Towards an integrated network

Jenny Sprince, London

Journal of Child Psychotherapy Vol. 26 No. 3 2000: 413-431

Summary

This is a description of psychoanalytic consultancy within the social service network around looked-after children. I describe the culture of social services as I have experienced it. I attempt to show how consultancy in various forms can provide an alternative to direct psychotherapy, as well as supporting it, and how it may encourage children and carers to value psychotherapy and even, in some cases, to seek it out for themselves. I demonstrate how it can lead workers to a more positive engagement with the inner world of the children, and with psychodynamic thinking. I explain how my experience has influenced my clinical practice with individual children. I suggest that direct psychotherapy without such consultancy can endanger children’s more urgent need for stable placements, and explore some possible reasons. I touch on the need for further training so that as child psychotherapists we can apply our expertise more effectively in this direction.

Introduction

This paper is a brief account of my experience over several years as Consultant Child Psychotherapist to various inner city social services departments. My first post of this kind was created by a senior social worker, Head of Resources of the Children and Families Department. His energy and commitment were an unfailing source of strength, and the quality of our partnership was crucial in engaging the trust of the resource teams. Through my partnership with him I developed a model for such work, which I was able to apply elsewhere.

My particular interest is in working through consultancy, and my aim, which the Head of Resources enthusiastically endorsed, was to create a therapeutic network that could support individual clinical work, or make it less necessary by deepening the understanding available to children through their carers. By the time I left, the level of foster-placement disruption within the borough had decreased dramatically. Indeed, in the league tables for placement stability the borough was placed in a position among the top ten in the country – quite an achievement in an inner-city area noted for high level of poverty, crime and racial disharmony.

This success would not have been possible without the participation of the Head of Resources who kept in close touch with me not just as line manager but also as an interpreter of the strange environment in which I found myself. In return, I contributed a psychodynamic commentary on the turbulent politics he described to me, and he was able to transmit some of this learning to his senior colleagues within fieldwork. This was of great benefit to my relationships with individual field-workers and their line managers. The stability of our pairing also acted as a model for more junior staff in their attempts to work co-operatively together. In my experience this degree of collaboration with the head of a social services department is vital in any attempt to create a co-operative network.

In what follows I therefore draw extensively from my experiences within this borough, especially when describing the social services context. However, most clinical illustrations and many examples of specific scenarios are taken from work elsewhere.

The Environment

The Social Services Children and Families Department had recently been restructured – yet again. The latest structure had reinforced a purchaser/provider split. On the one hand, there were the resources teams – the providers – and, on the other hand, the assessment field-workers – the purchasers. All cases were held and assessed by field-workers, but all provision was overseen and provided by social workers within the resources teams. As a result, the two sections were widely divergent in culture.

The field-workers were crisis driven. They were anxious to fight for immediate provision for their clients, and aware that they would be blamed for any delay and consequent disaster. They were overburdened by the sheer number of impossibly complex cases that they could not refuse to deal with. For financial reasons, they were under pressure to decrease the number of cases on the at-risk register. On the other hand, they were under a statutory obligation to protect children who were at risk, and could be held responsible by press and politicians if a child on their caseload came to any harm.

The ghosts of old scandals haunt all social workers. They all know of colleagues who have been sacrificed in the wake of past disasters that hit the headlines, and they all feel under pressure to protect their own backs. Their political masters cannot be relied upon to support them against any public outcry fed by the press, and any case can erupt into a scandal at any moment. Social services are directly answerable to political masters, who are vulnerable to public opinion. These political masters are generally reluctant to acknowledge that there simply is not the money to provide what is needed to keep children safe.

This reluctance had its consequences throughout the department. It was impossible for senior social workers to openly admit that, on a limited budget, nothing could be done for, say, a 15-year-old who had been involved in prostitution for the last three years, and was keen to continue. Every case had to be seen to be given help. Managers, unable to keep expenditure within budgets, would argue for less expensive provision – or none – for the less urgent cases. Field-workers would thus offer the minimum to clients – and find that the problems were not solved, but recurred in an exacerbated form a year or two later. Then, out of guilt and worry, they would agree to expensive out-of-borough placements and the budget would be overspent again.

To complicate things still further, the field-workers felt themselves to be at the mercy of the courts. They described how judges looked on social workers with suspicion, and would frequently disregard painstaking evidence out of misplaced sympathy for a plausible parent, or denigrate a social worker’s professional expertise while deferring to a psychiatrist who had seen the family on only one occasion and been misled or thoroughly taken in by a false show of insight or promises of reform. It seemed that a field-worker’s place is in the wrong.

