Parental Psychiatric Disorder Distressed Parents and their Families 2nd Edition by Michael Göpfert, Jeni Webster, Mary Seeman 0521534976 9780521534970

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ISBN 10: 0521534976 

ISBN 13: 9780521534970

Author: Michael Göpfert, Jeni Webster, Mary V. Seeman

‘A unique and innovative approach to family issues in psychiatric disorders. The authors tackle a broad range of complex issues that are rarely covered in the depth or with the expertise that this volume brings. This book is a major contribution to the field and provides the kind of international perspective that enhances our understanding of the complex dimensions of psychiatric disorders from a multigenerational and cross-cultural perspective.’ From a review of the first edition by Carol Nadelson, Professor of Psychiatry, Harvard Medical School. It is indisputable that mental illness in a parent has serious and often adverse effects on the child, something which is surprisingly unreflected in clinical service provision. In this completely rewritten second edition, an international, multidisciplinary team of professionals review the most up-to-date treatment interventions from a practical, clinical point of view. It is essential reading for all professionals dealing with adult mental illness and child-care.

Table of contents:

Part I Basic issues
1 What we want from adult psychiatrists and their colleagues: ‘Telling it like it is’
Introduce yourself, tell us who you are and what your job is
Tell us what is going to happen next
Give us as much information as you can
Talk to us and listen to us – remember it is not hard to speak to us, we are not aliens!
Ask us what we know and what we think – we live with our parents, we know how they are behaving
Keep on talking to us and keep us informed – tell us it is not our fault
Tell us if there is anyone we can contact
Please don’t ignore us, remember we are part of the family and we live there too
Conclusion
REFERENCES

2 Parenthood and adult mental health
Introduction
Perspectives of power and hierarchy in mental health services
Why does it matter?
Prevention
Gender
Assessment
Intervention
Legal/ethical issues
Humanitarian issues
Issues for the psychiatrist
Conclusion
Acknowledgement
REFERENCES

3 Parental psychiatric disorder and the developing child
Childhood disorder
Physical harm to children
Death
Child maltreatment
Psychiatric illness and the developing child
Attachment and the quality of the mother–child relationship
Adult attachment
Attachment and decisions regarding placement
Distress
Case 1: Amanda
Case 2: Stephen
The effects of parental psychiatric disorder on the adult child
Developmental framework
Constitutional factors
Temperament
Gender
Genetic endowment
Prenatal and perinatal adversity
Physical attributes
Perpetuating factors
Early mother–infant relationships
Socio-cultural factors
Familial factors
Precipitating factors
Life events
Current family psychopathology
The interaction of risk and protective factors
REFERENCES

4 Parental psychiatric disorder and the attachment relationship
Introduction
Attachment – background
Attachment – the parent’s contribution
Mental illness, parenting and attachment
The risks for psychiatric disorder also affect the parent–child relationship
The combination of pre-existing risks and the disorder affect the parent–child relationship
Psychiatric disorder alone may affect the parent–child relationship
Factors that might be associated with preservation of secure attachment in the face of parental psychiatric disorder
REFERENCES

5 The construction of parenting and its context
Introduction
‘Parenting’ as a construct
Definition
The relative value of parents and children
Parenting, mental disorder and its context – a role perspective
The role-relationship paradigm
Parenting as a role
Parent role and mental disorder
The parent as patient and the helping relationship
Professional role in relation to patient
Parental role and mental illness
Parental role and personality disorder
Spouse/partner
Marital conflict
Parentification: the effects on the child of role reversal; becoming a young carer
Role of siblings
The role of extended family and community in relation to the task of parenting
Poverty as an issue of individual parents and of communities
Clinical implications of the role-relationship model
Service dilemmas and the role of organizations
Implications for services of the role-relationship model
Swings and roundabouts of policy between statute and therapeutic support
The limits of rationalism
The contribution of service culture to outcome
Conclusion
Acknowledgements
REFERENCES

