THE ATLANTIC MONTHLY, September 1992
Problem Adoptions, by Katherine Davis Fishman
One would have difficulty finding a clinician more knowledgeable about extreme situations than the Vogel family 's therapist, Hugh M. Leichtman, the administrative director of Wediko Children's Services, a Boston-based mental health agency serving seriously disturbed children, their families, and their schools. Wediko's operations include a residential treatment milieu (a community in which daily life is structured to be therapeutic), in the form of a summer program and winter boarding school in Windsor, New Hampshire; and a clinical consulting service that provides follow-up therapy to Wediko clients through the Boston public schools' special-education program.
Wediko is affiliated with the Douglas A. Thom Clinic. Leichtman, forty-eight, an intense man with sharp eyes, boyish features, and receding silver hair, has been co-directing Wediko for twenty-two years. By the time families reach him, they are pretty much at the end of their rope. Leichtman estimates that nearly 40 percent of his milieu clients are adopted or foster children. "Back in the late seventies we began to have a run of adopted children from Connecticut," he remembers. "Somehow the Connecticut Open Door Society (a parents' support group) found out about Wediko, and these kids started to trickle north to us. What struck me about them as a group was how high-functioning the parents were and how extraordinarily disturbed the children were, and how the way we perceived the children varied remarkably from the clinical report - how the home therapist saw the children. "Almost always the therapist's formulation; was made in terms of the standard theory of the day - that these children's symptoms represented family conflict.
They were playing out the struggle of the parents and allowed these family systems to stay together. One formulation was that because a child is adopted, the parent isn't giving the child enough, is communicating somehow that the child is second-class. "Many of these families had biological children who were doing very well. But these adopted kids seemed to be blowing out left and right, causing havoc to the family, so much so that the other kids would start to become symptomatic. As we worked with the parents to get the adopted children's histories, we saw the way these terribly traumatic stories played out.
We still didn't have an appreciation of how attention-deficit disorder or other constitutional factors could magnify the effects. But we began to understand the stress these children could bring to their families. It's important to see the direction of the effect: it's not the parents producing it.
"In the past ten years we have treated probably four hundred complex adoption cases, so we have a pretty sizable sample. You can point to your successes and your failures. We believe the only way you're going to save these kids is by preserving the adoptive families, and these families require extraordinary services: expert diagnosis, extensive treatment for the kids, and respite care."
Among those four hundred cases are a handful that Leichtman and his staff consider pivotal in shaping their understanding of children with histories of abuse, neglect, and many disruptions. One winter morning I sat with Leichtman and Tom Hays in the Back Bay townhouse that is Wediko's headquarters, discussing a young woman I'll call Marie Hays, a doctoral candidate with an M.A. in clinical psychology, is a clinical consultant at Wediko who has held various positions there for more than a decade.
"Eight years ago I had this little ten-year-old girl, cute as a button, bright, polite, not your typical Wediko kid," Hays remembered. "and I get a call from this lunatic of a mom: 'My daughter this, my daughter that.' How this child runs up to the third floor, opens all the windows, and yells, 'Rape! Help! Police,come get me!' I'm listening to this mom and I'm, seeing this girl, who's just as sweet as can be. So I'm thinking, this is fairly typical family-dynamics situation where the parents are the cause of the problem, you get the child out of there, the child calms down, and the parents are still lunatics. I'm telling this to Hugh, and he says, 'so you think so, huh?' and he's got a huge smile on his face. Hugh obviously thinks something else is going on. "Finally we set up a family meeting. Hugh is still saying, "We'll see what happens." As soon as this mom got out of the car, the child threw a tantrum like I have never seen, a tantrum for about two hours at the sight of the mom. What the mother did, after the tantrum, was put her hands on Marie's face and say, "It's so good to see you, Marie." She instantly bonded with this girl, and the girl responded - at the moment." "Right after that," Leichtman interposed, "Marie started going "Hmmmmmmmmmmmmm," this noxious, eerie droning that grated on you. The girl was creating noise, and you wanted to close it out - so the noise gave her distance.