The resource workers had the comparative luxury of working long term with ongoing cases, and being protected from some of the rawness of responsibility that burdened the field-workers. They had a little more time to think things through. But the system ensured that the dilemmas that were faced by the ‘purchasers’ were projected into the ‘providers’, too. Just as field-workers had a statutory obligation to work with any child at risk, so the resource workers were made to feel that they had to accept any case that the field-workers sent them. Junior staff on duty at a children’s home could receive phone calls at two in the morning, from levels as high as assistant director, insisting that they take in a new child who would be arriving by taxi within the hour. And just as field-workers lived under the constant threat of reprimand and disgrace, or the deaths of their clients, each resource unit lived under the constant threat of cuts to staff numbers or total closure.

Nor were resource staff immune from the press and the politicians. Here is one example. A white woman had twins by a black father. The day nursery where the mother enrolled them duly listed them both as mixed race children. One of the twins was fair and the other was dark. The mother insisted that the fair child be listed as white, and, when the nursery refused, went to the press accusing the department of racism. The press took it up, and the workers involved were reprimanded, up to the highest level.

However, on a day-to-day basis, the difference in culture between resource workers and field-workers was considerable, and the split was exacerbated by the clients, who brought their own dynamic of violent conflict into the system. In almost any case, violent disagreements tended to break out between the field-worker and the resource worker responsible while the children watched bemused, or sided gleefully with one against the other.

My work centred on the two teams responsible for foster-placements and the two children’s homes linked with them. I attended regular meetings with all four of these staff groups, gradually learning to understand the pressures under which they operated. On another day I offered individual consultation on demand – on the phone or in person – to field-workers worried about individual cases: a structure that seemed more appropriate to their crisis-driven culture. I also offered assessments and clinical vacancies to a few looked-after children. This provided a panoramic view of what was going on for looked-after children within the borough. It was often a frightening prospect: I counted seven deaths among children known to social services within the first four months.

A field-worker rang me in the aftermath of one such death: a small child who had accidentally drowned in a bucket of water while his mother slept. I asked him why he thought it had happened. ‘Just a terrible accident,’ he said. I wondered what might have been going on that had led up to it. ‘I wouldn’t know,’ he told me. ‘I’d closed the case a week before.’ In my naïveté, I imagined I could discuss the case with him as though he were a fellow member of a multi-disciplinary team, someone in a position to think about the dynamics of the case, rather than someone caught up in terror that his professional life might be at risk. I made the obvious link, commenting on how hard it must have been for this mother to lose her long-standing social worker, and how dreadful he must feel that somehow mother’s sense of abandonment might have led to such a tragic consequence. It was precisely the wrong thing to say. I received a furious letter from him and from his team manager, accusing me of cruelty, insensitivity and lack of professionalism.

It was an essential lesson. It gave me an insight into the intensity of the projections that operate within the system. It forced me to realize how powerfully clients project into their social workers, and how field-workers, in consequence, become so identified with the families they work with that they are unable to think and have to pass the feelings on. My feeling, in the contertransference, was that I had been worse than useless: I had done irreparable damage, I should count myself lucky to be only reprimanded rather than publicly sacked and disgraced, and if I had any conscience as a professional I would instantly hand in my resignation – all this when I had thought I was just doing my job. It was the best possible demonstration of the pressures under which field-workers operate, and I kept it in the forefront of my mind from then on.

In my conversations with the Head of Resources, we both recognised how much more vulnerable the field-workers are to these projections than are the resource workers. Resource workers operate within a team structure that offers some protection, however fragile. Within the fostering teams, the workers delegate to foster-carers, who take the fullest force of the projections. Field-workers, like foster-carers, take on cases that flood them with feelings that are difficult to understand, and work with them in relative isolation. In many cases they are filled with the neediness of the parents who function at the same level as damaged children, and in their concern for them find it almost impossible to make space to think about the conflicting needs of the rest of the family.

Because of the power of the clients’ projections, on the one hand, and the need to reduce expenditure, on the other, there was, throughout the department, an overwhelming wish to deny the level of damage in looked-after children and a longing to believe that all that was needed was a good experience in a normal family. The field-workers, who met with the children once every fortnight at most, had little evidence to help them challenge this delusion. But the fostering teams, who had to support their bruised and battered foster-carers, knew better. As a result, my difficulties in communication were least extreme with the link workers in the fostering teams, though here too the fear of allegations and consequent reprimand or disgrace was a constant pressure. The field-workers were liable to believe a child’s allegation against a foster-carer and remove the child forthwith. The link workers within the fostering teams would be powerless to protect their foster-carers.

