bscb dorota iwaniec

Understanding and Dealing with Emotional Abuse and NeglectBristol, 24 April 2007Emeritus Professor Dorota IwaniecAcSS, MRIAMA, DipEd, CQSW, DipSW, PhDQueen’s University BelfastEmail: d.iwaniec@qub.ac.uk Address: 15 Torgrange Tel/Fax: 028 90 425141 Holywood Co Down  BT18 0NG: 

Understanding and Dealing with Emotional Abuse and Neglect Bristol, 24 April 2007 Emeritus Professor Dorota Iwaniec AcSS, MRIA MA, DipEd, CQSW, DipSW, PhD Queen’s University Belfast Email: d.iwaniec@qub.ac.uk Address: 15 Torgrange Tel/Fax: 028 90 425141 Holywood Co Down BT18 0NG

Objectives of the Talk: 

Objectives of the Talk Overview of emotional abuse Problems with definitions The nature and impact of emotional abuse Emotional care of children Attachment and emotional abuse Brain development and emotional abuse Planning intervention Helping children and their carers When does a case of emotional abuse become serious enough to warrant social work and legal intervention?

Defining Emotional AbuseDoH Definition of Emotional Abuse: 

Defining Emotional Abuse DoH Definition of Emotional Abuse Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

Defining Emotional AbuseDorota Iwaniec (1994): 

Defining Emotional Abuse Dorota Iwaniec (1994) Emotional abuse and neglect refer to hostile or indifferent [or misguided] parental behaviour which damages a child’s self-esteem, degrades a sense of achievement, diminishes a sense of belonging, and stands in the way of healthy, vigorous and happy development. Emotional abuse is described as overtly rejecting behaviour of carers on the one hand, or as passive neglect on the other.

Defining Emotional Abuse: 

Defining Emotional Abuse Categories of ill-treatment Emotional unavailability, unresponsiveness, and neglect e.g. parental insensitivity Hostility, harsh punishment, denigration and rejection e.g. parental perceptions based on persistent negative beliefs, attitudes, and feelings that child deserves to be treated in such a manner Developmentally inappropriate or inconsistent interactions with the child e.g. unrealistic expectations, overprotection and restrictions of exploration and learning, exposure to confusing or traumatic events and interactions

Defining Emotional Abuse: 

Defining Emotional Abuse Categories of ill-treatment (contd) 4. Using the child to fulfil the parents psychological needs e.g. failure to distinguish the needs of the child and the parents’ needs: failure to accept the child’s individuality and psychological boundaries 5. Mis-socialisation of the child e.g. failing to promote the child’s social adaptation, social isolation, involving children in criminal and corrupt activities 6. Stunting of growth and failure to thrive

Emotional Abuse: 

Emotional Abuse Prevalence and Manifestation Core of all major forms of abuse and neglect Impact more damaging on long term basis than other forms of abuse Exists independently of other forms of abuse Distinctive features: Relationship rather than an event Does not require direct contact Only form of abuse characterised by both acts of omission and commission Not a homogeneous entity

Research: 

Research Emotional abuse has been linked to difficulties: forming secure attachment (Egeland, Stroufe & Erickson, 1983); increased aggression (Spillane-Grieco, 2000); development of eating disorders (Rorty, Yoger & Rossotto, 1994); low self esteem (Mullen, Anderson, Romans, & Herbison, 1995); stunted physical growth and self-harming (Iwaniec, 1995); withdrawal, academic under-achievements, instability (Hart, Brassard & Karlson, 1995); depression, suicidal ideation, anxiety, inter-personal and sexual problems (Gagne, 1995); aggressive, less worthy, overwhelmed in inter-personal relationships (Morimoto & Sharma, 2004).

Research: 

Research Effects of emotional abuse Insecure attachment Poor social adjustment Interpersonal problems Behaviour problems Internalising problems Low self esteem Low self control Poor academic achievements Morimoto & Sharma (2004); Iwaniec (2004); Brassard et al., (1987); Glaser & Prior (2002)

Research: 

Research Effects of Emotional Abuse - 20 year follow up Iwaniec (2004) serious conduct problems; emotional disturbances; low self-esteem; eating disorders; difficulties in building social relationships; acute insecurity; social isolation; academic under-achievement (semi-illiterate); poor employment record.

