Linking Parents to Play Therapy

A Practical Guide with Applications, Interventions, and Case Studies

Deborah Killough-McGuire, Donald E. McGuire

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135058210
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Linking Parents to Play Therapy is a practical guide containing essential information for play therapists. It includes coverage of legal and medical issues, pragmatic assignments for parents, guidelines for working with angry and resistant parents, a listing of state protective and advocacy agencies, and tips for working with managed care. Combining theoretical understanding with a variety of techniques, this book makes working with parents possible, practical, and productive.

1

CHAPTER

Initial Contact with Parents

Beginnings are very delicate times—young plants are easily uprooted. The epitome of a delicate beginning is a child attending the first day of kindergarten. The kindergartner is supposed to separate from his or her parents, go into a building he or she has never seen before, and bond with an adult stranger. Parents will have various expectations for their child on this very, very delicate day. Many kindergartners are expected to gracefully and happily run inside, learn important things, and have (a little) fun. The various children will differ in their expectations, as well. Some will be going to school with friends; some will not know any other children. Of a certainty, their expectations will be colored by their imaginations, and influenced by explanations and stories from their parents and others. Very likely, children will be wide-eyed, hopeful, apprehensive, curious, scared, interested, and incredibly off-balance. In a perfect world, they would quickly begin to experience numerous small, positive events (i.e., another child’s attentive smile, a friendly teacher, or a good friend in the same class).

So it is with the beginning of a child’s play therapy. Balance is sought; attention is focused on minutiae; trust is being established. Ideally, a solid foundation is being built, along with a therapeutic relationship. Parents who make the decision to seek therapy services for their children will most likely experience many “new beginning” emotions themselves. As Bromfield (1992) states, “entrusting your child to any caretaker is hard. Entrusting your child to a therapist, and to the vulnerability of treatment, is even harder” (p. 46).

The therapist must keep this in mind and attempt to provide small, positive experiences to encourage parents and help them to believe in their decision. If a general attitude of success and confidence in the therapist can be cultivated, parents will be more likely to pursue therapy for their children. Also, the therapist’s belief in the parents as a positive force in their child’s life will encourage the parents to be involved and supportive throughout the therapy process.

Initial Contact

Initial contact with parents is very significant in the therapy experience. The original telephone call sets the tone for the relationship between the therapist and the parents. During the original call to make an appointment, parents may attempt to tell the therapist the “whole story” about their child. A multitude of details may be provided about the child’s problems and the parents’ reactions to the indicated unacceptable behaviors. The therapist’s first goal is to listen. This may be the first contact parents have ever made with a mental health professional. Inherently, contacting a therapist makes parents more vulnerable in the context of admitting the need for help. Unfortunately, and erroneously, this implies to many people a general lack of adequacy as parents.

During the original call, the therapist should be empathic with the parent. According to Carkhuff (1969), “empathy is the key ingredient of helping. Its explicit communication, particularly during early phases of helping, is critical” (p. 172). Making contact with someone’s feelings is the best means of helping that person feel understood—a basic element in building rapport. Sensitivity to the parents’ feelings (especially vulnerability and apprehension) can be pivotal in their decision to obtain therapy for their child and, subsequently, to participate in the therapy process themselves to increase the probability of successful outcomes for their child. If the parents’ initial contact is qualified by insensitivity, lack of understanding, impatience, or a lack of acceptance on the part of the therapist, the quest may be abandoned by the parents. The parents’ perception of the therapist’s message is more important than the actual words or intended message. Parents need to believe that it is actually possible to improve the present situation. At this point, parents can begin to discover, and believe in, their own ability to make positive modifications in their child’s life. It is tremendously helpful if the parents believe that contacting the therapist was a good idea. The therapist must try to help parents feel understood, cared about, validated, and empowered.

The initial telephone contact is not the time to give advice to parents regarding their child. There has not yet been sufficient time or contact to build a deep, trusting relationship between the therapist and parents, and the risk of offending the parents is great, especially if the parents do not like the suggestions. Giving excessive advice during the original call is very easy to do because most parents directly ask for, or at least implicitly expect, immediate information on how to deal with their problem. However, the therapist risks giving advice that may not be helpful to the parents or the child. Since the therapist has neither met nor observed the parents or children, enough information could not have been collected during this one phone call to allow the therapist the chance to give appropriate advice. At this time, it is most important to listen, support the parents’ initiative in calling, and encourage them in taking the next step—whether it involves continuing with therapy, following up on a referral, or pursuing some other course of action.

