Only Connect
A sexually abused girls’ rediscovery of memory and meaning as she works towards the transition from a therapeutic community to a foster family.
Diana Cant
Some of you will recognise the first two words of my title today from the frontispiece of E.M. Forsters’ novel ‘Howards’ End’. Only connect is the over-arching theme of the work, which describes the fraught, and fatal coming together of two families, and two different ways of living life and being in the world. The rather bohemian, free thinking Schaegel sisters emotionally collide with the respectable and repressed Wilcox family in a way that exposes both hypocrisy and naivety and sacrifices two child-like and helpless victims in the process. It can also be read as a struggle to bring together the internal and external worlds of these characters – the prose and the passion of the full quotation – so that something worthwhile may emerge from the chaos, and a sense of hopefulness may prevail.
It is this business of ‘connecting’ that I would like to focus on today. Increasingly, in our work as child psychotherapists, we are called upon to extend our skills and ourselves in to areas that are less familiar to a more ‘classical’ and pure training tradition. We are asked to offer psychotherapy in situations of uncertainty and instability, we are asked to work in situations where boundaries are unclear and shifting, or we are asked to offer containment in situations where confidentiality resists a more formal and reassuringly ‘tidy’ definition. We need to find a way of offering a vibrant and thoughtful service under these conditions – a service that reaches out to the children and young people in need, but that also connects with the reality of their lives. In order to do this, we often need to be active in their external lives in a way previously unfamiliar to us. We need to be prepared to engage – to connect – in the service of the child, and to struggle to bring together the prose and the passion that is part of the way their life is constructed.
Perhaps the complexities of this are most marked when working with ‘looked-after’ children. The nomenclature itself – looked-after child – seems to speak of the unwieldy and cumbersome nature of the experience, where ‘looking-after’ has replaced ‘care’ in an attempt to de-stigmatise and sanitise what is often an almost unbearable emotional experience. ‘Looked-after’ children are often severely traumatised, having suffered deprivation, neglect, physical and/or sexual abuse. They have lived early lives characterised by many moves, changes, and losses. Their experience is often fragmented and chaotic, with no-one consistently present in their lives to make and sustain the connections that might give shape and meaning to a bewildering and terrifying jumble of sensation.
Some of these children, often the most damaged, find their way into therapeutic communities – full time residential units where the children are not only looked-after, but are offered a psycho-therapeutically informed treatment programme (which may or may not include individual psychotherapy) over a considerable period of time. Here, a team of professionals from various disciplines come together around the child. Residential workers, teachers, therapists and consultants need to be able to join-up around a child, and to offer a connected and thoughtful experience that can begin to repair some of the internal and external fragmentation. The treatment goal, of course, is not only healing internal damage, but also enabling the child to move-on in a very concrete way – hopefully culminating in a move to long-term foster-care.
For the psychotherapist, this is a daunting task, and one that forms the subject of this paper. What I would like to do today is to share some of my work with one such child, Chloe, over the four-year period during which she managed the successful transition from therapeutic community to foster-placement. The theme of ‘connecting’ is a theme that resonates in several places simultaneously. First, there is the actual work of connecting therapeutically with Chloe – with her past experiences, her memories and with the gradual evolution of meaning, so long resisted. Chloe’s memories, when she felt safe enough to allow them into consciousness, were of a particularly terrifying kind, and involved a great deal of painful re-evaluation of the quality of her parenting – how could her parents have allowed such terrible things to happen to her? As she gradually became able to use her therapy, and her mind, so her internal fragmentation decreased, and she came increasingly into contact with reality.
Secondly, there is the ‘connecting’ to be done within the therapeutic community itself, so that the insights gained in Chloe’s therapy could be shared in a judicious but helpful way with the rest of the residential and teaching staff. This is very much ‘the work of the day’ of the therapeutic community, and what sets it apart from other residential provision. A shared understanding of the concept of confidentiality is absolutely crucial here, and is, I suspect, somewhat at odds with the more traditional idea of the primacy of the individual psychotherapy session. In order for the whole community to work together effectively, confidentiality needs to be held by the whole staff team, on behalf of the child. This needs careful handling, and posits a considerable degree of trust within the team that boundaries will be held in a clear and consistent way.
Thirdly, the word of connecting has to increasingly encompass the external network. As Chloe moved from the community to a foster placement, this meant increased contact with her social worker, her foster carers, and her fostering officer. Chloe’s therapy continued throughout her transition, and for a year into her foster placement. Initially this took place within the therapeutic community, but later moved to a venue outside. Chloe’s ambivalence about all these changes, and her struggle to incorporate them into her internal and external world were sometimes very testing, and on occasions dramatic and life-threatening. In effect, her therapy acted as a bridge – even as a transitional object – between one stage of her life and another. It became the one reliable and consistent feature at a time when so much else was changing and re-configuring itself. I suspect that it was not enough for Chloe to know that her therapy would continue. She also needed to know, in a very concrete way, that I was actively involved with the professional network – that I had met and approved of her new foster parents, that I had seen where she would move to, and that I was, in an active way playing a part in handing her care on to others who might come to understand something of her past and it’s terrors.
