Scientific research

Introduction

No Kids in the Middle is an intervention developed from practice. In the clinical setting we offered treatments to families caught up in a conflict divorce which were not effective enough. We were not able to come to grips with the destructive interparental conflicts, and we could not relieve the pain in the children. At the same time, we were offering group treatments for other types of family problems at the Lorentzhuis (Centre for systemic therapy, training and consultation) and the KJTC (Children’s Trauma Centre), and these group treatments were found to be effective. That is why we developed a group treatment for the families.

We then went on to give the treatment a scientific basis and started to formulate research questions. We did so in consultation with other therapists, scientific researchers and with the parents.

Until recently, psychotherapeutic treatments were considered effective, in particular if research had been done with a randomized controlled trial (RCT). This means that a group receiving treatment is compared to a group not receiving treatment (the control group). Evidence-based working means that, preferably, treatments are given which are “proven effective” after multiple RCTs. It is a top-down approach: practice implements what science claims to be effective. Fortunately, practicebased evidence is getting more and more recognition these days. It is a bottom-up approach, from practice: the therapist makes implicit practical knowledge explicit. He or she evaluates this knowledge with clients, incorporating it into the treatment. In doing so, practical knowledge can lead and add to theoretical knowledge.

That is what we have done. First, we summarized the answers to the research questions in this chapter. Then, we discussed the study results and its implication for the intervention with the parents hr the groups

26 Theory and research

in treatment at the time. We talked about the results of the children’s experiences as well as the implication for the intervention with a group of adolescents with high-conflict divorced parents. Finally, we discussed the study results and the reflections of the adolescents with various providers of the No Kids in the Middle programme. The opinions of researchers, parents, adolescents and providers have been incorporated into the intervention, as described in Part 2 of this book, “Practice”.

Of course, we are already busy formulating new research questions together with researchers, providers, parents and adolescents. In this way, we ensure the continuous interplay of practice and science.

Study in the Dutch language area

From April 2014 to July 2016, the Academic Collaborative Centre Child Abuse (Academische Werkplaats aanpak Kindermishandeling (AWK) conducted a scientific study of parents and children taking part in the No Kids in the Middle programme in the Netherlands and Belgium. Tire AWK is a cooperative of the VU University Amsterdam and the KJTC (Children's Trauma Centre). The study was carried out by Prof Dr. C. Finkenauer. Dr. Kirn Schoemaker, Annelies de Kruijf MA and Dr. Mar-greet Visser. Justine van Lawick and various other colleagues from the Lorentzhuis, the KJTC and the VU University were involved in the study design. In total, 17 different institutions throughout the Netherlands and Belgium took part in the study, some with more than one group. A total of 27 groups were included.

Parents are usually referr ed to the No Kids in the Middle programme via child protection services or by judges. The referrers are concerned about the development of the children, as they are caught between the parents. Parents can register themselves, too. They fill out an online questionnaire before the start of No Kids in the Middle (pre measure) and afterwards (post measure). Six months after the intervention, parents receive a request by email to fill out a short follow-up questionnaire.

Children between the ages of six to 18 can participate in the study, for which both custodial parents must give informed consent. To make sure that children are not put under pressure or feel forced to give certain answers, the children fill out the questionnaire during the first and the last group session of No Kids in the Middle. They can do so on paper or via a link on the computer or iPad. There are three different versions available of the questionnaire, and they are linked to the child’s age.

This study comprehensively deals with what children and parents go through, feel and think in a conflict divorce. We look, for instance, at

what problems children do and do not experience, and we ask them who they turn to for support. We try to find out how parents think about each other and how they adjust to the divorce.

The study focusses on the following questions:

• 1 Who are the parents and the children taking part in No Kids in the Middle?
• 2 How do the children experience the conflicts and the divorce?
• 3 What changes in behaviour and feelings are observed in parents and children after participating in the No Kids in the Middle intervention?
• 4 What is the link between the changes in the parents and those in the children?
• 5 What is the role of forgiving and of the social network in parental conflicts?
• 6 What is the role of trust and of interpersonal processes in parental conflicts?

Description of the study population

The study focussed on the question: Who are the HCD parents and their children? Finkenauer et al. (2017) answered this question. A summary of the article in question follows.

The population of the study consisted of 165 divorced parents, of whom there were 83 fathers and 82 mothers. The age of the parents ranged between 26 and 66 years old. Fathers had a mean age of 43.5 and mothers had a mean age of 41. The group of parents appeared to be diverse, especially in terms of type and duration of the relationship prior to the divorce. Some parents did not have a relationship; others had been together for a long time (up to 27 years). The parents were relatively highly educated.

On average, the parents have two childr en. Almost one-third have one child, and that is a high percentage compared to the Dutch average of ten per cent. The large majority of divorced parents have joint custody and a new partner. Of the parents with a new relationship, one-third have a child with the new partner.