At one early meeting with the twelves-and-under team, link workers described how their foster-carers avoided physical contact with children for fear they might be accused of sexual abuse. One member reported that foster-carers were advising one another that this was ‘good practice’. The team were shocked to realize what was happening. Young, frightened children, separated from their parents, could go to bed night after night without a goodnight cuddle, while they watched their foster-carers showing ordinary affection to their own children. We discussed how much this must exacerbate a foster-child’s jealousy, and how violent and angry it might make him. Workers gave examples of behaviour that, they realized, might well be the result of such feelings. They started thinking about how much a child who had been sexually abused might wish to return to the abuse if the alternative was life without any physical affection at all, and how such treatment was bound to increase their belief that the abuse was their own fault, or made them bad and dirty and unloveable. We discussed how the team could help their carers to distinguish parental cuddling from sexual cuddling, and pass this learning on to the children. ‘Yes’, they said, ‘but how do we pass that learning on to the field-workers?’

Indeed, my early meetings with the resource teams were dominated by complaints about the unthinking behaviour of the field-workers, and it was hard to find a helpful response. I could talk, and did, till I was blue in the face, about the persecutory pressures that the field-workers were under. But far the most useful solution, I discovered, was to ensure that in all such cases the foster-team link worker could arrange a consultation meeting for themselves and their field-work counterparts so that we could discuss the case together.

Over time, as I got to know the network better, I used these meetings in a variety of ways to explore cases with workers, carers, children and parents. Perhaps I can best illustrate this by turning to case material.

Some Case Examples

Yepoka
A foster-team link worker brought a field-worker to a consultation to ask my opinion over a disagreement. The field-worker had placed a 9-year-old African girl, Yepoka, with temporary foster-carers of a different ethnicity. The girl’s father was a prominent figure in his expatriate community. He had been a politician within an oppressive totalitarian state, and used to beat his daughter regularly, insisting that within his culture this was what good fathers did to instil discipline. His wife, Yepoka’s stepmother, supported him, and explained that Yepoka was lazy and needed firm handling. When the girl’s school had expressed concern that Yepoka arrived in clothes that were not warm enough for the cold weather, her stepmother had dragged her into the headteacher’s office, thrown her to the floor and insisted that she apologize on her knees for her slovenly appearance. Eventually the girl showed her scars to her teacher, and was taken into care. The field-worker was anxious to ensure that she found Yepoka a foster-home that exactly matched her ethnicity, but the girl was frantic not to be placed with anyone who might know her parents, or have any connection with them. When the field-worker tried to move her she swallowed a bottle of disinfectant, and had to be taken to hospital.

The link worker felt that Yepoka should stay where she was. She had made a good relationship with her foster-mother. She was, very slowly and fearfully, beginning to talk to her about how her parents had treated her. But the field-worker felt in a quandary. She thought she should try to move Yepoka again. Surely the girl must need to be in a same-ethnicity household, or she would have problems later around her racial identity.

I talked about a hierarchy of needs. First, the girl needed to feel safe. Considerations about racial identity could come later. Maybe in time she might want to visit with people from her parents’ country, but for the moment she felt that they were all part of the terrorist regime under which she had suffered, and she could not trust any of them.

The field-worker saw the point, and thought that that might be all right, so long as I was prepared, in my capacity as a health professional, to back her in letting Yepoka stay put for a while longer. But what about contact with the parents? Surely it was important that contact was maintained.

The link worker said that Yepoka had made it clear she did not want contact. The field-worker disagreed. The girl had not actually said that she did not want to see them. She just ran away whenever a visit was arranged.

I asked if the field-worker had ever met with the girl and her parents together. The field-worker described the one meeting they had had. Yepoka had sat in silence, her head down, while the father and step mother shouted at the field-worker, and threatened her with legal action, calling her a racist. The parents had not spoken directly to the girl, or asked after her, or shown any interest in how she was doing. I asked why the field-worker felt that contact was so important, as neither the daughter nor her parents appeared to want to communicate with one another. The field-worker thought that maybe the way the father and stepmother had behaved was what would be expected within their culture. The parents might accuse her of racism if she did not take account of that possibility, and the courts might agree. They might refuse to grant the care order. She was certain that the judge would go against her if she failed to show that she had supported contact. The judge would be sure to take the parents’ side. She had consulted her manager, and the legal department, and they had both shared her anxiety.

