Accepting children into your practice mix introduces multiple uncertainties with roots that can run for several generations. Parents of these children are children themselves with a multitude of parents and grandparents. We inherit more than DNA. We inherit a pattern of tendencies to include behaviors. We see some of these patterns in the children that come to our practice. Some can be very disruptive at home, school, and in the therapist’s office. They can bring legal uncertainties, especially when they have to cross a street to get to the office. A parent bringing candy, soda, and/or chips into the office creates sticky messes on the floor, chairs, television, and games, and these sticky parts will attract bugs, flies, and mice. In addition, children are not reliable candidates for psychotherapy because of their limited vocabulary and ability to abstract.

Therapists that see children and adolescents have to make adjustments in location, the availability of off-street parking, a play/art/music therapy room(s), selected toys, table games, building games, art and music tools, and any special equipment (i.e., puppets or small stage). Then there is the need for additional training such as continuation courses, equipment, or toys/games/videos, not only for the children, but also for their parents. All these additional expenses take away revenues from payroll.

Children can be useful in balancing a therapist’s caseload of adult patients. Children are the products of more than just their parents. They have roots that can extend to Mexico and Central America, Europe, Asia, the Middle East, Canada, and just about any other country in the world. The influence of multi-cultural backgrounds may not be readily apparent to the therapist or to the parents, but that doesn’t imply that you shouldn’t at least attempt to ask about family traditions and their influence on the current family’s daily lifestyle. This could be on the physical (height, weight, tendencies for illness), spiritual (issues of aging and death), educational (if mom and dad are 8th grade dropouts, could this be influencing their 9th grader to consider dropping out to work?), and emotional (is there a history of anger control, substance abuse, and/or legal problems in the family?).

Dealing with problems of childhood development can be very draining on the therapist. If you deal with these problems all day, you might want to be ready for a peer-review session. Adult problems add, to a large extent, issues that can be energizing when balanced against those issues of childhood and adolescence. Building a more general practice rather than a fairly narrowly focused practice (i.e., chronic pain patients; psychological testing; ADHD cases; marital therapy; patients suffering from bipolar disorder, depression, and panic attacks, etc.) can help balance levels of cases, issues, and energy needed to help solve problems. It doesn’t matter what theory or technique a therapist uses; psychotherapy takes a lot of emotional and cognitive energy for both patients and therapists. No matter which setting you work within, psychotherapy deals with roots of uncertainty. Such uncertainty isn’t all from the individual or the family. It includes the therapist, too.

The goals of a family practice tie both adults and children to common threads of concerns as well as to pathways of healing. Most therapy goals point to reducing the patterns of disruption, violence, miscommunication, and detachment in relationships. There are two sides of therapy: one reduces disruptive behaviors and irrational thoughts; the other side promotes those thoughts, feelings, and behaviors that lead to emotionally healthy relationships. One of the factors that promote dysfunction within a family is the single parent.

Fatherless Homes

A single parent, normally the mother, raises many of these children. Fatherless homes have a negative effect on children. According to the Center for Disease Control, 85% of all children that exhibit behavioral disorders come from fatherless homes (Center for Children’s Justice, n.d.). The Bureau of the Census reports that 90% of homeless and runaway children are from fatherless homes (Center for Children’s Justice). Seventy-one percent of high school dropouts come from fatherless homes (Center for Children’s Justice). Seventy-five percent of all adolescent patients in chemical abuse centers come from fatherless homes (Center for Children’s Justice). Sixty-three percent of youth suicides are from fatherless homes (Center for Children’s Justice). Eighty percent of rapists motivated with displaced anger come from fatherless homes (Knight & Prentky, 1987). Eight-five percent of all youths sitting in prison grew up in a fatherless home (Center for Children’s Justice). Criminal behavior experts and social scientists are finding intriguing evidence that the epidemic of youth violence and gangs is related to the breakdown of the two-parent family (Center for Children’s Justice). Additional statistics that emphasize the trauma of growing up in a fatherless home include the following:

● 5 times more likely to commit suicide

● 32 times more likely to run away

● 14 times more likely to commit rape

● 20 times more likely to have behavioral disorders

● 20 times more likely to end up in prison  (Center for Children’s Justice)

School systems have attempted to keep students focused on a graduation scheme that rewards them with the opportunity to attend college. Most students know that college can provide alternatives that they don’t have with only a GED or high school diploma. No other program has created as much stress in the lives of parents, students, teachers, and administrators as the “No Child Left Behind” program. There has been a dramatic increase in testing over the past dozen plus years. These tests have seriously cut into teaching times and have added enormous pressure on the students, teachers, and administrators.

