Skip to main content
Log in

Therapeutic Work with Parents’ Childhood Experiences in the Context of Intensive Home-Based Treatment for High-Risk Youth: Practical Mentalization-Based and Trauma-Informed Interventions

  • Original Paper
  • Published:
Contemporary Family Therapy Aims and scope Submit manuscript

Abstract

Although childhood experiences are widely recognized for their potential impact on adult health and happiness, clinical practices apt to solicit and process such experiences with adult clients are often not described in sufficient detail to offer meaningful guidance. The present paper describes how to use the Important Childhood Events (ICE) scale to anchor psychotherapeutic work with parents of extremely high-risk youth in intensive home-based treatment, where childhood experiences may ultimately provide a salient port of entry into identifying and addressing parents’ perceptions of their own children’s difficulties. We aim to contribute to trauma-informed and mentalization-based clinical practices, particularly for clinicians who are working with families affected by complex, intergenerational trauma in the context of social marginalization. We do this by operationalizing steps in the therapeutic process to prepare both parent and clinician for such difficult conversations, and by describing clinical vignettes which illustrate interventions to foster mentalizing and repair in response to avoidance or dysregulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. American Psychiatric Pub.

  • Bruns, E. J., Benjamin, P. H., Shepler, R. N., Kellogg, M., Pluckebaum, H., Woolston, J. L., & Zabel, M. D. (2021). Manuscript: Defining Quality standards for Intensive Home Based Treatment Programs for Youth with Serious Emotional disorders. Administration and Policy in Mental Health and Mental Health Services Research, 48(6), 1065–1088. https://doi.org/10.1007/s10488-021-01116-8.

    Article  PubMed  Google Scholar 

  • CDC (2016). About adverse childhood experiences. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/about_ace.html.

  • Choi, J. K., Wang, D., & Jackson, A. P. (2019). Adverse experiences in early childhood and their longitudinal impact on later behavioral problems of children living in poverty. Child Abuse & Neglect, 98, 104181. https://doi.org/10.1016/j.chiabu.2019.104181.

    Article  Google Scholar 

  • DiGangi, M. J., & Negriff, S. (2020). The implementation of screening for adverse childhood experiences in pediatric care. The Journal of Pediatrics, 222, 174–179. https://doi.org/10.1016/j.jpeds.2020.03.057.

    Article  PubMed  Google Scholar 

  • Dollberg, D. G., & Hanetz-Gamliel, K. (2023). Therapeutic work to enhance parental mentalizing for parents with ACEs to support their children’s mental health: A theoretical and clinical review. Frontiers in Child and Adolescent Psychiatry, 2, 1094206.

  • Feder, G., Ramsay, J., Dunne, D., Rose, M., Arsene, C., Norman, R., & Hague, G. (2009). How far does screening women for domestic (partner) Violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria. https://doi.org/10.3310/hta13160.

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8.

    Article  PubMed  Google Scholar 

  • Finkelhor, D. (2018). Screening for adverse childhood experiences (ACEs): Cautions and suggestions. Child Abuse & Neglect, 85, 174–179. https://doi.org/10.1016/j.chiabu.2017.07.016.

    Article  Google Scholar 

  • Ford, K., Hughes, K., Hardcastle, K., Di Lemma, L. C., Davies, A. R., Edwards, S., & Bellis, M. A. (2019). The evidence base for routine enquiry into adverse childhood experiences: A scoping review. Child Abuse & Neglect, 91, 131–146. https://doi.org/10.1016/j.chiabu.2019.03.007.

    Article  Google Scholar 

  • Fors, M. (2021). Power Dynamics in the Clinical Situation: A confluence of perspectives. Contemporary Psychoanalysis, 57(2), 242–269. https://doi.org/10.1080/00107530.2021.1935191.

    Article  Google Scholar 

  • Hambrick, E. P., Brawner, T. W., Perry, B. D., Brandt, K., Hofmeister, C., & Collins, J. O. (2019). Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children. Archives of Psychiatric Nursing, 33(3), 238–247. https://doi.org/10.1016/j.apnu.2018.11.001.

    Article  PubMed  Google Scholar 

  • Kia-Keating, M., Barnett, M. L., Liu, S. R., Sims, G. M., & Ruth, A. B. (2019). Trauma‐responsive care in a pediatric setting: Feasibility and acceptability of screening for adverse childhood experiences. American Journal of Community Psychology, 64(3–4), 286–297. https://doi.org/10.1002/ajcp.12366.

    Article  PubMed  PubMed Central  Google Scholar 

  • Liu, S. R., Kia-Keating, M., & Nylund-Gibson, K. (2018). Patterns of adversity and pathways to health among White, Black, and latinx youth. Child Abuse & Neglect, 86, 89–99. https://doi.org/10.1016/j.chiabu.2018.09.007.

