Child-Focused Practice: A Collaborative Systemic Approach Jim Wilson CHAPTER THREE

Making a connection: the first encounter

This chapter focuses on important themes that emerge when engaging children and their parents in therapy. Jay Haley (1976), in talking about the first interview, makes the point that one has to have certain procedures in mind in seeing families for the first time, but he also sees the need to guard against the danger of being formulaic in applying procedures in real-life conversation with clients: Any standardized method of therapy no matter how effective with certain problems cannot deal successfully with the wide range that is typically offered to a therapist flexibility and spontaneity are necessary yet any therapist must also learn from experience and repeat what was successful before. A combination of familiar procedures and innovative techniques increases the probability of success, [p. 9] ENGAGING IN INTERNAL AND EXTERNAL CONVERSATION A MATTER OF PACE Each of us is involved in an exchange between internal and external conversation all the time. In engaging clients, there may be an external conversation occurring about the nature of a child's worries whilst the therapist is also aware of the other interactions taking place such as a parent's detachment from a child, or how uncomfortable the other parent seems at the number of problems being levelled at the child. These ways of noticing both what is spoken and what is occurring in the unspoken conversation of action, posture, voice, tone, and emotional mood of the session contribute to the therapist's internal conversation about the way relationships appear to be organized in the family (or at least in the session with the therapist). Such spoken accounts offered by family members about what is the matter do not solely determine the therapist's thinking but provide important external accounts, which together with the therapist's attention to his internal dialogue and noticings form our understandings in the to-ing and fro-ing of conversation in the room. At the early stages of engaging children and parents in therapy, the therapist will notice more than can be addressed at that time. Noticing and remarking ahead of time (say, parental disagreement or a poor father-child relationship) may lead parents to become defensive and highly sensitive to their non-verbal behaviour. Therapy at this early stage of engagement should be concerned with placing a restraint on the expression of hunches or the giving of opinions: it is better to wait and see the extent to which one's inferences may become useful or redundant as the encounter evolves. At this stage, one should be careful to create an exploratory dialogue, both within oneself and externally with the family, rather than jump to premature formulations about the family relationships and organization. The process of engagement is concerned both with hearing the relevant accounts of each family member and creating a conversational context in which ideas are entertained, explored, and contextualized. In child-focused practice, the general aims for engaging families in therapy are: firstly to access the child's own descriptions and accounts of his/ her concerns; secondly by bringing these accounts into the open, to help weave them into the fabric of the views, descriptions, and account of other family members. By drawing the children's views alongside the parents' and those of other children, the therapist attempts to create a different and more useful exchange in which new ideas, behaviours, and experiences may be promoted.
ENTERING THE CHILD'S WORLD

It is necessary to gauge each of the ways of entering a child's world through the medium of the

family's style of relating to one another, including attention to cultural, class, and gendered styles of address. For example, a fixed therapist belief in offering a gentle, empathic approach to young children might be completely out of place in a family where most interactions with the children are loud/robust/challenging. In other words, a therapist's first position is to notice what happens when family members come into the room for the first time and to take the lead from the family's interactional styles. Having said this, there are general therapeutic manoeuvres that, on the whole, prove useful to therapists wanting to increase their options in working with children...
Welcoming contextual clues

Ensuring that there are some simple toys and playing material available in the waiting-room and the therapy-room sounds an obvious inclusion, but it can be useful in creating opportunities to make a beginning connection with children through participation in a playful, non-threatening activity. Children may find eye contact disconcerting or embarrassing, and having a joint focus such as drawing a family genogram on a whiteboard or a sketch of important people in your life or using miniature dolls to reconstruct a family event (see chapter five) usually makes it easier to have a conversation through participation in an activity.
A l l o w y o u r s e l f t i me t o b e n o t i c e d b y c h i l d r e n

