Improving Children's Future

**63**

**Chapter 4**

**Abstract**

clinicians.

**1. Introduction**

Adoptive Bond

parent-child first meeting, post-adoption

the adoption process have to face [1].

*and Alessia Carleschi*

The DAVAd: A Narrative Tool to

The DAVAd (the first bond process diary) is a new narrative tool created to accompany the adoptive couple during their trip to the land of the child/children to whom they have been matched. The tool presented is the first to explore what happens, in term of events and emotional experiences, during the first meetings between the parental couple and the child/children. This period is clinically relevant as the ideal is compared with the real. The DAVAd supports the parental couple in focusing on their experiences and their meanings and learning to deal with the complexity related to the bound construction. Moreover, the DAVAd allows the clinical psychologist in detecting and treating, if necessary, the familiar dynamics, favoring the prevention of the distress. A clinical case that utilizes the DAVAd will be presented, to enlighten the way its compilation can be used by researchers and

**Keywords:** adoptive bond, international adoption, narrative diary, adoptive

The method to investigate the phenomenon of international adaptation has progressively changed over the years. There has been a shift from a perspective that was meant to legitimize mostly the needs of the parental couple to a perspective aimed at safeguarding children's rights; later on a new perspective was developed that regards the adoptive family as a *system* to be protected and supported. In other words, there has been a shift from an extremely optimist outlook, which considered the adoption the best solution for children, biological parents, and the adoptive couple, to a more realistic approach, which regards adoption as an opportunity but at the same time acknowledges the challenges and the issues the people involved in

The Hague Convention of 29 May 1993 on Protection of Children and Cooperation in Respect of Intercountry Adoption certainly drove this change of perspective. The convention recognized that the child should grow up in a family environment, thus promoting the adoption of children with special needs and/ or school-age children and making adoptive families face specific difficulties and issues. It is widely acknowledged that when children have been in the child welfare

Explore the Early Stages of the

*Barbara Cordella, Paola Elia, Marzia Pibiri* 

#### **Chapter 4**

## The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond

*Barbara Cordella, Paola Elia, Marzia Pibiri and Alessia Carleschi*

#### **Abstract**

The DAVAd (the first bond process diary) is a new narrative tool created to accompany the adoptive couple during their trip to the land of the child/children to whom they have been matched. The tool presented is the first to explore what happens, in term of events and emotional experiences, during the first meetings between the parental couple and the child/children. This period is clinically relevant as the ideal is compared with the real. The DAVAd supports the parental couple in focusing on their experiences and their meanings and learning to deal with the complexity related to the bound construction. Moreover, the DAVAd allows the clinical psychologist in detecting and treating, if necessary, the familiar dynamics, favoring the prevention of the distress. A clinical case that utilizes the DAVAd will be presented, to enlighten the way its compilation can be used by researchers and clinicians.

**Keywords:** adoptive bond, international adoption, narrative diary, adoptive parent-child first meeting, post-adoption

#### **1. Introduction**

The method to investigate the phenomenon of international adaptation has progressively changed over the years. There has been a shift from a perspective that was meant to legitimize mostly the needs of the parental couple to a perspective aimed at safeguarding children's rights; later on a new perspective was developed that regards the adoptive family as a *system* to be protected and supported. In other words, there has been a shift from an extremely optimist outlook, which considered the adoption the best solution for children, biological parents, and the adoptive couple, to a more realistic approach, which regards adoption as an opportunity but at the same time acknowledges the challenges and the issues the people involved in the adoption process have to face [1].

The Hague Convention of 29 May 1993 on Protection of Children and Cooperation in Respect of Intercountry Adoption certainly drove this change of perspective. The convention recognized that the child should grow up in a family environment, thus promoting the adoption of children with special needs and/ or school-age children and making adoptive families face specific difficulties and issues. It is widely acknowledged that when children have been in the child welfare system for long periods or have a background of abuse and neglect, those conditions may cause developmental delays, interfere in the relationship with the new caregivers, and represent a risk factor for adoption breakdown [2, 3].

If in the past, the adoptive family was considered to be on the same level of the biological family, thus neglecting its peculiarity, today we know that building an adoption bond is a complex phenomenon that may only safely be developed if the specific development challenges, involving adoptive parents, children, and the counsellors working with them, are acknowledged. Risk factors may be reduced by the relationship with the new family [4, 5], provided that its members are supported by trained counsellors and can benefit from dedicated services [6, 7].

However, Van IJzendoorn and Juffer [8] state that adoption is already a "curative intervention" and a "protective factor" (p. 1229) as it fulfills the desire of adoptive parents to have children and offer children a second chance to experience a family and emotional relationship and bond, which are essential to them.

Vadilonga [9] agrees with Van IJzendoorn and Juffer as he states that adoption represents a reparative effort and promotes the development of a multiple identity. He writes, "Children placed for adoption have specific problems and often show signs of post-traumatic stress disorder; in order to make the adoption process successful, it is essential that adoptive parents become the main point of contact in the reparative and working-through process of the child" (p. 34). This is possible if parents managed to "activate" their reparative capabilities, which mainly refer to the ability to listen, thus sharing a development process that allows the child to listen to himself/herself. Adoptive parents can therefore provide children with support, containment, and bonding and help them to reflect and process their own story [10].

In other words, the path to adoption can be therapeutic and trigger a transformation process, provided that the child is accompanied toward new relational experiences that may integrate the construction of the self and the representation the child has got of himself and the others. The answers of adoptive parents can confirm or discount the survival strategies children developed to handle with violent, untrustworthy, or absent caregivers.

From that point of view, both research and interventions should be focused less on the exclusive placement of the child with special needs and more on the care of the family system, the relationship between the child and the parents; the aim should be to support and promote a circular growth path, thus driving the development of patterns of relationship different from those learnt in the birth family background of the child [11]. A better awareness of the rights of adopted children and of the role played by adoptive parents as potential co-therapists helped to turn the attention on the training of adoptive parents but also on the need to develop preliminary and continuous interventions.

#### **2. Research on adoption breakdowns**

Research carried out with the aim of quantifying and understanding the phenomenon of adoption breakdowns can be useful to the purpose of this study to the extent that it offers information to rethink support to adoptive families.

The main references will be made to what is stated by Vadilonga [9], in his book published in 2010, and to what is recommended by Paniagua, Jiménez-Morago, and Palacios [12] with regard to their research carried out on adoption breakdowns in Spain, over the decade 2003–2012, and presented in Milan in 2016. Further reference will be made to the Italian research carried out by the Commissione per le Adozioni Internazionali (CAI), in collaboration with the Istituto Innocenti [13], and

**65**

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

the literature review carried out by a team at the University of Minnesota [14]. Even though the research reviewed is not recent, it is the only one available on a topic not

In literature, authors agree on the fact that the phenomenon of adoption breakdown is the result of multiple risk factors coexisting and regarding three main players: the parental couple, the child, and the counsellors and adoption professionals working with the family. With regard to children, several risk factors were identified. The most important of them is the one connected to late adoption [14]. However, the research carried out by Paniagua and his colleagues shows how the risk of adoption breakdown increases proportionately with the age of the adopted child only in the age bracket between 2 and 6 years old and that it cannot be the only risk factor explaining the adoption breakdown [12]. With regard to the parental couple, the same research identifies as a risk factor the low motivation and training of the parents. It is also interesting to observe that, both in Spain and Italy, there is reluctance among parents to ask for support so that it is advisable not only to develop further local support services but to drive a real change in the culture

The authors agree that there is a low percentage of adoption breakdown, but estimates may vary depending on the source taken into consideration (from 1 to 1.8% [13]; from 1 to 7% [16]; from 1 to 32% [12]). The differences observed among the estimates may be due to the different areas investigated, to the difficulty to collect data, but also to the definition of adoption breakdown used. From a legal perspective, it is possible to distinguish between adoption disruption and adoption dissolution. The term disruption is used to describe an adoption process that ends before the adoption is legally finalized through the adoption order, while the term dissolution is used to describe an adoption process that ends after the adoption is

In both cases, however, all the difficult relationship patterns experienced as insurmountable by the main actors, that is, children and adoptive parents, which however are not the cause of a final separation are not taken into account. Those critical situations may be overlooked in the monitoring, if the families do not ask

According to a research carried out by CAI, the number of adoption breakdowns

Different research articles show how adoption breakdown happens during the adolescence or preadolescence of the adopted child in most of the cases, revealing signs of distress in the adoptive parent-child relationship that has been going on for years without being identified and treated. In those situations, as Vitolo [19] observes, the "rejection and pushing-away" behavior of adoptive parents seems to be aimed at distancing themselves from the child as well as from the anguish of

In the interviews carried out with some children who experienced adoption breakdown [13], a common factor emerging seems to be the impossibility to

acknowledge the other and be acknowledged by him/her, and such a distress may be shown even when children were adopted at a very young age. In those cases, according to Lombardi [20] what seems to lack is a "a mental space for the other and the bonding, which turns into the impossibility to experience a verbalized space and the inability to become beings experiencing relationships subject to change: the dysfunctional family (unlike the others) is blocked in that experience, not progressing but sticking in time to that feeling of 'non-belonging' around which the subsequent

Those results are connected to the opportunity to adopt a constructive approach to respond to adoption crises through two preventive strategies: the training of the

is mainly the same in national and international adoption processes [17, 18].

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

forming the background of the adoption process [15].

easy to analyze.

legally finalized.

feeling helpless.

relationship is built" (p. 80).

for help.

#### *The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

the literature review carried out by a team at the University of Minnesota [14]. Even though the research reviewed is not recent, it is the only one available on a topic not easy to analyze.

In literature, authors agree on the fact that the phenomenon of adoption breakdown is the result of multiple risk factors coexisting and regarding three main players: the parental couple, the child, and the counsellors and adoption professionals working with the family. With regard to children, several risk factors were identified. The most important of them is the one connected to late adoption [14]. However, the research carried out by Paniagua and his colleagues shows how the risk of adoption breakdown increases proportionately with the age of the adopted child only in the age bracket between 2 and 6 years old and that it cannot be the only risk factor explaining the adoption breakdown [12]. With regard to the parental couple, the same research identifies as a risk factor the low motivation and training of the parents. It is also interesting to observe that, both in Spain and Italy, there is reluctance among parents to ask for support so that it is advisable not only to develop further local support services but to drive a real change in the culture forming the background of the adoption process [15].

The authors agree that there is a low percentage of adoption breakdown, but estimates may vary depending on the source taken into consideration (from 1 to 1.8% [13]; from 1 to 7% [16]; from 1 to 32% [12]). The differences observed among the estimates may be due to the different areas investigated, to the difficulty to collect data, but also to the definition of adoption breakdown used. From a legal perspective, it is possible to distinguish between adoption disruption and adoption dissolution. The term disruption is used to describe an adoption process that ends before the adoption is legally finalized through the adoption order, while the term dissolution is used to describe an adoption process that ends after the adoption is legally finalized.

In both cases, however, all the difficult relationship patterns experienced as insurmountable by the main actors, that is, children and adoptive parents, which however are not the cause of a final separation are not taken into account. Those critical situations may be overlooked in the monitoring, if the families do not ask for help.

According to a research carried out by CAI, the number of adoption breakdowns is mainly the same in national and international adoption processes [17, 18].

Different research articles show how adoption breakdown happens during the adolescence or preadolescence of the adopted child in most of the cases, revealing signs of distress in the adoptive parent-child relationship that has been going on for years without being identified and treated. In those situations, as Vitolo [19] observes, the "rejection and pushing-away" behavior of adoptive parents seems to be aimed at distancing themselves from the child as well as from the anguish of feeling helpless.

In the interviews carried out with some children who experienced adoption breakdown [13], a common factor emerging seems to be the impossibility to acknowledge the other and be acknowledged by him/her, and such a distress may be shown even when children were adopted at a very young age. In those cases, according to Lombardi [20] what seems to lack is a "a mental space for the other and the bonding, which turns into the impossibility to experience a verbalized space and the inability to become beings experiencing relationships subject to change: the dysfunctional family (unlike the others) is blocked in that experience, not progressing but sticking in time to that feeling of 'non-belonging' around which the subsequent relationship is built" (p. 80).

Those results are connected to the opportunity to adopt a constructive approach to respond to adoption crises through two preventive strategies: the training of the

*Family Therapy - New Intervention Programs and Researches*

ers, and represent a risk factor for adoption breakdown [2, 3].

and emotional relationship and bond, which are essential to them.

violent, untrustworthy, or absent caregivers.

preliminary and continuous interventions.

**2. Research on adoption breakdowns**

system for long periods or have a background of abuse and neglect, those conditions may cause developmental delays, interfere in the relationship with the new caregiv-

If in the past, the adoptive family was considered to be on the same level of the biological family, thus neglecting its peculiarity, today we know that building an adoption bond is a complex phenomenon that may only safely be developed if the specific development challenges, involving adoptive parents, children, and the counsellors working with them, are acknowledged. Risk factors may be reduced by the relationship with the new family [4, 5], provided that its members are supported by trained counsellors and can benefit from dedicated services [6, 7].

However, Van IJzendoorn and Juffer [8] state that adoption is already a "curative intervention" and a "protective factor" (p. 1229) as it fulfills the desire of adoptive parents to have children and offer children a second chance to experience a family

Vadilonga [9] agrees with Van IJzendoorn and Juffer as he states that adoption represents a reparative effort and promotes the development of a multiple identity. He writes, "Children placed for adoption have specific problems and often show signs of post-traumatic stress disorder; in order to make the adoption process successful, it is essential that adoptive parents become the main point of contact in the reparative and working-through process of the child" (p. 34). This is possible if parents managed to "activate" their reparative capabilities, which mainly refer to the ability to listen, thus sharing a development process that allows the child to listen to himself/herself. Adoptive parents can therefore provide children with support, containment, and bonding and help them to reflect and process their own

In other words, the path to adoption can be therapeutic and trigger a transformation process, provided that the child is accompanied toward new relational experiences that may integrate the construction of the self and the representation the child has got of himself and the others. The answers of adoptive parents can confirm or discount the survival strategies children developed to handle with

From that point of view, both research and interventions should be focused less on the exclusive placement of the child with special needs and more on the care of the family system, the relationship between the child and the parents; the aim should be to support and promote a circular growth path, thus driving the development of patterns of relationship different from those learnt in the birth family background of the child [11]. A better awareness of the rights of adopted children and of the role played by adoptive parents as potential co-therapists helped to turn the attention on the training of adoptive parents but also on the need to develop

Research carried out with the aim of quantifying and understanding the phenomenon of adoption breakdowns can be useful to the purpose of this study to the

The main references will be made to what is stated by Vadilonga [9], in his book published in 2010, and to what is recommended by Paniagua, Jiménez-Morago, and Palacios [12] with regard to their research carried out on adoption breakdowns in Spain, over the decade 2003–2012, and presented in Milan in 2016. Further reference will be made to the Italian research carried out by the Commissione per le Adozioni Internazionali (CAI), in collaboration with the Istituto Innocenti [13], and

extent that it offers information to rethink support to adoptive families.

**64**

story [10].

parental couple before the adoption and first of all early detection of conflicts and problems and early intervention to support the "therapeutic" abilities of adoptive parents. The attention focused on the prevention and early support to parents makes attention also to be drawn on the first stages of the path to adoption, starting from the meeting between the child and the parental couple. Even though prospective parents were trained and their ability to manage conflicts and adjust to new and problematic situations was analyzed, it is in the face-to-face contact between the main players of the adoption that feelings of joy and acceptance but also misunderstandings and frustration can be experienced. Conflicts may become harsher, above all in the case of older children, who already have a well-defined personality and are less willing to give up the psychological strategies that have saved them from the despair of abandonment. At the same time, parents may develop defensive strategies unconsciously that make them afraid of their educational role, not self-confident, disappointed by the emotional distance of the children, and unable to deal with the developmental crisis and the necessary paths to mutual adjustment having a positive and constructive attitude. The presence of qualified counsellors as well as the early detection and management of distress may stop that potentially destructive process [21]. In other words, it is necessary to intervene before the development of deep-rooted mutual prejudices makes the parties impossible to know each other and "reach an agreement" [22].

#### **3. Useful guidelines to develop the intervention**

The research carried out and cited in the previous paragraph provides some guidelines for the development of further research and intervention in the matter.

In general terms, it seems necessary to drive a cultural change that, on the one side, allows adoptive families to turn to support services to receive the support they need in their path to adoption and, on the other side, allows services to look at adoptive families as a resource to be trained instead of subjects to be analyzed.

Throughout this path, it appears essential to focus the attention on the meetings between parents and children, both in the pre-adoption and post-adoption stages, in order to detect any problem, thus promoting the development of a "family system" rather than mutual incomprehension getting worse.

This would be possible if adoption professionals work with parents on their ability to narrate about themselves, recognizing and validating the feelings aroused by the relationship with adopted children, first imagined and later experienced, in order to promote the necessary learning that will allow the parental couple to accept the experience of life and behaviors of children.

Narrating the family relationship means to give oneself the opportunity to think about it, weakening, as Salvatore [23] emphasizes, "the sense of truth connected to the emotional building of the experience, offering the opportunity to explore different and additional ways of interpreting reality" (p. 68).

Such a line of development is further confirmed by psychoanalytic literature [24, 25], which studied the path to biological parenthood, from the preparation to the transition to parenthood. In the course of the pregnancy and when meeting the newborn, the parental representations play a crucial role as they will drive the type of emotional investment and the care quality the parents will provide to the newborn. The emotional and symbolic dimension of pregnancy, which is common to biological pregnancy and to the path to adoption [26], plays a key role in the psychological wellbeing of the family. It prepares and helps parents to develop their role as parents, allowing them to think about and mentally contain the child, identifying his/her needs that have to be met and separating them from their own needs [27].

**67**

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

meet a child to adopt have been long since recognized as essential.

therefore useful to have the space and time needed to analyze it.

there is also a gap in the literature.

and the one actually experienced.

**4. A new tool: the DAVAd**

facts [31].

In the case of adoptive parents, in addition to the development of their own role as parents and the acceptance of the history of the children, it is necessary to take into account the grief for failed procreation and the awareness of meeting a child who has already lived a part of his/her own story, probably affected by adversities [28]. It is easy to think that, on the other side, the child waiting for an adoptive parent will have his/her own feelings of anxiety and expectations. To the purpose of this study, this is regarded as important as international adoptions, which are today more frequent, involve school-age children. Based on the present knowledge, children's expectations are often hard to know, for both the adoptive parents and researchers, and may be revealed only at the time of the face-to-face contact; however, it can be said that this is not applicable to the expectations of adoptive couples. For adoptive couples the meeting groups of parents who prepare themselves to

The group plays a very important role because it allows peer comparison and the open discussion of parents' fantasies about the child and the first interactions with him/her [10]. In the groups, the verbalization of doubts, fears, and prejudices is explicitly favored in order to prevent reactions including rejection, detachments, and extreme defense against resistances or simply against what is unknown and cannot be predicted [29]. Prospective parents often daydream about their first meeting with the child, so long-awaited, thinking about it as an immediately acknowledgment of their own role as parents and that of the child, as a magic ailment to the wounds experienced by the child due to abandonment and by the couple for failed procreation [20]. As experiences show, it is a fantasy that helps to remove the effort for being involved in a new and demanding relationship, and it is

With regard to the stage of face-to-face contact between adoptive parents/child,

Our review of specialized literature only allowed us to find one article [29]: it is a qualitative study, based on the interviews of 46 parental couples who told about their meeting with the adopted minor. The limitation of the above mentioned article, however, is the time between the adoption and the interview, which ranged from 1 to 16 years. In the interviews carried out, the three topics most frequently discussed and which show a higher level of emotional intensity were the time when the child was officially placed into the custody of the adoptive parents, the discovery of his/her own body, and the first interactions. Different themes emerged were referred to those topics: the feelings of loneliness and anxiety felt at the time of the face-to-face contact, the shocking images of the life conditions of children, the lack of training to the contact with the child, the lack of information received about the child, the fear about his/her health conditions, the fear for reactions of the child such as rejection or aggression, and the contrast between the expected interaction

The themes identified confirm the need to focus more on the stage of the first

In the view of what is stated in the previous paragraphs, our research group

Accompagnamento del Viaggio Adottivo, translated as "first bond process diary"),

face-to-face contact, but in the literature there are no tools designed for this.

developed a narrative diary, called DAVAd (Italian acronym for Diario di

Although that stage of transition is regarded as highly important, with the identifications of the issues that may arise [30], there is no research analyzing the

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

#### *The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

In the case of adoptive parents, in addition to the development of their own role as parents and the acceptance of the history of the children, it is necessary to take into account the grief for failed procreation and the awareness of meeting a child who has already lived a part of his/her own story, probably affected by adversities [28]. It is easy to think that, on the other side, the child waiting for an adoptive parent will have his/her own feelings of anxiety and expectations. To the purpose of this study, this is regarded as important as international adoptions, which are today more frequent, involve school-age children. Based on the present knowledge, children's expectations are often hard to know, for both the adoptive parents and researchers, and may be revealed only at the time of the face-to-face contact; however, it can be said that this is not applicable to the expectations of adoptive couples.

For adoptive couples the meeting groups of parents who prepare themselves to meet a child to adopt have been long since recognized as essential.

The group plays a very important role because it allows peer comparison and the open discussion of parents' fantasies about the child and the first interactions with him/her [10]. In the groups, the verbalization of doubts, fears, and prejudices is explicitly favored in order to prevent reactions including rejection, detachments, and extreme defense against resistances or simply against what is unknown and cannot be predicted [29]. Prospective parents often daydream about their first meeting with the child, so long-awaited, thinking about it as an immediately acknowledgment of their own role as parents and that of the child, as a magic ailment to the wounds experienced by the child due to abandonment and by the couple for failed procreation [20]. As experiences show, it is a fantasy that helps to remove the effort for being involved in a new and demanding relationship, and it is therefore useful to have the space and time needed to analyze it.

With regard to the stage of face-to-face contact between adoptive parents/child, there is also a gap in the literature.

Although that stage of transition is regarded as highly important, with the identifications of the issues that may arise [30], there is no research analyzing the facts [31].

Our review of specialized literature only allowed us to find one article [29]: it is a qualitative study, based on the interviews of 46 parental couples who told about their meeting with the adopted minor. The limitation of the above mentioned article, however, is the time between the adoption and the interview, which ranged from 1 to 16 years. In the interviews carried out, the three topics most frequently discussed and which show a higher level of emotional intensity were the time when the child was officially placed into the custody of the adoptive parents, the discovery of his/her own body, and the first interactions. Different themes emerged were referred to those topics: the feelings of loneliness and anxiety felt at the time of the face-to-face contact, the shocking images of the life conditions of children, the lack of training to the contact with the child, the lack of information received about the child, the fear about his/her health conditions, the fear for reactions of the child such as rejection or aggression, and the contrast between the expected interaction and the one actually experienced.

The themes identified confirm the need to focus more on the stage of the first face-to-face contact, but in the literature there are no tools designed for this.

#### **4. A new tool: the DAVAd**

In the view of what is stated in the previous paragraphs, our research group developed a narrative diary, called DAVAd (Italian acronym for Diario di Accompagnamento del Viaggio Adottivo, translated as "first bond process diary"),

*Family Therapy - New Intervention Programs and Researches*

and "reach an agreement" [22].

**3. Useful guidelines to develop the intervention**

parental couple before the adoption and first of all early detection of conflicts and problems and early intervention to support the "therapeutic" abilities of adoptive parents. The attention focused on the prevention and early support to parents makes attention also to be drawn on the first stages of the path to adoption, starting from the meeting between the child and the parental couple. Even though prospective parents were trained and their ability to manage conflicts and adjust to new and problematic situations was analyzed, it is in the face-to-face contact between the main players of the adoption that feelings of joy and acceptance but also misunderstandings and frustration can be experienced. Conflicts may become harsher, above all in the case of older children, who already have a well-defined personality and are less willing to give up the psychological strategies that have saved them from the despair of abandonment. At the same time, parents may develop defensive strategies unconsciously that make them afraid of their educational role, not self-confident, disappointed by the emotional distance of the children, and unable to deal with the developmental crisis and the necessary paths to mutual adjustment having a positive and constructive attitude. The presence of qualified counsellors as well as the early detection and management of distress may stop that potentially destructive process [21]. In other words, it is necessary to intervene before the development of deep-rooted mutual prejudices makes the parties impossible to know each other

The research carried out and cited in the previous paragraph provides some guidelines for the development of further research and intervention in the matter. In general terms, it seems necessary to drive a cultural change that, on the one side, allows adoptive families to turn to support services to receive the support they need in their path to adoption and, on the other side, allows services to look at adop-

Throughout this path, it appears essential to focus the attention on the meetings between parents and children, both in the pre-adoption and post-adoption stages, in order to detect any problem, thus promoting the development of a "family

This would be possible if adoption professionals work with parents on their ability to narrate about themselves, recognizing and validating the feelings aroused by the relationship with adopted children, first imagined and later experienced, in order to promote the necessary learning that will allow the parental couple to accept

Narrating the family relationship means to give oneself the opportunity to think about it, weakening, as Salvatore [23] emphasizes, "the sense of truth connected to the emotional building of the experience, offering the opportunity to explore

Such a line of development is further confirmed by psychoanalytic literature [24, 25], which studied the path to biological parenthood, from the preparation to the transition to parenthood. In the course of the pregnancy and when meeting the newborn, the parental representations play a crucial role as they will drive the type of emotional investment and the care quality the parents will provide to the newborn. The emotional and symbolic dimension of pregnancy, which is common to biological pregnancy and to the path to adoption [26], plays a key role in the psychological wellbeing of the family. It prepares and helps parents to develop their role as parents, allowing them to think about and mentally contain the child, identifying his/her needs that have to be met and separating them from their own needs [27].

tive families as a resource to be trained instead of subjects to be analyzed.

system" rather than mutual incomprehension getting worse.

different and additional ways of interpreting reality" (p. 68).

the experience of life and behaviors of children.

**66**

which is a useful tool offered to couples, who chose international adoption, as a "companion" during their journey to the country of birth of the child they were matched to. This tools was designed with the aim of providing clinicians with a support tool to their work, "opening a window" on the first interactions between adoptive parents and children.

The tool offered to parents suggests them to narrate an episode regarded as meaningful one for each day they spent abroad, during which they experienced the relationship with their adopted children.

The diary follows the following narrative pattern:


After that, parents are asked to write down their emotions and the relevant level of intensity (very low, low, medium, quite high, very high, incredibly high), indicating whether those emotions refer to the father/mother and/or child.

The DAVAd therefore suggests a narrative framework, but it also gives parents the opportunity to tell about the episode freely. The focus, even with regard to emotions and feelings, is on the ability of the couple to acknowledge them, write them down, and state their level of intensity. The DAVAd is used to collect the narrative choices made by the couple, the way in which the parents tell the experience they are having. The focus is not on the collection of facts, rather on the identification of the strategies developed by adoptive parents and children at the beginning of their relationship.

