Children in Family Therapy

Treatment and Training

Joan J Zilbach

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781317736127
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Here is one of the few books that focuses explicitly on including children in family therapy sessions. The contributors to this enlightening volume are seasoned family therapists of various theoretical perspectives who work in a variety of settings and include children of all ages in their therapy practices. Recognizing that many practicing therapists are not comfortable including children, they address the treatment and training issues and provide extensive case studies and fascinating background material on their own early involvement in the practice. Children in Family Therapy will be extremely valuable to family therapists of all levels of experience. For the veterans, the cases that are different in approach from their own will be particularly informative. Less experienced therapists will find here a basic introduction and a clear description of the range of clinical practice in family therapy.

TREATMENT

Interviewing Families with Children: Guidelines and Suggestions

Richard Chasin

INTRODUCTION

One of the great common failings in the current practice of child therapy and of family therapy is that in neither case is there sufficient use of whole family sessions including children. Child therapists tend to interview children without adults present and family therapists often leave out children, especially young ones. A major reason for these exclusions is that little effort has been made to develop the techniques necessary for conducting joint sessions.

Numerous authors have sung the praises of whole family sessions for enriching the therapist’s understanding of both child and family, and also as a setting in which intervention can be particularly effective (Ackerman, 1966; Zilbach, Bergel & Gass; 1972; Bloch, 1976). But the literature is relatively scant on the subject of techniques which might be useful when the therapist simultaneously interviews family members at different levels of development (Villeneuve, 1979; Keith, 1986; Zilbach, 1986, Chasen & White, 1989).

In this paper I shall outline briefly some considerations about the use of play and about the office set-up, and then offer general guidelines and specific suggestions to help therapists keep children in their families during assessment and treatment sessions.

PLAY AND PLAYTHINGS

Any interviewer who wishes to fully engage young children should be prepared to use play as a medium of communication. Play does not necessarily involve toys. In fact, no equipment is required for role-playing, which is the most flexible, revealing and impactful play technique in the therapist’s treasure chest. When toys are made available they should be ones that an adult can comfortably use and should lend themselves to play which is easy to interpret. It may be fun for a three-year old to spill marbles over the floor and kick them around, but the grown-ups will probably not join in or learn much from the child’s preference for dispersing the red ones rather than the green ones. By contrast, hand-puppets, dolls, and crayon drawings foster play that is more intelligible and collaborative for people of all ages.

In family sessions, the therapist will usually be more directive than in individual play therapy sessions. He or she will often have to decide when to play, what to play, how to play, who joins in, and who watches. Even with these decisions in the therapist’s hands there will be plenty of room for spontaneity. If the therapist is too non-directive, impulsive families will become chaotic and repressed ones will freeze in the face of so much freedom.

THE INTERVIEWING ROOM

Offices that are specifically set up either for adults or for children are not necessarily good spaces in which to conduct whole family interviews. Spaces designed for grown-ups will not be sufficiently child-proofed and the child may feel alienated by the formal furnishings and lack of toys. The parents and therapist will be nervous about elaborate equipment or delicate art objects that may be within the reach of naturally curious children. Settings which are suitable for children often feel uncomfortable to adults, who may be cramped in small chairs and menaced by the presence of paints and clay that could soil the fine clothing they have worn to impress the therapist.

The best workspace is relatively bare, and contains only moveable chairs and a few cushions. Initially, most of the toys and equipment should be kept in cabinets and drawers. The therapist decides which ones to bring into the room, and when. I have described elsewhere an ideal arrangement of space and facilities which allows observation from behind a one-way mirror, has a time-out space, and provides play and talk areas which may be joined together or separated from each other (Chasin, 1981).

THE EVALUATION PROCESS

When a family is being assessed, a child is usually the index case. In such instances, the least complicated way to proceed is for the therapist first to interview the parents and/or other caretakers in order to get oriented and to gather information about the membership and workings of the household, the development of the children, the families of origin, the relationship among the adults responsible for day-to-day care, the context in which the present problems arose and the solutions which have been attempted. Some of this data is best discussed without the children present. It is prudent to spare children the tedium of insurance data or the burden of learning details of their parents’ sexual life. However, any information gathered in the parent session which is appropriate and interesting for children can be addressed again when the whole family meets together.

Many family therapists prefer to see the whole family together first, with no prior parental interview. While such an approach has the advantages of fostering an unbiased stance and a clear focus on the family unit, it can be risky, especially for a therapist inexperienced in either family or child work. The therapist may feel forced to choose between attending to the children while ignoring the adults, or getting complex background information from the adults, thus provoking disruptive behavior from the children. By contrast, the therapist who interviews the parents first has already gathered considerable information and begun to join with them. This therapist can afford to concentrate more on the children in the full family session, because the parents will not feel neglected. He or she will also be prepared by the parent session for some of the special problems and opportunities that will present themselves when the whole family is interviewed.

The following procedure is useful for whole family sessions during the assessment process (Chasin, Roth & Bograd, 1989). Some of these suggestions will be irrelevant or inadequate for specific cases. However, the recommended steps can serve as a guide, especially for those readers who have not yet developed an approach of their own.

Step 1: The Therapist Explains the Reason for the Family Meeting

I have seen experienced therapists begin interviews by asking the children, “What did your parents tell you this meeting was about?” or “Why do you think we are here?” Frequently parents have not prepared children for the meeting and sometimes they have even lied to them about it. In those cases, the session gets off to an awkward start with the parents confronted by their incompetence or dishonesty.

