RSS Feed

Tag Archives: therapy

Head-banging therapy

When I was at middle school, our deputy head announced that from that point on, at school discos, ‘head-banging’ was forbidden. She went on to explain how dangerous it was to bang your head on the floor repeatedly. This was one of the early moments in my life where I realised that adults are not infallible. (It’s particularly weird, looking back, because our school disco was run by the caretaker who owned only three records – Prince Charming, Stand and Deliver and Eye of the Tiger. We must have been head-banging to Eye of the Tiger. Also, frankly as none of us had long hair head-banging was utterly pointless )

Anyway, this case involves the welfare stage of a set of care proceedings, some devastating findings having been made at a fact finding stage by Keehan J.

K (Children) [2021] EWHC 1409 (Fam) (26 May 2021) (bailii.org)

Some of what Keehan J said about the parents included this: –

The mother and the father have serially lied to the court, to the social workers, to the children’s guardian and to every other professional with whom they have had contact, including the police and health professionals.

  1. The mother is the most egregious liar I have ever encountered. The father has also serially lied to the court, to the social workers and to the children’s guardian.

There was an abduction of the children during proceedings and a concealed pregnancy.

The President of the Family Division dealt with the welfare portion of the case

The Court instructed an expert, Dr Banks, to try to understand why the parents were locked into a pattern of denial of the findings and whether this pattern could be broken.

In oral evidence, Dr Banks said this:-

Because of the nature of the parents’ difficulties, and particularly the mother’s approach which is to push and talk so as to ‘bamboozle’ others, Dr Banks advised that the therapist needs to do, what he called, ‘head-banging’ therapy, so as to be directive with respect to each parent, rather than passive.

Dr Banks in his written report made these observations :-

  1. Dr Banks conducted three sessions with the mother and two with the father, each over a video link. With respect to the father, Dr Banks considered that there was a deficit in the father’s ability to integrate emotional and cognitive information in order to provide a sound conclusion. This deficit might lead to distortions in his presentation and to misunderstanding. The father is unlikely to understand the role of formal organisations and institutions and is unlikely to be able to balance competing priorities leading him to be ‘mono directional’ in his decision-making and choices. Dr Banks identified ‘a high level of denial and lack of insight as to the impact of the father’s overall behaviour on the outcome of the current proceedings.’ In short, the father did not consider that he had acted in a way that might demonstrate a lack of cooperation or deception. The father, in Dr Banks’ view, feigned helplessness and lack of understanding of the English legal process as an explanation; a claim that Dr Banks considered was ‘likely to have little foundation’.
  2. The father explained to Dr Banks that, although he had agreed with the court order requiring him not to have any contact with his wife in order to facilitate the rehabilitation of the two boys to his care, he took the view that the court had overstepped its boundaries in imposing this restriction, had not given him any explanation as to the reasons for it and that it was, therefore, an unfair request. He claimed that he had effectively agreed to the conditions under duress.
  3. Dr Banks found the father to be ‘particularly psychologically defended using high levels of denial and minimisation to protect him from feelings of guilt, shame and blame’, with regard to his involvement in the difficulties in the court process and the removal of the children. Importantly, Dr Banks advised ‘this process will ultimately inhibit the father’s capacity for change where he will find it difficult to manage future behaviour when not recognising that outcomes are a consequence of past behaviour.’ Further, Dr Banks considered that the father had difficulties in mentalising and emotionally appreciating his children’s experience and, when specifically asked about the impact on the children, the father gave more detail about the emotional impact on himself.
  4. In view of the father’s reliance upon an interpreter, Dr Banks decided that it was not appropriate to undertake psychometric testing of him.
  5. With respect to the mother, Dr Banks’ initial appraisal was:
  6. Dr Banks considered that the mother’s adult attachment style was motivated by fear (of the authorities) leading to strategies of withdrawal and escape, and ways of dealing with the perceived threat which would become incoherent, self defeating and non-productive.
  7. The mother is seen as by far the more dominant of the two parents within their relationship.
  8. During his sessions with the mother, Dr Banks saw evidence of false beliefs, and an underlying theme of anger towards professionals. There was also ‘a high degree of fragmentation and false innocence and blame with distorted episodes’ which indicated that, essentially, the mother has difficulty in integrating both emotional and cognitive information. The mother identified difficulties in her relationship with the father, and displayed anger with respect to his behaviour, as she alleges it, of making contact with other women. Whilst the mother accepted that she had ‘done wrong’, Dr Banks, despite pressing on more than one occasion, was unable to illicit more that minimal examples of this from her – for example accepting that she had made a false allegation against the father with regard to the original injury to R in May 2017.
  9. During the exercise of psychometric testing, the mother’s scores indicated a high level on the ‘Obsessive Compulsive Subscale’. Dr Banks advised that such individuals tend to be fairly rigid and follow their own personal guidelines for conduct in an inflexible manner, even when this may conflict with social norms. The mother also demonstrated elevated scores on the paranoia scale and the hyper-vigilance subscale. She demonstrated a markedly elevated score on the ‘dominance scale’. Such a score, Dr Banks advises, identifies an individual who is generally domineering and tends to have little tolerance for those who disagree with their plans and desires.
  10. In a further test designed to assess socially desirable responding, the mother’s score on the ‘self-deceptive enhancement scale’ was very much above average indicating, in Dr Banks’ view, that she shows ‘a form of self-enhancement best described as rigid overconfidence akin to narcissism’.
  11. More generally Dr Banks considered that the father exhibited passive aggressive characteristics of a type that would typically result in attempts to sabotage agreements or disrupt agreements that have been reached, while attempting to appear cooperative. It is particularly difficult to resolve the source of conflict within such individuals, due to it being denied.
  12. The mother, too, is seen by Dr Banks as having passive aggressive personality characteristics. He considers that ‘The mother is now faced with a situation where even with her back against the wall, she does not show good reflective qualities to consider alternative strategies to those that have clearly failed her.’ She has a poor reflective capacity, which may give some insight to explain why the children’s needs were not prioritised.
  13. Dr Banks considers that ‘individuals who show passive aggressive behaviour are highly manipulative and tend to avoid responsibility for their behaviour.’ He further (and importantly) concluded:
  14. Dr Banks found that both parents take the view that Keehan J ‘got it wrong’ and that the court process was flawed. Both parents ‘struggled to agree any point in the judgment’.
  15. Despite his appraisal, Dr Banks concluded:

