Disenfranchised grief: the emotional impact experienced by foster carers on the cessation of a placement

Abstract

This study uses a qualitative approach to explore the experiences of 22 UK foster carers when a child is ‘moved on’ from a placement, focusing specifically on their experiences of loss. In most cases participants report loving the child as their own and describe their surprise at the profundity of their feelings of loss and grief when living through the child’s departure. These emotions can be fruitfully perceived as ‘disenfranchised grief’ in that its severity was unexpected and was not recognised as legitimate by the carers’ social group or professionals working with them. As a result, their loss was neither perceived as legitimate nor given a vehicle for expression. In some cases, participants report that the experience changed their approach to caring for children and even resulted in them ceasing to foster. The implications for practice include preparing foster carers to expect a grief response when their children move on, to recognise that this might be disenfranchised and to enhance peer and professional support during that process.

Keywords

Foster carers disenfranchised grief loss placement change

Introduction

This article presents findings from a qualitative study exploring the emotional impact experienced by foster carers in England when a placement comes to an end, focusing especially on their feelings of loss.

Fostering is the most common method of caring for looked after children in the UK. Yet Mullings (2010) highlighted a paradox within this provision whereby encouragement for carers to form deep relationships with their children sits alongside scant recognition that losing him or her can cause them considerable grief (Bick and Dozier, 2013; Dozier, et al., 2001; Dozier, et al., 2007).

Children move from foster carers for a variety of reasons such as return home, adoption, allegations, court orders, placement breakdowns or departmental decisions, and many of these moves can be abrupt. For instance, Boswell and Cudmore (2014) found that children who moved from foster care to adoption usually did so within seven to 14 days of meeting their new parents; afterwards they tended not to see their foster carer(s) again for at least three months or in some cases not at all.

Although a considerable body of research has charted the loss and grief following the ending of a foster placement, most of it focuses on the effects on the children rather than on their carers (Boswell and Cudmore, 2017; Fahlberg, 1994; Kalland and Sinkkonen, 2001; Williams, 2017). The aim of this study is to redress this imbalance and explore the impact on foster carers in the UK.

The theoretical framework adopted for the research incorporates the concept of ‘disenfranchised grief ’. This was not the a-priori framework for the investigation, but became evident from participants’ accounts and was subsequently found in some aspects of the supporting literature. Doka (1989: 4) defined this as ‘the grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported’. Grief is always experienced within a social or cultural context and the adjective ‘disenfranchised’ recognises that social and cultural communities may deny recognition, legitimation or the need for support regarding people’s feelings (Corr, 1998). Doka suggested that disenfranchisement can apply to many relationships, such as in divorce, elective abortion or bereavement. It is essentially a failure or unwillingness on the part of society to recognise that certain types of events do involve a real sense of loss.

There is a plethora of UK and international research on the emotional impact that foster carers may experience on the cessation of a placement. The UK studies contribute greatly to our understanding of these processes but tend to take a broad view rather than looking specifically at the emotional impact and feelings of loss (Farmer, Lipscombe and Moyers, 2005; Hendrix and Ford, 2003; Picken, Brunsden and Hill, 2011; Whenan, Oxlad and Lushington, 2009; Wilson, Sinclair and Gibbs, 2000). Moreover, much of this research uses quantitative methods that can hinder free expression and serendipity. Some international studies have utilised qualitative methods to investigate loss and grief but the culture, resources and legislation in which the fostering takes place often differ from those of the UK, which may colour an individual’s experience.

Relevant UK studies include Ian Sinclair and colleagues who studied the impact of stressful events on foster carers and investigated why some gave up (Sinclair, Gibbs and Wilson, 2004; Wilson, Sinclair and Gibbs, 2000). Their research used postal surveys to seek out those who had experienced one or more of six potentially stressful events, including a placement breakdown. While this investigation is highly informative, it did not look specifically at loss and was limited by its reliance on quantitative methods. Farmer, Lipscombe and Moyers (2005) used semi-structured interviews and measures, such as the General Health Questionnaire (GHQ), to explore foster carer strain and its impact on parenting and placement outcomes for adolescents. The stressful events reported by participants were wide ranging but included the loss of a foster child, either in a planned move or a disruption. The authors concluded that foster carers’ parenting capacity was markedly reduced in several areas when they experienced a high number of stressful life events in the six months prior to the placement, and that they more often than not scored poorly in the sub-clinical or clinical range for social functioning on the GHQ.

