Tag Archives: therapy

Speech and Language Therapy: A Guide

A few weeks ago we met blogger BlogFox at Adoption: The Bear Facts as she answered some questions about herself. This week, we’re pleased to bring you a guest post from BlogFox too.

As a Speech and Language Therapist, I’m not sure we’ve done a great job as a profession in letting other people know what we do. We are not like Ronseal, we don’t just do what it says on our tin. There is an urban myth circulating that all we do is elocution or work on “diction”. No. No, no, no. That is enough to bring an SLT (Speech and Language Therapist) out in a cold sweat. We can (hopefully) offer a lot more than that. Here is my guide to what we do offer and why your child might need us.

SLT’s see children who:
• Are non-verbal or have very little speech.
Unfortunately, there is another myth circulating that if your children are pre-verbal they wouldn’t need any SLT support. In reality, they need an SLT more than most. Verbal language is not the only way to communicate. There are many alternative systems that we can provide/ advise upon: using objects, pictures, books, signs or electronic devices to replace or enhance the spoken word.

• Have difficulties with social communication (interacting with others)
This could range from children on the Autistic Spectrum to those who require more support due to their attachment difficulties.
SLTs are often involved in assessing this area of communication and might work with other professionals to make decisions around diagnoses. This is useful because Autism and Language Disorder can present similarly but are very different diagnoses.
Difficulties with attachment can also be confused with Autism so it is important that any professionals involved in diagnosis have sufficient knowledge of early trauma and loss and how this can impact a child’s development.
Children with social communication difficulties are frequently anxious and struggle with change. An SLT can provide advice/ training around the use of Visual Supports (timetables, now/next boards etc) and Social Stories to lower anxiety.

• Have difficulties understanding what they hear
The process of listening to and processing spoken language is complex. There are many things that can go wrong – from difficulties learning the meaning of new vocabulary; to difficulty processing too much information at once; to difficulties learning language concepts (big, hot, fast, different etc) to difficulties interpreting non-literal language e.g. “pull your socks up” doesn’t actually mean pull up your socks.
Knowing what your child can/ cannot understand can really help in everyday parenting, especially when it comes to behaviour management. Are they being disobedient or are they struggling to understand what you mean?

• Have difficulties using language to express themselves
Children need to hear language (used within all the right contexts) to be able to learn it and use it themselves. As many of our children have experienced neglect, they probably were not exposed to good language models as infants and consequently many continue to have delayed language skills for their age. An SLT can look at where they are up to and what gaps they may have e.g. a poor range of vocabulary, difficulty putting words together to make longer sentences, difficulty applying grammar rules and can provide advice/ therapy accordingly.

• Have unclear speech
This is the bit people confuse with elocution! What an SLT will actually do is decide what type of speech difficulty your child has. It could be Speech Delay (their speech is following a typical pattern of development but more slowly) or Speech Disorder (the mistakes they make are not part of a typical developmental pattern). There are some very specific speech disorders such as Verbal Dyspraxia which require more tailored therapy approaches.

• Have difficulties with fluency (Stammering)
This is a complex area of communication and usually involves the SLT considering all aspects of a child’s life – their health, background, communication skills, routines, environment as all of these things can impact upon a child’s ability to be fluent. This is one area of communication that can worsen without treatment.

• Have difficulties with their voice
Children whose voice is frequently hoarse or husky or disappears completely, may benefit from seeing an SLT. They will usually be referred to ENT (Ear, Nose and Throat) too, to rule out a physical problem (e.g. Vocal nodules) but an SLT will work with them to improve the sound of their voice and help them to look after their voice.

• Have difficulties speaking in different situations
There is a rare Speech and Language condition called Selective Mutism. It is a fear of speaking and results in a child being able to speak freely in some situations e.g. at home and not at all in others e.g. at school. It has its roots in Psychology but is generally treated by SLTs. I mention this because I do wonder whether there could be a higher incidence of this condition in children who have experienced trauma (based on my own professional hunch only).

What to do if you are concerned about any aspect of your child’s communication:

Every child is entitled to NHS Speech and Language Therapy so contact your local department. Many will accept referrals directly from parents. If they don’t, your Health Visitor or Nursery/ School should know the referral procedure or can refer for you.

