Disrupting Intergenerational Maternal Maltreatment in Middle Childhood: Therapeutic Objectives and Clinical Translation

Abstract

Background: Child Maltreatment is a concerning worldwide problem. The population of distressed mothers with their highly disturbed children, in middle-childhood, often present to child and adolescent mental health services (CAMHS). Finding effective therapies for this population has proved elusive. This led the authors to undertake a theory-driven research program to better understand intergenerational child maltreatment from a clinical perspective, in order to determine how best to treat the entrenched distressing and destructive behaviors.Methods: The model describing the mechanisms of the intergenerational transmission of maternal maltreatment is briefly described, from which the objectives of any effective treatment for these mothers and children are derived. A clinical model for achieving the therapeutic objectives is then elucidated.Findings: Core objectives of therapy are; first to support the mother and child to develop differentiated senses of self and, second to disrupt a relationship style built on a competitive dominance and submission hierarchy, replacing it with a hedonic (cooperative and compassionate relationship style). This requires a deep healing of the mother and child's trauma histories. A clinical operationalization of these objectives, through a novel dyadic psychotherapeutic protocol, Parallel Parent and Child Therapy is described, which addresses the therapeutic objectives while attending to the safety of mother and child.Interpretation: This research contributes to a better understanding of the components of effective treatment in what is a notoriously hard to treat population. It also illustrates the value of clinically informed theory development in understanding and refining treatment strategies for highly distressed and distressing populations.

Intergenerational transmission of child maltreatment in South Australia, 1986–2017: a retrospective cohort study

“…This study found a strong association between the CPS involvement of mothers and their children, supporting the hypothesis that child maltreatment has a substantial inter generational component. This finding is consistent with the well described pathways between child maltreat ment and disrupted brain development 23 and disturbed relational patterning, 9 which can result in deeply embedded behavi ours and emotional responses that under mine nurtur ing parenting, even with a strong desire to do better. 6,9 Children of mothers with a history of both substantiated maltreatment and out-of-home care had 6•3 times the risk of any CPS involvement, 13•7 times the risk of substan tiated maltreatment, and 25•8 times the risk of having time in out-of-home care, compared with children of mothers with no CPS involvement.…”

“…This finding is consistent with the well described pathways between child maltreat ment and disrupted brain development 23 and disturbed relational patterning, 9 which can result in deeply embedded behavi ours and emotional responses that under mine nurtur ing parenting, even with a strong desire to do better. 6,9 Children of mothers with a history of both substantiated maltreatment and out-of-home care had 6•3 times the risk of any CPS involvement, 13•7 times the risk of substan tiated maltreatment, and 25•8 times the risk of having time in out-of-home care, compared with children of mothers with no CPS involvement. Adjusted associations are appreciably larger than those reported in other large cohort studies 11,15,18,24 and systematic reviews.…”

“…[5][6][7][8] Child maltreatment can also have long-term relational effects, which can hinder an individual's subsequent capacity to adequately care for their own children. 6,9 A history of maltreatment is one of the most prominent risk factors for perpetration of maltreatment; 10 this is known as intergenerational transmission of child maltreatment.…”

Using the Adult Exploration of Attachment Interview (AEAI) to Break the Cycle of Intergenerational Trauma: Illustrations from a Family Reunification Program

“…This model has been used to predict the objectives of any effective intervention to break the cycles of intergenerational transmission of child maltreatment. These are to identify and process trauma‐related emotion, including overwhelming fear and shame, disrupt the reliance on competitive relationship dynamics, support cooperation, and help the parent differentiate themselves from their child, so that the child is seen as a separate individual with their own identity and agency (Amos & Segal 2018).…”

The serious health consequences of abuse and neglect in early life

“…25 Secondly, trauma based therapies could be part of all statutory child protection service responses-to address parental histories of maltreatment, child mental health, and include parent-child dyadic therapy to repair damaged relationships. 18 The third pathway is to better address the harmful and risky behaviours that emerge in adolescence or early adulthood. And fourthly, to recognise that early life trauma can underlie clinical presentations across a range of health conditions-addressing the trauma might improve clinical outcomes and reduce the need for invasive investigations or medical interventions.…”