The therapeutic management of emotionally deprived parents whose children are in residential treatment.
I have always of necessity and of choice worked with the parents of disturbed children. This particular paper was written for a course run by Chris Holtom at Bristol University for child care officers, probation officers, and others. My audience gave many interesting examples of experiences with deprived parents.
I am finding difficulty in starting to write this paper, because I cannot decide where to establish a beginning. I am going to make basic assumptions concerning your starting point: I am going to assume that most of what I might say has already been experienced, realised and conceptualised by all of us, so that I could be wasting our time in covering a well tilled field.
There is a considerable collection of literature on the whole subject of separation of children from their families, with which I am sure you are already familiar; so that I propose to narrow down the subject to certain special considerations which could perhaps be interesting to discuss together.
We are all one way or another concerned with the effects of severe emotional deprivation in parents and children, and with the phenomena of ‘acting out’ which stem from a breakdown in communication both with the self and others.
The people in a residential place, be it approved school, maladjusted children’s school or children’s home, may be suddenly confronted with a massive bloc of deprivation; which can have serious effects on grown ups and children alike. How best we can deal with this confrontation is what I wish to consider here.
In the therapeutic school where I work, we are selecting cases entirely on a basis of severe emotional deprivation during the first year of life. This being so, we have had to evolve a plan for admission which will avoid a sudden and tremendous build up of stress for ourselves, the parents, and the child.
Because children are referred to us from child guidance clinics, we are in a position to make the whole process of separation from the family and admission to the school fairly gradual. We start with interviews at the clinic, followed by one or more visits to the school. Eventually the parents bring the child to the actual placement, to people and a place already fairly familiar. There have, however, been occasions when we have admitted an urgent case from one moment to the next. I am sure that such a course of action is traumatic, but must become necessary in many cases where a child is committed to an approved school, or has suddenly to be taken into care because of some family catastrophe. On the whole, our small customers at the Mulberry Bush have been living in a sate of endemic crisis, without total breakdown having taken place. Home, therefore, however pathological, continues to exist, thus making a gradual process of placement possible. Because deprived children tend to be the children of deprived parents, we can assume an absence of transitional experience in their lives: the filling of gaps in their emotional experience must be our primary task, and ‘bridging’ techniques in placement procedure can make a foundation on which we can hope to build, in providing primary experience.
The sudden removal of a child from his family, however pathological, is likely to be traumatic, and to reproduce previous traumatic breaks in the continuity of the child’s existence which have led to his present state. Nothing can be more likely and more traumatic than such faithful reproduction for child and parents of earlier disasters, in the residential setting. There are circumstances in which there is no alternative, where transitional techniques cannot be employed, and the break between child and family has to take place form one moment to the next: at least we can be aware that this is something terrible, even in cases where there may be cruelty and neglect.
It is important to realise that the parents of severely emotionally deprived children are likely to be themselves deprived, even though this may not be immediately apparent from histories or initial interviews. One is liable to expect envy and hostility from the parents of disturbed children, arising from their feelings of inadequacy in having to allow outsiders to care for their children. This kind of reaction is certainly to be expected from the parents of neurotic children: in cases of deprivation the problem is rather different. Parents in such cases feel envy also, but they are envious not of us, but of their own children, because their children are receiving the care which they know themselves to need. Once we become aware of this particular form of envy, we are already in a position to establish a link with the child and his parents (as compared with casework with individuals). It is possible to make limited provision for deprived parents, in terms of communication, food, time and so on.
We are going to have a difficult task, in any case, in attempting to preserve the child’s place in the family. If we start our programme by breaking the continuity of the family life by a sudden act of separation, we are certain to have much more difficulty than we need expect. If we can link both parents and child to us and the place, by localised provision before the child is actually placed, we may be able to replace an act of separation by a process; which, though sad and painful, need not be inevitably traumatic and can establish a bridge between family and place. Psychiatric social workers, health visitors, child care officers, teachers and probation officers can all play a part in this process, by acting as catalysts through whom the child and his family can come into communication with the people in the place (be it children’s home, school for maladjusted children, or approved school). This assumes that the main catalyst agent is already in touch with the people in the residential place: this would seem to be the essential in any case.
