Where can I mourn? Psychodynamic contributions to working in residential child care

ABSTRACT

Loss permeates the experience of being placed in residential child care, yet residential workers are rarely trained to work with young people who are grieving the loss of family and home. This article will provide an overview of psychodynamic theories of mourning, and will discuss how grief work can be facilitated for children and youth in residential child care.     

The Long Goodbye: Women, Companion Animals, and Maternal Loss

Heightened and often anxious attachment to companion animals can be one of the sequela of women's unresolved grief over early maternal loss. Clinical data suggest that, especially among women, the death of pets can reactivate the unfinished mourning over the mother. Drawing on one extensive case study, this paper examines this little explored, but commonly experienced relationship. From the perspectives of attachment theory and feminist therapy, the paper addresses the human-animal bond, gender differences in grief, the long term effects of early maternal loss, later attachment style, and companion animals as internalized parent/child figures. Recommendations for treatment are offered to help women work through both losses.     

Concurrent child history and contextual predictors of children's internalizing and externalizing behavior problems in foster care

This study contributes to current research on the behavior problems of children in foster care by analyzing a more comprehensive set of concurrent child history and contextual predictors. Kinship home status and sibling status (i.e., whether the sibling is a biological sibling to the foster child) were evaluated as moderators of significant associations. Data were collected at the baseline of a foster parent training intervention program prior to any intervention services using parent phone interviews (N = 310, 51.6% male, M age = 7.57 years). Two linear hierarchical regressions were used to evaluate each set of predictors' association with behavior problems as well as each individual predictor's contribution. Results indicated that as a set, the contextual variables predicted a significant and unique amount of variability in the child's internalizing and externalizing behavior scores, whereas the child history variables did not. Specifically, the child's placement in a non-kinship home, being in a non-ethnically matched child-parent pair, higher parent stress scores, a greater number of prior group home placements, and higher internalizing behavior scores for the child predicted higher child externalizing scores. Higher parent stress scores, higher focal sibling externalizing behavior scores, and higher externalizing behavior scores for the child predicted higher internalizing scores for the child. The association between focal sibling externalizing behavior scores and child internalizing scores was moderated by kinship home status, such that there was a stronger association between the focal sibling's externalizing score and the child's internalizing score if the child was in a kinship compared to a non-kinship home. Implications for intervention services are discussed, particularly the importance of assessing the child's foster home environment when addressing the child's behavior problems.     

“She was more than a friend”: Clinical intervention strategies for effectively addressing disenfranchised grief issues for same-sex couples

This article focuses on grief experienced by same-sex couples with attention to the distinct factors that influence same-sex grieving partners within all social work system levels. An actual case narrative—the first author's lived experience—guides the reader through a powerful, personal journey to gain a greater perspective and connection on the impact of grief and loss. The concept of disenfranchised grief is applied to same-sex couples focusing on the grieving process. The authors delineate effective strategies for practitioner intervention for those working with individuals experiencing grief due to the loss of their same-sex partner. Particular emphasis is placed on cultural competence and cultural humility for enhanced effectiveness while working with same-sex-partner grief issues.     

The Autodriven interview: A photographic viewfinder into children's experience

As children have been increasingly conceptualized as active participants in their own social worlds, researchers have sought methods able to reveal children's perspectives as arbiters of their own experience. In an autodriven interview, photographs of the child's experiences serve as the basis for a child‐directed interview. Studies using this method illustrate its benefit for revealing child‐relevant content. In a study of childhood chronic illness, autodriving encouraged the child's free recall, sense of personal control, and ability to reflect upon photographed events.     

Understanding loss: The origins and value of current theories of loss

Abstract

This article discusses the origins of concepts concerning the nature of loss and its consequences for mental health. It suggests that, while the experience of loss is self-evidently of importance for individuals, the view that loss represents a major risk factor in mental health has led to unwarranted professional intervention in the belief that grief must be 'resolved' in order to prevent a negative psychological impact. It is suggested that this view has not been sufficiently explored theoretically and that professional helpers, such as social workers and counsellors, should use models which purport to facilitate mourning with some caution.     

Parent and Child Therapy: An Attachment‐Based Intervention for Children With Challenging Problems

Parent and Child Therapy (PACT) is an attachment‐based intervention for children aged between 4 and 12 years old experiencing emotional and behavioural problems. It is appropriate for distressed parent—child relationships which have not responded to systemic family therapy. PACT seeks to reframe parent—child relationship distress using narrative techniques and experiential tasks based on the concept of supported looking. Therapy occurs in parallel for parent and child using a one‐way screen. PACT improves parents' reflective capacity and sensitivity, and for the child's sense of security in her primary attachment relationship. An outline of the four stages of PACT is presented along with a case study to illustrate the course of PACT. Finally, we discuss the dissemination of PACT within a busy child and adolescent mental health service and outline our plans for future outcome evaluation.     

