Keywords: control; therapy; child protection; family abuse; institutional abuse.

Family abuse

Incredible as it may seem, full recognition of the existence of family abuse is a recent phenomenon, one that both science and politics have traditionally resisted. We know that a mind as lucid as Freud’s refused to accept the evidence of the sexual abuse of children, attributing to fantasy the clues brought by patients in analysis. The famous article by Kempe et al. (1962), which describes the “battered child syndrome” and lays the foundations for an inevitable awakening of institutions and the scientific community, is not yet fifty years old. And the question continues to puzzle professionals and lay people alike: how is it possible that the family, and parents in particular, pervert protective objectives rooted in the instinct for the preservation of the species, to the point of attacking it and endangering the very lives of their children?

The answer is to be sought in the singular relationship of the human species with nature: far from being content with passive belonging, it has never ceased to challenge it actively, making this challenge one of its most important defining traits. And this especially since the invention of agriculture and animal husbandry freed up labour to develop activities other than the daily struggle for survival: art, philosophy, religion… Painting a forest, proposing a cosmological theory or clinging to immortality represent challenges to nature of differing scope, as do love and its destructive counterpoint, the result of its blockage by power: abuse. Love and abuse alike define us as a species (Linares, 2002), since we humans alone love and abuse. With, however, an important differential nuance: we are creatures who are primarily loving and secondarily abusive.

From the foregoing follows the need to encourage love and to diminish abuse, understanding that it would be as vain to try to enthrone the former as the absolute king of human relationships as to eradicate the latter down to its last vestiges. Let us leave the promotion of love to undertakings more ambitious than this article, and confine ourselves for now to reflecting on the reduction of abuse.

Child protection institutions

Over recent decades, modern states have equipped themselves with institutions responsible for ensuring the well-being of children by protecting them from the risk of abuse. As family abuse became manifest, these institutions specialised in it, acquiring material, human and legal resources intended to combat it. But, in general, they have dragged along with them the contradiction inherent in exercising control combined with, or complementary to, restoration or repair.

Control is simple when it is exercised over targets perceived as hostile and when, as in war, it matters little whether they are destroyed; but it becomes extraordinarily complex if the object to be controlled must, at the same time, be cared for and protected. Exasperated by the difficulties of such an undertaking, Bateson (1972) went so far as to deny the very possibility of control, defining it, with disqualifying intent, as a dormitive concept. There is no shortage of arguments, given the fate of some of the most important and massive experiments in social control of modern times. The prison system was supposed to control offenders while facilitating their social rehabilitation, and we know, without it being worth dwelling on, the extent of its failure. The asylum system was also supposed to control the mentally ill while enabling and stimulating their recovery, and today there is not the slightest doubt about the radical failure of its mission (Foucault, 1972). These are disturbing precedents, which should serve as a warning about the dangers that lie in wait for the system for preventing abuse and domestic and family violence, if radically new ideas and resources are not put in place.

For, to date and in Spain specifically, the institutions responsible for preventing abuse continue to apply hard-line control, in its two aspects: repressing the perpetrator of the abuse and protecting the abused person. But, as the law against gender violence tragically demonstrates, there is in reality no protection, because the abuser who is repressed (and only repressed) tends to exacerbate his self- and hetero-destructive tendencies, and the abused woman who is protected (and only protected) escapes protection to expose herself to danger once again, both driven by psychological forces far more powerful than control. It is to be hoped that society and institutions will become aware of the need for control to be exercised from a higher level of complexity, which includes and qualifies it, and which is necessarily therapeutic. Couple therapy is indispensable for deconstructing and dissolving the morbid bonds that tie the abuser and the abused woman together around violence; and this, of course, not in the final and fatal stages of the process, but in the early ones, when the damage is still minor and reversible.