A brief work or two about the therapeutic community (for those of you interested, I have written about it in more detail in a paper in the Journal about 18 months ago, and Monica Lanyado has described it, from a rather different perspective, in her recent paper to the Tavistock Society of Psychotherapists). It is a small residential unit that can take up to ten children between the ages of five and ten on admission. The children are referred from all over the country, and live in the community all year round. They usually stay between two and four years, and move on to carefully sought and supported foster placements. All staff are very committed to a psychodynamic, psychoanalytic way of working, and there is an “in-house” training for all residential workers. The community also has it’s own school, which provides primary age special education. Almost all the children attend this school initially, but may then go on to gradually re-integrate into local mainstream schools, or to other special education facilities when they reach secondary school age. The school also has a strong psychodynamic base, and there is a great deal of shared communication and understanding passed between school and the community. The philosophy of the community draws particularly on the work of Winnicott & Dockar-Drysdale. It aims to create a secure environment which can hold, contain and nurture very damaged children. Primarily, this is achieved through consistency, reliability, and the embedded understanding that the children will be unconsciously driven to recreate their traumatic experiences in ways that may feel very attacking, but which can be understood, disentangled, and survived.
All children have a full psychotherapy assessment after they have substantially settled. Most (but not necessarily all) are seen in once or twice weekly psychotherapy for between two and four years. In the spirit of joining-up services around the child, my role as psychotherapist is diverse, and potentially complicated and complicating. Not only do I see children individually but I also offer regular clinical supervision to the residential staff, consult to the teachers, and teach on the training course. When things are working well, this means that therapy, and insights gained from therapy, are integrated with the fabric of the work. It also means that my knowledge of the child extends well beyond the boundary of the therapy room. This is something that I find very helpful, and something that, very often, the child can find quite reassuring and containing. When things are not working well – well, then we struggle!
Chloe
The girl I want to talk to you about today, Chloe, was 9 years old when she first came to the community, and ten when she started therapy. She and her sister came from a background of particularly sadistic physical and sexual abuse, which slowly became more apparent as the work progressed.
Prior to Chloe’s birth there had been concerns about the family from neighbours and the beat policeman, centering mainly around her mother’s vulnerability, the state of the flat, and the number of large dogs. Chloe and her mother stayed in hospital for 3 weeks after her birth, largely because of her mother’s unpredictability, her father’s disturbed and confrontational behaviour, and Chloe’s poor feeding. Chloe was then abandoned in the hospital and placed in foster-care for four months. She and her mother then moved to a mother and baby home for 2 months, where her mother again abandoned her. At 14 months, she was rehabilitated back to her parents, and her young sister was born. Her mother continued to come and go from the family until she finally left when Chloe was 3 years old. It subsequently came to light that there was substantial domestic violence within the household, with both mother and Chloe beaten and terrified by father. Father continued to look after the children, often with an extremely angry and acrimonious attitude to Social Services. He was seen as belligerent, frightening and intimidating. Neighbours and teachers became increasingly concerned about the children’s behaviour. They were seen to be often hungry, and scavenging food from rubbish bins. They were left unattended, not picked-up from school, and often inadequately clothed. Teachers reported instances of sexualised behaviour. They were not finally taken into care until Chloe was 8 years old. Chloe quickly began to make allegations of sexual abuse against her father, allegations that seemed to involve her sister, a paedophile ring, the making of pornographic videos, and the systematic use of terror. The foster-family with whom she was placed found her disturbed and highly sexualised behaviour too challenging. A Consultant Child Psychiatrist’s report at this time found a very disturbed and disturbing child, who dissociated much of the time, and who was then unreachable. The report recommended intensive therapeutic input to prevent an increasing state of disintegration. Chloe therefore moved to the therapeutic community with which I am associated, and I saw her for an assessment after she had been living there for a year.
The Assessment
Prior to meeting Chloe, I met not only with her social worker, but also with a number of the residential workers caring for her day-to-day. I accumulated quite a vivid picture of her which accentuated her ‘vagueness’, her sometime desire to please, her unpredictable and destructive behaviour, and a sort of benign exasperation on the part of the staff about how difficult it was to make an ordinary connection with her. She was described as often seeing to be ‘on another planet’. Frequently staff reported her ‘whole being’ seemed slowed down, and she seemed quite handicapped. She put everything into her mouth, including such things as berries, mud and perfume. She cut up her clothes, took other children’s toys and broke them, and would wear their underwear. One image in particular stuck in my mind. Apparently, on most evenings, Chloe would pile all her belongings in a heap on her bedroom floor, in a random and chaotic way. This pile would often be topped by some rather odd macabre construction, for example, a bent wire coat-hanger with a doll’s head on top. The staff would put everything back, only to be faced with a similar pile the following evening.
