Living a Provisional Existence: thinking about foster carers and the emotional containment of children placed in their care

Published in Quarterly Journal – Adoption and Fostering – Vol 28 No 4 Winter 2004.

‘He climbed into people’s eyes and became
an exasperating expression’

God of Small Things – Arundhati Roy

Abstract

Foster carers can find themselves placed in a situation of extreme difficulty and trauma when looking after abused, deprived and neglected children and their ability to manage can be tested to an intolerable degree. In this paper I will be examining the sometimes extraordinary states of distress that can result from this experience. In particular I will describe a state of being, which I have called ‘Living a Provisional Existence’, in which foster carers feel  ‘locked in’ and forced to parent in a way that feels very contrary to their hopes and ideals.  It is a state filled with contradiction and confusion and the foster child is experienced as having ‘got under the skin’ of the foster carer in a very destructive way. I explore how this state of being can be understood and usefully conceptualised in terms of emotions evoked in the foster carers through the child’s projection of intolerable feelings. The foster carer may then become filled with the very feelings that the child can not deal with and the foster carers’ emotional reaction can be understood in terms of the child successfully imparting his/her feelings into those that are charged with his/her care.

Introduction

Many foster children from traumatic backgrounds progress in a relatively smooth, developmentally positive and loving way through their school and care experience and I do not want to suggest that the issues I will be describing in this article are somehow inevitable characteristics of the foster care experience. However, in my work as a child psychotherapist, foster carers and the children in their care are usually referred to me when the story is quite different and matters have become extremely dire. The placements are often felt to be on the edge of breakdown and the children experienced as beyond parental control. The language of attachment theory (See for example Golding K  2003,  Steele,M et al 2003) and a knowledge of the impact of traumatic experiences upon a child’s development is extremely helpful as a way of understanding the children’s behaviour, however, some foster carers present in a particular and sad state in which they and their foster children have become locked into a seemingly hopeless and destructive relationship. A defining quality within this particular state is that there seems no way out of it, though continuing within it is experienced as a living hell for all concerned. As one foster mother said, “It is as though a switch has been turned and then broken off. I then just feel caught up in an endless spiralling round of just being on her (the foster child’s) case all the time. I see it’s no good for her – or me- but there is nothing I can do. The on/off switch is broken.”  Another foster carer spoke of her experience in the following terms, “It is as though one minute you are outside a goldfish bowl looking in and the next you are in there – with the sharks – going round and round fighting for your life and there is no way out.” This pernicious state of being may lead to foster breakdowns or indeed breaks downs in the mental and physical health of carers and children.

The descriptive term I have used to try to capture the essence of this experience in a short hand way is that of ‘Living a Provisional Existence’. This is a term loosely borrowed from Frankl’s (1959) moving book, Man’s Search for Meaning. In this book Frankl was writing about the experience of living in a Nazi Concentration Camp and an individual’s extreme experience of trauma and the loss of a familiar framework in which to function. Frankl articulated how it is ‘a peculiarity of man that he can only live for the future’ (p70) and he speculated how ‘if an individual was not able to see an end to his provisional existence, if he was not able to aim at an ultimate goal in life, he ceased living for the future in contrast to man in normal life. Therefore the whole structure of his inner life changed and signs of decay set in’ (P70).

I am not suggesting that the movement from loving families and safe communities into a concentration camp and moving from situations of neglect and abuse and into foster care are the same, however, it is the foster carers experience of the loss of a comfortable sense of themselves and the description of the loss of hope and the sense of inner decay that  is so resonant and absolutely pertinent to their situation. All the children discussed in this paper were in planned long term placements, however, the term provisional also resonates in a profound, if different way, the sometimes temporary and conditional nature of the foster care experience itself.

The Experience of becoming a Looked After Child

It is important to, firstly, remind ourselves of the reality of many foster children’s lives and their often very shocking personal histories.  The combination of the trauma and neglect in the birth family along side the complex loss and grieving processes involved in separation from that birth family can make for a very damaging cocktail of experiences.  A ten year old child in therapy, for example, drew a picture of himself before and after the event – before going into care he depicted himself as being whole, after, as blown to pieces. I do not believe the authorities had any option but to place the child in care, given the appalling nature of what was happening in the parental home, and yet for the child the experience was unbelievable explosive and the picture brought to mind just how fragmented the child now seemed – an anxious, angry child and seemingly blown apart by his experiences. This was the child the foster carers were expected to manage. They felt totally overwhelmed by the experience and in the light of his very aggressive and problematic presentation they, quite understandably, could not see a way forward within the placement.