The Consequences of Parental Underestimation and Overestimation of Youth Exposure to Violence

This study investigated differences in parent and child estimates of the child's exposure to violence. Using data (N = 1,517) from the Project on Human Development in Chicago Neighborhoods, analyses related differences between parent and child reports of the child's exposure to violence to the child's psychosocial functioning. Most parents (66%) underestimated their children's exposure to violence. Further, parental underestimation was associated with the child's internalizing and externalizing problems and delinquent behaviors but parental overestimation was not. Family support partially mediated these associations. Parental underestimation of the child's exposure to violence, therefore, reflected lower levels of family support, which in turn led to more internalizing and externalizing problems and delinquency for the child.     

The Effectiveness of Guided Mourning for Adults with Complicated Mourning

Loss of a loved one is a common experience. For the bereaved to grieve is a natural expression of the loss, and mourning is the process through which one must pass in order to adapt to the reality of the loss. For various reasons, for some the mourning process becomes complicated, and the bereaved gets “stuck” in the process and fails to return to living life unburdened by the loss. Practitioners need to be aware of interventions that are proven to be effective in addressing complicated mourning. Initial search began with experimental and quasi-experimental studies but ended up including four pre-experimental studies. The study included adults who are not known to be intellectually challenged but who have suffered the loss of a loved one as a result of natural (illness) or violent (homicide, suicide, fatal accident) circumstances. A total of seven studies were reviewed. Guided mourning can be effective in helping an adult move through the mourning process. It is, however, imperative that the practitioner understands the mourning process and what has prevented the bereaved from moving forward through the process. Given how common grief and mourning are in the human experience, there is surprisingly little research on what is effective in helping those whose mourning has become complicated. More needs to be done in this area, including clearly defining the specific components of guided mourning and the clients who will be best served by this intervention.     

Brief Emotion Focused Family Therapy: An Intervention for Parents of Children and Adolescents with Mental Health Issues

This study evaluated the 2‐day intensive modality of Emotion Focused Family Therapy (EFFT). The intervention attempts to prepare parents to take a primary role in their child's recovery from a range of mental health issues. One hundred and twenty‐four parents completed the intervention and provided data a week prior to intervention, post‐intervention and at 4‐month follow‐up. Results include significantly reduced parent blocks and increased parental self‐efficacy in relation to involvement in their child's recovery, as well as significant improvement in child symptomatology. The findings confirm positive results from an earlier pilot study involving eating disorders and demonstrate the potential for EFFT as an intervention for a range of clinical problems in children and youth.     

Child abuse prevention: Blending research and practice

For over two decades, child abuse interventions have been plagued by poor definitions of what (or who) exactly is being treated, what constitutes ‘success’, and how services can be delivered in such a way as to minimize the harm to the child and to his/her family. Most recently, intervention/prevention programmes reflect the growing recognition that child maltreatment is the product of the interaction between the parent's abilities and resources and the child's emerging behavioural and emotional characteristics (i.e. the parent–child relationship), and place less emphasis on individual psychopathology. Accordingly, ways to strengthen this relationship offer considerably more promise than those aimed at correcting only one component (i.e. the parent) or treating only the visible symptoms of conflict. In an attempt to focus greater effort on prevention and early intervention, this paper reviews prominent risk factors that have been linked to physical abuse and neglect of children and their consequences. Major intervention targets are identified from this literature and discussed in reference to: (a) problems related to the family context; (b) child treatment needs; and (c) parent/caregiver treatment needs. The paper concludes with a discussion of promising developments in early intervention that are beginning to address problems in the early formation of the parent–child relationship (i.e. the pre-natal and infancy periods of development) and problems associated with parental competency and family support. Most notably, preventive efforts have been associated with more positive parenting knowledge, attitudes, skills, and behaviour, as well as fewer child injuries, emergency room visits, and reports to protective agencies among at-risk parents and children. Further evaluation and expansion of these programmes appears to be warranted by these data.     

Parental Housing Assistance and Parent‐Child Proximity in Italy

Many studies of intergenerational exchanges include parent‐child proximity as an exogenous explanatory variable. Proximity may itself be a consequence of intergenerational resource flows, however. We analyze patterns of economic transfers between generations and their relationship to parent‐child proximity in Italy. Parental support for a child's home purchase may influence the child's choice of location, whether to facilitate parent‐child contacts, grandchild care, or parent care. We examine the situation of married couples, focusing on housing help received and the association of that help with proximity to each spouse's parents. Using 1998 survey data and multinomial logistic regression models, we find that past housing assistance has a significant effect on current proximity to each spouse's parents, controlling for parents' survival, family composition, and other factors.     