Meeting Chloe was instructive. I had expected, from the descriptions of her to encounter a degree of fragmentation that might make symbolic thought and communication hard to establish, but this was emphatically not the case.
On the first session, Chloe walked immediately in through the door, and attempted to walk into several other rooms without waiting to hear where we were going to meet, asking questions all the while. Her stream of questions were asked in an anxiety-driven way, without pausing to hear the answers – for example “Do other children come in here?” ” Is this your bedroom?” “Can we go in the garden?” She quickly moved on to explore all the toys in the room, moving from object to object, and discarding each thing once it had been examined for it’s possibilities. She appeared pleased to discover most things, but did not play with them; rather they joined each other on the floor (as in her bedroom), and were inadvertently trampled on during the course of the session. The only item that seemed to hold her attention for any length of time was a pair of handcuffs. She placed them on me initially, very pleased with the thought that I might be immobilised. She then placed them on herself, and laughingly began a series of physical contortions, ending up being trapped on the floor underneath my chair. She needed very concrete ‘rescuing’ from this position, and the play had a manic, terrorised feel to it. Throughout the whole session, she showed a marked disinclination to answer any of my direct questions about her family or her history, talking over me, but largely unconscious of what she was doing. She came across as very fragmented, with no clear sense of a boundary between herself and others, and as a child whose capacity to link or think had been profoundly damaged.
However, the second session had a rather different feel. She had brought a friendship bracelet, which she called a ‘rope’. She offered me one of her two remaining sweets from her pocket and said she liked therapy. There was a greater sense of relatedness between the two of us, although placating. She was again attracted to the handcuffs, locking them on her wrists, and putting herself ‘in jail’ behind the curtains. Then I had to be the prisoner, while she brought me a series of meals, beautifully arranged on a tray. A story emerged whereby she was a policeman with twin babies which she could not manage, so she gave them to the prisoner (me). She said she did love them a little, but she did not want them any more, so I should look after them “for ever and ever.” She was able to agree that perhaps she herself needed some therapy-looking-after. She then briefly examined the dolls, taking particular exception to the father doll, pulling his legs apart and flinging him on the floor. She was reluctant to end, but gathered her belongings together in quite a focussed way. Thus, although there had been much in her relating that had been superficial, she had been more aware of me as a whole object and separate from herself. She was considerably less manic, seductive or fragmented.
She began the third assessment session by telling me about a cat who was “quite a character”. She was at pains to explain this phrase to me – she did not mean, she said, a character out of a film or a cartoon, but rather that it did funny things. I was struck by how clearly she explained a difficult, rather abstract concept. She was again drawn to the handcuffs, but only briefly. Instead, she spent quite some time leaning out of the open window in the sun, in a rather dreamy state. This had a calmness to it that seemed to enable some reflection. She moved to playing with the skipping rope, saying she was going to tie herself up with it, and then saying that she missed her daddy. When I asked her why she thought she had remembered him just then, she could not say. Instead, she told me she missed her sister, and hoped that I might somehow arrange for them to meet.
I have talked about this assessment in some detail because, as is so often the case, the material contained therein prefigured so much of what was to come later. Chloe initially brought her fragmented and abused self, trapped in a terrifying internal word. She demonstrated the degree to which she could be plunged into internal terror, when she was then extremely persecuted, out of thoughtful emotional contact, and linked to an abused and fear-induced sexuality. But she was also able to vividly present her abandoned baby self – abandoned more in sorrow than in anger.
There were signs that she could allow herself to experience some emotional containment, and when that happened she was more able to think and link than was at first apparent. Indeed, in the final session, there were indications that she might be able to reflect, and use me/the therapy as a way of making some connections in her life (for example, by somehow bringing her and her sister together).
Because of funding negotiations, I was only able to see Chloe once a week for the first term. This proved frustrating for both of us, and Chloe spent almost all the time playing versions of hide-and-seek, in which she needed to be found again and again. Of course, she was right, and the weekly gap did mean she felt lost, time after time. When funding was finally agreed for the second session, the therapeutic work took a quantum leap forward. It was as if there was a part of Chloe that had been waiting for just this experience. She began with a sequence of ‘cops and robbers’ play, in which we both had to be very brave in the face of considerable violence. We rarely got a good night’s sleep, so besieged were we by intruders. When I, with some hesitation, offered an interpretation that rather concretely linked the play with her past, she readily agreed that she had had to find a way to fight all the bad things at night – “it was hard for me”, she said, “I couldn’t tell my dad to stop ‘cos it made him more angry”. She said she was going to keep on playing the game “cos I need to have it in my mind”. She returned to the game of the assessment session, in which a mother left her 2 children at the police station, and a police dog got stolen. She became very thoughtful, and sat dreamily on the couch. I wondered if this play had put so many questions in her head about her and her life. She said she remembered her old dog Flame, and that a woman had come and taken her away. Why? Where did she go? I said that perhaps she was wondering why nobody came and took her away when all the bad things were happening – “nobody rescued me”, she said flatly. As she left, she said that she couldn’t stop thinking about her mum – “all this thinking is giving me a headache”.
