Lifelines of young people with a history in residential care: A qualitative investigation from a complex systems perspective

• Residential care is often disorder-focused, lacking a holistic understanding of youth. • Lifelines contained general dynamic patterns with distinct developmental mechanisms. • The worsening of problems occurred fast, whereas recovery was a much slower process. • Recovery required a nurturing living environment with a strong therapeutic alliance. • We need an interaction-based approach to care, focusing on history, context and youth. Care for youngsters in residential settings is often disorder focused rather than based on a holistic understanding of their unique developmental histories. In this study, we used a lifeline drawing method, inspired by complex systems theory, to map the life histories and broader developmental contexts of young people with residential living experience. Lifelines of wellbeing were analyzed for distinct dynamic patterns to arrive at a process explanation of how person-environment interactions shape the onset and maintenance of psychological suffering and recovery. Lifeline interviews were conducted with seven adolescents with residential living experience. Each lifeline was segmented and coded for the functioning of the person and their environment. We then sought for dynamic patterns that were repeated within and across cases. The overall line shape showed that youth experienced the majority of their lives as hardship and that their psychological problems worsened over time. While idiosyncratic in content, we found general dynamics (patterns of stability, fluctuations, and diverse change patterns) that could be linked to distinct developmental mechanisms. Fluctuating patterns pointed towards periods of instability (or crisis), during which youth appeared more sensitive to external stressors, and which typically marked the start of recovery. Whereas the worsening of youths’ problems typically occurred fast, recovery was a much slower process which required an autonomy-supported living environment, psychological interventions, and/or changes in youths’ school or living environment. We call for an interaction-based approach to diagnosis and care, in which psychological suffering is understood in the light of a person’s history and developmental context.