If you are hoping to find a therapist for your child, you may be feeling desperate for someone to solve the problem and restore harmony to family life. In this article I explore the idea of taking a systemic approach to supporting your child’s mental health and making sure the whole family is involved in the process of bringing about change.
“A system which may run through all its possible internal changes without effecting a systemic change…is said to be caught in a game without end. It cannot generate from within itself the conditions for its own change; it cannot produce the rules for the change of its own rules.”
Watzlawick, Weakland and Fisch, (1974) Change: Principles of Problem Formation and Problem Resolution. New York, NY: W.W. Norton & Company
When I was growing up in the 1980s, I had a wonderful, eccentric GP who believed that the answer to any problem was psychotherapy. I suspect I was a normal child, with normal fears and anxieties struggling to make sense of a complex family dynamic, but the drive to ‘cure’ my endless list of symptoms led to years in and out of therapists’ offices, talking to some analyst or other with varying levels of success. I loved talking about my feelings, I enjoyed analysing my relationships and my experiences and trying to come up with ‘a-ha’ moments that would make sense of them all. But when I walked back into the real world, I had neither the strength nor the ability to translate my experiences into actual change. With all I now know, I want to reach back in time to that child and gently remind her that it is normal to feel frightened and worried and, although there was a great deal that wasn’t right, it really wasn’t her fault or her job to fix it.
I believe that this experience fuelled my career trajectory and underlined for me how important it is, when working with children, to involve the whole family in the process of change. Fast forward twenty years, and I was a newly qualified Dramatherapist working for Kids Company running therapy provisions in two inner-London primary schools. For every child who benefited enormously from the 1-2-1 support and space to explore their inner worlds, there were many for whom it didn’t feel enough. The systems of which they were a part were letting them down, failing to meet their basic needs. It felt imperative to me that I learn how to engage parents, how to support the teachers who were struggling with integrating these kids into the classroom, to work with the siblings and grandparents who were part of the story. The symptoms and behaviours that they were manifesting were not their fault and certainly did not exist in isolation to the rest of the family. If I wanted to bring about real change, it was going to be necessary to work with the systems around them and this is what led me to enrol at The Tavistock Clinic and begin my Systemic Therapy training.
Systems theory derives many of its ideas from cybernetics. Families are like machines that rely on the interaction of all constituent parts to maintain the status quo. If one component shifts, moves or does something different, the remaining parts need to alter their behaviours to keep the machine moving. Like machines, however, human beings are programmed to resist change. If you have ever tried to break a habit or start a new routine, you will know just how difficult it is to bring about even the simplest changes in our lives. It is not that we can’t do it, in fact current thinking about neuroplasticity (the brains’ ability to adapt and change throughout our lives) shows that human beings’ ability to change throughout the life cycle is greater than ever previously believed; but it isn’t easy. We often find ourselves being pulled back into old habits and, most interestingly of all from a family therapy perspective, the people around us will modify their own behaviours if they sense change, in order to retain the status quo.
Not only is it difficult to create new patterns of behaviour, but also we need to recognise that in families we often misdiagnose the problem in the first place. Sticking to the machine metaphor for a little longer, we don’t always see the actions that led to the ‘broken’ part being displaced or getting stuck. If we spend too much time trying to fix the presenting problem, then we can miss the underlying issue. You can oil a squeaky break until it works perfectly, but if the gears are broken the car still won’t run. Delays in getting treatment can have catastrophic effects on family life. Often, by the time a family has reached my therapy room, a small problem has infected the whole family with anxiety, fear, and sadness. It is not always obvious where the problem started, or in what ways the problem itself has become the coping mechanism used to keep the system alive.
