Due to competing claims in the literature regarding the relationship between self-esteem and being ‘looked-after’, and the implicated ethical and clinical issues, a systematic review of the literature was carried out. Ten articles met inclusion criteria for review. The majority of studies made a limited contribution to the review due to poor study quality, and the ethical, clinical and research implications of this are discussed. In addition, anecdotal evidence suggests that young people in care do not want to be made to feel different to others but there appears to be an absence of empirical research confirming this. Interviews were carried out with nine 12-16 year olds currently residing in foster care to explore their representations of ‘feeling the same or feeling different’. Interpretative Phenomenological Analysis (IPA) guided how data was analysed, and resulting super-ordinate themes were identified. The research paper reports on one of these themes: ‘difference’, which is explored through four sub-ordinate themes. These relate to participants not wanting others to know they were in care, feeling alienated due to their foster care status, perceiving that others viewed them differently and, at times, noticing differences themselves. Findings are considered in relation to the extant literature on foster care and identity development and practice and research implications are discussed. A second super-ordinate theme: ‘making sense’ is presented in the ‘extended results’ which is explored through five subordinate themes. Representations involved participants making sense of why their birth parents could not care for them, conflicting feelings towards both birth parents and foster parents, and a desire to feel a sense of agency in their lives.

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