You learn to operate by the gut: I called for some masking tape. We put a line on the floor with the tape, and I said to Marie, "This side is out of the family, that side is in the family. Where do you want to be?' And she did something that absolutely surprised us. She hopped right on the middle of the the tape. "I'm here,' she said. When Tom helped her off to the family side, she immediately jumped right back onto the middle. And when she was on the middle of the tape, her noise stopped." "It was the proverbial 'on the fence,'" Hays said, "and as you would do things to get closer to her, the noise would accelerate. When you psychologically distanced yourself, the sound would come down." "Tom took her in and out of the family, and she kept hopping back in the middle," Leichtman said. "So I said to her, 'Marie, I'm so confused. Your mother was killed in a car accident, and I thought after that you wanted a family.' She hops up and down on the middle of the tape and says, 'No!' I say, 'No?' and Tom says, 'No?' and Marie says, 'No! All I asked for was a home! I never asked for a family!' Mother is just blanching when she hears this.
So Mother says, 'Marie, let's go for a walk.' Her response is to reestablish the attachment. So they go out to walk, and they come back, they're talking, and they're emotionally connected again. And we say to Marie, "Where do you want to be, in the family or out of the family?' Guess what; she hops right back on the middle of the tape and starts droning. "We know something very big has happened here.
Later on, as we talked about this and pieced it together with what we'd seen of other children, we started to understand this pattern of attachment and the various degrees of breaking the attachment. It appeared among children who had traumatic events and losses in their history. It confused us at first, because it wasn't that the kid couldn't make the attachment. but every time she made it, she had to break it. Then she would reach out and reattach."
Harold Vogel's behavior had been even more violent than Marie's. Harold's residential school had trained the Vogels in the holding techniques used on disturbed children when they have long tantrums. "Even though I had seen other kids being held," Antonia says, "I wasn't prepared for the fury of that first tantrum. It was like two hours of fighting with a wild animal. There was this little seven-year-old, who must have weighed all of fifty pounds, and I just could not get him under control. I'd put my hands out and he'd try to butt me with his head. All the training went out the window.
Finally it got to the point where he was sobbing, and his body would soften and get limp, and at this point you could snuggle up. He wasn't seven; he was two." Over the next two years Harold's tantrums became so frequent that Antonia couldn't play the piano: her wrists were constantly damaged, and they never got to heal before the next episode. Harold was taken to a series of play therapists, whose offices he wrecked, with no positive effects.
The therapists - who often said, "Harold, you must be very angry" - told the Vogels to develop Harold's self esteem by giving him experiences that made him feel successful. "We followed their advice and things got worse and worse," Ted says. Antonia adds, "All this makes sense up to a point, but with his intelligence and the profoundness of his problems, he can keep avoiding the whole point of therapy. He'll just keep his secrets to himself and hang on to his disturbed behavior and wreck his own life - and yours while he's at it." Finally the Vogel's social worker heard a lecture of Leichtman's and sent the family to the Thom Clinic. "We sat down and Harold went right to the toys," Ted says. "He's a veteran. Hugh said, 'Harold, I need you to come over here," and Harold continued to fool around. Hugh bounded over to Harold and grabbed his face and said, "Harold, do I have to hold you and look in your eyes while we have this conversation?' and we looked at each other and said, 'This guy's got it.'" Over several years Leichtman, through techniques ranging from gentle questioning to reenactment to imagery induction - "I told him to use his eyelids as a movie screen where he could project the interior of his foster home, and he vividly described the layout and where the abuse occurred" - has elicited precise descriptions of physical abuse and hints of sexual abuse.
"The question here is how do we put the feelings that come from these early traumatic events in the appropriate place?" Leichtman says. "How do we get these kids to tie the rage to its original source, instead of having it displaced like a shadow in the grass? With Harold we have three families. We're not even going to try to get to the biological mother. If we can just tie some of the anger to the foster family he was with for five years, instead of having it always fall on the Vogels..."
Since signing on with Leichtman, the Vogels have had periods of tranquility lasting several months. Harold has been to Wediko twice, but only the second visit, a three-month stay in he winter program, helped. Other therapists' efforts were completely ineffective; Leichtman's successes are of limited duration. A year ago Harold "broke the attachment" by riding off on his bicycle on a highway in a snowstorm with cars whizzing around him. Another time he needed two weeks in a mental hospital. When Harold makes progress, some credit goes to Prozac, the anti-depressant, which enables him to benefit from therapy. His own cognitive development has also helped his understanding. At twelve, Harold is moving away from tantrums and violence and is into stealing and fire setting; the prognosis is uncertain. Still, the Vogels feel that Leichtman is the first therapist to grasp the problem, and that he has saved their family. "Kids like Harold are very difficult for even the most skilled of parents to manage and control,' Leichtman says. "These people have admittance to St. Peter's gates already, and Harold will test them further."