The parents would benefit from a couples therapy approach which would need to take place with two family therapists who could work with the parents to help achieve an alteration in the parents’ perspectives of their behaviours. The approach here will need to be direct and challenging and certainly not a non-directive type approach, as this would only lead to both parents going round in circles and having their existing views confirmed.”
Dr Banks advised that a minimum of twenty sessions would be needed, but that this was within the children’s timescales in his opinion.

The Court had to consider whether to make the Care and Placement Orders sought by the Local Authority or whether to extend the proceedings to commence the ‘head-banging therapy’ recommended by Dr Banks. The President analysed the issue here

  1. Of particular note is Dr Banks opinion (set out at paragraph 35 above) that it would be very difficult to establish a cooperative agreement with the parents that would hold up, due to the high level of the parents’ defensive avoidance, their denial and their huge degree of psychological defendedness. This conclusion is entirely supported by the analysis offered by Dr Banks with respect to each parent. Both the psychological labels that he attributes to the various elements of what he has identified from the parents’ behaviour, and the, at times, striking evidence that he reports of their responses to him during his sessions, justify the application of terms such as ‘high level’ and ‘huge degree’. Yet, despite the coherence of his analysis and his negative conclusion as to the ability of the parents to enter into a sustainable working agreement, Dr Banks’ recommendation is that this couple could respond sufficiently to a single course of therapy to such a degree that his opinion as to their ability to abide by an agreement could change sufficiently for the authorities to trust them to work cooperatively in the future. With due respect to Dr Banks, that recommendation seems to be wholly at odds with, and not supported by, the body of his report.
  2. No matter how directive and robust a therapist may be, the task in hand, namely bringing about sufficient change to establish a situation where the parents can each be trusted not only to enter into, but to stick with, a working agreement with the social workers for the protection of their children, is a very complex and substantial one. Not only must the therapist seek to challenge and turn around a long-established element of the mother’s character, which is maintained by a high level of avoidant behaviour and denial, he or she must also address the difficulties that exist in the couple’s relationship and enhance the father’s ability to understand and resolve his own difficulties. In addition the therapist will be working with a couple for whom lies and deceit are second nature, and who are each in almost total denial that they have any problems that need to be resolved.
  3. Dr Banks advises, and I readily accept, that it is not necessary for parents to exhibit a significant degree of understanding or acceptance of the nature of their difficulties before embarking on therapy. But, where the issue is should the course that would otherwise be in the children’s interests be put on hold for months, there surely needs to be some basis for the court understanding and accepting that there is at least the potential for sufficient change to take place. Here, the description of the nature of the parents’ difficulties, the degree to which those difficulties have been seen to be entrenched over years and the absence of any indication from the parents that they even recognise that they have those difficulties, make it difficult to accept that a single course of couple therapy could provide a commensurate remedy.
  4. After reading his report and then hearing his oral evidence, I was therefore left in the position of understanding and accepting his analysis of the problems, but far less able to understand and accept that his recommendation for therapy offered a sustainable potential solution.

