"Wor=
king
with Families - How not to perpetuate the abuse".
Director Youth Support=
The following is based on a workshop setting designed =
to
help professionals to make positive interventions with families where child
protection has been important.
"Working with Families - How not to perpetuate the
abuse".
The following is based on a workshop setting designed =
to
help professionals to make positive interventions with families where child
protection has been important.
Introduction -
The way in whic=
h we handle
families and individuals within those families, have far reaching effects on
the way that family will function afterwards.
However much we=
may
disapprove of or be at odds with a family's structure and functioning, we m=
ust
realise that the child has been brought up within that structure and will h=
ave
to survive within it after the 'professional' intervention is over.
In addition sin=
ce this
family structure is the only one the child has known; the way that child
perceives his world is based on this blueprint - all the child's 'survival
tactics' are based on this reality.
We cannot destr=
oy the
child's environment without replacing it with something else and without
realising and appreciating the
'dynamics' of the situation.
Altering the st=
ructure
or dynamics can leave members 'exposed' and unearth other conflicts.
this can be desired -> used in therap=
y
=
or
undesired -> recreating the conflict &nb=
sp; =
from a different =
base.
(false cure).
Family structure
A family is str=
uctured
around it's own ethos - it may be an emotionally distanced grouping of
individuals who constitute a 'family' in name only and where the individual
feels no support or bonding with his fellows.
Alternatively, =
as is
more common in many of the families coming under professional scrutiny, it =
may
be an enmeshed body which takes on an existence of it's own and where
individual personalities are lost in a common boundaryless ego.
So called 'norm=
al'
families fall somewhere between the two extremes but are still prone to pow=
er
struggles between the members - who is in charge, who is the spokesperson, =
who
is the scapegoat? Family members assume or are pushed into a role and
interactions between family members are influenced by these roles and by the
interplay between them - striking up allegiances, involving one another in
power triangulations and using one another in indirect communication.
How often have =
we heard
a child used in something like - "Tell your father if he wants his din=
ner
he had better come home on time".
or a parent imp=
licated
in indirect communication as in -
"Wait till=
your
father gets home" or "What will your mother say when .."
Families freque=
ntly
take sides - with one child siding with mother and another with father, or =
all
'ganging up' on the weakest member. In 'abusive' families a child frequently
appears to side with the abusing parent against the other - since this is t=
he safest
thing to do.
It is worth whi=
le
taking a little time to consider some examples of this - think of the last =
two
families you worked with and how they functioned - consider also your own
family of origin - what part did you play? This topic can form the basis of=
an
excellent role play with colleagues in a workshop situation.
The family is a
microcosm of the outside world and of the wider environment. The way in whi=
ch
we learn to function within our families, provides the 'blueprint' for how =
we
function in society at large.
We carry our fa=
mily
'role' with us from our family of origin to school, to our workplace , to
relationships and social settings and to our eventual roles in the family we
create.
The stability of
maintenance of a role and 'place' within the world, of being secure in the
knowledge that things turn out or people behave in the way we expect them t=
o do
- this is the most important factor in family life.
Stability and
predictability are more important than the quality of that condition. In ot=
her
words the secure knowledge that mother loves you is certainly conducive to
mental health and well being - but so, in a perverse way, is the secure knowledge that fathe=
r will
hit you every time he comes home - as opposed to the insecurity of not know=
ing
whether he will or not.
There is nothin=
g so
destructive as the insecurity and unpredictability of not knowing whether f=
or
instance dad will be drunk or sober when he comes home and thus whether he =
will
hit you (perhaps when you have been good) or hug you and give you a present=
(maybe
when you have not had such a good day).
If your behavio=
ur has
no predictive consequence - then it has no importance. And if your behaviour
has no importance, then perhaps you do not either. The child's self worth is
destroyed because nobody cares what he does or how he acts. It is as if he =
does
not exist.
This is no less=
the
case for those unfortunate children who are raised in families where abuse -
physical, sexual or emotional has taken place.
Sarah had been sexually abused by her grandfather since the =
age
of 4 or 5. In common with many victims of sexual abuse, she was unable to
'disclose' what was happening. She at the same time could not believe that
people - her mother, her aunt and her grandmother could not 'see' her
distress and acted as if they=
did
not know.
