DIFFERENT METHODS OF HELPING CHILDREN

Achild is born into a family system which ideally tries to support and nourish his or her development. Most families try their best to help their children succeed. However, the stresses of modern life mean that this goal may fall short, thereby leaving children without the strong foundation that will give them the stamina and confidence to learn and try new undertakings. Parents may be working hard to meet the family’s financial obligations, and they may lack the energy and time to interact meaningfully with their children. Or an adolescent single-parent mother may find it next to impossible to juggle being in school with being a parent. Children sense their parents’ anxiety, and they may withdraw and spend more hours with peers or on line instead of relating to their parents at home. Some children may fall behind in school or become angry and aggressive with peers, or they may withdraw and become isolated. Although the parents certainly are not to blame for their children’s problems, their responses are critical in helping or hindering various helping efforts by any practitioners who may become involved. Families today come in many different sizes and forms. The majority (69%) of children in the United States under the age of 18 live in families with two parents, and about 23% live with a single mother (U.S. Bureau of the Census, 2016). Of the 50.7 million children living with two parents, 47.7 million live with two parents who are married, and the remainder live with two unmarried parents. Other family formats are those consisting of two mothers or two fathers, or with a grandparent or other relative as the main caretaker. When the child develops difficulties that concern the school, the parent(s) will be notified and the social worker will try to set up appointments to explore the problem or to make a referral to an outside practitioner. Some parents may be very cooperative, but others, who are pressured with their own time constraints, may present special challenges in trying to engage them. This chapter deals with the various options of helping a child through involvement with the child’s family. The focus here is not on family therapy per se but rather on the child, with acknowledgment that the child’s family is a critical resource in helping alleviate any problem. Chapter 7 addresses some methods for working with the child individually, although, even when individual therapy is the treatment of choice, most therapists will consult with the parents periodically. The family model that is recommended here is one that integrates child and family treatment (Drewes, Bratton, & Schaefer, 2011; Gil & Selekman, 2015; Schaefer & Carey, 1994). It includes the following options: • Parent counseling/guidance • Parent–child sessions • Sessions with siblings • Sessions with the entire family Regardless of the focus of treatment, cultural and ethical considerations must be acknowledged and addressed, and these are discussed in the following section. The different treatment approaches listed above all rest on a foundation of systems theory, which assumes the mutual interacting influences of each member on the others. In addition, “the family is viewed as a transactional system that functions in relation to its broader sociocultural context and evolves over a multigenerational family life cycle” (Walsh, 2012, p. 29). All these approaches to working with the child in a family context emphasize a competency and strength-based perspective, rather than focusing on deficits and pathology, which might have been typical in past years. Ideally the helping efforts will involve an interdisciplinary team, rather than only one practitioner, and the child’s “problems” will be analyzed in terms of how the child’s and family’s strengths can be mobilized to achieve a positive goal. DIFFERENT LEVELS OF FAMILY INVOLVEMENT As I emphasize in this book and demonstrate in various examples, work with children should always include some sort of involvement with their parents, when parents are living and available. Whether siblings are seen depends on the nature of the presenting problem and on conflicts in relationships that become evident as the work progresses. For example, in previous publications (Webb, 1993, 2002a), I have included several cases involving sibling and family sessions following deaths and parental separation following divorce. The deployment of one or both parents in the military may call for certain adaptations in interventions with caretakers that are focused on helping children. Sometimes it may be possible to hold a telephone conference call using Skype to include an absent parent in a family session, and when this is not possible, a copy of the deployed parent’s photograph in the session can serve to emphasize the parent’s ongoing role in his or her child’s life. Absent family members, whether deceased, deployed, or divorced, continue to play a symbolic role and to exert influence on the child and the family. Sometimes it is appropriate for a babysitter or a member of the extended family (e.g., a grandmother) to be included in sessions with the child. Adults who have frequent and significant contact with the child should be invited to present their perspectives on the problem situation. I usually see the entire family together for one or more sessions in the beginning to assess the nature of the family members’ interactions and to involve them in thinking about how they might get along better. I refer to myself as a “child and family social worker,” thereby indicating to the family my ability to work flexibly with the various family members in different combinations, as well as in a group. Parent Counseling/Guidance When a child is being seen on a weekly basis, I try to confer with the parents monthly in “counseling/guidance sessions.” The main purpose of these parent meetings is to give and receive feedback about the child’s progress. The meetings also offer the worker the opportunity to ask questions about matters the child may have raised, to reinforce a parent’s positive efforts with the child, and to support the parent regarding his or her continuing frustrations. The issue of confidentiality always comes up in family work. Because of my belief that it is important to encourage parent–child communication and to convey the sense that the parent(s), child, and practitioner are all working together to try to alleviate the problem situation, I do not want to overvalue the importance of a child’s relationship with me and leave a parent feeling like an outsider. Therefore, I share my impressions about the child openly with the parent, and, without quoting the child verbatim, I give the parent a sense of the nature of the child’s participation in his or her sessions with me. Because this is a two-way street, I also share with the child, discreetly and appropriately, concerns that the parent may have brought to my attention. Sometimes the parent meeting indicates the need for a family session, which I then schedule, after clarifying with the child the purpose and potential positive outcome from such a meeting. Practitioners in agency practice sometimes encounter parents who are reluctant to come to parent or family meetings. These parents may not be aware that their child has a problem, or they may prefer to let the school or someone else handle it. Often, such parents may be burdened by work and home responsibilities and worries. Their child’s difficulty may arouse their anger, and they may resent that yet another demand is now being placed on their time. Practitioners, in turn, sometimes become resentful when parents are unwilling to put the necessary effort into trying to help their own children. It is the professional’s responsibility to reach out and make the extra ef ort to connect with parents who seem resistant to becoming involved. Often, doing this requires stretching one’s empathic sensitivity, to try to understand and feel what this mother’s or father’s life must be like. Offering to make a home visit may have a positive effect, as may trying to schedule an appointment for coffee or lunch in a restaurant near a parent’s workplace at a time convenient for the parent. A practitioner who sincerely believes in the importance of parents’ involvement and backs up this conviction with both words and action has a better chance of engaging parents effectively. Parent–Child Sessions Certain circumstances may make it appropriate to see a child together with a parent. First, there may be no choice if the child has separation problems of such severity that he or she cannot tolerate being separated from the parent (usually the mother). Second, it is essential to have the parent present during at least part of the session when a behavior modification program has been set up; the therapist will need to encourage the parent to praise the child for gains or to discuss with both the child and parent certain alterations in the program if the child is not achieving success with it. The use of parent–child sessions together with a behavior modification program is described in greater detail later in this chapter (see the case of Tim). When a child is experiencing separation anxiety, as in the case of Tammy (Chapter 7), the issue becomes one of helping mother and child learn to separate from each other. The session itself serves as a training opportunity. It is advisable for the practitioner to have a separate session or a telephone conference with the mother before the joint session to coach her in an overall plan for gradual separation and increase her willingness to carry out the plan. Depending on the child’s tolerance level and other possible contributing factors (such as the mother’s own need to keep the child close), a plan can be established for the mother to sit in the doorway of the playroom, watching but not playing actively with the child. When the child appears to have established an adequate level of comfort with the practitioner, the practitioner may suggest to the mother that she look at an interesting article in a magazine in the waiting room. The mother should then leave without a big goodbye scene, which might raise the child’s anxiety again. This planned leavetaking may need to be repeated several times before the child can eventually begin the session in the playroom without the mother. This protocol for gradual separation can also be applied to a day care or nursery school situation in which the child cannot tolerate separation from the mother and, with modification, to bedtime separation problems.