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Working briefly with reluctant clients: child protective services as an example
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Working briefly with reluctant clients: child protective services as an example
Working briefly with reluctant clients: child protective services as an example
Journal of Family Therapy (1992) 14 231-254. 0163-4445 $3.00 Working briefly with reluctant clients: child protective services as an example J ohn H. Weakl and* and L ynn J ordanf Therapists and counsellors often are faced with reluctant clients and constraining circumstances. Such difficulties are especially prevalent and severe in casework in child protective services - the parents of abused or neglected children are all involuntary clients, case loads are large, and time is limited. Drawing on experience in applying and modifying prior work at the Brief Therapy Center of MRI 1.0 work in child protective services of a Northern California county, thi’s article suggests general principles for effective intervention in such difficult circumstances and illustrates these with specific case examples. Since consideration of extreme conditions is often helpful in dealing with parallel but less extreme ones, the authors’ aim and hope is that readers will find this article helpful not solely in child protective work but also in the much wider territory where similar obstacles to effective counselling also occur. In an ideal world, any person with a significant problem would voluntarily seek out a counsellor and say, ‘I have a problem which I am unable to resolve on my own, so I have come to ask your help’. In addition, this person would be compliant with requests for information and suggestions about changes - and there would be ample time available for the clinician to work with the client. In the real world of the child protective services worker, unfortu- nately, the situation is very different, in fact almost opposite in every major respect. The case worker must seek out the ‘client’ who is thus under duress rather than volunteering, and must declare, in effect, ‘You have a problem’, namely the alleged abuse. This inevitably will be interpreted, at least initially, as blame and accusation. Such an * Mental Research Institute, 555 Middlefield Road, Palo Alto, CA 94301, USA. t Mental Research Institute; and San Francisco Child Abuse Council, 1757 This article first appeared in Family Therapy Case Studies (1990), 5: 51-68, and Waller Street, San Francisco, CA 941 17, USA. appears here by kind permission of the Editor and authors. 232 John H. Weakland and Lynn Jordan adversarial beginning is more likely to elicit defence and withdrawal than co-operation. While it is true that the case worker has considerable formal authority involving consequences that can be threatened or imposed, this authoritative stance is quite different from effective influence to promote the co-operation and compliance needed to bring about positive change. Indeed it may be antithetical; passive resistance is a common, and very powerful, response to authority. In addition, organizational and situational circumstances impose certain more specific and concrete difficulties on the case worker, especially limitations of time. For example, in San Mateo County, CA, on which our experience is largely based (but which is also a legislative and organizational model for child protective services in urban counties of California), the typical case load may allow perhaps eight hours overall per initial assessment of a family, part of which must go into transportation, mandatory record keeping, reporting, and interviewing all minors who reside in the home. Whenever possible, the minors are to be interviewed first, a further restriction on the operating manoeuvrability of the case worker, and one involving possible additional obstacles to gaining parental co-operation. We bring up these difficulties, however, not as a counsel of despair but of realism. The rest of this paper will offer some practical suggestions on how, by taking these realities into account, a case worker can deal with them, in only a few interviews, so as to gather the necessary information and assist the family to make changes that though small are significant - that is, changes that will improve the immediate functioning of the family, offer the possibility of continued improvement, and make recidivism less likely. I. Theoretical orientation All the major schools of psychotherapy, from psychoanalytic to family systems, offer views of individual and family development and behavioural problems, and propose broad guidelines toward the resolution of problems. However, none specifically addresses two crucial matters facing the Child Protective Service (CPS) case worker- namely, how to attain co-operation rapidly in an initially antagonistic situation, and how to introduce what one hopes will be lasting change in only a few hours, especially in multi-problem families. Also, even if the case worker had time to gather a detailed history from such families (and their co-operation is questionable in a task that many Working briefly in child protective services 233 families would see as wasting time instead of getting to immediately useful matters), it is likely that learning of all the problems of the family over time would paralyse the worker much as it has the family. The methods suggested and illustrated in this paper derive largely from the model of the brief therapy team of the Mental Research I nstitute of Pal0 Alto (Haley, 1973, 1976; Herr and Weakland, 1979; Watzlawick, Weakland and Fisch, 1974; Watzlawick, 1978) with modification to fit the particular circumstances of CPS work. This approach was selected because it focuses on how change can be begun in only a few sessions, even with difficult clients. Moreover, the specific features of this method can be applied usefully in CPS case work whatever the general theoretical persuasion of the practitioner. Since in it promotion of useful change is closely related to information- gathering, i t effectively doubles the time spent working toward solutions with families. Finally, this model addresses the needs of the situation and the strengths and values of the family; change formulated in terms that the family sees as both positive and consistent with its values is more likely to be accepted, adhered to, and incorporated into the ongoing fabric of family life. 11. Building co-operation I t is essential to clarify at the outset that promoting co-operation with abusive parents in no way suggests condoning abusive behaviour. Rather, it represents the surest way for the worker to lead the family away from its history of abuse, and so make it both immediately safer for the child(ren) and possible to introduce the beginning of what one hopes will be lasting change for the family. A co-operative and pleasant interview will likely leave the parents in better spirits than will a contentious one. The parents may then be less prone to blame the child(ren) for having been the cause of the visit by the social worker. Additionally, if the parents are able to work co-operatively with the worker, they may feel more resolved to attempt to manage problems differently and feel more adequate in general. At the very least, they will have experienced a more positive way of approaching a difficult situation. (a) Getting off to a good start with parents The duel goals of gathering information about possible neglect or abuse and facilitating change within a family - the only avenue 234 John H. Weakland and Lynn Jordan toward lasting protection of children except the extreme measure of permanently removing them from their home - depend on establishing and then maintaining a co-operative relationship between parent(s) and case worker. How effectively this is done may well be determined in the first few minutes of the interview with parents. Initially, many parents