Fostering and the Therapeutic Relationship.  By Dr. Chris Hanvey

It was the very first thing Judy did when she started work: she bought three bars of chocolate.  After a childhood characterised by her father’s violence, Mary, her mother and her younger sister had eventually escaped from him to a rented house in another town. When the three of them went on any family outing, now freed from tiptoeing around their father’s ugly moods and violence, her mother always treated them to the one small bar of chocolate she could afford and divided it into three. For Judy, being able to buy three bars of chocolate felt like an act of triumphant liberation.

This almost forgotten story from Judy’s past re-emerged when she and her partner applied to become foster carers. Sensitive probing into her childhood awoke memories of emotional and physical hardships and was, she asserted, now a powerful driver for her desire to help provide “better” childhoods for looked after children.

Fostering and adoption applications follow similar routes. Potential applicants are usually invited to an initial meeting, allocated a social worker and then undergo checks, training and the completion- over several months- of a “Form F”, designed to explore the applicants’ pasts, their motivation to foster or adopt and expectations of those children for whom they would feel best able to offer care.

Fostering, in particular, falls very much into the kind of “gift relationship” that Richard Titmuss first defined in terms of blood donors. It springs partly from what he described as an “expression of altruism and regard for the needs of others” (1), albeit foster carers are paid and for some it represents full-time employment. For others, who may offer respite or short-term care for example, it is a way of continuing to care for children when their own off -spring have left home. But there are easier ways of earning a living and the twenty four hour care of challenging children often goes well beyond the demands of many nine to five jobs.

What follows are observations developed from several years of participating in adoption and fostering panels. (These are the panels that make recommendations to the fostering or adoption agencies as to whether individuals or couples should be approved to have children placed with them). As such, the views are subjective and deserve to be tested by more objective research. If we cared more for looked after children- in the same way that we care for the physical health of children- we would be investing in this kind of research, as a matter of routine, as paediatric medicine does for physical conditions.

Two observations remain uppermost. The first is the number of applicants who have experienced troubled childhoods, characterised by the break-up of their carers’ relationship, violence, sexual or physical abuse, bullying and/or a degree of unhappiness that might be regarded as outside the “normal” parameters of childhood. No one gets out of childhood unscathed. As Alan Bennett wryly asserted “It is a good job childhood is at the beginning of our lives. We’d never survive it if it were in the middle”. (2) But what a lot of potential foster carers report seems to go beyond the slings and arrows of cruel children or the normal ups and downs of family relationships. What Judy reported is, I would suggest, by no means unusual for foster carers. Years of fear; of dodging the moods of her father. At first listening to the physical abuse her mother experienced and then the awful silence. It was a childhood characterised by alienation from her peers, because of the secrets and fear within the family.

There is an important seam of research to be mined here, in terms of drawing up a series of indicators which permit a comparison between UK foster carers and the wider UK population of parents. This is not without considerable difficulty and challenge. Tolstoy’s warning that “All happy families resemble one another, every unhappy family is unhappy after its own fashion” (3) should ring in our ears. Are foster carers intrinsically different in having the kind of childhoods that help them keenly to identify with looked after children or are my observations not representative of the foster carer’s population as a whole? The psychologist Carl Jung spoke of each of us having a story- “the story which is not told”; a secret story or “rock against which he is shattered” (4). The aim of the Form F and foster carer assessment is to explore and understand this “story” and to provide foster carers- perhaps for the first time in their lives- with a chance  to stand back, examine the past, frame their story and reflect on how it has led to where they are and why they wish to foster.  If we were to subject a wider cross section of parents to the scrutiny of the Form F process and the chance for detailed introspection about their earlier lives, would we find the same range of bruised childhoods? Is it only the lack of opportunities for this introspection that holds back memories we all have?   Reflecting, after acceptance on the assessment process, foster carers often say that this marks the first time that they have sat down and systematically thought about their earlier lives. Could this exposure and therapeutic intervention be the same for everyone?

