TEN-YEAR-OLD BRIAN* arrived at his new Montana foster home on a snow-covered ninth of December, 1990, just in time for the holiday season. It was to be his first Christmas after more than two years in an institution, and his new foster mother was determined to make it a good one. A letter from Santa came in the mail for him, and he made construction-paper wreaths at school to hang on the tree. He and his foster mother, Theresa*, put tiny blinking lights and other decorations on the pine tree in the living room and pinned stockings to an imitation fireplace.
But one afternoon soon after that, according to Theresa, all hell broke loose. “He refused to practice his multiplication tables,” she says. “He tore the flash cards into little pieces and went wild. He tore the Christmas tree down and the lights over the door, and the socks over the mantel.” Then he upended chairs and a table. Theresa was startled, but she had known that she was taking in a child who was full of rage. Brian had been severely abused by his parents from infancy until he was taken from them at age 5. At foster home after foster home, the story had been the same: He had violent episodes, attacking his foster siblings. He tortured animals. Punched holes in the walls. Ripped apart a mattress with his bare hands. Each time, he was returned to institutions where, until two years ago, he was usually drugged or punished for his outbursts.
But as part of a new treatment, Theresa had been trained to respond to Brian differently. Faced with a husky and out-of-control boy, she would grab his arms, wrestle him to the living room carpet and then sit on top of him until he calmed down. “The floor method,” says Theresa, 58, a slim, gray-haired grandmother of 13. “Him face-down. Me on top holding his wrists, far enough back on his legs so he can’t kick.” It was a technique designed to harm neither the child nor the adult, and it was to be used any time Brian had a tantrum. The principle was simple: If he tries to destroy something, don’t yell or punish; hold him. If he tries to harm himself, hold him. If he becomes violent in any way whatever, hold him.
In her first months with Brian, she had to restrain him repeatedly, holding him, she says, anywhere from 10 minutes to half an hour. She lost 25 pounds in those daily struggles. “ ‘Turn me loose,’ he’d say,” Theresa recalls. “I’d say, ‘Who’s in charge?’ He would have to say, ‘Theresa’s in charge,’ before I would let him up.”
After the Christmas tussle, as they lay on the floor and Brian had calmed down, Theresa mopped perspiration from his head with a tissue and they talked about what had happened, how he might better handle his feelings next time. “Afterward he picked up the chairs and lights, cleaned up and put everything back. It was over and we didn’t talk about it anymore.
“When Brian came out of the home,” Theresa says, “I had to restrain him, my God, three or four times a day, four or five times a week. He needed to be touched, and the only way he knew to get touched was to be put into the restraining position. He knew I liked those Christmas decorations, and he tore them down so I would restrain him.”
Over time, Brian has learned other ways to get the touching he needs, but he still loves to swear a blue streak, which Theresa believes is therapeutic. “We have contests if he uses the word f ---,” she says. “I say, ‘I really like that word, let’s you and I stand here and have a contest.’ And we’ll scream at the top of our voice, over and over again. With the windows closed, hopefully. I tell him, if you’re going to swear, close the windows.”
Some parents would call this hell, but those who know Brian’s story and prognosis call it a miracle.
BRIAN CAME TO THERESA from the Intermountain Children’s Home, one of a handful of residential centers in the country that uses an innovative long-term program for treating severely abused children. This home, in the isolated, mountain-ringed city of Helena, Mont., is often a last-chance stop for children who, like Brian, have been brutalized by adults until their minds have snapped. In the aftermath of neglect, sexual abuse and even physical torture, they face a raft of problems including psychoses and post-traumatic stress disorder, an affliction suffered by Vietnam veterans haunted by the horrors of war. These children can be savagely violent. Emotionless. Sexual molesters of other children. Fire starters. There is evidence indicating that such children untreated are likely to be come the most brutal of criminals--at worst the Ted Bundys, Jeffrey Dahmers and Richard Specks of the next generation.
