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It is considered good practice to keep siblings together wherever possible, but sometimes this can be very difficult to achieve, particularly when one child is perceived to be destructive to the placement. This was the situation faced by Essex social services in the case of Abby and Keeley Hart.

It was important to find ways of listening to and understanding the emotional pain of these children. Was Keeley so torn apart that it could only be conveyed by tearing apart other people's property? To reach a conclusion, the children needed to be assessed both individually and together, and this was achieved by intensive therapy aimed at building trusting relationships. Many traumatised children behave in ways which are often described as "disruptive". To reduce anxiety, the children were encouraged to direct the activities and to tell their own life stories symbolically.

Principal social worker Jenni McRae noted early on that Keeley desperately needed to have the complete attention of a parent - something she had never experienced at home. "Her behaviour certainly brought attention, and negative attention was better than none," says McRae. "Keeley's play suggested that she thought that 'all mums were nasty', so foster mothers were no different."

Therapeutically, Keeley needed to re-work this missing phase in her development. She did not trust anyone, expected to be rejected, and resisted well-meaning carers before they rejected her. This pattern had to be interrupted and repaired, or it would continue into adulthood.

"A few weeks into the therapy, Keeley lined up teddy bears and began, very symbolically, to feed them," continues McRae. "Each bear represented a significant person, always male, never women, with the exception of Abby. So I knew that she was an important attachment in her life."

Abby, however, had learned how to manage her pain by keeping quiet, being compliant, and hiding behind her sister's acting out. "This made her much more acceptable to carers, who found it easy to attach to her," says senior practitioner Sarah Carter.

"We had concerns that Abby showed signs of depression early on in the sessions, always having to be this good enough child," adds McRae. Carter agrees: "There were times when you could see her thinking her actions through: 'How do I get this right? How do I please this person?'"

Between them, Carter and McRae became the good enough mother missing from the girls' lives. "We had sought to be role models, always looking the same, always speaking in the same way, and never shouting," said McRae. "They needed to learn how to predict."

If they could not make a session, the workers would write to the children personally, including pictures.

"They needed to know that we would not let them down," says McRae. It was clear that the girls had a valuable attachment to each other, and as they had already suffered so many losses and rejections, it would benefit them both to remain together.

Keeley's anxiety needed to be understood and responded to, whenever she gave the signal by acting out and controlling others. Abby needed to be released from the responsibility of always being "good", and experience what it would be like to be herself.

When a prospective long-term family came forward, the Lionmede workers became involved in the assessment to discover if the family could recognise and meet both girls' needs.

"We were clear about expectations, and that it was important that this was the last move as we were seriously worried about their long-term mental health if they were moved again," says Carter.

Although they have moved away from the area, similar services have been put in place, so that the therapeutic work continues. But this time for the girls, unlike the past, the separation has been a positive one. "It was a good goodbye," adds Carter.

The children are happy and blossoming. They are, for the first time, being given space to develop their own personalities.

As the children's current social worker remarks: "Outcomes like this reassure us and remind us why social work exists, to make a difference to people's lives."

Case notes

Practitioners: Jenni McRae, principal social worker, and Sarah Carter, senior practitioner.

Field: Mental health assessment and treatment service for looked-after children.

Location: Essex

Clients: Sisters, Abby (aged seven) and Keeley Hart (five) have been in the care of the local authority almost since birth - their mother was drug dependent and their father's whereabouts was unknown.

Case history: The children (always together) had a history of disrupted placements, mainly because carers viewed Keeley's behaviour as unmanageable. She repeatedly demonstrated her despair by breaking things and by controlling others. Most carers were keen to keep Abby, who was seen as compliant and loving, but not Keeley. Their individual needs seemed so diverse. The children were then referred to the Lionmede Centre, which offers a rapid response short-to-medium term multidisciplinary assessment and treatment service, to assess the emotional needs of the children, and the quality of their sibling attachment. Also, to advise whether they should remain together or be placed separately. The work had to be focused and intensive.

Dilemma: Should the sisters be denied the chance to be brought up together because the adults in their lives can't manage them?

Risk factor: How long must this pattern of placement breakdown be repeated to the detriment of both children's mental health?

Outcome: Both children have now been placed together with long-term carers and are thriving in their new environment.

Independent comment

The case highlights the need for specialist and dedicated therapeutic services for children requiring permanent placement, writes Alan Burnell. It is very important that children such as Abby and Keeley are seen first in the context of their traumatic past, rather than as a failure of parenting in the present. It is Family Futures' experience that, as in this case, when Jenni MacRae and Sarah Carter were able to address the children's traumatic past and provide them with a constant and safe relationship, that their behaviour began to change before a permanent placement was made. In order for children to make secure attachments to permanent carers, it is essential that therapeutic work is done as early as possible in the placement process, as only then are children freer to begin to form secure and healthy attachments. It was heartening to read that the workers involved systematically considered the risks involved in the children being placed separately and together, rather than just assuming that placing them together was "a good thing". The priority has to be that each child need's to be re-parented and to form a secure attachment to a safe, caring adult. For this to be achievable, intensive support and therapeutic input are essential. I believe that, without the therapy, the sibling placement would have been unsustainable as in previous placements.

Alan Burnell is director of Family Futures, an agency specialising in adoption assessments and post-placement therapy.

Arguments for risk

• Despite the history and pattern of placement breakdowns it was clear to the workers that Abby and Keeley did have an attachment, and that Keeley's behaviour had caused people to miss this. Their relationship needed to be worked on.
• By targeting the children's emotional neglect and abuse, the workers were able to begin to positively fill those voids. It was recognised, through the team's specialism, that Abby and Keeley could not be treated in an age-appropriate way, as they were not sufficiently developed emotionally. Therapeutic play helped the team understand the different ways these children communicated their feelings of abandonment.
• Separating them would not have been useful to either child. Once the Lionmede team began to engage with Abby, they realised that her compliance was rooted in her need to be accepted. However, they were mutually dependent and Keely acted out Abby's frustrations for her. Removing Keeley might cause a deterioration in Abby's well-being.

Arguments against risk

• The department felt there must be a time when it draws the line over how many times Keeley would be permitted to break up the placement. Her needs could not be met in the same place as her sister because she was simply too disruptive. Also, Abby herself was entitled to a family of her own. She had a right to be settled in one place and not to be moved every time Keeley inevitably decided to play up.
• The sisters had been freed for adoption for some time. The plan had always been to have them placed together but no carers had been found. How much longer before permanent decisions are made that give at least Abby a decent chance of stability and permanence?
• Carers had been making it very clear that they had successfully developed attachments to Abby and wanted to make permanent commitments to her, but would not tolerate Keeley.