Therapy and Children

An appointment for a 5-year-old child is usually assumed to include a parent or caregiver. When a child is unceremoniously delivered with the expectation that they will be ‘fixed’ and the adult leaves, the practitioner is rightly confused and at a loss to know how best to proceed. This is even more confronting when the parent returns and expresses disappointment and a sense of urgency that something be done to solve the problem ‘now’.

Sometimes this may be due to a genuine misapprehension, which is understandable in a culture that locates human difficulties inside a person rather than between. However even if this is the case, it is distressing and disturbing for a small child to be left alone with a stranger. It is even more difficult when the practitioner is confident that the parent or caregiver has been fully appraised of the process of therapy and the expectation that the adults will be an integral part of process and has chosen to act differently.

This may present in a number of forms including arriving late for appointments and expecting the practitioner to achieve the same result in half the time, insisting the interview be conducted by phone or by having the child brought to the session by an adult who has little understanding or investment in the process. There may also be a request that the first visit process be abandoned on the ground that all the necessary information is contained in other’s reports.

This represents a breach in the contract from the outset and a contest about the definition of therapeutic practice with the client actively asserting a particular form over the one proposed. It is a question of authority and responsibility in the therapeutic relationship where the client is taking authority to define how therapy should be conducted yet takes no responsibility for the outcome which rightfully remains with the practitioner. This must be resolved in the practitioner’s favor at some point or the likelihood of successful systemic work is low. The practitioner must either agree and then work without information or the influence of those around the child hoping that this may be a way to engage further in the process or decide to actively assert the way they choose to work. Choosing to acquiesce from the outset may appear appealing in that it avoids conflict with the client and offers a promise of ongoing engagement yet carries significant difficulties. A child cannot provide information they do not have or do not understand which may be crucial in the practitioner’s assessment and advice. A systemic practitioner is particularly interested in the wider system including potential legal, education and medical involvement. A child is unable to give information about the family system and the history of difficulties that precede their own. It is a risky engagement strategy in that it implies the practitioner has agreed with the client’s request yet then is unable to deliver the promised service and must somehow ‘change their mind’.

A better approach is to directly address the ‘misunderstanding’, even when one suspects that the client is fully aware of the terms of service. The practitioner can take a ‘one down position’, apologize for the confusion, regretfully refuse to conduct the appointment, and explain how they work and the rationale for this. If the parent is in a hurry to leave, the offer can be made to call them and explain the process and potentially recommend a different service that may better accord with their expectations. This directly addresses question of authority and responsibility where-by the practitioner takes full responsibility to explain the way they work and locates responsibility with the client to either choose to continue in this form or seek help elsewhere.