Treatment for such children is most often based on what psychologists call the behavioral model, based on the work of B. F. Skinner. If a child behaves well, he is rewarded with points or privileges. If his behavior is unacceptable, he may be banished to a room alone for a timeout. Eventually, the child learns what is acceptable and incorporates the preferred behavior into his life. There are few alternatives to this approach, and if it fails, there is little recourse but to keep the child in an institution for the rest of his life--or face the consequences of giving up on him.
But the Intermountain home--and the program it’s modeled on, that of Forest Heights Lodge in Evergreen, Colo.--claims success with a far different program, one that showers abused children with the constant and consistent nurturing that they never got from their parents. The goal is to allow them, for the first time in their lives, to develop a strong bond with another person. Thus, they are not corrected so much as accepted. This treatment is based on the attachment model, the principles of which were noted in mid-century by psychoanalyst Rene Spitz and developed by psychoanalyst John Bowlby and others. Spitz studied infants reared in orphanages and found that given only perfunctory care by an overworked nurse--and without a physical, nurturing relationship--many of the infants simply withered away and died.
The attachment theory that grew from his work holds that in order to heal, severely abused children need to rebuild the twisted foundations of their lives--in the process, revisiting critical stages of development that have been stunted by abuse and neglect. Children 8 or 10 or even 12 years old often regress to infancy and are given a bottle, or rocked in a rocking chair, or coddled or engaged in a game of peekaboo. Eventually, many of them learn to function in the world. It’s a slow process--children live for an average of two years at these centers--and it’s labor-intensive, with a child-staff ratio of 1 to 1.
According to Ray Curtis, director of social services at the 36-year-old Forest Heights Lodge, which developed the attachment-oriented method of treatment in a long-term residential setting, as many as 85% of those chosen for treatment--children like Brian who had exhausted the system--can be plucked back to some semblance of a normal life.
Leading attachment theorists have a mixed response to the way their ideas have been applied at the two Western institutions. “A lot of what they’re doing is right down the straight path,” says Mary Ainsworth, the retired 78-year-old doyenne of attachment theorists who, when active, taught at University of Virginia in Charlottesville. “At any age, hugging is appropriate and therapeutic. Close bodily contact is the key to the thing.”
“It’s interesting and worthwhile,” says Justin D. Call, a psychoanalyst and chief of child and adolescent psychiatry at the UC Irvine Medical Center. “It makes an awful lot of sense to be tolerant, to contain a child, hold the child and stay with the child rather than trying to manipulate or drug the child.” Whether and how the regression and attachment aspects can work in the long run, especially after discharge from a treatment unit, is difficult to say without more research, Call says.
Curtis admits such concerns are important, but academic. Though no one comes right out and says so, the basis for the treatment he administers is the closest thing to family-style love that an institution can create. “Our program is really just common sense,” Curtis says. “That’s what good parenting is about. We’ve rediscovered what grandma knew. There’s so much research and science on children that something has been forgotten. Kids need to be touched, kids need to be hugged, kids need to be nurtured. They need to feel loved and feel worthwhile.”
There is no universally accepted road map to how a child develops, but the attachment model has gained increasing credence since the 1950s. In a nutshell, it says that the first months of a child’s life are critical to well-being--more so than science ever imagined. For it’s in those early months that children build their first emotional and psychological bridges to the outside world, with the critical help of a nurturing care-giver--mother, father or someone else. The quality of their lives will depend on the strength of those bridges.
The early part of the attachment process works like this: Babies get hungry or wet their diapers. They cry and scream, kick their legs and wave their arms, and tension builds until a parent answers. The child is given a breast and cradled, or the diaper is changed, and the mother sings to baby softly. The mother and the child come down from the stressful peak together, relaxing and comforting each other. As children get older, they begin to explore the world, to take in new experiences and people, but always--if the attachment process was a healthy one--with the knowledge of a secure home base to return to. The baby has been taught the rudiments of human relationship: that other people can be trusted to soothe, nurture and care for you--indispensable psychological nutrients, apparently, for human development.
