Kaplan, T., Black, D., Hyman, P.& Knox, J. (2001) Outcome of Children Seen After One Parent Killed The Other

Clinical Child Psychology and
Psychiatry
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Outcome of Children Seen after One Parent Killed the Other

Tony Kaplan, Dora Black, Philippa Hyman and Jill Knox
Clin Child Psychol Psychiatry 2001 6: 9
DOI: 10.1177/1359104501006001003
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03 Kaplan (to/d) 21/11/00 7:40 am Page 9
Outcome of Children Seen After One Parent

Killed the Other
TONY KAPLAN, DORA BLACK, PHILIPPA HYMAN & JILL

KNOX
Traumatic Stress Clinic, London, UK
A B S T R AC T
A group of children (N = 95) seen by our team at least one year previously for
assessment after one parent had killed the other, was followed up by a postal ques-
tionnaire to the original referrer. Through this we examined a number of outcome
variables including placement effects, the frequency of their contact with the
surviving parent, the referrer’s view of the difference our intervention had made
and their view on the child’s adjustment over time. We analysed the data to deter-
mine any associations between these factors to help us understand the difficulties
these children face and to aid clinical decisions.
K E Y WO R D S
bereavement, children, homicide, outcome, trauma
Introduction
THERE CAN BE few more appalling events for a child than the violent death of one
parent where the assailant is the other parent. The orphaned child has to cope with trau-
matic bereavement, numerous other losses and changes of carer and home, as well as
with the shame and ignominy of being the child of a killer. Since declaring an interest in
the predicament of these children (Black & Kaplan, 1988), we have, as an NHS clinic,
formerly based at the Royal Free Hospital and now at the Traumatic Stress Clinic,
London, seen more than 370 children from all parts of the UK, where one parent has
killed the other. Our book When Father Kills Mother: Guiding Children Through Trauma
and Grief (Harris Hendriks, Black, & Kaplan, 1993) describes this work and summarizes
research findings on 95 children from 45 families who were referred consecutively to our
clinic for assessment.
In that study, 40% of the children were under 5 years old at the time of their parent’s
killing, 41% were between 6 and 11 years and only 18% were already teenagers. Ninety
per cent of cases involved the killing of the mother by the father; fathers were the victims
in only 10% of cases. Jealousy was the commonest reason cited for the homicide; other
Clinical Child Psychology and Psychiatry 1359–1045 (200101)6:1 Copyright © 2001

SAGE Publications (London, Thousand Oaks and New Delhi) Vol. 6(1): 9–22; 015212

CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)
factors acting in conjunction with previous domestic violence, which occurred in many
of the cases, were alcohol abuse and the spouse’s threats to leave. About one-half of the
children had witnessed previous domestic violence; one-third witnessed the actual killing
and a further 10% heard the killing or saw the dead body immediately afterwards. There
was a strong association between witnessing the homicide and the development of post-
traumatic stress disorder (PTSD). Moderate to severe PTSD affected 25% of the chil-
dren; a further 25% had mild or isolated symptoms of post-traumatic stress. At the time
of assessment, almost 60% of the children had behavioural problems in the moderate to
severe range and 40% had symptoms of emotional disorders.
The group of children we saw was heterogeneous, referred for different reasons and
at different times after the homicide, ranging from days to years. It might be said that all
that they shared in common was an event, the tragic loss of one parent at the hands of
the other. Otherwise the children were more different than they were alike. However,
there were some significant findings, in particular that this was a highly symptomatic
group of children and that these children, who required security and stability more than
most, seemed to have many changes of placement. We wished to examine further these
two observations by asking the original referrers by means of a postal questionnaire,
what had happened to the children following our assessment and intervention.
Most of our assessments had included a brief crisis intervention, particularly if the chil-
dren were referred soon after the homicide, and in some cases we engaged the child in
a more comprehensive therapeutic programme. We wanted a rough estimate, from the
referrer’s perspective, of the effects of the intervention or therapy on the child and caring
system. We also wished to know whether the children we saw soon after bereavement,
when we were more able to influence placement decisions, had had fewer placements
AC K N OW L E D G E M E N T S :
We are grateful to Lisa Strickland-Clark and Tracey Thorns who
performed the data entry and helped with the statistics. Our thanks also to Jean Harris-
Hendriks for her comments and suggestions. This article is adapted from Chapter 12 of the
revised second edition of the book When Father Kills Mother: Guiding Children Through
Trauma and Grief authored by J. Harris Hendriks, D. Black, and T. Kaplan (2000), published
by Routledge.
T O N Y K A P L A N , M B , M R C P S Y C H , is Consultant Child and Adolescent Psychiatrist at the