And the argument also applies to family abuse and to the institutions responsible for preventing it, where it also happens that teams of professionals have to become involved in policies oriented towards control devoid of any therapeutic vision. Sometimes, the rejection of family therapy is explicitly declared, invoking the supposed unconditionality of support for the child as the higher criterion that must govern the intervention. But, to arrive at this position, one must ignore the opinion of the children, who rarely wish to be separated from their family, as well as the evidence that, sooner or later, the vast majority of children in care end up “returning” to it, provided it still exists. It is a paradox to protect the abused child while turning a deaf ear to his wishes and requests, and ignoring his interests. This underlying position is compatible with another, more subtle attitude, which consists in accepting, or even seeking, family therapy, but keeping it at arm’s length, isolated from the field of administrative decisions, which remains the exclusive preserve of the child protection team. Deprived of any operational capacity, family therapy then runs the risk of disqualifying itself in impotence.

It is to this latter modality that the case which prompted the present article belongs, in which ingredients perfectly characterisable as institutional abuse come together.

Institutional abuse

When the social institutions responsible for providing services fail to accomplish their mission and cause harm to their users or clients, they commit institutional abuse (Linares, 2006). As health institutions are among the oldest, there is a very extensive casuistry linked to their failure, which has its own, very widespread, name: iatrogenesis.

Social services and child protection institutions are much younger, but they too have frightening precedents of the perversion of their objectives. This is why, in the absence of a specific name established by usage, critical reflection that helps to prevent such abuses is important. For it is just as intolerable for a surgeon to leave a swab in a patient’s abdomen, or for someone to contract an infection following hospitalisation, as it is to leave in a pitiful state the family of a child, which is his only relational resource for the future.

Child protection teams have an immense responsibility, which would require resources of proportionate scale: dignified physical spaces; an adequate, clear and well-planned policy; and well-selected, well-maintained human resources with high-level training. Although there are markedly more critical opinions (coming from the professionals themselves who work there), as far as our experience allows us to judge, there is nothing to object to regarding the dignity of the physical spaces, which are generally more than adequate since these are new institutions housed in new facilities. But, unfortunately, the positive assessment stops there.

In Catalonia, from where this article is written, policy was dictated by the first government under which child protection institutions were created, and it has not been substantially modified since. Its result could be summed up in two main directives: for the child but without the child; and against “the guilty family”. We have already pointed out that both directives seem to us profoundly inadequate, anchored as they are, respectively, in paternalistic protectionism and in a persecutory and vindictive obsession. But, in addition, this policy does not meet the requirements of clarity and good planning either. It treats families with a homogenising gaze, without distinguishing in practice between the different modalities of dysfunction they may present, as if all of them were multi-problem families.

As for human resources, they are of course insufficient, which prevents them from dealing in good time with situations considered to be of lower risk, even though, paradoxically, it is precisely these that give the best results and are the most profitable for the future well-being of the population being followed. Exaggerating for didactic purposes, one could say that, faced with a hundred cases of children at risk, in ninety-nine they abstain, and on a single one they bear down relentlessly. These are, for the most part, young professionals, who therefore inevitably have significant gaps in their training, which many meritoriously try to fill by paying for it out of their own pocket. The system should not rely on this mechanism (in fact, to a large extent, it obstructs it!), but should instead set up serious continuing education programmes, with systematic external supervision that strengthens self-criticism and reduces corporatist defensive reflexes.

In short, child protection institutions, in the context that serves as our reference, meet some of the most important conditions for dispensing institutional abuse. What follows is a small sample.

The author has had experiences (few in number, but highly significant for the quality of the work accomplished) of positive collaboration with child protection institutions. He has also had negative experiences, unfortunately far greater in number. If he has chosen this case to illustrate the present article, it is because, while being of lesser gravity, it shows in a manner as dramatic as it is exemplary the paradoxes of institutional abuse: the victims are victimised again, and the perpetrator of the abuse receives a reward.

The case of Sandra

Sandra López Castro, aged 11, is the only daughter of Sara and Enrique, aged 38 and 40 respectively. The EAIA (Child and Adolescent Support Team) of the comarca where they live refers them for family therapy after having taken the decision to remove the parents’ guardianship of the minor and entrust her care to the paternal grandmother. The reason is the repeated physical violence exercised by the father on the mother, without the latter having, for the time being, separated. Although there had never been any violence against Sandra, she is considered to be suffering indirect abuse, through her passive exposure to that endured by her mother.