Cooling the Mother Out: Revisiting and Revising Goffman's Account

This article revisits Erving Goffman's important yet neglected metaphor of “cooling the mark out.” Drawing on a study of mothers whose child has Down's syndrome, I explore the value of Goffman's work for capturing how mothers interpret their child's diagnosis as a loss and rectify this breach by constructing an acceptance of their new situation. The mothers' accounts highlight how Goffman's contentions can be enriched by acknowledging the gendered, temporal, and public character of a loss. This article, thus, can be read both as a celebration and critical revision of his theoretical contribution.     

A STRUCTURAL APPROACH TO UNRESOLVED MOURNING IN SINGLE PARENT FAMILY SYSTEMS*

The mother's depression is considered as a special problem in the family therapy of single parent families. It is seen as resulting from unresolved mourning that is maintained by the family system. Several reasons why the single parent family's structure seems inherently vulnerable to unresolved mourning are offered. Some techniques of Structural Family Therapy are proposed in a specific order to facilitate mourning in such families. A successful mourning experience requires a restructuring of the family that provides energy for the remainder of the therapy.     

Selected Aspects of Parenting and Children's Social Competence Post-Separation:

The purpose of this study was to assess the moderating effects of child's sex, ace, and family economic hardship on the relationship between (a) residential mother's parenting and frequency of nonresidential father's visitation, and (b) child social competence following marital separation. Dimensions of mother's parenting included loss of time spent with the child since separation, mother's current levels of companionship and coercion, and daily involvement in meaningful activities with the child. Dimensions of children's social competence included dependency, aggression, anxiety/ withdrawal, and productivity. The results indicated that the relationships among mother's parenting, father's visitation, and children's social competence are fairly consistent, regardless of child's age, sex, or level of family economic hardship. The few exceptions are noted and intervention implications are discussed.     

How Do Social Workers Respond to Potential Child Neglect?

Although neglect is a common form of child maltreatment, it can be difficult to detect within a clinical interview between a social work clinician and client for the purpose of assessment and intervention, leading to a failure to act and secure a child's safety. This Canadian study utilized the objective structured clinical exam (OSCE) to assess social work clinicians' ability to recognize and respond to a case of suspected child neglect. Twenty-three participants (social work students, recent graduates of a Masters in Social Work programme, and experienced social workers) conducted a 15-minute interview with a standardized client followed by a structured reflective dialogue focusing on case conceptualization and emotional awareness. Qualitative analysis of the reflective dialogues revealed participants' difficulty in detecting child neglect as opposed to focusing on a client's negative self-beliefs or mental health issues. Implications for social work education and practice are suggested.     

When a Baby Dies: Ambiguity and Stillbirth

ABSTRACT

Stillbirth, or sudden intrauterine death, is in many ways an invisible death. A stillborn infant is one mature enough developmentally to have lived outside the womb but for some reason, or perhaps multiple reasons, was born dead. Stillborn infants are often demarcated from other types of child death and are rarely legitimized as a real loss. When a baby is stillborn, mothers, fathers, surviving siblings, and grandparents may struggle for years to find answers to a series of complex and inherently unanswerable questions. The family members' profound feelings of grief and ambiguity loss are borne in a social environment that denies this reality because the child's death was invisible to most of the world. Boss's framework for understanding ambiguous loss proves quite helpful in thinking about stillbirth.     

The Impact of Childrens' Divorce on Parents:

Little has been written to date concerning the impact of an adult child's divorce on his or her parents-their anguish, grief, concern, humiliation or even occasional elation. The senior parent's reactions affect their own life cycle development. And within the context of a cybernetic circular systems model of conceptualization about family relations which we adhere to, it is posited that their reactions impact upon their childrens' (and grandchildrens') post divorce readjustment. This article is written to attempt to begin to address this issue and to fill this gap in the literature. It is primarily on the author's combined clinical observations with hundreds of clients and friends and their experiences living through their childrens' divorces. The next step is process and outcome research about this issue.     

PARENTAL DEATH AS A PRECIPITANT OF MARITAL CONFLICT IN MIDDLE AGE*

When a long-standing marriage suddenly becomes conflictual, one precipitant can be the recent death of the parent of one of the partners. The bereaved spouse can identify with the deceased parent, attacking or withdrawing from his or her partner; or he/she can become irrationally angry because the partner cannot replace an idealized parent. The main goal of therapy is to facilitate the bereaved partner's mourning of the dead parent. Choosing an effective therapeutic method depends on the couple's capacity for mutual empathy and support and their need for insight. Without marital therapy, unrecognized mourning may contribute to the breakdown of long-standing marriages.     

A bereavement model for working with families of handicapped children

SUMMARY. This paper presents a model for counselling families of young handicapped children. It is argued that the process that parents go through following the birth of a handicapped child is akin to bereavement following loss. Therefore, professionals on a wide range of disciplines should be sensitive to the grief that parents are experiencing. The authors have used Le Poidevin s theory of adjustment to loss to structure their own theories and to devise a checklist to aid other professionals. Their experience indicates that the birth of the handicapped child may act as a catalyst for psychological growth in parents—mast particularly mothers.