When psychologist Toni Vaughn Heineman, DMH, first told a social services administrator in San Francisco her plan to offer mental health services to foster children free of charge, the administrator asked her if she was serious.

"You want to commit to free therapy for a child for an indefinite period?" the social worker asked. For Heineman, the remarkable answer was "yes."

In 1993, Heineman recruited 13 other therapists in California's Bay Area to form the Children's Psychotherapy Project: Each volunteer agreed to do free weekly therapy for a child in the foster system for as many months, or years, as were needed. Thirteen years later, the group has expanded: Therapists across the United States and in Australia now see a total of 120 foster children, Heineman says.

One of those therapists, psychologist Cary Littell, PhD, of Oakland, Calif., has worked with a girl, now 11 years old, for two years on issues related to early deprivation. Social services had removed the girl from her mother as a result of endangerment and neglect and put her in foster care when she was 6 months old and had then placed her with her paternal grandmother when she was 18 months old. The project referred the grandmother to Littell when the girl's behavior became more disruptive both at home and at school--the girl had been demonstrating temper outbursts, aggression and distractibility and had engaged in stealing and lying. Littell was able to help resolve some of those problems by working with the girl's grandmother on how to understand the girl's behavior in the context of her history and to set appropriate limits and expectations.

"Much of the work involves dealing with issues the result from being abandoned by both her mother and father, imagining that it was her fault that they didn't take care of her," Littell says. "She's working out some of her attachment issues through her relationship with me. She worries about disappointing me, about whether or not I have enough time for her, whether or not she's too much for me. Through our relationship, much of her past and present experiences can be better understood and hopefully reworked."

What's more, the benefits of the relationship extend beyond her small client, Littell says. Because Littell is part of the Children's Psychotherapy Project, she consults about the girl's case with a group of other therapists who also see children in the project. She also receives continuing-education credits for the consultation.

"It's an opportunity not just to do some pro bono within this population of children, but also to have consultation and to stay connected to colleagues and training," she says. "Private practice can be very isolating, so this is an important opportunity for me to be part of a larger group."

Help for troubled children

The project--one of three housed in a larger San Francisco-based organization called A Home Within--offers a solution for care of foster children, who experience the profound loss of a parent or guardian, says psychologist Richard Ruth, PhD, clinical director for the Washington, D.C., chapter of the project. The other projects of A Home Within--one involving local artists that encourages foster children to express themselves through photography and creative writing and another that pairs local professionals with children for mentoring--also attempt to improve conditions for foster children through community partnerships.

Foster children are often in and out of group homes, foster homes and family-member homes, and, as their living status changes, the children interact with an ever-changing group of social-services personnel, teachers, foster parents and mental health practitioners--an inconsistency that further complicates mental health issues, especially attachment problems, and ratchets up the need for psychotherapy, Ruth says.

"Therapy can really help these kids," Ruth says. "The therapy takes care of very disturbing behaviors like aggression, fighting, negativism, isolation--those behaviors, common to foster children, are the center of what we deal with in our patients."

The volunteer therapists have a greater chance at being successful, he says, because the consistency of their work creates a stable relationship for the children and develops a level of trust that may not be possible with the other transient adults in the children's lives, Ruth says. The boy who Ruth sees through the project started out distrustful and angry because he didn't like the constant influx of new adults in his life, including his new therapist, Ruth says. "But now he looks forward to his weekly sessions and knows that I'll always be there for him to talk about his problems," he says. "When he comes into my waiting room, it's like he's in his own home."

The relationship is slightly different from those he has with his other patients because of the level of commitment, Ruth says. For example, when a child from the project misses a series of appointments, it's discussed with foster parents and social-service personnel. In addition, transportation issues are examined and, in general, the group of caregivers take it as a cue that something might be amiss.

"I've been a child therapist for 30 years, and most days I feel like I know what I'm doing, even when it comes to foster kids," says Ruth, who is a member of the Board of Directors for APA's Div. 39 (Psychoanalysis). "But when you make this commitment, everything is different. I think about the child's problems differently, we work to solve them differently, and I get to talk about it with my colleagues and, together, we do a lot of thinking about how to move forward."

The therapists become so thoroughly familiar with the children's cases that they are able to advocate for the children's best interests over a long period of time, says Fred Jones, the supervisor of Family, Youth and Children's Services in Sonoma County, Calif., who regularly refers children to therapists in the program. For example, they can work in the child's best interest with social workers, foster parents and other advocates in a foster child's life.

"Their motto, which I love, is 'One child. One therapist. For as long as it takes,'" Jones says. "That means even if a youth ages out of the foster system, they will be able to continue their work with a therapist, even into their 20s."

Benefits abound

The collaborative nature of the project produces perks for practitioners too, Ruth adds.

"These aren't the easy years for being a mental health worker--these are the tough years," says Ruth. "The financial pressures are intense, and the sense of community you get, of working with like-minded people on a great adventure, you almost forget that it used to be that way. The consultation group work has enriched our lives as much as it has enriched the lives of our children."

Heineman echos that sentiment. Given the project's accreditation and continuing-education credits, she says she sometimes gets the same happy disbelief from therapists as she did from that first social-services administrator.

"They say 'What? All this just for seeing one child once a week?'" Heinemen says. "It's really one of those happy situations where everyone benefits."

Further Reading

For more information on the Children's Psychotherapy Project, go to www.ahomewithin.org or look for the book "Building a Home Within: Meeting the Emotional Needs of Children and Youth in Foster Care," available in October from Brookes Publishing.