Enfield Child Guidance Service, and Honorary Consultant and Senior lecturer at the Trau-
matic Stress Clinic, Camden and Islington Community NHS Trust, London.
C O N TA C T :
Tony Kaplan, Service for Adolescents and Families in Enfield, 24 Dryden Road,
Enfield, EN1 2PP, UK.
D O R A B L AC K , M B, F R C P S Y C H , F R C P C H , D P M ,
is Honorary Consultant Child and
Adolescent Psychiatrist, lately Director, at the Traumatic Stress Clinic, Camden and Isling-
ton Community NHS Trust, London. She is also Honorary Senior Lecturer, University of
London at Royal Free Hospital School of Medicine and UCL, and Honorary Consultant, Gt
Ormond Street Hospital, Royal Free Hospital and the Tavistock Clinic.
C O N TA C T : Dora Black, Traumatic Stress Clinic, 73 Charlotte Street, London W1P 1LB, UK.
P H I L L I PA H Y M A N , B A ( H O N S ) is a Research Psychologist.
J I L L K N O X , BA (HONS), MSC, is a Research Psychologist.
10

KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER
than the children referred late. We know of no other specific study and certainly no
outcome studies on a cohort of children who have lost one parent at the hands of the
other.
Method
Every professional referrer (in most cases, the allocated social worker) of the 45 families
(95 children) in the original cohort was sent a 12-item questionnaire for each child in the
family we had assessed originally. A reminder letter was sent out after three months, in
some cases followed by a telephone call. Data were analysed using the statistical package
of the SPSS with Pearson’s Chi-squared analysis of association (verified by Fisher’s exact
two-tailed test because of the small sample size).
All children had had their initial assessment with our service more than 18 months
before follow-up (the median was 3.5 years, with a range of 19 months to 15 years). Many
of the children had not yet reached adolescence.
Results
Response rate
Approximately three-quarters (74%) of the referrers returned our questionnaires. Ques-
tionnaires were, in some cases, returned incompletely filled in. The information we
requested was not always available to the respondents. We obtained useful but incom-
plete data on 61 children from 33 families whom we had assessed, and in some case
treated. (Similarly, data from our original study were not uniformly complete.) Thus
‘missing data’ varies across different tables.
Characteristics of non-responders
The children lost to follow-up (n = 34) were not significantly different from those we
were able to follow-up with regard to age or whether they had witnessed the killing. Most
successfully followed up were the children who were, at the time of the assessment, living
in children’s homes or other residential institutions – questionnaires were returned on
15 children of a total of 18. This compares with 8/13 who had been staying with paternal
(in all cases, perpetrator’s) relatives at the time of our original assessment, 10/24 who
had been with maternal (in all cases, victims) relatives and 16/34 who had been with
foster parents. It was not possible, from an examination of the case notes to determine
where six children in the follow-up sample were living at the time of the assessment.
Placements
At the time of assessment there were more children living with mother’s (i.e. the victims)
relatives (27% of the original sample) than with father’s (15%), 38% were in foster care
and 20% were in children’s residential establishments. At the time of follow-up approxi-
mately one-third of children (21) were living with their mother’s relatives, 16% were with
their father or his relatives (six and four children, respectively), and almost one-half were
not living with relatives. Most of these were in foster care.
The three children whose mother killed their father were all living with non-related
carers. Therefore, all children living with maternal relatives had lost their mother and so
had all children living with father or his relatives.
Only approximately half of the children (30) on whom follow-up data was available,
were in the same placement as they had been in at the time of our original assessment.
Fourteen children (approximately one-quarter) had had more than one change of
11

Table 1. Children with three or more placements since the death of a parent
Number of placements Number of children Number of families
3 15 8
4 6 4
5 6 3
6 2 2
Total 29 17
Table 2. Children who had had one placement only

Children Families
With mother’s kin 16 9
With father’s kin 1 1
With long-term foster parents 6 2
Total 23 12
placement following the assessment. Twenty-nine children (that is nearly one-half) had
had three or more placements after the homicide of their parent (Table 1).
Of the first placements after the homicides which became permanent, 75% were with
the mother’s kin. In all of these cases, the mother was the victim (Table 2).
Children who were in foster care or in adoptive placements at follow-up had had more
placements than the other children, although the only significant difference within this
domain was between the number of placements experienced by those in foster care or
adopted, and those in the mother’s family. Our early involvement did not reduce the
number of placements.
Children’s contact with their surviving parents (perpetrators)