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Part II Comprehensive assessment and treatment
6 ‘The same as they treat everybody else’
Being a parent should come before being a person with a mental illness
Parents feel supported when the needs of their children are met
Professionals sometimes assume that a mother does not know about or understand…
Service providers need to work out the best way to ensure the health…
Professionals should be more willing to listen to and value a parent’s points of view and experience
Evaluate parental ability before removing children without question
Professionals should give the parent with mental illness, and the partner, information…
Professional support is needed for the partner when a parent is acutely ill, and education to prepare…
Please respect confidentiality with regard to sharing information with family members
When a parent has a mental illness they may experience many feelings…
No one from the school asked me: what is your contribution to this child?
Respect a right to privacy
Be sensitive to our culture
Educate service providers to network all available services and link parents into the most useful one
How do we want to be viewed? We want to be viewed as being persistent and zealous and working to battle…
Acknowledgements
REFERENCES

7 Formulation and assessment of parenting
Introduction
Principles of ethical assessment practice
Commitment to the parent
Ensure appropriate assessment of risk
Timing
Ensure assessment can address needs of both child and parents
Take time to clarify the reason for the assessment
Coordination of professional contributions
Consent
Formulation of parenting
Focus on role of parent
Focus on role of child
Focus on mental illness and the interface of role of parent and role of patient
Focus on parental role of other parent
Focus on role of spouse/partner
Focus on role of context/extended family
Preparation of court reports
Indications for formal assessments
Standards
Sequence
Content
Recommendations for writing court reports
Giving evidence in court hearings
Methods of assessment/intervention
Parent–child game
Family group conferences
Conclusion
Acknowledgements
Appendix 7.1
Assessment of the needs of mentally ill parents and their children
REFERENCES

8 Mentally ill mothers in the parenting role: clinical management and treatment
Introduction
Approach to treatment
Components of a comprehensive evaluation
Mental illness and treatment factors
Environmental and demographic factors
Maternal attachment
Child factors
Components of a comprehensive approach to parenting rehabilitation
Services for pregnant mothers
Psychotic denial of pregnancy
Intervening in the postpartum period
Parent coaching, skills training and parenting groups
The parent’s clinic at the University of Illinois
Mother–infant psychotherapy
Conclusion
REFERENCES

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Part IV Specific treatments and service needs
16 Psychopharmacology and motherhood
Breast-feeding
REFERENCES

17 Social work issues
Introduction
Case example: Linda
Implications of the case example
Parent and service provider perceptions of the child welfare agency
Two systems at odds
Conclusion
REFERENCES

18 Parental psychiatric disorder and the law: the American case
Introduction
Termination of parental rights
Federal law
State law
‘Harm to the child’
‘Inability to care for the child’
‘Present mental condition’
Americans with Disabilities Act
Child custody disputes
The ‘best interests of the child’ standard
Parental fitness
Effect of custodial disputes on emotional health
Visitation rights
Recommendations for attorneys
Conclusion
REFERENCES

19 Parenting and mental illness. Legal frameworks and issues – some international comparisons
Introduction
The issues
The role of legal intervention in families affected by parental mental illness
Why are legal frameworks required?
Potential conflict of interest?
Searching for a balance in the law
Comparing legal frameworks
Reasons for legal intervention
Variation in legal requirements for intervention
Supporting families
Protection of children
Family support or child protection. What works? Striking the balance in legal intervention
Summary and conclusions
REFERENCES

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Part V Child-sensitive therapeutic interventions
20 The child grown up: ‘on being and becoming mindless’: a personal account