The President went on to look at the written evidence and the parents oral evidence,

  1. the court has the parents’ respective responses to the detailed findings of fact made by Keehan J. These can only be described as being wholly minimal and self-serving. In the mother’s case, once those elements which are indisputable (for example ‘the police came to the hospital’ and ‘by chance a nursing professional in America identified the mother and alerted the authorities’) are removed, the only statement which is a genuine acceptance of an adverse finding is that the parents colluded with each other to conceal the birth of Q and her presence in England. In the father’s case, the only matters of genuine acceptance are that he lied about events in May 2017 and that he never had any intention of being a sole carer for the two boys. It is of further note that the mother’s admission that the parents colluded together to conceal the birth of Q, is wholly at odds with the father’s assertion that he did not even know of the pregnancy until he was introduced to his baby daughter at the age of four months.
  2. Despite Keehan J’s express and detailed findings, and despite stating that they accept that the judge made those findings, the parents’ evidence at this hearing demonstrated that, far from accepting that the findings have been made and must form the basis of planning for the children’s future, they still deny many matters of significance and seek to establish alternative conclusions. This is particularly so in relation to the bruise on R’s eyebrow, the trip to Stranraer, the calling of police in December 2019 and the attempt to flee with Q via Gatwick Airport, but the reality is that (as the parsimonious response to the findings of fact demonstrates) this is their approach to any of the adverse findings save for the minimal matters that have now been admitted.

strikingly given the stage that the court process has reached, the identification of her problems by Dr Banks, and the proposal for therapy to address those problems, during her evidence in chief the mother volunteered a detailed account of church-based therapy. Her account was, even on its own basis, internally lacking in credibility. It was roundly denied by her husband, who had only attended a few early sessions, but had not found them helpful and had withdrawn. He considered that there were still significant difficulties in the couples relationship. Against his evidence, the mother’s account of a course of couple counselling for well over a year, totalling over 100 sessions, and which had resolved all the difficulties in their relationship can only be a blatant lie.

(If you are going to lie, at least get your stories straight)

The President reached this conclusion

  1. Once the parents’ evidence is brought into consideration, the prospect of therapy being able to achieve and maintain a sufficient change in each parent are, in my view, further reduced to a significant degree. The findings that I have now made as to there being nothing other than minimal change in the parents’ acceptance of past harmful behaviour, and their apparently undiminished ability to produce and develop new lies to this court, do not provide any basis at all for identifying that there is any prospect of change on the part of either of them (paragraphs 95 to 98).
  2. Neither parent accepts Dr Banks’ assessment of their individual problems; the mother simply does not see herself as Dr Banks sees her. Rather than receipt of the expert’s report providing a mirror that each parent can look into and gain some understanding of what now needs to be addressed, this potentially dynamic moment has come and gone without any hint of impact in terms of enhanced self-awareness, and with the parents’ dishonest behaviour presenting as firmly embedded as ever. One is driven to the conclusion that, when the parents say that they are willing to undergo therapy and will do whatever is necessary to establish that they can care for their children, they are simply saying what they perceive is necessary and doing no more than paying lip-service towards accepting that there is a need for therapy. It may be that they are not deliberately doing so. It may be that they are incapable of seeing the truth of what Keehan J has said about their past behaviour and what Dr Banks says about why they behaved as they did. Be that as it may, the result is that they have not demonstrated to this court that they genuinely understand why they need therapy.
  3. Taking this appraisal of the parents’ evidence and presentation in the court process into account alongside my concern that the prospect of success in therapy does not seem sustainable even on Dr Banks’ evidence because of the scale of the problems to be addressed, it is impossible to escape the conclusion that there is no realistic prospect of therapy producing sufficient enduring change of the scale and degree necessary to justify consideration of placement of the children in their care on the basis that it would then be sufficiently safe to do so.
  4. Given my conclusion, which is that, despite Dr Banks recommendation, the evidence does not establish that the parents’ problems might be sufficiently resolved through therapy, it is not strictly relevant to consider the question of an adjournment of the case for four months to monitor how the parents might engage with the therapist and establish a therapeutic relationship. Even if a positive report were received after four months, my conclusion that the degree of change that is needed to establish safe parenting is beyond the scope of the proposed therapy would still stand. Indeed to take four months even to reach that stage indicates just how much work would then need to be done in the months that followed, thereby stretching the time during which the children were, yet again, waiting for a permanent placement yet further.
  5. On the issue of capacity, therefore, my sad conclusion is that the current lack of capacity to provide sufficiently safe, stable and nurturing care for their children cannot be reversed by a single course of therapy, starting as it would, from a baseline where the parents simply do not accept that there is any problem that needs to be addressed