But if emotionally crippled parents respond to children’s crying with neglect or violence, the children can begin to “numb out,” to actually stop feeling pain and to stop expressing needs, both physical and emotional. They never develop basic skills for bonding and cannot bond in a healthy way to others. They have been taught that there is no one for them to depend on, so they never trust.
Once children do learn to trust other people to care for them, they can go on to learn a second level of trust: trust that others will protect them from harm. As children begin to crawl or toddle, they’re guided through the world by their parents, who protect them. If, for example, a toddler tries to put a hairpin in a socket, the parents tell the child no. The child may have a tantrum or cry, but eventually children learn to trust adults to keep them from harm and to provide some consistency in their surroundings.
The first two levels of trust lead to the third stage: the trust of self. Based on what the parents taught, the moral compass they have provided, the young child comes to trust his or her own nascent conscience, an inner voice. “These three levels of trust,” Curtis says, “are the basic elements of attachment and are necessary for bonding. The bonds become essential to friendship, marriage, parenting, work relationships and a meaningful, moral participation in society.”
Attachment theory may be a Rosetta stone, a key to explaining such diverse social problems as drug abuse, teen-age pregnancies, delinquency, gang violence, even mass murders. The theory holds that these problems can often be traced back to those first pivotal months of life, when a child failed to become securely bonded, or attached, to a caretaker.
Insecure attachment, as it is called, can happen even with good parents. Children may be born with brain defects that don’t let them form attachments, or they may be born with defective hearing or sight, which keeps them from tuning in to the cues provided by parents--a soft voice or a friendly face.
Certainly, not all children who have attachment difficulties will turn out to be ax murderers; according to research by Ainsworth and others, about a third of the white middle-class population in the United States is insecurely attached, and within that group there’s a wide spectrum of behavior. But children who are severely abused suffer the most extreme attachment problems. “Some of these kids have so isolated their feelings, they don’t know if they’re full or hungry,” Curtis says. “They eat until they throw up. We have to watch them all the time. We have kids who go out in the wintertime in bare feet. They don’t feel the cold. We have one kid who would stare at the sun if we didn’t interrupt.”
Because these children don’t feel their emotions, they do not recognize that others have emotions and feelings. There is no empathy. And they are are the ones, attachment theorists claim, who become children without conscience.
The attachment model has some disturbing implications. It essentially says that children taken out of abusive families after age 3 often find it extremely difficult, if not impossible, to form bonds with anyone, no matter how much loving care they get. They can’t overcome their lack of strong first attachments without intensive therapy. Intermountain and Forest Heights offer that therapy--and hope for Brain and others like him.
HEAVYSET AND LITTLE-BOY handsome, Brian sits nervously on a couch in a meeting room at a mental health center in Montana where he’s come to meet me. He is wearing shorts, sneakers, a San Francisco 49ers shirt and glasses. He chews gum rapidly and, along with a tapping foot, betrays nervousness. He whistles a few bars of “Eine Kleine Nachtmusik” by Mozart. “It’s my thinking whistle,” he says. Brian was one of six children, though only he and one of his sisters remained at home during his childhood, according to state records. The single-family house that Brian lived in was squalid. Clothes were piled in the corners. Dog feces, rocks and dirt were scattered on the floor. Ashtrays and garbage containers overflowed. He once showed up at school covered with dried feces, wearing dirty dishrags in place of diapers.
Emotionally children themselves, Brian’s parents were unable to deal with his demands as an infant. His mother often treated him as though he didn’t exist, letting him cry until he stopped. “He was tied in his highchair, tied for days,” Theresa says. “They would eat. Sometimes he would get food, sometimes he wouldn’t.” Brian spent so much time tied in his highchair “that when we took him out of his home at age 5, he barely knew how to walk,” says David DuBois, social worker for the Cascade County Department of Family Services. Brian has since been a ward of the state.
