Please Note: Only COVID-19 vaccinated adults and children over 5 can attend the Clinic.

How do We Include Children in Family Therapy

While it is generally agreed that involvement of children in family therapy is a ’good thing’ consensus ends there. The definition of children’s involvement in sessions varies widely and ranges from measures of time spent in verbal and non-verbal activities to conceptualisations that suggest this entails more than single acts and comprises behavioural, cognitive, and emotional elements. Other authors have proposed multi-faceted definitions which extend beyond the therapy session. Given this lack of agreement, research into the potential outcome benefits of children’s greater involvement is also contradictory. While some studies noted increased children’s involvement correlated with improved teacher’s reports and more positive outcomes, others showed no correlation. One study found the effect size between involvement and outcomes varied across therapeutic settings and approaches while another has suggested that positive outcomes relate to engagement in different phases of therapy.

Can we Find out More?

Authors Edman et al 2024 decided ‘to delve deeper’ and answer the question, ‘What clinical practices facilitate children’s in-session involvement in child and family therapies?’ Data was collected through observation of audio-visual recordings and stimulated-recall interviews with those who participated in them. Both children and practitioners were interviewed as they have been found to have different perspectives on what is helpful and here too there was a lack of research. Sixteen recordings of between 30 to 90 minutes were analysed and included cognitive behavioural therapy, eclectic therapy, functional family therapy, narrative therapy, solution-focused therapy, systemic family therapy, and unspecified family therapy.

What Did They Find?

Based on the data collected, a framework of four involvement-enhancing practices was developed with proportions and relationships between each changing over the course of the session. Managing time includes allocating time for children’s involvement, regulating the pace of talk and managing the timing of therapeutic elements like questions, and activities. A second element, staying relevant involves sense and meaning making and includes ‘contextualising sessions and therapeutic elements and activities, incorporating children’s concerns and interests, mitigating one’s utterances, offering interpretations that resonate with children, accommodating to children’s language, allowing children to set the treatment agenda, and revising one’s own agenda and interpretations.’ Adjusting intensity addresses the emotional impact sessions and therapeutic activities have on children and actions that provide emotional relief or increase  intensity if there is a risk the child may become bored and disengage. The final element, facilitating inclusion, recognises the need for children to be involved in sessions on their own terms. This may involve decisions about who to include in sessions and communicating with children in ways that are comfortable for them.

Practice at Bower Place

The processes and protocols developed at Bower Place include all these elements and facilitate engagement and change with complex and challenging matters that include children. The initial explanation of the session provided to children and parents at the beginning of therapy manages time and is done through both word and image. The first item on every session agenda is the request which is sought from each family member, no matter how young and is an example of three of the four elements, managing time, staying relevant, and facilitating inclusion. Throughout the session and wherever possible, both word and image support questioning and intervention which facilitates inclusion while also incorporating practices of staying relevant.

In Conclusion

Work with children is rewarding and challenging and with skills and protocols congruent with sound principles is also highly effective.


Edman,K., Gustafsson, A. and 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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