Kjerstin Almqvist

Silence and survival: Working with strategies of denial in families of traumatized pre-school children

Abstract Silence and denial about previous traumatic experiences are common features in families exposed to organized violence. Mutual protection between family members, and especially between parents and children, is seen as the fundament for the silencing of traumatic experiences. This strategy is suggested to have adaptive advantages in dangerous situations in general, where it serves the function of saving the childs internal representations of his/her parents as secure bases. If, however, the dangerous situation escalates and a psychic trauma cannot be avoided, the strategy of mutual silence concerning the event(s) becomes an obstacle for giving traumatized children parental support and professional treatment. It is argued that clinicians need to take seriously the strong reasons families have for upholding their strategy of denial, if they want to help traumatized families to a better functioning. A case presentation is made to illustrate how it is possible to use refugee childrens re-enacting pla...

Effects of a Group-Based Intervention on Psychological Health and Perceived Parenting Capacity among Mothers Exposed to Intimate Partner Violence (IPV): A Preliminary Study

This study evaluated a community-based treatment program in Sweden for mothers subjected to intimate partner violence. Results based on group means indicated that the mothers showed significantly reduced trauma and psychological symptoms and improved sense of coherence after participating in the program. Surprisingly, no improvement regarding perceived parental locus of control was found. Furthermore, as a complement to group statistics a reliable change index was used, which resulted in more modest results regarding the effectiveness of the treatment.

Maternal report on child outcome after a community-based program following intimate partner violence

Background: This study examined the perceived effectiveness of a 15-week community-based program for 46 children exposed to intimate partner violence (IPV) and their mothers. Aims: The primary aims were to describe the children who entered one of the existing community-based programs in terms of behavioral problems and to evaluate the impact of the program on childrens general behavioral functioning as assessed by their mothers. Results: Childrens rated behavioral problems (SDQ) dropped following treatment; the effect size was in the medium range. The social impairment caused by the problems decreased as well. The effect regarding behavioral problems was not related to the degree of exposure to IPV or the mothers own changes in trauma symptoms following treatment. Results were analyzed as well at the individual level with the Reliable Change Index (RCI), which showed that the majority of children were unchanged following treatment. Conclusions: One implication from the study is the need for baseline screening and assessment. About half of the current sample had a clinical symptom picture indicating the need for specialized psychiatric/psychotherapeutic treatment. Furthermore, the reduction in behavioral problems was significant but many children still had high levels of behavioral problems after treatment, indicating a need of a more intense or a different type of intervention.

How children with experiences of intimate partner violence towards the mother understand and relate to their father

The aim of this study was to describe how, in the aftermath of intimate partner violence against the mother, children understand and relate to their father. Face-to-face interviews with four girls and four boys, aged between eight and twelve, were analysed using an interpretative phenomenological approach. All of the children had been exposed to the father’s violence towards the mother. Two super ordinate themes were identified in the analysis: the disjunctive image of the father and being entangled in a conflict. The children’s understanding of the father and their relationship with him was built on different versions of the father and his actions; those experienced by the child and those recounted to them. The situational context surrounding the described experience pervaded the image of the father. An ambiguity appeared to exist in the sense of different versions of the father and children described different emotions that could both hinder and elicit other feelings connected to the father. Children also conveyed the sense of being trapped or entangled in a conflict where their own needs and desires could be deemed as unsafe to express, and that they felt responsibility for dealing with the father’s influence.

Children exposed to intimate partner violence and the reported effects of psychosocial interventions

Using a repeated measures design posttraumatic stress (PTS), psychological and behavioral problems significantly decreased following intervention in children exposed to intimate partner violence (IPV), with use of traditional group analyses. Analyses using the reliable change index (RCI), however, revealed that few children were improved or recovered, implying that interventions in common use should be evaluated for their significant impact on the individual level in addition to group level statistics. Positive changes in children’s behavioral problems were related to the mother’s improvement of their own mental health. Direct victimization by the perpetrator was not associated with treatment changes but with higher symptom levels at study entry. Amount of contact with the perpetrator was neither related to symptom load nor to changes following treatment.

