What do Care Experienced Children Need From Me?
Today is Care Day, when the world marks the rights of children and young people with care experience. Sheetal Amin, a psychotherapist with a special interest in working with developmental trauma and ‘looked after’ children, explains why responding to their complex needs has to mean adapting the boundaries of the therapeutic frame.
Imagine being removed from your home. Imagine being hurt in unspeakable ways by the people who are supposed to protect you. Imagine not knowing the meaning of unconditional love.
Now imagine being placed in a home with strangers, calling them foster parents/carers, being unable to depend on them. Imagine you have a social worker who makes all your decisions, and they keep changing, and you are always being moved all over the country, from house to house, from room to room, family to family and school to school.
According to the latest Ofsted figures, over 78,000 of our children and young people in the UK are in care and experience these adverse conditions, contributing to complex developmental trauma. Unless we have lived experience, we cannot really imagine what it is like.
The Children Act 1989 states that children deserve the best experiences in life, from excellent parenting to a wide range of opportunities to develop their talents and skills. This includes stable placements, good health, and support during times of transition. These are all essential elements. But children will only achieve their potential through the commitment, genuine care, sincere hope, ambition, and high expectations of all those involved in their lives.
What contributions can I make to my work with children and young people who experience attachment disruptions, placement instability, whose lives are in flux or who have developed a whole range of different defences to survive the emotional pain?
Our psychotherapy training instils the need for a therapeutic frame providing consistency and continuity, including:
- Meeting in the same room wherever possible
- Meeting at the same time wherever possible
- The boundaries of privacy and confidentiality
- Clarity about the potential and limits of our role and responsibilities
When working with children with experience of care, these working alliance contracts are crucial for building trust, safety and offering an opportunity for security and predictability.
But children who have experienced ruptured attachments, abuse, neglect, adversity, or repeated experiences of displacement also need something more. They need me:
- To be able to show them over time that I will not abandon or betray them
- To show them through my actions that I am committed and will not give up on them
- To recognise that they may not want to come into the clinic or the consulting room
- To send them a text to check in, to meet with them in a park or community context
- To go to their home if necessary, when life just becomes too difficult for them to face
- To attend Looked After Children’s Reviews and be their voice, advocating for their needs
- To talk to their teacher, help the school understand so that they do not get excluded
- To present their view to the resource panels when a placement is being considered
- To support carers to empathise that the child does not want to move again
- To work with the professional systems and safeguarding network to help keep them safe
… In other words, they need me to be able to adapt the boundaries of the therapeutic frame to be responsive to their needs.
To truly nurture attachment, rebuild trust and the wounded self-image of a child or young person, we need to provide an experience of what has been absent from the beginning.
Our role as therapeutic practitioners is not just in the clinic room, mourning the losses, the gaps, and the holes. That is just not enough. We need to be able to work flexibly in complex situations and have the moral and emotional courage to truly walk alongside them.