Whenan, Oxlad and Lushington (2009) also examined the factors associated with foster carer well-being, satisfaction with their task and intention to continue providing care. They utilised a quantitative approach and similar to the studies by Sinclair, Wilson, Farmer and colleagues, measured a wide range of variables. These included child behavioural and emotional problems, parenting self-efficacy and the foster carer–child relationship. They measured the association between these factors, such as satisfaction with fostering and intention to continue. Similarly, Hendrix and Ford (2003) studied the hardiness of foster families and their intent to continue to foster, and included loss and grief in the analysis. Their research utilised the Family Hardiness Index and concluded with some important implications for practice, such as the potential of hardiness screening of prospective foster families to improve support and retention. But neither study focused exclusively on the emotional impact of loss due to a placement ending.

One study by Picken and colleagues (2011) did try to fill this gap by utilising a qualitative approach to investigate the emotional experiences of foster carers. They used the ‘Photovoice’ technique, which involves asking participants to use photographs to document aspects of their experience and to accept the results as a basis for interviews. In this case, the resultant visual and verbal data were analysed using interpretive phenomenological analysis (IPA). The research offered a greater understanding of the emotional needs of foster carers and highlighted a range of issues, for instance dealing with challenging behaviour, but again did not focus specifically on loss.

Many of the overseas studies that do emphasise loss reach similar conclusions to those from the UK. For example, Herbert, Kulkin and McLean (2013) found that US foster carers do grieve the loss of their children and in a third of the cases studied this was severe enough to be life changing. In many instances, their experience of grief was also disenfranchised in that their feelings of loss were not adequately recognised by others and so could not be publicly mourned. Riggs and Willsmore (2012) reported a similar situation in Australia. At a personal level, Mullings (2010) reflected on her experiences of disenfranchised grief as a foster carer in the US and posited that this was exacerbated by health and social care professionals viewing the loss of a child as part of the job. Many did not understand the intensity of her grief and expected her to display a mixture of detachment and stoicism.

The findings from other overseas studies are more contextual and caution is needed when applying them elsewhere. For example, the US Adoption and Safe Families Act promotes the adoption of fostered children by their carers (Hort, 2000) and requires that states move to terminate parental rights for children who have been in foster care for 15 out of the last 24 months. There is an expectation that foster carers are in pole position to adopt if a child cannot be reunited with their birth family. As a result, some 80% of the children adopted from care in states like Tennessee move from their foster families. This is different from the UK where a ‘fostering for adoption’ initiative exists but without an assumption that foster carers are first in line.

The existing research does, therefore, shed some light on the experience of loss when a child is ‘moved on’, and it is clear that foster carers throughout the world are likely to be significantly affected by grief, much of which is disenfranchised, and that they would have valued the opportunity to talk about their feelings and have them acknowledged. However, most studies consider a range of stresses rather than specifically focusing on loss and tend to use quantitative methods. In this respect, they make an important contribution but often lack the free expression and serendipity that is fruitful for the exploration of sensitive issues.

Methods and analysis

Participants

The study was carried out in England and participants were recruited via an advertisement on the website of The Fostering Network, a charity that provides support to foster carers. Twenty-two carers (three men and 19 women) from various parts of the country responded but as three of these were interviewed with their partners, the study comprised 19 interviews. Participants’ experiences of fostering varied as they were responsible for short- and long-term placements and children of all ages. Some had experience of only one previous placement while others had had more than 20. Two of the women interviewed had lost a biological child in infancy and were able to compare this experience with losing a foster child. Two participants were single carers and one couple was same sex – all of them women.

Ethics and consent

The study received approval from the Research Ethics Committee at the Faculty of Health and Social Care, Edge Hill University and from The Fostering Network. An information and consent form was read to all participants who verbally consented to be interviewed. Measures were also in place to deal with any distress the study might generate.

