Catching the tail-enders

How many child therapists go into a session believing they will win (as in: their child or young client will manage to come out of the intervention with whatever they needed)?

I ask because the newspapers said that this is how Federer went into his finals match in Australia – believing he would win. Conversely, they make the assumption (because who really knows?) that Murray went in hoping he might win.

There’s something important here. The key words “hoping” and “might” are tentative, exploratory. “Believing” and “would” are much more positive. And they bring up two issues that we all have to bear in mind as we work in counselling or psychotherapy:

1 How much does our having confidence in the young person to solve their own problems affect them?

Do we hold back on the encouragement because we need to honour the “keep yourself out of the way” and “don’t invest too much in a particular outcome” model of working? Do we deprive ourselves of the power of our influence while intending to empower the young person? Surely it is possible to hold both positions without seeming to put a bet on a particular outcome? Can we ever be sure we will win with any client? Should we try and show that faith to the client?

2 When anyone says “hope” or “might”, there is an implicit and unspoken “BUT”.

Some of us term this a tail-ender. Murray may have been thinking: “I hope I might win but Federer’s very good.” Likewise: “Yes, it’s okay…” (BUT); “Fine…” (BUT); “I hope to do that…” (BUT). You can hear them all the time once you start listening for them. And noticing them saves us ploughing on thinking that the young person is with us, or even as positive as their spoken answers suggest. If we hear the tail-enders, we can address them first. That then helps displace the “hope” and “might” with something more certain.

Now, I think these two issues are in most therapists’ minds. But I do know that EFTers (those who use Emotional Freedom Techniques, alone or integrated into their practice) are alert to these all the time.

You see, you can’t really have that “I believe” or “this will be the outcome” attitude unless you deal with the tail-enders as you go. And if we do, then a positive outcome is much more certain. I mean, which gardener would pass over some deadheading while still expecting the plant to blossom for a second time in the season? And we are psychological gardeners of a sort, aren’t we?

To put it in a nutshell: pick off the BUTs and the outcome is certain.

Happy 2nd birthday!

This blog has now been running for 2 years: a million thanks to all those therapists and other professionals who come week by week to investigate. I hope you continue to find resources that help, alongside the (sometimes contentious) point of view up front!

Seems a fitting time, then, to mention that the Children’s Society has published its report into Understanding Children’s Wellbeing – a survey of about 7,000 young people focusing on their subjective experience of wellbeing (as opposed to the “objective” view ie saying they have enough food, a good school, and lots of toys).

And guess what comes top in their “bad” list? You’ve got it: parental splits.

And there’s more. Other factors affecting their subjective experience of wellbeing are: family arguments, lack of freedom and choice, school work, where they live, their appearance, and a lack of confidence in life.

Well, well. Who’d have guessed? I mentally surveyed my teenage client list while reading the report and ticked off each of those items many times over. And I fully applaud the stance of asking children about their subjective experiences. That’s what counsellors bother to find out, isn’t it? Not saying ‘Well you have this and that in your favour’, but hearing the young person’s interpretation. Well done to The Children’s Society, I say.

The other thing that has plagued therapists during these last two years is regulation (bother, I really wanted to ignore it for a while). And a couple of analogies spring to mind.

Would you rather have an e-reader that is made from cold plastic or metal, inflexible and joyless, or a paperback book that is sensual, warm and bendable?

Would you rather have a robo-dog or a real one?

Would you rather treat counselling as a regulated activity that is fixed, manual driven and “score” oriented, or as an art that is not attached to any presumed outcome, is inventive, flexible and co-created?

Okay – I’ve taken a straw poll of one (as no one is here to ask) and the answer is in each case the second. Point made.

And that’s where I start the third year of this blog. I sincerely hope that by the same date next year something sane will have entered the HPC’s brain so that I can do my job in peace. And that more people are listening to what kids are really saying about their lives.

Large or small – where to look?

Sometimes I have a fright and wonder if I’ve lost the bigger plot while concentrating on the detail. Other times, I wonder if I’ve missed the detail that counts, while seeing the whole scenario of what might need to happen or what is going on in the child mental health world. It’s enough to make my mind split!

Let me explain.

