Counselling Children, Adolescents and Families: A Strengths-Based Approach

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John Sharry

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  • About the Author

    Dr John Sharry is a social worker and psychotherapist at the Department of Child and Family Psychiatry, at the Mater Hospital, Dublin. He is also a Director of the Brief Therapy Group (along with Melissa Darmody and Brendan Madden) and a Consultant Research Scientist, with Media Lab Europe, a research institute based in Dublin and affiliated to the MIT in Boston. John is co-author and producer of the Parents Plus Programmes (video-based parenting guides), which are used as the basis of parenting groups throughout the UK and Ireland. He is also the co-author of several self-help books for parents including Parent Power: Bringing up Responsible Children and Teenagers (Wiley, 2002) and two previous psychotherapy books Solution-Focused Groupwork (Sage, 2001) and Becoming a Solution Detective (BT Press, 2001; Haworth, 2003). More information can be obtained on the following websites:

    Copyright

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    Dedication

    To the families who keep hope alive.

    Foreword

    Every generation has its challenges. When I was growing up during the 1960s and 1970s, my parents worried about drugs and changing sexual mores. ‘We just didn't do the kinds of things you kids do nowadays,’ I can remember my mother saying to me on repeated occasions during my childhood and adolescence. My father would invariably add something on the order of, ‘Yes, Scott, listen to your mother. It's a lot harder growing up in today's world,’ and then, after a brief pause, he would continue. ‘There are more temptations and the consequences more severe, less room for a miss-step. Don't make any choices that might ruin your future.’ Commentators of the time described my generation as rebellious like no other in history – a label many of us at the time wore as a badge of honor. We were striking out against the established order. We were for peace instead of war, love instead of hate, freedom in place of rules and restrictions.

    Now a parent myself, I have a much better appreciation of my parents' concerns. As Mark Twain once wryly observed, ‘When I was a boy of fourteen, my parents were so ignorant I could hardly stand to have them around. But when I got to be twenty-one, I was astonished at how much they'd learned in seven years.’ And while I hate to admit it, I find myself believing at some deep level that these are the most troubling times yet in which to raise a child. In addition to the drugs and changing social mores, we now have AIDS, violence, sexual abuse, high divorce rates, as well as a frightening number of psychiatric disorders that were either rare or non-existent during my generation.

    Attention-deficit disorder, depression, anxiety, eating disorders, learning problems, Asperger's syndrome, conduct disorder, autism, anger and emotional dyscontrol, obsessive-compulsive disorder, and childhood onset schizophrenia are but a few of the maladies in recent years to provoke public anxiety about the status of children's mental health. One can rightly wonder, what is happening to our kids? Has the world grown so toxic? Is modern life merely too complex? And, perhaps most important, what should I do as a parent, educator, counselor, or social worker?

    The answer to these questions have far reaching implications for how we handle the problems that invariably show up in the rearing of children. For example, a recent study found a three-fold increase in the use of psychotropic drugs in children between 1997 and the present. Never mind that most such drugs have never been approved by the FDA (Food and Drug Administration) for use with kids under any circumstances. In fact, seven out of ten drugs given to children have never been tested and proven safe or effective for use by them. All of this, however, begs the question: is such widespread use of medication with kids the right thing to do? Sadly, the answer, at this point in time, is unknown. We simply don't know the long-term consequences of this increasingly popular form of intervention.

    When the health and well being of children is at stake, whatever we do, however much we spend, may never seem adequate. The serious nature of the problems unites with our strong desire for change, compelling us to take dramatic and immediate action. Unfortunately, history shows that perspective is a frequent casualty of this process. For example, many treatment approaches have, with time, later proven ineffective or actually dangerous – and not just in the past. Recently, when the public was concerned about a rise in the juvenile crime rate, many adolescents were sent to inpatient settings to be treated in groups. Only later did research find that this approach actually made the problem worse! At the same time, diagnostic labels seem to come in and out of professional and public focus with some regularity. Not long ago, for example, there seemed to be a dramatic increase in the numbers of kids with eating disorders. Anorexia and bulimia were the focus of a wide number of books, workshops, and talk shows. And then suddenly, and without fanfare, the problem simply receded into the background.