Too often therapists anxious to counteract their own fear of working with children will throw themselves enthusiastically into befriending mode smiling, making intense, direct eye contact. In most situations, this is a disastrous move particularly with older children and young adolescents who mostly wish for some safe distance between themselves and the therapist. If the therapist is trying too hard to make a good connection with older children or worse, is trying to ingratiate himself by appearing cool and knowledgeable this will, understandably, be cause for rejection. Children are good detectives and can easily see through a therapist's phoney attempts to overly identify with them. It is advisable to monitor how parents view attempts to engage their child and also to note children's reactions to the conversation with their parents. Indirect and genuine compliments to children and/or parents can help ease the connection for the therapist.
Don't get stuck to the therapist's chair

Like many systemic family therapists, for a long time I felt I needed to stay rooted to my chair. However this is a very restricting stance and limits the therapist's options to use the space and props available in the therapy room. More often than not, I now try to find ways of working, at, or below, the eye level of children. This has the useful effect of making children (and often their parents) feel that the therapy-room is a safer and more playful place to be.
Restrain problem talk

Early on in therapy, the child's view of his situation is often muted by the referrer's or parent's desire to describe the child's problems for him. It is therefore necessary to find ways to delay this description until later in the session, once a safer relationship has been established with everyone present, by focusing more on family members' views and feelings on coming to therapy. The therapist is more likely to engage a child's cooperation and involvement if the early exchanges include talk about a child's life inside and outside the family, particularly acknowledging the importance of friends or relatives, interests, and important transitions (like starting a new school). Building a brief picture of a child's life provides the therapist with an awareness of a child's wider social identity and resourcefulness, which can be developed later in the therapy with the child. For example, one uncommunicative young adolescent was obsessed with computers and was sceptical about coming to see a therapist with his mother. When I asked him about his interest and knowledge of computers (mine is very limited), I was told that computers can develop problems called glitches. From this point we were able to talk about glitches in his life and how he had tried to solve them. Therapy became a little more acceptable once the notion of family glitches had been accepted as a useful framework for talking together.
Don't expect children to talk about feelings

Unless children volunteer feelings, barriers can be built if therapists try to prise out a child's

feelings, certainly in the early stages of getting to know the child. Adolescents seem to respond more positively to matter-of-fact descriptions and stories about their situation and if a parallel story (such as one of those outlined in chapter six), suggestions, and understandings of a dilemma can be offered rather than imposed upon them. Feelings may be offered as hunches I imagine that must have upset you a lot without dwelling on the response, except perhaps to allow an acknowledgement or dismissal of the idea before moving on with the flow of the session. Weighty, emotionally laden silences can be experienced as oppressive and Embarrassing for many children. One reluctant young teenage boy was brought to therapy by his mother but refused to be drawn into problem talk, despite his mother's prompting. I quickly turned my attention to non-problem areas of his life. I asked if I could hear more about his life to help me have a bigger picture. He reluctantly agreed and after some prompting he told me that one of his pastimes was playing the guitar. I secretly lit up inside because playing the guitar is one of my personal passions, and I asked him more about his interest in music. He described a number of musicians who came from an era well before he was born. When I asked him how he became so interested in this music, he explained that his father had given him many records which he still listened to. This allowed the beginnings of a discussion about the importance of his father; he had committed suicide eighteen months earlier, and since then the boy had not talked to anyone about his relationship with his father. These circuitous routes to more painful topics need to be tempered with a requirement to find out if it is permissible to continue with the discussion in the more painful and difficult areas of the child's emotional life. With this boy, it was only possible to talk about his father for a minute or so before we moved away from the topic. In essence, the therapist takes his cue from the child and avoids being overly directive.
Insist on creating contexts of competence: visual aids

Inviting children to use a whiteboard/blackboard or large pieces of paper to create a map/picture of all the significant people in their lives is a useful means to connect. This includes school friends, relatives, teachers, and other adults. By building a visual representation of the child's context, the therapist and child can later place problems and resources into the picture. The picture should emphasize those resourceful relationships (without denying those involving difficult or distant or otherwise absent but significant others). Even in very bleak descriptions of family life, there are usually one or two significant others who are considered helpful to the child or aspects of other relationships which hold value for the child I don't like nanny's bad temper, but she always gave us lots to eat. The next section looks at specific areas in the practicalities of therapy setting the ground rules and outlines some considerations that attend to children's participation in these early negotiations. SETTING THE GROUND RULES Introducing the video and screen and team If working with a team of colleagues behind a one-way screen or using video cameras to record sessions, it is important to explain this context in appropriate ways to children (and adults). Young children are often not able to comprehend fully what is meant by using a camera unless by referring to their use of videos at home. It is important to explain that the video you wish to make will not appear on TV! By far the most effective way to explain the use of video with young children is to take them behind the screen and let them see the picture on the television screen and view of the interview-room from behind the one-way mirror. Parents often find this procedure intriguing and can be reassured and pleased that their children have been engaged in this explanation. I explain that the video helps me to get a clearer picture of my talks with people, because I can look back on it. When I talk with young children I may say: It's a bit like doing my homework so I can try to get things clear for the next time we meet or When you look at things for a second time,

