Dr Andrew Dawson Consultant Child and Adolescent Psychotherapist Specialist Children's Services NHS GGC

1. Warning Signs and Traps: Stuck Cases,
Emotional Abuse and Intergenerational Trauma
In Child and Adolescent Mental Health Services
BASPCAN CONGRESS
2015
Dr Andrew Dawson
Consultant Child and Adolescent Psychotherapist
Specialist Children’s Services NHS GGC

2. What is a stuck case?
• Clinical Background to Research
• Midegely and Kam (2006) examined
reasons for referrals to psychotherapy
• Professional Symptoms, Britton (1982)
• Systemic Review
• Psychoanalytic Review
• Interview stem

3. Method
• 12 Intensive Interviews with
experienced CAMHS practitioners
• Social Constructivist Grounded Theory
• Additional analysis using Glaser’s
(2002) structured approach to the
identification of emotional abuse
• Reflexive sensitivity to psychoanalytic
and systemic ways of thinking

4. Results
• Strong connection indicated between
stuck cases, emotional abuse and
intergenerational trauma.
• Clear evidence of professional
symptoms in clinicians
• Warning signs were evident
• Cases subject to professional traps that
prevented successful treatment

5. CHART 1: REPORTS OF PARENTAL ADDICTION
3
0
9
Parental Addiction
Known
Parental Addiction
Suspected
No Report of Parental
Addiction

6. CHART 2: REPORTS OF PARENTAL MENTAL HEALTH PROBLEMS
8
3
1
Known Mental Health
Problems
Suspected Mental Health
Problems
No Report of Parental
Mental Health Problems

7. CHART 3: REPORTS OF TRAUMA IN FAMILIES
9
1
2
TRAUMA
REPORTED
TRAUMA
SUSPECTED
NO REPORT OF
TRAUMA

8. CHART 4: Life and Death Anxieties Present?
7
5
YES
NO

9. Chart 5: Harmful Parent Child Interaction
10
2
YES
NO

10. CHART 6: REPORTS OF CHILD PROTECTION CONCERNS
3
3
6
No Action Taken
Action Considered but
not taken
Social Work involved or
Referral to Reporter
made

11. Warning Signs
• Taboo
• Life or Death Anxieties
• Blinding Trauma
• Career Shaking Experiences
• Compelled Care
• The Insult
• Crisis of Confidence

12. Traps
• Benevolence Trap
• Professional Traps
• Loyalty Trap

13. Potential for Harm
• Vulnerable parents and children
• Harmful parent child interactions clearly
observable in some cases
• Not addressing the unconscious emotional
relationship leads to harmful family-service
relationships
• Use of structured assessment such as
FRAMEA is indicated to protect children,
clinicians and families
• Need to include psychoanalytic and systemic
ways of thinking to support staff

14. Suggestions
• Anticipate possibility of becoming stuck
• Recognise professional symptoms and
use psychoanalytic and systemic
interventions to bring about some
manoeuvrability in the cases
• Staff training in FRAMEA approach
• Support staff with appropriate
supervision and use of FRAMEA

15. References
Britton, R. (1981) ‘Re-enactment as an unwitting professional response to family dynamics.’
in Box, S. et al (eds) Psychotherapy with families. An analytic approach. London: Routledge
& Kegan Paul.
Charmaz, K. (2006) Constructing grounded theory: A practical guide through qualitative
analysis. London and California: SAGE.
Glaser, D. (2002) ‘Emotional abuse and neglect (psychological maltreatment): a conceptual
framework’. Child Abuse and Neglect, 26:697-714.
Glaser, D. How to deal with emotional abuse and neglect—Further development of a
conceptual framework (FRAMEA). Child Abuse & Neglect (2011, in press)
doi:10.1016/j.chiabu.2011.08.002
Hindle, D and Boulton, S. (2000) Emotional Abuse: The Work of a Multidisciplinary Consultation
Group in a Child Psychiatric Service. Clin Child Psychol Psychiatry July 2000 5: 439-452,
doi:10.1177/1359104500005003012
Kam, S. and Midgely, N. (2006) ‘Exploring ‘clinical judgement’: How do child and adolescent
mental health professionals decide whether a young person needs individual
psychotherapy?’ Clinical Child Psychology and Psychiatry, 11(1):27–44.
Lofland, J. and Lofland. L.H. (1995) Analyzing social settings (3rd ed.). Bekmont, CA:
Wadsoworth.
Treacher, A. and Carpenter, J. (1982) ‘“Oh no! Not the Smiths again!” An exploration of how to
identify and overcome ‘stuckness’ in family therapy. Part I: ‘Stuckness’ involving the
contextual and technical aspects of family therapy’. Journal of family Therapy, 4:285-305.
Van Lawick, J. and Bom, H. (2008) ‘Building bridges: home visits to multi-stressed families
where professional help reached a deadlock’. Journal of Family Therapy, 30:504-516.