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Foster Carers' TSD Standards covered:

Author Details

Adele Freeman

Name: Dr Adele Freeman

Job Title: Clinical Psychologist

Specialist Therapy: DDP/NVR

Current place of work: The Child Psychology Service

As a relative newcomer to working with adoptive parents (albeit with lots of experience working with children and families in mainstream services), I have noticed this question coming-up a lot. During my time working in CAMHS, parent-focused work was also often felt to be the best way of helping a family in distress but there was perhaps a greater emphasis on offering direct work to children and young people, usually using Cognitive Behavioural Therapy (CBT). I’ve thought a lot about the similarities and differences of working with adoptive and non-adoptive families and about the differences in their therapeutic needs and adopter’s questions have really helped me reflect on why we work the way we do.

Whilst thinking about this question, I recalled some work I did with a dad who had a biological daughter and adopted son. His daughter had struggled with anxiety and received a course of CBT via CAMHS. His son really struggled to manage his behaviour and was frequently verbally and physically aggressive. I offered to see mum and dad using ideas drawn from Dyadic Developmental Psychotherapy (DDP) and Non-Violent Resistance (NVR) to help them with their son’s behaviour. Understandably, dad wanted to better understand the rationale for this – “Why did my daughter get individual therapy whilst my son doesn’t?”.

I’ve wondered whether as a society, individual one-to-one therapy is viewed as the ‘gold-standard’ intervention and what parent wouldn’t push for their child to receive what is perceived as the best therapeutic support? Parents (especially adoptive parents), often have to fight so very hard to advocate for their children and help people to understand the long-term consequences of early trauma. It is no wonder that if one-to-one therapy for their child appears to be on offer in some places, parents want to know why it is not available to their child. Other professionals in the system may also hold this view and suggest that the best way to help is for the child to have therapy.

Another factor I’ve considered is how living with a traumatised child can sap parent’s confidence. Parents have shared with me that they began the process of adopting their children feeling strong, motivated and hopeful. They had no illusions about the damage caused to their son or daughter by early abuse and neglect, but felt they had the resources to help them heal. It is so, so hard to hold on to this confidence over months and years when a child struggles to let you parent them and rejects your attempts to nurture. Over time, parents begin to question, “Is it me?” “Would my son / daughter have been better off with a different family?” “I don’t know if I can do this”. At this point, parents might feel they have run out of ideas and that perhaps a professional can make the difference to the child that they feel they can’t.

So why do we work with parents? There are several reasons but the first thing to discount is that it’s because there is something ‘wrong’ with how you parent and we think we have to fix it! We work with parents because we think it offers the very best chance of helping your child and I recently watched one of Dan Hughes’ talks (Clinical Psychologist, and originator of DDP) which for me really crystallised why. You can watch the whole video at http://www.iriss.org.uk/resources/how-early-years-trauma-affects-brain but I thought it might be helpful to summarise some of the key points below:

  1. Children who have experienced abuse and neglect have a complex range of difficulties which inhibit their ability to capitalise on the love and care provided by their adoptive parents. They have deep-seated difficulties with trust which can make it hard for them to see their parents’ positive intentions and perceive attempts to discipline as abusive. These issues with trust are also likely to be manifest in other relationships with adults including relatives, teachers and professionals (including therapists!). Ultimately, most adoptive parents would like their children to be able to develop a trusting relationship with them and individual work with a therapist is often not the best way to facilitate this.
  2. Trauma perpetrated by birth parents impacts directly upon brain development meaning children with these experiences will not only have problems forming attachments, but will also struggle with their cognitive abilities (e.g. memory, planning, organisation), managing their emotions, sensory issues (e.g. recognising pain, warmth, discomfort etc.), dissociation, impulsivity and a poor sense of self. Popular therapeutic approaches such as CBT rely on children to be able to notice their thoughts and feelings, have a language for these, and then feel secure enough in themselves to share this internal world with others; many adopted children just aren’t able to do this without significant preparatory work.
  3. Traumatised children have learnt not to rely on others or to trust adults to have their best interests at heart, it is safer to be self-reliant. Children will avoid strong and uncomfortable feelings such as sadness until they feel safe and parents are in the best position to offer this sense of safety. Better still, if parents are able to offer comfort to their children when they are distressed, attachment can be strengthened. If parents are supported to do this as part of day-to-day life, it is far more powerful and influential than the work a therapist can do in one hour a week.
  4. For many parents, years of rejection from their child risks putting them into a position of blocked care. Characteristics of this are:
    a. Taking a more defensive / guarded position to protect yourself from rejection.
    b. Being aware that you’re meeting your child’s practical needs but that it’s hard to derive any real pleasure from parenting.
    c. A focus on the child’s behaviour rather than the meaning of the behaviour
    d. A tendency to be reactive rather than proactive.
    e. Finding it hard to consider different ways of being with your child – hard to keep an open mind.
    f. Feeling very sensitive to rejection.This state of blocked care closely mirrors the child’s state of blocked trust making it hard to create attuned interactions that strengthen attachments. Providing parents with the support and understanding they need to move from this position is absolutely critical to strengthening the bond between you and your child.
  5. Learning what your own triggers are from your own upbringing and understanding your history, values and beliefs can reduce the chance of you becoming defensive and reactive with your child. Work with a therapist can provide the space for you to do this.

So, a lengthy response to a simple yet critical question because after all, if we are to help you retain some hope that you’re making a difference, you have to believe that the therapy you’re being offered is right for you and your family

Top Tips for Making the Most of Parent Focused Therapy

I know this is mentioned in almost every piece of writing about adoption and fostering but self-care is absolutely crucial to being able to sustain the energy and optimism required to parent traumatised children. It’s a tough job, prioritise ways to do things you enjoy and which help you feel light-hearted and playful.

On a similar note, be compassionate towards yourself! Months and years of having your attempts to nurture your child rejected can have a profound impact on your confidence and self-esteem. Know that you are doing your very best and try to apply the same compassionate thoughts to yourself that you might to a loved one struggling with similar issues.

Spend some time thinking about qualities you like or admire in your child and write these down e.g. beautiful eyes, a great singing voice, a wicked sense of humour. Or perhaps keep a diary for a week, making a note of any small things you can appreciate about your child’s behaviour e.g. they responded to a request without arguing back, they attended school every day, they came home on time. Look at some photos of a time when things were easier – what were the things you really loved about your child back then?

Try to seek out your child or make yourself available to them – be approachable. This can be hard especially when you’re still smarting after being sworn at or dismissed. It may feel forced at first but give it a try when you can with no agenda other than spending time with him or her.

If you have any doubts about the therapy you’re receiving, share them with your therapist. Exploring your hopes for therapy (and any disappointments) is important, nothing is out of bounds.

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