Does counselling have a place in interventions to help ‘troubled families’ break free from the cycle of disadvantage? Catherine Jackson talks to practitioners on the frontline
Families in trouble
‘You’re not supposed to bring another life into the world when your world is falling down around you but you think it’s going to be better each time. You do it for yourself. I’ll never get over the fact that I feel like I let me own children down. I messed my children up just as much.’
Launched in December 2011 by the Prime Minister, the Troubled Families programme has a budget of some £450 million to ‘turn around the lives’ of 120,000 families within the current Government’s lifetime. A Troubled Families Team, headed by Louise Casey (formerly the Labour Government’s homelessness ‘tsar’) has been established within the Department for Communities and Local Government. Local authorities have been told how many ‘troubled families’ they are likely to have within their boundaries and instructed to do whatever it takes, within a budget of £4,000 per family, to sort out their chaotic lives. ‘Kim’, whose words open this article, is one of 16 parents interviewed by Louise Casey to ‘get to know these families’ and the problems they face.
The Government has created three main criteria to define a ‘troubled family’: involvement in crime and anti-social behaviour, truancy, adult unemployment and reliance on benefits. An additional ‘discretionary’ criterion allows local authorities to target families that are ‘causing high costs to the public purse’: their children may be at risk of being taken into care; they may be regularly in trouble with the police; the parent(s) may have mental health problems or physical disabilities or use drugs and alcohol, or there may be high rates of teenage pregnancy.
Social policy commentators argue that the programme scapegoats a small, unrepresentative number of families; that it presents them as families who cause trouble, rather than families in trouble and in need of help; that it will do nothing to address the real problem of deepening poverty and widening inequalities in our society and it will not improve the life chances of children in deprived families and break the intergenerational cycle of disadvantage and dysfunction.
Ruth Levitas, Professor of Sociology at the University of Bristol, questions the Government’s definition of ‘troubled’, and says that the number of very deprived families is far greater and rising, and has been since 2008, thanks to the Government’s own tax and benefits policies.
‘There is no evidence to suggest that the majority of such poor families are “troubled” in the Government’s sense,’ she argues. ‘Indeed, local authorities from Birmingham to Kensington and Chelsea are finding that the numbers who meet the Troubled Families programme criteria are a tiny proportion of the target figures with which they were issued. The programme is a diversion from the wider question of the rising numbers of children brought up in poverty. Dysfunctional families can be found across the social spectrum, and their difficulties are compounded when they are poor. There is no substitute for an adequate social safety net.’
The stories of the 16 interviewees in Louise Casey’s report illustrate vividly the way family dysfunction, emotional and mental damage and lost hopes and potential are passed from generation to generation. The cycles of teenage pregnancy, violence, abuse, educational drop-out, grinding poverty, criminal and anti-social behaviour, and drug and alcohol use feature in the lives of their mothers and in those of their children.
All the families in the Casey report were already on the caseloads of the national network of Family Intervention Projects introduced by the then Labour Government in early 2006 in a bid to tackle the economic and social costs of anti-social behaviour, criminality and social exclusion.
Sally Taylor is Children’s Service Manager with the Northamptonshire FIP, which Action for Children runs under contract to the local authority. She says they are dealing with precisely the same families who would qualify as ‘troubled’. Families are referred to the Northamptonshire FIP at crisis point, when a child is on the verge of being taken into local authority care.
The FIP approach does work, Taylor says. ‘We use a strengths-based approach and work with the family, with clear expectations of what they have to do and the consequences if they don’t. We do parenting support, boundary setting, budgeting, working alongside families to help them identify what they need to change, modeling how to make the changes and monitoring and challenging them when they do something that isn’t appropriate. It’s a very intensive service.’
But it’s a crisis-driven service, and very outcome-focused, which itself can be a limitation. Says Taylor: ‘A lot of the time you are focusing on quick wins – sorting out their finances, welfare claims, managing money, keeping GP appointments and making sure the children get up on time and get off to school. And we have been successful; we have been able to return some children home, we have kept other siblings at home. We’ve improved education attendance too. But we’ve achieved other softer outcomes that wouldn’t necessarily be seen as a success.’
