An exploratory study of pathological processes in latency care-experienced children. Implications for assessment and treatment

Looked After and Adopted Children (LAAC) who are seen in Child & Adolescent Mental Health (CAMHS) clinics by Child Psychotherapists can present in challenging and disturbing ways. This exploratory study examines the type of pathological processes in latency care-experienced children that are present at the early stage of contact with a Child Psychotherapist and how such processes impact on the lives of care-experienced latency children. An extensive literature review analysis identified gaps in child psychotherapy literature in relation to drawing theoretical and clinical links between the challenges of latency and the experience of care for children. The aim of this research was to explore the links between pathological processes, latency and the experience of care, from a psychoanalytic perspective and through the analysis of data using Grounded Theory. A systematic exploration of process notes obtained from a specialist assessment (State of Mind Assessment/SOMA) of four LAAC, corroborated psychoanalytic knowledge, observation and experience in this field but also generated new thinking. The analysis of the findings indicated that participating children were developmentally ‘stuck’ in unresolved conflicts of earlier developmental stages (pre-latency / early latency) facing unresolved oedipal conflicts, lack of ego strength and the impact of severe anxiety in relation to abandonment, separation and loss. For the research participants, the experience of care and early history of maltreatment, have increased the likelihood of chronic and complex use of manic defenses, sadomasochistic types of relating and excessive omnipotent control. Data analysis using Grounded Theory encouraged the development of four distinct ‘states of mind’ categories: Artificial Connection, Entropy, Antihero & Resignation. These underpin and maintain an unrealistic phantasy that dependency and love equate defeat and humiliation, whereas power and omnipotence lead to triumph and superiority. Pathological processes identified in this research point to the predominant and excessive use of omnipotence for the purposes of control and mastery over others and sadomasochistic relating as the main means of relating to others. These anti-developmental processes can become fixed and rigid solutions for LAAC. The key role of Child Psychotherapy as a necessary and valuable treatment pathway for LAAC presenting in CAMHS is highlighted. This research adds to the work of child psychotherapists by highlighting the value of paying homage to pathological processes and presentations as early as possible (assessment stage), so that treatment formulations can be tailored and more effective so that outcomes for latency LAAC could improve especially before coming into adolescence. Further research in this area could also expose links between latency, the experience of care and the development of childhood borderline features.