Journal of Family Therapy ( 1 985) 7: 81 -98

Redressing the balance-involving children in family therapy

Alison O’Brien and Penny Loudon*

This paper argues that family therapists have tended to ignore the problem of how to engage children in family therapy, and it presents a number of techniques specifically aimed at involving children in therapy. The socio- historical context of childhood is discussed and its implications for therapists examined. A number of visual techniques are then described, illustrated by case examples. These serve the function of addressing the whole family system on a number of levels and involving children fully in the process of therapy.

Introduction

Children in family therapy sessions often present problems to their adult therapists. In The Little R i m e (de Saint-Exupery, 1943), the little prince accuses his adult companion: ‘You talk just like the grown-ups’ because he has become too involved in ‘matters of consequence’. We feel a similar process has happend to family therapists because among the mushrooming literature on family therapy there is a great dearth of published work on a topic familiar to many therapists, namely how to involve children fully in family therapy sessions. Some years ago, Guttman (1975) drew attention to the need to pay more regard to children in family therapy sessions. However, it is largely true in our experience that many therapists do not take as much notice of children in practice as they do in theory. A familiar scenario consists of the therapist talking to the parents while the children sit passively on their chairs, often looking glum and making monosyllabic replies to the occasional question directed to them. An outsider could justifiably ask why we bother to invite children since it would lessen everyone’s discomfort if they were absent.

Received September 1984. * Child and Family Centre, Bethel Hospital, Bethel Street, Norwich Norfolk NR2

1NR. 81

0163-4445/85/020081+ 18$03.00/0 0 1985 The Association for Family Therapy

82 A . O'Braen and P. Loudon

Our solution to this difficulty has been to develop a number of techniques which are essentially non-verbal and are aimed specifically at involving children in the process of therapy, and it is the purpose of this paper to describe these attempts.

Attitudes to children

We believe that most adults have an ambivalent attitude towards children which oscillates between enjoying their company and wanting to dismiss them. Often, we only want to communicate with children on our terms and most of us treat children as though they are unimportant, even if we espouse a liberal philosophy which claims that we should treat children as people. We feel it is particularly important for therapists to be aware of their own ambivalent attitudes towards children and in this respect we have found it helpful to examine the changing attitudes towards children in Britain in the last 500 years. As Paget (1982) points out, it is important for therapists to be aware of the influence of their own society's past.

Childhood is a recent discovery in Western culture (Aries, 1973) and THE CHILD has progressed rapidly in the course of the last 300 years to a place where he or she holds the central position in our culture. In the Middle Ages, the upper class English child emerged from the nursery at the age of seven years and was thereafter regarded as a miniature adult, being dressed and treated accordingly. Adults were generally indifferent to children and little importance was attached to childhood. This was partly due to the high rate of infant mortality and the precarious nature of a child's life which were central features of family life in the fifteenth and sixteenth centuries. As a child's life was likely to be short, there was a corresponding lack of emotional investment in childhood.

The relative unimportance of childhood was also a result of the prevailing conception of society in which the family was regarded as the essential unit of social organization. The promotion of family ambition and the advancement of family interest were considered more important than individual fulfilment and the realization of personal success. Marriage was therefore regarded as a contract about wealth and property made for the advancement of family fortunes, and emotional relationships were characterized by distance.

Childhood was seen as a brief introduction to the heavy responsibilities of adult life and the popular view of children in the fifteenth and sixteenth centuries was the one upheld by the Church, that the child was the seat of Original Sin and therefore Old Adam had to be beaten out of

Involving children in therapy 83

him and his will subdued. Many children grew up in fear and few, if any, escaped the rod.

Throughout the seventeenth and eighteenth centuries, attitudes towards children underwent considerable changes as health and standards of living improved and family size decreased. Adults started to pay more attention to children and some degree of family intimacy began to develop as servants started to live separately. Gradually a family self-consciousness began to emerge. The relationship between parents and children was strengthened, as reflected in their central position in family portraits, the development of children’s fashions, books and educational games and the recording of child deaths on family tombs. There is no more poignant evidence of the growing importance of children than those small tombs which reveal that although life was still precarious, those children did not go unheeded as had been the fate of their predecessors in previous centuries.