If you are not sure or have any questions, feel free to ask me by commenting below or e-mail me at blogfox14@hotmail.com

Here are some further sources of information:

www.afasic.org.uk
www.ican.org.uk
www.stammering.org
www.autism.org.uk

If you decide you want to explore the private route to getting therapy, you can find local therapists here:
www.helpwithtalking.com

Your experiences of SLT:
Have any of you accessed Speech and Language Therapy for your children? Did you find it useful? Were there any shortcomings?
Did the therapist take into consideration your child’s background and communication difficulties you might be having as a household?
I am doing some work on trying to set up a Specialist SLT Service for adopted children and would love to hear your views.

What are your Experiences of DDP?

Today our mum from Life on the Frontline asks you to share your DDP experiences.

Recently I wrote about how Tall and I had started DDP therapy. The first session brought about a very horrid evening. Tall was angry and aggressive in a way I’d not seen for a while and, as my husband was not at home, I was actually fairly scared of what might occur. Thankfully I managed to defuse the situation and all was well the next day. However, I was left with a sense of oh my goodness can I cope with this again on a regular bases. Very selfishly I feel that I’m actually starting to get my life back a little, teaching my yoga classes and both boys doing better in school, well at least there most days for a full day.

depressionWe have since had two more sessions and there has not been a similar occurrence afterwards, however, we’ve not been digging too deeply just yet. I know it will take a bit of time for Tall to feel able to share certain emotions. I’m not about to abandon the DDP therapy, I know it’s much needed and will really help us all. I know I was just feeling a little scared after that first session and I now know what to expect might happen and I can prepare for it. I’m sure it’s going to get harder before it gets better. What I’d like to ask of you, is to share your own experiences of DDP therapy?

Did it get worse before it got better?

Did it help your family?

How did it help?

Do you have any tips on supporting your child through this tough type of therapy?

Therapeutic Services and the Adoption Support Fund

The Government recently announced that from 1st May 2015, adoptive parents throughout England can benefit from new funding under the Adoption Support Fund (ASF).

£19.3 million worth of extra funding is available to support adoptive families across England to ensure they get access to the best possible care and support.

The goal is to help adopted children recover from previous experiences, bond with their new adoptive families and settle into their new forever homes and they plan to achieve this through the use of free therapeutic services.

Edward Timpson, Minister for Children and Families, said:

“We know that children adopted from care have often lived through terrible experiences which do not just simply disappear once they have settled with their new families.

The Adoption Support Fund will provide adoptive families with the right support – from cognitive therapy to music and play therapy and attachment based therapy – to ensure that these children have a stable and fulfilling childhood – a fundamental right for every child, no matter what their starting point in life”.

It is available to all children adopted from care in England and not just newly adopted children. The ASF will pay for post-adoption-order support for children adopted up to the age of 18 (25-years-old with an SEN statement). It is not applicable to inter-country adoptions.

What Are Therapeutic Services?

The Adoption Support Fund will pay for therapeutic services that are not currently provided including:

  • Dyadic Developmental Psychotherapy
  • Therapeutic parenting courses
  • CAMHS assessment
  • Multidisciplinary assessment including education and health
  • Cognitive and neuropsychological assessment
  • Other mental health assessment
  • Psychotherapy
  • Theraplay
  • Filial therapy
  • Music therapy
  • Art therapy
  • Drama therapy
  • Eye Movement Desensitisation and Reprocessing (EMDR)
  • Sensory integration therapy
  • Non-violent resistance training

What will the Adoption Support Fund NOT pay for?

  • Support for physical medical conditions
  • Speech and language therapy, physical therapy, occupational therapy, and other universal health services.
  • Education support
  • Membership of clubs and organisations
  • Legal support
  • Support provided by private sector and third sector organisations that are not Ofsted regulated unless commissioned through Local Authorities
  • Training of staff
  • Support not delivered in England, Scotland, Wales and Northern Ireland
  • Animal, pet or equine therapy
  • Ex- Local authority (associate) social workers

 How Can I Get Therapeutic Services for My Adopted Child?

  • Get in touch with your allocated adoption authority/agency for an assessment of your adoption support needs.
  • The local authority that placed the child with you is responsible for assessing your adoption support needs for three years after the adoption, and then it becomes the responsibility of the local authority where you live.
  • The adoption agency will then submit your application for funding before an Adoption Order.
  • They will then consider if therapeutic support is needed as well as the type required and if it is eligible for payments from the fund.
  • The Adoption Team will then seek the support that is available and apply directly to the Adoption Support Fund on your behalf.
  • If funding is approved, the Adoption Support Fund then transfers the funds so we can purchase your support.

