Tools for Effective Therapy with Children and Families

A Solution-Focused Approach

Pamela K. King

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317296829
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Tools for Effective Therapy with Children and Families provides mental health professionals with step-by-step tools and strategies for effective therapeutic outcomes with children and their families. An integration of solution-focused brief therapy and play therapy, this groundbreaking book is uniquely suited to clinicians working with school-aged children and their parents. Tools for Effective Therapy with Children and Families uses clearly articulated and creative play activities to elicit conversations about solutions, successes, and collaborative goals with clients. Session transcripts and technique illustrations throughout the chapters allow clinicians to see the solution-focused approach in action.

BACKGROUND

Trust the family to know what they need.

Solution-focused brief therapy (SFBT), developed by Steve de Shazer, Insoo Kim Berg, and their colleagues at the Milwaukee Brief Family Therapy Center, positions clients as the experts on their lives, and therefore, as the experts on solutions that will work for them. We may have ideas about what will be helpful, but only they know whether something has helped or not, and only they know what their lives will look like when things are somehow better in the future. Therapy is future-focused and concerned with eliciting instances of the desired future already happening in the present. We assume that this future does not include the problem, or that the problem has been transformed somehow so that it is not problematic (de Shazer, Dolan, Korman, Trepper, McCollum, & Berg, 2007). Using solution-focused brief therapy with children is a good fit because children naturally think about the future rather than the past, are intrigued by the idea of miracles and wishes, and will happily focus on what they are doing right rather than what they are doing wrong (Berg & Steiner, 2003; Selekman, 1997). Additionally, SFBT facilitates collaborative, client-focused goal setting when working with families.

SFBT TENETS AND CHILDREN

There are many resources for learning the nuances of SFBT (Berg & Dolan, 2001; de Shazer, 1985; de Shazer et al., 2007; Ratner, George, & Iveson, 2012). There are a few texts that apply SFBT to children and families (e.g., Berg & Steiner, 2003; Ratner & Yusuf, 2015; Selekman, 1997, 2010), and still others that include children in case examples (De Jong & Berg, 2013; Lipchik, 2002; Nelson, 2010; Nelson & Thomas, 2007).

The professional literature on SFBT and children is present but sparse. This book aims to add to the scant literature integrating SFBT and child therapy and play therapy.

To begin our integration, let’s look at the basic tenets of SFBT (de Shazer, 1985; de Shazer et al., 2007) in light of working with children, and specifically with a blended family of six as an example.

If It Isn’t Broken, Don’t Fix It

Trust the family to know what they need. A blended family I worked with asked for help in reducing fights between the children. The family of six consisted of a Mom and her two kids and a Dad and his two kids. I learned that Dad was a widower; his two children had lost their mother to cancer. They were not asking for grief counseling; I made no assumptions about the impact this unfortunate event had on the children’s behavior or well-being.

If It Works, Do More of It

I learned that the four children sometimes had fun together and had even combined some of their toy collections. As we explored solutions I knew getting along was a skill they already had.

If It Doesn’t Work, Do Something Different

Mom expended lots of energy most mornings trying to get the kids up and going for school. She said she was tired of hollering up the stairs for them. She said the hollering didn’t work anyway; she would have to go upstairs and drag them out of bed, annoyed that the day was already off to a bad start. I asked her to describe an ideal morning. What will happen instead?

Small Steps Can Lead to Big Changes

The children liked the idea of mom making breakfast, part of her ideal morning, so the family made a plan to change their morning routine. They predicted how it might even improve their school and work days. At our next appointment we made a long list of all the ripple effects that their simple routine shift facilitated. Mom exclaimed there is even less fighting!

The Solution Is Not Necessarily Directly Related to the Problem

Purchasing alarm clocks and cooking pancakes, eggs, and other yummy breakfasts for anyone downstairs by 7:20 am really didn’t have a direct relationship to the children fighting.

The Language for Solution Development Is Different Than That Needed to Describe a Problem

In exploring what difference it would make to have these morning changes, parents and children were hopeful, even excited about future mornings. A discussion about the problem surely would have included negativity, blaming, and intractable problems.

No Problem Happens All of the Time; There Are Always Exceptions That Can Be Utilized

I learned that when the children had something they were looking forward to they were up and ready all by themselves. A recent example was a school ski day. The children were downstairs, dressed, with ski gear by the door and chattering happily.

