“Attachment Theory has a special place in Adoption and Fostering, as it provides a conceptual framework for the practitioner who is grappling with major decisions about the future of vulnerable children. It provides a scaffolding for thinking about the children’s experiences, the impact of these experiences of the children’s internal expectations of parental figures, and information about how best to support both the children and the substitute parents”
Kanniuk (2014): “The application of attachment theory to the field of adoption and fostering”
Too often, fostering and adoption is seen as an easy route to fixing a damaged child, with insufficient attention paid to the nature of the fostering / adoptive relationship itself. Self-evidently, it is not the placement type in and of itself that makes a difference to the welfare of a child, but a parent-child relationship that is supported (or not) by the legal process. When the carers themselves become simply a role, rather than seen as people who are both impacted upon, and personally impact the relationship, then critical issues get missed, and ultimately, the child’s experience is not properly understood.
Looking after children who have been endangered, and moving to a family who are not your family of origin, challenges the attachment system of both children and adults in unique ways. Attention needs to be paid to the impact of the child on the foster parents / adopters as well as the pattern of relationships of the carers themselves. Assessment tools are needed that shed light on what is going on between the carers and the child, in order to understand struggling foster or adoptive parent-child relationships; and of the impact of the carers’ own experiences on their relationships, in the assessment of carers themselves.
Dr Grey and Juliet Kesteven have considerable experience in working with foster and adoptive relationships at the point of permanence planning, and also subsequently, in the case of struggling relationships and potential placement breakdown. Dr Grey has previously sat on an adoption panel, and has taught courses on specifically attachment & adoption/fostering for different organisations, including Hampshire County Council, Manchester Metropolitan University, and NAGALRO. CCA has conducted work with adoptive families for the Adoption Support Fund.
‘I have trained in the MotC assessment with Cambridge Centre of Attachment, and also use them to code interviews with both parents and foster carers. I have found the measure extremely useful in understanding the ‘space’ between a parent and child, and have valued being able to discuss the results with Dr Grey and Juliet Kesteven to think about the management of risk, but especially to develop a plan for therapeutic work where appropriate.
Their skills and experience have helped me make sense of the most complex cases, and have enabled the multiagency service I lead to really help the parents and carers to find ways have an enjoyable and ‘good enough’ relationship with their children where this previously wasn’t possible.’
Elaine Sullivan – Clinical Lead, Fostering and Adoption Service, Suffolk County Council
1. Compulsivity in Looked After / Adopted Children
Compulsive attachment refers to patterns of managing caregivers based upon inhibiting one’s own needs, feelings, and desires, and focussing on pleasing and conforming to powerful others (Crittenden 2015). It is commonly seen in abused children who have learned to hyper-vigilantly attend to adults in order to ensure that they do not put a foot wrong (and so incur harsh reprisals); in role-reversed relationships, where children suppress their own vulnerability and look to make the parent happy, less withdrawn and depressed, and more able to function protectively as a parent; and in cases of severe neglect, where children have had to become proto-adults and learn to ‘drive their own train’ and manage without adult nurture and protection. Compulsive children learn to develop a ‘false self’, a positive self that pleases adults (including professionals) but hides their own fear, anger and distress. Baby P, for example was known as ‘smiley‘ and Victoria Climbie was ‘a little ray of sunshine‘, who ‘had the most beautiful smile that lit up the room’, despite the fact that both children were being regularly beaten and abused.
In addition, compulsivity is also extremely common in the care system, not just because of the trauma that children bring into the system, but also a history of uncertainty and frequent moves of placement that inadvertently ‘teaches’ the child that there is no-one who can be ultimately relied upon to protect or nurture them. Children experiencing frequent moves need to learn to rely on themselves, and do all that they can to prevent rejection by future carers (rather than seek nurture). For example, in one study comparing looked after children to a community sample, 82% of the LAC children were exhibited this kind of pattern, either on its own, or in conjunction with something else (Farnfield 2014c).
The fact that these children are also carrying around experiences of trauma (see below) that they cannot make sense of, means that, at times, their strategy of adult-pleasing breaks down. However, they are often treated as if they are manipulative, provocative and strategically controlling of their carers (because this is how it feels to them), when they are in fact trying to meet expectations but failing. The problem here is not that the children are using anger to manipulate, but that they lack even a basic awareness of difficult feelings such as anger until they are overwhelmed and explode. Simply applying behaviour management techniques to these children will not work unless their underlying and hidden fear and anger is allowed to safely be expressed ‘in the open’. The lack of recognition of compulsivity in children leads to inappropriate blaming and labelling of both the children, and the carers who often feel judged for struggling with the rejection and emotional self reliance of these children, as well as damaging outbursts, when the children in other contexts (such as school or in activities, or with strangers) are able to manage their behaviour because intimacy is not required.
Loss or traumatic experience can be a powerful motivator to foster and adopt, as well as work in the caring professions. Almost by definition it is characteristic of children in the care children (including those who are subsequently adopted) as these children have lost parents, carers, in addition to the experiences that brought them into the care system. This commonality is not necessarily problematic and can lead to carers having a greater openness to difficult experience, and empathetic understanding of the child’s experience.
