Child-Focused Practice

A Collaborative Systemic Approach

Jim Wilson

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429911835
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The author, with over twenty years of experience of working with children, writes refreshingly about the practical aspects of his work. He takes traditional and contemporary theories and explains them in the context of how he works with children.

CHAPTER ONE

A framework for child-focused practice

THE PLACE OF THEORY

Although we need theories to help us shape our thinking, in practice it is also useful to hold theories in respectful abeyance in order to hear more about the accounts offered by the people involved themselves. Child-focused practice is not primarily concerned with the causes of children’s problems (these are probably too numerous to list). Whatever the origins of a child’s problem, the approach is concerned with:

1.how various accounts offered by different family members may be drawn together in what Hoffman (1993) has called the “cradle of communication” between significant people in the child’s life and, particularly, how problems are defined, shaped, and influenced through language and interaction;

2.how the family’s contexts of resourcefulness may have been closed down such that they have become unable to respond in an effective way to tackle their problems. Usually, when these descriptions and accounts are brought to the therapist, they already have a habitual or repetitive character to them;

3.how to gain access to individual and family contexts of competence and resourcefulness as a source for creating more expanded and useful accounts, interactions, and behaviour related to their main difficulties.

(I prefer to use the term “account” for these descriptions rather than “narrative”, because not all accounts told to a therapist can adequately be described as personal narratives. Accounts are specific descriptions of an aspect of a family member’s life brought to the therapist for a particular purpose: that of having their predicament relieved or helped in some way.)

CHANGE AND THE THERAPIST/PRACTITIONER’S STANCES

The framework offered here emphasizes attention to the child’s account within the context of other important contributors. The therapy does not assume the need to liberate the child’s “marginalized” accounts so much as provide an irreverent challenge to them. Since problems tend to become described in ways that close down options for people, my role is to look for the contradictions in the descriptions that people bring and to help open up new possibilities based on the child’s, the parents’, and the therapist’s resourcefulness. To this end, I allow access to various aspects of my personal and professional knowledge and expertise as a resource for my clients’ benefit. The approach is minimalist in that I do not assume that the therapist needs to unearth some presumed hard-to-find cause lying in the past, and it is inclusive in that the therapist ultimately acts as a link in bringing together and mobilizing the family’s own resourcefulness—avoiding the danger of exclusively replacing a parent by being seen as a parent substitute. Independence from therapy is valued over the creation of dependence upon therapy, though in some cases dependence may be a transitional phase for the therapist to join effectively with the family.

Since the practice aims for collaboration and resourcefulness, it is useful to develop constructions and ideas that keep at bay theories that pathologize individuals. If one is genuinely concerned to value and focus on the child’s and parents’ accounts, it is a contradiction for the therapist secretly to hold a view that he knows best what is really wrong with the family. We can all have ideas about what could be done to improve matters, or hold beliefs about what could be leading to problems. These ideas can be useful so long as we do not become convinced that they are the only truth about the child or the family’s problem. On the contrary, clients’ accounts compose the words and actions that provide the material for the improvizations between the therapist and family members so that new meanings and actions will begin to emerge.

The central assumption in this approach is, then:

•That what is spoken about or enacted by the child and other family members is not the only account of the situation. No matter how fixed these descriptions have become, the therapist should help to bring other words, actions, and more expanded accounts to life in order to make a wider repertoire available to the child and the adults in dealing with their difficulties.

THE CHILD’S VOICE

In recent years, the metaphor of “voice” (Gilligan, 1982) has become particularly applicable to children in emphasizing their contribution to their own helping processes. Talking with (as opposed to “about”) children emphasizes a more lateral attempt to work with young clients, but one should not misconstrue this as eschewing our power and influence in our practice nor should we become sanctimonious about children’s rights. How often as therapists have we wanted to escape the difficulty of talking to a child who is omnipotently trying to control parents and shout down everyone else’s opinion. In these situations it is difficult to think of the child’s voice being “marginalized”! So I am not advocating an approach to therapy that emphasizes gentleness. In fact, to work in this way requires a therapist to be robust sometimes, helping to find more useful ways for children to bring new meaning to their actions, including struggling to make a connection with the possible meanings in their anger, outrage, or distress. Collaborative styles of practice suggest that the therapist’s job is to offer a link between these different accounts and to raise the child’s other voices where these have become muted, turning the volume up without drowning out the parents.

The metaphor of voice also helps focus attention on the individuality and resourcefulness of the child, which may otherwise have been ignored or overlooked particularly in top-down styles of practice.

Recently a friend told me about the miraculous survival of her son John, who was born prematurely at 25 weeks. He had just celebrated his fifth birthday and was playing in the garden. She told me how silent the doctors and assembled nurses had become after her son was born. The delivery-room had become quiet: each person was waiting to see if there would be a reaction from her son. The doctors were prepared not to take any steps to sustain her son’s life because he was so weak and premature. When her son suddenly made a sound this galvanized everyone into immediate action to save his life. By quite literally finding his voice, he ignited a spark in the nurses’ and doctors’ desire to save his life.

Example of an account in action

One girl, Emma, aged 6 years, had been quiet during most of the second session of family therapy. She had come with her mother and more talkative elder sister because the mother was worried about the children’s “bad” behaviour since their father had left the family the year before. The mother explained that Emma would not, or could not, talk about her father, despite her attempts to make her tell her about her feelings.