    Returning to the question posed earlier, ‘So what is a parent, educator, counselor, or social worker supposed to do?’, I remember a quote from a textbook I read during my second year as an undergraduate student in psychology. We were studying adolescent development at the time. Specifically, we were learning about the challenges parents face raising kids during this difficult phase of life. The authors of the text cited various parents, including the following:

    The children now love luxury; they have bad manners, contempt for authority; they allow disrespect for elders and love chatter in place of exercise. Children now are tyrants, not the servants of their households. They contradict their parents, chatter before company, and tyrannize their teachers. (Patty and Johnson, 1963: 277)

    The comments were hardly surprising in their own right. After all, the sentiments sounded similar to those expressed by adults about my generation and me. Imagine my surprise, however, when I learned that the quote was nearly 2500 years old! Although edited somewhat to fit modern times, Plato was the parent complaining about the problem of ‘today's youth’.

    From that experience, I learned a lesson about the importance of maintaining perspective that has stayed with me to this day. These are not the worst of times; neither are they the best. True, we don't want to look at the world through rose-colored glasses. It is equally important, however, that our lenses not be tinted in a way that always has us seeing smoke and fire. In other words, when trying to determine how best to be helpful, maintaining a balanced view is critical. It is a simple idea that is not always easy to put into practice.

    In his book Counselling Children, Adolescents and Families: A Strengths-based Approach, Dr John Sharry accomplishes exactly that. First, he addresses the many serious issues facing children and adolescents without ever losing sight of the fact that the kids themselves are the greatest problem-solving resource available to helpers. Second, in a clear, engaging, and step-by-step fashion, he describes how therapists, social workers, and helpers of all stripes, can tap into the many assets and abilities lying in wait in today's youth. Troubled children and adolescents will most certainly benefit from the perspective offered to their therapists within these pages. I highly recommend it.

    Scott D.Miller, PhD Institute for the Study of Therapeutic Change, Chicago, Illinois, USAhttp://www.talkingcure.com

    Preface

    It's the space between the bars that holds the tiger and it's the silence between the notes that makes the music.

    Zen Proverb

    The map is not the territory.

    Bateson

    Writing a book on how to help people therapeutically as a professional is somewhat a doomed project. At the heart of the helping process are human relationships and the experience is far too subjective and personal to be satisfactorily summed up in a theory. No therapeutic model is a complete explanation and no set of techniques will lead to perfect therapy. Therapy is more of an art than a science, and though models can sometimes illuminate the way, they can also sometimes obscure, especially when people believe the model to be truer than the unique reality of the clients in front of them and forget that the ‘map is not the territory’. Solution-focused therapy, the model that underpins this book, is equally prone to these dangers. Exponents can over-rely on the techniques and miss the strengths-based thinking that underpins the model. Or they can neglect aspects of the helping relationship such as empathic listening, hearing the client's story and establishing an alliance that are not explicitly emphasised in the original model.

    I'm reminded of a story told by Irvin Yalom about a young cook who wished to learn the skill of a master chef renowned for his legendary cooking. The young man obtained copies of the great chef's recipes and though he followed them to the letter, he could never arrive at the master's standards and his meals always fell a little short of excellence. Undeterred, he went to the master chef's restaurant and sneaked into the kitchen to observe him cooking. As he watched, he noticed that during the cooking the chef would break the rules of the recipe and would add unmeasured handfuls of extra spices and herbs, apparently at random to the meal. Surprised, he challenged the chef as to why he was not following the recipe and adding all these extra ingredients that didn't appear in the recipe. The chef answered simply that it was these extra ingredients that made the meal taste so good!

    So in writing this ‘recipe book’ for therapy with children and families, I realise that it is quite limited. I realise that there are many more ‘extra ingredients’ to effective therapy that are not contained in this book and that these may vary across different professionals and different contexts. Furthermore you may not know what these ‘extra ingredients’ are until you meet the individual child that you are trying to help. Each child and adult are their own unique individual and each meeting is a unique inter-subjective encounter. For this reason it is important not to start from a position of complete certainty, but rather from ‘one of unknowing’. When you don't know everything you make room for the client's knowledge and ideas, and these are certainly the most helpful. It is the willingness to let go of assumptions and the ability to look for freshness and newness in each human encounter that makes the therapeutic relationship work.

