Children and young people’s engagement and disengagement, adherence and non-adherence, compliance and non-compliance in family therapy has important implications for services (O’Reilly & Parker, 2012). Although parents can physically bring their child to therapy, this does not guarantee engagement or commitment to work for change. Strickland-Clark, Campbell, and Dallos (2000) note that there has been little research describing children’s experience of family therapy, or how therapists achieve a therapeutic relationship or sense of connection with children. This is surprising given one of the goals of family therapy is to reduce the focus on the child as ‘the problem’, and encourage an understanding of the child’s perspective. If, as health professionals, we base our therapeutic decisions on input from parents alone, we risk missing the issues that matter to the child (Hawley & Weisz, 2003).

When researchers have interviewed children following family therapy sessions, they have found that they want to be included in therapy in meaningful ways (O’Reilly, 2006, 2008). However, children also expect to be judged and reprimanded during sessions, speak less than their parents, and are interrupted more frequently (O’Reilly, 2006, 2008; Strickland-Clark et al. 2000). For example, Cederborg (1997) analysed videotaped family therapy sessions and found that children spoke only 3.5% of the words during session, and interacted verbally and nonverbally only 14% of the time. In other words, they were “not talked to, but rather talked about” (p. 37). As the child listens to negative descriptions of themselves without recourse to contribute their own perspective, this can have a potentially damaging impact (Parker & O’Reilly, 2012).

Despite the fact that the greater the involvement of the child the greater the therapeutic change, family therapists often report that the type of training they receive is simply not adequate to prepare them to work effectively. (Chu & Kendall, 2004; Sori, Maucieri, Bregar, & Kendrick, 2015). They note that they require training that emphasises practical skills, such as how to talk to children, how to engage them and their parents emotionally, and how to facilitate family interactions (Sori et al., 2015). At Bower Place, we have extensive experience engaging and including children in the therapeutic process. Our practitioners and trainers have worked with children in public mental health systems, child protection and family therapy, and can suggest a range of therapeutic techniques that enable children to become active and enthusiastic participants in the process of change. If you would like more information about how you can more effectively include children in your current clinical work, please register for our workshop outlined below entitled ‘Bringing the Young Person’s Voice into Therapy’, or contact Carly Case on 08 8221 6066 or via email on info@bowerplace.com.au.

References

Cederborg, A. D. (1997). Young children’s participation in family therapy talk. American Journal of Family Therapy, 15, 18–38.
Chu, B., & Kendall, P. (2004). Positive associations of child involvement and treatment outcome within a manual-based cognitive behavioral treatment with anxiety. Journal of Consulting and Clinical Psychology, 72, 821–829.

Hawley, K. M., & Weisz, J. R. (2003). Child, parent and therapist (dis) agreement on target problems in outpatient therapy: The therapist’s dilemma and its implications. Journal of Consulting and Clinical Psychology, 71(1), 62.
O’Reilly, M. (2006). Should children be seen and not heard? An examination of how children’s interruptions are treated in family therapy. Discourse Studies, 8(4), 549–566.
O’Reilly, M. (2008). ‘What value is there in children’s talk?’ Investigating family therapist’s interruptions of parents and children during the therapeutic process. Journal of Pragmatics, 40, 507–524.
O’Reilly, M., & Parker, N. (2013). You can take a horse to water but you can’t make it drink’: Exploring children’s engagement and resistance in family therapy. Contemporary Family Therapy, 35(3), 491-507.

Parker, N., & O’Reilly, M. (2012). Gossiping’ as a social action in family therapy: The pseudo-absence and pseudo-presence of children. Discourse Studies, 14(4), 18-29.

Sori, C. F., Maucieri, L., Bregar, C., & Kendrick, A. (2015). Training graduate students to work with children and families: A content analysis of students’ perceptions of a child-focused course. The Family Journal, 23(4), 427-434.

Strickland‐Clark, L., Campbell, D., & Dallos, R. (2000). Children’s and adolescent’s views on family therapy. Journal of Family Therapy, 22(3), 324-341.