Factors thought to maintain children and young people’s mental health problems

From Alan Carr’s Handbook of Child and Adolescent Clinical Psychology (2nd ed) pp. 62-70:

Family system factors

  • Inadvertent reinforcement, e.g., frequently inquiring about mood or commenting on negative conduct
  • Insecure attachment, whereby children don’t experience carers as a secure base
  • Coercive interaction, e.g., escalating negative interaction leading to withdrawal and relief, reinforcing behaviour just before relief
  • Over-involvement, parental criticism and emotional over-involvement
  • Disengagement, low frequency carer-child interaction
  • Inconsistent parental discipline, leading to problems internalising rules
  • Confused communication, e.g., indirect rather than direct communication
  • Triangulation (not always negative), e.g., a “coalition” where one carer is peripheral
  • Chaotic organisation
  • Absent carer
  • Carer relationship discord

Parental factors

  • Parents with similar problems as child act as a role model maintaining the behaviour
  • Resources for parenting compromised by mental health issues or criminality
  • Misinterpreted crying (interpreted as intentionally punishing carer)
  • Low self esteem
  • External locus of control
  • “Immature defences”
  • Unemployment (failure to meet financial needs; impact on status)
  • Boredom in work
  • Excessive stress in work
  • Role strain with parallel “homemaking” and working

Social network factors

  • Lack of social support, e.g., lack of positive interactions with extended family/friends
  • Chronic life stress
  • Unsuitable education placement, e.g., understaffed schools
  • “Deviant” peer-group e.g., peers using drugs
  • Community problems, e.g., social disadvantage, racism, social exclusion, high crime rates

Problem maintaining treatment system factors

  • Family members’ denial of problems
  • Poor working alliance with clinicians
  • Rejection of formulation and/or treatment plan
  • Failure of communication between MDT members
  • Failure of inter-agency network
  • Conflicting formulations in multidisciplinary team and inter-agency work
  • Culturally insensitive clinicians

Also flip side of these, protective factors, such as good physical health, high intellectual ability, high self-esteem, humour, positive engagement with treatment agencies, protective peer group, …

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s