From mythical idealisation to political and personal reality

Dr Joanna North, winner of the Society’s Award for Distinguished Contributions to Professional Psychology; what lessons can be drawn from 10 years of running an Ofsted-registered adoption support agency?

Children can act out in bizarre and disturbing ways when they feel threatened by new experiences, when they are afraid and insecure. As a psychotherapist and psychologist in this work, I can end up holding in mind a lot of disturbed behaviour. At such times of confusion I always bring myself back to a central principle of psychological work: always listen and remain focused on the client rather than the theory. My adoptive parents are not just moaning and complaining, they are telling us about their lives. That particular client, in that particular moment, has unique needs. Even during the most chaotic episodes I have noticed that adopters really find it healing to be considered as an individual rather than an object to be worked on.

This is true for clients who at first appear difficult and defensive, as well as those who are vulnerable and distressed. When we identify the strengths of the client, they can build their own healing pathway through what at first appears to be indecipherable behaviour from a child. If I am supportive and empathic and work with them on the journey, I’m much more likely to get the outcome that I want: a supportive parent providing good care during good times and bad. This is what I have to model, and this is what I can start to do by listening.  

The second principle is to focus on my own self-care, so that I am fit for practice and fit for my life. It’s too easy to disappear in a slurry of demand, and I have learned that I can work very hard as long as I give back time to myself to rest and play very hard too. Simple centring practices such as stretching, breathing and yoga keep me focused and feeling well, and I take regular breaks and focus on my own hobbies. My service users notice when my batteries are running down and seem glad I am taking a break. This is another mirror of what I am asking the adoptive parents to do. We have a saying – ‘put your own oxygen mask on first before you help others’. I have to be a good model of this for my adoptive parents or they won’t believe me.

Aside from these abiding principles, which serve me time and time again in this work, I think the key learning that I would want to share is that I have learned not to be afraid to risk failure. If you put any effort into a project, you might not get the exact outcome that you planned for; but you will get an outcome. There have been times over the last 10 years of maintaining my adoption agency that I have been faced with potential failure: for example, drastic government cuts in 2012 meant that local authorities were not spending money on adoption support services, and my income plummeted to a degree that I thought that I would have to close it down. I temporarily let my office out and worked from home, and undertook agency work at Child and Adolescent Mental Health Services. This was both a blessing and a wonderful learning experience, but it was also an enormous challenge: a day’s work at CAMHS and stopping off to see the adoption support service users on my way home or at weekends. I felt absolutely at sea, but I would not let go of what I had created. My instinct said that things would change. Then two years ago government funding was released for adoption support and there is now a demand for adoption support agencies – and my agency is there, not lost on the tide of economics as I feared it might be, but up and running and open for business. Don’t fear failure, and don’t ever give up if you feel that what you are offering matters.

The changing face of adoption
The face of adoption has changed dramatically over the last 60 years in this country. We are more skilled at identifying the psychological impact on adoptees, particularly on their sense of identity and belonging, and the effects of trauma and broken attachment on the sensitive and developing brain of a child. What was historically a very private and personal experience for families has become a process run by statutory demands and procedures, deeply embedded in our social and political structures. Yet this sophisticated social machinery has not made adoption either smoother or less complex. There remains around the process of adopting children a critical tension between the rights of a child to be with a birth parent and the rights of a child to a life free from harm.

Why do adopters need support? Surely being an adopted parent is just like being any other parent, and the lines of difference are blurred by the overwhelming nature of parental love, with everyone living happily ever after? This is what we have all believed, this mythical view of adopting someone else’s baby knitted into the fabric of society. The idea that adopted children might always crave a relationship or have a biological sense of the primary parent from whom they were separated was not part of either social or psychological consciousness in the past. It was never discussed. It is now becoming a part of our everyday thinking and discourse about adopted children.

