Tuesday, March 20, 2012

Attachment Therapy

We went to attachment therapy today...we weren't sure what to expect, but it was great!

One of my professors in January just welcomed his second daughter through adoption from China over Christmas.  We were talking and he mentioned that they had found this attachment therapist to be really helpful when their older daughter joined their family, so I got her info.

After a significant game of phone tag b/c our phone availability absolutely did not mesh:-) we saw her this morning.  We just wanted to make sure that we were on the right track and to get some feedback/strategies to deal with a few specific questions/situations.

She was really helpful, respectful, insightful, and had specific and pragmatic suggestions.

Neither Ababa nor I had ever been to a therapist of any kind, so we weren't sure what to expect.

I had emailed her a full history of B and of our past 9 months as a family so that she would have some context ahead of time, and I included some specific questions we had.

We were 15 minutes late to the session (thank you Second Avenue subway construction! grrrr!!!)  but she was calm and gracious and engaged.

B played with a young social worker at the end of one hall, with the door open, and we sat in a living room-like room at the other end of the hall and spoke to the therapist.  

I thought that the first part of the session would be more of a play therapy/observation kind of thing, but she only observed our brief interactions arriving and getting B settled in the playroom, it was really more of a sit and talk kind of session.

Yes, there were phrases like "fully evolved" and "ego has been strengthened"bandied around, but all in all it was very practical.  It was also very nice to have most of our parenting choices affirmed and to get professional feedback that we are doing what's best for our child to help him grow and develop.  Overall, she thinks B and we are doing incredibly well, are securely attached, and are in a great place, but, as with all families, especially those with complex situations like adoption, there is work that can still be done.

We talked about some specific questions we had and got some interesting answers, here are a few highlights (disclaimer, I am not a professional, this is my understanding of the professional advice we received, every child and family is different):

Co-sleeping: As we thought, this should continue for as long as needed, and it is definitely still needed for our family.  She stressed that we should trust our intuition and we'll "know"when B is ready to sleep in his own bed at night, and it might not be for several more years and that's ok.  We are going to take it one month at a time (as much as we love snuggling with B at night, the thought of co-sleeping until age 8 or 10 is not really attractive to us:-) 

B doesn't get out of bed to come and get us if he needs anything (a big indicator that he's not totally comfortable/secure, and a significant detriment to night-time potty-training, sleeping in his own room at night, etc.).  He has started getting out of bed during nap sometimes to play with toys but he won't come get us.not ever.not once.not for potty.not for a drink.not if he feels sick.never...one suggestion she had was to take the toddler rail off of his bed.  Although he clearly has the dexterity to get out of bed with it on, she suggested that perhaps it is emotionally a reminder of orphanage life where he was most definitely required to quietly stay in bed and not ask for things (we saw this first hand).  She also said it might just take more time, and that's ok.

We have been faltering about how to tell B his story, the story of his birth, his first family in Ethiopia, and his adoption story.  I tend to overshare and make it too detailed for a 3 year old to understand (he understands that he grew in his Enat's tummy, but for some reason he also thinks I grew in Ababa's tummy!) and Ababa tends to not talk about it much.  She helped us find some language that strikes a good balance and that we're both comfortable with. She suggested that 3 year olds need really simple concrete language like:

 "Your ____ died and is in heaven now.   ______ took care of you but then they couldn't take care of you anymore so you stayed at the orphanage.  Sometimes you were happy and sometimes you were sad. Then mommy and daddy found you and we are a family now, forever and ever and ever.  Mommy and daddy love you so much"


"Your _____ lives in Ethiopia.  It's sad that we can't see them now.  Someday when you are older we can go and visit them." 


"Babies grow in their Enat's tummies.  You didn't grow in mommy's tummy, but you grew in mommy's soul.  Mommy will love you and take care of you forever and ever."

One scenario she described (which doesn't relate to B's situation, but I thought it was such a great example I wanted to share) is what to say to a child who is conceived through a non-consensual situation. 