She became very preoccupied by thoughts of her mother – why didn’t she rescue her, why didn’t she stand up to her father? These questions were in her mind much of her waking life – as she said at the end of one session “therapy makes you think of things”. She decided to write a letter to her mother, care of her social worker, to ask her when she was coming to see her, and did this with the help of one of the therapeutic care staff. When there was no response to this letter, Chloe became very angry, and impatient with the idea of her mother’s vulnerability and limitations – “talking about things in therapy is difficult, but I do it, and I’m a child”.
I am aware that my condensation of the material endows it with a coherence it did not always feel to possess. Many of our sessions were spent in a much more dismantled way, with Chloe out of emotional contact, manically rolling on the floor, or covering herself and the therapy room in sticky glue and assorted debris. Toys got broken, a hapless fly was tortured, and I was often left feeling mindless and confused. The separation of holiday breaks meant Chloe returned in a lost, ‘other planet’ dissociated state, and it took considerable time and work to re-establish our connection. But time and time again I was impressed by the courage and determination with which she pursued the past, and the truth about her past. She was pretty unflinching, and this surprised me. In my experience, it is unusual to be able to make the sorts of direct interpretations I was able to make so early on in the work. But it is, I think, one of the consequences of working within a therapeutic community, where the work can be very much held by the whole team. There were times when, after a particularly difficult session, Chloe would ask me to let the staff know things had been hard. There were times when I felt the need to let the staff know. There were also times when Chloe would leave the session, but attempt to continue it with other staff, and with other children present. I needed to be in close communication with the rest of the staff team in deciding when this was appropriate, and when it was not. There was a period of time when staff had to be very active in discouraging Chloe from ‘spilling-over’ in this way, clearly saying that she was not in therapy now, and should focus on other things. There was a period when, after an afternoon session, Chloe was extremely disruptive all evening, week after week. Again I was in close discussion with the staff about the best way to handle this – which aspects needed picking-up and working within the community, and which should be brought back to therapy. There can be no hard and fast rule about these matters – it will depend both on the child, on the strength and capability of the staff team working at the time, and on the containment (or otherwise) offered by the children’s group.
Meanwhile, the focus of Chloe’s work in therapy was shifting. She began a piece of play, continued over months, in which she and I were two children, out camping on a Scout trip. The Scoutmaster was in a tent nearby. As night fell, and midnight approached, the children heard all sorts of noises outside, especially the terrifying howl of a werewolf. They would alternatively venture out bravely with torches and knives, or cower fearfully in their tent. Sometimes the Scoutmaster would save them, but sometimes he would turn ‘mad’, and merge with the werewolf, prowling and waiting in the dark. In the counter-transference, this game often felt utterly terrifying, and could induce in me a state of breath-holding paralysis. In one memorable session, the ‘mad’ Scoutmaster would not allow the children to go home to their parents ‘ever again’. Chloe and I, as the children, had crept out of the camp and into a nearby town to hire a new Scoutmaster who would take better care of his charges. We ‘found’ one on the street, who agreed to take on the job. There then followed a ‘conversation’ between the mad and sane Scout masters. In the middle of this, Chloe suddenly stopped, and looked very blank. She appeared not to hear me when I asked if she was alright. She then asked me if I could hear it? Could I hear the noise inside her head? Several times she began to say something, but could not. I could almost watch her fall out of contact with me, in a panic-induced attempt to take refuge inside herself. I wondered out loud if this was something that had happened before, and whether this was how Chloe had managed the thought of a mad and angry dad. Although she did not directly respond, she was able to recover a sense of connection sufficiently to ‘come to’, and complete the play – interestingly by the two Scoutmasters becoming friends.
In the following session, she said she didn’t want me to forget about the Scoutmasters game, but she didn’t want to play it that day. Instead, she kneaded a piece of clay, and whispered that she hoped her dad would die soon – “do daddies die when they’re 60?” She said that she knew she shouldn’t say it, but sometimes she felt like murdering her dad. She wouldn’t really do it she assured me, but she just wished he was dead. She used to forgive him, but she was getting older now, and couldn’t forgive him any more.
Shortly after this, Chloe made a disclosure to her key-worker about the nature of the abuse. She said she had been made to watch horror films, and had been abused by her father and his friends, some of whom had worn werewolf masks. She wrote a letter to another child, saying she wanted to have sex with him, and when confronted with this, she said “you push a willy in your vagina, and it feels like it’s coming out your mouth and your ears”.
