Patterns of adoption placement over the past decade have changed enormously;  we are now seeing an increasing proportion of children who have survived overwhelming emotional pain, often suffering distress on a chronic basis, being placed in permanent families.  In other words, they have experienced repeated traumatic hurts which will affect their perceptions of the world for the foreseeable future – unless we can effectively interrupt their patterns of social interaction, their thinking and their reacting in their inside and outside worlds.