A Feeling of Fullness
Reflections on Therapy with Kids in Foster Care
The thought of working with children who’ve survived trauma can be an intimating prospect for many therapists. Children reeling from the impact of loss and neglect often cope through hypervigilance, guardedness, and actions seen as deliberate misbehavior. And yes, this can make for challenging situations for therapists. But there’s much more to working with these kids than meets the eye. I’ve learned this personally, working with foster kids from the very start of my therapy career. Along the way, I’ve discovered what it really means to find fulfillment as a clinician.
Early in my career, while pursuing my bachelor’s degree in psychology, I started working with a local organization in Florida that licensed foster parents and provided group homes for kids in foster care. I started off as a volunteer, but by the time I reached graduate school, the organization had appointed me as a “house dad” for kids who’d aged out of foster care after reaching 18. Back then, when you aged out of foster care, the state would just give you a check and say, “You’re an adult now, and you’re on your own. Good luck!” But these kids were in no way prepared for real life. So they moved in with me, and for the next two to three years, we’d live alongside each other. I was only 23 at the time, but there I was, living with five other guys who watched how I lived, and learned to do the same. I’d teach them life skills, like how to budget your money. I wasn’t doing therapy, but there was real growth taking place in our shared life together. There was fellowship, and over time, we became family for each other.
After I got my master’s degree in clinical psychology, I became the organization’s clinical director, coordinating with the nearly 300 foster homes we served in Broward and Palm Beach counties. Because I was the only therapist on our organization’s team, I spent a lot of time on the road, travelling to daycares, schools, and homes, working directly with foster parents and their kids and teaching them therapy skills like how to help develop secure attachment, give and receive care, and build a child’s confidence, all of which would make their lives a little easier.
In order to be placed in foster care, you have to have experienced abuse, whether it’s sexual, emotional, physical, or neglect. Most children in the foster care system have experienced some form of neglect, which isn’t like other kinds of abuse. It’s the kind that says to a child, You don’t matter, you don’t exist. The behaviors that stem from neglect tend to be very difficult to treat.
On the surface, I was working with behavioral issues like defiance, inappropriateness, hypervigilance, and what looked like ADHD and impulse control problems. But doing this work, you realize that you can’t treat the behavioral problem without allowing the child to touch or deal with their trauma story.
I’d learned how to treat trauma in graduate school, but kids express their mental health challenges differently than adults. They’re less in touch with the abstract, unconscious realities of their trauma. Those realities become clear in two areas: in their play and in how they act out.
Playing is crucial for kids who’ve survived trauma because it allows them to access the unconscious part of their trauma where the fear, shame, and guilt—which follow them all the time—lives. Kids in foster care often feel like everyone knows their story, like they don’t have any privacy. And it makes sense: their story is written in a file that’s sitting inside of a cabinet. So how do you get to the unconscious part? You have to play. But that also means you have to work really hard to become the kind of person these kids want to play with.
A few years ago, I was working with a preschool-age boy at his daycare. We were playing with two Spiderman action figures, and he’d named one of them “the bad one”—something I took note of. At the end of the session, when we were packing up the toys, he went into a nearby closet and started climbing boxes. That’s a no-no according to the school rules, so I started redirecting the behavior. But then he said, “I’m not the good Spiderman, I’m the bad Spiderman. I’m not a good boy, I’m a bad boy.”
When the boy’s foster mom came to pick him up, I shared what had happened. Suddenly, she broke down in tears and told me that the day before, he’d been climbing the shelves at home and she’d scolded him, telling him he was bad. If he hadn’t felt secure with me, this boy wouldn’t have been able to “unlock”—to tap into and express the feelings he was holding. I realized that he’d been climbing those boxes because he needed to relive what had happened the day before. It was his way of processing and dealing with it. When kids experience something traumatic, they often feel like their identity, their sense of self, is under attack. Afterward, they’re constantly trying to gain confidence and stability and consistency, so they sometimes try to walk through that story again, however they can, to find out for themselves what feels true to their identity and what doesn’t.
Here’s another thing about doing play therapy with kids: engaging your own inner child is key. I have to become playful. That means any self-consciousness goes out the window. I have to press pause on my embarrassment and my insecurities. Lots of times I have to get down on my hands and knees and just be there, be curious—I follow the child’s lead. Contrary to the popular notion that most trauma survivors are closed-off and shut-down, many of the kids I work with are constantly on the lookout for a potential source of salvation, and if they see me as a connection point, then they hold on to me. Very often, they’ll use toys and movement to cocreate a sense of safety and trust, and if I just go along with it, sometimes I’ll start to understand the story they’re trying to tell, and help them navigate it.
There’s a misconception that it’s impossible to work with kids in foster care, or that you need to specialize in play therapy. Yes, you do need to have some training, as well as a decent understanding of trauma, but having the ability to connect and be the kind of person a kid wants to spend time with is just as important. If you can do that, you can help these kids navigate hard moments, walk through their stories, and own them. There’s a lot of power in that.
There’s another often-overlooked ingredient in this work: in the world of foster care and adoption, it’s crucial to work with the family system, because the child’s attachment is often a key issue. That doesn’t mean the work is long and drawn-out. On the contrary, it’s often faster, because you’re enlisting the parents’ help and giving them trauma-informed tools to better navigate their child’s behavior. I’ve seen families for as few as five sessions. If they need to, we check in down the road. We think of the therapist similar to how we think of a family doctor—as someone you can check in with as needed, whether it’s once a month or once a year. I think that’s a good thing, especially when you’re working with trauma. I teach families I work with that trauma is developmental. In other words, you may deal with it at one stage of your life, but when you enter another stage of independence, like moving out of your parents’ home or getting married, the trauma can come back, and you have to know how to deal with it when it does. So, for some families, I’m just their family therapist.
In my 14 years as a therapist, I’ve worked with hundreds of kids. I’ve been on the road every day for years, traveling from child to child and parent to parent. It’s been a long, hard journey. But what drives me, what draws me to this work, is knowing that I’m making a generational impact. One life can ripple out and touch so many; you can affect generations beyond the child.
Sometimes, the pain and hurt I’ve witnessed over the years starts to feel too heavy. It ruins your hero mindset when you’re working in a system that’s designed to keep kids safe, but often makes things worse. There are days when I feel like my ability to continue doing the work is coming to an end. I don’t know how much more I can give.
But I’m hanging on because of moments like one I experienced recently, when I got an email from a teen I’d worked with years ago. She said that before we started working together, she’d felt like nobody had taken the time to see or hear her. She wrote that me being able to do that changed everything. Today, she’s doing great. It just shows that, a lot of the time, these kids experience significant change very quickly with just a little effort because of how bad life has been for them. For a long time, they’ve had this constant feeling of being in survival mode, and you can help them give themselves permission to switch that off and just be present and whole.
When I remember that, it lets me be even more present now, with my current caseload, and at home with my own kids. At the end of the day, maybe our work isn’t about the pursuit of something we have yet to accomplish, but a matter of feeling full right now.