Core Principles of Assessment and Therapeutic Communication with Children, Parents and Families

Towards the Promotion of Child and Family Wellbeing

Ruth Schmidt Neven

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136896590
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Practitioners today are confronted by a bewildering array of therapies as 'cure alls.' This book provides an integrated approach to working with children, parents and families that can be applied by all professionals in a variety of settings. Informed by a psychodynamic perspective, it identifies how we can avoid pathologising the behaviour of children by instead considering:

• the meaning of behaviour as an important source of communication
• the commonality of all experience for children, parents and families
• the emotional milestones of development
• the core principles of assessment and therapeutic communication and how they are applied

Through the presentation of sound clinical evidence and research Core Principles of Assessment and Therapeutic Communication with Children, Parents and Families creates connections between clinical practice and community action and, as such, is essential reading for anyone working to promote child and family wellbeing.

Part I
Point of departure

Introduction

The rationale for the book—a return to core principles

The rationale for the book

This book attempts to provide an integrated approach to work with children, parents and families that can be applied by all professionals, working in a variety of different settings. It is concerned with instating the rightful place of the professional and practitioner, and with enriching and expanding their clinical and observational skills in the service of child and family mental health. The core philosophy of the book is that of identifying the commonality of all experience that underpins a wide range of presenting problems. This is as opposed to foreclosing on, and compartmentalizing, children young people and their parents, solely according to the identification of pathology. At a time when professionals and practitioners are confronted by a bewildering array of therapies as ‘cure-alls’, this book is intended to counter a fragmented approach to work with children, parents and families and the important people in their lives. Through its presentation of the core principles of assessment and therapeutic communication, the book highlights the following areas:

• The recognition that all behaviour has meaning and is a communication.

• The centrality of advocacy for the child and young person.

• Understanding and working with the parental and family context— how the child ‘speaks’ the family.

• Promoting a therapeutic process for children, parents and young people that provides containment and empowerment.

• Understanding the importance of the setting—working towards the implementation of a ‘therapeutic environment’.

• Taking care of ourselves as professionals.

• Working towards a broader conception of child and family wellbeing.

In asserting core principles of assessment and therapeutic communication, the main thrust of the book places the professional at the centre of this process and values and promotes practitioner skills from the inside out, rather than from the outside in. To this end, the book is informed by a psychodynamic perspective that integrates understanding about individual development, relational experience, family systems and organizational dynamics, and the impact these dynamic processes have on the provision of a therapeutic environment. Numerous examples are presented to illustrate how the core principles of assessment and therapeutic communication can be applied to working with children, young people and their families in clinical settings, as well as in the school, early childhood, health welfare and community settings. The book is intended for all professionals who work with children and families: doctors, psychologists, social workers, health visitors, teachers, community workers and allied health workers. It is also intended for people working at a managerial and policy level, in the hope that the approach contained in the book will inform how services may be conceptualized differently to promote child and family wellbeing.

Current challenges and a critique of contemporary child and family mental health practices

The book additionally presents a critique of those aspects of current child and family mental health practices that are not considered to be in the best interests of children and young people. Professionals are challenged as never before with the overwhelming pressure that emanates from government directives to address an increasing range of mental health and social problems. These pressures and demands take place in the context of the momentous shifts that have occurred within the contemporary emotional and social landscape of childhood and adolescence. These shifts have been propelled in part by the enormity of social change in the last half of the twentieth century, the most significant aspects of which have been changes to family life and parenting. These significant changes also include changes to women’s roles, as well as changes to our views of gender, sexuality and identity. External influences with respect to expanding technologies, economic fluctuations and changes in broader political alliances have also had a powerful impact.

A paradox and some current dilemmas

Whilst these changes have contributed in some areas to an advance in democratic ways of living and relating, and to embracing a wider more tolerant view of difference and relationships, it is paradoxical that this tolerance in many cases falls short with respect to the ways in which we conceptualize childhood and adolescence. In fact, child and adolescent behaviour at the present time is defined within increasingly narrow theoretical, clinical and research frameworks. When we take a historical view, we recognize that the history of childhood is littered with assumptions about the child’s congenital need for reform and improvement, and our era is no different in this respect (Zornado, 2001). Contemporary views of reform and improvement have led to our embracing the predominant paradigms of technology and bio-medical knowledge in the service of healing, helping or changing the child and young person. This is exemplified by a preoccupation with government targets, and with the increasing categorizing of child and adolescent difficulties.