However, in some cases, a failure to ‘resolve’ loss or traumatic experience in such a way as to allow thinking and feeling about the experience without feeling overwhelmed, can lead to difficulties where substitute parents are either threatened by the child’s difficult experience, or ‘enmeshed’ and overly identified with it. Both can have significant consequences on the placement and the child’s development. The loss involved for adoptive parents may be the loss of their own fertility and the birth child they never had; this can place a huge burden on the adopted child to replace the ‘lost’ child that they are still grieving. Similarly, the child’s unresolved loss and trauma can unearth issues for the adoptive and foster parents, eliciting feelings that they are able to dismiss in other relationships, but can be powerfully destabilising in their relationship with their adopted or Looked After child.
Unresolved trauma and loss can be identified using the Adult Attachment Interview (AAI), and its consequences on the parent-child relationship using the Meaning of the child Interview (MotC). The child’s unresolved trauma can be assessed using the attachment Story Stems, or the Child Attachment Interview. The use of these procedures prior to placement can help identify potential difficulties and take action to either avoid them, or put support in place. In situations where the relationship is already struggling, the use of these assessments allows the critical issues to be identified in a human and non-blaming way, as something that is happening in the relationship rather than the fault of the adoptive/foster carer or the child. A realistic plan of support can then be developed that goes to the root of the problem.
3. Reflective Functioning
Reflective functioning refers to the capacity to understand the behaviour of oneself and others in terms of underlying mental states: for example, desires, beliefs, intentions, and feelings. It is associated with sensitive parenting and good outcomes for children in both the general population (Slade 2005) and in adoption and fostering (Steele et al. 2008). The need for substitute parents to be able to perceive, contain, and hold in mind the experience of a child whose history is in all likelihood very different from their own, makes the need for a reflective capacity particularly critical. Traumatised children need to externalise the traumatic feelings that they cannot process for themselves, and so tend to project them onto those caring for them (Fonagy et al. 2004). This can be an incredibly overwhelming and de-stabilising experience for adoptive parents especially, who find themselves treated as if they were the abusing parent, without always being fully prepared for this. A capacity for mentalisation – seeing the child’s experience for what it is, and putting it in its fullest context, can be key to managing this without needing to resort to either blaming and rejecting the child, or withdrawing from the relationship, defensive processes that will put the new parent-child relationship at severe risk. Reflective Functioning can be assessed both in the Adult Attachment Interview (about the adults’s early relationships) and the Parent Development Interview (about the child).
4. The Meaning of the Adopted/Fostered Child
All children hold a psychological meaning to their parents (Reder and Duncan 1999), and this is no less true for adopted or Looked After Children. In the case of adoption this is influenced both by the adoptive parents’ prior expectations of adoption (and motivation to adopt) and their understanding of the child’s history and parenting. Adoption involves taking into your home and heart, a child whom you may well have been told comes from bad or dangerous parents. This runs against the grain of the biology of attachment, which can be seen, albeit crudely, as a behavioural system developed to enable the passing on of one’s own genes and protection of one’s progeny. In many, perhaps most cases, the adoptive relationship progresses well, and this does not present a particular problem. However, in some cases, when adoptive parents are struggling with the child, this can colour the meaning the adoptive parents give to these difficulties and they can feel, as one adoptive parent put it to us, that they are bringing up an ‘alien in [their] family’.
In addition, the adoptive relationship is first and foremost an attachment relationship, and like all such relationships involve intense emotions. As Bowlby first drew our attention to, looking after any child is an exhausting and emotionally challenging endeavour, but one that is managed because of the intense joy and pleasure such relationships can bring:
‘If it goes well, there is joy and a sense of security. If it is threatened, there is jealousy, anxiety, and anger. If broken, there is grief and depression’
Bowlby (1988) ‘A Secure Base’, p. 3
In relationships that cannot be reciprocal, as is the case in many adoptive relationships where the child is externalising their own trauma and abuse, and cannot ‘reward’ the parent, and in some cases actively rejects the parent, this threatens the relationship and can break it, with all the attending feelings that Bowlby identifies. In fostering, these issues are commonly overlooked, as the foster parent is seen as a ‘carer’ performing a role, rather than a ‘parent’ involved in an intense relationship, which more closely characterises how things actually feel for both child and foster parent.
These issues are examined and assessed using the Meaning of the Child Interview (MotC), which can be given both prior to placement (in relation to the carers birth children if they have any, and their expectations of the child), or within an established relationship. Again, the procedures identify what is going on in the relationship, often allowing the past and present experience of suffering to be given a voice and support offered, rather than engaging in any kind of fault finding exercise. Often carers feel blamed because professionals (and even the society around them) impose their own expectations of a happy ending to their own experience of removing children from birth parents. Assessments like the MotC allow these issues to be raised and sympathetically addressed.