Lay therapy—intimacy as a form of treatment for abusive parents

Child Abuseand Neglect, Vol.2,pp.233-241 OPergamon Press Ltd., 1978. PrintedinGreat Britain.

0145.2134/78/1101-0233$02.00/O

LAY THERAPY - INTIMACY AS A FORM OF TREATMENT FOR ABUSIVE PARENTS

Sylvia Lane, ACSW and Vicki Van Dyke, ACSW former Project Coordinators of the Family Center, Westminster, Colorado Reprint requests c/o Ms. Van Dyke, 4338 Batavia Place, Denver, Colorado 80220

INTRODUCTION

In recent years, as emphasis has been placed on programs for abusive parents, the concept of lay therapy has been developed and implemented in several communities in the country. The basic philosophy of lay therapy is that by providing an intimate and nurturing person for the abusive parent, one allows for a more healthy expression of the parent's emotional needs and prevents excessive, unrealistic demands being made of the child. The ultimate end is to enhance the emotional growth of the parent through supportive techniques combined with environmental modification. Eventually, it is expected that the parent will feel more comfortable in establishing a natural and ongoing support system for himself or herself and can use the relationship with the lay therapist as a model for how this can be done. The lay therapist is introduced into a family as a "parent" person rather than a "child" person. It is a program to help parents grow emotionally in order that they may provide a sound- er base for the child's emotional development. The goals of lay therapy are to prevent reabuse, to shorten the treatment for the primary counselor by providing a more intensive program, and to promote more independent functioning of the parent by assisting in the development of more effective coping mechanisms.

The concept was first developed in 1969 by C. Henry Kempe, M.D. and Helen Alexander, MSW, at the National Center for the Prevention and Treatment of Child Abuse and Neglect, Denver, Colorado. They discovered in their work with abusive families, that the professionals were often unable to meet the enorm- ous dependency needs of most parents in the time available to them. They decided to experiment with the use of lay people who could develop close relationships, spend several hours weekly, and be available at times of crises.

In this paper, we will share our observations and experiences with two lay therapy programs. The first was implemented at the Family Center in Westmin- ster, Colorado. This project served Adams County, Colorado which has a population of approximately 214,800 and was a federally funded demonstration and research project in child abuse. This program was funded by the U.S. Depart- ment of Health, Education and Welfare through the grantee agency, Adams County Department of Social Services. The second was implemented at the Peoria Area Office of the Illinois Department of Children and Family Services. The service area covered by this program had a population of approximately 300,000 and covered five counties.

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234 S. Lane and V. Van Dyke

I. PROGRAM CONSIDERATIONS

The process of establishing a lay therapy program within a protective service

agency, as was the case in both instances, was greatly enhanced by input from staff. This was encouraged by conducting individual and group conferences with protective service supervisors and workers to determine their feelings about the concept, ideas on the program structure, ideas regarding the needed services, tasks lay therapists could perform, training needed, and suggest- ed evaluation methods. Ideas were also sought from others such as representa- tives from the community mental health center, the local probation department, the public health department, public schools, and law enforcement agencies. The advantages of input from social work staff at the planning level were that : (a) practical considerations geared to a knowledge of the protective service system were included in the program; (b) more appropriate cases were referred to the lay therapy program; (c) an increased commitment to program goals was encouraged through administrative channels; and (d) improved communication with protective service personnel was achieved, which served to reinforce all of the above.

Although the advantages of input outweighed the disadvantages, it should be noted that a strong involvement tended to cause delays in program implementa- tion and at times resulted in communication issues between protective service workers and Family Center staff taking precedence over client treatment services.

In Illinois, the staff was involved to a lesser degree. This resulted in a greater amount of misinformation being prevalent regarding the program. This in turn increased suspicion and mistrust among social work staff. As a result, fewer referrals were received for lay therapists.

