A Framework for Engaging Resistant Parents in Child Welfare

A Framework for Engaging Resistant Parents
Info@FamiliesInSociety.org

FamiliesInSociety.org

alliance1.org

September 18, 2012

Reactance and the Child Welfare Client
A Framework for Engaging Resistant Parents

Rebecca Mirick, PhD, LICSW
Adjunct Faculty
Simmons School of Social Work
mirick@simmons.edu

Goals
 Develop an understanding of psychological reactance

and how to use it as a framework to understand
resistance in child welfare services
 Identify client responses to feelings of reactance

 Utilize the reactance theory framework to assess for

reactance and identify interventions with ―resistant‖
child welfare clients

September 18, 2012 ● Alliance for Children and Families

2

Children in Child Welfare
Who is impacted by child welfare services?
 675,000 children became involved with child welfare

services in 2010
 Approximately 400,000 children were in foster care in 2011
 55% of children in foster care have been there for more
than 1 year
 31% of children in foster care have been there for more
than 2 years
U.S. Department of Health and Human Services, 2010; www.acf.hhs.gov


3

Characteristics of
Child Welfare Services
What is expected of parents in child welfare work?
 Participation
 Compliance
 Demonstration of ―deference to the authority of the worker‖
 Task completion
 Parents are often resistant to child welfare services
Alpert & Brittner, 2009; Altman, 2005; Altman, 2008; Reich, 2005; Smith, 2008


4

Resistance in Child
Welfare
 Anger
 Defensiveness
 Aggression
 Arguing
 Interrupting or ignoring the worker
 Challenging the worker
 Blaming others for problems

 Making excuses for behaviors
 Minimizing/denying the problem
 Being unwilling to make changes or engage in the work
 Arriving late to services or not attending at all

 Passive resistance

Rooney, 1992/2009


5

Impact of Resistance
and Noncompliance
Parental lack of participation (noncompliance) and
resistance impacts decision making.
Noncompliance is associated with:
 Longer stays in foster care
 Higher rates of child removal
 Higher rates of future maltreatment reports
 Greater chance of termination of parental rights
Atkinson & Butler, 1996; DePanfilis & Zuravin, 2002; Jivanjee, 1999; Karski, 1999; Rittner & Dozier, 2000; Reich, 2005


6

Examples of Resistant
Clients

Suzy (23) is a Caucasian mom of two small children involved with child welfare services for the first time;
the baby (5 weeks old) broke her leg while her dad was watching her. She is very angry and frustrated that
the children are in foster care—she yelled at the worker in a planning meeting. She does not like two of the
goals (admitting that the boyfriend intentionally hurt the baby & getting a restraining order ) and believes the
baby’s injury was an accident. She has been told not to contact her boyfriend; while her children are living in
foster care, she secretly sees him. As a result, overnight visits with her children were postponed for 6 months.
She is now pregnant.
Jenna (28) is an African American mom living in an urban public housing development. She is polite and
respectful to the worker, but is often not at home, even when visits were scheduled ahead of time. She has a
history of substance abuse issues. She has missed multiple sessions of substance abuse treatment. She is
always regretful about missing services and has a reason why she missed (e.g., car wouldn’t start, boss
wouldn’t let her off of work, etc.) and promises not to miss any more…and yet always does. The worker told
her that she has to attend all treatment services and meetings for the next month or the worker will
recommend that she not regain custody of her little boy.
Maria (35) is a Latina mom with a history of substance abuse; her children’s school filed a 51-A for neglect.
She is angry that CPS is back in her life, and that she has mandated drug testing and substance abuse
treatment. Although she was attending AA regularly a few months ago, she has now stopped. She blames the
school for CPS involvement—they just don’t like her. Maria’s children remain with her at present, but the CPS
worker has said that the children may need to live with a family member if she cannot cooperate with
services. Maria’s been asked to do anger management treatment, a substance abuse program, attend AA
regularly, do drug testing, and attend a parenting class.

7

Explanation #1: Family
Characteristics or problems that negatively
There are family characteristics
impact participation.
 Substance abuse/major mental illness
 Shame
 Domestic violence
 Poverty
 Cultural issues/disconnect
 Lack of access to transportation or ability to get
time off of work
 Lack of access to health insurance
Resistance: These issues interfere with parents’
engagement in services or access to services.
Ayon & Aisenberg, 2010; Reich, 2005; Staudt, 2007

9

Explanation #2: Lack of
Motivationto change or motivation to parent can impact
Lack of motivation
participation.
 They do not care enough about their child to make
changes or participate in treatment services
 They are in denial
 Therefore, lack of participation is a predictor of whether the
parent can parent the child safely
Resistance: The parent is not motivated enough by the love
of the child or desire to parent, the parent is in denial.