It is true that for many adopted children, adoption is a happy and secure process. National figures on ‘failed’ or unhappy adoption have never been formally gathered, but it is believed that it may be up to 20 per cent that are fraught with continuous difficulty, starting with troublesome anxiety about attachment within the family home, and potentially ‘ending’ with children being sent back into care or walking out in their teenage years. This is the area where adoption support was recognised as a necessary part of the package of extreme change families are subjected to.  

Children are adopted because their primary homes are insufficient to meet an acceptable standard of care. Contrary to populist views in the press, it is not easy to take a child out of a pathogenic or abusive environment. Social workers cannot go into homes heavy handed, to snatch babies from innocent parents who are trying their best. It takes very extreme circumstances for children to be taken from their homes without warning (one way being a Police Protection Order, which requires special consent), and even once this is achieved it takes at least a further year of court proceedings for an Adoption Order to be made by a judge who has determined that there is never any chance of a child being cared for to a reasonable degree by their parents. The test is of significant harm to the child, through neglect or indirect or direct abuse (physical, mental, emotional or sexual). A threshold has to be reached where it is deemed that a parent just cannot provide an environment in which the child can thrive with a sense or security or reach life goals. Even if meeting this criterion of significant harm is proved in the courts, it is often the case that children remain in foster care and have regular contact with their birth parent during that time. It will take a minimum of a year of foster care before any child is finally found an adoptive parent, and this is not always straightforward.

There is no doubt an infant is an appealing bundle: developmentally, a baby will adapt quickly to a new carer and so it is easier for babies to be placed. A child who is placed into foster care at two will possibly be three by the time they are adopted, and that is a lot of development under the bridge with an interim foster carer before the child is finally settled. What this means is that during the adoption process the child may have experienced three primary carers in as many years: the primary parent in which care will have been either pathogenic, abusive or neglectful, the foster parent where the attachment formed is only ever temporary, and the final destination of the adoptive parent. It is not really surprising then that a three-year-old may arrive with a new adoptive parent feeling less than confident about permanency in life, even assuming that the process of foster care has gone well and the child has had a satisfactory experience of human attachment.  

And this is an extremely straightforward example. Many children in our current social environment are adopted in groups ranging from a duo to a group of six or more. I can’t quite think of anyone who would be prepared to meet the needs of a group of children who have come to harm… without some support. Fortunately our last Prime Minister, David Cameron, took a personal interest in supporting adoptive parents, and following scoping and feedback made a fund available – even in these austere times – so that adoptive parents can have the emotional and psychological support that they need to survive the transition into their adoptive ‘for ever’ family.  

This is where adoption support becomes important: helping new and relatively naive carers to understand why their little person or people may not be able to return immediately the endless love that they wish to offer, or why even they may actively reject and fight this. Indeed, their love may be a threat to a small child. New adoptive parents need to understand the defensiveness of any small child who may be fighting for their psychological survival, given that they don’t know what is happening to them. It’s not their fault that they had to change carer; it’s not their fault that they had to leave their primary home in the first place.

The impact of this anxiety on the child’s developing brain is obvious, but how to manage it so that the child returns to a secure state of mind from which to feel confident and happy about new carers is a complicated and nuanced process that requires sensitive support… particularly of the carers, who are often shocked to have their hopes and dreams floundering.

Adoptive parents have their own adaptation to make as parents: we forget this, thinking it is about keeping the child happy. If we add to the mix the possibility that children have undiagnosed conditions that need extra sensitive care of their special paediatric needs, for example fetal alcohol syndrome and children born drug-addicted, we can see where the stress emerges from. Children may also have inherited neurodevelopmental conditions such as autism and ADHD, or learning difficulties, which profoundly affect their behaviour and make them hard to understand or help in the early stages. This is all aside from the child’s underlying vulnerability to stress due to the trauma of separation and very likely the harm caused by abuse or neglect in infancy. Do you start to get a picture of what modern adoptive parents are up against?