One of the initial program considerations was whether lay therapists were to be paid. In both programs, lay therapists were paid, while at the Family Center, some volunteers were also used. Both functioned well. By being able to pay lay therapists, we were able to recruit from all socio-economic levels. Without some compensation for personal expenses, low income persons would be unable to accept positions as lay therapists. We also recognized the value of money as a motivator and as an indication of the value of a service per- formed to the agency requesting the service. In our experience, volunteers have worked as lay therapists for only a few months which was significantly shorter than the tenure of the paid lay therapists. We feel strongly that funds should be made available to include lay therapists as valued and salaried employees of the protective service system.

Although a pay standard based on fifteen hours per week was established, it was understood that this may vary week by week or family by family. In periods when families are functioning with minimal difficulty, the lay therapist would spend less time with a family. When crises occur, much more of the lay therapist's time would be required. Also, regardless of planned face-to-face time, the lay therapist is required to be available on a 24-hour basis. This available time also merits compensation. Flexibility of time is necessary for a successful program amd this would seem to be best served by a set salary plus additional expenses such as automobile mileage and incidentals, rather than pay only for actual face-to-face time with clients.

Treatment for Abusive Parents 235

II. RECRUITMENT

Applicants for lay therapy positions were referred by persons familiar with the program and the position was advertised through the local newspaper and the personnel department. Notices were sent to a wide variety of community agencies. In Illinois, a feature news article assisted in the initial recruitment. Despite this, recruitment was more difficult in Peoria, perhaps because of the size of the community to be served. Affirmative action guidelines were used in recruitment and hiring.

It was important to find people who were comfortable being supportive and would not make unrealistic demands upon the parent because of their own needs to see someone else succeed. There are many people who function this way with their friends, neighbors or relatives. We looked for the "natural helpers" in the community. As the program became more visible in the communi-

ty, these people were more readily identifiable.

III. SCREENING

In contrast to the experience the National Center had in receiving 200 -250 inquiries at the time of initial recruitment, both the Family Center and the Peoria program averaged 20 - 30 applications. Interviewing was conducted by a team, preferably a team of people who were working together with the lay therapists. The inclusion of present lay therapists as interviewers is highly recommended whenever possible.

Areas considered in selecting lay therapists were :

1. The adequacy of the applicant's own parenting - how sound an emotional base she has - had she received enough care and attention in her early years to be able to give some of this to another person at this stage ? If the candidate's own early experiences and conditioning were negative ones, what things had she done to overcome this ? Had she received help for this? Was it effective? What insights does she have into how her early life experiences are related to her desire to help abusive parents as an adult ?

2. Does she have the ability to be a nurturer ? Will she be comfortable in this role?

3. How adequate are her own coping mechanisms in handling personal problems?

4. Does she have a personal support system that is functional?

5. Do you feel that she can separate the needs of the parents from the needs of the child?

6. What are her feelings about discipline?

7. Can she work as a member of a team, or will she feel the need to be the sole advocate for the client? Is she open to group supervision?

8. Does she accept program sponsorship ? This is especially significant when programs are sponsored by agencies which have negative connotations in the community.

9. What is her stated feeling about child abuse and abusive families ? Can she admit to having angry or unpleasant feelings and does it appear that she is willing to look at feelings and how they affect what she might do with the families?


We strongly recommend that people selected as lay therapists be parents themselves. Not only does this give the person the first-hand knowledge of the frustrations and difficulties of parents, but it also is an advantage initi- ally with the parent who cannot dismiss the lay therapist with the familiar complaint, "What does she know, she's never had any kids ?". We also suggest that the applicant's children be beyond infancy, as the responsibility of very young children severely limits the availability and flexibility of time. If a candidate is not a parent, at the very minimum, we feel they should have extensive experience caring for children on a 24-hour basis.

IV. TRAINING

It is important to remember and emphasize that the basic skills used in lay therapy are not skills that you can train someone to do. They are skills learned through the lay therapist's own life experiences. Rather, training is geared to orientation and improvement of existing skills, as well as in- troducing the dynamics of child abuse.