One of the most important influences, however, in changing attitudes to children, was the development of schooling (Pinchbeck and Hewitt, 1969). This served to isolate the child from adult society, thereby creating a separate world for children, and in so doing gave to childhood an independent and recognizable status.

Also, the Utopian view of the child as innocent and only corrupted by his experience in society, gained ground over the attitude that the child was inherently sinful, and generally more humanitarian attitudes towards children gained in popularity.

Initially, these changes were selective and tended to be felt in the upper strata of society. During the nineteenth century the greater awareness of the needs of children led to increasing legislation on behalf of the child and the development of kindlier attitudes towards children, so setting the scene for the twentieth century which has become in many respects the century of the child.

One grandfather summarized the remarkable change in attitude which has taken place in the last eighty years like this: ‘I was born into an unfortunate generation; when I was a child I had to knuckle under to the grown-ups, and now I am a grown-up I have to knuckle under to the children.’ The respective childhoods of this grandfather and his grand- children, separated by more than half a century of remarkable change, belong to separate worlds. By the beginning of this century children were ‘modern’ in the sense of being protected from many aspects of adult life. Many areas of children’s lives were regulated by State legislation so that children were, for the first time, shielded from the hardships of employ- ment, sexuality and punishment until their mid-teens (Walvin, 1982).

84 A . O’Brien and P. Loudon

Children are no longer seen simply as miniature adults, but as a distinctive group in need of particular treatment and care. They are viewed as the raw material of the race and the child is seen as an object of care and giving, for whom nothing is too good. Society is concerned to provide children with a happy childhood and childhood is seen as a holiday, a quarantine from life summed up in the popular term ‘kids’.

Although society now advocates the importance of children, Seabrook (1982) argues that the self-conscious provision of a happy childhood as though it were a superior consumer item, creates its own problems. Many parents feel devalued and unworthy as though they themselves have nothing to offer, so the best they can do for their children is to buy them the best. The loss of confidence experienced by the parental gene- ration is matched by a dependence among the young upon the values of the market place with a consequent loss of social values and cohesion.

The relatively recent elevation of the child to the centre of the stage is therefore something of a double-edged phenomenon. While not wanting to deny the importance of taking account of the child as an individual, the ideal of a happy childhood creates an impossible set of expectations for adults to meet. Parents who are failing are particularly vulnerable to society’s expectations and likely to feel unsure of themselves in relation to their offspring. Therapists need to be aware of the extent to which they and distressed parents are influenced by prevalent attitudes to children.

The developing concept of the child has also, to a much lesser extent, proved to be a mixed blessing for children. While it is clearly in the best interests of children that their needs and stages of growth and develop- ment be provided for, the separation of childhood from the rest of society allows adults to accord childhood an inferior status. Consequently, adults tend to patronize and dismiss children. It may be that in terms of independence and being taken seriously, the ten-year-old Elizabethan child received better treatment than his counterpart today. Sheehy and Chapman (1984) suggest that those working with children need to address themselves to the predominant attitude of society to the status of children in general. We also believe that many therapists would do well to reflect on their own behaviour towards children in therapy, particularly as any tendency to undervalue children and give them an inferior status means that one is dismissing or ignoring an important part of the family system, and hence failing to adopt a truly systemic approach.

Besides being aware of the history of childhood, it is useful for therapists to have an awareness of attitudes to children from a more

Involving children in therapy 85

philosophical point of view. Four important strands have been influ- ential in moulding attitudes to children in recent centuries. The first is the religious view, upheld by the Church, that the child is the seat of Original Sin. As we have seen, this view was popular in the Middle Ages and indeed has been of considerable influence until this century. Contrary to this, is the Utopian belief that the child was born innocent and only corrupted by his experience in society. This idea was originally advocated by the Renaissance humanists but then it was lost under the Calvinist onslaught of Original Sin, only to be revived at the end of the seventeenth century by philosophers like Rousseau, as more humani- tarian attitudes to childhood gained ground.

