Reviews

Raising Parents: Attachment, Parenting and Child Safety

Patricia McKinsey-Crittenden, Willan Publishing, 2008
ISBN 978-1-84392-498-2, PB, pp 381, $142.95

Patricia McKinsey Crittenden has written a comprehensive and compelling

book about those parents whose risky behaviour as caregivers jeopardises the
welfare and lives of their children. This makes the work a very valuable contri-
bution not only for those whose occupation focuses on child protection issues in
particular, but also for others who work with troubled families.
Crittenden eschews over-simplified theories about child maltreatment that
can result in a lack of empathic understanding of, and engagement with, parents
who endanger their children. However, her explicit concern is about minimising
harm and safeguarding children from serious parental transgressions. She
contends that the causes of child abuse or neglect arise from the principle that
behaviour is an adaptive strategy imbued with affective and cognitive meaning,
and this principle correspondingly provides a basis for intervention.
In order to understand how meaning is created and behaviour organised,
Crittenden has developed the dynamic-maturational model (DMM) of attach-
ment and adaptation. She describes the DMM as a life-span model in which
maturation is in dynamic interaction with experience and consequently available
to modification by new experiences and learning. The book explicates this model.
Raising Parents is divided into three parts of roughly equal length: ‘Growing
Up’, ‘Raising Children’ and ‘An Integrative Approach to Treatment’.
Growing Up addresses the developmental challenges that need to be negotiated
from birth onwards, moving through the various stages of early childhood, the
school years, adolescence and early adulthood until the child eventually matures into
parenthood. Crittenden includes diagrams of increasing complexity as development
progresses and is accompanied by an expansion of social relationships, new contexts,
and exposure to real or potential threats. Her schema depicts a range of adaptations,
either healthy or pathological depending on the pathway taken. Crittenden shows
how each of her additional subcategories of the basic patterns of attachment
(avoidant, secure and ambivalent) emerges as a specific strategy that is profoundly
linked to emotional and cognitive development.
Raising Children explores parents’ perspectives in understanding why they
behave as they do towards their children. Six chapters look in depth at various
distortions that may occur in parents’ care of their children. These may result in
marginal maltreatment to more serious cases of physical abuse, or may involve a
skewing of the parents’ perceptions emphasising parental self-comfort, or an
absence of parental protection through to the most extreme cases of parents
misconstruing children as either being threatened or being the source of threat.
An Integrative Approach to Treatment presents a model for assessment and
treatment based on the DMM. All managers who work in child protection
should seriously consider Crittenden’s recommendations for a reorientation of
service provision. Professionals must not only protect children but also engage

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 Reviews

with parents’ own emotional suffering and cognitive distortions. Her model
promotes psychological development and avoids interventions that risk substi-
tuting compliance, a shallow form of adaptation, for growth. An example is
parent education that is only advocated for relatively healthy families.
This book deserves to be an essential text for people who work with children
and parents, especially children at risk. Complex theories are balanced by highly
engaging, illustrative case histories enhancing its readability. Crittenden’s devel-
opment of attachment theory with her dynamic-maturational model of attach-
ment and adaptation has great merit.
Anna McDowall
Individual, Couple and Family Therapist, Private Practice, Malvern, Victoria
E-mail: annamcdowall@optusnet.com.au

The Child’s Voice in Family Therapy: A Systemic

Perspective
Gammer, Carole, WW Norton & Company Inc, NY 2009
ISBN 978-0-393-70541-6, HB, pp 329, $52.95.

This excellent book reflects Gammer’s wide experience of working with families,
and her determination that children are meaningfully included in the therapy.
Gammer notes that there has been an increasing emphasis on language in family
therapy since the 1980s, and she argues that ways must be found to ensure that
children can participate in the therapy although their verbal skills are less developed
than those of the adults.
Gammer originally trained in the United States, and later moved to Europe
where she practices and teaches in France, Germany and Switzerland. She writes,
in the introduction to the book, of her professional journey from early family
therapy (her first teacher was Carl Whitaker), through psychoanalytic child
psychotherapy, to her present theoretical stance of working systemically with whole
families. This book is not about child psychotherapy, but about systemic work
with families in which children can participate in a meaningful way.
The book is divided into three parts. Part One, ‘Techniques’, is devoted to
various techniques which can help give children a ‘voice’ in the therapy. Part Two,
‘Putting it All Together’, focuses on case conceptualisation and the structure of the
therapy. Part Three, ‘Special Themes’, attends to issues which commonly arise in
work with families.
The first four chapters of Part One focus on dramatisation, use of metaphor, art
techniques and externalisation. Gammer explains clearly how these techniques
provide opportunities for all members of the family to participate in the work, and
she describes the techniques, explaining how she has adapted them for systemic use.
She also gives practical advice about the age of a child with whom they could be used
successfully. Other chapters address setting limits, play and links to the past.
Gammer writes about the systemic modifications she makes to cognitive–behavioural
techniques so commonly used when children’s misbehaviour is an issue. She describes

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guidelines for improving the relationship between parents and children through
positive experiences of play. Gammer delineates three different kinds of past — the
family, individual, and multigenerational past — and gives reasons for exploring any
or all of these at various stages of the therapy. She also includes some guidelines for
using videotape or DVD in work with families.
I found Part Two of the book particularly helpful. A chapter entitled ‘A
Roadmap for the Therapy’ describes how family therapy can be organised into
three phases (she calls these resolution, extension and intimacy), and she offers
some useful ideas on dealing with new issues that emerge as the therapy
progresses. In this chapter Gammer also refers to particular difficulties that may
be experienced by single-parent and blended families.
The next two chapters provide guidelines for the process of the therapy.
Gammer writes about five stages of the first family interview (acquaintance, goal
determination, goal exploration, change elaboration, and concluding), giving
concrete suggestions about techniques which could be used and clear explanations
as to the purpose of these. She points out possible pitfalls, and continues to
provide the reader with information about adaptation of well-known techniques to
make them more systemic. The chapter on subsequent sessions of the therapy is
equally clear. Gammer suggests that the work done in these sessions can be divided
into stages, and again she provides plenty of case material as illustration.
The first chapter in Part Three is about working with children with hyperactive
behaviour. It is not difficult to see why this topic is included in the book, as keeping
these children engaged in a session with their family is often very challenging.
In this section, there is also a chapter on sibling relationships. Gammer suggests
that these relationships are very significant, and that difficulties are often raised by
the siblings themselves during the therapy. Otherwise, she recommends that the
quality of the sibling relationship should be explored by the therapist before
concluding the work with the family. Again, Gammer gives plenty of concrete
suggestions and illustrative case material.
I highly recommend this book. I think it will be very useful for those who have
not worked systemically with families including children before, and I also think it
will be useful for those with previous experience in this area. The practical sugges-
tions about techniques are very simply and clearly described, and yet Gammer
avoids superficiality by linking these with systemic theory, sharing her knowledge
of child development, and providing additional information through generous
endnotes and bibliography.
I have worked with entire families for several years, and have developed skills in
a somewhat ad hoc manner, first training in child psychotherapy, then in family
therapy. Like Gammer says she did at one time, I know how easy it is to fall into
the trap of doing child therapy in the presence of parents, or adult therapy in the
presence of children. This is the first book I’ve encountered which directly
addresses the difficulty of engaging children meaningfully in family therapy so that
all members of the family can be involved.
Pru Crombie
Social Worker, Child Development and Behaviour Service,
Community Child Health, Gold Coast Health Services District, Queensland
E-mail: Pru_Crombie@health.qld.gov.au

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