#### **4.1 Why a diary?**

The proposal to write a diary or to use the narrative of the events as a tool is not something new (Daily diary methodology: Bolger et al. [32]; Gunthert and Wenze [33]; Lischetzke [34]). In the post-adoption context, autobiographical narrative is often used as a cognitive and reflection tool to save memories and make a family tale be organized more easily in order to support the construction of a bonding [35], legitimizing at the same time the need of each family member to feel part of the family but also to have his/her own story to tell [36].

More in general, narrative is thought to have a transformational value as it allows the experience and memories associated to it to be turned into a narrative form (e.g., Freud [37]; Bion [38]; Matte Blanco [39]; Bucci [40]). Giving a structure to that form means to organize communication in a consistent way, with a precise time and causal order, identifying and giving a name to the emotions felt, thus driving people to provide an interpretation of the events inevitably [41, 42]. According to this approach, narrative is considered also a tool that may help to overcome traumas and improve the psychophysical conditions of the narrators [43, 44].

In the case of the DAVAd, the narrative to be built can pursue even more specific goals, besides those already mentioned.

In particular, it is useful to underline its educational role, both on the levels of content and method.

On the level of content, it has to be pointed out that parents are suggested to write a diary during the only period of time they are alone, without their own cultural and personal reference points, in a foreign land. Thinking over their own

**69**

each other [47].

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

help to develop the observation skills of prospective parents [45].

and therefore what type of support should be offered to them later on.

**4.2 The DAVAd and the reflexive function**

make based on his/her new role as a parent. This can be better explained as follows.

experience of foreignness consisting of an environment made of smells, climate, cultural codes, language, habits, food, etc., different from their familiar ones, may help adoptive parents to understand what their adoptive children will experience once they will have left their country of birth and daily life. Therefore, this could

With reference to method, it has to be highlighted that the habit of writing a diary about the events related to the family relationship means to be able to stop and recollect what happened during the day and choose only one episode. Therefore, before starting writing, parents need to detach from the flow of events, thus building a particular material and mental setting. The act of writing the DAVAd can be considered a useful pretext to develop the ability to reflect on personal and

Lastly, the act of writing a diary represents a meaningful act within the relation between the couple and the clinician working with them in the pre-adoption and post-adoption stages. The receipt of the DAVAd and its writing are acts proposed to make more present the background support provided by the counsellor in charge of managing the path to adoption: the diary can be regarded as a transitional object that reminds of the dialogue, temporarily interrupted, with the reference clinician. The episodes narrated will give the counsellor useful clues to understand how the narrative of the new family is being built, the criteria for interpreting and explaining events within the relationship, the type of reflexive ability used by the couple,

Despite the observations made in the previous paragraph, the act of writing a diary can also be considered a very demanding effort for the couple. Even though such an issue needs to be taken into account, it also needs to be addressed when considering the specific role adoptive parents start to play during their journey. The act of writing requires an effort similar to the one the adoptive parent is going to

A child going through the path to adoption is a child who suffered from being separated from his/her birth family but who may have experienced other events that may be defined as traumatic ones. Those events affect the child's reflexive function [46], that is, the ability to interpret behaviors, personal and those of others, in terms of hypothetical mental states, be they thoughts, feelings, wishes, and intentions, thus promoting the building of (self and others') representations that are incompatible among themselves and are therefore left separated from

For example, the feeling of having been inflicted an unfair punishment may lead to a representation of parents incompatible with that of a loving and caring parent. On the contrary, if the child is able to consider the unfair punishment not a result of his/her condition as a child not deserving love or of the cruelty of adoptive parents, experienced as absolute dimensions, but only as the result of a temporary condition, then it is possible to be able to reconnect the two different representations. For the child the opportunity to regain a unitary model of the self and of the other is connected to the reflexive function of his/her new parents who can gradually make understandable and foreseeable the behavior of the self and of the others; this will reduce the needs to separate the representations and will promote the absorption of new relational experiences. As Bastianoni [48] observes "the entry of the child in the world of minds is almost a process of apprenticeship whereby caregivers encourage the child to adopt mentalizing concepts. The acquisition of a

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

relational daily dynamics.

#### *The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

experience of foreignness consisting of an environment made of smells, climate, cultural codes, language, habits, food, etc., different from their familiar ones, may help adoptive parents to understand what their adoptive children will experience once they will have left their country of birth and daily life. Therefore, this could help to develop the observation skills of prospective parents [45].

With reference to method, it has to be highlighted that the habit of writing a diary about the events related to the family relationship means to be able to stop and recollect what happened during the day and choose only one episode. Therefore, before starting writing, parents need to detach from the flow of events, thus building a particular material and mental setting. The act of writing the DAVAd can be considered a useful pretext to develop the ability to reflect on personal and relational daily dynamics.

Lastly, the act of writing a diary represents a meaningful act within the relation between the couple and the clinician working with them in the pre-adoption and post-adoption stages. The receipt of the DAVAd and its writing are acts proposed to make more present the background support provided by the counsellor in charge of managing the path to adoption: the diary can be regarded as a transitional object that reminds of the dialogue, temporarily interrupted, with the reference clinician. The episodes narrated will give the counsellor useful clues to understand how the narrative of the new family is being built, the criteria for interpreting and explaining events within the relationship, the type of reflexive ability used by the couple, and therefore what type of support should be offered to them later on.

#### **4.2 The DAVAd and the reflexive function**

Despite the observations made in the previous paragraph, the act of writing a diary can also be considered a very demanding effort for the couple. Even though such an issue needs to be taken into account, it also needs to be addressed when considering the specific role adoptive parents start to play during their journey. The act of writing requires an effort similar to the one the adoptive parent is going to make based on his/her new role as a parent.

This can be better explained as follows.

A child going through the path to adoption is a child who suffered from being separated from his/her birth family but who may have experienced other events that may be defined as traumatic ones. Those events affect the child's reflexive function [46], that is, the ability to interpret behaviors, personal and those of others, in terms of hypothetical mental states, be they thoughts, feelings, wishes, and intentions, thus promoting the building of (self and others') representations that are incompatible among themselves and are therefore left separated from each other [47].

For example, the feeling of having been inflicted an unfair punishment may lead to a representation of parents incompatible with that of a loving and caring parent. On the contrary, if the child is able to consider the unfair punishment not a result of his/her condition as a child not deserving love or of the cruelty of adoptive parents, experienced as absolute dimensions, but only as the result of a temporary condition, then it is possible to be able to reconnect the two different representations.

For the child the opportunity to regain a unitary model of the self and of the other is connected to the reflexive function of his/her new parents who can gradually make understandable and foreseeable the behavior of the self and of the others; this will reduce the needs to separate the representations and will promote the absorption of new relational experiences. As Bastianoni [48] observes "the entry of the child in the world of minds is almost a process of apprenticeship whereby caregivers encourage the child to adopt mentalizing concepts. The acquisition of a

*Family Therapy - New Intervention Programs and Researches*

adoptive parents and children.

relationship with their adopted children.

of the child/children, etc.

relationship.

**4.1 Why a diary?**

The diary follows the following narrative pattern:

• Introduction: place, time, people participating

• Event: what they decided to write on the diary

family but also to have his/her own story to tell [36].

goals, besides those already mentioned.

content and method.

which is a useful tool offered to couples, who chose international adoption, as a "companion" during their journey to the country of birth of the child they were matched to. This tools was designed with the aim of providing clinicians with a support tool to their work, "opening a window" on the first interactions between

The tool offered to parents suggests them to narrate an episode regarded as meaningful one for each day they spent abroad, during which they experienced the

• Consequences: how the event terminated, what the parents learnt, the reaction

After that, parents are asked to write down their emotions and the relevant level of intensity (very low, low, medium, quite high, very high, incredibly high), indicating whether those emotions refer to the father/mother and/or child.

The DAVAd therefore suggests a narrative framework, but it also gives parents the opportunity to tell about the episode freely. The focus, even with regard to emotions and feelings, is on the ability of the couple to acknowledge them, write them down, and state their level of intensity. The DAVAd is used to collect the narrative choices made by the couple, the way in which the parents tell the experience they are having. The focus is not on the collection of facts, rather on the identification of the strategies developed by adoptive parents and children at the beginning of their

The proposal to write a diary or to use the narrative of the events as a tool is not something new (Daily diary methodology: Bolger et al. [32]; Gunthert and Wenze [33]; Lischetzke [34]). In the post-adoption context, autobiographical narrative is often used as a cognitive and reflection tool to save memories and make a family tale be organized more easily in order to support the construction of a bonding [35], legitimizing at the same time the need of each family member to feel part of the

More in general, narrative is thought to have a transformational value as it allows

In the case of the DAVAd, the narrative to be built can pursue even more specific

In particular, it is useful to underline its educational role, both on the levels of

On the level of content, it has to be pointed out that parents are suggested to write a diary during the only period of time they are alone, without their own cultural and personal reference points, in a foreign land. Thinking over their own

the experience and memories associated to it to be turned into a narrative form (e.g., Freud [37]; Bion [38]; Matte Blanco [39]; Bucci [40]). Giving a structure to that form means to organize communication in a consistent way, with a precise time and causal order, identifying and giving a name to the emotions felt, thus driving people to provide an interpretation of the events inevitably [41, 42]. According to this approach, narrative is considered also a tool that may help to overcome traumas

and improve the psychophysical conditions of the narrators [43, 44].

**68**

reflexive ability thus becomes part of an intersubjective process between the child and the caregivers" (p. 34).

If we look at this from the point of view of the couple, for example, the child is likely to have learnt dysfunctional patterns of relationships that are symptoms of the need to defend himself/herself and the inability to trust caregivers. This means that adoptive parents need to learn that a rejection behavior against them may be the expression of the child's fear to trust them but also the desire to meet them.

On the other side, the possibility to accept the life experiences of the minor, the "internal events" driving his/her behavior, is based on the parental ability to identify their own emotional states, recalled by the relationship, reflecting on them [49].

The DAVAd can therefore be a useful tool whose writing should be recommended to parents.

#### **5. A case study**

By way of example of what is stated above, the analysis of a DAVAd is hereby presented, which was written by a couple who left for a journey for the international adoption of two sisters, aged 8 and 9 in 2017. As researchers, we analyzed the written report using the same reading categories used during the observation of an interview, taking into account When, How, and What was "said" (see **Table 1**).

#### **5.1 When**

The first remark is about the days of diary writing. Even though the couple was given instructions to write the dairy every day, the act of writing is clearly and strongly irregular. Over a period of 30 days spent abroad, only eight episodes were reported. In addition to those episodes, five more were added when the family came back home and narrated over a period of 5 months. What is therefore analyzed is not a diary but a collection of episodes, which clearly points out the need to understand when the diary writing was regarded as appropriate.

#### **5.2 How**

In the 13 episodes narrated, no attention is paid to the field "Introduction," which is filled in with a more general reference to the place where the event occurred. The perception is that the episode narrated is regarded as a moment of discontinuity compared to their expectations or the normal flow of events. In other words, unexpected events seem to be narrated, which are hard to refer to the previous situation, in line with what is stated by Chafe [50], according to whom the need to narrate, to give consistency and continuity to one's own experience, is revealed only by what actually does not match with the expectations, that is, the incomprehensible and unexpected event. On the level of content, the hypothesis made is further confirmed by the repetition of the term "suddenly."

#### **5.3 What: emotions**

**Figure 1** shows the emotions both parents list to have felt with reference to the episodes narrated.

**71**

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

**Introduction Event Consequences Emotion Event**

X Mother:

X X Mother:

X X Mother:

X X Mother: fear (3)

X Mother : sorrow

X Mother:

X X Mother:

X X Mother :

X Mother: sorrow

(5) Father: dejection (4), fear (2) Child 1: Child 2:

tenderness (3) Father: tenderness (3) Child1: Child2:

impotence (3), sorrow (3) Father: impotence (3), fear (3) Child 1: Child 2:

impotence 5, confusion (4), sorrow (4) Father: impotence (4), confusion (4), sorrow (4) Child 1: Child 2:

Father: fear (4) Child 1: Child2:

sadness, sorrow Father: fear Child 1: despair Child 2: despair

confusion Father: Child 1: Child 2: rage

Father: Child 1: Child 2:

(5) Father: Child 1: Child 2: Leaving the institute

Collaboration and jealousy of the girls

Whim of the oldest

Intolerance to frustration of older

Whim of the oldest

Nocturnal enuresis of the older sister

Melancholy due to the lack of children who were in the institution

Desperation for the removal of the mother

Provocation of the youngest child

sister

girl

girl

**When How What**

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

1st day of trip 13/06

2nd day of trip 14/06

5th day of trip 17/06

9th day of trip 21/06

18th day of trip 30/06

20th day of trip 02/07

23th day of trip 05/07

27th day of trip 09/07

15/09 at home X

X

X

X

X

X

just the place

just the place

just the place

just the place

just the place

just the place

It can be observed that helplessness and grief are the emotions most cited, together with fear, often described as the fear "of not understanding" and


#### *The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

*Family Therapy - New Intervention Programs and Researches*

and the caregivers" (p. 34).

them [49].

**5.1 When**

**5.2 How**

**5.3 What: emotions**

episodes narrated.

mended to parents.

**5. A case study**

reflexive ability thus becomes part of an intersubjective process between the child

The DAVAd can therefore be a useful tool whose writing should be recom-

By way of example of what is stated above, the analysis of a DAVAd is hereby presented, which was written by a couple who left for a journey for the international adoption of two sisters, aged 8 and 9 in 2017. As researchers, we analyzed the written report using the same reading categories used during the observation of an interview, taking into account When, How, and What was "said" (see **Table 1**).

The first remark is about the days of diary writing. Even though the couple was given instructions to write the dairy every day, the act of writing is clearly and strongly irregular. Over a period of 30 days spent abroad, only eight episodes were reported. In addition to those episodes, five more were added when the family came back home and narrated over a period of 5 months. What is therefore analyzed is not a diary but a collection of episodes, which clearly points out the need to under-

In the 13 episodes narrated, no attention is paid to the field "Introduction," which is filled in with a more general reference to the place where the event occurred. The perception is that the episode narrated is regarded as a moment of discontinuity compared to their expectations or the normal flow of events. In other words, unexpected events seem to be narrated, which are hard to refer to the previous situation, in line with what is stated by Chafe [50], according to whom the need to narrate, to give consistency and continuity to one's own experience, is revealed only by what actually does not match with the expectations, that is, the incomprehensible and unexpected event. On the level of content, the hypothesis made is

**Figure 1** shows the emotions both parents list to have felt with reference to the

It can be observed that helplessness and grief are the emotions most cited, together with fear, often described as the fear "of not understanding" and

stand when the diary writing was regarded as appropriate.

further confirmed by the repetition of the term "suddenly."

If we look at this from the point of view of the couple, for example, the child is likely to have learnt dysfunctional patterns of relationships that are symptoms of the need to defend himself/herself and the inability to trust caregivers. This means that adoptive parents need to learn that a rejection behavior against them may be the expression of the child's fear to trust them but also the desire to meet them. On the other side, the possibility to accept the life experiences of the minor, the "internal events" driving his/her behavior, is based on the parental ability to identify their own emotional states, recalled by the relationship, reflecting on

**70**


*Table summarizes the writing of the diary by parents with respect to all the fields proposed by the format and to the indication provided. The "When" field reports the days when the parents filled out the diary. The "How" field considers the introduction of narrated episode, the description of the event occurred, and its consequences. The table also highlights the fields completed by parents. The "What" field present the "emotions" (experienced by each family member according to the writer's point of view; each emotion has a degree of intensity on a scale from 1 to 6) and the "events" (a brief summary of each event occurred).*

#### **Table 1.**

*Summary of the coding procedure of the case study.*

confusion. Parents seem to show the discomfort created by the clash between expectations and reality, indicating their own ability to identify and express their emotions that the problems faced make them experience.

With regard to the girls (see **Figure 2**), only in some cases the emotions felt by them are listed. In more details, only one episode among those narrated during the journey (desperation referred to both girls) and four episodes (crossed, listed three times and referring only to one of the girls, sad referred to both of them) out of five narrated when being back to Italy were listed. The above mentioned data show an increasing attention to the moods expressed by the girls, above all in period after their arrival in Italy. It may be supposed that the need to organize a family routine leads parents to pay more attention to what is felt and experienced by the minors and above all to the most difficult events to manage.

Although only negative emotions were listed as felt by the girls, it seems advisable to analyze that information taking into consideration the number of episodes narrated compared to the time. Even in this case, it has to be underlined that the couple chose to narrate some specific episodes, thus not complying with the instructions given.

With reference to the intensity of the emotions, it is possible to observe that in the first episodes, a medium/high value is always listed, but from the sixth episode, no intensity is described. One of the hypotheses that can be made is that, over time, the level of intensity of the emotion expressed was regarded less essential than the identification of the same emotion.

**73**

**5.4 What: the events**

*of reports about the emotions attributed by parents to the girls.*

the cause of the girls' sadness.

the couple.

**Figure 2.**

**Figure 1.**

*considered.*

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

The events narrated show some cohabitation issues and the solutions found by

*The emotions listed by the parents as felt by girls. The results, represented in the graph, refer to the total number* 

*The emotions described by the parents as felt by them. The results, represented in the graph, refer to the total number of times that parents have reported the emotion. Each emotion reported by the father or mother was* 

The first is about the leaving of the orphanage, the most intense event on the emotional level, in which it is difficult to understand whether the tears of the girls are for what they are leaving, their poverty (they know they are leaving only bringing with them a small backpack containing just a few things), or for what they are going to face, and the adoptive parents obviously wonder if they themselves may be

Going on reading the episodes, regressive behaviors (thumb sucking, bedwetting, and incontinence during the day) referred to the oldest girl and the relevant worries of parents are described. The inconsistency between the behaviors adopted and the age of the girl causes reactions sometimes based on compassion, sometimes

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

#### **Figure 1.**

*Family Therapy - New Intervention Programs and Researches*

11/10 at home

5/12 at home

10/01 at home

21/01 at home

**Table 1.**

**When How What**

**Introduction Event Consequences Emotion Event**

X X Mother:

X X Mother: rage

X Mother:

X Mother:

*Table summarizes the writing of the diary by parents with respect to all the fields proposed by the format and to the indication provided. The "When" field reports the days when the parents filled out the diary. The "How" field considers the introduction of narrated episode, the description of the event occurred, and its consequences. The table also highlights the fields completed by parents. The "What" field present the "emotions" (experienced by each family member according to the writer's point of view; each emotion has a degree of intensity on a scale from 1 to 6) and the* 

confusion Father: Child 1: Child 2: rage

Father: Child 1: Child 2: rage

Father: Child 1: Child 2:

sadness, impotence Father: sadness, impotence Child 1: sadness Child 2: sadness

Provocation of the youngest child

Provocation of the youngest child

Nocturnal enuresis of the older sister

Melancholy for the sister who remained in the institute

confusion. Parents seem to show the discomfort created by the clash between expectations and reality, indicating their own ability to identify and express their

With regard to the girls (see **Figure 2**), only in some cases the emotions felt by them are listed. In more details, only one episode among those narrated during the journey (desperation referred to both girls) and four episodes (crossed, listed three times and referring only to one of the girls, sad referred to both of them) out of five narrated when being back to Italy were listed. The above mentioned data show an increasing attention to the moods expressed by the girls, above all in period after their arrival in Italy. It may be supposed that the need to organize a family routine leads parents to pay more attention to what is felt and experienced by the minors

Although only negative emotions were listed as felt by the girls, it seems advisable to analyze that information taking into consideration the number of episodes narrated compared to the time. Even in this case, it has to be underlined that the couple chose to narrate some specific episodes, thus not complying with the

With reference to the intensity of the emotions, it is possible to observe that in the first episodes, a medium/high value is always listed, but from the sixth episode, no intensity is described. One of the hypotheses that can be made is that, over time, the level of intensity of the emotion expressed was regarded less essential than the

emotions that the problems faced make them experience.

*"events" (a brief summary of each event occurred).*

*Summary of the coding procedure of the case study.*

and above all to the most difficult events to manage.

**72**

instructions given.

identification of the same emotion.

*The emotions described by the parents as felt by them. The results, represented in the graph, refer to the total number of times that parents have reported the emotion. Each emotion reported by the father or mother was considered.*

#### **Figure 2.**

*The emotions listed by the parents as felt by girls. The results, represented in the graph, refer to the total number of reports about the emotions attributed by parents to the girls.*

#### **5.4 What: the events**

The events narrated show some cohabitation issues and the solutions found by the couple.

The first is about the leaving of the orphanage, the most intense event on the emotional level, in which it is difficult to understand whether the tears of the girls are for what they are leaving, their poverty (they know they are leaving only bringing with them a small backpack containing just a few things), or for what they are going to face, and the adoptive parents obviously wonder if they themselves may be the cause of the girls' sadness.

Going on reading the episodes, regressive behaviors (thumb sucking, bedwetting, and incontinence during the day) referred to the oldest girl and the relevant worries of parents are described. The inconsistency between the behaviors adopted and the age of the girl causes reactions sometimes based on compassion, sometimes on reprehension. It could be useful to analyze those topics with the psychologist in charge of the case to look at the regression as an expected event and, at least in the beginning, beneficial as it is a sign of the need of the child to recover her own dimension of "being a little child in need of care."

Several references are made to the defiant behavior of the youngest sister over the first months of their life on Italy. It is interesting to observe the ability of the parents to recognize the emotion aroused by that behavior but also the opportunity described by them not to act out. Parents seem to express the need to keep up with the image of a loving, caring, patient, and sympathetic parent and had problems in managing negative and unexpected emotions.

The uneasiness of the girls to accept rules and frustrations is also described, but most evident is the feeling of helplessness parents experience when the girls show signs of homesickness and regret for what they left.

Therefore, parents describe moments of discouragement for which they try to give comfort or oppositional behaviors they try to contain: those actions shown ever appear to be poorly effective as they should be based on the certainty of a bond still being built. What is evident is the struggle of parents when trying to balance loving care with frustration as well as the ambivalence of the girls, who ask for attention but are scared by the new experience. The parents seem to manage a fragile balance between the desire to meet the requests of the children, which are ambivalent and cannot be met in a linear way, and the desire to reduce the riskiness of their bond, thus making the family life normal and reassuring the minors while reassuring themselves as parents.

The return to Italy and the placement in a new, larger family become the source of embarrassment due to some behaviors of the girls: grandparents are described as silent witnesses, observing what they think is due to the lack of educational skills of their own children.

#### **5.5 The DAVAd in the relation between the clinician and parents**

The above mentioned considerations, which are the result of the reading of the DAVAd, allow the psychologist who works with the couple to understand the dimensions of fragility that were emphasized by the meeting between the parents and the girls. Some of those considerations were introduced in the dialogue the psychologist had with the couple, during the first assessment session.

As provided for by the procedure detailed in the agreements between the country of birth of the children and the agency for international adoption, after the first months of cohabitation, a first assessment session of the adoptive family is held, following an interview structure suggested by the country of birth of the minors. In one section of the interview that has to be filled up, it is asked to analyze the level of adjustment of the girls and integration within the new family. Talking about those topics allowed the psychologist to recollect what parents had reported during the journey, reflecting on the meaning given to the events described and the impact they had on the parental couple. The couple seemed to be very aware of what they felt and experienced and was ready to regard it as elements of the dialogue. In this way, it was possible to talk about their need to be "a good parent," acknowledging the possibility that they may feel upset due to defiant behaviors. Furthermore, it was possible to reflect on the respect of the time of adjustment of their daughters, on the acceptance of "upsetting behaviors" by the girls on different occasions, and on their sorrow for the unease of the daughters that they cannot explain. Sharing with the parents the events occurred allowed the psychologist to help them to relieve their tensions, their feeling of being helpless, and their feeling of losing control over the experience made.

**75**

own story.

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

opportunity to acknowledge themselves as resilient and caring people.

Furthermore, reading again the narratives of the DAVAd and noticing that mainly "negative and critical" events were narrated drove the "newborn parents" to also tell about the occurrence of many pleasant events and their joy to recognize themselves as a family. A more flexible narrative was therefore created, with the

In this research, it was useful to recognize and accept the experience of distrust and fear of the couple and at the same time the feelings of anxiety and fear expressed by the girls. The relation with the counsellor, who recognizes and legitimates what is felt and experienced by the parents without judging them, seems to have activated the resources of the couple useful to accept and legitimate the

A new tool was presented in this work, a narrative diary, which is the result of the considerations implicitly made reviewing the literature about adoption breakdowns. According to the literature reviewed, there seem to be two elements that may be useful to develop: the relationship between families and counsellors, as to launch early and long-lasting support services, and the attention to the "birth stage"

Therefore, a tool was designed that could be useful to guide adoptive couples and the counsellors working with them when monitoring of what happens during the stage of face-to-face contact with the children. A meeting in case of international adoptions takes place in the country of birth of the children and is difficult to

The act of writing a diary by the adoptive parents can thus make it easier to monitor a stage that is very important as it lays down the foundations on which the family relationship will be based. In addition to the monitoring of the first stages of the relations, such a tool is also not very intrusive and is meant not to harm the

The reading of the diary, on the other side, can provide counsellors with useful information to implement early actions of prevention aimed at safeguarding the wellbeing and development of the adoptive family, taking into consideration the

In more general terms, it can be stated that the act of writing is a preventive action, as it allows the actors to narrate about themselves and think back to the

According to Paradiso [51], narrative is the space for resilience, because narrating oneself and sharing one's own life experience with a "fairly good" interlocutor allow oneself to rethink the representation of the self and of one's own future. This is important for the adoptive couple in their relation with the counsellor, within a narrative path already started in the pre-adoption stage. And it is even more important for adopted children in their relation with the new parents, because they bring with themselves traumatic memories and are working hard at reconstructing their

Even though the design of a tool is a small thing, compared to the desirable change in the culture driving the behavior of those who are involved in adoption processes, based on the evidence of our research, the diary proposed may be considered one of the elements that may drive such a change. It is a good pretext to help the ability of the spouses to think [52] of the family relationship and what happens within it every day, progressively walking away from a predictable interpretation of the events, based on habits according to which events are interpreted. Thinking

way in which parents talk about their relationship with the children.

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

problems experienced by the minors.

**6. Conclusions**

of the family relations.

be directly observed.

events that occurred.

intimacy of the family being built.

#### *The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

Furthermore, reading again the narratives of the DAVAd and noticing that mainly "negative and critical" events were narrated drove the "newborn parents" to also tell about the occurrence of many pleasant events and their joy to recognize themselves as a family. A more flexible narrative was therefore created, with the opportunity to acknowledge themselves as resilient and caring people.