I was struck by how the field-worker was as scared of the courts as the girl was of her family’s compatriots. I talked about this, and about how much the girl needed someone to prove to her that there were grown-ups who could withstand being bullied and oppressed. The field-worker agreed – in principle. But she felt unable to take responsibility for the decision. Would I not see the girl, and get her to tell me in so many words that she did not want to see her father and stepmother? Then I could take responsibility if the courts questioned the lack of contact.

It was clear that, before she could help Yepoka to feel safe, I had first to help the field-worker to feel safe. In the face of her terror, I agreed on a compromise. I met the girl, along with her foster-carers and the link worker, and was then able to tell the field-worker that I could bear witness to the fact that Yepoka had told us that she did not want to have contact with her family. The field-worker had refused to be present herself, for fear the parents would claim that she had influenced their daughter’s decision.

It would be easy – and misguided – to deride the field-worker for her lack of courage. But the link worker and I were protected. She was not. There was a reality to her fear. When cases went wrong, they could spiral into a series of complaints and allegations that caused huge distress to all the workers involved and seemed almost impossible to resolve.

A cycle of blame
One such case was notorious: ‘Every time you touch it, it’s like picking up shards of broken glass’, as one worker said. A spate of allegations had been generated around a large family of siblings who had been taken into care. One foster-mother was accused of sexual abuse, because she had been allowing a scared 3-year-old into her bed when he woke in the night. Another foster-carer laid an official complaint of negligence against a field-worker because she had cancelled a visit. All the professionals quarrelled bitterly about which of the siblings should be placed where, and in what groupings. Expert after expert was called in to endorse the various views, and their advice duly differed, according to which professional had briefed them.

On the surface the disagreements hinged around two vexed questions of policy, on which various professionals took their stand as though they were articles of religious faith. Number one: siblings should never be placed separately. Number two: children should always be fostered by carers of the same race. The passion aroused by infringement of these rules was considerable, and it was extremely hard to move the conversation beyond the rules and consider the individual circumstances of the children involved.

The parents were of mixed race, well-educated and plausible, and each had in turn convinced the authorities that it was the other parent who was to blame for the ill-treatment of the children, while they themselves were innocent. However, both were addicted to their sadomasochistic relationship with one another as well as to drugs. All the children had had to watch and be part of their parents’ violence, and had also suffered long periods of total neglect. Social workers, misled by the parents’ plausible explanations, had taken the children into care for a week or two at a time and then returned them. It was the foster-carers who had fought to get the scale of abuse recognized, and had eventually succeeded. The foster-carers were, consequently, virulent in their criticism of the field-workers. The field-workers reciprocated by invoking policies: the foster-carers were the wrong ethnicity, they refused to take on all the siblings and had ‘favourites’, preferring the ones who were less violent, or less damaged. They got too close to the children: this was surely not good practice, as the children might need to be moved after a year or two, and should not be encouraged to bond.

I talked with all of them about how the cycle of blame that had been set up exactly replicated the behaviour of the parents. We discussed how the policies that were invoked, however useful as a general rule, got in the way of looking at the particularities of these children and this case. That, again, replicated the parents, who were able to present plausible and convincing rationalizations that had understandably deceived the field-workers, and disguised their neglect of the children. We thought that a similar dynamic might have been true for the parent and they might have sought refuge from their own emotional pain in the buzz of sex, violence and drugs. We began to look at how the children were behaving, and how the siblings who were placed together were themselves replicating the sado-masochistic relationship of their parents. It soon became clear to all the professionals how much the ferocious cruelty of these parents, along with their capacity to intellectualize, had filtrated the entire network, and attacked a capacity to think in the workers as well as in the children.

Slowly, over many months and after many meetings, the animosities being played out by the professionals began to be resolved. The various workers began to think together and arrive at compromise solutions, giving due weight to everyone’s point of view. The complaints and allegations were eventually dropped. For the first time, the children experienced a group of adults who could think together about their needs, rather than fight one another. Their behaviours began to show some improvement, and plans for their future were reached by consensus.

The usefulness of talking together
As I became involved with more cases, and got to know more foster-carers, I became more aware of the fostering culture. In the fostering teams, we started regularly to discuss the dynamics within the groups of foster-carers: how their rivalries reflected the fierce jealousies the children imported into the network, and how that in turn was projected into the link workers and field-workers.

