Children are among the most powerless in our society and a child suffering emotional distress relies on adults to notice and act to secure care. This means those seen in traditional clinical practice are also those whose adult carers are aware, resourced, and confident to access appropriate support.
Steve Cobbett, lead therapist at the Beckmead Family of Schools in London, recognized this disparity in his work with young people who had experienced complex trauma. He noted that systemic therapy was valuable as ‘many of their difficulties are systemic in nature’ but required adaptation to meet the specific needs of these young people.
What Adaptations are Recommended?
In reviewing the literature and his own practice Cobbett notes that there are significant difficulties with engagement and dropout when traditional approaches to complex trauma are offered to high risk and diverse populations with multifaceted presentations. He recommends a hybrid model, a both/and approach combining the benefits of systemic and family-oriented approaches to address ongoing relational difficulties to develop resilience and support relationships, and individual opportunities to process trauma that may be unsafe to speak of in the family.
The Key Elements
The integrative approach includes specific elements to better suit this population. Cobbett draws on attachment theory and systemic models, in recognition of the central importance of secure attachment experiences both between family members and with the practitioner. This means therapy, with both the young person and their family, may be long-term requiring two years or more to experience genuine transformation and ensure continuing change. The work also includes individual sessions with the child run in parallel with family work which reduce in frequency as family work progresses.
Recognising that children may find it difficult to engage in talking therapy, the approach incorporates activities tailored to the child’s developmental age and stage. These include ‘playing musical instruments, listening to pre-recorded music, art, dramatic roleplay, expressive play with figures, sport and physical play, riding bicycles, weight training, using a punch bag, woodwork, watching video material and playing games such as hide and seek or cards.’ Parents are inducted into the value of activities tailored to their children’s developmental needs and family sessions include both verbal and non-verbal elements that support children’s voices.
Many of these families have experienced powerlessness and the use of non-verbal methods is one way to address the disparity between the verbal capacity of the client and their practitioner. Locating therapy outside a clinic is also helpful in supporting engagement and addressing inequality. Children spend a lot of time in school, which are often seen as safe and supportive places, especially where there are caring relationships with staff. Locating work in the school also offers opportunities for collaboration with teaching and support staff and development of coherent responses across systems. Home based sessions are offered when parents find attending school difficult, or the child is disengaged from the education system.
Male-friendly, Working-Class-Friendly and Minority-Ethnic-Friendly Practice
The approach is informed by the understanding that young men, those from working class backgrounds and minority ethnic groups are disproportionately represented among children with complex trauma. Adapting therapeutic approaches to become accessible and effective is central to the model with the authors offering practical strategies to achieve this.
In Conclusion
Therapy offered in the comfort of the practitioner’s room and clinic is familiar and valuable to those who can readily access it. However, it may be that we need to challenge ourselves, our preferred models, and orderly processes to offer services to children who may have greater need but less capacity to access the care they need and deserve.
Cobbett, S. (2022) Systemic and family therapy with socially disadvantaged children and young people with complex trauma. Journal of Family Therapy, 44:205–223. https://doi.org/10.1111/1467-6427.12353
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