Working with families
Being useful to families
Ideas underlying this approach:
- Families hold knowledge and resource which can enable movement
- Families need to feel (rather than be told about) the respect we hold
It seems to be a feature of the societies we live in and the context we work in that families experience a lot of blame and guilt. Experiencing these feelings tends to undermine, rather than enable, parenting. It is extraordinarily unusual, perhaps unknown, for parents not to hold some intentions to parent well, hopes for the best for their child(ren), etc.
Families are very important for their children. They not only spend a lot of time with them, but they comprise relationships - for instance: mother, brother, auntie - which may fail or be avoided but can never be replaced and are in place for life. There are also emotional and blood connections as well as societal and institutional support for these relationships. Families have a lot of knowledge and experience of their children. This can be from practical observation, shared family and cultural context of development and genetically mediated similarities in personality and ways of functioning. It is unusual to find children or young people who do not hold some hopes for things to be better between them and their family.
We can best serve children and young people by bringing forward and enabling access to the resources, knowledge, love and commitment, hopes, intentions, etc, in their families. To do this we need faith in the resilience and resourcefulness of the family. We need a commitment to the potential for discovery of the family’s knowledge, values, intentions. We need profound respect for the family, their practices, values and intentions. They need to feel this from the conversation. It is of limited value to tell them this, they need to feel it.
- Risk of prioritizing therapist knowledge and losing access to family knowledge
Operating in a modernist epistemology with a hierarchy of knowledge, often results in an understanding that the therapist has more and better knowledge and uses this knowledge to assess, identify problems and intervene. Because of the complexity of non-linear causation in a system such as a family, the clinician begins a long way behind family members in developing knowledge of any family. The prioritizing of clinician knowledge, risks undermining the family’s sense of expertise in their personal and family knowledge, sending it underground and decreasing its availability. Modernist epistemology seeks causal explanations based on underlying structures. Experience in quantum physics has shown this to be a limited strategy, the further physicists looked 'underneath' for smaller and smaller particles, the more they were led to empty space. In working with families, looking underneath risks leading therapists to blaming and pathologising formulations. Even trauma based formulations often focus on damage rather than resources, agency, etc.
Alternatively, using social constructionism we can look at a range of knowledges, which are evaluated, not by absolute truth but by values, usefulness and effects. In this context, the most useful explanations are those which mesh with the family’s knowledge, support their sense of agency and enable movement.
- Focus is movement supported by bringing forward resources of the family
- Hearing resources languaged in the room increases their availability
Profound respect for the resources and knowledge of the family is key to collaborative family work. This respect influences the amount of interest we have in hearing about the family members’ decision processes. Asking a question about family practices has the focus of enabling them to hear themselves describe their agency, knowledge intentions, hopes and commitment and put them into words. This can be particularly potent in a family context as other members of the family are also hearing this, not just the person giving form to the ideas.
Rather than identifying deficiencies, the focus is movement. It is the resources of the family which will enable movement. As with individual work processes of inquiry and gathering threads is used to bring these forward, developing a sense, in the moment, that change is possible. This inquiry can be done in a spirit of conversational interest and curiosity, as with an agenda of one family asking about another family’s practice, in order to open options they might consider. For example:
"How do you do things in your family?"
"How do you decide who does the dishes?"
"How well does it work?"
"What do you do if this doesn’t work?"
"Who else in the Family has had experience of something like this? How did they deal with it?"
"How has the Family got through other difficult times?"
As clinicians, we develop ideas about the families which can inform the questions. For instance:
“How do you think the experience of parenting you had as a child influences the strategies you use in your parenting now?”
- Contrasts with totalizing and traditional externalizing
- Opens space for the family to look in on the issue in relation with themselves
Relational externalizing can also be used in a family context. This contrasts with totalizing language and traditional externalizing.
We are a disconnected / dysfunctional / violent family.
What led to your becoming a violent family?
How long have you been a violent family?
What effect does this violence have on your family?
How did the violence get into your family?
How does the violence protect itself from being stamped out?
The violent acts you describe, are you noticing them more at some times than others?
This lack of respect you have noticed in your children, is it more noticeable at some times than others?
"Are you a close family?" versus "What sorts of closeness do you experience in your family?"
" Did she attach well?" versus "What signs of attachment does she show?"
" Have you grieved for …?" versus "What sorts of grieving have different members of the family engaged in?"
" Do you trust Johnny again?" versus "Are you noticing signs of trust starting to build again?"
" Are you an OK parent?" versus "What parenting that you do would you describe as OK?"
- Altering pattern of talk to focus on agency, movement and resource can be increasingly powerful where all hear the talk
- Small changes can amplify in family system
These strategies can be particularly powerful in a conversation with a family as they open up new possibilities. Because of the systemic nature of family interaction, small changes can amplify and be surprisingly powerful. This can be particularly so when there has been a self-reinforcing spiral, or vicious circle, operating where the family takes on blame and judgment for the difficulty and feels further undermined by this. A conversation which shifts this spiral by supporting the awareness of the agency, knowledge and resource that they can draw on, can be powerful in enabling movement.