Making a Referral

Sometimes the only appropriate advice that can be given during the initial contact involves making a referral. Specific disorders, behaviors, handicaps, and challenges may require specialized facilities, training, or certification. Certain services may be requested that the therapist is not able or not qualified to provide. It is very possible that a therapist is uncomfortable with certain clients or issues. This does not manifest a weakness or lack of character on the part of the therapist but, rather, a healthy awareness of one’s professional boundaries. Being aware of and comfortable with one’s own boundaries, allows a greater opportunity for positive outcomes to the therapy process. As an example, one therapist may be uncomfortable with parents who have physically or sexually abused their children. Other therapists may find it difficult to work with aggressive, angry, or culturally different parents. The therapist needs to become aware of personal limitations and boundaries; without this awareness, it is unlikely that the therapist can provide safe and effective help or support for parents and children.

In such cases, a referral may be the only ethical option. To locate and recommend appropriate treatment and support for clients requiring referrals, the therapist should be acquainted with other professionals and services in the community. These resources can be an extremely valuable starting point for clients. If a referral is not necessary, setting the first appointment can be addressed.

Setting the First Appointment

The therapist should request that parents or primary caregivers attend the first appointment, without the child. Many different family structures are common in today’s society. When possible, however, both parents should be included in the initial session (James, 1997). Meeting with both parents can provide a wealth of information about the family dynamics, how the parents feel about their children, their individual and collective perceptions about the children, and how the parents relate to one another (Copley, Ferryan, & O’Neill, 1987). Valuable information can be learned about consistencies and inconsistencies in parenting styles. For example, whether or not one parent is more strict about a child’s table manners than the other is therapeutic material that is more likely to present itself when both parents are present in the session. Likewise, any covert resistance about coming to therapy on the part of either or both of the parents is more likely to be evident with both parents present. These seemingly small pieces of information, taken together, can tell the therapist a great deal about the family atmosphere surrounding the children.

The Intake Interview

The primary objectives of the first session are to gather data about the reason for the referral, the presenting problem, and changes related to the presenting problem (Kottman, 1995; Norton & Norton, 1997). In addition, winning the parents over to the play therapy process is vastly more important. This is done through rapport building, not interrogation. Information regarding how the parents interact, the types of discipline they use with their children, parents’ enjoyment of their children, how the parents perceive the problems of the family, and how they perceive the problems of their children is often gathered by passive observation (Greenspan, 1991). Parents who feel interrogated prior to the establishment of a trusting relationship often feel resentment toward the therapist and tend to prematurely terminate the therapy process. Being sensitive and responsive to the emotional dynamics underlying the parents’ reactions to each other and to the child’s difficulties is a more valuable strategy at this point than strict information gathering (Guerney, Guerney, & Stover, 1972).

Reflecting the Feelings of Parents

Therapists should start intake sessions by reflecting the feelings of the parents. For example, the therapist might say, “You seem concerned about what might happen with your child.” This facilitates the process of identifying parents’ feelings. Touching the parents’ feelings and accepting those feelings is the most powerful accomplishment a therapist can make toward building rapport and trust. The value of empathy must not be overlooked. Reflecting and empathizing are two foundational skills and two very powerful tools of the therapist.

Consider the following example: A five-year-old boy was referred to therapy because his parents caught him “playing doctor” with another five-year-old boy. Both parents attended the first session. The father was noticeably angry and agitated, his arms were crossed, he was frowning, and he kept tapping his foot. He repeatedly complained that his son needed more severe discipline, attesting that the mother was much too lenient. He insisted that his son should now be kept under constant surveillance, with at least one parent accompanying the child during all of his waking hours.

Realizing that some kind of fear is beneath all anger, the therapist chose not to focus on the father’s anger or on appropriate styles of discipline. The therapist’s response was, “I can see this has caused you great concern. In fact, you’re so concerned that you’re willing to go to great lengths to make sure this doesn’t happen again. I’m wondering—what are you afraid might happen? What’s the worst possible thing that could happen if your son plays doctor?”

The father stared at the floor, clenching his hands. A tear rolled down his cheek as he whispered, “I’m afraid he might be gay.” Because of this information from the father, the therapist was able to empathize about his fears and reassure him that playing doctor was not an indicator that his son would be gay. If the therapist’s response had been based solely upon the information that the father was saying, an opportunity to understand the true issue would have been missed. Most likely, further contact would not have been reached, and the father would have been less likely to trust and hear the therapist. Through the therapist’s reflecting and attempting to touch the father’s true feelings, the father became more relaxed. Feelings were validated, and the father felt accepted by the therapist. Rapport was increased, and the father began to genuinely trust the therapist. Both the father and therapist had increased awareness about what was influencing the father’s reactions, behaviors, and feelings.

Again, the extended outcome of this rapport-building is a greater probability of the father’s continued involvement in the therapy process. This kind of contact and trust with the therapist helps the parent gain self-acceptance, self-awareness, and self-confidence as a parent and as a person. The impact of the experience can have long-lasting benefits for the parent, as well as for the child-client and other family members.

