Critical cause of concern and critical cause of change

By Richard Devine (17.07.20), Social Worker and Bath and North East Somerset Council (BANES).

Introduction: Too much support? 

Frequently, I am overwhelmed by the variety and severity of problems that a parent or family is experiencing. Drug and/or alcohol use, domestic abuse, poor mental health alongside dire housing conditions, financial difficulties, and children with a host of emotional and behavioural problems. Our response to this, at times, can be equally overwhelming.

With the best intentions, we ask parents to access drug and alcohol services, domestic abuse services, mental health support, parenting courses, as well as a raft of other services each designated to address a specific problem. That is, we reguarly ask families, often to their frustration and reluctance, to attend a range of different courses, in different places, with different agencies, within the given agencies pre-determined time frames (Featherstone et al, 2018). Failure to engage in these services, regardless of how useful or relevant they may seem to a parent, can lead to a negative judgement being made and an escalation in social care involvement (Devine, 2017).

Underlying this approach is the belief that each issue constitutes a separate entity that can be divorced from the individual’s developmental experiences/social context. However, the issues are often interconnected and represent a manifestation of psychological distress and/or relational impoverishment and social deprivation. Another contributing factor seems to derive from the expectation that if the level of concern about the child’s safety is such that care proceedings are instigated, and permanent removal considered, then the Local Authority has to demonstrate that they have done everything possible to support the parents (See para 28: Re B-S). This is an irrefutably sound and indispensable principle. In my experience, however, the principle is applied against the quantity of support, rather than the quality or appropriateness.

Irrespective of the underlying reasons I have speculated about, ‘too many goals and too many professionals working towards the goals are likely to distract parents’ attention, generate anxiety about performance and change, and obscure the critical aspect of treatment’ (Crittenden 2016: 284).

Critical Causes 

Patricia Crittenden, the founder of the Dynamic Maturational Model, in her seminal text Raising Parents outlines an idea that I have found useful, referred to as ‘critical causes’ (2016: 284-285). Critical causes is divided into 1) the ’critical cause of danger’ and 2) the ’critical cause of change’; 

1. The ‘critical cause of danger’ is that which in the past caused the development of a psychological self-protective strategy. For example, the parent may have been required to learn ways of coping to deal with violence, parental substance misuse, sexual abuse, neglect, etc in their childhood. It can also be a ‘danger’ in the present such as a domestically abusive partner, substance misuse and/or threat, perceived or real, of social care removing their child. These current ‘dangers’ deny parents the pyschological safety necessary to explore past adaptations, that is, the coping strategies they developed to past danger.
2. The ‘critical cause of change’ refers to that, which if changed, would instigate a cascade of changes that would ultimately resolve other concerning aspects of the family’s functioning (Crittenden, 2016). As an attachment theorist, Crittenden (2016) argues that attachment is often a critical cause of change, because attachment constitutes the development of a self-protective coping strategy, and crucially, the underlying psychological processing, that underpins such a strategy.  

Conceptualised this way, our role should arguably be organised around understanding and reducing danger, current and past, and identifying the critical cause of change. What would this mean for practice?

Firstly, it would require narrowing the definition of the ‘problem’. As already indicated, attempting to provide a service for each problem and every consequence of each problem is unlikely to succeed, and will overwhelm the family and social worker. To give two examples;

1] When a parent’s developmental experiences have been characterised by neglect/abuse and/or exposure to trauma then they may struggle with their intrapyschic (thoughts, feelings) and interpersonal (relationships) functioning. This can lead to one, or a combination of difficulties, such as conflictual relationships, poor mental health, and/or reliance on drugs/alcohol. Consequently, these issues frequently undermine their parenting ability. A logical, albeit fallacious inference from this, is that the parent should attend a parenting course. However, difficulties in parenting are usually a symptom of an underlying issue, rather than the cause of difficulties for children per se. Address the underlying issue, and most of the parenting concerns would automatically diminish, at least to a degree that doesn’t warrant social care involvement. In 10 years, I have yet to encounter a family who were able to address their issues by attending a parenting course. But attendance at a parenting course featured on most support plans.