The Court went on to make Care and Placement Orders.

Is the system failing parents?

Unlike most newspaper headlines that pose a question, to which the answer turns out to be “no”, this particular article from the Guardian ends up with the answer “yes”, and I would agree with it.

http://www.theguardian.com/society/2015/apr/25/are-we-failing-parents-whose-children-are-taken-into-care

 

I do complain often about how the mainstream press report on care proceedings, but this piece is a good example of how it can be done properly.

Firstly, when reporting on a particular judgment, the piece provides a link to the judgment itself, so that the readers can if they wish read the source material.

http://www.bailii.org/ew/cases/EWFC/OJ/2014/B158.html

Second, the account of the judgment holds up as being accurate even after you’ve read the judgment itself.

And third, rather than a single source story (which is specifically against the code that journalists have signed up to), this particular journalist, Louise Tickle, has taken the trouble to go and speak to a variety of sources to inform the story.  And she has picked smart people (like Cathy Ashley of Family Rights Group, Karen Broadhurst and the Pause project) to speak to.

The really sad thing about this case is that it is not a unique and unusual outlier – it isn’t the story of a dreadful miscarriage of justice, or the truth coming out following dogged cross-examination, or a Local Authority being put to the sword for mistreatment.

It is an example of a case that people working within the system will see week in and week out – a mother who is very damaged by her own experiences and upbringing, who needs proper therapeutic help to address those difficulties and who didn’t get that therapeutic help in time to make a difference for her care of her child, with the effect that the child can’t  be with her.  This sort of thing happens all the time, up and down the country. The fact that it happens all the time shouldn’t immunise us to the pain involved and the sense that it must be wrong.

 

Whilst the Judge, His Honour Judge Wildblood QC, carefully pointed out that this was a mother who had a need to change substantially and was not going to change within the time that the baby needed her to, he went over and above the usual expression of sadness and into not only a critique of the system but an exhortation that the system must do better.

 

This case is another example of how important it is that, if therapy is needed, it is obtained at an early stage. Time and time again I see a process whereby the following occurs: a) a Local Authority intervenes and begins making assessment of a family; b) months later proceedings are issued; c) an order is made for some form of expert evidence to be produced (often a psychological report); d) months later the psychological report is obtained which says, invariably and utterly foreseeably, that someone within the family needs therapy and e) it is stated that, by then, the beneficial effect of therapy would be ‘outwith the timescales for the child’. In this case, for instance, it would have been perfectly obvious to all that, when the mother was referred before birth, she was a prime candidate for therapy. If therapy were to be obtained at an early stage such as that there is at least a prospect that outcomes in some cases might be different. I have therefore already set up arrangements in the New Year to look very carefully at how we facilitate and access therapy in this area, with a view to doing my utmost to encourage much earlier therapeutic intervention if possible. I ask for as much help as possible with that endeavour.

 

The Judge is completely right here. I’ve been saying for many years that the system was geared up to get and pay for a Harley Street diagnosis but left the business of obtaining  treatment to a model of  stand outside Superdrug looking sad and hoping the staff take pity on you.  {It’s even worse now, since we don’t even have the Harley Street diagnosis money any more to redirect where it always should have been going}

It’s really easy to wring our hands and say that the system is the system and what can you do. It is even easier to say that when the pragmatic reality is that Local Authority budgets were cut massively in the current Parliament and are set to be cut still further in the next one, whoever is in charge.  Social Services isn’t education and it isn’t health, so there’s no budgetary ringfencing – it will have to take its share of the cuts and some of health and education’s share into the bargain.

