Treatment Options & Services

Services Provided

Individual & Couples Outpatient
We provide Individual Outpatient therapy services for all ages for most types of issues, including Marital Therapy.
We have staff trained in child trauma, adult abuse-trauma resolution, grief/loss, EMDR, couples, anger management, anxiety reduction, self-esteem, life coaching, child defiance/conduct, parenting, and sibling and family relationship building.

Comprehensive Psychological Assessments & Evaluations
Dr. Tricia Hoffman provides full psychological evaluations, assessments for Learning Disabilities, and AD/HD. As a team, we also provide evaluations for Reactive Attachment Disorder, with subsequent recommendations for placement, sibling sets, and treatment.

Family Attachment & Bonding Therapy
The total time commitment for treatment is typically 9-12 months. We are seeing significant symptom reduction within 4-6 months. ALL PRIMARY CAREGIVERS to the child are required to attend treatment. It is critical that the family make arrangements to attend therapy on a weekly basis, if not twice a week at the beginning phase of healing. We strongly encourage families to not take on any extra projects or responsibilities during treatment (especially adding children, even temporarily) when possible.

Social Skills Group Therapy for Children
We provide psychoeducational groups for children to address issues related to being adopted, normalizing adoption, enhance social skills, process grief and loss, enhance attachment, develop effective sadness and anger management skills, develop internal impulse control, and develop appropriate communication skills.

Parent Education & Training
In the beginning of treatment, we provide training on Reactive Attachment Disorder (etiology, bonding cycle/broken bonding cycle and how this creates the symptom set, impact of neglect and abuse on the brain) and our specialized Parenting Program, that is an essential part of the Treatment Protocol. We continue to provide parenting training throughout treatment, as well. On the average parents are reporting that our parenting training is 80% effective and reduces their own symptoms by at least 70%.

1 or 2 Week Intensives
It is highly recommended for those families who can, to participate in an Intensive prior to weekly sessions, as we see a significant symptom reduction in a much shorter time. For those who participate in a 2 week Intensive Attachment & Bonding program, on the last day of treatment we provide a follow-up plan prepared for the family and provide follow-up consultation with the ongoing therapist treating the child, if applicable. This will include a list of prescribed techniques for responding to, and directing their behaviors, therapeutic techniques to continue the healing process at home, and follow-up plan for professional treatment, all designed for the child’s specific needs.

Private Online Parent Support Group
We recently added a Parent Support Group on Yahoo that can be joined only by ‘application approval’ for confidentiality. This enables our parents to receive support, understanding, and ideas from other parents at various stages of the healing process. Many parents feel isolated and misunderstood; this provides a caring forum to receive non-judgemental help and support.

Description of Attachment & Bonding Treatment Process

Intake/Admission:
An initial referral includes a telephone interview to assess the necessity and recommendations for treatment. Once accepted, the parents will need to complete additional paperwork before starting treatment such as: physician's release, testing, permission to treat, and other assessment-related information. It is very helpful if families send in previous records. This allows staff to review this information and facilitate the most comprehensive treatment plan for your child and family. All families begin with an interview process. This is where you get to tell your child’s story, and your story. It is an interactive process where we all work together to assess the child’s needs (interpersonal issues and behaviors), and the parents' needs (as we know by now the stress of parenting a child with RAD has likely taken a toll on your relationship, and areas of parenting challenges) and further evaluate/plan for the treatment process.

Assessment:
We offer a vast array of assessment tools to develop and implement a unique treatment plan to fit the family’s specific needs. During the parents interview time, the child may meet with a trained child therapist in the play therapy room (children communicate better through play; the playroom is equipped with miniatures of the world, sand tray, art therapy, therapeutic games). The therapist will assess and evaluate specific issues with the child regarding grief/loss, power/control, anger, ability to adapt, parent-child relationships, attention deficits, neurobiological, sensory integration difficulties, and any other relevant areas of concern.

Evaluation tools may include a combination of the following; Comprehensive Psychological Evaluations, Learning Disability testing, AD/HD assessments, RADQ, Child Behavior Rating Scale, Parenting Stress Index, Cline Helding Adopted and Foster Child Assessment, Sensory Integration Screening, Vineland, Adult & Adolescent Parenting Inventory, Child Depression Inventory, Myers-Briggs Personality Type Inventory, Amen Brain Checklist, Antisocial Personality Screening Device, Child Behavior Checklist, and behavioral and relational (Marshak Interaction Method) observation. We also have screening tools for neurological, sensory integration, intellectual, cognitive, speech, and other disorders that may need further specialized care that we would make appropriate referrals for.