are angry about having to meet the worker, defensive about their handling of problems, and - legitimately - object to the intrusion into their private lives. Other parents are so overwhelmed by the circumstances that precipitated the referral that they meet the interviewer with passivity, despair, depression, and too little energy to make the prospects for change look likely. It is crucial that the worker and the parent(s) form a partnership at the outset, lest limited energy and attention spans be exhausted before the essential matters are addressed. There are a number of ways to get off to a good start with parents. For example, if a child has already been interviewed outside the home, the worker can begin by saying something complimentary about the child, repeating a humorous remark the child said in the interview, or passing on a positive comment made about the child by a teacher or day care worker. A six-year-old boy was interviewed at his school after a referral was made describing his poor hygiene, dirty clothes, and combative behaviour with his peers. Midway through the interview with a 35-year-old worker, the boy looked intently at the top of her head and exclaimed. ‘you have grey hair - you must be very old.’ The worker then went to the parents’ home, introduced herself, and without giving the parents time to interrupt, said that the parents had the most delightful child, and repeated the child’s remark. The parents were so embarrassed at their child’s lack of tact that they were congenial and co-operative throughout the interview, including a discussion about the dirt that was also caked on the father’s hands and bare feet. The parents agreed that the child’s appearance attracted a lot of negative attention from both peers and teachers, preventing others from enjoying this obviously bright and witty child. The interview concluded with the parents thanking the worker for her interest in the child, and the mutual good will that occurs when people spontaneously share laughter. It is more difficult, but necessary, to defer to the parent when the child has been seen earlier. This can be done by apologizing for intruding, offering to be brief, to come back at a more convenient time, and setting other limits that may help the client relax. The client can then overcome the worker’s objections, invite him/her in, and offer to spend a few minutes talking together. That is, since the case Working briefly in child protective services 235 worker represents authority, obviously and perhaps painfully, co- operation is more likely to be promoted by playing this authority down rather than by emphasizing it. If there has been a prior referral, the client may respond to the introduction by the worker with complaints and invective about the other worker, the agency, the juvenile justice system, etc. There are a number of reasons why the client should be allowed to state his/her objections, although not endlessly. First, he/she will not listen to anything else until this point has been made. Second, complaints about past approaches will tell the worker what to avoid in the present. Third, it will give the worker a picture of the outlook of the family, as well as an indication of the amount of emotional control of the client(s). The worker can utilize any tirade volunteered by the parent(s) to gauge the amount of responsibility taken by the parents, the efficacy of the efforts made since the earlier referral, and especially the values of the family and their view of the problem. Without either defending or discrediting the other worker, the agency, or the larger system, the worker can say to the parents that it is understandable if they felt violated or mistreated by what happened (using their wording), and can voice his/her regret that things had not gone better for thzm before. The worker can then express a most sincere desire to do better and be more considerate. He/She can next ask the clients to help him/her accomplish this by pointing out immediately when he/ she errs. This unites the worker and the parents in a common purpose and empowers the parents by giving them an evaluative role. Moreover, they then have to allow the worker to discuss this referral with them, and they have to listen, in order to monitor the work. (b) Not arguing with people This matter of getting off to a good start is probably the clearest and most important example of a principle that is crucial throughout all counselling work, especially work involving potentially difficult relationships: avoid arguing with clients, as this almost necessarily leads to adversarial exchanges. We realize, of course, that case workers already seek to establish positive rather than adversarial relationships, but there are two important reasons why one might err inadvertently, and pointing these reasons out specifically may be helpful. First, child abuse is a painful and provocative situation, and one in which the case worker’s first duty is protection of the child. In this situation, it is all too easy to 236 John H. Weakland and I p n ,Jordan become a one-sided advocate of a child against a parent: the parent is the abuser and the child the abused one, and in addition, as mentioned earlier, the parents are likely to behave in defensive and aggressive ways toward the worker. Nevertheless, parental co- operation is crucial to any lasting improvement in the child’s situation. Therefore, it is helpful to give the parent(s) the benefit of the doubt as much as possible, that is, to take the view that parental intentions usually are good even if their behaviour is less than adequate, so that based on these intentions the parents can, with guidance, change. Second, while i t is not too hard to avoid obvious and overt arguing, arguing also comes in more subtle forms which can often go unrecognized, especially when labelled otherwise: pointing out facts, clarifying realities, or reasoning. All of these apparently innocuous or even positive terms may obscure what is actually covert argument or put-downs. We suggest the following as means to avoid arguing unawares: 1. Listen attentively, even to provocative and apparently misguided clients; 2. Agree with them as much as possible, even if this agreement must be subtly qualified (‘From what you say, it certainly sounds as if. . .’) ; 3. Mention, with approval, anything the client brings up that sounds positive; 4. Frame any comments, reservations, or advice in terms consonant with the client’s own language and expressed views as much as possible. A concrete illustration of avoiding argument in potentially difficult circumstances is the following excerpt from an interview conducted by one of our colleagues, Richard Fisch: Fisch was interviewing an adolescent who had been abused for some time by his stepfather and in retaliation shot the stepfather’s pet duck. The teenager was maintaining that he had shot the duck accidentally, and it appeared necessary to have the child own up to his behaviour and state his anger at his stepfather, so that a decision could be made on the possible danger if the child were to be sent home. FISCH: So you say you were in the back yard shooting at bottles lined up along the fence, and the duck accidentally walked into the line offire. . . CHILD: Yeah, that’s what happened. FISCH: Forgive me if my questions sound a bit stupid, but I don’t know very much about ducks. I have dogs at home, but no ducks, and I’m a little Working briejly in child protective semices 237 confused. You say that you werejust shooting at bottles along the fence when this duckjust happened to walk into the line offire (child nods) - but (genuinely) don’t ducks tend to waddle? CHILD: Yeah. The duck waddled into where I was shooting. FISCH: Again, you’ll have to forgive me because I really know so little about ducks and am having some difficulty following this, but was this an especially fast waddling duck? CHILD: No. The duck kind of waddled at an average