Girdles, Laxatives, and Respite

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You're probably wondering just what these three things have in common, and even more likely, what they have to do with attachment! My answer? Excessive use of any of them may lead to further reliance upon them; in fact, ongoing use may increase the need for them.

Respite care, the focus of this article, has become sacred in some corners, hailed as the very thing-perhaps the only thing-that keeps some placements together. That may very well be true. However, I think that we should take another look at respite through these questions:

Is respite supposed to improve the child's capacity to attach to the family?

Is the ultimate goal of respite to no longer need or want respite?

What is the message that respite sends to the child about the family's capacity to love, nurture, control, or manage the child?

Does respite mimic or parallel the child's own approach/avoidance attachment responses?

How is respite different from the child's experiences in multiple placements?

I would hope that the goal of any respite plan is to do more than give people a break. These breaks may actually further damage the breaks in attachment the child has already experienced; they may concretize the child's thinking that he only needs to be able to function for short periods of time-then he can go elsewhere for another short period of time. One of the goals of respite should be related to enhancing the child's capacity for attachment as well as helping the family address its difficulties.

I assume that people would like to be with their children. I assume that parents want their kids to be fun to be with. And, I would hope that kids would like to be with their families. That is the purpose of adoption! Therefore, I think the ultimate goal of respite ought to be the elimination of it, or at least a reduction in the frequency of it.

While it's difficult to estimate just what message any child gets about anything, particularly if he or she is quite disturbed, I think it is critical to evaluate this issue. If the child gets the idea that she has to go to respite because her parents can't handle her anymore, the child gains too much power. We need to remember that children and adolescents who have hurt so much in their early lives fear vulnerability. If the parents seem vulnerable, the child will have extreme difficulty ever attaching. Children with attachment difficulties will only identify with and attach to powerful images. After all, if the parents are too weak (in the child's view) to handle the child, how could they ever be counted on to protect her? Who would want to attach to someone who might not be able to protect (read: control, manage, love, nurture) them?

I think that ongoing use of respite parallels the child's fragmented attachment response. It seems to me that regularly scheduled respite allows, and perhaps even promotes, ongoing dysfunction. If parents end up feeling or thinking, "Oh well, at least he'll be gone for the weekend," they may also accept behaviors they would not if they knew the break wasn't coming. They may avoid yet another conflict, just to hang in there for another day.

The child's already well-developed (though not healthy) temporal thinking patterns inevitably get reinforced. Everyone who works in the attachment field knows that individuals suffering from attachment problems perceive that yesterday was the distant past and tomorrow doesn't exist. Fragmentation in the child's life has led to this development, and I think that regular utilization of respite may perpetuate this kind of thinking pattern.

Continuity of environment helps to bring about continuity of thought. Thought continuity leads to improved cause and effect thinking, which in turn evolves into conscience.

Respite should be different from a child's pre-adoptive experiences of moving around. Children and adolescents who have had child welfare experiences get accustomed to moving about. Moving, in a way, allows them to remain irresponsible and unaccountable in their current setting. "After all," they might think, "if I'm making bad choices today (Friday), I won't have too much to worry about because I'll be going to respite tonight!" By Monday, of course, Friday will be ancient history.

I wrote this article to help us re-examine an assumption that I see developing. Parents and professionals frequently talk about just how important respite is. I agree that some families feel they could not exist without it. However, just like girdles and laxatives, too much use of respite or unfocused use of it may prove to be habituating. Excessive use may further complicate what I believe parents and professionals truly desire: children who can attach to and live with them comfortably. Temporary relief may not be the solution to a permanent situation.

Before I hear myself misquoted-as I frequently do-let me clearly state that:

I am not saying that a respite plan is never helpful.

I am not in a position to judge what and who other people can live with nor for how long at a stretch. Only individual families can decide that.

I do think that respite is temporary relief that may become habit forming.

I do think that the goals of any respite plan should include an attachment rationale.

I do think that the ultimate goal of respite should be its elimination.

I hope that people will start to more carefully evaluate the issue of respite and not simply accept what we keep hearing so much about. Remember, what is accepted practice now will probably be critically evaluated by others in the future. Once upon a time (not very long ago), foster parents were discouraged from allowing infants in their care to attach to them; that was to be done later with an adoptive family. Now, how wrong was that?

Founder of the Attachment and Bonding Center of Ohio, Dr. Gregory Keck works to help children and adolescents who have experienced developmental interruptions. Dr. Keck is also a frequently sought out adoption trainer and consultant, a parent, and the co-author (with Regina Kupecky) of Adopting the Hurt Child: Hope for Families with Special-Needs Kids. "Girdles, Laxative, and Respite" was originally published in Connections, the Association for Treatment and Training in the Attachment of Children (ATTACh) newsletter.

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