When the state still recognized Cascade as a viable mental health option for troubled children, Risenmay sometimes took her kids there four days a week for therapy sessions that lasted from 9 a.m. to 4:30 p.m. VanBloem says approximately 95 percent of therapy sessions last two hours, and holding therapy typically lasts for 15-20 minutes. Cascade also put a "tracker" in the home to monitor the child's behavior and administer holding therapy if necessary. Overall, Cascade charged $2,000 a month.

Because most parents can't afford that on their own, two things have happened: VanBloem's business has suffered and, according to Risenmay, children who need holding therapy have regressed. Now VanBloem comes to Risenmay's house every few months. Some of her children are faring well, with occasional outbursts, while others have suffered dramatically from the decrease in contact with Cascade, she says. Risenmay's 9-year-old adopted daughter, for example, is at the Utah State Hospital, the state's mental institution.

"She needed a safe, nurturing and contained situation to even begin to deal with the things she was dealing with, and when she didn't have that, she couldn't cope," Risenmay says.

"I respect what the hospital is doing, but I don't know if they can treat her," VanBloem says, shaking his head.

Reactive attachment disorder is a disease few understand, manifesting itself in monstrous ways that would shock most parents, VanBloem says. Risenmay's 13-year-old, for example, ripped doors off their hinges as a 5-year-old, smacked her mother upside the head with a baseball bat and came after a sister with a pipe. Her daughter living at the mental hospital, adopted as a 2-year-old, smeared feces on the walls, put plastic bags over her head and once attacked her mother, cracking a rib. Her first word was the F-word.

Stories like these are common for those who have sought VanBloem's services. Tales of abuse that emerge during therapy are often so hideous VanBloem has to take breaks and walk around the Cascade building. Risenmay has vomited in a bucket.

"It is gut-wrenching what we do, but if we can't witness it and be there emotionally for the child, how can they trust us?" VanBloem asks.

"We had to design our therapy to meet the needs of these families. If that meant we had to create new programs, we created new programs. If that meant we had to come out on a Sunday, we did. Typical programs are not flexible enough to do that. The child's needs have to be addressed."

At first, Risenmay took her adopted daughters to conventional therapists, who told her what she already knew: Her girls were angry. Much of the blame for the child's condition came back to her.

With VanBloem it was different. He didn't make Risenmay sit out in the waiting room; he involved her in the therapy process. And he listened to her, without placing fault.

"I saw more progress in one therapy session than I saw in months of conventional therapy," Risenmay says.

She was not alarmed when her children screamed during therapy sessions, because it was emotion she saw every day.