In this research, it was useful to recognize and accept the experience of distrust and fear of the couple and at the same time the feelings of anxiety and fear expressed by the girls. The relation with the counsellor, who recognizes and legitimates what is felt and experienced by the parents without judging them, seems to have activated the resources of the couple useful to accept and legitimate the problems experienced by the minors.

#### **6. Conclusions**

*Family Therapy - New Intervention Programs and Researches*

dimension of "being a little child in need of care."

managing negative and unexpected emotions.

themselves as parents.

their own children.

signs of homesickness and regret for what they left.

on reprehension. It could be useful to analyze those topics with the psychologist in charge of the case to look at the regression as an expected event and, at least in the beginning, beneficial as it is a sign of the need of the child to recover her own

Several references are made to the defiant behavior of the youngest sister over the first months of their life on Italy. It is interesting to observe the ability of the parents to recognize the emotion aroused by that behavior but also the opportunity described by them not to act out. Parents seem to express the need to keep up with the image of a loving, caring, patient, and sympathetic parent and had problems in

The uneasiness of the girls to accept rules and frustrations is also described, but most evident is the feeling of helplessness parents experience when the girls show

Therefore, parents describe moments of discouragement for which they try to give comfort or oppositional behaviors they try to contain: those actions shown ever appear to be poorly effective as they should be based on the certainty of a bond still being built. What is evident is the struggle of parents when trying to balance loving care with frustration as well as the ambivalence of the girls, who ask for attention but are scared by the new experience. The parents seem to manage a fragile balance between the desire to meet the requests of the children, which are ambivalent and cannot be met in a linear way, and the desire to reduce the riskiness of their bond, thus making the family life normal and reassuring the minors while reassuring

The return to Italy and the placement in a new, larger family become the source of embarrassment due to some behaviors of the girls: grandparents are described as silent witnesses, observing what they think is due to the lack of educational skills of

The above mentioned considerations, which are the result of the reading of the DAVAd, allow the psychologist who works with the couple to understand the dimensions of fragility that were emphasized by the meeting between the parents and the girls. Some of those considerations were introduced in the dialogue the

As provided for by the procedure detailed in the agreements between the country of birth of the children and the agency for international adoption, after the first months of cohabitation, a first assessment session of the adoptive family is held, following an interview structure suggested by the country of birth of the minors. In one section of the interview that has to be filled up, it is asked to analyze the level of adjustment of the girls and integration within the new family. Talking about those topics allowed the psychologist to recollect what parents had reported during the journey, reflecting on the meaning given to the events described and the impact they had on the parental couple. The couple seemed to be very aware of what they felt and experienced and was ready to regard it as elements of the dialogue. In this way, it was possible to talk about their need to be "a good parent," acknowledging the possibility that they may feel upset due to defiant behaviors. Furthermore, it was possible to reflect on the respect of the time of adjustment of their daughters, on the acceptance of "upsetting behaviors" by the girls on different occasions, and on their sorrow for the unease of the daughters that they cannot explain. Sharing with the parents the events occurred allowed the psychologist to help them to relieve their tensions, their feeling of being helpless, and their feeling of losing

**5.5 The DAVAd in the relation between the clinician and parents**

psychologist had with the couple, during the first assessment session.

**74**

control over the experience made.

A new tool was presented in this work, a narrative diary, which is the result of the considerations implicitly made reviewing the literature about adoption breakdowns. According to the literature reviewed, there seem to be two elements that may be useful to develop: the relationship between families and counsellors, as to launch early and long-lasting support services, and the attention to the "birth stage" of the family relations.

Therefore, a tool was designed that could be useful to guide adoptive couples and the counsellors working with them when monitoring of what happens during the stage of face-to-face contact with the children. A meeting in case of international adoptions takes place in the country of birth of the children and is difficult to be directly observed.

The act of writing a diary by the adoptive parents can thus make it easier to monitor a stage that is very important as it lays down the foundations on which the family relationship will be based. In addition to the monitoring of the first stages of the relations, such a tool is also not very intrusive and is meant not to harm the intimacy of the family being built.

The reading of the diary, on the other side, can provide counsellors with useful information to implement early actions of prevention aimed at safeguarding the wellbeing and development of the adoptive family, taking into consideration the way in which parents talk about their relationship with the children.

In more general terms, it can be stated that the act of writing is a preventive action, as it allows the actors to narrate about themselves and think back to the events that occurred.

According to Paradiso [51], narrative is the space for resilience, because narrating oneself and sharing one's own life experience with a "fairly good" interlocutor allow oneself to rethink the representation of the self and of one's own future. This is important for the adoptive couple in their relation with the counsellor, within a narrative path already started in the pre-adoption stage. And it is even more important for adopted children in their relation with the new parents, because they bring with themselves traumatic memories and are working hard at reconstructing their own story.

Even though the design of a tool is a small thing, compared to the desirable change in the culture driving the behavior of those who are involved in adoption processes, based on the evidence of our research, the diary proposed may be considered one of the elements that may drive such a change. It is a good pretext to help the ability of the spouses to think [52] of the family relationship and what happens within it every day, progressively walking away from a predictable interpretation of the events, based on habits according to which events are interpreted. Thinking

about one's own emotiveness, aroused by complex relations, can be useful to any family, but it becomes highly significant for those families who since the beginning show relationship issues with their own children.

### **Author details**

Barbara Cordella1 \*, Paola Elia2 , Marzia Pibiri1 and Alessia Carleschi1

1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy

2 Society of Interpersonal Psychoanalysis and Analysis Group, (S.P.I.G.A.), Rome, Italy

\*Address all correspondence to: barbara.cordella@uniroma1.it

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**77**

*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond*

Research. 2015;**41**(1):75-92. DOI: 10.1080/10926755.2014.895469

[8] Van IJzendoorn MH, Juffer F. The Emanuel miller memorial lecture 2006: Adoption as intervention. Meta-analytic evidence for massive catch-up and plasticity in physical, socio-emotional, and cognitive development. Journal of Child Psychology and Psychiatry. 2006;**47**(12):1228-1245. DOI: 10.1111/j.1469-7610.2006.01675.x

[9] Vadilonga F. Curare l'adozione. Raffaello Cortina: Milano; 2010

[10] De Bono I. Incontrarsi altrove. Il gruppo nell'adozione. Funzione Gamma. 2013. rivista scientifica telematica Sapienza Università di Roma; Disponibile presso: www. funzionegamma.it [Ultimo accesso 15

[11] Stovall KC, Dozier M. Infants in foster care: An attachment theory perspective. Adoption Quarterly. 1998;**2**:55-88. DOI: 10.1300/

[12] Paniagua C, Jiménez-Morago JM, Palacios J. Adopcionesrotas en Andalucía: Caracterización y propuestas para la intervención. Apuntes de Psicología. 2016;**34**(2- 3):301-309. DOI: 10.22201/iisue.244861

Ottobre 2018]

j145v02n01\_05

67e.2016.152.57612

internazionali. CAI

2010

[13] Ricerca italiana del 2003 commissione per le adozioni

[14] Semanchin-Jones A. Adoption disruptions and dissolutions [thesis]. St. Paul: Center for Advanced Studies in Child Welfare, University of Minnesota;

[15] Rosnati R. La 'nascita' di una famiglia adottiva: sviluppo psicosociale dei bambini e benessere genitoriale.

*DOI: http://dx.doi.org/10.5772/intechopen.88329*

autobiografia nella famiglia adottiva. Rivista italiana di educazione familiare.

[2] Hussey DL, Falletta L, Eng A. Risk factors for mental health diagnoses among children adopted from the public child welfare system. Children and Youth Services Review. 2012;**34**(10):2072-2080. DOI: 10.1016/j.

[3] Lebrault M, André-Trévennec G. Adoption internazionale accompagnée. Devenir des enfants adoptés à l'international de 2001 à 2005 par l'intermédiaire de l'OAA Médecinsdu Monde. Neuropsychiatrie de l'Enfance et de l'Adolescence. 2015;**63**(3):141-156. DOI: 10.1016/j.

childyouth.2012.06.015

neurenf.2015.01.008

neurenf.2015.04.006

[4] Wuyts R, Duret I, Delvenne V. Adolescentsadoptés: Un risque psychopathologique? Neuropsychiatrie

de l'Enfance et de l'Adolescence. 2015;**63**(6):385-391. DOI: 10.1016/j.

[5] Barone L, Lionetti F. Attachment and emotional understanding: A study on late adopted pre schoolers and their parents. Child: Care, Health and Development. 2011;**38**(5):690-696. DOI:

10.1111/j.1365-2214.2011.01296.x

[6] Burke RV, Prevention Group

10.1177/1534650114556696

Research Team, Schlueter C, Vandercoy J, Authier KJ. Post-adoption services for families at risk of dissolution: A case study describing two families' experiences. Clinical Case Studies. 2015;**14**(4):291-306. DOI:

[7] Hartinger-Saunders RM, Trouteaud A, Matos Johnson J. The effects of post adoption service need and use on child and adoptive parent outcomes. Journal of Social Service

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*The DAVAd: A Narrative Tool to Explore the Early Stages of the Adoptive Bond DOI: http://dx.doi.org/10.5772/intechopen.88329*

#### **References**

*Family Therapy - New Intervention Programs and Researches*

show relationship issues with their own children.

about one's own emotiveness, aroused by complex relations, can be useful to any family, but it becomes highly significant for those families who since the beginning

**76**

**Author details**

Barbara Cordella1

Italy

Italy

\*, Paola Elia2

provided the original work is properly cited.

, Marzia Pibiri1

\*Address all correspondence to: barbara.cordella@uniroma1.it

1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome,

2 Society of Interpersonal Psychoanalysis and Analysis Group, (S.P.I.G.A.), Rome,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

and Alessia Carleschi1

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study. La Psychiatrie de l'Enfant. 2017;**60**(1):49-70. DOI: 10.1016/j.

[36] Demetrio D. Scrivere l'adozione: Resilienza e passaggi di vita. Minori

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di fronte alla sfida dell'adolescenza.

[23] Salvatore S. L'intervento clinico. Roma: Giorgio Firera Editore; 2015

maternità. Individuazione, prevenzione e trattamento. Milano: Franco Angeli;

[25] Ammaniti M, Tambelli R, Odorisio F. Intervista clinica per lo studio delle rappresentazioni paterne in gravidanza: IRPAG. Età evolutiva. 2006;**85**:34-44

[26] St-André M, Keren M. Clinical challenges of adoption: Views from Montreal and Tel Aviv. Infant Mental Health Journal. 2011;**32**(6):694-706.

[27] Ammaniti M, Gallese V. La nascita dell'intersoggettività. Lo sviluppo del sé tra psicodinamica e neurobiologia. Raffaello Cortina: Milano; 2014

[28] Paradiso L. Prepararsi all'adozione.

[29] Harf A, Skandrani S, Radjack R, Sibeoni J, Moro MR, Revah-Levy A. First parent-child meetings in international adoptions: A qualitative study. PLoS One. 2013;**8**(9):e75300. DOI: 10.1371/journal.pone.0075300

[30] Guivarch J, Krouch T, Lecamus S, Vedie C. La filiation adoptive à l'épreuve du traumatisme. Annales Médico-Psychologiques. 2017;**175**(8):705-709. DOI: 10.1016/j.amp.2017.02.013

[31] Paradiso L. Stress post adozione e depressione post-adottiva: una distinzione importante [Internet]. 2007. Available from: https.//adozione percorsi.it/prospettive-psicologiche/

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stress post-adottivo

DOI: 10.1002/imhj.20329

Milano: Unicopli; 1999

[24] Zaccagnino M. I disagi della

2009

Milano: Franco Angeli; 1998

In: Convegno Internazionale Allargare

[16] Coakley JF, Berrick JD. Research review: In a rush to permanency: Preventing adoption disruption. Child & Family Social Work. 2008;**13**(1):101-112. DOI:

10.1111/j.1365-2206.2006.00468.x

[17] CAI. L'accoglienza di bambini in stato di abbandono nel mondo: strumenti giuridici a confronto. In: Convegno sulla sostenibilità del Sistema adozioni internazionali della CAI e Istituto degli Innocenti; 19 ottobre 2018;

[18] Zuccalà MA. Rilievi giuridici e comparatistici del fallimento adottivo. Percorsi problematici dell'adozione internazionale. Commissione per le adozioni internazionali. Firenze: Istituto

degli Innocenti di Firenze; 2003

[19] Vitolo M. Le difficoltà legate alla costruzione di un rapporto di affidabilità con la nuova famiglia: le storie e la memoria. Percorsi problematici dell'adozione

internazionale. Commissione per le adozioni internazionali. Firenze: Istituto

[20] Lombardi R. La famiglia adottiva al "banco di prova" dell'adolescenza, specchio che amplifica e confonde. Percorsi problematici dell'adozione internazionale. Commissione per le adozioni internazionali. Firenze: Istituto

Degli Innocenti di Firenze; 2003

degli Innocenti di Firenze; 2003

[21] Luzzatto L. Il ruolo dei servizi. Percorsi problematici dell'adozione internazionale. Commissione per le adozioni internazionali. Firenze: Istituto

Degli Innocenti di Firenze; 2003

[22] Bramanti D, Rosnati R. Il patto adottivo. L'adozione internazionale

lo spazio familiare: essere figli nell'adozione e nell'affido; 13-14

febbraio 2015; Milano

Firenze

**78**

[33] Gunthert KC, Wenze SJ. Daily diary methods. In: Mehl MR, Conner TS, editors. Handbook of Research Methods for Studying Daily Life. New York, NY, US: The Guilford Press; 2012. pp. 144-159

[34] Lischetzke T. Daily diary methodology. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht, Netherlands: Springer; 2014. pp. 1413-1419

[35] Sarmiento L, Skandrani S, Benoit L, Harf A, Moro MR. The experience of late international adoptees: A qualitative study. La Psychiatrie de l'Enfant. 2017;**60**(1):49-70. DOI: 10.1016/j. amp.2017.02.013

[36] Demetrio D. Scrivere l'adozione: Resilienza e passaggi di vita. Minori giustizia. 2011;**2**:31-40

[37] Freud S. Il poeta e la fantasia. OSF. Volume 5. Torino: Bollati Boringhieri; 1907

[38] Bion W. Transformations. London: William Heinemann Medical Books. Trad. it. Trasformazioni. Il passaggio dall'apprendimento alla crescita. Roma: Armando; 1973

[39] Matte Blanco I. L'inconscio come insiemi infiniti. Saggio sulla bi-logica. Torino: Giulio Einaudi; 1975

[40] Bucci W. Psychoanalysis and Cognitive Science. A Multiple Code Theory. New York: Guilford Press; Trad. it. Psicoanalisi e scienza cognitive. Roma: Fioriti; 1997

[41] Bruner J. The narrative construction of reality. Critical Inquiry. 1991;**18**(1):1-21

[42] Montesarchio G, Venuleo C. Narrazione generativa. In: Montesarchio G, Venuleo C. (a cura di). Colloquio Magistrale. La narrazione generativa. Milano: Franco Angeli; 2009. p. 71-105

[43] Pennebaker JW, Seagal JD. Forming a story: The health benefits of narrative. Journal of Clinical Psychology. 1999;**55**(10):1243- 1254. DOI: 10.1002/(sici)1097- 4679(199910)55:10%3C1243:aidjclp6%3E3.0.co;2-n

[44] Solano L. Scrivere per pensare. La trascrizione dell'esperienza tra promozione della salute e ricerca. Roma: Franco Angeli; 2007

[45] Braga P, Tosi P. L'osservazione. In: Mantovani S, editor. (a Cura di). La ricerca sul campo in educazione. I metodi qualitativi. Milano: Mondadori. 1995

[46] Fonagy P, Target M. Attachment and reflective function: Their role in self-organization. Developement Psychopathology. 1997;(4):679-700. DOI: 10.1017/s0954579497001399

[47] Baldoni F. Alle origini del trauma: Confusione delle lingue e fallimento della funzione riflessiva. In: Crocetti G, Zarri A, editors. (a cura di). Gli dei della notte sulle sorgenti della vita, il trauma precoce dalla coppia madre al bambino. Pendragon: Bologna. p. 2008

[48] Bastianoni P. Funzioni di cura e genitorialità. Rivista Italiana di Educazione Familiare. 2009;**1**:37-53. DOI: 10.13128/RIEF-3332

[49] Slade A. Relazione genitoriale e funzione riflessiva. Teoria, clinica e intervento sociale. A cura di Zavattini GC. Roma: Astrolabio Ubaldini; 2010

[50] Chafe W. Some things that narratives tell us about the mind. In: Narrative Thought and Narrative Language. Hillsdale (NJ): Lawrence Erlbaum; 1990. pp. 79-98

[51] Paradiso L. Memorie familiari e narrazioni nella genitorialità e filialità adottiva. Rivista Italiana di Educazione Familiare. 2017;**1**:77-95. DOI: 10.13128/ RIEF-20974

[52] Carli R, Paniccia RM. Analisi della domanda. Teoria e tecnica dell'intervento in psicologia clinica. Il Mulino: Bologna; 2004

**81**

**Chapter 5**

Illness

**Abstract**

recommendations for practice.

**1. Introduction**

KidsTime Workshops:

Strengthening Resilience of

*Klaus Henner Spierling, Kirsty Tahta-Wraith,* 

*Helena Kulikowska and Dympna Cunnane*

Children of Parents with a Mental

This chapter will introduce children of parents with mental illness (COPMI) as a group and explain the impact and risk factors of parental mental illness on children. We will provide examples of approaches that can help children in this situation, using the KidsTime Workshop model as a case study. We will describe the approaches and methods of the KidsTime practice model and explain how a combination of family therapy and systemic therapy influences, together with drama, can create an effective multi-family therapy intervention. It will describe the impact of the KidsTime model, including testimonials from children and families, and highlight the evidence in support of preventative approaches, as well as the barriers to securing investment for these interventions. The chapter will conclude with

**Keywords:** parental mental illness, children, multi-family, systemic therapy, drama

Children of parents with a mental illness face childhoods that can be full of challenging experiences, threatening their quality of life, development and longterm outcomes [1–4]. However, these children are not an officially recognised group in the UK, and data and statistics are not gathered about them. While UK policies recognise the needs of young carers, they do not address the specific challenges experienced by children whose parents have a mental illness. This is not the case in other countries; in Australia, these children are officially known as children of parents with mental illness (COPMI) and as "young relatives" in most Nordic countries. Children of parents with a mental illness remain a hidden group in the UK, and many are reluctant to identify as young carers due to the shame and stigma often associated with mental illness, making them vulnerable and at risk of neglect. The UK Children's Commissioner Vulnerability Report (2018) found that in an average classroom, eight children have a parent with mental health problems—this is the equivalent to 25% of the UK school population [3]. In 2018, Our Time, a UK charity that advocates for and offers support to this group did an analysis of the existing data (supported by a team from Ernst and Young), which found that in

#### **Chapter 5**

*Family Therapy - New Intervention Programs and Researches*

[51] Paradiso L. Memorie familiari e narrazioni nella genitorialità e filialità adottiva. Rivista Italiana di Educazione Familiare. 2017;**1**:77-95. DOI: 10.13128/

[52] Carli R, Paniccia RM. Analisi della domanda. Teoria e tecnica dell'intervento in psicologia clinica. Il

Mulino: Bologna; 2004

RIEF-20974

**80**

## KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness

*Klaus Henner Spierling, Kirsty Tahta-Wraith, Helena Kulikowska and Dympna Cunnane*

#### **Abstract**

This chapter will introduce children of parents with mental illness (COPMI) as a group and explain the impact and risk factors of parental mental illness on children. We will provide examples of approaches that can help children in this situation, using the KidsTime Workshop model as a case study. We will describe the approaches and methods of the KidsTime practice model and explain how a combination of family therapy and systemic therapy influences, together with drama, can create an effective multi-family therapy intervention. It will describe the impact of the KidsTime model, including testimonials from children and families, and highlight the evidence in support of preventative approaches, as well as the barriers to securing investment for these interventions. The chapter will conclude with recommendations for practice.

**Keywords:** parental mental illness, children, multi-family, systemic therapy, drama

#### **1. Introduction**

Children of parents with a mental illness face childhoods that can be full of challenging experiences, threatening their quality of life, development and longterm outcomes [1–4]. However, these children are not an officially recognised group in the UK, and data and statistics are not gathered about them. While UK policies recognise the needs of young carers, they do not address the specific challenges experienced by children whose parents have a mental illness. This is not the case in other countries; in Australia, these children are officially known as children of parents with mental illness (COPMI) and as "young relatives" in most Nordic countries. Children of parents with a mental illness remain a hidden group in the UK, and many are reluctant to identify as young carers due to the shame and stigma often associated with mental illness, making them vulnerable and at risk of neglect.

The UK Children's Commissioner Vulnerability Report (2018) found that in an average classroom, eight children have a parent with mental health problems—this is the equivalent to 25% of the UK school population [3]. In 2018, Our Time, a UK charity that advocates for and offers support to this group did an analysis of the existing data (supported by a team from Ernst and Young), which found that in

excess of 3.4 million children and young people in the UK are currently living with a parent with a mental illness [5]. Further evidence indicates that, without support, 70% of these children are likely to go on to develop mental health problems themselves. With two ill parents, there is a 30–50% chance of the child developing a *serious* mental illness later in life [6]. A WHO review stated: "Children with a parent who has a mental illness or substance use disorder are placed at high risk of experiencing family discord and psychiatric problems. The intergenerational transfer of mental disorder is the result of interactions between genetic, biological and social risk factors occurring as early as pregnancy and infancy" [7, 8].

In Germany, where Our Time's partners, the "KidsTime Netzwerk", use the KidsTime Workshop model to support children and families, research has identified 3.8 million children affected by parental mental illness [9].

#### **1.1 Summary of key facts and statistics**


Research into adverse childhood experiences, known as ACEs [10], identifies parental mental illness as one of the ten most powerful sources of toxic stress in young people. The presence of mental illness in a parent is known to negatively impact a child's cognitive and language development, educational achievement and social, emotional and behavioural development [2–4, 10]. It can lead to anxiety and guilt coming from a sense of personal responsibility. Where there is severe mental illness in a parent and no second parent who is well it can lead to neglect or abuse. These children are also at greater risk of bullying, a lower standard of living and financial hardship [2–5, 9].

**Figures 1** and **2** show the lifetime impact of adverse childhood experiences affecting the mental and physical health of the individual as a result of toxic stress.

**83**

**1.2 A hidden risk**

**Figure 2.**

**Figure 1.**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

The hidden status of these young people in the UK means that they have no statutory entitlement to specific support related to parental mental illness. Provision of formal, organised support or targeted intervention is therefore at the discretion of local funding bodies or entirely dependent on the voluntary sector. Any informal support is dependent on the awareness and understanding of professionals coming into contact with these children to identify and support their needs. However, this sometimes requires stepping outside of the remit of current practice and expertise, adding an additional "burden" to already high workloads. Additionally, many professionals report worrying about talking to children in this situation, as they are concerned about "*saying the wrong thing*" or "*making the situation worse*". Social service providers are dominated by risk concerns and are therefore reluctant to intervene in this area, which means that low intensity, early help is not commissioned. Despite these challenges, there are things that can be done to help children in this situation, enabling them to thrive, despite their

*Long-term effects of ACEs (Centers for Disease Control and Prevention, cdc.gov).*

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

*The ACE pyramid (Centers for Disease Control and Prevention, cdc.gov).*

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

#### **Figure 1.**

*Family Therapy - New Intervention Programs and Researches*

risk factors occurring as early as pregnancy and infancy" [7, 8].

3.8 million children affected by parental mental illness [9].

• 70% likely to develop a mental health condition.

intervention spending by local authorities.

law, 4 in 5 young carers were not identified.

**1.1 Summary of key facts and statistics**

• 20–25% of the school population.

issue.

generation.

financial hardship [2–5, 9].

excess of 3.4 million children and young people in the UK are currently living with a parent with a mental illness [5]. Further evidence indicates that, without support, 70% of these children are likely to go on to develop mental health problems themselves. With two ill parents, there is a 30–50% chance of the child developing a *serious* mental illness later in life [6]. A WHO review stated: "Children with a parent who has a mental illness or substance use disorder are placed at high risk of experiencing family discord and psychiatric problems. The intergenerational transfer of mental disorder is the result of interactions between genetic, biological and social

In Germany, where Our Time's partners, the "KidsTime Netzwerk", use the KidsTime Workshop model to support children and families, research has identified

• In excess of 3 million children in the UK live with a parent with a mental health

• Parental mental illness is one of the 10 adverse childhood experiences (ACEs),

• WHO identifies PMI as one of the most important public health issues of our

• Intervention late after the onset of an ACE is less likely to be effective. Rising thresholds for acute support are exacerbated by significant reductions in early

• By focusing on clinically diagnosable mental illnesses, the children and adoles-

• In 2018 the Children's Commissioner reported that despite the new provisions in

Research into adverse childhood experiences, known as ACEs [10], identifies parental mental illness as one of the ten most powerful sources of toxic stress in young people. The presence of mental illness in a parent is known to negatively impact a child's cognitive and language development, educational achievement and social, emotional and behavioural development [2–4, 10]. It can lead to anxiety and guilt coming from a sense of personal responsibility. Where there is severe mental illness in a parent and no second parent who is well it can lead to neglect or abuse. These children are also at greater risk of bullying, a lower standard of living and

**Figures 1** and **2** show the lifetime impact of adverse childhood experiences affecting the mental and physical health of the individual as a result of toxic stress.

cent service (CAMHS) interventions are too late to address ACEs.

• Average of 8 children in an average classroom will be in this situation.

which has a lifetime impact on both physical and mental health.

• Parental mental illness (PMI) is a root cause of many other ACEs.

**82**

*The ACE pyramid (Centers for Disease Control and Prevention, cdc.gov).*

**Figure 2.** *Long-term effects of ACEs (Centers for Disease Control and Prevention, cdc.gov).*

#### **1.2 A hidden risk**

The hidden status of these young people in the UK means that they have no statutory entitlement to specific support related to parental mental illness. Provision of formal, organised support or targeted intervention is therefore at the discretion of local funding bodies or entirely dependent on the voluntary sector. Any informal support is dependent on the awareness and understanding of professionals coming into contact with these children to identify and support their needs. However, this sometimes requires stepping outside of the remit of current practice and expertise, adding an additional "burden" to already high workloads. Additionally, many professionals report worrying about talking to children in this situation, as they are concerned about "*saying the wrong thing*" or "*making the situation worse*". Social service providers are dominated by risk concerns and are therefore reluctant to intervene in this area, which means that low intensity, early help is not commissioned. Despite these challenges, there are things that can be done to help children in this situation, enabling them to thrive, despite their

adversity. There is evidence to suggest that relatively simple and low-cost interventions can build protective factors and the resilience of children and young people affected by parental mental illness, reducing their risk of harm and of developing problems themselves in later life [2, 11].