She began to ac=
t out
the anger and frustration she felt in delinquent activity - smashing window=
s on
her estate and minor acts of vandalism. This did not get her into trouble,
people did not seem to notice. There was no consequence to her behaviour - =
just
as there appeared to be no consequence to her grandfather's behaviour.
Later, as an
adolescent, Sarah's rages became more intense. She walked a long distance w=
ith
a knife in her hands , wanting to kill her grandfather. When she arrived she
saw her grandmother and could not commit the deed. She thus went home, smas=
hed
the family home and was committed to a mental institution. She calmed down =
and
was released. Another example of missed communication.
In adult life d=
uring
therapy she went into an 'uncontrollable rage' one night and smashed window=
s in
the treatment unit. The following day she doggedly refuted that there was a=
ny
possible consequence to her behaviour. A breakthrough in therapy occurred w=
hen
she was faced with possible consequences and a code of 'acceptable behaviou=
r'
was laid down. It was as if at last 'it mattered' what she did and therefore
'she mattered'.
Problems of the 'meddlesome ' worker
When working in=
child
protection - there is an intense desire to 'do something' - it is thus very=
easy
to take action just so that this need can be fulfilled and the professional=
can
be 'seen to be doing something'. Under such pressure however there is a very
real danger that the 'something' can be of no use whatsoever to the child
needing protection or to his or her family - and can at best be useless and=
at
worst harmful and dangerous.
Some of the aft=
ermath
of 'meddlesome activity' in child protection is not immediately apparent du=
e to
the flawed manner in which much child protection work is conducted - i.e. t=
hat
of crisis intervention based mainly on protection from harm without follow =
up
or any treatment process to 'heal the wounds' . Hence the total gamut of the
inflicted harm is not appreciated nor the contribution within that wounding
process which can be laid at the door of professional error or misjudgement=
.
Hence , when we=
feel
urged to 'do something' - it is imperative that we consider for whose sake =
we
do that i.e. are we being helpful to the client or 'helpful' to ourselves?.=
In looking at t=
his
dilemma , it is useful to consider a concept borrowed from Transactional
Analysis (TA) - that of Karpmann's drama triangle. The 'Drama Triangle' can=
be
used to look at roles in any situation where a psychological 'Game; is being
played ; in other words, where two people are not being straight with each
other, not saying what they really mean.&n=
bsp;
In such 'Game play' the roles of Victim, Rescuer and Persecutor are
played and switched by the participants in a manner that can leave both fee=
ling
uncomfortable.
A classic 'fami=
ly view'
of the triangle in action is provided by the alcoholic family. A common
scenario might be - drunken husband (Persecutor) comes in late and berates =
wife
(Victim) for not having dinner ready; she (now Persecutor) then turns on hi=
m (Now
Victim) for being drunk again ; he then throws up and complains how ill he
feels so she 'Rescues' him by sympathy and cleaning up after him and probab=
ly
rings his boss in the morning to tell him her husband has the flu'.. thus
enabling him to continue in his behaviour pattern and Persecute her all over
again.
In our scenario=
of the
'meddlesome worker' one might play the game with the professional as Rescuer
turning Persecutor. In such a situation the term 'Rescuer' is not complimen=
tary
, such a person 'Rescues' for their own personal ends and their actions are
generally harmful to their clients even though superficially they might fool
some of the people some of the time.
The Rescuer beg=
ins by
making the inappropriate intervention in the vein of the dentist telling the
patient that 'It won't hurt' or the old fashioned school teacher caning the
pupil with a 'This is for your own good and it hurts me more than it hurts =
you'
attitude.
When the client=
, hardly
surprisingly, fails to respon=
d to
such treatment; the Rescuer becomes Persecutor, blaming the client for lack=
of
response rather than seeing that his methods might be flawed. This is akin =
to
the Doctor blaming his patient for failing to get better rather than stoppi=
ng
to consider that the 'cure' might have been the wrong one.
