doi:10.1684/nrp.2021.0627
Rev Neuropsychol
2020 ; 12 (S1) : 27-31
From the impact of lockdown
on the professional practice
of the child welfare psychologists to its effects in families *
De l’impact du confinement sur la pratique du psychologue de l’Aide sociale à l’enfance à ses effets dans les familles
Julie Sénécal, Valérie Martin Clinical psychologists
Conseil départemental du Calvados, 17, avenue Pierre Mendès France, 14000 Caen, France
<julie.senecal14@outlook.com>
To cite this article: Sénécal J, Martin V.
From the impact of lockdown on the professional practice of the child wel- fare psychologists to its effects in fami- lies.Rev Neuropsychol2020;12(S1):27-31 doi:10.1684/nrp.2021.0627
T
he lockdown linked to the COVID-19 pandemic has greatly modified the practice of all profes- sionals in the domain of prevention, support and protection under the Child Welfare system (social work- ers, doctors, paediatric nurses, midwives, psychologists).With the exception of accommodation establishments (chil- dren’s homes and nurseries), most of the workers have been kept at home, away from their professional environ- ment and their colleagues. In particular, for psychologists, the effect of keeping professionals at a distance has been to put psychological interventions on the back burner in terms of institutional organization, and to prioritize on- site activities that are “essential” for the subsistence of users and families, such as social, educational and medical emergencies.
We, the clinical psychologists working in the commu- nity, within multidisciplinary teams that provide assessment, accompaniment and support to socially, educationally and psychologically vulnerable families, have had to trans- form and reinvent our practice in order to keep meeting the specific needs of families in terms of listening and psychological support. In this crisis, maintaining our rec- ommendations for “urgent” referrals to care services or protection measures, providing psychological support to parents, children and foster families, and supporting the teams, were our daily concerns and tasks. We carried them
∗This article is an English language translation of the following article:
Sénécal J, Martin V. De l’impact du confinement sur la pratique du psychologue de l’Aide sociale à l’enfance à ses effets dans les familles.
Rev Neuropsychol2020; 12(2): 143-7. doi:10.1684/nrp.2020.0553.
Correspondence:
J. Sénécal
out through weekly telephone interviews with the people concerned, often alternating between contacts with our medical and social partners.
This unprecedented and anxiety-provoking context led in the first days of lockdown to an increase in the acts of violence among certain particularly vulnerable (poorly structured psychologically) adolescents for whom the prospect of being deprived of their freedom and being exposed to lasting proximity with their parents could gen- erate and increase anxiety (abandonment, separation and individualization).
This is the case for Ethan, 12 years old, who has been living with his mother for years, in the absence of his father whom he lost in his early childhood. An only child, Ethan has developed a very close relationship with his mother, in a family environment in which he has been a “fetishized child” (in good/bad terms) who gradually imposed his
“rules”, due to an insufficient or inconsistent educational framework coupled with emotional deprivation. An intel- ligent and cultured boy, his behavior oscillates between movements of great emotional immaturity (he cannot stand to stay in a room or to sleep alone) and expansive behav- ior of “omnipotence”, such as refusing to obey his mother or provoking her aggressively in order to stay connected.
Because of this intolerance of limits and a “problematic”
relationship with others (of the fusion/rejection type), his mother requested educational support, at the same time as therapeutic care. For Ethan, the move to home confinement and the consequent dropout from school has abolished the possibility of relying on third party and socially accept- able spaces for him. His anxieties, previously focused on the body, have overwhelmed his mental capacities, with the viral threat of COVID-19 (fear of being contaminated and contaminating, fear of dying or causing death), to
the point of unleashing a behavioral disorganization with dramatic auto- and hetero-aggressive acts. During this period of the pandemic, his needs for security were such that they led to countless interventions by emergency ser- vices at his home before he finally settled down, thanks to the continuous alternation of calls and psycho-educational actions with him and his family.
Thus, our clinical listening capacity has had to adapt in the absence of “face to face” relational proximity with our patients, in order to maintain an empathetic level of attention, whatever the situations. Our action was certainly of poorer quality than in ordinary times, because of the lack of gesture, facial expressions and non-verbal commu- nication perceptible face to face. Nevertheless, our specific listening and our regular presence have established a certain intimacy with families, with perhaps an easier and quicker access to their psychic fragilities. In addition, our capacity to intervene for certain families and our availability have increased considerably, thanks to the interruption of the usual institutional meetings, whose time-consuming nature in the psychologist’s professional life often encroaches on clinical work time. Several families have reported their satisfaction or relief and noticed our reactivity in con- tacting them again or offering them regular interview slots.