The Impact of Trauma

To the child the experience of going into care may be yet another extreme shock on top of an already abusive and neglectful history, underlining, in the child’s mind, the lack of a parent able to protect the child from the awful reality of his/her experience. In such traumatic situations to talk simply of this as being a child’s experience of events does not do justice to the reality of the situation. It is rather as though the child’s psychological defences have been perforated or penetrated in a very destructive way.

In addition, the brain development of children who have been exposed to neglect and /or abuse in formative early years may be effected in a way that does seem to influence the uncaring, overactive and violent behaviour that these children are so prone to in later years. (Perry 1997) The more complex parts of the brain dealing with language and thought may be relatively underdeveloped in comparison to the less complex parts of the brain that regulate heart rate, temperature etc. Some authors (Schore 1994, Joseph 1992) argue that the infant must experience nurturance and affection in order for the limbic nuclei, relevant for the regulation of emotion, to develop normally. Neglected and abused children often show physiological hyper-arousal with associated increase in heart rate, muscle tone and sleep disturbances. They often seem ‘wound up’ and are much more prone to displays of violence, impulsivity and various forms of delinquency. These outbreaks of behaviour can be brought on by the slightest event, or, indeed a child may seem constantly to be in such an aroused state.  It is as though the normal mechanisms for monitoring the reality of a situation are by passed and the child is geared-up for an immediate flight/fight response. This is a sub-cortical response and is not amenable to conscious thought. It is by definition impulsive.

What this means is that these children may find it incredibly difficult to bear any form of emotional distress or anxiety and such an internal experience will be quickly changed to that of seeing the world as the enemy. Others will then experience the child as someone with an attitude problem of one sort or another. They may, for instance, often be experienced as control freaks or bullies.   The transformation from ‘anxiety’ to ‘attitude’ will happen in a flash or the child may be seen to be permanently in such a state.  A number of foster carers have movingly described to me watching such a child awaken and how the child immediately perceives any intervention, interest or even presence of another person as persecutory.  The foster carer can then feel in battle with the child from the first moment of awakening to the last moment of the day and be caught up in a dread filled vicious circle of interaction.

Neglected and abused children are therefore likely to be more difficult to parent and manage in school and are liable to arouse feelings of inadequacy and uselessness as the ordinary ways of managing their behaviour are likely to be re-buffed.  As a result the foster carers of such children may feel insecure and inadequate simply because of the nature of the task that they have set themselves.

However, whilst bearing in mind the impact upon the physiological development of the child, it must also be recognised that a child who has lived through the experience of abuse and neglect may have internalised parental figures who in a fundamental way have not kept the child’s best interests in mind and protected the child from the experience of a state of having been psychologically perforated or penetrated by these traumatic experiences. The sometimes extreme and dire states of mind experienced by the foster carers can then also be thought about in terms of a process of projection whereby the foster children manage to communicate something of the intolerable nature of their experience to the foster carers and how unbearable it is for anyone to be acquainted with and feel that experience. Unless the foster carers themselves manage to understand and process this a further cycle of deprivation (Henry 1974) may take place as the foster carers’ style of parenting can become increasingly limited and in definable ways begin to emulate the child’s initial neglectful experience. The foster carers’ may feel that the child has been able to psychologically penetrate/perforate their psychological defences and at this point will feel that they have been invaded by a poisoning chalice rather than be able to think that it is as if they have been so invaded.

