Whose Fault Is It in Play Therapy If It’s Not Working?
Cathi Spooner 
What do you do when it seems like your child or adolescent client isn’t making progress in the counseling process
and doesn’t seem to be resolving the problem that brought them to your office?
Typically, a central theme when I talk with child and adolescent therapists about identifying the reason their client isn’t making progress or progress is slow and inconsistent is frustration with parents. (Note: parents in this article refer to any adult in a caregiving/guardian role, such as grandparents, foster parents, etc.)
How often have you heard your colleagues (or even you) say something like…
“I wish I could just work with kids and not their parents.”
“My client would be doing better if they had different parents.”
“Dealing with parents is burning me out.”
I get it. Dealing with systemic issues and challenging parents can be overwhelming and frustrating when there’s no change. Our profession can be exhausting if stressors aren’t managed well. This is also true when it comes to working with children who live within the context of their family systems.
With that said, I believe it’s time for us as child and adolescent mental health professionals to stop blaming parents when there is no change in the treatment process if you haven’t integrated them from the beginning of treatment and established an intentional plan for active involvement of parents.
I know that sounds harsh, and I don’t mean to offend. My goal is to help you be more effective and avoid burnout. Children and adolescents need your help and that means being effective. No one actually gets into the mental health profession to be ineffective. You get into this field because you want to make a difference in the lives of your clients and their families. So, ask yourself these questions...
What’s your plan for active participation of parents and families in the treatment process?
Is it working?
How do you help challenging families engage in the change process?
Are you actively engaging the family in the change process or just meeting with your child or adolescent client (with the occasional parent “check-in”)?
To help children heal it’s important to have an intentional plan for integrating parents/caregivers as active participants in the change process. And, since children live within the context of their family system, engaging the family in the change process can have lasting long-term benefits for your young clients because you have successfully helped the family to shift and engage in healthy attachment relationship patterns.
Here are some things to think about so you can be more effective engaging parents and family members in the treatment process to help your young clients experience more successful treatment outcomes.
What is the role of the therapist?
The role of the therapist is to conceptualize the “roots” of the presenting issue and formulate a plan with your clients. You need to figure out what’s causing the problem so that you fully understand all the nuances for why your client is experiencing the problems that brought them to your office. Once you figure out what factors are contributing to the problem, then you need to identify who needs to be involved in treatment and how they need to be involved.
This is where you consider how your clients need their parents to be involved in the treatment process and set expectations for that to happen. Sometimes it can be challenging to get parents into your office. However, if you believe parents need to meet with you then you need to communicate that expectation to them and why it’s important to help their children. After all, parents brought their child to you to get help since you’re the expert, so own that role. This means you need to first develop your professional expectations for how and why parents need to participate in the change process. Then communicate that to parents from the beginning of the treatment process and continue to reinforce that expectation throughout the treatment process.
I’m a firm believer that clients want to be heard in treatment, so it’s important to get their input so you can address their concerns in the treatment process. They also need you to help them understand what needs to happen for the change to occur – You’re Yoda, and parents are Luke Skywalker. (I love a good Yoda reference).
Building trust with parents
You need to identify and communicate your expectations to parents from the beginning of the treatment process about the way in which you provided mental health counseling to their children. That’s the first step. Then, you need to make sure that you’re building trust with parents. Trust is the key to helping parents engage fully in the treatment process to help their children and actually implement your recommendations. When parents believe you understand them and the difficulties they’re experiencing, then they’ll trust you. If they believe you’re not judging them, then they’ll trust you. If they believe you care about them (within professional boundaries), they’ll trust you. This process for building trust takes time. It also takes an intentional plan to get to know them and for them to get to know you. When parents trust you, they’ll be willing to make the changes you’re asking of them.
The treatment process is a relational process, which includes building relationship with your client’s parent(s). When I’ve taken the time to build trust with parents and help them understand the importance of co-regulation and the benefits of using an attachment-based parenting approach, then they’ll usually make the changes I’m asking them to make. This required that I set aside time to meet with parents without their child present so we can build trust and work together to help their child.
Facilitating the Change Process
Grounding your treatment approach in theory that’s guided by research is important. It’s like your roadmap to help you understand where you are (what are the roots of the presenting problems) and where you’re going (what needs to happen in order for your client to accomplish their goals). I like using an attachment and neuroscience framework because it’s an effective way for you to engage even challenging parents in the change process. Attachment and neuroscience provide you with important information about creating safety for your clients and understanding challenging behavior. It also provides information about effective ways to engage your clients and their parents in the change process. Change requires vulnerability and vulnerability requires the need for safety in order to make uncomfortable, and sometimes painful, changes. You can help parents understand their important role for co-regulation and the benefit of using an attachment-based parenting approach.
I’m a firm believer in the importance of viewing children within the lens of attachment theory as well as understanding them systemically. Children live within a family system and understanding family relationship patterns provides valuable information to help your young clients. What are their sibling relationships like and how do parents help their children navigate those important relationships? How do parents help family members navigate shifting individual needs versus family needs. This includes understanding family culture, including parents and children whose country of origin is not the country in which they’re currently living.
Sibling relationships are important and often overlooked in the child and adolescent treatment process. Siblings can be a source of support and/or a source of distress. How do family members resolve conflict amongst siblings? How are differing needs met amongst siblings?
Once you decide who needs to be involved in the change process and how they need to be involved then you need to use a framework to facilitate healing and resiliency to guide you through the process. Since I love using an attachment and neuroscience lens and having flexibility to adjust treatment to each client, I use an attachment-focused family play therapy approach. I created an attachment-focused family play therapy framework to help guide me through the clinical decision-making process with my clients and their families. With this framework, I can include children and their family members in the play therapy process to give me an idea what are the strengths and needs of my client within the context of their family to facilitate the healing process. Having a framework guides you through the change process with your clients so they can successfully engage in the healing process within the context of their most important relationships – their family.
Here’s a recap:
Your role as the therapist is to know what needs to happen to bring about change and healing for your clients, then communicate that effectively to parents so you can help them engage more fully in the change process.
Accomplishing engagement with parents means you need to build trust because they won’t trust you until they have rapport with you which takes time to build.
Facilitating change means you need to have an intentional plan and communicate that plan to parents from the beginning of treatment.
You also need a framework grounded in theory and informed by research to effectively help guide your client and their family successfully through the treatment process
If you’re interested in learning more about Attachment Focused Family Play Therapy, check out this training and my book, Attachment-Focused Family Play Therapy: An Intervention for Children and Adolescents After Trauma.
Categories: : Attachment-Focused Family Play Therapy
