Changing the narrative – Life span perspectives on multiple adversity

Introduction

The presence of multiple adverse experiences in childhood has a well-established association with an increased likelihood of harm throughout the lifespan (Felitti et al., 1998), damaging children’s health, intellectual development and mental well-being as well as impairing their ability to form meaningful relationships as adults (Ehlert, 2013; Kendall-Tackett, 2002). Nonetheless, there are the vast individual differences in acute and long-term responses to childhood adversity with some children exhibiting significant effects (Luthar, 2003, 2006) and others appearing “resilient” to negative consequences Daniel and Wassell (2002). Resilience is a dynamic developmental process rather than a fixed trait, and while there are a range of protective factors and person characteristics associated with increased resilience, five decades of research suggest that ‘resilience rests, fundamentally, on relationships’ (Luthar, 2006: 780). Secure attachments develop most optimally when children have positive relationships with significant others, usually parents or carers (Bowlby, 1988; Feeney and Collins, 2014; Ungar, 2012). However, where secure parental relationships are unavailable, evidence suggests that a supportive adult can help to build resilience, encouraging the development of functional coping behaviours (Norman et al., 2012). Studies also indicate that positive marital or co-habiting relationships can ameliorate the impact of adversity experienced in childhood, resulting in improved parenting (Rutter, 2012), and improved physical and mental health and emotional stability in adulthood (Bano et al., 2013). These close and caring relationships are undeniably linked to health and well-being at all life stages, helping to alleviate the risk of developing emotional or mental health problems (Feeney and Collins, 2014).

Although resilience and attachment theories are widely used in child welfare both have been critiqued for their lack of clear definition and varied terminology across studies (Barth et al., 2005; Luthar et al., 2000). Resilience, in particular, has come under attack for being overly focused on individual factors and traits that make up the ‘resilient’ individual. However, over time, it has increasingly been constructed as a multi-dimensional concept with theorists such as Ungar (2010; 2013) making a strong argument for a social ecological approach to resilience which incorporates individual, family, community and cultural factors. Arguably, the strongest critique has been the lack of a consistent and objective measure of what precisely a resilient outcome is, who defines this and across which domain(s) (Luthar et al., 2000).

Given that the operationalisation of resilience can be hugely varied and individual, narrative identity theory provides a valuable framework for not only understanding the stories resilient individuals tell about their lives, but capturing the subjective nature of individual biographies. Building on Erikson’s (1963) theory of psychosocial development, McAdams and McLean (2013) proposed a formation of identity model through narrative, arguing that the stories we tell about ourselves provide powerful insights into who we are, how we came to be and where we think we are going in the future. The model identifies four themes which are considered universal to life story narratives and which reflect many of the key protective factors identified in the resilience literature: communion (interpersonal connection and attachment), agency (motivation and ability to effect change), redemption (deriving good from bad experiences, meaning making), and contamination (good experiences going bad). A growing number of both quantitative and qualitative studies demonstrate that an ability to construct meaning from adverse experiences is central to the resilient narrative and is closely associated with psychological well-being and generativity in adulthood (Adler, 2012; Dunlop and Tracey, 2013). Within this framework, resilience is an emergent quality of the life-story grounded in the narrator’s ability to generate a redemptive narrative which focuses on agency, communion and growth.

Similarly, resilience within the social work literature tends to be associated with more strengths-based, narrative and relational practice approaches (Anderson, 2010; Milner and O'Bryne, 2009; Powell, 2012; Ruch et al., 2010). Wilks (2005) contends that the social work assessment itself is essentially a qualitative, narrative process in which the worker constructs a story about the situation in question. Narrative approaches to practice place an emphasis on power-sharing and engagement in the collaborative co-construction of narrative between service user and practitioner (Milner and O'Bryne, 2009). However, inflexible use of standardised assessment tools and over reliance on electronic systems may reduce the capacity of practitioners to both understand and convey the qualitative nature of service user narratives, resulting in more superficial assessments (Featherstone et al., 2014; White et al., 2009). Without an understanding of both past and present, of the dynamic nature of child and adult resilience and the importance of close caring relationships, assessment and intervention can tend to focus on presenting issues (Brandon et al., 2010) ignoring the importance of longer-term needs and missing opportunities to promote and develop resilience. An increasing tendency to interpret child protection as meeting the needs of the child (Featherstone et al., 2014) can also lead to the needs of mothers and fathers being left unattended, their narratives unsolicited or ignored.

