From Alan Carr’s Handbook of Child and Adolescent Clinical Psychology (2nd ed) pp. 62-70:
Family system factors
- Inadvertent reinforcement, e.g., frequently inquiring about mood or commenting on negative conduct
- Insecure attachment, whereby children don’t experience carers as a secure base
- Coercive interaction, e.g., escalating negative interaction leading to withdrawal and relief, reinforcing behaviour just before relief
- Over-involvement, parental criticism and emotional over-involvement
- Disengagement, low frequency carer-child interaction
- Inconsistent parental discipline, leading to problems internalising rules
- Confused communication, e.g., indirect rather than direct communication
- Triangulation (not always negative), e.g., a “coalition” where one carer is peripheral
- Chaotic organisation
- Absent carer
- Carer relationship discord
Parental factors
- Parents with similar problems as child act as a role model maintaining the behaviour
- Resources for parenting compromised by mental health issues or criminality
- Misinterpreted crying (interpreted as intentionally punishing carer)
- Low self esteem
- External locus of control
- “Immature defences”
- Unemployment (failure to meet financial needs; impact on status)
- Boredom in work
- Excessive stress in work
- Role strain with parallel “homemaking” and working
Social network factors
- Lack of social support, e.g., lack of positive interactions with extended family/friends
- Chronic life stress
- Unsuitable education placement, e.g., understaffed schools
- “Deviant” peer-group e.g., peers using drugs
- Community problems, e.g., social disadvantage, racism, social exclusion, high crime rates
Problem maintaining treatment system factors
- Family members’ denial of problems
- Poor working alliance with clinicians
- Rejection of formulation and/or treatment plan
- Failure of communication between MDT members
- Failure of inter-agency network
- Conflicting formulations in multidisciplinary team and inter-agency work
- Culturally insensitive clinicians
Also flip side of these, protective factors, such as good physical health, high intellectual ability, high self-esteem, humour, positive engagement with treatment agencies, protective peer group, …