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Rehabilitation and the Family - "What do we hope to achieve?&=
quot;
&=
nbsp; This
year has seen me reeling from one intense court case to another - Should th=
is
mother be allowed a chance to have her child back? - Should a child be brou=
ght
up by her natural parent? Can you achieve good bonding after prolonged
separation? Is a child more harmed by failed rehabilitation than no
rehabilitation? Should a teenage mother be encouraged to bond with her chil=
d?
What is the aftermath of parental loss? Clichéd questions coming up =
time
after time. Nevertheless hard to answer in the harsh glare of the court
scenario when respected colleagues argue against each other - quoting
contrasting literature and research findings with equal zeal. 'Zeal' is I f=
eel,
the right word for it - there are few areas where passion, and subjective
fervour are more apt to cloud objective judgement than in that of child pro=
tection
and separation of parent and child.
&=
nbsp; Certainly
there is a difference in perspective - social workers do not want a dead ba=
by
on their case load and know the media will point the finger of blame in the=
ir
direction; paediatricians may see neglected children gaining weight in hosp=
ital
away from their families; child psychiatrists look at the disorganised fami=
ly
structure and find it hard to see a child being able to overcome parental
patterns.
&=
nbsp; I
wonder sometimes quite what we are hoping to achieve when we take the other
view? What are we doing in our rehabilitation programme? With success rates
running at perhaps 50% - if you're lucky and how do you measure success any=
way?
Varying criteria for selection for rehabilitation and no consensus on long =
term
goals. Helping disturbed mothers parent disturbed children can seem a thank=
less
task.
&=
nbsp; Unless
you work with adolescents. That is when you begin to see the point. What do=
we
see as the child reaches adolescence? And what happens when that child beco=
mes
a parent? Removal from the family is sadly not a panacea - we see young peo=
ple
whose self esteem is in their boots - crying out to know why their families=
did
not want them, why they failed their parents so badly - and often recreating
their own family disturbance and imagined parental traumas in an attempt to
understand and identify with their absent parents.
&=
nbsp; Mark
was placed in care at the age of four, lived in children's homes and then a
'good' foster family. He did well at school and college, gained professional
qualifications and then 'blew it all', lost his job, on the verge of divorce
and with seething rage directed at his four year old daughter. He remembers
nothing of his early life but his fantasy is that his behaviour was so bad =
that
his parents had to send him away. He needs to somehow prove that his parents
were good and he was bad by recreating the scene in this generation.
&=
nbsp;
&=
nbsp; A
teenage mother may well prove, with help, to be an excellent parent, able to
meet her child's needs in a way that cannot be faulted. On the other hand s=
he
may be too much a child herself, needing love, care and attention which her
child cannot supply. The same situation could apply to a mother who is for
other reasons unable to meet her child's needs - by virtue of mental or
physical illness or deprived circumstances. It is important that such mothe=
rs
(and fathers) be given the chance to explore their own potential - to be
supported and encouraged and to be allowed to share in the decision whether=
to
parent their own children or give them over to the care of another.
&=
nbsp; I
know how grateful fourteen year old Kim was when I asked her if she would l=
ike
me to find a foster mother for her child.&=
nbsp;
She had wanted so much to please us all by being a good mother - but=
the
depression and loss of herself showed through. At the court hearing they ca=
lled
her an unfit parent and brought up all her past delinquency - several months
work on self worth destroyed in a day. But her little son will know, when he
reaches his adolescence that he was a valued child, that his mother tried h=
er
best, and then gave him up in love.
&=
nbsp; I
am constantly being told by my paediatric colleagues that good bonding betw=
een
parent and child is essential for future mental health and that this can on=
ly
occur in the first year of life - many authors have disputed this time
limitation and even Bowlby has revised his views. However - even if this we=
re
so - surely the chance of establishing a rapport with your own mother - at
whatever age is preferable to whatever bond may be established with a stran=
ger?
&=
nbsp; Winnicott once wrote a paper titled
"Delinquency as a sign of hope". Rebelling, pushing out against t=
he
injustices that you have suffered in childhood - that is indeed a sign of h=
ope
- a sign that the spirit is not broken, that there is an individual in there
shouting out "Hey! What about ME!" The beginnings of change, of a
sense of one's own needs, of self worth.
