A place within the heart: finding a home with parental objects

For adopted and Looked After children with compromised early experiences, there can be troubling phantasies and anxieties associated with parental objects. These internal object relations can seriously restrict the development of secure intimate relationships with new parental figures. Adoptive parents and foster carers bear the brunt of the associated difficulties. Clinical work with the child, parents/carers, family, or network, may help processes of containment, differentiation, working through, mourning, and integration. This paper is based on thinking derived from clinical work with children who are adopted or Looked After, and with adoptive parental couples, carers, and networks. The primary focus is on how the child needs to find a ‘psychic home’ in the minds of others for their damaged internal parental objects, and the emotional capacities required in adoptive parents to provide this. I describe some of the complexities for adoptive parents and others in providing what is needed to enable the child to experience their internal parental objects in a fuller way. This process can allow the child to introject, identify with, and re-imagine their internal parental objects, and through this develop a more realistic relationship to their adoptive parents and to their birth parents. It promotes trust, freedom, and emotional depth in the relationship with parental figures.     

Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

Child molestations by homosexual foster parents: Illinois, 1997--2002

Do those who engage in homosexuality disproportionately sexually abuse foster or adoptive children as reported by child protective services? Illinois child services reported sexual abuse for 1997 through 2002. 270 parents committed "substantiated" sexual offenses against foster or subsidized adoptive children: 67 (69%) of 97 of these mother and 148 (86%) of 173 of these father perpetrators sexually abused girls; 30 (31%) of the mothers and 25 (14%) of the father perpetrators sexually abused boys, i.e., 92 (34%) of the perpetrators homosexually abused their charges. Of these parents 15 both physically and sexually abused charges: daughters by 8 of the mothers and 4 of the fathers, sons by 3 of the mothers, i.e., same-sex perpetrators were involved in 53%. Thus, homosexual practitioners were proportionately more apt to abuse foster or adoptive children sexually.     

Transference and countertransference in an applied setting — education

This paper offers an overview of current clinical approaches to psychoanalytically informed work with parents by child psychotherapists. The analysis is based on practice at the Tavistock Clinic and on broader knowledge of trends in work with children and families within the National Health Service. A brief history sets the scene. Four varieties of approach are described, with clinical examples. The particular sensitivity of child psychotherapists to infantile features in the personality is highlighted, and it is argued that this, together with their broad clinical experience, provides a proper basis for psychoanalytic psychotherapy with parents. Such work significantly extends and enriches the clinical contribution of child psychotherapists and has involved a shift in professional identity. It also raises ethical issues which are discussed.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

Siblings as Selfobjects in Childhood: An Interview Study of Factors and Consequences

This study explores the factors psychotherapists working with adult clients identify as contributing to their clients' use in childhood of relationships with siblings to meet selfobject needs or the use of clients by their siblings for selfobject purposes in childhood, and the consequences of this to the children's intrapsychic development as evidenced in their adult psychotherapy. Using interviews with six psychotherapists practicing within the framework of self psychology, this research determines that the emotional and physical unavailability of parents was a common factor causing children to use their siblings for selfobject purposes. The research also explores the lasting impact of these selfobject ties on the psychological development of both the child using a sibling for selfobject purposes and the child who serves this function for another, as well as the role of psychotherapy in understanding these relationships. These findings give psychotherapists from a variety of disciplines, including social work, an enhanced conceptual framework from which to consider the role of siblings in psychological development.     

Parent–adolescent communication in foster,inter‐country adoptive,and biological Italian families: Gender and generational differences

There is a paucity of studies aimed at comparing how parents and children in different family structures cope with the challenges posed by the adolescence transition; in particular, there are few studies aimed at comparing adoptive and foster families. In order to partially fill this gap, the principal aims of the present study were to verify whether there are differences in parent–child communication among foster, intercountry adoptive, and biological families according to the adolescents' gender, and to compare the perceptions of parents and adolescents concerning parent–child communication. Data were elaborated on two levels: a generational level (adolescent's and his/her parents' perceptions among the three family groups) and a dyadic level (mother–child and father–child perceptions). The sample was composed of 276 Italian families with adolescents aged between 11 and 17 (81 foster, 98 international adoptive, and 97 biological families). Subjects (mothers, fathers, and children) filled out a questionnaire including the Parent–Adolescent Communication Scale (Barnes & Olson, 1985 ). Results highlighted that in foster families, parent–child communication showed more difficulties from both the adolescent's and the parents' point of view. Adoptive adolescents, however, reported a more positive communication with both their parents than did their peers living in biological and foster families. At a dyadic level, some differences emerged among the three groups. In biological families, a more pronounced distance emerged between parents and children. In adoptive families, father and adolescent shared more similar perceptions, whereas a significant discrepancy emerged between mother and child. A higher level of perceptual congruence between adolescents and parents was found in foster families. Gender differences were also seen: Mothers experienced a more open communication with their children than did fathers, and adolescents, and above all females, communicated better with their mothers than with their fathers in all three family groups.     

