Clinician and lived experience perspectives on non-judgemental family care, in working with childhood maltreatment and intergenerational trauma: A pilot narrative review

Abstract

Non-judgemental care is a widely acknowledged aspect of therapeutic work with children and families. There is limited literature that defines current practices of non-judgemental family care and assesses its implementation within mental health settings. Clinicians who encounter and work with childhood maltreatment and abuse may make moral judgements and potentially ascribe culpability to a child's parents, carers or support network. This is despite understanding that adverse childhood experiences (ACEs) are associated with the complex interplay of sociocultural factors and wider determinants of health. This pilot narrative review explores facilitators and barriers to provision of non-judgemental care in the modern literature from clinician, as well as lived and survivor, perspectives. A detailed search of the literature was conducted using PubMed, Cochrane Library, Ovid, Embase and PsycINFO databases, with focus on childhood maltreatment, intergenerational trauma and ACEs between 2014 and 2024 and published in English language. Title and abstract screening, then full-text screening, was completed by the primary author and results were identified via informal analysis of themes. Eight studies of clinician perspectives identified facilitating themes of professionals' responsiveness, positive personal attributes and utilisation of strength-based approaches. Clinician-identified challenges included maintaining curiosity in the context of uncertainty and complexity, power differences and unconscious processes. Nine lived experience studies were included, identifying listening and attunement as facilitators. Shame, barriers and inadequate acknowledgement of historical traumas hindered therapeutic engagement. Shame was found to be a key barrier to the experience of non-judgemental care and postulated to influence how clinician interventions are received. The author concludes that non-judgemental care is incompletely understood in practice, with clinician judgements being ubiquitous and diffuse in therapeutic impacts. Future research is required to understand intersubjective therapeutic perspectives and elucidate existent gaps between delivery and perception of non-judgemental care.