The environmentalists believed that children were born a tabula ram with a propensity for either good or evil and with their character and behaviour moulded by experience. This attitude can be summed up as ‘manners maketh man’ and it was taken up in later years by the educationalists. The contrary position was adopted by the biologists and astrologers who believed that the character potentialities of a child were determined at birth either genetically or by the configurations of the planets, so that a child’s personality was predetermined, and one can only encourage good habits and restrain bad ones. The nature/nurture debate still continues and has had considerable influence on child-care policies.

One can still trace today the traditional conflict about whether children are from God or Satan, whether they are inherently good and innocent to be protected from wordly corruption, or inherently evil to be protected from themselves (Crompton, 1980). Although this dichotomy was to some extent ended by Freud and other twentieth century psycho- logists who provided a more realistic appraisal of the developing child, there remains a tendency for ingrained attitudes to affect the present. Much modern welfare legislation tends to be concerned about possession and control, although at the same time liberal philosophies which view children as needing love, respect and freedom often influence current work in relation to children. We suggest that in order to serve children best, therapists need to be aware of their own attitudes to them and whether these lie within a liberal of restrictive philosophy. Unconsciously held attitudes are likely to influence therapy, so the more therapists understand their own reactions to children’s behaviour and the attitudes behind them, then the greater will be their understanding of children and the more effective their therapy. Also, in situations where the therapist espouses a liberal philosophy and the family a restrictive one, or vice versa, then therapy is likely to prove difficult until this difference

86 A . O’Brien and P. Loudon

has been acknowledged and clarified (e.g. in planning behavioural strategies therapists often suggest rewarding a child whom the parents think should only be punished).

In addition, therapists need to be familiar with child development and be able to communicate with children at different stages of development in an appropriate manner.

T h e neglect of children in family therapy

There has been a considerable neglect of children by family therapists as evidenced by the dearth of references to children in family therapy since Satir ( 1 967) first commented on the uncertainty about how to involve children in family therapy. Although twenty years have passed we believe that many therapists still lack confidence about how to adequately engage children in family therapy. Dare and Lindsey (1979) comment that ‘within the child mental health professions constant pressure is necessary in order to keep the needs of children at the centre of interest. The fundamental skills of making contact with children and understanding their inner worlds must be acquired’. Therapists need to overcome their reluctance and difficulty in communicating with children and avoid adopting too intellectual an approach to therapy.

There are a number of possible sources of difficulty which a therapist may encounter when attempting to engage children in therapy. Firstly, as Carpenter and Treacher (1982) point out, children in family therapy sessions can present problems. They can be withdrawn and obstinately silent or they can be noisy, disruptive, bored or complaining. An unco- operative child in a therapy session may cause the therapist to feel silly, rejected, angry, embarassed or humiliated and consequently to lose confidence and credibility.

Secondly, therapists can bring personal problems to therapy and these are often harder to identify. They usually relate to the therapist’s stage in the life cycle and their own previous experience and training. In particular we all have painful childhood memories- the fear of the dark: the first hint of mortality: thwarting of the will; the learning of limits: a glimpse of imperfection in loved and loving parents; fear of being lost in a huge buzzing shop: fear and resentment at the arrival of a new sibling, etc. -which can be re-awakened by seeing a child suffering.

In order to overcome the difficulty of seeing children in families, therapists tend to respond in one of two characteristic ways. They may ignore the children altogether, as Carpenter and Treacher (1982) argue, ‘rationalising that the problem is basically a marital problem expressed

Involving children in therapy 87

through the children, and further that it is parents who have the power in the family and it is through them that effective interventions will be made’. Dare and Lindsey (1979) suggest that this tendency to do marital therapy in front of the children is usually to do with therapists being ‘more comfortable in a situation in which they are in verbal communication with adults’

Alternatively, therapists may attempt to join with the children, seeing their main task as an advocate, interpreting the child’s world to the parent. They may, through over-identification, wish to save the child from his parents and see the parents as insensitive or rejecting; or they may become a ‘superparent’ thereby alienating the parents who are made to feel inadequate and likely to resist the therapist’s attempts to interpret the child to them.