A Case Example

Jo a 14 year old boy, in care and with a history of abuse and neglect drew a picture in one of his therapy sessions of how he saw himself. He drew his face surrounded by descriptions of himself as friendless, short tempered, mean, thick, dangerous stupid, and  ‘everyone hates me because of the way I act’. His foster mother had described to me how she was feeling, at the end of her tether, really struggling to be anything but punishing towards Jo and, of importance, her description of her view of her life at present seemed to resonate with Jo’s description of himself. I asked Jo if I could show her the picture when I next met with her. He agreed to this and at the meeting she took one look at it and, as I had half expected, said ‘but that is just how I am feeling – I’m loosing all my friends, I’m so isolated, I feel so stupid and useless, I’m always angry. I lock up all the biscuits. I’ve become so mean etc’ There followed a great tirade of often repetitive negative thoughts before we were gradually able to begin to think about what might be happening. Yes, Jo was difficult to look after, he did present enormous challenges to her but she could also see how he was unconsciously managing to communicate to her something of his own inner turmoil. The foster maother seemed so relieved by this revelation and exclaimed…’so I’m not just going mad!’  She was then able to recognise this altered state of consciousness within herself and described how she had become ‘like an alien’ and ‘unlike her old self’. Her inner voice of sympathy then returned and rather than simply feeling persecuted by Jo she was able to say how awful Jo must be feeling….’If I’m feeling bad I hate to imagine what it is like for him after all he has been through.’  The foster placement remained difficult and the foster mother would continue – as she described it – ‘ to loose it’ but she became more able to gather herself together through reminding herself of Jo’s drawing and the powerful nature of what he evoked within her. This is an ideal example of the process I am trying to describe in terms of Living a Provisional Existence.

Foster Carer’s Observations

It is easier to take a child out of a family than the ‘family out of the child.’

Anonymous

The foster carers own experience can then become as ‘provisional’ as that of the foster child, leaving the foster parent feeling trapped in emotional turmoil, torn between the hell of living with the child and the guilt of contemplating separating from the child. At my initial meetings with his foster carers, Jo had been described in the following harrowing terms –  “He exhibits violent, self injurious and sexualised behaviour. He is explosive, he holds onto things then explodes and ‘loses it’. He doesn’t let you close to him.  I do not really know what’s going on underneath. He is inconsistent, moody, detached. He gets under your skin. There is a facade of competence.  He won’t let you help him. He insists he knows how to do things but he doesn’t. He hears voices that tell him to do things. He’s mad. They (i.e. professional workers) are useless, nobody can help.  I’ll kill him one of these days.”

These were foster carers who were well-practiced biological parents and foster parents who could have told of happy and successful experiences in raising children, however, with Jo they were absolutely at the end of their wit’s end. What was so noticeably missing in the relationship between this child and his carers was any positive mention of a containing flow of interactions between them and the modification of intolerable feelings (Bion 1963).  Instead, what seemed to be evoked in the foster carers was a pathogenic process of parenting, a concrete experience of a lack of flow of emotional interactions and an overwhelming feeling of poisoning rather than a positively modifying process.  At this point Jo would have been living with foster carers who were not experienced as catering for his psychological development. What had come into being was a reoccurring experience of mutual deprivation in which the foster carers felt violated. They felt that they were in contact with a bizarre and frightening state of mind and struggled, and failed, to integrate this experience into their ordinary family life. In fact the experience was colouring their relationship with their other children and in a bleak way they began to question their competence to parent at all.

Types of ‘not knowing’

Jo had certainly become a highly persecutory figure, deeply affecting them, getting right ‘under their skin’ and yet they also felt that they did not really know him.  This common complaint, however, belies another view of this experience as I would suggest that far from ‘not knowing’ Jo, the foster parents were in fact describing a bleak quality inherent in nature of ‘knowing’ these children whilst in this state of being. It is a certain kind of  ‘knowing’ of an unbearable emotional experience of rejection and a consequent retraction from emotional engagement. If the foster carer is able to keep this in mind, and this is easier said than done, then the child’s behaviour can be thought about in symbolic terms; it is as if I do not know him, and not a reality. This will lessen the persecutory nature of the experience and so lessen the foster carer’s internal sense of being locked into living in this state of being.

Children with traumatic histories find it extremely difficult to ‘know themselves’, let alone let others know them. To be full aware of all that they have been through may be more than can be expected. Life history work may be advocated, and may be useful, however, it can also be extremely difficult because a history of trauma, neglect and abuse may lead to extreme feelings of shame and an abhorrence of ‘knowing’.

