‘The Whole Family Suffered,So the Whole Family Needs to Recover’: Thematic Analysis of Substance-Abusing Mothers’ Family Therapy Sessions

ABSTRACT

Substance-abusing mothers and their children are more likely to experience a range of social, behavioral, and psychological difficulties. Despite the significant challenges faced by these families, little is known about their experiences in treatment. The current study analyzed 12 sessions of family therapy using thematic analysis to identify common themes that arose during discussion between substance-abusing mothers and their children during family therapy. Mothers’ ages ranged from 28 to 35 years old, and the children's ages ranged from 12 to 14 years old. Four therapy sessions from 3 families were coded for a total of 12 therapy sessions. An ecological framework was used to classify themes, in which themes related to each level of the families’ ecological systems were identified. Thematic analysis of the therapy sessions indicated that mothers and their children primarily discussed topics related to their relational and emotional needs. The findings indicated that mothers with substance use disorders and their children have unique treatment needs that should be addressed when the mother seeks treatment. More research is needed to further clarify and confirm the observations in this study. In particular, future research should include a larger sample and quantitative methodology.     

Social support available for substance‐dependent mothers from families with parental substance abuse

Substance‐dependent mothers, who have grown up with parental substance abuse, struggle during and after treatment to abstain from substances while trying to process traumatic experiences and integrate their family into society. The aim of this study was to explore the social support available for these mothers to help them stay abstinent and create safe family environments for themselves and their children. Using purposeful sampling, we approached nine mothers admitted for 1 year to a family ward at a substance abuse clinic and their significant others. Through in‐depth, qualitative interviews, first with the mothers, later with their significant others, we investigated characteristics of the available social support. The findings indicated that the significant others had limited resources and were themselves exposed to adverse and cumulative psychosocial and socioeconomic risk factors. Their relationships with the mothers were, nevertheless, close, consistent and reliable. Supporting the existing social network should be an integrated part of the work of family welfare services aiming to help substance‐dependent mothers from families with parental substance abuse to rehabilitate and to integrate successfully into local communities.     

Substance‐dependent women becoming mothers: breaking the cycle of adverse childhood experiences

Parenting may be particularly challenging for substance‐dependent mothers who have grown up with parents who themselves had substance use disorders (SUDs). The aim of this study was to explore how substance‐dependent mothers describe their childhood experiences with substance‐abusing parents and the association between these earlier experiences and their own role as caregivers. Using purposeful sampling, mothers admitted for 1 year to a family ward at a substance abuse clinic were approached. Through in‐depth, qualitative interviews, nine substance‐dependent mothers described their lives in the form of present, past and future tense. The findings indicate that substance‐dependent women, who have experienced SUDs in their families of origin, face several major challenges when they become mothers. Some describe having lived their whole lives ‘on the edge of society'. This makes their rehabilitation process more complex. All mothers work to abstain from substances, process traumatic experiences and integrate their family into society. They need help to build supportive social networks and to establish a safe and predictable family environment for themselves and their children. The therapeutic implications of these findings will be discussed.     

Parenting and children’s negative emotionality,self‐regulation,and academic skills: The moderating role of fathers’ residency

We examined whether fathers’ residency modified the associations among mothers’ supportiveness, father involvement, children’s negative emotionality during toddlerhood and children’s academic skills in pre‐kindergarten via children’s self‐regulation. Participants were 2,291 mothers (M_age = 23.24 years) and children (M_age = 14.99 months at Wave 1; 50.7% girls) in the Early Head Start Research and Evaluation Project. Results revealed distinctive associations by fathers’ residency: self‐regulation mediated the association between mothers’ supportiveness and academic skills only in resident‐father‐families. Self‐regulation mediated the association between negative emotionality and academic skills only in nonresident‐father‐families. The findings highlight the family processes of mothers, fathers, and children in low‐income family contexts that contribute to children’s academic skills, and how those family processes may vary by fathers’ residency status.     

