Some useful ideas on what to do and say in those difficult situations with children and families. More from our guest blogger Mark Donovan.
Children misbehave in session
Ideally you want the parent or carer to respond and set limits for their children, as this provides useful information about how they manage misbehaviour and set boundaries. It can be helpful at this point to say.
Please feel free to do what you do at home.
Please feel free to do what you normally do when they ….
You may, however, need to intervene if the child is doing something potentially dangerous. I will often use this as an opportunity to explain:
I can’t let you climb on the table/chair in case you hurt yourself, please get down
Then maybe redirect towards toys etc. Your directions to the child need to be firm but fair.
A child gets too physically close (sits on your lap etc.)
Again this is useful information about the child’s knowledge of social boundaries and/or ability to inhibit impulses. I usually remind the child: You don’t know me well enough to sit on my lap/hug me. Then redirect so it isn’t received as a punitive comment. Everyone in the family starts arguing or talking at once More useful information! Try to move from the particular content level to the general process level.
Is what is happening right now a good example of what happens at home?
I noticed that everyone wanted to get their point across – did you feel listened to when you did this?
What do you think might be happening?
What happens at home when…
A family member storms out of the room
You need to think about safety issues as a priority. You could ask the remaining family members if they want to follow them out. Family members will generally know whether this behaviour is part of a wider pattern and therefore perhaps less concerning, or whether it is out of character/more concerning. Often the person will return to the room, and rejoin the conversation that has continued during their absence. It is useful to explore this behaviour sometime after they have returned, so that you can all be clear about what happened, why, how it relates to other issues, and possibly then agreeing a new ‘rule’ for therapy sessions around leaving the room
Let’s have a think about how we could manage this if it happened again.
Different family members have different goals for therapy
This is the norm and your assessment session needs to help family members each to express what they view as problematic and what they would want to gain from therapy. There is often some common ground, and if not, deciding on what to focus on can be put back to the family similar to asking an individual client to prioritize identified problems or goals.
The parent or carer wants to know what their child told you in an individual session
Parents and carers are often curious about what their child has told you. I set up a ‘limited confidentiality’ understanding prior to seeing the young person individually in order to clarify expectations:
Before we meet up, I just want to let you know that what (child) and I discuss will be confidential or private between the two of us. We may decide at the end of our chat that it would be helpful to tell you (Mum/etc) about some of what we talk about. We can work this out as we go. If I’m concerned about your (child) safety or well-being, then I have to pass that on and I will then of course talk to you (parent/carer) about this. Do you have any questions about this?
The child discloses abuse
Therapy sessions can provide children at risk with an opportunity to talk to a safe adult about abuse issues – it is important that we provide this to young people by asking them in a neutral manner about possible abuse. If a child does disclose abuse you generally want to reinforce the child for doing this You’ve done well in telling me about this…these issues can be difficult to talk about. Your job is not to investigate the abuse; however you need to know enough information to know what you need to do next. Has the child told anyone else about this? Has there been a report to DoCS already? Is the child in a safe home environment? If the child is ‘at risk of harm’ then you have an obligation to pass this information onto DoCS as a mandatory reporter.
A young person discloses that they are using cannabis – do I tell the parents or carers?
Again the issue is potential risk. Is the cannabis use at a level that might constitute ‘risk of harm’ or ‘serious criminal activity’? Discuss such issues with the young person, and what you need to do to make sure that they are safe. With most young people you will want to routinely screen for risk issues such as use of drugs and alcohol, sexual activity and protection, self-harm, and excessive risk-taking behaviours. Adolescents are very sensitive to others’ judgements so be aware of any of how your beliefs and values influence your questions or responses.
By way of conclusion…remember that play is child’s work
Hopefully the information above provides a few tips for managing the tricky bits in family sessions. Children enjoy playing and having fun, as do we all really, so remember to break out of the usual inhibitions and get involved in play activities with them as much as possible. Provide some visual or concrete props to support what you are saying verbally. If you can make therapy fun and invite a child’s imaginative abilities, the problems will shrink before your eyes!