At a certain point during the session Emma started to create a court scene with small dolls and wooden bricks. She played in this way for a while without making a remark to me or her mother. Eventually, she began to tell the story of the court scene in which her father was “told to go away because he had done bad things and took tablets”.

There are many possible explanations for why Emma chose to tell us about her father at this point during the session, but it is likely that Emma decided it was safe enough to tell us about this reminiscence in which her secret views about her father could become voiced and offered to the therapist and to other family members.

A child, such as Emma, who has never before disclosed experiences may find that the initial telling of her account is in itself a “difference that makes a difference” (Bateson, 1972). The therapist’s reaction may be significantly different from the feared response anticipated by a child. Would I still like her and her family if such “bad” things had happened? In this case, Emma was able to return to the story several times in the retelling and in the sharing between herself, her mother, and me. The therapist in child-focused practice does not assume that a child necessarily requires to work through problems as in child psychoanalytic psychotherapy (Axline, 1969), or, for that matter, that the relationship with the therapist is the main medium for healing.

THE CHILD’S VOICE IN CHORUS

Whilst factors such as warmth, empathy, and attentive listening are important, the therapist is not expected to provide a therapeutic nursery-ground for the child’s growth. The wider angle of the systemic viewpoint is kept in focus. As mentioned above, the child is seen to be inextricably linked in a cradle of communication with significant others in his life, and in this sense the wider context provides the foreground rather than the background to the therapy. Individual work with a child is located within the wider context, in which the therapist acts as a link—sometimes coaching, sometimes persuading or educating, or giving advice, at all times concerned to consider himself as an inclusive part of this wider picture. The therapist/practitioner is partly observing and also contributing from the “inside”, listening to himself reflect on the overall picture of the child-family-therapy system. This demands a self-reflexive stance from the therapist, illustrated here in a quote from Brian Keenan’s book (1992) about his captivity in The Lebanon:

I decided to become my own self-observer—I would be the voyeur of myself. This strategy I employed for the rest of my time in captivity. I allowed myself to do and be and say and feel all the things that were in me but at the same time could stand outside, observing and attempting to understand, [p. 78]

THE TENSION BETWEEN UNDERSTANDING HOW THINGS ARE AND HOW THINGS OUGHT TO BE

The practitioner assumes that there is a systemic logic (no matter how “crazy”) to whatever actions or accounts are offered by family members, and that we should be mindful not to rush towards ideas of “what ought to be” the case for the family. While it is necessary and unavoidable to pay attention to those views, ideas, and suggestions that come to mind, we should endeavour to attend firstly to how things have come to be the way they are. This is not to suggest a passive non-interventionist stance for the practitioner, but it assumes a position of curiosity about how the child’s life has been shaped. No matter how crazy a situation appears to the therapist, it is still useful to think about how this came about, even though we may at the same time require to take immediate action if this is required, such as in child-protection cases.

POWER AND AUTHENTICITY

“Each of us faces the potential that our actions can do good or harm” (Inger & Inger, 1994). More openness in sharing thinking about therapeutic processes may help to demystify therapy and the therapist and reduce to some extent the power differential between practitioner and client. This is extremely important in working with children, where they nearly always feel less powerful and have less than an equal say in the therapeutic process. The therapist needs to be mindful of a child’s anxiety about coming to therapy and particularly about the dangers of therapeutic expertise (whether from a transparent or more opaque stance) that may lead young clients into conversations that they would later regret. Being more open does not, as Inger (1998) points out, always lead to benefits for the client:

… the act of sharing does not, ipso facto, prevent a therapist from using power and dominance in the therapeutic relationship. An opportunistic therapist may be skilled at sharing this pseudo personal as a power move. The personal can be fictional but presented as real to enhance therapeutic dominance. The act of sharing the personal in and of itself is not a leveller of hierarchy, particularly if the client interprets the personal statement of the therapist as a pseudo personal strategic technique.

In my own practice, it is important to allow a width of stances—from interventionist and relatively “emotionally closed”, to non-interventionist and relatively “open”—whilst working with clients. Just as the children may rightly keep some views private from our ears, the therapist also has a right to silence and private reflection.

CREATING A PLAYFUL DOMAIN

In attempting to create a safe-enough context for change to occur, children require to enter into a state of play (Winnicott, 1971). This is a domain in which alternative ideas and behaviours in relationships may be explored and experienced. Without playfulness in this sense, no change is likely to occur. Children, like adults, are unlikely to change if their views or their identity or their relationships are seen to be defined negatively. Establishing a playful domain requires the therapist to persist in building a picture of how things came to be the way they are—that is, the logic of the child and family’s ways of relating to one another. The onus is on the therapist to create a context in which the child and her family are valued, whilst allowing opportunities for problematic ideas and descriptions and behaviour to be drawn out and challenged. Coleman (1985) states: “No way of looking at things is too sacred to be reconsidered. No way of doing things is beyond improvement.” This refers to the need for therapists constantly to monitor and review the...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Acknowledgements
• Table of Contents
• Editors’ Foreword
• Foreword
• Introduction
• Chapter One A framework for child-focused practice
• Chapter Two The child in the therapeutic context: convening and consulting with the significant people
• Chapter Three Making a connection: the first encounter
• Chapter Four Child-focused questioning
• Chapter Five Playful dramas for serious problems
• Chapter Six Forms of writing in therapy with children
• Chapter Seven Preoccupying questions
• Chapter Eight Children’s views
• End notes
• Appendix
• References
• Index