Strengthening Foster Parent–Adolescent Relationships Through Filial Therapy

Reunification and Failed Reunification

The most common goal in foster care is reunification with the child’s parents or guardians (U.S. Department of Health and Human Services, 2009). The purpose of reunification is to keep families together and lessen and secondarily to lessen the number of adolescents in long-term foster care. Social service agencies often attempt to reunify families after specific therapeutic interventions are implemented to address the issues relevant to teens and their families. Many times the potential for reunification is the primary motivator for teenagers to work on their treatment goals. When the process of reunification fails, adolescent foster children often exhibit an increase in behavioral, psychological, and grief issues. Sometimes these responses, specifically in behavior, may be a direct effort to sabotage their existing foster parent/child relationship for fear this relationship will also fail (Hartnett, Falconnier, Leathers, & Testa, 1999). If teenagers have constant hope of being reunified with their families of origin, they may not focus on building relationships with their foster families. Promotion of strong relationships with adults is key in efforts to find permanent families for foster children (Leathers, Falconnier, & Spielfogel, 2010). More specifically, when adolescents had a strong bond with their biological mothers, this predicts a successful reunification. When adolescents in foster care had a high degree of integration into a foster home, this predicted adoption (Leathers et al., 2010).

Behavioral and Psychological Difficulties

Adolescents in foster care often experience behavioral problems. Chamberlain et al. (2006) discovered a positive correlation between the commencement or escalation of behavioral difficulties and placement disruption. Research consistently suggests that foster children with behavioral difficulties experience a greater number of foster home and residential placements than children with fewer behavioral difficulties (James, Landsverk, & Slymen, 2004; Newton et al., 2000; Palmer, 1996).

There does not appear to be much tolerance for behavioral struggles in foster care. When conflict between foster parents and adolescents in foster care occurs, foster parents or social service workers have the option to terminate the relationship and adolescents are placed in different foster homes, treatment facilities, group homes, or detention facilities. In contrast, teenagers who act out in their biological homes are not placed immediately outside the home. Instead, parents tend to have a greater threshold of tolerance for their biological teen’s behavior. Most biological parents would not call social services and facilitate an out-of-home placement for their teenagers. Further, foster parents site discord between foster children and biological kids as a reason for termination of placement (Cautley, 1980; Hodges & Tizard, 1989; Lipscombe, Moyers, & Farmber, 2004), behavioral problems, and subsequent placement disruptions are mediated by adolescents’ sense of belonging to foster parents and adolescents degree of integration into foster homes (Leathers, 2006). Often teenagers in foster care have experienced many roadblocks in establishing and maintaining secure attachments with adults and peers. Being removed from their family of origin and frequent movement within the foster care system can negatively impact their attachments. Adolescence is a period of time when relationships and connections with peers and adults are particularly important.

Interventions With Teenagers in Foster Care

Between one half and three fourths of youth entering foster care exhibit some type of behavioral or emotional problems warranting mental health intervention (Landsverk, Burns, Stambaugh, & Reutz, 2009). Numerous types of interventions have been implemented depending on the nature of the concern. Since child abuse and neglect constitute the leading cause of kids being placed in foster care, interventions addressing posttraumatic stress disorder, and abuse-related trauma is vast. Other types of interventions for adolescents have included focus on depression, substance abuse, disruptive behaviors, and in-home and community-based interventions (Landsverk et al., 2009). The inclusion of foster parents occurs sporadically in service provision and the need for their inclusion must increase. Chapman, Wall, and Barth (2004) discovered that adolescent satisfaction with foster placement was most related to the relationship the teenager developed with their foster parent/parents. In this research, former and current teenagers in foster homes emphasized the importance of feeling accepted by their caregivers and having supportive relationships with them on their satisfaction with the placement.

Teenagers identified parental warmth as particularly important, and two thirds of former foster children reported ongoing contact with their foster families in adult life when warm and bonded relationships developed between adolescents and their foster parents (Chapman, Wall, & Barth, 2004). Additionally, adolescent foster children incorporated their foster parents into their perception of “family” when satisfaction with the relationship was present. When teenagers do not feel connected with foster parents, they may feel isolated and detached and look outside of the family for connection which may include contact with negative peers and criminal activity. Teenagers who are guarded may feel weary to attach.