One-third of the 31 perpetrators were convicted of murder and one-half of manslaugh-
ter. Three were detained under the Mental Health Act and in two cases the trial had not
yet taken place. One parent committed suicide. Of those convicted, one was released on
appeal and one died in prison of a heart attack. In the UK, a life sentence is mandatory
if an individual is convicted of murder, but they may be released on licence after a
minimum stay in prison (usually not less than 7 years). Only four of those convicted of
manslaughter received a sentence of more than six years. Those not receiving life
sentences rarely served more than a few years before being released on licence or parole.
In two of the three cases in our original cohort in which the mother had killed the father,
the mother was convicted of murder. Both had suffered chronic violence from the
husbands they eventually killed.
Children with regular contact with their perpetrator fathers at follow-up were all living
with long-term foster parents. All the children living with maternal kin had either no
contact or no regular contact. For the two sibling groups (four children) living with pater-
nal relatives, contact was infrequent or had ceased. (It must be said that this latter finding
is at odds with what we found in our original study and subsequently with the much larger
number of children we have seen, where the children living with paternal relatives are
almost inevitably in contact with their fathers.) At the time of the follow-up, 16 of the
convicted parents had been released (all fathers). In three families, the children (five
12

Table 3. Referrers’ view of outcome of brief intervention

Much improved Improved No change Worse Not known
18 (30%) 16 (26%) 17 (28%) 1 (2%) 9 (14%)
boys and one girl) were now living with their father. In one other case, a daughter (living
independently at follow-up) had lived with her father for a while but eventually had to
be moved because of his violence. Of the other 13 sibling groups whose fathers had been
released, only two had regular contact with him, and both these sibling groups were living
with long-term foster parents. The remaining 11 sibling groups had infrequent or no
contact. Of these, seven were living with maternal kin.
Psychological outcome for the child/children

Our intervention was designed to clarify for the child what had happened to the parents,
and if they had witnessed the killing, either to intervene specifically to try to prevent the
onset of PTSD, or to begin psychotherapy for established post-traumatic symptoms
(usually along the lines suggested by Pynoos & Eth, 1986). If the child did not witness
the killing, we would begin the process of bereavement counselling. This was a short-
term intervention aimed at helping the child, consonant with his/her age, stage of
development, culture and religion, to understand that his/her parent was dead, that death
is permanent, irreversible and has a cause; that it involves the cessation of feeling and
all bodily function; and to help him/her to begin to mourn for his/her dead parent and
work through feelings of loss using appropriate play and drawing materials. We tried to
arrange for therapy and bereavement counselling to be continued by local professionals
if the child lived far from our clinic.
At follow-up we wanted to get a rough idea about the children’s adjustment in the
longer term. We asked whether, in the referrer’s view, the child/children had benefited
from our brief intervention. Referrers felt that more than half the children had shown
some improvement (Table 3). The intervention had made things worse for only one child.
We were particularly interested to know whether the child felt freer to talk more
openly to their carers about their parent’s death following our brief intervention, and
indeed this was the case in the majority of cases in which the referrer was able to form
a view (56%). Twenty-eight children (46%) could talk more openly to carers about their
parent’s death, 6 (10%) could not and in 27 (44%) children the referrer was unable to
give an opinion. It seems that the children who were fostered or adopted at follow-up
were more likely to be able to talk with their carers about their parent’s death (16/21),
than children living with related kin (with mother’s family [7/17], with father’s family
[2/4] or with their father [0/6]). However, these results must be treated cautiously as the
referrers on the whole had more information about those children living in foster or
adoptive placements. If we only take those cases that the referrers could be definite
about, then it would seem that following our intervention, 82% (28/34 children) were
enabled to talk about their parent’s death.
As a rough gauge of chronicity of morbidity, we asked the referrers whether the chil-
dren seemed to be having emotional and/or behavioural problems. About one-fifth could
not give an opinion, but from the responses of those who could, it seemed that 14/47
(33.5%) were having emotional problems and 16/52 (32%) were having behavioural
problems. That is, approximately one-third seemed to have chronic problems evident to
the referrer.
13

After our assessment we recommended specific psychiatric treatment in most cases,

but as far as we were able to establish, only one-half (29 children, 49%) actually received
further therapy. Our method of data collection did not allow us to ascertain whether
those who did not have further intervention needed it as much as those who had received
it. The children living with their father were the least likely to be in receipt of psychi-
atric or therapeutic follow-up (only one of six).
Witnessing the killing