&=
nbsp; Adolescence is regarded traditional=
ly as
a time of 'delinquency' and rebellion, a time of change and energy - both can be
channelled in the healing process and that is often what makes working with
young people so exciting. How=
ever
the 'adolescent process' can be seen in many phases of change. An abused
'victim' who begins to assert himself, a 'battered wife' who gains the cour=
age
to leave her husband, a drug addict or alcoholic who decides to opt for a
different lifestyle - all enter a new way of being - all experience the
honeymoon elation of starting on a fresh beginning - they all in their own =
ways
feel the exhilarating freedom of an 'Adolescence'.
&=
nbsp; Thus
, just as for the adolescent, we can make use of this energy for change in =
the
rehabilitation process for our damaged families. And , just as in adolescence, we m=
ust
appreciate the stages of this process and work through them with our patien=
ts -
understanding and support is the cornerstone - coercion and ultimata have no
place in rehabilitation.
&=
nbsp; The
damaged parent of whatever age, needs to go through a stage of being allowe=
d to
be the 'needy child' - for th=
at
indeed is what he or she is. =
Years
of deprivation and abuse have usually taken their toll in terms of the
individual's needs never having been met. A young parent generally becomes a
young parent partially to find a way to fill this unmet need. A common mist=
ake
is to either disregard this need entirely, or to somehow expect it to be
dismissed at will. How often have we heard the expression that a parent is
"Unable to place the child's needs above her (his) own". As if this were a conscious
decision. OF COURSE they can'=
t!.
&=
nbsp; The
answer lies not in condemning this need, or pushing it to one side - but in
fulfilling it. A needy parent is like an empty vessel , without caring or
'mothering' to fill the void - they have no resources - nothing to give the=
ir
children. So our first task is to accept the needs of the patient's inner
child, to allow them to be child like and to parent them - often for the fi=
rst
time in their lives. Here 'dependence' is healthy and a required stage in t=
he
treatment process - however, like all good parents, we need to set boundari=
es
and be consistent in our caring during this childlike dependency stage.
&= nbsp; As the patient grows in trust and confidence, we also, as good parents, relinq= uish some control and responsibility so that our 'children' can grow up. Having = had some of their own needs met, they can now look to their own children's need= s - but gradually at first. We take them through Bowlby's 'exploring from a safe base' , we ARE that safe base. They go through an adolescence with us 'hold= ing' and 'containing' their anxieties and gradually emerge as competent adults.<= o:p>
&=
nbsp; Let
us not forget that all parents need a measure of 'parenting' themselves. Not
just as a model, a way of building up the 'inner parent' by example as
described above. But also when giving birth, at the time of becoming a pare=
nt,
we also need to be cared for - to be 'mothered' or cared for by a loving
partner. Those who often need this most - our deprived or damaged patients,=
are
those least likely to get it. And to make matters worse, they have far grea=
ter
traumas to bear during the early months of parenthood - single parenthood,
domestic violence, poverty, poor housing, inexperience etc. etc. In addition
they will suffer greater stresses and assaults to their self worth and their
parenting - criticism, children failing to thrive, childhood illness,
professional intervention (usually perceived as unhelpful and critical), ca=
se
conferences, child protection procedure and possibly court action or
assessment.
&=
nbsp; It
is too easy for assessment and observation to become negative, destructive =
and
almost a sneer from the sidelines rather than a productive process. There i=
s no
value in watching a sinking man drown - if you see he can't swim, you throw=
him
a life raft. So there is no value in purely observational assessment - seei=
ng a
faltering parent damage herself and her child holds no joy for observer or
observed. Such an observer de=
serves
to bear the shame of such failure and is a perpetrator of abuse to child and
parent alike.
&=
nbsp; Assessment
means 'working together ' to see what can be achieved and what can not. It =
is
only in this way that a fair evaluation can be made of the situation and one
that has a chance of being accepted by the family. So I suppose that I have
answered my initial question "What do we hope to achieve?" - We hope to achieve a realistic
appraisal of a families strengths and weaknesses; a forward plan which will best ser=
ve the
needs of each individual within that family as well as the needs of the who=
le ;
and an appreciation of the dynamics of the situation which is not based on
blame, fault or failure, but rather on understanding, empathy and regard.