Du désir parental de consulter au risque de la maltraitance infanto-juvénile

Objective

This contribution proposes to address different aspects of parental posture as regards the decision to seek help (or not) for their child, whether for a physical and/or mental health issue, in order to identify some possible ways of helping the professional. To do this, we will explore different scenarios of the parent's “desire” to consult a medical-psycho-social worker, whose repercussions can result in a situation of child abuse.

Method

At the risk of being schematic, we propose to group into seven categories the possible postures used by the parent when consulting, or not consulting, a professional for any reason. We accept the arbitrary nature of this classification. It should be noted that each table presented at the moment of the initial professional/parent(s)/child contact can switch from one category to another according to the evolution of several parameters, whether they are individual, relational, or contextual.

Result

We will focus on two specific cases that reflect the adult's massive anxieties towards the child, which can lead to the parent's development of delusions about the child, or a more or less elaborate process of using the state of the young person for a defined purpose. Thus, we will present, on the one hand, situations of parental alienation syndrome (PAS) and, on the other hand, situations in which parents “create” symptoms in their children, whose paradigm is represented by Munchausen syndrome by proxy (MSP).

Discussion

Behind the desire to seek professional help and the parent's concern for the child, there are sometimes hidden situations of parental inadequacy that are difficult to identify. Thus, let us keep in mind the hypothesis of child abuse, when we question the ins and outs of a consultation approach that gives rise to puzzlement, to a disconcerting parental concern… Let us also point out that we evoke these entities by taking as paradigmatic the case of a mother calling on the professional; it is obvious that many situations concern fathers, certainly when it comes to processes of alienation. In any event, it seems to me useful, from the point of view of relevant support for the child and his or her entourage, to address as precisely as possible the relational context encountered. Understanding without judgment is usually the first step in any care and support intervention. Otherwise, the professional is threatened with being merely an actor immersed (in)-voluntarily, (un)-consciously, in a hypothetically abusive system. Ultimately, we have to be careful when we consider that a child is being used as a tool, because there are many situations…

Conclusion

One of the risks for the professional is to take at face value the parent's primary request without taking the time to explore the ins and outs of the process. The child in this case is the object of a consultation, not the object of care. It should also be pointed out that the reason for consultation is sometimes present only in the representations of the parent, their convictions or even their certainties; it may happen that children do not display clear calls for help in their body or in their psychological or relational functioning. More than ever, the share of subjectivity is present in both the parent and the professional. We will therefore have to be careful to base ourselves on a few benchmarks in order to avoid producing what is feared.