This chapter will explain the impact of parental mental illness on children and the associated risk factors. We will provide examples of approaches proven to help children in this situation, using the KidsTime model as a case study. We will describe the approaches and methods of this practice model and explain how a combination of family therapy and systemic therapy approaches, together with drama, can create an effective multi-family therapy intervention. We will provide evidence of the impact of the KidsTime model and highlight some of the barriers to securing investment for preventative approaches. The chapter will conclude with recommendations for practice.

#### **2. Parental mental illness (PMI) and its impact on children and young people**

This section outlines some of the common difficulties experienced by children and young people who have a parent with a mental illness. These include but are not limited to:

#### **2.1 Parental emotional availability and its impact on the child-parent relationship**

Research, using case studies and personal testimonies, depict the kinds of difficulties experienced by children and young people growing up in a family where there is a parent with a mental illness. For example, it is common for children, particularly younger children, to report experiencing the same symptoms as their parents, i.e., symptoms caused by the parent's diagnosis, such as delusions [12]. explains this can be due to the parent's illness limiting their emotional availability to their child. Both symptoms of the illness and side-effects of the medication can result in emotional withdrawal from the child, which the child typically perceives as rejection. The child therefore intensifies his or her attempts to achieve closeness with the parent, which may cause the parent to withdraw further. Not only does this create a vicious cycle of interaction between the parent and the child, but these attempts can expose the child to further risk, such as the distress of being drawn into the parent's psychopathological symptoms that are not their own. This is particularly likely in the absence of a sufficient explanation of the parent's mental illness that could enable the child to differentiate between behaviours caused by the illness and those that are not [12, 13].

#### **2.2 Burden of caring roles and responsibilities on young people**

The experience of living with a parent who has a mental illness often means that the child or young person often adopts caring roles in their family, which are not age-appropriate. They may fill any gaps in their parent's role, which the parent is not consistently able to fill themselves due to their illness. This is the case both when the parent is markedly unwell and thus genuinely less able and also when the parent is able, but the child has become used to fulfilling this role or does so in anticipation of the parent's next period of illness. The young person may care for their parent and other family members practically, through assuming responsibility for structuring the daily life of the family, fulfilling siblings' needs or household tasks, but also emotionally, in that their mind is occupied by issues related to their parent's wellbeing [12, 13]. These children also

**85**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

experience frequent role reversal, as they help their parent manage symptoms of their mental illness, such as emotional distress or behavioural difficulties. This often leads to *parentification* and loss of focus on the child's needs by both the affected parent and the

The long-term impact of such experiences can be that children in this situation gradually form a view of the adults around them as having limited capabilities and therefore do not trust or expect adults to meet their needs. The responsibilities they believe they must fulfil themselves are a large burden for a young person to carry. These young people will often experience feelings of guilt in taking over the parent's role and inadequacy, while trying, and inevitably failing, to navigate such unrealistic responsibilities. This can also negatively impact their own self-esteem and sense of self-efficacy, and they may start to question their capabilities in other spheres of their life, which also has an adverse effect on their wellbeing. This combination of taking responsibility for others and worrying that they are not up to it is often carried into later life and causes hidden stress and sometimes prevents them from fulfilling their full potential [14, 15].

Children of parents with a mental illness and their families suffer from the shame and stigma surrounding mental illness in multiple ways [9, 14, 16]. It hinders communication about mental illness and emotions more generally within the family. It also hinders communication and the development of supportive bonds outside of the family, i.e., with extended family, community and other social networks. This leads to feelings of isolation and withdrawal from social interaction [9, 14]. As a result, many children of parents with a mental illness feel very different to their peers:

*"Well, all of last week I wasn't in (school), because I was ill. I think, sometimes, my friends might think that I've been avoiding them, or bullies might think they have affected me so much that I'm not coming to school anymore." (Young boy, KidsTime* 

*"So, it's nice to finally meet people that know how it feels, especially, like in school, barely anybody would have the same situation, but when I come to KidsTime, there's all these people around me that have similar situations to my family and* 

Such shame, stigma and isolation, combined with children's imagination, means

The KidsTime model is built on three principles in its work with children and families affected by parental mental illness and will be described in more detail in

many of these children live with damaging fears and/or misconceptions about mental illness. For example, they fear they will "catch" their parent's illness, that they are predetermined to developing it themselves, or that they caused the illness or its symptoms [15, 16]. The shame, stigma, fear and isolation further decrease the likelihood that they will ask for help, advice or information that would reassure them and enable them to make sense of their situation and develop strategies for

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

child themselves [9, 14].

**2.3 Shame and stigma**

*Workshop)*

coping with it.

**3. Protective factors**

the next section [2, 11].

1.Having a good explanation

*me." (Teenage girl, KidsTime Workshop)*

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

experience frequent role reversal, as they help their parent manage symptoms of their mental illness, such as emotional distress or behavioural difficulties. This often leads to *parentification* and loss of focus on the child's needs by both the affected parent and the child themselves [9, 14].

The long-term impact of such experiences can be that children in this situation gradually form a view of the adults around them as having limited capabilities and therefore do not trust or expect adults to meet their needs. The responsibilities they believe they must fulfil themselves are a large burden for a young person to carry. These young people will often experience feelings of guilt in taking over the parent's role and inadequacy, while trying, and inevitably failing, to navigate such unrealistic responsibilities. This can also negatively impact their own self-esteem and sense of self-efficacy, and they may start to question their capabilities in other spheres of their life, which also has an adverse effect on their wellbeing. This combination of taking responsibility for others and worrying that they are not up to it is often carried into later life and causes hidden stress and sometimes prevents them from fulfilling their full potential [14, 15].

#### **2.3 Shame and stigma**

*Family Therapy - New Intervention Programs and Researches*

problems themselves in later life [2, 11].

recommendations for practice.

illness and those that are not [12, 13].

**2.2 Burden of caring roles and responsibilities on young people**

The experience of living with a parent who has a mental illness often means that the child or young person often adopts caring roles in their family, which are not age-appropriate. They may fill any gaps in their parent's role, which the parent is not consistently able to fill themselves due to their illness. This is the case both when the parent is markedly unwell and thus genuinely less able and also when the parent is able, but the child has become used to fulfilling this role or does so in anticipation of the parent's next period of illness. The young person may care for their parent and other family members practically, through assuming responsibility for structuring the daily life of the family, fulfilling siblings' needs or household tasks, but also emotionally, in that their mind is occupied by issues related to their parent's wellbeing [12, 13]. These children also

**people**

limited to:

adversity. There is evidence to suggest that relatively simple and low-cost interventions can build protective factors and the resilience of children and young people affected by parental mental illness, reducing their risk of harm and of developing

This chapter will explain the impact of parental mental illness on children and

the associated risk factors. We will provide examples of approaches proven to help children in this situation, using the KidsTime model as a case study. We will describe the approaches and methods of this practice model and explain how a combination of family therapy and systemic therapy approaches, together with drama, can create an effective multi-family therapy intervention. We will provide evidence of the impact of the KidsTime model and highlight some of the barriers to securing investment for preventative approaches. The chapter will conclude with

**2. Parental mental illness (PMI) and its impact on children and young** 

This section outlines some of the common difficulties experienced by children and young people who have a parent with a mental illness. These include but are not

**2.1 Parental emotional availability and its impact on the child-parent relationship**

Research, using case studies and personal testimonies, depict the kinds of difficulties experienced by children and young people growing up in a family where there is a parent with a mental illness. For example, it is common for children, particularly younger children, to report experiencing the same symptoms as their parents, i.e., symptoms caused by the parent's diagnosis, such as delusions [12]. explains this can be due to the parent's illness limiting their emotional availability to their child. Both symptoms of the illness and side-effects of the medication can result in emotional withdrawal from the child, which the child typically perceives as rejection. The child therefore intensifies his or her attempts to achieve closeness with the parent, which may cause the parent to withdraw further. Not only does this create a vicious cycle of interaction between the parent and the child, but these attempts can expose the child to further risk, such as the distress of being drawn into the parent's psychopathological symptoms that are not their own. This is particularly likely in the absence of a sufficient explanation of the parent's mental illness that could enable the child to differentiate between behaviours caused by the

**84**

Children of parents with a mental illness and their families suffer from the shame and stigma surrounding mental illness in multiple ways [9, 14, 16]. It hinders communication about mental illness and emotions more generally within the family. It also hinders communication and the development of supportive bonds outside of the family, i.e., with extended family, community and other social networks. This leads to feelings of isolation and withdrawal from social interaction [9, 14]. As a result, many children of parents with a mental illness feel very different to their peers:

*"Well, all of last week I wasn't in (school), because I was ill. I think, sometimes, my friends might think that I've been avoiding them, or bullies might think they have affected me so much that I'm not coming to school anymore." (Young boy, KidsTime Workshop)*

*"So, it's nice to finally meet people that know how it feels, especially, like in school, barely anybody would have the same situation, but when I come to KidsTime, there's all these people around me that have similar situations to my family and me." (Teenage girl, KidsTime Workshop)*

Such shame, stigma and isolation, combined with children's imagination, means many of these children live with damaging fears and/or misconceptions about mental illness. For example, they fear they will "catch" their parent's illness, that they are predetermined to developing it themselves, or that they caused the illness or its symptoms [15, 16]. The shame, stigma, fear and isolation further decrease the likelihood that they will ask for help, advice or information that would reassure them and enable them to make sense of their situation and develop strategies for coping with it.

#### **3. Protective factors**

The KidsTime model is built on three principles in its work with children and families affected by parental mental illness and will be described in more detail in the next section [2, 11].

1.Having a good explanation


#### **3.1 The importance of a good explanation**

Many children affected by parental mental illness report receiving little or no information or explanation about their parent's illness. Even at the point of hospitalisation, only ~1 in 3 young people receive any information about their parent's situation [17]. Not having an explanation or not understanding what is happening can be an unsettling experience in itself. However, young people who have been given an explanation often identify this as a key factor in helping them to cope with their situation. Receiving an explanation about their parent's mental illness could make a significant difference in helping affected children to feel more in control of their situation. It could also mitigate the impact or even prevent the development of frightening misconceptions about mental illness and the confusion and self-blame many young people feel about the origins of the illness and its symptoms. This would enable children to differentiate between their parent's "ill" and "non-ill" behaviours and thus also decrease the likelihood of adopting any of these behaviours themselves [13]. Having a good explanation is one of three protective factors identified by international research as key in building resilience for children whose parent/s have a mental illness.

There is a lack of specialist support for children affected by parental mental illness in the UK. These children may cross paths with multiple services, such as health services, children's social care, schools or professionals directly involved in their parent's psychiatric or social care. However, these professionals do not have the awareness or understanding of the unique experiences of children living with, or caring for, a parent with mental health issues and also often lack confidence in speaking to children about mental illness. The negative impact of this is twofold: Firstly, it reinforces these young people's disillusionment with adults as protective or supportive figures. Secondly, these young carers remain under the radar and are therefore unlikely to receive a satisfactory explanation or helpful support. However, the potential harm and many of the risks associated with having a parent with a mental illness can be addressed by training adults to provide good, child-friendly explanations and appropriate support, which increase the protective factors and develop the child's resilience, examples of which will be given in the following sections.

#### **4. Specialist intervention: the KidsTime Workshops**

Adverse childhood experiences (ACE) have recently become the focus of research and public discourse. However, despite its official recognition as an ACE, parental mental illness has been somewhat overlooked in this debate, and there is no recognition or provision for children affected by parental mental illness in England.

Our Time is a UK charity that was set up to advocate on behalf of this group through raising awareness of the issue and developing specific support through the KidsTime Workshop approach, which has been adopted across the UK, Germany and Spain. These are multi-family support groups that combine systemic family therapy approaches, drama and play to provide families with the three protective factors outlined above. There are currently 12 KidsTime Workshops operational in England, supporting up to 250 children and their families.

**87**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

KidsTime Workshops take place once a month, after school, for ~2.5 h, and are run by a multidisciplinary team of at least three members of staff. The model

• Clinical Lead, with a clinical background working in mental health services

• Drama Lead, who has experience in creative and drama-led group work with

• Logistical Lead/Coordinator, responsible for managing referrals, engaging and supporting families to attend the workshop and logistics (venue, equipment,

The group begins with all staff and families, (typically 6–10 families per workshop), coming together for a playful activity, followed by a seminar-style session that explores a single topic related to (parental) mental illness. The Clinical Lead facilitates this session using informal discussion and playful activities. Importantly, the particular topic will have been identified by the families themselves as something they want to discuss, for example, what to do in a crisis. The KidsTime Workshops have developed a model for explaining mental illness to children. Explanations are provided by the Clinical Lead, which is relevant to the seminar topic (i.e., not at every workshop). The Clinical Lead will employ visual aids and clear, simple and child-friendly language to describe how the brain works and how it can become "overloaded" as well as other aspects of mental illness (e.g., side-effects of medication) without being a diagnosis specific. An example of this can be seen in the videos, "*What does it mean to have a parent with a mental illness?*" and, for younger children, "*Making sense of mental illness*", available on the Our

After the seminar, the families separate into two groups, one for adults and the other for children, which run in parallel for 1 h. The children's group is facilitated by the Drama Lead. It starts with group games to help the children relax and focus, followed by drama work during which the young people create, rehearse, perform, and film a dramatic scene. The drama content will often be related to the seminar topic, but it is important that the children are free to set and interpret the topic themselves. The drama allows the children and young people to address issues of interest or concern without having to expose their own personal situation, giving them a voice and a way to explore different perspectives and reactions to difficult family issues. The adult group consists of the parents or carers (sometimes guardians, grandparents or close relatives), with or without a mental illness, and explores their experiences of being a parent with a mental illness or supporting the family in which this is the issue, sometimes using the seminar topic as a starting point. The

(often a psychiatrist or clinical psychologist or family therapist)

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

requires the following critical staff members:

**5. The KidsTime model**

children

transportation, etc.)

*5.1.1 Seminar (adults and children together)*

Time website: www.ourtime.org.uk.

*5.1.2 Group work (adults and children separate)*

**5.1 Workshop structure**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

#### **5. The KidsTime model**

*Family Therapy - New Intervention Programs and Researches*

2.Having a trusted adult to talk to

**3.1 The importance of a good explanation**

Many children affected by parental mental illness report receiving little or no information or explanation about their parent's illness. Even at the point of hospitalisation, only ~1 in 3 young people receive any information about their parent's situation [17]. Not having an explanation or not understanding what is happening can be an unsettling experience in itself. However, young people who have been given an explanation often identify this as a key factor in helping them to cope with their situation. Receiving an explanation about their parent's mental illness could make a significant difference in helping affected children to feel more in control of their situation. It could also mitigate the impact or even prevent the development of frightening misconceptions about mental illness and the confusion and self-blame many young people feel about the origins of the illness and its symptoms. This would enable children to differentiate between their parent's "ill" and "non-ill" behaviours and thus also decrease the likelihood of adopting any of these behaviours themselves [13]. Having a good explanation is one of three protective factors identified by international research as key in building resilience for children whose parent/s have a

There is a lack of specialist support for children affected by parental mental illness in the UK. These children may cross paths with multiple services, such as health services, children's social care, schools or professionals directly involved in their parent's psychiatric or social care. However, these professionals do not have the awareness or understanding of the unique experiences of children living with, or caring for, a parent with mental health issues and also often lack confidence in speaking to children about mental illness. The negative impact of this is twofold: Firstly, it reinforces these young people's disillusionment with adults as protective or supportive figures. Secondly, these young carers remain under the radar and are therefore unlikely to receive a satisfactory explanation or helpful support. However, the potential harm and many of the risks associated with having a parent with a mental illness can be addressed by training adults to provide good, child-friendly explanations and appropriate support, which increase the protective factors and develop the child's resilience, examples of which will be given in the following

**4. Specialist intervention: the KidsTime Workshops**

England, supporting up to 250 children and their families.

Adverse childhood experiences (ACE) have recently become the focus of research and public discourse. However, despite its official recognition as an ACE, parental mental illness has been somewhat overlooked in this debate, and there is no recognition or provision for children affected by parental mental illness in England. Our Time is a UK charity that was set up to advocate on behalf of this group through raising awareness of the issue and developing specific support through the KidsTime Workshop approach, which has been adopted across the UK, Germany and Spain. These are multi-family support groups that combine systemic family therapy approaches, drama and play to provide families with the three protective factors outlined above. There are currently 12 KidsTime Workshops operational in

3.Knowing you are not alone

mental illness.

sections.

**86**

KidsTime Workshops take place once a month, after school, for ~2.5 h, and are run by a multidisciplinary team of at least three members of staff. The model requires the following critical staff members:


#### **5.1 Workshop structure**

#### *5.1.1 Seminar (adults and children together)*

The group begins with all staff and families, (typically 6–10 families per workshop), coming together for a playful activity, followed by a seminar-style session that explores a single topic related to (parental) mental illness. The Clinical Lead facilitates this session using informal discussion and playful activities. Importantly, the particular topic will have been identified by the families themselves as something they want to discuss, for example, what to do in a crisis.

The KidsTime Workshops have developed a model for explaining mental illness to children. Explanations are provided by the Clinical Lead, which is relevant to the seminar topic (i.e., not at every workshop). The Clinical Lead will employ visual aids and clear, simple and child-friendly language to describe how the brain works and how it can become "overloaded" as well as other aspects of mental illness (e.g., side-effects of medication) without being a diagnosis specific. An example of this can be seen in the videos, "*What does it mean to have a parent with a mental illness?*" and, for younger children, "*Making sense of mental illness*", available on the Our Time website: www.ourtime.org.uk.

#### *5.1.2 Group work (adults and children separate)*

After the seminar, the families separate into two groups, one for adults and the other for children, which run in parallel for 1 h. The children's group is facilitated by the Drama Lead. It starts with group games to help the children relax and focus, followed by drama work during which the young people create, rehearse, perform, and film a dramatic scene. The drama content will often be related to the seminar topic, but it is important that the children are free to set and interpret the topic themselves. The drama allows the children and young people to address issues of interest or concern without having to expose their own personal situation, giving them a voice and a way to explore different perspectives and reactions to difficult family issues.

The adult group consists of the parents or carers (sometimes guardians, grandparents or close relatives), with or without a mental illness, and explores their experiences of being a parent with a mental illness or supporting the family in which this is the issue, sometimes using the seminar topic as a starting point. The

discussion is facilitated by the Clinical Lead who ensures that the experiences and needs of the children are a central focus. The adult group provides an opportunity for parents to talk more openly about their own experience and the challenges of parenting with a mental illness in a non-judgemental environment and to receive support and encouragement from one another.

#### *5.1.3 Community time and reflection (adults and children together)*

The children, parents and staff reunite after their respective groups for 30–45 min. First, everyone takes a break and shares food together (traditionally pizza because the children like it and it is easy to prepare). Then, everyone watches the film of the young people's drama, which leads to a collective group discussion about what the drama communicates and what insights the children and young people have demonstrated in their dramatisation. The parents contribute to the discussion by sharing a summary of their group discussion and their own reflections from watching the drama.

While the KidsTime Workshop model draws on some therapeutic methods and techniques, KidsTime is not designed as a form of therapy, but it is therapeutic in its effects. The design aims to create a community where the families can safely share their experience and knowledge and are listened to and able to ask the questions they need to ask without fear of judgement or having solutions imposed on them. The aim is to provide information, support and some relief to the families through a social intervention, while children and their needs remain the focus. Cooklin et al. state that an explicitly therapeutic intervention directed at the children may lead to the child seriously misjudging their predicament and adding to the sense that they (the child) are the problem and encourage further mistrust in adults [16] because they are not taken seriously. Firstly, the offer of therapy to the child may be falsely perceived as confirmation that they, like their parents, are going to develop a mental illness. Secondly, as these children will often adopt responsibilities beyond their years, in nature and volume, there is a risk that the child or young person would conclude that they are somehow failing to solve the problem or feel dismissed and undermined, if treated as a passive recipient of therapy. Therefore, the approach of professionals should aspire to take the role of an understanding, friend/mentor or relative rather than the formal and inevitably hierarchical role in which a therapist may be perceived.

*"KidsTime has helped myself and my son to learn about my mental health, together. There's a great understanding of how they can help us, how they can help myself, my child, and, also, it's a place that you are accepted to have mental health (problems) and it not be a stigma. For the first time you can openly talk about any of your issues and concerns." (Mother, KidsTime)*

*"Because it's somewhere where you can go to be with somebody that you know understands how you feel, and they might have the same situation too, and they just cheer you up, so it's a great place to go. Sometimes your parents are on medication or there is something wrong, so this just is a place to come to to calm you down." (Young boy, KidsTime)*

#### **6. Key approaches**

This section outlines some of the key approaches employed by the KidsTime model to achieve the desired protective factors, particularly and uniquely, an ageappropriate explanation of mental illness, its treatments and impact.

**89**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

The model views and encourages families to appreciate the systemic contributors to experiences; that the experience of each individual in the family results from their relationships with other members of the family; and what their feelings and thoughts about these relationships are. Based on this, the individual forms their view of themselves and perceptions of others. Bringing the whole family together to think about their situation and find ways of managing their lives in the context of the illness is one of the innovative and most powerful aspects of the model.

The KidsTime model recognises and aims to counter the potentially damaging effect of parental mental illness on the quality of social interactions within the family and with the wider social environment and support networks (other families and services, etc.) including social care providers, teachers and even the school. It aims to do so through facilitating communication between family members, with the focus of helping them understand the role of each person and the impact of parental mental illness on them. The model aims to promote social ties and trust between family members, neighbours and the general social world within which the family is

In general, families develop different patterns of internal communication and sharing of experiences. In families affected by parental mental illness, there is often little or no communication about the mental illness, due to shame and stigma, and a lack of understanding about mental illness [15, 16]. KidsTime Workshops aim to combat this stigma and social withdrawal by encouraging families to speak more freely about mental illness and finding creative ways to make this easier. Adapted systemic therapy methods, such as sculpture work, are used to help families visualise relationships and patterns of communication; this facilitates mutual reflection and discussion in the group helping them to identify their current patterns and how

*"My daughter, she was very quiet. She would sit in her room all the time and now, because of KidsTime, we can have half an hour to 45 minutes family time, and ask, "How has your day been?" and we can get a nice polite answer (from her). If anything does affect her, she can open up and get it off her chest, and if we can* 

While the effect of parental mental illness on the children is the overarching focus of the parent and children's groups within the KidsTime model, parents' reactions to the impact of their illness are also actively discussed and considered. This results in children communicating their experiences to, and receiving feedback from, their family and the wider group (and vice versa), leading to a multi-systemic perspective rather than one-direction linear communication. This also leads to group interactions in which everyone is considered on the same level and equally able to contribute to discussion, thereby recognising the young people's knowledge

Also consistent with systemic approaches, the KidsTime model puts special

emphasis on recognising and promoting families' capabilities. Families are respected as autonomous, self-organising systems and capable experts in their own situation. Within this, particular efforts are made to appreciate the young people's knowledge and expertise in their parent's mental health. Indeed, young carers will often notice signs of crisis or decline in their parents far earlier than the parent themselves or professionals. However, for a number of reasons that can be very frustrating and damaging for the child, this expertise is often invalidated in their interactions with the adults around them. Children and young people express

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

**6.1 Systemic influences**

located.

to develop healthier ones [18].

*help, we can help." (Father, KidsTime)*

and experience and the roles they perform within family life.

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

#### **6.1 Systemic influences**

*Family Therapy - New Intervention Programs and Researches*

support and encouragement from one another.

tions from watching the drama.

*5.1.3 Community time and reflection (adults and children together)*

discussion is facilitated by the Clinical Lead who ensures that the experiences and needs of the children are a central focus. The adult group provides an opportunity for parents to talk more openly about their own experience and the challenges of parenting with a mental illness in a non-judgemental environment and to receive

The children, parents and staff reunite after their respective groups for 30–45 min. First, everyone takes a break and shares food together (traditionally pizza because the children like it and it is easy to prepare). Then, everyone watches the film of the young people's drama, which leads to a collective group discussion about what the drama communicates and what insights the children and young people have demonstrated in their dramatisation. The parents contribute to the discussion by sharing a summary of their group discussion and their own reflec-

While the KidsTime Workshop model draws on some therapeutic methods and techniques, KidsTime is not designed as a form of therapy, but it is therapeutic in its effects. The design aims to create a community where the families can safely share their experience and knowledge and are listened to and able to ask the questions they need to ask without fear of judgement or having solutions imposed on them. The aim is to provide information, support and some relief to the families through a social intervention, while children and their needs remain the focus. Cooklin et al. state that an explicitly therapeutic intervention directed at the children may lead to the child seriously misjudging their predicament and adding to the sense that they (the child) are the problem and encourage further mistrust in adults [16] because they are not taken seriously. Firstly, the offer of therapy to the child may be falsely perceived as confirmation that they, like their parents, are going to develop a mental illness. Secondly, as these children will often adopt responsibilities beyond their years, in nature and volume, there is a risk that the child or young person would conclude that they are somehow failing to solve the problem or feel dismissed and undermined, if treated as a passive recipient of therapy. Therefore, the approach of professionals should aspire to take the role of an understanding, friend/mentor or relative rather than the formal and inevitably hierarchical role in which a therapist may be perceived.

*"KidsTime has helped myself and my son to learn about my mental health, together. There's a great understanding of how they can help us, how they can help myself, my child, and, also, it's a place that you are accepted to have mental health (problems) and it not be a stigma. For the first time you can openly talk about any* 

*"Because it's somewhere where you can go to be with somebody that you know understands how you feel, and they might have the same situation too, and they just cheer you up, so it's a great place to go. Sometimes your parents are on medication or there is something wrong, so this just is a place to come to to calm you down."* 

This section outlines some of the key approaches employed by the KidsTime model to achieve the desired protective factors, particularly and uniquely, an age-

appropriate explanation of mental illness, its treatments and impact.

*of your issues and concerns." (Mother, KidsTime)*

*(Young boy, KidsTime)*

**6. Key approaches**

**88**

The model views and encourages families to appreciate the systemic contributors to experiences; that the experience of each individual in the family results from their relationships with other members of the family; and what their feelings and thoughts about these relationships are. Based on this, the individual forms their view of themselves and perceptions of others. Bringing the whole family together to think about their situation and find ways of managing their lives in the context of the illness is one of the innovative and most powerful aspects of the model.

The KidsTime model recognises and aims to counter the potentially damaging effect of parental mental illness on the quality of social interactions within the family and with the wider social environment and support networks (other families and services, etc.) including social care providers, teachers and even the school. It aims to do so through facilitating communication between family members, with the focus of helping them understand the role of each person and the impact of parental mental illness on them. The model aims to promote social ties and trust between family members, neighbours and the general social world within which the family is located.