I thought it was really helpful to see how the explanation unfolds so that it stays age appropriate but also builds a clear foundation so that it is not a shock for child to learn of these circumstances when they are older.  Of course ages/exact words are approximate:

-Age 3-your birth mommy and birth daddy didn't know each other (or didn't know each other very well)

-Age 6-your birth father didn't grow up in a house where he learned right from wrong. 

-Age 8-Your birth father didn't have good manners

-Age 10-Your birth father didn't ask permission to make a baby with your birth mother

-then when the child is a teen they can learn more details/terminology

She said that you reveal more as the child grows up, and the "why" of their story (why was I adopted, why couldn't my first family take care of me, why didn't my parents know each other...) usually starts to become more important around age 6-8.

She STRONGLY supported our efforts to try and get photos/interview transcripts from our placement agency (who have said that they have some of these kinds of materials and are compiling them into a video lifebook for B but they are "behind schedule").  All we really want are a few photos, but to date (9 months in!!!)we have not received them from our agency.  We are still working on this and are quite frustrated.

She suggested some strategies to help strengthen the bond between Ababa and B and Mama and B. We had read many of these in books and tried some, but it was a good reminder to keep doing these things, especially she suggested putting stickers on your face (just one or two small ones, like stick-on earring size) in different places each day, writing shaving cream "disguises"on mirrors and play with aligning your reflections on the disguises, hand feeding foods...

The bottle stays.  As long as B likes it and is making eye contact we should keep doing it.  I have to say that I am glad about this for now too as I love that special time with B:-)

Since Ababa doesn't do the bottle, she suggested him finding a special  toy/activity that he can regularly play with B.  She especially suggested a toy stroller that B and Ababa could play with together outside.  (Guess who is getting a toy stroller for Easter:-)

She also had great suggestions re how to continue our work of helping B to firmly attach to us while empowering him to explore the greater world and preparing him to build meaningful, fulfilling, and positive relationships in the future (no big task, right:-).  She suggested framing other people's roles more clearly.  E.g. right now we say, "your teacher is nice, but she's not our family.  Our family is mama, ababa, and B".  She suggested something like "Your teacher is nice.  Her job is to teach you lots of fun things and take care of you when mama and ababa are at work." and then restating our family mantras if needed.

She also suggested that 3 year olds are really visual, so it might help B to start to grasp extended family by drawing a poster diagram of concentric circles with us in the center and then circles going outward that include people like daycare providers, extended family, family in ethiopia, very close friends, etc.

She affirmed that we're handling things in a positive way when B is overly friendly to someone (gently redirecting him to us but not completely snatching him away from the situation, remaining neutral, not getting emotional/showing if our feelings are hurt...) and overall thinks that the rare times B is inappropriately friendly are due to a deep sense memory (maybe the sound of someone's laugh, or their smell, etc.) and that it's important for us to acknowledge that those are real feelings, we just need to show B how to process and act on them appropriately and to remind him that we are his family forever and ever.

In all, the hour was totally worth the $150 fee and we plan to keep getting yearly or bi-annual check-ups!

And, just because he's cuter than you can possibly imagine, here's my little man:-)  He's getting so big! Today he wore 4T pants (b/c we have a laundry situation:-) and they basically fit him!

Tuesday, March 6, 2012

Effective International Aid?

I thought that this was a really interesting article, and one that I agree with in many ways, so I wanted to pass it along.

7 Worst International Aid Ideas

Although I appreciate the sentiment of Toms Shoes, I personally can't justify the cost and would rather buy less expensive shoes and donate the difference to organizations that I can hold accountable and can use their money to both provide for people's needs and stimulate the local economy. (Full disclosure, although I have several friends who love Toms shoes, I don't own any and never have--I am not such a fan of how they look--so if they are the world's most amazing shoes to wear, I don't know that:-)

Before we went to Addis, I had read many blogs re what to pack, had my geeked out spreadsheets of packing info, and felt ready and informed about what was and wasn't available in Addis.  Included in our suitcases were donations for our son's orphanage and care center, namely formula, disposable diapers, cloth diapers, and shoes.  All the blogs I read and people I spoke with said, "you can't get diapers or formula in Addis" "the kids all need shoes and shoes there aren't made well"...blah, blah, blah...