you quite often see something different, especially as I'll be looking in on me talking with you. This makes a difference, too like seeing yourself from a different angle. I encourage children to ask questions about this idea because of the metaphoric connection with therapeutic process. The importance of stating that you will bring back any new thing that you have noticed to the child means the video viewing does not become a secret kept from the child. This makes the introduction and use of the video a more transparent part of the overall process. With young adolescents, who are usually more self-conscious about the mirror, video, and team, I take time to answer any questions that they may pose. These usually centre on the need for confidentiality and people talking about them behind their backs. If the young persons' views are treated with respect and taken seriously, then they are often reassured that they are being attended to and will agree to give it a try. I avoid any tendency to try to convince teenagers that it would be for their benefit this is the kiss of death. Instead, I usually say something like: The team/ video is helpful to me, but I can work without both or either of them. I need your permission to go ahead with this if that is OK but if it's not and it gets in the way of our meeting, then I'd prefer not to use it. It is more problematic when parents insist that their teenage child should agree to the use of the team and video, in which case the therapist is immediately thrown into dealing with family matters and the video is the cannon fodder for the next row. I usually intervene quickly with a ground rule: For young people and their parents, I need everybody's permission; if there are reservations expressed by anyone, I prefer not to use the video, on this occasion, since it often becomes a worry for the person who feels forced into it whoever it may be. Sometimes by asking family members to think about the pros and cons of the video/team after the first session, this allows further time for consideration and gives children and their parents a sample of therapy-talk before they make a final decision. Unless young children are very shy or frightened, they are keen to meet team members either at the beginning or the end of the first meeting. If reflecting teams are used (Andersen, 1990), then an introduction to team members at the beginning can be effective in drawing the team and the family together from the outset. Putting these points across succinctly is important since overly elaborate explanations about the setting and the team often increases the participants' anxiety or creates an impatience in wanting to tell the therapist about why they have come for help. The therapist must be flexible in judging how much detail to go into at the beginning. Explaining in simple terms for children the way that the team works is important, and a brochure explaining our usual ways of working can be sent in advance of the first meeting. This gives family members an opportunity to raise questions or comments before the beginning of the first session. Referring to the colleagues by name and introducing them as my helpers in person if desired is useful to include in the beginning explanation. Children will often ask further questions about the team from time to time later in the therapy, and more detailed responses can be offered if needed. If other means of communication between the therapist and the team are used such as telephone messages, it is reassuring for children to know that the therapist will tell them what the message is about and not keep it to herself. One family arrived for a session and the children (aged 10 and 12) brought special dolls, Poakie and Billy. I asked if I could be introduced to them and remarked on the dolls' colourful appearance, one of which had green hair. I then mentioned my friends pointing to a teddy bear and toy donkey placed on a chair next to me. I explained that these too were part of my team, as well as the helpers behind the screen. Such opportunities to engage children present themselves, and the therapist needs to be on the look out for how to respond in the session. If a child brings special toys to a session, it is useful to engage in a playfully serious way, bearing in mind their importance and status for the child. Assuming that agreement is reached, then at the end of the first meeting children and parents are

asked to consider again the videotaping of the session and whether it should be erased or kept for the therapist to review for his further reflection and learning. In this way, children and parents can withdraw or confirm consent with the hindsight of their experience of the first session. At this point, a written agreement is requested.
The right to speak/listen and not to speak/listen