In general, families develop different patterns of internal communication and sharing of experiences. In families affected by parental mental illness, there is often little or no communication about the mental illness, due to shame and stigma, and a lack of understanding about mental illness [15, 16]. KidsTime Workshops aim to combat this stigma and social withdrawal by encouraging families to speak more freely about mental illness and finding creative ways to make this easier. Adapted systemic therapy methods, such as sculpture work, are used to help families visualise relationships and patterns of communication; this facilitates mutual reflection and discussion in the group helping them to identify their current patterns and how to develop healthier ones [18].

*"My daughter, she was very quiet. She would sit in her room all the time and now, because of KidsTime, we can have half an hour to 45 minutes family time, and ask, "How has your day been?" and we can get a nice polite answer (from her). If anything does affect her, she can open up and get it off her chest, and if we can help, we can help." (Father, KidsTime)*

While the effect of parental mental illness on the children is the overarching focus of the parent and children's groups within the KidsTime model, parents' reactions to the impact of their illness are also actively discussed and considered. This results in children communicating their experiences to, and receiving feedback from, their family and the wider group (and vice versa), leading to a multi-systemic perspective rather than one-direction linear communication. This also leads to group interactions in which everyone is considered on the same level and equally able to contribute to discussion, thereby recognising the young people's knowledge and experience and the roles they perform within family life.

Also consistent with systemic approaches, the KidsTime model puts special emphasis on recognising and promoting families' capabilities. Families are respected as autonomous, self-organising systems and capable experts in their own situation. Within this, particular efforts are made to appreciate the young people's knowledge and expertise in their parent's mental health. Indeed, young carers will often notice signs of crisis or decline in their parents far earlier than the parent themselves or professionals. However, for a number of reasons that can be very frustrating and damaging for the child, this expertise is often invalidated in their interactions with the adults around them. Children and young people express frustration that they are often the closest observer of the parent and have responsibilities beyond their years and yet are not consulted, listened to, and frequently talked over by professionals. This combination of shouldering adult responsibility and being treated as a child who has no information or insight is particularly difficult and leads to mistrust and resignation on the child's behalf, adding to the notion that they are on their own with the problem and that adults cannot be relied upon, which leads to hyper-independence. The KidsTime model aims to be realistic about the different family situations and challenges and to support and empower affected young people within their roles to develop appropriate coping strategies that will help them to understand and manage their own situation rather than "fixing" the problem for them and importantly knowing what to do in a time of crisis and developing a network of people to whom they can turn to for help when they notice that their parent's mental health is deteriorating. This means that awareness raising and the education of professionals is a key factor in supporting these children and young people.

#### **6.2 Multi-family work**

Multi-family work is based on systemic approaches; it aims to combine the benefits of single-family therapy with group therapy while still encouraging the agency of all individuals participating.

The coming together of families in similar situations has multiple benefits, particularly when the shared experiences are as stigmatised and hidden as those related to parental mental illness. It enables affected families to discuss mental health issues without one child, parent or family feeling exposed, judged or different. It is also crucial that facilitators do not single anyone out. The KidsTime Workshop model encourages openness and reflection, and, through conversations about mental illness and common experiences, it reduces the often-associated stigma and shameinduced isolation. Unlike in the outside world, at KidsTime, the individuals and families are no longer the odd ones out:

*"Since we've been coming here for a year and a half they (the children) get to see other children with parents with mental health (problems), and there's other families in same situation, so they don't feel so alone, because, I think, before, they thought our family was really strange. They've seen other people the same as us." (Mother, KidsTime)*

Multi-family work, in this context, is intended to enable solidarity and a sense of community between families, a sense that "we are all in this together". The individual family is viewed as part of the wider system of multiple families—a system that all families contribute to and benefit from. The families build a social network and mutually support each other. One of the most powerful ways in which this happens is the socialising and exchanging of experiences, ideas and advice facilitated by the multi-family model. In the KidsTime Workshop, families use each other as resources. Sharing in a multi-family group means they learn from each other's experiences and perspectives and are empowered to make changes themselves. In this sense, the multi-family model is intended to contribute towards helping families to help themselves; it allows individual parents and children to hear both positive and corrective responses from other adults and children, which may be both more acceptable and meaningful than comments from professionals [16, 18].

Actively involving families in discussion of similar problems in other families strengthens the self-esteem and agency of all involved. When experiencing difficulties, people tend to develop rigid and narrow ways of problem solving but are

**91**

and symptoms of diagnostic criteria.

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

still often able to offer useful ideas to others in similar situations. Drawing on the expertise and experiences of families in similar situations leads to families viewing themselves more positively, as more capable. This strengthens self-esteem and the family's sense of agency and for the adults, in particular, a sense of pride as capable parents. In turn, this may enable families to become more resourceful and creative in finding solutions for their own difficulties [18]. Thus, the group becomes more

Methods of creative therapy and drama work are powerful tools in creating a playful attitude and a relaxed, light-hearted atmosphere. This facilitates young people to have fun and foster positive relationships with each other and their families. It is within this type of setting that the young people are able to relax and to engage with drama as a powerful, therapeutic tool in the ways outlined below. Children of parents with a mental illness are often highly anxious and stressed, and the drama and games, first and foremost, allow them to forget their worries and just have fun, to be a child and to be able to play like a child, free from the burden of

In the young people's group, playful exercises are combined with devising and acting out fictional scenes together. Designing the content of these dramas acts as a channel of free expression for fear, anger and anxiety or other difficult emotions that a young carer may struggle to access and express in daily life. The invention of fictional characters also means children can choose to play out different perspectives and new narratives—ideals of who they want to be. This encourages optimism and gives them a sense of control over their situation, thereby enhancing their

While the dramas do address parental mental illness, they often do so in an indirect or metaphorical way. They allow the children to differentiate from the illness, exploring it from a removed and outside perspective and not getting caught up in it. Indeed, the staff are careful not to lead the young people into sharing their specific experiences, as the drama work is intended to act as a helpful tool to enable young people to explore their experiences from a distance, to make up stories and create

The dramas tend to capture the everyday experiences of the children and, in a more or less explicit way, the impact of their parent's mental illness. The dramas are filmed and played back to parents and staff and therefore serve as an effective channel for young people to communicate their experiences and fears. Moreover, the themes and experiences depicted in the dramas are not owned by one person; they are devised, played out and therefore communicated, as a group; this feels safer and

less threatening for the young people to express and for the adults to receive.

The dramas are also useful in communicating important messages and explanations of mental illness to young people. The KidsTime model emphasises that explanations should address and challenge presumptions and fears that young people have about mental illness, for example, that they might "catch the illness themselves", which the dramas frequently illustrate. In order to reduce rigid ideas and fears about mental illness in young people, the dramas should also present mental illness as a changeable process rather than as a fixed, constant entity. Including the subject of mental illness in dynamic dramas is particularly useful as it depicts mental illnesses through characters' experiences rather than through listing signs

The drama work contributes to the aim of the workshops in creating a space where "kids can be kids". The drama is part of a predictable and secure structure

looking out for their parents, because they are safe in the parent's group.

self-esteem and trust in their ability to take action.

roles that focus on general aspects of mental illness and crisis.

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

powerful than any single therapist.

**6.3 Drama work**

#### *KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

still often able to offer useful ideas to others in similar situations. Drawing on the expertise and experiences of families in similar situations leads to families viewing themselves more positively, as more capable. This strengthens self-esteem and the family's sense of agency and for the adults, in particular, a sense of pride as capable parents. In turn, this may enable families to become more resourceful and creative in finding solutions for their own difficulties [18]. Thus, the group becomes more powerful than any single therapist.

#### **6.3 Drama work**

*Family Therapy - New Intervention Programs and Researches*

young people.

**6.2 Multi-family work**

agency of all individuals participating.

families are no longer the odd ones out:

*(Mother, KidsTime)*

frustration that they are often the closest observer of the parent and have responsibilities beyond their years and yet are not consulted, listened to, and frequently talked over by professionals. This combination of shouldering adult responsibility and being treated as a child who has no information or insight is particularly difficult and leads to mistrust and resignation on the child's behalf, adding to the notion that they are on their own with the problem and that adults cannot be relied upon, which leads to hyper-independence. The KidsTime model aims to be realistic about the different family situations and challenges and to support and empower affected young people within their roles to develop appropriate coping strategies that will help them to understand and manage their own situation rather than "fixing" the problem for them and importantly knowing what to do in a time of crisis and developing a network of people to whom they can turn to for help when they notice that their parent's mental health is deteriorating. This means that awareness raising and the education of professionals is a key factor in supporting these children and

Multi-family work is based on systemic approaches; it aims to combine the benefits of single-family therapy with group therapy while still encouraging the

*"Since we've been coming here for a year and a half they (the children) get to see other children with parents with mental health (problems), and there's other families in same situation, so they don't feel so alone, because, I think, before, they thought our family was really strange. They've seen other people the same as us."* 

community between families, a sense that "we are all in this together". The individual family is viewed as part of the wider system of multiple families—a system that all families contribute to and benefit from. The families build a social network and mutually support each other. One of the most powerful ways in which this happens is the socialising and exchanging of experiences, ideas and advice facilitated by the multi-family model. In the KidsTime Workshop, families use each other as resources. Sharing in a multi-family group means they learn from each other's experiences and perspectives and are empowered to make changes themselves. In this sense, the multi-family model is intended to contribute towards helping families to help themselves; it allows individual parents and children to hear both positive and corrective responses from other adults and children, which may be both more

acceptable and meaningful than comments from professionals [16, 18].

Actively involving families in discussion of similar problems in other families strengthens the self-esteem and agency of all involved. When experiencing difficulties, people tend to develop rigid and narrow ways of problem solving but are

Multi-family work, in this context, is intended to enable solidarity and a sense of

The coming together of families in similar situations has multiple benefits, particularly when the shared experiences are as stigmatised and hidden as those related to parental mental illness. It enables affected families to discuss mental health issues without one child, parent or family feeling exposed, judged or different. It is also crucial that facilitators do not single anyone out. The KidsTime Workshop model encourages openness and reflection, and, through conversations about mental illness and common experiences, it reduces the often-associated stigma and shameinduced isolation. Unlike in the outside world, at KidsTime, the individuals and

**90**

Methods of creative therapy and drama work are powerful tools in creating a playful attitude and a relaxed, light-hearted atmosphere. This facilitates young people to have fun and foster positive relationships with each other and their families. It is within this type of setting that the young people are able to relax and to engage with drama as a powerful, therapeutic tool in the ways outlined below. Children of parents with a mental illness are often highly anxious and stressed, and the drama and games, first and foremost, allow them to forget their worries and just have fun, to be a child and to be able to play like a child, free from the burden of looking out for their parents, because they are safe in the parent's group.

In the young people's group, playful exercises are combined with devising and acting out fictional scenes together. Designing the content of these dramas acts as a channel of free expression for fear, anger and anxiety or other difficult emotions that a young carer may struggle to access and express in daily life. The invention of fictional characters also means children can choose to play out different perspectives and new narratives—ideals of who they want to be. This encourages optimism and gives them a sense of control over their situation, thereby enhancing their self-esteem and trust in their ability to take action.

While the dramas do address parental mental illness, they often do so in an indirect or metaphorical way. They allow the children to differentiate from the illness, exploring it from a removed and outside perspective and not getting caught up in it. Indeed, the staff are careful not to lead the young people into sharing their specific experiences, as the drama work is intended to act as a helpful tool to enable young people to explore their experiences from a distance, to make up stories and create roles that focus on general aspects of mental illness and crisis.

The dramas tend to capture the everyday experiences of the children and, in a more or less explicit way, the impact of their parent's mental illness. The dramas are filmed and played back to parents and staff and therefore serve as an effective channel for young people to communicate their experiences and fears. Moreover, the themes and experiences depicted in the dramas are not owned by one person; they are devised, played out and therefore communicated, as a group; this feels safer and less threatening for the young people to express and for the adults to receive.

The dramas are also useful in communicating important messages and explanations of mental illness to young people. The KidsTime model emphasises that explanations should address and challenge presumptions and fears that young people have about mental illness, for example, that they might "catch the illness themselves", which the dramas frequently illustrate. In order to reduce rigid ideas and fears about mental illness in young people, the dramas should also present mental illness as a changeable process rather than as a fixed, constant entity. Including the subject of mental illness in dynamic dramas is particularly useful as it depicts mental illnesses through characters' experiences rather than through listing signs and symptoms of diagnostic criteria.

The drama work contributes to the aim of the workshops in creating a space where "kids can be kids". The drama is part of a predictable and secure structure within which children do not take the lead, do not have to feel responsible and are thus able to relax and play in their more age-appropriate roles. In this way, the drama work enables the team to strike the important balance between the serious and the playful. The overall aim of the workshops is to provide a relaxed environment within which young people can explore and recognise their own roles, and the challenges within these, and have this validated by others while remaining optimistic and hopeful for the future. At KidsTime, young people are encouraged to recognise their successes and strengths despite their difficult situation and to have fun while doing so, which is enabled by creating an environment where they can engage in more age-appropriate roles and activities. The ability to play is a fundamental aspect of psychological health and creativity, and this is built into the method. It is noticeable that when children first come into the workshop, the ability to join in and play is very low but grows quite quickly once they feel safe.

*"It's good, because we get to play games, and parents get to go upstairs, and we get to stay downstairs and have some fun."*

*"KidsTime is a good place to go because you get to play games, run about, have fun and have pizza."*

*"KidsTime is a wonderful place to go and you can express your feelings." (Testimonies from young children, KidsTime)*

#### *6.3.1 KidsTime participant (aged 17)*

*"People think depression is when you feel low and want to kill yourself. But there is so much more to it than that. My mum has schizoaffective disorder. That means she gets schizophrenia symptoms, such as hallucinations, and mood disorder symptoms, including mania and depression. She mixes up reality with imagination. She takes antidepressants and sleeping pills but there is often no way of knowing what state she is going to be in.*

*My dad found out about KidsTime when he was looking for ways to help me. I already knew about my mum's illness, but it was good to know that there are people who, like me, have to remind their parents to shower and eat.*

*People say mental illness is invisible, but you can usually tell by the look on someone's face or the way they are not keeping up with personal hygiene that they are unwell. Being a carer for my mum is not a bad thing, but it is a responsibility. I know that sometimes she does not want to talk she just wants me to sit with her. The annoying thing is that because I have lived with my mum, I can usually tell when other people are down as well. You start to feel guilty if the people around you are not happy, which is illogical, but I cannot help it. That is one of the things we have talked about at KidsTime—the burden of having that insight. My school and college mates do not understand that, but with my friends from KidsTime we can just jump straight into a deep conversation, and that means a lot to me."*

### **7. Impact and evaluation of the KidsTime Workshops**

To date, several evaluations of the KidsTime Workshops have been carried out, using a variety of methodologies, the findings of which are summarised in the

**93**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

following paragraphs. As a general rule, individual feedback forms are completed by the adults and children after each workshop. A study of the German KidsTime

• 95% of families submitting evaluations stated they benefited from attending

• All family members stated they had learned something new about mental illness at the workshops and that the workshops helped them to talk about

Similar themes were present in the children's feedback; however, the most important impact for children was the sense of freedom they experienced in being able to return some of the responsibility to adults they could trust and talk to and in connecting with adults in a more positive way, challenging their previous thoughts and feelings about adults and professionals coming into contact with them and their families. The feedback especially highlighted how children experienced KidsTime Workshops as a secure framework within which they could act more freely [19]. In England, an evaluation by the Anna Freud Centre for Children and Families found that the workshops increased understanding of mental illness, improved parent-child relationships, reduced feelings of fear, shame and isolation and boosted confidence in children and young people [2, 11]. Due to the nuances and the number of factors at play within the workshops, Our Time has found that case studies are a useful tool in understanding the impact of these interventions on children and families. An analysis of recent family case studies in England has identified the following key themes: Rise in confidence among children and young people, improved relationships within and outside of the family, making new friendships and increased knowledge and understanding of mental illness.

• Watching and reflecting on the children's drama film, as well as the multi-family group format (particularly the feeling of solidarity among families) were viewed as helpful catalysts in enabling the open discussion of issues that may have been perceived as being too "shameful" to talk about outside of the group.

Findings from the different evaluations undertaken to date demonstrate that the strength of the workshops lies in their ability to facilitate communication and positive relationship building within and outside of the family, providing effective peer support for children and parents and, in tackling the shame, stigma and misconceptions surrounding mental illness, reducing feelings of fear and isolation and raising

A common barrier to setting up and maintaining a KidsTime Workshop is securing funding for a preventative model. The fundamental rationale for the workshops is to prevent young people from developing psychopathology themselves. However, funding for support for people who do not have a formal diagnosis is almost impossible to obtain within curative and risk-oriented medical systems, which are often the result of restrictive fiscal policies that will only allocate funding for critical interventions. However, what such policies and approaches fail to address is that, without appropriate universal, preventative support in place beneath thresholds for critical services, the demand for these services will continue to grow at an alarming

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

the workshops and wanted to continue attending.

mental illness within and outside of their families.

young people's confidence and self-esteem [2, 11, 19].

**8. The case for investing in preventative approaches**

rate, leading to significantly increased costs in the medium to long term.

Workshops found that [19]:

#### *KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

following paragraphs. As a general rule, individual feedback forms are completed by the adults and children after each workshop. A study of the German KidsTime Workshops found that [19]:


Similar themes were present in the children's feedback; however, the most important impact for children was the sense of freedom they experienced in being able to return some of the responsibility to adults they could trust and talk to and in connecting with adults in a more positive way, challenging their previous thoughts and feelings about adults and professionals coming into contact with them and their families. The feedback especially highlighted how children experienced KidsTime Workshops as a secure framework within which they could act more freely [19].

In England, an evaluation by the Anna Freud Centre for Children and Families found that the workshops increased understanding of mental illness, improved parent-child relationships, reduced feelings of fear, shame and isolation and boosted confidence in children and young people [2, 11]. Due to the nuances and the number of factors at play within the workshops, Our Time has found that case studies are a useful tool in understanding the impact of these interventions on children and families. An analysis of recent family case studies in England has identified the following key themes: Rise in confidence among children and young people, improved relationships within and outside of the family, making new friendships and increased knowledge and understanding of mental illness.

Findings from the different evaluations undertaken to date demonstrate that the strength of the workshops lies in their ability to facilitate communication and positive relationship building within and outside of the family, providing effective peer support for children and parents and, in tackling the shame, stigma and misconceptions surrounding mental illness, reducing feelings of fear and isolation and raising young people's confidence and self-esteem [2, 11, 19].

#### **8. The case for investing in preventative approaches**

A common barrier to setting up and maintaining a KidsTime Workshop is securing funding for a preventative model. The fundamental rationale for the workshops is to prevent young people from developing psychopathology themselves. However, funding for support for people who do not have a formal diagnosis is almost impossible to obtain within curative and risk-oriented medical systems, which are often the result of restrictive fiscal policies that will only allocate funding for critical interventions. However, what such policies and approaches fail to address is that, without appropriate universal, preventative support in place beneath thresholds for critical services, the demand for these services will continue to grow at an alarming rate, leading to significantly increased costs in the medium to long term.

*Family Therapy - New Intervention Programs and Researches*

once they feel safe.

*and have pizza."*

*6.3.1 KidsTime participant (aged 17)*

*she is going to be in.*

*stay downstairs and have some fun."*

*(Testimonies from young children, KidsTime)*

within which children do not take the lead, do not have to feel responsible and are thus able to relax and play in their more age-appropriate roles. In this way, the drama work enables the team to strike the important balance between the serious and the playful. The overall aim of the workshops is to provide a relaxed environment within which young people can explore and recognise their own roles, and the challenges within these, and have this validated by others while remaining optimistic and hopeful for the future. At KidsTime, young people are encouraged to recognise their successes and strengths despite their difficult situation and to have fun while doing so, which is enabled by creating an environment where they can engage in more age-appropriate roles and activities. The ability to play is a fundamental aspect of psychological health and creativity, and this is built into the method. It is noticeable that when children first come into the workshop, the ability to join in and play is very low but grows quite quickly

*"It's good, because we get to play games, and parents get to go upstairs, and we get to* 

*"KidsTime is a good place to go because you get to play games, run about, have fun* 

*"People think depression is when you feel low and want to kill yourself. But there is so much more to it than that. My mum has schizoaffective disorder. That means she gets schizophrenia symptoms, such as hallucinations, and mood disorder symptoms, including mania and depression. She mixes up reality with imagination. She takes antidepressants and sleeping pills but there is often no way of knowing what state* 

*My dad found out about KidsTime when he was looking for ways to help me. I already knew about my mum's illness, but it was good to know that there are people* 

*People say mental illness is invisible, but you can usually tell by the look on someone's face or the way they are not keeping up with personal hygiene that they are unwell. Being a carer for my mum is not a bad thing, but it is a responsibility. I know that sometimes she does not want to talk she just wants me to sit with her. The annoying thing is that because I have lived with my mum, I can usually tell when other people are down as well. You start to feel guilty if the people around you are not happy, which is illogical, but I cannot help it. That is one of the things we have talked about at KidsTime—the burden of having that insight. My school and college mates do not understand that, but with my friends from KidsTime we can just* 

*jump straight into a deep conversation, and that means a lot to me."*

To date, several evaluations of the KidsTime Workshops have been carried out,

using a variety of methodologies, the findings of which are summarised in the

**7. Impact and evaluation of the KidsTime Workshops**

*who, like me, have to remind their parents to shower and eat.*

*"KidsTime is a wonderful place to go and you can express your feelings."* 

**92**

In relation to children of parents with a mental illness, the stakes are high. An estimated 3.4 million children and young people in the UK live with a parent with a mental illness. Without help, 70% (3.1 million) of these children will go on to develop mental health problems themselves at huge expense to the public purse [6]. For example, if a quarter of these young people develop depression by 2021, the projected cost to the UK government could be up to £470 million [5]. This is the tip of the iceberg—depression is just one of many ill consequences likely to befall this group. Other potential long-term consequences include disrupted education, restricted peer relationships (due to carer role), financial hardship, potential separation from parents, stigma, future physical and mental health problems, greater risk of suicide, unemployment, marital problems and crime and violence [2–5, 10]. Consequently, without intervention, the long-term prospects are bleak, and the cost of doing nothing could amount to £17 billion per year in the UK alone [20]. In comparison, the cost of preventative approaches is relatively small. To give an example, in England, it costs ~£2000 per family, per year, to take part in a monthly KidsTime Workshop, while an initial assessment by Child and Adolescent Mental Health Services costs £700 per child, prior to any intervention taking place.

While the case for prevention is clear, support for early intervention requires a culture shift across the health, social care and education system, which can only be achieved through policy change and the allocation of appropriate funds to facilitate this at a more local level. This will have to include training and awareness raising for professionals who deal with children in the course of their work, including adult mental health professionals. For this reason, organisations such as Our Time are campaigning for government to count the numbers of children affected by parental mental illness and to invest in prevention to help break the cycle of intergenerational mental illness.

#### **9. Conclusion and recommendations for practice**

This chapter has provided an overview of the workings and impact of multifamily approaches in supporting families affected by parental mental illness, using the KidsTime Workshops as a case study example. It has described the benefits of a more informal and non-therapeutic, multi-family intervention in helping children and families to understand and communicate about mental illness. As well as highlighting the potential risks associated with having a parent with a mental illness, it has demonstrated the power of receiving a clear explanation in helping children to understand and cope with their situation. Access to a supportive and non-judgmental environment where families can share experiences and talk to others in the same situation has been identified as a key protective factor for children and their parents, as illustrated in the feedback and testimonials from families listed in this article. Recommendations for professionals and practitioners working with children and young people affected by parental mental illness are to:


**95**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

parental mental illness should pay attention to the following principles:

• Recognise that these children may fear or reject traditional interventions. Ask children what would help and listen to what they have to say, so that any support offered does not undermine or further isolate the child or young person.

Those interested in trialling multi-family interventions for children affected by

• Create a relaxed, safe and supportive environment that is welcoming for

• Avoid imposing traditional hierarchical structures, i.e., of professional and patient, and, instead, encourage staff to adopt the role of a friendly helper to

• Use a range of creative methods, such as drama, to engage and make it a fun experience for children, to enable exploration of the subject from different

Further information and guidance about the KidsTime model, including how to set up a KidsTime Workshop, is available on the Our Time website: www.ourtime.

facilitate trust and communication within and outside of the family.

• Provide clear age-appropriate explanations for mental illness.

\*, Kirsty Tahta-Wraith2

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Agaplesion Diakonieklinikum, Rotenburg, Germany

\*Address all correspondence to: h.spierling@diako-online.de

, Helena Kulikowska2

perspectives and to encourage reflection.

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

parents and children.

org.uk.

**Author details**

Klaus Henner Spierling1

and Dympna Cunnane2

2 Our Time, London, England

provided the original work is properly cited.

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

• Recognise that these children may fear or reject traditional interventions. Ask children what would help and listen to what they have to say, so that any support offered does not undermine or further isolate the child or young person.

Those interested in trialling multi-family interventions for children affected by parental mental illness should pay attention to the following principles:


Further information and guidance about the KidsTime model, including how to set up a KidsTime Workshop, is available on the Our Time website: www.ourtime. org.uk.

### **Author details**

*Family Therapy - New Intervention Programs and Researches*

intervention taking place.

In relation to children of parents with a mental illness, the stakes are high. An estimated 3.4 million children and young people in the UK live with a parent with a mental illness. Without help, 70% (3.1 million) of these children will go on to develop mental health problems themselves at huge expense to the public purse [6]. For example, if a quarter of these young people develop depression by 2021, the projected cost to the UK government could be up to £470 million [5]. This is the tip of the iceberg—depression is just one of many ill consequences likely to befall this group. Other potential long-term consequences include disrupted education, restricted peer relationships (due to carer role), financial hardship, potential separation from parents, stigma, future physical and mental health problems, greater risk of suicide, unemployment, marital problems and crime and violence [2–5, 10]. Consequently, without intervention, the long-term prospects are bleak, and the cost of doing nothing could amount to £17 billion per year in the UK alone [20]. In comparison, the cost of preventative approaches is relatively small. To give an example, in England, it costs ~£2000 per family, per year, to take part in a monthly KidsTime Workshop, while an initial assessment by Child and Adolescent Mental Health Services costs £700 per child, prior to any

While the case for prevention is clear, support for early intervention requires a culture shift across the health, social care and education system, which can only be achieved through policy change and the allocation of appropriate funds to facilitate this at a more local level. This will have to include training and awareness raising for professionals who deal with children in the course of their work, including adult mental health professionals. For this reason, organisations such as Our Time are campaigning for government to count the numbers of children affected by parental mental illness and to

invest in prevention to help break the cycle of intergenerational mental illness.

children and young people affected by parental mental illness are to:

This chapter has provided an overview of the workings and impact of multifamily approaches in supporting families affected by parental mental illness, using the KidsTime Workshops as a case study example. It has described the benefits of a more informal and non-therapeutic, multi-family intervention in helping children and families to understand and communicate about mental illness. As well as highlighting the potential risks associated with having a parent with a mental illness, it has demonstrated the power of receiving a clear explanation in helping children to understand and cope with their situation. Access to a supportive and non-judgmental environment where families can share experiences and talk to others in the same situation has been identified as a key protective factor for children and their parents, as illustrated in the feedback and testimonials from families listed in this article. Recommendations for professionals and practitioners working with

• Notice these children, and recognise the role they play in caring for their parents.