Altman, 2008; Reich, 2005; Smith, 2008

10

Explanation #3: Mistrust
A lack of trust that the worker or agency is there to help
can impact participation in services.
 Mistrust is common particularly in poor, urban
neighborhoods of color
 Child welfare agencies often have negative
reputations (―baby snatchers‖)
Resistance: The parent does not trust the worker or
the agency.

Anderson, 2000; Reich, 2005

11

Explanation #4: Readiness to
Change exclusive stages of change that clients cycle
There are mutually
through in a non-linear manner.
 Precontemplation
 Contemplation
 Preparation
 Action
 Maintenance
Resistance: Clients are pushed to change in the
precontemplation or contemplation stage.

Girvin, 2004; Littell & Girvin, 2004; Prochaska & DiClemente, 1984

12

Explanation #5:
Worker/Client Relationship
A motivational interviewing approach suggests
that worker’s behavior in the relationship can
impact resistance.
Resistance: Occurs when there is dissonance in the
relationship between worker and client. The worker
should address this by changing her/his approach.

Hohman, 1998; Miller & Rollnick, 2002; Mullins et al., 2004

13

What is Reactance?
Take a minute and think about a situation where you were
forced to do something you really did not want to do.

What did you think?

How did you feel?
What did you do?
Rooney, 1992


15

Psychological Reactance
A normal, expected motivational drive to regain a lost or
threatened freedom a person had assumed would be
available to him/her.
The magnitude of the reactance depends on:
1. The importance of the lost/threatened freedom to the person
2. The presence of an implied threat to other freedoms
3. The strength of the person’s assumption that this freedom
would be available to him/her
4. The proportion of freedoms threatened/lost versus those
available to the person
Brehm, 1966; Brehm & Brehm, 1981; Rooney, 1992/2009


16

Threatened or Lost
Freedoms
Threatened/lost freedoms in child welfare include:
 Decisions about who to date/ live with
 Living arrangements
 Decision to leave a partner or to obtain a restraining






order against a partner
Custody of a child
Parenting decisions
Alcohol or drug use
AA/NA attendance/ treatment attendance
Altman, 2008; Reich, 2005; Smith, 2008


17

How Is Reactance
Expressed?
Responses to reactance can be viewed as attempts to
decrease intolerable affect (reactance) and regain feelings
of power and control.
How do clients express reactance?
1. Attempt to regain the lost/threatened freedom
2. Search for loopholes to restore the lost/ threatened
freedom
3. Express hostility or aggression towards the person
who restricted/threatened the freedom
4. Value the lost/ threatened freedom more than before
it was lost/ threatened
Brehm, 1966; Brehm & Brehm, 1981; Rooney, 1992/2009


18

1. Attempts to Regain the
Freedom
People often respond to reactance by trying to regain the
lost freedom directly.
Examples:
 Arguing with the child welfare worker
 Denying the abuse occurred
 Demanding the return of the child/ children
 Defending parent’s behavior

Rooney, 1992/2009

19

2. Search for Loopholes
Parents respond to the feeling of reactance by trying to
regain the freedom—not outright, but indirectly through a
loophole in the limit.
Examples:
 If children are placed with family members, the
parent may try to visit there, instead of at the
supervised, scheduled visits
 A mother who has lost custody of a child may get
pregnant again

Rooney, 1992/2009

20

3. Anger
Parents express reactance as anger, hostility, or
aggression toward the limit-setter. This occurs even
when the expression of anger will not restore the lost
or threatened freedom.
Examples:
 Parent gets angry and frustrated in a team meeting
 Parent spends half of a treatment session
expressing anger and frustration about CPS
involvement

Rooney 1992/2009

21

4. Restricted Behaviors
Become More Appealing
Sometimes reactance is not expressed either directly or
indirectly and must be tolerated instead. The prohibited
behavior can become more desirable.
Examples:
 The unsafe partner becomes more desirable
 Although a parent with substance abuse issues had
been contemplating about change—the mandate
to attend treatment services and label of ―substance
abuser‖ decreases her desire to enter
treatment services
Rooney, 1992/2009

22

Example #1
Suzy (23) is a Caucasian mom of two small children involved
with child welfare services for the first time; the baby (5 weeks
old) broke her leg while her dad was watching her.
She is very angry and frustrated that the children are in foster
care—she yelled at the worker in a planning meeting. She does
not like two of the goals (admitting that the boyfriend intentionally
hurt the baby and getting a restraining order ) and believes the
baby’s injury was an accident.
She has been told not to contact her boyfriend; while her
children are living in foster care, she secretly sees him. As
a result, overnight visits with her children were postponed
for 6 months. She is now pregnant.