    The Audience of This Book

    Though the book draws its ideas from solution-focused counselling and therapy (and other strengths-based psychotherapies), it is not just relevant for counsellors and psychotherapists. The solution-focused model is very versatile and practical and is relevant for all professionals who work with children, adolescents, their parents and families to help them change and reach their goals. Thus, I hope the book is relevant for professionals from fields as diverse as social work, psychology, child care, family support workers, pastoral work, nursing and teaching, as well as psychotherapy and counselling.

    I believe ‘therapeutic work’ is not the strict remit of qualified counsellors and psychotherapists, and this is borne out by the research evidence. For example, a recent review of the latest research data suggested that para-professionals with minimal counselling training were generally as effective as professionally qualified psychotherapists in helping their clients (Atkins and Christensen, 2001). My sense is that what counts is not simply your length of training, but rather the core values of respectful and responsible practice that you bring to the work.

    This book is practice-based rather than theoretical, concentrating on the ‘how to’ of working with families. The emphasis is on developing strengths-based, collaborative practice that is family based and inclusive of the different perspectives of children, adolescents, parents and extended family. This book briefly describes the systemic and social constructionist theory and philosophy that underpins the practice ideas (in Chapter 1). But this is far from comprehensive and readers who are interested in exploring such theory can pursue further texts (for example, de Shazer, 1994; Gergen and McNamee, 1992; Street and Downey, 1996). To make the book accessible and practice-based I have illustrated the ideas using a variety of case examples and sample session dialogues.

    Though the aims of this book are broad, the case examples are set within the bounds of my own professional training and experience, as a psychotherapist and social worker, and within my professional work context, in a child and adolescent mental health service. For example, you will notice that many of the chapters refer to the Parents Plus Programmes and to other groupwork interventions that combine cognitive/behavioural ideas with a strengths-based approach. These are the models that have evolved within the multidisciplinary context in which I work, but clearly there are other strengths-based applications and models as well as different professional contexts that raise different challenges. As you read this book, I encourage you to adapt the ideas to your own particular setting and context.

    Overview of Content and Chapters

    This book is divided into three parts. Part 1 consists of five chapters that describe the theory and practice principles of a solution-focused and strengths-based approach to therapy with children and families. Chapter 1 establishes the professional and theoretical of working with children and families, describing the principles that underpin the book. Chapter 2 outlines three core principles for strengths-based practice, notably establishing an alliance, elaborating strengths and focusing on goals, illustrating these ideas with a number of practical case examples. Chapter 3 describes the process of engaging and motivating children and families, in particular highlighting the need to establish a collaborative partnership from the outset. Chapter 4 considers how we can ensure that children and adolescents are included in therapeutic work by making our practice more child and adolescent centred, in particular by incorporating creative activities into the process. Chapter 5 considers the issue of completing a collaborative assessment and provides a guide to structuring a first session with a child or family. Chapter 6 considers the important but controversial area of diagnosis and formulation, and attempts to propose a strengths-based way of making formulations that recognises the benefits as well as the dangers of using formal diagnoses with children.

    Part 2 of the book contains a series of chapters on specific applications of a strengths-based approach to working with children and adolescents and their families. Chapter 7 argues that groupwork is a naturally strengths-based intervention and describes how parenting groups can be established. Chapter 8 looks at groupwork with children and adolescents, and the specific issues and challenges that arise. Chapter 9 (co-authored with Grainne Hampson and Mary Fanning) describes the use of video feedback in a strengths-based early intervention programme with preschool children with developmental and behaviour problems. Chapter 10 describes the approach of externalising the problem, illustrating this with an extended case study.

    Finally, Part 3 of the book contains two chapters that outline the application of a strengths-based approach to challenging contexts, namely suicidal behaviour and depression (Chapter 11, written jointly with Melissa Darmody and Brendan Madden), and child abuse and neglect (Chapter 12, written jointly with Declan Coogan).

    Acknowledgements

    Writing this book represents the work of many years and would not have been possible without the support of so many colleagues and friends. First I would like to thank Melissa Darmody and Brendan Madden, my partners at the Brief Therapy Group in Dublin, who inspire and challenge me in equal measure and who are great partners to share a vision with. I'm also indebted to Scott Miller, Chris Iveson and Michael Carroll for their constructive comments and mentoring as this manuscript developed.