Contemporary assumptions about the child’s and young person’s need for reform and improvement have further led to the elevation of a ‘scientific’ attitude to childhood that has spawned an unprecedented preoccupation with diagnosis, and with the identification of specific problems within the child. The twinning of this scientific attitude to childhood with the commitment to ‘evidence-based practice’ suggests the heralding of a new dawn. However, a critical examination of the rhetoric and the evidence suggests a considerable recycling of old assumptions that are more in keeping with practices of over half a century ago, the most concerning of which is the conflation of treatment with social control.

Adherence to a rigid instrumental vision of evidence-based practice ignores the experience of the professional on the ground, as indeed it ignores the lived experience of the child within their relational and family context, and that of the wider environment. There are three key outcomes that emerge from this reductionist approach to child and adolescent problems: the first is that these diagnoses focus on identifying deficit and pathology in the child; the second is that the diagnosis is concerned with an instrumental utilitarian outcome in terms of treating a distinct malfunction in the child or young person, and trying to eliminate it; the third is that the information and capacity possessed by the child, the young person and their parents is perceived as secondary to that of the professional.

A groundswell of concern amongst clinicians and researchers, which takes a critical stance on these issues, is represented by clinicians (Billington, 1996, 2006; Breggin and Breggin, 1994; Breggin, 1999; Timimi, 2002) and by community and research psychologists (Maton, 2000; Maton et al., 2006; Prilleltensky 2005; Fox et al., 2009), amongst others. The research findings and clinical experience of both groups indicates that, despite an unprecedented rate of ‘diagnosis’ of children and young people, the increase in psychosocial problems continues unabated. We may therefore infer that a preoccupation with the diagnosis of pathology in the child has not had the desired outcome. In fact, research and clinical evidence (Schmidt Neven, 2008) points to a position in which concern about the lack of progress in child and family mental health appears to go hand-in-hand with an increasingly decontextualized and fragmented view of children’s problems. In the place of the much-lauded ‘joined-up services’, for example, we find greater discontinuities in professional practice and provision of services than ever before. These discontinuities, in turn, appear to mirror the problems associated with a decontextualized, and deficit-oriented view of child and adolescent problems.

Promoting the best interests of the child and adolescent through promoting the best interests of the professional

The main theme of this book is that the best interests of the child are served by promoting the best interests of the professional, in the form of promoting their clinical skills and capacity as well as their organizational understanding. Current discontinuities in the provision of child, adolescent and family services reflect, at least in part, a lack of commitment to promoting these competencies in professionals who work directly with children, parents and young people. Moreover, there is a tendency to substitute professional skills with myriad programmes and ready-made packages of care that purport to address complex individual and family problems. These programmes, supported by governments intent on cost-saving, suggest an ‘outsourcing’ of services that overrides the importance of developing and nurturing professional skill in a variety of different settings. Furthermore, the programmes, many of which originate from countries other than those in which they are applied, generally come packaged with snappy euphemistic titles that belie the longstanding intergenerational deprivation of the client group who are their apparent beneficiaries. Typically, the programmes are carried out within an unrealistic time frame, and become discarded when they do not yield the hoped for results, only to be replaced by others.

One of the themes of this book is that child and adolescent services that are predicated largely on the provision of programmes, and that purport to address specifically identified pathologies and syndromes, not only fail children, adolescents and their families but also fail professionals. That is because professionals become deskilled and children, adolescents and their parents become silenced. This book attempts to redress this balance by demonstrating how the core principles of assessment and therapeutic communication are central, not only to all work with children, adolescents and their families, but also to promoting a broader conception of prevention and overall child and family wellbeing.