23

Example #2
Jenna (28) is an African American mom living in an urban public
housing development. She is polite and respectful to the
worker, but is often not at home, even when visits were
scheduled ahead of time.
She has a history of substance abuse issues. She has missed
multiple sessions of substance abuse treatment. She is always
regretful about missing services and has a reason why she
missed (e.g., car wouldn’t start, boss wouldn’t let her off of
work, etc.) and promises not to miss any more…and yet always
does.
The worker told her that she has to attend all treatment services
and meetings for the next month or the worker will recommend
that she not regain custody of her little boy.

24

Example #3
Maria (35) is a Latina mom with a history of substance abuse;
her children’s school filed a 51-A for neglect. She is angry that
CPS is back in her life, and that she has mandated drug testing
and substance abuse treatment. Although she was attending AA
regularly a few months ago, she has now stopped. She blames
the school for CPS involvement—they just don’t like her.

Maria’s children remain with her at present, but the CPS worker
has said that the children may need to live with a family member
if she cannot cooperate with services. Maria’s been asked to do
anger management treatment, a substance abuse
program, attend AA regularly, do drug testing, and attend a
parenting class.


25

Benefits of Reactance
 Can be predicted

 Client-centered approach
 Some approaches are supported by

preliminary research
 Is congruent with social work values
 Separates client behavior from client
motivation/ desire to parent
 Not client blaming
Rooney, 1992/2009

27

Assess for Reactance
Signs of reactance: Anger, refusal to participate in
services, denial, interrupting, getting off task
easily, making negative comments, questioning the worker
or treatment provider’s expertise, missing appointments or
visits.

Formal measures of reactance:
 Hong Psychological Reactance Scale
 Therapeutic Reactance Scale (Dowd)
Beutler et al., 2011; Dowd, Milne & Wise, 1991; Hone & Page, 1989


28

Approaches With Reactant
Parents of reactance theory to interpret the
1. Use the lens
2.

parent’s behavior
Use interventions likely to reduce the reactance
versus increase it

Interventions to Reduce
Reactancethe power differential
1. De-emphasize
2.
3.

Use nondirective approaches
Limit restrictions


29

Intervention #1: Limit Use of
Power
Parents in child welfare services are sensitive to the
power issues inherent in the work.
 Examples:
○ Mandates
○ Threats
○ Unscheduled home visits
○ Asking parents to ―jump through hoops‖ to
demonstrate motivation
○ Persuasion
○ Coercion
Altman, 2008; Berg & Kelly, 2000; Diorio, 1992; Dumbrill, 2006; Smith, 2008


30

What Does It Look Like to
De-Emphasize Power?
 Avoid threats, coercion, or persuasion

 Avoid unnecessary requirements or mandates
 Be respectful of client’s space particularly when in

their home (e.g., ask permission to look in the
kitchen or talk to the child—if the response is
no, then have a conversation about what that
might mean)
 Focus on a collaborative, empathetic approach
versus one that highlights power differential
Berg & Kelly, 2000; Dumbrill, 2006; Rooney 1992/2009


31

The Cycle of Reactance and
Use of Power
Reactance
behaviors
expressed

Increased
reactance

Increased use
of power &
authority

Social worker
responds with
use of power &
authority

Increased
reactance
G. D. Rooney, 2009


32

Example #1
Suzy (23) is a Caucasian mom of two small children involved
with child welfare services for the first time; the baby (5 weeks
old) broke her leg while her dad was watching her.
She is very angry and frustrated that the children are in foster
care—she yelled at the worker in a planning meeting. She does
not like two of the goals (admitting that the boyfriend intentionally
hurt the baby & getting a restraining order ) and believes the
baby’s injury was an accident.
She has been told not to contact her boyfriend; while her
children are living in foster care, she secretly sees him. As
a result, overnight visits with her children were postponed for
6 months. She is now pregnant.

