Examining the Role of Self Compassion in the Mental Health of A Child Protection Services-involved Youth
By Meghan McPhie, BA; Christine Wekerle, PhD; Randall Waechter, PhD; Maria Chen, BSc 

SCOPE OF THE PROBLEM

Child maltreatment is a substantial issue in Canada, with an estimated 22 per 1000 children at risk (Trocmé, Fallon, MacLaurin, Daciuk, Felstiner, Black, et al., 2005; Wekerle, Chen, Leung, Waechter, Wall, MacMillan, et al., in press). According to the Ontario Association of Children’s Aid Societies (OACAS), between 2007 and 2008, Ontario’s Children’s Aid Societies (CAS) investigated 77,089 referrals from families, teachers, doctors and neighbours concerned about the protection, safety and well-being of children and youth (OACAS, 2009).

The impact of maltreatment often extends far beyond the actual occurrence of the maltreatment episode or the period of time spent in the maltreatment living environment (Goldberg, Muir, & Kerr, 1995). It is an experience that has been associated with a wide range of challenges across the lifespan (Wekerle, Chen, Leung, Waechter, Wall, MacMillan, et al., in press). Some of these challenges include impairment in areas of basic physical functioning (e.g., eating, sleeping), cognition (e.g., attention, memory, learning, academic achievement), emotion (e.g., mood disorders), motivation and relationships (Wekerle, MacMillan, Leung, & Jamieson, 2008). The effects of maltreatment vary depending on the circumstances of the abuse or neglect, personal characteristics of the child, and the child’s environment (Child Welfare Information Gateway, 2008). Maltreatment is a major problem that not only impacts the child and family, but through related costs to public entities such as human services, health care and educational systems, impacts society as a whole.

MALTREATMENT AND DEVELOPMENT

Maltreatment imposes serious risks on the developing child, not only during the immediate period in which the maltreatment is occurring, but across the lifespan (Goldberg, Muir, & Kerr, 1995). Developmental research has demonstrated that insufficiently responsive parenting heightens a child’s risk for problems with future relationships, managing emotions, self-efficacy (e.g., belief about one’s ability to accomplish a task) and violence (Dube et al., 2001; Kim & Cicchetti, 2003; NICHD Early Child Care Research Network, 2004).

Typically, each child needs to form a secure relationship with a primary caregiver, which fosters normal social and emotional development. Attachment is an enduring emotional bond that develops during the first year of life while the infant is completely dependent on his or her caregiver for survival (Miller-Perrin & Perrin, 2007). Children become attached to caregivers who exhibit confidence, sensitivity and responsiveness in social interactions. For the infant, these caregivers become a secure base from which to explore the world and to return to for support and security. These positive attachments create mental working models which help guide the child’s feelings, thoughts and expectations in later relationships.

Maltreatment during childhood constitutes a serious failure of the caregiving environment. This failure can seriously hinder the child’s ability to accomplish the tasks that are necessary for successful development (Goldberg, Muir, & Kerr, 1995). For example, the child may experience difficulty in developing emotional intimacy, may develop abnormal eating behaviours (e.g., hoarding food) or develop uncharacteristic soothing behaviours (e.g., biting themselves; Perry, 2001). Dysfunctional attachments exert a considerable effect on the development of psychological disorders and symptoms that are commonly associated with child maltreatment (Goldberg, Muir, & Kerr, 1995), and contribute to difficulties later in life such as the ability to form close personal relationships (Miller-Perrin & Perrin, 2007). For example, failure to develop a secure attachment with a caregiver may impact a child’s ability to regulate stress. A secure attachment with a caregiver serves as both a source of stress regulation and a model of stress regulation to be internalized (Wekerle, MacMillan, Leung, & Jamieson, 2008). This internal model is used in future situations as a central means to regulate stress (Goldberg et al., 2001). Stress regulation is compromised in circumstances involving an abusive relationship. The caregiver who is supposed to be a source of predictable comfort and support is instead a source of fear, confusion and hesitancy (Lyons-Ruth & Jacobvitz, 1999).

