Clinical material

Background

Carol is an 11-year-old girl of mixed British and Caribbean origin. She was adopted at age one, as her teenage mother, who had been in care herself and was a drug user, could not look after her. Carol was born prematurely and spent a few weeks in an incubator. During her first year, she was in foster care with attempts at rehabilitation with her birth mother. Mr and Mrs A. adopted Carol as their first child. Mr A. is originally from the Caribbean and Mrs A. is British. They present as a trendy, well-to-do couple who deal with the difficulties around their daughter by becoming the experts themselves. Carol has an adoptive sister, three years younger than her, whose adoption was described as extremely successful.

Carol was a complacent young child who showed no separation difficulties from her foster parents, but was found to have problems forming a good attachment to her adoptive parents. She was referred to the clinic by a post-adoption social worker at age seven. The parents reported that she could barely express loving feelings towards them and had an attitude of not caring much about them. She sometimes expressed emotions by enacting playing as a cat. Carol was wetting and soiling the bed, had sleeping difficulties, had no friendships in school, was aggressive towards her sister and was found to speak in often confused ways, in that the content of her speech was disorienting and disconnected. Worryingly, she frequently went up to strangers, showing no anxiety. Her parents had a tendency to downplay her difficulties as being a sign of an eccentric and interesting personality. Carol's sister on the other hand was described as a highly intelligent, sensitive girl who fitted into the family perfectly. Inevitably, there is a lot of rivalry between the siblings.

Before being referred for intensive therapy, a colleague saw Carol for two years of once-weekly therapy and the period of work ended because the therapist left the clinic. Carol herself asked to come b