It is our contention that the failure to involve children adequately in therapy is a perilous path for therapists to venture down. Firstly, as Montalvo and Haley (1973) point out, children ‘are a necessary and integral part of the family’s problem and its resolution’. The assumption that a child’s problem is merely an extension of parental or marital difficulties does not just reveal a theoretical blind spot but in systems terms a blinkered perception, since to ignore one part of the system represents a failure to adopt a truly systemic approach.

Secondly, we believe that for family therapy to be successful, it is vital that the therapist stays in charge. It is therefore crucial that therapists know how they are going to communicate with children and deal with the difficulties they may present so as to avoid being caught ‘on the hop’, simply reacting to a child’s awkward behaviour and thereby becoming in danger of being ‘sucked in’ to the family system, hence losing therapeutic manoeuvrability. To remain in charge, it is helpful if therapists have a wide range of techniques at their disposal so they can then encounter and deal effectively with a wide range of situations from the attention- seeking disruptive four-year-old, to the silent, withdrawn adolescent.

It is also important from the point of view of the agency, to engage children in therapy. Working in a child-centred agency as we do, we feel that our clients have certain expectations that therapists will focus on their child. While not wanting to collude further with the view of ‘child as patient’, we believe that ignoring these expectations may create unnecessary resistance among the parents.

Involving children in family therapy

Having become aware of the dangers of neglecting children in therapy,

88 A . O’Brien and P. Loudon

the question of how to involve them must be answered. As children communicate most easily through actions and play, we decided that in order to ensure their greater participation we needed to use alternatives to words. We chose to concentrate on the use of visual modes of com- munication,* because children seem to express themselves readily using visual means.

In the first instance, therefore, we have created an interview room in which we emphasize visual stimuli. Hence the room is clean and bright with children’s drawings and rhymes on the wall, a mobile hanging from the ceiling, paper and pencil readily available, and balancing scales, puppets and a Newton’s Cradle on top of the bookcase (see below for discussion of the use of this equipment). This creates an environment in which children and childhood are accorded a high status and, equally important, it emphasizes a visual medium, and so children receive an implicit message that they can communicate visually.

Visual aids

Secondly, having established a visually oriented interview room, we employ a number of visual aids at appropriate moments during therapy. These fulfil a number of important functions:

(1) Using both a verbal and visual mode of presentation engages the whole family system in the process of therapy. We believe that it is important when working from a systems perspective to find ways to address the family system in its entirety.

(2) For therapy to be successful we believe it needs to address itself at several levels simultaneously, using a variety of means to express the same idea. There are two languages in common usage, the language of concepts and the language of images. It is important that therapy, if it is to be effective, avoids an exclusive use of one or other language and combines both concepts and images.

Bandler and Grinder (1979) suggest that people characteristi- cally tend to think in one of three ways-visually, auditorily, or kinesthetically, i.e. people think either by generating visual images, or by talking to themselves and hearing sounds, or by having feelings. If their thesis is correct (and Jenkins and Donnelly, 1983 suggest that ‘impasses in therapy may result from

* It is difficult to communicate visually using words but we hope the reader will bear with us and will be able to make use of his visual faculties.

Involving children in therapy 89

the therapist failing to recognize the language or idiom of the client’), then it is all the more important for therapists to use more than one mode of communication. This seems particularly true for families where family members are at different stages of development and where individuals may think in different modes. It is our experience that when we feel ‘stuck in therapy, changing from a verbal to a visual way of communicating helps to get therapy moving again.

(3) Using visual aids often helps family members remember the content of sessions, and using a visual image can often convey an idea which would be difficult and complicated to explain in words. When advising and educating parents, therefore, we find they are more likely to remember what has been said if we use a visual aid.

(4) Visual aids are fun and simple, both of which are key elements of effective therapy.

The kinds of visual aids we might use arise directly out of the content of the session and the needs of the family. They are merely techniques and means to the end of achieving change in the family, not ends in themselves. Following Jenkins and Donnelly’s (1983) classification, the development of visual aids is a therapist oriented activity* which draws directly on the therapist’s own creativity and resources and her interplay with the family. Among the visual techniques we have found useful are mobiles, balloons, balancing scales, family figures modelled out of Fimo,? a cake cut into segments modelled out of Fimo, plant symbolism, gears, rubber bands, wheels, magnets, Newton’s Cradle, knots, and nesting dolls. The list is endless once a therapist begins to generate visual images and each therapist will have hidher own individual favourites. We shall describe the use of four visual aids: the mobile, balloons, balancing scales, and the Fimo family.

