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Children referred for therapy from foster homes or residential settings typically have experienced multiple placements and losses of caretaking adults. These early disruptions lead to expectations of further discontinuity and impermanence. Placed children are especially vulnerable to severe pathology because of unresolved mourning and unfavorable life conditions preexistent to subsequent placements (Samuels, 1995, p. 309). Deficits in development, restriction of cognitive capacity, and underlying depression may lead to symptomatic behavior that interferes with attachment to new caretakers. Without psychodynamic psychotherapy, placed children rarely sustain more than superficial, conflictual relationships to the outside world.
A major thesis of this chapter is that effective psychotherapy needs to focus on the child's understanding of his/her past experiences, in order to give meaning to them and to build a sense of coherency within the framework of the child's developmental stage and cultural surround.
This approach is derived from narrative theory as formulated by Joseph Palombo (1992). He postulates that overwhelming experiences that have not been integrated into one's understanding of oneself prevent the establishment of a coherent sense of meaning. In this framework therapists “function as historians who have an understanding of human nature who are entrusted with the task of constructing a plausible coherent narrative of the patient's life” (p. 265). Palombo