No Man's Land: Making a Map Marie Agnes Bradley

331 Pages·2014·2.38 MB·English

by  Marie Bradley

No Man’s Land: Making a Map
The contribution of child psychotherapy to decision-making for Looked
After Children in transition

Marie Agnes Bradley
MSc; CQSW; MPsych Psych; MPsych Adult

A thesis submitted in partial fulfilment of the requirements of the
University of East London
for the degree of Professional Doctorate in Child Psychoanalytic
Psychotherapy

The work was conducted in conjunction with the Tavistock Clinic,
London and Parkside Clinic, London.

October 2013
Table of Contents

Abstract

Acknowledgements

Dedication

Chapter 1: Introduction 4
1.1 The Research question
1.2 No Man’s Land
Chapter 2: Literature Review 11

Chapter 3: Research Methodology Part 1 47
Contextualising the study
Chapter 4: Research Methodology Part 2 75
4.1 The sample
4.2 Data collection and analysis
Chapter 5: The case study of Danny 91
Chapter 6: Similarities and Differences 185
Chapter 7: Conclusions from the research 195

APPENDICES
Appendix A: Assessment report for Danny 206

Appendix B: The stories and assessment material from Sophie, Millie
and Oliver 213

Appendix C: (i) Ethics Committee Submission 265
(ii) Letter of Acceptance
(iii) UREC letter of confirmation 290

Appendix D: Letter to Social work team leaders 290

Appendix E: Research Information sheet 292
Appendix F: Consent forms 293

Appendix G: Strengths and Difficulties Questionnaire
for teachers 297

Appendix H: Semi-structured interview schedules for social workers
and foster carers 299

REFERENCES 306
Abstract
The research is a small-scale study of the potential benefits of Child Psychotherapy
assessment of Looked After Children in transition, for the child and for the
professional network caring for the child where the child psychotherapist-researcher
is part of the network working together to plan for the child’s long-term future. The
assessments aim to bring specific understanding of the child’s emotional state and
emotional needs, of his perception of what has happened in his life and of the ways in
which his development has been influenced by these external events and perceptions.
The assessments also explore the potential for the work to help the child make sense
of his history and of himself and the assessments aim to be a distinct and essential
part of the overarching assessment process which informs preparation of the children
and their prospective carers for permanent alternative placement.

Four latency-aged children in transition were assessed in an inner-city community-
based Child and Adolescent Mental Health Service by the clinician-researcher. using
Standard child psychotherapy techniques were used with some adaptations of
technique to address the children’s transitional status. The assessment framework
included in-depth interviews with social workers and foster carers and information
from schools. Process recordings of the assessment sessions are the primary data in
this enquiry and these are analysed using an adapted version of Grounded Theory
methodology.

The depth and complexity of the children’s experiences and their internal worlds is
strikingly revealed by the assessments, in new and compelling detail. All of the
assessments were highly significant in shaping short and long-term provision for the
children. The outcome of the study strongly supports the inclusion of child
psychotherapy assessment as part of an integrated, multi-disciplinary assessment
process for all children in transition. The method of assessment and of analysis of data
transfers well to a range of Looked After Children in transition in the study as well as
providing an effective basis from which to communicate clearly and effectively across
interdisciplinary boundaries: making possible a more truly representative, responsive
and integrated map for the future. Word count 68396
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Acknowledgements

I thank my supervisors Dr. Dora Lush, Professor Michael Rustin and Mrs. Jenny
Kenrick for their wisdom and constant support. I thank Dr. Grace Jennings for her
rigorous and thoughtful encouragement and friendship and I would like to thank
Gabrielle Crockatt Consultant Child Psychotherapist and my colleagues at Parkside
Clinic, the children, their foster carers and their social workers for helping me to
grow.
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Dedication
For my daughter and all my grandchildren and their parents
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Introduction

The research question:
In what ways can Child Psychotherapy assessment contribute to understanding the
long-term needs of Looked After Children when planning for their permanent
placement? How can this contribute to the work of the professional network around
the children and how do the children themselves respond to this intervention?