Two looked after children with different foster-carers had been involved in some slight sexual exploration when one had stayed the night in the other’s home. The two foster-carers immediately started to fight about which child was the ‘abuser’. The field-workers of both children became very anxious, and wanted to remove one child from a placement where he ‘posed a risk to other children’, and the other child from a placement where ‘the foster-carer had proved unable to protect him’. The fostering team workers were unable to defuse the situation, and asked me to intervene. I convened a series of meetings with the foster-carers, field-workers and link workers, where we were able to explore the backgrounds of these children and to relate what we knew of them to their behaviour that evening. One child had been sexually abused, the other had been frequently punished with beatings to his bare bottom. We thought about how confused these boys must be about what was punishment and what was sex. We thought about how jealous the one child must have felt of the other who had been invited by his foster mother to spend the night, and given special treatment because he was a guest. We thought about the rivalry between the two foster mothers. We could all understand, in light of our conversations, why the incident might have happened, and how much more useful it would be for both children if their carers and social workers could talk with them about such issues, rather than disrupt their placements. The panic subsided, the children stayed put, and I provided ongoing consultation to the workers on how to talk to the children.

Leroy
I soon found that in many cases which were presented as referrals for therapy I could intervene more usefully by holding similar meetings with the workers. This became an increasingly effective method and I developed stronger ongoing relationships with many of the link workers and field-workers, who had discussed numerous cases with me.

Once such case involved young Leroy. Leroy’s placement was on the point of breaking down and his field-worker wanted to arrange immediate psychotherapy for him. I refused, but offered a series of occasional network meetings. When it emerged that Leroy’s behaviour was always at it worst after weekend visits to his mother Yvonne, we decided to invite her to join us.

Yvonne came to several meetings. She was able to talk with us about Leroy’s experiences as a toddler, and her guilt about what had been done to him – things we had not known about before. As Leroy’s foster-carers grew closer to his mother and gained an understanding of her history, Yvonne became less possessive and more able to support his placement. Leroy’s behaviour became less and less worrying, and I began to hear of his success. He was doing well in school for the first time ever. He did so well in his work experience placement that he was offered a permanent Saturday morning job.

Just before I left the borough, I received a phone call from a colleague attached to an adolescent counselling service, to tell me that Leroy had referred himself to the service for individual counselling, and was using it well. He mentioned my name to the counsellor and asked if she know me. ‘When you next speak to her,’ he said, ‘say hi from me. Tell her I’d have lost my placements if it weren’t for her.’

I was very struck by how important I was in Leroy’s mind, although he had never met me. It helped me to understand more clearly what needs to be provided for these children and their carers, where the continuity between babyhood and subsequent childhood has been breached. Leroy needed someone to provide a bridge between his infantile experience and his present reality, to make sense of his inner world for himself, and help his foster-carers make sense of it too. He needed to feel that they had insight into early experiences that he could barely remember and certainly could not describe. Most importantly, he needed to feel that they could make a sympathetic relationship with the mother of his infancy, so that he could attach himself to them without too great a conflict of loyalties. I could do this for him in a very concrete way, bringing together his mother and foster-carers, helping her to give us information bout his childhood, helping his foster-carers to make sense of what they heard, and supporting his social worker and his foster-carers’ link worker to continue the process. For many looked after children such an intervention is impracticable: birth parents cannot or will not cooperate. But it is still possible to achieve the same result: a network of carers who interest themselves in a child’s inner world, and who see it as part of their job to make sense of it.

Keeping in mind the wider network
In individual treatment, we try to help children do all this work for themselves. I think that that is sometimes too much to ask of them, and frequently too much to ask of the struggling network. The children may make good use of us. But who, then, do we become for their workers who are left out of the process? In the transference we easily turn into the possessive birth mother, privy to intimate information but refusing to share it, jealously guarding our special relationship and making it harder for our patients to bond elsewhere.

All child psychotherapists who work with looked after children will be aware of the possible consequences. Foster-carers and fieldworkers can abdicate responsibility for the inner world of the child, leaving all the emotional work to a therapist and providing an emotional desert – unsatisfying for them and unhelpful for the children. They can feel threatened by the therapist’s expertise and excluded by the requirements of confidentiality. They can be seduced by the child’s need to denigrate therapy. They can feel jealous of what the child is getting when they get so little themselves.

If we can bear to relinquish, at least for a while, the privilege of being the primary object of a child’s passionate transference, I think we can provide for the wider network what Yvonne could eventually give to Leroy: a mother who can bear to relinquish her child to others, appreciate the value of what they can give and enable them to understand something of her child’s inner world and early experiences. Most importantly we can use our expertise to bring a group of carers together, rather than join the group in a way that may exacerbate splitting.