Training is also a time to introduce lay therapists to the people and systems with whom they will be working. Involving social work staff and community people has proved to be productive. In addition, we have used the comments and suggestions that each group of lay therapists has given after the training was completed in planning future and ongoing training efforts. As in the selection process, lay therapists themselves have much to offer to those in training. The areas we feel necessary to be included:

1. Basic information on child abuse: medical, emotional, and social factors which are pertinent to understanding the dynamics of child abuse.

2. Sensitivity training as related to abuse. This would include an understanding of the significance of the lay therapist's own style of discipline with his or her own family. They must also be sensitive to how they really feel about parents who will physically injure a child. Discussion of this must be allowed in a non-judgemental atmosphere so that the lay therapist can adequately explore and deal with these feelings.

3. Information on legal issues related to child abuse: lay therapists should have a good understanding of the child abuse law for the state and what their responsibilities are as a private citizen as well as an agency representative.

4. Understanding the social service system.

5. The training program should include time for practice and sharing. It is important that the lay therapists develop group cohesion which provides a mutual support system.

The Family Center's training consisted of two weeks of intensive orientation and case assignment in the third week with follow-up inservice sessions and weekly group supervision. The Peoria area program extended the initial training program for three months before a case was assigned to the lay therapists. The advantage of the shortened training period was that it allowed the lay therapist to get involved with families at a time when their enthusiasm was highest and their training experiences were fresh, as well as maximizing the time of their direct involvement with parents. We also recognized the value of problem-solving with actual situations. The risk of the shortened training period was that the lay therapists might be less comfortable and less knowledgeable. Also, there may not be sufficient time for the lay therapy coordinator to evaluate the lay therapist's skills and commitment prior to


case assignment. Choices on this issue will probably vary with the time limi- tations of the agency, prior experience and training of the lay therapists, and the philosophical orientation of the program coordinator.

V. CASE SELECTION

The case selection process first involved the agency reaching a decision about the types of situations in which a lay therapist would be used. For instance, it needed to be decided whether they would be used in actual and/ or potential abuse situations, and whether they would be used in cases at intake or reserved for cases which had been in treatment for some period of time and where some of the immediate crises had been resolved. Decisions were also made regarding the age, sex, and ethnic background of the lay therapists in consideration with that of the client.

In addition to these basic determinations, the following criteria were used:

1. Cases of severe emotional illness were screened out. It was felt that lay therapists should not be expected to handle situations resulting from poten- tially psychotic or dangerous behavior.

2. Cases were given priority where parents' unmet dependency needs were seen as a great source of difficulty.

3. It was required that the parents be willing to accept a lay therapist.

4. It was required that the primary therapist for the family was willing to accept the responsibilty for consulting with the lay therapist on a regular basis and being available for crisis situations.

5. Personality matching: It was essential that the lay therapist supervisor get a feel for the lay therapist as an individual and attempt to assign clients that the lay therapist would feel comfortable with as a friend. If there was a strong dislike for certain kinds of behavior or personality types, the lay therapist needed to be comfortable in refusing the case or dropping out after early involvement.

VI. SUPERVISION

Lay therapists were provided supervision through three methods. The basic and most essential was a weekly group meeting with the lay therapy coordinator. It was at these meetings that the lay therapists discussed their cases, gave and received mutual support, and ventilated their feelings.It was essential during group sessions for a lay therapist to receive support and positive feedback for independent functioning. It provided validation of the knowledge and skill which the lay therapist brought from her own life experiences. By hearing the issues and problems that other lay therapists were struggling with, they could more easily put their own struggles into perspective. It was important to create an atmosphere where the lay therapist had permission to fail without reprimand.

Individual conferences were also necessary at times. These usually occurred regarding a crisis in the family, but they were also utilized when an issue or problem arose which was not appropriate for group supervision. It was important that the lay therapy coordinator be available to the lay therapists at any hour. Since the lay therapists were asked to be available to their families on a 24-hour basis, it was necessary for them to feel that they readily had supervisory back-up.