Focusing on presence rather than absence, invites a more optimistic conversation. Specifically asking what is happening in the family that they would like to keep the same can be a useful question for people. There is a wide range of other possibilities:
- When was there last closeness in this family?
- What's it like when the arguing is not happening?
- What are the nice times in the family like?
- When you make these efforts to get communication going who notices?
- What keeps you going with ….?
- What would happen if everyone got along?
Researching difference between views of family members, can enable family members to hear each other with much closer detail. For instance:
"Does everybody have the same amount of concern about this, or are some more interested than others?"
"Do your mum and dad have the same idea about your finishing school or are they a bit different? How do you understand the difference?"
"If we x, y, z what would happen?"
"If Mandy’s behaviour did start to shift, what difference would it make?"
"Who would notice?"
"When Mandy was a baby, did you have ideas and hopes about what sort of parent you would like to be?"
"What sort of relationship you would like with your daughter?"
"How would you like the conversation about how late Mandy can stay out, to go?"
Moving between ideas and practice can bring forward much resource in the family which might otherwise not be noticed. For instance:
"How does love show itself in this family?"
" If Johnny did start to show respect, what would he be doing?"
"You say you came here because mum wanted you to. Does that indicate some respect for her ideas, wanting her to be happy, fear of her?"
"You have taken a lot of trouble to tell me about all this, I notice a lot of strong feelings. Is this an indication of how much Johnny means to you?"
" If I was to look in the window when all this anger was happening, what would I see?"
- Using therapeutic strategies in respectful conversation about ordinary issues can support movement
Discussion of how everyday tasks are managed in a family can be surprisingly rich. Here is an amalgamated example of a conversation with a mother about dishes.
"How do you get the dishes done in your family?"
"I (mum) do them."
"Does this work for you?"
"Not really but it is easier than arguing."
"Sounds as if there is a weighing up process going on, balancing the work of doing the dishes vs wanting to live in a family with less arguing. At the moment you are not all that comfortable with how it is working out. Has there been a time when the balance was working for you?"
"Not really, I’ve always been a skivvy for the family."
"What keeps you going in that role, stops you from throwing it in?"
"Then nobody would do the dishes."
"It sounds as if you are prepared to go to quite a lot of effort to make sure things like dishes happen in this family and also to lessen the arguing. It also sounds as if there is some cost to you in getting this stuff done without arguing. Is it your commitment to your children that keeps you going with this?"
"My kids are everything to me."
"You hold a powerful commitment to your children. Do you think they realise this? Should we ask them about this, and if they see this commitment in other ways in the family?"
- Any argument engaged in can be considered lost
- Make an inquiry to make people think
- Embody confrontation
As the family feel the respect for them that you hold, you can address almost anything. Confronting and arguing are high risk strategies; one might consider any argument engaged in as lost. Finding aspects of the family’s processes, ideas, intentions, etc, to validate and acknowledge is likely to be more helpful. For instance:
"I understand you described some reluctance to come in. Does that reluctance indicate the care you take about what outside influences your Family is exposed to?"
" I am wondering if the strength of the anger you experienced when you 'lost it' is an indication of the strength of love you have for Mandy?"
" I notice you are answering a number of the questions I put to Mandy. Is that because you want to be sure we have the fullest information in order to help her?"
Challenge is an effective stimulus for movement when felt by the family as respectful inquiry. It can stimulate the family’s thinking. For example:
"Is this working for you/Johnny/Mandy?"
"What are you hoping Mandy will take from that?"
"What do you think the effect is of …?"
"Is this the sort of parenting you are wanting to be doing?"
"Has this worked in the past?"
" Do you want things to keep going the same or do you want some movement?"
When a parent is lecturing a child or young person, it can be very clear to a clinician that this is not a helpful strategy and there is a strong temptation to tell the parent this. But the process of telling is a high risk strategy as it has an implicit agenda that the therapist knows and the parent doesn’t. There is a range of inquiries which can enable the parent to reflect on the conversation style they are using, bring forward intention and their own assessment of its usefulness.
"What are you hoping Mandy will take from this?"
" Is this something you have tried before?"
"How well has it worked?"
"Should we ask Mandy what her thoughts are about it?"
"Do you feel this sort of talking is an important part of being a parent?"
"Do you have concerns about what might happen if you did not keep letting Mandy know how you think she should behave?"
In the extreme situation where confrontation or coercion is needed, it is important to own it in the context of the power relation and the authority we hold.
"I have a concern".
If this is taking a different view from the family make this explicit.
"The understanding of this that I have is different from the understanding that you hold."
Clarify the role and authority on which the overriding of the family’s choice is based. It is not that we have a hotline to truth, but that we take up responsibility in the role or position we hold.