• Recognise and acknowledge that they are experts in their family situation, with often very advanced knowledge and insight into their parent's illness and/or

• Provide children with clear explanations of their parent's illness and what is happening to the parent and for the reasons behind decisions (e.g., when a

**9. Conclusion and recommendations for practice**

**94**

behaviours.

parent is hospitalised).

Klaus Henner Spierling1 \*, Kirsty Tahta-Wraith2 , Helena Kulikowska2 and Dympna Cunnane2

1 Agaplesion Diakonieklinikum, Rotenburg, Germany

2 Our Time, London, England

\*Address all correspondence to: h.spierling@diako-online.de

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **References**

[1] Wiegand-Grefe S, Jeske J, Bullinger M, Plass A, Petermann F. Lebensqualität von Kindern psychisch kranker Eltern. Zusammenhänge zwischen Merkmalen elterlicher Erkrankung und gesundheitsbezogener Lebensqualität der Kinder aus Elternsicht. Z f Psychiatrie, Psychologie und Psychotherapie. 2010;**58**(4):315-322

[2] Cooklin A. Promoting children's resilience to parental mental illness: Engaging the child's thinking. Advances in Psychiatric Treatment. May 2013;**19**(3):229-240

[3] Children's Commissioner Vulnerability Report. 2018

[4] Welsh Adverse Childhood Experiences (ACE) study. Public Health Wales. Centre for Public Health, Liverpool John Moores University; 2015

[5] Ernst and Young. Sizing the Problem—Analysis. Our Time

[6] Rubovits PC. Project CHILD: An intervention programme for psychotic mothers and their children. 1996

[7] Effective Interventions and Policy Options, WHO (2004). Parents with Mental Disorders and Mental Health Fact Sheet 2016. Available from: www.who. int/mediacentre/factsheets.f220/en/

[8] Hetherington R, Baistow K, Katz I, Trowell J. The Welfare of Children with mentally ill parents: Learning from Inter-country comparisons WHO paper. 2001

[9] Mattejat F, Remschmidt H. Kinder psychisch kranker Eltern. Deutsches Ärzteblatt. 2008;**105**(23):413-418

[10] Felitti Vincent J, Robert A, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventative Medicine. 1998;**14**(4):245-258

[11] Evaluation Report of KidsTime Workshops, Anna Freud Centre, (2010- 2011). KidsTime Workshop Manual, & Wolpert. An exploration of the experience of attending the KidsTime programme for children with parents with enduring 7 mental health issues: Parents' and young people's views, Clinical Child Psychology and Psychiatry; 2014

[12] Wiegand-Grefe S, Cronemeyer B, Plass A, Schulte-Markwort M, Petermann F. Psychische Auffälligkeiten von Kindern psychisch kranker Eltern im Perspektivenvergleich. Kindheit und Entwicklung. 2013;**22**(1):31-40

[13] Cooklin A, Cunnane D. Learning from the kidstime model. Rotenburg: Conference bag-kipe; 2018

[14] Wagenblass U. Risiko-und Schutzfaktoren bei Kindern psychisch kranker Eltern. In: Vortrag im Rahmen der Fachtagung vom Runden Tisch in Braunschweig: Frühe Kindheit— Frühe Hilfen; 2009. Im Web: https:// wwwvhs-braunschweigde/vhshdf/ downloads/hdf-fachtagung/Prof-Dr-Wagenblass\_15-05-09pdf [Zugriff: 4 November 2015]

[15] Wiegand-Grefe S, Halverscheid S, Plass A. Kinder und ihre psychisch kranken Eltern. Familienorientierte Prävention—Der CHIMPs-Beratungsansatz. Göttingen: Hogrefe; 2011

[16] Cooklin A, Bishop P, Francis D, Fagin L, Asen E. The Kidstime Workshops. A Multi-Family Intervention for the Effects of Parental Mental Illness. London: CMHS Publications; 2012

**97**

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness*

*DOI: http://dx.doi.org/10.5772/intechopen.87017*

[17] Bohus M, Schehr K, Berger-Sallawitz F, Novelli-Fischer U, Stieglitz R, Berger M. Kinder psychisch kranker Eltern. Eine Untersuchung zum Problembewußtsein im klinischen Alltag. Psychiatrische Praxis.

[18] Asen E, Scholz M. Praxis der Multifamilientherapie. Heidelberg:

Multifamilienarbeit für Familien mit psychisch erkrankten Elternteilen.

[20] The Cost of Late Intervention: Early Intervention Foundation Analysis. 2016

[19] Spierling KH. Kidstime workshops—ein Projekt mit

Systeme. 2016;**30**(1):54-74

1998;**25**:134-138

Carl-Auer; 2012

*KidsTime Workshops: Strengthening Resilience of Children of Parents with a Mental Illness DOI: http://dx.doi.org/10.5772/intechopen.87017*

[17] Bohus M, Schehr K, Berger-Sallawitz F, Novelli-Fischer U, Stieglitz R, Berger M. Kinder psychisch kranker Eltern. Eine Untersuchung zum Problembewußtsein im klinischen Alltag. Psychiatrische Praxis. 1998;**25**:134-138

[18] Asen E, Scholz M. Praxis der Multifamilientherapie. Heidelberg: Carl-Auer; 2012

[19] Spierling KH. Kidstime workshops—ein Projekt mit Multifamilienarbeit für Familien mit psychisch erkrankten Elternteilen. Systeme. 2016;**30**(1):54-74

[20] The Cost of Late Intervention: Early Intervention Foundation Analysis. 2016

**96**

2001

*Family Therapy - New Intervention Programs and Researches*

leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventative

Medicine. 1998;**14**(4):245-258

and Psychiatry; 2014

[11] Evaluation Report of KidsTime Workshops, Anna Freud Centre, (2010- 2011). KidsTime Workshop Manual, & Wolpert. An exploration of the experience of attending the KidsTime programme for children with parents with enduring 7 mental health issues: Parents' and young people's views, Clinical Child Psychology

[12] Wiegand-Grefe S, Cronemeyer B, Plass A, Schulte-Markwort M, Petermann F. Psychische Auffälligkeiten von Kindern psychisch kranker Eltern im Perspektivenvergleich. Kindheit und

Entwicklung. 2013;**22**(1):31-40

Conference bag-kipe; 2018

November 2015]

2011

[14] Wagenblass U. Risiko-und

[13] Cooklin A, Cunnane D. Learning from the kidstime model. Rotenburg:

Schutzfaktoren bei Kindern psychisch kranker Eltern. In: Vortrag im Rahmen der Fachtagung vom Runden Tisch in Braunschweig: Frühe Kindheit— Frühe Hilfen; 2009. Im Web: https:// wwwvhs-braunschweigde/vhshdf/ downloads/hdf-fachtagung/Prof-Dr-Wagenblass\_15-05-09pdf [Zugriff: 4

[15] Wiegand-Grefe S, Halverscheid S, Plass A. Kinder und ihre psychisch kranken Eltern. Familienorientierte

Beratungsansatz. Göttingen: Hogrefe;

Intervention for the Effects of Parental

[16] Cooklin A, Bishop P, Francis D, Fagin L, Asen E. The Kidstime Workshops. A Multi-Family

Mental Illness. London: CMHS

Publications; 2012

Prävention—Der CHIMPs-

[1] Wiegand-Grefe S, Jeske J, Bullinger M, Plass A, Petermann F. Lebensqualität

von Kindern psychisch kranker Eltern. Zusammenhänge zwischen Merkmalen elterlicher Erkrankung und gesundheitsbezogener Lebensqualität der Kinder aus Elternsicht. Z f Psychiatrie, Psychologie und Psychotherapie. 2010;**58**(4):315-322

**References**

[2] Cooklin A. Promoting children's resilience to parental mental illness: Engaging the child's thinking. Advances

in Psychiatric Treatment. May

[3] Children's Commissioner Vulnerability Report. 2018

[4] Welsh Adverse Childhood Experiences (ACE) study. Public Health Wales. Centre for Public Health, Liverpool John Moores University; 2015

[5] Ernst and Young. Sizing the Problem—Analysis. Our Time

[6] Rubovits PC. Project CHILD: An intervention programme for psychotic mothers and their children. 1996

[7] Effective Interventions and Policy Options, WHO (2004). Parents with Mental Disorders and Mental Health Fact Sheet 2016. Available from: www.who. int/mediacentre/factsheets.f220/en/

[8] Hetherington R, Baistow K, Katz I, Trowell J. The Welfare of Children with mentally ill parents: Learning from Inter-country comparisons WHO paper.

[9] Mattejat F, Remschmidt H. Kinder psychisch kranker Eltern. Deutsches Ärzteblatt. 2008;**105**(23):413-418

[10] Felitti Vincent J, Robert A, et al. Relationship of childhood abuse and household dysfunction to many of the

2013;**19**(3):229-240

**99**

**Chapter 6**

*Eva Mydlíková*

**Abstract**

**1. Introduction**

Mirage: Possibilities and

Home as a Family

Limitations of Experiencing Foster

The theme of this chapter is the life of children living in state foster homes of the so-called family type. The theoretical scope of the research on the quality of life is based on the chosen capabilities according to the theory by Martha Nussbaum. The qualitative strategy has been chosen as a base for the methodology of the research. Predominantly, the deductive method has been used for collecting and processing the research data by openly coding the transcripts of clinic interviews with children living in foster homes. The research has been searching for answers to these four questions: How can children, living in foster homes, develop cognitively? How can children build relationships and emotions in foster homes? What does the term "home" mean for children living in foster homes? How do children living in foster homes perceive their own identity? Among the most important research findings belongs the information on an excessive burden of adoption on the children, on a weak engagement in creation and improvement of children's home, on wrong conditions for the self-

development, self-evaluation and self-reflection of a child and other.

There are children living everywhere in the world, for which their parents cannot or will not care. Every society creates its own mechanisms to cope with this phenomenon. That applies to Slovakia with its over 5 million population as well, marked by the culture of central Europe, Christian values, but also by a half-century of the socialism regime. The socialistic period of the life of society has been defined by the state monopoly and by a high centralization of provided social help to citizens, which practically meant a high rate of the provided social care in the state residential form. That brought along the uniformity, poor range of forms provided, and a high rate of passivity in clients. After the 1989 revolution the passive approach of social care has changed into active approach of social help, which also applies on the area of help for children. Post-revolutionary legislation has broken down the state monopoly on providing the social services and sociolegal protection of children and offered participation to private subjects. The enforcement of social help has been decentralized into public and private providers. *The Agreement on rights of a child* and consecutively established *Directives of the United Nations on the foster-family care* have been an important influence on sociopolitical and economic change in the approach towards child care. The government

**Keywords:** capability, child, foster home, quality of life

#### **Chapter 6**

## Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family

*Eva Mydlíková*

#### **Abstract**

The theme of this chapter is the life of children living in state foster homes of the so-called family type. The theoretical scope of the research on the quality of life is based on the chosen capabilities according to the theory by Martha Nussbaum. The qualitative strategy has been chosen as a base for the methodology of the research. Predominantly, the deductive method has been used for collecting and processing the research data by openly coding the transcripts of clinic interviews with children living in foster homes. The research has been searching for answers to these four questions: How can children, living in foster homes, develop cognitively? How can children build relationships and emotions in foster homes? What does the term "home" mean for children living in foster homes? How do children living in foster homes perceive their own identity? Among the most important research findings belongs the information on an excessive burden of adoption on the children, on a weak engagement in creation and improvement of children's home, on wrong conditions for the selfdevelopment, self-evaluation and self-reflection of a child and other.

**Keywords:** capability, child, foster home, quality of life

#### **1. Introduction**

There are children living everywhere in the world, for which their parents cannot or will not care. Every society creates its own mechanisms to cope with this phenomenon. That applies to Slovakia with its over 5 million population as well, marked by the culture of central Europe, Christian values, but also by a half-century of the socialism regime. The socialistic period of the life of society has been defined by the state monopoly and by a high centralization of provided social help to citizens, which practically meant a high rate of the provided social care in the state residential form. That brought along the uniformity, poor range of forms provided, and a high rate of passivity in clients. After the 1989 revolution the passive approach of social care has changed into active approach of social help, which also applies on the area of help for children. Post-revolutionary legislation has broken down the state monopoly on providing the social services and sociolegal protection of children and offered participation to private subjects. The enforcement of social help has been decentralized into public and private providers. *The Agreement on rights of a child* and consecutively established *Directives of the United Nations on the foster-family care* have been an important influence on sociopolitical and economic change in the approach towards child care. The government

of Slovak republic has elaborated the *Strategy of deinstitutionalization of the system of social services and foster-family care* and ever since 2011 creates legislative, social and economical conditions to support a life of children in their natural, foster and community environment. The state policy after the revolution prefers child care in a family in the form of foster personal care, step-family care and personal care of a legal guardian. According to the records of the divisions of socio-legal child protection there are approximately 2,24,000 families in Slovakia [1]. In 2016, 1,058,300 children have been living in Slovakia, out of that 14,065 children (1.33%) have been living without their own home. Based on the court order, 744 children have not managed to find their home by above stated forms, 1468 children have been placed into professional families, 835 children (17.60%) have been placed into other groups and 2441 children (51.45%) have been placed into individual groups in a foster home [2]. Namely the group of these 2441 children living in a foster home has been a subject of interest to the qualitative research of which the results are being presented in this thesis. The task of a foster home is to temporally provide an alternative natural family environment to a child or to create a replacement of the family environment. Through its executive branches, the state provides and ensures for children: housing, food, services, personal equipment of a child, safe keeping of precious things, health care, mandatory school attendance and preparation for career [3] and in this way the state tries for an integration and individual approach towards the child. The integration approach is used in a sense of closing the conditions for integrating child into local communities (professional families and groups properly arranged and localized under conditions on a level of community), as well as creating conditions for integrating children with less serious development disorders into professional families and individual groups. An individual approach is based on an application of professional methods, forms and programs for working with children that require a special approach [1]. The aim of this chapter is to describe research findings on life children living in a foster home of the so-called family tape considering the capability phenomenon.

#### **2. The capability of children approach**

The capability concept stems from the approach of "child's well-becoming." This approach, preferred more or less up to the 80s of the last century, perceives child as a little person who experiences the in-between state towards adulthood, ergo a future adult. This approach is focused on the future of the child. The central point of interest is to ensure that the child gets good education and has good health once the child reaches the adulthood and this should be predisposed by a proper parental care. However, these goals can be formed by an adult person only. All in the name of child's well-becoming. The child alone is perceived only as a passive receiver of these benefits [4, 5].

Decreasing birth rate, unsteadiness of human relationships in family and society, centralization and fixation of partnerships through child, have concluded into a need of a new legal position of a child, brought by the Agreement on rights of a child [6]. The situation of society in the postmodern period has brought an orientation of the society on the individualization of a person, built on the reflection [7]. This way, the "well-becoming" has changed the approach to "well-being." This approach considers children as active participants and carriers of rights. New priorities are asserted, for example, a much higher engagement of children in achieving social skills, their engagement as citizens, and their part in creating the culture of the society. The theoretical developments of the child's well-being approach have been built at first in the concept of life quality. The reason for this has

**101**

homes in Slovakia in 2016–2017.

**3. Research methods and realization**

The content analysis has been used in the quality research, which was originally only quantitative research method [24]. However, the arrival of quality method of the research has influenced its usage in quality research as well [25, 26]. The aim of our research was to find out how can children living in foster home lead a life they

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

mostly been the attempt at quantification and measurement of the extent of child's well-being, as the phenomenon of human happiness has been difficult to measure and it was too vague. Sociably acceptable indicators as well as methods for their reading and measuring have already existed in that period in the area of life quality. It was assumed that it would be mainly social indicators that could influence the

In the 60s of the last century UNICEF has published a report on the state of children, in which it also published the results of measuring the life quality of children, as well as socio-demographic trends, risks and needs of children [5, 11–15]. In the 90s of the last century the Nobel Prize winner for economics, Amarthy Sen, has started to promote the so-called *capability approach* [16–18], further developed by the philosopher Martha Nussbaum [19–22]. Both had decided that the *capability* is an ability of an individual to achieve such a life the individual can value. Therefore, the *capability approach* is mostly about social arrangement of a just approach to such living conditions that the individual values himself. Both have understood that not every person has the same options of freedom and choice to reach a dignified life. They tried to find out what are the necessary expectations, options and skills people need to reach their goal. According to Nussbaum [22], in every society individuals exist who cannot even form their rights not to say fulfill them, therefore, they need support. In this classical understanding is the capability a connection: fulfilling individual's needs, human prosperity, material conditions, and fulfillment of individual needs, human desires and emotions. These characteristics have an interdisciplinary aspect of well-being. In this context, Robeyns [23] talks about the capabilities as substantive freedoms. Nussbaum [21] has formulated 10 basic capabilities; in 2014, Bigeri has presented 14 of them [5]. Martha Nussbaum described these following functions of human capabilities: (1) normal length of life—a person should not die prematurely; (2) good health—a person should have an option to enjoy good health, have appropriate care; (3) physical integrity—have the option of a free movement, a feeling of safety, protection of personal space); (4) utilization of senses, perception and thinking—access to information, education, space for selfexpression, for searching for one's own meaning of life, religious freedom, freedom of expression; (5) emotions—option to create relationships with things and people, to love and to be loved, option to safely relive anger, love and other emotions; (6) practical thinking—option to create goodness, actively plan one's life, option to realize one's own plans; (7) relationships—option to live with others, participate in social interactions, empathy, to have self-worth and respect others, protection from discrimination, reciprocal appreciation; (8) other living creatures—to have the option to relive the relationship with animals, plants; (9) game—option to play, entertain and relax; (10) control over one's own environment—have the right to engage, associate and protect one's own work, as well as to own a property. At first glance, these 10 capabilities might sound a little bit generalized, stemming from the combination of some human rights and psychological, biological and social human needs. In spite of this overall universalism is out of it built a theoretical scope of quantitative research the subject of which was capability of children, living in foster

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

children's life conditions [8–10].

#### *Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*

*Family Therapy - New Intervention Programs and Researches*

family tape considering the capability phenomenon.

The capability concept stems from the approach of "child's well-becoming." This approach, preferred more or less up to the 80s of the last century, perceives child as a little person who experiences the in-between state towards adulthood, ergo a future adult. This approach is focused on the future of the child. The central point of interest is to ensure that the child gets good education and has good health once the child reaches the adulthood and this should be predisposed by a proper parental care. However, these goals can be formed by an adult person only. All in the name of child's well-becoming. The child alone is perceived only as a passive receiver of these

Decreasing birth rate, unsteadiness of human relationships in family and society, centralization and fixation of partnerships through child, have concluded into a need of a new legal position of a child, brought by the Agreement on rights of a child [6]. The situation of society in the postmodern period has brought an orientation of the society on the individualization of a person, built on the reflection [7]. This way, the "well-becoming" has changed the approach to "well-being." This approach considers children as active participants and carriers of rights. New priorities are asserted, for example, a much higher engagement of children in achieving social skills, their engagement as citizens, and their part in creating the culture of the society. The theoretical developments of the child's well-being approach have been built at first in the concept of life quality. The reason for this has

**2. The capability of children approach**

of Slovak republic has elaborated the *Strategy of deinstitutionalization of the system of social services and foster-family care* and ever since 2011 creates legislative, social and economical conditions to support a life of children in their natural, foster and community environment. The state policy after the revolution prefers child care in a family in the form of foster personal care, step-family care and personal care of a legal guardian. According to the records of the divisions of socio-legal child protection there are approximately 2,24,000 families in Slovakia [1]. In 2016, 1,058,300 children have been living in Slovakia, out of that 14,065 children (1.33%) have been living without their own home. Based on the court order, 744 children have not managed to find their home by above stated forms, 1468 children have been placed into professional families, 835 children (17.60%) have been placed into other groups and 2441 children (51.45%) have been placed into individual groups in a foster home [2]. Namely the group of these 2441 children living in a foster home has been a subject of interest to the qualitative research of which the results are being presented in this thesis. The task of a foster home is to temporally provide an alternative natural family environment to a child or to create a replacement of the family environment. Through its executive branches, the state provides and ensures for children: housing, food, services, personal equipment of a child, safe keeping of precious things, health care, mandatory school attendance and preparation for career [3] and in this way the state tries for an integration and individual approach towards the child. The integration approach is used in a sense of closing the conditions for integrating child into local communities (professional families and groups properly arranged and localized under conditions on a level of community), as well as creating conditions for integrating children with less serious development disorders into professional families and individual groups. An individual approach is based on an application of professional methods, forms and programs for working with children that require a special approach [1]. The aim of this chapter is to describe research findings on life children living in a foster home of the so-called

**100**

benefits [4, 5].

mostly been the attempt at quantification and measurement of the extent of child's well-being, as the phenomenon of human happiness has been difficult to measure and it was too vague. Sociably acceptable indicators as well as methods for their reading and measuring have already existed in that period in the area of life quality. It was assumed that it would be mainly social indicators that could influence the children's life conditions [8–10].

In the 60s of the last century UNICEF has published a report on the state of children, in which it also published the results of measuring the life quality of children, as well as socio-demographic trends, risks and needs of children [5, 11–15]. In the 90s of the last century the Nobel Prize winner for economics, Amarthy Sen, has started to promote the so-called *capability approach* [16–18], further developed by the philosopher Martha Nussbaum [19–22]. Both had decided that the *capability* is an ability of an individual to achieve such a life the individual can value. Therefore, the *capability approach* is mostly about social arrangement of a just approach to such living conditions that the individual values himself. Both have understood that not every person has the same options of freedom and choice to reach a dignified life. They tried to find out what are the necessary expectations, options and skills people need to reach their goal. According to Nussbaum [22], in every society individuals exist who cannot even form their rights not to say fulfill them, therefore, they need support. In this classical understanding is the capability a connection: fulfilling individual's needs, human prosperity, material conditions, and fulfillment of individual needs, human desires and emotions. These characteristics have an interdisciplinary aspect of well-being. In this context, Robeyns [23] talks about the capabilities as substantive freedoms. Nussbaum [21] has formulated 10 basic capabilities; in 2014, Bigeri has presented 14 of them [5]. Martha Nussbaum described these following functions of human capabilities: (1) normal length of life—a person should not die prematurely; (2) good health—a person should have an option to enjoy good health, have appropriate care; (3) physical integrity—have the option of a free movement, a feeling of safety, protection of personal space); (4) utilization of senses, perception and thinking—access to information, education, space for selfexpression, for searching for one's own meaning of life, religious freedom, freedom of expression; (5) emotions—option to create relationships with things and people, to love and to be loved, option to safely relive anger, love and other emotions; (6) practical thinking—option to create goodness, actively plan one's life, option to realize one's own plans; (7) relationships—option to live with others, participate in social interactions, empathy, to have self-worth and respect others, protection from discrimination, reciprocal appreciation; (8) other living creatures—to have the option to relive the relationship with animals, plants; (9) game—option to play, entertain and relax; (10) control over one's own environment—have the right to engage, associate and protect one's own work, as well as to own a property. At first glance, these 10 capabilities might sound a little bit generalized, stemming from the combination of some human rights and psychological, biological and social human needs. In spite of this overall universalism is out of it built a theoretical scope of quantitative research the subject of which was capability of children, living in foster homes in Slovakia in 2016–2017.

#### **3. Research methods and realization**

The content analysis has been used in the quality research, which was originally only quantitative research method [24]. However, the arrival of quality method of the research has influenced its usage in quality research as well [25, 26]. The aim of our research was to find out how can children living in foster home lead a life they

would like to lead. Through 2016, we have realized 35 in depth interviews with four categories of participants: children between the age of 6 and 14, children above 15 years old, young adults and professional employees of three foster homes. Foster homes have been chosen for the research on the basis of two criteria: its capacity should top 70 children and they should have been from various regions. Children have entered foster home either from biological families or from professional, in some cases foster families. The selection of concrete children for the interview has been done on the basis of their age, sibling relationships and mainly proclaimed willingness of a child to talk. The bottom age line was stated by the legislation that in Slovak republic does not allow children below the age of 6 to live in a residential facility. The exception consists of children with grievous health disadvantage, living in specialized socio-health facilities who can be younger than 6 years. In this chapter we present the results of the group of children between the age of 6 and 14, living in individual nurture groups of family type. The nurture group of family type itself has its own budget that is usually around 6–10 children. The group consists of siblings, filled in by other children. The group is therefore heterogeneous in age and gender. Children should participate in domestic chores, they should learn individually how to manage finances: foster home is divided spatially into several units—stand-alone nurture groups and some of them can be in a family home outside of the main domicile of the foster home. Children share rooms in two or three, have a shared living room and kitchen. Six employees alternate fixedly, usually consisting of a team of educators, social and therapeutic educators, housekeepers. A psychologist and social worker is employed in the foster home as well. From 29 hour footage we have transcribed a 406 page long transcript. This transcript formed the research sample. For one unit of analysis were considered quotes of children, regarding the way of life in the foster home. We have acquired on one side manifest contents, obvious from interviews and latent contents on the other side, that result from verbal as well as non-verbal utterances of children during the interview, located in its in-depth structures. We have created four research questions: (1) How can children living in foster home develop cognitively? (2) How can children in foster home develop their relationships and emotions? (3) What does the term home means for children in foster home? (4) How children from foster home perceive their identity? (5) When analyzing the transcripts of the recorded interviews we used symbolic interactionism, which Hendl [27] considered to be the basis assumption of the correct application of the grounded theory approach and the modification of which [28–31] we used to process our results. Our goal was to clarify the phenomenon of the capability of children living under the conditions of an institution that simulates the family environment. The capability phenomenon is presumed in the context of strictly recorded data that anchor it into theoretical frameworks. The primary focus of this research is capability of children. Through a three-level coding (open coding, axial coding and selective coding), we have abstracted variables that lead to the formation of the conceptual scheme describing relationships between the obtained variables.

#### **4. Process of analysis**

We have collected the data through in-depth interview that we have record on the audio-record and transcribed into transcripts. The transcripts were coded at first, and then we have repeatedly checked their suitability considering the observed factors of children's capability. Some were discarded; some were modified and consecutively used in the next sequence of coding. In the research we have follow the rules of ethical research. A high probability of subjectivism in interpretation of collected data was minimized by having four researchers work at the same

**103**

**5. Outcomes**

capabilities.

**5.1 Capability 4**

they want for themselves.

freedom of expression **Tables 1** and **2**.