In our original study (Harris Hendriks et al., 1993) we found that there was a strong
correlation between witnessing the killing and the development of post-traumatic stress
reactions (PTSR) in the child. Twenty-six of the 33 children who witnessed the killing
developed PTSR, while only 18/53 who did not witness it, developed PTSR. Many of the
latter children who had PTSR at assessment had witnessed serious domestic violence
before the killing occurred. Children who had witnessed the killings were more likely to
have more treatment sessions with us. Nevertheless, according to the referrers, children
who witnessed the killing of their parent had significantly more persistent behavioural
problems at follow-up. There was also a tendency for such children to have more
emotional problems.
The referrers’ observations were that children who had post-traumatic stress symp-
toms at assessment were not more likely than their counterparts without post-traumatic
stress symptoms to have overt emotional problems at follow-up. Children who had
witnessed the killing of their parent were also not any more likely to be in receipt of
psychiatric follow-up, but they had undergone more therapy sessions with our team. It
is possible that therapy helped to reduce long-term emotional difficulties.
Further local psychiatric intervention did not appear to make a significant difference
to the outcome. The length of time which had elapsed between the homicide and the
assessment did not appear to affect outcome.
Children who had undergone more than three sessions were regarded by the referrers
as much more able to speak freely about their parent’s death to their carers than chil-
dren who had only had assessment sessions. Overall, of those children in the follow-up
sample on whom we have sufficient information regarding the original contact with our
service (44), 15 had 3 or more therapeutic sessions. Most of them (14/15) were rated by
the referrer as having improved, whereas only 17/29 children who had fewer than 3
sessions showed an improvement. Of the 13 who did not seem to improve after seeing
us, 12 had had the assessment component only. Thus, those children who received an
assessment interview plus a more formal therapy component were more likely to show
improvement discernible to the referrer, compared with children who received assess-
ment only, even if that included a brief intervention (Table 4).
Placement effects
We examined aspects of outcome for the children according to where they were living
at the time of our initial assessment and, separately, at follow-up. In all three cases in
which the mother had killed the father, the children were placed with non-related carers.
At follow-up we found that children who had, at assessment, been living with the
perpetrator’s (in all these cases, father’s) family were doing relatively worse than chil-
dren in any other placement with regard to behavioural and emotional problems.
We identified children with pronounced bullying or victim behaviour. On this dimen-
sion, the children who were in foster families at the time of assessment were doing much
worse than the other groups at follow-up. Children living with their mother’s family at
assessment had less problematic peer relationships than children placed with their
14

Table 4. Improvement, by contact type

Improved Stayed same or got worse
Assessment and treatment 14 1
Assessment only 17 12
Pearson’s Chi-squared = 5.72, d.f. = 1, p =.016
Fisher’s exact test (two-tailed) p =.016
Table 5. Global improvement, by placement type

Improved Not improved
Mother’s family 13 2
Father’s family 0 4
Missing data on eight not known, therefore excluded from calculation.
Pearson’s Chi-squared = 10.97, d.f. = 1, p =.0009.
Fisher’s exact test (two-tailed) p =.0038.
Table 6. Global improvement, by placement type

Improved Not improved
Foster care/adopted 16 4
Father’s family 0 4
father’s family. The children who were in children’s homes when we first saw them,
tended to come from large sibling groups who could not be placed together elsewhere.
It may be that being kept together helped to protect these children from extremes of
social maladjustment as they tended to be better adjusted on the bullying/victim dimen-
sion than the children in foster care.
These trends appeared to be persistent. Thus, children living with the victim’s family
(in all cases, the mother’s family) at follow-up were doing better with regard to their peer
relationships than children in foster care, and both groups were doing slightly better than
children in the perpetrator’s (father’s) family. Children in adopted placements were
doing better than children still in foster care. If this finding is confirmed by further studies
on our larger number of cases, then the results are important for long-term planning for
these children.
Furthermore, children living with their father’s family at the time of follow-up were
less likely to be showing improvements in their behavioural and emotional adjustment
following our intervention than those children living with their mother’s family (Table
5) or in foster or adoptive families (Table 6). The numbers are too small and the level of
significance is not high enough to justify far-reaching conclusions. However, if these
tentative findings are correct, they would call into question – at least in these unusual
circumstances – the received wisdom embodied in the Children Act, 1989, which assumes
that, when children cannot live with their parents, it is better for them to be placed with
any family members than placed outside the family.
15

Relationship to family violence

Only one of the children in our follow-up group for whom data were available had not
been exposed previously to domestic violence. Analysis of the associations between
exposure to family violence before the homicide and subsequent findings was therefore
not possible. However, it is worth noting that only between one-quarter and one-third
of these children, who were known to have been exposed to previous domestic violence,
were seen to be having overt problems with regard to their behaviour or their emotions
or were bullies or ‘victims’. Most (i.e. between two-thirds and three-quarters) were not
(n = 38). This argues for significant resilience, if the referrers were accurate and reliable
in these observations.
Relationships with new carers

