Counselling Children, Adolescents and Families

A Strengths-Based Approach

John Sharry

• Publisher: SAGE Publications Ltd
• Year: 2003
• Print ISBN: 9780761949510, 9780761949503
• eBook ISBN: 9781446236314
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`I recommend this book to anyone who lives or works with families, children or teenagers? - Nurturing Potential

`This is a valuable book, worth attention in every child and family service. My own agency has ordered a copy!? - Robert Cumming, Nurturing Potential

`John Sharry?s book is a jewel in the solution-focused literature. It is clearly and engagingly written, draws on a host of ideas from different therapeutic approaches and is packed with practical examples. There is no better book on strengths-based therapy with children and adolescents. Every team should have one? - Chris Iveson, Brief Therapy Practice

Counselling Children, Adolescents and Families describes an innovative approach to therapeutic work which builds on the strengths of children and their parents. As the author?s experience shows, helping clients to focus on potential solutions rather than problems can be a powerful means of engaging them in the therapeutic process, even in the most conflicting family circumstances. Harnessing the client?s personal, family and community resources in this way also helps counteract their feelings of powerlessness and the possibility of increasing reliance on professional services.

Part One outlines the basic principles of a solution-focused and strengths-based approach, tackling such thorny issues as how and when to use diagnosis. Part two describes creative applications of the approach, using groupwork, play-based activities and video feedback. Part Three, examines practical issues which arise in more ?difficult? cases, such as child abuse and suicidal teenagers and children.

This book is aimed at professionals and trainees in fields including social work, mental health, childcare, education, psychotherapy and counselling.

PART I

BASICS AND PRINCIPLES OF THE APPROACH

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1	Establishing the Context

On Childhood

For children, childhood is timeless. It’s always the present. Today is what they feel and when they say ‘When I will grow up…’ there is always an edge of disbelief – how could they be other than what they are?

Ian McEwan

There is always one moment in childhood when the door opens and lets in the future.

Graham Greene

On Parenthood

Becoming a parent brought me the greatest joy in my life, but also the greatest heartache.

A parent

My life completely changed when I became a parent. It was so hard because I wanted my old life back. It only became wonderful when I let go and went with the flow.

A parent

Working as a professional with families requires the ability to listen to and take on board different perspectives. The professional needs to be able to appreciate and see the world from a child or adolescent’s eyes as well as from those of their parents.

Childhood and adolescence are times of first encounters and intense experiences in the present. They are periods full of joy and sadness, excitement and fear as well as rapid growth and new learning. They are also critical times when certain events and relationships greatly impact individual lives and determine futures. To engage children and adolescents as professionals, we need to take time to appreciate their experience and to understand the world they move in, while recognising their relationships with their families.

When we engage with children we also engage with their parents and the other significant members of their families. To be effective we need to be sensitive to and appreciate the experience of being a parent in its ups and downs, its joys and sorrows. The lives of children and parents are so inextricably linked that we almost cannot help one without helping the other. Parents who bring their children to therapy also bring their own needs, concerns and wishes. If we help parents with their own concerns, then we also help their children, and if we help children to change positively, then we also help their parents who care for them. When therapy is well done, it is hopefully a moment in the life of a child and their family when the door opens and a ‘positive future is let in’ that benefits each person in the family.

Working effectively with families also involves appreciating and understanding the professional context from which we operate. As professionals we bring our own perspective, and that of our profession, to the therapeutic process. This includes our personal style and beliefs as workers, the theoretical models we subscribe to, the standing and context of the agency we work for and the values and goals of our profession as a whole. The more self-aware and self-reflexive we can be of the theoretical models we bring to our work and the professional context from which we operate (both their strengths and their weaknesses), the better we can help our clients.

In this spirit of self-reflexivity and transparency, this chapter describes the guiding principles and theoretical context of this book, attempting to locate them within the context of professional knowledge (see Box 1.1). The chapter also describes how these principles can contribute to working with children and families, taking into to account the different and inter-connected perspectives of parents, children and significant others, including concerned professionals.

Box 1.1 Theoretical context and guiding principles

• Social constructionist framework.
• Developing strengths-based practice.
• Towards inclusive, multi-systemic practice.
• Appreciating the professional context.

Social constructionist framework

Truth is not what we discover, but what we create.

Saint Exupery

Nothing is good or bad, but thinking makes it so.

Shakespeare

Assumptions can be like blinkers on a horse – they keep us from straying from the road, but they block our view of other routes and possibilities along the roadside.