Present study

This paper argues for the importance of narrative in social work assessment, particularly in relation to families with complex needs, and views resilience and attachment as complimentary constructs in the debate. It presents findings from a qualitative study using biographical narrative interviews to explore parents' experiences of key adversities over their lifespan, their close relationships, and their experiences of child welfare interventions, in particular engagement and relationships with statutory social work. Three biographical narratives are used to explore resilience and attachment through a narrative identity framework, illustrating how this approach enables a richer, more nuanced understanding of mothers and fathers as individuals in their own right and provide insight into how alternative narratives might be better supported and developed.

Methodology

Selection, recruitment and ethics

Barnardo’s NI and NSPCC service managers were asked to identify parents over the age of 18 years in receipt of services and who were experiencing three or more of the eight areas of adversity identified by Davidson et al. (2012) (see Table 1). Services provided to parents included both family support and child protection services.

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Table 1.

Participant’s experiences of childhood adversity (n = 17).

Childhood adversity	No. of participants
Family separation	12
Child abuse/neglect	11
Parental substance misuse	10
Poverty	9
Parental Domestic abuse	7
Parent with illness/disability	7
Parental mental health problems	6
Parental offending and/or antisocial	6

Manager/practitioners discussed the study with the parent and if she/he expressed interest, and passed on contact details to the research team to follow up. Formal ethical approval was provided by Barnardo’s Research Ethics Panel and all participants were given written and verbal information about the research which emphasised the voluntary nature of participation, made clear the boundaries of confidentiality and explained how data would be securely stored. All participants signed written consent forms for each stage of the research and all those who participated in an initial interview also agreed to take part in a second interview.

Case studies

Discussion

In keeping with both the resilience and narrative identity literature, close relationships were a key aspect of the stories participants told, providing insight into their childhood and adult attachment relationships. While routinely used by child and family social workers to guide work with children, attachment has received considerably less attention in relation to work with parents. Attachment, or communion in the language of narrative identity, is itself a life-course construct with stable relationships being integral not only to childhood but to adults throughout all life stages. If we take the case of Cheryl, her attachment needs have rarely been adequately met, her close relationships have been characterised by violence and abuse, yet her desire to establish a connection with others is apparent. Featherstone et al. (2014) argue that through the privileging of the risk assessment paradigm, we have lost the vocabulary to talk about the 'irrationalities' of intimate relationships, leaving us unable to engage in conversations about sexual relationships or recognise the powerful feelings of loneliness and fear that parenting alone can engender. Hearing Cheryl's life-story, recognising her need for connection gives us another way to understand her, a way that moves beyond characterising her as an alcoholic, who routinely becomes involved in dangerous relationships and puts herself and her children at risk. It allows us to identify her attachment seeking behaviours as not only normal, but valid and important, worthy of our attention.

We can clearly see from Kevin's narrative the power of the redemptive relationship. From a similar background as Cheryl, he has been able, in part, to recover from extremely negative and disruptive childhood relationships, mental health problems, relationship breakdown and separation from his children Keeling and van Wormer (2011). Having a stable loving relationship in which he is understood was a key turning point in his life and although the problems have not gone away, they are manageable within the context of the emotional support he receives from his wife, providing a sense of resilience. This is in stark contrast to Cheryl's experiences. Without any secure base or network of support to build on, the life changes she has embarked on will likely be difficult to sustain. Understanding Cheryl's lack of connection raises questions as to how she might be supported to meet her attachment needs in a safe way, not just as a means to secure the return of her children but as a person in her own right. How might we build on those small glimmers of resilience that emerge from the bleakness of a lifetime of abuse, how can we support her to maximise the progress she is trying to make, how can we give her hope?