Attachment dysfunction in maltreated children is a serious concern to healthy development; however, the effects of maltreatment also negatively impact social learning. Social Learning Theory (SLT; Bandura, 1973) emphasizes the significance of observational learning in the attainment of interpersonal skills in children. Observational learning is a type of learning that occurs as a result of observing, retaining and replicating novel behaviours performed by others. Learning in the child is strengthened through rewards and punishments given by the caregiver.  This learning process can lead to the development of healthy behaviours and thoughts; however, the opposite effect is also possible.  When children are exposed to maltreatment (e.g., physical abuse), they are being exposed to a set of norms and rationalizations that justify the maltreatment (Miller-Perrin & Perrin, 2007). For example, if a father hits his child for “mouthing off”, this behaviour is reinforced within a social context and teaches the child that hitting is effective because it “shut him up”.

Additionally, as a result of maltreatment, the child is deprived of the chance to learn healthy, appropriate and nurturing forms of adult-child relations that are typical of non-maltreated children. Furthermore, children are also informed about how stress is regulated within a close relationship through the experience of interacting with their caregivers. Maltreatment creates relationship representations wherein maladaptive ways of coping with stress are modelled by the caregiver, and the experience is reinforced by the outcome (Wekerle, MacMillan, Leung, & Jamieson, 2008).

Attachment and Social Learning Theory provides a framework within which to conceptualize, treat and understand the development and possible transmission of the risks of maltreatment for abnormal developmental and psychological problems in children. Strong bonds between a caregiver and a child are critical for developing a sense of trust and security, a sense of self, and an ability to explore and learn about the world (Ainsworth, 1973; Bowlby, 1980).

Despite the unfavourable conditions and circumstances in which maltreated children are reared, some children demonstrate resiliency. Resiliency is the ability to do better than expected in bad conditions (Gilligan, 2009). Resiliency is a dynamic process that involves shifting the balance of protective and vulnerability factors in different risk circumstances, and at different developmental stages. Many factors can influence resiliency, which can in turn help to prevent the negative outcomes of child maltreatment such as psychiatric disorders.

PSYCHIATRIC DISORDERS AND CHILD MALTREATMENT

Youth who have experienced child maltreatment are at an increased risk of experiencing psychological problems such as depression, anxiety, post-traumatic stress disorder, dissociation, oppositional behaviour, suicidal and self-injurious behaviour, substance misuse, anger and aggression, and sexual symptoms and age-inappropriate sexual behaviour (Gilbert, Kemp, Thoburn, Sidebotham, Radford, Glaser et al., 2009). Data collected from caseworker observation and reported diagnoses in the Ontario Incidence Study (OIS) show higher incidences of depression and/or anxiety and Attention Deficit Disorder (ADD) or Attention Deficit Disorder with Hyperactivity (ADHD) in children with a history of maltreatment compared to those with no history of maltreatment (Wekerle, Waechter, Leung, & Chen, in press).

Depression is a serious debilitating disorder that is strongly related with maltreatment. Studies have demonstrated that depression outweighs other problems in individuals with a history of maltreatment, and such individuals have a three-fold increased likelihood of developing depression during adolescence or adulthood (Wekerle, MacMillan, Leung, & Jamieson, 2008; Brown, Cohen, Johnson, & Smailes, 1999).  The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-IV; APA, 2004) states that the symptoms of depression in children and adolescents are the same as those experienced by adults; however, symptoms may be more prominent at different ages.  For example, irritable mood and somatic (i.e., body pains) complaints are particularly common during childhood and adolescence.

Anxiety disorders are another common mental health problem observed in individuals with a history of child maltreatment. Maltreated children typically exhibit general symptoms of anxiety, nightmares, inappropriate fears of certain places, and a tendency to cling to parents (Giardino & Giardino, 2002; Kendall-Tackett et al., 1993).  Additionally, children with a history of maltreatment were described by their parents as being significantly more afraid of being left alone with others, exhibiting more suspicion, and getting upset when touched, in contrast to non-maltreated children (Kolko, Moser, & Weldy, 1988).

