How Psychotherapy might help a child to develop positive internal representations of self and carer, and could this put him in a better position to make a new attachment to adoptive parents?

Presentation delivered by Sue Chantrell, on Saturday 7th November 2015, to the International Attachment in London, N19.

Written by Desmond King

Dr Susan Chantrell, a member of our exec committee, led the November workshop presenting an over view of her doctoral research on the psychotherapy treatment of a child who she worked with during her training as a Child Psychotherapist.

This was a single case study of a little boy which followed him from her first contact with him when she assessed him at a Family Assessment Centre as a 4 ½ year old still in nappies and then over a 16 month period while he was fostered, preparing and then placed for adoption with his new family, during which she saw him for 3 x weekly child psychotherapy.

The research was based on the analysis of 12 sampled sessions of detailed process notes written at the time. The sessions were analysed using a qualitative research method based on grounded theory.

What I found really illuminating as someone with no specialist experience of adoption was to be enabled to share in the process of this complex journey largely from the  perspective of the treatment relationship, but one which was sensitive to many of the important figures in the narrative: his mother with mental illness; his step father and birth father; a younger but developmentally more advanced younger brother; the other professionals actively involved with the process of adoption; his foster family and adoptive parents. 

Susan’s presentation provided a theoretical context and rationale which for someone with only the most rudimentary understanding of child psychotherapy gave a real insight into how the therapy developed in the context of the transition described above.  It was not difficult to follow a trajectory from initial difficulty engaging, a developing capacity to express ‘crossness’ and then symbolic expression of relationship, expressed both in terms of illuminating vignettes and in the range of scoring quantified categories used to represent the elements recorded. 

Finally as someone who was stirred by a previous workshop (presented by Graham Music) to explore the neglect ‘which we know exists but don’t see’ I noticed that Susan highlighted at least 2 episodes which explored her patient's experience of earlier neglect.

Thank you Susan and to all who contributed. 

Desmond King

 

Commentary written by member of the audience Colin Critchley

Sue shared with us the fascinating narrative of her direct involvement in the life of ‘Alfie’, before his coming into the care system when he was 4 years of age through to his adoption at the age of 6. Like any powerful story we wanted to know the outcome before the narrative had unfolded! 

Sue has a relaxed style of presentation and was able to share with us the traumatic early years of Alfie’s life leading to him being placed for adoption. For me, it was refreshing to hear that a child with so many needs was able to receive appropriate therapeutic help before having a permanent placement. So often, one encounters the opposite position being advocated, that is the denial of therapeutic support until the child is in a permanent placement.

The other key element for me was the decision to defer adoption and allow Alfie to develop a stronger attachment to his foster carer. Children like Alfie are usually highly traumatized by the experiences they have encountered and will need a period of stability before experiencing further trauma through another move. I became acutely aware of this whilst working as the psychologist in a specialist unit in a children’s home in the 1980’s (see Critchley [1]).

It was obvious from the warmth of Sue’s narrative that a significant attachment developed between her and Alfie over their intense sixteen month interaction. The end of Alfie’s story, to date, answered Sue’s question; it was clear that Alfie was in a better position to make positive attachment relationships with his adoptive parents due to her work. Vera Fahlberg used the concept of “bridging attachments” [2], Sue’s work exemplified this concept.

This was my first visit to an IAN occasion; it won’t be the last!

Colin Critchley, Psychologist

 

[1] C. Critchley, The Role of residential care for Pre-Adolescent Children, Fostering and Adoption, 17, (July 1993), pp 22-26.

[2] Vera Fahlberg, Good Enough Parenting, eds M. Alcock and R. White, British Agencies for Adoption and Fostering, London, BAAF, 1985, pp 91-95.

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