by Dr Georgina Hibbert, Clinical Psychologist. BSc Hons, DClinPsy
Working in both a Child and Adolescent Mental Health Service (CAMHS) and independently in private practice has allowed me to see a whole spectrum of children with a wide range of mental health difficulties. The children I come across in independent practice and those I meet through my NHS work, often seem to represent a social dichotomy.
As well as working therapeutically with children, my work in private practice encompasses carrying out clinical psychology assessments for the Family Court. This is one of the most interesting aspects to my role as a clinical psychologist. Whilst the work involves bearing witness to stories of abuse, and usually at the more serious end of abuse, it can be hugely rewarding and fascinating.
When I begin an assessment, I hope to meet the whole system around a child and their family, as I need to understand the family history going back generations. My training as a clinical psychologist has enabled me to work across the lifespan, and this is essential in trying to make sense of the reasons and intentions behind the abuse. For example, I aim to look for intergenerational patterns of abuse, experiences of parenting and being parented, mental health histories and learning profiles. Without looking at the whole family system, I cannot fully understand the experience of the child within it.
Often other professionals and clinicians are involved in the same case and so the work involves communicating with other disciplines. Sometimes court timescales mean that I only get sight of their reports at the last hour. On occasions, when parents do not cooperate, there can be little background information available. Local Authority assessments can help to shed light on the family history, but the nature of the cases often means that secrecy and untruths are a part of the family make-up. At times, it is evident that this way of being is so engrained in the family life that it has been passed on to the child/children and I come across children in my assessment for whom protecting the truth from professionals has been part of their experience of growing up. This is particularly evident in cases where domestic violence or alcoholism features. A thorough assessment therefore involves interviewing as many informants with knowledge of the child as possible, so as to best understand their behaviour and emotional presentation over time and in different settings.
Regularly I am asked to comment on whether or not I believe a parent is able to meet the psychological, physical and social needs of their child or children. The more complicated cases are often where there has been a history of one parent failing to protect their child or children from a violent or abusive partner. In my experience this has in the vast majority of cases been a mother who has failed to protect her child or children from a violent partner. The mother has not been able to prioritise her children’s needs above her own and to leave the relationship. This is due to a complicated mixture of factors. Amongst others these can include: a lack of resilience, a history of being abused themselves, a low cognitive profile, drug dependency, fear of violence, low self-esteem and a lack of any support network. The child/children have often experienced a great amount of love and nurture at times from their mother, but this has been interspersed with incidents of abuse by their father or mother’s partner. When I am instructed to comment on whether or not a mother is capable of caring for her child/children in the long-term, I need to weigh up the effects of these periods of abuse, against the mother’s ability to provide consistent love and nurture, and her understanding of these effects. This helps me to reach a decision about whether or not the mother is able to protect the child/children in the future. Sadly, in most cases, the mother has already been offered several opportunities by Local Authorities to prove she is able to permanently break from the relationship. Cases like these, and also ones that involve parents who misuse alcohol or drugs are the more emotionally challenging ones to deal with, as the love the parents have for the child/children is clearly evident.
Many of the cases I am involved in include carrying out a ‘Sibling, Together or Apart Assessment’. The challenge here is often the knowledge of the longterm effect of my recommendation. My recommendations are always supported by scientifically grounded research and evidence regarding factors that minimise placement breakdowns. Sadly my recommendations occasionally involve having to prioritise the needs of one or two children above the needs of a sibling. For example, if it is unlikely that all children will be able to remain together due to a lack of foster or adoptive placements able to take all siblings, or if two younger children are of an age at which they are more likely to be adopted, and/or may have less challenging needs than an older sibling, my recommendation may be for the younger ones to be placed together so as to ensure a sense of permanence and stability. This recommendation is made with the knowledge that it will have serious repercussions for the older sibling, and they will struggle to understand the reasons for it. Whilst foster carers and adopters are often encouraged to maintain contact between siblings, in reality this is not always possible due to geographical locations, different priorities or sometimes because the contact is too painful and difficult for one of the children.
My role as an expert witness is always to have a duty to the needs of the child and this sometimes involves making recommendations that do not fit with the Local Authority Care Plan. For example, last year I recommended that four siblings aged between two and nine remain together in their foster placement, which would come at a serious financial cost to the Local Authority. This was a lengthy and complicated assessment as the youngest two were of an age at which they would have most likely been adopted. However the strength of the sibling bond between all siblings was so evident, and had served as such a strong protective factor against the effect of abuse and separation from their parents, that I deemed a life in a loving foster placement together to outweigh being split.
One of the most stressful parts of the role as an expert witness has to be giving evidence in court. Sometimes solicitors representing four different parties are questioning me. Having a detailed knowledge of my report and assessment is vital if I am to be able to make my argument in the stand. There is no excuse for tiredness or even illness! Having given evidence several times now, and in different courts, the familiarity of the process is comforting, but the anticipation of the experience is always difficult. Whilst some cases have been challenging to say the least, on the whole I come out exhausted but satisfied that I have played a part in helping to make a decision about a child’s life - perhaps the most important decision that will ever be made about that child.