Well...you know what...I think it would have been smarter to avoid any extra baggage fees and only take specialized items that absolutely can't be purchased in Addis like:

-Childrens Benadryl
-high quality hypoallergenic formula like Nutramigen and maybe quality regular formula--check first with the orphanage re what formula they are using as many are quite specific (we took 8 of the giant 40oz tubs of Target formula as it's supposedly the same formulation as the Enfamil formula our care center used)
-new, high-quality cloth diapers and covers IF you know the orphanage/care center will use them

and then I would have used the money I would have spent on extra baggage fees or buying items in the US to buy diapers and shoes and food for the orphanage while in Ethiopia.  Shoes are readily available new or used, basic shoes like crocs are very inexpensive and can be found anywhere. Disposable diapers are easy to find and not that much more expensive than in the US.  The quality is not quite as good, but they are serviceable (just bring some good ones for your kid(s) on the flight home b/c that does make a big difference when you are on a plane!):-)  This way, you can buy more quantity, support the local economy, and talk to the orphanage first to make sure that they need what you are buying.

The donations we brought were much appreciated and I'm sure went to good use, but I think that the above strategy would have been more effective, more wide reaching, and would also have had the impact of helping the local economy.  It's really true that you can buy almost anything in Addis.  It may not be quite the same quality as you are used to at home and the price may be as much as in the US (which is really expensive in Addis) or even a little more, but you can find it (except Benadryl, bring that with you for sure!  Childrens Claritin syrup is readily available, but multiple doctors and pharmacists told us that neither Benadryl  nor epipens were available--scary news for a mama who is allergic to bees and a B who we learned the hard way in Ethiopia was allergic to eggs!).

So, I guess today's ramble is a support of the"buy local"philosophy.

***On a totally unrelated note, I am reading Infidel by Ayaan Hirsi Ali and it is incredibly moving, fascinating, and eye opening.***  

Thursday, March 1, 2012

Bonding and Attachment

I started this post in November and, well, life got in the way,  so now I am writing a post about the most feared, loved, and intensely scrutinized aspect of adoption...bonding and attachment.

Becoming a parent involves committing to meet your child's material needs, and also committing to love this child unconditionally.  It can be hard to love a child that the day before was basically unknown to you, and it is 1000 times harder when said child doesn't want to love you.  From the child's perspective you are a total stranger who has taken them from everything they have ever known.  Why should they love you?  You need to bond with this child and they need to bond with you, and most of the natural mechanisms for bonding that intuitively and necessarily occur with a newborn (feeding and changing multiple times a day, 24/7 care and attention, near constant holding and snuggling, eye contact, etc. not to mention to time in utero where mommy and baby have a special chemical and biological bond).  How do you recapture some of those things with an adopted child, especially a toddler who is developmentally testing limits and gaining independence?

Before I delve into attachment, I want to be very, VERY clear that B is an amazing child, he is resilient, he is loving, he is funny, he loves to cuddle, and we are beyond blessed that he is our son and we are a family.  Also, we are still struggling with exactly how much of B's history and personal experience we are willing to share (we want him to have the freedom to share the deepest parts of his story with people in the future if and when he wants) so I am not giving specifics of that here.

When we met B he was 2 years and 8 months old, he had had at least 4 different living situations and in his short life he had become intimately acquainted with illness, death, and loss.  His little body was covered with scars, he had limited language skills as he spoke his own hybrid version of Sidamingo and Amharic--neither fluently, and he was described as quiet, but loving music, books, and toys, but most especially quiet.