speed. FISCH: I do appreciate your patience with me in my slowness in understanding what happened. Let me see if I’ve got it right this time: the duck waddled at an average speed for a duck into the line of fire . . . Throughout thediscussion, Fisch presented himselfas someone who was fond of animals but ignorant about ducks. He was therefore able to defer to the child’s greater expertise on this subject. He was at all times polite and gracious, stressing his shortcomings in comprehension and knowledge rather than confronting the less believable aspects of the child’s story. Voices were never raised. Both questions and answers were taken seriously. Each treated the other respectfully throughout the interview. As a result, the child was able to modify his account in response to Fisch’s questions without losing face or having to admit that he had lied. In addition to avoiding arguing, there are two important positive ways to build rapport and co-operation: finding something to praise and being generous. (c) Finding something to praise Asstated earlier, rapport and co-operationare promoted by any possible agreement with parents, especially if they can be praised for any of their behaviour as parents. While especially diffkult with abusive parents, it is still possible, as in the example that follows. A referral described a father hitting his two sons across the face with a belt. The older boy, age 10, had an I Q of 70, and was in the school’s special education programme havingfailed thirdgrade twice. The youngchild, age6, hadan I Qof 50, barely spoke, and then almost inaudibly, and seemed terrified. The father was from J amaica, a very proud man who worked twelve hours a day to provide for his children and give them all the opportunities America could offer. The father had been asked by the school to take the children for many diagnostic and evaluative tests. He had complied promptly with each request. Neither the school nor the testers had made clear to the father the purpose of the testing, and he mistakenly assumed the tests would make the children get better and learn more rapidly. No one had told him what the low I Q scores indicated. I n his understandable frustration with the children’s failure to learn, he would make 238 John H. Weakland and Lynn Jordan them practise their reading at least three hours per night and would hit them when they did not improve. The school described the children as lovely, hardworking, and good natured. Therefore, the worker praised the father for having such agreeable and industrious children. She explained to him the limitations of the children, and shared his sadness and anger that noone had told him this hard truth before. She offered to join him in a meeting with the educational tester and the paediatrician. She briefly described more realistic expectations, and then told the father how much she admired his boys for having such extraordinary perseverance when they experienced such little gain for their efforts. The father agreed that it was indeed admirable to work so hard in the face ofsuch odds, and began to appreciate for the first time the real strengths of his children. We believe that in most families, even ones where there is serious abuse, some behaviour or attitude which can be praised or complimented can be found ifsearched for; this will lay an important basis for co-operation and change. (d) Being generous -for workers and parents Sometimes, in an effort to solve a problem, people will focus so much attention on the problem that it eclipses many other things. As the problem takes on a more central role more attention is directed to what is wrong in the family. Frequently, then, little effort is made to build on what is effective and positive. This over-emphasis on the negative and failure to attend to the positive can grow until it consumes virtually all of the family’s interaction. Clients respond all too often to the questions ‘What do you like about your child?’ and ‘What do you enjoy doing together?’ with the word ‘Nothing’. At this crucial juncture - lest the worker also be engulfed in this ocean ofnegativity-a kind note must be interjected. The worker can genuinely say that it must be hard for the parents to spend so much time and energy with a child who gives them little pleasure, and add, ‘I wish things were easier for you’. Even in the grimmest situations, it is possible to give in fantasy what one cannot in reality (Faber and Mazlish, 1975). By expressing the wish to the client that it were not so painful, the worker says something the client can agree with and respond to less defensively (Haley, 1973). Perhaps the parent can then also say to the child a similarly charitable remark. This shared sentiment might well be the first close moment they have experienced in a great while. While waiting at her dentist’s office, J ordan overheard a child leaving the dentist remark to his mother that his tooth hurt a lot. The mother Working briefly in child protective services 239 contradicted him. He replied, more upset than before, that it did indeed hurt. She again told him he was exaggerating, and an argument ensued leaving the child in tears, feeling both invalidated by his mother and attached to the painful tooth. The mother was exasperated by the child’s exaggeration and very angry. I t is likely that if the mother had remarked initially, ‘I bet it does hurt’, or ‘I’m sorry’, and then proposed doing something more enjoyable that the child would have agreed, and the entire fight would have been averted. Liberated Parents; Liberated Children, an inexpensive paperback by Faber and Mazlish (1975), is an excellent book to recommend to parents who would like to learn more effective ways of responding to their children and of avoiding arguments. It is dificult enough to get parents to consider verbal generosity which costs them nothing. Still harder is to propose to them that they change the negative climate by giving their young monster a gift. This example of the effective use of generosity comes from Karen Pryor’s superb book Don’t Shoot the Dog! ( 1985; pp. 32-33): When I was fifteen my greatest pleasure in life was riding lessons. The stables where I rode sold tickets, ten lessons on a ticket: From my allowance I could afford one ticket a month. I was living with my father, Philip Wylie, and my stepmother, Ricky, at the time; and although they were very good to me, I had entered one of those adolescent periods in which one practices being as truculent and disagreeable as possible for days on end. One evening the Wylies, being loving and ingenious parents, told me that they were pretty tired of my behaviour, and that what they had decided to do was reward me. They then presented me with a brand-new, extra, free riding ticket. One of them had taken the trouble of going to the stables to buy it. Wow! An undeserved jackpot. As I recall, I shaped up on the spot, and Ricky Wylie confirmed that memory as I was writing this book many years later. Why the unearned jackpot should have such abrupt and long-reaching effects I do not fully understand . . . I do know that the extra riding ticket instantly relieved in me some strong feelings of oppression and resentment. 111. Agreeing on the problem Unlike therapy, where the client presents to the practitioner a source of discomfort, a case worker with a CPS referral must focus on a problem that poses a potential danger to a child. Therefore, after introductions, the interview must begin by reaching an agreement on what the problem is. This definition of the problem must be in terms consistent with the family’s outlook and values if it is to be effective. The barrage that greeted the worker upon arrival should be viewed not as cacophony but as an introduction to the language of the family. 