When one parent kills the other, the child loses both parents. In most cases, this means
the child becoming used to new surrogate parents. The child’s assumptions about the
availability and reliability of carers is disorganized by the violence and the sudden loss
and disruption of their caring environment and relationships. We wished to evaluate how
the traumatic bereavement had affected the child’s care-eliciting and care-seeking
(attachment) behaviour, as reflected by the child’s capacity to form meaningful relation-
ships. In our original assessments, we had histories and descriptions which pointed to the
fact that 30% of the children had not formed meaningful relationships following the
killing. We speculated that for some that was possibly an effect of time, i.e. not being
with their substitute carers long enough to attach. We asked the referrers to rate the chil-
dren at follow-up on this criterion on a 10-point visual analogue scale, with one end of
the scale defined as ‘forms meaningful relationships’ and the other end as ‘superficial
detached relationships’. We regarded a rating of 7 or above as indicative of possible prob-
lems in this domain. In more than half of the cases, the referrers did not feel able to
answer this question (although it was not clear whether this was due to the subjectivity
of the question, or whether the referrers did not know enough about the child’s relation-
ships).
Of the children on whom we have these data (37), 5 were not rated as having attach-
ment-related problems at assessment. Of these, 4 continued to have no problems at
follow-up, and only 1 child having no problems initially was thought to have developed
problems at follow-up. In the other 32 children, considered to have had attachment prob-
lems of some kind when seen by us at assessment, approximately one-third (10/32)
continued to have some problems, while almost two-thirds (22/32) were thought by the
referrers to have no significant problems forming meaningful relationships. However, of
the children with attachment-related problems at assessment, those whom we thought
showed elements of avoidant attachment (Ainsworth, Blehar, Waters, & Wall, 1978) had
the least favourable outcome. Six of the 10 children who appeared to be ‘avoidant’ at
assessment, had attachment-related relationship problems at follow-up, while only 4 of
the remaining 18 seemed to be having problems of this kind (Table 7). Furthermore,
these supposedly ‘avoidant’ children seemed more liable to go on to become victims or
bullies.
Where the children were living at the time of the original assessment did not seem to
be associated with the children’s capacity to form meaningful relationships, at least in
the view of the referrer. However, placement at follow-up did seem to have some signifi-
cance. Compared with children in foster placements, children in both the mother’s family
and children living with paternal relatives were doing less well in this way. To try to
increase the accuracy on this scale, children doing very well, 0–3 on a visual analogue
scale, were compared with children doing poorly, 7–10 on this scale, and an intermediate
16

Table 7. Continuity of attachment-related problems

Assessed: Assessed: All other
‘Avoidant’ attachment problems
Follow-up: Attachment-related problems 6 4
Follow-up: No attachment related problems 4 18
Pearson’s Chi-squared = 5.59, d.f. =1, p =.018.
Table 8. Capacity to attach, by placement type

Foster family/adopted Mother’s family Father’s family
Forms meaningful relationship 10 4 0
Superficial or distant relationships 3 7 2
category, 4–6 on the scale, was excluded from the calculation. According to the refer-
rer’s view, children in either of the placements with relatives did not seem to form
meaningful relationships as easily as children in foster placements or adoptive place-
ments, and there seemed to be no particular difference, at least at a statistical level,
between children living with mother’s family or with father’s family (Table 8).
Children who return to their father’s care

In the small group of children that returned to their father’s care after his release from
prison and living with him at follow-up (six children from three families) very little infor-
mation was available from the referrers. In some cases they were relying on the fact that
the children had not come to their attention again to presume that there were no prob-
lems. They were usually denied access to the child when a supervision order expired.
Most of the children who were returned to their fathers were not particularly disturbed
or poorly functioning in our original assessment, but we have no information on the chil-
dren from the referrers after their return to father’s care. We have limited clinical experi-
ence after children return to a perpetrator’s care. Of the 16 fathers who had been
released, only 3 resumed the care of their child/children. Our clinical experience with
children living with the surviving parent (and this now includes some mothers, who are
the subject of another article) is that they tend to be ‘very good’ during the primary
school period, but their rebelliousness, sexuality and individuation during adolescence
may be experienced as extremely challenging to their perpetrator parent. In two cases
at least, daughters aroused their father’s jealous anger when they start taking an inter-
est in boys, thus recreating the pathological dynamic which had led to their mother’s
death. They were removed into care when their father became violent towards them. In
another case, a teenage daughter reunited with her father to whom she had remained
loyal while in the care of her paternal aunt, ran away when she was reminded of her
father’s proclivity for violence during an argument with his new wife. She developed
flashbacks, which had apparently been repressed previously, became anorectic and was
admitted to a psychiatric unit. She did not return to live with her father. In another case,
an 8-year-old girl went back to her father on his release, but was removed at 13 because
he was sexually abusing her.
17

