natalie kemp b.a. (hons) - welcome to .natalie kemp b.a. (hons) fathers’ experiences of a mother

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  • Canterbury Christ Church University’s repository of research outputs

    http://create.canterbury.ac.uk

    Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder/s. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

    When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given e.g. Kemp, Natalie (2011) Fathers' experiences of a mother and baby unit: a qualitative study. D.Clin.Psych. thesis, Canterbury Christ Church University.

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  • NATALIE KEMP B.A. (Hons)

    FATHERS’ EXPERIENCES OF A MOTHER AND BABY UNIT: A QUALITATIVE STUDY

    Section A: The issues and challenges of fathering in the postnatal period and in the context of maternal mental ill health

    5488 (605)

    Section B: How do fathers experience a partner’s admission to a Mother and Baby Unit?

    7886 (245)

    Section C: Critical Appraisal 4072 (299)

    17446 (1149)

    A thesis submitted in partial fulfilment of the requirements of Canterbury Christ Church University for the degree of

    Doctor of Clinical Psychology

    MAY 2011

    SALOMONS

    CANTERBURY CHRIST CHURCH UNIVERSITY

  • 2

    Acknowledgements

    This thesis would not have been possible without the help of Janice Rigby, who welcomed

    me to the Mother and Baby Unit to find out more about the service, and who fostered my

    interest in the fathers‟ role there. I owe my deepest gratitude to Janice and Celia Heneage

    who supervised this study with unswerving support, advising me through the many learning

    curves inherent to doing something new. I would like to thank Anne Cooke, my manager at

    Salomons for being an anchor during the times when I felt at sea, helping me to stay focused.

    I am grateful to Kathy Chaney without whose unrivalled knowledge of the library services,

    this piece of work would not have come to pass so smoothly. To Ken Bledin and the

    rehabilitation psychologists at Camden and Islington NHS Foundation Trust, you knew me as

    I grew up in the sphere of mental health prior to the course, and your heartfelt encouragement

    during carrying out this work has been deeply meaningful, and will not be forgotten. And

    finally, with love to my family and friends: my parents for taking me in again during the final

    throes of „getting it done‟ and providing a safe and nurturing space to concentrate and create

    away from the madding crowd; and my beloved climbing friends, who made sure that every

    so often I took some very important time out to focus on something else. I am indebted.

  • 3

    Summary of the Independent Research Project

    Section A presents a literature review of the issues and challenges facing fathers in the

    postnatal period, in the context of an historical marginalisation of fathers in the study of child

    development. The review leads to a specific focus on the limited research evidencing the

    increased risk fathers face to their mental health, when coping with a partner‟s admission to a

    Mother and Baby Unit (MBU). Section B presents the qualitative research study undertaken

    to further explore how fathers experience a partner‟s admission to an MBU. Interpretative

    phenomenological analysis was used to capture the essence of this experience for the six men

    interviewed. Five master themes emerged, and the impact of negotiating cultural differences

    in child rearing practices was noteworthy. The findings support the efforts of government

    policy to build effective family focused perinatal services, whilst explicating where

    challenges might be faced in doing so. Section C sets out the journey taken from the

    ethnographic inception of the research idea, through dilemmas encountered in carrying out

    the study, to reflections on what was learnt during the process.

  • 4

    Contents

    Acknowledgements 3

    Summary of the independent research project 4

    List of tables and figures 7

    List of appendices 8

    Section A literature review: The issues and challenges of fathering in the postnatal period and in the context of maternal mental ill health

    Abstract 10

    1.0 Introduction 11

    2.0 The changing constructions of fatherhood in research 12

    3.0 The developing child: The unique contribution of the father 13

    3.1 Paternal play 14

    3.2 Father closeness and involvement 14

    3.3 Father-child attachment 15

    3.4 The indirect role of the father through his influence on the mother 18

    4.0 Focus on the postnatal period 19

    4.1 The triadic relationship with partner and child 19

    4.2 Paternal depression in the postnatal period 21

    4.3 A dynamic family health system: The associations between paternal and

    maternal postnatal mental health difficulties and the impact on the child 23

    4.4 Issues of father exclusion in perinatal services 24

    5.0 The specific challenge of a partner‟s admission to a Mother and Baby Unit (MBU)

    25

    5.1 The nature of MBUs 25

    5.2 The importance of fathers in MBUs 26

    5.3 The impact of MBUs on paternal mental health 27

    6.0 Gaps in research literature 30

    6.1 Further research on fathers in the postnatal period 31

    6.2 Further research on fathers in the specific context of the MBU 32

    Section A references 34

  • 5

    Section B research: How do fathers experience a partner’s admission to a Mother and Baby Unit?

    Abstract 2

    Introduction 3

    Method 7

    Results 12

    Discussion 27

    Study limitations and future research 29

    Clinical implications 30

    Section B references 32

    Section C: Critical appraisal

    The genesis of the research 2

    Choosing a methodology to fit the research question 4

    Ethical dilemmas 5

    The experience of interviewing 7

    The process of interpretation 9

    Methodological limitations 12

    Theoretical implications 12

    Clinical implications 13

    Future research 14

    Section C references 16

  • 6

    List of tables and figures

    Section A

    Figure 1. Quotes from „Support for All‟ (DSCF, 2010). 27

    Section B

    Table 1. Participant characteristics 12

    Table 2. Master theme „ Striving to make sense of what has happened to the partner, helps adjust to, and cope with, this unexpected trauma‟ and contributing super- ordinate themes

    14

    Table 3 Master theme: „Feeling limited in being able to help and needing professional support‟ and contributing super-ordinate themes

    16

    Table 4 Master theme: „Pulled physically and emotionally between the needs of partner, child and self‟ and contributing super-ordinate themes

    17

    Table 5 Master theme: „The Mother and Baby Unit as a challenge to fathers‟ role and identity‟ and contributing super-ordinate themes

    19

    Table 6 Master theme: „Treatment as a “family affair”: supporting the mother, father and their relationship, as key to recovery‟ and contributing super-ordinate themes

    22

  • 7

    List of appendices

    Appendix A: Literature search for this research

    Appendix B: Study information sheet

    Appendix C: Invitation to participants to take part in the study

    Appendix D: Consent form

    Appendix E: Semi-structured questionnaire

    Appendix F: Transcript extract showing initial textual notes for analysis

    Appendix G: Extracts from research diary

    Appendix H: NHS National Research Ethics Committee approval

    Appendix I: Research and Development approval from the host Trust

    Appendix J: Demographic information sheet

    Appendix K:Table of master themes and contributing super-ordinate themes, emerging themes, notes and key quotes for cross check to the original transcript.

    Appendix L: Journal of Family Psychology Guidance for Authors

  • 8

    The Issues and Challenges of Fathering in the Postnatal Period and in the Context of

    Maternal Mental Ill Health

    Word Count: 5488 (605)

  • 9

    Abstract

    This paper reviews issues and challenges of fathering in the postnatal period, leading

    to a specific focus on the implications of maternal mental ill health, sufficient to warrant

    admission to a Mother and Baby Unit (MBU). The review begins by presenting research

    about different aspects of the father‟s unique contribution to the developing child. It moves

    on to focus on the challenges faced by the father in the postnatal period, including the

    psychological demands of transition to fatherhood, the