In the days following the referral, barely a week before the start of therapy, Sara separated from Enrique and rented a flat where she moved in with her own mother. In view of this important development, the EAIA was asked to confirm whether it was appropriate to continue with the therapeutic plan. The answer was affirmative, based on the opinion, expressed by the psychologist in charge (we will call him Jordi), that the mother was a very immature woman and the maternal family very manipulative, so that therapy remained necessary.

And therapy began.

Sandra was an intelligent and very lively child, who gave the impression of knowing what she wanted. And what she wanted was to live with her mother and, for the time being, not to see her father. She also wanted to keep in touch with her maternal family, in addition to the paternal family, with whom she was living. But the EAIA had decided that she should have no contact with the maternal family, and only one meeting every fortnight with her mother. Almost the same relationship as with the father, who was also to telephone her every two weeks.

Jordi claimed not to trust Sara’s decision to separate, because she had already done so on other occasions and had always gone back to Enrique. As for the maternal family, it was even less trustworthy, because it had refused to take the child in.

Sara acknowledged having had a serious problem of dependence on her husband, but assured that she was overcoming it on seeing the difficulties it created for her daughter. As for the maternal family, she explained that they had resisted accepting care of Sandra because, living in the same village, they feared being subjected to violent pressure from Enrique. They were socially well-adjusted people, well-off small shopkeepers. Sara owned two shops jointly with Enrique, which made a total separation difficult since they were condemned to maintain professional contact. But her decision was irrevocable.

As for the paternal family, the grandmother and two aunts, they lived in the big city, thirty kilometres away. This put them more out of reach of Enrique’s pressure, over whom, moreover, they had unquestionable authority. That is why everyone accepted that it was a good idea for them to look after Sandra, except that… the problem was that they had taken the matter too much to heart. There had always been good relations between the two families, but now the paternal grandmother and aunts had fully identified with the EAIA’s philosophy and were disqualifying Sara and her relatives. It is also true that Jordi was threatening to place Sandra in a children’s home if they did not strictly follow the rules. This is how they came, with the EAIA’s agreement, to confiscate the child’s mobile phone because she had spoken with her mother and with the maternal family. Sandra did not hide her exasperation. She had been forced to separate from her mother, she was not allowed to see her family, she had had to change school and could not see her friends…!

The therapy

The bet was made to strengthen the mother and to legitimise the right to a relationship with the maternal family, without thereby detracting from the validity of the paternal family’s position. This was no easy task, since manifest animosity had already set in between the two families. “The administration’s policy” was criticised, while at all times preserving the good intentions of the professionals as people. Sara was held back from taking her frustration and anger into the judicial arena, being encouraged to be cooperative with the EAIA and being guaranteed, from the therapeutic space, support along this conciliatory line.

And Sara was beginning to show clear signs of change. On the one hand, she acknowledged her previous dependence on Enrique, almost as if it had been an illness, but on the other hand she was consolidating her steps towards autonomy. She was living for the time being with her mother, as a kind of guarantee that she would not go back to Enrique, but she was beginning to see a man who treated her very well and to whom she felt increasingly attracted. She did not dare, however, to make this relationship public, for fear of the reaction of both Enrique and the EAIA. Be that as it may, when Sandra began to challenge her on this point (“If you had a boyfriend, we’d all be more at ease, we’d know you weren’t going back to Dad”), she understood that she had to start talking about it. And the first to find out was Sandra.

But things were getting complicated on several fronts. The paternal family, having become “the good guys” through the EAIA’s intervention, was becoming increasingly rigid towards Sara and her family, and did not conceal a certain mistrust of the therapist’s attempt to present a positive view of everyone. In the Manichean logic introduced by this type of intervention, if they are “the good guys”, the others are “the bad guys”, and there is a tendency to preserve this status quo and to entrench oneself in the privileged role.