No Man’s Land:
Examining the lived experience and the state of mind of children in temporary foster
placements, Janet Philps’ (2009) observes and describes ‘borderline’ (Rey 1994)
features in their ways of perceiving and responding to the extreme uncertainty and
conflict inherent in their transitional care. Rey describes the essential feature of
borderline states of mind as the difficulty or even absence of communication between
different parts of the mind which represent emotional experience and which together
make meaningful sense of our lives and of who we are. In borderline states of mind
these parts ‘go on functioning separately and are incapable of integrating’ (ibid p3.)
In the context of transitional care, Philps observed that the children and to some
considerable extent their carers and social workers turned, largely unconsciously,
towards this borderline way of functioning. Keeping experiences apart which, if
connected, might overwhelm the individual with anxiety and despair, offers a
formidable defence against emotional integration; it is a profound response to the
terror of such extreme uncertainty. There is an understandable longing for life to
continue in the most ordinary way possible, as if it was ordinary. There is a hope that
children will resume growing and developing when they are relieved of the immediate
impact of the unsustainable family situations from which they come. To this end
something of an agreement may be reached, to live ‘as if’ (Deutsch 1965) the life the
children are living is a reliable and integrated experience. The capacity to make use of
the relative steadiness and containment of temporary care is necessary and helpful but
the splitting often sought between external and internal experience, to survive the
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inherent emotional trauma may mean that real development is often suspended
beneath a semblance of ‘moving on’.

Making a map:
The way forward is sought through the concerted efforts of the professional network
around the children. A deeper and more complex understanding of what constitutes a
child’s potential and the factors which tend to enable and limit it has grown over the
past seventy years. There have been significant developments in our understanding of
human development and human needs, from theory, from developments in practice
and from developments in social policy which have supported changes in addressing
human needs (Johnson and de Souza 2012).

Networks:
Each part of the network around the child will explore his needs from a particular
professional perspective. Each part of the network is working towards finding the
right home and the right parent(s), where the child can grow up, continue his
development and realize his potential in every sense - physically, socially,
intellectually and emotionally - to the fullest extent (HMSO 2003). Longstanding
difficulties continue to be observed in communication and integration between
component parts of the professional networks around children and between these and
the networks around their parents (Rustin 2005; Laming 2009); working together
effectively to reduce these difficulties continues to be a struggle (DoE April 2012;
DoE December 2012); highly significant factors contribute to this struggle, including
the under-resourcing of social work services leading to high ‘burn-out’ and turnover
rates in staffing and the lack of satisfactory support and supervision of this highly
demanding work. There are other less easily observed factors which militate
powerfully against integration in the professional network. Organisational defences
(Emanuel 2006) against the emotional pain of working with traumatized and highly
distressed children and families elicit powerful and often largely unconscious
defences against the emotional experience of being in touch with such experiences, of
which splitting and denial are central (Cooper and Webb 1999; Menzies Lyth 1988)
and which potentially damage and limit the work which is possible.
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Psychoanalytically-trained child psychotherapists are equipped to explore and address
the powerful unconscious determinants of human behaviour and the thoughts and
feelings behind it. In the professional network the child psychotherapist is usually
primarily a practitioner working individually with the child but she is also a core
member of the team around the child in the assessment process. The decision-making
process for Looked After Children in transition charges us as human beings and
professionals with the emotional impact of facing and understanding the most painful
of experiences; it is difficult work to remain genuinely in touch with these, open to
what is communicated while maintaining the capacity to function in such work
without resorting to defences which protect from the experiences and separate
workers from the children and from each other. Child psychotherapists learn from
theory, practice and experience to bear ‘unbearable experience’ (Reisenberg-Malcolm
1999) in a realistic way; this is what the child psychotherapist can bring to the
professional network of which she is a part (Emanuel 2006).

‘Making a map’ signifies the process of bringing together past and present
knowledge and understanding of a child in transition from multiple perspectives so
that his future can be approached realistically with some hope, some confidence and
more understanding of what it will take to make a good future possible. This thesis
explores how child psychotherapy can work together as part of the multi-disciplinary
team which puts together a meaningful account of the child and his needs.

The contribution of Child Psychotherapy to decision-making for Looked
After Children in transition:
Children growing up in adversity often find it difficult to put into words what they
think and feel. Their experiences of growing up always include very significant
experiences of trauma and loss. These experiences frequently impact powerfully on
children’s capacity to use their minds to explore what happens to them and the
development of a mind which feels confident and safe enough to engage with and
enjoy the world beyond their immediate circumstances may be very much restricted.
Living with the unpredictability and deep anxiety of direct or indirect abusive care by
the adults on whom they depend takes a heavy toll on children and they will try to
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