Association for Family Therapy 40th Anniversary Conference, Durham 16 th- 17 th April 2015

1. Association for Family Therapy40th Anniversary Conference,Durham 16th-17th April 2015 Being Seen and Heard: Multi-family approach to releasing the emotional lives of the children of adults with mental illness Alan Cooklin

2. What we are addressing:

3. Young people who have a parent with a mental illness • One in six of all school age children will have a parent with mental illness • Equivalent to 2,000,000 children (SCIE 2010) • 165,000 children identified as young carers • 2010 estimate suggests at least 750,000 (of which 250,000 or more) are caring for a parent with mental illness

4. Effects on a child With one ill parent, about 70% of children have some level of emotional, or cognitive adjustment difficulties. They will experience one or more of: • Loss of education through poor attendance and emotional distraction. • High levels of anxiety about the parent/s and their own potential of succumbing to the same illness. • Social isolation resulting from stigma, rejection by peers and self-isolation. • Guilt and an excessive sense of personal responsibility. • High levels of subsequent depression

5. . • If two parents have a major mental illness, a child can have up to 40% chance of developing the same or similar mental illness • BUT …..Children are more likely not to develop an illness than to develop it, and the figure assumes one has done nothing about it......................

6. What about the Children 2013 • Young Carers • The Care Act 2014 and • COPMI

7. The care Act may lead to some merging and improvement in response for these young people But • The nature of mental illness means that many young people of parents with mental illness will never be acknowledged as Young Carers – the concept not recognised by the young person or accepted by the ill parent.

8. Young People’s Perspective • Extracted from the series of ‘Master Class’ films from the ‘Who Cares ?’ Project for schools, in which 15 young people from ages 8 to 20 years old question (and challenge) a Child Psychiatrist, a Senior Approved Mental Health Worker, and an Adult General Psychiatrist. • The video is a compilation of discussion between young people from age 11 to 20, with most of the professionals edited out. • It starts with Juliet (age 11), but focuses on the experiences of Angel (then just 16)

12. ...and when the first episode of a parent’s illness occurs before the child has developed good language skills, it can have effects that are more difficult for the child to undo…

14. What do young people say they want? • Understanding of the illness; including their own concerns, ideas about the cause of the illness, their own feared responsibility, and their own risk. • How to recognize the signs of an impending illness or relapse. • Answers to their many questions about hospitalisation. • Advice about management of the illness; including coping with the effect on themselves as well as on their parent. This fits with the evidence of what increases resilience in these young people………………………….

15. Small interventions can help young carers to build resilience • A neutral adult, not usually a therapist or counsellor – who can help confirm and validate the young person’s own thoughts and perceptions about the ill parent and help that young person to think more clearly • An explanation which makes the mental illness understandable to the young person • Interventions to reduce the young person’s social isolation (and challenge the belief that ‘I am the only one’)

16. The Question of what is Systemic ? • 1960s and 70s crusade – We discovered the wheel • But Bateson, and before Elderkin Bell, and before that Lyman Wynne –See Bebe’s board outside • The thrill was partly to be free of prescribed behaviours: from either psychiatry or psychoanalysis • No ‘Authorised’ version, and for many years the feud between Ackerman and MRI.

17. Jyvaskyla 1992 • Not surprising because most of the shared elements of thinking : • Connectedness of all parts of system • Circular or recursive thinking • The observer (or therapist ) being part of the observed system Had all been borrowed from other sources such as Field Theory, and developing Social Science thinking. Gregory Bateson’s use of Bertrand Russell’s Theory of Logical Types was innovative........

18. ......In development of the Double Bind Hypothesis. A very elegant description of a common and noxious set of interactions – very common in many relationships. Sadly discredited because • Was not a theory of the cause of Schizophrenia. • Was linear and did not describe a 2 way or triadic process. • By focussing on the mother, it was inevitably very gender biased.

19. ......but a useful description of how a young person’s perceptions can easily become invalidated. • Very relevant to this group of young people.