On the other hand, Sandra was approaching adolescence. Her school results, which had always been excellent, were showing signs of deterioration, while a few shadows were appearing in the range of her social relationships. Confrontations with her mother arose, of increasing virulence, sheltering behind a reproach of some legitimacy, but expressed with a harshness that made it terribly unfair: “It’s your pig-headedness that has complicated my life; if you had known how to stop Dad from abusing you, we wouldn’t be here.” This is the effect of what Colapinto (1995) calls family dilution, the result of the untimely intervention of control institutions in the family: as professionals occupy vital spaces of the family fabric, particularly those relating to decision-making, bonds weaken, to the detriment above all of the children.

It was laborious work to reduce the tensions between the two families, and the atmosphere of cordiality that had existed before was never restored. As for Sandra, she stabilised at school and normalised her social relationships as well as her relationships with both her families, but she never ceased to be excessively critical and demanding towards her mother, who was deeply hurt to see her daughter’s estrangement. Contact with the father, which the therapist had always approached as necessary as and when she felt encouraged to have it, also gradually became more relaxed. From the very first moment, the therapist had announced his intention to summon the father in order to involve him in the process of change the family was going through.

All in all, despite a few minor difficulties, the therapy was progressing reasonably well.

The relationship with the EAIA

That was how things stood, and the therapist could not manage to get in touch with Jordi; the therapy was suffering from this lack of communication. News of decisions taken by the EAIA without the slightest input from therapeutic criteria was constant, and always with the same bias: prohibitions and control. If Sara asked to extend contact with Sandra by a few hours, the answer was no; contact with the maternal family was rejected; protests were stifled under the threat of even more forceful measures; and even, at the height of controlling fury, an inspection visit to Sara’s new flat was announced to check whether it met the conditions necessary for receiving Sandra. As if Sandra had ever been abused by her mother, or Sara were suspected of neglect!

The therapist telephoned and left messages without any result. Until the day when, under the threat of causing a scandal, Jordi finally picked up the phone. He was very angry with the therapist because Sandra’s paternal family had told him that the therapist had criticised him in session. It was no use the therapist assuring him that he had never made any personal criticism, but that he had expressed his disagreement with the policy of the institution, the Directorate-General for Child and Adolescent Support, and this with the strategic objective of creating an anonymous and impersonal antagonist in the face of which to unify the two families and put an end to Sandra’s emotional laceration. Nor was it any use for him to claim his decisive role in ensuring that the matter had not been taken to court, having always advised Sara and her relatives to adopt an attitude of cooperation with the paternal family and the professionals. Jordi proved inflexibly disqualifying towards the therapy and the therapist, declaring himself offended and impervious to any reasonable explanation.

The therapist understood that the bridges had been burned and decided to write a letter, which we transcribe below.

Letter to the EAIA professional in charge of the case

I am sending you this document in view of the evidence that we are not going to coordinate on the matter of Sandra’s family. My intuition is that this is so because:

a) You identify with the institution that is the object of my criticism (the DGAIA, in an entirely impersonal capacity) and you take that criticism personally.

b) You have offended me and treated me with contempt, and, at this stage of my life, that is not something I intend to tolerate.

Nevertheless, I have a moral commitment to Sandra and her family, and I therefore feel bound to communicate my professional impressions to you.

Reason for the intervention

Abuse with physical violence by Sandra’s father towards his wife. Up to the time of the intervention, she proved incapable of defending herself by effectively interrupting the dysfunctional pattern. This affects Sandra in the form of indirect psychological abuse.

Intervention

Removal of the parents’ guardianship of Sandra. Initially, an attempt is made to have the maternal family assume care of the minor. The latter argues that, living in the same village as the father, they fear being unable to control the situation if he does not respect the measure. Secondly, recourse is then had to the paternal family, who live in Barcelona and agree to take Sandra in.

The couple is referred for therapy at Sant Pau but, before it begins, the mother decides to separate. The indication for family therapy is maintained.

