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Can you imagine total chaos? 26/01/2010

Posted by Sir Ralph in how it came about.
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I bet you can´t! Imagine a room, full of half eaten sandwiches, empty plastic packs of youghurt or quark, chocolate bar wrappings, tons of sheets of paper, cut and torn clothes…

This was the state in which Susan´s room was in. And this was not the work of a week or even days. Susan could create a mess like this in a matter of two hours.

But how did she do that? Where did she get all the things from? For months now, we have been locking the kitchen the copying paper has been locked away in my study, we supplied her with sweets of all kind for a case of emergency – and still, she found ways to access our supplies, partly stored in the fridge in the cellar. Shopping for the week has become an incalculable adventure, not knowing how much there would be left of anything.

The same, Susan is unwilling to put her clothes into the wardrobe or take worn clothes to the washing machine in the cellar. It was all spread out on the floor of her room.

And you better don´t criticise her behaviour, unless you are prepared to get an aggessive outbreak and slammed doors.

We ask ourselves constantly what might go on in her mind that makes her do the things she does. We know that because of neglect in her early years of childhood, she was storing food and drinks in her room. We know that cutting and tearing her clothes derives from her urge to destroy what she likes, and the same goes for enjoyable situations. But why does she tear sheets of paper and spread them out on the floor?

Many times, I helped her with tidying up her room, or at least part of it. As a result, one hour later, the state was as before. Some people say that her room was a sort of mirror of her inner self: chaotic, unstructured, messy.

We decided that we couldn´t go on with Susan like that, and bear her behaviour that was destroying our family. An immediate solution of the problem had to be found. This would definitely mean an admission in a mental institution where we could rely on a special trauma treatment. It would mean that we would be integrated in the therapeutical process, so that Susan could return to our family and would be able to go on with a trauma therapy to bring relief to us all.

There is no question of why we are doing all that. We´re in too deep. Can we really manage all that and find an acceptable solution?

Susan, what is becoming of her? 20/01/2010

Posted by Sir Ralph in How it went on.
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The day couldn´t be more controversial. In the morning the assistance conference for Susan took place. Our welfare official was present, together with another official who is in charge of children who are in danger of mental handicap. Both of our foster daughters have been classed in this category. As Susan is in the custody of the youth welfare, there is a change in responsibilities. Not to our best, as will be proven.

Furthermore, the biological father and family case manager were taking part. No idea why the co-ordinator of the family case manager was present, as well. Does she mistrust her own employee?

In the beginning, I gave a detailed description of the reasons for giving Susan into the youth welfare office custody. It is a strange situation. Why couldn´t I get rid of the feeling that we have failed? Nobody said so, and the atmoshere is professional. Maybe that´s the reason. A mention like “Don´t worry, you have done all that there was to be done” would have shown some appreciation for us.

In fact, the decision-making of the authorities played an important part in the coming up of the present situation as we see it. The authorities argue rather blodly that the trauma therapy which we applied for during a year´s period was not sufficient any more. No word about the fact that it was them who refused a special therapy, without having an idea of how it works. No word about the fact that in my position as foster parent had tried to find an appropriate institution, writing letters and making telephone calls. Is this my competence, anyway, or isn´t it rather the responsibility of the professionals to get this under way?

The educator in charge of Susan is looking at the problem from another position. We believe her report to be trustworthy, as she leaves an impression of dedication with us. Her report gives a totally different picture than we had of Susan before she had left us. She is easy to be integrated, keeps to the rules. She is amazed about how calm and relaxed the reaction to her situation was.

The biological father came up with what he probably thought to be a brilliant idea. Susan should be accommodated in an institution near his place of residence, so that he could visit her more often. Was this the start of returning her to the person who had abused and neglected this girl for such a long time? Was it going to start all over again? Is the fact that he had served his sentence enough of a reason to give it another try? Just the idea of that gives me the creeps.

Fortunately, this suggestion isn´t acceptable even for the youth office officials. Most of all, the intention to keep up Susan´s relation to Janet was reason enough not to follow this proposal.

It is evident to everybody present that Susan needs a therapeutical housing group. A suggestion for such a group near our residence is turned down because it is supposed to be unsuitable.

At least, everybody agreed on the procedure to visit any chosen institution beforehand and also escort the removal. I agreed because it gave me the chance to keep up some influence at least on the choice – as things will develop, I won´t be very successful with putting through this intention.

Change of location and situation. Emergency unit in the emergency housing group. Susan was already attending my arrival. We were spending ten minutes outside on the playground. I observed that the present situation is of utmost importance for her. She left the impression of being distractable and nervous, always moving about and avoiding eye contact. She is not able to concentrate on any conversation, all the time looking around as if she was searching for something. It gave me the impression of a typical lack of concentration syndrome, like when she lived with us, only more intense. She spoke in confusion about clashes amongst members of the housing group. Maybe it is only my perception from a more distant position that made me feel uncomfortable. Anyway, soon Susan had enough of my presence and decided to leae.