This quality of ‘not knowing’ the children can then be seen as the child’s communication of something of extreme importance to the foster carers as well as an evacuation of intolerable feelings into them. If the foster carers are able to tolerate it, and not experience it as simply a motivated attack, the positive side of this is that of a child being able to project a necessary but awful state of anxiety onto the carer and the carer’s task is, if possible, to carry this on behalf of the child. In this re-framing of the experience the child can be seen to still be fighting for life and to be desperately grasping out to form a meaningful and intimate relationship.  This raises hope for the future of the child and a movement away from living this Provisional Existence. The emotional toll on the foster carers must not, however, be underestimated.  The child may present the foster carers with an emotional experience that is more than can reasonably be managed.

This form of ‘not knowing’ must be differentiated from a ‘not knowing’ that arises from a different source. Foster carers may describe how it was ‘never meant to be like this’, ‘Nobody warned us what it would be like’, ‘ We didn’t know it would be like this.’ Such complaints would seem to suggest an obvious implication for practice, i.e. better preparation and support from others in the same situation.  This argument undoubtedly holds water, however, matters are often rather more complicated than these complaints might suggest. As with the drama of having a first biological child, the initial experience of fostering a new child can be so very personal and so graphic that each individual carer may feel that they have discovered something new and original and be convinced that no one has ever felt that way before. In addition the intensity of the feeling can be so great that despite whatever the foster carer has been told – and sometimes for conscious and unconscious reasons they may not have been told the ‘whole story’ – the shocking reality of the experience can leave the carer taken completely by surprise and left blaming, usually the social worker, for not having been more explicit about the foster child and his/her behaviour.

The full extent of the child’s presentation may be downplayed by professionals because of fears of labeling the child or ‘putting the family off before they have met the child’ but at other times the behaviour is explained in graphic detail but the foster carer’s frame of mind means that they do not quite believe it.  An omnipotent state of mind, and I feel this needs to be understood and not be seen simply as a criticism of foster carers, may arise in the carer through an understandable desire to rescue the child.  The foster carer may feel that the child will be manageable – ‘he is only a child’ – and the foster carer may then not fully heed any warning signs.

The dynamics of the process of ‘knowing’ a child prior to the child living in the family are complex. We are all vulnerable human beings and liable to fail to hear what we are told. There is a great deal we do not register until it is relevant to our situation in a real and alive way.  On the other side of the coin the desire to rescue the child and a defense against acknowledging the pain of the child’s situation may also mean that the foster carers are only given a partial picture of the child.  This may lead to a conscious and /or unconscious ‘conspiracy’ occurring between the foster carers and the professionals that know the child and lead to a distortion in shared communication and understanding. However, this must be differentiated from the feeling of ‘not knowing’ described above that in fact arises from  ‘knowing’ unbearable and intolerable psychic distress.

It must also, of course, be recognised that the experience of fostering itself really does involve an enormous struggle in terms of  ‘bearing the unknown’ in both foster children and foster families. It is, after all, usually a complete stranger that is being welcomed into a household and for the child it is a strange household that is being entered. How do you fill the gap of the frightful ignorance implied in such a situation?  What about the basic fabric of family life that is so difficult to explain? There are a multitude of things that define a family’s and an individual child’s way of being that can not be fully verbalised but rather need to be absorbed through experience. Leaving aside issues of loss, neglect, abuse and trauma, this appropriate state of ignorance and worry can of itself lead to an extreme state of anxiety and the question of ‘bearing ignorance’ can then take on a particularly persecutory note for both the foster child and the foster family.

In addition it is sadly noticeable how such children really struggle in terms of a more generalised ability to acquire knowledge and to do well in their education. The process of learning can create an enormous psychological disturbance that can present as an insurmountable block to progress and can again lead to an experience of further deprivation within the child’s educational career. To be a student one has to be able to bear ‘not knowing’ and for these children this can prove to be an overwhelmingly disturbing experience.

