Monthly Archives: February 2012

Respecting Specificity


Lou and Betty Sander, January, 2012

Photo courtesy of Marilyn Davillier


On Thursday, I attended a lecture by Charles Nelson, Ph.D., who is a professor of Pediatrics at Harvard Medical School and affiliated with the work of the Center on the Developing Child. He is a researcher who has done pivotal studies on brain development in relation to institutionalization in early childhood (Bos K, Zeanah C, Fox N, Drury S, McLaughlin K, & Nelson C, Psychiatric outcomes in young children with a history of institutionalization, Harvard Review of Psychiatry, January/February, 2011, pp. 15-24; Fox S, Levitt P, & Nelson C, How the timing and quality of early experiences influences the development of brain architecture, Child Development, January/February, 2010, Vol. 81, Number 1, pp. 28-40).  I was impressed not only by the quality of the research, but also by Chuck Nelson’s commitment to using his research to achieve such important humanitarian goals. It is clear that he really cares about protecting the potential of young children living in circumstances devastating to their healthy development. 

Last night I had dinner with close friends, and I was telling them about my dilemma. I very much believe in the value of the movement to reunite children with their families and support these families in the community where they live, but if only it were that simple. I also believe in what the good people from Better Care Network called “general systems approach” and “sustainability”. But I also see the damage that is being done in the short run as institutions such as the children’s homes that have emerged as the unique solution to a particular country’s abandoned children are dissolved by courts that do not take the needs of the individual children into account.  In the children’s home, I have observed the opposite of what Chuck Nelson described in the Rumanian orphanages – that the earlier the children were when they entered the institution the more damaged they became in that developmentally damaging environment. By contrast, in the home, often the children who did the best were the ones who entered the home as infants, where they were well fed and protected, welcomed into a “home” of loving caregivers and older children who are also caregivers by nature through their belonging to a caregiving culture. I always call up my friend, Lou Sander’s thinking about specificity when I puzzle about this kind of dilemma (Sander, L. Living systems, evolving consciousness, and the emerging person: a selection of papers from the life and work of Louis Sander, The Analytic Press, New York, N.Y., 2008.) 

My friends were arguing that there was nothing I could do, that “the pendulum swings” are large, and one will have to wait for the changes in reunification to be modified over time.  They said, “Surely you agree that the bad orphanages are worse than any alternative!” I said I did agree bad orphanages were terrible, but that what was getting lost in the reunification initiative was the uniqueness of the societies and cultures of the children themselves and the specificity of the institutions that had arisen in those societies – the whole idea of “one size fits all”, which is an essentially reductive perspective. 

It was an enjoyable discussion in which everyone listened respectfully to everyone else, and my friends insisted, “we all agreed” on the basics.  They told me that I wasn’t a politician, and it would be immensely hard to try to make any change on that level. I had been thinking of all the other things I am involved in – all related to children and families, but in different venues – and I began to feel tired. Then I thought of the children in El Salvador that I knew. I thought of the heroic efforts of the children’s home to support the families in the community, and I felt inspired. I though of the previously academically successful, robust, beloved in the home, little boy who has recently been seen begging in the streets at midnight after reunification. I thought of the difference between the two approaches – the larger “systems” approach, and the “one starfish at a time” story – (In the story, a visitor encounters an old man sitting by the side of the sea taking starfish, one at a time, and throwing them back into the surf. The beach was full of stranded starfish. The visitor asked him, “Why are you taking the trouble to throw them into the sea? There are so many, and the surf will carry them all back anyway.” The old man kept picking up starfish and throwing them back into the surf one at a time. “You are correct,” he told the visitor, “But if I save one starfish, I will have done a good thing.”) and I was unsure. Wasn’t each starfish thrown back into the surf a “momento magico”? My friends have never been to El Salvador. 



This post’s “Momento Magico”:

In the last post, I promised that in each posting I would include a “magic moment” told to me by a parent, teacher, or child. Here is the “magic moment” for this post.

In this loving family, a painful conflict between the parents has resulted in a sadness and hypervigilence in the two girls. In a recent family meeting, the older girl watches her parents’ faces closely, scanning for trouble, while the younger one seemingly picks up the emotional “vibes” indirectly and makes attention-getting gestures with the puppets from her position lying on the floor in the middle of the circle. I am thinking that I want to balance the openness to the expression of painful, angry feelings in the family, against the expression of hope. I don’t want to lose one or the other. As the characteristic painful pattern emerges – that of one parent feeling abandoned and devalued by the other and the second parent feeling “taken over” and marginalized by the first – I acknowledge this pattern as it occurred the night before the meeting. Then I ask for a “magic moment” in the past week. One parent identified the moment, the other agreed, and both girls enthusiastically elaborated the situation in which the younger child asked the older child for help with a puzzle, and the older one, instead of rejecting her, joined her in figuring out the problem. The entire family was enhanced by this small collaborative activity of the children. I attempted to make clear that the girls were not expected to take the parental responsibility in the family, but that this was one example of how all of them had the power to change bad habits. Every family member could partake in the positive feelings about themselves and about the family the two girls had generated. It is important to learn to recognize magic moments, because the more you recognize them, the more you will see the potential for them in an ordinary family interaction, and the more you can make them – and hope – happen.