Towards a model
In 2010 I took the time to understand these processes in a more in-depth way, completing a doctoral research degree with Metanoia and Middlesex University into looking after adopted children with troubled behaviour. This culminated in a workbook for parents advising them on how to understand a child who has been adopted and why their mindset might be different. The book, How to Think About Caring for a Child with Difficult Behaviour has sold over 1000 copies. In 2015 I followed it up with Mindful Therapeutic Childcare, which discusses further developments in my thinking about the care of troubled children. More recently I published Mind Kind – Your Child’s Mental Health.

The model that I propose makes the construct of mentalisation, from Peter Fonagy, Howard Steele and others. I stress the importance of securing the mind of the parent (Steele at al., 2003), a capacity that is particularly important for adopted children with a history of maltreatment. My work, based on this model enables parents to become ‘mediator, reflector, interpreter, and moderator of the child’s mind’ (Slade, 2005), providing a secure and unambiguous base for their child. I have made it the focus of my work to find straightforward ways of supporting the development of reflective function in parents, so that they are well placed to see any problems as issues arising from attachment disorders. Simplifying complex psychological concepts for parents enables them to understand their child’s otherwise overwhelming difficulties as episodes of despair and upset, revealed through challenging behaviour. We offer solutions for management that provide hope and self-efficacy.

All of this work has to take place within the inspection framework of Ofsted due to the status of the child as a child looked after by the state until formal adoption is in place. This does add an extra layer of obligation to practitioners working in this field. Ofsted go straight to the children and families and ask them about their experiences of support and how it has helped them to make progress. All of my reports are online for anyone to see. One of my families reported to an inspector:

The adoption support is the reason we did not disintegrate as a family. We don’t think we could have coped without the support in the first 2-3 years and as importantly, the ongoing support… the benefits for our family are beyond words.

Last week I reminded a mother that at her first meeting with me she had told me she expected and needed a miracle. This was a mark of how much she was struggling with a child who was severely neglected from birth and had spent too long in foster care where his needs were not fully met. I have now worked with that family for five years, giving continuous psychological support and advice. The result is that the adoption has held together through extremely difficult times of stress and frustration, but the main outcome is that the child is doing very well and is contented and happy and feels he belongs in his family. That same mother laughed when I reminded her of the unreasonable expectation of a miracle. She laughed because she had learned the truth that her journey is all about the ability to develop herself as a parent in order to understand the child and offer that all-important consistent and predictable secure base. There are no magic pills.

Box text: A mouse click away

Without wanting to be too pessimistic, modern living, especially social media, has added some very surprising twists to the process of adoption. I have known of cases where children have found their birth parents with a few clicks of the mouse. Birth parents used to be a private and hidden, even forbidden matter to the child. This is no longer the case and it is presumed now that birth parents and adopted children will eventually reconnect. Adoptive parents now are encouraged from the outset to teach a child that there are two sets of parents in the relationship: the adoptive parents and the parents whom the child may long for and hope for, but with whom they will not share their lives due to the Adoption Order. This is a complicated dilemma for any child to take on board, let alone one that is already insecure and confused. 

- Joanna North is a Chartered Psychologist & BACP Accredited Psychotherapist

Key sources

Fonagy, P. & Target, M. (1997). Attachment and reflective function:  Their role in self-organisation.  Development and Psychopathology, 9, 679–700.
Fonagy, P., Gergely, G., Jurist, E. & Target, M. (2004). Affect regulation, mentalization and the development of the self. London: Karnac.
Howe, D. (2003). Attachment disorders. Attachment and Human Development, 5(3), 265–270.
Howe, D. (2005). Child abuse and neglect: Attachment, development and intervention. Houndmills: Palgrave Macmillan.
Lieberman, A.F. (2003). The treatment of attachment disorder in infancy and early childhood. Attachment and Human Development, 5(3), 279–282.
Magagna, J. (2003). Clinical concepts and caregiving contexts. In C. Archer & A. Burnell (Eds.) Trauma, attachment and family permanence: Fear can stop you loving (pp.97–112). London: Jessica Kingsley Publishers.

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