Therapeutic care addresses children’s poor relationships

Carers with therapeutic skills can help rebuild children’s psychological foundations, says Jonathan Pearce, who will be speaking on the subject at a Community Care conference

Imagine a wall. That wall represents your childhood. Your whole sense of self, personal identity, values, beliefs. And world outlook as an adult is built on that childhood wall.

Each brick in the wall represents a need. For instance, a baby will need milk, love, warmth, affection, security, stability, consistency and so on. As you age, many of those needs will continue, but some will develop and adapt, while new ones will be added. Healthy emotional and physical development is dependent on those needs being met. Our ability to function and to interact with others hinges on it. In that sense, our childhood wall represents the foundation for our lives.

For many children in care, and children on the edge of the system, their “wall” would have been poorly built: many bricks will either be missing or broken.

For instance, in their early lives, affection and love may have been in short supply or missing altogether. Milk, food and nourishment may have been irregular or inconsistent. Overall, they are highly likely to have experienced abuse or neglect. In essence, their lives are built on shaky foundations.

Much of this comes down to the impact of early life traumatic experiences of abuse or neglect on brain development and function. From a parenting perspective, the future carers of such children – be they foster carers or adoptive parents – will thus have a unique healing or therapeutic role. At Adoption UK we see this as the therapeutic parenting of traumatised children.

Therapeutic parents will be dealing with their children’s poor relationships with siblings, friends, teachers and others. Their children are likely to be unable to trust or feel safe with them and others, which may manifest itself in the form of hyperarousal, hypervigilance, poor impulse control, aggressive reactions and so on.

Poor choices

Their children may underachieve educationally, and suffer from ADHD, poor executive functioning or learning disabilities. In the future, they make poor lifestyle choices, including drug and alcohol dependency, delinquent and criminal behaviour, and inappropriate or dangerous sexual behaviour. In turn, there is also the risk that the cycle of poor parenting to which these children have been exposed will be repeated if they become parents.

For professionals, the first aim must be to understand the effects of maltreatment on early brain development and to learn about interventions that are likely to be effective. Across health, education and social care, there needs to be a greater understanding of the impact of trauma on child development, both pre- and post-birth.

Children and families need a holistic approach that recognises how a child’s internal working model has been affected or disorganised by their early experiences. Above all, professionals need to help, support and train parents in their therapeutic role and view them as part of the solution, not part of the problem.

Therapeutic parents need to build a new parenting relationship that begins to replace or mend some of the “missing bricks”. Rather than focusing on changing the child’s behaviour, such carers will focus on understanding the message behind the behaviour – much of this will require parenting strategies that avoid retraumatising a child. That message is about the child’s lack of trust in their new parent’s ability to keep them safe and to stay with them in the long term.

This is why many traumatised children will try to recreate in their new families the chaos they experienced in their early ones. It allows them to use the survival strategies that served them well in their earlier families and with which they feel comfortable.

To return to the image of the wall, what therapeutic parents or carers will be doing is rebuilding a child’s foundations – the success of which will only be known when the child reaches full adulthood and if they too become parents.

Jonathan Pearce is the director of Adoption UK and will be a speaker at Community Care’s conference, Therapeutic Care of Children: Understanding Child Development and Attachment on 22 May.

This article appeared in the 10 April issue under the headline “Another brick in the wall”