In a very powerful session, she talked about how her dad was in her head now, and she wanted him out. As she spoke, she chopped with scissors at a large lump of clay. This was her dad, she said, and she was cutting him up. These were his arms, his legs, his eyeball, – these were all his bits, and they were in hell. Her father had spoilt her family, and they were all too frightened of him. She tried to cut her dress, and her mouth, and then wanted to go to the toilet – “it’s so painful it makes me hurt inside”. She then wanted to “cook” the clay pieces, and eat them – “then he’ll really be gone”. At the end of the session, we had to parcel up all the clay bits, and she sellotaped up the parcel, wrote ‘dad’ on it, and put it in her box, making very sure the lid was firmly on. And that parcel remained in her box for another 3 years, until near the end of her therapy, when she felt able to throw it away.
I think it is evident that a great deal of highly-charged work occurred in the therapy, relatively quickly. Chloe seemed to use her therapy as a sort of active transitional space between the past and the present. It became a space in which she could think, in the presence of another, and begin to make direct connections between her internal and external worlds. It was as if she had been hungry for the experience, and once it was placed in front of it, she grasped it eagerly. As she herself made connections, so the reality of her horrific early life was made conscious, not only to Chloe, but to all those working closely with her. The intensity would shift from one arena to another, and required us all to monitor our own responses of shock, anger, or protectiveness. Chloe often played a ‘mock sword-fight’ game with me, in which it was vital to her that I did not flinch as she attacked. I think it was also vital that she could see that none of us – therapeutic care staff and teachers alike – flinched at her revelations, and her raw and uncompromising vision of her past. As a staff team, we all had to be strong enough to connect around Chloe, and only then could she feel sufficiently held to continue. I suspect that this was not work that could have been done in isolation, that it needed the consistency and reliability that only a residential setting could have offered.
In the meantime, change was on the horizon for Chloe. The community itself was moving to new premises about a mile away and Chloe’s move from the community’s school into secondary school was imminent. Coupled with this was the question of Chloe’s long term future, and whether and when she might be able to move into a foster family. A vignette from this period will illustrate how, in the face of change, Chloe’s new found but fragile integration could collapse. As part of the planned transition from the old premises to the new, it had been decided that the office and the therapy room should be the first to be occupied in the new building, and that the children should come to the new therapy room and the new house for some weeks prior to their actually moving in to ease the transition. Hence the administrative assistant and I found ourselves in the interesting position of being in the vanguard of the move, with all the attendant building–work idiosyncrasies! The night before Chloe’s first session in the new building, the water-tank in the old building had sprung a leak, which had dripped through her ceiling as she slept. She arrived looking enormously disorientated, and told me about this. She was convinced that the water-tank would have some how followed her, and was perched overhead, about to leak on the two of us. This was not a fantasy; Chloe clearly believed that it would happen. (Indeed, when some weeks later she made a model of the new building as part of a school project, she was most insistent that the roof should be detachable, in order to reveal this peripatetic water-tank!) Of course, subsequently we were able to understand this as her fear that her father might discover her new whereabouts and break in on her in the night.
Chloe accomplished the move to secondary school and then the move of premises. The change of school, although not directly part of the therapy, clearly involved a great deal of co-ordination and close professional working-together by the teachers at both schools and the residential staff. Enduring relationships between new tutors and residential staff had to be established with an atmosphere of mutual trust and respect. Also involved in this was the taxi-driver who would be taking Chloe to and from the new school each day, and careful work on boundaries, appropriate conversations, inappropriate gifts needed to be done. (There is a whole additional paper to be written, I think, on the therapeutic management of taxi arrangements for these children! Here, the taxi driver had got into a violent altercation with the local farmer, related this to Chloe, and told her not to tell anyone. Obviously, this had enormous implications in terms of violent men and secrets, and involved a lot of co-ordinated work on many fronts to put right.) Chloe was extremely anxious about the school, and her prospective peers, although also excited and encouraged by the very concrete endorsement of all the progress she had made.
Chloe also had to cope with the start of menstruation, a development she regarded with distaste and displeasure. She was able to say very clearly that she wanted to be a girl, not a woman – “I haven’t had enough time being little”. This put her in touch with some very fearful images of vampires and sexuality. She came to one session bringing with her a compass, and 3 history books, saying she wanted to think about her ancestors, but she found it impossible to understand the idea of inherited characteristics. What she could respond to, as she played with the compass, was an interpretation that addressed her uncertainty about where she was going – where her future lay – and her need for a clear direction.
Social Services had managed to trace Chloe’s mother, and it was discovered that she had had another baby. Chloe was told this. She became extremely angry and disturbed, and intensely rivalous games were played out in session, often with the ‘baby’ called “the rat”, and hated, with attempts made on its life. Worryingly, this play coincided with an incident during a contact visit, when Chloe picked up a toddler at an activity centre, and shook the child. She was limited in her ability to think about this incident, and not really able to acknowledge its resonance.