Discussion
The original research was carried out post hoc on a clinical sample. The children were
interviewed within a clinical framework, not a research one. We felt that it would be
unethical to approach the children and their carers directly for follow-up information
without careful preparation. This would, in all probability, have also introduced a selec-
tion bias, as the children and carers who would have given their permission for a follow-
up research interview, would have been more likely to be those who felt that the children
had benefited from our initial intervention. Although there are clear limitations to the
methodology we chose, i.e. a questionnaire to the referrers, we thought that this would
give us a wider and more balanced sample. With hindsight, we have some reservations
about the form of some of the questions we posed to referrers and recognize that we did
not test the questions for reliability or indeed for validity. This of course applies in
particular to the psychological outcome data. We did not anonymize the responses, and
even though the correspondence was carried out through a research assistant and our
covering letter encouraged frankness, some referrers may still have erred on the side of
politeness when asked to evaluate the effect of our intervention. It was noticeable that
respondents answered with least frequency the questions that required the most in-depth
knowledge about the children, that is, regarding their openness about their mother’s
death with their carers and the extent to which they were able to form meaningful
relationships. It seems likely that they would have had less contact with those children
who did not seem problematic, and this may have limited their responses (recorded as
‘don’t know’) on some children whose adjustment was satisfactory.
However, the information about the nature of the children’s placements and their
contact with their surviving parent could be regarded as relatively hard data. We were
able to confirm that in the long-term, these children did indeed have a greater number
of changes of placement than was desirable or expected. For some of the analyses, cells
were so small that results should be regarded, at the most, as suggestive. None of our
data should be regarded as sufficiently robust to dictate important social decision-
making for such children. That being said, the referring social workers’ responses suggest
that placement within the victim’s family appeared to have advantages over placement
with that of the perpetrator’s, and was the most stable (i.e. fewest moves) placement
type. Surprisingly, since in the original sample the children in the children’s homes were
the most globally disturbed, at follow-up they appeared to be doing reasonably well in
terms of their social adjustment, at least as well as, or better than children in foster
homes. One of course needs to question whether there might be a greater degree of toler-
ance and optimism by their carers towards these particularly disadvantaged children
growing up in a children’s home.
In the majority of cases, referrers felt that our intervention had done some good (56%)
or at least no harm (28%). This was important information for us as our brief inter-
vention sometimes produced distress at the time. In the majority of cases the assessments
were requested by a civil court to help with decisions about where the children should
live and with whom they should have contact and the frequency of contact. In many of
the cases referred the children travelled great distances; this made it difficult for us to
offer treatment ourselves. We often questioned whether a brief ‘preventive’ intervention
without the opportunity to review and extend treatment, might do more harm than good.
This did not appear to be the case. However, there was more observable improvement
in children who had a longer period of therapeutic work. It is possible that the children
who persisted with treatment came from more supportive families and that may be an
influential factor in their better outcome.
18

