Working with warring parents
Healthcare Counselling and Psychotherapy Journal, October 2021

There is a strong body of evidence that conflict between parents – whether together or separated – can have a significant, negative impact on children’s mental health and long-term life chances.¹ The Government’s parental conflict indicator 2011/12 to 2017/18² shows that 12% of children in two-parent families were living with at least one parent reporting relationship distress. In other words, about 1.25 million children in Britain are exposed to sustained inter-parental conflict.

It’s important to stress that not all conflict between parents is damaging to children. It can be a valuable experience for a child to see parents resolve arguments and disagreements, as it gives them a model they can use in their own lives to handle conflict effectively.
However, when conflict is frequent, intense and poorly resolved, it can harm children’s mental health.

From 2015 to 2017, the Department for Work and Pensions (DWP) piloted the provision of expertise and evidence across 12 local authorities in England, to develop innovative strategies to promote relationship quality. This ‘Local Family Offer’ trial³ informed the
development of the ‘Reducing Parental Conflict’ (RPC) programme, which was announced in April 2017 as part of ‘Improving Lives: helping workless families’.⁴ The DWP subsequently established the RPC programme⁵ in 2019, working with 31 local authorities in England. The RPC programme supports local authorities to integrate services and approaches for families to reduce parental conflict. It also funds training for frontline practitioners and strategic leaders.

The RPC programme aims to promote improved outcomes for children, with a focus on disadvantaged families. Its objectives are to develop the evidence base on effective methods to reduce parental conflict, to inform future commissioning practice and to help local areas integrate support to reduce parental conflict.

As well as assisting professionals working with families to be better equipped to discuss parental conflict, the RPC programme offers parents in four pilot areas in the UK the opportunity to engage with a number of interventions that are designed to support the co-parenting relationship, whether parents are together or separated.

Parents are usually referred by a professional they are working with. But in some parts of the country, they can self-refer. Tavistock Relationships, alongside partner organisations, delivers the DWP’s RPC programme in Buckinghamshire, Cambridgeshire, Hertfordshire, Southend, Peterborough, Thurrock and Essex.

The RPC programme is also available in seven London boroughs: Westminster, Kensington & Chelsea, Camden, Hammersmith & Fulham, Croydon, Brent and Lambeth. Parents living in the North East, Dorset, Somerset and Devon are also able to receive support from the programme.

To gain access to the support, parents or referrers simply complete a referral form, called a referral stage questionnaire (RSQ). The RSQ contains screening questions designed to determine the intensity of inter-parental conflict in the co-parent relationship. Parents will then be recommended an intervention of a moderate level of support or a higher level of support. These interventions are being piloted within the programme to measure the impact they have on inter-parental conflict.

Tavistock Relationships has developed a mentalisation- based therapy for parents, which is one of the interventions the RPC programme is testing. The intervention seeks to address and defuse heightened states of dysregulated emotion, such as hostility and aggression.

Mentalisation parenting under pressure (MBT-PP) aims to help parents better understand their co-parent’s emotional feelings and responses, as well as their own.

Parents can gain ‘perspective’, if they can become more aware of how they affect each other, how their relationship might affect the people around them, and have the ‘child in mind’.

MBT-PP supports parents who are experiencing high levels of inter-parental conflict to:

• focus on and think about not only their own feelings and emotions, but also those of their children, learning to modify their behaviour
• appreciate that their partner’s thoughts and feelings might be different from their own, and that their partner might have a different perspective, particularly in relation to alcohol/substance abuse
• be curious about possible differences between themselves and their partner, especially about the reasons why people might behave as they do
• consider each person’s involvement in and contribution to the problems of the co-parenting relationship, and develop a better appreciation of what their children need
• promote awareness of their own and their partner’s mental states, with a view to making choices that are in the best interests of their children
• practise skills of mentalising, communication and problem solving, particularly in relation to parenting and choices around alcohol use.

The MBT-PP intervention can be delivered to either one or both parents, and to parents who are together or separated. There are 10 weekly sessions, which can be in person or online.

Analysis of data collected from parents receiving MBT-PP across Hertfordshire, Buckinghamshire, Cambridgeshire and Essex has shown impressive outcomes across a range of adult and child measures.

The measures used are the clinical outcomes in routine evaluation (CORE), which evaluates psychological wellbeing, and the couple communication questionnaire (CCQ), which measures couple communication, conflict and violent problem solving. Impact on child wellbeing is gauged directly via parental assessment of their children.

