Family Focus

General Principles

In treating children and adolescents, including family components is important to most effective treatments.  How the family unit is included differs based on the age of the child being seen in therapy, the presenting problems of the child, and personal preferences of youth and parents.  For there to be important outcomes in therapy, it is often necessary for all the important adults in a child’s life to be “on the same team.”  Cooperation and support of members of different systems (i.e., parents, teachers, therapist, and probation officers) is important so that persons in one system do not accidentally disrupt the progress and goals of persons in other systems.  Furthermore, with a “unified front” change often occurs faster. The separate modes of treatment may include one or more of the following:

(1)     Parental Consultation;

(2)     Family Values;

(3)     Parent Training; and/or

(4)     Family Therapy.

(1)    Parental Consultation

Therapy is a place where people should feel comfortable talking about difficult matters.  Establishing a strong and trusting relationship with children and adolescents in therapy is exceptionally important.  Thus, when parents decide that counseling may be necessary for one or more of their children, they must consider the possibility that their child may be sharing information that the child does not want their parents to know about.  While developing an honest and trusting relationship with one’s family is often a goal of counseling, the relationship between the child and therapist sometimes dictates that “secrets” be kept.  Often this is a frustrating and anxiety eliciting situation for parents, but one that is necessary to positive outcomes.

It is important to note that there are certain situations in which the therapist must breach confidentiality.  These generally revolve around life-safety issues, such as threat of suicide, threats of harming other people, and child abuse.  In these situations the parents and/or other parties (e.g., child protective services, police) may be notified.

With these factors identified, parental consultation is very important.  Having parents communicate clearly about goals, expectations, and concerns about their children is very important.  Unless stated otherwise, many therapists typically share these concerns with youth in order to develop treatment plans and goals for therapy.  Occasionally, parents are also asked to attend a therapy session in order to process through issues that may have been brought up in counseling sessions.  The goal of these sessions is for productivity, greater understanding of problems, and sometimes solution-focused interventions.

Often times (especially for younger kids), behavior intervention plans (e.g., sticker charts) must be developed and implemented.  Because adults typically have more “control” over the environment, their assistance in these programs is essential.  Thus, parents are often brought into the counseling relationship in order to develop goals, interventions, and to be educated about how to best follow-through with these interventions.  Parental consultation also takes place in following up on the progress of these programs.

One unique aspect of parental consultation with therapists includes learning new communication strategies.  Many therapists find it critical to talk to parents about how to more effectively talk to their children, how to set realistic limits, and how to follow-through with parental decisions when parents “hit a brick wall.”  Many of these factors can be discussed without breaching the confidentiality of the child.

Above all, remember that if parents have concerns, they should consult with their therapist and talk about the situation.  Many times doing this earlier rather than later can head off unnecessary conflicts and can put parents at ease about the therapeutic process.

(2)    Family Values

Along with parental consultation, one aspect that is integral to therapy is maintenance of family values.  Often times parents are uncertain about types of things therapists work on with their children.  Most therapists should take into account those values, morals, and practices that parents wish to teach their children.  In effect, family values are those principles that parents wish to integrate into their children’s belief system—those things that parents want their own children to find important in adulthood.  Generally, therapists attempt to find several (i.e., 2 to 4 family values) that can be used as behavioral guidelines and belief systems within the household.  These primary values are different from family to family but may include one or more of the following:

·         Honesty;

·         Integrity;

·         Responsibility and Hard Work;

·         Education;

·         Faithfulness or Religion;

·         Friendliness;

·         Cooperation;

·         Loyalty;

·         Family Centeredness;

·         Generosity;

·         Empowerment;

·         Individuality; and

·         Others that are important to your family.

These family values can then become goals for counseling.  Breaking these down is often important so that families know more specifically what is very important and so that therapeutic work can have increased focus.