We would tentatively conclude from our findings that, especially for children who
witnessed the killing who have a high risk of developing PTSR, a brief crisis intervention
is not sufficient, and the children should be assessed for their treatment needs following
any brief intervention. The children who did best in our study were those who received
longer therapeutic input, even though one might have predicted that these children, who,
on the whole, were witnesses to the killing, would have done worse. We treat these results
with caution, as internalizing symptoms are notoriously unreliably rated by untrained
observers (Barrett et al., 1991; Klein, 1991). The children’s post-traumatic symptoma-
tology may well have continued in some cases without this having come to the attention
of the carer or referrer. It would be necessary for a clinician to examine children in order
to elicit symptoms and signs of post-traumatic stress disorder as children rarely volun-
teer them, and indeed may actively conceal them from their carers in order to protect
them emotionally. It was not possible using our method of data collection to ascertain
whether PTSD persisted. Our clinical experience and that of others in this field, is that
PTSD is a chronic, remitting and relapsing psychiatric disorder which is difficult to treat
once it is established. There is controversy about whether early intervention following a
disastrous event can prevent it (Raphael, Meldrum, & McFarlane, 1995).
Approximately 10% of our larger clinical group is of mothers killing fathers (41 chil-
dren). We are currently evaluating this group of children separately. Most of them have
not yet reached adolescence but our clinical impression to date is that these children do
well during their pre-adolescent years, becoming very difficult and defiant when peri-
pubertal.
The children placed with relatives of the perpetrator are more likely to return to their
surviving parent’s care when he is released from prison. Even if the relatives are horri-
fied at the actions of the father, and form a firm intention to rear the child to adulthood,
they find it very difficult to resist the pressure from father for the child’s return, and the
child is more likely to return to his care. Our clinical experience is that the children who
do return to their surviving parent’s care on the whole do badly. This has led us to be
very wary of recommending placement with paternal relatives or the perpetrator parent.
When that option seems the ‘least detrimental’ (Goldstein, Freud, & Solnit, 1980) then
it may help to recommend some statutory oversight either by wardship or a care order.
Our finding from this study, that there was an persistence of an apparently avoidant
attachment style, especially in young children living with relatives, is likely to have
significance for later mental health. Insecure attachment patterns have been described
as ways for a child to deal with particular abnormal parenting situations and although
they may represent the only adaptation possible, they are maladaptive in that they do
not prepare the child for successful adaptation in the world outside their families and
they are risk factors which increase the likelihood of later psychiatric disorders (Zeanah
& Emde, 1994).
We had an hypothesis that traumatically bereaved children, placed either with rela-
tives who are grieving (victim’s family) or who avoid making close attachments to the
child, because they anticipate returning the child to the (perpetrator) father on his
release from custody, would be less able to talk freely about the dead parent, would be
less likely receive the therapy they needed, would fail to make secure attachments
following the homicide and would be more prone to develop disorders of attachment.
Although our numbers are too small and the methodology insufficient to amount to a
proof, our findings are in keeping with our hypothesis. Furthermore these attachment-
related problems are compounded by the high number of moves of home and carer that
many of the children have.
The findings from this limited study do not enable us to make any definitive
19

recommendations for practice and it must continue to be good clinical practice to

approach each case on its merits. The findings that children are less likely to move
frequently when placed with the victim’s than the perpetrator’s family, and are less likely
to develop psychological problems may help to form an opinion when the advantages
and disadvantages of placement are otherwise fairly balanced. For this rather unusual
group of children, thankfully rare, we do question the assumption, embodied in the Chil-
dren Act, England & Wales (1989), that it is always better for children to live with rela-
tives when they cannot live with their parents. The complexity of their circumstances,
their varied reactions and the relationships which may help or hinder them, make it
imperative that decisions about the caring environment in which the child is placed
should be determined by more than mere kinship. We think the findings of this study
support this assertion. For example, the adopted (even though small in number) and the
foster children seemed to do quite well on a number of ratings, especially, according to
the referrers, with regard to forming meaningful relationships.
The finding that there was little relationship between the degree of trauma experi-
enced and later behavioural and emotional problems must be treated cautiously as this
very young group had on the whole not negotiated their dependent years and in particu-
lar, their adolescence when many behavioural and peer problems may occur.
Congruent with our clinical view, the findings from this study confirmed that for many
of the children psychological problems were persistent. It was disappointing, therefore,
to find that fewer than half of the children received any further therapy after they left
our clinic. In some cases, as when the children returned to the care of the perpetrator
parent, treatment was refused, but in most cases the lack of local child psychiatric
resources was the reason.
Summary
A postal questionnaire was sent to the referrers of 95 children whose one parent had
killed the other, on whom data had been collected at assessment at least one year before.
The response rate was 74% with data on 61 children. The main findings were as follows:
1. This young group of children experienced many changes of home and carer. Half
the children were living at time of follow-up with unrelated carers. Of those living
with relatives, the fewest changes of carer occurred when they were initially placed
with relatives of the victim, rather than the perpetrator.
2. Most children had little contact with the surviving parent. They were more likely to
have maintained regular contact if they were in care.
3. Children who had treatment sessions as well as assessment interviews, appeared to
have fewer problems on follow-up than those whose contact was briefer. This
included the children who had witnessed the killing. About half the children who
had had a brief intervention were rated as being able to talk more openly to carers
about the death of their parent, especially if the carers were unrelated to them. The
small number of children who had been adopted seemed (to their referring social
workers) most able to talk freely about the dead parent. (The small numbers
involved make this finding suggestive only.)
4. Few children received further therapy in their locality, even though it had been
recommended in most cases.
5. At least one-third of the children had continuing overt emotional and/or behavioural
problems. Children who witnessed the killing were more likely to develop post-trau-
matic stress disorder, and were more likely to receive treatment, but were, it seems
20

