Therapeutic observation of an infant in foster care

Abstract

The paper describes a clinical research study of therapeutic observation of an infant in foster care. Infants and children under five represent more than half of all children entering care in the UK. The emotional needs of this population tend to be overlooked. This study aimed to find out about the experience of an infant or young child in care, to learn about possible reasons for the under-detection of mental health and emotional difficulties in a group of particularly vulnerable children, and to inform training and support for professionals. Therapeutic observation has been reported to be a cost-effective, home-based component in multidisciplinary treatments for infants and young children with a range of difficulties. The study found that the model was acceptable to foster carers and provided a child-centred perspective to the professional network. Grounded theory analysis of the observational data produced a description of dynamics around the infant in foster care, varying from experiences of emotional connectedness and containment (Matrix) to those of confusion, pressure and fragmentation (Tornado), dissociation (Machine), and drift or provisionality (Limbo). Observational data suggested that when ‘Tornado’, ‘Machine’ and Limbo dominate, organisation is driven by trauma rather than by development. This increases the risk of losing contact with the emotional reality of children's experiences. Dilemmas are also explored in relation to the transition from foster care to adoption. The study highlights the role of specialist training to support emotionally responsive caregiving for infants and young children in care. Further research is suggested to investigate the application of this model with infants and young children in a range of care contexts.

Keywords:

• looked-after infant
• foster carer
• transition to adoption
• therapeutic observation
• clinical research
• grounded theory

Acknowledgments

I owe a particular debt of gratitude to Nadira and her family, who welcomed me into their home, and from whom I learned so much. I wish to thank the social workers and managers who collaborated and gave support to the project. As tutors on the Doctorate in Psychoanalytic Child Psychotherapy at the Tavistock Centre, Biddy Youell and Michael Rustin provided helpful guidance in the early stages of the project. My supervisors, Margaret Rustin and Eilis Kennedy, were very generous with their time, thinking and support. I also thank my first tutors in observation, Dilys Daws and Roberta Mondadori, for giving me a grounding and enduring interest in this way of working. I express thanks to Kate Robertson, Kasia Macholla, Leonie Gafson and Kat Johnson for their assistance, to Gianna Williams, Anna Fitzgerald and Thomas Hillen for many fruitful discussions, and to Birgit Mallmann, organiser of the Grundtvig European Learning Partnership ‘education for foster parents’ programme. I gratefully acknowledge Deborah Steiner who helped me to conceive the project and to see it through. I also wish to thank family and friends who were ‘companions on the journey’, and my husband David Matthews for reading many drafts and sharing my interest in the project.