The third mode of supervision was that of conferences with the protective service worker. The coordinator must encourage regular communication in order to help them to get to know each other, feel comfortable with each other, and trust each other's judgement.

It was helpful, whenever possible, to include the primary therapist (usually a protective service worker) in meetings with the lay therapists at planned intervals. This served to reinforce the concept of joint treatment. It also allowed for continuing clarification of the differences in the roles of the two therapists with the family. It further allowed for clarification of the function of the coordinator and the primary therapist in their relationship to the lay therapist. The coordinator functioned more as a program planner and group facilitator while the primary therapist acted more as a case con- sultant.

During group meetings, the lay therapy coordinator identified problems a particular lay therapist was having and related them to other issues discussed in the group. Ideas and suggestions were sought from everyone in the group. The coordinator also identified any gaps in training needs as they existed and planned any special sessions in regard to them. It was also helpful to invite lay therapists to attend any workshops or agency meetings which might have been relevant.

In addition to the responsibilities outlined above, the coordinator served as an advocate for the lay therapists and a buffer between the lay therapist and the system. The coordinator and the protective service supervisor con- sulted on case management problems. It was the coordinator's responsibility to maintain the role of the lay therapist as a "parent person" rather than protector of the child. Other duties of the coordinator included activities to encourage referral, initial screening of cases, and assignment of cases to individual lay therapists.

VII. EVALUATION

An evaluation process was undertaken by the Family Center as a part of the total evaluation of the project. In Illinois, unfortunately, an evaluation component was not included. It is important to plan such a process as early as possible. Some of the factors which can be assessed before and after a lay therapist is introduced into a family are listed below:

1.

2.

3.

4.

5.

6.

Incidence of abuse

Severity of abuse

Length of treatment of cases with or without lay therapists.

Effectiveness of treatment

Time-cost effectiveness analysis

Behavioral indicators of parents a. Support system b. Ability of parent to initiate relationships c. Ability of parent to initiate activities

Additional data which can be collected is a profile of the families served by lay therapists, types of contacts the lay therapists had with the family, who initiated the contact, length of contact, and activities related to the parenting of the abused child identified by the lay therapists.


Through an adequate and appropriate evaluation process, an agency can determine the value of the program to their clients and to the agency. This will undoubtedly be critical to continuing support and funding.

VIII. SUMMARY OF FINDINGS

After the first ten months of the Family Center Project, nineteen families had received services from lay therapists. In the next twelve months, eight more families were also served. After the first twenty-two months, half of that total (13) were active cases. The reason for "closingn lay therapy cases were (in order of frequency) : (a) family moved; (b) lay therapist left the program; (c) family referred for treatment elsewhere; and (d) family refused involvement of a lay therapist.

The profile of the families referred for services in the first ten months of the program was as follows: average age of parent - 26% years; average number of children in the family - 2.7; severity of abuse - 29% were severe abuse, 29% were moderate abuse, 12% were mild abuse, and 29% were potential abuse; income - all families had incomes less than $10,000 and 21% were receiving public assistance.

Each lay therapist completed a monthly contact report for each family. From these reports, the following data was collected in the first 22 months.

Primary Reason for Contacts with Parents

a. Visiting and companionship 68% b. Transportation 10% c. Recreation with parent 6% d. Recreation with parent and child 3% e. Babysitting 2% f. Assistance with family finances 2% g. Meal planning and nutrition 2% h. Assistance with medical needs 3% i. Food shopping 1% j. Other 3%

Type of Contact

Home visit 54% Telephone 46%

Contact Initiated By

Lay Therapist Client

71.5% 28.5%

Average Number of Contacts Per Month 7.5

Average Length of Contact 1 hour 35 minutes

Major Changes Occuring in Family During Lay Therapist Involvement

Total Changes


Percentage of Total Change Change in Harital Status 3 8% Change in Employment 9 23% Change in Address 7 19% Illness (Serious) 16 40% Placement of Children 2 5% Other 2 5%

Techniques of parenting described by the lay therapist fell into two basic categories : (1) parenting techniques related to the client's children; and (2) techniques related to reparenting for the client by the lay therapist.