from the referrer’s feedback, also more likely to have persistent emotional and
behavioural problems at follow-up.
6. Although numbers are too small for results to be regarded as definitive, children
placed with the perpetrator’s (father’s) family did worse on ratings of overt
emotional, behavioural and social identity problems than did those placed with the
victim’s (mother’s) family, who, in turn, did worse than children living in non-related
households, except with regard to social adjustment.
7. Even though most children had witnessed domestic violence before the killing, the
majority were not having problems at follow-up, in the referrer’s opinion.
8. Children originally assessed clinically by our team as having attachment-related
problems with their new carers, were more likely to be having similar problems at
follow-up.
9. Children living with relatives at the time of follow-up may have been having more
difficulty in forming meaningful relationships than children living with non-related
carers. (However, this question about the child produced the fewest responses from
the referrers and this limits the conclusions that can be drawn. Because the impli-
cations of this finding are likely to be of such importance, this bears further research
with larger numbers.)
10. Children living with relatives of the perpetrator are more likely to return to their
surviving parent’s care. The clinical evidence is that they behave well as children but
may show disturbance in adolescence. The numbers of those who returned to their
parents’ care in our sample were too small to either verify or disprove this.
We conclude that, while good practice requires that each child and family are assessed
on their merits, placement of these children with the victim’s family appears to lead to
fewer changes of placement than placing with the perpetrator’s family, and that the treat-
ment needs of these children who carry an enhanced risk of developing emotional and
behavioural problems, attachment disorders and problems of social identity, need to be
given more consideration.
Note
A version of this article appears in J. Harris-Henricks, D. Black, & T. Kaplan (2000). When
Father Kills Mother; Guiding Children Through Trauma and Grief (2nd ed.). London: Rout-
ledge.
References
Ainsworth, M.D.S., Blehar, M.C., Waters, E., & Wall, S. (1978). Patterns of attachment.
Hillsdale, NJ: Erlbaum.
Barrett, M.L., Berney, T.P., Bhate, S., Famuyiwa, O., Fundudis, T., Kolvin, I., & Tyrer, S.
(1991). Diagnosing childhood depression: Who should be interviewed – parent or child?
The Newcastle Child Depression Project. British Journal of Psychiatry, 159 (Suppl. 11),
22–27.
Black, D., & Kaplan, T. (1988). Father kills mother: Issues and problems encountered by a
child psychiatric team. British Journal of Psychiatry, 153, 624–630.
Goldstein, J., Freud, A., & Solnit, A. (1980). Beyond the best interests of the child. London:
Burnett Books.
Harris-Hendriks, J., Black, D., & Kaplan, T. (1993) (rev. 2nd ed., 2000). When father kills
mother: Guiding children through trauma and grief. London: Routledge.
21

Klein, R.G. (1991). Parent–child agreement in clinical assessment of anxiety and other
psychopathology: A review. Journal of Anxiety Disorders, 5, 187–198.
Pynoos, R., & Eth, S. (1986). Witness to violence; the child interview. Journal of the
American Academy of Child and Adolescent Psychiatry, 25, 306–319.
Raphael, B., Meldrum, L., & McFarlane, A.C. (1995). Does debriefing after psychological
trauma work? British Medical Journal, 310, 1479–1480.
Zeanah, C.H., & Emde, R.N. (1994). Attachment disorders in infancy and childhood. In M.
Rutter, E. Taylor, & L. Hersov (Eds.), Child and adolescent psychiatry: Modern
approaches (pp. 490–504). Oxford, UK: Blackwell.
22

Kaplan, T., Black, D., Hyman, P.& Knox, J. (2001) Outcome of Children Seen After One Parent Killed The Other

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Clinical Child Psychology and

Outcome of Children Seen after One Parent Killed the Other

The online version of this article can be found at:

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Outcome of Children Seen After One Parent

TONY KAPLAN, DORA BLACK, PHILIPPA HYMAN & JILL

Clinical Child Psychology and Psychiatry 1359–1045 (200101)6:1 Copyright © 2001

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

T O N Y K A P L A N , M B , M R C P S Y C H , is Consultant Child and Adolescent Psychiatrist at the

J I L L K N O X , BA (HONS), MSC, is a Research Psychologist.

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KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

Table 2. Children who had had one placement only

Children’s contact with their surviving parents (perpetrators)

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KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER

Table 3. Referrers’ view of outcome of brief intervention

Psychological outcome for the child/children

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

After our assessment we recommended specific psychiatric treatment in most cases,

Witnessing the killing

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KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER

Table 4. Improvement, by contact type

Table 5. Global improvement, by placement type

Table 6. Global improvement, by placement type

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

Relationship to family violence

Relationships with new carers

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KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER

Table 7. Continuity of attachment-related problems

Table 8. Capacity to attach, by placement type

Children who return to their father’s care

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

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KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

recommendations for practice and it must continue to be good clinical practice to

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KAPLAN ET AL.: AFTER ONE PARENT KILLS THE OTHER

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CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 6(1)

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