Parental Assessment

Introduction

The assessment of parenting is a complex task. Families often attend parenting groups when they run into difficulties, as there is an evidence base for group-based parent training programmes (NICE Guidelines, 2010). However, a range of studies suggest that approximately one third of people attending parenting courses will not benefit significantly (Scott & Dadds, 2009). When this occurs, we need to understand the issues that make parenting such a difficult task for the parent(s).

Offering an AAI (Adult Attachment Interview) assessment provides an opportunity to understand the psychological information processing of the parent and what may be interfering with a parent taking in information that was offered in a parenting group and implementing their learning.

The AAI can help us to understand the parent’s patterns of psychological information processing and their underlying self-protective strategy when relating to other people - most importantly, their children. Helping a parent to understand their self-protective strategies can lead to more effective parenting interventions.

Case description

An example of this in my clinical practice is a mother whose daughter presented with oppositionality and severe self-injurious behaviours that the mother was having difficulty managing. This mother considers herself to be a responsible parent; she cares for her daughter and tries to meet her needs. Following the administration of the AAI, we understand that she organizes herself around her own experiences of trauma and loss, which are considerable. She lost her own mother, whom she now idealizes, when she was only twelve years old. This led to considerable neglect; as her father’s use of alcohol escalated, she was left to be the main care-giver in the family. As a ‘parental child,’ she felt that she had ‘failed’, because her youngest brother was taken into care. This left her with considerable guilt, which she still experiences to this day.  She also experienced frightening physical and sexual abuse from her elder brother.

As she got older and things got tougher for the family, she used a compulsive A strategy with performance (A4-) to her mother, and after her mother’s death, she took on a parental care-giving role (A3). As things became more difficult in the family following her mother’s death, she also developed a pre-occupied C strategy with complaints and anger towards her father and older brother.

At the present time, she is not able to reflect in a meaningful way about how and why she behaves in the way she does. This limits her choice of behaviours when faced with stressful situations.

It is important to be compassionate and understand that, more than anything, she would have liked to protect her own daughter from losses and disappointments in life. The issue we need to help her understand is not the loss or danger in itself, but how these experiences may affect her own behavior, especially regarding how she relates to her daughter at present. Although she may know intellectually how to parent, she may not be able to successfully attune to her own daughter until the loss of her own mother, and past traumas (with the consequent impact on her own self-protective strategies), have been understood.

Mother spent most of her early life being a victim (shy, low confidence, bullied, parental child, hardship, sexual molestation) and being rescued, occasionally, by her mother or grand-mother. We hypothesize that she probably still feels herself to be a victim, of both professionals and her daughter. This can lead her, briefly, into alternating between a persecutor and rescuing role; if there is no resolution, as she may go back to feeling victimized. We can further hypothesize that during periods where mother gets highly aroused, she will utilize more extreme self-protective strategies, which may hinder long-term improvement in the mother-daughter relationship and which has contributed to the ambivalent relationship that exists at present.

Her daughter is extremely special to her, but the unresolved traumas and losses interfere with the close relationship she yearns for with her daughter. Mother may become emotionally unavailable to her daughter when aspects of the external environment remind her of past traumatic experiences. This leads her to become emotionally absent or incongruent to the present emotional / social focus. If her daughter does not know about mother’s problems, she may attribute the cause of her mother’s behavior to herself. Further, her daughter will not get consistent and understandable responses from her mother.

Treatment plan

Mother’s current difficulties with her daughter will be a strong motivating factor for treatment. Individual work with mother should focus on her experience of neglect and loss. Her personal issues require the privacy and intimacy of individual therapy. There needs to be an explicit focus on the distinctions between intentions (to be a good parent), behaviour (which may be misguided by confusing past with present moments of psychological absence) and effects (which can be unwanted and unexpected). She needs to be able to articulate in her own words the mixture of protection, love, neglect and violence she has experienced, and understand how these experiences have shaped the person she has become. She also needs to see how she has carried fear into her relationship with her daughter. Past experiences have led mother to her present strategy, but it is unhelpful in her present relationship with her daughter.

Conclusion

The AAI has helped me to elucidate the particular problems in psychological information processing which can guide therapy. Without the AAI assessment, an understanding of the difficulties mother experiences as a parent would have taken much longer to achieve.

Alison Dunkerley is a Consultant Child and Adolescent Psychiatrist, Bolton Child and Adolescent Mental Health Services, UK. [email protected]

References

NICE (2010).  Antisocial Personality Disorder: Treatment, Management and Prevention [online]. Available at: http://www.nice.org.uk/guidance/CG77

Scott, S., & Dadds, M.R. (2009). Practitioner Review: When parent training doesn’t work: theory-driven clinical strategies. Journal of Child Psychology and Psychiatry, 50 (12), 1441-1450.