow-up. Most families who come to me have spent vast sums of money on therapies that don’t work, on short-term residential placements or hospital evaluations, on damages to house, property and animals, etc. By the time they get to me they are broke, angry, resentful, depressed, suffering from Post Traumatic Stress Disorder, and losing ground fast. Families adopting domestic special-needs children should negotiate the subsidy and funds to pay for an intensive before finalizing the adoption. Additionally, it would be wise to negotiate funds to pay for a period of residential treatment should that step be necessary. Families adopting internationally are usually out-of-luck in procuring financial assistance, although I am told it is possible in some cases. We certainly never found any financial support either from the government or from our international placing agency. Unfortunately, most insurance companies and HMO’s run the other way if "holding therapy" is even mentioned or “unusual” session lengths, such as a multiple-day intensive, are pursued. How sad, for this is often the best and only way to reach our troubled children. Usually, this expensive treatment approach must be funded privately, and many families do not have the resources to do so.

It is my opinion that all five of these factors should be present to maximize the possibility of a successful intensive intervention. Certainly there have been successful therapeutic results in families where several of these items were absent. Each family is a unique working model, and each child a totally unique individual. These suggestions are offered as guidelines to assist families in deciding just what is their best option. They are offered from the frame of reference of an individual who has experienced that decision-making process, as well as listened to the frustrations of many, many families trying to make a similar decision. Hopefully these ideas will assist others in deciding what is best for their child and their family.  


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