Engaging parents in their young person’s mental health

treatment-Facilitating agency based hope

Jenny Brown PhDinfo@thefsi.com.au

Policy -Practice gap

• the vital goal of strong family involvement, with genuine partnerships between parents, families and professionals

• reviews of actual involvement, reveal that parent and professional partnerships are rare

• “Although a strong family movement is evolving, true partnerships between families and professionals have yet to be achieved (Huang et al., 2005:620).”

Clinician’s experience

• I think a lot of parents are kind of poised to feel blamed for their adolescent’s difficulties; and so they come in perhaps a bit defensive or can become a bit defensive in the context of family therapy sessions. [Clinician group interview]

• I think parents probably, in the lead up to coming to us, have copped quite a lot of blame, especially if the kid’s not in school. [Clinician group interview]

• It is difficult to work with a parent who is so "other-focused". I had to frequently remind myself to be patient and …lean in to prickly behaviour.

Clinician feeling aligned with the adolescent and concerned about her perception of the mother’s rejecting behaviour:

• I was particularly concerned about the Talia’s position and her sense of distance/rejection in relationship with her mother.

Clinician challenges in engaging parents

• to manage their reactions to parent defensiveness;

• to broaden the focus from just alleviating symptoms in child;

• to not take sides with the young person; and

• to resist becoming an expert instructor.

Reciprocity with clinicians –joint research

We were always asked the questions and we were always asked to think for ourselves. …it was more questioning us and making us come up with answers.

It was very clear from CW that we had to come to our own decisions and work things out ourselves.

to be able to look at it, sort of not so close in…It was actually giving you the chance to look at things differently. So you’re actually answering your own questions, so therefore you’re not being put down.

I think because we were so caught in the situation and it’s so heated and so tight …you don’t ever look at the situation from a distance to see where you’re going wrong.

Our sessions have revealed that it’s not even a medical condition, its more her upbringing and the way I conditioned her, what she got used to and then her playing on that too.

In our meetings we were asked lots of questions about how we were doing things, like ‘How do things happen in the morning? And what are you doing?’ And it opened your eyes up, like, seeing it for the first time sort of thing…

Reciprocity with clinicians –medical model

I think it made my husband and I more aware of .. how to deal with a child with an anxiety disorder.

Well the family session was sort of like a catch up. She would fill me in with…what the doctors thought and things like this.

Now I understand it’s an psychological illnessand I can’t get angry with her.

Side taking

Every time I bring something up in the counselling, there would be an excuse (from the counsellor) for why she’s like that and it’s done in front of her. M plays her parents against each other and now she gets the worker on side and we are offside.

Family systems theory

“The child functions in reaction to the parents instead of being responsible for him/herself. If parents shift their focus off the child and become more responsible for their own actions, the child will automatically (perhaps after testing whether the parents really mean it) assume more responsibility for him/herself”

Kerr & Bowen (1988). Family Evaluation. p. 202.

Is this piece of parent involvement promoting ‘agency’ or a ‘fix the child’ project?

The key to parent insight:tracking detailed interaction with child

• When, Where, What, What next, etc.

• How was the tone for you and for the child/adolescent? What was the body language?

• How were your stress levels? Who else was there?

• Where were others? How did others react? What happened next?

• How did each respond?

• Then what? Then what? How did it finish up?

• What was left over for you, and for the child/adolescent?

Promoting avoidance/dependence or responsibility & independence?

• Consider the interaction example in terms of what promotes the child’s/adolescent’s responsible and appropriate independence?

• What aspect of the interaction lead to the young person being more dependent or avoidant?

Set backs & getting back on track

• “the child’s behaviour usually ramps up around the time of discharge. The anxiety in the system usually ramps up quite a bit at that time, which means the child’s behaviour goes up. And parents sort of tend to switch to the same old patterns of responding.” [clinician group interview]

Parallel process for parent and coach

Parent – managing self not child

• Shift focus on fixing child to changing self

• Observe patterns

• See own part without blame

• Patience not quick fix

Coach – managing self not parent

• Shift focus from fixing and directing parent to managing self

• Research not fix

• See patterns not fault

• Patience not push

‘After the first couple of sessions, we thought we were total and utter failures. But, you know, just, after a while, you sort of re-establish and get back on track….We were caring parents and trying to do our best.’

Clinical engagement with ambivalent parents in adolescent mental health services

1. To explore the parent’s experience of help seeking and engage with the challenges;

2. To appreciate parent’s sensitivity to blame and listen well;

3. To avoid side taking with the young person and see the reciprocal parent child relational patterns;

4. To resist the invitation to be an expert fixer and relate to parent expertise about what happens at home;

5. To track interactional patterns and promote parent insight.

Acknowledgements

The parent participants at Redbank House – and their clinicians

My supervisors Assoc. Prof Jan Breckenridge & Kerrie James MSW M lit.

School of Social Sciences, Faculty of Arts and Social Science

THE UNIVERSITY OF NEW SOUTH WALES