For Brian, life at home had been an endless and confusing series of beatings and sexual abuse. At times his father made a living sharpening knives and scissors. Alcoholic and emotionally disturbed, the father would fly into drunken rages and threaten to cut off the boy’s toes, even to shove a knife up his rectum if Brian failed to perform sexually, so the boy was forced to comply.
Brian was sometimes beaten and sexually abused by his older sister, which posed a dilemma for the child. If he told his father about the abuse, his father would tie her to the bed and beat her, and Brian would feel guilty. At other times the sister would spirit him away from his raging, violent father to a relative’s home, playing what psychologists call the “little mother” role. He was brimming with anger, hate, fear and confusion when Family Services officials sent him first to a series of foster homes and ultimately to the Intermountain home, which specializes in children between the ages of 4 and 12 who have an average IQ and show no signs of brain damage. Most important, Intermountain looks for children in deep emotional pain. The pain “is a god-awful sadness,” Curtis says, “an empty, dark hole.” But children who still feel that pain can be helped. If they are not in pain, the experts say, they have gone too far, are too numb to be helped.
Brian spent almost three years living in one of the residential cottages at Intermountain, undergoing intensive therapy along with a small, family-like group of other children, all of whom had suffered at the hands of parents or grandparents.
Raul* plays in a sandbox outside one of the cottages. Born in an impoverished South American city, he was abandoned in infancy by his mother to filthy, crime-infested streets, where he was apparently reared by other orphans. When he was about 18 months old, someone who had known his mother recognized him and took him to an orphanage. His frail, brown body was covered with cigarette burns and rat bites, and he had been eating out of garbage cans. In the orphanage he ate anything he could find--clay, rocks, glass.
A couple from the Pacific Northwest came to South America and adopted the child, taking him home to give him the love they felt would heal him. But the little boy with the curly brown hair and big brown eyes had become, for all intents, a wild animal. He was hyper-vigilant, an attribute that had served him well on the streets, where threats could come from any quarter. He didn’t sleep through the night, taking only 10-minute catnaps, and he banged his head against the wall to soothe himself. He was unable to turn attention inward and learn anything.
Other patients at Intermountain include two brothers and a sister. Their schizophrenic mother abandoned them to their grandparents in a small Montana ranch town. The grandfather repeatedly raped the girl and sodomized the boy and taught them to have sex with each other. They, in turn, physically abused the youngest in his playpen. After sex, the grandfather would get out the Bible and tell them why his treatment of them was according to God’s law. The children’s needs were generally neglected, and they grew up in a filthy home.
The first real, supportive family these children knew was at Intermountain, where they, as do all who participate, live in one of four orange-brick cottages with six to eight other children. These cottage-based family units of children and the seven counselors and therapists are at the core of the program. Children get up in the morning, make their beds and help with breakfast. They go to schools in classrooms in the basements of each cottage or, if they do well, can attend public school and events in the community. There’s counseling as well, with psychotherapists working to help them find ways to deal with the traumas they’ve been through.
The Bridger Cottage counselor works one-on-one with the children, teaching them how to play. They learn how to run, how to be children. Some of these kids must go back to the beginning. Brian, for example, “had no ego boundaries, no sense of self,” said Brian’s primary attachment figure, counselor Martha Bottelson. “We played ‘my nose, your nose’ and he didn’t get it.” Because many of the children suffer from post-traumatic stress disorder, ordinary experiences may trigger extreme responses. Theresa recalls that one evening, when she was teaching Brian how to scrub himself with a washcloth, he began screaming and crying. It turned out that he had been abused in the shower.
After school, the children ride bikes or play games until dinner, and in the evening they do homework or watch TV. One basic rule at Intermountain, however, is that all children must be within sight of a counselor at all times or have permission to be away. Counting counselors, therapists and maintenance people, there is one staff member for every child. The state of Montana foots the bill for half the costs involved, with the other half coming from private donations.