On the importance of the therapist in psychotherapy: A summary of current research

Abstract The American Psychological Associations Presidential Task Force on Evidence-Based Practice articulates a decision-making process based on the integration of the best available research, clinical expertise, and patient characteristics. The treatment method, the individual psychotherapist, the treatment relationship, and the patient are all vital contributors to successful psychotherapy. Several studies have shown that the variation in treatment effect among psychotherapists using the same method is greater than the variation in treatment effect among different methods. This outcome pleads for a comprehensive psychotherapist-related “g-factor” of psychotherapy. In terms of decision-making for health-care institutions and clinical practices, it would seem wise not to separate the psychotherapist, the patient, or the relationship from the method as there seem to be extensive effects relative to the interaction among these parameters. Parallel to a growing knowledge of evidence-based methods, there is still a decisive lack of scientific knowledge about these interactions.

Young children’s experiences of participating in group treatment for children exposed to intimate partner violence: A qualitative study

The risk of exposure to intimate partner violence (IPV) between caregivers is increased during early childhood. The adverse effects on the health and development of the youngest children may be severe. Effective and promising interventions for children who have experienced IPV have been developed and evaluated. However, there is a lack in knowledge about how the children themselves experience the interventions. The aim of this study was to contribute to the evaluation of group treatment designed to improve the psychological health of young children in the aftermath of family violence by elucidating the children’s experiences of participating. Nine children, aged 4 to 6 years, were interviewed after participating in group programmes specifically designed for children who have been exposed to intimate partner violence. A semi-structured interview guide with open-ended questions was used. The interviews were transcribed and analysed using interpretative phenomenological analysis, to ensure a focus on the children’s own views and experiences. Five master themes embracing the children’s experiences were identified: joy – positive emotional experience of participation; security – feeling safe; relatedness – relationships within the group; to talk – externalised focus on the violence; and competence – new knowledge and skills. Theoretical and clinical implications and the benefit of including very young children’s views and experiences in research are discussed.

A Comparison of Applicants' and Incumbents' Mean Scores on Health Constructs and Personality Constructs. A Follow‐Up Study of Military Recruits in a Selection Setting

This study investigated the change in means on both personality constructs and the more infrequently studied, health constructs, as a possible effect of self‐enhancement in a real selection setting. The participants (N = 202) were assessed first as applicants, and later as incumbents. The result revealed that, while all the means for personality constructs changed across situations, the effect sizes on the health constructs were stronger. The analysis also revealed that it was twice as likely for the incumbents to confirm having experienced previous traumatic/stressful events compared with applicants. Implications for the observed changes on both personality and health constructs in military selection setting are discussed.

Mothers’ opinions on being asked about exposure to intimate partner violence in child healthcare centres in Sweden:

Intimate partner violence (IPV) constitutes a hidden health risk for exposed mothers and children. In Sweden, screening for IPV in healthcare has only been routine during pregnancy, despite an increase in IPV following childbirth. The arguments against routine questions postpartum have concerned a lack of evidence of beneficial effects as well as fear of stigmatizing women or placing abused women at further risk. Increased understanding of women’s attitudes to routine questions may allay these fears. In this study, 198 mothers in 12 child healthcare centres (CHCs) filled in a short questionnaire about their exposure and received information on IPV at a regular baby check-up visit. The mothers’ lifetime prevalence of exposure to IPV was 16%. One hundred and twenty-eight mothers participated in a telephone interview, giving their opinion on the screening experience. The intervention was well-received by most of the mothers who reported that questions and information on IPV are essential for parents, considering the health risks for children, and that the CHC is a natural arena for this. Necessary prerequisites were that questioning be routine to avoid stigmatizing and be offered in privacy without the partner being present.

Replicability of Effect when Transferring a Supportive Programme for Parents Exposed to Intimate Partner Violence and Their Children from the US to Sweden

ABSTRACT Transferring an evidence-based parenting programme for parents exposed to intimate partner violence (IPV) and their children with emotional and behavioural problems reveals the extent to which cultural and social aspects can interfere with the programme’s effectiveness. Feasibility studies are of value in such circumstances, and the aim of the present feasibility study was to explore, on a small scale and in its natural context, whether the effects of the parenting programme, Project Support, were replicable when transferred to another country. In this study, the programme, which was originally designed for parents exposed to IPV and their children who had developed psychological symptoms in the United States, was evaluated in an equivalent population receiving Swedish social services. Parents (n = 35) self-assessed their parenting capacity and their children’s (n = 35) psychological symptoms. The results indicate that the parents improved their parenting capacity, and feelings of helplessness and fear regarding parenting their children decreased. Those feelings were also associated with the children’s psychological symptoms. The promising results are similar to the findings of previous research from the US, and further implementation and evaluation of Project Support in Sweden are indicated.