Read this blog in Spanish.




Making Links




Last week I decided to change the name of my blog from to There were several reasons why I decided to do this. First of all, I had begun to appreciate the fact that the basic principles I was writing about in my blog were the same as those I write out for parents of children in my child psychotherapy practice after our meetings about their children. Of course, parents are the primary caregivers. Next, I thought that I wanted to reach out to child caregivers in developing countries who were not necessarily working in institutions. Some might be working in day care and some might be teachers. Finally, and probably most important, the children’s home in El Salvador with which I have been connected has been undergoing major transformations related to the “reunification” of the children with their biological families. Instead of holding tight to their old traditions and procedures, they have extended themselves to the families of the children and tried to support the families in the community both materially and psychologically, so that they could be prepared to nurture and protect the children after reunification. This change in direction the home has taken has been inspirational to me. 

In my efforts to support the children’s home and to learn more about how to support child caregivers in developing countries in a general sense, I have contacted both The Better Care Network and the Center for Health Policy and Inequalities Research at Duke University.  I also plan to be in touch with the investigators of some of the recent important studies done in orphanages in Eastern Europe. The goal is to identify multiple ways to support the caregiving relationship both within the family and also in alternative care situations – whether in institutions or in other homes in the community.  The more we understand about what can work in various contexts – including the cultural context – the better we will be able to put in place flexible procedures for creating and maintaining caregiving situations responsive to the needs of specific children and families.

I will also try to include in each blog posting some practical ideas for caregivers in their daily work caring for children. 

The Repair Option:

Today’s idea is that of the repair option as an alternative to punishment for children. This means that instead of a time out or taking away a privilege, the child can be given a small task designed to repair the relationship with the person who was inconvenienced or injured by the child’s behavior, such as the parent when the child did not comply with the parent’s demands that he get ready for school, or the sibling when the child took a possession of a sibling. In those cases the child may be given the task of drawing a picture for the parent or the sibling, or of doing a household chore that the child does not typically do, such as set the table. Remember, that with a young child it is important for the parent to work alongside the child. The object of the consequence is to help the child learn how to take appropriate responsibility, not for the child to do someone else’s work. 






Need for Creative Solutions


Since my last posting, I was guided by a colleague to The Better Care Network, and to The Better Care Network Working Paper (Williamson and Greenberg, 2010).  This paper describes the deleterious effects of institutional care on children, referencing important studies of institutionalized children, particularly in Rumania, Russia, and African countries. Although it includes a section addressing the Latin American countries, the section is short and reflects the relative lack of literature on residential care of children in this part of the world. The paper attempts to address the general problem of abandoned or neglected children throughout the world. It is a valuable document, but does not attempt to deal with the many specific and unique situations included in this important issue.  As the authors acknowledge, “… in some countries and in some specific cases, it (residential care) may be acceptable” (pp. 3-4). The paper offers an example of adolescents living on the street and unable to return to their families of origin, who may use a substitute family or even residential care as “the best currently available alternative to an abusive family situation”, “a short-term measure until the child can be placed with a family” (pp. 3-4). 

What the authors do not consider in the paper is the powerful effect of “breaking the cycle” that can occur when young children are removed from depriving and abusive environments and placed in a nurturing and protective “home”. This is what the directors of the children’s homes refer to when they call themselves “cycle breakers”.  It is important to note that living in a children’s home does not mean that children must lose the connection with their biological families. It simply means that there are many potential creative solutions to the problem of families who cannot care for their children, and a residential home – at least during the week – may be one of them.  

The use of Attachment Theory to support the position against residential care often involves an internal contradiction in that abusive and neglectful “attachment figures” have been shown to be at the root of “attachment disorders” (Lyons-Ruth K, “Attachment disorganization: Unresolved loss, relational violence, and lapses in behavioral and attentional strategies”. In J. Cassidy & P. Shaver, Eds., Handbook of Attachment Theory and Research, NY: Guilford Press, 1998).  While true that “it is poverty that pushes most children into institutions”, the fact that poverty is often the result of war and other traumatic events cannot be overlooked. Addressing the roots of poverty often takes generations; children returned to traumatized communities cannot wait for the healing to take place. The “targeted, community-based alternatives to children in need” recommended to replace institutional care are an excellent goal but too often remain a fantasy in the minds of planners or politicians (p. 11).

This well-intentioned and intelligent working paper should not be used to justify the hasty and often ill-advised process of “reunification” of children with families that are not prepared to care for them. Children are growing fast; in many cases they cannot wait for community supports to be put in place.