How Effective Are Therapeutic Services?

There is limited hard evidence on the effectiveness of different therapeutic approaches. But therapy in general has been found to relieve aspects of distress and ensure the wellbeing of children.

Findings published in 2011  ‘An Effective Way of Promoting Children’s Wellbeing and Alleviating Emotional, Behavioural and Mental Health Problems – revealed that between 74% and 83% of children receiving play therapy showed a positive change.

We can expect however a research report to be completed in June 2015 by Durham and Bristol Universities. The NSPCC-funded study, which commenced in April 2013, will evaluate the effectiveness of therapy service for children affected by sexual abuse.

This article was provided by Lancashire-based, Blackpool Council Adoption Support Team.
We provide a wealth of experience, knowledge and support for the North West. The new Adoption Support Fund will be a great opportunity for many adoptive families and we aim to help you access such specialist services.

The Adoption Social have previously published a number of posts about the Adoption Support Fund, including our recent response from Edward Timpson MP which you can find here.

Other related posts include:
The Adoption Support Fund
Launching the Adoption Support Fund Prototype
Helping our children at school – a breakthrough in support from Local Authority
Taking Action with #MeetTheMinister
#MeetTheMinister round-up

And we’re pleased to announce that on 6th August we’ll be hosting another Twitter chat to enable you to feedback your thoughts and experiences of the Adoption Support Fund to some of those who sit on the Expert Advisory Group who can in turn, use your experiences to improve the Adoption Support Fund and it’s access. More info coming soon.

Anna Writes: What’s helped

Phonto

Our resident columnist Anna is back again after a break for our Adoption Sore Point week, this time talking about what’s helped her…

A couple of posts in and I feel as though I’d like to offer some balance, I can’t change my experiences, they are as they are, but I have been reflecting on some of the things that I have found helpful along the way.

I was adopted at the end of the 1970’s at a time when the adoption of a child was more often through relinquishment than removal and the general consensus seemed to be that ‘what babies don’t know, won’t hurt them’ – the theory being that if you adopted a child young enough, they wouldn’t ever know any different (I’m not entirely sure what the thinking was around older children…)

Now, although adoption support is still not universal, it is at least being recognised as necessary and the advent of the adoption support fund (ASF) will hopefully provide some much needed intervention and support for all of those impacted by adoption. Adopted people are over- represented within the mental health system in the UK, it seems as good a time as any to begin to address this and get the right support in place for families, sooner.

For me, one of the most helpful things growing up, was knowing other people who were adopted- living in the middle of nowhere this was a bit of a challenge, but there was another boy in my school who was adopted. We never talked about it (and nor did my adopted brother and I, save for one conversation where he told me he never wanted to discuss it again) but it was enough to know there were other people. I wasn’t the outsider that I felt like.

As a bit of a music/ comedy/ literature fiend growing up- I discovered some of my favourite artists were adopted, Wendy James from Transvision Vamp, Jackie Kay, Jeanette Winterson and the comedian Stewart Lee and each time I discovered another I felt less alone. I had fantasy conversations with them and they just got me, and I them, because in my head they would know what it felt like, adoption was a shortcut to understanding.

I also had therapy, lots and lots of therapy, from 14 onwards- unfortunately my parents, not being au fait with attachment theory bundled me off to a boarding school at 16 as they found it hard to cope with my me-ness, so for two years I felt rejected, abandoned and displaced all over again, without really understanding why, but at least I had my music, my books and my friends, a surrogate family of people who put up with me in spite of (or maybe because of) how I was.

At 18, I moved away and had my first experience of person centred counselling, it was via the University counselling service and lasted a whole year- accessing a whole year of therapy was wonderful ..and at last I didn’t have someone telling me that what I was feeling was wrong, or ungrateful, or weird, my counsellor accepted me, completely, and wow!…that was powerful. The idea that someone could accept all the different parts of me, the light and the shade was almost overwhelming, and the fact that I could internalise some of it helped immeasurably over the following few years..