Mobile

The mobile hangs permanently in our interview room and when we receive the frequent challenge at the commencement of the first sesson:

* Jenkins and Donnelly distinguish between two primary complementary modes of activity in therapy: therapist oriented activities and client oriented activities. The former are activities where the therapist personally engages in bringing about changes as a direct result of her intervention and creativity.

Fimo is modelling material like Plasticine, which is available in many colours, and models can be baked hard in the oven.

90 A . O’Brien and P. Loudon

‘Why do we all have to come when it’s his problem?’, our response is simply to pull the mobile and ask one family member, usually the one who posed the question, or one of the children, to describe what happens. In our experience we do not have to say anything more - all the family feel happy to attend further sessions.

Balloons

We use balloons in families where we feel one member, usually the identified patient, is under a lot of strain, in order to convey to the family the effects of stress and also to demonstrate how a number of anxieties can have a cumulative effect, creating considerable pressure on an individual family member.

Case illustration 1

The D. family were referred because fourteen-year-old Mary had a number of nervous tics, the most distressing of which was sticking out her tongue. The family consisted of Mr and Mrs D., Mary, and her twelve-year-old brother Mark. Mrs D. and Mary were both tense and anxious individuals and Mary had a history of nervous tics for some years but these had recently intensified. Mary’s tics were associated with anxiety about a change in schools, bullying at school and worry about her mother.

In the second session the balloon was used to demonstrate the effect of anxiety. The therapist described how the balloon represented Mary, and Mark was asked to blow up the balloon every time a family member named a stress Mary was under. These included: ‘Worry about changing schools’: ‘being teased; ‘concern about mother’; ‘not wanting to go to school’: ‘rows at home about her tics’: etc. Meanwhile as the balloon grew, Mary and Mrs D. became visibly more anxious as the point of bursting was reached. When the balloon burst the therapist explained that if someone is subject to too much pressure and anxiety they develop a symptom, in this instance nervous tics, hence one of the aims of therapy is to reduce the level of anxiety within the family.

The use of the balloon in this case served to involve the younger child and helped the family gain understanding of their problem. In some instances it can be useful to ask how the balloon was prevented from bursting at home, and one can also use a second balloon to show how positive events and statements can decrease the pressure, bringing the balloon to its flaccid state.

Involving children in therapy 91

Balancing scales

We have used the scales with families to talk about the need for balance, especially where parents have a rigid set of perceptions seeing one child as all ‘bad’ and the other as all ‘good’. In instances where parents complain how they hate a particular child, how he upsets all the family, how he does nothing but cause trouble, etc., we often use the scales. Parents are suddenly made aware of the possible devastating effect of all their different complaints, and the skewed nature of their perceptions of their chidren, and again children are involved in therapy.

Case illustration 2

The C. family were referred because fourteen-year-old Simon was irrespon- sible, not to be trusted, didn’t care about his appearance, and was behind at school. His twin brother Peter was described as responsible, mature, well- dressed, polite, and reported to be doing well at school. There were no problems with the two younger boys.

The therapist felt it was important to make clear to Mr and Mrs C. their imbalanced perceptions of the twins. She brought out the scales and for each negative statement about Simon put a weight on ‘his’ pan. As nothing negative had been said about Peter, ‘his’ pan was left hanging free with no weights. The immediate spontaneous response of Mrs C. to this was to start commenting on the good things Simon did, like playing with the younger children, being helpful around the house, etc., and she started to mention the bad things about Peter. The therapist was able to redress the balance and evenly balance the scales, each pan containing a mixture of weights, some representing good qualities and some bad ones.

The use of the scales in this case served to involve all the children and it altered the family’s perceptions of the ‘identified patient’.

