Kathryn de Bruin

How To Involve Parents So That Play Therapy
Can Be As Successful As Possible

http://www.calplaytherapy.org/onl/2009/Volume20/Number04/titftcdt/p01.html

By Kathryn de Bruin

So it's play therapy with children you've come to select
Then it's their parents you've got to RESPECT

Have you ever had a child yanked out of play therapy just when you thought it was going well? I have, and it happened to me all the time! I was always able to connect well with children so I was eager to do play therapy as a young therapist. I often would just be making progress when the parents would question the efficacy of play therapy, or even worse, just stop bringing their child to sessions. Alliance with child? Check! Alliance with parent? Obviously something was wrong.

I have come to learn that building relationship with parents is just as important, if not more so, than with the child. Not just because parents pay the bill and have the authority to end therapy, but because they go home with their child. They'll spend a lifetime doing "therapy" with their child and we have them only for a brief moment. Parents will pull their child from therapy if they don't feel empowered or if they feel threatened by our connection with their child. Perhaps, as with a child experiencing trauma, the parent is experiencing their own "play disruption" with nowhere to work out their own stuff.

Seligman (2000, 213) talks about the importance of including parents. He says, "To the extent that the parents feel that they have been collaborative partners in the assessment, they will be better able to embrace the treatment process." Scheel and Rieckmann (1998) agree that parents who feel less empowered will participate less in the therapy. So all my attempts at first to win over parents by demonstrating to them what a passionate, skillful and serious therapist I was with their child backfired. The very connection I was building with their child set them up to feel excluded. Therapy? Game over.

Here are some of the lessons I've learned in how to effectively involve parents in the process of their child's therapy. The acronym RESPECThelps me to remember these important lessons.

Reflect On Your Part In It

I brought a lot of my own countertransference into parent interactions. I approached them all with skepticism and expectation of premature termination. My insecurity made me emotionally unavailable to the parents. I cut them off before I even gave them a chance to connect with me and build a team of support for their child. It helped me to think systemically; the parents and I were all part of the same team.

Empower Parents by Involving Them

In private practice every referral source is important. I was recently speaking to a church counselor who decided to send referrals my way. The counselor told me that he refers to me because I don't set children up against their parents. By the time parents bring children to treatment they sometimes feel distant from them, and are fearful of this growing distance expanding even more. Parents are desperate to know that you will help them reinstate their relationship with their child. As a family therapist my long term goal is to strengthen family ties. My personal policy now is that I only work with children if their parents will be involved (of course where this is possible and appropriate). Let parents know that they are your biggest resource, that their role is important, and that you need their involvement for therapy to work. I frequently tell parents that after the assessment phase, we will sit down together and decide what treatment will be best for their child. It takes the three of us to do this together.

Show Interest

Ask questions about the child. Potential customers often interview multiple therapists before choosing which one they will go with. Recently I spoke with a mother after she'd already interviewed three other therapists. Obviously she knew what she was looking for. She chose me. Later, she said it was because I was the only counselor who showed interest in her child. I had asked questions not only about the child's symptoms but also about the child's interests, strengths, and general personality. As a parent myself, I can relate to this need to have people simply like my child. I have an internal radar that lets me know who is genuinely interested in my son. If you're in this field, you enjoy working with and playing with children. Don't hesitate to show that passion.

Parent Consultations

Wherever possible, I meet with both parents before the play therapy begins. I let parents know that our first few meetings will give them an opportunity to get to know me and decide if I will be the right counselor for their family. I take time to explain play therapy to them, show them the playroom, and get them ready to explain therapy to their children. This sets the parents up for success and gives them time to formulate and satisfy any questions they might have. This time with the parents before therapy begins is valuable assessment time and enables me to get to know the child's system, even the parent relationship.

Ongoing parent consultations are essential and it is my goal to build and maintain secure attachment with each parent. This means being responsive and accessible. I see parents on a regular basis, make myself available by telephone between sessions, and regularly check in with parents to assure myself that we're all still tracking together.

Equip Parents To Do The Work

As each child is effected by their environment, we want to attend to family dynamics which will mediate or support the effects of the child's progress. As we broaden our focus beyond the identified patient and treat the system, we set the family up to attend to the child's future needs as well as the needs of other family members. I find that Child-Parent Relational Therapy (CPRT) is useful to teach parents the basic skills of attunement and help them to build more secure attachments within the family. Parents feel empowered and even grateful!

Guerney (1991) writes about the importance of involving parents in play therapy and recommends doing so in the form of filial therapy. She writes that when parents are left out of treatment they resent the exclusion and this can result in premature termination. She believes that empowering parents as active partners in the process will not only assure their continued involvement but would bring about therapeutic change more quickly. Scheel and Rieckmann (1998) agree that unless parents come away from therapy feeling more capable of helping their child, the effects of therapy will not generalize as effectively outside of the counseling setting.

Compress Information

Parents carry a lot of responsibility and by the time they have contacted us for help, they are very concerned about their children. Many parents are tired, worn out, and often have ideals that they are not able to achieve for sheer lack of time and resources. Prior to becoming a parent myself, I idealistically gave parents elaborate handouts and tutorials, contributing to their burden and feelings of failure when they were unable to follow through on my instructions. Now I keep suggestions as short and sweet as possible. The books that I find most valuable as a parent are those that present one idea at a time and are easily skimmed. Since quiet reading time at home is often short-lived and frequently interrupted, I provide parents with a comfortable place to sit while their child is in therapy, and set up videos or give them simple handouts that can be completed in the time their child is in session.

Trust Is Cultivated

If there was ever a time to delve into deep psychological work with a person, it's when they're involved in an intimate relationship. Relationships tend to surface all of our insecurities and wounds, and parenting even more so. Parenting is a humbling experience but also a great opportunity to learn more about ourselves and begin to make changes. As I meet with parents for ongoing consultations, opportunities arise for them to talk about their own emotional journey. Parents begin to feel safe with me and will share more as this trust is developed. The focus expands even more within the family system. Scheel and Rieckmann (1998) found that parents who have young children with emotional disorders tend to experience themselves as being less efficient and disempowered in their parenting roles. They go on to show that parents who feel less empowered have families that operate less adaptively and are not as close. Since these are often the families we see on our caseload - all the more reason to RESPECT them!

Summary

These are some lessons I have learned along the way. As I have implemented RESPECT for parents, I have grown to enjoy the process a lot more and have become more effective in working with children and their families. It's really not outside of our reach. We simply Reflect on our own part in the alliance with parents, Empower parents so they know their importance in the process, Show them our passion and interest in their child, involve them in ongoing Parent consultations, Equip them do to the work, Condense any information we give them out of respect and empathy for their overloaded lives, and build Trust by being accessible and available to them. Parents will in turn respect and receive our work with their child. They may even bring their child back for more sessions.

References

Guerney, L. F. (1991) Parents as partners in treating behavior problems in early childhood settings. Topics in Early Childhood Special Education; Summer, 11(2), 74 - 91.

Scheel, M. J. & Rieckmann, T. (1998). An empirically derived description of self-efficacy and empowerment for parents of children identified as psychologically disordered. American Journal of Family Therapy; Jan-March, 21 (1), 15 - 28.

Seligman, S. (2000). Clinical interviews with families of infants. In C. H. Zeanah, Jr. (Ed.), Handbook of Infant Mental Health (2nd ed., pp.211-221). New York: Guilford Press.