(Up to this point, the intervention seems correct to me.)

Sandra’s contact, both with the father (whom Sandra does not want to see) and with the mother (whom Sandra wants to see in complete freedom), is limited to a symbolic minimum. Sandra’s contact with the maternal family is prohibited. Things go as far as confiscating the minor’s mobile phone so that she respects the prohibitions. The mother is denied all credibility in her steps to separate from her husband, although these appear qualitatively different from previous ones (for example: she initiates divorce proceedings and goes to live with her mother in a new flat).

Assessment of the intervention

It seems to me very negative that indirect psychological abuse should be approached with the same protocol as would be applied to direct physical abuse. It must be understood that Sandra was not in immediate danger: the risk lay in her participation, as a witness, in a chronic dysfunctional interactional pattern. In such cases, the possibility of limited exposure to the source of suffering does not imply a major danger to the mental health of the minor, who has already largely internalised the dreaded situation. As for her physical health, it was never threatened.

It seems to me very negative that no attention is paid to the minor’s reasons (11 years old!, and a very intelligent and sensible girl) in the distinction she draws between her father and her mother. The mother is pressured and threatened in a manner totally inappropriate for a woman who is barely emerging from physical abuse. In fact, she is made to feel that she is guilty of having been abused.

It seems to me very negative that the maternal family is demonised, being turned into “the bad guys” following its more than reasonable objection to assuming care in circumstances of great insecurity. A comparative grievance is created between the two branches of the family, which find themselves drawn into a conflict with each other that did not exist before.

Iatrogenic consequences of the intervention

Sandra, who has always been a mature child, begins to feel insecure and to display rebellious behaviour. School difficulties appear, whereas she previously had excellent results. Fortunately, all these alarming signs tend to disappear as the repressive measures are relaxed.

The mother, who had always got on well with her husband’s family, begins to clash with them (in particular with her mother-in-law and sisters-in-law), as she feels accused of irresponsibility (the voice of the EAIA, taken up by them as their own).

The two families enter into a dynamic of mutual disqualification. It is obvious that both have shadowy areas in their past (what family does not?), but the reciprocal accusations amplify them, introducing in Sandra a tendency towards splitting, worrying from a future perspective.

I insist on the fact that, since the relaxation of the repressive measures, all these alarm signals have diminished in intensity, even if the mere fact that they existed invites reflection. Is it tolerable, even as a mere possibility, that institutional abuse should be added to family abuse, to the point of exceeding it?

Guidelines for the therapy

Suggestions

I hesitated a great deal before setting out this part, aware that it may produce the opposite effect, but I feel professionally bound to do so.

I consider it indispensable that the specific circumstances of the case, which I have already described, be taken into account, and that, consequently, this family not be treated as a directly abusive or neglectful family. It is meaningless, for example, to inspect the mother’s new home, when these are people whose good social adjustment is proven.

In the same spirit, Sandra should be given as soon as possible full freedom to maintain the contact she wishes with her mother and with her mother’s family, weekends and holidays included.

Sandra, although she wishes to go back to living with her mother right now, does not want to change school again in the middle of the school year, and therefore resigns herself to postponing this return until June. The mother understands this too. But this should not stand in the way of the complete normalisation of contact that all parties, in all legitimacy, desire.

For my part, I guarantee the continuity of the therapy as long as there is suffering, risk and motivation, at least on the part of Sandra and her mother, while also counting on the collaboration of the extended families. And the inclusion of the father in the future is not ruled out.

Final considerations

Although I have never ceased to express publicly my respect for the professionals of the EAIA and for their work, I must confess to you that, after our unpleasant telephone conversation, serious doubts assailed me in this case.

In a matter as delicate as the suffering of children, it does not seem legitimate to me to invoke due obedience. There are ways of getting around the rigidities of protocols, while waiting to be able to exert influence so that they are modified, for this too is a task that falls to all of us who work on these fronts. That is why I count among my professional assets the experience of exquisite collaborations with certain EAIAs.