B was very withdrawn when we met him, although he would interact with us and the toys we brought (especially the bubbles and Ababa's watch), we was mostly quiet, wary, and passive.  We were all surprised that we got to have custody of B following court (our second day in Ethiopia) so I was beyond grateful that we had done a lot of reading and preparation before we left and in the weeks to come I was also grateful that I had brought the two favorite books with us (The Connected Child by Karen Purvis and Parenting Your Internationally Adopted Child by Patty Cogen).  They helped Ababa immensely as he finally buckled down and read them, were great refreshers for me when I felt clueless about what to try next, and B liked them too:-)

When B came home with us, he was very passive and overall just seemed shellshocked.  He'd put his head down and float his arms up if anyone made a move to pick him up.  He would have quietly gone with anyone.  He seemed scared and just kind of resigned and had some subtle but pervasive coping behaviors.  After a day or two he started to alternate between being in a passive shellshocked fog and long hour+ bouts of crying (usually either because he was angry he was told he couldn't do something or because he just seemed scared/sad/grieving).  It was hard and heartbreaking to see him so upset.

We started from the time we met him to try and implement some of the bonding strategies that we had read about and learned from other adoptive families.

*Full disclaimer, this is what we did.  Some things worked, some other things we tried didn't.  Every child, parent, and family is different and there is no one set of strategies/activities that work for everyone.  If you are an adoptive parent, do what works for you.  Learn as much as you can, gain exposure to as many different strategies and philosophies as you can, and then see what works for you and your family, but please do recognize that whether your child is 6 months or 6 years or 16 years, they will likely have some challenges due to their complex background and you will likely have some challenges from your own preconceived notions.  Bonding and Attachment is a two-way street, it's a family thing.  This is what we tried.  Do what works for you.  No judgements here!:-)*

For friends and family, now that I am sharing a little more about what we do and why, please don't try to use these techniques with B:-)  These are special things that we do to teach us all the mommy, daddy, and B relationship.  He loves extended family and friends and there is a lot of adoption research that points to involved grandparents and extended family as major influences in whether an adopted child really feels secure in his family, but first the mommy and daddy and B bonds need to be securely in place.  We are working on it, but we're not there yet.

By day 3 Ababa was freaking out, I was tired, and B was scared/tired/sad/angry/confused/and probably a million other emotions I can't even fathom.

  • We used the Boba carrier extensively.  B loved it (and still loves it even thought we don't use it much anymore except for emergencies).  He clearly felt safe in the Boba.  He'd stop a full-on meltdown in 5 seconds flat when the Boba came out.  It was great for me b/c B was close and we could snuggle, etc. while he was in it and it was great for us as a family b/c it made sure that no one would come up and try to grab him, take him with them, or actively engage with him (all of which happened often in the very friendly Ethiopian society). For the first two months B was in the Boba 99.9% of the time when we left our guest house.  If he wasn't in the Boba, we were pretty much guaranteed a "situation" either in public or as soon as we returned to our room.

  • I had brought bottles and formula for B.  He drank half a bottle the first day and then refused it for the next week (he had pretty much no suck reflex, none, so we focused on trying to develop that through straws). No big deal we thought, he doesn't like bottles.  Two weeks later we donated all the formula b/c he still wasn't interested, but kept the bottles for the airplane ride home in case they could help his ears, and wouldn't you know it...the next morning he woke up asking for a bottle:-)  Since then, he's had a bottle every morning.  It's a great time for cuddling, eye contact, and reciting our family mantras.  He loves it, I love it, and we're going to keep doing it until he doesn't want to anymore (or maybe when he turns four...whichever comes first). He pops out of bed in the morning chattering about "mommy, bottle time, mommy makes a bottle for B, bottle time, bottle time (giggle, giggle, giggle)".

  • We have tried to distill a lot of what we want B to know about our roles in the family and say them multiple times each morning (and throughout the day):

         -Mommy, Daddy, and B, that is a family
         -We're a family, and families stick together
         -Mommy and Daddy's job is to love B, to take care of B, to keep B safe, and to teach B about God.  B's job is to love Mommy and Daddy, to listen to and obey Mommy and Daddy, and to learn about God. We're a family and families stick together (it's on here twice, we say it a lot!:-)
         -Mommy and Daddy always come home
         -Mommy and Daddy will always come to pick you up

  •  We talk about the day's schedule everyday--especially who is going to feed B, put him down for his nap, and put him to bed and reiterate that Mommy and Daddy always come home and when we'll be back (and for the first 7 months at least one of us was always with him).