“It's like he just goes off,BOOM!”: mothers and grandmothers make sense of child‐to‐parent violence

Child to parent violence (CPV) involves continual and cumulative abusive actions perpetrated by children and adolescents towards their parents or caregivers. This abuse produces short‐term distress and ongoing long‐term harmful consequences for parents and their families. Practitioners, researchers and policy‐makers are increasingly challenged to identify, conceptualize and respond to this form of family violence. A major challenge is that parents and caregivers under‐report this abuse so there is a lack of awareness and understanding of their psychological experiences in relation to CPV. This research adopts an interpretative phenomenological approach to explore the psychological experience of CPV. Interviews were conducted with six New Zealand mothers and two grandmothers who all experienced CPV. This abuse was experienced as an ‘emotional bloody roller coaster’ of unconditional love through to hatred; as ‘judgement’ – self‐blame and others' blame of their parenting skills; and the ‘absent father’ in their adolescents' lives was drawn on as an explanation for the abuse. Taken together, these psychological experiences identify the silencing of CPV is related to parents' conflicting emotions towards their children, their thoughts and feelings about themselves and how other people view them, and the impact of an absent father figure in their children's everyday lives.     

Children's experiences with an intervention aimed to prevent further physical abuse

Although many children across cultures are victims of physical abuse, few treatment models target these children and their parents. In Sweden, Combined Parent–Child Cognitive Behavioural Therapy for families at risk for child physical abuse has been successfully used according to pretreatment and posttreatment studies. However, few studies have explored how physically abused children experience treatment. This study includes 20 physically abused children aged 9–17 who completed Combined Parent–Child Cognitive Behavioural Therapy. Children had a positive overall impression of the treatment and highlighted addressing the abuse, as well as processing their experiences as particularly essential. Children described a positive transformation in their family life as a result of treatment, including violence cessation and bonding among family members. Children experienced the intervention as inclusive and child‐friendly. The implications of the promising findings are discussed.     

The Intersubjective Action of Case Advocacy and Engagement in a Working Alliance

This article presents a viewpoint for explaining the positive associations between case advocacy and the engagement in a working alliance of low‐income single mothers at‐risk for physical abuse of their children. Utilizing narrative vignettes from a qualitative study about clinical social workers’ experiences in engaging this population, the article suggests that client/worker partnerships in case advocacy enhanced opportunities for client/worker mutuality and for worker capacities to experience and communicate empathy to their clients. Theoretical constructs from Daniel J. Stern’s infant research and neuroscience are then applied to suggest an intersubjective framework for understanding what occurred.     

Blame and family conflict: symptomatic children as scapegoats

The study’s aim was to examine the relation between children’s symptom type, specifically externalized vs. internalized symptoms, and children’s perception of being blamed by family members for various family conflicts. The research hypothesis was based on theories of family therapy, in particular on the concept of scapegoating and projective identification processes. The subjects were chosen from treatment centres for children and adolescents, using the Achenbach Self‐Report Questionnaire. Subjects included males and females, aged 10–17, who had either internalized or externalized symptoms and no history of organic or psychotic disorders. The control group consisted of non‐symptomatic children. The research groups also included each child’s sibling closest in chronological age, who served as an additional control group. A total of 161 children participated in the study. It was found that externalizing children reported greater subjection to parental blame than did the other children.     

The symptom‐carrying child as a preserver of the family unit

The aim of this study was to investigate the operational validity of the theoretical concept of the ‘symptom‐carrying child’. Its purpose was to examine whether, and to what extent, the symptom‐carrying child plays a central role in maintaining the internal balance and unity of the family, and whether he holds a focal position in ‘triangulation’. The research hypothesis was based on theories of family therapy, in particular on the concepts of the ‘identified patient’, and ‘triangulation’. Our major question was whether symptomatic children would be more likely than non‐symptomatic children to exhibit greater responsibility and involvement in their parents’ marriage, and as such act as preservers of the family unit. Subjects in each of the groups participating in this study were identified in treatment centres for children and adolescents using the Achenbach Self‐report Questionnaire. Subjects included males and females aged 10–17, who had either internalized or externalized symptoms and no history of organic or psychotic disorders. The research groups also included each child’s parents and the sibling closest in chronological age, who served as an additional control group. A total of 118 children from nuclear, two‐parent families participated in the study. It was found that symptom‐carrying children exhibited greater involvement and responsibility in their parents’ marriage than non‐symptom‐carrying children. Likewise symptomatic children reported that they had greater influence on their parents than children without symptoms.     

