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Relational Treatment of Trauma


Written by Toni Heinemann

Reviewed by Kari S. Morris

The foster system often serves as both a haven and a horror for the children it serves. Although group homes and foster families usually meet the physical needs of this population, the children’s emotional, social, and psychological lives are turbulent and underdeveloped. Toni Heineman, psychologist and executive director of A Home Within, shares the struggles of working with foster youth and how clinicians can begin to make a lasting difference in their lives. The book is filled with accounts of children’s experiences with foster families, therapy, group homes, homelessness, and countless struggles of this population, and Heineman paints a picture of reality for many who are fortunate enough to not know that type of pain. She provides this beginner’s manual to build trusting relationships and hopefully mend trauma’s wounds as well as provide case workers, attorneys, and clinicians with tools to understand foster youth.

From a developmental standpoint, foster children are at a disadvantage. Without their hierarchy of needs being met throughout much of childhood, Heineman asserts foster youth display insecure attachment, behavioral problems, and mistrust for others. Foster children expect to be discouraged and anticipate turbulence. Although Heineman points out the struggles and weaknesses of foster youth, she does not address the apparent resilience these children must also possess. If a child can adapt to constant change and emotional turbulence, he/she inherently shows potential for clinical progress. Regardless, as in any setting, building trust and respect between client and clinician is pivotal. When working with a population who has been abused, neglected, tossed around, and left homeless, developing a therapeutic relationship is unnatural for all parties involved. Patience, trust, and stability are Heineman’s starting place toward building a better life in the foster system.

Foster children need stable, consistent therapists whom they can slowly learn to rely on. Patience and understanding are key, as their behavior tends to be wilder and mis-intuned (not attuned with others) with few relationship skills. Heineman suggests behavior is an important starting place to learn about youth traumatized in the foster system, as behavior may explain past experiences. Further, as demonstrated by trauma theories of dissociation and splitting, behavior might be all a patient is capable of conveying early on in therapy. After all, Heineman points out, sharing a painful story is nearly impossible when the brain buried the memory for its own protection. When the adults in foster children’s lives establish a patient, understanding, consistent, non-judgmental relationship for them to grow, healing can finally begin.

Heineman recognizes upfront the difficulty of treating foster children when such variables complicate progress. Emotional regulation is optimally learned and tuned over time through caregiver nurturing. Because of this, Heineman discusses the incidence of pediatric bipolar disorder and other emotional illness among foster children. First, laying a framework, Heineman stresses the importance of family history, assessment, and external considerations when diagnosing any individual. If a disorder is present, careful planning and individual therapy must be aligned to best help the patient. Working with the caregivers as well to build strong, lasting relationships is an important piece in treating the trauma and emotional disturbance in this population. However, this section fails to identify specific treatments or methods that could help foster children, leaving a gap in known treatment plans for the population.

In her closing section, Heineman notes the constant evolution of therapy, the foster system, pharmacology, and research. However, the most important ingredient to help children of the foster system remains the therapeutic relationship. Progress cannot be made unless the client and the clinician are on the same page; mutual trust, respect, and understanding are vital to even begin progress. Once a therapeutic relationship is established, the therapist can create interventions to mold these wounded souls into bodies of hope. The therapy used by Heineman is known as RBT (Relational Based Therapy). To make progress, therapists must show engagement, empathy, a mind for context, enthusiasm, embracing individuality, endurance, extending relationships, and effective methods. Through these tools, a therapist can build the vital relationships with foster youth and bring hope back into foster care.

Taking a more personal approach to discussing trauma, Heineman successfully breaks through clinical jargon to expose the faces and stories of a wounded population. In illustrating the need for better attention and treatment in the foster system, she successfully evokes a passion for foster youth in readers.

Heineman strides beyond the pack in the field of youth trauma. She maintains a strong theoretical framework of relationship building consistently throughout, giving a strong foundation on where to start. Her belief that the therapeutic relationship can be the strongest healing agent for trauma is optimistic but could also be seen as naïve. Accessing and healing trauma classically requires a multi-disciplinary, pharmacology-fueled, cognitively based therapy, and listing several case studies does not definitively support an entire theoretical framework. However, her groundbreaking work, through this book and through A Home Within, adds depth and meaning to trauma therapy, especially in the foster population. She successfully gives readers passion and inspiration, highlighting the necessity for further care in the foster system. For someone looking to work with foster youth, Relational Treatment of Trauma provides a strong foundation of healing therapy.

Kari MorrisKari Morris is currently a senior studying applied psychology at New York University. When she is not researching LGBT youth or preparing for grad school, Kari enjoys taking pictures of her labradoodle, competing in Fitbit step challenges, and combating the inevitable list of three.

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