Given the traumatic nature of maltreatment, some children who have been abused or neglected go on to develop post-traumatic stress disorder (PTSD). Symptoms include flashbacks and nightmares, avoidance of stimuli associated with the trauma, difficulty falling or staying asleep, anger and increased arousal (Wekerle, Waechter, Leung, & Jamieson, 2008). It is important to note that subclinical levels of PTSD symptoms can be as important as clinical-level symptoms, in that both can lead to significant functional impairment in youth (Carrion, Weems, Ray, & Reiss, 2002). PTSD is commonly found in association with mood and anxiety disorders, and symptoms of PTSD are an important link  between maltreatment and negative outcomes such as substance abuse or dating violence (Risser, Hetzel-Riggin, Thomsen, & McCanne, 2006; Wekerle et al., 2001; Wekerle et al., 2009). Thus, developing interventions that target PTSD symptomatology may be an important avenue of study.

An important concept to look at in relation to well-being in maltreated youth is self-care. The concept of self-care involves meeting and managing physical (e.g., nutrition), emotional (e.g., anger), behavioural (e.g., aggression) and cognitive (e.g., learning) needs or impulses. The process of self-care involves self-discovery, self-soothing, self control, self-health and health seeking, and self-compassion.

SELF COMPASSION AND CHILD MALTREATMENT

Self compassion is a component of self-care and represents a warm and accepting attitude towards those characteristics of oneself and one’s life that are disliked (Neff, Kirkpatrick, & Rude, 2007). It is comprised of three main components, which combine and mutually interact to create a self-compassionate state of mind (Neff et al., 2007). The first component is self-kindness versus self-judgment. It involves being kind and understanding to oneself in circumstances of suffering or perceived inadequacy (Neff et al., 2007). When a disliked trait is noticed, rather than attacking and criticizing oneself for being inadequate, the self is offered warmth, support and unconditional acceptance (Neff, 2009). For example, a flaw is treated gently, and the emotional tone of language used towards oneself is soft and caring (Neff, 2009).

The second component is having a sense of common humanity versus isolation, for example, accepting that pain and failure are part of the shared human experience (Neff, Kirkpatrick, & Rude, 2007). It is the ability to recognize that all humans are imperfect, all people fail, and all people make mistakes (Neff, 2009). For example, people often feel isolated and cut off from others when they are considering personal flaws, or believe that they are the only ones struggling when they experience a difficult point in their lives. However, a person encompassing common humanity would feel connected to others when experiencing pain and would likely view it as a shared human experience. This realization can provide a certain level of comfort.

The last component of self compassion is mindfulness versus over-identification. This involves having a balanced awareness of one’s emotions in which one has the ability to bare painful thoughts and feelings (Neff, Kirkpatrick, & Rude, 2007). It involves having a balanced outlook in the present moment so that one neither ignores nor ruminates on personal traits or aspects of one’s life that are disliked (Neff, 2009). For example, taking a step out of oneself and encompassing an overall perspective on one’s own experiences means that less bias is imposed, and the situation can be considered from a more objective perspective.

Self compassion is important for protecting against excessive or unrealistic negative self-feelings or self-thoughts (Neely, Schallert, Mohammed, Roberts, & Chen, 2009). For example, consider stress tolerance. A maltreated child exhibiting self compassion may feel panicky in the presence of abuse cues (e.g., driving past a house where abuse occurred). He or she might think about the abuse, reassure him/herself that it is natural to be upset, and feel sorry for him/herself for what has happened.  On the other hand, a child who does not encompass self compassion may not engage in this process of assessment and self-talk but act out his/her feelings in other ways, such as through self-harm behaviours. There are several routes through which one can obtain self-compassion. For example, Neff’s (2003) Self Compassion Scale (SCS) uses the following six subscales to assess the level of self compassion:

Self-kindness: For example, “I try to be loving towards myself when I’m feeling emotional pain.”