Of the child-related parenting, the techniques used were : (a) discussion of parent-child communication; (b) d iscussion and actions regarding the need of the child for additional services such as speech therapy, tutoring, evaluation, etc. ; (c) modeling "how to play" with children; (d) modeling behavior modification techniques; (e) discussions regarding appropriateness of parental expectations of the child; (f) information on child's developmental stages ; (g) counseling regarding consistency of discipline; (h) counseling regarding helping the child express his real feelings.

Activities involving reparenting the parent included : (a) encouraging the client to "take care of himself or herself," (b) encouraging the parent to follow through on individual goals; (c) encouraging the parent to be more assertive; (d) giving advice on how to improve housekeeping; (e) providing praise for doing a good job with the child; (f) encouraging the parent to plan leisure activities for self; and (g) allowing for expression of negative feelings toward the lay therapist.

Most contacts were social visits in the family's home. In addition, lay therapists frequently arranged outings, such as meals, shopping, or visits to community recreational facilities. A special effort was made to remember important occasions such as birthdays, Christmas, or other holidays. The giving of small remembrances on such occasions was one way of providing nur- turance. In some emergencies, money and housing were provided by the lay therapists. Such requests were carefully evaluated by both the lay therapist and the coordinator. Every effort was made to prevent problems of overdepen- dency.

CONCLUSION

We view child abuse as a symptom of a matrix of problem-producing potential in a parent. Basic to this treatment approach, is the premise that failure to adequately resolve very early stages of emotional development is incon- sistent with acquiring personality traits necessary for healthy parenting as an adult. The introduction of a positive nurturing relationship is one way or reworking these early developmental problem areas. Lay therapy then becomes one element of a more elaborate plan of treatment and never the sole method of intervention. It intensifies a process which usually requires a much longer period of treatment with traditional psychotherapeutic techniques. It becomes a part of that process as well as other treatment components such as therapeutic day care, services of a crisis nursery, temporary foster care, support group therapy such as Parents Anonymous, and other approaches still being developed.

Lay therapy is often spoken of as a reparenting process for the client. It


is essential then to seek out as lay therapists persons whose own personality traits will be complementary to those of the client. Positive parent messages must be substituted for the negative messages received earlier. A nurturing acceptance of natural feelings and behaviors must replace the rejection, criticism and control experienced earlier by the parent. It is for these reasons that the recruitment and selection process becomes the point at which the program is able to succeed or fail.

We cannot stress too much the following : (1) the need for a philosophical base that sees lay therapy as part of a complex treatment approach and not as an isolated, inexpensive panacea, as well as (2) the lay therapist as a unique individual who is able to promote, allow, and nurture the expression of child-like needs and feelings in another adult. Some of the obvious potential hazards in the process are : (1) the creation of an overly-dependent relationship which will always require the lay therapist to be there to meet the parents' needs; (2) psychological regression with fixation at an earlier developmental stage; or (3) possible neglect of the children due to preoccu- pation of the parent with his/her own needs as opposed to those of the child. It is for these reasons that the constant communication is necessary between the primary therapist, the lay therapist, the program coordinator and other treatment specialists who might be involved. A constant effort to monitor and objectify what transpires is necessary to assure treatment effectiveness. We have attempted to present the techniques used in two lay therapy programs to demonstrate how this can be done. We have shared our mistakes, as well as our successes, in hopes that our experiences can be used in other situations to make lay therapy an asset to other treatment programs for abusive parents. This is a feeling and doing kind of treatment. Contrary to popular opinion, it is not inexpensive. It requires time and money of a system to plan and implement such a program. It includes the stress of change, the threat of exposure, but also the advantage of improved services to families.

Lay therapy—intimacy as a form of treatment for abusive parents

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