A child’s adjustment, like many aspects of their functioning, is usefully thought of as sitting on a spectrum ranging from maladjustment at one end to positive adjustment at the other end. Where a child is on this spectrum depends on influential experiences in their life. Considered in this way, their adjustment is something of an average of influential experiences.

Relational experiences play a key role in how a child approaches life and relationships. Relational experiences impact attachment security. Attachment security is also usefully thought of as a spectrum, ranging from secure attachment to disordered attachment. Where a child is on this spectrum is influenced by their experiences of relationship and dependency with key adults in their life. In turn, attachment security influences their approach to life and relationships based on beliefs about self, other, and world that reflect relative attachment security.

Where children have had grossly deficient experiences of care and relationship during the developmental period, their attachment security and adjustment is likely to be adversely impacted. These children need positive experiences of care and relationships to compensate for prior negative experiences and support movement towards attachment security and successful adjustment.

However, across twenty years of continuous work in child welfare it has become clear to me that conventional nurturing care is not sufficient to compensate for grossly deficient experiences of care and relationships. Returning to the idea of a spectrum and where a child sits being something like an average of their experiences, it will only get a child part of the way towards attachment security and positive adjustment. Rather, the child who has experienced grossly deficient care needs one or more of the following:

• A (much) higher number of positive relationships;
• Enriched experiences of care and relationships;
• Repair of early relationships where care was grossly deficient.

So, in terms of the question that gives rise to this post, children and young people who have experienced grossly deficient care during the developmental period need enriched care to buffer against and compensate for the impacts of deficient care and relationships. Thought of in this way, enriched care is therapeutic inasmuch as it supports progress towards a desirable outcome for the child in terms of their attachment security, adjustment, and approach to life and relationships.

The Triple-A Model of Therapeutic Care and the CARE Curriculum are two examples of programmes that I have developed for foster and kinship care, and have been implemented in out-of-home care sectors in Australia and Ireland. Perhaps, the broadest coverage of my recommended approaches to therapeutic care can be accessed through Pearce, C (2016). A Short Introduction to Attachment and Attachment Disorder (Second Edition). London: JKP.