Schools have promoted tutoring and mentoring programs to encourage students to stay in school. There is a Special Education program and a 504 program to help students with disabilities or problems in learning and/or behavior. School counselors try to make themselves available to students for problems in school, but with 300–500 children they cannot do the job that many children need. School counselors usually get bogged down with testing and other “gofer” tasks that their principal requires. Most counselors are happy to have a source to which they can refer behavioral problems.

The truant officer’s responsibility is to ensure compliance with the school’s attendance policy. When students skip classes and/or school, this officer normally talks to them. When the number of unexcused classes and/or days reaches a certain point, the truant officer sends a notice to the parents to appear in court. The court fines the parents, orders community service, and can also order counseling.

Parents try to get their children to conform, but it isn’t easy when one or both parents are themselves school dropouts. Sometimes these kids are depressed from abuse at home or from their inability to focus on their work due to being easily distracted, staring out the window rather than at their books, or having problems sitting still. Parents can ask the court for help, but the courts are very limited in resources for parents. Some students gradually accept the counseling or help from family members while others join gangs and drop out of school.

Teenagers that run the streets often get into trouble and are taken to jail. Some are given short terms and placed on probation. Over time they lose their fear of courts and jail and get bolder in their attempts to “fight back.” The courts have been getting tougher with kids over the past 20 years, creating laws that allow them to treat young teens as adults based on their crime. However, new research is showing that these teens never become “better” citizens; instead they become better criminals. “Each year 200,000 defendants younger than 18 years are sent directly or transferred to the adult system, known as criminal court” (Cohen, 2007).

“It’s really the trifecta of bad criminal justice policy,” said Shay Bilchik, a former Florida prosecutor who heads the Center for Juvenile Justice Reform at Georgetown University. “People didn’t know that at the time the changes were made. Now we do, and we have to learn from it” (Cohen, 2007). The new laws were created to deal with some very dreadful crimes committed by teenagers and adolescents during the 1990s. Those trained in psychology and social work are normally taught about the development of the brain. The brain of an adolescent is significantly different than that of an adult. Now research, sponsored in part by the MacArthur Foundation, points to the high costs to the legal and prison systems, the increased costs of higher recidivism, reduction of education and job opportunities, and racial disparities (National Center for Juvenile Justice, 2006–2008).

Value of Therapeutic Intervention

Therapy can be valuable to families that feel overwhelmed, frustrated, and confused. Children need it, because they often need a friend. Their roots to the past can be valuable tools in the search for patterns of mental and physical family health. These patterns can be golden keys to the inner workings of families that will lead to explanations of physical and mental systems or characteristics of the children sitting in your office. Therefore, taking these insights of history can lead to family therapy sessions that explore the sources of anxiety, depression, fear, phobias, and many other issues that disrupt childhood. Thus, the keys to recovering the uncertainties within our lifespan are available by looking at the history of relationships within the parents and their parents. Learning to find and use them effectively during individual and family therapy sessions requires a lifelong journey. Such a trip frequently includes potholes filled with nails of resistance and denial, which sidetrack therapy.

The value of therapeutic intervention is not always observable by the naked eye or by feedback from the family or community grapevines. But some keys to quality control can be personal statements by the participants. A decrease in family violence, an increase in quality sleep, an improvement in grades, a decrease in truancy, and a decrease in oppositional defiance and fighting are all noticeable changes in “attitude.”

There are many books on family therapy. Some extrapolate on a number of techniques of therapy that are creative, powerful, and effective in helping parents regain their positive roles within a family. One of these techniques is “spontaneity,” which describes how a therapist that has the training and education of different therapeutic interventions can now “react, move, and probe with freedom, but only within the range that is tolerable in a given context” (Minuchin & Fishman, 1981, p. 2). Like a painter who is limited by the size of the paper or the size of the wall for a mural, a therapist is restricted by the context. The more experienced the psychotherapist is with family therapy, the more valuable is the intervention.