Deprived people, both grown-ups and children, have usually had to shift their trust from people to things: environment, therefore, can offer either security of threat. The unknown environment tends to be the threatening one, and I have known deprived parents and children to disorientate completely in going round our school for the first time. One must provide families with a base, a ‘safe place’ from which they can talk with members of staff, where they can have some food, and where they can be securely alone.
The illusionary ‘safe place’ will be a permanent need, because such people have no safe place within themselves. The ‘safe place’ can only exist at the price of other places being ‘dangerous’: if the safe place becomes less safe, the other places become more dangerous.
Initially, we ourselves combined with our residential environment will be felt as a dangerous place; so that by providing a family base we are preventing the child’s family from starting their contact with us from a persecuted position. Of course we are hoping to establish relationships, but this is a long-term treatment aim. In working with deprived families, ‘things’ may come before ‘people’, just as acting-out is likely to precede communication.
What we do can in a symbolic way perhaps be more use than what we say, however relevant the latter may be. However warm a welcome we give to the family, what we feel and what we express may not reach them if the sun is not shining or if the room is cold. The hot cups of tea may convey this warmth, evoking what Sechchaye has described as symbolic realisation.
When we are trying to help neurotic people, we can assume that they will transfer this and that on to us from their own early experiences; so we may become established in all sorts of roles which do not often have much to do with what we really are like as real people. We accept such roles, but do not act out in the roles; we keep these within the framework of our particular functions.
Working with deprived parents and children, we may be having very different responsibilities and commitments, since for them there can be no transference in areas where they have not had experience. This state of affairs leads to what Little has called ‘delusional transference’: for deprived people we are the parents – there is no ‘as if’ in such a feeling. It is all very well when such a delusional transference is positive, but when the negative form turns up we can feel destroyed by the violence of annihilating rage which we may collect. Sometimes we may receive this terrible onslaught in the first place; more often we start with a positive delusional transference, in which we are the ideal parents who can take care at last of the parents and their children. They have been looking for such maternal care all their lives: so that if we reject these deprived fathers and mothers of deprived children, we confirm all that they suppose. On the other hand, we are in no position to take on full therapeutic responsibilities in relation to these families: it is their children who are our clients. Workers in a residential place recognise intuitively the needs of deprived parents, and realise how overwhelming would be their demands: so they tend to defend themselves against intolerable commitment, and in doing so tend to build a wall between themselves and the family of the child, who is now on the workers’ side of the wall of defence.
What I am suggesting is the possibility of meeting the parents’ needs in a highly localised way from the start. In fact we are much more likely to be able to give real therapeutic care to deprived parents than to neurotic ones, because provision rather than interpretation is the primary need. It is this fact that makes it possible for unanalysed therapists to learn this very special skill. The workers will need support and supervision; but they are quite likely to have sufficient personal resources at their disposal to provide appropriate therapeutic management in all areas for the deprived children, and in localised form for their parents.
People working with deprived parents tend to ask: ‘How can we hope to help such damaged people? – how can the little we can do be of any use?’ I think we can only reply as we would to the same question put to us concerning severely emotionally deprived children and adolescents: ‘The ego is built of experiences. Therefore, in terms of strengthening a weak ego, we can be sure that no positive experience that we provide will be wasted.’ This is a problem of economy, not of success or failure. We can only give what can be spared; but localised provision can be of value: parents and children can increase functioning areas through such provision.
I very rarely use the word ‘adult’, preferring to say ‘grown-up’. ‘Adult’ seems to deny that a child has grown up, confirming the split which many parents and children feel divides them from each other. In recognising the deprived child who has grown up into this unhappy and troubled parent, we can understand the unsatisfied and continued childhood needs of such a grown-up.
Talking about herself, a little patient of mine once said of her drawing, ‘This is a puddle in a pond’. The child hidden in the personality of the grown-up may be as secret as the puddle in the pond. The more well a mother is, the more linked she is with her own childhood, and therefore the more able to identify with her child’s needs. If we can help the deprived grown-up to let us know about the hidden child with its desperate needs and to allow us to meet some of them (however small), we may be putting the mother in a position to feel for her child.