In the volatile atmosphere of a social services department, any splitting in the network can lead to further splitting, and ultimately to the loss of a child’s placement. That is a high price to pay for individual psychotherapy. As untrained foster-carers are asked to look after increasingly disturbed children, and as social workers are placed under increasing pressure by lack of resources, looked after children find themselves being moved between one placement and the next with frightening rapidity. Once-weekly psychotherapy is a poor substitute for a stable home, as I discovered in my work with Deirdre.

Deidre
Deirdre was a 9-year-old with a history of sexual abuse. She was a strikingly pretty child with long fair hair, blue eyes and an engaging smile. She had been successfully placed in a long-term foster home with carers who, it was hoped, might eventually adopt her. Within months of the start of our therapy, her foster-carers announced that they could not keep her. Deirdre was moved to a temporary placement, and after a year to another foster placement which it was hoped would prove long term. Lyn, the new foster-carer, seemed at first to be ideal. She and Deirdre had so much in common; fathers who came from the same part of Ireland, a love of cuddly toys. The honeymoon ended abruptly when Lyn found herself telling Deirdre what she had never told anyone before: that she too had been sexually abused as a girl. Having made this disclosure, she found herself hating Deirdre, who had to be moved yet again, this time to a placement too far away for her to continue in her therapy. This is the sort of story that child psychotherapists working with fostered children will find depressingly familiar: a few years of good work disrupted by failed placements.

My involvement with the network meant that, around each change, I could at least call a meeting of professionals. At first this was vital to prevent the ending of Deirdre’s therapy, whenever Deirdre wanted to pass on to someone – me – yet another experience of abandonment. Later, as the understanding between the professionals grew stronger, we could use the meetings to discuss what was happening, and how the field-worker could talk to Deirdre about it. Eventually, we were able to include Deirdre herself in the meetings, safe in our knowledge that we formed a cohesive group around her.

This was particularly useful when Lyn had disclosed her own abuse to Deirdre and thereafter ‘couldn’t stand the sight of her’. The link worker started the conversation, making it clear that she know that Lyn’s reaction was not Deirdre’s fault, and that, on the contrary, Lyn had let Deirdre down. She and Deirdre’s much-loved field-worker then discussed why it had happened. They related it to Deirdre’s own feelings about things she hated to think and talk about. ‘It’s not Lyn’s fault, either’, said the field-worker, ‘It’s just that, because she’s kept it a secret all these years, she’s never had the chance to get over it, and she hates thinking about it. And when she sees you she finds herself thinking about it. And then it hurts. You know, it’s just like how you sometimes hate talking to me or coming to see Jenny, because it reminds you of things that hurt.’

Deirdre looked thoughtful. Then she said: ‘You know, Lyn showed me her photo album, and they were all in black and white. They didn’t have colour photos in her family when she was little.’ The link worker agreed that maybe sometimes Lyn did see things too much in black and white, particularly around painful issues to do with her family that she had never had help to think about. Perhaps that was because she herself came from a family that, like their photos, could only see things in black and white, and she had not been helped to change.

There was a pause. Deirdre looked hard at me and then looked hard at her field-worker. ‘You and Jenny come form the same family, don’t you?’ she said. ‘Are you cousins?’ This was, on the surface, an odd thing to say, as the field-worker was black and I was white. But she and I had worked with one another for a long time on this and other cases and had developed a shared understanding. So now we agreed that we often thought in similar ways, because we had spent a lot of time thinking together about Deirdre. We said that maybe that helped us to see different shades of colours, and not just black and white. When last I heard of her, Deirdre was informing her new foster-carers that she needed more psychotherapy, because she was stealing again, and would they please arrange it.

I think Deirdre’s feeling that her therapy was supported by a network family that could think together in the same way was at least as helpful to her as what happened within the therapy itself. But the fact remains that we were unable to prevent the breakdown of her placements, and ultimately of her therapy. I often wished that I had insisted on working with Deirdre – and others like her – in the way I decided to work with subsequent cases. Ali was one of several.

Ali
Ali was a 10-year-old boy who had been severely physically abused by his parents and his violence had lost him his first foster placement. His second foster mother, Yasmin, had agreed to take him on long term after six months as his temporary carer. At this point he tried to throw himself under a lorry on his way to school, and she panicked. I was asked to see him in individual therapy but, wiser by this time, refused and insisted on seeing him along with his foster-carer. She was extremely reluctant, but I had the support of the foster team behind me, and after a few preparatory meetings with Yasmin and her link worker, she and Ali duly arrived in my therapy room.

At our first meeting I was astonished by the apparent similarity between them. To look at, they could have been brother and sister. Both were small, dark and skinny, with the same intense, wary expression. But there was a difference in their behaviour: Ali immediately climbed up on the windowsill, methodically threw each of the plants onto the floor and then proceeded to tear down the curtains. Yasmin sat quietly in her chair, staring past me into space, as though oblivious of what was happening.