20. This and future feuds were more about what one does with one’s thinking – what is the role of the therapist – as much as the thinking about systems themselves. However – The paradox that some systems practitioners underwrote a dangerous duality, almost denying the relevance of the physical body

21. Mental processes became sometimes divorced from the brains and bodies in which they occurred. • Only interested in our ‘software’ not our ‘hardware’. • Only excuse – the brain was like the dark side of the moon used to be – no excuse now.

22. We can still hear people described as ‘biological’ psychiatrists – perhaps as a term of abuse. • We cannot not be biological (apols to Watzlawick)...it is all we are. • ‘Biological’ ? means pre-insulin medicine

23. The Role of professional for these young people ? What is the useful role for a professional working with the families in which these young people – or young carers – live ? Uzma – age 14

25. And Kids hate it if what they know is not recognised.........

28. When a parent develops a mental illness, many children experience it as emotional withdrawal from themselves…

29. …Child often responds to this by trying harder to achieve emotional closeness In response, ill parent may withdraw further…

30. …The child's attempts to become close to the ill parent may then force the child to adapt his or her own ideas to the parent's thinking…

31. … can lead child to doubt his or her own perceptions, to feel he or she must ‘join’ the ill parent’s beliefs. Thus increases the common fear of ‘catching’ the parent’s illness.

32. … A vicious spiral can result which disrupts child’s development of attachment. Child can become confused about own identity, especially about their own thoughts vis a vis those of ill parent…

33. Resilience Better if: • Another adult – if not too intrusive • Siblings • Social network • Explanation Worse if: • Ill parent is physically or emotionally violent • No other adult • No siblings • Socially isolated • No explanation

35. Increasing Resilience • Explanation can reduce a child’s vulnerability to invasive aspects of parental mental illness by helping the child to distance their own emotional responses from those of the ill parent (and thus – in another language - reduce identification). • This is what meant by ‘releasing’ the emotional life of the child.

36. What kind of explanation? • …Providing visual imagery of the process of the illness can offer the child an alternative set of images to that of the ill parent’s distressed, angry, or confused face...  • Explanation also needs to address their fears: • of ‘catching’ the illness • that they are in some way to blame for the illness

37. Designed to help the young person gain an ‘outside view’ – a metaphorical ‘X-Ray’ of the parent’s behaviour • Goal is that the young person can distance him/herself from the aspects of the parent’s which the young person experiences as intrusive • So can take the behaviour ‘less personally’

38. The Function of Explanation: • Human Rights – Article 12 UNCRC • It responds to what children demand • It increases resilience • It defines a respectful role for the professional, which respects the child’s ability to think

39. What kind of explanation? • Working model • Process not static (Video not photo) • Visual imagery • Promotes thinking (All just ingredients of good teaching?)

40. What kind of explanation?What would a systemic explanation – that a child could understand - look like ?

41. From ‘Chemical imbalance’ to a moving/movie model of brain/mind function • Chemical imbalance • It runs in families • Your mum/dad is poorly • He/she has got mental health • Mental health issues

42. Illness – to be or not to be • Illness is the best model to help a child disengage from the more intrusive elements of a parent’s disturbance. • Illness means............ • ‘Can’t help it’ But • Can take some responsibility – for a physical or a mental illness

43. Our old model

45. Working contexts • Working Together Project • Kidstime • ‘Who Cares ?’

46. Kidstime – To be or not to be Systemic ? • Kidstime is a multi-family social and educational intervention. • The role of the different Kidstime workers is a mixture of informal and intimate mixed with a professional responsibility to protect both adults and young people • The main medium of discourse is generic explanation, rather than attention to the needs of individual families

47. Key Elements: • Not a ‘treatment’ • Multi-family • Drama, play and pizza • Focus on explanation enhances respect for child’s caring role

48. Structure: • Welcome to families • Joint Seminar or demonstration event • Separate adult and children’s groups • Pizza, feedback and films • Discussion – No pressure for individual disclosures

49. Now 12 soon 16 in UK and 3 soon 4 in Europe • Evaluation – soft an of course positive • RCT being worked towards