Tavistock Relationships is 70 years young this year. Here is why the work that the organisation has develped and evolved to help couples, familes and children is as relevant today as ever.
CEO Andrew Balfour
Created in 1948, the Family Discussion Bureau (as Tavistock Relationships was then known), sought to develop relationally-orientated practice to help families and children. Applying the insights of psychoanalytic thinking to the sphere of family work was radical then and, to a certain extent, remains so even today.
For while family relationship problems are the leading presenting problem (rated by clinicians) among children attending Children and Young People’s psychological therapy services (CYP-IAPT), and the only issues appearing in the top 3 difficulties for all ages groups of children according to ChildLine’s most recent survey, relationally-focused practice which seeks to address the couple relationship difficulties which so often lie at the heart of such problems is still relatively sparse.
Why is such practice so fundamental to Tavistock Relationships’ approach over the years, and to the present day? Essentially because what is at stake here is about finding the most effective way of interrupting inter-generational cycles of transmission of mental health problems, emotional difficulty and deprivation that have their roots in disrupted parental couple relationships.
This may appear to be a bold claim, and yet we know, for example, that children in households marked by high levels of inter-parental conflict are at elevated risk for a variety of negative psychological outcomes including anxiety, depression, aggression and reduced academic attainment.
Explicitly identifying the quality of the inter-parental relationship, as the Early Intervention Foundation did in its 2016 review of the evidence on inter-parental conflict and children’s outcomes, was a confirmation in many ways of the soundness of Tavistock Relationships’ approach over its 70 year history.
What goes on between parents, in terms of the quality of their relationship, is a critical element affecting children’s wellbeing, and it follows that services should be expected to address the relational distress at the heart of so many of children’s difficulties.
Yet while the Early Intervention Foundation’s interest in the issue of inter-parental conflict is hugely welcome, we cannot ignore the fact that our approach to children’s mental health largely ignores the context within which children’s mental health problems are caused and exacerbated. Indeed, a critical analysis of the last fifteen years of child and adolescent mental health policy has argued that ‘the focus of the most recent major policy report in this area, Future in Mind “reproduces the idea that family life is reducible to a set of skills parents can be trained in, rather than thinking about whole families with histories and contexts, needing insight and support. Focusing on parenting skills without attending to the relational and social context of parenting is not an optimal strategy”.
One of the reasons I am so proud to lead Tavistock Relationships is because of its long-standing challenge to this individualised and atomised way of conceiving and addressing the emotional difficulties which adults and children face. Historically, there has always been some stigma around the idea of intervening in couple and family life, and couple therapy has been vulnerable to being associated with the promotion of a particular socio-political agenda, of ‘nuclear family values’. Perhaps there will always be some resistance to recognising that our relationships are the crucible of mental health throughout our lives and that it is the quality of the relationship between parents that we need to be attending to if we are to help children as best as we can. Or that the quality of the relationship between adults has an effect on their own, and their partner’s, mental health and also physical health (for example, the links between relationship quality and the experience and management of cardiovascular disease and diabetes are becoming more established by the day).
Last year, our groupwork programme, Parents as Partners, was awarded the 2017 Family Support Award at the Children and Young People Now Awards. Outcomes from this programme show that it produces significant reductions in terms of depression and anxiety, parenting stress, violent problem-solving strategies, harsh parenting, arguments between parents about their children – and fewer acting out/aggressive and withdrawn, depressed behaviours in the children. This year, we are particularly excited about working with researchers at King’s College London to design a study on couple-focused approach to the management of patients with type 1 diabetes.
To carry on this work, and the many other of our projects – which range from: helping couples affected by dementia, to psychosexual counselling, to helping couples where one partner has depression, to training frontline practitioners to be better able to address and attend to relationship issues among the people they work with – we need to continue Tavistock Relationships’ core mission – which is to train more and more practitioners in couple therapy and couple-focused approaches to improving health and well-being. To respond to the needs of the population, this requires that there be a universal offer, where front line staff across a broad range of health, social care and the voluntary sector are trained to recognise and to incorporate within their work an awareness of, and capacity to assess and engage with, couple and family troubles, linked to a range of specialist services to which they can refer those couples and families who need it, in a stepped-care model.
As I lead the charity into its next period of development, I do so with the conviction that this organisation has built up enormous experience and knowledge over its 70 year history which stand us in good stead to continue the work of establishing couple-focused practice as the optimal way of helping individuals, couples, children and society as a whole.