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

freely add text to the rows and columns into a final representation.

time. Even though each one had their "own" age group of participants, the strategy of acquiring and processing the data had been mutually agreed upon. We processed the transcripts of the recordings into a spreadsheet form [32], which allowed us to

When naming the statements, we used the procedure of asking questions [28]. The child's statements have already been conceptualized in the first step. The goal of interviewing the child was to identify categories of its life experience (capabilities) in the context of possibilities and limitations provided by living in foster care. Even at this stage of open coding, we had an idea about these categories, but we tried to schematize them and interpret them as objectively as possible by using codes. Another level of coding, so-called axial coding, was used to construct the main categories into a concepts [28, 30, 33] and thus to try to find their properties and characteristics. The subcategories resulting from open and axial coding have been allocated into seven outcome categories of research findings. We have assigned them to the selected Nussbaum capabilities. We compared the outcomes to the descriptions of the selected capabilities in order to create a solid structure for interpreting the research data. At the outset, Nussbaum's capabilities have mainly been used to form a framework for creating the questions asked in the interview. At the end of the process, they were used again to form a framework that would keep us from straying from the validity of the research.

The outcomes obtained during this research were divided into four categories. These give an insight into the extent to which children in foster care can live the life

For better clarity, we sorted the obtained results according to selected Nussbaum

Use of senses, ideas and thoughts—access to information, education, space for self-realization, for searching one's own, meaning of life, religious freedom,

Recording of the interviews with children had started on the last day of the school year. The report and the school were therefore a spontaneous theme number one in our interviews. Children talked by themselves about not liking to attend school, about almost all of them having postponed the school attendance and at least half of them visits school with special needs. This quantification is not as interesting considering the low numbers of participants. However, interesting is the way of attendance in specialized schools. A child, after being taken out of a family, has been by the court order placed into a foster home—an institution of residential type. Considering the social deficits of the family, the child comes to the foster home and most probably with the postponed school attendance or with very bad school achievements, which is usually caused either by socially uneventful environment or by undiagnosed or deeply neglected learning disability. Almost automatically, child switches into a school for special needs. Considering the integration at Slovak schools is only a wish, child is moved into a school for children with special needs. These are almost all of the dormitory type; build in socialism regime on the edge regions with hard accessibility. Therefore, the child leaves on Monday the residency of foster home and enters the residency of specialized school, which the child leaves again on Friday afternoon, to come back to foster home. For example,

even a 7-year old child must manage adaption in two residential systems!

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*

time. Even though each one had their "own" age group of participants, the strategy of acquiring and processing the data had been mutually agreed upon. We processed the transcripts of the recordings into a spreadsheet form [32], which allowed us to freely add text to the rows and columns into a final representation.

When naming the statements, we used the procedure of asking questions [28]. The child's statements have already been conceptualized in the first step. The goal of interviewing the child was to identify categories of its life experience (capabilities) in the context of possibilities and limitations provided by living in foster care. Even at this stage of open coding, we had an idea about these categories, but we tried to schematize them and interpret them as objectively as possible by using codes. Another level of coding, so-called axial coding, was used to construct the main categories into a concepts [28, 30, 33] and thus to try to find their properties and characteristics. The subcategories resulting from open and axial coding have been allocated into seven outcome categories of research findings. We have assigned them to the selected Nussbaum capabilities. We compared the outcomes to the descriptions of the selected capabilities in order to create a solid structure for interpreting the research data. At the outset, Nussbaum's capabilities have mainly been used to form a framework for creating the questions asked in the interview. At the end of the process, they were used again to form a framework that would keep us from straying from the validity of the research.

#### **5. Outcomes**

*Family Therapy - New Intervention Programs and Researches*

would like to lead. Through 2016, we have realized 35 in depth interviews with four categories of participants: children between the age of 6 and 14, children above 15 years old, young adults and professional employees of three foster homes. Foster homes have been chosen for the research on the basis of two criteria: its capacity should top 70 children and they should have been from various regions. Children have entered foster home either from biological families or from professional, in some cases foster families. The selection of concrete children for the interview has been done on the basis of their age, sibling relationships and mainly proclaimed willingness of a child to talk. The bottom age line was stated by the legislation that in Slovak republic does not allow children below the age of 6 to live in a residential facility. The exception consists of children with grievous health disadvantage, living in specialized socio-health facilities who can be younger than 6 years. In this chapter we present the results of the group of children between the age of 6 and 14, living in individual nurture groups of family type. The nurture group of family type itself has its own budget that is usually around 6–10 children. The group consists of siblings, filled in by other children. The group is therefore heterogeneous in age and gender. Children should participate in domestic chores, they should learn individually how to manage finances: foster home is divided spatially into several units—stand-alone nurture groups and some of them can be in a family home outside of the main domicile of the foster home. Children share rooms in two or three, have a shared living room and kitchen. Six employees alternate fixedly, usually consisting of a team of educators, social and therapeutic educators, housekeepers. A psychologist and social worker is employed in the foster home as well. From 29 hour footage we have transcribed a 406 page long transcript. This transcript formed the research sample. For one unit of analysis were considered quotes of children, regarding the way of life in the foster home. We have acquired on one side manifest contents, obvious from interviews and latent contents on the other side, that result from verbal as well as non-verbal utterances of children during the interview, located in its in-depth structures. We have created four research questions: (1) How can children living in foster home develop cognitively? (2) How can children in foster home develop their relationships and emotions? (3) What does the term home means for children in foster home? (4) How children from foster home perceive their identity? (5) When analyzing the transcripts of the recorded interviews we used symbolic interactionism, which Hendl [27] considered to be the basis assumption of the correct application of the grounded theory approach and the modification of which [28–31] we used to process our results. Our goal was to clarify the phenomenon of the capability of children living under the conditions of an institution that simulates the family environment. The capability phenomenon is presumed in the context of strictly recorded data that anchor it into theoretical frameworks. The primary focus of this research is capability of children. Through a three-level coding (open coding, axial coding and selective coding), we have abstracted variables that lead to the formation of the conceptual scheme describing relationships between the obtained variables.

We have collected the data through in-depth interview that we have record on the audio-record and transcribed into transcripts. The transcripts were coded at first, and then we have repeatedly checked their suitability considering the observed factors of children's capability. Some were discarded; some were modified and consecutively used in the next sequence of coding. In the research we have follow the rules of ethical research. A high probability of subjectivism in interpretation of collected data was minimized by having four researchers work at the same

**102**

**4. Process of analysis**

The outcomes obtained during this research were divided into four categories. These give an insight into the extent to which children in foster care can live the life they want for themselves.

For better clarity, we sorted the obtained results according to selected Nussbaum capabilities.

#### **5.1 Capability 4**

Use of senses, ideas and thoughts—access to information, education, space for self-realization, for searching one's own, meaning of life, religious freedom, freedom of expression **Tables 1** and **2**.

Recording of the interviews with children had started on the last day of the school year. The report and the school were therefore a spontaneous theme number one in our interviews. Children talked by themselves about not liking to attend school, about almost all of them having postponed the school attendance and at least half of them visits school with special needs. This quantification is not as interesting considering the low numbers of participants. However, interesting is the way of attendance in specialized schools. A child, after being taken out of a family, has been by the court order placed into a foster home—an institution of residential type. Considering the social deficits of the family, the child comes to the foster home and most probably with the postponed school attendance or with very bad school achievements, which is usually caused either by socially uneventful environment or by undiagnosed or deeply neglected learning disability. Almost automatically, child switches into a school for special needs. Considering the integration at Slovak schools is only a wish, child is moved into a school for children with special needs. These are almost all of the dormitory type; build in socialism regime on the edge regions with hard accessibility. Therefore, the child leaves on Monday the residency of foster home and enters the residency of specialized school, which the child leaves again on Friday afternoon, to come back to foster home. For example, even a 7-year old child must manage adaption in two residential systems!

#### *Family Therapy - New Intervention Programs and Researches*


#### **Table 1.**

*Children and the development of cognitive skills.*

Home preparation for classes is a group thing. As a daily program, children have classes when they study, during which the employees have their chores connected with the run of "household." Since the groups are heterogeneous by age, both first-years and high schoolers share the place and time for homework—disregarding whether the child is focused, motivated and whether the child understands the covered topic. It seems that children lack motivation the most. One can say that low school achievements and low social background practically push children into special groups of "outsiders" at school, which only strengthens the already bad social status and children circle in the identity of "fosters." Similar findings are presented by Milan Fico from the "Institute for Research of Labour and Family" [34], who in his extensive research from 2017 talks about "rare instances of supporting a child in meeting his or her individual needs."

Through the communication with children we have noticed very weak vocabulary of our participants. This is strongly constricted by a "lexicon" of foster surrounding and TV program. Children have problems to orient in time. A study of the "time perception" of children at foster homes would be considerable, because a child during the interview had his own "time anchors" which we as researchers did not understand much. Despite the fact that children reach the age of professional decision-making (14–15), no one works with them systematically on building their professional career. Children automatically accept the "traditions" of the foster

**105**

**5.2 Capability 5**

**Table 2.**

**5.3 Capability 6**

ties in a safe environment **Tables 3** and **4**.

against discrimination, mutual recognition (**Table 5**).

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

Codes Trains 3× a week (only been once); cycling; shooting; I won a second place at world

Categories The perception of the current time is relatively good, but the events of the past cannot be

Concepts The perception of time lacks continuity, children struggle to place events in time and do

"anchored"—not even by significant holidays or by events

championships! Tomorrow I am going to camp—that is in 3 days; then we are going to be at dad's for 2 weeks and from Friday. We came to the children's care home, do not know, not sure, long time ago. At some point. I do not know how old I was, but I was 6 years old and I have been there for 8 years (is currently 10 years old); Fero murdered my brother, we washed up and were taken away in a car… I do not know how long I have been here. Was it snowy or was it summer? We did not go to school on Monday (holidays). I came here with Dominik when?—When Tomas was in a different family. They had to leave house. When? Because

not understand the past. They lack understanding of what happened to them at home and therefore they are unable to explain their own role and involvement in any of this

home and attend the same high school as the foster children before them, not thinking about the major of the given high school not being in their point of interest. The foster home functions, in a way, as a sub-supplier of children for regional high schools. Similar findings are presented in the research on the life perspectives of young adults after the end of their stay in the foster care, authored by Juhásová [35]. The group approach is visible in the interests and hobbies of the child. If some child even shows interest in something outside of supported foster home activities, the child has no chance to develop his interest further. The reason for absence of an individual approach is the lack of employments, weak ability and missing tradition to organize volunteers, who would have time to spend with children individually, as

Emotions are the ability to create bonds with things and people, to love and to be loved, the possibility of experiencing anger, love and other emotions and capabili-

Relationships are the opportunity to live with others, to participate in social interactions, ability to empathize, self-esteem and respect of others, protection

The second category of the research results consists of relationships and emotionality of children. Children come to the foster home usually on the basis of an incident in the family, where the trigger is usually the process of taking the child away from the family. Thus, usually all the children living in the particular family enter the foster home at the same time. These children have common family history, therefore having sibling identity as well. If nothing changes in the way of life of parents, the incident repeats itself again after several years, now with different, younger children in the family. These children enter the foster home and meet their siblings living in the foster home for years. The sibling relations of these two sub-categories are only biological. Moreover, older children have the feeling that the younger ones were "enjoying" their parents, while they were "stuck" in the foster home. Among the siblings is then strong, almost hateful relationship. If the parent switches partners too often, the connection of these siblings is only their

well as deficit of financial means to pay the quality hobby groups.

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

*Children and the development of cognitive skills-time.*

grandfather was yelling at dad

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*


#### **Table 2.**

*Family Therapy - New Intervention Programs and Researches*

Codes Bad school results; problems with mathematics and English; deferred schooling; school for

and he also wins at tennis (never played it); I like water (sister can swim)

Concepts The disadvantaged starting position in school is unmotivating for children, which reflects

in poor performance and then results in lack of education and the absence of a professional

Children, with limited cognitive capacities, must from an early age adapt to two systems at the same time: school and home. Children appear to be sharing a sort of leisure time activities model among themselves. Activities aim to ventilate the accumulated energy. It is in this area where one can observe the largest disproportion in self-reflection. Children present results that they neither really reached, nor even tried to confront. The only real results were achieved by a

almost all children have deferred school attendance and are 2 years older than other children in their year; children in schools for special needs children have better results, but significant problems with adaptation; even though the children are integrated in classes, relationships with other classmates are limited to "foster kids"; an important role in the school environment is played by "service" persons in the school—a tutor, a janitor; unclear professional career, no goals; in calmer children, interest in drawing and playing on a computer; in more excitable children, interest in climbing, cycling, football, tennis, other physical activities; hobbies are monothematic and there is a lack of diversity; a high manifestation of individuality in this environment is the interest for owls, which is not

Categories Bad school results are associated to disinterest in learning;

further developed because of finances

career development.

children with special needs; disinterest in learning; school with Slovak/Hungarian language; ADHD; expelled; likes to help the school janitor; indifferent towards/dislike of teaching staff; the closest classmates are from foster care; they live in special needs school for 5 days—that is not a home, they just sleep there—and spend the 2 holiday days in children's care home; should improve school results but; would like to become a chef, carpenter, but does not do anything to achieve this; I can help myself, but … without hobbies, interests; art—I am very good at it (reality is different); I have a talent to draw, but I do not do extracurricular activities; next year I am going to finish the drawing and attend a competition; the size of the drawing matters; I enjoy IT technologies, computers (does not have any); I exercise and climb trees (never attempted to climb one), likes owls because they have beautiful big eyes; painting; likes to play football, but is better at ice hockey (never played it); likes to go out, get a soda, go swimming, but not with kids from foster care… Jumping, badminton, third place

Home preparation for classes is a group thing. As a daily program, children have classes when they study, during which the employees have their chores connected with the run of "household." Since the groups are heterogeneous by age, both first-years and high schoolers share the place and time for homework—disregarding whether the child is focused, motivated and whether the child understands the covered topic. It seems that children lack motivation the most. One can say that low school achievements and low social background practically push children into special groups of "outsiders" at school, which only strengthens the already bad social status and children circle in the identity of "fosters." Similar findings are presented by Milan Fico from the "Institute for Research of Labour and Family" [34], who in his extensive research from 2017 talks about "rare instances of supporting a child in

boy who was led to the activity by the professional foster parent (shooting sports)

Through the communication with children we have noticed very weak vocabulary of our participants. This is strongly constricted by a "lexicon" of foster surrounding and TV program. Children have problems to orient in time. A study of the "time perception" of children at foster homes would be considerable, because a child during the interview had his own "time anchors" which we as researchers did not understand much. Despite the fact that children reach the age of professional decision-making (14–15), no one works with them systematically on building their professional career. Children automatically accept the "traditions" of the foster

**104**

**Table 1.**

meeting his or her individual needs."

*Children and the development of cognitive skills.*

*Children and the development of cognitive skills-time.*

home and attend the same high school as the foster children before them, not thinking about the major of the given high school not being in their point of interest. The foster home functions, in a way, as a sub-supplier of children for regional high schools. Similar findings are presented in the research on the life perspectives of young adults after the end of their stay in the foster care, authored by Juhásová [35]. The group approach is visible in the interests and hobbies of the child. If some child even shows interest in something outside of supported foster home activities, the child has no chance to develop his interest further. The reason for absence of an individual approach is the lack of employments, weak ability and missing tradition to organize volunteers, who would have time to spend with children individually, as well as deficit of financial means to pay the quality hobby groups.

#### **5.2 Capability 5**

Emotions are the ability to create bonds with things and people, to love and to be loved, the possibility of experiencing anger, love and other emotions and capabilities in a safe environment **Tables 3** and **4**.

#### **5.3 Capability 6**

Relationships are the opportunity to live with others, to participate in social interactions, ability to empathize, self-esteem and respect of others, protection against discrimination, mutual recognition (**Table 5**).

The second category of the research results consists of relationships and emotionality of children. Children come to the foster home usually on the basis of an incident in the family, where the trigger is usually the process of taking the child away from the family. Thus, usually all the children living in the particular family enter the foster home at the same time. These children have common family history, therefore having sibling identity as well. If nothing changes in the way of life of parents, the incident repeats itself again after several years, now with different, younger children in the family. These children enter the foster home and meet their siblings living in the foster home for years. The sibling relations of these two sub-categories are only biological. Moreover, older children have the feeling that the younger ones were "enjoying" their parents, while they were "stuck" in the foster home. Among the siblings is then strong, almost hateful relationship. If the parent switches partners too often, the connection of these siblings is only their


#### **Table 3.**

*Children and the emotional development—parents.*


#### **Table 4.**

*Children and the emotional development—others.*

biological mother, who is not constituted to connect the children. This is probably an occurrence of disorganized relationship attachment [36]. Mentally or physically weaker siblings form a coalition in the foster home against the stronger sibling and

**107**

**Table 5.**

*Children, their relationships.*

negative connotation they support it.

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

Codes Camp love; good director—but she split me and brother up as a punishment, she sent him

Categories Children's home management is perceived by the children as someone who fatalistically decides their fate (to what school they go, how the siblings are split)

Concepts In some ways, the worker who has been with the children the longest is very important

joy; children sensitively register the night staff;

surrounding environment are from foster care

a "partial parenthood"

foster care

to a different city; I do not like my sister because I have not been with her since when I was small; she can punish us, because she likes to; I have a best friend in blue shirt (does not know his name); he likes miss Silvia, the other one likes miss X; sisters are getting on his nerves; professional parent was beating him until he peed himself; then he was beating X and he died; he does not like Maja because of her crossed eyes; he was saying that X was bad (professional foster parent), but no one was listening to; they had to leave his foster family because one of the brother was always hitting people; he hates him now… they packed us up and we had to go… their money disappear; then it was found but they did not take us back…she brought us out things but never came back after that (professional foster mother)… we hid ourselves in the car boot so they cannot take us; if it was not for Mateo they would take us back…; the foster mother hit us sometimes; day and night carers alternate in the children's care home; we always know who has the night shift; the miss that was here when I came has now left… she was here the longest; at school, at summer camp and also outside there are always just kids from foster care.

Children who are in a children's care home since their birth do not have strong bonds to either friends or staff; professional foster parents are perceived as those who require order and discipline and children have learned a lot of activities with them, which they mention with

They do not understand the context of why they left their families; all kids in the child's

An important role is played by "night workers"—the children perceive them as those who are not employed in the care home as you do not sleep at your place of work. They attribute them

Children liked it at professional foster families', but they had a regime, discipline and duties. Although these were limiting them in some ways, they would still prefer to stay there. The children then come to the social environment as an isolated community of children from

fight him actively. The policy of the state, however, states that siblings have to be together. Even in a case of a family with numerous children who do not have any emotional relations among themselves. As it happens, one of the siblings might not be with his behavior accepted by professional or foster family and therefore, has to leave the family. But with him go all the other siblings. The hatred of others towards him only grows on strength. As early as 2010, Bowlby pointed out that there is a higher probability of an unstable emotional connection in children with experience of pathological circumstances in the family and then with the residential environment. This results in different forms of social learning, weaker adoption of family patterns and social skills [37–40]. The antagonism in sibling relationships is supported by the biological parents, grandparents, other relatives, who when visiting, take only one or two children for a walk, because they could not manage more. The frequency of visits is so small, that parents forget which child they took for a walk last time, and end up always taking the child with the least problematic behavior, which only encourages the reciprocal jealousy. When talking to children, an interesting phenomenon has popped up—children "stamp" themselves as well as their siblings. Almost fatalistically they accept that "he takes the bad behavior after mum." Even despite the fact that they have no common family history, that they cannot possible remember what their mother was like. The children accept this sad inheritance in spite of not being able to consider its truthfulness and despite the

Children were not living a harmonious life in their families and since their birth were usually put through many emotional stress situations. The strongest one was

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*


#### **Table 5.**

*Family Therapy - New Intervention Programs and Researches*

they do not have a mobile phone…

other way around;

other

home;

towards them

*Children and the emotional development—parents.*

Categories There is a more regular and intense contact with one parent;

Codes Visits father every day—he has 16 children—he lives with one of them; they know their

parents but they hate them; parents tortured him; his life is great without the parents; father would not take me because he cannot afford to pay for my schooling and foster care will provide education for me; hates his mother; likes her mother; mother has a boyfriend; they are expecting a new child together; father is in prison; parents do short visits of their children in foster care; they always take the kids for walks one by one; children are jealous of each other; regressive desires to be cuddled up in one's arms; parents always promise and children blindly believe; parents treat children differently and take each of them home for different periods of time; brother lives in a different children care home; grandmother used to visit, she died, now no one visits; grandmother visits with grandfather, and auntie too; they cannot go to their parents', they live somewhere else now, they do not have money, they have other kids,

the other parent is ignored, perceived as the weaker one, there are tendencies to always find excuses for them; children get constant disappointments from their parents' promises; if they are less in contact with the mother, they despise her more than they would the father if it was the

in case of family violence, there is a categorical rejection of any connection the parents;

if children have an occasional contact with one of the parents, they have regressive desires

parents take siblings home, or for walks, individually one by one making children jealous of each

grandparents and other relatives create emotional backing for the children;

Concepts Children without a contact with their parents are appreciative of their life in the children's care

**106**

**Table 4.**

**Table 3.**

biological mother, who is not constituted to connect the children. This is probably an occurrence of disorganized relationship attachment [36]. Mentally or physically weaker siblings form a coalition in the foster home against the stronger sibling and

Codes Telephone contact with godmother, with uncle; siblings usually stick together in pairs if they got

Categories Siblings divide themselves into real- and step-siblings; children pair up in sibling coalitions

no one is then helping the children to process heavily traumatic events

Concepts As if the children did not have a potential to be close to more than one sibling

common crisis history that leads to a stronger mutual bond

families, and thus they are creating incorrect cognitive schemes

worker, but they are often alone;

two with

*Children and the emotional development—others.*

to the foster home together; as if they did not have a capacity for more than a coalition of two; outside of the coalition if they are step-siblings, but they were problematic together, which is why they had to leave the family; she likes her sister because they play together; brother beats them; they do not know where are the other siblings, but they do not care; they know the names of specific employees of the children's care home when they like them; when I am said I go to my sister, brother (from the coalition of two), miss (care worker), I hide in my bed alone and I cry; Mum's boyfriend stabbed her with a knife, and brother as well… I was afraid; they took us away

of two and are actively aggressive towards third, and other; the child outside this coalition is perceived as problematic, the one who is responsible for their punishment; at a time of emotional crisis, children seek closeness of the sibling from their coalition, occasionally a care

The strongest coalitions form with children who came to foster care together—they have a

The sibling who is "outside" this coalition is actively and passionately hurting the coalition of

No one is helping the children to process the traumatic events witnessed and experienced by them (the murder of smaller brother, attempted murder of mother and older brother) Children do not know the reasons why they had to leave their own families, or even foster

*Children, their relationships.*

fight him actively. The policy of the state, however, states that siblings have to be together. Even in a case of a family with numerous children who do not have any emotional relations among themselves. As it happens, one of the siblings might not be with his behavior accepted by professional or foster family and therefore, has to leave the family. But with him go all the other siblings. The hatred of others towards him only grows on strength. As early as 2010, Bowlby pointed out that there is a higher probability of an unstable emotional connection in children with experience of pathological circumstances in the family and then with the residential environment. This results in different forms of social learning, weaker adoption of family patterns and social skills [37–40]. The antagonism in sibling relationships is supported by the biological parents, grandparents, other relatives, who when visiting, take only one or two children for a walk, because they could not manage more. The frequency of visits is so small, that parents forget which child they took for a walk last time, and end up always taking the child with the least problematic behavior, which only encourages the reciprocal jealousy. When talking to children, an interesting phenomenon has popped up—children "stamp" themselves as well as their siblings. Almost fatalistically they accept that "he takes the bad behavior after mum." Even despite the fact that they have no common family history, that they cannot possible remember what their mother was like. The children accept this sad inheritance in spite of not being able to consider its truthfulness and despite the negative connotation they support it.

Children were not living a harmonious life in their families and since their birth were usually put through many emotional stress situations. The strongest one was

for most of them the act of being taken away from the family. Some children went through it many times in their short lives. Children do not know the official reason for being taken away from the family, for which they were put into that particular foster home, or professional family. So they think by themselves, or they take over the arguments from older sibling, roommate or an angry employee. They carry the stigma of the "one who made problems their whole life."

Children, who did not grow up in a family but have been "institutionalized" since birth, create only very vague relationships. They do not even know the name of their best friend (that one in the red shirt), they do not know what they get from which employee, they live through the changes in roommates completely smoothly—as in a hospital, one leaves, and another comes. Exactly the aspect of "at the moment" situation is the most important in their living; children do not plan their life ahead.

The relationship with their biological or foster parents is built mostly on how the child leaves the family. Children have the tendency to apologize the parents from the failure to raise children. They are constantly being let down by false promises of their parents about being taken home, buying them a new phone, taking them shopping or to a restaurant and so on. It functions on the same mechanism as an addiction. The cycle of hope alternates with feelings of hopelessness.

When creating a model of hypothetical ideal home and in forming images of their own future, the children have completely refused their parents and erased them completely from their imaginary. If the child had not an easy time living with his family, he creates only quick and shallow human relationships which the child leaves with the same easiness. The child often changes persons on which he fixates and disengages with the smallest and the pettiest impulse [41–43].

Their parents do not believe in their own parental competencies and it would be the best for them to just visit their children right in the building of the foster home or they would take the children to a restaurant or playground that is the nearest to the foster home. The children like to flaunt others with the fact that somebody came to visit them, on the other side they miss the feeling of having their parents just for themselves. Parents, very childishly, promise attractive things. Both parents and their children in foster home know will never come true. Despite that, the disappointment and hope are two most frequented emotions the child feels towards his parents. The child knows that the parent is lying, but still he defends the parent from himself but mostly from others, and always believes to be consequently disappointed.

The great advantage for the child and the staff is if the children stay in contact with their biological family. These impulses from the side of relatives bring up false hope (maybe he will take me) which results in the disappointment of the child. On the other hand, it increases the confidence of the child and his "value" in the eyes of other children in the foster home that have no contact whatsoever with their relatives. The children can very categorically define their "non-love" towards parents, but would not say the reason for the world. The children who left their family for very dramatic reasons have built a basis for creating and keeping the relationships with other people. These children usually have a person at the foster home or in the close surroundings that they like, seek when they have problems or when they are sad: janitor, auntie in a home, Patrik. Even according to the author Roháček [44], traumas of children in foster care can also be induced by the alternation of educators, the existence of working time, etiquetation, and a lower emotional engagement.