I like that His Honour Judge Wildblood QC isn’t satisfied with hand-wringing and wants to do something about it. I very much hope that his scheme works, and I hope that it works so well that versions of it are rolled out nationally.

As Louise’s article touches on, there’s precedent for that. District Judge Crichton saw so many care cases with drugs and alcohol being a feature that he took it upon himself to devise and champion a specialist Family Drug and Alcohol Court, and that model is now being rolled out to other areas in the country.

As George Bernard Shaw said “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man”

I have no idea at all whether His Honour Judge Wildblood QC is an unreasonable man – I’m sure he is instead a deeply reasonable one. But if he is choosing to be unreasonable about a system that can see when a parent is crying out for therapeutic intervention but doing nothing about him, then all power to him.

I’d love to see some legislation that insists that where a Local Authority issues care proceedings, they must arrange and provide funding for therapy for the parents; it must be more economically sensible and morally sensible and less costly in terms of pain and trauma to try to fix what is wrong with a parent rather than simply waiting around for them to have the next child and starting the whole process off again.  (I’d love also to see that legislation backed with some government funding to pay for it, but although I am an unreasonable man, I’m not an unrealistic one)

Yes, there’s far more to tackle in family justice than this one issue of providing therapy for those who need it (rather than them trailing off to see their GP who at best puts them on a two year waiting list), but it would be a starting point, a base camp – and a message that there’s more to do to make a family justice system really be about both families and justice – rather than at the moment, where it is all simply about “system”

 

[I feel like I ought to put a You-Tube clip of “My name’s Ben Elton, good night” here, as I got a bit student ranty there]

Let’s watch out for Louise Tickle – this is damn good journalism, and it would be nice for mainstream writing on family justice to have this blend of outrage and factual accuracy.

“I’m Batman”

 

This will now be the fourth time I’ve written about this particular case,  you may recall that it involves a family whose relationship with their daughter broke down and she came into care voluntarily as a result of being beyond parental control. The parents obtained a judgment in which the Court found that their complaints of being treated badly by the LA and being marginalised and excluded were made out, though the Court went on to make a Care Order believing that the better option of wardship was barred to them.

https://suesspiciousminds.com/2012/07/30/forensic-ferrets-or-standing-in-the-way-of-beyond-parental-control/

The Court of Appeal then ruled that it wasn’t and wardship was made.

https://suesspiciousminds.com/2012/12/31/the-case-i-am-most-pleased-about-this-year/

The parents were then asking the Court whether they could speak out in public about the case – providing that they did nothing to give away the identity of themselves and the child.

 

(You may remember, it was my clunky Batman analogy – the parents wanted to say in their interviews that the published judgments were about them, using the alias in the published judgments but not give their real name – i.e they could say “I’m Batman” but not  “I’m Bruce Wayne, and I am also Batman”)

https://suesspiciousminds.com/2013/08/01/rubrics-cube/

 

Okay, so the Court now finally have said that they can indeed say  “I’m Batman”   – their faces would need to be either silouhetted or pixellated but they don’t need voice-changing technology. I think it is important for family justice that in a case where the Court have found that the State got things wrong, that this gets properly aired, and those concerned ought to be able to tell their story, so I think it is a good thing.  (unlike Re J, where there was not yet any published context to ascertain whether the parents huge sense of injustice and aggrievement was justified by bad treatment as opposed to being a natural human reaction)

http://www.bailii.org/ew/cases/EWHC/Fam/2013/B21.html

 

There’s even a fifth judgment, which deals in part with the wrangle that the parents had to obtain the therapy that their daughter so clearly needed.  If you have seen the title of the case and got excited that it is a ‘compelling the LA to fund therapy’ case, it isn’t.  Firstly this is wardship, and secondly the LA had agreed to be bound by the Court’s views – it was about who was to provide that therapy (the organisation supported by the psychologist and parents, or the one supported by the LA), the LA lost that argument too, but to their credit agreed to be bound rather than sheltering behind technical arguments about the court’s powers.

http://www.bailii.org/ew/cases/EWHC/Fam/2013/B20.html

 

Having played a microscopic part in all of this, I am very pleased for these parents, who have had a long and gruelling journey to get justice and the help that their daughter so badly needs and have finally done so. I hope that some of the principles they have fought for may help others.

 

And in a final flourish – Bale is amazing, obviously, but against all the odds, wimpy Michael Keaton delivers THE line better than anyone could have expected.