Study design

Sixteen interviews were conducted by telephone and three face to face. They started with a ‘grand tour’ question which asked participants about the emotional impact of losing one or more children over a period of time and then moved on to elaborate the issues identified. The interviews were recorded and transcribed and the analysis was informed by the principles of IPA, which aims to give insight into how individuals make sense of their experiences (Reid, Flowers and Larkin, 2005; Smith, Flowers and Larkin, 2009). In accordance with this method, the researchers reflected on their own preconceptions about the data and attempted to suspend these in order to focus on the world of the participants. The researchers came from different backgrounds and independently identified common themes among which disenfranchised grief was especially salient, making it the key element in the analytical framework.

Findings

Five themes emerged from the analysis: (1) loving the child as your own; (2) unanticipated profound loss and grief; (3) disenfranchised grief and the support received; (4) changing the way they did things; and (5) coping strategies and other things that helped assuage grief.

Loving the child as your own

Most of the foster carers interviewed said that they loved their child deeply. Indeed, some indicated that this love could equal that for their own children:

[Interviewee crying] You connect with different children at a different level. I can honestly say that you love some children as much as your own, but some children you don’t. (P1)

One participant who strongly emphasised this parity had hoped to adopt the child she looked after. She was in the advanced stages of the process when she fell pregnant and, despite making strenuous efforts, was prevented from going through with the adoption:

It was like a bereavement and it will always be like that. I didn’t love the foster child any less than I love my own baby now. (P2)

All those interviewed acknowledged their struggle to remain aware that they might lose their child but could not prevent themselves from loving him or her as their own:

You tell yourself all the way through the process that the baby is not yours but your emotions tell you a different thing. It is like losing a child. (P11)

The love that many of them developed was neither intended nor anticipated. It was not something that they had factored into their fostering trajectory.

Unanticipated profound loss and grief

It is difficult to overstate the intensity of grief experienced by some of the carers. The majority were keen to emphasise this and some cried when interviewed. For example:

Experiencing it was horrendous, it really was. This is the worst thing I have ever experienced in my life. A bereavement. (P19)

I was empty… we’d wake up crying, constant crying. I think I rang you up once [speaking to her partner during the interview] and said, ‘I’ve not cried for an hour.’ It was constantly like that for three weeks. I thought I was losing my mind. (P7)

Two participants who had previously lost children of their own reflected that the experience and intensity of the grief when a foster child leaves was very similar to their earlier bereavement:

I lost my birth child; she died at six months. Actually it’s quite on a par; having been through both, the experience is similar. The intensity of feeling is just the same. It is very, very hard. It’s just like your child as you’re with them 24/7, but suddenly…. You miss everything, you miss the kisses and the cuddles, everything is gone…. I never thought the pain could be anything like losing my own child but actually it really is. (P11)

The same carer went on to describe a period when she struggled with constant reminders of her child and how these triggered episodes of grief, and of repeatedly staring at the child’s empty cot and seeing nothing: ‘The basket is empty.’

In fact, her grief became so severe that she had to seek professional help. Although her previous tragedy obviously compounded the bereavement she felt when losing her foster child, it is important to accept her account at face value and to avoid minimising the validity, severity and significance of her loss.

Those who experienced intense grief all said that it took them by surprise. They had not foreseen the magnitude and had not planned for it, in much the same way that they had not expected their intensity of love for the child. Indeed, this love was often volunteered as a justification for the profound feelings of loss and grief:

I was not at all prepared for this. You give them your heart, but the flipside of it is they break your heart. (P16)

The duration of the grief also shocked them. In some cases, it had remained unresolved for several years and a number of carers experienced distressing flashbacks. They found that they were often reminded of the children by situations or artefacts and this could trigger a grief reaction:

It still feels like a bereavement. He used to treat me like a mum and told people I was his mum and that is how close we were. I cried and cried and cried and I was devastated, devastated that I had lost him and devastated that I might have let him down. For a trusting bond to be broken is devastating, and I kept saying, ‘I’ve failed I’ve failed.’ (P5)

As foster carers became more experienced, they reported that although they still experienced a sense of loss when a child moved on, it was never quite as severe as the first time:

The more children you move on, the less time it takes before you feel like you can handle another one. (P17)

Disenfranchised grief and the support received

One of the strongest themes reported was that people, including social workers, rarely understood the intensity of the carers’ grief and that this was reflected in the level and type of support they received. They said they were expected to behave in an emotionally detached manner.