Hello/goodbye new families: group work with five looked-after siblings in foster care together awaiting a move to separate adoptive families

This paper describes group work with five siblings aged between three and nine. They were taken into care following severe abuse involving neglect, physical and emotional abuse. In it, we consider the impact of the losses on the network and the children. We explore how Freud, in his paper ‘Mourning and melancholia’ (1917), and others who built on his work, helped us understand the children’s losses. The sibling group was planned in order to address the children’s need to say goodbye to their birth parents, their foster carers and to each other and to prepare them for their individual separate adoptions. The group ran for 18 months and ended when four children had been placed in their adoptive homes; the last child to be adopted was then seen individually until she was also placed. The group work is described with the use of quotes from sessional material to illuminate the processes for these children in facing their complicated and ambivalent losses, the mourning process and their progress towards becoming individuals in their own right rather than enacting fragmented functional parts/roles on behalf of their sibling group as a whole. Their mourning of the loss of each other was complicated by their earlier reliance on each other to manage the difficulties they had faced when surviving their abusive early lives together.     

Understanding the ‘blind spot’ when children move from foster care into adoption‡

Current social work practice in the UK dictates that when children move from foster care into adoption, the transition takes place within 7 and 14 days, and usually there is no contact between the child and their former carer for several months after the move, if at all. Very little attention or research has been aimed at understanding the rationale for these procedures, or their impact on the children. Joining forces with social work colleagues in a Looked After Children’s team, two child psychotherapists carried out a piece of qualitative research to look at these moves in more detail, and try to tease out how and why these key decisions are made. Analysing data from interviews with foster carers, adopters and social workers, the researchers found that the emotional experience of the child, particularly their experience of losing their foster carer, loses centre stage in people’s minds during this transition, leading to what is described as a ‘blind spot’ across the network. A significant reason for this emerged, in that the children tended to be very compliant both during and after the move and lacking in any obvious distress at losing their former carers, despite having previously been described as passionately attached to them. The research showed that adults across the network, all struggling with intense anxieties of their own, tended to interpret this as evidence that the children were ‘fine’ rather than questioning what might be going on at a deeper level. These research findings are explored in the light of a knowledge base accumulated from a working understanding of attachment and loss in early childhood, and of the psychoanalytical phenomena of individual and organisational defences against loss. Implications for future practice are suggested.     

Vicarious and post‐memory practices in adopting families: The re‐production of the past through photography and narrative

In this paper, we explore how adoptive parents manage and order visual information relating to their adoptive child's birth or foster family. More specifically, our task is to make sense of the ways in which the memories that children have of their past families are (re)constructed and managed within the context of present adoptive parental concerns. Life story books have become a dominant way in which narratives of the child's past family are formed. The aim of this book is to provide the child with relevant information, objects, possessions and images of the past and to create a coherent narrative between the past and the present. Parents are encouraged to make use of visual images, consisting mainly of photographs of birth families and foster carers to order the autobiography of the child. To date, there is no research that has examined how the process is experienced by parents and children. In order to examine how parents made use of visual information in particular, we carried out two focus groups with adoptive parents who participated in an adoption agency support group. A social remembering approach informed the questions asked, and a discursive analysis of the data was developed. The main analytical focus in this paper is on how photographs, objects and places serve as active participants in the production of the adoptive children's memory. Copyright © 2008 John Wiley & Sons, Ltd.     

Exploring the factors affecting child and adolescent psychotherapists' and counsellors' decision‐making in clinical work with parents

This study examined interventions with parents/carers in child and adolescent counselling and psychotherapy (CAP). The aim was to investigate clinicians' rationale behind their decision to work with parents and what types of interventions they use. Furthermore, the nature of clinicians' core training with regard to interventions with parents was investigated. The study used both quantitative data and qualitative textual data from an online survey of 110 CAP clinicians. There was significant agreement, regardless of previous training or level of experience, that clinical work with parents in CAP is beneficial, but little consensus for a rationale or model for best practice. There was a relationship between training, theoretical orientation and whether CAPs felt competent to work with parents. Unexpectedly, a significant number (83%) of integrative practitioners said that there had been ‘little’ to ‘none at all’ focus on working with parents on their core training course. Other unforeseen findings were in the domain of working outside generally accepted boundaries for CAP, with a notable number of clinicians making home visits—24.1% with parents alone and 38.9% with parent and child together—along with 47.2% using phone calls and/or email for coaching and support with parents. Many clinicians were candid about their sense of a lack of competence in working with parents, even though at least half were senior, experienced clinicians. A number of these practitioners made specific reference to the wish for further specialist training, with many asking for signposting to where further training could be obtained.     

Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service

Abstract

This paper is adapted from a presentation first given at the 2017 Association of Child Psychotherapists (ACP) Conference. We hope to give a feel of our work as psychoanalytic child psychotherapists working in a Tier 4 national assessment service for gender variant children and connect with our colleagues working therapeutically with these families in Child and Adolescent Mental Health Services (CAMHS) and other settings. Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to. To this end, three case studies from the clinic, taken from Under Five, Latency and Adolescent phases of development, are explored. The complexity of the cases is then discussed, followed by parallel issues of development, divergence and difference. These three ‘average’ cases from the Gender Identity Development Services (GIDS) serve to demonstrate the need for child psychotherapy as part of multi-disciplinary thinking about gender variance and how attention must be maintained to each unique story and process of identity development; as well as our clinical task to establish and encourage depressive functioning and secondary processes where possible.     

Exploring the bio-psycho-social

The United Kingdom Council for Psychotherapy (UKCP) was formed to provide a professional body for all psychotherapists in the UK. It maintains a register of trained practitioners who abide by the ethical standards ratified by UKCP, which includes psychotherapists working in all the modalities recognized by UKCP irrespective of their primary professional training. In the absence of statutory registration, there is no fully representative list of UK psychotherapists, but the UKCP register is probably the nearest thing to it. The UKCP board recognized that a survey of registrants would provide a snapshot of the state of UK psychotherapy, which would be valuable in understanding the contribution of psychotherapists to health services in the UK.

A questionnaire was designed, and sent out to all 4005 practitioners registered by UKCP in December 1997. One thousand three hundred and thirty-one questionnaires were returned, a response rate of 34 per cent. The respondents were representative of all registered psychotherapists in 1998 in those characteristics that are published in the paper register, or that can be inferred from it. The respondents were aged 51 years on average, predominantly white (97 per cent described themselves this way) women (69 per cent) practising in London and the South East of England (55 per cent). All the respondents described themselves as being influenced by psychotherapeutic approaches rooted in psycho-analysis. Ninety-five per cent of respondents had another profession previous to psychotherapy. This was most commonly teaching (27 per cent), social work (22 per cent) or counselling (21 per cent). Only 11 per cent of respondents were psychologists.

The contribution of UKCP registrants to the National Health Service has never previously been estimated. A breakdown of the diaries provided by respondents in this survey suggests that UKCP registrants may contribute as many as 44,760 hours of psychotherapy per week to the British National Health Service and other health sectors. Assuming that a whole-time-equivalent psychotherapist works 37 hours per week, this means that UKCP registrants may provide the equivalent work to health service organizations, both public and private, of more than 1,311 full-time psychotherapists.     

Intentions to Care for Children Orphaned by HIV/AIDS: A Test of the Theory of Planned Behavior

HIV/AIDS has added an unparalleled number of children to South Africa's orphan population. The theory of planned behavior (TPB) was used to investigate the decision-making processes of potential substitute caregivers of children orphaned by AIDS. Existing foster and adoptive parents ( n  = 175) completed a self-report postal survey. Of the sample, 76.0% reported willingness to care for an HIV-negative child and 62.2% an HIV-positive child. Analyses of the theory's components reveal contradictory and disappointing results. While the theory is most useful in conceptualizing the factors that bear on fostering and adoption, the current study suggests that the TPB is limited in its ability to address the complexity of decisions that attend fostering and adoption of children orphaned by HIV/AIDS.     

Children in psychodynamic psychotherapy: changes in global functioning

This study was part of the Erica Process and Outcome Study. The aim was to investigate if children's global functioning improves after psychodynamic psychotherapy. Variables that may predict changes in global functioning were examined both statistically and qualitatively, for example, the child's age and gender; diagnosis and comorbidity; treatment variables. The sample consisted of 33 children (five to 10 years of age) who participated in psychodynamic psychotherapy with parallel work with parents. Twenty-nine children had at least one DSM-IV diagnosis, and 15 children had comorbid conditions. At the start of psychotherapy, the most frequent diagnoses were attention disorder and disruptive behaviour. Child psychotherapists rated the children's global functioning using CGAS and HCAM. Large effect sizes were obtained (d = 1.80 and d = 1.98). However, no statistical correlations were found between global functioning and the selected variables. In order to illuminate the complex connection between process and outcome the study was complemented with in-depth case studies where data were taken from questionnaires, completed by the child therapists every third month. Two child therapies were selected: one in which the therapist rated a large change and one in which a small change was rated (CGAS). The analysis showed that important individual change, for example, attainment of formulated goals, was not always reflected in the change rated using the CGAS. Findings suggest that psychodynamic child psychotherapy can be beneficial. However, further research is needed to identify factors that contribute to change in children's global functioning.     