But, for this, one condition is indispensable: that the unavoidable exercise of control functions should not tarnish the therapeutic spirit. There are many ways, many models, for making control and therapy compatible, and one of them is the one habitually practised by our EAIAs, and by you too in this case: referring for family therapy and retaining the control functions. This is correct and reasonable, provided that the latter continue to be exercised from a therapeutic outlook and sensibility. Unfortunately, you have exercised control from a controlling outlook and sensibility, clinging to decision-making power in a manner totally dissociated from the therapeutic space. First there is a sensible reflex: we are going to refer this case so that it benefits from the best resources. But then the tics of institutional inertia prevail. And so, things do not work. I say in your defence that this is the most frequent outcome in the vast majority of referrals, so that none of these reflections constitutes a disqualification of you as a person. But the cup of my patience has overflowed and, you see, I have taken the decision to no longer accept referrals from the EAIAs. The credit for that is only partly yours.

I hope I have not offended you with my words, but I cannot keep my thoughts to myself. Not between professionals. I also hope you are aware of the respect towards you implied by having devoted an entire Saturday afternoon to writing these lines. And, finally, I hope you will reply to me in the constructive spirit in which I have addressed you.

Signed

Conclusions

Jordi never replied to the letter, which should come as no surprise to anyone who knows how work is done in these contexts. In the past, only God gave children and took them away; today, child protection professionals compete with him. It is an excessive responsibility for young people, often with precarious training, and obliged to follow crude and inadequate directives. It is not surprising that, oscillating between impotence and omnipotence, they defend themselves against burnout (Coletti and Linares, 1997) with manifest arrogance. The case of Sandra and her family clearly shows how far the consequences can go.

The situation improved because it could not be otherwise: after all, there were no pathologies or serious dysfunctions, apart from… the violence exercised by the father against the mother, fortunately interrupted by the latter’s firm decision. However, the mother-daughter relationship was affected. Sara rented another flat, with the intention of strengthening her life together with her new partner, but it was in another town, and Sandra complained of having to change school and friends again.

And it was then that the EAIA decided to grant custody of the minor… to her father!

As far as we know, it seems that the higher authorities of the DGAIA did not immediately accept such an absurdity and decided to grant Sandra the right to decide. But the damage was done, and Sandra chose to go and live with her father. The conduct of the institutions speaks for itself, but it is worth reflecting on it briefly. First, the child’s opinion had been systematically ignored; then she was made the absolute arbiter of the situation. Neither is a correct option. The minor must always be listened to, but she must not be made to bear the responsibility for taking decisions that touch on questions as sensitive as loyalty to her parents. It is a heavy mortgage on her future mental health. On the other hand, Sandra never hid the fact that, if she wanted to go with her father, it was not because a sudden enthusiasm for him had been awakened. She had always loved him, but she would a thousand times have preferred to go with her mother, were it not for the material disadvantages this entailed. Consequently, by institutionally legitimising the paternal option, the instrumentality of material convenience over emotional choices was validated.

And let us not even speak of Sara, the incomprehensible object of institutional vindictiveness. From the outset, she was persecuted for the “offence” of having let herself be abused, and in the end she was stripped of the care of her daughter so that it could be entrusted to her abuser. She is a paradoxically strong woman, or perhaps her resilience (Cyrulnik, 2003) has to do with a desperate movement of self-affirmation in health, after having managed to emerge from the abysses of the domestic violence suffered in the past. From the therapy, everything was done to consolidate this movement, trying to neutralise the evidence of the institutional abuse that she and her daughter are suffering in the present.

If one tries to understand what happened, self-criticism is called for on the part of the therapist who, although he strove doggedly to look after his relationship with the EAIA professionals, perhaps fell short of what was needed. This difficulty in the face of an obstacle which, for having been foreseen, was no less insurmountable, confirms the indication that such complex interventions must be carried out in contexts that allow real coordination, at the organisational level and not as a mere declaration of intent. Only in this way can control be exercised with the guarantee of being subordinated to a genuinely therapeutic strategy.