240 John H. Weakland and Lynn Jordan By stating the problem in the family’s idiom, the worker can demonstrate hislher accurate understanding of the family’s situation, thereby building credibility in their eyes. A formulation that is both plausible and solvable in the family’s view is one they may well be able to work on after the departure of the worker. A school principal telephoned both the police and CPS to say that a five- year-old had a bruise on her face. There had been several prior referrals alleging beatings by the mother involving all four of her children. Unfortunately, the principal had also phoned the mother when he made the two other calls, with the result that the worker arrived just after the mother had, and the mother had already taken the child home with the police officer’s permission. When asked why he had allowed them to leave, the oficer explained that the bruise was at least five days old and fading, that there was insufficient evidence to arrest the mother, and that the mother was bigger than he (six feet tall, easily two hundred and fifty pounds) and he was afraid of her. I t should be noted that the CPS worker was five feet tall. She interviewed the three siblings who were still in school and found them to be extremely timid children. On returning to her office, she learned that the mother had already phoned and was furious. She called to schedule an appointment with the mother for the next morning and confirmed the secretary’s assessment of the mother’s fury. The mother began the interview with the worker by yelling at her for having frightened the children. The worker agreed with the mother that she had indeed frightened the children and said that she felt badly about having done so. The worker added that the children were much more frightened than most of the children she had interviewed that week, and asked the mother if she had any idea why. The mother talked about how much she cared about the safety of her children, did not let them ‘hang out’, talk to strangers, or stray from either school or home. She said that since they played mainly with each other they did not socialize much, and were therefore very scared around strangers, especially people who asked them questions. The mother had sensed genuine concern in the worker about her having scared the children and she responded in a way that (1) acknowledged her appreciation of the worker’s sincerity, (2) showed a desire to protect her children and ( 3) gave a plausible explanation within which frame change could be introduced consistent with the values articulated by the mother. The mother agreed with the worker that the children might benefit by having the opportunity to increase their skills at socializing. She mentioned that the children had recently voiced an interest in gymnastics and proposed signing them up for lessons. The worker expressed agreement with this very wise suggestion of the mother’s and gave her the names of a few local recreation programmes. The interview ended amiably with the mother offering to let the worker know how the children were doing in their new activity. Working briefly in child protective services 24 1 The mother’s proposal was seen as excellent for several reasons: the children would be seen regularly while they were wearing only a leotard by a coach who would likely know which bruises were the result of beginner’s mistakes in a gymnastics class and which were inflicted. Moreover, the suggestion was the mother’s, and the conclusion to the CPS interview was the mother giving the children something they would enjoy. Not only did the mother call the worker several weeks later to report on how well the children were doing, but she also asked for advice and resources on an unrelated problem, the speech impediment of the youngest child. (a) Distinguishing between solvable problems and insoluble dzfJiculties I n the world in general and in CPS case work in particular, there are two kinds of problems: problems which can and should be resolved, and insoluble difficulties that at best can only be lived with. The former call for promoting appropriate action while the latter call for acceptance and making do. It is an unfortunate loss of opportunity if no useful action is taken in the first case, but in the second the main danger is to squander time and effort on actions that can serve no useful purpose. Unfortunately, it is often dificult to estimate accurately which of these two situations obtains in any given case. Perhaps one can never be absolutely certain, but we can at least suggest some guidelines for making this necessary and important judgement. First, the case worker is in a better position to make an accurate judgement than are the parents simply because the worker’s relative detachment from the situation lends perspective. Nevertheless, parents’ opinions must receive an attentive hearing; they provide basic information both on the problem and how the parents view it. Second, the best basis for any such judgement is to pose the question ‘What has been tried so far in attempts to change or resolve this problem, and what observably has followed from these attempts?’ I f the parents take the position that the situation is hopeless and they are helpless, or perhaps more commonly that they have ‘tried everything but nothing works’, then the case worker needs to inquire concretely and specifically just what they have tried. It often will then become clear that they have at most tried a few variations on one simple theme, e.g., that they have admonished or reasoned with a child about difficult behaviour without success until growing frustra- tion led to physical force. I n this case, the worker should consider what possible alternative means may not even have been thought of, much less tried, and how the parents might be persuaded to try something new. 242 John H. Weakland and Lynn Jordan At the opposite pole, there are parents who expect and seek standards of behaviour from their children that are unreasonable or impossible because of the ages of the children, or for any other reason. I n this case, the worker’s task is to enable parents to recognize and live with the realistic limitations of their situation. If this is accomplished, the frustration and escalation of behaviour toward apathy or violence that naturally result from repeatedly attempting the impossible will diminish. In either case, success will depend greatly on how well the case worker can give advice in terms that ‘make sense’ to the client, that is, in terms that recognize and fit with the client’s own views and language. ( b) Directing energy so as to make a difference Most parents will admit that they are tired, overworked, and expending more energy dealing with their child than they can afford. Many will agree that their past efforts have been inefficient and ineffective. The answer to this dilemma is not to try harder, but to try something different. A thirteen-year-old ~o y was referred to CPS by his school when the nurse found more than twenty bruises on his back and buttocks. The child said that he had stopped to play a video game on his way home from an errand, spent 77 cents without permission and then lied about it, infuriating his parents. The mother, a waitress, came home from work each day and put all her change from tips in a jar. She thought her son stole quarters from this jar, and he had admitted to having done so approximately five times. The boy also lied about his homework, and was failing maths. The parents described the child as a thief and a liar, and asked questions about Toughlove, the possibility of sending the child to jail for a weekend, and other severe measures. They wanted to show the child the logical extreme of his misbehaviour. The worker began her response by stating that she saw how much they cared about the child’s future and how worried they were. They agreed. Her aim was to appreciate their concern while also introducing the idea that they had a rather nice youngster with a video game habit and the erratic impulse control typical of children his age. She volunteered that if she were left alone in a room with a plate full of chocolates, she would probably steal one or two and eat them and then lie about it if asked. She added that she paid taxes, worked forty hours a week, and thought of herself‘ more as chubby than as a thief and a liar. The parents laughed in recognition of a common human failing. She next asked the parents what they liked about their child, and - happily - they had much to say. They agreed that by focusing on the Working brieflr in child protective services 243 negatives they had almost forgotten the child’s strengths. With considerable eagerness, they talked with the worker about how to redefine the financial problem to build on existing strengths. The parents agreed to the following changes: 1. No physical force would be used in disciplining the boy. 2. No loose change would be left around the house. 