Children are often anxious that they will be put on the spot, and it can be useful to anticipate this reaction by explaining that all participants have the right to speak and listen as they wish. The therapist helps himself by not being trapped in the position of being an expert who will make the children talk about problems where the parents have failed to do so. However, parents may be disappointed at first since they may have come precisely because they presume that the therapist will have the necessary skills to make the child talk. Children are more likely to engage with the therapist when not compelled to do so; when the parents notice the therapist engaging their child in other ways, they usually feel reassured by the therapist's abilities. The therapist's job is to refuse the invitation without antagonizing the parents. One 9-year-old girl, Debbie, was brought by her father for a second session to discuss her many worries, as the father put it. When I met the father and daughter in the waiting-room, Debbie avoided any eye-contact with me and refused to speak. When I showed them to my room I began a discussion with the father about his concerns and occasionally made a remark to Debbie, who played in the corner of the room with a doll. I continued to speak with the father and only occasionally glanced in her direction. I mentioned how important it seemed to me that Worries are things people like to keep to themselves unless they know someone well enough. Then they decide 'Will I keep this to myself or not?' I think that's a good idea. Debbie began to look up in my direction a little more. I knew from talking with the father that she had started at a new school and quite liked her teacher. I mentioned how important it is for children to feel OK about a new teacher. Was she somebody who was bossy or friendly or something else? Debbie volunteered: She's quite strict, but quite fair. I responded: So, starting a new school with a new teacher who is strict but fair. That's not easy to do to get on in a new school. These gentle excursions into conversation led to a greater ease of talking with Debbie at a pace that she was able to engage in whilst acknowledging the father's desired agenda to address his child's many worries.
Inviting contributions

Alongside the right to speak or not is the right of the therapist to explain his wish to invite each person's opinion so he can be useful. The therapist can explain this invitation simply, at the beginning of the first session. Citing a hypothetical example of the type of invitation helps to give children an idea of the rules of the encounter. So if I ask your mum a question about you, I'll then come back to you and ask you what you think too. Ok? You don't have to answer, but I'll come and ask your view anyway. This sort of explanation conveys again the idea that each person's views will be encouraged and cross-linked. Confirmation or disagreement is less important than the invitation to offer a view. The generation of multiple views can be conveyed simply by voicing the therapist's opinion, such as: I usually find that each person has his own point of view sometimes strongly sometimes he agrees or disagrees with another person. Anyway I would like to check your point of view is that ok?

Paying attention to names and relationships

Children will convey important meanings in the way they refer to others by name. A maternal grandmother may be referred-to as Nanny and paternal grandmother as Nanna. If the therapist uses the children's words for such distinctions, this will be noticed and create easier participation in the talk. In complex family structures, the distinguishing of different relationships may be even more important to appreciate. In one family, a 10-year-old boy used to refer to his mother's ex-partner as Dad, until he left the household. Now, two years later, he is referred to only by his first name. Sometimes therapists forget to shift their definition of family roles in response to the conversation. One colleague, who had worked for many years in a child-centred service, habitually referred to the adults in a session as Mum and Dad when the couple in fact wished to discuss their marital relationship not their roles as parents. In fact, too much attention to their roles as parents was contributing to their marital difficulty. Children can be engaged also by eliciting their expertise and knowledge of who's who in the family, advising the therapist if he forgets a name and spelling out people's names so that the therapist can help them to register. Sometimes genuine incompetence can be a useful attribute! TYPICAL CHALLENGES IN THE EARLY STAGES OF THERAPY Tackling a blame-laden account While it is important for the therapist to engage with parents and to hear their account of their child's problem, at the same time the therapist needs to be careful that these accounts do not stultify the early stages with repetitive stories of criticisms of the child, laden with accusation and blame. If this begins to occur, the therapist should quickly try to create a less fraught and painful description; otherwise, therapy can become an abusive experience for the child and the parents caught up in such negative descriptions of their child.
Therapeutic interruptions
The therapist can take such repetitions and toxic descriptions of the child as a cue to interrupt the story. For example:

(To the parent): Mrs Smith, can I stop you there for a minute because I need to hear everybody's view briefly. What I do hear is that you want me to understand how serious the problem has been for some time. Is that right? This type of response tries to address what other words may lie behind the blaming account. In some cases, the parents are desperate for the problem to be taken seriously, and by touching on these unspoken themes the parent may cease to repeat the blame-laden story (at least for a while). Other themes embedded in the blame-laden account may be to do with the parents' disguised sense of failure or self-blame, in which case the therapist can offer suggestions that point towards these possible meanings and so shift focus from unhelpful blame to more useful constructions. For example: I don't know if it's the same for you, but many parents who come here because of their child often feel quite taken aback by having to come and see a therapist. Is that the same for you, or do you have other views about talking with a therapist? If the parents can move away a little from the blame-laden account, it can be effective to encourage them to imagine their child's reaction to being in the therapy-room. For example: Do you think John is more nervous about coming here than you were? Or is he just pleased to be off school? Or: Can we widen the picture a bit to get some different angles on things. It sounds as though you're

exasperated. I imagine you must have gone round in these circles a hundred times. Can I make a move here so I get a bigger picture to see where we go?
If the blame-laden account is not interrupted, children will feel unprotected or humiliated and parents may also feel increasingly that the therapist is not taking charge of the session.

Focus on the parents' attempted solutions

By encouraging discussion of the parents' attempts to deaf with their child's problems, the therapist can gain valuable information about how to proceed. If framed as useful to help the therapist appreciate how to work with their child, parents often notice that their views are sought as an aid for the therapist and not to establish, as a form of criticism, what they have already done wrong. Questions that elicit the parents' views on how the therapist might avoid traps in working with their child, established through conversation, help form a more collaborative, resource-oriented approach.
Questions that encourage the expression of parental knowledge

Inviting the parents' expertise in knowing their child can both help the therapist avoid mistakes and create a context of collaboration with the parent. With one young adolescent and his mother who had lost confidence in therapists, I first spoke with his mother alone about how previous offers of help had been received by him. By engaging the mother's expertise about her son she became more active in subsequent attempts to involve her son. She probably conveyed this growing confidence to him. Eventually he agreed to come for a talk with me. (To the mother): What do you think would be the best way for me to approach your son a letter, phone call, message through you...? Who, out of the previous therapists/workers were the most effective and useful for your son... was it because of the type of person they were, or their way of going about their work? What would be the biggest mistake I could make in trying to meet with your son? Questions such as these help involve the parent in the intricacies of the therapist's attempts to get to know the child rather than play along with the myth of the expert-in-human-relations-who- shouldknow-how-to-talk-to-kids. The expertise involves an ability to tap into the parent's expertise. In this case the mother suggested that I should not try to be tricky, because her son would figure this out very quickly. She thought that her son would come to therapy as long as he thought it would also do her some good. This became our explicit reason for arranging a session with the mother and son. If parents feel under threat by their child (Gorell-Barnes, 1986) and also perceive therapy as a context in which they again may feel threatened, then it is more likely that their descriptions of their child's problems will be blame-laden. Children's problems will be construed as of their own making, distancing themselves from the context in which such problems have emerged. Not all blame-laden descriptions will be interrupted, perhaps because the parents feel threatened by their children. It may, on occasion, be most useful to decide not to proceed with the family session. Meeting family members separately may be the only option available. As long as the idea of creating links between family members can be upheld, this can be an effective way to change the interaction and give the therapist and family members some alternative configurations to work within. I have found it helpful to remind myself that I do not need to be a hero (Wilson, 1998). I do not mind being a referee in the verbal fights of my clients, but if the referee's rules are broken I will stop the session. Unfortunately, sometimes therapists including me have felt mesmerized by antagonistic family members and are rendered useless. Since nothing can be gained by this, a therapist should feel able to stop a session where the clients are either out of control or damaging one another. In these circumstances, the rules of therapy need renegotiating see the section below, Shameful Accounts. Attention to a number of general themes about engaging clients has so far been considered, but practitioners face many challenges in engaging children and their families in therapy in more specific circumstances.

