INVISIBLE CHILDREN

reprinted from Sunday, February 12, 2006 (SF Chronicle)

One Child, One Therapist/An innovative program partners foster children with therapists for as long as they’re needed, providing a stability otherwise missing
Rob Waters

When child psychologist Norman Zukowsky first met him, 6 1/2-year-old “William” had already lived through more hardship and trauma than many people experience in a lifetime.

He was born exposed to drugs and alcohol,one of three children of a drug-addicted mother who lived in an unheated garage with no cooking or bathroom facilities.

Child welfare reports suggest that the children were physically abused, exposed to sexual behavior and often went without food or clothing. Eventually, William was
removed from his mother’s care only to be placed with a relative who scarred his chest beating him with a belt.

Then William finally caught some breaks. When he was 5, he and his 7-year-old sister were placed with Mrs. Smith (not her real name), a loving, attentive foster mother who ran a stable, orderly home.

Under her influence, he began to settle down and shed some of his wildness and anxiety. One year later, Zukowsky became his volunteer therapist through an innovative San Francisco program called the Children’s Psychotherapy Project.

For the next two years, Zukowsky and William saw each other once a week, usually at the therapist’s San Francisco office but sometimes at Smith’s tidy blue house. Zukowsky saw in William an endearing, charming boy who was hungry for adult friendship and connection.

They spent most of their hour-long sessions playing cards, board games and improvised baseball using paper wads and pencils. “He made the rules … he kept score, and he always won … repeatedly, inevitably, and — in my clinical view –necessarily,” Zukowsky wrote in a chapter of a recent book about the psychotherapy project.

William was playing “developmental catch-up,” Zukowsky wrote, seeking and getting from his therapist the warmth, attention and emotional nourishment he had missed in his earliest years.

Things were going well for William. He had fallen in love with his foster mother, who was in the process of adopting William and his sister. He adored Zukowsky. And he was doing well in school.

Then, one horrible night, William’s life crumbled again. Mrs. Smith’s husband, a depressed, quiet man who rarely interacted with the children, shot his wife and himself. William and his sister found their bodies and lost the only stable, loving home they had ever known.

Zukowsky was now the key adult in William’s life, the one person he could
count on, and who was truly looking out for his needs. Zukowsky was in that position because 12 years ago San Francisco psychologist Toni Heineman got mad about the many ways the child welfare system fails foster children — and decided to do something about it.

Heineman had worked with foster children for many years and had learned firsthand how the system sabotages the ability of foster children to form lasting relationships with caring adults.

“We send foster kids from home to home, community to community and case worker to case worker,” says Heineman, an associate clinical professor of pediatrics and psychiatry at UCSF. “It’s the biggest problem in the system.”

The system’s failings take a heavy toll. A recent report from Casey Family
Programs, a foster care agency, found that former foster youth now in their 20s and early 30s suffer from staggering rates of post-traumatic stress disorder and other mental health problems; high rates of unemployment, homelessness and poverty; and low rates of college and vocational school completion.

Heineman realized that revolving therapists were part of the problem. Foster children who get therapy usually are seen by interns who rotate every few months to get diverse experience. Just as a child forms an attachment with a therapist, she explains, the therapist leaves and the child is once again abandoned.

To address this problem, Heineman and a group of colleagues founded the Children’s Psychotherapy Project, which recruits therapists to spend one hour a week working with a foster child.

The guiding principle is simple: “One child, one therapist, for as long as it takes.” The project asks for a long-term commitment from the therapists it recruits, but it also gives something back: In addition to their one-hour session with a foster youth, each volunteer therapist also participates in a weekly consultation group led by a veteran clinician.

These groups, which therapists might normally pay to attend, allow colleagues working with children to come together, discuss cases and get advice and support from each other.

After Mrs. Smith was murdered, Zukowsky’s consultation group became a crucial source of support for him as he mourned her death and its impact on William. “I was sustained by the emotional sharing” of the group, he wrote.

Zukowsky’s role in William’s life was now more critical than ever. He comforted William, worked his connections in the welfare system and strategized with the therapist working with William’s sister, also a project volunteer. When they resumed their sessions, a subdued William continued to want to play — and did not want to talk about his foster mother’s death. Zukowsky followed his lead, rarely bringing up Mrs. Smith’s death.

William eventually recounted the story of finding the bodies, the shock and sorrow playing briefly over his face. Eventually, William brought up the question Zukowsky had been dreading: Perhaps, the boy asked, they could live together. Zukowsky awkwardly explained that would be impossible, and William let it go.

Today, two years after Mrs. Smith’s death, William and his sister are again living in a stable home. William is now 10, and he continues to see Zukowsky once a week for sessions of indoor basketball mixed with a bit of talk. Zukowsky is guarded and self-effacing when he talks about William and his impact on one boy’s life. But this much, he will say: “In a psychological sense, I was family. We shared a loss, and he had someone to lean on.”

The Children’s Psychotherapy Project, meanwhile, has gone national. From its start in San Francisco, the project has spawned 12 chapters in cities around the country.

More than 100 therapists are donating their time and more than 200 foster children have been served. In a system that, on any given day, includes some 500,000 children nationwide, that number is a drop in the bucket. Heineman keeps on working to recruit more therapists and serve more children. But whatever the numbers, she believes the program has an impact beyond the individual children served.

“When we make a difference in the life of one foster kid, it also has an impact on the system,” she says. “It’s small and it’s subtle, but over time, it adds up and people begin to think about the importance of long-term relationships in the lives of foster youth in a different way.”

Freelance writer Rob Waters is a recipient of a 2005-2006 Rosalynn Carter
Fellowship for Mental Health Journalism. ———————————————————————-
Copyright 2006 SF Chronicle