So how can we make sure that we are thinking about cause and not just treating the symptom? Early intervention is the most powerful tool we have. But finding a therapist for your child can be a daunting task. I don’t think it is possible to underestimate the importance of the work that Lou, Lorna and The Sunflower team are doing to help parents, carers and professionals to support child and adolescent mental health. The Sunflower Directory is ground-breaking not only because it is creating a portal into a world that can often feel impenetrable and overwhelming, but also because it recognises the reality that there is no one-size-fits-all approach to mental health. For too long have we, as a profession, failed to work collaboratively and to recognise the power and good in each other’s varied approaches to the field of mental health. At last, we can acknowledge the need to see children in the context of their emotional, behavioural and somatic worlds, as well as in the context of the wider systems around them.
At the same time as ensuring early intervention and ease of access to therapeutic services, we need a cultural reframe of the way that we think about treating children. Looking after a child who is struggling with their mental health is exhausting. It can feel utterly relentless and, inevitably in such a pressure cooker, it can be all too easy to focus all our attention on the presenting problem. We start to engage in magical thinking, believing that if the behaviour went away all would be well. If someone could just fix the child, then we could all get on with our lives. I have met many overwhelmed parents, bringing a child to therapy and expecting the work to go on behind closed doors and for the child to magically emerge ‘better’. I am often asked to refer to the therapy as ‘lessons’ and implored to keep the work a secret from other family members. I have faced frustration, anger and outright hostility when a child has not been cured in 6 sessions.
The reality is that change requires work from all members of the system and it will often be slow and painful. We need to understand that the mental health of our children doesn’t exist in isolation to the world around them and, for children more than anyone else, it is vital that parents understand the role of the wider system in bringing about change. For children who have experienced trauma, who are suffering from acute mental health conditions, or who are finding it hard to cope, receiving therapeutic support is a lifeline. But understanding that therapy is not a journey your child goes on alone, that the rest of the family must also engage in the hard work of change, is key if we want to ensure successful outcomes.
Does this mean the answer is always family therapy rather than individual therapy? Of course not. I have worked with countless children who needed the 1-2-1 support of individual therapy, the space to reflect, and for whom a creative approach is the single most successful intervention. Equally, there have been many occasions when family circumstances simply don’t allow for systemic work. Even so, it is possible to use some simple systemic ideas to bring new perspectives and encourage a more collaborative approach to change. Engaging a therapist is the first step in a journey that involves a great deal of self-reflection and honesty between all family members. It is vital that you remain curious about your child’s perspective and don’t get stuck in your hypothesis because the problem may look very different from their point of view. Taking the time to reflect on the problems through a systemic lens before the work begins will scaffold your child’s chances of finding long term change and strengthen the therapeutic alliance.
Here are a few questions for you to ask yourself before engaging a therapist to help your child:
1) What are your reasons for seeking therapeutic support?
It is unlikely to just be for your child. In what ways do you, and the rest of the family, also need to bring about change? What do the other members of your family think?
2) When did the problem begin?
Think about this as a family and be curious about ways the problems might have been subtle at first. Who first noticed the problem? What other problems exist alongside this one?
3) What changes/events took place in the 12 months leading up to the onset of symptoms?
Children experience loss in different ways to adults and something that may feel inconsequential to you, could have had a significant impact on your child. What else has been going on in your lives?
4) How does the problem affect the family as a whole?
How are the relationships within the family affected and how does it affect your relationships with the wider world?
5) What techniques have you already tried?
Bringing about change is hard work and requires the ABCs of parenting to be enforced with rigour – Agreement, Boundaries, Consequences. What makes you give up on routines? Who is most likely to stick to agreements in your family?
6) If the problem were to disappear overnight, how would your life be different?
This is called The Miracle Question. It helps you to think about a life without this problem and to focus on the possibility of change. Sometimes we get so bogged down in the problem that we stop being able to see the solution. We give up on hope and feel stuck. You might be surprised by what comes out of this question.
Remember, however distressing the situation may feel right now, there is help out there, and whatever approach you choose, it is possible for things to change. By thinking systemically, you can make sure that the family can cope with change as it arises and integrate, rather than reject, what feels new.
The Sunflower Network provides a platform for professional community members to publish articles on this website. The views expressed in this article are those of the article author.