(3)    Parent Training

Parent Training is an important aspect of therapy, particularly for toddlers and young elementary school age children.  While some parents are hesitant to ascertain advice about parenting, particularly if they have been successful with older siblings, parent training is important because many of the natural tendencies that parents have and one’s that are successful with most children may not be successful with children who have special needs.  This is because children with special needs often view the world differently than their peers.  Take for example a child who has a history of being oppositional, defiant, argumentative, and perhaps even aggressive.  In attempting to get this child to clean their room, the child may respond with anger and violence.  While arguing back and perhaps inflicting some type of punishment works for most kids, the oppositional child may be reinforced by simply getting out of doing the chore for two hours even if in the end they have to complete the chore.  In this way, the time that the child is allowed to avoid the task may be what is motivating the conflict.  For most children, simply not being able to do things until it is done or being grounded following the conflict may diminish this type of behavior.  For some, this is not the case.  Thus, skills related that are taught often include many of the following:

·         Effective communication (giving clear and concise instructions);

·         Developing effective consequences, both reinforcers and punishers, such as token economies and time-outs;

·         Calming strategies for when the child, and sometimes the parent, is getting very frustrated;

·         Altering expectations to make them more realistic and functional, thereby decreasing the likelihood that the child feels overwhelmed;

·         Developing methods for compliance training; and

·         Developing ways to increase cooperation between parents and the school.

It is also important to note that effective parenting and behavior modification plans lead to an escalation in behavior at first.  The child, in this situation, often times seem to be “testing” the new strategies to see if parents follow through with the new program.  In this situation, it is critical to use the skills learned in parenting training to follow through with the plans.  When parents don’t follow through and the child continues to exhibit significant problems they become disheartened and may quit trying.  Often, this is what happens when parents initially seek counseling—many of the techniques attempted are effective but because of the escalation they were abandoned.  Thus, in participating in parent training, parents frequently say that they’ve tried these methods but they didn’t work.  Therapists then attempt to help parents figure out what went wrong and to develop new strategies for a revived attempt.  It must be noted that the parenting strategies and training that takes place are based in research and practice.  Further, the support that parents get in therapy can be very reassuring for them.

Specific parent training techniques for younger children (i.e., ages 4-7) often have a different flavor.  One of the most common and researched strategies for parents of children with disruptive behavior includes what is called Child’s Play.  While Child’s Play is only the first step in a sequence of specified training techniques, it is also the most important according to research.  The premise of Child’s Play is to help parents improve the relationship with their child.  In this technique, parents are, in effect, learning how to be “play therapists.”  This technique can be defined as “child-directed play” and parents have to abide by a particular set of rules for the 10 to 15 minutes each day that they use it.  Many times, parents recognize that a different way of communication and a stronger relationship lead to significant improvements in behavior alone.  Following successful performance of skills, the therapist works with parents more specifically on compliance training (Parent’s Play), use of effective time-outs, and developing effective token economies (i.e., ways to reinforce positive behaviors designed around the child’s interests).

(4)    Family Counseling

In some instances, the therapist may identify that family therapy may be the best means toward achieving positive gains in the child and in the family.  At the University of Idaho Child & Youth Study Center (UICYSC), this does not occur frequently.  However, with some youth who have significant conflict with their parents and where relationships between family members appear to be of primary importance, family counseling can be very effective.  In these situations, the family is the focus of treatment, rather than the identified child. 

Family counseling can take on a number of different forms.  At the UICYSC, family therapy typically takes a solution-oriented focus.  This means that specific patterns of maladaptive interactions, situations, or behaviors are identified and the family along with their therapist work toward developing specific solutions.  As with all therapies, the relationships between individuals often take a primary focus.  Part of the assessment process that can take place in family counseling relates to these interactional patterns and why conflict is occurring.  In addition, the family therapist often looks for maladaptive cycles, those instances that always lead to the same result, which nobody is generally happy with.  Part of family counseling includes developing ways to break these cycles and to promote continued change once progress is being made.