Client
- Victim
(This is hurting me)
(This can't be right)
=
/ \
&nb=
sp; / =
\
/ =
\
&nb=
sp; / =
\
=
/ =
\
=
/ =
\
=
/ =
\
/ =
&nb=
sp;
\
Persecutor - - - - - - -=
- Rescuer
(This is for yo=
ur own
good) (I'm only trying
(I know what's =
best for
you) to hel=
p you)
(I'm an expert =
in this
field
- you'll ruin my
reputation).
Case Histories -
The following c=
ase
histories illustrate a number of difficulties faced by workers and the
contrasting possible end points which could be brought about by insensitive=
or
inappropriate action. The cases are based on true facts although one end po=
int
actually happened , and the other was fabricated. Sadly , the end point whi=
ch I
would have liked to see happen is the fabricated one.
Unfortunately w=
e work
in an age when the very words 'child abuse' can engender such subjective
response from professionals that interventions are often less than ideal and
once the hot potato of abuse has started rolling, albeit in the wrong
direction, it can acquire a momentum of it's own and be impossible to stop =
or
to shift onto a more appropriate course.
Hence ill thoug=
ht out
actions, however well meaning can have devastating results for the child who
has been the victim of abuse and for it's family. It is thus that our
interventions can be in themselves abusive. As they say "The path to h=
ell
is paved with good intentions".
Please read through the case histories and evaluate how
you would have acted. Discuss the two possible endpoints.
Case History 1 - Margaret, Harry and Tom.
Margaret had he=
r first
baby when she was in her late thirties. Her husband was a business man who
spent a lot of time away from home on business trips.
In the weeks af=
ter the
birth, Margaret was tired, lonely and depressed. She had not expected to ha=
ve a
child at this stage in her marriage and had not imagined that her life coul=
d be
so changed.
One night, baby=
Harry
seemed to cry incessantly. She did not know how to pacify him. Margaret
eventually managed to get him to sleep and , just as she was dropping off
herself - he started to cry again. She picked him up roughly and shook him,
crying, "Please, please stop it" - she pushed him back down into =
his
cot, ran crying into the next room and shut the door on him.
The next mornin=
g,
Margaret found that Harry had two tiny bruises on his cheeks - she must have
handled him more roughly than she thought. She wrapped him up and rushed ro=
und
to her GPs surgery.
A. The GP examined the child, found light finger tip
bruising on the cheeks, and no other signs of abuse. Harry was well nourish=
ed
and developmentally up to date.
He did seem to =
be a
'windy' baby however and so advice was given about feeding regimes to try a=
nd
reduce his indigestion and night time colic.
The GP also dia=
gnosed
post natal depression, which was contributing to Margaret's low threshold of
tolerance and which, combined with her excessive tiredness, was diminishing=
her
supply of breast milk and thus contributing to Harry's fractiousness.
It was arranged=
that
the health visitor call regularly on Margaret to help her build confidence =
in
handling her baby. He knew that this was a long awaited child and felt Marg=
aret
may be feeling a sense of anti-climax ad failure in not being able to be the
perfect mother. The GP asked her husband to take some time off work to allow
Margaret to rest.
B. The GP found finger tip bruising on the baby's cheeks
and questioned Margaret about it. She was distraught and confessed that she=
had
handled the child roughly and had shaken him.
The doctor had = recently moved into the practice and did not know the family, he was very concerned about Harry and decided that since he was born late to a professional career oriented couple, he was probably an unplanned and possibly unwanted child.<= o:p>
The child was s=
ent to
hospital for X ray studies and Margaret was cross examined by the Casualty
officer, followed by the paediatric houseman, registrar, senior registrar a=
nd
consultant. The hospital social worker came and asked if she understood abo=
ut
the child abuse procedure in their district.
The social work=
er then
telephoned Margaret's husband, Tom who was embarrassed to be summoned out o=
f an
important meeting because a place of safety order was being taken on his so=
n.
When Tom arrive=
d at the
hospital, he was not immediately able to speak to his wife or see his child,
first he was cross questioned about his wife's character, her history and
whether he thought she was capable of injuring her baby. Tom was devastated.
Margaret confessed, she felt like a criminal.
It was several =
days
before they had Harry back, and then they were told he was on the 'at risk
register'. Margaret's depression got worse, she could not cope. One night s=
he
took an overdose, Tom came home to find Harry crying alone and his wife semi
comatose. What danger Harry was in!