Oppositional accounts When adults disagree It is usually the case in child-centred problems that one parent will express a difference from the other, sometimes in emphasis over the seriousness of a problem and sometimes more fundamentally. These disagreements may take many forms, and it can be useful to explore the nature of the disagreement without taking sides. For example, parents may come with very different views about what may be talked about. One parent may feel that a child's problems are connected to a more fundamental problem: that of the other parent's poor handling of the child, implicitly or explicitly blaming that parent for the child's problems. This may be noticed with divorced couples who operate two very different styles of parenting in two different households. The couple may have had longstanding disagreements based on their separation and divorce, in which their different parenting styles have provided more material to carry on their separation struggles as a couple. In such situations, it is useful to highlight the difference between the parental roles and their roles as ex-spouses and to explore with the parents the ways in which their different views as parents can be talked about and distinguished from their continuing hurts or dissatisfactions as a separated couple. In dealing with disagreement, the therapist may also require to tolerate and normalize these (typical) reactions, and, depending on the ease of engagement with the parents, the therapist can begin to discuss the effects of such disagreement on them and their children and how such disagreements have come about. A family was referred to The Family Institute because the 13-year-old boy had been suspended from school for sexual harassment of a young child. The parents had been divorced for several years and rarely communicated about child care matters, though both parents continued to be actively involved with each of their children. By meeting with the parents separately and eventually together, I was able to negotiate much more direct lines of communication between the parents regarding their respective styles of handling the boy. This in turn led to an improvement in the overall situation, despite the parents continuing to feel angry and bitter towards one another over their divorce seven years earlier. By focusing directly on their mutual concern and love for their son, it was possible to create a context in which the couple's fraught ex-marital relationship did not cloud their concerns as parents for their son. When adults and children disagree Disagreements should be a point of interest and exploration for the therapist. I have sometimes found myself tempted to try to make a safe middle-ground between argumentative parents and children as though a compromise will help solve a problem. Sometimes it does, but often compromise tactics water down the discussion and have more to do with the therapist avoiding conflict than creating a useful context for the encounter. One therapist trap is to be drawn into an attempt to get the child to agree with some part of the parent's viewpoint, or, alternatively, to try to convince a parent that the child's disagreement is valid. Instead, I have found it useful to try to create an exchange in which disagreements can be voiced and put to some use. This can be done by asking questions that address the argumentative process between parents and an older child. Here are some hypothetical questions that give a flavour of the style of exploration.
Exploring

pattern:

Does this always happen? Or are there times when the two of you agree to disagree? Exploring meaning: What has made the disagreement so intense in the last while? Are the disagreements mainly about who is the boss, or do you have another theory? Exploring hypothetical consequences: If you two continue to argue like this over everything for the next six months, do you imagine you will be completely out of ammunition or need a break to refuel your anger? Explore wider relational context:

 How come the disagreements in the family just focus on you two? Is no one else allowed to have disagreements? Why do you two monopolize them?
Exploring

resolutions: exceptions:

How do the disagreements and rows get sorted out? Who makes up first?
Exploring

Are there times when you get along well enough, or do you forget about them in the heat of the rows? Embedding a suggestion: If disagreements happen when you want to be your own boss, or be more independent, is it also possible to be a little freer without a row first? Exploring a connected theme: Can you disagree with your mother and still respect her? These are a few options amongst many. A useful exercise to help therapists avoid falling into the trap of hearing unproductive arguments/disagreements in therapy is to try to list a number of associative words that may connect with the dominant theme say, disagreement/row and keep them as a resource. It is surprising how a well-timed provocative question can stop parents and children in their argumentative tracks. For example, rows and disagreements: 1.May disguise more painful topics, e.g. loss, separation, unresolved event. 2.May occur between the closest/most intensely involved family members, so who is being excluded? 3.May be seen as a metaphor, e.g. an unstated request for a parent to become more assertive. I assume that the words expressed in rows are connected to other meanings and feelings that have become hidden or muted by the persistent row-speak. This idea is useful when rows are repetitive and unproductive for the family. Abusive accounts when to stop Sometimes therapists working with children and their families will tolerate insulting and abusive behaviour from adults towards children or vice versa. In these circumstances, unless the therapist can find ways to reduce such abuse and refocus the conversation then I consider it necessary to draw a halt to the proceedings (at least temporarily); although it may be difficult to take this action, not to do so conspires with the abusive interaction in the room. The therapist, though, should be careful that his reaction is not predicated on only his personal beliefs about tolerable levels of anger unless these are blatantly abusive. Still, it can be necessary on occasion to state clearly that the therapist cannot proceed because the level of insult or anger is too painful for the therapist to tolerate and that he cannot continue with the session in this way. Stopping the session has been necessary only rarely in my career (so far), but it is important to consider such an action because abusive verbal behaviour from parents towards children can sometimes threaten to silence the practitioner, rendering him impotent and overwhelmed. If parents and children have become so enclosed in their usually bitter exchanges, the danger for the therapist is to be defeated by this style of interaction. If children are being insulted or threatened, the therapist can deal with this by considering what may be the subtext for the ranting parent. If the parents feel threatened and abused themselves, then perhaps the therapist can make a connection with the parents to discuss their own sense of threat. Yet this is not a rationale for doing therapy with the parents at the expense of the child. The overarching consideration of the child's right for protection from abuse has to be the prime consideration, no matter how concerned one might be to help the parents. One may have to re-group with a different configuration perhaps individual sessions with the parents and the children in order to create a