  • We co-sleep...for the first 3.5 months B and I (mama) co-slept for every nap and every night.  B actually fell asleep on my chest for most of the first couple months.  Since October we've just been co-sleeping at night and B sleeps in his own bed for naps.  Co-sleeping has been great for us all.  Just snuggling together, hearing him breathe, feeling his heartbeat, smelling his sweet baby smell, those things all help me.  He clearly loves it too (although he's a total bed-hog:-) and snuggles up all night long.  We are gearing up to start transitioning B into his own bed and I'm not sure either of us are ready yet...we'll see how it goes...it may get delayed a little:-)

  • We try to be very intentional with playing with B, interacting with him, promoting eye contact, and encouraging eye contact and appropriate family responses (hugs and kisses when we come home, eye contact when asking for things, as many different kinds of snuggles that we can think of...)

  • Mirroring-B actually mirrored Ababa one day a few weeks in and it was Ababa's big breakthrough in bonding--he was like Karen Purvis is actually right:-) So, we try to encourage mirroring and want to focus more on that in the coming months.

  • Skin to skin contact-newborns and infants get a lot of this, toddlers and older kids not so much.  So we try to take every opportunity we can.  B also gets a massage with babycakes or organic coconut oil every day or two after his bath.  We both love this time and it visibly helps him relax and let down his guard.

  • We feed B by hand.  in the beginning, we fed him everything--meals, snacks, etc.  Now it's about 75% us and 25% him.  He responds well to it and it really helps with eye contact and interaction.  We also have feed us sometimes (with real food or with his tea set).  He loves this and it really helps all of us feel more connected.

  • I was with B 100% for the first 3+ months, Ababa was then home with him exclusively for the next 4 months, and for the past month B has been going to "school" 3 days a week and is home with Ababa the other two.

In a perfect world, I would have loved to be home with B 100% for at least the first year.  That's not possible for us, so there's really no use spending too much time thinking about that.  I am grateful for the 3 months I had and am thrilled for the special time that Ababa and B have had.

Despite all the strategies we are trying (which again, help us as well as B--bonding and attachment are truly a whole family activity!) we still have some rough days.  B is a far more confident, secure, calm, cheerful, animated, child than he was when we met him in July.  He talks constantly, usually loves to snuggle, enjoys being with us, is gradually becoming more attached to us instead of being willing to go with anyone (but this is still an issue to some degree) and he will try to physically and emotionally push us away with regularity, but overall it is getting better.  

Ababa and I definitely feel more bonded to B.  When we first met him, we were fully committed to being his parents and were beyond thrilled that he was our son, but I would also see kids on the street and sometimes think "they could just as easily be my child"  "what makes them different from my son"  "why am I his mother and not theirs"?  I think in some very real ways I had indiscriminate mommy affection!

B is our son, 100%.  We could not love him more or be more committed to him if he had been born of our flesh and blood.  He is our son in a way that children on the street are not.  that distinction is very clear in my mind and heart.  He is my son, physically, emotionally, and spiritually!  We are now trying to find ways to handle how to explain his unique story and Ethiopian heritage, respecting those integral aspects of his history and identity, while still helping him to feel 100% part of our family, our heritage, and our son. 

We definitely make mistakes, taking two steps forward, but one step back, and not always being the parents that we want to be, but we are trying, and in his own 3 year old way, B is trying.  We've had some big hurdles recently with the start of "school" and one of us not being with him all the time, but by God's grace we are being knit together as a family.  It is a hard, painful, beautiful, challenging, inconsistent, unknown, uncharted journey, but it's our journey and we are a family, mommy, daddy, and B.