And, says Taylor, ‘For some families FIP arrives too late and the problems are too entrenched or too deep for us to pull them back’. She believes there is a need for much earlier intervention, and an integrated approach that ensures more continuity between prevention, early intervention and crisis intervention. ‘Some families aren’t ready to do this kind of work until they reach real crisis point, but it’s too easy to pass families on to the next level of intervention without looking at why it’s not been successful at previous tiers.’
One-to-one counselling can make a very useful contribution to the constellation of support and services offered to families with high levels of dysfunction, Sally Taylor believes, but says that in reality most of the parents with whom they work aren’t ready for it. ‘Even then the referral would need to go through the local authority. We can only make recommendations.’
Anne Crisp is a community development worker with a charity in East London. She previously set up and ran a family support project, and is now a trained counsellor. She says, from her experience, that counselling can be very helpful to struggling parents, but accessing it presents huge problems. ‘In my experience in family support work, services tend to focus on specific areas – domestic violence, the child’s behaviour, debt – but no one looks at the roots of the families’ problems. The issues run deep. That is why we started to think about counselling.’
The family support service helped to set up a community counselling service. ‘We asked parents what would make it accessible to them. We offered sessions in a local school so it wasn’t obvious why clients were coming. We helped with childcare, but the most radical change was that the therapist agreed that the parent’s support worker could go along with them for the first session, and sometimes the second one if needed, to give them confidence to go at all. We also asked them to be more flexible about attendance. That was important. The orthodox therapeutic boundaries can be quite unhelpful in the early days when the relationship with the counsellor is still very fragile and when the client’s life is so very chaotic.’
Crisp says the benefits of counselling can be limited by the sheer weight of other factors in the person’s life. ‘You need a package of support that also includes help with the practicalities of daily life. It can be hard to feel you have any control and there’s any hope for change when wherever you turn you meet a problem. To begin to make changes you have to believe it’s possible and sometimes that is difficult, especially when you’ve been brought up in a family where that is how it always has been; where your parents weren’t in control of things and couldn’t make choices.
‘But counselling can help in many ways. For some parents it can be the first time they’ve ever had someone who is there for them properly, and doesn’t make them feel they’re doing it all wrong. Experiencing a relationship that is healthy, that accepts you as you are, can be a first too. And if you can get that right, you can begin to go to the next level to look at how they may have ended up in that situation and to possible different futures and other role models. But you can only do that when you have established a relationship of trust.’
Mary Rose Brady, Head of Parenting and Creative Therapies at the children’s charity Coram, says it’s vital to be able to offer family support and therapy within the same agency, to avoid having to refer families elsewhere once they are engaged with the programme.
‘Therapeutic support all too often sits apart from generic family and parenting support. But when parents recognise that past experiences – for example, unresolved childhood trauma – could be affecting their coping now, we have a golden window of opportunity to make real and lasting change. It’s at this point that a family is often referred on to a specialist counselling service and that is when they often disengage. That may be due to long waiting lists or just not wanting to tell their story again. Coram can offer therapy as part of the package, which means that the relationship a family has built with their Coram family support worker can then be transferred to their Coram therapist who operates as part of the same team, often under the same roof.’
Brady has a background in art therapy and believes creative arts therapies offer something unique that can be more accessible to families than talking therapies. ‘Creative therapy can be particularly successful with priority and excluded groups, partly because it does not carry the stigma often carried by more traditional therapies. We try to avoid counselling jargon and to use language that works for clients but music or art can provide an additional channel through which families can express feelings for which they may not have verbal language.’ She describes one group of young mothers who couldn’t engage with psychotherapy, but benefitted hugely from participation in a community arts project. ‘It brought up some really deep feelings about their own childhoods and ambivalence about being young parents and enabled them to externalise some very complex feelings,’ she says.
Coram also uses creative therapies with children and young people as part of the family support package. Brady argues that these kinds of interventions should be more readily available in schools to help break the intergenerational cycle of disadvantage. ‘Too often the support is directed to the parents and we assume that the children will benefit vicariously from this. We’ve seen educational and emotional outcomes greatly improved for children and families through offering art and music therapy in school environments, outside the clinic. Children need to have more access to school-based therapeutic support and not be placed on a clinic waiting list for three months while their problems worsen.’
