Dr Carole Kaplan is Director of the Transformation Programme at Northumberland, Tyne & Wear NHS Foundation Trust. She has been a consultant in Child and Adolescent Psychiatry and group medical director. She has served on a number of national bodies such as the NHS LA, ABFL and others. Dr Kaplan spoke at NACCC’s conference in November on the mental health needs of children affected by family breakdown and how awareness of child development theories can be helpful in understanding the needs of these children:
Background: “Relationships are vital to good mental health”
Divorce and separation are a major challenge to mental health – a situation where perceptions of self, others and systems are all questioned. Contact helps preserve relationships and these are vital to mental well-being. Family breakdown is estimated to cost the UK £46 billion per annum and over one million children have no contact with one of their parents after separationi. In the last three years Childline had 8,849 counselling sessions specifically relating to parental divorce and separationii. It is estimated that 1 in 4 adults have a common mental disorder at any one time and 1 in 10 children have a diagnosable mental health condition.
NACCC’s aimsiii are to prevent children from losing touch with a parent or other family members, to break down entrenched conflict between parents and to help resolve parenting issues without recourse to Court proceedings and to raise awareness of the existence of child contact centres. Research seems to show that children from divorced families have lower educational achievements, more behaviour concerns, poorer psychological adjustment, lower self-esteem, poorer social competence and poorer long term health. Different factors can have an impact on children’s mental health including the functioning of the family, parental conflict, the quality of parenting, parents’ mental health, financial factors and whether there have been repeated changes in family contexts.
Relevance of child development theory to family breakdown
Erikson Theory of Psychosocial Development (1959)
There are many different theories of human development, but perhaps the most accessible and useful for NACCC workers is that of Eriksoniv.
Different age children have different needs and family breakdown impacts in different ways depending on the age and development of the child. However these are not ‘hard’ stages which are passed through and left behind, but rather ways of functioning that can manifest and recur at any age. Awareness of child development theories can be a useful framework to understand the mental health needs of children coming to contact centres. E.H. Erikson (see diagram below) describes the stages of psychosocial development whereby children progress from one stage to another (and often backwards and forwards between stages). Each stage brings ‘virtues’ associated with healthy development – if these virtues are balanced by more negative attributes.
Case study: Jack
A drawing by Jack (age 4) was presented (see below). He has drawn himself with two spots either side representing the sun and the moon. This drawing shows Jack’s view of himself within the world; he dominates the picture with the sun and the moon revolving around him. He is developing autonomy and self-assurance – expected and ideal for his age.
The impact of family breakdown on young children: “I must have done something wrong” “I must be a bad child” “I am not worth much”
Erikson suggests that if an infant experiences care that is consistent, predictable and reliable, they will develop a sense of trust which will carry with them to other relationships, and develop the virtue of hope that as new crises arise, there is a real possibility that people will be there. This trust is learned through stable and secure attachments with their main carers. The autonomy and confidence of toddlers and pre-schoolers grows as they develop greater skills. Relationships with siblings, extended family and carers become more important. An infant who has not had a consistent experience may experience anxiety and feelings of mistrust in the world around them. Some children who are negatively affected by family breakdown may experience the following feelings: “I must have done something wrong” “I must be a bad child” “I am not worth much”.
“School age children need capacity to take in what is going on…which results in less space for their own development”
School age children are developing their personal identity, their cognitions are quite concrete and their peer group and achievements are becoming more important. Children at this age who are affected by family breakdown might be feeling angry and they may take sides or demonise/idealise the non-resident parent. School work could be affected, alongside struggles with rules and boundaries. If there is a need to cope with negative effects and emotions then there is less capacity for their own personal identity to develop. For teenagers, routine tasks of adolescence such as independence, developing sexuality, socialisation and career are made more difficult if family breakdown is taking place.
Contact centre staff and volunteers can have a huge impact on children whose world has turned upside down following separation…
The personal impact of supervised and supported contact centre staff can be of great importance to a child whose world has turned upside down following separation. Whatever the role of the member of staff or volunteer they can support the children they are working and this can be of great importance to those children.
Another drawing was presented (see below), completed during a contact session between a little boy (age 10) and his dad. In her capacity as child psychiatrist Dr Kaplan saw him later that day. The child was withdrawn and not wanting to talk. He had with him the drawing that he had made during the session so they talked about this. The picture was of two boats and he explained that the big boat was him, and the little boat was dad. He had drawn the cloud and added the unhappy eyes and mouth and said that this was his mum watching them. He pointed to the waves that explained that he had asked the contact centre worker to add to his picture and she had drawn the waves. This was important to him and helped to show visually that the worker understood how unsettled his environment was. This simple act showed the child that he was heard and understood by an adult which he valued. The boy asked if the worker could be at the next contact session.
“Small interventions can help to put things back that have been lost…”
People who run a child contact centre can be important to the children visiting. Small interventions can have a positive impact for a child having difficulty developing a sense of trust or self-worth. Workers do not have to be supervising contact or writing a written report to still be able to offer encouragement to children – praising their artwork when they return to their resident parent, observing parents working cooperatively, saying how well contact has gone. This all helps to reinforce with the child that the environment is a positive and stable place, provided that this is a true reflection of the situation.
Dr Kaplan stressed the importance of training, support and supervision in order that workers can understand better what is going on in the lives of the children coming to their contact centre and feel supported in working with them.
i ‘Fractured families – Why stability matters’, The Centre for Social Justice 2013.
iiNumber of Childline counselling sessions about parental divorce/separation (2014-17)
iiiNACCC Strategic Plan (2017-2020)
ivErikson, E.H. Childhood and Society. (2nd ed.). New York: Norton; 1993. Erikson, EH & Erikson, JM. The Life Cycle Completed. New York: Norton; 1998.
The NACCC team would like to take this opportunity to thank Dr Kaplan (who also gives her time as a trustee of NACCC) for all her assistance with this article.