Chapter 1
Finding the meaning in communication

Setting the scene for work with children, young people and their parents—how the child ‘speaks’ the family

Introduction

This first chapter provides an introductory conceptual framework for carrying out assessment and therapeutic communication with children, parents and families. This work with children, parents and families should not be perceived as confined solely to clinical settings, but can take place in schools, social and community settings, hospitals, GP surgeries, health visiting, kindergartens, nurseries, child-care centres, residential centres and parent support services, as well as in many other places. The aim of this first chapter is to demonstrate that, in order to work effectively with children, parents and families, whatever the setting, it is essential to combine two key elements in our work; first, to recognize the meaning of child and adolescent behaviour within an individual, family and social context; and second, to advocate for the child within that family and social context. A therapeutic approach based on understanding the emotional and social world of the child, combined with child advocacy, is therefore perceived as not only inextricably linked but also essential to good practice.

As a precursor to any consideration of assessment and therapeutic communication, it is important, in our work with children, adolescents and their families, that we do not become blinded by the lights of our own therapeutic orientation and treatment modality. Thus, we need to avoid a schism in which, for example, children and young people become ‘divided up’ between proponents of a cognitive-behavioural approach versus a psychoanalytical approach. Our focus at all times needs to be on what is in the best interests of the child and young person. Regardless of our therapeutic orientation, the best interests of the child and young person are always served by commencing with an understanding of the meaning of their behaviour.

Linking understanding of the meaning of behaviour with child advocacy

The validation of behaviour through understanding its meaning has a strong advocacy function, because it enables us to view the child’s and young person’s behaviour, however challenging and annoying, as more than a noise in the system, something to be disposed of. Viewed as having meaning, the child’s and young person’s behaviour presents us with an important source of information that provides a pathway to understanding, as well as identifying a solution to the problem. The reason for this is that children and young people, through their behaviour, ‘speak their families’ and their important relationships. It is therefore part of the task of all professionals who work with children and young people to be in a position to understand and ‘decode’ this meaning in order to be more effective in their day-to-day work.

By recognizing that all behaviour has meaning, we respect the child and young person through validating their experience, and go further in not only listening to them but also learning from their communication.

The objective of this book, therefore, is to demonstrate how, regardless of the therapeutic orientation or setting, effective work with children young people and their parents is underpinned by creating linkages between the experience of the individual child and adolescent, the family system in which they operate, the organizational professional setting and the wider social and cultural environment. Thus, in order to be effective as practitioners, we need to widen the field of our inquiry rather than narrowing it down. In this regard a psychodynamic framework within which to explore assessment and therapeutic communication is particularly relevant, since it encompasses individual, interpersonal, systemic and organizational elements. A psychodynamic approach, as its name suggests, is also concerned with the underlying psychological and emotional aspects of behaviour, which are never static but are dynamic and constantly changing. The key elements of a psychodynamic approach may be described as follows:

• All behaviour has meaning and is always a communication between children and their parents and caregivers.

• The events surrounding our infancy and early childhood shape our future development.

• The child exists in the parent and the parent exists in the child.

• Behaviour is dynamic and changes all the time—it is not static.

• There is a constant tension and interplay between our inner world of thought and fantasy and our outer world.

• Our behaviour has covert as well as overt meaning.

• Play and dreams have an important place for both children and parents.

Behaviour as meaning making

For children and young people in particular, the meaning of their behaviour is closely linked to their developmental experience. Understanding behaviour as a communication which has meaning helps us to reframe it and avoid blame and recrimination. It also helps us to open up communication between children and parents, rather than close it down or take an adversarial approach. We start from the assumption that the childparent dialogue is the fundamental dialogue of life, creating the potential for mutuality, reciprocity and shared meaning. As we will see in the following chapter, it is predicated on a healthy infant-parent interaction, which is mutually transformative and promotes, simultaneously in the child and the parent, the capacity to ‘give voice’ and to ‘find one’s own voice’. That is why the most successful therapeutic outcomes in work with children also create transformative experiences for parents. Thus, professionals, in grasping the opportunity in the ‘here and now’ to reflect on the meaning of behaviour with both the children and their parents, help to promote insight in leaps and bounds. This has the enormous advantage of being able to actually influence the course of development for the child.

Recognizing the importance of the meaning of behaviour in particular enables us to move away from unhelpful foreclosing statements about children. Even the earliest stage of child development is not immune from this practice. The commonly used phrase ‘the terrible 2s’ is one such example. From this phrase we may ded...

Table of contents

• Contents
• Part I Point of departure
• Part II The clinical core
• Part III Application of core principles of assessment and therapeutic communication
• Bibliography
• Index