Caroline finds herself in a similarly bleak situation. From a very different background than either Kevin or Cheryl, she experienced a relatively stable upbringing and went on to develop stable relationships in her twenties resulting in marriage and the birth of her child. However, her sense of stability and security was decimated by the unexpected breakdown of her marital relationship. Her loss and grief are palpable, and she is grieving not just for the end of the relationship but the life that was, the identity she had as a married, relatively well-off mother and homeowner. Caroline has been unable, as yet, to construct an alternate identity to develop a narrative which takes her beyond contamination to growth and redemption. She is positive about engaging with services but fearful of being left without social support, recognising her own vulnerability and difficulties in coping.

The narrative identity approach helps us to reframe how we understand the lives of parents like Caroline, Cheryl and Kevin and begins to ask how we might go about changing the narrative, and what kinds of services and social support might help to develop and promote resilience in these circumstances? While narrative theory’s emphasis on co-construction and power sharing may appear at odds with the process driven and risk averse nature of modern practice (Featherstone et al., 2014; Munro, 2011), through assessment social workers are already engaged in the construction of a client narrative (Wilks, 2005). Using a narrative approach means explicitly recognising the voice and experiences of the service user as central to the change process. This does not mean that challenges are ignored but rather that the focus of assessment and intervention is shifted more towards ‘need’ and less toward ‘risk’. Instead of simply identifying parenting deficits, strengths-based and solution-focused approaches to social work practice are used to uncover the individual’s unique survival story and facilitate transformation from a problem saturated narrative to one which celebrates growth (Anderson, 2010; Milner, 2001).

While the case studies highlight how narrative approaches can be used in direct social work practice, they also point to the need for sustained emotional and social support over and above the ‘traditional’ social work interventions that are routinely made available. Innovative approaches which foster identity and relationship building, promote and encourage resilience through social support and community integration are also needed to address isolation and chronic low self-esteem. While many groups are at increased risk of social exclusion and marginalisation, arguably those parents who have had their children removed from their care are the most marginalised group of all. Shame and stigma emanating from the 'spoiled identity' of parental failure, in particular the gendered identity of a ‘bad’ mother, can act as significant barriers to engaging with others.

Lack of social integration in a network of meaningful relationships predicts mortality more strongly than many lifestyle behaviours such as smoking or physical activity (Holt-Lunstad and Smith, 2012). Recognition of this had led to the development of a wealth of community initiatives aimed at building social networks and social capital through befriending schemes, mentoring peer programmes and other community-based activities (Akister et al., 2011; Berrick et al., 2011; Windle et al., 2011). Although social work involvement in such initiatives has clear resonance with the profession’s value and skills base, social work tasks in the UK have increasingly been conceptualised as reactive and risk orientated rather and proactive and supportive. Too often, practitioners report that they are engaged in surveillance rather than support (Baginsky et al., 2010). This raises important questions as to the future role of the profession in developing more preventative, community-based practice. Growing calls from academics and practitioners to “reclaim” social work values and “re-imagine” practice (Featherstone et al., 2014; Ferguson, 2009) suggest that the profession’s own discourse is also evolving. Changing the narrative for both professionals and parents will require a clear vision of the contribution social work can and should make to preventive, strengths-based community services.

Conclusion

This paper argues for the importance of narrative within social work practice, not just as a means of enabling practitioners to better connect with and understand the lives of service users, but as a way of developmentally understanding resilience and attachment and maintaining a strengths-based focus when working with families in complex situations. Focusing on what individual narratives say about the identity of the narrator and their belief in their ability to effect change can act as an important starting point to considering how such narratives might be enhanced or revised and what services might be beneficial in achieving this. A number of the life-stories presented here illustrate that some vulnerable parents lack not just physical resources but internal resources and external support. Put simply, they often have nowhere to go and no one to turn to outside of formal services. Developing ways to actively build support networks and enhance attachment bonds amongst vulnerable mothers and fathers are needed to reduce isolation and build resilience. As social work is pushed more towards risk assessment and surveillance, the role social work can and should play in this development process remains a key question.