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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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3: The “added value” of attachment theory and research for clinical work in adoption and foster care

Jenny Kenrick Karnac Books ePub

Miriam Steele

Our work often brings us into contact with children whose parents were unable to care for them, leaving others to assume this duty. They have often endured multiple separations and losses. It was children like these who first inspired John Bowlby to devote his career to studying and understanding the impact upon children of maternal deprivation. In a report for the nascent World Health Organization, Bowlby commented on how mental health depends on children receiving continuous care, from which both mother—or mother-substitute—and child derive an enduring sense of joy (Bowlby, 1951). During the 1950s, at the Child and Family Department he helped to establish at the Tavistock Clinic, Bowlby convened a study group aimed at elucidating the importance of the parent–child relationship. Among his many colleagues was Mary Ainsworth. She conducted longitudinal studies of infants and their mothers, which identified sensitive and responsive care as the vital ingredient in promoting secure or “healthy” infant–parent relationships and, in turn, a solid sense of self within the child that would launch him towards trusting relations with others, and a sense of competence in pursuing cognitive and social goals. Bowlby drew on Ainsworth’s developmental research, cognitive psychology, control theory, and evolutionary theory to advance a theory of attachment in three volumes, Attachment (1969), Separation (1973), and Loss (1980).

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8: Cognitive behaviour therapy

Jenny Kenrick Karnac Books ePub

Sally Hodges

This chapter outlines the basic principles of cognitive behaviour therapy (CBT) and how CBT can be adapted for children who have been fostered or adopted and their families. Children are usually placed into care either because their families of origin have decided that they cannot parent them or, more commonly, because outside agencies have concerns about the quality of care provided to them. Children who are looked after by others have, by definition, experienced trauma. This trauma has often been considerable and over a long period of time. Looked-after children can present a very real challenge for psychological treatment. They are likely to have undergone multiple traumas such as emotional or physical abuse and then the loss of their family and home (even though relationships may have been difficult) and often multiple placements. They can be extremely emotionally damaged by their difficult life experiences and sometimes also by the subsequent events related to moving into care.

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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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5: The role of psychiatric assessment and diagnosis

Jenny Kenrick Karnac Books ePub

Caroline Lindsey

The work of a specialist multidisciplinary CAMHS team assessing and treating looked-after and adopted children necessitates in almost all cases consideration of whether a diagnosable mental health disorder is present, especially given present knowledge that suggests that this is so for almost 50% of looked-after children (Melt-zer et al., 2003). The well-known, strongly expressed antagonism to the making of diagnoses is based on a belief that damage is done to children by the process of labelling and a fear of the stigma associated with mental illness. However, the dangers of disadvantaging children and young people, their parents and carers, and the professional network by the failure to recognize a significant mental health problem outweighs these concerns. There is therefore a clear role for a child and adolescent psychiatrist in participating in the diagnostic assessment process undertaken by the multidisciplinary team. In addition to the significant level of mental health difficulties in this group of looked-after and adopted children, they also are more likely to have physical disorders, including epilepsy, speech and language disorders, developmental delays due to both organic and environmental factors, such as enuresis, conditions such as foetal alcohol syndrome, and other forms of learning difficulties (Meltzer et al., 2003). There is, therefore, an additional role for the psychiatrist in identifying physical health problems and referring young people, if needed, for investigation and further assessment by a paediatrician or, where appropriate, for a psychological assessment.

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