3. The boy was paid $20.00 per month by the manager of the apartment complex for doing odd jobs. The parents had been cashing the cheque for him. I t was decided that the parents would take the child to the bank to open his own account so that he could deposit his cheques. The parents agreed to the worker’s suggestion that they call ahead and request that the person in charge of new accounts call the child ‘Mr’, put him on mailing lists, and promote earning interest by leaving money in the account. The parents smiled at the thought of how pleased the child would be to be treated like a businessman depositing his paycheque. 4. The parents agreed that if they asked him to run an errand they would expect him to use his own money, then present his receipt to be reimbursed. Tipping was to be allowed for a job especially well done. Both the reimbursement and the child’s weekly allowance were to be paid by cheque. As a result, the only cash around the house would be the child’s. 5. To be positive about these new financial plans, and indirectly to help the child with fractions, the parents decided to buy him one share of highly fluctuating stock as a gift. Thus, he could follow its ups and downs in the paper and daily track its worth. 6. The parents were enthusiastic about this new approach, and also aware that at least initially it would be easy to backslide. They readily agreed to enter counselling to work on consolidating the gains made in the CPS interview. IV. Solutions already attempted Careful inquiry about what solutions have been attempted for a given problem not only helps identify difficulties that simply must be lived with, but also indicates what has not worked in soluble problems, and thus what must be avoided in the future. While the solutions attempted will be as varied as the people themselves, these solutions can generally be categorized as follows (Watzlawick, Weakland and Fisch, 1974). (a) More of the same The classic example of this type of attempted resolution of an impasse is the person who speaks more loudly and eventually shouts at a 244 John H. Weakland and I gnn Jordan person that does not speak the same language as he/she does, as if reaching a certain decibel level would cause the listener to become bilingual. Parents will often describe an infraction of a child, a curfew violated as an example, and a punishment levied, perhaps being grounded for a day. As often occurs, the child will stay out even later at the next opportunity and the parents will ground the child for an even longer time. This process can rapidly escalate into a situation that could prove dangerous to the child, namely his/her staying out all night. Rarely will parents respond to this escalation by changing the consequence for the behaviour. (6) Action needed but not taken Attempted solutions of this sort include denying, avoiding, or trivializing the problem. Common examples are people who find a lump or other possible indication of cancer and delay going to the doctor because they are afraid of what might be wrong. People at times ignore warning signs of substance abuse in family members. In CPS work, the non-abusing parent’s failure to protect the children from abuse would be a prime example. (c) Action taken but not needed The father mentioned earlier who attempted to make his retarded children read through hours of practice is an example of action taken - and great effort expended - to no practical purpose and in fact to the detriment of the children. Parents may also describe as hyperactive the normal exuberant behaviour of their child, and seek unnecessary medical attention for a non-existent condition. Carried to extremes, this behaviour results in the sometimes fatal syndrome of Munchausen’s by proxy. I n addition to the three varieties of attempted but fruitless solutions described above, two somewhat more specific blocks to resolving problems may be mentioned briefly. (d) Going two ways at once Although this phenomenon may manifest itself in a number of ways, one common situation may be sufficient to remind the case worker to keep alert to the potential difficulty of parents trying to go in two directions at the same time. Parents may overtly criticize or punish an undesired behaviour, yet at the same time take other actions which Working briefy in child protective services 245 covertly reward that same behaviour, or parents may preach to a child about being more responsible while themselves taking on so much responsibility for this behaviour, such as by protecting the child from natural consequences, that the child does not need to act more responsibly. In such circumstances, typically the covert reward goes unrecognized by the parents, who then are increasingly frustrated and angry because their efforts at changing the undesirable behaviour of course are futile. If the covert rewarding can be made clear to the parents, they are then in a better position to alter this behaviour. (e) Needing the perfect solution Even - or perhaps especially - in desperate circumstances, certain clients will express goals that are easily recognizable as utopian; the client, for example, might seek a ‘perfect child’, or might press the worker to take large steps in each of five difficult situations all at once rather than picking a main problem and seeking an initially small but positive step. There is nothing wrong with utopian dreams; they may even be helpful at times, but attempts to do the impossible in actuality will prevent doing what is possible and desirable, and will also make what might otherwise be bearable appear intolerable because it is imperfect. These five categories which have been discussed are not mutually exclusive, and families may describe attempted solutions of several types. Typically much energy has been expended and the worker can honestly recognize and appreciate the enormous effort made in attempting to handle the problem. Generally the family will then agree with the worker that their efforts have not been effective. At this juncture, the worker should also ask what other people have suggested the family do about the problem. This information will protect the worker from suggesting something that has already been tried (or rejected), and it also will give the worker the cast of peripheral characters, meddlesome relatives, caring teachers, and the like, who can then be relied upon or deliberately blocked when the intervention is designed. The stage is now set for proposing a different means of dealing with the problem. V. Taking a small but significant step toward change Though it may be small, the first step that moves family behaviour away from endless repetition of problem and attempted but ineffective 246 John H. Weakland and Lynn Jordan solution is the most important; in fact, the more severe and long- standing the problem, the more true this is. I t is not possible to specify in advance what step this should be; the general guideline is that it should be very different from the attempted solution. Moreover, in addition to being small, this first step should also be prosaic. The more ordinary