However, the mental workload associated with our function has clearly not been lightened by this new work- ing environment, the boundaries of which have become difficult to define, both for the psychologist and for our priv- ileged interlocutor. Intervening with a person, by telephone, videophone or through e-mail exchanges, does not go with- out ethical problems insofar as it is not possible to ensure strict confidentiality of the setting within the home of the person we are listening to at a distance, even if we ask for his or her vigilance. It is therefore likely that there are biases to “free speech” in such a context.
In addition to having to arrange a workspace in the private sphere, exercising our mission of support and psy- chological accompaniment with families within our home implies avoiding as much as possible the risk of psychic invasion and collision between our personal (and family) experience and that of the families. Indeed, the psycholo- gists also have to adapt their own family organization and make relational adjustments with members of their fam- ily (most of us have children at home, either young or teenagers); moreover, they too may have been prey to sim- ilar worries about their own health or that of their relatives.
Furthermore, their usual space for professional supervision no longer takes place elsewhere than at home. Similarly, the weekly regulation space with the multidisciplinary team no longer exists strictly speaking, although professional contacts continue “on an ad hoc basis”, without a regular and predictable character. It has been necessary to deal with a framework which has allowed a certain availability and flexibility in our interventions, but which has also proved in the long term to be stressful and psychologically “at risk”, in terms of exposure to a form of overwork, both at family
and professional level. The private and professional spaces are constantly overlapping, in a working time whose limits are difficult to apprehend in quantitative terms, and which sometimes stretches into the evening because of family and school obligations.
At the same time, many other families that we accom- pany demonstrated a “spirit of initiative” and the desire to take advantage of this bubble of “protection” and this cocoon to organize personal occupations and/or share activities at home, for which they have had to innovate.
Many parents and host families suddenly had to take on various functions (as parents, educators, leaders, teach- ers, etc.) in order to succeed in preserving, in addition to their well-being, the life balance of the children in their care.
During the first month of lockdown, some children and adolescents have adapted extraordinarily well to the situa- tion and even demonstrated unexpected skills in organizing their school and leisure time, or in their ability to manage their emotional states. For them, the family seems to have become a safe, impermeable space, in which the risks of confrontation with the outside world (exposure to the virus, and more generally to any danger) have been minimized.
For those children whose relational experience has been excessively traumatic in the past, however, the seemingly great adaptability they show in this anxiety-provoking cri- sis is only a “lure”, adaptive and pathological. While their malaise is likely, they cannot express it, having been cut off for a long time from a connection with their emotions.
With the closure of the medical-social establishments in which they are usually cared for during the day, children and adolescents have seen their disorders increase during lockdown, by the resurgence of massive anxieties linked to
“locking” them in a single place and in an affective bond of closeness to a single person experienced as threatening or even persecuting.
Mathieu, 10 years old, was entrusted to the Child Wel- fare at the age of one. During his first months of life, Mathieu lived in a context of verbal and physical violence and suf- fered the unpredictable and senseless violence of his father himself. He grew up in a first foster family, warm and educa- tionally structuring, while maintaining a regular link with his mother. Health problems of the family assistant led Math- ieu to change foster family at the age of 7. The new family assistant reported educational difficulties for Mathieu, with sometimes violent oppositional behaviors including with other children in care. Mathieu had to go through a new separation. In this new environment, initially idealized by Mathieu, the same difficulties arose, revealing a problem of attachment in this boy. Every time the question arises of moving to a new “family” place, behavioral problems appear, as Mathieu needs to feel the solidity of the bond to others as soon as he begins to become attached to them.
Relay reception in another foster family have been set up again, allowing Mathieu to invest another link in a “partial”
way, requiring less commitment on his part, but reactivat- ing each time at home the idea of an ideal elsewhere. It
is in this context that Mathieu found himself locked down in his host family, a caring and benevolent family, with two other children. Being aware of Mathieu’s behavioral difficulties and abandonment problems, the service inter- vened from the very beginning of the lockdown through weekly educational and psychological interviews with the family assistant. We could say that the interviews were a
“decompression valve” for him, allowing us to discuss and elaborate on Mathieu’s oppositional behavior in a third- party space. All the psychological processes usually at work (identification with the abusive father in connection with the integration of a terrifying and destructive paternal imago, abandonment anxieties related to the multiple separations in his placement) increased and multiplied tenfold in this spatial-temporal context of lockdown. Mathieu found him- self “trapped” in a unique bond of attachment, he for whom foster care is usually maintained because there are other third-party spaces such as school, sports club, regular relays in another foster family and encounters with his mother.