Armand Eisen

The underpinning philosophy to this book is social constructionism (Gergen, 1999; Gergen and McNamee, 1992; Hoyt, 1998): notably that people construct rather than uncover their psychological and social realities. Human knowledge and meaning is not absolute or universal, but evolves within specific contexts and communities of people. In human affairs there are many different systems of knowledge that could be derived to explain events and to guide meaning, that equally fit within the limits of the physical world and boundaries of historical facts and events. Taking the particular case of psychological knowledge, this implies that the ideas, theories and models that we as therapists, counsellors and other professionals hold about our work with families are not absolute, but rather social constructions that have evolved over time as discourses within certain communities of professionals. They may or may not be helpful in our work with the clients we might meet and could be in need of re-thinking and re-negotiation as we face the specific experience of an individual child or family. This means that guiding therapeutic principles, such as the medical principle ‘that symptoms reveal underlying problems’ or the solution-focused therapy principle ‘that solutions can be created independent of original problems’, are not true or false, but rather may or may not be the most helpful in guiding the therapeutic experience towards a positive outcome. Similarly, therapeutic constructs such as the DSMIV (American Psychiatric Association, 1994) diagnostic category of ‘attention deficit disorder’ or the solution-focused category of a ‘visitor level of client motivation’ do not necessarily exist as entities, but simply are more or less helpful ways of describing common patterns across distinct clients and families.

Social constructionism is not a licence for ‘anything goes’, nor theoretical anarchy. All ideas are not of equal value, either in terms of effectiveness or ethical quality. As Alan Carr states:

Thus we can never ask if a particular diagnostic category (like DSM IV depression) or construct (like Minuchin’s triangulation) is really true. All we can say is that for the time being, distinctions entailed by these categories fit with observations made by communities of researchers and clinicians and are useful in understanding and managing particular problems. The challenge is to develop integrative models or methods for conceptualising clinical problems that closely fit with our scientist-practitioner community’s rigorous observations and requirements for workable and ethical solutions. (1999: xx)

Thus from a social constructionist perspective, we have a collective professional responsibility to ensure that our models are ethical to use and to conduct research to make sure that they are indeed beneficial to our clients.

The implications of social constructionism on the individual practice of therapists are quite profound. It means that when we engage in conversation with clients, we should be aware of the limits of our theories and conceptions. We should be prepared to revise them or to co-create better conceptions, should our models of the theories not fit with the unique experience of the clients in front of us. Frequently ‘stuckness’ in the therapeutic process stems from the therapist inadvertently holding on to a belief that is limiting progress or that does not fit with the client (see Case Example 6.4A in Chapter 6). Gillian Butler (1999) describes a systematic process whereby therapists, when faced by difficulty, can begin to deconstruct and analyse the therapeutic conversation to identify a disputed belief from their model that supports the difficulty, and then to be able to change this by drawing on another model. Social constructionism demands that we strive to be self-reflexive and self-critical. We are compelled to be theoretical-flexible and not to cling to ‘pet’ or favourite theories. For example, though solution-focused therapy is my model of choice, I strive to be flexible enough to abandon this approach if it does not work for a certain client. I remember one teenager who teased me, ‘Ah, don’t ask me another miracle question’ (his previous social worker was also trained as a solution-focused therapist), to which I responded, ‘What would you like me to ask about instead?’ He answered, ‘I just want to talk about how bad things are at the moment,’ and so I followed his preferred direction.

Thus from a social constructionist perspective, the therapeutic relationship is a collaborative one in which therapist and client co-construct meanings, understandings, goals and treatment plans within the therapeutic conversation, operating from their respective knowledge bases, with the therapist cognisant of psychological models and best therapeutic practice research and the client as expert in the details of his life. The aim is to construct helpful understandings that fit both with the unique experience of clients’ lives and the ‘best known’ psychological knowledge, and which satisfy ethical norms and broader societal expectations and which ultimately are of benefit to clients in achieving solutions to their problems.

Social constructionism and therapeutic conversation

Life should be more about holding questions than finding answers. The act of seeking an answer comes from a wish to make life, which is basically fluid, into something more certain and fixed. This often leads to rigidity, closed-mindedness, and intolerance. On the other hand, holding a question – exploring its many facets over time – puts us in touch with the mystery of life. Holding questions accustoms us to the ungraspable nature of life and enables us to understand things from a range of perspectives.

Thubten Chodron – on Buddhism.