Self-judgment: For example, “I can be a bit cold-hearted towards myself when I’m experiencing
suffering.”
Common humanity: For example, “I try to see my failing as part of the human condition.”

Isolation: For example, “When I fail at something that’s important to me, I tend to feel alone in my  failure.”

Mindfulness: For example, “When something painful happens I try to take a balanced view of the situation.”
Over-identified: For example, “When something upsets me I get carried away with my feelings.”

Sample items were provided for each subscale; however, all items can be found in the full Self Compassion Scale available on Neff’s website:
https://webspace.utexas.edu/neffk/pubs/listofpublications.htm.

One way to develop self compassion involves paying more attention to events as they happen in the present, rather than ruminating. This is also known as “mindfulness”. Self compassion can also be fostered by taking an objective view of personal events in order to self-identify less with the content and more with the awareness of content. Lastly, it is important to increase acceptance or tolerance of the thought or feeling, rather than processing it for personal meaning.

AN EXAMINATION OF SELF COMPASSION IN THE MALTREATMENT AND ADOLESCENT PATHWAYS (MAP) RESEARCH STUDY

A group of CAS-involved youth that took part in the MAP research study completed the self-report Self Compassion Scale (SCS; Neff, 2003). The MAP is an ongoing longitudinal study that examines the health outcomes of maltreated youth who are randomly selected from all the active CAS case files in a large Canadian urban centre. MAP youth complete an initial testing and have follow-up assessments every six months for three years. Here, data on self compassion is presented from a sample of 90 youth (60 percent males) who participated in the two-year testing point of the MAP where the SCS is administered. Additionally, youth also reported on PTSD symptoms and psychological problems. The mean age of the adolescents in the current sample was 18.1 years, and on average, the adolescents in the sample were with CAS for 10.1 years. MAP study youth were composed of a diversity of ethnicities as depicted in Figure 1.  CAS status of the youth in the study is shown in Figure 2.  

Figure 1. Proportion of youth by ethnicity in MAP sample.

Figure 2: Proportion of youth by CPS status in the MAP sample.

The result of this analysis indicates a significant relationship between child maltreatment and self-compassion. Specifically, youth who have been physically and emotionally abused, and physically and emotionally neglected, have lower levels of self compassion (e.g., greater tendency to isolate oneself, to impose negative self-judgment, and to over-feel).  As reports of emotional abuse increased, self compassion decreased. Some maltreated youth go on to experience PTSD symptoms. Some of the symptoms of PTSD include depression (e.g., feeling lonely), anxiety (e.g., feeling nervous or jumpy inside) and anger (e.g., wanting to hurt other people). Those youth in the study who reported experiencing such symptoms had lower levels of self-compassion. Specifically, the youth reported greater self-judgment, self-identification and isolation, and less self-kindness. Psychological problems, as assessed by responses on the Brief Symptom Inventory (BSI; Derogatis, 1975) were positively related to lower levels of self-compassion. Youth who reported lower levels of mindfulness were more likely to report a greater number of psychological symptoms.

IMPLICATIONS

The results of this analysis suggest that self-reported self compassion may be an important target for intervention that can address negative moods and other mental health issues among maltreated CAS-involved youth. It is thought that self compassion enhances well-being by helping individuals feel cared for, connected and emotionally calm, all of which may be lacking in children and youth with a history of maltreatment (Gilbert, 2005). Several studies have looked at the impact of using self compassion as a buffer against psychological problems and have found similar results to the present analysis. For example, a study by Neff, Kirkpatrick and Rude (2007) found that self compassion buffered against anxiety and was associated with increased psychological well-being. Thus, self compassion appears to be a promising trait that can be used to help promote well-being in maltreated children and youth.

Neff (n.d.) provides several tips and thoughts on how to increase self-compassion:

Self-kindness: To increase self-kindness, it is important to develop a kind and constructive way of thinking about and rectifying mistakes and thinking about ways in which one can do better in the future. For example, a child who is experiencing a period of suffering due to maltreatment may ask him or herself, “What would a caring friend say to me in this situation?”