Each child gets his or her own room. Each child has an “attachment figure,” one counselor with whom he or she has chosen to build the kind of relationship a daughter or son should have formed with parents. Once the child gravitates toward a counselor, that counselor begins taking on the role of a parent--holding the child and giving a bottle. Getting the child up for school. Going to special events. This is the attachment theory in essence, and the centerpiece of treatment at these two institutions: Each child must build a strong bond with a counselor.
And nurturing such bonds, not correcting children’s behavior with rewards and punishments, is the unrelenting theme of the program. If a child erupts at the Intermountain home and begins smashing dishes or fighting, there is no punishment. The violent behavior, the theory holds, is the child’s way of keeping a distance from adults--getting the parents so angry that nurturing is impossible, says psychologist Elizabeth Kohlstaedt, director of clinical services at the Intermountain home. So the raging child is wrapped up in one of the counselors’ arms and held, like a baby. The surrogate parents may not get angry, no matter what a child does. That can be a considerable challenge.
“These children are very good at keeping people at a distance,” Kohlstaedt says. “Even the most loving, saint-like parents in the world could easily become furious with them. But what we’re trying to teach is that you’re going to let us in, and you’re not going to hurt us and we’re not going to hurt you. Your emotions are OK, and they won’t hurt you. We’ll hold you and make sure of that. You can go through this with us there.”
RAUL, ALONG WITH ONE of the children who’d been abused by their grandfather, is part of the family living in Bridger Cottage. Tonight in Bridger, eight children and two adult counselors, Doug and Carol, are seated at two battered, heavy wooden tables with wooden benches, having tacos. The cottages are open, well lit and airy, and in the warmth of summer, two fans spin overhead.
The children wear shorts or jams and T-shirts that say “Rude Dog” or “Property of the Philadelphia Phillies,” and plastic soldiers are strewn across the floor. When the meal is over, everyone must pitch in and help with the dishes. Things go smoothly for a while. Then one of the kids--the youngest child among the siblings abused by their grandfather--begins banging his back against the table, softly at first, then hard. He is picked up and held. Another child begins puncturing a pop can with a fork, and then crushes it. He is quietly asked to stop, and does.
The ones who hold the program together are the staff members, who become these children’s surrogate parents. They encourage play and spontaneity. A football game in the snow. Spaghetti dinners without silverware. They make the children do chores, and they throw birthday parties. They help with their homework and make them brush their teeth. And when children lose themselves in violent outbursts, staff members restrain them, using a series of holds developed at Forest Heights--the same kind that Theresa used on Brian.
The most extreme hold has as many as four counselors--at the ankles and the wrists--holding the child face-down to keep him from hurting himself or others. The second hold, for a less violent, though still raging child, requires a single counselor to wrap the child up in legs and arms. The child gets a bear hug and the counselor also places a leg over the child’s legs on the floor. As the rage diminishes, the holds become less restrictive until the child is in a nurturing hold--held in a lap, talked to and soothed. Then, as the tension dissipates, the child often regresses to infancy and is given a bottle, cooed to and rocked.
Though the work is physically demanding and requires a steep emotional investment, staff members are extremely loyal, and the average length of stay is unusually long for the child-care field. At Intermountain, half the staff has been there more than seven years; at Forest Heights, these career mental-health counselors stay between seven and eight years. Counselors at both places receive between $18,000 and $25,000 a year--high for the field, in which $16,000 a year is the average.
As the Bridger Cottage children run screaming outside, Mitch Johnson, a brawny counselor with red hair and a beard, dressed in shorts and sandals, steps into the cottage office. It’s an odd job, says the 11-year veteran of Intermountain, because it provides psychic as well as financial income. “You’re not going to get paid enough for the emotional energy and emotional commitment you put out,” he says. But there are other rewards. “You get kids to a point where you are putting out a lot for them, then they start responding, start giving back. That fills you up and ignites the fires again.”