The life in professional families is perceived by the foster children as good in principal, but they "had to" work a lot there. Only after further conversation we have realized that children in professional families usually did only what the

**109**

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

children living in functional biological families do. Only in confrontation with the regime approach of the foster home the children felt, like they have to work a lot. They appreciated, that they learnt some concrete skills in professional families and these they take as their own virtues. Leaving the professional family have not been consulted at all with them, therefore they make their own wrong cognitive schemes. The relationship of children towards things has several specifications as well. The children at foster home have shared stuff. That is common in biological families as well. But besides shared stuff has each member of the family their own personal stuff. Presents from sponsors are given to the children from foster home–ergo, to all of them. The only "other" thing the child can buy for himself either from his very humble pocket money or gets it from relatives. The pocket money is usually spent on sweets. If the parent or the grandparent manages to give something to the child for birthday or Christmas, the thing functions as an attraction, mainly for other children at the foster home. It should support character, privilege and uniqueness of the gifted. But with time children stop envying, because the thing becomes banal. The gift loses its value, so after a very short period of time it is damaged or thrown among other toys at the foster home. Because the children do now experience the ownership of things, they cannot build their "ownership" to people. It is even better to say that relationship building is very flat, shallow short-termed. The value of owned things is insignificant for the child with which is also connected the non/ living of the sense of responsibility for something. Useful things, such as pyjamas, undergarment, pens and pencil cases and other, are not chosen by smaller children, but are bought by the staff of the foster home together. Therefore, even the things for children look like "foster" and loose on individuality. Because the children only seldom participate actively on running the household of the foster home, they have no real idea that the rent and energies have to be paid. All of the children would like to live in a house when they grow up, because one must pay for a flat! The older children wait for being 15 years old so that they can find a part-time job and buy

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

whatever they want from the money they will earn.

Game is option to play, entertain and relax **Table 8**.

protect one's own work, as well as to own a property **Table 9**.

Practical thinking is option to create goodness, actively plan one's life, option to

Other living creatures are to have the option to relive the relationship with

In view of the results of the analysis, we have decided to include this capability, albeit in a slightly altered form. Very specific is the relationship of children to things

Control over one's own environment is to have the right to engage, associate and

For the children is somehow very important the fact how long a member of staff works at the foster home. Senior staff is preferred more, although that does

**5.4 Capability 7**

**5.5 Capability 8**

animals, plants **Table 7**.

that are not living.

**5.6 Capability 9**

**5.7 Capability 10**

realize one's own plans **Table 6**.

#### *Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*

children living in functional biological families do. Only in confrontation with the regime approach of the foster home the children felt, like they have to work a lot. They appreciated, that they learnt some concrete skills in professional families and these they take as their own virtues. Leaving the professional family have not been consulted at all with them, therefore they make their own wrong cognitive schemes.

The relationship of children towards things has several specifications as well. The children at foster home have shared stuff. That is common in biological families as well. But besides shared stuff has each member of the family their own personal stuff. Presents from sponsors are given to the children from foster home–ergo, to all of them. The only "other" thing the child can buy for himself either from his very humble pocket money or gets it from relatives. The pocket money is usually spent on sweets. If the parent or the grandparent manages to give something to the child for birthday or Christmas, the thing functions as an attraction, mainly for other children at the foster home. It should support character, privilege and uniqueness of the gifted. But with time children stop envying, because the thing becomes banal. The gift loses its value, so after a very short period of time it is damaged or thrown among other toys at the foster home. Because the children do now experience the ownership of things, they cannot build their "ownership" to people. It is even better to say that relationship building is very flat, shallow short-termed. The value of owned things is insignificant for the child with which is also connected the non/ living of the sense of responsibility for something. Useful things, such as pyjamas, undergarment, pens and pencil cases and other, are not chosen by smaller children, but are bought by the staff of the foster home together. Therefore, even the things for children look like "foster" and loose on individuality. Because the children only seldom participate actively on running the household of the foster home, they have no real idea that the rent and energies have to be paid. All of the children would like to live in a house when they grow up, because one must pay for a flat! The older children wait for being 15 years old so that they can find a part-time job and buy whatever they want from the money they will earn.

#### **5.4 Capability 7**

*Family Therapy - New Intervention Programs and Researches*

stigma of the "one who made problems their whole life."

their life ahead.

disappointed.

for most of them the act of being taken away from the family. Some children went through it many times in their short lives. Children do not know the official reason for being taken away from the family, for which they were put into that particular foster home, or professional family. So they think by themselves, or they take over the arguments from older sibling, roommate or an angry employee. They carry the

Children, who did not grow up in a family but have been "institutionalized" since birth, create only very vague relationships. They do not even know the name of their best friend (that one in the red shirt), they do not know what they get from which employee, they live through the changes in roommates completely smoothly—as in a hospital, one leaves, and another comes. Exactly the aspect of "at the moment" situation is the most important in their living; children do not plan

The relationship with their biological or foster parents is built mostly on how the child leaves the family. Children have the tendency to apologize the parents from the failure to raise children. They are constantly being let down by false promises of their parents about being taken home, buying them a new phone, taking them shopping or to a restaurant and so on. It functions on the same mechanism as an

When creating a model of hypothetical ideal home and in forming images of their own future, the children have completely refused their parents and erased them completely from their imaginary. If the child had not an easy time living with his family, he creates only quick and shallow human relationships which the child leaves with the same easiness. The child often changes persons on which he fixates

Their parents do not believe in their own parental competencies and it would be the best for them to just visit their children right in the building of the foster home or they would take the children to a restaurant or playground that is the nearest to the foster home. The children like to flaunt others with the fact that somebody came to visit them, on the other side they miss the feeling of having their parents just for themselves. Parents, very childishly, promise attractive things. Both parents and their children in foster home know will never come true. Despite that, the disappointment and hope are two most frequented emotions the child feels towards his parents. The child knows that the parent is lying, but still he defends the parent from himself but mostly from others, and always believes to be consequently

The great advantage for the child and the staff is if the children stay in contact with their biological family. These impulses from the side of relatives bring up false hope (maybe he will take me) which results in the disappointment of the child. On the other hand, it increases the confidence of the child and his "value" in the eyes of other children in the foster home that have no contact whatsoever with their relatives. The children can very categorically define their "non-love" towards parents, but would not say the reason for the world. The children who left their family for very dramatic reasons have built a basis for creating and keeping the relationships with other people. These children usually have a person at the foster home or in the close surroundings that they like, seek when they have problems or when they are sad: janitor, auntie in a home, Patrik. Even according to the author Roháček [44], traumas of children in foster care can also be induced by the alternation of educators, the existence of working time, etiquetation, and a lower emotional

The life in professional families is perceived by the foster children as good in principal, but they "had to" work a lot there. Only after further conversation we have realized that children in professional families usually did only what the

addiction. The cycle of hope alternates with feelings of hopelessness.

and disengages with the smallest and the pettiest impulse [41–43].

**108**

engagement.

Practical thinking is option to create goodness, actively plan one's life, option to realize one's own plans **Table 6**.

#### **5.5 Capability 8**

Other living creatures are to have the option to relive the relationship with animals, plants **Table 7**.

In view of the results of the analysis, we have decided to include this capability, albeit in a slightly altered form. Very specific is the relationship of children to things that are not living.

#### **5.6 Capability 9**

Game is option to play, entertain and relax **Table 8**.

#### **5.7 Capability 10**

Control over one's own environment is to have the right to engage, associate and protect one's own work, as well as to own a property **Table 9**.

For the children is somehow very important the fact how long a member of staff works at the foster home. Senior staff is preferred more, although that does


#### **Table 6.**

*Ideas and plans for the future.*


#### **Table 7.**

*Relationship to material things.*

not mean he is liked more. Maybe, there is a certain form of assurance in it. An important person for the children is the night worker, even though same six workers switch regularly. In a way it can mean for the children that when the staff comes during the day, they are employees at a job (everyone works during the day), but the night shift means they are "coming home."

The children do cleaning chores without objections, but in food preparation they participate only little and sporadically. They perceive it more as an opportunity to have a worker besides only for themselves during cooking. From aunties and nursemaids the children receive some instructions to fulfill their duties, but at the same time they know that these would not check properly upon them, therefore the children do not take them seriously. However, this results also in social habits not being

**111**

**Table 9.**

*Life in a children's care home.*

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

Codes They will be with their sister during the holidays (she is in a boarding school)—only the two

Categories Children spend the summer at camps; over the year they run around children's care home

Codes In the children's care home no one is restricting me; if it's our turn we clean up; we do not

Categories The children will obey the scheduled shifts for cleaning and serving planned meals according

Concepts The children fatally accept the regime of the social institution and they do not actively fight

to the weekly menu; they would like to get more money to buy more sweets—however they do not complain about the system for allowances; they do not like to noise made by other children in the home, sometimes even the regime, but they cannot really imagine a different

it. In an increase of their financial income they see a promise of freedom—mainly in how much they can buy from it. They are unable to make use of a freedom in experience, as once

"foster" kids around; they do not want to go to their parents'; Christmas has the importance of free time and fairy tales watching Concepts During the school year children spend their free time running around the children's care

of us here in care; they will go to a summer camp; the children's care home will be locked and all of us go to a summer camp—everyone from care; they do not want to go home to their parents; from one summer camp to another one; up to three different camps during one summer holiday; mostly there are just kids from foster care; I look forward to the pool and water at summer camp; he goes with the brothers that he does not like; she and her sister play as doctors and the other one wants to play as well, she is ruining the game for them; Christmas is a holiday when school is off and there are fairy tales in television; after school they are running around on the children's home's yard; if the bike is not broken, they ride it; they play football; the nice night shift miss lets them go on computer; they watch football on

and the yard there; they do not attend any after school activities; everywhere there are just

home and its yard without a proper focus or a goal. The staff take holidays during the summer, the children's care home is being renovated and in the meantime the children are sent to summer camps. They again spend the time in the closed communities of children from

cook; we do not do the shopping; I can do laundry; there is a miss here who has been with me since I was little; we have freedom—I can go, but I have to tell; I am not being hungry; I can ask for stuff and they give me; I get some allowance but I spend it straightaway; we usually study in the canteen at a table; the menu us at the office with the social worker; dirty clothes go to the bathroom; torn clothes go to the miss; he spends his allowance on soda and sweets and then it's gone!; it is always so loud in the children's home, a lot of shouting, a lot of children; things for hygiene are bought by the misses; at the social worker's office there are locked photos, birth certificates—they allow me there if I want; I always know which night staff is on shift; one cannot eat what one wants—they always make a menu for a whole week; the regime here is terrible; I would not change anything here; I would like to have freedom

confirmed in their behavior. Dixon and Stein [45], Stein [46, 47] also suggest that the probability of homelessness in children from foster care is rising by the absence of practical skills in obtaining housing, by the presence of debts, or by inadequate relationships with the roommates. Lukšík et al. [48], also Lukšík and Lukšíková [49] emphasizes the importance of stability and continuity of the system as a basic tool in preventing homelessness of young people from foster care. An interesting fact is that the children to not perceive negatively having always to accommodate to new. They are only disturbed by a great amount of screaming children and "it gets on their nerves." The life in the foster home seems like too organized, therefore

the regime relaxes a little, they instantly get bored

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

it and play games

foster care

way of life

*Entertainment, play, and free time in the children's care home.*

**Table 8.**

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*


#### **Table 8.**

*Family Therapy - New Intervention Programs and Researches*

Codes He got a bike from his auntie, it is only his and no one else can take it—he does not know

Codes Have a normal family; not seven children; have a peaceful life; family home—no need to pay

brothers; she wants to have three kids but with only one man

Categories The image of the ideal home certainly does not include the birth parents or a lot of children;

Concepts Children fatalistically accept their life and professional career—someone more powerful

the rent; silence; few children; I teach them to do something; have dogs; certainly not to my mother; to live with my mother and sister, but not with my brothers; he does not know what will be after he leaves the children's home; wants to stay in the city, close to the children's home; wants to keep dogs and owls; does not want any children; wants to be a painter; she wants to be a baker—her sister too (not really); he would like to be a chef on a ship and make a lot of money (in fact, he does not even cook and he does not like it); wants to be a cop; she does not know what she's going to do—she's talking to a psychologist; wants to go to the capital—there's a lot of chances for life; he does not want a family; he will return to his children's home to see his friends (he does not understand passing of time); to see his small

the profession of a chef is popular among the children, because this school is attended by many foster care children and you can make good money on a ship; if they say that they cook in the children's care home, it is only because they can be alone with "the miss" in the kitchen and they have her all for themselves in that moment; living in a family home, because they consider this being without costs; they will be returning to the children's care home (time factor)

(children's care home management) has already planned it for them and they are able to

The concepts of one's own family relate to none or maybe 1–2 children with a stable partner

Categories Children get things from the people they care about; for a while, these gifts make them feel

short-term pleasures; they are not aware of the running costs of a home Concepts Children do not bond with things just as they do not bond with people. They are unable to define their own "self" against other children, not even through material things

not mean he is liked more. Maybe, there is a certain form of assurance in it. An important person for the children is the night worker, even though same six workers switch regularly. In a way it can mean for the children that when the staff comes during the day, they are employees at a job (everyone works during the day), but the

The children do cleaning chores without objections, but in food preparation they participate only little and sporadically. They perceive it more as an opportunity to have a worker besides only for themselves during cooking. From aunties and nursemaids the children receive some instructions to fulfill their duties, but at the same time they know that these would not check properly upon them, therefore the children do not take them seriously. However, this results also in social habits not being

gets broken a new one will be bought

accept it without questioning it

living in a quiet and peaceful family home

where it is now; she got a doll from her mum (loves her), she took its head off and then legs; there are still other dolls in the children's home; I share a wardrobe with my sister; she does not have anything that is just hers; everything is ours; she does not want anything that's only hers—what for?; mum has promised to buy them a mobile phone; she will be calling a baby to Austria with it; the godfather is nice, he bought a pistol for him, but he threw it away; if a roof is broken in a family house, a repairman comes and he does it for free because he is a repairman; they would like some money for soda; she got a microphone for Christmas, but she does not know where it is anymore; her mother has bought her pyjamas, she only has one pair, but there are a lot of others in the drawer and so she will take a different one; if the bike

special, but then they do not matter at all; money is of great value to them, because they bring

**110**

**Table 7.**

**Table 6.**

*Ideas and plans for the future.*

*Relationship to material things.*

night shift means they are "coming home."

*Entertainment, play, and free time in the children's care home.*


#### **Table 9.**

*Life in a children's care home.*

confirmed in their behavior. Dixon and Stein [45], Stein [46, 47] also suggest that the probability of homelessness in children from foster care is rising by the absence of practical skills in obtaining housing, by the presence of debts, or by inadequate relationships with the roommates. Lukšík et al. [48], also Lukšík and Lukšíková [49] emphasizes the importance of stability and continuity of the system as a basic tool in preventing homelessness of young people from foster care. An interesting fact is that the children to not perceive negatively having always to accommodate to new. They are only disturbed by a great amount of screaming children and "it gets on their nerves." The life in the foster home seems like too organized, therefore restricting. They cannot use an occasional freedom (freer regime during holidays) to their own advantage and usually they become bored. The foster home is perceived as one big small world. The same people live in it. The same people are at home, at school, those same attend summer camp, and those same children play outside on the playground. They "rely" only on themselves.

In the hypothetical model of an ideal picture of their own home the children cannot or will not imagine their own parents. A normal home, according to their imagination, looks like this: in a family house (for which one does not have to pay) lives a family with one, two children max. In no case they would let their biological parents "inside" this ideal world not even when they idealize their parents on the outside.

All want to leave the foster home once and live somewhere else. The answer for the question where would they return from the world is the foster home. But they wish to find only friends there, ignoring the time shift. After our objection, that those same friends will grow up and leave, they say they would then return back to their siblings.

Identity has been the last category that is more or less connected with all the basic capabilities. The most problematic seems to be the absence of an individual approach towards children, living in the foster home. We have noticed a weak ability of self-reflection up to non-criticism towards real abilities, which can probably be the result of defenses. The children are non-critical towards their real abilities even when they did not try out the stated activity. With the reaction from the surroundings outside of the foster home they go into defense, because in reality they are usually the aim of attack or laugh for their social background. They are not lead to, and no one guides them, to learn how to endure confrontation, to accept it as a challenge for their further growth and not as another proof of their failure. All this leads to a strange type of behavior, to which children from the "normal" population do not know how to react properly, thus the "fosters" get back to isolation. Fico and his research team has found [34], that in the area of social identity, a child can be labeled a "foster child" or "state child," which then can act as a barrier while searching for housing, or prospective employment. Their personal stuff are locked in a locker of a social worker, because they would lose them. Their personal identity takes on the identity of the room where they live in.

Most of the children is not able to anchor in firmer relationships. Younger children presented their regressive desires. The living through unprocessed sadness is cured by anger and aggression.

The children do not build their own career, they only passively accept their fate and when they reach the adulthood, they lose the restricted assurances and cannot lead their own life. In a better case, one enters the foster home midway (prolongation of the problem) or ends up on the streets.

#### **6. Conclusions**

The aim of this chapter was to describe the research findings about the life of children living in the foster home of the so-called family type, considering the phenomenon of capability. We have stemmed from the theoretical concept of Martha Nussbaum and her 10 capabilities, out of which we have followed only five. The challenge for us was to search for the capability at the foster home of family type and we wanted to see how can this state institution ensure such a life for the children they would want and could live?

We dare to make some references at the end. However, we are not entirely sure that we form these references again only from the point of view of adults who know the best what is good for the children.

**113**

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

Child must experience at least for a while functioning in a family. Otherwise, the child knows nothing about sharing tasks, roles, and does not experience the feeling of responsibility—for himself, for things, animals or people. Only then the child is able to form lasting relationships. If the child must leave the family, someone must talk with him about it, analyze his part in this act and help him understand it. Teach the children to decide systematically and take responsibility for decisions. The absence of responsibility is a phenomenon they acquire from

The child cannot live in two residencies at the same time. This way overrides the adaptive skills of any one the siblings, who for various reasons do not feel their family affiliation, cannot be force to relive it, so that feelings of guilt and anger towards sibling will not stem from it. Family identity should get a chance, but not a forced

The share of the children on household chores should be higher, in a case the staff is occupied, the volunteers should be brought in. First and foremost, with the imitation of others they would learn about "household," about spending free time. Their abilities to live their own life are developed this way and the children would not fall into hopelessness of not being able to live without organizing their life by

The child should get, considering his options and skills, an individual care, so that the personal identity of an individual is developed instead of the identity of the "foster." We should build child's personality more and support a positive confidence and self-evaluation and teach the child self-reflection, so that he does not become a

Help parents and profit parents, and other relatives, to handle visits of children, written contacts with children and short visits in a way that does not scare them and they would not end the contact with children from the fear of offices returning their

It would be interesting to research the perception of time dimension, as well as

Our chapter has been called mirage. The image, that a very tired person sees somewhere in the distance and one just needs to take one step and all will be fine. Such a mirage is a family for the children living in the foster homes of family type.

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this chapter. This chapter was created with the support of the Grant of Slovak Research and Development Agency APVV N. 16-0205 titled Identification of mechanisms for early diagnosis CAN

The author of this chapter declared no potential conflicts of interest with respect

children back into their care and them not handling it that well again.

the ability of self-reflection in children living in a residential care.

to the research, authorship, and/or publication of this chapter.

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

one, because one can repair only what truly exists.

the foster home or other social "greenhouse."

laughing stock outsider of the society.

An image, that vanishes into thin air.

**Acknowledgements**

**Conflict of interest**

syndrome.

their biological family.

#### *Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family DOI: http://dx.doi.org/10.5772/intechopen.85662*

*Family Therapy - New Intervention Programs and Researches*

outside on the playground. They "rely" only on themselves.

takes on the identity of the room where they live in.

tion of the problem) or ends up on the streets.

children they would want and could live?

the best what is good for the children.

is cured by anger and aggression.

**6. Conclusions**

restricting. They cannot use an occasional freedom (freer regime during holidays) to their own advantage and usually they become bored. The foster home is perceived as one big small world. The same people live in it. The same people are at home, at school, those same attend summer camp, and those same children play

In the hypothetical model of an ideal picture of their own home the children cannot or will not imagine their own parents. A normal home, according to their imagination, looks like this: in a family house (for which one does not have to pay) lives a family with one, two children max. In no case they would let their biological parents "inside" this ideal world not even when they idealize their parents on the outside. All want to leave the foster home once and live somewhere else. The answer for the question where would they return from the world is the foster home. But they wish to find only friends there, ignoring the time shift. After our objection, that those same friends will grow up and leave, they say they would then return back to

Identity has been the last category that is more or less connected with all the basic capabilities. The most problematic seems to be the absence of an individual approach towards children, living in the foster home. We have noticed a weak ability of self-reflection up to non-criticism towards real abilities, which can probably be the result of defenses. The children are non-critical towards their real abilities even when they did not try out the stated activity. With the reaction from the surroundings outside of the foster home they go into defense, because in reality they are usually the aim of attack or laugh for their social background. They are not lead to, and no one guides them, to learn how to endure confrontation, to accept it as a challenge for their further growth and not as another proof of their failure. All this leads to a strange type of behavior, to which children from the "normal" population do not know how to react properly, thus the "fosters" get back to isolation. Fico and his research team has found [34], that in the area of social identity, a child can be labeled a "foster child" or "state child," which then can act as a barrier while searching for housing, or prospective employment. Their personal stuff are locked in a locker of a social worker, because they would lose them. Their personal identity

Most of the children is not able to anchor in firmer relationships. Younger children presented their regressive desires. The living through unprocessed sadness

The children do not build their own career, they only passively accept their fate and when they reach the adulthood, they lose the restricted assurances and cannot lead their own life. In a better case, one enters the foster home midway (prolonga-

The aim of this chapter was to describe the research findings about the life of children living in the foster home of the so-called family type, considering the phenomenon of capability. We have stemmed from the theoretical concept of Martha Nussbaum and her 10 capabilities, out of which we have followed only five. The challenge for us was to search for the capability at the foster home of family type and we wanted to see how can this state institution ensure such a life for the

We dare to make some references at the end. However, we are not entirely sure that we form these references again only from the point of view of adults who know

**112**

their siblings.

Child must experience at least for a while functioning in a family. Otherwise, the child knows nothing about sharing tasks, roles, and does not experience the feeling of responsibility—for himself, for things, animals or people. Only then the child is able to form lasting relationships. If the child must leave the family, someone must talk with him about it, analyze his part in this act and help him understand it. Teach the children to decide systematically and take responsibility for decisions. The absence of responsibility is a phenomenon they acquire from their biological family.

The child cannot live in two residencies at the same time. This way overrides the adaptive skills of any one the siblings, who for various reasons do not feel their family affiliation, cannot be force to relive it, so that feelings of guilt and anger towards sibling will not stem from it. Family identity should get a chance, but not a forced one, because one can repair only what truly exists.

The share of the children on household chores should be higher, in a case the staff is occupied, the volunteers should be brought in. First and foremost, with the imitation of others they would learn about "household," about spending free time. Their abilities to live their own life are developed this way and the children would not fall into hopelessness of not being able to live without organizing their life by the foster home or other social "greenhouse."

The child should get, considering his options and skills, an individual care, so that the personal identity of an individual is developed instead of the identity of the "foster." We should build child's personality more and support a positive confidence and self-evaluation and teach the child self-reflection, so that he does not become a laughing stock outsider of the society.

Help parents and profit parents, and other relatives, to handle visits of children, written contacts with children and short visits in a way that does not scare them and they would not end the contact with children from the fear of offices returning their children back into their care and them not handling it that well again.

It would be interesting to research the perception of time dimension, as well as the ability of self-reflection in children living in a residential care.

Our chapter has been called mirage. The image, that a very tired person sees somewhere in the distance and one just needs to take one step and all will be fine. Such a mirage is a family for the children living in the foster homes of family type. An image, that vanishes into thin air.

#### **Acknowledgements**

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this chapter. This chapter was created with the support of the Grant of Slovak Research and Development Agency APVV N. 16-0205 titled Identification of mechanisms for early diagnosis CAN syndrome.

#### **Conflict of interest**

The author of this chapter declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this chapter.

*Family Therapy - New Intervention Programs and Researches* 

### **Author details**

Eva Mydlíková Trnava University, Trnava, Slovakia

\*Address all correspondence to: eva.mydlikova@truni.sk

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**115**

*Mirage: Possibilities and Limitations of Experiencing Foster Home as a Family*

revisited. The Scientific World Journal. 2003;**3**:1050-1057. DOI: 10.1100/

developmental perspective. American Journal of Economics and Sociology. 2006;**45**(3):329-342. DOI: 10.1111/

[10] Sirgy MJ. A quality-of-life theory derived from Maslow's

j.1536-7150.1986.tb02394.x

December 2018]

[11] Ben-Arieh A. Measuring and monitoring the well-being of young children around the world. Paper commissioned for the EFA Global Monitoring Report 2007, strong foundations: Early childhood care and education [Internet]. 2007. Available from: https://unesdoc.unesco.org/ ark:/48223/pf0000147444 [Accessed: 10

[12] Ben-Arieh A. From child welfare to children well-being: The child indicators perspective. In: Kamerman SB, Phipps S, Ben-Arieh A, editors. From Child Welfare to Child Well-Being. An

International Perspective on Knowledge

Andrews AB, George RM, Lee B, Aber LJ. Measuring and Monitoring children's Well-Being. Berlin: Springer Science & Business Media; 2013. p. 153. DOI:

[14] O'Hara M, Lyon A. Well-being and well-becoming: Reauthorizing the subject in incoherent times. In: Hämäläinen TH, Michaelson J, editors. Well-Being and beyond: Broadening the Public and Policy Discourse. Camberley Surrey: Edward Elgar Publishing; 2014. pp. 98-122

[15] Navrátilová J. Využití capability přístupu při posouzení dětského wellbeingu. Czech and Slovak Social Work/ Sociální Práce/Sociálna Práca. 2018;**5**:65-77

in the Service of Policy Making. London: Springer; 2010. pp. 9-22. DOI:

10.1007/978-90-481-3377-2

10.1007/978-94-017-2229-2

[13] Ben-Arieh A, Kaufma NH,

tsw.2003.84

*DOI: http://dx.doi.org/10.5772/intechopen.85662*

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[Accessed: 10 December 2018]

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[4] Ben-Arieh A. Beyond welfare: Measuring and monitoring the state of children—New trends and domains. Social Indicators Research. 2000;**52**(3):235-257

[5] Biggeri M, Santi M. The missing dimensions of children's well-being and well-becoming in education systems: Capabilities and philosophy for children. Journal of Human Development and Capabilities. 2012;**13**(3):373-395. DOI:

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[6] Beck U. Riziková společnost. Praha:

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[8] Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. The Scientific World Journal. 2003;**3**:1030- 1040. DOI: 10.1100/tsw.2003.82

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**114**

**Author details**

Eva Mydlíková

provided the original work is properly cited.

\*Address all correspondence to: eva.mydlikova@truni.sk

Trnava University, Trnava, Slovakia

*Family Therapy - New Intervention Programs and Researches* 

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

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Section 3

Specific Topics
