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19: Children who cannot live in families: the role of residential care

Jenny Kenrick Karnac Books ePub

Hamish Canham

For many years now, the tide of opinion has been against placing children and young people in residential care, and there has been a commensurate burgeoning of fostering and adoption services. This opinion has been rooted in the feeling that children need to be in families, a well-founded desire to give children homes, and a prejudice against institutional care, reinforced by a constant flow of scandals in children’s homes. In this chapter I outline why I feel there will always be a need for residential provision for certain children. I then look at some of the issues that besiege children’s homes and make the work so demanding and difficult. Finally, I also reflect on what is needed in children’s homes if they are to provide a containing and therapeutic environment for children to live in.

There is a large number of children and young people who, when things go wrong at home, are placed almost as a matter of course in foster care. Very often these children are not suited to family life, and there is a tragic mismatch between foster carers who want to provide children with a substitute home and the children whose level of disturbance means they place an impossible burden on any family where they go to live. There are, of course, exceptional foster carers who seem to be able to tolerate very high levels of destruction, sexualized behaviour, and violence in their homes. However, for most foster carers, the daily impact of living in close proximity to such distress, which so often manifests itself in attacks on the foster home and indeed on the foster carers, causes immense emotional strain and can lead to burnout and breakdown.

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14: From tired and emotional to praise and pleasure: parenting groups for adoptive, foster, and kinship carers

Jenny Kenrick Karnac Books ePub

Julia Granville & Laverne Antrobus

In this chapter we describe parenting training groups that we have offered alongside other clinical work to families referred to the specialist Fostering, Adoption and Kinship Care team at the Tavistock Clinic. We consider what is special about these groups and the various additional issues that needed to be addressed because of the particular needs and demands of adoptive, foster, and kinship families. We explore some of our ideas about the cognitive–behavioural approaches of the group programme we have followed and how these fit with other core theoretical models and trainings.

Many of the families we work with come to us in a state of exhaustion and despair. Some of their struggles are undoubtedly shared by parents in more ordinary circumstances. However, for adoptive, foster, and kinship families, the difficulties in managing the daily tasks of parenting and the levels of challenging, disturbing, and oppositional behaviour in the children for whom they care may be extreme. Parents and carers may be feeling defeated and in touch with sides of themselves they just did not know existed, which can be very disturbing for them. As in many fields, offering groups to people who have a common presenting difficulty may be a helpful experience that enables them to begin to feel less isolated and more empowered to deal with problems and to connect with their strengths. For this reason, and in response to a growing body of research into the effectiveness of some parenting programmes, we decided to train in and then offer some groups to parents seen by our service. The aim was to offer a structured parenting programme and an opportunity for parents and carers to come together with others in similar circumstances.

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4: The uses of a neuroscientific perspective

Jenny Kenrick Karnac Books ePub

Graham Music

In the last decade neuroscience and developmental research have-provided convincing evidence about the impact of early experience on later development, and in particular of the impact of trauma and neglect on the developing brains of young children. This has become a powerful explanatory tool to be used alongside other bodies of thought, such as attachment theory and both psychoanalytic and systemic therapy, to make sense of the plight of many children who have been adopted or fostered and their families. We now have neu-roscientific explanations for why such children provide such a huge challenge to their carers and the systems around them, for why all too commonly we see in these children symptoms such as aggressive and self-destructive behaviour, being impervious to ordinary affectionate care, impulsiveness, the inability to regulate emotions, and the other signs described all too clearly in this book.

Much has changed since the early days of psychoanalysis, when it was believed that traumatic early experiences, such as of sexual abuse, were repressed, leading to all manner of malevolent symptoms that were cured by helping people to remember the traumatic episodes. We have since discovered that cure and changing symptoms are not so simple, and that the basic explanations used in those days were somewhat off the mark. In particular, our understanding of the fine details of how early experience affects children is much more advanced, as is our understanding of how certain experiences affect different parts of the brain. More is now known about how different areas of the brain link up, and how some brain functions may be more to the fore at different points in a child’s life. We know now, for example, that levels of stress in a mother as early as pregnancy affect the unborn child (Field, 2004), and that the stress hormone, cortisol, released by pregnant mothers, will cross the placenta and impact on the developing foetus. We know that infants who have consistent and attuned caregiving develop the ability to “self-regulate”, whereas experiences of either neglect or trauma might not be consciously remembered but will affect not only behaviours and attitudes, but also the very structure of the brain as well as the HPA axis, a central part of the neuroendocrine system that controls reactions to stress, particularly through the releases of hormones. This is a system that humans share with many organisms from way back in evolutionary history.

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9: Individual psychotherapy for late-adopted children: how one new attachment can facilitate another

Jenny Kenrick Karnac Books ePub

Juliet Hopkins

One of the risks of adopting children in care is that they may perpetuate their deprivation by rejecting the loving care offered them. Clinical experience shows that when this happens, it can sometimes be possible to facilitate children’s attachment to their new parents by involving them in individual therapy.

This chapter aims to describe the difficulties inherent for these deprived and rejected children in making new attachments and to consider how a new relationship to a psychotherapist may help these children to take the risk. Concepts from psychoanalysis and from attachment theory are used to understand the therapeutic process.

In order to explore these issues, I bring examples from the psychotherapy of two children—Max and Pauline—who had each been adopted at the age of 4 years but who had not bonded with their respective adoptive parents.

When they started therapy, Max was 9 years old, and Pauline was 14.

The early histories of these two children were typical of children placed in late adoption and do not need for present purposes to be individually specified. Enough to say that after two or three years in their birth families, where they suffered both abuse and neglect, they experienced several foster home placements before joining their adoptive families. Both sets of adoptive parents were caring, concerned, and thoughtful people who supposed, as many adoptive parents do, that they could undo the adverse effects of their children’s early experiences within a year or two.

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2: Psychoanalytic framework for therapeutic work with looked-after and adopted children

Jenny Kenrick Karnac Books ePub

Jenny Kenrick

Psychoanalytic child and adolescent psychotherapy as practised at the Tavistock Clinic has two main roots: one is its psychoanalytic theoretical base; the second is its base in the observation of infants and young children. These come together in practice with children and families. This chapter is to show the particular relevance of the theoretical base in our work with looked-after and adopted children and in our participation in the work of a multidisciplinary based team. The same frameworks inform work with both foster carers and parents.

Freud developed a new theory of man and of mind at the end of the nineteenth and early twentieth centuries. His new “science” challenged the prevailing views of mind, motivation, and the innocence of children. A medical, neurological model, it described impulse-driven behaviour in a quantitative way. Later he developed a formulation of mind, in which man is driven by conflict between the life and death instincts, under the influence of ego, id, and superego. He described transference and countertransference. It was left to his followers to elaborate his theories into more finely honed working clinical tools.

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