Aims in parent work: a brief qualitative survey

Child psychotherapists’ views of the treatment aims of parent work in a community Child and Adolescent Mental Health Service (CAMHS) were explored. Parent work undertaken by the child psychotherapy team in one calendar year was analysed. The parent worker was asked to describe the primary aim of the work for each case. The resulting thematic analysis found that the main aims of parent work were: increasing empathy with the child; decreasing enmeshment; and containing anxiety. Linking with Alvarez’s notion of a hierarchy of interpretative approaches, the study’s findings suggest that there are parallel ‘levels’ of intervention in parent work, where therapists work in ways appropriate to the parent’s psychological functioning.     

Latino Foster Parent Health Perceptions of Chronic Conditions: A Qualitative Exploration

Prior work using nationally representative data of children in the child welfare system suggested that Latino foster parents were less likely to identify children in their care as having chronic conditions. Hispanics comprise over one-fifth of children in foster care, the majority of whom have special health care needs, and there is a growing need to recruit qualified Latino families into the child welfare system. Little is known about Latino parents’ health perceptions regarding chronic conditions, and potential reasons for differing identification rates of children with special health care needs. We conducted 17 home-based, in-depth interviews with Latino foster parents to explore health perceptions and cultural beliefs for children in their care around the concept of chronic illness. We found that Latino foster parents’ understanding of conditions that occurred “over and over again” related to emotional and behavioral health problems. In contrast, their perception of “chronic” was associated with terminal, biological conditions that had limited treatment options, such as cancer, HIV, and hepatitis. Latino foster parents did not interpret the survey question on chronic illness as it was intended, and their view of recurrent conditions did not reflect chronic health conditions. Developing survey questions that are culturally sensitive should improve accuracy in assessing chronic health conditions for this high-risk population. Sensitivity to cultural interpretation for this high-needs population is vital to enhancing communication between families and health providers caring for children in foster care.     

Role of foster family belonging in recovery from child maltreatment

Research on foster care suggests that children who have experienced abuse are susceptible to a range of negative life outcomes. Such research also suggests that children removed into foster care can recover from abuse if given opportunities to develop healing relationships with caregivers. Drawing on qualitative data from a national research project on Australian foster carers, this paper explores how foster families enact forms of belonging that potentially work to ameliorate experiences of abuse among foster children. With a specific focus on experiences of family solidarity, rituals, identity, and culture among foster carers and the children in their care, the findings highlight the role that foster carers can play in contributing to national child protection agendas aimed at addressing experiences of maltreatment among children removed into care in Australia.     

Building seven bridges with young asylum seekers living in exile in the UK (Part 2)

This paper is derived from a talk given in November 2016 as the Birkbeck Counselling Association Autumn Talk in collaboration with Psychodynamic Practice. The original talk has been divided into two related papers of which this is the second, concentrating on the effects on young asylum seekers of the political and social situation in which they find themselves when they reach the UK. Both papers explore how, working with young asylum seekers, we can slowly build sturdy and protective connections during and after the developmental years following experiences of sequential violence. This means building links within the internal worlds of these young people between themselves and: (i) different aspects of themselves that emerge after violence and loss; (ii) their peers; (iii) listening adults; (iv) various social influences; (v) cultural influences; (vi) their past, present and future lives; (vii) links with local, national and international communities. Describing further the work that takes place at the Baobab Centre, a ‘transitional therapeutic community’, and using case material to illustrate this, the author raises the challenge of how we might best address the needs of this group of children, adolescents and young adults who objectively have to live for several years of their lives in a situation of ongoing uncertainty that is in fact much more than a young person can bear. As Jo Goldstein a legal specialist, Anna Freud a child psychoanalyst and Al Solnit a paediatrician write, in their trilogy of works, States and State Agencies cannot parent children, and children need involved parenting, (i.e. involved relationships with individual caring adults). Often for children separated from their original families, the parenting role is split between large bureaucracies and foster carers who work with agencies outsourced from the Social Services Departments. Yet this country makes Social Services Departments and the Home Office responsible for decisions about whether or not child asylum seekers might remain in the UK, in fact often without a very deep assessment and hence little knowledge and understanding of their experiences and their developmental needs. Asylum seeking minors usually have to wait for decisions about their safety and protection, and about permanence and continuity, for a much longer period of time than a child can bear.