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A ground-breaking NSPCC project refutes the notion that families in denial about abusive behaviour towards their children cannot be treated. Susie Essex, John Gumbleton, Colin Luger and Andy Lusk explain why partnership between families and professionals is usually possible, even in the most serious child protection cases

Denial has long been seen as a major factor in judging whether families in which there has been child abuse are 'treatable'. Most treatment programmes specifically attempt to break down denial of child abuse, but where this is unsuccessful the usual view is that little, if any, therapeutic work can be undertaken to help ensure the children's safety.

Some programmes, such as that described in Dangerous Families, have specifically excluded families who cling to their denial. The belief that the prognosis for such families is poor is endorsed by both Morrison and Jones in the influential publication Significant Harm, and further support can be found in the work of Arnon Bentovim and his colleagues at the Great Ormond Street Hospital for Sick Children, in London. Government guidelines on child protection also reflect the pervasive influence of such views.

The tendency to equate denial with untreatability appears to be based primarily on a psychodynamic perspective. Its premise is that insight needs to be achieved before change can happen and that denial is a form of ego defence which stands in the way of insight.

Denial is not a single, unchanging phenomenon, however, and needs to be seen in the context of each specific family situation. While it may be evidence of a deep-seated unwillingness or inability to face reality, it may also be an understandable response to a system that primarily pursues criminal prosecution rather than therapeutic intervention.

The consequences for individuals who admit they are to blame for abuse can be unpleasant, possibly including custodial sentences, loss of status, and the break-up of relationships. It should not just be assumed that adults who deny abuse are unwilling to work towards keeping their children safer in the future, and it may be that they also wish to find a 'safe' way of acknowledging some responsibility during treatment.

Viewing such families as untreatable generally leads to one of two consequences.

Where there is sufficient evidence of abuse, children may be removed from home with little likelihood of rehabilitation. The convention of rescuing abused children through removal is certainly less attractive than it used to be, in the light of persuasive evidence that children in the care system, far from being rescued, drift pointlessly in a disorganised care service with little prospect of returning home once they have been in the system for more than six months. More recent evidence shows that removing children from apparently abusive carers is still no guarantee that their behaviour or mental well-being will improve in future.

Where there is insufficient evidence for their removal, children may be left in the same potentially harmful situation while little or nothing is done in the way of therapeutic work with their family. But research has shown that this course of action, or inaction, can be detrimental to these children, who often suffer the highest re-abuse rates.

Either approach fails the children, especially those who have made clear and believable allegations in the hope of bringing about a process of change and protection. Recent research has looked at how professionals - social workers and child care solicitors - think about denial by carers in child protection cases and how this then influences their actions. The respondents in this study overwhelmingly took the view that denial increases risk, which in turn led to a belief that co-operation and partnership with such families would be less achievable.

While there is empirical evidence to support this argument, one is entitled to ask whether this is because of the denial itself or the views held by the professionals involved. There is an element of self-fulfilling prophecy if professionals believe from the outset that trying to work with these families is a waste of time and effort. It may be just as meaningful to say their attitudes stopped them from even attempting to work seriously with the families, which would itself increase the risk to the children.

The Department of Health's document Messages from Research says the single most important factor in protecting children is the quality of the relationship between a child's family and the professionals responsible. Failure to achieve this level of co-operation helps to explain why some children remain safe when others do not. Messages from Research takes the view that a worthwhile partnership between families and professionals is usually possible, even in the most serious child protection cases.

The challenge of developing co-operative relationships with families who deny responsibility for serious injuries to their children has been attempted by an NSPCC team in Bristol over the past four years. Their service, Resolutions, works to ensure children's safety, while allowing them to remain with their families.

Practitioners avoid taking children into care wherever possible, except for short periods. Work is done with carers and children, in various combinations, but only when, on a balance of probabilities, there is a non-abusing carer, and the family (including the children) wants to stay together and aim for rehabilitation. The aim of the work is to reinforce and foster the power of the non-abusing carer, strengthen the bond between the non-abusing carer and the children, and restrict and control the power of the alleged abuser.

The team's view is that denial, though an unhelpful factor in attempting to make children safer, does not make progress impossible. No attempt is made to investigate who committed the abuse, on the grounds that acceptance of responsibility by the alleged abuser does not always serve the best interests of the child or the non-abusing carer.

Instead, the emphasis is placed on creating a partnership with the family to address the concerns of child protection agencies and the question of how the children can be kept safe in the future. Common ground is established in a way which recognises the family's strengths and helps them reach their own solutions without losing sight of the seriousness of the problem.

The ability of men to undermine social work with children and mothers if they are not actively involved in therapy is well known.

So far, though, little difficulty has been encountered in engaging male alleged abusers in the Resolutions programme, perhaps because of its unconfrontational style. Alleged abusers are treated with respect and their importance to their children and families is acknowledged. They are left in no doubt, however, that all abuse of children is strongly condemned.

The project's work is still in its early stages and has focused primarily on white families. Further thought may need to be given to how it might be adapted to different family structures and cultures, but there is optimism that a similar programme could work well given that families - with guidance - are asked to design changes to policies themselves.

This helps ensure that policies are sensitive to their needs and gives them ownership of the changes, as well as attending to professional concerns.

Family friends and religious figures are readily included in the programme, which could be transferred to the wider family. To date, the anecdotal evidence regarding re-abuse rates appears favourable. More systematic research has begun to establish more precisely what has happened to children since completing the Resolutions programme.

Although the Resolutions programme uses specific methods and techniques, no one is under the illusion that this is the only way of approaching work with families in denial of abuse. But the work of the project does have an important contribution to make in questioning the orthodoxy that equates denial with untreatability.

It is undoubtedly true that we must take into account practice and research experience accrued over many years, but we also have a professional obligation to keep the received wisdom under review and refine it when necessary.

The denial of child abuse by carers whom the system deems culpable is a serious problem, not least for children who remain at risk of re-abuse or who are removed into our unpredictable and sometimes abusive care system.

But interrogating our professional assumptions does not mean abandoning what we know about denial and risk, nor does it mean relaxing intelligent caution.

It is hoped that the Resolutions programme will act as a catalyst for other workers to develop more creative ways of thinking about, and working with, families where abusers are in denial.

P Dale, M Davies, T Morrison and J Waters, Dangerous Families: Assessment and Treatment of Child Abuse, Tavistock, 1986

T Morrison, 'Change, control and the legal framework' and D Jones, 'The effectiveness of intervention', both in M Adcock et al, Significant Harm, Significant Publications, 1991

A Lusk, The Significance of Denial in Child Abuse Work: The Professional Construction of Risk, MSc Dissertation, University of Wales, College of Cardiff, 1996 (unpublished)

Department of Health, Child Protection: Messages from Research, HMSO, 1995

S Essex, J Gumbleton, and C Luger, 'Resolutions: Working with families where responsibility for abuse is denied', in Child Abuse Review, Vol 5, pages 191-201, 1996

Susie Essex, John Gumbleton and Colin Luger are members of the Resolutions team, NSPCC Avon Child and Family Centre, Bristol, and Andy Lusk is assistant director, NCH Action For Children, Wales