Although Chloe seemed to manage her new school very well, her therapy sessions were full of disturbed and often rather manic behaviour. She played a re-occurring game ‘Doctor Mad’. This was a game in which an unsuspecting patient, visiting the doctor in good faith, was suddenly confronted by a manic and sadistic doctor, who proceeded to pull out teeth, eyeballs, intestines, and heart, whilst laughing with hysterical glee. The patient was unable to protest, or stop the violation. On these occasions, Chloe was hard to reach, and ricocheted around the therapy room, unable to think. All the external changes in her life had propelled her into a very fragile internal state, and it cost her a great deal to cope with daily school life, with a different set of boundaries and expectations. Her heightened anxiety made her prey to all sorts of primitive disturbance, but she worked hard at trying to metabolise this in her sessions
When Chloe had first come to the community, the long term aim was that she might eventually be able to move into a foster placement. Initially, that had seemed a slender hope. However, three years on, it began to seem a real possibility. Chloe herself was very clear about wanting the chance to live with a family – “the worst thing about being in care is not having a family to love you”. Indeed, she had a vivid dream in which she and the other children in the community built a rocket in the garden, got in, (“girls on one side, boys on the other”, she assured me), and took off. They went into space, “put on their space uniforms and floated around for a bit”. This dream was followed by another the same night, in which Chloe found herself in a new family, with a mum, a dad, and a golden collie dog that “jumped up and licked me”. We thought about these dreams as a hopeful part of Chloe, that could imagine herself as part of a new family, and was attempting, by means of the rocket, to find herself a space somewhere. She added that, in the dream, the collie had had a flea collar, and the mother had said that that was because she did not want fleas in the house. Chloe and I thought about her worry that there might be “flea-bits” of her, that would be unwanted and unacceptable, as she modelled the dream rocket out of clay. She asked many questions over the next months about the process of finding a family for her – when would it happen? Who would be involved? How could anyone tell if they were a good family? Would the director of the community tell them to treat Chloe well? Would I meet them first? She asked that she not be placed in a family with young children, and could now acknowledge her fear of not being able to keep a young child safe. Chloe also began to talk about how she did not think about “all that abuse stuff” so much anymore. She said she had done that and now it was time to move on. She was angry when her peers at school had problems – she wished they’d all just shut up and get on with their lives like she was trying to do. Whilst this could be seen as a wish to deny a troubling past in an effort to make herself acceptable, it was also true that Chloe had worked through a great deal, and was attempting to close the door on some of the most terrifying of her experiences. As Ann Alvarez has said, she needed to be able to forget.
In fact a prospective foster family had been found, although at this point unbeknownst to Chloe. They were an older couple, with a grown-up family, and a strong sense of family cohesion. They were taking part in a specialist-training programme, and lived nearby.
There followed one of those very difficult periods in the life of looked-after children where plans are progressing, but the child cannot be told until all the formalities and procedures are accomplished. The foster-carers met with residential staff to hear about Chloe, saw a video of her recent birthday party, and met with me, to hear more. We discussed arrangements for therapy. They were happy for therapy to continue, although had no experience of it. They were keen to do all they could for Chloe, and understood that her therapy would be a valuable support over the transition to foster-care, but they also, as Chloe’s prospective parents, were keen to ‘get stuck in’ and take possession of her. This is a very familiar dynamic. It is often hard for foster carer to recognise that the residential placement has been offering treatment, without which the child would be unplaceable. Often, their hope is that a family will solve the problem, and their (unspoken) thoughts are that the child has somehow just been ‘waiting’ in the community, rather than ‘working’. It can be quite a complex task to explain all this in a way that neither alienates nor frightens prospective carers, nor invites competition. We agreed that Chloe would continue to come to therapy at the community for some months after she had moved, and would then transfer to another venue, again for some months before ending altogether. This plan was very much attempting to model a transition where as much remained consistent in Chloe’s life as possible. Her school and her therapy would remain constant whilst she made such a major move. By coming back to the community for therapy once a week, she not only could be reassured that the physical fabric of the building remained intact, but she could also meet whichever staff or children were around at the end of her session, as she left the building. Thus her leaving of the community would be gradual, and her final ending of therapy would happen once she was firmly and securely established in her new home.
In the first session after Chloe was told that a family had been found for her, she entered the therapy room snarling at me, and attempting to hit me in the face with a doll. Although she talked about the news as being “like a dream come true”, she was primarily pre-occupied with what she imagined would be the other children’s jealousy of her – (in part a displacement of her own triumph). She was angry with me for (as she thought) stopping therapy, and found it very difficult to hear and to understand that this was not the case. She was angry with the community for getting rid of her, and said she wanted to stay in the therapy room “for the rest of my life”. She was then able to say that she was very frightened that this new family would not want her after a few months, once they saw “the grumpy, selfish” Chloe. She thought they would put her out on the streets like her dad did. She then proceeded to dress herself up with a bizarre assortment of articles, wrapping herself in a rug, a tea-towel, a skipping rope, with a tambourine round her neck and a plastic bowl on her head. I was reminded of the early mounds that she used to create in her bedroom. When I commented lightly that she looked a bit peculiar like that, she said that the family wouldn’t like her because she was peculiar. She could hear my suggestion that perhaps she needed to feel they would still like her, even if she was a bit peculiar at times. “I’m not like an ordinary girl,” she said. In the following session she was less disturbed, and said she didn’t feel her life had a curse on it anymore
The few weeks before the move saw her state of mind in oscillation. At times she could be thoughtful and reflective, but at times she dipped into a more disintegrated panic, when I experienced her as very vulnerable and precarious.