A Case Example

An eleven year old foster boy, who I shall call Robert, was in therapy for a number of years and had a checkered history in foster care eventually wrote a poem in which he described how pink wall paper, half eaten toast and fresh air through the open door reminded him of his mother’s death and made him feel dead inside. He was a child with a very problematic, neglectful background and in addition his mother had suddenly died in front of him in the kitchen. Robert’s broad history was ‘known’ but the fine detail and the symbolic significance of particular things were not known. His behaviour was very aggressive and unmanageable. Various foster families had found him very difficult to tolerate and it proved difficult to remain sympathetic to his history and to deep mourning processes.  The writing of the poem however marked something of a watershed in his development and again I would suggest a movement away from the pernicious effect of living a Provisional Existence. The poem clearly brought to everyone’s mind the degree of his suffering and how images normally associated with warm, positive feelings were for him forever tarnished through his experiences. The poem  indicated a profound shift in his development; from destructive acting out processes to more creative symbolic processes and alongside this those charged with his care were more able to relate to Robert in a robust but understanding way. As with the previous case example, Jo, the progress was by no means linear but the sense of the development of some hope and a generally more positive spiral of interaction between Robert and his foster carers became increasingly evident.

Is he sick?

Both Robert’s and Jo’s foster carers were also deeply troubled by fears that this person living in their household had a discrete but undiagnosed psychiatric disorder. This is not an uncommon fear and the prevalence of a psychiatric disorder in children in the care system is conspicuously higher than that of the general population (McCann1996). However, in both these cases and in others I have worked, with the question of  ‘madness’, and the desire for a ‘medical solution’ rested immediately alongside a statement that they knew this wasn’t the answer.  The picture that was then presented was that of a traumatised state of mind; the foster carers ‘caught’ in a state of emotional turmoil, ‘to-ing and fro-ing’ between unsatisfactory solutions to what seemed to be  ‘sanity preserving’ questions.

At such times of crisis it is, of course, very understandable that foster carers should think in the direction of a diagnosis as this would give them something to ‘hold onto’ and a way to define their experience. In this sense it would alleviate them from living this ‘Provisional Existence’ as they would be able to feel emotionally ‘separate’ from the destructive projections of the child in their care. The child would then have a condition, and in this way become more comprehensible.  No longer would the child’s behaviour have such an extreme impact upon their own sense of confidence in their ability to parent. They would not ‘have to’ feel that they were doing something ‘wrong’ which, if corrected, would lead to the children behaving themselves. The often extreme sense of self-blame would then be lifted.

Jo and Robert  had had a formal psychiatric assessment and the  view of a classical psychiatric illness – such as schizophrenia – was not shared by the psychiatrist. In both cases the child’s presentation was seen to arise as a result of the impact of early childhood trauma and a distinct attachment disorder.  And yet despite discussion of the physiological and psychological implications of such a diagnosis the possibility of there being some further organic disturbance persisted in the foster carer’s mind because of the frightening states that the children seemed to enter at times. The question of co-morbidity and the importance of correct diagnosis must be kept in mind but the persistence in such questioning also highlights the ‘disturbed and disturbing’ impact of these children and the feeling that there is something completely indigestible about the emotional affect they may have upon their foster carers.

‘But he might be a psychopath!’

In addition Jo’s foster carers went onto describe how  ‘he shows no remorse’. This led to a statement that he was ‘just not normal’,   ‘You can’t punish him in a normal way. He doesn’t care.’  The foster carers seemed to feel quite dehumanised by the experience of caring for Jo and the word psychopath entered the conversations in terms of their fears for his future.   They felt that they could provide some form of physical care  but were forced to parent in a way that they felt did not pay attention to the child’s psychological development.  They, in common with many other foster carers I have worked with feared for the worse if they ‘could not get through to him’. I, in turn, feared for the worse if I was not able to contain and manage the fears of the foster carers.

Out of their depth

An analogy I often use to try to understand this presentation is to ask the foster carers to picture a non-swimmer in a pool gradually increasing in depth.  There comes a certain point when a minute increase in depth suddenly sends the individual into a completely different arena. Gone is the state of well-being characterised by having your feet on the ground. Its place is taken by a state of life threatening terror and of importance a state in which, as with the drowning man, the hand that is there to help may be perceived as persecuting. Foster carers may feel out of their depth through the enormity of the task they have set themselves but in addition the foster child may also be projecting such a state into them and thus evoke these very feelings in the foster carers.  This will create a ‘double –sense’ of inner turmoil within the foster carers. If foster carers feel out of their depth this dynamic may also serve to heighten any ambivalence that they might already feel towards their professional network and provoke a negative spiral of interaction with both the child and the support network.