It is better for the therapist to begin the session by introducing himself or herself and asking the family members how they would like to be addressed. Once introductions are over, the therapist takes responsibility for the session by immediately telling the family members why he or she has assembled everyone and what it is that they can expect. This requires the therapist to disclose the gist of prior contacts with the parents and other informants and to indicate the purpose of the whole family session.

In this opening step, the content that is shared and the simple phrasing that is used by the therapist should model respectful candor and reflect the therapist’s wish that all members of the family understand and participate in the meeting. A conscious effort should be made throughout the sessions to ensure that the language and sentence structure used is easily comprehended by children and adults and that each member of the group is treated with equal respect.

Therapist (to each parent and then to each child): What name would you like me to call you?

Family members reply: (Mother is Ellen. Father, Dan. Children, Eric, seven and Susie, five)

Therapist (to everyone): My name is Dr. Chasin. You may call me Dick if you would like to. My work is to help families find ways to make things better for themselves when everything is not all right. Ellen and Dan called me on the phone the other day and told me that you have a good family but that everyone in the family was unhappy in some way. They said Susie has been sad and has scary dreams. They told me that her teacher says she is unhappy in school, too. When I heard all that, I asked Dan and Ellen to visit me here in this room.

Therapist (continuing): We met a few days ago and talked about Susie. They said they were also a little worried about Eric who seems angry a lot. They even said they themselves disagreed a lot with each other and fought sometimes. After we talked I told them that I would like to meet with everyone in the family. What we are going to do here today is to talk and play so that you can find new ways for the family to be happier.

Step 2: Therapist Sets the Rules for the Meeting

It can be terrifying for anyone to play a game without knowing the rules, particularly if the stakes are high. Yet many therapists will conduct family meetings without having established even the most rudimentary contract. Whether or not a contract has been made in a prior parent session (and I would hope it has), the therapist should explicitly set out rules for the whole family interview. At the minimum, it is wise to make agreements about non-coercion, safety, discipline, and use of the space and equipment.

Therapist (to everyone): Before we begin I want to tell you the rules. First, you should not answer a question or do anything I ask unless you feel ready to do it. If you do riot feel ready to answer a question or do something I ask, just don’t do it and it will be all right. If you wish, you can tell me that you are not ready by saying the word “pass” or “not now” or something like that.

The second rule is that Dan and Ellen are responsible for discipline. If Eric or Susie does something that is not allowed at home, then Ellen and Dan should do here just what they would do at home.

The third rule is that we all try to make sure that everyone is safe. If somebody does something that might cause a cut or a bruise, everyone here should help to stop it from happening. The last rule is that I decide what toys we use and when we use them.

After the rules are stated, the therapist makes sure they are understood and are agreed on by everyone. In some cases, the therapist may need to make agreements about other matters, such as confidentiality and videotaping. It is indeed a challenge to establish boundaries and define expectations briefly enough not to exhaust the patience of the family but clearly enough so that the rules are understood by everyone who can possibly comprehend them.

Without rules the family may experience iatrogenic anxiety and their behavior can be misleading. I have seen children so badgered by a parent to “answer the doctor’s question” that the doctor regrets ever having asked it. With the non-coercion or “pass” rule in place, the therapist can say, “Your son has just passed. Thank you for trying to help me but it is my problem, not yours. I need to think of questions he is ready to answer.”

Step 3: Joining

After the rules are established, the therapist can begin to interact more extensively with the family. The word “joining” rather than “alliance building” has been used by family therapists for this early period of exchange because the therapist does not simply ally, but temporarily becomes part of the family or, more precisely, becomes a member of a new system, the therapist-family system. While many therapists tailor their joining methods to each individual family, I almost always join by asking family members to tell me their strengths. By always using the same approach, I learn a great deal from families right away because I have a yardstick of extensive comparable experience to apply. Furthermore, this method is almost always agreeable to families, and it starts the session off on a distinctly positive note.

Therapist (to everyone): If I am going to help you find a way to figure out how to make things better, I first need to know what power, strength and ability you all have. I’ll ask each of you to tell us about something that you are good at doing, something that you know how to do and are proud about. I’d like to start with Eric.

Eric: I have good friends.

Therapist: What is it about you that makes it possible for you to have good friends?

Eric: Kids like me. I don’t tell them lies and junk.

The father might mention that he works hard and supports his family no matter what. Mother might indicate that she too is a hard worker and that she protects her children. The daughter might say she is nice, that she is no trouble to anyone.

The therapist continues until each of the family members has described two or three positive character elements. Young children often interpret this inquiry as referring to things they like, rather than to abilities. However, for anything a child likes, the therapist can suggest a skill that such a preference reflects. When this mode of joining is used, the family is relieved that the therapist is not dragging out the worst problems immediately. Indeed, the family’s morale is strengthened by discussing its strengths. In multi-problem families with poor self-esteem, the members may expect disrespectful treatment from therapists. They are sometimes deeply moved when a therapist is interested in celebrating their strengths.

Step 4: Exploration of the Family’s Goals and Problems

No aspect of an evaluation interview is more important than the manner of the therapist’s exploration of goals and problems. Each school of therapy, indeed each clinician, charts a different course and employs a different style for this investigation. My own approach is eclectic, borrowing ideas and techniques from various methods to achieve results basic to a good assessment: a therapist with sound information upon which to base recommendations and family members who have not only learned something from the evaluation process, but who also feel good enough about it that they w...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• Introduction and Overview
• Treatment
• Training
• Resources