Fase I: Panificación Preliminar

Studies that focused explicitly on parents diagnosed as emotionally abusive, had on the whole evaluated the effectiveness of two approaches to working with emotionally abusing parents – cognitive-behavioural and attachment/psychotherapeutic-based approaches.

Cognitive Behavioural approaches

We identified two studies that explicitly examined the role of CBT with emotionally abusive parents. Sanders et al. (2004)62 compared two group-based versions of CBT62 (standard and enhanced versions of the Triple P parenting programme, the latter of which included additional components aimed at addressing parents misattributions and anger).. This study found that there were no differences between the two group-based programmes, with both treatment groups making substantial gains. There were three areas where the enhanced version appeared to have greater effects (anger management, misattribution and unrealistic expectations), although the observed differences had narrowed six months after the intervention ended. In other words, there was little difference in the long term effect of the standard and enhanced versions of Triple P. However, this study did not include a control group, and while the sample involved parents identified as emotionally abusive by child protection services, many had self- referred. This means that the intervention included a substantial proportion of participants who were aware of their difficulties in managing anger. Boulton and Hindle (2000) have observed, however, that parents who are severely abusive are less inclined to self-refer or to recognise the effect of their own behaviour on children‟s externalising behaviours. Thus, while a proportion of the parents in the study on standard and enhanced Triple P had been formally diagnosed as 'emotionally abusive', it seems unlikely that it included a majority of severely abusive parents, as in other studies.

combined programme reduced emotionally abusive behaviour and decreased parental state anxiety and parenting stress. The study also found that participants valued group interaction as was predicted, and that lessons learned in the group and home intervention were applied not only to parenting, but to other aspects of their lives, enabling troubled adults to gain a greater sense of overall control. This study, once again, did not include a no-treatment control group, and as such, these results only indicate the benefit of combining group and individual treatment.

None of these studies included any assessment of costs and it seems likely that there should be a comparison of group CBT alone prior to the use of home-based programmes. Moreover, the nature and severity of the abuse involved in this study was not clear. Cognitive-behavioural interventions have been shown elsewhere to be effective with diverse groups of parents120 but it has been noted that group-based CBT appears to be least effective with parents who are abusive or multiply disadvantaged (Morrison Dore and Lee, 1999). Further research is therefore needed to identify the profile of parents with whom this approach is effective.

Psychotherapeutic versus cognitive-behavioural approaches

One study63 compared a psychotherapeutic intervention for parents of preschool children with a cognitive-behavioural (CBT) home visitation programme. The results suggest that the psychotherapeutic intervention produced a greater decline in children‟s negative representations of their mother and of themselves, and improved children‟s expectations of the mother-child relationship compared with the didactic CBT model. However, the outcomes in this study were limited to children‟s representations and as the authors note, no assessment was made of constructs that might have been expected to improve more dramatically following a cognitive-behavioural parenting programme such as for example, parenting skills and knowledge of child development.

One case study examined the effectiveness of a mentalisation-based intervention underpinned by both attachment and psychotherapeutic theory.66 Mentalisation refers to the capacity of individuals to understand mental and emotional states in others. Work on the application of mentalisation theory is still in the early stages, but case studies suggest its value in improving a range of outcomes for extremely distressed parents.

While more in-depth work with parents has to date, tended to be undertaken using psychotherapeutic approaches that are delivered on a one-to-one basis, such approaches can be used effectively on a group-basis over an extended period of time. For example, NEWPIN4 comprises a multidimensional group-based approach for very high-risk parents (i.e. who have children on the child protection register) (see Jenkins, 1996; Gurr and Hansen, 1997; Mondy and Mondy, 2004). This programme comprises an intensive 4- month intervention package including three elements: i) group based psychotherapy which aims to draw links between the mother‟s past and current relationships and present feelings; ii) supported activities with their children, and; iii) groupwork focused on parenting topics, and aims to support the development of problem-solving, and working with the mothers strengths. The intervention is based on a partnership model in which parental expertise about their child is encouraged. This intervention was evaluated with 21 mothers with severe parenting difficulties including 12 children on the child protection register. The results show that following this intervention ten out of twelve children had their names removed from the Child Protection Register, with both remaining children subsequently returning to the mother‟s care.121

While this package has not been evaluated with mothers with a single label of emotional abuse, it seems likely that such comprehensive packages may be necessary to help parents who demonstrate seriously emotionally harmful behaviours.

Behavioural Case Work

One study suggested that behavioural case work involving the use of problem-solving techniques delivered over the course of eight intensive sessions in the home65 could be effective in changing some aspects of family functioning. However, this was a case study only, and further rigorous evaluation is still needed.

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