Including children in family therapy as active and participating contributors can be challenging and it is well recognized that many who call themselves family therapists often choose to exclude the youngest and most challenging members. Edan et al (2024) in a study published by the American Psychological Association noted the difficulty interpreting the literature referencing the inclusion of children due to inconsistent definitions about what involvement entails and contradictory therapeutic outcomes. They undertook a study based on observations of audiovisual recordings of practice and stimulated-recall interviews with the participants in the recordings to answer the question ‘What clinical practices facilitate children’s in-session involvement in child and family therapies?’
What Did They Find?
The researchers result identified four involvement-enhancing practices: managing time, staying relevant, adjusting intensity, and facilitating inclusion. They note that practitioners moved around this framework. emphasizing different elements at different times and in response to the clinical process.
The Four Elements
Managing time involves ensuring time is allocated for children to be actively involved, regulating the pace of talk, and effectively managing the timing of therapeutic elements including questioning and activities.
Staying relevant refers to activities that allow a child to make sense and meaning of the experience. These include setting the session and its activities in context, ensuring children’s interests and concerns are incorporated, managing, and softening the practitioner’s utterances, accommodating children’s language, and offering interpretations that resonate with them, allowing children to set the treatment agenda, and revising one’s own agenda and interpretations, as necessary.
Adjusting intensity is interwoven with aspects of time management and staying relevant and refers to the emotional impact of the session and activities on children. It includes both the reduction of emotional intensity by explaining the setting and activities and moderating or reducing elements and activities that are too intense and amplifying when the intensity is too low, and a child may withdraw and become disinterested.
The final element, facilitating inclusion, refers to activities that help children become more involved on their own terms. This includes negotiation about who is present in sessions, communicating through the modality the child prefers using a number of ways to enhance engagement and being open and encouraging of child-initiated processes of involvement even if these are surprising, unusual or outside the expected time frame.
bower(note) and Inclusion
bower(note), the processes and protocols developed at Bower Place to manage therapeutic practice, addresses these elements and guides practitioners to incorporate elements that will facilitate inclusion. bower(note) was developed to manage the inherent inequality of the therapeutic encounter and children are, by definition, unequal. Children are usually brought to the practitioner as ‘the problem’ with no agency about who, when or how they will be seen. Often, they have been given inadequate or false explanations for the process and may be missing their important activities. Children are also unequal to adults in their cognitive processing capacity, receptive and expressive language ability, and capacity to understand and manage emotion.
If you would like to know how bower(note) facilitates inclusion, read the full article on bower(knowledge)
Edman, K., Gustafsson, B., Cuadra, C. (2024) Facilitating Children’s In-Session Involvement in Child and Family Therapies: A Dynamic Framework of Clinical Practices American Psychological Association, Psychotherapy Vol. 61, No. 1, 55–67
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