    Thanks also to all my colleagues at the Mater hospital, in particular Declan Coogan for his enthusiasm about Chapter 12 and to Matt McDermott for many helpful conversations about working with children. A particular word of thanks to my colleagues on the Parents Plus Programmes: to Grainne Hampson and Mary Fanning, who co-authored the Early Years programme and who have taught me how much fun it could be to work with preschool children; to Jean Forbes for teaching me balance in groupwork; and to Carol Fitzpatrick for her vision and constant encouragement. I would like to also acknowledge Suzanne Guerin and Michael Drumm for keeping the research going (though Michael was doing this remotely!). Thanks also to John Wheeler for his helpful ideas on engaging young children, to his son Matthew for providing the pictures in Chapter 3, and to Joshua Davis for locating one of my favourite quotes. I would like to acknowledge all the staff at Sage and in particular Alison Poyner for being constantly upbeat and constructive.

    I am also very grateful to all my family and friends for their support as I was caught in the writing of this book.

    Finally, I would like to acknowledge the many children, adolescents and families I have worked with over the years. It has been an honour to be a witness to your courage and triumph in the face of adversity.

    A Note on Language

    In an attempt to make this book as inclusive as possible, I have alternated many of the terms used. For example, I use the terms ‘therapist’, ‘counsellor’, ‘worker’ or ‘professional’ interchangeably to include all the different professionals who work therapeutically with children and adolescents and families. To avoid unwieldy uses of ‘he/she’ or ‘him/her’, plurals are used where possible when referring to clients and professionals. In specific case examples, an attempt is made to alternate between male and female clients and professionals.

  • Epilogue

    Life should be more about holding questions than finding answers. The act of seeking an answer comes from a wish to make life, which is basically fluid, into something more certain and fixed. This often leads to rigidity, closed-mindedness, and intolerance. On the other hand, holding a question – exploring its many facets over time – puts us in touch with the mystery of life. Holding questions accustoms us to the ungraspable nature of life and enables us to understand things from a range of perspectives.

    Thubten Chodron on Buddhism

    So we have come to the end of this book, and in doing so I recall what I said in the preface, that writing a book about human affairs is a precarious venture. Any time that we propose a theory or answer a question, we exclude other possible theories and other possible answers. A written theory or description never captures the complexity of the human experience or the mystery of interpersonal encounters that occur in the helping relationship. It is important that we never satisfy ourselves with answers and keep asking questions. Each time I meet a client, I endeavour to put to one side all my fixed answers and to start with a simple open question: How can I be of best help to this person who has come to see me?

    You may have noticed that throughout the book I have enjoyed telling stories. Stories often reveal deeper truths and are far more inspirational than prose or theoretical debate. As a result I would like to introduce a final, somewhat paradoxical story, which for me personifies a central aspect of the strengths-based approach to helping people. Many children, adolescents and families start therapy focused on their limitations and deficits with a vague sense of what they want to achieve but often feeling hopeless about making progress. They can be burdened by feelings of failure and blame. Like the eagle in the story below, they are often out of touch with their strengths and resources and the possibilities that could be open to them. A strengths-based approach to therapy is about helping the client awaken to the potentials and strengths that are within their reach and to move to a more transformational and ideal view of self. Drawing on the story's metaphor, the role of a strengths-based professional is to help clients realise the ‘eagles’ they already are, and to believe that they can fly high in the skies like the ‘king of all the birds’.

    A man found an eagle's egg and put it in a nest of a barnyard hen. The eaglet hatched with the brood of chicks and grew up with them. All his life the eagle did what the barnyard chicks did, thinking he was a barnyard chicken. He scratched the earth for worms and insects. He clucked and cackled. And he would thrash his wings and fly a few feet into the air. Years passed and the eagle grew old. One day he saw a magnificent bird above him in the cloudless sky. It glided in graceful majesty among the powerful wind currents, with scarcely a beat on his strong golden wings. The eagle looked up in awe. ‘Who's that?’ he asked.

    ‘That's the eagle, the king of the birds,’ said his neighbour.

    ‘Wow’ replied the eagle ‘I wish I could fly like him, how I wish I was an eagle … but unfortunately I am only a barnyard chicken.

    Adapted from the book Awareness by Anthony de Mello (1997)

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