Engaging with parents in adolescent mental health services, Australian and New Zealand Journal of Family Therapy, June 2020 doi: 10.1002/anzf.1409

Jenny Brown. PhD

Excerpts

As a family therapy supervisor in the child and adolescent mental health field over some decades, it is common for the author to hear clinicians express the challenges of developing a therapeutic alliance with the parents of young people in treatment. In supervision clinicians frequently convey they often feel critical of the parent’s relationship with their young person and struggle to break through parental evasiveness and defensiveness. It is especially difficult to involve parents in exploring the family relationship context of their young person’s symptoms with clinicians reporting that many parents push to outsource the fixing of their child to professionals. The common request clinicians intuit from parents is they do not want to be part of the change process but expect the experts to fix their child (Brown, 2008). Nonetheless in the author’s research (Brown, 2018, p. 8) parents expressed they did not want to be sidelined in their child’s treatment and expressed a hope that professional experts held the key to ‘fixing’ their child: ‘Prior to admission . . . parents all expressed regularly feeling excluded from communication about their child’s treatment and a sense of blame or judgment from the “expert”.’ Here the research interest has been to better understand the clinical barriers to a better partnership with parents in child and adolescent mental health.

Family systems and attachment paradigms raise awareness of the links between family relationship systems and the development and/or maintenance of symptoms in children (i.e., Crittenden, 2006; Donley, 2003; Klever, 2009; Kozlowska, 2007). The systems view is that ‘cognitive, emotional and behavioural processes do not stay contained within the individual but are expressed in the family system’ (Klever, 2009, p. 321). At the same time, a family systems paradigm is alert to avoiding parent blame when involving parents in looking at family factors as part of their child’s treatment. Certainly ‘de-emphasising blame’ for all family members is stressed as important by researchers in the field of family factors and children’s mental health (Garber, 2005, p. 260). A family systems clinician will need to grapple with this tension of opening consideration of family and parent factors connected to the young person’s symptoms while not loading a parent with an unhelpful burden of guilt.

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This paper has sought to open up hypotheses about ways to effectively engage parents

in the course of their child’s or adolescent’s mental health treatment. Reflecting on parents’

experiences alongside clinicians’ challenges offers a potential road map for building

an effective partnership. The parent data provide another angle for considering clinician reports about their challenges in engaging parents. It concludes that a respectful, attentive, collaborative approach that explores the relational dynamics of the family can provide a basis for clinicians to overcome their identified challenges to:

• manage their reactions to parent defensiveness;
• broaden the focus from just alleviating symptoms in the child;
• not take sides with the young person; and
• resist becoming an expert instructor.

In response to the four identified clinician challenges, this paper has discussed four clinical components for positive family systems engagement with parents who have a child/young person requiring mental health treatment. They are to:

• explore the parent’s experience of help-seeking and engage with their history of difficulties in trying to assist their struggling child;
• genuinely involve parents and attend objectively to the reciprocal parent/child relational patterns;
•  keep a wider system view but avoid any hint of blaming parents; blame can be averted when parents discover how they can make a difference for their child’s future wellbeing;
• explore relationship patterns through the therapy process, thereby promoting parent agency/self-discovery.

It is hoped that this paper will open genuine dialogue about clinical and policy pathways to positively involving parents as part of their child’s mental health treatment.

Workers in the field can be assisted to identify their own challenges in engaging with parents and to consider the parent’s sensitivities to entering collaborative family systems-informed therapy. When workers have awareness of their own reactions to parents, they are better placed to manage the sensitivities that parents of a struggling child inevitably bring to their interface with treatment systems.