Basic Principles of Assessment: 

Basic Principles of Assessment Systematic-chronological recordings of observed concerns or events. Information collected from other agencies. Assessment should be done in the child’s home, school, nursery, or other places where child goes. Assessment must include direct observation of child and family interaction, parental responsiveness to children’s needs, family functioning, supervision, attachment of children to parents, and quality and style of parenting. Interviews with children. Play and projective techniques to elicit information with younger children.

Assessing Child’s Developmental Needs: 

Assessing Child’s Developmental Needs Health Education Emotional and behavioural development Identity Family and social relationships Social presentation Self-care skills

Emotional Needs of Children and Qualities of Emotionally Caring Parenting: 

Emotional Needs of Children and Qualities of Emotionally Caring Parenting

Emotional Needs of Children and Qualities of Emotionally Caring Parenting: 

Emotional Needs of Children and Qualities of Emotionally Caring Parenting

Attachment and Emotional Abuse and Neglect: 

Attachment and Emotional Abuse and Neglect Bowlby suggested that there is an innate proximity-seeking behaviour by the child towards his/her caregiver in the underplaying guise for physical and emotional comfort, and ultimately for survival. This requires an attachment figure, e.g. parent, to be available, dependable, and benevolent. Where these qualities are absent attachment is interfered with resulting in anxious, avoidant, insecure, weak, promiscuous attachment behaviour in the child with resultant emotional/behavioural problems.

What we know about Attachment: 

What we know about Attachment The concept of a secure base relates to the physical and emotional ties that support and sustain us in our growth and development and which console us in times of distress. (Gilligan, 2001). The internal working model refers to our core beliefs about ourselves and others based on accumulation of experiences/memories (cognitive schemes) which are either positive, trusting, caring and accepting or distrustful, painful and rejecting. (Bowlby, 1987). The consistent sensitive responsiveness of the parent helps the child to develop an internal working model in which the self is perceived as worthy, others are perceived to be reliable and viable, and the environment is experienced as challenging but manageable with support.

Internal Working Model (contd): 

Internal Working Model (contd) Social cognition involves an awareness of oneself in relation to others and an awareness of the emotions of others. If these abilities are poorly developed many types of social interaction may be experienced as stressful, unfamiliar and strange, because the child has not developed a strong internal representation of what is happening and how to respond. The capacity to reflect and reappraise, to learn from experience.

Internal Working Model (contd): 

Internal Working Model (contd) To be empathetic and sensitive to others. Emotionally abused and neglected children often lack empathy and truly do not understand what others feel like when they hurt them.

Types of Attachments, Parental Behaviour and Child’s Reactions (Outcomes) : 

Types of Attachments, Parental Behaviour and Child’s Reactions (Outcomes)

Adaptability in Insecure Attachments: 

Adaptability in Insecure Attachments Infant’s capacity to adapt to less than optimal environment. Bowlby’s ‘defensive exclusion’ in order to maintain proximity to attachment figure that is not available or actively rejecting. The avoidant and ambivalent styles are adaptive and demonstrate some resilience allowing children to manage relationships and emotions under difficult circumstances. Disorganised attachment is developed by high risk children. They lack a coherent strategy for managing relationships, feelings, or experiences.

Adaptability in Insecure Attachments (contd): 

Adaptability in Insecure Attachments (contd) The avoidant child has to become self-reliant early in life and learns to shut down attachment behaviour in order to protect self from repeated rejection. Emotional responses become deactivated and over-regulated while cognitive strategies are amplified. They use play as a means of diverting attention. Dominant approach is pragmatic problem-solving. Relationships are regarded as not important. Control is a dominant strategy.

Adaptability in Insecure Attachments (contd): 

Adaptability in Insecure Attachments (contd) Avoidant adolescents present as sullen and withdrawn with intermittent outbursts of rage. Peer relationships are superficial and aggressive – as they do not trust others, especially those close to them. Adults are characterised as dismissive, placing little value on relationship.

Adaptability in Ambivalent/Resistant Attachment: 

Adaptability in Ambivalent/Resistant Attachment Cognitive responses become deactivated because they are experienced as ineffectual due to inconsistent carer response. Emotional responses are increased and under-regulated to maintain proximity with the attachment figure. Exploration is inhibited resulting in poor brain development in cognitive areas. Manipulation is the dominant strategy. Helplessness and resentment as the major characteristics.