2] The use of drugs and/or alcohol by parents can often lead to chaotic home routines, inconsistent parenting, financial problems, including debt, poor mental health, and parental conflict. If we ask a parent to address their drug and alcohol use, there are few avenues in which to do this; 1:1 and group work through community drug and alcohol services, Alcoholics Anonymous or Rehabilitation Centres. This should be our primary focus. Yet, more often than not, we ask parents to engage in support to address their drug and/or alcohol use AND attend a parenting course for inconsistent parenting, engage in 1:1 family support to improve routines, attend the GP and access mental health support and engage in domestic abuse services. If parents were able to gain a better understanding of the function of their substance misuse, be supported to develop alternative coping strategies, then it is more likely that they will be able to reduce their substance misuse, or even better, abstain. In that context, the rest of the services would be redundant. If ongoing support was needed after they had reduced their substance misuse or abstained, then they could more likely focus on accessing help to repair past harm caused in relationships and strengthen their parenting capacity.

After we have narrowed and better understood the problem, then we can focus on addressing the identified danger. For example, risk taking behaviour, drug and alcohol use, domestic abuse, isolation, and/or poverty. 

Once immediate and current danger has been removed or substantially reduced, including the danger that children’s services represents, then we can embark upon a compassionate enquiry into the underlying issues that contributed to, and maintained, the behaviour and/or relationships that undermined a parent’s ability to protect their children from harmful experiences. We should aspire to meet parents where they are, and not where we think they should be, or expect them to be. From this position, we can function as ‘transitional attachment figures’, and collaboratively, slowly, and incrementally facilitate parents ability to make long term changes, whilst recognising that participating in a reciprocal process of change often involves revealing negative aspects of the self which may be psychologically threatening (Crittenden, 2016: 230). 

Conclusion

We are often guided in our work to improve the experience of children in their parents’ care and prevent, where possible, significant harm.

We observe children with significant emotional and behavioural problems, or an anxious attachment, and try to resolve this by sending the parent on an array of courses. In many cases, we provide an intervention for the child. However, as pointed out by Crittenden ‘anxious attachment is not the problem; danger is the problem…change the danger, not the child’ (2008: 21). How do we this?

Primarily, we help parents and we avoid multiple solutions for multiple problems and instead identify and address the essential issue(s). Ideally, we would invoke the use of a ‘transitional attachment figure’, that ‘functions like a parent in helping each person to address the problem from which they can learn without being overwhelmed by the complexity of the entire problem’ (Crittenden, 2016: 282).

By Richard Devine (17.07.20)

**If you are interested in learning about the DMM, which according to Peter Fonagy is ‘the most clinically sophisticated model that attachment theory has to offer’, then you may want to check out Rebecca Carr Hopkins here. She provides brilliant, highly engaging and incredibly informative training.

If you have found this interesting/useful, you may wish to consider scrolling down to the bottom and signing up for free blogs to be sent directly to your inbox (no advertisements/requests/selling). I intend to write every fortnight about matters related to child protection, children and families, attachment and trauma. Blogs I have coming up include a book review of Bronfenbrenner’s Ecology of Human Development and 10 lessons from 10 years on the frontline. Or you can read previous blogs here

Vacancy in BANES currently for deputy team manager – just click on the job title and it take you directly to the website.

Bibliography

Crittenden, P.M. (2008) Raising Parents: Attachment, parenting and child safety. Cullompton, Devon UK: Willan.

Crittenden, P.M. (2016) Raising Parents: Attachment, Representation and Treatment,(2^nd ed.) Abingdon, Oxon: Routledge

Devine, L. (2017). Rethinking child protection strategy: Progress and next steps. Seen and Heard, 26 (4). pp. 30-49. 

Featherstone, B., Gupta, W., Morris, K & White, S. (2018). Protecting children: A social model. Bristol: Policy Press.