Wednesday, 18 July 2012

Brief Encounters

I managed to get to an interesting seminar this week - looking at issues of emotional neglect and emotional abuse. The main presentation was devoted to what the academic literature has to say about the consequences (sequelae) of what Americans, who undertake nearly all of this research, call psychological maltreatment.

There were no real surprises. Insecure attachment, delayed development, cognitive delay, negativity and aggression during play, poor peer relationships, low self-esteem and language delays; all featured prominently. It was reassuringly, if tragically, familiar. But what I suddenly found myself taking a great deal of interest in was an aside about research methods, particularly relating to observation of parent-child interaction in longitudinal cohort studies such as the Minnesota Mother-Child Interaction Project [1]

It was blindingly obvious really, but I had never thought about it with such clarity before. Researchers are trained to be objective and dispassionate. They try to minimise observer effects, to be like a fly on the wall. And that, it occurred to me, is why they can produce such clear and incisive descriptions of emotional abuse and neglect.  They watch for a long time and so they see the negative, but often subtle, behaviours of some parents - lack of eye contact, failure to respond to distress, mechanical handling, disparagement, subtly conveying to the child that s/he is worthless/unloved/inadequate, having developmentally inappropriate expectations of the child, preventing the child participating in normal social interactions etc.

On the other hand social workers and other service providers may find it much more difficult to spot the signs of emotional abuse and neglect.  Thats not because they do not know what it is, but because the nature of the service encounter [2] makes sustained observation difficult. Unlike the researcher, the social worker often has only a relatively brief encounter with the family. Perhaps a couple of visits of less than an hour each in order to assess child-parent interaction. So its not surprising that emotional abuse and neglect, in the absence of other types of abuse, are often missed; or at the very least, not confirmed by social workers during a child protection episode.

Another consideration needs to be entertained at this point. The impact of emotional abuse and neglect which, of course, will always accompany other types of abuse is known to be particularly significant during the first two years of life, not only because babies are highly dependent and vulnerable, but also because the impact is long-term, involving both emotional and physical consequences. Studies [3] of young children emotionally neglected in Romanian orphanages found that their brains did not grow at the normal rate and were significantly smaller than those of normal children [4]. Such studies point to the need for the earliest possible intervention, before the long-term physical damage becomes established.

Applying some of these thoughts to the design of child protection service encounters it seems to me that we need to think much more imaginatively about how they take place. Following-up a concern of emotional abuse and neglect may be, quite literally, a different sort of job to following up an allegation of physical abuse where there is often clear, objective evidence in the form of a bruise, fracture or lesion.  It may involve longer and more sustained observation in the early stages of involvement. Working practices that mean that contacts are brief, and procedures that mandate that decisions be taken quickly, may simply result in lots of emotional abuse and neglect being ruled out because of lack of evidence in what are, in effect, fleeting involvements.

End notes 

[1] See Erikson, M.F., Egeland, B. and Pianta, R. (1989) "The effects of maltreatment on the development of young children", in Cicchetti, D. and Carlson,V. (eds) Child Maltreatment: theory and research on the causes and consequences of child abuse and neglect, Cambridge University Press, pp. 64784.
[2] The term service encounter is used extensively in services management and services marketing, referring to the moment of interaction between the service-user or customer and the service. Thus a service-user will typically have several service encounters with the same service. (See Mary Jo Bitner, (1990), "Evaluating Service Encounters: The Effects of Physical Surroundings and Employee Responses," Journal of Marketing, 54 (April), 69-82.) A home visit by a social worker to investigate a concern that a child is being abused is an example of what I call a child protection service encounter.
[3] See Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky & E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221-238). Washington, DC: American Psychiatric Press, Inc.
[4] A good summary of research in this area can be found on the Child Welfare Information Gateway,