The authors emphasize that the therapist is dependent on the field of psychology and regulated by the goals of psychotherapy. “He can be comfortable in the knowledge that he does not have to be correct. In this situation, he will at least be approximate. He can allow himself to probe, knowing that at worst his responses will yield useful information. If he goes beyond the threshold of what is acceptable, the system will correct itself” (Minuchin & Fishman, 1981, p. 3). The therapist has to be confident in his or her own identity and experience in solving problems and not be afraid of making a mistake (i.e., working on one symptom when another proves to be more significant to the outcome of therapy).

1. Family therapy is about change. The very suggestion of change can run into problems from the start. There are members within the family who are in denial and others who want change “but are not ready yet.” There can also be resistance within the family system (“I’m not the one who is stealing!”). Problems are hard to define at times. “If a therapist accepts in therapy a young adult who is defined as schizophrenic and who is in a mental hospital, how does one define the problem? Therapists have assumed for years that the social unit in such a case is the young adult and his family. This does not necessarily imply that the family unit is the ‘cause’ of the schizophrenia, but it does assume that the expression of the problem is in the family and that the family is the best source of help for the young adult. That is where he will go when he comes out of custody” (Haley, 1991).

Collaboration

Collaboration implies others could be part of the therapy intervention. Although there are therapists who may have concerns with confidentiality, many find it valuable to consult with the teacher and/or school counselor of a child, in an effort to obtain collaborating information and to monitor the effect of medication and/or therapy while in school. Parents can offer collaborating information about sleep and appetite habits and behavior and medication compliance at home, in addition to interpersonal skills as it relates to siblings and neighborhood peers.

Many insurance companies require or encourage that either the primary care physician (PCP) do the referral to the therapist or that the therapist write a letter to the PCP with a summary of the reason for the therapy and any recommendations for medical intervention or awareness. PCPs are not trained to work with health-care providers other than medical physicians. What appears to be breaking their resistance are the insurance companies asking for their input or participation in the referral process, the addition of certified family nurse practitioners (FNP-C) and certified physician assistants (PA-C) who tend to have more effective interpersonal communication skills than many physicians, and competent and passionate therapists who are willing to visit medical offices and discuss cases with medical staffs in order understand the effects of physical disease or disorder on mood changes.

Family therapy can be very successful if it can (1) deal with the above issues, (2) address problems of communication between parents and their children, and (3) teach parents more effective parenting styles and discipline techniques. Being a parent is the most important job on earth, but there is no class offered in high school. There is also no course in college unless you are completing graduate work in social work or psychology.

Collaboration can also mean working with another therapist. Sometimes co-therapy can be an effective way of working with families. Six to 10 family members can easily overwhelm one therapist. One of the most important factors of co-therapy is that the co-therapists “like each other and that each bring a complementary interpersonal skill to the relationship—one who can be humorous, for example, while the other is more serious and logical. It’s also useful if the therapists grew up in families with different dynamics. This heterogeneous history provides a buffer against either therapist’s becoming over involved with the family” (Napier & Whitaker, 1978, p. 285). Having a co-therapist can add strength to the therapeutic intervention by allowing one member of the team to make an observation comment while the other therapist watches for nonverbal reactions that can be useful in judging the effectiveness of the therapist’s observation.

There is no “magic technique” in changing disruptive patterns that transcend generations. There is a lot of fear and uncertainty in our lives today. The roots of one’s life crisscross the community and impact the family on different levels. Whether we work in a metropolitan community or in a rural community, we need some type of peer support. Working with another therapist can give us new energy and a new perspective on people, problems, and life. We do not live or work in isolation, but we can die in isolation. To calm the roots of uncertainty we need to “touch” others, including other therapists, in a meaningful and healing manner.

References:

1. Center for Children’s Justice, Inc. (n.d.). Effects of fatherlessness. Retrieved December 17, 2007, from     www.childrensjustice.org/fatherlessness2.htm

Cohen, S. (2007, December 2). Youth on trial. Corpus Christi Caller-Times, p. A1.

Haley, J. (1991). Problem-solving therapy. San Francisco, CA: Jossey-Bass Publishers.

Knight, R. A., & Prentky, R. A. (1987). The developmental antecedents and adult adaptations of rapist subtypes. Criminal Justice and Behavior, 14(4), 403–426.

Minchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press.

Napier, A. Y., & Whitaker, C. (1978). The family crucible. New York: Harper & Row Publishers.

National Center for Juvenile Justice (2006–2008). Models for change: Systems reform in juvenile justice. Retrieved from www.modelsforchange.net