Who uses public childcare for 2‐year‐old children? Coherent family policies and usage patterns in Sweden,Finland and Western Germany

European countries have increased their public childcare provision for children under age 3. However, it is unclear if and how usage patterns differ across countries. This study examined the relationship between the socio‐economic characteristics of mothers and the use of childcare for 2‐year‐old children. Using European Union Statistics on Income and Living Conditions data for the years 2005–2008, we analysed the characteristics of mothers and usage patterns in Sweden, Finland and Western Germany. To single out the effect of maternal employment, working and non‐working mothers were investigated separately. Our findings showed that, in Sweden, a country with strong support for dual‐earner families, usage was largely independent of mothers' characteristics. However, in Western Germany, where more support is given to male breadwinner families, and in Finland, a country with pluralistic family support, highly educated mothers were found to be more likely to use childcare than were mothers with lower levels of education.     

For the child's sake: parents and social workers discuss conflict-filled parental relations after divorce

After a divorce, the former partners have to form new relationships between themselves as parents, and with their children. What does this reconstruction involve? What are the tasks facing the parents? What are the areas of conflict? This paper attempts to answer these questions. Eight initial sessions of parental mediation were chosen for the analysis. The analysis indicates that statements about the ways in which parents are entitled to their children, and vice versa, are common denominators for the transition from nuclear family parenting to post‐nuclear family parenting. In the sessions, parents dealt with this duty by fighting a battle for a place in the children’s lives. The battles were expressed in negotiations about time and place. The analysis revealed two different solutions to the problem of the parents’ entitlements. One was the creation of the homogeneous family, with one parent and the children living together in a close relationship, giving the other parent visiting rights. The other was to form a heterogeneous family, based on the idea that it is possible to build a childhood on differences and dissimilarities. Most of the conflicts originated from parents’ efforts to create homogeneous families.     

Child sexual abuse: a marker or magnifying glass for family dysfunction?

A report of child sexual abuse leads to a multi-agency investigation that often reveals other maltreatment and dysfunctional behaviors within the family. Due to recent developments in this field, the emphasis of the investigation has shifted to the child’s history rather than information from the parent or accused, or the presence of injuries. In the last 10 years Children’s Advocacy Centers have become a central component to the investigation of child sexual abuse and provide a means for long-term follow-up of referred families. The idiosyncrasies of this investigative and advocacy system have provided an in-depth view of the families of sexually abused children.Four family types emerge: safe and secure, safe and insecure, unsafe and enmeshed, and unsafe and insecure. The characteristics of child sexual abuse, the response to the child’s disclosure of abuse, and the prognosis for the child victim vary among the different family types. An innovative long-term program of wrap-around services for sexually abused children and their families provides counseling, peer activities, family mentoring, and child mentoring while tracking the symptoms and behaviors of the child victims. The identification of a child victim of sexual abuse can be a tragic crisis and an opportunity for intensive and timely intervention.     

Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

‘Poor prison flowers’: convict mothers and their children in Ireland, 1853–1900

Pregnant women and mothers were among the thousands of individuals who were sentenced to at least three years’ penal servitude and admitted to the nineteenth-century Irish female convict prison. While some babies were born behind bars, others were permitted to accompany their convicted mothers into the prison after the penal practice of transportation had ceased. Other dependent children were separated from their convicted mothers for years, cared for by family members or friends, or accommodated in Ireland’s growing web of institutions. Using individual case studies, this article focuses on convict mothers and their young offspring. It draws attention to the increasing restrictions on the admission of infants that were imposed as the nineteenth century progressed, the problems that children of various ages in the penal system seemed to pose for officials, and the difficulties faced by incarcerated mothers who wished to maintain communication with their offspring. This article argues that while there were benefits to parenting within the confines of the prison, sentences of penal servitude had a significant impact on the lives of dependent offspring by dislocating families, separating siblings, or initiating institutional or other care that broke familial bonds permanently. In so doing, the article reveals attitudes towards motherhood as well as female criminality and institutionalization generally during this period and sheds light on an aspect of convict life unique to the women’s prison.     