Practitioners collected responses to both the CORE and CCQ questionnaires from each parent during the initial assessment session and the last session, in order to measure the CORE and CCQ at pre-intervention and post-intervention.

In total, questionnaires from 290 individuals at pre-intervention and 124 individuals at post-intervention have been collected so far from parents receiving MBT-PP. All these parents exhibited intense problems with their partner/co-parent at intake, with a roughly
even split between couples still together and separated.

Analysis of data on the 101 parents who provided CORE scores before and after the intervention, and whose score before the intervention indicated they were experiencing a clinically significant level of psychological distress, shows a significant alleviation in their psychological distress.

In addition, when the CORE scores of the 38 participants who had completed the post-intervention CORE questionnaire – and who showed moderate/severe depression at pre-intervention – were converted to the Beck depression inventory (BDI)⁶ score, it was shown that the mental health difficulties of 68% of these 26 parents had reduced to minimal/mild.

The results give a strong indication that improving the quality of the parental relationship has a direct impact on parental mental health, a finding that corroborates analysis of data from patients receiving couple therapy for depression through the Improving Access to Psychological Therapies (IAPT) NHS programme.

The CCQ measures levels of conflict between parents, levels of violent problem solving and conflict in co-parenting the children. Analysis of the data shows a significant reduction in:

• conflict between parents in intact relationships and separated relationships
• violent problem solving for parents in intact relationships and for parents in separated relationships
• conflict about the children for parents in intact relationships and for parents in separated relationships.

In addition to the CORE and CCQ measures, 69 participants responded to three further questions, after completing the MBT-PP intervention:

• conflict in my couple relationship has decreased/stayed the same/increased
• communication with my partner has increased/stayed the same/decreased
• my child’s wellbeing has increased/stayed the same/ decreased.

Analysis of the answers shows that:

• 70% of parents reported decreased conflict in their relationship with their partner or ex-partner
• 65% reported improved communication
• 55% reported MBT-PP had increased their child’s wellbeing.

The results not only echo the analysis of the pre- and post-intervention CORE and CCQ, but also show the effectiveness of the intervention.

The intervention clearly helped to provide parents with time to reflect and consider what is in the best interests of their children. In the words of one participant: ‘I would definitely recommend this programme. It has taught me to realise these triggers, before the situation escalates into aggression, irritation and arguments. It has also taught me how to relate to my son to improve our relationship and get the best from my son.’

The online approach has proved extremely helpful, as it allows separated parents to dial in from their own homes, rather than sit together in the same room.

It reduces the amount and intensity of emotional behaviours that we sometimes see in face-to-face work. It also optimises the circumstances under which beneficial work for the parents can take place. 

Groupwork interventions have also been put to the test online, and we are heartened to learn they have been successful, with expected outcomes met and, in some cases, exceeded. Parents have reported that it’s easier to engage if the support can be offered at a flexible time. Parents can also more readily take up the support, because they don't have to travel to a community venue. With this in mind, the interventions will, in the main, remain online in the future.

There is growing evidence that the coronavirus pandemic has dramatically increased the number of children with mental health problems. NHS data published last October reveal the number of children with a probable mental disorder has risen from one in nine in 2017, to one in six in 2020.⁷ A survey of 42 local authorities by the Early Intervention Foundation showed 73% believe parental conflict has increased since COVID-19.⁸

Furthermore, the workload of the family courts has been growing. Cafcass, the court service, is reporting record numbers of child cases in England⁹ and, in 2018, the Relationships Foundation estimated the cost of family breakdown cases ending up in court had risen to £51 billion, up from £37 billion in 2009.¹⁰ The cost to children’s mental health and life chances is surely even higher.

The DWP has allocated up to £11 million for the next phase of the RPC programme, which runs to March 2022. The DWP has also confirmed that the interventions will be extended for the following year, too.

The SortItOut campaign¹¹, which calls for immediate action to reduce the damaging impact of parental conflict on children in Britain, wants the RPC programme to be extended across the UK. The campaign, which is backed by a broad spectrum of organisations involved in children’s mental health, also asks for parental conflict to be specifically assessed in child mental health services and other settings, including schools. In addition, it wants local authorities, NHS services and courts to offer relationship support services to parents, to reduce the impact of conflict on children's mental health.

Information about the Reducing Parental Conflict programme can be found at www.tavistockrelationships.org