The Future Is Both Created and Negotiable

The seven of us (four kids, two parents, and one therapist) had a lively collaborative discussion about their future. They designed the ideal morning, complete with playful illustrations on a giant whiteboard. I asked questions to elicit details and more details. When I saw them a week later, the mom and kids attended the session and described what was better. I asked if they knew if Dad noticed a difference. Mom laughed and said he’d have to be dead not to notice the difference.

LET’S PLAY

Drawing and writing on the whiteboard provided a playful way for each member of this family to be involved. The importance of play is well documented. The American Academy of Pediatrics reports that “Play is so important to optimal child development that it has been recognized by the United Nations High Commission for Human Rights as a right of every child” (Ginsburg, 2007, p. 1). Poverty, neighborhood violence, excessive screen time, reduced recess, and limited physical education, as well as a hurried and pressured lifestyle, often deprives children of the protective benefits of child-driven play (Elkind, 2007; Ginsburg, 2007). Richard Louv (2008), in Last Child in the Woods: Saving our Children from Nature Deficit Disorder, has amassed the literature supporting the position that nature-play and especially self-directed exploration and free play are vital to the physical and mental health and well-being of children and adults.

Fred Rogers, aka Mister Rogers, taught us that play is the way children learn to cope with life and prepare for adulthood. He said, “Play is often talked about as if it were a relief from serious learning, but for children, play is serious learning” (Moore, 2014, n.p.). The position of a favorite educational television personality parallels the research on child development and play. Play creates positive feelings between those who play and facilitates social, cognitive, physical, and relational skill development.

You can discover more about a person in an hour of play than in a year of conversation.

(Attributed to Plato, n.d.)

Play as a Therapeutic Tool

Using play in therapy is transtheoretical, just as using talk is transtheoretical. Therefore, play is a tool, and, like talk, is an important communication tool.

Play therapy is the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychological difficulties and achieve optimal growth and development.

(Association for Play Therapy Board, n.d.)

I read Dibs in Search of Self (Axline, 1964) in a high school psychology class. I was captivated by this idea of play therapy, which built on a desire that was present in me years earlier to somehow be helpful to kids who felt sad, lonely, or scared. Post-master’s degree, when I started attending conferences on play therapy, I was astonished to flashback on this book as I learned that its author, Dibs’ therapist, Virginia Axline, was in fact one of the pioneers of non-directive play therapy.

Non-directive play therapy is based on the assumption that children have within them the ability to solve their own problems. The therapist accepts and starts where the client is and exclusively follows their lead (Axline, 1947). The therapist in directive play therapy, in contrast, plays a much larger role in guiding the play: structuring the session, interpreting play themes, and guiding the child in the direction the therapist sees as most useful. Some play therapists are proponents of a rigid separation, directive or non-directive. I believe, as does Eliana Gil (1994), that the two approaches can be successfully integrated. A collaborative approach would have the child, parent, and therapist co-constructing the therapy conversation.

SYSTEMIC CONSIDERATIONS

Systems theory (von Bertalanffy, 1968) looks at the mutual influences of family members on each other, thus moving away from an ‘identified patient’ model and towards a way of understanding the problem and solution in the context of the system from where they emerge. SFBT is “based on some of the same interactional and systemic ideas as family therapy” (Berg, 1994, p. 9). Family play therapy is the convergence of play therapy and family systems. Therapy too often expects children to engage in adult conversation or ignores the children because they are developmentally incapable of adult conversation. A family play therapist, in contrast, “enters, and directs parents to enter, the world of children” (Gil, 1994, p. 37).

Play therapists who work exclusively with children may unwittingly be marginalizing parents and reducing their positions as experts and leaders on their own families. Parents play an important role in therapy and are a valuable resource for children. Of course there are times when it is not feasible, safe, or legal for parents to participate in therapy. There are times when family therapy is conducted without the child present. The needs of each family, their situation, their best hopes for therapy, as well as our clinical judgment, are all to be considered when deciding who will be present. When it is sa...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction
• 1 Background
• 2 H. Hello
• 3 O. Orientation Toward Solutions
• 4 P. Past and Present Exceptions
• 5 S. Scene 1: Future Play
• 6 C. Create a Scale
• 7 O. Optimizing Creativity
• 8 T. Trauma and Abuse Solutions
• 9 C. Collaboration: The Art of Playing Well with Others
• 10 H. Hope for Families
• Index