Working with Brian, says Bottelson, “was an intense experience for me. I had to go so deep and become so close. I could really imagine what he went through. It was painful. You can’t just go home and turn the love off.”
Yet staff members must not get too close to the children, become so involved that they begin to lose professional distance or objectivity. They might think that other counselors are picking on a favored child and become defensive. Or they might become stressed when the child is anxious and lose the ability to soothe. If counselors show such signs, other staff members will talk to them about pulling back and becoming less emotionally involved.
Some of the best counselors, Kohlstaedt says, seem to be those who have suffered abuse and undergone therapy themselves. They know what is going on inside and what needs to come out. “They’re not afraid to get in there and get dirty,” she says.
That is the kind of attention Brian received constantly during his two years at Intermountain. At first he threw constant tantrums, sometimes for hours, his eyes actually turning from their normal deep-brown color to a steel gray. He would throw things and make physical threats. “I was punching, I wasn’t really trustful. I was scared at first,” Brian recalls.
When he arrived, “he was a car for several hours a day,” Bottelson recalls. “He beeped and he blinked. That was how we communicated. He would walk up to yellow mop buckets that had the word caution on them and stand there and say ‘government vehicle’ again and again. He would spin and spin, and I would enter his world and I would spin and spin with him,” Bottelson says. “I had to go deep to find out what was in his head, to bring him out of it.” Her goal was to empathize completely with Brian as a car, beeping and blinking with him. She was the first adult to reach into his world, and gradually she was able to communicate with him in words.
“Obsessive preoccupation with cars, death and food,” a psychologist noted in one of his files. “Theme of death, emptiness and barrenness is prevalent.”
During play therapy in a psychologist’s office, the boy noticed play people stuck in the sandbox. He rolled his toy truck toward them and said he was going to rescue them. Instead, he pounded them violently into the sand. “I hate Brian. Brian is dead,” he said. Brian suffered from echolalia: He automatically repeated words spoken to him. Auditory hallucinations haunted him constantly. Ghosts came at night. “He would hear voices saying ‘you should be dead, you should be dead and done away with and flushed and gone,” says Laura Taffs, Brian’s therapist at Intermountain, a flashback to the times his father held him over the toilet, made him watch a pebble being flushed and threatened to do the same to him. In therapy, Brian, who is part American Indian, would pretend to apply war paint to his face “to cover my tears,” he said, a way for him to deal with his profound sadness. He’d fly into rages and be brought to a rocking chair to be held and talked to, given a bottle and nurtured. “They’d rock you in the rockin’ chair, asking you what you’re feeling,” Brian says. “I’d be getting kinda sleepy, and sleepy is the goal.
“I feel better about myself now than when I first came to (Intermountain),” Brian says. “I felt bad about myself inside, you know. I’ve been through tough times with my old parents. They didn’t treat me good. I was beaten up, I was treated bad. And so I had a tough time controlling my anger. I needed treatment for my anger, ‘cause when I was a toddler I’d try hitting people. But that didn’t help, it just made things worse. I needed treatment for the anger spot. It gets bigger and bigger if you don’t go to treatment. But if you go it gets smaller and smaller.”
Brian sounds almost like an adult when he talks now. He’s nervous about being interviewed, and under stress, he, like many other abused children, reverts automatically to an adult voice that enables him to deal with feelings that would otherwise be overwhelming. His vocabulary is full of the concepts (“the anger spot”) he’s picked up in years of intensive therapy. For him, as for all children who enter these institutions, one of the most difficult challenges is to learn to leave “adulthood” behind.
A cornerstone of the treatment, according to Ray Curtis, is the extremely long stay in a residential setting, which allows the intense feelings and emotions that bond humans to come into play. Foster-parent programs often make things worse for abused children, Curtis says, because they move children around and break the attachments they form, again and again. But long-term residential treatment allows the counselors to become role models. And a child who is watched around the clock can be treated when a crisis or especially needy time arises. The children aren’t allowed to lapse back into damaging behavior when they leave a therapist’s office.