And I wanted more, so at various times since, I have engaged in the same kind of counselling, I am still seeing the same counsellor I started seeing 8 years ago when I found my birth mother and she is amazing, she doesn’t judge, she doesn’t offer me her version of events or interpret, she just listens, and accepts and she even went out and bought a copy of ‘The Primal Wound’ by Nancy Newton-Verrier in order to understand me better: now that’s commitment..

With hindsight, I think what would have helped me at home growing up would have been lots of expressed love backed up with a healthy dollop of evidence, the time and space to talk about being adopted, empathic understanding (including asking how I was feeling) firm boundaries and an ability to hold my needs in mind- I’m sure my adoptive parents did their best, and certainly thought they were doing it- but unfortunately the things that I needed most (love and acceptance) were traded in for money and projected wants.

Please don’t get me wrong, I know that my adoptive parents really tried and I certainly didn’t give them the easiest ride, but the generation chasm between us and my adoptive mothers unresolved attachment issues coupled with some fairly regular corporal punishment (it was the 80’s…)  did not make for a secure base.

Not everyone wants to be a therapist, but many people already have the skills, values and attributes to offer children unconditional love, empathy and genuineness, but people shouldn’t have to provide that in a vacuum- the ASF offers many types of therapeutic support, several of which are specifically aimed at the whole family, which I hope, can only be a good thing.

So below, I have reproduced the list of recommended therapies potentially accessible via the ASF, to highlight what’s available now- and it’s great that it is (although a comprehensive glossary of all the different therapies would be helpful too) I hope that the choice on offer reflects the needs of those accessing it and that alternatives to the list aren’t discounted out of hand either.

The Adoption Support Fund will pay for therapeutic support and services including but not restricted to:

Therapeutic parenting training
Further more complex assessment (e.g CAMHS assessment, multidisciplinary assessment including education and heath, cognitive and neuropsychological assessment, other mental health needs assessment.)
Dyadic Developmental Psychotherapy
Theraplay
Filial therapy
Creative therapies e.g. art, music, drama, play
Eye Movement Desensitisation and Reprocessing Therapy (EMDR)
Non-Violent Resistance (NVR)
Sensory integration therapy
Multisystemic therapy
Psychotherapy
Specialist clinical assessments where required (e.g. Foetal Alcohol Spectrum Disorder)
Extensive therapeutic life story work
Respite care (where it is part of a therapeutic intervention)

Source: First4Adoption, 2015

Anna. W

The Apple Tree Centre and CPRT

Today we’re pleased to bring you a guest post from the newly launched Apple Tree Centre…

Logo - Text

We are Rosie and Jenny, two Play Therapists and mothers to small children. Just this month, we launched The Apple Tree Centre in Sheffield.   As part of our work to support children, young people and families, we are running Child Parent Relationship training courses for parents and carers.

Child-Parent Relationship Therapy (CPRT) is a structured training programme for parents and carers. Delivered by qualified and experienced Play Therapists, the course introduces parents to the essential principles and skills used in Non-Directive Play Therapy, so that they can become “therapeutic agents” for their own children. The training is usually provided to small groups of adults, in ten weekly sessions of two hours each. Additional individual support can be offered if this is needed.

Play is really important to children because it is the most natural way children learn, process experiences and communicate their thoughts and feelings. Bearing this in mind, we train parents and carers to conduct special 30-minute playtimes with their child in their own home, using a kit of carefully selected toys. The adults learn how to respond empathically to their child’s feelings, build their child’s self-esteem, help their child learn self-control and self-responsibility, and set therapeutic limits during these playtimes. For 30 minutes each week, the child is the absolute focus and the adult creates an accepting atmosphere in which the child feels safe to express themselves through their play. This is not a ‘normal’ playtime. It is a special playtime in which the adult follows the lead of the child. Within this half hour, there is no criticism of the child or the play, no praise, no questioning or instructions for the child on what to do or how to do it, and no evaluation of the child’s behaviour or what he or she has produced.

During these special playtimes, the parent/carer will build a different kind of relationship with their child, and the child will discover that they are capable, valid, understood, and accepted just the way they are. When children play under these conditions, they are free to explore their worries in the play and, in the process, release anxieties, stresses, and burdens. The child will then feel more positive about themselves and this will bring about significant differences in their behaviour. CPRT trains parents and carers to focus on the child rather than the child’s problem, and they will begin to react differently to their child both inside and outside of the special playtime.