Attachment

Bowlby pioneered research on attachment (Bowlby, 1951, 1958, 1969, 1970, 1973). He concluded that all children, need to experience is “a warm, intimate, and continuous relationship with [their] mother (or permanent mother substitute) in which both find satisfaction and enjoyment” in order for the child to grow up emotionally healthy (Bowlby, 1951, p. 13). An important challenge in applying attachment theory to foster parenting comes up because most research has focused attachment formation in infancy (Schofield & Beek, 2005; Schofield, Beek, Sargent, & Thoburn, 2000; Triseliotis, 2002). However, many kids in foster care are forming new attachments in long-term foster families well into adolescence. Leathers (2006) found that the extent adolescents in foster care were able to form relationships within the foster home was correlated with placement disruptions and behavioral problems. Teenage foster children’s integration in their foster homes is an important dimension in decreasing placement disruption and increasing adolescents’ satisfaction in the home.

Many of the previously mentioned interventions address the needs of the adolescent individually. When family therapy is implemented, it is often focused on addressing communication, family issues, behavioral issues, and coordination of services. While these interventions are helpful in addressing some personal, emotional, and behavioral issues they do not often specifically improve attachment between the foster parent/parents and the teenager. Filial therapy techniques may be a viable option for building attachment, particularly when implemented in conjunction with more traditional therapies.

Defining Filial Therapy

Filial therapy is a therapeutic intervention that focuses on improving the parent–child relationship. Although this modality has been traditionally applied to young children, this intervention as well as play therapy has been adapted to adolescents (Gallo-Lopez & Schaefer, 2010; Wilson & Ryan, 2002). Filial therapy is an approach derived from play therapy with the primary task being to teach parents play therapy skills to implement with their own children (Landreth, 2002). This intervention promotes connectedness between the parent and child (Landreth, 2002 ). Filial therapy was originally developed by Louise and Bernard Guerney as a type of treatment for children experiencing a variety of emotional, social, and behavioral issues (Guerney, 1964). Filial therapy is an intervention that has primarily been implemented with children only; its implementation with adolescents and their foster parents has been sparsely addressed in the literature. However, the book Play Therapy with Adolescents by Gallo-Lopez and Schaefer (2010) includes a chapter on filial therapy’s adaptation to adolescents. Brown, in his chapter on filial therapy and adolescents, distinguishes adolescent needs in filial therapy as different than children’s reporting that adolescents communicate through a combination of motor activity and verbal discourse. This process allows adolescents and parents to participate in self-actualization and meet adolescents within their developmental framework.

Van Fleet (1992) applied filial therapy to adopted children and their adoptive parents. Although Van Fleet studied younger children in this study, the results of her study are still valuable when in reference to adolescents and foster children. Foster and adoptive children at any age, exhibit distinctive developmental and relational needs that receive benefit from filial therapy. Van Fleet suggested using filial play therapy as a way to prevent future problems or intervene when problems arise in these adoptive situations. Her goal was to strengthen adoptive parent–child relationships through teaching the filial therapy model to adoptive parents. Filial therapy would also be a reasonable intervention with adolescents in long-term foster care as they experience similar concerns.

Reynolds and Schwartz (2003) investigated teaching parent’s filial therapy techniques and found that it provided a means to increasing parental awareness of children’s needs, a reduction in parental stress and better child–parent relationships. Ray, Bratton, and Brandt (2000) investigated the use of filial play therapy with single parents and their children. They found that filial therapy had preventative, educational, and clinical implications for these single parents and their children. Because children in single-parent homes and adolescents in foster care have some common issues including negative stressors, emotional and behavior issues, and long-term adjustment issues, these results have positive implications for applying filial therapy to adolescents and their foster parents.