Most of the communication between parents is in writing, via email or WhatsApp. Three-quarters of the parents indicate that they often communicate in this way. Half of the parents only communicate in writing. We asked parents abotrt then- most important reasons to go for a divorce. On average, they mention three different reasons. The two most important are too many conflicts and bad communication (both 56%). It is

28 Theory and research

remarkable to fmd that both parents do not always give the same answers when it comes to their children), especially when it comes to care for the children and the place where they live.

There were 142 children who took part in the study, 75 of whom were boys and 67 of whom were girls. The childr en ranged between the ages of six and 18, with a mean age of ten years. Almost two-thirds of the children receive care.

Tire time span after the divorce until the start of No Kids in the Middle varies considerably, from zero to 12 years, with a mean duration of 4.5 years. It implies that children ar e often exposed to conflicts and arguments between parents for year s. Tire divorce often has serious consequences for the income, which will decrease for the average par ent, especially for women.

How do children experience the conflicts and the divorce?

The results of this study are described in the report of Schoemaker et al., 2017. The children clearly describe how they experience the situation of the conflicts and the divorce. They fmd it particularly hard to deal with:

• • changing houses;
• • parents having different rules;
• • their belongings being in the other house;
• • the feeling that they have to choose between father and mother and;
• • parents speaking ill of each other.

Research has shown that almost all children of divorced parents suffer from these issues. In “normal” divorces, children are perfectly able to deal with them after an average of one year (Spruijt & Konnos, 2014). Children of parents in a conflict divorce continue to struggle with these issues for as long as their parents have been separated (on average 4.5 years). These children indicate that parents do not jointly decide on these issues, they do not agree and continue to fight. It seems as if the transition front a family living together to a family of parents living apart is not made; as if parents remain caught in the transition phase with the corresponding burden for the children. See also section 2.2.6.

The interspace

We refer to “interspace” as the relational space in which parents need to work together. In this space, they have to organize how the child will go

Scientific research 29

from one parent to the other and on which days and at what times, how birthdays and holidays are celebrated and where, how holidays are split up and organized, how finances are managed and who buys the coats and shoes, what will be for dinner and so on. This is where the children experience tension and conflicts - where they are tom and feel caught in the middle.

Many children indicate that they worry about their family and that, especially at home with then parents, they suffer from the divorce. A majority of the older children (12 years old and up) say that they suffer from the divorce while learning in the classroom. One-third of the childr en indicate that they suffer from the divorce dining other activities, and one-quarter of the childr en have tr ouble coping with the arguments between then parents in friendships and when at their- grandparents’. It is a good sign that a majority of the childr en suffer less from the divorce when they are busy doing other activities. Divorce-related difficulties therefore seem to be tied to the context. Our study, however, does not provide insight into how children feel when parents meet each other at, for instance, parents’ evenings, sporting events, school trips or performances, hr clinical practice, we often hear that children find it hard to deal with these situations.

The majority of the children say that they can turn to their- mother (63%) with then- worries; a minority (40%) say that they can turn to their father. Their best friends, brothers or sisters are also often mentioned as confidential advisers. It is remarkable to find that more than one-third of the children say that they share then- worries with their- teacher. This underlines the important part that school plays for children of divorced parents.

Change study

The results of this study are described in the report of Schoernaker et al., 2017. For research question 3, we have mapped the changes in parents and children by comparing pre and post measures. A total of 110 parents have completed both the pre and post measures. That is 67 per cent of the 165 parents who completed the pre measure. To test whether a change can be seen in time, a change between men and women, and a difference in change between men and women, the data have been analyzed with a repeated-measures analysis of variance (ANOVA), with time (pre and post measures) as the within-subject factor and gender as the between-subject factor. A p-value smaller than 0.05 usually indicates a significant (meaningful) change or effect. Since many different tests have been conducted, we used a Bonfenoni correction for the number of tests. We speak of a significant change or effect only if revealed after the

30 Theory and research

Bonfenoni collection. In the analyses, we did not, as a rule, find a difference between men and women in the extent of change.

Change in parents

Parents report, in particular, change in behaviour; as time goes by, there will be less conflicts. Parents report that these conflicts are more constructive and less serious after the No Kids in the Middle intervention. This is what the children report, too.

Changes which parents report seem to be connected, in particular, with positive processes:

• • Parents forgive each other more easily.
• • They find it easier to accept the divorce.
• • We also find a tendency for parents to trust each other a little more.

At the same time, we see no or hardly any change in especially negative processes. The parents:

• • think as badly about the ex-partner as before;
• • put the blame for the conflicts on the other one as often as before;
• • feel the same about the ex-partner.

We asked parents about their relationship with their children. We do not find any changes here. Parents think that they have a good relationship with then' children and that they are available. Parents also have the impression that children think they matter to their parents. The good relationship that most parents mention in the pre measure may be the reason for the fact that parents do not experience any change. It is also possible that parents find it difficult to put themselves in their children’s shoes. Maybe they do not really know what then- children feel for the parents and what they feel when they are with both parents.

