---

VanBloem has treated many of these children, who suffer from what he calls "reactive attachment disorder," a malady that most often affects adopted children who have suffered severe abuse, either physically or emotionally, by a previous primary caregiver.

If a child does not form an attachment during the first three years of life, he or she will not "think and feel like a normal person," says Nancy Thomas, a Colorado therapist and advocate of holding therapy, and will often feel "a deep-seated rage, far beyond normal anger."

The goal of holding therapy is to help children release this pent-up rage through confrontation and physical prodding and poking, usually to the abdomen, where attachment therapists believe emotions are stored. Through the process — which sometimes lasts hours — the child learns to bond to his or her adoptive parents.

---

On this fall day, VanBloem, a licensed clinical social worker, is making a house call to treat one of Risenmay's daughters. The teenager has bony hips and light brown eyes that never seem more than halfway open. She leans into VanBloem when he calls her and tucks her head as she softly reports what got her sent home from school. They have some things to work out, he says, their foreheads touching. She smiles shyly and nods.

Because Hutchings' house is too noisy, they cross the street to Risenmay's large two-story home for the therapy session. In a quiet upstairs room, VanBloem takes three cushions from a green leather couch patched with duct tape and sets them on the floor. The girl lies down on the cushions as instructed, and VanBloem gently places a white blanket over her, up to her neck, and sits beside her cross-legged. Her mother sits on the other side, looking through a pile of bills.

---

The bills are stacking up. Since the DCFS terminated its contract with Cascade in October 2002, parents like Risenmay have had to pay for VanBloem's services on their own. Treatment at community mental-health centers, such as Wasatch Mental Health in Utah County, is fully covered by Medicaid, while half the treatment costs at private clinics are paid for by DCFS for children adopted through the state agency.

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