    Article  Google Scholar 

  • Loveday, S., Hall, T., Constable, L., Paton, K., Sanci, L., & Hiscock, H. (2022). Screening for adverse childhood experiences in children: A systematic review. Pediatrics. https://doi.org/10.1542/peds.2021-051884.

    Article  PubMed  Google Scholar 

  • Malberg, N., Jurist, E., Bate, J., & Dangerfield, M. (2023). Working with parents in therapy: A mentalization-based approach (pp. xvi-389). American Psychological Association.

  • Masten, A. S., & Barnes, A. J. (2018). Resilience in children: Developmental perspectives. Children, 5(7), 98. https://doi.org/10.3390/children5070098.

    Article  PubMed  PubMed Central  Google Scholar 

  • Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., & Muller, N. (2017). Mentalization-based treatment for children: A time-limited approach. American Psychological Association. https://doi.org/10.1037/0000028-000.

  • Moffett, S., Brotnow, L., Patel, A., Adnopoz, J., & Woolston, J. (2018). Intensive home-based programs for youth with serious emotional disturbances: A comprehensive review of experimental findings. Children and Youth Services Review, 85, 319–325. https://doi.org/10.1016/j.childyouth.2017.10.004.

    Article  Google Scholar 

  • Novick, K. K., & Novick, J. (2011). Working with parents makes therapy work. Jason Aronson.

  • Nurius, P. S., Logan-Greene, P., & Green, S. (2012). Adverse childhood experiences (ACE) within a social disadvantage framework: Distinguishing unique, cumulative, and moderated contributions to adult mental health. Journal of Prevention & Intervention in the Community, 40(4), 278–290. https://doi.org/10.1080/10852352.2012.707443.

    Article  Google Scholar 

  • Rariden, C., SmithBattle, L., Yoo, J. H., Cibulka, N., & Loman, D. (2021). Screening for adverse childhood experiences: Literature review and practice implications. The Journal for Nurse Practitioners, 17(1), 98–104. https://doi.org/10.1016/j.nurpra.2020.08.002.

    Article  PubMed  Google Scholar 

  • Schickedanz, A., Halfon, N., Sastry, N., & Chung, P. J. (2018). Parents’ adverse childhood experiences and their children’s behavioral health problems. Pediatrics, 142(2), https://doi.org/10.1542/peds.2018-0023.

  • Slade, A., with Sadler, L. S., Eaves, T., & Webb, D. L. (2023). Enhancing attachment and reflective parenting in clinical practice: A minding the Baby approach. Guilford.

  • Steele, H., & Steele, M. (2008). Clinical applications of the adult attachment interview. Guilford Press.

  • Stob, V., Slade, A., Brotnow, L., Adnopoz, J., & Woolston, J. (2019). The family cycle: An activity to enhance parents’ mentalization in children’s mental health treatment. Journal of Infant Child and Adolescent Psychotherapy, 18(2), 103–119. https://doi.org/10.1080/15289168.2019.1591887.

    Article  Google Scholar 

  • Stob, V., Slade, A., Adnopoz, J., & Woolston, J. (2020). The family cycle: Breaking the intergenerational transmission of trauma through mentalizing. Journal of Infant Child and Adolescent Psychotherapy, 19(3), 255–270. https://doi.org/10.1080/15289168.2020.1786762.

    Article  Google Scholar 

  • Stob, V., Slade, A., Brotnow, L., & Woolston, J. (2023). The Family cycle in Supervision: Enhancing Clinician Mentalizing in Work with highly stressed families. Journal of Infant Child and Adolescent Psychotherapy, 1–12. https://doi.org/10.1080/15289168.2023.2228719.

  • Whitefield, C., & Midgley, N. (2015). And when you were a child?’: How therapists working with parents alongside individual child psychotherapy bring the past into their work. Journal of Child Psychotherapy, 41(3), 272–292. https://doi.org/10.1080/0075417X.2015.1092678.

    Article  Google Scholar 

  • Woolston, J. L., Adnopoz, J., Berkowitz, S., & Berkowitz, S. J. (2007). IICAPS: A home-based psychiatric treatment for children and adolescents. Yale University Press.

Download references

Acknowledgements

The authors wish to acknowledge the support and contribution of the IICAPS research and model development group, uniting clinicians and researchers in the continued pursuit of understanding and improving clinical services. The authors also wish to acknowledge the kids and parents who have shared their life experiences and shown us how new relationships can transform old wounds.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Line Brotnow Decker.

Ethics declarations

Ethical Approval

The present paper describes clinical practices and does not include data collected from treatment participants. The clinical material contained within the present paper is entirely fictional and any similarity with actual events is coincidental.

Competing interests

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Decker, L.B., Torres, B., Dunnum, S. et al. Therapeutic Work with Parents’ Childhood Experiences in the Context of Intensive Home-Based Treatment for High-Risk Youth: Practical Mentalization-Based and Trauma-Informed Interventions. Contemp Fam Ther (2023). https://doi.org/10.1007/s10591-023-09687-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10591-023-09687-4

Keywords

Navigation