Using filial therapy with adolescent foster children and their foster parents has the potential to strengthening the connection between the two parties and thus potentially improve the longevity and satisfaction with the placement. Because an emphasis of filial therapy is on open and empathic communication, it may decrease behavioral struggles and increases thoughtful communication and problem solving between the foster parents and the adolescent. It allows the opportunity for intentional, consistent interaction between the teenager and foster parents. Attachment is used here to imply an increase in trust, increased ability to problem solve and manage behavioral problems, and an increase in the foster parent–child bond.

Filial therapy is an intervention built upon the foundational principles of child-centered play therapy (Landreth, 2002). Landreth defined play therapy in his book Play Therapy: The Art of the Relationship as:

A dynamic interpersonal relationship between a child and a therapist trained in play therapy procedures who provides selected play materials and facilitates the development of a safe relationship for the child to fully express and explore self (feelings, thoughts, experiences, and behaviors) through the child’s natural medium of communication, play. (p. 14)

Filial therapy does not focus on correcting a specific problem but focuses on building the parent–child relationship where the child feels safe enough to play out problems (Watts & Broaddus, 2002). Filial play therapy is an intervention based upon providing parents/caregivers with basic therapeutic play and/or nurturing skills to help them to improve their parenting. Parents are taught to reflect children’s play in a nondirective, caring manner. Just by nature of attending to a child, uninterrupted, for a specified amount of time per week has the potential to strengthen the connection and bond between the parent and the child.

Filial therapy is a type of parent training model (Watts & Broaddus, 2002). While other models stress problem-solving techniques filial therapy is developed from play-based exchange. Filial therapy is primarily experientially based, whereas other parent training models use a discussion format. Because play is the child’s natural medium of expression and filial therapy is play-based, it is the only model (compared with other parent education models) that allows children to express their emotions fully through the safety of symbolic expression (Landreth, 2002). The youth takes the lead in filial therapy; there is no emphasis on correcting the child’s behavior. The purpose is to change the child’s perception of the parent rather than to correct behavior which is a unique approach to a parent–child relationship.

While the primary focus of filial therapy is to strengthen the adolescent–parent bond, another goal is to facilitate change in the parent (O’Connor & Schaefer, 1994). In many other childhood interventions, the goal is to change the child. In filial therapy, there is no focus on understanding the purpose of the child’s behavior, but rather the focus is on the parent–child relationship. Filial therapy is a more modern and progressive therapy in that there is not an emphasis on determining the “why” of the adolescent’s behavior. Instead, filial therapy is future based as opposed to other models that are grounded in past relationships and happenings. Skills learned in filial therapy training are generalizable because they are not problem-correction focused and not behaviorally specific (O’Connor & Schaefer, 1994).

Foster parents may enter the training phase of the intervention not expecting any changes in themselves. Often, parents’ primary orientation is toward their children and problem oriented. In filial therapy, parents are encouraged to challenge this orientation. Parents are usually able to adjust this orientation and become increasingly future and strength oriented. This parental awakening per se is oftentimes the catalyst for positive changes in the youth. Foster parents begin to recognize the meaning in their child’s behavior and become sensitive to their child’s emotions. They must learn to be sensitive to the child and the child’s emotions and learn how the child’s emotional development may impact the child’s behavior (Carmichael, 2006).

The Application of Filial Therapy to Adolescents in Foster Care

The play therapy techniques used in filial work have been adapted for use with adolescents in the past (Breen & Daigneault, 1998; Brown, 2010; Wilson & Ryan, 2002) and specifically to adolescents in foster care (Cabe, 2005). Typically, when children engage in play therapy, they do so in a playroom. For teenagers, it makes sense to give teenagers the option to engage in filial activities outside of a playroom because most adolescents are beyond the development level of wanting to play with toys. That being said, giving them the option to play with younger aged toys in a nonjudgmental environment can also be fruitful. Because many adolescents in foster care have come from homes where they were abused and/or neglected, their opportunities to engage in developmentally appropriate activities as young children may not have been possible. By affording them this opportunity, they may reclaim some of the developmental experiences they missed.

