Exploring the factors affecting child and adolescent psychotherapists' and counsellors' decision‐making in clinical work with parents

Abstract

This study examined interventions with parents/carers in child and adolescent counselling and psychotherapy (CAP). The aim was to investigate clinicians' rationale behind their decision to work with parents and what types of interventions they use. Furthermore, the nature of clinicians' core training with regard to interventions with parents was investigated. The study used both quantitative data and qualitative textual data from an online survey of 110 CAP clinicians. There was significant agreement, regardless of previous training or level of experience, that clinical work with parents in CAP is beneficial, but little consensus for a rationale or model for best practice. There was a relationship between training, theoretical orientation and whether CAPs felt competent to work with parents. Unexpectedly, a significant number (83%) of integrative practitioners said that there had been ‘little’ to ‘none at all’ focus on working with parents on their core training course. Other unforeseen findings were in the domain of working outside generally accepted boundaries for CAP, with a notable number of clinicians making home visits—24.1% with parents alone and 38.9% with parent and child together—along with 47.2% using phone calls and/or email for coaching and support with parents. Many clinicians were candid about their sense of a lack of competence in working with parents, even though at least half were senior, experienced clinicians. A number of these practitioners made specific reference to the wish for further specialist training, with many asking for signposting to where further training could be obtained.

“The Parallel Dialogue”: Parental experience of their role in the relationship with their child's counsellor/psychotherapist

“…One was a misrecruited dyadic therapy intervention, in another, the parent attended and actively participated in sessions to help overcome remote‐working challenges, and the remaining two had minimal parent–therapist interaction. While this supports Jäderberg et al's (2019) findings around the diversity of ways child practitioners work with parents, it is somewhat surprising that half the sample had very limited ongoing contact given the high levels of parent work reported in Jäderberg et al's sample. The self‐referring recruitment method may have contributed to the variance, attracting participants at extremes of involvement and satisfaction, keen to tell their story.…”

“…Siskind (1997) suggests there has historically been systemic ambivalence and avoidance surrounding parent work, leaving practitioners feeling unsupported, resigned and burdened in their dealings with parents. This view is supported by a survey of child and adolescent practitioners (Jäderberg et al, 2019), which found that while the vast majority of practitioners worked with parents in some capacity (94.4%), only 58.8% felt competent in this area, with less than half feeling adequately prepared for this work by their training (44.8%), leaving them unsure when and whether to involve parents.…”

“…This "amorphous and multifaceted" (Slade, 2008, p. 209), "vaguely defined and poorly understood" (Holmes, 2018, p. 264) relationship is a necessary and central component of the work due to the child's dependency on their parents to initiate the therapy, liaise with the therapist and pay for the therapy (Kirkbride, 2021), yet it can also be complex and anxiety-ridden.Siskind (1997) suggests there has historically been systemic ambivalence and avoidance surrounding parent work, leaving practitioners feeling unsupported, resigned and burdened in their dealings with parents. This view is supported by a survey of child and adolescent practitioners (Jäderberg et al, 2019), which found that while the vast majority of practitioners worked with parents in some capacity (94.4%), only 58.8% felt competent in this area, with less than half feeling adequately prepared for this work by their training (44.8%), leaving them unsure when and whether to involve parents.Current British Association for Counselling and Psychotherapy (BACP) guidelines recommend careful contracting to avoid the potential "pitfall" of acquiescing to parental expectations to be "kept informed" of the work (BACP, 2018, p. 25). While not explicitly denouncing parental involvement, it evokes a dynamic where parents are potentially impinging intruders who need to be held at bay to retain the sanctity of the child-therapist relationship.…”

Neuropediatric rehabilitation for psychogenic gait disorders in children and adolescents

“…The child in turn reacts to the ambivalence of the parents by clinging on to his or her symptoms. Not all doctors are sufficiently trained to overcome such communication deadlocks (Jaderberg, Goss, & McBeath, 2019). The parents' desire to visit other clinics should be considered as a warning signal.…”

Counselling as a calling: Meaning in life and perceived self‐competence in counselling students

“…Perceived self‐competence (PSC) is the belief of an individual that they can apply these strengths (Lippe et al., 2020), with higher levels of PSC linked to increased subjective happiness (Li, 2015) and improved work–life balance (Fotiadis et al., 2019). Competence in counsellors tends to focus on their ability to counsel certain groups (Jäderberg et al., 2020; Wada et al., 2019).…”