Fimo family

This family was modelled out of Fimo by one of us (P. Loudon) and it contains grandparents, parents, and adolescent, a latency child, a toddler and a baby (see Figure 1). The Fimo family is extremely versatile and can be used in many situations. It can be used to sculpt the family to talk about family structure and stages of the family life cycle, handling issues and to look at adolescents leaving home. We use it most extensively in conjunction with a set of wooden rods of differing lengths to emphasize a child’s need for consistent limits and a secure structure.

92 A . O’Brien and P. Loudon

Figure 1 . The Fimo family.

Case illustrations 3

The H. family were referred because their four-year-old son Sean was out of control, disobedient and Mr and Mrs H. felt unable to control him. His older sister (eight years) was no problem. Mrs H . lacked confidence in herself as a parent and both parents were unable to set firm and consistent limits to Sean’s behaviour. In fact they disagreed about how to manage Sean.

The therapist explained the problem using the Fimo family and rods (Figure Z), the latter representing structure:

I

/ Rods-\

Model of child

Parents not united

( 0 )

Involving children in therapy 93

The effect of using the Fimo models and rods during the session was to engage Sean, who sat absorbed in watching the therapist manipulate the models and rods, and it made it very clear to Mr and Mrs H. how they were contributing to Sean’s difficult behaviour. Thereafter, Mr and Mrs H. were able to reach an agreement on the management of Sean and to provide him with a consistent routine.

Visual aids used appropriately during the course of therapy therefore enhance the therapist’s effectiveness. They invariably invglve children, including the most stubborn and unco-operative adolescent, and they serve to engage the whole family system. Not only do they also clarify and simplify the problem for the family but they help us to make sense of a particular family’s dilemma. The use of visual aids also serves to bring an element of the unexpected into therapy and they are often fun to use.

Drawings We also encourage the family’s visual communications to us. Jenkins and Donnelly (1983) have recently discussed the usefulness of drawing in family therapy. We frequently ask children to draw, not merely as a way of occupying them, but in order that they can more readily communi- cate their views of the subject under discussion. Almost invariably we set the subject of a child’s picture and it is usually related to the verbal content of the session.

For example, we may ask children to draw (i) their family, doing something or at mealtimes or bedtimes, (ii) presents to give to each family member, (iii) something that happened in the last two weeks, (iv) a happy and a sad time, (v) school, etc. In our experience, children’s drawings have been helpful in clarifying the nature of the family system and when it feels appropriate we utilize drawings in the course of therapy. Some parents have spontaneously commented how illumina- ting they found their children’s drawings.

We also use the one-way screen as a positive reinforcer for drawings, all of which are held up in front of the screen which ‘replies’ as a mark of

Figure 2.( a) There is no structure and the child can go and do as he pleases. There are no consistent limits, the child has nothing to push against and feels insecure.

(b) The rods are placed in a precise way creating a rigid structure around the child, representing routines, agreement between partents, etc., and giving him a sense of security, boundaries and limits.

(c) The rods separate allowing the growing child to move into the next stage of development, but he is still able to move back and fourth until he feels secure in the next stage of development.

~~

94 A . O’Brien and P. Loudon

its approval! Again this accords children and visual communications a high status.

Case illustration 4

The G. family were referred because Peter (aged ten) was lying and stealing from home, being anti-social and difficult out of home and had already been in trouble with the police. Mrs G . had left her children Peter and Jane with their father five years prior to the interview and had gone to live with Mr G. They had subsequently married and had a child, John (aged 4). Peter and Jane were placed in Care for two years and then came to live with Mr and Mrs G . eighteen months prior to the interview. They were still the subject of a Care Order.

At the start of the interview, Peter and Jane were asked to draw a picture of their family. One of the aims of therapy with the G. family was to revoke the Care Order, so this question came up fairly early in the session. Mr and Mrs G. made it clear they wanted to keep the children, which was important as, previously, Mrs G. had been known to make ambivalent statements about returning the children to their father. Meanwhile Peter and Jane had produced drawings indicating the importance of their mother (see Figures 3 and 4) in their lives. Peter only drew his mother and she is a large figure taking up the whole page. Jane drew other family members but her mother is the largest figure in the centre and she dominates the picture. The therapist used the drawings to reinforce the importance of Mrs G. to her children, and this proved to be a moving moment in therapy.