more manageable context, and clearly, in cases of overt abuse, child-protection issues would require to be in place as part of the context of ongoing therapy. Shameful accounts renegotiating the context for work Certain ways of talking about problems can be humiliating for children, particularly if parents volunteer details to the therapist that leave the child feeling exposed. Although therapists may go to some lengths to negotiate how and what can be talked about, this is no guarantee against contributions from family members that effectively shame a child. In one case, a 13-year-old boy was humiliated by his mother during the first family meeting when she revealed the painful details of her son's abuse by her ex-lover. The impact of this brief and hurried utterance was like a hammer blow to the boy. The mother's words ran ahead of her as though she were unable to catch them and stop what she was saying. I was taken aback by the impact of her hurried disclosure and tried to intervene in an attempt to establish the boundary around what was able to be discussed and agreed upon by both the mother and the son. The mother insisted that her child needed to talk of his abuse, and the situation looked almost lost. The boy kept his head down, eyes on the floor, saying nothing. A few moments later, I asked the mother if she could allow me to talk with her son on his own for a short while. I found it difficult to know how to proceed. To ask him questions about how he was feeling would have sounded crass since it was obvious from his downcast eyes that he felt shamed and unable to talk. The room fell silent as though we had both been rendered speechless by the mother's words. Then I apologized to him for my error in not keeping sufficiently in charge of our meeting. I explained how I'd allowed my own ground rules to be broken. I did not accuse his mother of humiliating her son but kept the focus on the therapeutic error committed by me. However, it was also important not to humiliate myself by over-reacting to a therapeutic mistake! It was necessary not to imply a coalition, or worse, a secret to be kept between therapist and child as a result of the mother's betrayal of him in the session. I was then able to talk with the boy about him being in charge of what could be discussed and whether he wished for another meeting, either with or without his mother present. Later we agreed to invite the mother to rejoin us in the meeting. I spoke with the mother and son together and renegotiated how to conduct the conversation from then on. The mother was calmer and more reflective. The session moved on to focus on the mother's sense of betrayal of her son and her obsession with trying to find out what damage had been done to him. By shifting the focus away from humiliating descriptions of abuse and towards the meaning of the mother's behaviour (her anxious and overflowing talk), I was able to negotiate with the mother to give me permission to work with the son if he also agreed and for her to leave this part of the work to me. It is not often that the therapist needs to make a heart-felt apology to a client, but in this situation it seemed an important statement to make a move from humiliation on the boy's part to humility on mine.
Chaotic accounts: making sense of disorder