Ruth and Janet were already attending my return when I arrived. What was it like? I told them of my impressions. All of us felt distressed. Still, it will be me to keep up contact. Both of them wouldn´t be able to bear this sort of situation, and I don´t like it, either.

The Search goes On 21/12/2009

Posted by Sir Ralph in How it went on.
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Searching is one of my main activities these days. Today I am searching the virtual world of the Internet for a pulmonologist. Ruth has fallen ill with an asthmatic cough. The excitement during the last days finally shows also in her physical health. All doctors we are calling, however, have a waiting list of three months or more. How can it be that in a civilised country like ours, you have to wait for an appointment with a medical speciaist for months?

Finally we succeeded. The diagnosis is evident. Asthma. Ruth now has to stay under constant surveillance. All exciting situations are problematic for her health.

Second search. We decided to finally tackle the problem from the very basics. Janet is refusing to begin with a therapy. She needs our help and support when being confronted with a therapist; no chance for a male therapist. So I am trying to find a family therapist.

An enquiry at the health insurance turned out that systemic family therapies wouldn´t be paid for for what reason whatever. No chance to get costs reimbursed by the youth welfare office.

So I looked for welfare organisations who offer this sort of coaching for free. After a while I found out that again, there are responsibilities according to areas of service. Finally, I found a social welfare organsiation which was willing to make an appointment.

Unfortunately, we had to discover that this sort of assistance was not sufficient. Ruth and Janet were calling it a “tea-time small talk”. Both ladies really did their very best, but we had to notice that they hardly had an insight into our problems.

Many specialists had already told us that our situation was extremely difficult and complicated. Still, what´s that good for if we don´t get any assistance?

Besides, there are lots of foster families fighting just the same as we do to obtain the best results for the kids for whom they are responsible. We know some of them. It is only that far to few people know what ist means to bear responsibility for children who had to endure such a lot during their shot lives.

I still remember the quote of a well-known psychiatrist during a coaching for foster parents:

Foster parents are obliged to stand for the interests of their traumatised foster children. Who else will do that if not them? They have to show their foster children full solidarity by unconditionally taking their part.

When will authorities, therapists and clinics finally accept this fact and begin helping foster parents and their traumatised foster children, regardless of specialist discussions and responsibilities?

Not in charge of mental disasters 13/12/2009

Posted by Sir Ralph in how it came about.
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If you are in need for help in case of mental distress, don´t count on assistance of medicl institutions if you live in Germany.

This is a letter I wrote to the head psychiatrist of a mental clinic for juveniles in the atempt to organise help for our foster daughter Susan and the result that came from it.

Dear Mr XXXXXXXx,

We are turning to you because we are in urgent need of help for our 12-year old foster daughter who has been living in our family for more than five years together with her older sister.

For one year, the symptoms of a post-traumatic stress disease caused by a crime in her family. She is transferring her traumatic experience inflicted by her biological mother to my wife, is over-reacting aggressively to her, is restaging in our family the situations she had experienced and is putting herself into isolation in our family because of her uncontrolled behaviour. Beginning puberty is causing aggressive outbreaks. Dyscalculia has been diagnosed, and is leading to problems at school.

In cooperation with the local youth welfare office in charge, we see the necessity of helping Susan in a fast and competent way. For us, the precondition for a diagnosis and therapy is being treated and cared for by a multiprofessional team specialised on traumatology, as well as the inclusion of the foster parents and psychological parents into decision-making and therapeutical processes. We class your institution according to the description of your therapeutical methods and treatment plans in your Internet presence as most suitable and would like to discuss the futher steps with you in a personal contact.

The present crisis in the development of our foster daughter is calling for immediate action. On the other hand, we refrain from putting Susan into an institution which does not ensure our taking part in the therapeutical process and the use of appropriate therapeutical methods.

We would like to urge you to assist us in this situation of distress which we are not able to bear much longer. We are available by e-mail or the above-mentioned mobile number at any time. I would try to contact you during the next days, at any time which will be convenient for you.

Yours sincerely

P.S.:

The reply reached us in form of a call by the secretary of the head psychiatrist who let us know that Susan could not be admitted because we weren´t living inside the clinic´s service area.

P.P.S.:

This is horrifying. There is no way to choose the best treatment for our foster daughter. You have to take what you get, no matter if it is first or second best or not suitable at all. In our country, for those who have to suffer the most terrible fate there is the least help. Fates and experience are administered, there is somebody in charge for every problem, everything is socially balanced. Who does really care for the psychic state of these traumatised people? Why is it left to circumstance which treatment they are entitled to and if the clinic in charge for the service area really fits the needs of the individual person? Why is the traumatised kid not entitled to the latest, best, most efficient methods of treatment? Why are there so few trauma therapists who are fully booked for years? Why are some therapists still allowed to class EMDR and other trauma therapies as ineffective? And why do youth welfare offices still trust in those who are discrediting trauma therapies?

The most important of all questions is why those who are in need of a special therapy but are not able to meet the costs to get the best of all therapies are denied financial support. Why may biolgical parents in custody of the kids they have mistreated so often prevent such a therapy by refusing ther consent, and thereby provoke a legal conflict in court the outcome of which is more than uncertain?