Thus the children’s drawings provided an important contribution to further the aims of therapy. By using the drawings the therapist was not only emphaiszing the importance of the child’s contribution and hence their presence during sessions, but also served to clarify for parents in a direct and obvious way some of the areas of difficulty within the family.

Use of the one-way screen

We also make use of the one-way screen which is a vital piece of the visual equipment in our interview room. In order to engage children we use the screen in a ‘magical’ way in which the children can ask the mirror for drinks which then ‘miraculously’ appear. Once used, we find this often becomes part of the ritual of therapy sessions with a particular family, and it is an extremely good way of developing a relationship with children.

One four-year-old was reported to have spent the time between

Involving children in therapy 95

Figure 3. Peter’s drawing. Figure 3. Peter’s drawing.

96 A . O’Braen and P. Loudon

Figure 4. Jane’s drawing.

sessions talking solely about the ‘magic lady’, i.e. the therapist. We also occasionally use the screen to provide a magic light show using fairy lights or matches. The ability to ‘play’ with the equipment not only helps to involve children but also results in parents feeling more relaxed about live supervision and, to an extent, demystifies it.

Personality attributes of therapists

We have found that the creative use of play and visual imagery in our therapy is a result of the dialogue within our live supervision team. One of us tends to think most readily using the language of images, of imagination, symbol and metaphor; whereas the other thinks easily in the language of concepts, of the rational intellect. I t is by the effective marrying of these two different langauges that we feel we produce our most effective techniques. Like Cade (1982) who argues for humour as ‘facilitating the therapeutic functioning of a consulting team’, we find

Involving children in therapy 97

thinking in visual terms frees us from becoming trapped by too narrow a focus on the verbal content of sessions and enables us to make construc- tive and creative suggestions for therapeutic interventions.

We, therefore, believe that live supervision teams are probably most effective not only when they contain people of different professional disciplines, and personality traits, but also when individuals charac- teristically use different ways of thinking. This diversity can then be fully exploited to give families the most effective therapy.

Future directions

We hope to refine our use of visual and play techniques further, in con- junction with verbal interventions made to families and, in so doing, develop a more coherent way of including children throughout therapy sessions. We are also still grappling withe the difficulty of addressing all members of a family system simultaneously at all levels and for us this remains the main challenge. We know that for a few precious and magical seconds we can achieve the position where the therapist and family are all involved in the process of therapy. However, we find this momentum hard to maintain and so we are trying to develop techniques which will enable us to keep the whole system engaged for longer periods of time.

Conclusions

In attempting to involve children to a greater extent in the process of therapy, we have argued that therapists need to be aware of themselves and their attitudes in relation to children; they need to understand how they react to children and the socio-historical context of children and families.

We suggest that freeing oneself from a too rigid dependence on verbal therapy by using non-verbal techniques such as drawing, visual aids and play, can facilitate both the engagement of children in therapy and also enables communication with the whole family system simultaneously at a number of different levels. By engaging in a fruitful dialogue utilising the language of both images and concepts, we suggest that therapists can arrive at effective interventions.

We are arguing more for an approach to therapy than for the techniques in themselves, since a too rigid dependence on techniques which may then be used out of context, is often counter-productive. Instead we hope to have sown the seeds and enable therapists to develop

98 A . O’Brien and P. Loudon

their own non-verbal techniques to use as and when appropriate for a particular family. It is particularly true of playthings that they are unique and spontaneous and belong only to the context in which they occur. Therefore, therapists need to develop their own particular ‘playful’ techniques. In so doing, we hope they will overcome the feelings expressed by the adult in The Little Prince: ‘I didn’t know what to say to him. I felt awkward and blundering. I did not know how I could reach him’, and be able with their children and their families to ‘go hand in hand with him once more’, working in tandem to promote change in the family system and redress the balance in the family from negative to positive.

Acknowledgements

We would like to thank Ann Lewis for suggesting the relevance of the historical concept of childhood and Bryan Lask for his enthusiasm and support.

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