Bringing a psychoanalytic treatment approach into a foster care agency: Challenges faced and gains made

Building Blocks (BB) is a psychoanalytically-informed mentalization-based dyadic approach addressing attachment deficits in birth parents and their children in the foster care system. Research shows that secure attachment depends on the caregiver's emotional availability and sensitivity to be a secure base for the child. Typically, different approaches are offered to improve parent behavior without focusing on building more securely attached relationships. In order to heal disrupted attachment between children in care and biological parents many didn't “know,” attention to unconscious processes and trauma was needed. I describe how BB came to be a preferred treatment by caseworkers and clinicians working in a foster care agency. Having articulated our relationship-based, non-didactic approach, and having funding for it, was not enough to bring this method into a system that focused on external behavior over internal processes. A larger systems approach was utilized including meeting with foster care personnel, providing training and supervision to clinicians, and getting parents to commit to the “new” dyadic therapy. Two cases are presented highlighting the impact that Nested Mentalization and Reflective Supervision had on the agency, the families, and its therapists and caseworkers. The BB Program has helped scores of families to better know each other, develop more secure attachments and interrupt the transmission of trauma.