Clearly this kind of speculation is an area that needs treating with considerable sensitivity, acknowledging the huge contribution made by thousands of foster carers across the UK. And this brings me to my second observation.

Ernest Hemingway, writing about the way that life tests, and is some cases breaks people, reassuringly added that some people become stronger in the broken places. If we were to summarise the process of assessment for fostering, it could be reduced to a positive belief that it tests out those who have become strengthened in the broken places. The process would assert that, armed with the insights and knowledge from their challenging childhoods, potential foster carers can now care for other children.

It is my experience that the process of assessment is subtly stacked in favour of the applicants and that anyone who has been through the kinds of traumas that, for example Judy experienced, is deemed to have turned them to good effect. Now this is clearly a generalisation- again well worth testing out in research- as to how far their past hasn’t “broken” but strengthened those about to offer therapeutic care to other damaged children.

It should be acknowledged that a good Form Assessment should explore some of the issues linked to the applicants’ childhoods. As well as covering practical issues like employment, finances, the size of the accommodation, health issues and family structure, the Form F provides a profile of each applicant, present and past relationships, “parenting capacity” and the way they value diversity. What, for example, are the kinds of behaviour in a child or young person which might trigger unfavourable memories from the applicant’s own childhood? What are the experiences buried almost beneath memory that could be stirred by behaviour in a troubled child? What actions by a child would prove the most difficult to observe because it awoke their own memories? But two related challenges remain from this process.

Firstly, there remains a world of difference between sitting and explaining how you have “come to terms” with those childhood experiences that could be flashpoints for painful memories or facing a difficult adolescent whose behaviour might suddenly trigger memories of your own past. The second, related point is that the part of the assessment process which is linked to the exploration of carers’ childhoods, is not systematic and varies widely from social worker to social worker and between Form F’s. Nor is it based on a particular researched model, such as the Adult Attachment Interview (AAI).

If we take the AAI, (5) it explores in a systematic way how childhood experiences may affect the adult personality. It begins by looking at childhood, moves to adolescence and ends with the present day. So, if we were to take questions around childhood, for example, it looks at who raised you, relationships with parents, as a young child, five adjectives that reflect your relationship with your mother and father and specific examples of early experiences that may have led to set-backs in early development. Redolent with echoes of John Bowlby, his work on attachment theory and his belief that if attachment paths aren’t secure, they continue to be evident throughout one’ life, especially- and this is the important point- at times of stress or danger. The AAI helps to discern the level of secure, loving attachment that parents had during their own childhoods.

The central question which the above begs, is whether the preparation process for foster care does permit an adequate exploration of the effects of childhood trauma on present behaviour. This is particularly important if we accept the premise that children who end up in the care system are increasing in complexity and in the challenging behaviour they often present.

In a 2019 lecture John Diamond  (6) makes the point that foster care is the preferred option for looked after children, but continues by asking “but what if many of the children find the concept and intimacy of family life alien and intolerable?” While the sentiment is admirable, he argues, to foster a sense of belonging, if this results in multiple placements because the child can’t cope with the intimacy, it can lead to an increase in the child’s sense of alienation. The author contrasts this with the “ethos of professional neutrality” and “emotional distance” that can be engendered in a good therapeutic residential milieu. At one level, unlike foster care, it becomes possible in a therapeutic setting to walk away at the end of a shift, or to test out your own vulnerabilities against other staff members and, hopefully, through analytical supervision. As Keith White has expressed it, “the therapeutic task is not to create a new and separate controlled environment, but to provide a safe and predictable setting and context in which the social and natural worlds can be reliably encountered and explored”(7)

This becomes possible within a skilled residential environment without a sometimes intolerable burden on the assimilated or otherwise childhood experiences of foster carers.

And so we have two untested hypotheses that deserve further exploration.

  • Foster care assessments seem to reveal that carers have frequently undergone the same kinds of challenging childhoods that young people in the care system today undergo. Secondly,
  • There is an in-built bias, as part of the Form F assessment that carers have, by the end of the process, turned round their childhood experiences in a positive way. This, in turn will equip them to cope with challenging behaviour.