Ideas for activities for age appropriate activities include exercise craft projects, cooking, or completing a home improvement project. There are a few important objectives to consider when selecting the activity. First, the activity should be selected by the adolescent, as this allows the activity to be child lead. Second, refrain from participating in rule bound activities such as board games as they do not promote freedom of expression. Finally, the activity selected should be one that promotes interaction between the foster parent and the adolescent; therefore, tasks like watching television should be avoided.

Teenagers may be suspicious of new therapeutic interventions. Many adolescent foster kids have been through several traditional behavioral therapeutic treatment modalities. However, it appears that even the weariest adolescent foster child may in fact be the perfect match for an intervention that needs little more explaining than “We are going to set aside one hour each week devoted to spending time together. There are some ground limits, but in general, you get to decide what activities we will do together each week.”

The implementation of filial therapy with adolescents and foster parents would begin with training sessions for the foster parents to teach them how to utilize and implement filial therapy techniques with their adolescents. Training adolescent foster parents in filial therapy techniques would be no different than training parents in filial work. Landreth and Bratton (2006) have done extensive work in developing training programs for parents using filial therapy and thus the training regime here is based off their work. Landreth and Bratton (2006) reported that training parents in filial work is much like the training that graduate students receive in an introduction to play therapy course. The training typically takes place in a group format, with approximately six to eight parents. Larger training groups do not allow enough time for the facilitator to relate to each parent.

It is recommended that the training consist of 10 weeks of 2-hr group sessions involving didactic training, role playing, and demonstration play sessions (Reynolds & Schwartz, 2003). During the training, parents learn and practice reflective listening, communication skills, and how to set therapeutic limits. Traditionally, videotaping filial sessions that parents conduct with their children has been highly valued as it provides an opportunity for parents to look critically at their interactions with their adolescent and make adjustments when necessary (Landreth, 2002). The first 3 weeks consist of training the foster parents in filial skills. Beginning the forth week, they will begin working at home in required 30-min, once-a-week, sessions with their foster child (Landreth, 2002).

In the second phase of this intervention, foster parent and their teenager would complete the filial work together at their home for 1 hr a week. This means that foster parent and the foster child would designate 1 hr each week of uninterrupted time to complete a filial activity together. The foster parent would then utilize the skills they had learned in training to work toward building the relationship with their foster child. Ideally, the foster parent would have a group point person to process these filial sessions with for a period of time following their initial weekly filial sessions with their foster child. It is also likely that supervision of filial sessions would have to rely more on self-report to the supervisor and supervision group for feedback as the ability to record filial sessions at home would be unlikely. Although there would be some loss in actual observation of parental technique in applying filial therapy it would still allow the parent to receive feedback on their filial therapy each week much like a therapist receives from their supervisor in traditional practice. Having a support group format after the initial training and intervention could be an added support for the foster parent and in many counties, support groups for the foster parent are already intact.

Along with the added benefit of attending support groups and implementing filial therapy into their relationship with their adolescent/adolescents in foster care, foster parents would also qualify to submit their filial therapy hours as training credit toward their certification as foster parents. There are yearly training hours required (both by state and federal law) each year—for foster parents in order to maintain their certification as foster parents. Participating in filial therapy also give foster parents the opportunity to improve their relationship with their adolescents in foster care and potentially prevent difficulties. Strengthening the connection between the foster parents and adolescents in the beginning, promotes health and stability.

Adolescents in the foster care are often seen as disposable. If a problem occurs in foster care, it is often easier to remove adolescents from the foster homes rather than continue to emotionally invest in adolescent foster children and strive to make these new family systems successful. Using filial therapy with adolescents and their foster parents offers a unique intervention that promotes connection between adolescents and their foster parent/parents. Through the use of this intervention, adolescent foster children’s stability in foster homes has the potential to be greatly impacted by facilitating an increase in the attachment bond, ultimately mediating the potentially detrimental effects of serial placements. Increased research in the application of filial therapy for adolescents in long-term foster care with their foster families will only strengthen the efficacy of this well proven classical therapeutic approach applied to a new population.