In addition some  foster children  may be recreating in the present relationship something of the unpredictable nature of their early experiences and be drawn, like an addict, towards living along this edge of well being.

This analogy can then usefully throw some light upon the often variable and contrary presentation of these children. The child will be experienced in a very different way depending upon whether or not the child feels in or out of his/her depth. A tiny event may move the child into a very different state of being. In a similar fashion if a foster parent is locked into this state of being the relationship between themselves and their support network may also be bedeviled by these same qualities. This is an observation and not a criticism and if understood can aid in the development of a more contained and positive relationship.

Working Alliance

At my initial meetings with foster carers I feel that it is very important to acknowledge these issues and truly to recognize the enormous extent of the task of foster families. There is a phenomenal emotional price that they, as individuals, as parents and as families, often have to pay in order to accommodate these children. The initial interviews with foster carers are of extreme importance for without the development of a sound working relationship this terrifying state of being is likely to persist or come to some calamitous conclusion.   Working with these children is extremely demanding and time consuming and it is also important to recognise that a child’s behaviour can continue to be persistently difficult and the future for the child  may remain very grim.

In terms of the processes intrinsic to such meetings, I find it important to acknowledge the fears and misgivings that are inherent in the situation – will I also see them, the foster carers, as bad, and if not bad, then mad? The intense emotionality and stress of these situations means that value laden concepts of good and bad, mad and sane, deserving and undeserving, success and failure cast enormous shadows over the proceedings. It is also a time when families and professionals can become immersed in powerful projections which can create strong splits in the system and it is useful to view the system as a ‘trauma organised’ one (Bentovim 1992), i.e. a system which might not operate in an ‘ordinary way’.

One example of this is that though, on the one hand foster carers often describe a sense of relief at having the opportunity to discuss the foster child and think about treatment options on the other hand, the very fact that they had arrived at my doorstep also has the potential of being a  ‘barrier to treatment’ (Scott and Ainsworth 1967; Scott 1973 a and b, Street 1994) as it fuels the fires of paranoid anxieties of ‘fear of failure’ and leads to a variant of the expression, ‘if we were good enough foster carers we would not need this service’.  These same dynamics can all to often come into operation in the relationship between the foster carers and their support network particularly the social worker. It is also  important to remember how this dynamic may mirror an internal feeling in the child, namely, if ‘I had been good enough this would not have happened to me’. The child may easily blame him or her self rather than than blame those upon whom he/she is dependant.

The working relationships within the professional network are a delicate matter. Different roles need defining and working relationships forged. However, it can be useful for foster carers to have a ‘listening ear’ available for them alongside the different and statutory ‘ear’ of the child’s social worker in order to think about these dynamics. ( See also Hart A and Thomas H, 2000) Needless to say, the potential splits in the system must be acknowledged and worked through and it is essential that every effort be made to liaise and maintain a close working relationship with all the professionals working with a child.

Some Implications for practice

Street, (1994) wrote of the importance of discussing with parents the possibility of separation when the situation feels impossible to them. He described how he felt it was better to deal with this as a reality and discussed how this might then take some stress out of the situation as the parents feel heard and understood.  He suggested that separation is, in fact, then less likely to happen. I feel that this is also very important with foster carers and it is important to begin to bring into play some sense of the possibility of concurrent planning so that there are several plans ‘on the table’ at once. This creates both a safety net and a real sense that such complex situations demand complex solutions.  A time line may then be decided in which the framework for decision making is re- framed into that of foster carers actively needing to decide that after a particular date the placement will continue.  The placement will end unless the foster carers say otherwise. The choice then is to actively decide to continue rather than to end.

In other more extreme circumstances I have worked with networks where we have found it useful to define a placement in terms of fixed duration – e.g. for 6 months – with a view to trying to break a particular cycle of seemingly endless unplanned breakdowns. This leads to a separation between the placement ending and the child’s behaviour and the child can carry with them the experience of a positive placement rather than an endless list of breakdowns. This can lead to the later development of more secure attachments.  If this is done within an umbrella organisation the child can then also experience the allied benefits of other major parts of his/her life experiences continuing in a secure fashion.

