Holding children in mind or holding therapy: developing an ethical position

Attachment theory and therapy have established themselves as major constructs in foster care and adoption practice. The depth of the explanatory power of attachment theory and research have done much to both identify the source of developmental difficulties in adopted and fostered children, and of the significant changes that can be made when these children are placed with 'autonomously' classified carers. However, the power of the concept has also led to a proliferation of ideas, particularly therapeutic models that can, in some cases, stray a long way from the core of what is effective, safe and ethical clinical practice. Holding therapy is one of these models. The British Association for Adoption and Fostering developed a position statement on this practice, setting it within a broader framework of assessment and intervention. But like the model, the development of the position statement became controversial in its development. The article charts some of the critical issues and identifies the very significant dilemmas for parents and carers caught up in the maelstrom of challenging behaviours and disturbing feelings. The conclusion turns to one of the key components of an attachment-based idea: The critical importance of finding the space to think and to feel what the child is communicating without resorting to dangerous retaliation.