Adaptability – Adolescents and Adults: 

Adaptability – Adolescents and Adults Ambivalent adolescents tend to be engaged in intense and explosive relationship with attachment figures. They fear rejection from peers or others and therefore drive others away from them. Adults remain preoccupied with relationships often enmeshed in on-going conflict, (Hesse, 1999).

Adaptability in Disorganised Attachment Style: 

Adaptability in Disorganised Attachment Style Unable to organise behaviour at times of stress because the carer is both the source of fear and potential safety. Older children cope with this dilemma through self-reliance and controlling behaviour. They do not trust the carer so they control the relationship. The child develops highly organised but controlling ways of interacting with the parent.

Adaptability in Disorganised Attachment Style (contd): 

Adaptability in Disorganised Attachment Style (contd) Survival is the dominant strategy. Some develop compulsive compliance compulsive caregiving, or controlling behaviour at a later stage. In adolescence psychopathology and violent crime. In adulthood this attachment style is unresolved.

Importance of Secure Attachment: 

Importance of Secure Attachment First priority of an infant’s development is to form an attachment to the primary caregiver. Attachment provides the foundation not only for future emotional relationships it also provides the base for other learning. Children learn best when they feel safe, calm, protected, and nurtured. If early attachment is weak it leads to impaired social cognition. Disrupted attachment because of neglect and abuse limits a child’s brain development as it focuses on survival rather than growth. The lower-brain responses become dominant and the cognitive regulating structures do not develop to the full capacity.

Brain Development: 

Brain Development The first relationships are the most important. Nurturing and positive interactions hugely stimulate and organise young brains. The quality of early caregiving determines how people develop, their ability to learn, and capacity to regulate their own emotions and form positive relationships with others. Early experiences sculpt the brain. During late pregnancy and after birth synoptic connections are most active and prolific. According to provided experiences the brain creates, strengthens, or eliminates synopses. Emotionally impoverished environment suppresses brain development.

Planning Intervention: 

Planning Intervention Start from identifying problems. Establish what you want to achieve/improve. Check available resources/services/expertise. What needs to be done to deal with each target to achieve positive outcomes. Who is going to deal with what? Duration of intervention. Arrangements for Review.

Putting Planning into Action: 

Putting Planning into Action Multidisciplinary/multi-agency approach. Always use a Core Group decision. Implement partnership model of problem-solving – remember the child is at the centre. Do not ‘cut corners’ in implementing helping strategies - it never works.

Progress Review: 

Progress Review Is your planned strategy working? What has worked and what has not? Have we tried long enough with adequate frequency to produce desirable change? What needs to be modified – what needs to be changed to take you there? Can we consider terminating our involvement? Do we need to take the case to Court? Is there anything better to offer?

Intervention and Treatment of Emotional Abuse and Neglect: 

Intervention and Treatment of Emotional Abuse and Neglect Neglect and abuse is multidimensional. Intervention should be based on comprehensive assessment. Combination of interventions over a single approach.

Intervention and Treatment of Emotional Abuse and Neglect: 

Intervention and Treatment of Emotional Abuse and Neglect Developmental counselling aims to: - educate parents - promote realistic expectations of child - raise awareness of individual differences in development

Intervention and Treatment of Emotional Abuse and Neglect: 

Intervention and Treatment of Emotional Abuse and Neglect Cognitive interventions aim to: - generate positive perceptions - promote self-efficacy

Intervention and Treatment of Emotional Abuse and Neglect: 

Intervention and Treatment of Emotional Abuse and Neglect Stress management training Attachment work Video feedback Working with children

Working with Children and Carers: 

Working with Children and Carers Attachment work by improving and increasing caregiver/child interaction – play and other everyday activities, communication. Building positive self-esteem: - praising, acknowledging success, reinforcing good image, reassuring, creating opportunities for good behaviour. Building self-efficacy in the older children – neutralising feelings and beliefs that they are worthless, undeserving, useless. Building new identity feeling by creating opportunity to experience self-worth and appreciation by others, e.g. after-school clubs, sports, music, etc. Developing interests, talents. Teachers are very influential in children’s lives – get them involved. ‘How will superman/woman help you?’