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Adoption-Telling the Child about Rape, Incest and Other Birth Circumstances
Adoption: Telling the Child about Rape, Incest and Other Birth Circumstances - 10 CEUs

Section 21
Teenage Adoption Case Study: Doubly Deprived

CEU Question 21 | CEU Test | Table of Contents | Adoption
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

Psychoanalytic approaches
Psychoanalytic work with adopted children conceptualizes and describes the meaning of late adopted children’s experiences. Individual clinical case studies discuss examples of children in difficulty in their placements and their own development, as experienced in psychoanalytic psychotherapy. The classic account of working with children in the care system and adoption is Boston and Szur’s (1983) study of Psychotherapy with Severely Deprived Children, and this forms the underpinning for current psychotherapeutic engagement with this kind of work. The relational difficulties of these children are conceptualized by Henry/Williams’ discussion of being ‘doubly deprived’. A primary loss through separation, experienced as extremely and unbearably painful, is then defended against in a way which inhibits or prohibits new relationships with substitute carers. The deprivation of loss of birth parents is then cruelly added to by the development of defenses which prevent the child having a satisfying relationship with subsequent carers, and this often takes the form of distancing or violent relationships with the substitute carer. Williams’s patient violently attacked vulnerability in himself as well as concern and attention from others. The application of the concept of ‘double deprivation’ continues to be extremely practical in work with looked after children, in residential as well as foster and adoptive care (e.g. Briggs, 2004) and forms a theoretical counterpoint to the contemporary emphasis on ‘resilience’.

Contemporary accounts of psychoanalytic work with late adopted children make some key points about the experience of this work. Firstly, there is an emphasis on the quality of the child’s internal objects which relate to the child’s primary experience of loss of a parent, which is experienced as being dropped from the mind (Edwards, 2000; Hindle, 2000). These children then are unable to protect themselves or use their objects in ways which will enable them to feel and be protected. Hindle gives a vivid account of a 10 year old, who constantly operated on the boundaries of sessions and raised anxieties in the therapist about the risks that may ensue from this behavior. Secondly, these accounts provide a vivid account of the attacks on the content and the boundaries of the therapeutic process, which leads to terrific pressure being placed on the therapist. Hindle discusses her repeated dilemma about whether to follow the child who has left the therapy room and puts himself at risk of hurting or damaging himself. Hopkins (2000) described the extreme behavior from her patient, who also threatened to self-harm, and involved the therapist in a battle for control:

he soon discovered he could always have the upper hand. When he leapt on the forbidden window ledge and started to kick the glass he knew I would rush to stop him so he could leap past me and bolt out of the door. Discovering he could go when he chose helped him feel safe enough to stay for longer. (Hopkins, 2000, p. 339)

The intense experiences in the transference and counter-transference of course provide a vivid description of these children’s internal worlds. They show that the therapy is often on the brink of a precipice and threatened with separation, through abrupt breaking off of contact.

Thirdly, and usually in a balanced way, these case studies provide accounts of the effectiveness of these treatments. Hopkins says that her case is ‘probably typical of how much and how little can be achieved in two years and a term of twice weekly work with such a disturbed child’ (2000, p. 338). If therapy can be maintained there can be some working through of the intense barriers to relatedness, the double deprivation, and these can have an impact on the relationship between the child and her/his carers. Hopkins shows the development in her treatment of her patient Max towards the capacity for affection expressed rather than violently defended against. Indeed she gives a touching picture of Max relating to her in a rather infantile way, playing ‘ring a roses’ and ‘round and round the garden’. Hopkins traces the parallel development of a better relationship in the adoptive home. ‘He began to refer to his relationship with them as ‘‘we’’ and ‘‘us’’ at about the same time as he achieved togetherness with me in play’ (p. 344). This was quite a shift since Max’s attacks on his adopters went for the origins:

He told me several times he did not want to be adopted and that he hated his new mother when she came ‘to choose’ him.

This goes right to the dynamics of matching and the child’s feelings, but to the point that it becomes possible to ask why did Max so hate the mother who chose him? It is also pertinent that the success of this case, relative to some others who do not accept therapy, might relate to the fact that Max was able to tell his therapist directly about these feelings. Often they are never verbalized, or communicated directly to the therapist. It provides a place to focus and a measure for change. Hatred of the mother who chose him is linked here with denial about the pain about the mother who rejected him.