Of course, this is equally true of fathers, but because deep deprivation belongs to the first year of life we can assume that the mother is our first consideration, in the interests of her child. On occasions, however, the father has been the parent who has been able to feel maternal towards the baby, while the mother has been forced into a paternal role. Pathological though this is, we may have to be thankful that there is maternal feeling somewhere, and make use of what is available. In such a case we certainly cannot begin to alter the psychopathology of the parents. Here again, we must accept a very limited aim, but the little we can do may go a long way eventually.
It is a delicate task to help the deprived children in the personalities of the parents, whilst continuing to respect them as grown-ups, objectively speaking. However, we do respect as people within their own right the patients we are treating who are indeed actually children: similarly, we can soon perceive the functioning areas in even very deprived parents, where we can respect and support their maturity.
I remember, from long ago, a very disturbed father whose child was having a period of treatment in the Mulberry Bush School. We had come to know him quite well, and he was talking about his own need to come and be a child also in our care. He said, ‘I wish I could do something here that I would do if I were small and living here.’ I knew that he could draw very well, and suggested that he might paint a picture on a wall in the place. He was tremendously pleased, set to work sitting on the floor in the corner of a play room, and painted a fine ship – low down on the wall, at just about the height he would have been able to reach as a little boy. We could all (grown-ups and children alike) respect and admire his skill and the beauty of the ship; but at the same time we could sympathise with the child who was briefly among the other children in our care.
I have considered some ways by which parents may be linked to their residentially placed children, through their own localised experiences provided by the people in the residential place. I wish now to consider the more direct links between the deprived child placed residentially, and his parents.
Communication between the deprived child and his parents has probably broken down – if it has ever existed. There can, or course, be an institutionalised exchange of stereotyped phrases, but this is not real communication; indeed, they are liable to react out themselves. We tend to think in terms of maintaining a link between child and home: but in the care of deprived family constellations, our task may well be to establish a link for the first time.
The telephone can be very useful: often this will be the first occasion on which child and parents have spoken to each other by telephone, and the very newness of the situation can break through the stereotyped conversation and lead to real communication. We explain to parents during initial interviews that we do not censor telephone calls or letters; so that (we point out) at first the child is likely to use this freedom to complain about us and other children. The deprived child will have learnt that his best chance of contacting his parents has been on a basis of persecution. This is the area where his parents can projectively identify with him because they themselves will be paranoid in a very primitive way. If we can show children and parents that we can allow them to verbalise such complaints (which are often wholly irrational) without being hostile or punitive, we shall be making a start in the clearing of ground for communication in the family.
We have noted how often a child will hurt himself, or develop psychosomatic symptoms, or get himself attacked, just before the start of holidays. He is trying in his way to ensure a place for himself in the family to which he is returning and from which he has been excluded. He feels – usually correctly – that a persecuted niche is the only one in which he can count in his home, better this than nothing. Gradually we may be able to alter this dreadful pattern: sometimes this can be done by helping the child to bring back home something from the place – a bunch of flowers, a cake he has baked, or a stool he has made.
Both child and parents will be constantly threatened by a harsh projected super-ego: all authority will seem threatening and punitive to them. We are, for them, authority figures. They may adapt to our demands, but this will be placating and based on fear. When we try to meet their needs and care for them, we do not cease to be authority figures; but we can replace the harsh super-ego by a benign one. Of course we should like to be in ego-supporting roles, but for this to be possible there must be egos to support! Working with really deprived people (whether parents or children) we must learn to do without functioning egos in our clients: bits of ego there will be, but not enough.
We have been perhaps too willing, in the past, to decry the super-ego (the conscience arousing guilt and anxiety). The concept of the benign super-ego has not been so familiar. The acceptance of a parental authority role based on compassion and concern involves us in a different kind of involvement from the supportive role which is appropriate for work with integrated neurotic clients.