Self-judgment: Remembering that human beings are not supposed to be perfect and that mistakes are a means of learning may decrease negative self-judgment. For example, a child who may have been physically abused for making a mistake may ask him or herself, “How will I learn if it’s not okay to make mistakes?” Furthermore, before commenting on a child’s behaviour, parents should ask themselves whether a caring mom would say this to her child if she wanted the child to grow and develop.

Common humanity: In order to promote common humanity, one should think about the human condition and how all humans are vulnerable, make mistakes, and have experienced pain and difficulty. It is important for an individual to recognize all the other people who have made similar mistakes, gone through similar situations, and been in similar positions. A child who has experienced maltreatment may ask him or herself, “How does my experience of neglect or abuse give me more insight into compassion for the human experience?”

Isolation: Preventing a sense of isolation involves taking responsibility for mistakes and failings, as well as recognizing and understanding that nothing happens in a vacuum – actions and behaviours are connected to the actions and behaviours of others. For example, a child who may feel alone in his or her experience of maltreatment may remind him or herself that “I am not the only one going through such difficult times, a large proportion of people experience difficulties like this at some point in their lives.”

Mindfulness: Trying to see the situation clearly with calm clarity and a balanced perspective can increase mindfulness. For example, a child may let him or herself feel the pain associated with the maltreatment without suppressing, resisting or avoiding it, and let him or herself be moved and touched by his or her own pain.

Over-identification: Trying to avoid getting lost in the storyline of the situation and feeling the feelings as they are without getting carried away by them can help to reduce over-identification. Incorporating these strategies into one’s thought processes can help to improve levels of self-compassion. For example, a child or youth who has experienced maltreatment may say, “These painful emotions and experiences do not define me, such feelings will inevitably change and pass away over time.”

Very little literature has examined interventions that target self-compassion. However, several important findings may prove useful in helping to promote self compassion or identifying circumstances in which self compassion may be in jeopardy. Neff and McGeehee (in press) found that maternal support, harmonious family functioning and secure attachment all predicted higher levels of self compassion among youth. A teenager with a secure attachment bond, supportive mother and functional family unit is likely to have greater self compassion than one with a problematic family environment, under circumstances that care and compassion have been appropriately modelled by family members. Therefore, in addition to providing direct care and support during periods of affliction, good family relationships may indirectly influence functioning by fostering compassionate inner dialogues.

In contrast, dysfunctional family relationships are prone to translate into self-criticism, negative self-attitudes, and a lack of self-compassion, thus resulting in restricted internal and external coping resources (Neff & McGeehee, in press). For youth with histories of child maltreatment, self compassion may provide a way to learn new methods of self-to-self relating that are more balanced and supportive, in contrast to the aversive process of self-judgment and evaluation. It is important for future researchers to examine ways in which self compassion can be targeted in interventions in order to promote well-being, specifically in relation to child maltreatment.

For further information on mindfulness training, please visit the following websites:

http://www.mindfulnessandacceptance.org;
https://www.jeffersonhospital.org/cim/article5030.html

CONCLUSIONS

It is critical to be aware of the factors that can exacerbate or moderate negative outcomes in maltreated youth. Data presented here highlights the strong connection between child maltreatment, self-compassion, PTSD symptoms and mental health problems in a sample of CAS-involved youth. It may be possible to enhance outcomes among maltreated children and youth by enhancing self compassion among the most vulnerable youth. There are a number of ways to accomplish this, and several points are presented here.

Foster the traits identified by Neff that lead to an increase in self compassion (e.g. self-kindness, mindfulness and common humanity) and helping to reduce those that have a negative impact on levels of self compassion (e.g., isolation, over-identification and self-judgment).

Early on in childhood, make sure that the child is under the care of someone who is able to foster the development of a secure attachment (e.g., a responsive caregiver).

Raise or place the child/youth in an environment that is supportive, nurturing and harmonious.

Make sure that the child/youth is provided with direct care and support during periods of affliction.

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