As Ali turned his attention from the curtains to the window itself, and attempted to break the glass with his fists I gave up on trying to dissuade him and turned to her, wondering why she was not helping me to get him down onto the floor. ‘Oh,’ she said, ‘I didn’t think you’d want me to interfere. You never said.’ This childlike passivity typified her involvement over the first few sessions. I met with them once a fortnight, and once a month with the network around them: Yasmin’s link worker, Linda, Ali’s field-worker, James, and Ali’s teacher.

James and Linda, it transpired, were at daggers drawn. This split between a field-worker and a link worker was by now familiar. The overt disagreement was around contact with Ali’s mother: James was keen that contact should resume as soon as possible. Linda and Yasmin, aware that Ali’s mother would use any opportunity to tantalize Ali and then disappoint him, were profoundly opposed to it.

I soon discovered that James himself had been refused contact: Yasmin would not allow him to come and visit Ali. She said that he was tactless and upset things, and Linda supported her. I said that, however tactless James might sometimes be, he was Ali’s social worker, and had a right to see him. Yasmin was a single carer, who had left an abusive husband. I thought that James had an important role as a father figure. I wondered why he was being treated as an abusive father who should not be allowed contact, and what sort of message this gave Ali about male authority figures, and what his foster mother thought of men.

This led to a fuller discussion. We started to wonder what was being re-enacted when James – a rather gentle person – was given the role of ‘tactless’ man who upset people. I suggested that there was an unconscious attempt to turn him into a violent male like Ali’s father or Yasmin’s ex-husband. Linda was struck by this idea, and thought I must be right. She described how social services had always seen Ali’s father as the aggressor and Ali’s mother as the helpless victim. But, now that they had separated, Ali’s father had been able to work on a good marriage with his new wife, and to co-operate with Ali’s social worker, while Ali’s mother was still playing provocative games in her current partnership, as well as in her relationship with social services and with her children.

As they explored this dynamic, James became clearer about why Ali should not resume contact with his mother, and Linda started to question why she had colluded with Yasmin in refusing to let James visit. As their relationship gradually improved, so did Yasmin’s ability to use our sessions.

As first, the best she could do was to come in and give me a catalogue of Ali’s wrong-doings since last we met. I talked about how frightening it was for Ali to come and hear this list of grievances, as though he were here to be told off, and wondered about how we could all understand things together. Ali responded by telling the story of one of Yasmin’s many dogs that he had taken for a walk. The dog must have suddenly smelled something – it started leaping about, got out of control, the lead broke, it ran away, and he would have lost it altogether if a friendly person had not found it and brought it back to him. I talked about his anger about everything that had happened to him in the past, and how he sometimes got a whiff of something that reminded him of it, how he tried to keep it in control, but sometimes he couldn’t, the lead broke and he lost it, just like losing the dog. I said it was so important that we could be friendly people who could bring the dog back, help him keep it on a lead, mend the connections. I talked about how difficult it was for Ali when Yasmin could not do this for him herself, and that that was why she needed to come here – not to get him punished but to learn to understand things better along with him.

Ali picked up the felt-tip pens and drew a picture of a plant in a pot. I asked Yasmin what she thought that might mean. She did not know. There was a pause. Then Yasmin started to talk about the weekend. She had some of her family coming to stay, and of course they would be leaving the children with her for a week while they went on to visit other family further north. And she had taken in another stray dog. She and Ali both hoped its owner wouldn’t claim it back, as it seemed so happy to be with them. But the other dogs were a bit jealous, and she had to keep them all in different rooms to stop them fighting.

Meanwhile the plant in the pot was growing and growing till it filled the whole page. I commented on its size, and Ali said it was a plant his teacher had shown them at school. It was called Lizzie something. I said I thought it was a busy lizzie: maybe that was a bit like Yasmin. Yasmin laughed and admitted that she did take on a lot: she enjoyed being busy. I said I thought sometimes Yasmin responded to problems by taking on more problems: no wonder Ali was worried about her, when I was expecting her to do yet more work on his behalf.

Ali was right to worry. After a few months Yasmin told Linda that, while of course I had been very helpful, she now thought the crisis was over and they had had enough. Anyway, Ali did not want to come – he felt I was making things worse.

