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

Adolescence and adopted children
It is an inescapable observation that most of the therapeutically oriented thinking about adopted children from both attachment and psychoanalytic perspectives focuses much more on latency aged children rather than adolescents. The relatively good outcomes for treatment in child psychotherapy were obtained, on the whole, with children up to 10/11. Attachment theory has paid relatively little attention to how the developmental changes of adolescence impact on attachment patterns, and vice versa (Scott Brown & Wright, 2001). Young adolescents are more difficult to engage and maintain in treatment (Baruch, 2001), more prone to psychosocial disorders (Rutter & Smith, 1995) and have poor outcomes in psychotherapy (Target, 2002). Often the most in need are the ones who do not engage. From a psychoanalytic perspective, early adolescence is a time of risk, turbulence and anguish: a time of awkwardness, of disproportions, of frightening sexual maturation, of pimples, and of new and untried feelings. Nothing is set. Nothing is solid. Everything is in flux and change. The aim with early adolescence is to get past it and then not to look back.

The often frightening and uncertain experiences of psychic and physical disequilibrium in early adolescence are vividly described by a troubled 13 year old, who projected his anxieties into his two friends:

He said that though he was growing it was not a problem for him, but he did have two friends who had problems, because for one of them his bones were growing faster than his muscles and ligaments, and with the other friend it was the other way round; his muscles were growing faster than his bones. One of them was very stiff and the other was very floppy.

Time for this young person was thus very literally ‘out of joint’. The turbulence of this kind of disequilibrium interacts with the loss of certainty in the multiple theatres of adolescent development: becoming more separate from parental figures, relating to the adult sexual body, and the impact of this on family and peer relationships and gendered subjectivity, the development of love and sexual relationships, and cognitive changes are key areas of physical, emotional and psychological transition.

The rise in persecutory anxiety and projective processes in early adolescence (Waddell, 1998) means that it is often the case that anxiety about an adolescent is experienced by others in their system — parents, teachers and other professionals. Thus, prior to working therapeutically with the young person directly, it is important to ascertain who is carrying which anxieties on behalf of whom (Briggs, 2002). This would tend towards a more family/systemic approach to the structure of therapy, in which the family members and professional network are engaged. Secondly, the approach to therapeutic work with young adolescents is somewhat different in method and aim than with younger children, in that a considerable focus is on containing and making sense of the anxieties which are generated by the contradictory pressures of the development towards greater separateness from parental figures, on the one hand, and the need for connectedness with others, which flows from the need for a sense of belonging. Elsewhere, one of us (Briggs, 2002) has discussed the shift in thinking about identity formation, in which more emphasis is now placed on the centrality of relatedness to others. The tendency to project in early adolescence requires another (an ‘object’) to receive and experience the emotions which are felt to be unbearable or alien, and hence ‘spilt off’ into others.

This does not imply that young adolescents should not be seen in individual therapy, but, rather, in setting up post adoptive services, there is a need to take into account the network and the family members as part of the process — as holding some of the adolescents’ emotionality. Taking into account these factors also implies that engagement and relationship with the adolescent in therapy will be of a rather different kind.

Matching and mismatching
Writing about foster care Sinclair and Wilson (2003) highlight the importance of matching child and caretaker. In the model they develop from their research findings they emphasize that, firstly, difficult behavior in the child is a major factor in placement instability and that training foster carers to handle and manage difficult behavior is crucial. Second they emphasize the importance of the child’s motivation and thus having a ‘choice’ of placement and, thirdly, they promote the idea of accurate selection, appropriate training and support for foster carers. Their interactive model depends on a key variable — matching. This is seen as involving ‘chemistry’ and ‘interaction’, suggesting that some foster carers and children ‘take’ to each other, while others do not, with calamitous consequences. This seems very true, but if services are to be effective, some understanding of these processes is necessary. Both attachment theory and psychoanalytic object relations theory have the capacity to look behind ‘chemistry’ and ‘interaction’ and provide some data on the way that specific carer and child relationships cohere, or become conflictual.

It is important that a range of interventions may apply psychoanalytic and attachment understanding. In addition to psychotherapy and therapeutic interventions psycho-educational approaches to enable adoptive carers to increase understanding and empathy for the adoptive child can be based on these assessments. Howe et al. (2001) point out that greater understanding of the meaning of underlying attachment patterns can enhance carers’ capacities and sensitivity to the meaning of the child’s behavior. Hopkins (2000) points out that her understanding of the reasons for the child’s difficult behavior enabled her to maintain a sympathetic stance in the face of great provocation. However, we emphasize that a sympathetic stance is not easily achieved, nor can this understanding prevent at times the breakdown of relationships in substitute care. The effect of underlying models and patterns of relatedness can make these difficulties extensive and even intractable. At the very least, processes of internal change are slow and progress is hard won. The understanding of the effects of underlying patterns of relatedness and the paradoxical illuminating and delimiting effects of these in adoptive families with young adolescents can be illustrated by reference to the patterns of relationships in Helen’s adoptive family.

Conclusions
In this paper we have focused on the strengths and limitations of therapeutic work with adolescents and provided some thinking about how these approaches may be used within the context of the comprehensive post adoption services for teenagers. In reviewing the legislation and policy context, and the literature relating to therapeutic work with looked after and adopted adolescents, we suggest that there is a potentially productive way of harnessing attachment and psychoanalytic thinking to develop these services. We emphasize that when working with these adolescents the projective processes so dominant in early adolescence must be taken into account in order to provide a reflective space for thinking about the meaning of the young person’s behavior and the relationships in the placement. We suggest that psychoanalytic and attachment thinking can provide a focus for therapeutic work and also understanding of the meaning of difficulties in the carer/parent–adolescent relationship which threaten the stability of the placement. In our view, these
approaches offer a potentially great capacity for understanding and engaging with adolescents and their carers when placements are in difficulty, but we are also cautious — or respectful — of the difficulties in bringing about change in these situations. We need to know more about how relationships in placement can be understood from this perspective and the different kinds of matching and mismatching patterns that can be thus identified. We need to know more about how interventions can be formulated based on this understanding and their effects on placement relationships.
- 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.

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Personal Reflection Exercise #8
The preceding section contained information about matching and mismatching in teenage adoption.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 22
According to Howe et al., a greater understanding of what can enhance carers’ capacities and sensitivity to the meaning of the child’s behavior? Record the letter of the correct answer the CEU Test.