21 Talking with children and their understanding of mental illness
Introduction
What to talk to children about
Does it help to talk?
What do we need to do?
Who should do the talking?
What do children require and what can they understand?
Engaging a child in an ‘active’ conversation about his parent’s illness and treatment
Didactic and dialectical approaches to talking with children
Avoid ‘problem-focused’ talk
Stress the child’s competence
Presume nothing – be ‘behind’ rather than ‘ahead’ of the child
Ask questions that are easier to answer than to not answer
Make no interpretations or presumptions about a child’s experience – but ask
Challenge the child’s expectation of compliance to adults
Allow a language of contest (but not combat), and talk which may appear as ‘silly’
The goal is to help the child think, not to elicit feelings – a child will show what he feels as and when ready
Draw or use other visual aids with a child and young person, both to explain illness and to understand their experience
Finding their own voices
Case example
Who will do it?
REFERENCES

22 Family therapy when a parent suffers from psychiatric disorder
Introduction
Why work with the family?
Who is the family to be worked with?
Relevant approaches to treatment – dominant contextual influences
The culture of mental health services
The impact of expressed emotion research on the shape of adult mental health services
Protection and stress in families
Goals and models of family treatment
The Family Project at University College Hospital, London (Camden and Islington Mental Health Trust)
Family structure, diagnosis and therapist’s choices
The structure of the family
The diagnosis of the ill member of the family
Case example 1
Development of alternative modes for the resolution of conflicts
Case example 2
Family ‘Mental Health Matters’ workshops
Outcome of groups
Format of groups
Children’s workshops
Working from a child-centred service: additional approaches
Developing alternative descriptions of a parent who is also a patient
Frameworks for working with the families of patients with psychiatric disorders
REFERENCES

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Part VI Models for collaborative services and staff training
23 Keeping the family in mind: setting a local agenda for change
Why change is necessary
The policy context
Building for participation
Learning to listen and listening to learn
The importance of strengthening parents and families
Trust and continuity of staff
Opportunities for prevention
Better joint working between child and adult services
Coordination of care and facilities for children
Stigma and labelling
Conclusion
REFERENCES

24 Are services for families with a mentally ill parent adequate?
Introduction
Background
Case example: John and his family vs. the system
A survey of the needs of parents with psychotic disorders
The needs of parents with psychotic disorders – the perspective of the health-care provider
How can we improve services for parents with a psychotic disorder?
Conclusions
REFERENCES

25 Models of service provision in three countries: Marlboro, New Haven, Sydney, Melbourne and Lewisham
Introduction
Massachusetts Clubhouse Family Legal Support Project, Marlboro, Massachusetts, USA
Problem and need
What services existed
Legal representation was missing
Client profile
The Family Support Collaborative, New Haven, Connecticut, USA
New programme services
The ‘B’ family
Programme partnership
Initial results
The Sutherland Children in Families Affected by Mental Illness Project, Sydney, Australia
Introduction and project aims
Barriers encountered
What has been implemented
Specific interventions
Evidence of the impact of the project
Conclusions
Parents in Partnerships: The Parents’ Project, Melbourne, Australia
Background
The project
The project today
The Building Bridges Project for parent-users of mental health services and their children, Lewisham
Services provided by Building Bridges
Review and evaluation
Conclusion
REFERENCES

26 Overcoming obstacles to interagency support: learning from Europe
The ‘problem’ for families and service providers
The European dimension
The Icarus Project
The research methodology
Barriers to interagency collaboration
Organization of services
Shared knowledge and training
Resources
Time, communication and trust
Translating findings into action
REFERENCES

27 Training and practice protocols
Introduction
Background and context
Crossing Bridges – The Department of Health (UK) training programme
Requirements for the programme
Key conceptual frameworks
Involving clinicians and managers
Harnessing specialist expertise in joint working
Aims
Content
Conceptual underpinnings – the family model
Use of the materials
Collaboration in Europe
Training the trainers – A county-wide implementation of Crossing Bridges
Challenges to systematic implementation and evaluation of training
Developing protocols to integrate training and practice
Conclusion
REFERENCES

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Tags: Michael Göpfert, Jeni Webster, Mary Seeman, Parental