Sometimes families with children will not so much enter the therapy-room as assault it, and the therapist feels his back is to the wall even before there is an opportunity to discuss the usual ground rules. In these situations, I have found that the worst thing to do is to try to be a quiet, contained therapist rooted to my chair and speaking in measured tones! It is more effective to engage a more active style if children are running around and parents are shouting at them. One family introduced themselves: We are the family from hell, and these are the children from hell. The trainee therapist responded What does that make me then the therapist from hell? Yet being active does not mean becoming over-controlling. If one tries to establish order out of chaos too early in the therapy, this can become counterproductive. The therapist can move quickly into talking with parents about how they wish to take charge of their children during the session, for toileting and responding to their questions and their children's behaviour. He can attempt to put the parents at ease by normalizing (some) behaviours of noisy children and by explaining that he does not expect the child to be quiet during the session. He can

explain that the therapist can talk and listen while children play and that their play is also part of the life of the family. If the therapist conveys that, within reason, disruption and interruption can be expected and tolerated, parents and children may feel more at ease in the unnatural surroundings of a therapy-room. Therapists may have to raise their voice above the din, or quickly engage the children with simple toys, and generally use voice, tone, posture, gesture, actions, and words to shift the session by degrees to a level that at least allows the therapist (and hopefully) family members to hear themselves think. This can mean learning to drop one's voice slightly, making a few more settled movements, noticing the reactions to these moves from family members, interrupting and structuring the parents' rapid exchanges, beginning to introduce the ground rules about hearing one person at a time (if possible!), and explaining that the therapist cannot manage to absorb all the details at once. Ultimately the therapist needs to create a manageable structure for the session whilst avoiding the desire to suppose immediately that the family, as an organization, needs to be restructured. The therapist thus takes charge of the session not of the way in which the family should organize their lives together. I once worked with a wild family of two parents and six young children, in which the parents tried to convince me that they were more like members of the children's group. I naively tried to create a rule that one person should speak at a time. By doing this I became like a head-teacher with a class of disruptive pupils this led me into a battle for control of the therapy. In desperation, I pointed to an empty chair and suggested that this could be the talking chair when you sit in it you can have your say and everyone can listen. This idea was prompted more by desperation than reflection and had the effect of converting therapy into a form of manic musical chairs, where there was only one chair left for eight participants. This taught me a lesson about the need to tolerate a family's characteristic style of interaction and not try to change this too soon. With the hindsight of several years I see how inappropriate it was to attempt to hold a family session as a first meeting in this case. The couple were so anxious about seeking the therapist's approval and so unable to allow their children to be given time and attention by the therapist that I would have fared better to have met first with the parents before attempting to work with their children. The uppermost and immediate concern seemed to be to bolster their executive skills as parents, and to do this in adults-only conversation would probably have been less intimidating for them.
SUMMARY

In making a connection with children and their families in the first therapy meeting, it is more than likely that much of the prior discussion will have involved adult descriptions of the child and his problems since almost all children are sent or brought to therapy because an adult has decided to take this action. For this reason, it is of benefit to think deliberately of ways to connect with the child's world lest the adult definitions should become the only truth about the situation. But to do this the therapist needs to be mindful and respectful of the descriptions and accounts of the adults as a beginning engagement with the child's world. One colleague sought consultation for a family in which the child was defined as having Gilles de la Tourette's Syndrome. She wanted a consultation because she was unable to find ways of creating a useful conversation with the child. I looked at a few minutes of the video-tape and noticed that when she asked the child questions about his life he was enthusiastic in response. So what was proving difficult? My colleague stated that her boss had told the family of the name of the boy's condition and prescribed her job as one in which she could help them come to terms with it and manage the child. However, the child had no say in this prescriptive aim of therapy and apparently did not want to talk about Gilles de la Tourette's Syndrome. I joked with my colleague about how this name seemed to define everyone's actions and wondered what the child would call it. Do you think he would call it Giles or George or a pain in the neck? What would happen if you were to ask the boy more about his views of the doctor's name for the condition? What effect does it have on his life, and what would he like to do about George or Giles or pain in the neck? This irreverent consideration of

other constructions seemed to help my colleague to find ways to create an entry into the child's views whilst still paying attention to the aim of exploring how to manage together. This section has illustrated ways in which therapist language and ground rules for the first session can begin to build bridges to the child's world. The endeavour attempts to be collaborative and respectful of each person though challenging and attempting to reshape accounts in more useful, less problem-oriented ways. The next chapter focuses on therapists' questions with children in order to sustain and build more connecting bridges over which new and useful ideas may traffic.