Fostering & Adoption One Day Conference

The Complexity of Contact in Today's Society

By Angela Evans

2nd July 2010

This day conference was organised by the Centre for Emotional Development in Brighton.  It was the third annual conference focusing on some of the challenges that we face in fostering and adoption.

The day comprised of four speakers, with each talk followed by small group discussions and feedback to the large group.  This worked very well and enabled each participant to contribute to the day.  Dr. Leslie Ironside, Consultant Child and Adolescent Psychotherapist and Director CfED, spoke first on ‘Keeping Multiple Families in Mind.’   He evoked feelings of empathy in the audience as we heard a child’s perspective on being fostered and thought about Fairbairn’s quotation on the greatest need of a child being to feel genuinely loved by his parents and to know that his parents accept his love, and the frustration of this desire being the greatest trauma a child can experience (1952).  Leslie then introduced us to the ‘dilemmatic space,’ an organisational consultancy term, where there is no obvious right thing to do and there are conflicting pulls, creating a lot of anxiety.  This set the scene for the day, as we considered children who have to keep multiple families in mind.

Leslie gave us three case examples of such children and families.  Through the relating of his work with a teenage mother with three children who had been adopted, Leslie described how hard the mother tries to stay in Klein’s depressive position, to keep thinking and to stay in touch with difficult feelings.  She is ‘raising three children in her mind,’ which was an interesting and moving perspective on keeping multiple families in mind.  We considered how easily systems around children and families fall into paranoid/schizoid positions as they receive strong projections from them.  Leslie emphasised the importance and the challenge of us as workers with complex families maintaining the ability to think, to make decisions and to help children and families to develop internal resources.

The groups all discussed similar themes: the need for reflective space in our work; the need to thoughtfully support contact with birth parents; a concern about the amount of conflict that children hold in their minds with their multiple families; a need to respect the views of members of each family system.

The second speaker was Lorne Loxterkamp, Consultant Child and Adolescent Psychotherapist.  He spoke on ‘Understanding Contact with Birth Parents: Truth and Meaning.’  We were challenged by Lorne to question the current thinking about contact with birth parents.  He pointed out that apparently good contact could be harmful.  Further, there is no evidence that lack of contact has inevitable negative consequences or that its presence brings benefits (see CfED website for source).  The many arguments that have been made for contact with birth family were questioned closely and alternative arguments were made, which seemed to have as their central motive the concepts of truth and meaning for children.

Lorne argued that the ‘conviction that healthy identity and self-esteem depend on the child having a positive view of birth parents guilty of maltreatment’ leads inevitably to the child thinking that if he is meant to feel positively about these birth parents, then it must in some way be his fault that he was removed from them.  Finally, we were left with the conclusion that contact can be a good thing only if it aims at the truth.

In our group, we discussed the difference between identity and belonging; some adopted adults wish to seek their identity but not to have any sort of ongoing relationship with their birth family.  Also, the topic of how much support birth parents need.

After lunch, we had two more speakers.  Richard Rose, Clinical Practice Director Mary Walsh Institute, began the afternoon by speaking to us about Life Story Work for Children and Young People.  He introduced us to the work he leads, where severely traumatised children from abuse and neglect, from ages four to twelve, undergo specialist therapeutic treatment based in residential settings.  The work is based on the HIDE approach, where the History, the Internal Working Model, the Development of the child and the child’s Environment are all given equal importance.  The Internal Working Model is based on attachment theory, where the child’s self-belief is directly linked with his belief about caregivers and about the world.  So, if a child feels he is unlovable, he sees adults and the world as unloving and unresponsive.  The life story work consists of a great deal of research taking place, with information-gathering taking place from many sources, until a full picture of the child’s history is obtained.  In the HIDE model, there is an equal emphasis on therapeutic input, life story work and therapeutic parenting.  All professionals work together and there is no client confidentiality between them.   It begins with the child and the therapeutic parent with feelings and trust games, then a ‘Bayeux Tapestry’ of the child’s interpretation of his or her life story is made on wallpaper.  A family tree is made, with much story sharing, allowing time to process.

As with the previous speaker, the emphasis was on truth, and not on presenting children with their histories ‘glossed over’ or ‘made better.’  Richard quoted from Vera Fahlberg (see CfED website for source), which included a striking sentence: ‘Whatever the past was the child lived through it and survived, and so can live with the truth.’

The group discussions shared a frustration with the lack of resources in most organisations, but a great wish to apply the sort of best practice of which Richard had spoken with our available resources.

The last speaker of the day was Katherine Green, Senior CAMHS Practitioner and Adult Psychotherapist.  She shared a case study with us, on her theme of Working with Problems of Contact: Developing a Therapeutic Model.  The case study was about a nine-year-old girl, Sarah, who was angry, aggressive, attacking, resistant to therapeutic intervention or to any exploration of her history.  She was an adopted child, with a history of physical abuse and neglect.  Sarah was born with an opiate addiction.  She spent her early years in and out of foster care and paternal grandparents’ home, suffering neglect – an all too familiar story to clinicians who work with this client group.  She held on to an idealised picture of her birth mother, fuelled by her contact with birth family.

Katherine and her colleague embarked on a piece of therapy with Sarah and her adoptive mother where they thoughtfully read out professionals’ notes made on Sarah from her birth onwards.  As they read out often very painful notes, they modelled a thoughtful parental couple, as they commented on how it must have felt for infant Sarah.  Through this process, Sarah gradually became interested in her story and wanted to know more.  Her behaviour improved dramatically and eventually she chose to stop all contact with her birth family, who were untruthful to her and kept alive her false hopes.

The group discussions continued the theme of the importance of two adults talking and thinking together.  I was put in mind of Leslie’s initial comments about the difficulty of maintaining the depressive position, and how two people are often needed to maintain it when there are such painful, traumatic stories.

Through this day, we as professionals working with this client population had what felt like a luxurious opportunity to reflect and think together on our practice.  We went away feeling refreshed and ready to continue with our work.