Moreover, many participants thought that their grief was not recognised as legitimate by others and felt the need to conceal it for fear of being deemed unprofessional. In these situations, their grief was clearly disenfranchised in that they did not feel able to publicly acknowledge it or mourn their loss. They also thought that the depth of grief was not socially recognised or supported, as noted by Doka (1989) in his original definition of disenfranchisement.

This failure to recognise and respond appropriately to this varied among different groups. Respondents explained that fellow foster carers were generally aware and sympathetic, unlike professionals who tended to be more dismissive, perhaps reflecting an ethos of avoiding emotional over-involvement. The general view was that social workers did recognise that the carer had experienced loss but they did not perceive it as deep:

I don’t think that social workers realise that the loss is as powerful as that. I don’t think that anybody could understand until they have been through it. (P11)

They also thought that professionals often perceived their grief as illegitimate:

We were told that we were too emotionally involved, which is really hard. It made us feel inadequate, it made us feel that we were doing it wrong. (P18)

The important point from all these comments is that the disenfranchisement of an emotion such as grief does not necessarily have to be overtly verbalised for it to be felt and there are cultural differences in the extent to which it is recognised. This was evident to some participants in the lack of support they received:

I was not supported with the loss, not at all. You don’t get any support – it’s like, that placement has gone. And I don’t think they have even looked at that, at all… I don’t think that social workers realise how emotionally attached you get to a child. (P5)

In three cases, carers feared that expressing their grief would be deemed inappropriate and would result in a cessation of fostering because it was seen as a sign of over-involvement. In this respect, the professional ethos referred to earlier resulted in the de-legitimisation of the foster carer as a griever:

If you admit vulnerability, then somebody might say don’t do it or you are not up to it. (P8)

On the other hand, some were keen to point out that this response was not universal, and that some social workers were supportive and aware, suggesting variation among individual practitioners:

The social worker is really good and if she is not there when I ring her she’ll ring me straight back. It’s just somebody to vent to really, to get everything off my chest. A good listener definitely does help. Just somebody there to understand how you are feeling really. (P15)

It is also important to look more widely as the experience of disenfranchisement was not restricted to interactions with social workers; indeed, it occurred when carers displayed grief to their own family and peers. Again, some groups recognised their grief more than others and participants particularly valued the support of others who had been through the same experience, as they could validate and confirm the experience of grief as legitimate: ‘Other foster carers understand but not many other people do.’ (P1)

Disenfranchised grief also affects men but they may be prevented from exposing their feelings owing to gender-related social expectations:

My husband went to work as normal, partly for his own sanity. I don’t think he felt that he could handle being around when the child left. He cried on the way to work. Six months later, when he was taken to hospital with appendicitis, he ended up telling them that we were foster carers and then he burst into tears. He was crying over… that was grief over losing her. (P10)

A number of factors lead social workers to convey a message of grief delegitimisation, but to explore these is beyond the scope of this study, which concentrates on the experience of foster carers. Nevertheless, some issues merit consideration. One is the effect of professional socialisation and the development of consensual norms and rules. Social workers may find themselves reinforcing these in the perspectives they assume. For example, they may perceive fostering as a career and see the unwillingness of carers to pursue other avenues of permanence for a child, such as special guardianship or adoption, as evidence that they are not fully committed to the long-term welfare of their child, hence disenfranchising the carers’ grief. This response is especially worrying as it does not reflect the reality of the situation; for example, a lot of fostering is short term so permanence is not an issue and the intensity of feeling experienced by many carers, whether of love or grief, was neither anticipated nor planned.

Changing the way they did things

Many of the participants indicated that loss, and repeated loss, had changed their approach to fostering. This ranged from a minor adjustment through to a decision to give up. The minority of carers interviewed who indicated that loss had a minimal impact appeared to have balanced the need to love the child with a recognition that she or he would eventually leave:

If I went into it thinking that these children are going to go therefore I won’t get attached, then I wouldn’t be doing my job. With younger children, you cannot not love them…. I would not be doing a good job if I did not get attached. Getting attached is the main part of the job. (P10)

Others revealed that loss had resulted in changes of perspective, all of which appeared to be an effort to protect individuals from the damaging impact of further experiences. In some cases, the carers successfully ‘held back’ and reduced emotional bonding in order to protect themselves:

Every time a child moves on it takes a little bit of my heart away so you just become more resilient, holding back on the emotional side of things…. It’s more of a surface relationship rather than a deep and meaningful one. (P14)

Others tried to reduce the degree to which they formed an emotional attachment to the child but were generally unsuccessful and continued to react with grief:

Because of the hurt with other children I tell myself that I am not going to love them as much. And that comes from the head as such, but unfortunately when the other child comes along it doesn’t come from my head, it comes from my heart, and it is something that you have no control over. (P13)

Several participants made the decision to cease fostering or were considering this because they wanted to protect themselves from further painful experiences:

When she went, my husband could not bear the thought of having another long-term foster child. (P3)

These findings have important implications for the child, carers and fostering services. Children need to be accepted as part of a family and to perceive that they are loved with parity to birth children. If disenfranchised grief is reducing the degree to which carers emotionally bond with those they look after, there is a risk that the children will not perceive themselves as being accepted as part of the family unit. Moreover, the experience of disenfranchised grief and the lack of opportunity to resolve it may reduce resilience among carers. Paradoxically, this may affect those who are in some respects best suited to fostering, i.e. those who are prepared to love the child. Consequently, acceptance of the foster carers’ experience of grief and the provision of therapeutic engagement, when appropriate, has the potential to improve the child’s experience of fostering and to increase carers’ resilience.

Coping strategies and other things that helped assuage grief

Having described their grief experiences, the foster carers highlighted strategies that helped them cope. Unsurprisingly, these related primarily to being listened to and believing that their grief was accepted as legitimate and expected. Simply talking to somebody who ‘knew what it was like’ was beneficial:

They buddied us up with another foster carer and she said, ‘No, you’re not going out of your mind, this is normal, it is normal to get this upset,’ and it was OK to get that upset. (P7)

It was especially important for social workers to recognise this need:

It only takes a few words from them [social workers], just to say that they understand. Just a few words of understanding, it doesn’t have to be much. (P15)

Hence, the disenfranchisement of grief is damaging because it blocks the therapeutic options to help those grieving; these can be as simple as acknowledging the legitimacy of their experience, providing opportunities to speak about their journey, knowing that the child was going to ‘a good place’ and updating them on the child’s progress. These can be extended to being involved with planning the move and the process of transition and, if appropriate, remaining in contact with the child or birth family. Indeed, if carers perceived the next placement as unsuitable, it intensified their experience of anxiety and grief:

[It helped] because we met the carers and we were confident that they were going to get good care. I was confident in the care they were going to get. If you can see positives in the children moving on, you can’t help getting upset, but if you have confidence in what the future holds for the child then you can cope more. (P4)

If the adoptive family have kept in touch, I know that our adopted child is loved and very settled. So that is very reassuring. (P11)

We were going to be denied access for three months [cries]. The girls came round to us after three weeks and that helped them because they could see that we had not abandoned them. (P8)

It was commonly understood that continual contact is not always possible, perhaps due to reluctance from new carers or adoptive parents, but in such cases carers appreciated updates on the child’s progress:

That is massively important to me. I have had two children who I lost contact with completely and I find that really, really difficult. One of them was a little girl who I had from birth. (P17)

Thus, the opportunity for carers to remain in contact with children and future carers or, where this is not possible, to receive updates complements the benefits of their grief being legitimised, along with opportunities to discuss their experience with informed and sympathetic listeners such as other foster carers. It is also clear from all these comments that the support that foster carers receive following a placement ending is perceived as crucial for their well-being and future work.

Discussion

There is little doubt that the majority of foster carers taking part in this research reported intense grief at the cessation of a placement, which was mostly experienced as disenfranchised. Nevertheless, when applying the research to practice it is important to recognise that while grief was a core theme, a minority revealed other emotions such as anger at the child, frustration with their situation, a sense of failure and relief if the placement had been problematic. Coping with any transition is difficult, but it has a distinct complexity and meaning in foster family care.

The findings of this study echo much of the previous research cited and confirm that international findings may apply in a UK context. But the study adds to these by showing that participants were surprised at the degree to which they develop attachments to and love for the children whom they look after, and at the depth and duration of the grief they felt. This was something they did not plan for and was especially difficult for those experiencing a placement ending for the first time. These findings reflect research that explores the experience of children when they leave a foster placement (Boswell and Cudmore, 2017). Their experience of loss can be equally disenfranchised, with adults often interpreting their compliance as proof that ‘they are fine’.