Breaking the cycle
Louise Casey says the high incidence of sexual abuse in her interviewees’ childhoods, and in those of their own mothers, is ‘the most striking common theme’ in her interviews. That the report highlights the problem of child sexual abuse is music to the ears of Fiona Ellis and Clare Wilson, who jointly run Clarifi Consulting, an independent training and consultancy company. Clarifi works with the public, voluntary and independent sectors to deliver training and therapeutic programmes in child and family wellbeing, including child sexual abuse. Ellis says the impact of child sexual abuse on adult survivors and on their own children is all too often overlooked; the effects are damaging not just for the mother but also for her relationship with her child and, consequently, for the child’s wellbeing and development.
The repercussions for the adult survivor include depression, eating disorders, suicide attempts, drug and alcohol abuse; it can also sever the emotional attachment between parent and child. ‘You can address all the other problems in the family’s life, but you won’t deal with the root problem unless you address the abuse. Mothers may have significant problems bonding with their children; they may be emotionally unavailable; they may struggle with setting boundaries. Even things like bathing a child may be difficult for them,’ Ellis says. Many adult survivors end up in relationships where there is physical and sexual violence, so their children are also living with violence in the home. It is all part of the intergenerational cycle, Ellis points out.
Clarifi has developed an eight-week ‘Butterfly Programme’ of group therapy for women survivors of CSA. The programme uses a range of interventions, including journal work and recovery writing, art and sensory therapy, inner child work and work on managing anger and grief, dealing with flashbacks and memories and challenging the silence and feelings of shame around the abuse. Wilson, who leads the programme, says the group approach is better than one-to-one therapy: ‘It’s the solidarity. Often I let the women work things out among themselves. They feel heard, accepted, loved, not judged. It’s hugely powerful.’
Clarifi has recently completed a series of Butterfly programmes with women referred through local authority children’s social services and funded by the Social Care Institute for Excellence, which is being evaluated by Birmingham University. Wilson and Ellis say it works: that women are getting back into education and employment and are telling them that it has made all the difference to their being able to parent their children. Wilson tells the story of one woman who had a diagnosis of borderline personality disorder (BPD) and whose four children had been taken into care. She was heavily pregnant when she joined the Butterfly Programme and was expecting to have this child taken away too. After four weeks on the programme, she was re-assessed and the BPD diagnosis was removed. After seven weeks social services decided they weren’t going to take away her new-born baby. She went into labour just after her final session. ‘The baby is still with her. Through the programme she says she realised she wasn’t going mad, that she can protect her children and she is a good mum.’
Sue Gerhardt, psychotherapist and author of Why Love Matters, used to work at OXPIP, the Oxford Parent–Infant Project. She dislikes the tone of the Troubled Families programme. ‘Yes, there are many families with multiple deprivations but they aren’t necessarily causing social problems. But I can relate to one aspect of Louise Casey’s report when she points out that many of the socially disruptive families, like the 16 families she interviewed, are “just not very good at relationships”. They’re used to expressing themselves in violent or abusive ways or they are trying to escape their feelings through drugs. But this means you can’t just see their problems in material terms; the way that people relate to each other is a major issue and we haven’t thought enough about that. You have to recognise the hurt, the anger at being mistreated, the desperate search for love, the lack of self-love because, if you have never been loved and cared for, it’s very difficult to create those things around you.
‘Louise Casey wants to threaten people into good behaviour but that doesn’t address the root causes of dysfunctional behaviour. It doesn’t recognise that when you haven’t had positive relationships in your life, the cure is to have a positive relationship. Threatening people to behave differently doesn’t address that. Many parents need someone to provide them with an experience of the sensitive, responsive care that they didn’t get in their own infancy and childhood. And, even more important, the best way to break these cycles of emotional disadvantage is to intervene early, in infancy. Parents are motivated to love their babies and do their best for them, so it’s the best point to intervene, and it’s a time when intervention can make the most difference in helping the children in these unhappy families to become better equipped to deal with life.’
Kim is sorting out her life, with the help of her FIP. ‘I thought, I can’t go on like this. I needed a shake and sometimes you do need that and just because you need help doesn’t mean you’re no less than anybody else,’ she says.