Margaret starte=
d seeing
a psychiatrist who gave her tablets which made her more sleepy and less abl=
e to
cope. Tom thought it best that Harry go and stay with his parents, who knew=
how
to look after children.
The marriage di=
d not
last long after that. Margaret was branded as 'unsafe' with children. Tom h=
ad
to change his job and is now less well paid.
What of Harry?<= o:p>
Case History 2
Ann and Zoe
Ann had been in=
care
for most of her life. She did not really know what family life was like, it=
had
been one children's home after another.
When she fell p=
regnant
at 17, she desperately wanted to make a go of her life, to bring up her chi=
ld
herself and to learn how to be a better mother than her own mother had been=
.
The pregnancy w=
as
unplanned but the baby was wanted. Her boyfriend Dave was supportive althou=
gh
he did not have a job and so could not help much.
Ann had been ab=
used as
a young child and had been on the social services, child abuse register. Wh=
en
her child was born, her social worker thought that her child was therefore =
at
risk of being abused - abused children become abusing parents.
A. Baby Zoe was placed with a foster mother; Ann fought to
have her back. She was given the task of 'proving' herself. Could she be a =
good
mother, did she know how to handle a baby?
So every weeken=
d Ann
was allowed to 'handle' Zoe under the supervision of a social worker. She
picked up the unfamiliar bundle and did not know what to do - criticism
followed criticism - she was set up to fail.
B. Ann and Zoe were placed in a residential unit together.
Ann was given support in caring for her daughter and was gently allowed to
assume responsibility for her care as her confidence grew.
Zoe was on the =
social
services 'child protection' register but after six months the authorities w=
ere
happy that Ann could cope with her child and plans were made for return to a
flat in the community and eventual de registration of the child.
Thus what might
initially appear to be merely a subtle difference of emphasis in dealing wi=
th a
case can have far reaching and devastating consequences for the child who we
are aiming to protect and the family who we can either support and 'nurse' =
to
psycho social health or who we can very easily destroy.
Sexual Abuse
Consider the ca=
se of a
sexually abused child who 'discloses' to a professional.
How do we stop =
him or
her from being further abused by the consequences?
What are the fu=
rther
possibilities for abuse?
1 - GUILT at having been the victim -=
it
must have been my fault somehow.
2. Being seen a=
s accuser - accusing 'family' and m=
other
or carer of not protecting her enough.
3. Breaker of f=
amily -
perpetrator - father possibly - being removed from family - break up of family his or her fau=
lt.
4. Made to test=
ify - witness of fathers or family's gu=
ilt.
5. Physical abuse - the examination itself can be 'abusing'.
6. Circumstance=
s of
examination and disclosure can be an abusing
ordeal.
7. Court appearance and evidence giving can be traumatic.
8. Abuse in not being believed or not taken
seriously.
9. Having to 'confront' perpetrator or argue w=
hat
did or did not happen.
10. possible fu=
rther
abuse in terms of what happens if child placed back in contact with abuser - revenge, blackmail, etc.
11. Professiona=
ls
involved giving covert messages -
e.g. why don't you retract and make life easier for everyone - perhaps you
exaggerated?
12 Or covert disgust at circumstances be=
ing
'misread' as disgust for victim?
13 What of the =
'stigma'
of being an abuse victim?
There are a num=
ber of
further possibilities which might arise in discussion. It is worthwhile pau=
sing
to consider - what could have been abusive in the last case you were involv=
ed
in? Could this have been circumvented in some way?
Conclusion
All interventio=
n both
effective and ineffective is going to produce change - either in the indivi=
dual
or in the family. Change is painful - it is often easier to stay with the
status quo than to risk the uncertainty of change and 'moving on' even if we
are moving to a healthier position.
The arguments p=
ut
forward here are not intended to deter the professional from making
interventions - many of which are essential to safeguard the welfare, and
sometimes the lives of children.
It is hoped how=
ever
that the measures we take are positive and helpful to the families we work =
with
and that if we have to cause a measure of harm and distress in our
interventions; that we are at least aware of such injury and can act
appropriately to minimise it's long term effect.