From a social constructionist perspective, beliefs and meaning are mediated by language and constructed and perpetuated by the ongoing communications between people, whether these are in the form of individual conversations or collective communications such as writing, television or other media. Rather than providing us with a neutral description of reality, language in part creates and shapes reality. Put simply, how we talk about things influences how we feel, how we think and how we might act. Our beliefs, meanings and ideas are determined by the ‘stories’ we tell ourselves and each other.

In the context of therapy with families, this means that the ‘stories’ (and the underpinning beliefs) that children, parents and families tell about the problems that afflict them and the solutions that might help them are not absolute accounts, but ones that have evolved over time in the family and wider system. Coming to therapy is often about retelling stories in a different way that provides new perspectives, ideas and meaning which are more helpful for the children and family concerned. Like Chodron’s quote above, the therapeutic aim is to engage in a therapeutic dialogue that eschews prescribing rigid answers and beliefs, and instead ‘holds questions’ in order to help clients understand things from different perspectives. This process helps clients generate new constructive meanings and beliefs that lead to action and change. The aim is to move from narrow stories of problems and oppression to empowering stories of strength and hope and liberation, that fit equally well with the evidence of the clients’ lives.

Let us consider a concrete example of this process in therapeutic practice, where the mother is helped to construct a new understanding of her son and develop a new self-construct about her ability as a parent. A mother brought her six-year-old son to a child mental health clinic, due to her son’s behaviour problems. The mother believed that there was something ‘wrong’ with her son, because he was ‘so aggressive’ and that she must be a ‘bad parent’ for not being able to manage him. Through careful dialogue with the therapist, who explored how the mother coped with the problem and also her positive influence on her son, different meanings and beliefs were negotiated. By the end of the therapy, she came to ‘view’ her son differently, realising that he was a sensitive boy who needed extra attention and encouragement. This new understanding, and subsequent change, helped her evolve a more constructive self-belief about her parenting. As she explained it to me, ‘When I first came I felt a complete failure with my son. I felt I was responsible for his problems. What helped was realising that I wasn’t a bad parent, but a good parent trying to do my best, and to realise that I could help my son.’

Sometimes the beliefs that limit and cause problems for clients are located in society’s expectations that reflect a certain cultural and historical context. For example, 30 years ago a gay client presenting with depression at a psychiatric service would have been likely to experience a discourse that pathologised his lifestyle seeing it as a possible cause for his depression, whereas the same client presenting at a counselling service today would be more likely to have his lifestyle validated and affirmed. From a social constructionist perspective, the aim is to help clients understand the source of the ideas and beliefs that may define them as having a problem. For example, a teenager with eating problems may have a strong belief that she must be a certain weight or have a certain body shape. In therapeutic dialogue a strengths-based therapist may gently invite her to examine this belief and to consider its source in oppressive societal expectations. Through dialogue the therapist may help her to generate alternative beliefs and ideas (for example, that she can choose her own body image) that are more empowering to her to move forward. Groups can provide a powerful arena for this process to take place and this is the purpose of the Anti-Anorexia League (Grieves, 1998; Madigan, 1998). By bringing people affected by the same problems together, through sharing experience and strength, people can be assisted to generate new, more helpful ideas and beliefs, and then be empowered to challenge existing societal prejudices which reinforce the problem’s influence.

Social constructionism and multi-cultural practice

A social constructionist framework has much to contribute to non-discriminatory multi-cultural practice. The challenge is for therapists to understand and appreciate the cultural factors that shape the lives of the clients they meet, while being self-aware of their own personal cultural identity and how this impacts their therapeutic practice. In addition, therapists are obliged to be aware of the societal forces and prejudices that may contribute to clients problems as well as the specific cultural context of the therapeutic model which is inherent in their own professional practice. This may seem like a tall order, but is the mark of a self-critical reflexive professional. Indeed, this is the reason why the practice of regular supervision and consultation that provides an arena to tease out these issues is universally seen as central (across all accrediting bodies) to good professional practice.

Case Example 1.1 The soft western way

A five-year-old boy whose parents were refugees in Ireland was referred to a child mental health service due to behaviour problems and a concern that he was displaying autistic type behaviour. During the first session the father reported his attempts to control his son using physical discipline. The therapist noticed her own feelings of unease at the father’s description, and wondered whether she should challenge the father’s use of physi...

Table of contents

• Cover Page
• About the Author
• Title
• Copyright
• Dedication
• Contents
• Foreword by Scott D. Miller
• Preface
• Acknowledgements
• Part I: Basics and Principles of the Approach
• Part II: Specific Solutions and Applications
• Part III: Some Challenging Contexts
• Epilogue
• References
• Index