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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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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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1: A systemic conceptual framework

Jenny Kenrick Karnac Books ePub

Caroline Lindsey and Sara Barratt

The systemic model has long been associated with seeing families in family therapy. Systemic practitioners have extended their practice more broadly into the wider domain of human systems, not exclusively focused on families, but applying the systemic approach also to work with individuals and couples as well as to training, consultation and liaison with professionals and agencies. A system is a name given to a set of relationships created between people characterized by a pattern of connectedness over time. Individuals in a system are seen to affect and be affected by each other in what is described as a circular way. This is in contrast to the idea that many hold, that one person affects the other unidirectionally—that is, in a linear fashion. Systemic therapists, however, also recognize that some people in a relationship may have, or be seen to have, more power to influence what happens than others—for example, parents often having more physical strength to impose their wishes on children. Systemic therapists intend to intervene to enable individuals to alter the balance of relationship between them, on the basis that the way the relationships are organized maintains or even creates the problems which are the source of their concern. Problems are not conceptualized as being located within the individual. Working systemically means that it is possible to choose to work, not simply with a family who live together, but to invite all those who are contributing to or have a role in constructing the problem that needs to be addressed: “the problem-determined system” (Anderson, Goolishian, & Windermere, 1986). The systemic approach is a crucial aspect of working with families who foster and adopt and with the professionals and agencies involved in their care. It offers a framework for understanding and intervening in the inter-relationships between the complex systems created for caring for children outside their birth families. Practitioners are seen as part of a new “co-created” system, which is formed between themselves and the families and other professional participants in the course of the conversations that they have together. The therapist actively participates in the creation of the story which emerges in the session, through questions which are asked or which remain unasked and by the interventions which are made. This contrasts with an idea that is sometimes held, that it is possible for therapists to act on the family from an outside, external position without being affected themselves.

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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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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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