This week, Natasha Finlayson, chief executive of the Who Cares? Trust, advised that there should be specialist Looked After children professionals in all CAMHS teams. She also advocates trauma assessment for all children coming into the care system. You can read about it here. Now, at the very minute that this bulletin was dropping into my inbox, I was actually feeling really proud of a teenager who had made a phone call to me to arrange their own next session. This was a huge step forward and one that bode well for a good outcome. But the comparison of the large and the small in the counselling world was too awesome to contemplate for more than the time it took to drink my morning coffee.

But I’m thinking about it now (feeling braver tonight!) and I can immediately think of other instances where I may have been caught on the wrong foot, so to speak.

I was watching the bullying advert that has been criticised (see here) and found myself yet again caught up in deliberations on how bullying can possibly be stamped out nationally. But the detail is that, of my current clients, six are being affected by bullying (in amongst their other problems). Have I been neglecting the need to work on each client’s personal solution while I’ve had my eyes on the larger problem? I hope not, but it’s their lives that matter right now, not bullying in general.

And again, I find I haven’t given a thought to impending regulation of counsellors for, ooh, about two months! I have been far too busy getting on with the job of helping kids heal. But panic set in for a moment as I wondered if something important had happened in the big wide world that I’d missed.

Okay, it’s a balance that’s needed, right? But it did make me question myself quite a lot, and I suppose that can only be for the good. The day we cease to question what we’re doing is the day we cease to be effective therapists. And the one certain thing in all this is that young people and children need us more than ever at the moment, in the counselling room and in society in general. So I guess we must continue to cultivate a split-brain attitude and persevere.

If you want to worry yourself with the wider happenings in the world of children and young people’s mental health, do consider subscribing to Children and Young People Daily – the trick is to read what is relevant to you and then ditch the email from your inbox before you get too caught up in it and forget your clients!

Nick Luxmoore podcast

Here is the “live bookshelf” item I promised earlier. A tad late, but remember, you heard it here first! So what do we have?

Young People in Love and in Hate

Well, I have coerced Nick Luxmoore to record for us the chapter “Love and Promises“ from his latest book, Young People in Love and in Hate, published by Jessica Kingsley, 2010. (He said he had to finish his mince pies first, which probably explains the delay!)

If you haven’t already seen the book, pop over to Amazon and have a look – it’s really excellent for counsellors and any others who work with young people.

I have no vested interest in Nick, and won’t profit if you buy his book. But I’m delighted to endorse it and offer you this extract as a special New Year prezzie. If you’ve already got the book, having Nick read you this chapter is an extra luxury! It lasts 15 minutes.

So – fetch your coffee, find a cushioned space, put your feet up and listen as Nick tells us about the promises young people rely on, and make, and fall foul of… And just sometimes, are able to keep:

In goes the dummy

As we start another year, I am struck again by how important words are to us in our profession.

Yes, we use arts and play to help children and young people express their concerns, yet words are still at the bottom of most therapy interventions. Words are important for giving narrative to our lives.

But The Times has highlighted today that 4% of parents claim their child did not speak before the age of 3. The article also mentions that this late speech development can lead to problems such as low achievement at school or mental health problems. They cite a boy in Reception who lashed out at another child in frustration, causing the teachers to notice his poor speech ability. (I wonder how many other teachers link poor speech ability with dysfunctional acting-out?)

That led me to thinking about how much “space to articulate” children have these days.

We therapists excel at offering it, but the world in general does not. The world likes dummies or, as the Americans say, pacifiers. Dummies are stuffed in the mouth to shut children up. But a spokesperson for I CAN, the children’s communication charity, rightly advises not using dummies except at night, so that children can have their mouth free to practice forming words during the day. Great advice.

Then they come to school and find they must shut up.

So school can be a metaphorical dummy. I expect you, like me, can think of many examples of children being told to shut up and listen, even when they’re trying to explain what really happened or just ask a question.

There are other dummies we use in society:

Stigma: a parent has a mental health issues or is drunk. In goes the dummy.

Fashion: a young person prefers a different clothing style but in goes the dummy and they keep quiet, following the crowd. This adversely affects their self-expression and self-valuing in other areas.

Peer pressure: a child may not agree with what a bully or ring leader is doing or saying. But in goes the dummy and nothing is said to stand up for the victim or a different idea.

Fear of rejection: this is probably the biggest metaphorical dummy of all. We all need to belong. If we fear we will be cast out, in goes the dummy and we shut up.

In a society like this, counselling comes as a relief. That counsellor gives me space, listens to me and accepts me for who I am. It’s like being allowed to learn to speak at last – and better late than never.