it appears to the family, the more likely they are to be able to do it. Furthermore, partial or total failure to follow through on an unremarkable task will not in itself cause a new problem or increase the family’s current level of difficulty and tension. A few examples may help clarify this point. (a) When the family’s solution is too large Some solutions proposed by families are impractical because they require unrealistic amounts of time, self-control, energy or money. The return for their efforts must be immediate and greater than the expenditure of energy involved. A family of six had lived in one room in a motel for several years. The parents had been together for fifteen years but argued frequently. A referral was made when a liquor bottle thrown by the mother at the father accidentally hit one of the children on the forehead, creating a large bruise and lump. The parents said they would never deliberately hurt their children, and this appeared true. The father added that they were not stupid people and knew better than to argue in the presence of the children. He said if they lived in a two bedroom apartment, they- would not have a problem, but with all of them living in one room there was no place to go. He said that their privacy mattered to them, so they could not go outside to argue because then the neighbours would know their business. They proposed as their solution that they would not argue any more. The worker replied that this seemed unlikely, however well intended. She said that she could give them some possible suggestions for larger quarters, but that this would take time to arrange. Therefore, she asked their indulgence with her next question, ‘Does this place have a laundry room?’ After a shared chuckle, the parents agreed that they would argue in the laundry room, and put a quarter in the dryer for especially charged debates. The mother remarked that by the time they got all the way around to the other end of the building, they might not even feel like arguing. While this is a positive statement by the mother, i t is important that the worker not agree too readily. Agreement would re-establish the worker’s one-up position and dampen the client’s motivation to change. Therefore, the worker said instead that if it were really important, they would with effect be able to resume the argument. Another answer would have been that they could then save the quarter for the next time. Working brieflr in child protective services 247 Another example of a proposed solution being too large to be practical involved a referral about the ongoing sexual experimentation between a thirteen-year-old girl and her nine-year-old brother. The children continued to sleep in the same bedroom despite the repeated interventions by several therapists and two CPS workers. When this third worker spoke to the parents, the father said that his solution was to enclose the porch so that each child could have a separate bedroom. In that the family barely had enough money for groceries, this solution seemed financially impossible. The nine-year-old, who had earlier expressed to the worker both a desire to be left alone by his sister and a fondness for camping, was only too pleased to be allowed to camp out with an air mattress on the living room floor. (6) When the farnib’s solution is too small Occasionally, the parents will describe the problem of their family so narrowly that any solution proposed within those terms would fail to address adequately the substantial danger to the child. A woman was holding their ten-month-old son in her arms when her husband approached, threatening her with a machete. Both parents said to the worker that the child was not in danger, even though the blade had been inches away from the baby’s head, because the father was only mad at his wife and would never hurt the child. Another referral described the extensive bruises a child sustained after a lengthy pummelling by both parents. They replied that they had used open hands, not fists or belts. Despite the strong temptation to do otherwise, in both cases the worker expressed appreciation for the parents’ precautionary intent. The parents’ defensiveness dropped when the worker said she was glad to know that they had such an awareness of the possible dangers and showed a concern for the safety of the children, for all that remained for them to do now was to expand these precautions to satisfy the rigid demands of a bureacracy like CPS. (c) When the farnib’s solution is irrelevant Another category of attempted solutions pertains to those proposals of parents that miss the point. A grandmother had been awarded custody of her grandson a few years earlier as a result of her daughter’s severe drug problem. The mother had subsequently entered treatment, maintained a drug-free life for more than two years and was working full time when the two women came to CPS for assistance. The grandmother had just lost her job, and thus her apartment which she could no longer afford, so both she and the boy were living with his 248 John H. Weakland and Lynn Jordan mother. The mother wanted to start legal proceedings to cancel the guardianship, and their questions centred on legal problems. In fact, however, there appeared to be enough stability between them to care for the child, but not enough if they worked against each other. Therefore, with the worker they drafted a statement expressing their shared concern to provide and care for the child, and to work co-operatively on his behalf. Each acknowledged the bond the child had with the other. The agreement added a few practical details to structure time and address possible conflicts. Without identifying information, the text of their agreement follows: ‘This is a voluntary agreement between X, the mother, and Y, the maternal grandmother, of Z. The purpose of this agreement is to protect the relationships the minor has with his mother and his grandmother, and to clarify matters pertaining to his care and supervision. The spirit of this agreement is co-operation. Z has spent the majority of his life with his grandmother, and she is his legal guardian. The mother acknowledges the attachment between Z and his grandmother, and wishes to support their relationship. Z is staying with his mother at present by mutual agreement of the mother and grandmother. The grandmother acknowledges the attachment between the mother and her son, and wishes to support their relationship. Therefore, so that they may work together to provide the most stable and nurturing environment possible for Z, X and Y agree to the following: 1. Z will stay with his mother for the time being. 2. The grandmother will pick him up at the babysitter’s house Mon. and Tues. afternoons, feed him dinner, and return him to his mother’s house at approximately 8.00 p.m. each evening. 3. The mother will pick Z up at the babysitter’s house Wed., Thurs., and Fri. evenings and he will have dinner with her those evenings. 4. Weekends will be planned in advance to allow Z to enjoy the company of his mother, grandmother, other friends and relatives, and to participate in outings and holidays. 5. Both the mother and grandmother realize that each may experience occasional dificulties in housing and employment, and that by working co-operatively, they can between them provide best for Z and foster family ties. Each acknowledges the mother’s willingness to provide housing and supervision for Z, as well the appropriateness of each having some time to herself to pursue adult activities and friendships. 6. Each agrees to support Z’s relationship with the other, and to allow him sufficient time with each for these relationships to thrive. 