Just before she was due to move she was taken away for a couple of days by her key-worker, and another member of staff who was extremely important to her. There was a serious incident where Chloe slipped on a sea-wall, and fell into deep water, fully clothed. One of the staff members had to dive in and save her, and they were both in the water for about 15 minutes. In the staff group, as we talked about it afterwards, we came to understand it as a manifestation of Chloe’s precariousness, and her unconscious sense of a life and death struggle going on inside her. We also thought about the staff’s own fears for Chloe’s safety as she moved away from their protection – would she survive when they were no longer there to care for her? There was also the possibility that some of this anxiety had been projected into Chloe and enacted, in a potentially fatal way. All of this was difficult, and chastening. In the individual work with Chloe, the insights were rather different. She was pre-occupied with how she had been convinced she was going to die, and had ”just gone all limp and heavy” and thought to herself “I might as well die”. It was only when the staff member called out to her to kick her legs that she began to move her body at all. Astonishingly, she said she thought the sea was like her dad, trying to pull her under again, saying “come back, come back”. He didn’t get her, but he nearly did. We wondered together whether going limp and heavy had been what she might have done when he was abusing her, and that then it was a way of trying to cut herself off from her body in order to survive. This seemed to make a great deal of sense to her, and, I think, illustrates the life-and-death nature of her internal struggle to ‘make it to shore’, which became so dangerously enacted. The whole incident also illustrates again the importance of working with the whole system in trying to understand the complicated dynamics that can be so powerfully set in train.
Well, Chloe moved. After the first few weeks, her foster parents were exhausted. Although a lot of work had gone into preparing them for caring for Chloe, the reality proved rather overwhelming. Chloe presented them with the whole gamut of her disturbed behaviours, and regressed considerably.
In her therapy sessions, Chloe was predominantly ‘switched off’ and disengaged. She attempted various pieces of play, but abandoned them uncompleted, with no emotional energy invested in them. She often seemed rather sad and fragmented, but in an unavailable way. She was reluctant to talk at all about the move, and her feelings, just saying everything was “fine”. I did not feel she was reluctant to come to therapy, but rather that she could not really engage with the process in an active way. This puzzled me, and continues to puzzle me. Initially, I suspect, the therapy itself had acted as a transitional space, in which she and I could begin to play, and look together at the images that symbolised her persecuted and fragmented inner world. But as the reality of her transition to her new family took place, I think she had less emotional energy available to invest in the ‘play’ of therapy. Chloe needed all her energy to manage the massive changes in her life, and I think that it felt too risky to her to re-open the lid on the Pandora’s box of her anxieties. Instead, I think the therapy became of importance because it symbolised a sense of connectedness and consistency that could accompany her on her journey. It therefore became, for a time, more of a talismanic object that a space for playing. My role became that of holding the physical and temporal space, holding the thinking space on her behalf, and bearing the emotional disconnectedness that was a projection of her own sense of disconnection and ‘lostness’. I also needed to bear my own sense of having ‘lost’ the Chloe who had previously been so active and eager a partner in the therapeutic work. She now had other partnerships to make, and they necessarily took priority.
However, I was not idle! Chloe’s foster parents were struggling to make sense of the tornado that had struck their relatively settled lives, and I met with them several times, and had lengthy telephone conversations. They were feeling hopeless and despairing about not seeing more of a change in Chloe’s behaviour. Although they intellectually understood that this would be very slow, emotionally they were disappointed and discouraged. They felt they did nothing but tell her off all the time, and that life, for none of them, was much fun. We can understand this, of course, as an enormous blow to their omnipotence; they felt demoralised and guiltily angry. It was also a narcissistic blow to their image of themselves as good parents. One of the main sources of contention was – unsurprisingly – the state of Chloe’s bedroom, again a nightly pile of possessions on the floor. They were exasperated by this – wouldn’t Chloe feel so much better, they reasoned, if only she kept her room tidy? As we talked together, they could begin to understand that her bedroom was a barometer of Chloe’s internal state, and that when she felt this degree of internal fragmentation, she was not capable of keeping her room tidy. Indeed, she was demonstrating that she needed someone to help her order things, and to continue to do this until she felt more held. Of course, what was so hard for them to bear was just that – the nightly demonstration of her degree of damage, and at one level, they were angry with her refusal to “tidy it all away”. This made it difficult for them to accord signs of Chloe’s beginning to put down roots with sufficient significance – for example, when she, unprompted, made them a card for their wedding anniversary. From their perspective, having always had a loving and close family, this was not unusual. For Chloe, however, it was an enormous leap of faith, trust and validation. Holding the anxiety and uncertainty in the system over this period was quite a task, and obviously one shared between the social worker, the fostering officer, and myself. There were numerous possible splits at this point, some of which were potential attacks on the therapy – for example, the idea that, if only Chloe were to stop therapy, she could leave the past behind, and things would be so much better. It took a great deal of ‘behind the scenes’ working to hold this together, and to be sure, that as a professional team, we were all saying the same thing. We had to hold on to the pain of the transition, and to the belief in its benefit, at a time when neither Chloe nor her new family could feel at all certain of anything. I suspect that it needed me to be actively involved in this – to be openly meeting with Chloe’s parents – for her to feel sufficiently held, and for her parents to dare to trust that her therapy sessions would ultimately be a help rather than a hindrance.