Shared Understanding of Parental Differential Treatment in Families

This study examined the extent to which children and parents have concordant views about parental differential treatment (PDT) and whether such concordance is linked with variations in sibling relationship quality. Seventy‐four 11‐ to 13‐year‐old children, their older siblings, and their parents were interviewed about their experiences with PDT and the quality of the children’s sibling relationships. Levels of agreement about the magnitude, direction, and fairness of PDT were generally low to moderate. However, sibling agreement about the magnitude of parental differential affection and the fairness of maternal control and affection were associated with more positive sibling relationships. Whereas family members were more likely to agree that parental behaviors were fair when they were concordant about the extent to which differential affection occurred, agreement about controlling behaviors was associated with lower levels of agreement about fairness. In addition, the frequency of family discussions about parental behaviors was not linked to shared perceptions of fairness. Results emphasize that capturing the multiple perspectives of family members is crucial for obtaining a comprehensive portrayal of family relationships.     

Marital Conflict, Child Emotional Security about Family Relationships and Child Adjustment

Addressing a gap in process‐oriented understanding of relations between marital conflict and children's adjustment, propositions of the emotional security hypothesis from a family‐wide perspective were tested in a longitudinal research design. Participants were 181 families and their 11–12 year‐old‐child (115 boys, 76 girls) living in Wales, in the United Kingdom. Relations between marital conflict, children's emotional security about marital conflict and parenting, respectively, and children's adjustment were assessed based on reports by mothers, fathers, and children and videotaped analogue procedures completed by children. Structural equation modelling indicated that children's emotional security about interparental conflict (emotional regulation, cognitive representations and behavioural regulation) mediated the relation between marital conflict and children's security about parenting. Processes pertaining to children's security in multiple family systems (i.e., interparental and parent–child) provided an indirect mechanism through which interparental conflict affected children's symptoms of psychological distress (internalising and externalising problems) assessed 12 months later. Future directions for further tests of comprehensive, theoretically based models for the effects of marital conflict on children are discussed.     

Research Review: The role of grandparents in intergenerational support for families with disabled children: a review of the literature

The family in late modernity faces demographic change. However, it is still apparent that intergenerational relationships and exchanges of resources are valued. There is a growing literature on the important role that grandparents play in their children’s families. In contrast, there is limited research exploring the support grandparents provide to families with disabled children. This is an important gap in our knowledge, as families with disabled children frequently face additional caring responsibilities and emotional demands. From the studies that do exist, it is clear that grandparents’ support to families with disabled children is generally valued. However, the literature remains partial: past studies are small‐scale, focused upon parents’ perceptions of support (especially mother’s), and frequently based upon North American data. Recognizing these limitations and the fact that grandparents themselves have support needs which require consideration, this paper identifies key areas where important issues remain unanswered and further research is required. It argues that research is needed to begin untangling the different support needs of parents, grandparents and other family members, and the different effects of grandparent support that different family members’ experience. Exploration of grandparents’ own support needs also indicates the need for wider policy and service consideration.     

Broadening constructions of family violence: mothers' perspectives of aggression from their children

This qualitative study used feminist insights to explore experiential aspects of the phenomenon of child‐to‐mother violence from the perspectives of six women survivors. Participants took part in conversational style audiotaped interviews lasting between two and four hours. Feminist analysis revealed that fear and violence had become a feature of mothering for these women. Three themes were identified: It was only a matter of time: feeling intimidated and under threat; He just punched me: physical violence from child to mother; and Other men in the house: violence directed to the mothers by friends and associates of their children. Currently the literature overwhelmingly constructs family violence as elder abuse, spousal/partner violence, or child abuse, and generally fails to acknowledge, or address, violence from children to parents. However, findings from this study suggest that the discourse about family violence needs to be broadened to include child‐to‐mother violence. Implications of this study for practice and research are discussed.