Challenges Facing Long Term Foster Carers: Exploration of the Nature of Psychoanalytic Parent/Carer Support

Prof Doc Thesis

Tiltina, Kristine 2015. Challenges Facing Long Term Foster Carers: Exploration of the Nature of Psychoanalytic Parent/Carer Support. Prof Doc Thesis University of East London Tavistock and Portman NHS Foundation Trust
AuthorsTiltina, Kristine
TypeProf Doc Thesis

This research study investigates the role and impact of psychoanalytically-informed
short-term parent work with long-term foster carers of looked-after children, in
support of the foster placement.
The study reflects on the data gathered from four child assessments and five foster
families seen by a psychoanalytic child psychotherapist for four sessions each. It
draws on psychoanalytic ideas from a range of theoretical traditions, exploring such
concepts as trauma, defences, compulsion to repeat, psychological-mindedness,
‘container/contained’ (Bion) and ‘holding environment’ (Winnicott).
One distinctive contribution of this research is what it adds to our already existing
understanding of the defences (or responses) aroused in the carer when faced with
the intense and distressing affect associated with the child’s early trauma; and the
impact of this legacy of trauma on the child, on the carer and on the wider Social
Services system.
Applying Grounded Theory and psychoanalytically-informed clinical case study
methodology to the research material, the study breaks down the data analysis into
seven stages of coding, from the initial reading of the data to the eventual
development of two key hypotheses. One of the predominant themes that emerged
from the analysis was the carer’s capacity to remain focused on the child’s emotional
needs and how this in turn was linked to the direction of the therapist’s focus. The
successive analyses of the data culminated in the hypothesis that the more the
therapist focused on the carer and the carer’s emotional states in the course of the
parent work, the more the carer was enabled to focus on the child’s emotional
As the system of categories emerged according to the themes exemplified in the
sessions, a particular focus of analysis became the concept of psychologicalmindedness,
considered under several sub-categories: displaying insightful
comments; awareness of the child’s bodily states; awareness of the child’s affect; the
carer’s ability to recognize the child’s defences; and the carer’s ability to make links
between the child’s current difficulties and the child’s past experiences. Through this
analysis it became apparent that degree of psychological-mindedness was closely
linked to the individual carer’s capacity to metabolize the child’s distressed and
distressing communication. This in turn led to a deeper exploration of the situations
that were particularly challenging for the carers: i.e., instances when the child was
compelled to repeat past traumatic emotional states and as a result was
communicating intense distress. This exploration eventually generated the second
hypothesis: that in reaction to the child’s distress, the response of each carer could
be plotted somewhere along a spectrum, from either distancing themselves from the
child’s emotional state to seeking excessive closeness with the child (merging). The
next stage of the analysis developed four new categories of carer responses to the
distressed child: identification and distancing from the child; identification and
merging with the child; the category that describes the carer’s psychologicalmindedness
as being ‘impaired’; and ‘good enough’ caring. This then led to an
exploration of the carer’s own defences at these most challenging times.
This research demonstrates clearly that even within the short space of four sessions
of weekly psychoanalytic parent work, it is possible to achieve significant
improvement in a carer’s capacity to bear the child’s compulsion to repeat early
traumas, and to help the carers become more emotionally available to provide the
child with effective psychological parenting at such difficult and challenging times.
Key words: looked-after children; long-term foster carers; psychoanalytic short-term
parent work; trauma; compulsion to repeat; psychological-mindedness; empathy;
defences; psychoanalytically-informed clinical case study research methodology;
Grounded Theory research methodology.

Digital Object Identifier (DOI)
Publication dates
PrintNov 2015
Publication process dates
Deposited03 Aug 2016
Publisher's version
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