‘I wanted to support children to feel safe’

At 22 I was Cabin Crew, flying the London to Tokyo route on a well-known airline. I should have been enjoying every second, but it wasn't for me.

With pen and paper, I set out to identify my values and interests and the potential careers that I could pursue. It had to be meaningful and challenging with the potential for lifelong learning. I knew I wanted to work with people and if I could entertain my interests in science, research and human behaviour that would be a bonus. Thus began my unconventional route towards a career in Clinical Psychology.  

All about attachment

I first became interested in adoption and attachment after I took a conversion course. I worked in a school on the outskirts of Newcastle upon Tyne, working with looked after and adopted children and piloting a nurture programme informed by attachment theory. I loved it, but I ended up working as an Improving Access to Psychological Therapies (IAPT) provider for six years. Later, when I had my own children, my interest in attachment and early life experiences was, quite naturally, reignited.

As I read Bessel Van der Kolk's 2014 book The Body Keeps the Score, it felt like a lightbulb moment. The book explores the impact of trauma on the brain and how different attachment styles can influence an individual's response to trauma. This helped me to better understand and support the people that I worked with in IAPT. Working as a psychological wellbeing practitioner, I was unable to provide therapy for such presentations, but my interest was piqued, and I found myself taking more compassion-focused approaches with my caseload. 

When I saw an advert for the role of Assistant Psychologist working alongside local authorities and regional adoption agencies supporting those with experiences of early adversity and trauma, I jumped at the chance to learn more about the field.

I wanted to learn how to support children with experiences of trauma to feel safe. How to help them to trust, even when they have developed strategies for their survival that tell them not to. I wondered how one might support the parents who have longed for moments of closeness with their child, not knowing how difficult that could be. How do you support them to accept the duality of the parent-child relationship? On those rare and unfortunate occasions, how do you support the families that break down? And how do we deal with the fallout that comes for everybody afterwards?

Foundations for attachment

Our service aims to support families throughout the adoption process and beyond. Therapeutic work is often integrative, drawing upon a range of psychological models and approaches as relevant to the client. Our main approaches within the team are Dyadic Developmental Psychotherapy (DDP) and Non-Violent Resistance (NVR) parenting.

Delivering training on attachment and providing reflective sessions to professionals working in adoption is also a key focus for our service. Our therapeutic parenting group follows the Foundations for Attachment Training Model developed by Kim Golding. We cover concepts such as blocked care, attachment styles, the principles of PACE therapeutic parenting and the importance of parental self-care.

Our services are funded by the Adoption Support Fund. The ASF was set up by government in 2015 to support children and families to access post adoption care (Department for Education, 2019). Local authorities and regional adoption agencies can apply for funding for children and young people and their families up to the age of 21 or 25 for those with an Educational Health Care Plan. 

My daily challenges

As an Assistant Psychologist in adoption, I divide my time between supporting specialist assessments, delivering groups or training and developing materials for children and young people and their families.

A typical day for me may begin with supporting the clinical psychologist in an assessment session. I take notes throughout the appointment, then send relevant psychometrics afterwards and complete my notes. In the afternoon I might work on turning those notes into part of a report or preparing resources like upcoming training for foster carers on how to advocate for their child in education, or our quarterly newsletter for parents who we have supported.

Through supporting assessments I've honed my skills in clinical formulation. When developing resources and materials, I find fulfilment in tailoring information to meet the unique needs of our clients and their families. I also enjoy cofacilitating the therapeutic parenting groups that we run twice a year. They provide a refreshing change of pace and allows me to cultivate my presentation skills.

The work is extremely varied, and even after over a year in the role, I am constantly learning new things. Assessments in adoption require a careful consideration of the complex interplay between factors such as attachment, neurodiversity or neurodevelopmental conditions and trauma. There can still be a lack of understanding or awareness in these areas which can pose certain challenges for parents.

Adopted children have a higher prevalence of certain neurodevelopmental conditions. Foetal Alcohol Spectrum Disorders (FASD) in particular, is common when working with this client group with as many as 17 per cent of children suspected to have FASD. Due to the wide range of symptoms and potential overlap with other developmental disorders and stigma which contributes to a lack of awareness, diagnosing FASD can be challenging. 

Last year NICE published new guidelines on assessing and diagnosing FASD and highlighted the importance of education on alcohol use during pregnancy and more specific training for those working in roles that support children and families. Prompted by the new guidance and the surrounding literature, last year I produced a social media series designed to educate parents on prevalence and symptoms of FASD and how to seek diagnosis.

Similarly, I have noticed that, despite the huge proportion of time children spend at school, not all schools appear to be well educated on trauma-informed practices. Recently, I assisted in writing and delivering training for Foster Carers on how to advocate for their children in education. Through these experiences, I have gained insight and developed an appreciation for the indirect work that Clinical Psychologists undertake.

I've found that working systemically with children presents a unique set of challenges. Developmental age or cognitive ability can impact their engagement. Their dependence on their family system adds complexity, requiring an understanding of intergenerational dynamics. Professionals bring with them their views on the family and how they provide emotional support can also contribute to the success of a placement.

I've been fascinated by the hidden work a psychologist in adoption will undertake; developing an understanding of some of the broader issues at play and being sensitive and sympathetic in how they act on this. Often clear and sensitive communication can diffuse any issues. At other times, psychologists can advocate for their clients within the broader context of their care. 

Making space for boundaries

After six years of working with adults, transitioning to a role working with children brought with it some trepidation. It wasn't the first time I had worked with children and families, but it was the first time I would be working with children as a parent myself. With a three-year-old and one-year-old at home, I wondered how I would manage the emotional weight of the stories told by the young people and children accessing our service. I was relieved to discover that the skills I have developed in past roles have been transferable and I have, thankfully, been able to maintain healthy boundaries between my work and personal life. 

I now view my experiences as a parent as a strength that I bring to the role. I hold in mind the challenges that many parents today face; parenting in an increasingly isolating society being expected to do more than any generation before them. For parents who foster or adopt they also need to learn a whole new set of skills to support them in calming and repairing a sensitised nervous system. This can seem an impossible task when the parent themself is not regulated. Many parents, through no fault of their own, were not taught these skills in childhood and must start from scratch whilst also grappling with their new role as parent and the associated difficulties (lack of sleep, a dysregulated child, societal pressure, managing work and childcare etc.)

I am passionate about psychoeducation on neuroscience and attachment to support these children and their families. 

I continue to learn, grow and be challenged in this role. I have found working with these families and young people to be some of the most rewarding work I have done. For many of them, an understanding of attachment and developmental trauma seems to be the missing piece of the puzzle.

I am hopeful that I will one day train as a Clinical Psychologist myself so I can continue my work in this field. I am excited about the future of working in attachment and hopeful that it becomes more widely discussed and understood.