Treatment Planning:
Since we are acutely aware of the differing needs of families and devise a specific treatment plan accordingly, the services each family is provided will vary from other families. We include the parents in the treatment planning process, as we consider them to be the expert on their child. The parents’ involvement and cooperation is essential to the successful outcome in treatment; therefore we only accept families where both parents/primary caregivers are committed to treatment (when applicable). Both child and parents will be asked to contract with the treatment team regarding their commitment to treatment and desired outcomes. However, we remain flexible, as it is not uncommon for additional family issues to arise while the family is in the healing process.

Treatment techniques used:
Marital Counseling to strengthen the parent’s relationship so that they can act as a united front and not be manipulated or triangulated by the child.

The RAD Education / Therapeutic Parenting Program is a prerequisite for beginning treatment. This is a very important part of our Treatment Protocol. Parents will be educated on new techniques and responses to their child’s behaviors that are very effective. We utilize a combination of Love & Logic and Therapeutic Parenting techniques. Our current outcomes data indicate that on the average, parents are reporting that our parenting training is 80% effective and reduces their own symptoms by at least 70%. The most common response to the Therapeutic Parenting Program is "I’m not angry all the time anymore". Parents will be able to observe us demonstrating these techniques with their child while in our clinic, which we have found very helpful for learning the new skills. We educate parents about how the RAD developed, the effects of the broken bonding cycle, and how the healing process works for a child with RAD.

A Therapist will work with the child to address their interpersonal issues, work on basic respect, and teach them their 6 "jobs". These tools are used to monitor their progress throughout treatment, as well as building their self-esteem.

Utilizing information from the MIM, and other evaluation tools, we will begin working with the parents and child together. Depending on where the child is developmentally, and/or emotionally, and where they are in the healing process, we will direct the parents to do specific tasks with the child. This may include applying lotion, combing hair, giving back massage, rocking, cradling, etc. During this phase we will also utilize Narrative Therapy where the parents tell a story that is therapeutic in nature. The therapist assists the parents in developing these therapeutic stories (Claiming, Trauma, Developmental, Successful Child Narratives). There is research that shows that Narrative Therapy can actually change the neuropathways of the brain. While being told a story, the child will be provided bilateral stimulation (from EMDR: Eye Movement Desensitization & Reprocessing). Trauma is stored in the right side of the brain, and the left side of the brain is the "Interpreter". Since many of these children’s trauma is preverbal, they have no language for it. This assists them in making more sense of the emotions they are feeling at this time.

After each session, parents are given directives for interactions and techniques to facilitate the healing process with their child. Parents are also provided a list of play activities geared for attachment and bonding, as well as developmental skill attainment. During the subsequent sessions, we will process how the child responded, what worked and what didn’t, and it provides us with further information for where we need to go next.
We utilize the Dyadic Developmental Psychotherapy model of treatment for RAD, developed by Dr. Daniel Hughes. DDP is a treatment approach to trauma, neglect, loss and/or other dysregulating experiences, that is based on principles derived from attachment theory and research and also incorporates aspects of treatment principles for PTSD. It involves creating a safe setting in which the client can begin to explore, resolve, and integrate a wide range of memories, emotions and current experiences, that are frightening, stressful, avoided or denied. Ensuring that this exploration occurs with nonverbal attunement, reflective non-judgmental dialogue, along with empathy and reassurance, creates safety. As the process unfolds, the client is creating a coherent life story, which is crucial for attachment security and is a strong protective factor against psychopathology. The therapeutic progress occurs within the joint activities of co-regulating affect and co-constructing meaning. The model includes the parenting component - creating a healing PLACE (Playful, Loving, Accepting, Curious, Empathic) and the treatment component of maintaining a healing PACE (Playful, Accepting, Curious, Empathic). Within this format, we process grief, loss, trauma, and Post Traumatic Stress Disorder issues.

Depending on the age of your child, frequency of treatment, and how well the parents work together on the Therapeutic Parenting program (possibly the single most important variable), you can expect to be in treatment for between 9 and 12 months. We typically see a significant reduction in symptoms after 4-6 months, depending on the severity of RAD and/or other comorbid conditions.

Finally, we work collaboratively with teachers, other caregivers, and other professionals working with your child. It is really important that the persons having significant contact with your child are “on board” with the specific behaviors of your child (so the child isn’t successfully manipulating others while not with you), and responds to these behaviors appropriately. We invite all caregivers to attend the Therapeutic Parenting Training!