‘Why we’re providing therapy for parents in pre-proceedings’

By Leigh Zywek and Richard Devine, Bath and North East Somerset Council

In our work, we have found that many of the challenges parents faced in safely caring for their children stemmed from coping strategies the parents had developed to handle extremely difficult and traumatic childhoods.

This exposed the significant disparity between the support provided to parents and what they required. We began to feel that the parents involved needed psychological treatment.

At the same time, psychological assessments of parents in care proceedings almost always recommended psychological treatment. But nearly all said such treatment would take too long and thus fall outside of the child’s timescale.

‘If therapy had been obtained earlier, outcomes might be different’

This issue was highlighted  in a judgment published eight years ago by His Honour Judge Stephen Wildblood KC, in which he said:

“Time and time again I see a process whereby the following occurs: a) a Local Authority intervenes and begins making assessment of a family; b) months later proceedings are issued; c) an order is made for some form of expert evidence to be produced (often a psychological report); d) months later the psychological report is obtained which says, invariably and utterly foreseeably, that someone within the family needs therapy and e) it is stated that, by then, the beneficial effect of therapy would be ‘outwith the timescales for the child’.

“In this case, for instance, it would have been perfectly obvious to all that, when the mother was referred before birth, she was a prime candidate for therapy. If therapy were to be obtained at an early stage such as that there is at least a prospect that outcomes in some cases might be different.”

Researching therapy options

We undertook research into psychological therapy and discovered that the primary therapeutic approaches (mentalisation-based therapy, dialectical behaviour therapy, trauma-informed cognitive behavioural therapy, cognitive analytic therapy, etc) produced similar outcomes (Wampold & Imel, 2015, Johnson and Boyle, 2018).

Even more surprisingly, “matching the model of treatment to a psychiatric diagnosis has an insignificant impact” (Sami Timimi, cited in Johnson and Boyle, 2018).

Furthermore, two critical factors were relevant to the success of treatment: the individual’s willingness to engage with the therapy and the relationship between the individual and the therapist (Johnson and Boyle 2018, Wampold 2001).

Providing therapy to parents in pre-proceedings

We were surprised and encouraged by these findings, so much so that we felt obliged to tentatively explore providing therapy to parents involved in pre-proceedings, one family at a time.

We applied two guiding rules, drawing on our learning from the research:

1. To increase the parent’s sense of control and improve the first variable, willingness to access treatment, we would provide an overview of the different therapeutic approaches and invite the parent to choose one.
2. We would work together to identify a therapist, with care taken to ensure that, relationally, it was a good match, thus accounting for the second variable, the quality of the relationship between the patient and therapist.

We learned along the way about which parents were ready and which were not, and how to create the conditions that facilitated participation.

One parent’s story

One parent from Bath and North East Somerset Council had had her child removed at birth due to being in a severely domestically abusive relationship. She separated from her partner and, with trepidation, attended therapy.

Through this, she was able to learn that she took on a caregiving role in her childhood and, without awareness, applied this to adult relationships:

“The only thing I see myself or deem myself good at is to look after people, which is why then sometimes I tend to attract a lot of people that are troubled and try to help them [because] subconsciously that is what I feel is my purpose…but then obviously that gets me then in a situation where people will take advantage.”

Through learning about herself, and understanding unconscious patterns, she was able to develop alternative ways of relating to herself and others.

She said that accessing therapy was “one of the reasons that he [her child] was able to come home to me and be with his mum”.

She added: “[Without it] I would’ve been in the same place and they wouldn’t have given me my son back. All because there wasn’t that help. Yeah, and all it took, all it would’ve took was the therapy.”

A potentially transformational impact

Cases like this and others have shown us first-hand how therapeutic support can have a transformational impact, break intergenerational patterns and allow parents to safely look after their children.

We think this illustrates why this is so important.

We have also received support from Cafcass, barristers, children’s guardians and the courts, including Judge Wildblood,

Spreading learning

Offering access to therapy is now a staple part of our offer for parents in BANES.

We have begun working regionally with other local authorities to see if we can collectively provide therapeutic support for families in pre-proceedings.

We are keen to share our approach in the hope that, in the same way HHJ Wildblood’s remarks eight years ago sowed a seed of inspiration for us that enabled this approach to come to fruition, we can do the same for other local authorities.

References

Johnstone, L & Boyle, M with Cromby, J, Dillon, J, Harper, D, Kinderman, P, Longden, E, Pilgrim, D & Read, J (2018), The Power Threat Meaning Framework: Towards the identification of patterns of emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis, British Psychological Association

Wampold, BE, & Imel, ZE (2015), The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed), Routledge/Taylor & Francis Group

Wampold, BE (2001), The great psychotherapy debate: models, methods, and findings, Routledge

Leigh Zywek is assistant director, children and young people services, and Richard Devine consultant social worker, at Bath and North East Somerset Council 

HHJ Judge Stephen Wildblood KC is the designated family judge for Bristol and surrounding areas