“It’s naive to assume that the most pregnant therapeutic moment is in my office at a given hour,” Curtis says. “We give too much credence to therapy and not enough to how we live. What changes people’s lives are the people they live with. Every moment has therapeutic potential, and every person is part of the therapy.”
EIGHT KIDS are seated on a couch, several chairs and Johnson’s lap in Bridger. A collage of snapshots hangs on one wall; a poster that reads “the road to success is always under construction” hangs on another. As usual, the room is in a minor state of chaos as the children talk to each other, laugh and argue. They are gathered around Loren*, a 10-year-old boy who has been at the home for two years, who has not made enough progress to go to a foster home, and whose prescribed future treatment, in a different home, will involve the more traditional behavioral method. It is time for a going-away ceremony.
“I’m leaving,” Loren sobs as he rubs his tear-filled eyes on the couch. “I’m leaving because I have to go on with my life.”
“Do we still care about you?” Mitch asks.
“Uh-huh,” the boy sobs and nods simultaneously.
“Does anyone stay here the rest of their life?”
“You’re not leaving because you’re a bad kid. You’re leaving because it’s time for you to move on.”
The other kids, Loren’s “brothers,” begin trying to make Loren feel better. “Loren sure has a good sense of humor; that’s one thing I’m going to miss,” one boy says. “I’ll miss his smile,” Raul says. “He’s got a good one.”
Loren, a hefty child, climbs into Mitch’s lap, and in minutes he’s curled into a fetal position and stares blissfully at the bearded man.
The attachments formed here are extremely powerful, the only healthy and loving relationships many of these children have ever known, and when a child leaves, those attachments must be replaced with new bonds to specially trained therapeutic foster parents. These foster parents undergo a police background check, a psychological evaluation, home visits and 14 hours of training a month. Gradually and carefully, the foster parents take over the attachment.
When Theresa was ready to take Brian home, she visited the Intermountain home, staying for a couple of hours the first day, then spending a whole day there, having lunch, playing games and just staying near Brian. But he refused to acknowledge her, grew anxious and acted out by sliding down stairs in a cardboard box, again and again. Finally, he needed to be held by Bottelson. “I have all day,” Theresa told him. “I won’t go away.” After four or five of Theresa’s visits, Brian went to visit Theresa, accompanied by a staffer. He toured the house, his room and his new school. He spent a day alone at his new home, then a night, eventually a weekend.
As of last January, Theresa had not had to restrain Brian, though he still has violent episodes. His three-hour rages and tantrums are down to less than 30 minutes, says Valerie Dunn, leader of Brian’s treatment team at the Golden Triangle Community Mental Health Center in Great Falls, which monitors his progress for the state of Montana. His rage has been reduced to a more manageable anger. “He has a garden he works in with flowers and veggies,” Dunn says. “When he gets angry, he goes out and pulls weeds. And he has stuffed Ninja Turtles that he uses if he needs to hit something.”
Brian seems to have internalized the lessons of his years of therapy. “If you’re bad, if you know you got trouble, you should go to treatment,” he says with a wave of his pudgy hand. “If you went to treatment and you know how to control your anger, then you’re doing just fine.” He has made great strides since he left the Intermountain home. He has 30-minute visits with his parents, supervised by Dunn, which also are considered therapeutic. Kohlstaedt says that all children become attached to the people who raise them, though for those who have been brutalized, the attachment is an unhealthy or insecure one.
Theresa says the program has been therapeutic for her as well. As she worked with Brian and he brought up the episodes that so twisted him, the same kinds of things emerged from her childhood. She realized that she, too, had been abused as a child--by foster brothers and her foster father. “There’s still a little girl in me that needs help,” Theresa says. “Brian has taught me a lot about myself.”
BRIAN IS A success story. He attends a special classroom at a public school, where he is an A and B student. He is optimistic about his future.