Therapeutic Management

When faced with these circumstances I do view my task as trying to contain the foster parents anxieties, to begin the process of trying to reflect on the difficulties together and to try to offer some management pointers that may be of help to them.  I try to enable the foster parents to, usefully and not too defensively, emotionally separate themselves from the experience – to manage rather than be managed by the child’s presenting pathology.

In order to do this I find it helpful to encourage the foster carers to see the behaviour in terms of infant development and regressed states of being rather than seeing the child as being either ‘mad’ or ‘bad’. Returning to a physiological model it is important to remember that at birth the infant is remarkably ill-equipped to cope with the variations and excitations of its new environment. The infant is a delicate creature, which is in danger of going into shock through overreacting to powerful or unexpected stimuli because it lacks the means for modulation of behaviour that is made possible by the later development of emotional control.  This emphasises the essential role of the carer who modulates the child’s overwhelming emotions and acts as the child’s ‘auxiliary brain’. (Diamond, Balvin and Diamond 1963).  Likewise foster carers may need to play the role of the auxiliary brain but this is a much more challenging, if sometimes impossible task, with older traumatised children. In addition, a reminder of the familiar state of tantrums and the terrible two’s but within a now older child can begin to encapsulate the experience and allow it to become more tolerable.

This then leads to different styles of management more in keeping with parenting a younger child that can sometimes be incredibly helpful. It can, for instance, be useful to follow a style of interaction, such as, – ‘Let’s go and  hang our coats up’ rather then ‘Go and hang your coat up’. The latter is important for an older, and securely attached, child but it is a quite different style of parenting that implies separation and independence. In my direct work with foster carers I also naturally use similar language, for instance, saying ‘Lets think about this together.’ This indicates an important commitment to a shared task in which together we are trying to find a bespoke solution to the presenting issues.

When working with and looking after such children it is also extremely important to respect the traumatised mind and to have a ‘knock on the door’ policy in terms of technique. I will, for instance, ask a child for permission to talk about things that I feel may carry a traumatic impact, or, I might say, ‘I have been thinking about something that might be difficult to talk about, would now be a good time to discuss it?’, or even, ‘If you would like to know what I have been thinking please ask me when you feel it is a good time for you’.   Sometimes children also respond well to a time limit, ‘Can we talk about this for five minutes?’ However, some more traumatised children may only manage one or two minutes or even only a few seconds! These techniques can aid discussion of problematic issues and avoid re- traumatising the child. (Again it is also important to maintain a similar respectful stance when meeting with foster carers who in turn may be feeling quite traumatised by their experience of caring for these children.)

Further, it is important to encourage the foster carers to think about important but very easily overlooked details within an interaction. If the foster carer is, for instance, wanting to speak to the child it is important to attract the child’s attention first, call his/her name, rather than expect the child to be paying attention in an ordinary way.  And, keep instructions simple and one at a time!  The foster child may find it difficult to retain a longer list and to expect them to do otherwise is only courting disaster. I also encourage the foster carers to play memory games in order to increase the child’s cognitive ability.

It is also useful to return to the adage of loving the child but not what they do; to try to separate the child from their behaviour and to encourage a style of parenting that deals quickly and robustly with disciplinary issues and then encourages some form of positive re- grouping. The disciplinary experience needs to have clear boundaries as the child is so vulnerable to both re-creating a depriving and aggressive relationship and to struggling with acute anxieties regarding abandonment. The solution to previous dissonance within family life has after all been that of separation.

On this note, it is sometimes useful to suggest to a child that he name his behaviour. If, for instance the child is called Fred, talk about an Angry Adam part of him that all parties are trying to best manage. It is this part that then needs to be controlled and if necessary be excluded from the house and not Fred himself. The child and the foster carers can then join in managing Angry Adam and thus aim to avoid increasing the child’s anxieties through fueling the fears of abandonment.

Such simple instructions, alongside the all important role of emotional containment of the foster carers anxieties, can enable foster carers to begin to think that they can get on top of things and through having some pointers in terms of managing the  behaviour the process of trying to then contain the anxieties of caring for these children can begin.  The child’s behavior can then become comprehensible, to a certain degree, without the child being labeled in a derogatory way. However, I must underline that there are no simple solutions to the extreme management problems that foster carers are faced with and this must be acknowledged in order to aid this process of containment.

