Lost In Care

15 years working in residential children's homes. 8 years training foster carers and care staff. Integrative child & adolescent counsellor. 14 years in care as a child. Diary, anecdotes and rants about the good, bad and mediocre. Anonymised but all true.

What is a therapeutic carer?

It is probably worth saying that I write this from the perspective of my background in residential children’s homes.  My knowledge of the experiences of foster carers and adopters is limited to some work as a freelance trainer for a few IFA’s.   That said, it is pretty obvious that many of the issues faced are the same.  And many of the attributes, skills and so on required for these roles will be similar.  It is definitely true that many of the  people I have met during my time in residential care and as a trainer did not have enough of these skills and attributes to undertake their roles successfully.

You will not find many children’s homes nowadays that do not market themselves as “therapeutic” (and presumably, by extension, this means the staff are therapeutically trained, right?).  Likewise, I notice the terms “therapeutic foster carer” and “therapeutic parent” are becoming common.

But what does therapeutic really mean? It’s a pretty broad church – covering everything from flower arranging to five times a week Freudian psychoanalysis.  So to be a therapeutic carer do I need to be a florist? Or have trained at The Tavistock for a thousand years and be an ACP accredited child psychotherapist?

Well, I kind of need to be a bit both.

I need thorough training and deep understanding of the impact of early years abuse and neglect.  I need to understand unconscious processes – both the child’s and my own.  I am very likely to be a wounded healer (drawn, consciously or otherwise, towards helping others as way of repairing myself) and this is fine, but my own wounds need to have healed sufficiently enough that I am not dripping blood into my relationship with the child.  This will take much more than a few hours on attachment theory here and a day of counselling skills there.

Perhaps I don’t need to be a florist but I do need to have interests, skills and knowledge so I can encourage the child’s own sense of curiosity and wonder (and, more pragmatically, keep them occupied).  And if they do want to learn flower arranging? Well then I need to be willing to learn it with them.  Even if I am rubbish at it.  Because they need to see it is OK to be vulnerable.

My understanding of why they are how they are will mean I have different expectations of them than I would have of ordinarily developed children, but I must not be permissive.  They need to know right from wrong and, in fact, boundaries, routine and structure will need to be tighter for them to feel safe.  Without containment – no therapy is possible.  I have to be constantly  thinking, on a minute-by-minute basis, about how to find my way through this paradox and the dilemmas it creates.

I have to manage this at the same time as tolerating sustained abuse and denigration – real attacks on my psyche.  I must be aware of my own, entirely legitimate, emotional responses to these attacks but without acting them out.  This way the child will see his or her most difficult and toxic parts can be contained.  But I  need to do this and somehow let the child know they have the capacity to hurt me.

I need to be able to do all of this, and much more, while still keeping on top of more prosaic tasks such as booking appointments, record keeping, report writing and cooking the dinner.

Children in care are damaged.  A lot of people don’t like me using that word – which is strange because if a child fell off his bike and broke his leg, no one would care if I said he had damaged his leg.  If you have an issue with this, well, feel free to check out the brain scans of a neglected three-year old. But it’s ok – the broken leg can heal.   Although,  if it has been badly damaged, perhaps it may play up a bit in cold weather or the kid will never run a marathon.

Because they are damaged, looked after children need looking after differently.  As I would look after a child with a broken leg differently – I would not try to make her walk.  A broken leg needs more than love – it needs a cast, it may need surgery, I might need to push the child around in a wheelchair for a while, then encourage her to walk on crutches and make sure she attends physiotherapy.  The cast will need removing and the level of support reduced.  These changes will have to happen at the right time or the leg might re-break and the damage could be permanent – it is a finely balanced business.  The child may be resistant to these changes – let’s be honest, there is probably something appealing about being pushed around in a wheelchair.

I am currently training to be an integrative child counsellor and then, hopefully, a child psychotherapist.  I will have had 18 months of training and, crucially, at least 18 months of personal therapy, before I am allowed to sit in a room with a child and work therapeutically with them – and still only as a trainee. I will have to have one hour of clinical supervision for each four hours I spend with a child.   And it is unlikely those first kids I see will be as traumatised as the young people I look after in residential care.

So it is odd, don’t you think, that someone could walk out of his or her job in, say, retail, answer a few not especially difficult interview questions and walk straight into working “therapeutically” for 40 hours per week in a “therapeutic” children’s home with the most damaged and vulnerable children in society.  An unskilled, entry-level, low paid job.



  1. Completely agree with you, but his type of work is not fully understood or, really, properly appreciated. We have the same conundrum in supported accommodation with homeless young ppl, some of whom are care leavers- but all of whom have suffered unpleasant if not traumatic childhoods yet no one really apprexiates what this means on a day to day basis & that translates into not really wanting to pay for the training and support of the staff so that those staff can properly support the young ppl. But nonetheless expectations are that the service can undo 16yrs in 6months to produce a non drug taking, untraumatised, qualified for a job, socially competent person.

    Sorry if that read like a rant! But yeah.

  2. Jack Brookes

    October 3, 2016 at 9:34 pm

    Rants are fine…it’s frustrating…

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