Parenting counselling for psychiatric patients, run by the hospital's own team

When a parent is admitted to a psychiatric hospital, the chart usually notes whether there are children at home, and the conversation often ends there. A group from Heidelberg University and Charité in Berlin used the hospital stay itself to work on parenting.

Video, groups and a team without psychotherapists

Mentalization-based parenting counselling (MB-PC) adds 12 hours to standard treatment. Five individual sessions use video feedback, five group sessions guide parents to understand their child's mental states and respond to them, and two sessions cover social counselling. The whole programme is delivered by the hospital's interprofessional team, none of whom are psychotherapists. The comparison arm received standard care plus a psychoeducation workshop.

The trial in German hospitals

The cluster-randomised, open-label bicentre trial, with partially blinded observers, included 252 patients treated for various serious mental illnesses. The primary outcome was the total score of the Alabama Parenting Questionnaire. Immediately after the programme, parents in the MB-PC arm reported better parenting practices: effect size 0.43, 95% CI 0.13 to 0.73, p = 0.004. Three months later the difference between groups was smaller, 0.25, with a 95% CI of -0.04 to 0.53 and p = 0.085. The abstract states that all secondary outcomes favoured MB-PC, among them parental stress, child abuse potential and the child's emotional well-being.

Using the weeks in hospital

My reading is that this trial moves the point of entry. Work against the cycle of abuse usually begins in the child's world, through child services, a paediatrician or a school, and often after harm has been noticed. Here it begins where the parent already is, during weeks of daily contact with staff. For the family, an admission is a rupture. Here it also becomes the time when a parent practises reading what the child feels.

For a psychologist in a psychiatric hospital, a first step is to ask every admitted parent about their children and about contact during the stay, and to treat the answer as the start of a plan.