Conclusion

The purpose of this paper has been to look at an aspect of the complex relationship between foster carers and foster children. It is an exploratory paper and I hope that it has sparked off ideas within the reader. In the paper I have described the sometimes extraordinary states of distress that can result from experience of fostering and I have suggested a particular state of being that I have called ‘Living a Provisional Existence’. When in this state foster carers  feel ‘locked in’ and forced to parent in a way that feels very contrary to their hopes and ideals. I have suggested that this extreme emotional experience can throw some light on the tortured inner worlds of the children in their care and if the foster carer is able to understand the powerful nature of the child’s projected feelings this can be very helpful in their own emotional management of their feelings and experience.

It is also important to understand that if the foster carers, like the children in their care, become immersed in their version of a Provisional Existence they may then seem unresponsive, if not actively and perversely destructive, to external support. This may lead to an unhelpful rift developing between the themselves and their support structures.

The foster carers task is a complex and problematic one. The carer needs to be close enough to the child in order to feel emotionally involved and yet distant enough not to be overwhelmed by the child’s presentation. This is a difficult and sometimes an impossible balance to maintain. However, if carers have a space in someone’s mind to think about and contain the very destructive forces that may abound within the fostering experience this can be very helpful and a space to think can begin to be established within  their own minds. The child and the foster family can then begin to feel some sense of security, containment and positive stability and the pernicious characteristics of living this Provisional Existence may lessen and some sense of hope for the future may begin to grow.

Acknowledgements

I am grateful to Margot Waddell, Angie Hart and Marcus Page for their helpful comments on earlier drafts of this paper.

Bibliography

Bentovim, A. 1992, Trauma Organised Systems, London, Karnac Books.

Bion. W. 1963, Elements of Psychoanalysis, London.  Heinemann.

Diamon,S., Balvin,R., and Diamond,F. 1963, Inhibition and Choice. New York, Harper and Row.

Frankl, V. 1959, Man’s Search for Meaning, Hodder and Stroughton.

Golding,K. 2003, Helping Foster Carers’ Helping Children: Using attachment theory to guide practice. Adoption and Fostering Vol 27 No 2  pp 64 to 73

Hart A and Thomas H, 2000, Controversal Attachments: the indirect treatment of fostered and adopted children via parent co-therapy Attachment and Human Development2;3, pp306 – 27

Henry, G. 1974, Doubly Deprived, Journal of Child Psychotherapy, Vol 4:2.

Ironside L 2001, Living in a Storm: An examination of the impact of deprivation and abuse on the psychotherapeutic process, Doctoral Thesis, Tavistock Clinic and East London University.

Joseph,R. 1992, The right brain and the unconscious: Discovering the stranger within. New York, Plenum Press

McCann, M. 1996, The Prevalence of Psychiatric Disorders in young eople in the care system. British Medical Journal Vol 313

Perry, B.D. 1997, Incubated in Terror: neurodevelopmental factors in the ‘cycle of violence’. In J.D.Osofsky (ed) Children in a Violent Society, New York: Guildford.

Roy, A 1997, The God of Small Things, Flamingo

Schore, A. 1994, Affect Regulation and the Origin of the self,  New Jersey, Lawrence Erlbaum

Scott, R. and Ainsworth, P. 1967,  ‘Closure’ at the first schizophrenic breakdown: a family study, British J. of Medical Psychology, Vol.40.

Scott, R.  1973, a, The Treatment Barrier Part 1, British J. of Medical Psychology, Vol.46.

Scott R 1973, b. The Treatment Barrier Part 2, British J. of Medical Psychology, Vol.46

Steele M, Hodges,J. Kanuik,J. Hillman, S. adn Henderson, K. 2003   Attachment representations and adoption: associations between maternal states of mind and emotion narratives in previously maltreated children. Journal of Child Psychotherapy Vol 29 No 2

Street, E. 1994, A family systems approach to child-parent separation: ‘development closure’. Journal of Family Therapy, Vol.16.