7. The mother and maternal grandmother have worked together to reach an agreement that they believe will meet their needs and the needs of Z . They are aware that as he grows his needs will change, and that their own circumstances may change periodically, with the result that arrangements Working brieJy in child protective seroices 249 will need to be revised from time to time. They agree to attempt to update this understanding as needed, and to enlist the assistance of a neutral third party to mediate the matter should their own good faith efforts not prove fruitful, before resorting to the courts.’ (d) When the solution is directed at an insoluble d$)culty The principal of a school requested that CPS place a child in a foster home because of her recent truancy, weight gain and unkempt appearance. Interviewing the mother and child revealed that the child’s father had died at home two months earlier after a six-month illness. This twelve-year-old girl had done a lot of the nursing required by her dying father, and was understandably depressed and despondent when he died. The worker thought the principal’s suggestion of removing the child from her one surviving parent unwarranted as well as lacking in compassion, and imagined that he might have been harsh with the family. Therefore, she said sincerely to the mother and child that they seemed to be doing as much as could reasonably be expected in such difficult times, and that she recognized the effort involved in managing as well as they were. The difficult situation would change gradually with time; the main problem they faced was how to get the school off their backs, and the worker wondered aloud how she might help them do this. The principal had said that the child was bright and in no danger of failing; the only problem was her attendance. Therefore, it was vaguely hinted at that on some of the better days it might be possible for her to go to school even if she did not pay full attention in class. The worker then asked if there might not be some enjoyable activity that the mother and child could do together that might also placate the school. They decided to enrol together in a computer class and an art class through the local community centre, and to propose to the principal that some of these hours be allowed to offset those missed earlier in the school year. (e) The importance o f timing I n describing their attempted solutions, many parents will talk of their use of positive and negative reinforcement when in fact they have been using bribery and punishment instead (Pryor, 1985). Positive and negative reinforcement must occur simultaneously with the behaviour being reinforced. Thus, a spontaneous smile or a kind word may be much more effective than an expensive gift given several days after the behaviour that was appreciated. Behaviour must exist, at least minimally, to be reinforced; offers of rewards for behaviour that has not yet occurred constitute bribery (Pryor, 1985). Even if the bribe elicits the desired behaviour, it does not also evoke respect. 250 John H. Weakland and Lynn Jordan Rather it creates a mercenary child who will respond only to increasingly larger bribes. The parents of the thirteen-year-old boy who had been beaten for lying and stealing (above) were asked during the interview what the child did that pleased them. With obvious pride, the father described how the child assisted him in repairing the truck and car, and was so knowledgeable that he could call the parts supply store and order parts - something few youngsters could accomplish. The worker mentioned that his success as measured by the store’s accepting the order was the reinforcement for the behaviour, and the father’s pride in the boy’s skill was additional reinforcement. The father agreed that it had never occurred to him to give money or a gift to reinforce the boy’s mechanical endeavours although they had tried precisely that to get him to do his homework, having offered a child who did no homework whatsoever an expensive skateboard if he completed all his assignments for an entire semester. What the father needed to do was to abandon his futile project of bribing the child for non-existent behaviour and instead begin to reinforce his son more frequently for useful and admirable skills. I n this way they would both be dealing from strength rather than weakness. VI. Solidifying gains Unlike the therapist, the CPS worker does not need to use a full hour. Rather, he/she can quit while ahead, leaving the family to bask in its accomplishment. This success can be reinforced both as the worker sums up the session and afterwards. A number of verbal techniques can be used to strengthen the gains made by the family (Watzlawick, 1978). The positive reframing used throughout the session can be thematically connected with the new behaviour agreed to by the worker and the family. Rather than describing specifically what the new behaviour should look like, thereby infantilizing the family, the worker can offer a parable, analogy, or anecdote as a prompt and let the client volunteer an example for his/her situation (Haley, 1973; Pryor, 1985). The worker can further strengthen the client’s commitment toward change by saying ‘yes, but . . .’ to the client’s proposal. This not only gives the client an opportunity to work the bugs out of the new solutions but also fortifies hidher determination. At this juncture, the worker should prescribe minor setbacks and slips, saying that these are a normal part of the learning process. Like a toddler learning to walk, so also the family will learn by trial and error and occasional stumbles. These stumbles - i t must be stressed - do not mean that the plan of action is a failure or that a member of the Working brieJy in child protective sewices 25 1 family is not co-operating. By recognizing that occasional backsliding is inevitable, the family can then be assisted to develop non-punitive, and preferably humorous, ways to catch slips and acknowledge successes. One teenager, who after being late for school ten times in one month was bruised on the forehead when her exasperated mother threw a telephone at her, purchased and gift wrapped a foam rubber telephone for the mother. A water gun is a very popular choice for calling attention to slips in behaviour, and brings out a playful side of parents that children enjoy. One father suggested using poker chips, blue ones which would be given without comment to acknowledge mistakes, and red ones which would be given with a smile or hug for successes, with the added attraction that they could be converted to extra treats. Because it is difficult to listen well when under stress, families may not retain accurately the information contained in the session, or be clear afterwards about what they really must do differently to satisfy the agency. Putting the agreement in writing both clarifies the plan of action for the clients and the agency, and makes their following through more possible. Should there be a subsequent referral, such a written understanding can be helpful to the next worker, especially in deciding whether the situation is serious enough to warrant filing a petition in juvenile court. This need not be a cumbersome task nor result in a formal document. It is our practice simply to take a sheet of carbon paper with us on visits and to make a list of things the client agrees to do. The client keeps one copy and one copy is placed in the agency’s record. Both copies can be signed and dated by all parties to the agreement. This lends a certain ceremony and weight to the informal document. Parents seem to appreciate the clarity the agreement brings to the situation. Also, the agreement protects them by stating what is expected, and thus limiting what can be challenged in the future. Additionally, the clients can craft the agreement in their own idiom, with the worker providing little more than secretarial support except when they get stuck or propose something impractical. People are much more likely to follow their own agreement than someone else’s directive on how they should run their family (Coogler, 1978). The agreement should begin by stating common goals and values that the family can