Disenfranchised grief is significant in that it exacerbates the ‘normal’ consequences of bereavement, such as anger, guilt, powerlessness and ambivalent relationships, while at the same time reducing sources of support. In addition, it can result in foster carers making reduced efforts in subsequent placements affecting the well-being of those whom they look after. Practice where carers’ views are taken seriously and where the child’s social worker is regularly and reliably available can attenuate stress, as can help from friends (Farmer, Lipscombe and Moyers, 2005; Wilson, Sinclair and Gibbs, 2000). The imperative of such support is a major component of the York University ‘Model of Foster Care’ (Wilson, Petrie and Sinclair, 2003).

These findings also have implications for the professionalisation of foster care (Kirton, Beecham and Ogilvie, 2007; Wilson and Evetts, 2006). Emotional detachment from clients is the norm in much professional practice but foster carers are often expected to act not just as carers but also as primary therapeutic agents for children (Simmonds, 2010). As the emotional aspect of foster care is more significant than in most other professional–client relationships, the toxic effects of disenfranchised grief can be especially severe.

Limitations

The methodology employed for this study has advantages and limitations. Telephone interviews enabled a wide geographical reach, but could not incorporate the facial expressions and body language of respondents. The sample of 22 is large for a qualitative study but not big enough to represent the wider population. Furthermore, those volunteering to take part are more likely to have experienced profound feelings of loss and to be motivated to participate.

Conclusion

The paradoxical and emotionally challenging situation where people are asked to love and then give up a child is a problem at the heart of the care system, and continued contact is often seen as unimportant or left to chance. Although no amount of preparation will completely eradicate the profound loss experienced by some individuals in these circumstances, preparatory training for foster carers would be beneficial and could incorporate advice from others who have been through this. Acknowledging that families do in many cases learn to love the children they care for is a credible message.

This training could also extend to children’s social workers as they guide and formulate contact plans post-placement. It should include the potential impact of the loss of a child, the support processes available and the key role of foster carers in supporting a child’s transition and long-term emotional security. Similarly, adoptive parents could receive preparatory training about the role that foster carers can play in contact arrangements since they, as the children’s legal parents, have the final say as to whether contact should continue.

The professionals involved should always be aware that, irrespective of the foster carer’s long-term plan, the experience of loss can be very real. Support could be routinely offered and social workers should explain to carers, especially new ones, that they should expect to feel grief. There needs to be consistency between workers and carers to develop trust, thereby enabling openness about the extent of grief and readiness to accept placement change. The professional culture should not convey, either formally or informally, the message that the relationship between the foster carer and the child does not count, that the loss is not significant and the grief is not recognised or supported.

Counselling would be beneficial where there is evidence of a complicated grief response and peer support could be routinely facilitated. Experienced foster carers can receive training as part of a mentoring programme to equip them for the delicate task of sharing their knowledge and for listening empathically. The therapeutic value of having grief acknowledged among a group of peers should not be overlooked as it empowers individuals and helps break the bond of silence that services and foster carers have allowed to persist. Programming and facilitating a group process where carers can speak openly about their experiences and have them publicly legitimised, even if they are historical, would send a strong message about a positive shift in understanding.

Maintaining the child–foster carer relationship throughout the transition and beyond may help to improve the foster carers’ experience of the process. Moreover, when carers know they will remain in children’s lives, they are less likely to withdraw emotionally from the child to protect themselves from the anticipated pain of separation. Changes to practice are moving away from advising foster carers to distance themselves from children as they ‘re-attach’ with new carers. Contact plans that encourage a more gradual approach to withdrawing from a key attachment role are being increasingly used. This leaves the door open for more flexible and creative support to be offered. This should not be seen as potentially damaging to foster children, including those who have been adopted. As Neil, Beek and Ward (2015) have found, young people who have had continual contact post-adoption still had a strong sense of their adoptive parents being ‘their parents’, but also had a better understanding of their past.

Footnotes

David Lynes is Innovation Lead, Research and Innovation Team in the Faculty of Health and Social Care, Edge Hill University, Lancashire.

Angela Sitoe is Training Development Officer, Sefton Council Fostering Service, Bootle, Merseyside.

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