As so often, in these transitional situations, there can be a rush ‘to get it all done and dusted’ and to leap-frog over the pain and ambivalence involved. This is not only driven by anxiety, often it is financially driven as well. It is more expensive to keep resources in place over and beyond a transition, and it is to the credit of the funding agencies that they were able to see beyond the short-term, and agree to Chloe’s therapy being funded for a year after her move.
It was not until Chloe had been living with her family for about six months that she felt able to actively re-invest in her therapy again. The more grounded she felt in the family, the more able she was to ‘come to life’ in her therapy. The venue for the sessions changed, to a consulting room away from the community. This came as somewhat of a relief to Chloe’s new parents, as it signalled another step in them truly “taking possession” of their child. It also enabled Chloe to begin to work towards the end of the therapy. She worked at this assiduously. She made a clay ‘tombstone’ with our initials and a heart of it. With remarkable perspicacity, she said it was a tombstone to therapy, but that it didn’t mean dying, but ending. She decided to sort out her box, and we went through the contents together, cleaning and re-packing it, and throwing some things away. She talked about each item, remembering how they had been used. Despite the seeming chaos of the box, she discovered that she had kept a copy of almost every holiday chart I had given her, and she asked that we put them in order and put them in a folder. Although there were still some months to go before we ended, Chloe insisted that she wanted to be prepared. She debated which one item she might choose to take from her box on the final day. Which one meant the most to her? Most of all, she began a half-jocular campaign to become the owner of the building in which we were meeting. Did it belong to me? If so, could she “put in an order for it when you’re old and crinkly and don’t want it any more?” Would I leave it to her in my will? This was an oft-repeated request over the last months, and Chloe always seemed pleased and satisfied with my response – always along the lines of this being a way of maintaining the connection between us, even when she no longer came to see me, together with a recognition that I had left her something in my therapeutic will, albeit not a building! In one session, she looked out of the window at some young heifers, one of which was mounting the other. She admonished them, saying they were too young for all that, and that they should leave it all for later, when they were grown-up. When I asked, she said she didn’t think of all that sex stuff anymore – she hadn’t done for ages – the community had helped her with all of that.
She spend most of her last session again trying to decide what to take and finally elected to take the box itself. I felt this was a very fitting symbol of everything that had been contained within the work, and her recognition of how important that secure containment had been.
Before I finish, I would like to reconnect a bit with the theme of this annual conference. My theme today has been the importance of making connections, of various kinds; not only the therapeutic connections with a child and a child’s internal world, but also with the professional networks surrounding the child. We, as child psychotherapists, potentially have considerable skills and insights to offer, but, in working with complex cases, these may need to be made available, not just to the child, but to the surrounding system as well. Working with looked after children, and children in transition, demands that we re-assess our ideas of suitability for treatment, timing of intervention, and of confidentiality. To offer a service that addresses the particularity of the child’s needs, we may well have to become more accessible, and more involved with external reality than we have been wont to do. Working from within a therapeutic community does pose particular problems, present particular challenges, but it also can have significant benefits.
As I have said, for Chloe, individual psychotherapy in itself would not have been enough. She also needed the therapeutic containment that the community offered. Conversely, the community without the psychotherapy would not have been enough, and I suspect that this is true for many children, especially those at the younger end of the age range. Working from within such an environment gives us, as psychotherapists, a real opportunity to pull the therapeutic thinking together firmly around the child in a way that simply is not possible if one sees these children individually, but outside of the setting. With the best will in the world, there are simply too many details and nuances that get lost or overlooked. In part, this is a plea for other child psychotherapists to consider this as a creative place to work. The need is certainly there. If one of our therapeutic goals for these very damaged children is that they may slowly begin to make more connections with both the internal and external worlds, and find a place for themselves in the world that brings them some joy and fulfilment, then perhaps we ourselves need to be able to model that ability to make connections, and to move with confidence between the protected space of the therapy room and the much larger world outside.
Diana Cant M.A.C.P.
Consultant Child and Adolescent Psychotherapist
21 April 2004