I recently had an initial interview in a child guidance clinic with the little son (aged eight) of psychotic parents: he was in care under Section 1.1 I shall refer to him here as Tommy. Both his parents could just about survive in society, but Tommy, a charming and intelligent boy, was breaking under the strain of wildly inconsistent and unreliable management (he ran away from any placement, and from home). Discussing his problems with the psychiatrist, I gave it as my view that Tommy must be brought before a court as beyond parental control, so that he could be sent to us with legal controls. I suggested that if this plan could be accepted by Tommy and his parents, they might all feel secure. Otherwise, I was sure, Tommy would be whisked away from us on impulse – either his own, or that of his parents. I wanted to establish authority between impulse and action. Accordingly, since the psychiatrist agreed with this line of thought, we discussed our ideas with the child and then with the mother; explaining our reasons, but in such a way that they were able to accept such authority, which was not felt by them as punitive (we have still to learn the father’s views).
I can remember several cases in which the children in treatment with us were making good progress, and we seemed to have a reasonably good contact with the mothers, albeit of a rather superficial kind. The fathers, however, stayed as shadowy figures in the background, both in regard to ourselves and to the clinics concerned: they appeared to accept what was being done to help their children, they did not participate but neither did they interfere. Suddenly, however, these fathers announced that their children must now come home. Nothing that any of us could do or say influenced this decision, and these children left us long before their treatment was completed.
However difficult the task of looking after these very disturbed people (be they grown-ups or children), their individual needs must somehow be met in very different ways. I think perhaps one’s own attitude can make this easier. If one is working in a personal way rather than in an institutional way, the treatment approach can be flexible. If there is not too rigid an organisation (in regard to visiting for example), then there is not so much likelihood that the social structure will be disrupted by individual plans for parents’ visits.
I remember a very ill mother, whom I met for the first time with her little daughter (aged seven) in a hospital department. The mother had tried to kill herself and her child, whom I shall call Polly. The hospital had offered to be responsible for both till other arrangements could be made – an offer which the court had accepted. There was a symbiotic tie of a most primitive kind between mother and child.1Children Act 1948 (Section I makes provision for local authorities to receive children into care on a voluntary basis).
I played squiggles with both of them together in their small bedroom, but I forget the exact details of this game.
The mother was sure that she and Polly could not be separated, but she agreed, following a long discussion, to come and see the Mulberry Bush, brought by a psychiatric social worker. During this visit we played squiggles again; and between the two of them, mother and child produce from my squiggle a chicken coming out of an egg.
Polly came to us on condition that her mother could visit or telephone her at any time. Presently her mother started to tell me about her own life, and for the first time wanted to see me apart form Polly. I suggested that on these occasions we should meet alone in Oxford, to be joined later by Polly. In the botanical Gardens we met on warm spring days, during which Polly’s mother started to attack me – only with her voice – but in such a terrible way that I felt destroyed by her. I was often tempted to withdraw from the full blast of psychotic rage (the other face of her suicide attempt): but not to survive her ‘destruction’ of me would have been to take a terrible revenge upon her.
So our meetings continued, until one day she was telling me how vile we all were and how awful it was for her to have to leave Polly in our care, and that she had been forced by us to do so. I pointed out that there was no reason why she should have to leave her child with us – there were other schools – would she prefer us to make arrangements for Polly to go elsewhere? I held my breath at this point, but Polly’s mother, having sat in silence for a moment, said slowly: ‘She’d better stay at the Bush. There wouldn’t be someone I could shout at, like I do at you, if she went somewhere else. Sensible people wouldn’t stand for it!’ On this basis Polly’s treatment could continue, although eventually her mother removed her on an impulse.
What I am saying about deprived parents of children in treatment is that we cannot count on their involvement. We may well have to accept them exactly as they are, have been and will be all their lives. We can nevertheless so gear our treatment programme as to make it possible to include them with their children in what we plan: should we fail to do so, they will certainly break into their children’s treatment because of envy and feelings of rejection.
While a deprived child is in our care, we may ourselves be helping him to establish a place in his family for the first time. A neurotic child may be a square peg trying to fit into a round hole: a deprived child may have to evolve into a peg for whom we have to carve a hole – this can only be done on a basis of caring for the family as well as the child.