Occasionally someone will call to ask how long emotion-focused therapy for their child would take if they were to come in.  I find two variables affect this.

One variable is the severity of the child’s current and previous dysregulation.  I.e., what is the width and depth of disruption so far?

The other variable is the capacity of the adult attachment figures to apply therapeutic parenting at home between sessions.  I.e., can they manage to shift to counter-intuitive responses when provoked?  Can they shift to time-ins instead of time-outs?  Shift to empathy versus reassurance?  Can they privilege preverbal and relational messages over cognitive logic?  (One adoptive father declared, “It’s like thinking backwards – and then it works!”)

Not every parent is ready to do this immediately. RS Toronto best

Let me illustrate with two examples – one a typically short case, and one lengthy.

Typically short case:

A child adopted from overseas was doing fine in his new home until parents decided to adopt a second child.  He then regressed to his old orphanage behaviors.  Parents called for help.

Parents were first seen without the child, to help them focus on his underlying fear (fear of abandonment, fear of being exchanged or replaced, fear of not being good enough, etc.)  Then they practiced how to respond to the child with P.A.C.E. instead of reassurance.  I.e., “You will be alright” does not reduce anxiety, but  Playfulness, Acceptance, Curiosity and Empathy do.  (But postpone playfulness if a child is upset.  They hear it as sarcasm.)

Then they brought the child in for family sessions.  Because he was nervous – (thinking Now I’m in for it!) – we let him just sit between parents on the couch and listen like a very young child is allowed to do.  He could soak up the safe atmosphere of feeling wanted, surrounded, contained, and clearly in our thoughts as we talked kindly (with PACE) about him, his struggles, and the fears driving his acting out.  The adult talk finally met and matched the needs of his inner thoughts and feelings!  He felt secure and accepted again, and we were done in four sessions, plus parenting homework.

Typically longer case:

An adopted child with a history of severe maltreatment in Maine was brought into therapy by his new parents in Vermont.  He was picking fights and seeking conflict with everyone.  The adoptive parents were raised harshly themselves and continued to take everything personally.  They were easily hooked into big surface conflicts about behavior.

I spent much time shoring up these parents, helping them to depersonalize things they had long ago learned to personalize.  “His behavior is not about you.  It’s a message about his inner life – his thoughts, feelings from the past….but you must feel so frustrated, having to work so hard!”

Two years later the child is stable in school (schools are structured to meet children’s needs), but only a bit more secure at home.  Parents feel a little less rejected, but still have ambivalence about their decision to adopt.