33

Intervention #2: NonDirective Approaches
 Directiveness is how much the practitioner is in

control of the work
 This intervention for high-reactant clients has the

most empirical support
 Practitioner directiveness is negatively correlated

with outcomes for high reactant clients

Beutler & Clarkin, 1990; Beutler & Harwood, 2000; Beutler et al., 2011; Karno & Longabaugh, 2005


34

What Are Non-Directive
Approaches? Non-directive approaches
Directive approaches
Cognitive behavioral therapy

Supportive therapy

Traditional, disease model-based
substance abuse treatment

Motivational interviewing

Practitioner as expert

Client as expert in his/her own life

Giving advice, confrontation,
interpretation, providing
information, initiating topics

Active listening, collaborative goal
setting

Limiting choices, using persuasion
or coercion, taking the lead

Offering choices, letting the client
take the lead, avoiding persuasion
or coercion

Avoid practitioner-directed
interventions

Use client-directed interventions
(like bibliotherapy)
Beutler & Clarkin, 1990; Karno et al., 2009; Karno & Longabaugh, 2005


35

Example #2
Jenna (28) is an African American mom living in an urban public
housing development. She is polite and respectful to the
worker, but is often not at home, even when visits were
scheduled ahead of time. She has a history of substance abuse
issues. She has missed multiple sessions of substance abuse
treatment.

She is always regretful about missing services and has a reason
why she missed (e.g., car wouldn’t start, boss wouldn’t let her off
of work, etc.) and promises not to miss any more…and yet
always does.
The worker told her that she has to attend all treatment services
and meetings for the next month or the worker will recommend
that she not regain custody of her little boy.

36

Intervention #3: Limit
Restrictions
Theoretically, decreasing the number of restrictions
on personal freedoms should decrease the
reactance response.
Examples:
 Keep goals as specific as possible
 Emphasize the freedoms which remain available to
the client
 Clarify ―silent mandates‖
G.D. Rooney, 2009; R.H. Rooney, 1992/2009


37

What Does It Look Like to
Limit Restrictions?
 If the parent is mandated to attend substance abuse treatment

services, offer the parent a choice of programs; thus, the main limit
still remains, but the freedom to choose which one remains
 Emphasis specific, not global, goals; and clarify that the parent

needs to stay away from a violent partner, not stop dating; the issue
is the violence, not the dating
 Help a parent manage losses associated with the required loss of an

unsafe partner—find new childcare, if he cannot watch the
children, or apply for financial assistance since he is no longer
helping to pay the bills
 Avoid restrictions or requirements that are only present to

determine how motivated the parent is
Smith, 2008

38

Example #3
Maria (35) is a Latina mom with a history of substance abuse;
her children’s school filed a 51-A for neglect. She is angry that
CPS is back in her life, and that she has mandated drug testing
and substance abuse treatment. Although she was attending AA
regularly a few months ago, she has now stopped. She blames
the school for CPS involvement—they just don’t like her.

Maria’s children remain with her at present, but the CPS worker
has said that the children may need to live with a family member
if she cannot cooperate with services. Maria’s been asked to
do anger management treatment, a substance abuse program,
attend AA regularly, do drug testing, and attend a
parenting class.


39

Future Research
 Does the use of reactance theory have the potential to improve child welfare

outcomes?
 How open are child welfare agencies to the use of reactance theory? Workers

themselves versus administration? If barriers to the adoption of this approach
are present, what are they?
 What is the impact of the context of child welfare work (e.g., federal

legislation, timelines, safety concerns for both child and self, lack of treatment
services)?
 How can child welfare workers effectively assess for reactance?
 How many parents are experiencing reactance? How many are resistant for

other reasons? What are these reasons?
 Does the use of reactance-based interpretations of parent-behavior improve

parent attendance and increase engagement in services? Is this associated
with more positive outcomes?

41

Presentation Resources
•

Reactance and the Child Welfare Client: Interpreting Parents’
Resistance to Services Through the Lens of Reactance Theory
(2012) Families in Society, (93)3, doi:10.1606/1044-3894.4224

•

Dr. Rebecca G. Mirick
mirick@simmons.edu

Presentation references available in handout file.

Additional Alliance Resources
PRACTICE
•
•
•

Practice & Policy Focus:
http://alliance1.org/ppf
Alliance for Children and Families Annual Conference (Innovation Track):
http://www.alliance1.org/nc/workshops-innovation-implementation
START and Family Outcomes: Collaborative Strategies That Work (Webinar):
http://alliance1.org/webinar/start-and-family-outcomes-collaborative-strategies-work

POLICY
•

Washington Insider: http://www.alliance1.org/policy/insider

Info@FamiliesInSociety.org

FamiliesInSociety.org

alliance1.org/intellectual-capital-division

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References (continued)

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44

References (continued)
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