There are two factors that might play into these hypotheses. The first is the pragmatic reality of fostering statistics. There are, for example, more looked after children than there are foster carers. And while the number of foster carers has seen a decline, Ofsted statistics (8) reveals that on 31 March 2019 there were 44,450 fostering households in England. Unusually, this was a slight increase on the previous year. However, the number of children entering foster care has increased at a faster pace. What this means is that, for example, there were fewer places available for children to be placed in March 2019 than the same date in 2018. There is, therefore, a constant pressure on local authority and independent fostering agencies to recruit more foster carers. This is not to imply that agencies are willing to drop their standards, but it would be reasonable to ask if the default position might be closer to acceptance than rejection.

The second factor is linked to the whole idea of gaining confidence as a result of previous experiences and learning from past patterns –what might alternatively be described as “wisdom”. I would suggest that wisdom, which is different from knowledge or intelligence, is a living through experiences and learning from past patterns which, in turn help to guide and influence future actions. As such, although you can hopefully become intelligent by reading etc., wisdom only comes through seeing the consequences of actions over a period of time. The surgeon who has performed forty hip operations has, hopefully, a wisdom which springs from both learning from experience and seeing, over a period of time, what works.

The reality of fostering panels is that they are never able to gain this wisdom. Having recommended the approval of carers, their work is done. They sometimes receive reports of foster carers who have ceased to look after children but it is unlikely they will know, in any detail, the reasons for this. Similarly, they will certainly not know how far the carers’ own traumatic childhood experiences re-emerged to trigger a reaction with the children in their care.

It is, to some extent, like doing forty hip operations but never seeing the patients again after the surgery, to evaluate the outcomes.  So panels who decide that carers appear to have come to terms with their own childhood traumas, never learn if this is the case. A 2015 report from Action for Children (8) revealed that one fifth of the UK’s children in foster care had experienced two or more moves in a year. There are clearly a number of reasons for this, ranging from the kind of challenging behaviour children presented to speculation that triggers within foster carers’ own pasts made caring for these children impossible. Whereas, as noted, residential care workers can share troubling experiences and triggers with each other- and walk away at the end of a shift- foster carers have less respite and less opportunity to escape the intensity of family life and the unlocking of difficult behaviour. The fact that panels never see through the consequences of their decisions has to be a major complication in the assessment process. How do you test out the “wisdom” of your decisions if you never see what happens as a result of them?

Every day, foster carers cope with thousands of challenging situations. This is particularly the case in a locked down world, where children are far more constrained than they previously were. They do this work, often ill supported, and forced to call upon their own resources. This is why they deserve far more attention.

We need to know more about the processes of selection, the backgrounds of those coming forward and the subsequent experiences they have of fostering- particularly for those who have experienced their own traumatic childhoods. A greater understanding is also needed of the therapeutic work that goes on during fostering assessments. We also need ways of finding assurance that when potential carers have experienced challenging childhoods, there is some reasonable assurance they understand and have internalised the meanings of it for them.  This research is long overdue and given that carers are collectively helping to prepare part of the next generation, what could be more important?


  1. The Gift Relationship. From Human Blood to Social Policy. Richard M. Titmuss, 1970, George Allen and Unwin.
  2. Poetry in Motion. Alan Bennett, 2002, Penguin Books, London.
  3. Anna Karenina, Leo Tolstoy, 1878.
  4. Memories, Dreams and Reflections. Carl Jung, 1963, Routledge and Kegan Paul.
  5. cf George C, Kaplan N and Main M, Adult Attachment Interview Protocol, 1985, University of California at Berkley
  6. John Diamond,” Creating Belonging”, 2019, Lecture at Coram Permanence Event.
  7. Keith White, Reflections on Living, Vol 2, 2016, The National Centre for Therapeutic Residential and Foster Care, WTL Publications.
  8. Ofsted. Fostering in England 2018-19. Main Findings and updated on September 22nd 2020.
  9. Children and Young People Now.September 21 2015



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