This is the end of my efforts. So much for the search for a suitable mental institution for Susan.

The Turning Point 15/11/2009

Posted by Sir Ralph in Introduction.
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Sunday. Like most sundays with a nice breakfast at the kitchen table with Susan and Janet. The plan for next week had been done. We hoped for the weekend to be finished without stress and hecticness, after yesterday was calm. All the same, all was prepared. Susan´s clothes were mostly packed into boxes in order to prevent her to spread them out on the floor of her room or cut or tear them. It will have to happen next week. Only I didn´t know what really was going to happen. All my efforts had failed. There was literally no more chance to help her. I had called two mental institutions for children which are able to treat traumatised children. They couldn´t accept her firstly because of lack of capacity and second because we live outside the area for which they are responsible. The responsible institution only offers general therapeutic treatment; not a word about special trauma therapy. This, however, was out of question.

Another possibility would be to accommodate Susan in a housing group offering therapies and could assist Susan in becoming more confident and coping with her multiple traumas. Years of depth psychology treatment had not brought about any visible results. Susann is twelve and at the beginning of puberty. Still no chance. All local housing groups are lacking capacities. Furthermore, they don´t take me serious as a foster father; some institutions insist on an application by the youth welfare office in charge.

Then it all happened at once. We asked Susan to clear the table. “No, I won´t. Why me?” Another attempt to convince her. Then it was all happening. Susan was shouting and rampaging. “You are so mean, so nasty.” Then she fell silent, sitting at the table without listening. My wife Ruth and Janet, Susan´s sister, were trembling and weeping. My heart was beating. I knew all of Susan´s problems, her multiple personality, and I knew that half an hour later she would be the dearest, most affectionate girl. The time between her aggressive outbreaks, however, was decreasing constantly and was ruining our family. All explanations of Susan´s behaviour wouldn´t do any more. We felt left alone amongst all this chaos. Something had to happen.

After Susan had disappeared in her room, shouting and crying, slamming the door like mad, I took the chance to gather Ruth and Janet around the kitchen table. Janet was all in tears. “If she won´t go, I´ll go.”, she was wispering.

We knew that we had to take Janet´s intention very serious. Janet had concluded to take her life into her own hands and to cooperate with us. Since I had managed to convince the headmaster of one of the last comprehensive schools in the region with a very good reputation to accept her into the beginners´class, she showed commitment and changed to be most sensible and grown-up, maybe even a bit too much. Traumatised children tend to take their lives and fate into their own hands, and seem very much like an adult. This goes especially for children like Janet, who had to care for their siblings for years, when their parents were unable to care for them and neglected them.

Something had to happen now. We decided to part from Susan to make our own situation endurable. We consented to take Susan to the emergency ward of the local children´s home. We needed some relief to be able to cope and go on. So I called the children´s emergency hotline. This is a switchboard of the fire department who pass on the caller to the local authority emergency service. We talked to the official on duty, and he took up contact to the emergency unit of the children´s home. The person in charge called us back and we notitied her that we would arrive with Susan during the next two hours.

It was all up to us, now. Susan had calmed down, as expected. We invited her to join us at the kitchen table. I started to explain the situation very calmly.

“Susan, you know what has happened today, and that this cannot go on as it is. Janet is suffering from the situation, and so do Ruth and I, and you do, as well. What we need, first of all, is some distance from each other. So we have concluded that it is best for all of us to take you to the emergency unit of the children´s home.

She nodded her head in silence.

“We will now put together the things you need and set off after that.”

Nodding, the head bowed. Ruth and Janet exchanged expecting, curius glances. Nothing happened.

“So let´s begin.”

Ruth and Janet gathered together the packed clothes. Boxes were filled. Susan got together the things that are important to her, while I collected those things which are necessary like the passport, the health insurance card and her spray against asthma.

Then, Susan entered my office in the basement. “Can you print out some of the photos of our holidays, Dad? I would like to take them with me so much.”

I was fighting my tears while the printer was working. There was no way back. Still, was this the right decision? Had we tried hard enough? Why did we only get refusal instead of support from the authorities? On the other hand, we had to protect Janet. It was all so very sad.

Finally, we had managed. We loaded everything into the car and drove off. Janet had filled a pencilcase with pens and given it to Susan, together with some things for her to remember. The situation unwinded during the ride, just as if a heavy burden had been taken from all of us.

The lady in charge was very nice and understanding. Ruth, Janet and I explained the situation and Susan´s problems first.Then, Susan joined us after having inspected her new room. She now had to sign an application for being accepted in the institution. She did so without batting an eye. A short, cordial farewell, and we were off. The three of us.

The evening passed in haunting quietness. Nobody talked about the day. That day had changed it all. Legally spoken, we had done now what we always had tried to prevent. We had given Susan into the custody of the youth welfare office. We would notice only later, what that meant. We had to give Susan into the custody of professionals, hoping that she would get the assistance she needed. So from now on, we would only have only few influence on how decisions would be made in regard to Susan. We would be referred to that fact many times in future.