readily agree to. It can be as vague as ‘the parents agree that they wish to do what is in the best interests of their child’ (see the example agreement, above). The rest is then reduced to 252 John H. Weakland and Lynn Jordan technicalities and mechanics. As few parents will put in writing that they do not wish to do what is in the best interests of their child (however they may fail to put this into practice), it is possible to appeal to their nobler side and lay the groundwork for small but significant change (Coogler, 1978). One recently divorced couple triggered a referral relating to the possible alcoholism and inappropriate sexual behaviour of the father. As it turned out, the parents had been devout Mormons throughout their marriage. The mother and children remained active in their faith after the father left the home, but he withdrew from the church. He was not drinking excessively, only about two drinks per week, but this was indeed a taboo for the rest of the family. He was unwilling to yield on this to accommodate his ex-wife. However, when the worker talked to him about the children’s need for stability and continuity, and their inability to handle so many changes so quickly, he agreed for their sakes not to drink when they visited him. A follow-up letter can serve the same function as an agreement drafted in the session. Even in this format, the clients should be given as much credit for the solution as possible. Therefore, the letter should describe and summarize their proposal. It can also contain referrals and information on services available in the community that the family might find helpful. When referred to counselling many of our clients have taken these letters or agreements to show the therapist what they want to work on. VII. Building a safety net and a network of support When an agreement is reached (or as the closing paragraph of a letter), the worker should both validate the decisions made and offer additional assistance if difficulties arise in the future. The worker can also involve others who are in a position to help the family (and refer the case back to CPS if these efforts fail). The principal of the school had referred the family who had inadvertently injured their child when a liquor bottle was thrown (above). She had known the family for some time and encouraged them to meet the worker despite their reluctance. She was concerned and the family trusted her. By mutual desire of the family and the worker, she attended the meeting in which the agreement was drafted and signed it as a witness. She assisted the family in locating a counsellor, and being familiar with the terms of the agreement was in a position to notify the agency at the first sign of serious difficulty. The text of this agreement ran as follows. ‘A and B understand that their family was referred to Children’s Services Working briefly in child protective services 253 out of concern for the safety of their children, one of whom was accidentally injured during an argument between the parents. Children’s Services recognizes the love and commitment of the parents for their children, and the considerable efforts the parents make with limited means to provide adequate food, clothing, shelter and supervision for the children. The parents agree that since the family lives in a one room apartment, any fighting between the parents in that room constitutes a potential threat to the safety of the children. Therefore, in an effort to ensure the children’s safety, A and B agree to: 1. Contact Catholic Social Services about housing [address and phone 2. Conduct adult talks and disputes in the laundry room. 3. Attend family counselling sessions, scheduling the first session by the end of the month, at one of the following centres [four services were listed along with an address and phone number for each].’ Sometimes the family appreciates the worker’s offer to assist with a referral, a resource, or to see if he/she can get the family moved to the head of a waiting list of some sought after programme. This not only shows the family a benign side of the system, but also expands the network of collaterals who can keep a protective eye on the children. The following letter from a worker to parents describes arrange- ments made with the school principal (who had initially referred the case) for low cost counselling and tutoring. As an added advantage, such collaboration not only shows the collaterals what the agency has done but also involves them as active participants. These collaterals have ongoing contact with the children and their families long after the CPS worker has had to move on to another case. number of the agency included in the agreement]. Dear Mr and Mrs Q: Following our conversation of April 4, 1986, I met with the principal of your son’s school, Mr. R. He was very pleased with the decisions the two of you reached and agreed to call the local high school about a tutor and the c‘ounselling center about setting fees as low as the contract would allow. While I was at the school, I spoke with your son and informed him of the tutoring and counselling sessions that were being arranged for him. He agreed to make an effort to take the best advantage he could of these resources. I trust the combination of counselling and tutoring will assist him at this dificult time and help your family work more cohesively as well. If you have any questions about the implementation of either of these programmes, please get in touch with Mr. R. If I can be of any additional assistance, please feel free to get in touch with me (phone number given). 254 John H. Weakland and Lynn Jordan VIII. Conclusion This paper began, largely, with pointing out the obvious: that case work in child protective services is difficult work. The worker is faced from the outset with the challenge - both professional and personal - of establishing a co-operative relationship with abusive parents in circumstances that are likely to hinder rather than facilitate such co- operation. Beyond that usually lie severe limitations of time and resources, on both sides, to deal with complex difficulties and chaotic family situations. However, it is hard to imagine a more significant challenge, an area in which any positive accomplishment offers equal potential gain. With a realistic assessment of the difficulties inherent in this work as a starting point, we have offered some suggestions based on our necessarily limited experience on how to establish the requisite co-operative relationship, and then how to use this to initiate small but significant changes toward reducing or eliminating abuse of children in their families. We recognize, though, that just as it is the families who must do the bulk of the work of changing, we have at most done only preliminary work in presenting these suggestions. Even if they are aseful, the larger task of applying, testing, and modifying them in practice necessarily falls on our readers. References Coogler, 0. J . (1978) Structured Mediation in Divorce Settlement. Lexington: D. C. Heath Faber, A. and Mazlish, E. (1975) Liberated Parents; Liberated Children. New York: Avon Fisher, R. and Ury, W. (1981) Getting to Yes: Negotiating Agreement Without Giving In, Haley, J . (1973) Uncommon Therapy: The Psychiatric Techniques oj . Milton H. Erickson, Haley, J . (1976) Problem Solving Therapy. New York: Harper Colophon Books. Herr, J . and Weakland, J . H. (1979) Counseling Elders and Their Families: Practical Pryor, K. (1985) Don't Shoot the Dog! New York: Bantam Books. Watzlawick, P. (1978) The Language of Change: Elements of Therapeutic Communication. Watzlawick, P., Weakland, J . H. and Fisch, R. (1974) Change: Principles ojProblem and Co. Books. New York: Penguin Books. M. D. New York: Norton. Techniques f o r Applied Gerontology. New York: Springer. New York: Basic Books. Formation and Problem Resolution. New York: Norton.
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