Dr. Am elie Lange, senior researcher at mental healthcare centre de Vier-sprong, is currently analyzing the data of the follow-up measure (a questionnaire filled out by the parents four to six months after the intervention). She compares the results with a reference gr oup of “normal” divorces.

Change in children

The study shows a very varied pattern in children. On the one hand, children indicate that they are doing fine: about the past week, they

Scientific research 31

say that they feel well and that they are happy with their lives. Adolescents indicate that they feel they belong somewhere. They have selfconfidence, are in control of their lives and think life is meaningful. Adolescent girls score worse than boys on this point. We find that No Kids in the Middle does not change this. After the intervention, they are still doing fine. This outcome is different from what we had expected.

On the other hand, children indicate that they can experience the divorce as traumatic. Half of the children in our study score so high on trauma complaints that they run a high risk of getting post-traumatic stress disorder (PTSD). After No Kids in the Middle, the children score lower on trauma complaints, but the improvement is not significant.

Children explain that they have a good relationship with both then-father and mother and that they matter. We asked children to judge then-mother and father separately. We think that children have a good relationship with each individual parent, but that in the very interspace described previously, tension and stress arise in the children’s lives. Instances of this include when parents refuse to bring things they forgot, or when one parent talks badly about the other. In this interspace, children are at risk of being traumatized. The question is also if children feel seen when they talk about the other house or the other parent or stepparent (see also section 3.4.4, Compartmentalization).

We have also considered if differences between children can be explained by age or gender. That does not appear from the results. The differences may possibly depend on other factors, such as the severity of the parental conflicts or the period of time the parents have already been separated. Van der Wai, Finkenauer and Visser (2019) have looked on an individual level at how the seemingly conflicting results of the children (high well-being and a high risk of PTSD) relate to each other. Children who experience the divorce as more traumatic also report a lower level of well-being.

Link between changes in parents and in children

Dr. Aurelie Lange is studying the link between changes in parents and changes in children following intervention. She does so in cooperation with Prof Dr. R.J.H. Scholte and Dr. Margreet Visser. At the time of publication of this book, the articles have not yet been published. Afterpublication, the results will be published online on the website www. krnderenuitdekrrel.nlnokidsmthemiddle.com

Role of forgiving and the social network

Visser et al. (2017) have studied the role of forgiving and the social network in parental conflicts. When parents continue to have conflicts after the divorce and do not solve these conflicts, this may lead to children performing badly. But it is not clear how interparental conflicts are maintained and/or escalate further. We think that the social network plays a part in this.

With research question 5 we examined whether co-parenting conflicts are associated with perceived social network disapproval of the ex-partner, and whether this relation is mediated by parents’ tendency to forgive each other. We exammed this in a group of “normal” divorces (136 parents) and a group of HCD parents (110 parents). Results show that parents who perceive a more negative attitude towards the other parent have more co-parenting conflicts. We explain this relationship by the tendency to forgive; the more the social network disapproves, the less forgiveness and the more parenting conflicts. This plays a role in both normal and high-conflict divorces.

We also looked at factors other than forgiveness which may mediate the link between the social network and the conflicts:

• • the parents’ educational level;
• • the duration of the relationship of the parents;
• • the time elapsed since the divorce; and
• • the parents’ gender.

We did not find any link with these factors. A unique element of the No Kids in the Middle treatment is its attention on the social network. Despite the fact that the network is explicitly involved in No Kids in the Middle, we have not found any indications of change in the perceived social network disapproval of the ex-partner.

What is the role of trust between parents?

Finkenauer et al. (2018) have examined the role of trust, forgiveness, appreciation, contempt and hostile attributions between parents in conflict. We know that in relationships where people trust each other, there are less conflicts than in relationships where people trust each other less. It is also common knowledge that trust reduces negative processes between people and, on the contrary, allows for positive processes.

Scientific research 33

We expect that more trust even allows for ex-partners to forgive and appreciate each other, and that more trust reduces contempt and hostile attributions regarding the ex-partner.

We have examined this in a group of 165 ex-partners with children (from 58 couples) who were involved in a conflict divorce. Our hypothesis was confirmed. Ex-partners who have more trust in their ex also have fewer conflicts about parenting, and this is found to be associated with more forgiveness, more appreciation, less contempt and less hostile attributions. So the more Mary trusts Oscar, the more she appreciates him and forgives him, and the fewer conflicts she experiences; and the more she trusts Oscar, the less she despises him and the less she feels he is to blame for the arguments, and the fewer conflicts she experiences.

We also found significant partner effects, which implies that the trust of the ex-partner also influences the level of co-parenting conflicts. In other words, Mary' experiences fewer conflicts if Oscar trusts her more. There are no differences in the results between men and women. In terms of the conflict level, there is no link with the duration of the divorce. It is therefore important that therapists focus on the trust level of both expartners when designing intervention programmes for ex-partners in a conflict divorce.