"In my position as … I need to …"
"I am aware that I could be wrong, but on the basis of a, b, c, I estimate the risk at a level where I feel a requirement to act."
It may be helpful to identify external authorities such as professional bodies or the coroner’s court to which we may be answerable if we do not act within certain parameters. It is also important to clarify avenues the family can take to oppose our stance or have it re-evaluated.
- Offer the family an opportunity to use us to have a different conversation from what they would have at home
- Use power relation to take control
- Sequential, individual, observed conversations
Often in work in mental health services we are engaging with families to support one of their members. In this context the family is not seeking our help as a family. We have found that a number of families we work with are not receptive to being offered family therapy and understand this recommendation as an indication of judgment and blame. We have found that families are more open to the idea of an opportunity to use our professional support to engage in a conversation which is different from the conversation they would have at home, with the possibility that some movement and new ideas might come out of it.
It can be very helpful to use the power relation to take control, such as in a 'lose-lose' argument, or negative conversation. Interviewing each person individually, using the therapeutic strategies for bringing forward resource, with the other listening can often enable movement. If the person in the listening role interrupts, ask them if they can hold their concern and ask what sort of support they need. Write it down, etc, and come back to it. For instance:
"I'd like to stop you here and reflect a bit on the conversation."
"Is there anything new happening in this conversation? Are you learning something?"
"Is this the sort of conversation which happens a lot at home?"
"Is it helpful, is it working for you?"
"Would you like to try something different?"
"I would like to try interviewing you one at a time."
"I am not 100% sure how helpful this would be but it would give you an opportunity to have a different sort of conversation."
"I will stop after a bit and I check as to how you are finding it."
When a family is using judgment to undermine their own processes, the agency and decision making processes involved in this can be brought forward, the values and intentions which support it made explicit and the effect of it considered.
"We don’t cope with that very well."
"How did you work that out? Is there a standard of parenting you measure your family against?"
"When you have that sense of “not measuring up” what effect does it have on your parenting?"
"It sounds as if you have put a bit of thought into this, into the sort of parenting you are wanting to be doing. It sounds as if you are describing a range of ideas as to what is important to you in parenting and placing a strong value on doing the very best for your children."
When one family member is talking for another, there can be a risk that that person is missing out on a possibility of engaging more directly in the conversation. If we make this explicit, we can bring forward the intention and consult with them as to how well the strategy is working.
"I notice you are helping Mandy with answering some of the questions. Do you have some concern that the questions may be difficult for her to answer, or perhaps that I need information that is more full than she can give?"
"Should we check with Mandy if her ideas are the same as yours or a bit different?"
"Mandy, do you feel 100% agreement with what your mum is saying or 50%? Would you like your mum to keep helping you like this or should we try something a bit different?"
Sometimes when a child or young person is not talking, we can consult with them as to whether it would be helpful if the supporting family member took up a role of speaking for them.
"I notice it doesn’t seem easy to talk here. Is there anything I can do to make it easier?"
"Would you like your mum to tell some of the story to begin with and we can check it with you as to how much she is getting right from your point of view?"
- Is this news to Johnny?
- Use power relation to manage conversation, focus on presence and bring forward values and intentions
One of the challenging situations which can arise with families is where one family member is speaking in such a negative manner about another. We then identify a risk that the talk in itself may be destructive and damaging. If we experience this level of concern we need to use the power relation to stop the conversation -
"I’d like to stop you there. Could you just hold on to what you are saying. There are a few things I’d like to check."
We need to consider whether to separate family members, particularly if some are children. If there are substantial issues of belonging, if there is significant doubt that the family remains committed to a child or family member then separation is most useful. The likelihood of a constructive collaborative conversation is limited.
It is more common that the family holds significant commitment to the child but also strong feelings which fuel the intensity of the negative diatribe. The dialogue is heard frequently by the child. In this case for the child to stay in the room and be party a different sort of outcome to the familiar talk can support movement. Asking,
"Is this news to Johnny, is this familiar talk or is it new?"
can help clarify this. It also opens an opportunity to move away from content. This can be supported with inquiry to increase understanding and bring forward values and intention to bringing forward values and intention.
"In telling me about this what are you hoping for?"
"I noticed that the talk just seems to be tumbling out in a stream. Is it ‘I am so frustrated I just need to ventilate.’ Is it that the hurt you have experienced is so huge that you cannot hold onto it?"
"Have you tried everything you can think of and nothing works, does that feel really frustrating and is this anger part of that frustration?"
Focusing on relational presence can create movement.
"What keeps you going as a parent, seeking help for Johnny, when things feel so hopeless?"
"Do you hold some hope, against all odds, that things could get better?"
"Are there times when Johnny does some different sorts of behaviour?"
If parent persists with the negative diatribe there needs to be a respectful inquiry. For instance:
"Are you concerned I am (underestimating) not taking the difficulties you and Johnny are facing seriously enough?"
"What would let you know that I am getting enough understanding of how serious things are?"