“I think I’ll go to college and become a pilot,” he says. “Get married. Have kids. I want to be a good parent. Not like my own parents. Good parents should be nice to their kids.”
The real question, of course, is whether this kind of intensive therapy, which clearly works on a small scale, can be applied to a much larger population of abused children. There is no easy answer to that. While the attachment theory has been considerably researched, its application in a therapeutic setting has not been.
It is definitely not a panacea. However, both homes carefully select the children who enter--those most likely to succeed. Still, there are failures. Both Forest Heights and Intermountain claim that their follow-up studies a year after children complete their stays show that as many as 85% of the kids are in a less-restrictive setting--returned to their parents, in foster homes or in institutions that give them more freedom.
Dunn, the mental health worker, says the results that the Intermountain home gets are “miraculous.”
“Before Intermountain, Brian was a truck,” she says. “When he came out of Intermountain, he was an adult. Now he’s becoming an 11-year-old.” Will Brian ever be normal? Dunn shakes her head. “The kinds of things he carries in his memory put him out of that category,” she says. “He will be productive, and he will be capable of living in society with minimal problems. But my guess is he will always have flashbacks and always have to deal with the pain.”
A major flaw in the child-abuse treatment system, says psychoanalyst Call, is that insurance companies have so reduced what they are willing to pay that the average length of treatment for such children in Los Angeles, for example, is four to five weeks.
Such short stays, Call says, are only stopgap measures, and at least 50% of the children who come to hospitals and to residential treatment centers could benefit from longer stays. But it costs an average of $73,000 a year to keep a child at Intermountain--$200 a day. (By comparison, it costs an average of $800 to $1,100 per day to treat an abused child full-time in a Los Angeles hospital program, and from $400 to $500 a day for a residential treatment center in the Los Angeles area, Call says.)
Psychologists at Intermountain and at Forest Heights say they’d welcome follow-up studies that might prove or disprove the efficacy of what they do. But long-term, scientifically solid studies are rarely conducted, by any program, because they are expensive and difficult. Many of the families whose children are treated move frequently, and privacy laws often rule out long-term studies.
So the programs are guided by the intuition of the people who run them, the feeling that they have found a part of the solution to the rampant problem of abuse and neglect, the feeling that they have discovered something that works, a way to fetch back some of the children who have suffered the most.
“I know where every kid is and what he’s doing,” says Russ Colburn, executive director of the Forest Heights Lodge. “Most are doing well.”
Officials at both Forest Heights and Intermountain say more can be done. Curtis and others train hundreds of foster parents to deal with insecurely attached children at home, before they need to be institutionalized. And three homes modeled after Forest Heights have opened in Oregon and New Jersey. Those who study attachment urge people to re-evaluate the current system of treating abused children.
Even in Brian’s case, the situation is less than ideal. Shortly before this article was finished, Theresa decided that after 11 months she was physically unable to continue caring for him. She talks to him daily on the telephone and visits him regularly, but he lives with another foster family now, a two-parent family this time. He’s still in public school, he no longer needs to be held, and, Theresa says, he’s doing well--becoming a child.
A COUNSELOR sits on the trim lawn in front of Bridger Cottage, surrounded by the children playing and talking and running around, as he strums his guitar. Some settle down and begin to sing:
Inch by inch, row by row
I want to make this garden grow .
I want to take the rake and hoe,
and a piece of fertile ground.
Pulling weeds and picking stones,
man is made of dreams and bones .
Feel the need to grow our own ,
‘cause the time is close at hand.
“Something is at work here at the Intermountain home,” Kohlstaedt says. “You can feel it. The children have stopped kicking each other. They don’t set fires. They don’t abuse animals anymore. They don’t sexualize each other. They don’t throw knives. But that’s not the magic. The magic is that you see the children when they come in and they look like wild animals. And in six months they’re children. They look like children. They feel like children. They have fun, they giggle and they laugh.”
* This name and others so marked have been changed.