Co-founders Jenny Reid and Rosie Dymond at the launch of The Apple Tree Centre

Co-founders Jenny Reid and Rosie Dymond at the launch of The Apple Tree Centre

The course is delivered through a mixture of presentations, video clips, group discussions, demonstration and skills practice, including discussion and debrief of the play sessions carried out at home.

Parents are taught

  • to identify and respond to their children’s feelings
  • to use active and reflective listening skills
  • to set effective limits, and
  • to enhance their children’s self esteem.

CPRT is equally suited to enhancing already positive parent-child relationships, enabling parents to support their children through particularly difficult experiences, and helping to build relationships which are new or have been damaged by ill health or life events. The system has proven effective in many different situations, including

  • families with step parents and children
  • foster and adoptive families
  • parents who are imprisoned
  • families affected by physical and mental illness
  • children recovering from trauma and abuse.

CPRT was developed in the United States by Dr. Gary Landreth, from the University of North Texas: a respected practitioner and teacher of Play Therapy. The programme is relatively new to the UK. However, the principles on which it is based have been used therapeutically since the 1960s, and the programme is constantly adapted to ensure that it is equally appropriate for parents, carers and families in Britain. We are really excited to be able to offer the training here in Sheffield, and look forward to contributing to the evaluation of its effectiveness here in the UK.

If you’d like more information about what we offer, please look at our website: www.appletreecentre.co.uk

 

Support, training and therapy glossary

A few weeks ago, we brought you an Adoption Lingo Glossary which has been a really popular post. So moving on a little, but in the same vein, this week we’ve got another glossary, but also a bit of demystification on some support, parenting courses and therapeutic interventions that you might come across. Please note we are not advocating all of these as appropriate strategies, but merely explaining what they might involve, and it’s definitely not an exhaustive list.

Attachment Focussed Counselling/Therapy – Family counselling to help improve attachment issues between children and their carers. Helps bonding, and builds positive images between parent and child.

Attachment Parenting – a term to describe a parenting philosophy used in both birth and adoptive families, used to help promote positive attachments.

Child to parent violence (CPV) – a term to describe domestic violence directed at parent, by child.

Dyadic Developmental Psychotherapy (DDP) – Developed by Dan Hughes, this is a continuation of PACE that is suitable for day to day parenting. This is a therapy that aims to help children who have suffered trauma, learn – amongst other things – to trust again.

Incredible Years/Webster-Stratton – a parenting program, occasionally offered by schools, developed by Carolyn Webster-Stratton. This behaviour modification technique uses time-outs and reward charts amongst other strategies.

Marschak Intervention Method (MIM) – an assessment, by way of a structured technique to help plan treatment and check suitability of therapies such as Theraplay. Usually videotaped, but not to be used alone in making assessments – best alongside other means of assessment.

Non violent resistance (NVR) – is a psychological approach for overcoming destructive, aggressive, controlling and risk-taking behaviour.

PLACE/PACE – Playfulness, (Love), Acceptance, Curiosity and Empathy. These are core parts of DDP, developed by Dan Hughes. Using these principles, children and parents can communicate more effectively.

Play therapy – a form of counselling or therapy that uses play to help patients communicate.

Self-care – a term to describe looking after oneself. A hot topic in adoption at the moment, self-care can include all manner of activities, all with the aim of caring for yourself.

Sensory Integration Therapy – a clinical approach to treating sensory issues. Usually an assessment is undertaken first, then a personalised programme of support is put in place to help overcome sensory issues.

Speech and language therapy (SALT) – Treatment to improve and treat speech and/or language delay, and can also include eating, drinking and swallowing issues.

Therapeutic Parenting – a term usually used to describe high structure, high nurture parenting.

Theraplay – a therapy to improve communication and attachment. Theraplay uses fun games and nurturing activities, where children and parents are led by the therapist. Such activities create an emotional connection between parent and child.

Triple P – The Positive Parenting Program is a parenting technique to help prevent and treat behavioural and emotional problems in children and teenagers.

User-led support – a term to describe support and help from other people who are using the same services as you, or in the same boat as you i.e The Adoption Social and The Open Nest.

What else have you come across? Other techniques or therapies?
Do please share in the comments below to help others understand what’s out there.

Will I have to choose between them?

