As the children who are placed in foster care appear to be more troubled and vulnerable many services and commissioners begin to use the discourse of providing or requiring therapeutic placements. But what do we mean by this? Does offering a carer support group facilitated by a psychologist or direct therapy by a psychotherapist to some children make a service therapeutic?

For me providing a therapeutic service is to offer something which will allow children and young people over a period of time to experience real and lasting internal changes to the way they think, relate and feel. It is not chiefly about trying to manage or alter behaviours though this is a very useful and welcome side effect. It is about providing a complete social and relational environment in which a child’s emotional distress and way of being can be held, understood and processed. Where the adults who work with them see behaviour primarily as communication from the child or young person, about how they see the world and what it is they are struggling with and where carers can use their own thoughts and emotions to further understand and explore what might be going on for a particular child. Children will often be neurologically stressed and firstly need to feel safe and contained, they can be overwhelmed by complex thoughts and feelings which make little sense and they need help to understand these better and this all this needs to be provided within a relational context which takes account of culture, community and environment.

There are many models which can be useful in providing therapeutic care but it seems essential to consider neurological, attachment, psychotherapeutic and sociological perspectives. Whatever models are privileged children and young people require a high level of emotional containment, care and understanding but so do the carers who look after them so the therapeutic environment needs to extend from the child, to the carers and throughout the whole organisation.

Dr Jane Herd – Completed her Doctorate on Hard to Reach adolescents at the Tavistock and Portman and is the Founder of Orb8 which provides a range of services for hard to reach, traumatised and marginalised children and young people and the organisations, staff and carers who work with them or