Clarifying Expressions Used by Parents

The therapist should ask parents to describe or explain the phrases and words that they use, especially those regarding the child. As each person tends to have definitions and understanding of words and phrases pertinent to one’s own experiences, the therapist’s understanding of the parents’ phrases used to describe the child is particularly vital. Expressions such as “aggressive” or “getting into trouble at school” will have different meanings for different people. Ask parents to be specific.

For example, if a parent says, “My daughter Susie is biting,” then the therapist might need to ask, “Did Susie bite one child last week, or does she bite several children everyday?” If the parent reports, “Jason is getting into trouble at school,” the therapist should clarify this and possibly ask, “When Jason is getting into trouble, is he talking defiantly to the teacher, not finishing his work, or something else?”

Other words can also carry a variety of definitions. For example, the definition of respect is often confused with the definition of obey. The expression “respect your elders” often has a lot to do with obedience, but little to do with respect. Another example is the parent who made several references to his “midwife”; upon request, he clarified the term as describing his live-in girlfriend. It is often necessary to ask parents about the meanings of their expressions; a clear understanding of parents is imperative. “What does that mean to you?” may frequently need to be asked. Through clarification of phrases and words used by parents, the therapist will learn more about the parents’ perceptions of their child’s problems. The more the therapist understands about the child, the more help he or she will be to the parents, and, of course, to the child. Therefore, therapists need not be shy about asking for clarification; this shows parents that the therapist cares enough about them to pay attention and strive to understand (Greenspan, 1991). If parents see the therapist putting forth effort on their behalf, it often inspires them to put forth more effort on behalf of their children.

Asking for clarification also models appropriate, respectful communication for parents. Appropriate communication is the key to understanding, and respect is the key to appropriate communication. Taken together, these are essential ingredients of healthy relationships. Hopefully, parents will increase their use of appropriate communication skills with their children.

Gathering Information

Gathering specific information is important, as are the techniques of reflecting and clarifying. There is no universal pattern or formula governing therapist responses. The therapist must use his or her professional judgment to sensitively intersperse specific questions among reflections, when additional information is needed. Many parents feel intimidated by direct, face-to-face questioning, especially during the early stages of building the therapeutic relationship.

Question, Response, Reflect Cycle

As the therapeutic relationship and rapport are developing, it may be possible for the therapist to focus more attention on gathering information. After parents begin to sense that the therapist can be trusted, they are more responsive to helping the helper. Typically, it is appropriate for the therapist to initiate this process, and most parents will be very willing to cooperate in helping the therapist. An example of how a therapist might begin is, “I want to hear more about what comes to mind for you. At this point, however, I’d like to ask several questions to help me build a better understanding of the total picture.” This type of request by the therapist will usually result in willing cooperation by parents. The therapist must remember to quickly reflect parents’ feelings that arise during this process. Gently, with sensitivity to the parents, the therapist can return to the previous question or ask another. This cycle of question–response–reflect can accumulate significant amounts of meaningful information to the therapist while trust and rapport continue to be built. It should be remembered that this technique is suggested for information gathering, primarily in the early stages of therapy. It is also a method of clarifying the therapist’s understanding.

Client Questionnaire

A valuable source of information is the client questionnaire. Properly constructed and administered, it can be less intimidating to parents than face-to-face questioning, thereby supplying information that would otherwise be difficult to obtain. The questionnaire can be completed in the therapist’s office, in the waiting room during the child’s first session, or at home. Those taken home are often lost and never completed. If the questionnaire is user-friendly, it can be completed along with the other intake and consent forms in the initial meeting with the parents. During early sessions, a completed questionnaire can be a useful reference, and relevant notes can be added by the the...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• About the Authors
• Acknowledgments
• Foreword
• Preface
• 1 Initial Contact with Parents
• 2 Developmental Issues
• 3 Legal and Ethical Issues of Therapy
• 4 Medical Issues in Therapy
• 5 Parent Profiles
• 6 Working With Angry, Resistant Parents
• 7 Parent and Therapist Meetings
• 8 General Homework Assignments for Parents
• 9 Special Issues
• 10 Incorporating Brief Therapy and Managed Care
• Appendix A: Sample Professional Disclosure Statement and Informed Consent
• Appendix B: Sample Play Therapy Parent Intake Session Checklist
• Appendix C: Sample Child Client Intake Form and Authorization for Treatment
• Appendix D: Managed Care Format
• Appendix E: National and State Protective Services and Advocacy Agencies
• Appendix F: Parenting Manual: Essential Skills and Practical Suggestions
• References
• Index