When a child is in crisis, parents need a 'safe space'

By Louise Kinross

Last year the office of Holland Bloorview family therapist Leticia Toro (photo right) was the only place Susan Cosgrove (photo left) felt safe. "Sometimes my two hours in Leticia's room were the only two hours I felt safe in a whole week," Cosgrove says. "She's the only person I tell the hardest parts of my life to."

Cosgrove, who is a single mom, saw Toro while her autistic son received therapy in Holland Bloorview's Extensive Needs Service (ENS), a multidisciplinary program designed for children with complex behavioural and medical needs. "Some mornings just getting my son to the school bus felt unimaginable," Cosgrove recalls. "We would both be so frustrated, and his feelings might escalate into physical behaviours."

Toro was initially a behaviour analyst working with children in the ENS program, but stepped in to the family therapist role on the team a year ago, after returning to school to become a psychotherapist. 

"My goal is to help parents feel seen and meet them where they're at," Toro says. "My experience, from sitting across from parents, is that the best service I can provide is a safe space for them to slow down and express whatever needs to be expressed, without judgment and with unconditional regard."

As a behaviour analyst for almost two decades, Toro noticed "there was such a huge gap" in mental health support for parents of children with autism. "It seemed like after their child's diagnosis, parents had to navigate things on their own," she says. "They were thrown into the deep end. Sometimes I felt bad asking them to do more, because I could see they were drowning. If a mom hadn't slept the night before, how could she pay attention to what I was trying to get her to implement at home?" 

She decided to return to school and got a master's in counselling, psychology and psychotherapy at the University of Toronto. Working as the family therapist in the ENS "is my absolute dream job," she says.

Toro sees parents while their child is at the hospital receiving therapy. She typically provides two to three counselling sessions a day and works closely with clinicians to help them better understand a family's unique situation. 

"I have the privilege of time with these families," she says, noting she can meet with a parent for up to 90 minutes. "I can get a really in-depth understanding of the family's story and world, and share that context with clinicians to help inform an intervention plan. I am able to really hear a parent's story for as long as they need me to. Sometimes a parent isn't comfortable sharing the information with [therapists] themselves, but they would like me to share it."

Toro says the greatest challenge of her work is finding how she can best help each parent. "We often come in wanting to help a family so desperately, and fix everything, but we can't do that. Sometimes the best thing I can do is really be there with them and hold a difficult feeling with them. It might not be psychotherapy the way you learn about it in school, but it's very therapeutic." 

Early on in a relationship, Toro says she needs to be sensitive to what a parent may be expressing without words.

Cosgrove says she was initially stuck in survival mode, and unable to talk about her feelings. So she and Toro talked about true crime podcasts. "It took me a very long time to learn to trust her," Cosgrove says. "But now I look forward to my time with her. She helps me process and cope with my experience." 

Toro says being flexible is one of the most valuable qualities she can offer families. "You need to really sit with people," she says. "I don't come in as a family therapist and say: 'I know what you need.' I come in and say 'Teach me about you. I don't know anything about you. Be my teacher. I'm open to whoever you are.' I've learned that if I come as a participant of this, rather than the expert, we go so much farther. I learned that from parents."

Toro says Acceptance and Commitment Therapy (ACT) is helpful for many parents. It involves learning to accept unwanted thoughts and feelings, rather than struggling to suppress or extinguish them, and working towards a life based on what you value.

"Because it's behaviour-based, it's action-oriented, so it gives people a tad of a sense of control back," Toro says. "There's also a heavy emphasis on self-compassion, particularly if you're in a situation you might not be able to change. And the last thing I love about it is that there's no pressure to change what you feel or think. You can just notice it. If that's sadness, it's sadness. If that's happiness and joy, it's happiness and joy. It's honouring whatever is showing up for you. It's such a welcoming approach that no matter where you're at, or what you're going through, it's open for you."

Toro leads an online Acceptance and Commitment Therapy support group for parents and caregivers.

She says the greatest joy of her role is "elevating parents' voices. It's where I can add a piece to the family picture that clinicians might not have been aware of, and noticing what a difference it has made for the families. It's improving their experience in ENS. I often find it's the little things that are so powerful."

If Toro has had a particularly emotional conversation with a parent, she may take a 10-minute walk outside in Spiral Garden "to acknowledge the emotions I'm feeling, and allow them to pass by, while reminding myself that it's important that the parent had that space. I'm pretty good at turning it around and saying: 'That was really hard, but it was also really cool that this parent could engage in that conversation. They may not have had the opportunity, other than in my space."

Toro enjoys the Tuesday staff lane swim in our hospital's pool, and aims to manage her time so that she doesn't get drained. "I try to give myself a 15-minute buffer between counselling sessions, and to take a lunch and leave at a decent time. I take adult ballet classes and I just started running and I love yoga. I do a bit of everything. It's important to have a support system as a therapist, and for me that's reconnecting with my family or talking with colleagues to debrief."

To a clinician starting out in this field, she advises: "Pace yourself. It means protecting your time, and spending the time to learn about yourself. You need to build your emotional awareness, so that you notice when your body is tired, and you learn how to take care of yourself. That's different for everybody. We talk a lot about pacing ourselves, but it's hard to do. Investing in learning about those things when you're starting out will make you sustainable, and more able to show up for your clients."

If she could change one thing about how we support families, Toro says she'd like to see more physical spaces designed for families. "I'm talking about little spaces. Like a little room where someone could sleep on a couch. Sometimes when I ask a parent what they need right now, they say: 'Sleep.' I've put a 'session in progress' sign on my door and let a parent sleep with a weighted blanket on the couch before. Sometimes a parent will say: "I want to go to a place where no one can see me cry, or where I don't have to say hi and put on a smiley face.' So if we had a private sleeping room."

She'd also like to see a crisis line where a parent could call if they need to talk to someone about their mental health that day. 

Toro says her desire to support people was nurtured by her mother, a psychologist in Paraguay who ran a nursery school that included children with disabilities and medical conditions. 

"I remember there was a child who had been turned away from other schools because she was HIV-positive," Toro says. "My mom said: 'This is not even a question for me, of course we will welcome her here.' With the family's consent, my mother explained the situation to other families and said: 'If you need to leave, we understand.' That memory is vivid in my mind. It's a bit of a culture of mind, of being there for people who feel alone or unsupported. I've always had a calling to be there for people."

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