An important aspect of the lockdown for him was that he could no longer see his mother. Mathieu had to settle with phone calls, which were admittedly regular and honored by his mother, but this arrangement was not enough to secure him emotionally, and after a month of lockdown, the care became very complicated. As the other children became the targets of Mathieu’s aggressiveness, and the family assis- tant’s anxiety increased, the service decided to organize, in this demanding health context, a relay reception of several days, which allowed Mathieu to calm down. For his part, the family carer was able to accompany Mathieu in this respite care without rejected him and to tell him the place he was keeping for him. This situation also necessitated working closely with the care services accompanying Mathieu and the other children entrusted with him, in order to measure the psychological impact of Mathieu’s violence on them.
Some children have suffered from not being able to see their parents and having to talk to them only on the phone, while others have been significantly appeased as a result of a privileged relationship with their family assistant. Indeed, in contrast to Mathieu’s experience, it is important to stress that some children, usually caught up in a massive loyalty con- flict between their family and their host family, or “stuck” in a pathological bond with their parents, showed a favorable evolution during the lockdown due to a distancing from the bond with their parents.
This is the case of Sarah, 12 years old, who arrived quite late in a foster family with her little sister. Her young and
“immature” parents had had a painful and deficient child- hood. Sarah was emotionally invested by her family, but very soon found herself confronted with the problems of adults. She was her mother’s confidante, and often had to take care of her little sister at home, assuming an adult and parental role. The little girl also witnessed the many spec- tacular crises in the parental couple. At the beginning of her placement, Sarah cried a lot over the absence of her parents and remained anxiously preoccupied with them, despite the distance caused by the placement. The weekly visiting rights
allowed her to be reunited with her parents and to reassure herself of their physical and mental health. Each visit was therefore approached with emotional ambivalence, and the separation was painful, reactivating the trauma of the place- ment. In this context, it was not easy for Sarah to allow herself to settle in at the same time with her host family, who were nevertheless warm and attentive. She needed to talk about her family on a daily basis, as if the work of psy- chological separation had not yet been carried out despite the physical separation. Sleep difficulties and motor rest- lessness, that were likely manifestations of Sarah’s anxiety and depressive background, were also identified. During the lockdown period, visitation rights were suspended, and Sarah’s overall calm quickly restored. She stopped talking about her parents on a daily basis and stopped comparing the “life model” of her foster family to that of her family.
It had been decided to maintain a link with her parents through her educator, who relayed news to both of them, in relation to the parental difficulty of respecting Sarah in her place as a child. As a result, it was perhaps easier for Sarah to free herself at that time from the pathological mar- ital problems of her parents, and from a form of control in which she had been imprisoned until then, we can say without pun intended. In this safe space and time, she was able to loosen her vigilance, and to regain the place and concerns of a child.
In the second part of the lockdown and in the perspective of deconfinement, more “depressive” phases (tiredness, loss of motivation and desires, physical and moral fatigue) and sometimes anxiety (physical problems, negative thoughts, ruminations...) have appeared in the people we provide sup- port to. These emotional states are linked to the difficulty of being able to project oneself into pleasant perspectives given the uncertainties regarding health risks and the very slow lifting of prohibitions. These fluctuations in mood have also been observed in children, who now are at the forefront of media coverage, with the announced return to school, but only on a voluntary basis that can be most distressing for parents and make them feel guilty.
In addition, we have also been particularly concerned and mobilized by the increase in domestic violence in the presence of infants and young children. The latter, immature as they are on a neuro-developmental and psycho-affective level, cannot make sense of this terrifying situation which they will go through in a real sensory chaos. In the absence of “good enough” care and the availability of adults (the
“care-givers” to use Winnicott’s expression), these babies and children, who are both witnesses and victims, are seriously endangered in terms of development. This, often chronic, traumatic situation leads to phenomena of psychic sideration and emotional dissociation: a cleavage mecha- nism makes the kids identify themselves both to the victim and to the aggressor, and undergo massive anxieties which, without immediate care, will later be a source of mental, cognitive and behavioral disorganizations.
Léa, 14 months old, was born at term without any notable difficulties, but her development has been
worrying from the very first months. The Maternal Child Protection Service has been alerted by the maternity unit, which is concerned about the perceived vulnerability of the parents, who are described to us as somewhat disabled.
The father and mother were both marked by deficient and traumatic childhoods (exposure to violence and abuse), and the interactions they propose to their baby are perceived as
“poor” and “not very stimulating”. The father, an emotion- ally unstable man, categorically refuses home interventions.
He seems to display little interest in his child and inter- prets and projects false intentions (“she refuses to come with me”). He remains self-centered on his needs which, beyond testifying to his great immaturity, are fulfilled to the detriment of the basic priorities for her daughter whom he can leave and “forget” in her bed. The mother does have maternal preoccupations, she responds to her baby’s needs but she poorly decodes her cries and laboriously adjusts responses that are not accurate. When she talks to Léa, she uses echolalic language, with little relational intentionality.