So – all strength to our “listening ears” and “encouraging quiet spaces” as we gift to our young clients the space to learn to speak in 2010.

From my bookshelf 4

Lots of rage and anger comes out at Christmas – I don’t know how children and young people cope with some of the stuff that goes on in their families during this holiday period. I’ll probably find out in my therapy room when term restarts… I fear for the ones who were promised so much when so little was likely to be given. They gradually cut themselves off from expecting anything good of parents, whilst remaining unutterably loyal.

Time to browse the bookshelf on rage – not for a cure-all but for some thoughts.

1

Rage and violence
“While rage is often a prelude to violence, this outcome is not inevitable … Rage is an emotion. Violence is an action, and the emotion does not always result in the action.”
Teens Who Hurt (p100) Kenneth Hardy and Tracey Laszoffy

2

Hot and cold rage
“[Take] the metaphor of a pot in which all the unprocessed life experience sits; the lid is firmly and permanently closed in ‘cold rage’, and ill-fitting and prone to flying off in ‘hot rage’. If hot rage fails to summon the necessary help, then a further coping strategy is called upon, that of cold rage.”
Anger, Rage and Relationship (p90) Sue Parker Hall

3

Dealing with pay-offs
“The pay-off of being angry is that you are seen as ‘tough, macho’. The cost of calm is being ‘a wimp’. The aim is to find an orthogonal construct that can be developed to give a positive way forward to obtain the pay-off. The middle ground may be construed as ‘confident and equal to anyone in a calm and considerate manner’.”
Working with Anger: a constructivist approach (p49) Peter Cummins (ed): Gina Selby on Time and Tools: Tools or Time?

From my bookshelf 3

Christmas is always a good time to play (fool?) around with relatives, Christmas crackers and jokes. For many adults, that’s it till next year. Yet we all know how important play is for everyone – not just young children. It’s a good medium for adolescents, too, and a great de-stresser for adults. I’ve even been known to say to a child who is leaving: “Never forget how to play.”

So the bookshelf quotes today are on “play”. But I cheated a little because I came across a great YouTube piece on play. When you have time, give it an ear.

1

Stuart Brown on play
This YouTube video lasts 26 minutes, so why not bookmark it and watch it when you have half an hour free? He says that plenty of play in childhood makes for happy, smart adults – and keeping it up can make us smarter at any age. You can find it here.

2

Play in a consistent setting
“If the setting is consistent, variations in a child’s play, behaviour and mood can be more clearly seen to derive from inside the child on any particular day. Different parts of the room and the play material come to stand for themes which can be explored, left and returned to as children gradually work on and work out, with the psychotherapist’s help, what is bothering them.”
The Handbook of Child and Adolescent Psychotherapy (p 97) Monica Lanyado and Ann Horne (eds)

3

Facilitating necessary play
“At times a specific toy may need to be brought into the play room because the child cannot ‘pretend’ or be flexible in the use of already-existing toys. For example, a child who is having difficulty wearing prescription glasses, might be able to cut out glasses and use these. Or, the child might have difficulty with this flexible use of paper-cut glasses and might respond better to actual plastic glasses that fit the doll.”
Foundations of Play Therapy (p179) Charles Schaefer (ed): Susan Knell on cognitive behavioural play therapy

From my bookshelf 2

Okay, around Christmas time, most of us including therapists, have an immovable goal to meet. We’ll probably make it in time.

But what about the same thorny issue with our clients – that of goals and targets and plans and being organised? Will it work or won’t it? Should we indulge in such ideas or wait and see if they want a goal? Will it work with all teenagers, anyway?

1

Keeping rigid goals
“Agenda setting provides adolescents with a greater sense of control … It may be hard for adolescents who resist structure and enjoy testing limits … If the adolescent sees you are not consistent in maintaining the session structure, they may begin to doubt your commitment to other areas of treatment.”
Clinical Practice of Cognitive Therapy with Children and Adolescents: the nuts and bolts (p57) Friedburg and McClure

2

Inappropriateness of expecting goals
“Cognitive features associated with aggressive and antisocial behaviour include … deficits in the ability to use means-end thinking in pursuit of a goal.”
Community-Based Psychotherapy with Young People (p132) G Baruch (ed): Charles Wells on treatment of severe antisocial behaviour

