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What do parental relationships have to do with choldren's mental health

A blog by Susanna Abse, Chief Executive, Tavistock Centre for Couple Relationships.

It’s Children’s Mental Health Week – a time which should focus our minds on how important it is that we place a lot more emphasis on ensuring that the next generation is offered whatever help it needs in order to grow and flourish.

Central to this is making sure that someone is listening to what children tell us. We know, for example, that many children and young people access youth counselling services as a direct result of what is going on at home between their parents.

This is something which chimes with our clinical experience of helping couples whose relationships are conflicted and difficult. So often, at least part of the problem, and at least part of the solution, lies with providing the right support to parents in order to limit the extent to which the problems in their relationship spill over on to their children. .

That we should place the focus more on the parental couple is also something, I would argue, that services themselves are coming to acknowledge. After all, in a survey of over 4,500 children seen by CAMHS services, ‘Family Relationships Problems’ were the biggest presented problem. So, workers who are seeing distressed children have identified the biggest single concern as being the difficulties caused by troubled dynamics in the home. And of course the relationship between parents is a major factor in determining the kind of dynamics which prevail in the home.

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Yet you would be hard-pressed to find this reflected in public policy. For example, in Healthy Lives, Healthy People (The Government’s 2010 strategy for public health) relationships are only mentioned twice – once in relation to child-parent relationships, and once in relation to sexual health and relationship education for children. Not in the context of how adults can improve their personal relationships, and therefore family life.

Other key national frameworks don’t address this aspect either:
 There is no NICE guideline for the treatment and management of relationship distress
 The Public Health Outcomes Framework doesn’t contain a single indicator around parental relationship quality
 And it’s not yet certain whether the Department of Health’s forthcoming survey of children’s mental health will include questions on parental relationship quality this time around

In NHS England’s Future in Mind: Children and Young People’s Mental Wellbeing, which sets out the Government’s plans for improving children’s mental health, this blind-spot is also apparent. The word count for phrases key to the family relationship reads thus:

 Parental relationships = 0
 Relationships = 5 (but none relating to parents)
 Conflict = 0
 Relationship quality = 0
 Family = 24

Regarding the last of these words, however – family – it is important to note that Norman Lamb MP does acknowledge that “We need a whole child and whole family approach, where we are promoting good mental health from the earliest ages”. At the Tavistock Centre for Couple Relationships we would absolutely echo that. When it comes to action that is needed, this is an issue of improving awareness, of course, but also more tangibly the ability of those who work with children and families to ensure they are “trained in child development and mental health, and understand what can be done to provide help and support for those who need it” (words that come directly from Future in Mind). To be truly effective, however, the workforce also needs to be trained to recognise and respond appropriately to parental relationship distress (of which mental health difficulties in children are often the symptom.)

Relationship challenges are wide-ranging and need the help of skilled professionals. The range of factors affecting relationships and family life quality are broad, namely:

 Family type – transitions particularly
 Economic strain
 Parental psychopathology
 Negative parenting
 Interparental conflict and violence

Furthermore, the links between relationship quality and depression in parents is real. Mental health disorders are a cause and a consequence of relationship distress; the bi-directionality of the link between the two is largely unacknowledged however in policy circles and professional practice. And the problem is more acute in ‘Troubled Families’.

If we don’t address this mental health aspect as well, it will be much harder to achieve improvement in children’s life chances, not least as depression and the strain it can place on relationships can lead to conflict in the home. 

Children of all ages are affected by exposure to conflict between parents. From the ages 6 months to 16 years the impact leads to:

 Physiological arousal
 Anxiety, depression
 Aggression, hostility
 IQ deficits
 Low academic attainment
 Poor peer relations
 Attention and behaviour problems

There are numerous studies that prove this. Moreover, these patterns run through the whole family system, intergenerationally, meaning the children we are seeking to help today run the risk of repeating negative behaviour they encounter at home. Focusing so much on the children themselves, as we so often do, can result in well-intentioned approaches to working directly with young people being rendered less effective.

So, what’s the good news?

We know positive couple relationships can buffer early insecure attachments and lead to the formation of new working models and patterns of interaction. In terms of the action we should take, it’s clear that the couple relationship is the early intervention opportunity – the fulcrum of change, straddling generations.

The benefits of working with couples are many and various:
 Improved outcomes for children
 Improved relationship satisfaction
 More authoritative and assertive parenting
 Relief from depression
 Better outcomes in reducing alcohol and drug abuse
 And builds family resilience

If that’s the case, why isn’t it being done already?

Well, a number of objections still persist regarding working with parents’ relationships: ‘Its private & personal’, say some; “ We don’t have interventions that work”, say others. More practically, the workforce often doesn’t have the right skills currently for this kind of approach.

The Tavistock Centre for Couple Relationships has developed interventions and undertaken research that counter these objections and produce results. We have worked successfully with parents via a range of interventions such as couple therapy, specialised post- separation support and across through country via the Parents as Partners Parenting Programme.

This parenting intervention, developed by US psychologists and researchers Professors Philip and Carolyn Cowan, provides 16 2-hour group sessions where couples/co-parents experiencing relationship difficulties attend together. The sessions are co-facilitated by clinically trained, experienced male/female pairs. The aim is to improve the couple’s lives together and their parenting.

The results for parents have been positive; but even more telling, in respect of children’s mental health, are the outcomes for the children (average age 5-6) of the parents who attend the groups:

prior to starting groups, 31% of children (compared to 10% of general population) were falling within the ‘abnormal’ range on the programmes Strengths and Difficulties Questionnaire , as reported by parents

After attending the groups, both mothers and fathers reported significant reductions in children’s overall difficulties. Pleasingly, both boys and girls showed significant improvement (based on parent-report).

You can read more about the longtitudinal research of the Cowans here

This kind of approach is what we need - namely systemic practice and whole family solutions.

Let’s not look at a mother and a child in isolation (nor, for that matter, a father and a child either) - let’s realise the power of helping them all, professionally, together.