At three months, during the consultations, it is also observed that Léa is an infant whose gaze is difficult to catch, she follows an object but face with more difficulty, she does not smile, her face remains impassive and her tonus in ten- sion, she has a tendency to take refuge in sleep. In view of the concerns, and with the parents’ agreement, consulta- tions are intensified, and both parents also go to parenting support workshops; we organize with the sector nursery the possibility of Léa’s reception, that will only take place very gradually because she appears to be distressed by the separation. The mother accepts the intervention of the psy- chologist after having refused to meet her for a long time. In addition to observation, these meetings are oriented towards play sessions proposed to the mother and the child. Léa grows up thanks to all the support provided to her (and her family), knowing that she is welcomed five days a week at the nursery. However, we see that her development is still not harmonious, and that a psychomotor retardation is already underway. Her linear and ponderal growth oscil- lates, with breaks and then weight regain. Whereas her relational contact appears to be “better”, it remains very discontinuous from one session to another, from one consul- tation to another, which casts some doubt into the risk evaluation. She smiles intentionally, albeit fugaciously, she never laughs, she does not babble, does not vocalize, or very little. The clinical observations highlight the post-traumatic nature of the attitudes of this little girl who presents, in addition to permanent hypervigilance and anxiety, lasting stops in exploration with reactive relational withdrawal.
Her mother is her main attachment figure, she can go and take refuge in her arms to seek security, just as she can also become disorganized in a stressful situation, without seeking comfort or in refusing contact. The assessment will supplement this gloomy picture by providing evidence of significant conjugal violence within the couple, the mother being unable to protect herself and her daughter.
With the entry into lockdown, all the support offered to this family was suddenly interrupted. Thanks to the
almost daily telephone contact with the family and the partnership with the nursery, we were able to quickly offer parents the possibility of entrusting their child to a childcare assistant during the day, which was a relief for them. For us professionals, identifying the risks of “rela- tional trauma” that this child will continue to experience remains a concern, in this context of health crisis, when services have become less operational, interventions at home restricted, and workers no longer able to have direct observation.
A number of little children are also at risk of psycholog- ical and emotional neglect. Some parents are themselves weakened by a poor personal history and, without outside help, are exposed to the risk of transgenerational repetition.
Parental neglect is likely to increase with lockdown, as these parents need to be supported, sometimes on a daily basis, by concrete parental guidance in addition to a remotely given advice. For most of them, the interventions of the Social and Family Intervention Technicians, whose role is to sup- port parenting, have been interrupted for the duration of the lockdown. Beyond the physical endangerment of these young children, it will be of foremost importance to con- tinuously monitor their development because of the lack of stimulation and emotional relationships, the lack of words addressed in the intentionality of a mutual relationship that gives rise in an infant to self-esteem and self-confidence.
Furthermore, overexposure to screens may create both addiction phenomena, delays in cognitive acquisitions and psychological/behavioral difficulties such as avoidance of relationships, frustration intolerance, difficulty in control and violent impulses.
Due to the psychological problems of their parents, some babies are also at risk of intra-family violence, includ- ing impulsiveness and acting out on the spouse or child, that result in relational and emotional discontinuity. Such a situ- ation can only worsen during lockdown, as the parents are no longer able to go and discharge the tension in third party spaces outside the home.
We can draw a parallel with so-called “incestuous” fam- ilies, in which the risk of increased sexual violence is also very present, as lockdown closes off the possibility of the child having a third party to speak to. During lockdown, the child forced to remain behind the family’s closed doors, is all the more at risk of sexual violence because of the absence of the “social” third party that is critical for these families.
With the ongoing situation of lockdown, it is very likely that we are lacking hindsight on certain issues. We are very much afraid of discovering the emergence of this type of trauma associated to a “chronic” situation of neglect or vio- lence after the lockdown, whether conjugal or intra-family, especially in young children. Through our clinical experi- ence, we know that in some of these children, the distress will be “noisy” enough to be noticed and taken care of, while a number of others, may have a “hollow” symptoma- tology, more silent, with regressions, loss of acquisitions, withdrawal and psychic sideration, less perceptible by
relatives. Such a traumatic symptomatology insidiously fits into the construction of a disharmonic development and the structuring towards a pathological personality. In the months and years to come, psychologists will have not only to provide protection, but also to look out for these devel- opmental disorders in order to systematically propose and
direct these children towards specific long-term care based on multidisciplinary interventions and networking.
Conflict of interest None.