Psychoanalytic work thus gives evidence for the meaning of some of the extreme difficulties experienced by late adoptive children and also some of the ways in which these difficulties can be ameliorated by resourceful and patient work with children who will engage in therapy.

The contribution of attachment theory
The contribution of attachment theory to adoption and fostering is of course a central one. Bowlby and the Robertsons (e.g. Robertson & Robertson, 1969) provided enduring evidence of the need to attend to the process of separation for young children and the vital role of continuity of care, familiarity of carer and individuality of approach in order to lessen the painful impact of separation and reduce the long-term consequences. These studies link with psychoanalytic thinking, and we can see, for example, the origins of ‘double deprivation’ in the experiences of the filmed children in the Robertson’s films. Following these classic studies, attachment theory was applied to understanding the need to prepare children who have suffered a placement disruption, for future placement (Fahlberg, 1991). Howe (1996) has shown how the experiences of adoptive parents were largely predicted by the attachment patterns of the children. Securely attached and anxious to please children were felt to be rewarding, whilst angry children were ‘wearing’ (p. 112) and uninvolved and wary children tended to experience extremely disturbed and disruptive relationships with their parents during adolescence. Some lost contact with each other: others gradually re-established contact during adulthood. It follows that it can be reasonably hypothesized which adoptive parents will need greater support, depending on their child’s attachment patterns.

The recent trend in attachment theory towards concentrating on internal working models, bringing this theory closer to psychoanalytic object relations theory, suggests that relationships are patterned according to internal representations of relationships. Thus avoidant and anxious/ambivalent representations of the insecure categories of attachment are carried forward into new relationships. If these are rigidly adhered to the new carer will be subjected to a negative experience of aggression or avoidance. Security of placement is threatened by the child’s negative internal working models and the effects of these on carers can range from creating an unpleasant, difficult atmosphere in the home to creating a sense that the relationship with the child is increasingly unviable. The impact of the child, in other words, is the main threat to placement security and thus to permanency. Internal insecurity and placement insecurity are closely linked. Therapeutic work may, in some cases, reduce the effects of ‘negative working models’ but this is poorly evidenced in terms of evidence-based practice. On-going support for adoptive parents may also be effective in reducing the impact of the child’s attachment characteristics, though again the exact ways in which this can be offered have not been evidenced. It can be inferred from the firm, clear classifications of different attachment behaviors and the operation of the different attachment patterns, through internal working models, that, in general terms, the effects of the child’s behavior in placement can be predicted.

Attachment theory has been less applied to thinking about the contribution of carers than to the relationship problems in placements where difficulties threaten disruption. With infants, there have been studies which show that the carer’s attachment pattern is a strong indicator of the behavior of the child (Stovall & Dozier, 2000). These studies show that if the parents are secure (free) in attachment the infants they care for will be more likely to be secure also. These approaches have not been used systematically with older children and there is an inherent danger, as with attachment theory in general of reducing the data to the broad standard categories of secure and the two or three (depending on the system used) categories of insecure attachment.7 However, there would also seem to be some possibilities here of exploring and analyzing which carers might be better disposed to caring for which children, who have different attachment patterns. It may be, therefore, that application of attachment theory, especially as recent developments within attachment theory accords greater concordance with psychoanalytic object relations theory, provides opportunities for matching carer and child, and purposively identifying the quality of interactions between carer and child which hold threats to the placement and providing a range of potential interventions to ameliorate these.
- Briggs, Stephen & Liz Webb; Matching and mismatching in teenage adoptions: implications of the adoption act for practice; Journal of Social Work Practice; Jul 2004; Vol. 18; Issue 2.

Personal Reflection Exercise #7
The preceding section contained information about psychoanalytic approaches and the attachment theory in teenage adoptions.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 21
What recent trend in attachment theory brings it closer to the psychoanalytic object relations theory, which suggests that relationships are patterned according to internal representations of relationships? Record the letter of the correct answer the CEU Test.

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