‘Something Else’ in Child Psychotherapy with Traumatised Adopted Children

There is a small cohort of traumatised adopted children whose fear of separation from parents, and fear of hostility and rejection from the therapist, prevent them from being able to make use of the therapist’s thoughts and words. Some children are in such heightened states of alarm and dissociation that they are unable to play. This personal account of clinical development recounts growing awareness of the extent to which some highly traumatised children’s mentalizing capacity in therapy is dependent on their neurophysiological regulation. Therapy with such children must therefore begin by attending to the alarmed body, triggered by the anticipation of what is termed ‘relational trauma’. Moving beyond psychoanalytic and attachment theory to draw on ethological studies, relational trauma behaviour can be understood as a symptom of humans in agonic mode; this is a group behaviour mode observed in higher primate troops when they are experiencing compromised resource acquisition and stress. Such troops organise themselves in relations of dominance and appeasement that are aggressively enforced and resemble disorganised attachment behaviours. Fear-infused relationships are designed to reduce uncertainty and increase intra-group predictability. Parent-child homeostasis therefore needs to be understood within its familial, historical, geo-political and socio-economic context. Helping traumatised families move from agonic to benign hedonic mode arguably requires the double task of reducing environmental stressors and transforming fear-fuelled hostile-helpless relations into those of mutuality, reciprocity and understanding. This paper argues that such support involves a form of social activism on the one hand, and recognition and acceptance that the subject of therapy is primarily the parent(s)-child dyad, on the other. Any effective therapy must address trauma triggers in all subjects. Finally, some novel ways of transforming hostile-helpless behaviours into safe nurturing reciprocal interactions are suggested, with clinical illustrations.