In a network meeting James and Linda discussed this response. They were able to see quite clearly how I had now become the ‘James’, the one who upset things. They were both fully aware that Ali was continuing to cause problems both at home and at school, Yasmin was running away from acknowledging the difficulties she would have to face as Ali grew into a young man. With this in mind, we decided that perhaps we should accept Ali’s reluctance as an opportunity. I invited Yasmin to continue meeting with me on her own, for a while, until Ali felt ready to return.

Yasmin came. She was a little hesitant at first, but within minutes began to tell me that she had started to realise for herself how much she wanted to keep Ali as a baby. ‘I don’t think I really like men,’ she said. She described her own background, her rebellion against her culture which she felt put girls down and allowed boys to get away with anything, how it had meant that her brothers got a good education, while she was expected to be a secretary, at best, because she would get married and have children. ‘Not that I don’t like children: it’s just a pity you have to marry someone if you’re going to have them.’ She told me about her failed marriage, and how she had chosen to marry someone she knew that her family would hate. But they had all sympathised with her when he had become violent, and had helped and supported her. And now they all understood why she would never want to marry again. I talked about her dislike of men, and what a hard dilemma that put Ali in. How was he to learn to be a good man when his foster-mum, whom he wanted to please more than anyone, did not like men anyway and preferred babies? Yasmin was very thoughtful about this. She started to talk about her own relationship with her mother, how much her mother wanted to keep her a baby, and how angry it had made her feel. ‘Of course, I couldn’t tell her that: it would have made her cry.’ Slowly we began to realise together how much Yasmin had needed to project all her own aggression into males.

Some weeks later, Ali decided to come back and join the sessions. At our first three-way meeting he said he wanted to talk about how angry he had got with Yasmin when they went on a bike ride together. ‘The trouble is,’ said Ali, ‘she doesn’t go fast enough.’ He said he thought there was something wrong with her bike: she should try to get it fixed. He started talking with great enthusiasm about overhauling their bikes, and how he had been starting to look at them the previous evening. He explained how one of them needed a particular fitting – a rod going into a hole. He drew it to show me. And he thought that the rod would need to be held on really firmly. There would need to be three blocks holding it in place. He added them to the drawing. I talked about his wish for a threesome – a father as well as a mother and son. I said it was maybe hard to be growing up, wondering how men and women got together, when he had a foster-mum but no foster-dad. I wondered whether he thought that his foster-mum would be upset if he was interested in that kind of thing: would she think he was going too fast for her if he was already thinking about it and trying to make sense of it?

I was aware, as I talked, of my own anxiety about going too fast for Yasmin. But I thought of her anger with a mother who expected her to stay at home and be a little girl while encouraging her sons to get an education, and felt that to underestimate her understanding would be the greater danger. Yasmin proved me right. She started to talk to Ali with great sensitivity about her sadness that she could not provide him with a father, her worry that he might feel that she would prefer him to stay a baby, and might not want him to grow up and become a man. She said she had been wondering about something, and had thought she would bring it up in this meeting. Her uncle and his son ran a garage: how would it be if she asked them if Ali could go and help sometimes, and learn about mending cars? And she thought that she would maybe use the time to do a course and catch up on her education.

Before I left the borough, Yasmin asked me for a referral to a private therapist. Ali too has gone into individual therapy, at his own request. When I least heard of them, Ali was at secondary school, and holding his own, and Yasmin was at college and doing well.

Conclusion

In their search for containment, looked-after children project elements of their disturbance into the network around them as powerfully as they do into us and our consulting rooms in the course of individual treatment. As child psychotherapists we have an expertise that should help us to make sense of this process. Similarly, our understanding of the unconscious interactions between children and parents gives us valuable insights into organisational dynamics. Social services departments are desperately in need of the help we are equipped to provide.

However, this is work that needs to be undertaken with caution. It can be hard to step back from the lure of one-to-one work with children, and our identification with them, and still harder to keep thinking psychoanalytically with a group of professional colleagues amid the turbulence of a social services environment. Over the years, I have found it essential to undertake extra training and supervision, in order to understand the dynamics of these and other organisations.

It is increasingly important that child psychotherapists working with looked-after children broaden their scope in order to understand and interpret the wider perspective, and provide better support to social workers and foster-carers who struggle with increasingly complex cases. Few of us would consider taking an individual child into therapy without working with the family. For looked-after children, parental responsibility is often in the hands of a complex organisation of carers, including field-workers and their managers as well as foster-families and birth parents. We have an obligation to learn to work more effectively with that larger family.

Acknowledgements

An earlier version of this paper was presented at the ACP Conference in London, October 1999. As an organisational consultant my work has been greatly influenced by the supervision and support of Dr Anton Obholzer and a long fruitful collaboration with William Halton.