3

Exploring goals
“It can be useful for adolescents to list their goals and then develop a hierarchy that prioritises the goals that are most important for them. Sometimes when they do this, they will be surprised to find that their priorities are not what they would have expected.”
Counselling Adolescents: the pro-active approach (p176) Geldard and Geldard

4

Never too late to set goals
“The future starts now! [This phrase] sums up where the power is to create your life the way you want – right here and right now. And if you happened to miss the ‘now’ that just went by, there’s another ‘now’ right here. Maybe you’ve been letting your ‘now’ pass by for months, years or even decades. It doesn’t matter – because here comes another ‘now’, completely fresh and full of potential. A brand new crucible in which to create your future.”
The EFT Coach Workbook (p78) Mary LR Jones, available as ebook or printed

From my bookshelf 1

December is here (see the snow?!) and I’m going to spend the month sharing with you some quotable quotes from books on my shelves – pieces that say something interesting and throw a certain angle on important issues. You may not agree with them all and that’s fine.

I’ll put live links to the books but the sentences themselves are the important thing (for me, at least). They give me something to both remember and chew over. Chewing – now that’s very seasonal, don’t you think!

1

Therapist persona
“Today’s child therapist chooses a certain way to behave with a certain child, based on that particular child’s needs. The therapist doesn’t usually develop an entirely new style of acting, but rather accentuates personality traits that are already operational.”
Magical Moments of Change (p34)Lenore Terr

2

Therapist clothing
“Therapists should carefully choose the clothes that they wear when working with adolescents because it can influence the way adolescents initially interact with and perceive the therapist.”
Play Therapy with Adolescents (p124) Gallo-Lopez and Schaefer (eds): Chapter 7, Scott Rivieri on techniques to engage adolescents

3

Therapist response
“While beginning therapists may tend to feel that often they are not responding – whether by reflection or interpretation – at the most appropriate times and that they are missing many situations in which they could have been therapeutic, it does seem that with children, perhaps more so than with adults, one can be permitted a few tactical ‘errors’. Activities and episodes tend to reappear if they are not adequately handled the first time.”
Child Psychotherapy (p259) Mary Howarth (ed): Chapter 13, Howarth on reflections and interpretations.

I’m hoping to bring you a live audio quote from a bang-up-to-date book in the course of the month. Watch this space!

Are the children cured yet?

I really believed I wasn’t going to mention ADHD again – and indeed I’m not. Because neither does Sami Timimi in his condemnation of the fast-cure parents who want instant results when treating their child’s bad behaviour and emotional distress. I found Timimi in The Telegraph last week, where he is quoted as saying: “With the widespread application of the techniques of medicine to manage our children’s behaviour and emotional state, particularly through use of drugs, we have achieved what I call the ‘McDonaldisation’ of children’s mental health.”

I know he includes ADHD in that because I have read his A Straight Talking Introduction to Children’s Mental Health Problems, but the book they are quoting from here is Childhood, Wellbeing and a Therapeutic Ethos, which has an enticingly wide selection of well-known contributors. The contents listing on Amazon is so good I have ordered it and will report back later when I’ve read it. That might be a while yet, because it’s scheduled as three- to five-week delivery. I guess that makes it a Christmas present to myself!

Moving tangentially from that thought, one of the chapters by Richard House is about “A Winnicottian and a Steinerean rationale for avoiding the premature ‘adultifying’ of children” – a bit of a mouthful! But this ‘adultifying’ is something we all find difficult to witness in our therapy rooms, since this is mostly a result of the society we’ve allowed to come into existence. It was only the other day that the MP Barry Sheerman lambasted the media coverage that has led to children enacting porn in the playground.

So what is the connection here? The fast food syndrome? Is it simply that parents can’t wait for their children to “cook” (grow up) properly for the correct length of time?

I’m sure I’m not the only counsellor who longs for parents to realise that kids need to be allowed to be kids and, for the duration, need parental time and attention. I think of a boy who wants only to play Ludo with me week by week as he absorbs what it’s like to have someone interested enough to be bothered, and also a girl who acknowledges she never has attention from her mother. At home, the partner is always there; out and about together, mum texts said partner and so isn’t entirely present. Both young people have a weary and worn view of life – mini adults in their resignation. Don’t you just hate to see it?

Medicating kids unnecessarily and shoehorning them prematurely into the adult world are equally obnoxious. No wonder they love coming to see us, however distressed they are.