Today’s problem comes from adoptive mum Rachel, who is worried about the way her husband is parenting their son…if you have any advice, or have been through something similar, please do share your experiences too.

ProblemI’m really struggling with my husband at the moment. He knows about attachment, he knows about therapeutic parenting, he knows our son’s background, and he knows that our son is very good at identifying and pushing buttons, but…he just can’t put it into practise.

We’ve been a family, him, me and our son for 5 years. We’re not new adopters, and I’ve been on many courses and fed back to my husband (unfortunately he just can’t get the time off to attend himself), he’s come to therapy when he can, and he’s even read and watched Dan Hughes (isn’t YouTube great?!).

He just can’t implement it. I really struggle to see him getting so cross at our son – shouting sometimes, sending him to his room, physically removing our son from situations, rather than moving himself into another room. It undoes all the hard work that I put in. It scares our son.

I’m worried that we’ll soon be at the point where I have to choose between them. Losing his father will be traumatic for our son, but surely this behaviour is just as damaging?

Moving on…

051Today’s blogless blog post comes from an adoptive mum. Lesley adopted Missy close to 8 years ago, and has just survived her first year of training on an MA in Child Psychotherapy.   

It’s the end of Missy’s therapy but the tears are all mine.

I had my last review meeting with Missy’s psychotherapist today.  She has completed her CAMHS training and now she’s moving on to another clinic.  It’s time for a new psychotherapist then. Time for a final report summing up what she has made of my little Missy.  Time to reflect. 

I admit – there have been times when I have truly resented her and the cool calm manner in which she talks to me and Missy. She’s so unlike the hurt, exhausted, anxious, distressed Mummy that I am.

I’ve wanted to say to her “See…you have her for 1 hr a week – now you know how I feel 7 days a week /24 hours!”

I don’t have a quiet, controlled little room and masses of resources and a team of specialists to help me reflect on how to make sense of her.  Missy has me, and our family and our chaotic home and somehow we’ve got to stand in the gap while she strays further and further from real life.  It feels like  a frantic, fruitless emotional battle most days.
I’ve wanted to yell at her for getting cross with me when I didn’t bring Missy to a session the same day as we had a TAF meeting.  “This is your job.” I thought.  “You get paid for this.”

Turning up to weekly meetings and reviews and therapy is what I’ve had to take on, part and parcel because it’s for Missy and if we can help her development we can have a hope that one day we’ll all have a life again.
It’s uncertain, it’s laborious and it’s a reward that I can only hope for, but it doesn’t pay the bills.  I forfeit my earnings in order to make the time to do this. That’s not easy to do in times of debt, stress and austerity.  

So I wonder why I’m in tears now, as I look at her report. I see her thoughts in black and white.  Now I know that she saw how hard I try to meet Missy’s needs when she’s anxiously climbing over furniture because she doesn’t want to go into the therapy room. I know she sees Missy’s face light up when she runs out of therapy to meet me.

I know that she too sees a terrified, hurt, angry little girl who hasn’t decided yet if she wants to grow up in order to cope with a world that has already failed her and which seems to be messed up in so many ways.

She’s Missy’s therapist, not mine.  Maybe it’s the realisation that Missy will be reminded of countless people who have walked in and out of her life already. Maybe it’s because for nearly 3 years I had somebody who knew Missy and could see her, just for one tiny hour a week in the same way that I do.  Maybe I’m angry at being reminded that she has the freedom to move on to a new job and new clients – but Missy still needs her so much.  She thought about Missy, remembered her, discussed her.  She pondered what was going on for her.  There was somebody else who emotionally held Missy the way I do, and somehow that meant so much more than I ever imagined. 

So – the hour is up in our last review and there’s not much more to say.  I nod at her and smile while I swallow hard and hold back my tears. Missy is pretending that she just needs to meet her new psychotherapist – that’s her way to avoid feeling loss.  I’m left holding her pain as well as my shock that I’m feeling anything at all and I’m struggling to hold it all in.

All I manage is a feeble, “Thanks, so much…for everything!” and somehow, I know that if she’s seen and known Missy, if she’s managed to make sense of her behaviour, she will also see what I can’t find the words for just now.  She’ll know that I’m so grateful, and sad and yet still hopeful.  And she’ll know that our difficult journey has been so much richer for having her with us.