OUTCOMES BRIEFING

The Parents in Conflict Study:

Putting Children First - A Random Allocation Feasibility Study

Between 2010 and 2014 TCCR undertook a robust, random allocation feasibility study comparing two interventions for parents in post-separation, entrenched conflict over their children. One arm of the study offered parents a brief psychological therapy based on Mentalization Based Treatment principles which was developed by TCCR with support from Professor Mary Target. The intervention is called ‘Mentalization Based Therapy for Parental Conflict – Parenting Together’ or MBT-PT.Parents were offered 6-12 sessions with parents attending sessions together. The other arm of the study was a parent education programme based on the nationally available 'Separated Parents Information Programme'. This offered a two-hour session which parents attended separately. This was a unique research study and to our knowledge, the only random allocation feasibility study worldwide undertaken on interventions with this population and certainly the only study of its kind to engage both parents using mixed methods, bringing together quantitative and qualitative findings.

30 parents took part in the study, i.e. 15 sets of co-parents.

This was a very small sample of parents and as such, the study did not have the statistical powerto provide a fair test of the superiority of one treatment over the other. However we established that both forms of intervention were credible and acceptable to most parents in this situation, and that we were able to operate a randomised allocation design with extensive, relevant quantitative and qualitative assessments of the kind that would make a larger-scale, formal randomised controlled trial feasible and productive. These encouraging findings indicate that not only is it possible to engage this important population in a randomized study, but also throw much light on the dynamics which seem to maintain these high-conflict situations known to damage children. It is abundantly clear that further research is both worthwhile and much needed, and possible to carry out in ways acceptable to the parent group.

Parents completed a battery of questionnaires and interviews at baseline, then two months after their first intervention session, and six months after baseline. There were statistically significant findings in the following measures:

1.Parents reported less expressed anger towards their ex-partner.

2.Parents reported feeling less stressed.

3.Parent reported reduced levels of depression.

4.Parents reported improvements in their children’s emotional and behavioural

difficulties.

This last outcome was seen especially in children’s externalizing difficulties with the Mentalization based therapy condition showed greater reductions in children’s externalising behaviours than the parenting group.

Alongside these quantitative results we have found qualitative findings which indicated that parent’s attitudes to their ex-partner had changed after the intervention. In the Mentalization Based Therapy arm we found that the descriptions parents gave of their ex-partnersbecame less polarised and rather than parents blaming each other and only seeing the other person as inherently bad, or deliberately making their lives difficult, their attitudes became more nuanced. We noted that parents seemed more able to entertain the idea that their ex-partner was also struggling with a complex array of feelings and motivations as they were themselves. They were less certain and rigid in their descriptions of their ex-partner’s character and intentions, with more capacity for a benign understanding of why their ex-partner might have behaved as they did. Also in both the treatment arms, parents reported that the interventions had helped them to move on and to work with their ex-partner to put their children first.

We have acquired a significant amount of learning through undertaking this small-scale RCT, about how best to work with this challenging population of parents and their children who are often in great distress. For instance one of the crucial issues is that within the context of a robust study design, these parents still need to be provided with a flexible engagement process, something due to the study constraintswe were unable to provide, leading to challenges in recruitment.

Parents in Dispute DWP innovation Project

More recently, however, we have been able to implement a flexible engagement process within our DWP (Department for Work and Pensions) funded Parents in Dispute Service which has adopted a different way to recruit parents into TCCR’s Mentalization Based Therapeutic Intervention for parental conflict. This new service, run in partnership with Cafcass, is working with parents who have been in entrenched conflict within the court process. In the intervention design we have taken into account the very great reluctance and fear that many parents have about sitting in the same room together to work on their co-parenting issues and this more flexible approach has worked with them more slowly to enable them to engage in therapy together.

Following on from this we have now found some promising initial findings from this project. Crucially, the high volume of referrals into this programme is strong evidence of a need for this service, and of the value of the flexible engagement process. At April 2015, through this flexible engagement we had succeeded in gettingover 50% of parents to participate in joint Mentalization Based Therapy sessions with their ex-partner. We have also been able to show that both mothers and fathers are reporting statistically significant improvements in the strength of the parenting alliance as early as their fourth session as measured by the Parenting Alliance Measure. Although we are still in the early stages of this evaluation, these improvements appear to be sustained over the course of therapy. These findings are particularly encouraging given that over a third of parents entering into the programme have been separated/divorced for over five years, reflecting years of Court attendance and an indication of their previous difficulties in maintaining a supportive co-parenting relationship.